Search PubMed⌕ Search

Biomedical subjects

R J Toohill

Publications and source records attributed to R J Toohill.

At least 55 records · Page 3Linked to original sources
PubMed1987

Cisplatin and fluorouracil as neoadjuvant therapy in head and neck cancer. A preliminary report.

A randomized, prospective trial utilizing cisplatin and fluorouracil as neoadjuvant chemotherapy in the treatment of advanced squamous cell carcinomas of the upper aerodigestive tract was initiated in January 1983. Sixty patients were stratified by site (oral cavity, 19; larynx, 14; hypopharynx, 14; oropharynx, 11; nasopharynx, one; and paranasal sinuses, one) and by stage (III, 19; IV, 41), and then randomized to receive either standard treatment (defined as preoperative irradiation followed by radical excision or irradiation alone) or adjuvant chemotherapy followed by standard treatment. An additional three patients were entered into the study, but withdrew. Chemotherapy consisted of three cycles for those patients in whom an objective tumor response was observed; nonresponders received standard treatment. Response to chemotherapy was complete in five and partial (greater than 50%) in 18 patients, for an overall response rate of 85%. The follow-up for surviving patients was a minimum of 24 months and a maximum of 44 months. Survival was compared for patients in both treatment groups according to the method of Lee and Desu. Despite excellent tumor response, actuarial survival was 70% in the standard treatment group as opposed to 56% in the experimental group. It was therefore evident that the high response rates reported in previous pilot studies do not necessarily result in improved survival in these cancers.

Carcinoma, Squamous Cell↗
PubMed1987

The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies.

It is often suggested that tumors will respond to induction chemotherapy and result in improved survival for patients with squamous cell carcinoma of the head and neck. Two regimens of induction chemotherapy were studied in separate randomized, prospective trials over the last 6 years. Eighty-three patients with advanced disease were entered into the first study (43/chemotherapy; 40/control), and 60 into the second (27/chemotherapy; 33/control). Patient randomization was stratified by stage (III/IV) and site (oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, paranasal sinuses). The first study utilized bleomycin, Cytoxan, methotrexate and 5-fluorouracil in two cycles (one cycle if no tumor response), followed by standard treatment which consisted of combined irradiation and surgery or, in some instances, primary irradiation alone. The second study utilized cisplatin and 5-fluorouracil in three cycles prior to standard treatment. An objective tumor response to chemotherapy was observed in 68% in the first study and 85% in the second. The patient survival in both studies (at 24 months in the first; at 19 in the second) was better in the control than that in the experimental groups (43% to 31%; 69% to 46%). In the second study, the average length of delay of standard treatment was longer than in the first study (95 days vs. 66 days; P less than .02). Results combining the P-values of both studies indicate that the relative risk of having persistent disease was 2.9 times greater for patients who received chemotherapy. While toxicity to chemotherapy was not a factor in survival, the number of patients who withdrew from the studies and those who did not comply with treatment were greater in the chemotherapy groups. Except for new drug regimens of exceptional promise, it is recommended that future studies be designed so that chemotherapy is given concurrent with, or following the completion of standard treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

The diagnostic accuracy of pharyngoesophagram compared to esophagoscopy in patients with head and neck cancer.

Two hundred and fifty-four patients with head and neck cancer were entered into a prospective study comparing the results of pharyngoesophagram to esophagoscopy. All patients had pharyngoesophagram deemed adequate to evaluate the esophagus and rigid esophagoscopy to at least 30 cm from the upper incisor teeth. In 239 (94.1%) patients both the pharyngoesophagram and esophagoscopy were negative. Four esophageal tumors were found. Only one of these tumors (25%) was detected on pharyngoesophagram. We believe that the pharyngoesophagram should be a part of the initial work-up of every head and neck cancer patient and should precede esophagoscopy. However, the barium swallow cannot be relied upon exclusively to detect small simultaneous second primary esophageal malignancies.

Aged↗
PubMed1987

The microtrapdoor technique for the management of laryngeal stenosis.

The use of the carbon dioxide laser as an endoscopic microsurgical instrument has stimulated interest in treating laryngeal and tracheal stenosis. Dedo and Sooy (1984) reported a significant improvement in the management of posterior commissure, subglottic, and high tracheal stenoses with the use of a microtrapdoor flap. A recent laboratory investigation of this method supported the clinical efficacy of this technique. Six patients are evaluated in this report, three with posterior commissure stenosis and three with subglottic or high tracheal lesions. All six patients had a tracheotomy present or performed at the time of their surgical procedures, and each patient had only one procedure. All six had improved airways after the microtrapdoor flaps. Five have been decannulated and one patient with associated hypopharyngeal stenosis still has a tracheostomy because of mild aspiration, although the airway lumen is moderately improved. It is felt that, as a group, the subglottic and high tracheal lesions respond to this technique better than the posterior commissure stenoses. Details of the technique are presented. This brief clinical report supports the efficacy of the microtrapdoor flap procedure in selected laryngeal and tracheal stenoses.

