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Biomedical subjects

R H Jesse

Publications and source records attributed to R H Jesse.

At least 37 records · Page 2Linked to original sources
PubMed1978

Surgical treatment of advanced carcinomas of the base of the tongue.

During the decade of 1964 through 1973, thirty-four patients with advanced squamous carcinoma of the base of the tongue (20 with T3 lesions and 14 with T4 lesions) were treated by surgical resection. These patients underwent an operative procedure as the only and definitive form of treatment. Twenty-eight (82.3 per cent) presented with clinically positive cervical nodal metastases (4 staged N1, 13 staged N2, and 11 staged N3). The number of primary lesions controlled, cervical metastasis, and the failures of treatment were analyzed. The patients were followed for a minimum of two years or until death or recurrence. The determinate control at two years was 27 per cent and the final determinate survival 20 per cent. Fifteen patients (44.2 per cent) required laryngectomy as part of the primary surgical treatment. The surgical procedures used and other therapeutic options available are discussed.

Adult↗
PubMed1978

Radical or modified neck dissection: a therapeutic dilemma.

Three hundred ten evaluable patients received a classic, functional, or spinal accessory-nerve-sparing neck dissection during 1970 to 1975. The functional procedure was at least equal to the classic procedure in the patients in whom it was employed. The spinal accessory-nerve-sparing operation is offered as an alternative to the classic procedure in all patients in whom the nerve is not directly invaded by cancer. If these guidelines are followed, the patient will rarely experience the pain and shoulder dysfunction that result from the loss of the trapezius muscle, while the chances of control of cancer in the neck remain optimal.

Head and Neck Neoplasms↗
PubMed1977

Treatment of the neck in patients with squamous cell carcinoma of the head and neck.

A retrospective study of 702 patients with clinically positive nodes associated with squamous cell carcinoma of the oral cavity, supraglottic larynx, and hypopharynx observed from 1954 to 1968 was done. The policies of treatment for the neck were not standardized during those years. Three hundred eleven patients who survived 24 months with the primary lesion controlled were divided into two groups: 1) those whose neck was treated by surgery alone; and 2) those who had combined radiation therapy and surgery to the neck, to test the efficacy of the two forms of treatment. For the three sites, the recurrence rate in the necks for the surgically treated group was 14% for stage N1, 26% for N2 and 34% N3. Rates for the group receiving combined treatment were 2%, 11% and 25% respectively. Results of the study also showed that elective irradiation, 5,000 rads in five weeks, will prevent metastasis from occurring in the NO staged neck.

Carcinoma, Squamous Cell↗
PubMed1977

Angiographic observations on chemodectomas of the head and neck.

Angiographic experience with chemodectomas in 21 patients is reviewed. Arterial supply was identified from the vertebral artery, the internal carotid artery, and branches of the external carotid artery. A striated cephalad extension from a cervical chemodectoma (five patients) is believed to represent arterial supply to tumor in vein. In two patients, internal and external carotid arteriograms did not opacify important arteries originating near the carotid bifurcation. Retrograde filling of sigmoid sinus (four patients), tumor mass in jugular vein (two patients), and arteriovenous shunting (nine patients) were observed during the venous phase. Thorough angiogra phy is essential for evaluation of chemodectomas of the head and neck.

Angiography↗
PubMed1977

Clinical and endocrinological evaluation of 16 acromegalic patients treated by transsphenoidal surgery.

Sixteen patients with acromegaly treated with transsphenoidal pituitary surgery were evaluated with the measurement of serum human growth hormone (HGH) before and after intravenous stimulation with thyrotropin-releasing hormone (TRH). Fourteen of these patients showed a significant rise of serum HGH after TRH stimulation before surgery. After surgery, 12 patients with Grade 2 noninvasive adenomas had normal fasting serum HGH levels which did not stimulate with TRH. Two of these patients showed high serum HGH levels both at fasting and after TRH stimulation and required a second operation to remove residual adenoma within the sella before adequate lowering of HGH was achieved. Evidence of recurrent adenoma has not occurred clinically or biochemically in this group of 12 patients followed for an average of 24 months (2 to 60 months). The results were unsatisfactory in four of these 16 patients. One patient who has a postoperative HGH of 9 ng/ml which still stimulates with TRH has made clinical improvement, but must have residual adenoma in the sella or invasive adenoma in the dura and tumor capsule. Additional treatment with irradiation has been given. Failure to achieve satisfactory results in the other three patients was attributed to the presence of locally invasive adenoma; one in the sphenoid sinus, and the other two possibly as a consequence of previous operative procedures.

