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Biomedical subjects

P Lavertu

Publications and source records attributed to P Lavertu.

At least 37 records · Page 2Linked to original sources
PubMed1997

Concurrent chemoradiotherapy for salvage in relapsed squamous cell head and neck cancer.

The results in 9 patients with unresectable recurrent squamous cell cancer of the head and neck who were treated with aggressive concurrent chemoradiotherapy are reported. Treatment consisted of one or two courses of chemotherapy with 5-fluorouracil 1000 mg/m2/day and cisplatin 20 mg/m2/day, both given as 4-day continuous intravenous infusions, concurrent with radiation therapy. Salvage radiation doses between 30 and 70 Gy were administered. Seven patients had previously undergone an attempt at curative surgery, and 7 had been treated with radiation doses between 52 and 72 Gy. The recurrent disease was locally confined in 3, locoregional in 5, and locoregional with metastases in 1 of the 9 patients. Treatment toxicity was significant and included mucositis, nausea/vomiting, and granulocytopenia, but there were no toxic deaths. Complete tumor clearance was possible in 6 of these 9 patients, and 5 patients remain disease-free at 41+, 43+, 45+, 47+, and 50+ months. Of these 5 patients, 4 had previously been treated with both surgery and radiation, while 1 had only undergone surgery. We conclude that aggressive chemotherapy and concurrent (re)irradiation can be given to patients with unresectable, recurrent, squamous cell cancer of the head and neck. Treatment is tolerable, and disease-free long-term survival is possible. Careful patient selection, however, is required.

Adult↗
PubMed1996

Extraparotid Warthin's tumor: clinical manifestations, challenges, and controversies.

Extraparotid Warthin's tumors continue to challenge the head and neck surgeon's diagnostic and therapeutic skills. A series of six extraporotid Warthin's tumors are presented to illustrate the need to keep a high index of suspicion for this lesion in the workup of cystic masses involving cervical levels II and III or in the event of a concomitant neck mass and a parotid Warthin's tumor. Discussion of the debate surrounding the embryogenesis and histogenesis of extraparotid Warthin's tumors follows. Clinical guidelines are suggested for the diagnosis, treatment, and follow-up of patients with extraparotid Warthin's tumors.

Adenolymphoma↗
PubMed1996

Pott's puffy tumor due to Haemophilus influenzae: case report and review.

Osteomyelitis of the frontal bone may be associated with a purulent collection under the periosteum, causing swelling and edema over the forehead, a condition known as Pott's puffy tumor. We describe an 83-year-old man with a Pott's puffy tumor due to Haemophilus influenzae that was successfully treated with surgery and antibiotics. A review of 22 cases of Pott's puffy tumor shows that this condition usually occurs in children, is spread from frontal or ethmoid sinusitis, and is usually due to streptococci, staphylococci, or anaerobes. Suppurative complications such as epidural, subdural, and intracerebral abscesses are common. Only seven cases of Pott's puffy tumor in adults have been reported, and only one of these cases was caused by H. influenzae. Surgical drainage and antibiotic therapy remain standard therapy for this condition.

Aged↗
PubMed1996

Multiple myeloma involving the thyroid cartilage.

Extraosseous multiple myeloma involving the larynx is rare. We describe a patient with multiple myeloma and a plasmacytoma involving the thyroid cartilage. Ossification of the thyroid cartilage with formation of a marrow space could explain the occurrence of multiple myeloma in this unusual location.

Cartilage↗
PubMed1995

Tonsillar carcinoma.

Carcinoma of the tonsil is the second most common malignancy of the head and neck. Various studies have attempted to define the presentation, diagnosis, treatment, and prognosis of these tumors. This report reviews the currently available information on tonsillar carcinoma and discusses treatment options.

Carcinoma, Squamous Cell↗
PubMed1995

Posterior scleritis with annular ciliochoroidal detachment.

