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Biomedical subjects

R J Carpenter

Publications and source records attributed to R J Carpenter.

At least 127 records · Page 7Linked to original sources
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Cryosurgery: theory and application to head and neck neoplasia.

While surgery and radiation therapy remain the time-tested modalities for the treatment of cancer in the head and neck, recent experimental and clinical experience has documented the effectiveness of cryosurgery as an adjunct in the treatment of selected neoplasms in individual patients. A review is provided of the theory of freezing as a method of cell destruction, and experimental and clinical experience illustrate the principles and application of cryosurgery to head and neck tumors.

Cryosurgery↗
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Reconstruction of the pharynx and upper esophagus after resection for cancer.

Construction of a new gullet after circumferential resection of the pharynx and upper portion of the esophagus for cancer is a major challenge to the head and neck surgeon. Techniques for reconstruction use cervical skin, adjacent pedicle flaps, and interposed visceral segments. Each technique has its place; none is ideal or free from complication or failure. Cure rates are poor, and unsolved problems remain. The quest for the perfect technique must continue, but the ultimate solution rests not with reconstruction techniques but with earlier diagnosis and elimination of the need for reconstruction.

Esophageal Neoplasms↗
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The use of ultrasound in the assessment of normal fetal growth: a review.

This review presents the basic principles underlying the quantitative assessment of normal fetal growth using ultrasound. Data on fetal growth derived from measurements of body, head, chest, and abdominal dimensions, are summarized, compared, and evaluated. Fetal volume and weight determination are also discussed. Most of the data evaluated were obtained in cross-sectional studies, but we present the preliminary results of our longitudinal study of fetal growth for comparison.

Abdomen↗
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Fetal heart rate influence on the pulsatility index in the middle cerebral artery.

In 1300 Doppler assessments performed on the fetal cerebral arteries, 5 cases of heart rate deceleration were recorded while studying the middle cerebral artery. There were 3 normal fetuses (mean menstrual age +/- standard deviation: 28.6 +/- 2.1 weeks), one growth-retarded fetus (34 weeks, menstrual age) and 1 fetus with red cell alloimmunization (27 weeks, menstrual age). The magnitude of decline in the heart rate during the deceleration ranged from 44 to 93 bpm (67 +/- 18 bpm). Pulsatility index values were calculated on 44 waveforms and correlated with the heart rate. Linear regression analysis showed a statistically significant inverse correlation between the heart rate and the pulsatility index in the middle cerebral artery of 4 fetuses. These results indicate that heart rate will affect the pulsatility index of the middle cerebral artery.

Cerebral Arteries↗
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International, collaborative experience of 1789 patients having multifetal pregnancy reduction: a plateauing of risks and outcomes.

OBJECTIVE: To develop the most up-to-date, complete data base of multifetal pregnancy reduction (MFPR) from cases, and to provide the best counseling for couples with multifetal pregnancies. METHODS: From nine centers in five countries, 1789 completed MFPR cases were collected and outcomes evaluated. Pregnancy losses were defined as through 24 weeks and deliveries categorized in groups of 25-28, 29-32, 33-36, and 37 or more weeks. RESULTS: Overall, the pregnancy loss rate was 11.7% but varied from a low of 7.6% for triplets to twins and increased with each additional starting number to 22.9% for sextuplets or higher. Early premature deliveries (25-28 weeks) were 4.5% and varied with starting number. Loss rates by finishing number were highest for triplets and lowest for twins, but gestational age at delivery was highest for singletons. CONCLUSIONS: Multifetal pregnancy reduction has been shown to be a safe and effective method to improve outcome in multifetal pregnancies. Outcomes are worse with higher-order gestations and support the need for continued vigilance of fertility therapy.

Abortion, Spontaneous↗
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Fetal and neonatal hematologic parameters in red cell alloimmunization: predicting the need for late neonatal transfusions.

The purpose of this study was to determine whether the need for late neonatal transfusion can be predicted in fetuses who received intrauterine transfusions. The records of 36 patients who underwent intrauterine transfusion were reviewed. Newborns who required late transfusions had a lower reticulocyte count at their last intrauterine transfusion, a longer duration between their lowest fetal reticulocyte count and delivery, and a higher umbilical cord blood hemoglobin and percent adult red cells on Kleihauer-Betke stain at delivery. The need for late transfusions appears to be related to the extent and duration of fetal bone marrow suppression.