Acromegaly↗
PubMed1976

Squamous cell carcinoma of the oropharynx: why we fail.

The squamous cancers of the oropharynx in 384 patients were staged according to a T and N system. Three hundred seventy-one of them were treated for cure at a time when modern surgical and radiotherapeutic technics were available. The patient records were analyzed in regard to five year survival, factors influencing treatment failure, and the effect of new primary cancers. Failure to eradicate the cancer at the primary site remains the largest reason for the patients' demise, but as aggressive local and regional treatment becomes more successful, greater numbers of patients survive only to become victims of distant metastases and second primary cancers.

Carcinoma, Squamous Cell↗
PubMed1976

Surgical treatment of advanced carcinoma of the floor of the mouth.

The anterior arch of the mandible is essential for satisfactory oral function and appearance. It can be preserved in surgical treatment of advanced cancers of the floor of the mouth by partial thickness resection. Surgery and radiation are approximately equally effective in the control of advanced (T3) primary lesions. A treatment plan is proposed which employs a combination of nondisabling surgical resection followed by immediate postoperative radiation. Of 19 patients with T2, T3, and T4 lesions treated and followed 1 year or more, 11 were free of cancer, including six who had positive lymph nodes. Of those dying of cancer, only one had local recurrence, while recurrence in the neck occurred in four. This report further strengthens the need for postsurgical radiation in certain situations.

Humans↗
PubMed1975

Intravenous hyperalimentation in patients with head and neck cancer.

Intravenous hyperalimentation was utilized to support nutritionally 23 malnourished patients with major head and neck tumors during surgical treatment, radiotherapy, or the convalescent period. Fifteen patients were treated during the perioperative period and 12 survived. Six patients received convalescent nutritional support successfully 4 to 24 months following operation or radiation treatment. Two patients received treatment with hyperalimentation throughout a protracted course of radiation therapy. Weight gain, wound healing, and recovery were achieved in all but 3 patients. Subclavian vein thrombosis occurred in 1 patient, and catheter-related sepsis occurred in 2 patients. Otherwise, hyperalimentation was safe and efficacious in the debilitated patients. These patients may now become acceptable risks for surgical treatment or radiation therapy by nutritional repletion with intravenous hyperalimentation.

Body Weight↗
PubMed1975

The efficacy of combining radiation therapy with a surgical procedure in patients with cervical metastasis from squamous cancer of the oropharynx and hypopharynx.

To determine whether combining radiation therapy and a surgical procedure was superior to either modality alone, the authors reviewed the records of 345 patients who had primary cancers of the base of the tongue, tonsillar fossa, or pyriform sinus associated with clinically positive nodes at the time of their first observation. Combining the two modalities of therapy produced a local and regional control of the disease in twice as many patients as did one modality alone. The absolute 5-year survival did not reflect this same trend, however, since as local and regional control increased, more patients lived longer but died before five years from distant metastases. Immunochemotherapy is suggested as a possible adjunct therapy to prevent distant metastases.

Carcinoma, Squamous Cell↗
PubMed1975

Combined therapeutic approach to malignant lacrimal gland tumors.

The medical records of 13 patients with primary malignant lesions of the lacrimal gland revealed adenoid cystic carcinoma as the most common malignant tumor. The histologic cell type, neural invasion, and bony destruction were correlated with localized control and ultimate survival. Surgical removal of the lacrimal gland was adequate treatment for low-grade mucoepidermoid carcinoma confined to the gland itself. Combining a radical surgical removal of the area in planned sequence with high voltage radiation therapy offered the only reasonable hope for localized control in the more aggressive cell types or in tumors with neural invasion or bony involvement. A 40%-localized control and survival rate was achieved in the adenoid cystic carcinoma group of patients. Radiation therapy administered for cancer that obviously recurs after surgical resection was generally unsuccessful.

Adenocarcinoma↗
PubMed1975

Clinical course of patients with squamous cell carcinoma of the upper respiratory and digestive tracts with no evidence of disease 5 years after initial treatment.

Eleven hundred sixty-three patients with squamous cell carcinoma of the upper respiratory and digestive tracts, treated from January 1948 through December 1965, had no evidence of disease five years after the initial treatment and no other manifestation of squamous cell carcinoma within the first five years. After five years, the incidence of disease at the initial location, in the vicinity, or in remote sites was found to be identical in the surgical and irradiation groups. There is a correlation between severe late complications in the irradiated patients and the volume of tissue irradiated.

Carcinoma, Squamous Cell↗
PubMed1975

Optimal treatment for the technically resectable squamous cell carcinoma of the supraglottic larynx.