PURPOSE: We studied an unusual case of posterior scleritis in a patient with sarcoidosis. METHOD: The medical record was reviewed for clinical manifestation, course, and tests performed, including laboratory evaluations, fluorescein angiography, and ultrasonography. RESULTS: The patient had posterior scleritis and unilateral angle-closure glaucoma caused by an annular ciliochoroidal detachment. Sarcoidosis was confirmed by biopsy of an enlarged parotid gland. CONCLUSION: The mechanism of angle-closure glaucoma may not be clinically or echographically apparent for a week or more in patients who develop annular ciliochoroidal detachment. We also found an unusual association of sarcoidosis and annular ciliochoroidal detachment secondary to posterior scleritis.

Adrenergic beta-Antagonists↗
PubMed1995

Aggressive fibromatosis of the prevertebral and retropharyngeal spaces: MR and CT characteristics.

A 47-year-old man had aggressive fibromatosis, and CT and MR showed a large, multilobulated soft-tissue mass within the prevertebral and retropharyngeal spaces. On CT, the lesion was slightly higher in attenuation than adjacent muscle; on MR, it was intermediate between muscle and fat on unenhanced T1-weighted images, isointense with fat on intermediate-weighted images, hyperintense relative to fat on T2-weighted images, and markedly enhanced after administration of gadopentetate dimeglumine. Multiple small focal and linear areas of decreased signal intensity that did not enhance with gadopentetate dimeglumine were observed on all pulse sequences.

Cervical Vertebrae↗
PubMed1994

The AO system for primary mandibular reconstruction.

We reviewed the records of 27 patients who underwent primary mandibular reconstruction with AO plates to investigate the outcome and complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P = 0.02). Late complications were mostly related to tumor recurrence (12). Late complications not associated with recurrence were persistent pain (2), minor infections (3), plate exposure (3), and plate fracture (1). Good to excellent cosmetic results were obtained in all but 1 patient. Full mastication was not possible for any of our patients, and therefore function was not fully restored. Speech and deglutition were mostly influenced by the amount of soft-tissue resection. Mean follow-up was 20 months (range 3 to 52). At last evaluation, 12 patients were alive and free of disease, and 15 were dead of disease or other causes. Our results show that primary mandibular reconstruction with rigid plates is a safe, effective, and reliable technique to restore mandibular continuity and cosmesis. For lateral defects, this method is a viable alternative to free vascularized osseocutaneous flaps.

Adult↗
PubMed1994

Continuous course radiation therapy and concurrent combination chemotherapy for squamous cell head and neck cancer.

Concurrent radiation therapy and chemotherapy is a promising approach to the treatment of squamous cell head and neck cancer. Toxicity, however, has required either scheduled breaks in radiation therapy administration or compromise in chemotherapy dose intensity. We describe the toxicity and results in 19 patients treated at diagnosis with a continuous course of radiation therapy and intensive concurrent combination chemotherapy using 5-fluorouracil and cisplatin. Toxicity among these 19 patients was significant, including mucositis, myelosuppression, and weight loss, and aggressive supportive efforts were required. No toxic deaths occurred, however. At the end of treatment, all patients had achieved complete control of their primary-site tumor. Primary-site resection was not required in any patient for tumor control, but neck dissections were performed in selected individuals with involved nodes at diagnosis. No patient recurred at the primary site and only a single patient recurred in the neck. We conclude that this chemoradiotherapy schedule is very effective, albeit toxic. Toxicity, however, can be managed with appropriate aggressive supportive measures. Confirmation of these encouraging treatment results will require performance of a randomized clinical trial.

Adult↗
PubMed1993

Facial nerve morbidity following parotid surgery for benign disease: the Cleveland Clinic Foundation experience.

Standard surgical management for benign tumors of the parotid gland requires either superficial, subtotal, or total parotidectomy with preservation of the facial nerve. Although this approach is effective in minimizing recurrence, the resultant facial nerve morbidity is seldom addressed. Two hundred fifty-six consecutive patients who underwent parotid surgery for benign neoplasia at this institution in the past 15 years are reviewed, with attention to postoperative facial nerve function. Immediate dysfunction was frequently encountered (46.1%), but permanent dysfunction was uncommon (3.9%). The incidence of long-term dysfunction may be higher in revision cases and when an extended (total or subtotal) parotidectomy is performed.