Bilirubin↗
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Effects of intravascular transfusion for red cell alloimmunization on fetal arterial blood pressure.

OBJECTIVE: To evaluate the effects of intravascular transfusion (IVT) on the fetal umbilical arterial pressure (UAP) in pregnancies complicated by red cell alloimmunization. STUDY DESIGN: UAP and amniotic fluid pressures (AFP) were measured immediately before and after IVT. Mean UAP was calculated by computing 1/3 (systolic blood pressure - diastolic blood pressure) + diastolic blood pressure. The fractional increase in fetoplacental blood volume with transfusion was calculated by dividing the net volume of blood transfused by the sum of the net volume transfused and the fetoplacental volume based on the estimated fetal weight by ultrasound. Statistical techniques included paired t-test, and the Pearson product correlation. Significance was defined as p < 0.05. RESULTS: The fetal umbilical artery was punctured during a total of 27 procedures in 21 patients. Pre- and posttransfusion mean UAPs were recorded in 16 of these procedures. Mean UAP increased from 34.0 +/- 14.2 mm Hg pretransfusion to 38.6 +/- 12.8 mm Hg posttransfusion (p = 0.34). There was no correlation between the fractional change in fetoplacental blood volume and the calculated difference between pre- and posttransfusion blood pressure. Bradycardia occurred during 5 procedures (31.2%). Fetal demise occurred after 2 procedures (12.5%). CONCLUSION: IVT appears to have a minimal effect on the fetal UAP. Fetal bradycardia occurs in a significant percentage of these cases.

Blood Pressure↗
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The otolaryngologic presentation of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a progressive dengenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. The course is relentless, and only 20% of patients survive five years after diagnosis.

Adult↗
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Sebaceous cell carcinoma of the external auditory canal.

Sebaceous cell carcinoma is an extremely uncommon tumor; fewer than 100 cases have been reported, with most of these lesions arising in the meibomian glands in the tarsal plates. Other sites in the head and neck have been noted, but this is the first reported case originating in the external auditory canal.

Adenocarcinoma↗
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Papillary cystadenoma lymphomatosum of the larynx.

Papillary cystadenoma lymphomatosum, or Warthin's tumor, is a benign lesion of the salivary glands occurring most frequently in the parotid region. Since the initial report of this lesion in 1910, numerous reports have appeared in the literature concerning the occurrence of Warthin's tumor in many extraparotid locations, including the larynx. The vast majority of those tumors arising in the larynx have been disproved because of the absence of one or more of the histologic characteristics of this lesion within the surgical specimen. This paper will review the histologic criteria of Warthin's tumor and the typical clinical occurrence. We will discuss a case of papillary cystadenoma lymphomatosum of the larynx that satisfies all the histologic criteria of this lesion. A review of the possible origins of this tumor will demonstrate that this case may lend support to the hypothesis that papillary cystadenoma lymphomatosum may be the end result of a delayed hypersensitivity reaction.

Adenolymphoma↗
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Selective section of the recurrent laryngeal nerve for the treatment of spastic dysphonia: an experimental study and preliminary clinical report.

The experimental and clinical results of the surgical treatment of patients with spastic dysphonia by selective section of the adductor branch of the recurrent laryngeal nerve are described. Experimental selective nerve section in dogs appears to retain cordal abduction during inspiration while producing a partial adductor paralysis. Selective section of the recurrent laryngeal nerve has been performed in four patients with 18- to 24-month follow-up. Speech results have been good with maintenance of partial vocal cord motion. No patient has experienced a return of spasticity. We theorize that selective nerve section may decrease the likelihood of the long-term failure that has been seen with complete nerve section by preventing medial fixation of the paralyzed vocal cord.

Animals↗
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A complication in the use of a Fogarty catheter for foreign body removal during bronchoscopic management.

The Fogarty catheter, developed originally for the removal of intravascular thrombi, has been used in recent years as an aid in bronchoscopic foreign body removal. Complications with the use of a Fogarty catheter are rare. We report the separation of the tip of a Fogarty catheter from the catheter body during rigid bronchoscopic management with resultant lodging of the catheter tip out of bronchoscopic range in the peripheral lower lobe of the lung. Use of a Fogarty catheter during bronchoscopic intervention is discussed as is the availability of different catheter models and their possible problems.

Bronchi↗