The charts of 431 patients with squamous cell carcinoma of the supraglottic larynx observed at the M.D. Anderson Hospital between January, 1954, and June, 1971, were analyzed. This study is concerned with those patients who had a technically resectable lesion. Emphasis is directed to the analysis of the effectiveness of primary irradiation instead of partial laryngectomy for those lesions which are technically suitable for a partial resection and to define the groups of patients which are best treated by combining surgery and planned postoperative irradiation. One hundred forty-seven patients with T1 and T2 lesions, selected exophytic T3 lesions of the suprahyoid epiglottis received irradiation for their laryngeal lesion. A satisfactory control of the laryngeal disease has been obtained with preservation of a normal voice ranging from 88.5 percent for T1 lesions to 60 percent for T4 lesion. Comparing the groups of patients who had surgery alone or postoperative irradiation an NED rate of 63 percent was found in the latter group which is clearly superior to the 37 percent found in the surgery only group. There is no difference for the five-year NED rates, because the patients who had surgery and postoperative irradiation had more advanced neck disease which is a cause for distant metastases. The incidence of recurrences above the clavicles is clearly less in patients having had surgery and postoperative irradiation than in those who had surgery alone. Correlating in the two groups, surgery only and surgery followed by planned irradiation, the surgical staging of the neck metastases with recurrences above the clavicles within 24 months after treatment, it was found that the planned combined treatment has reduced the recurrence rate from 45 percent to 15 percent in the N2 and N3 patients. Postoperative irradiation should be given routinely after resection for all T4 lesions and for any T3 lesion which extends to the pharyngeal wall(s), vallecula, base of tongue, and pyriform sinus. Postoperative irradiation should also be given for any patient whose nodal classification is greater than N1. Irradiation should be given within six weeks (preferably three to four weeks) after the surgical procedure. To achieve this goal, the operation need only remove grossly detectable disease.

Aged↗
PubMed1975

The evaluation of treatment of patients with extensive squamous cancer of the vocal cords.

Fifty-one patients with previously untreated squamous carcinoma originating on the true vocal cord, staged T4, were analyzed. Forty-eight of the 51 patients were selected for treatment. Total laryngectomy was the minimal surgical procedure, and the pathologist confirmed the presence of cancer outside the confines of the larynx in 47 of 48 patients. Seventy-three percent of the patients were thought clinically to have negative nodes, but examination by the pathologist showed a 20 percent false negative rate in this evaluation. Twenty-one percent of the patients had received an emergency tracheostomy prior to being referred to out institution. An additional 8 percent required an emergency tracheostomy or laryngectomy. Radiation therapy was employed postoperatively for 16 patients. Twenty-six (54 percent) of the 48 patients had no further evidence of cancer after treatment. In evaluating the failures, previous tracheostomy, extension of the disease to the pharyngeal wall, and positive cervical lymph nodes were found to effect adversely the survival of the patient; however, extension of the disease into the trachea, when it occurred alone, was not an adverse factor. In this patient group with a median age of 66 years, 27 percent died of causes other than the cancer within four years. Based on the data in this series, postoperative radiation therapy is now being routinely given to patients with disease extending to the pharyngeal wall, those with nodes in the neck, and those who have had an emergency tracheostomy previously.

Adult↗
PubMed1975

Aggressive surgery in treatment for parotid cancer: the role of adjunctive postoperative radiotherapy.

A 7 year follow-up of 120 patients with malignant parotid cancers revealed parotidectomy to be an adequate procedure for low-grade, nonaggressive lesions. The addition of radiation therapy postoperatively will improve local and regional control of high-grade, aggressive lesions. Postoperative radiation therapy may also make the removal of the facial nerve unnecessary in certain clinical presentations.

Adenocarcinoma↗
PubMed1975

Hypopituitarism after external irradiation. Evidence for both hypothalamic and pituitary origin.

Endocrine complications after radiotherapy for tumors of the head and neck are thought to be relatively rare. The availability of synthetic hypothalamic hormones for clinical investigations and the radioimmunoassay of hormones have enabled us to study function of the hypothalamic pituitary axis in 15 patients who had radiotherapy for nasopharyngeal cancer. Fourteen had evidence of endocrine deficiency. Twelve patients had evidence of hypothalamic dysfunction, 7 developed primary pituitary hormone deficiencies, and 3 developed primary hypothyroidism. These results indicate that [1] secondary hypopituitarism due to a hypothalamic lesion after radiotherapy for nasopharyngeal cancer may be more common than suspected in the past; [2] primary hypopituitarism after irradiation of extracranial tumors can occur; and [3[ primary hypothyroidism may result from irradiation of regional neck nodes.

Adolescent↗