Facial Nerve↗
PubMed1993

Lymphoma of the parotid gland.

In a consecutive group of 452 patients undergoing parotid surgery at this institution, 18 (4%) were found to have lymphoma. Review and analysis of presenting symptoms, predisposing factors, histopathology, postsurgical morbidity, and long-term outcome with treatment are presented. The current literature on parotid lymphoma is reviewed, and management strategies are outlined. Although a relatively uncommon primary lesion, lymphoma must be considered in the differential diagnosis of any mass presenting in the parotid gland.

Autoimmune Diseases↗
PubMed1992

Polymyositis presenting as a neck mass.

Polymyositis is a rare disease entity belonging to the class of enigmatic disorders known as the collagen vascular diseases. It is characterized by proximal muscle weakness. More than 50% of the patients with this disease have development of head and neck manifestations, most commonly a heliotrope rash or dysphagia. Weakness and atrophy of neck muscles, and lolling of the neck have also been described. We report a case of polymyositis presenting as a neck mass, a heretofore undescribed manifestation of this disease in the head and neck. A review of the literature and an interdisciplinary approach to the diagnosis and management of this unusual disease will be described.

Aged↗
PubMed1992

Factors influencing survival in ethmoid sinus cancer.

Nineteen patients with primary ethmoid sinus malignancies were treated at the Cleveland (Ohio) Clinic Foundation between 1976 and 1989. Pathologic diagnoses included adenocarcinoma (eight), sarcoma (four), squamous cell carcinoma (three), mucoepidermoid carcinoma (two), adenoid cystic carcinoma (one), and undifferentiated carcinoma (one). All patients underwent surgical resection: 13 had craniofacial resection, four had craniofacial resection/orbital exenteration, one had radical ethmoidectomy/maxillectomy/orbital exenteration, and one had transantral ethmoidectomy. Twelve patients had combined treatment with radiation therapy. Ten patients were alive with no evidence of disease. A trend toward improved prognosis is associated with negative surgical margins. Preservation of the globe was not associated with local recurrence at this site. A poor prognosis was noted with involvement of the dura, brain, nasopharynx, or sphenoid sinus.

Adenocarcinoma↗
PubMed1992

Complementary use of computed tomography and magnetic resonance imaging in assessing skull base lesions.

Twenty-six patients underwent computed tomography (CT) and magnetic resonance imaging (MRI) of skull base lesions at the Cleveland Clinic Foundation. CT provided improved bone detail, documenting invasion of the lamina papyracea, orbital floor, fovea ethmoidalis, cribriform plate, pterygoid plates, hard palate, and skull base. MRI defined invasion of the orbit, dura, brain, and cavernous sinus. Improved soft-tissue-tumor interface was evident on MRI. MRI was superior to CT in determining carotid artery involvement. MRI distinguished between tumor and retained secretions in the paranasal sinuses. Combining radiographic tumor staging reliably predicted surgical findings; however, MRI consistently yielded sufficient diagnostic information and the additional expense of performing two imaging procedures may not be justified.

Angiography, Digital Subtraction↗
PubMed1992

Complications of secondary tracheoesophageal puncture: the Cleveland Clinic Foundation experience.

One hundred forty-six secondary tracheoesophageal puncture (TEP) procedures were performed on 132 patients at the Cleveland Clinic Foundation in the past 10 years. The complications of these procedures are reviewed, along with assessment of potential risk factors such as irradiation, esophageal/hypopharyngeal stricture, alcoholism, diabetes, or chronic obstructive pulmonary disease. Among the subgroups studied, only stricture dilation was associated with an increased incidence of postsurgical complications. The majority of these, however, were immediate, and were probably related to the esophagoscopy or dilation itself. The incidence of TEP-related complications in all groups of patients may be higher than previously suspected.

Dilatation↗