Adolescent↗
PubMed1986

A randomized study of adjuvant chemotherapy for cancer of the upper aerodigestive tract.

A prospective, randomized trial of induction chemotherapy in advanced squamous cell carcinomas of the upper aerodigestive tract (UAD) was conducted between July 1979 and September 1982. Eighty-three patients with locally advanced Stage III-IV tumors received standard treatment (STD RX; defined as preoperative irradiation and radical excision or irradiation alone), or induction chemotherapy (CTX) followed by STD RX. Chemotherapy consisted of two cycles of bleomycin (30 units/day by continuous infusions Days 1-4), cyclophosphamide (200 mg/m2 IV Days 1-5), methotrexate (30 mg/m2 Days 1 + 5), and 5-fluorouracil (400 mg/m2 IV Days 1-5). Response to CTX was complete in 2 and partial (greater than 50% reduction) in 27; the overall response rate was 68%. Tumor clearance was documented in 30/40 STD RX patients at completion of irradiation and/or surgery and in 24/43 CTX patients (17/29 responders, 7/14 non-responders). Freedom from local-regional disease was noted at 2 years in 53% STD RX and 35% CTX patients (p less than .06). CTX patients had a higher proportion of local-regional persistence and recurrence. The difference was apparent only in the subset of patients treated with primary irradiation; local-regional control following irradiation and surgery was equal in STD RX and CTX groups. Survival at 2 years was 43% STD RX and 31% CTX. Disease-free survival in those with clearance was 64% STD RX and 59% CTX. Induction chemotherapy did not improve tumor clearance or survival in this series. Caution regarding local-regional control with CTX and primary irradiation is noted.

Bleomycin↗
PubMed1986

The radiological appearance of the post-Caldwell-Luc maxillary sinus.

A review of the radiographic findings in 19 patients who had undergone unilateral or bilateral Caldwell-Luc procedures for chronic maxillary sinusitis revealed improvement in the radiographic appearance of the sinuses in 13 and lack of improvement, progression or recurrence of disease in six. Eight of the patients had changes which could be attributed directly to surgery. These included fibro-osseous proliferation in five, antral contraction in four and compartmentalisation in two. Follow-up studies, including pluridirectional tomography and computed tomography, can reliably distinguish post-operative changes from recurrent disease in the patient who has undergone this type of radical maxillary antrostomy.

Follow-Up Studies↗
PubMed1986

CO2 laser management of laryngeal stenosis.

The introduction of the carbon dioxide laser as an endoscopic surgical instrument has stimulated interest in its application for removal of stenotic lesions of the larynx. Clinical reports have indicated mixed results in the efficacy of this treatment modality. Nineteen large dogs received acute subglottic injuries from a high-speed electric drill and electrocautery. All animals developed obstructing lesions from 7 to 21 days after injury. With at least weekly removal of granulation tissue and dilations, all animals developed mature subglottic and/or posterior commissure scars. Two animals required tracheostomy. The 15 animals in the experimental group underwent 16 laser procedures. Three animals had vaporization of one third of the scar, three of one half of the scar, and three had total circumferential vaporization. Five animals underwent microtrapdoor flap procedures. Of these, four had a single flap and one had three separate flaps created. In the remaining animal in the experimental group a glottic web developed, which was totally ablated. In one animal treated with a microtrapdoor flap procedure a posterior sinus tract also developed and was treated with laser ablation. The animals undergoing segmental resection of scar demonstrated no improvement in airway size. Those undergoing total resection experienced a worsening of the condition. Those undergoing microtrapdoor flap repair demonstrated moderate improvement in airway size. It can be concluded that large areas of scar removal in the larynx by the CO2 laser will result in prompt recurrence and possible worsening of the scar and smaller submucosal resection of the scar, with preservation of mucosa by the microtrapdoor flap technique, may be helpful in improving the airway.

Animals↗
PubMed1986

Early and late dilatation for acquired subglottic stenosis.

There has been widespread use of periodic dilatations in the management of subglottic stenosis. However, some authorities have questioned the value in the overall rehabilitation of patients affected by this disorder. The first phase of this study included fourteen large dogs in which acute subglottic lesions were created by use of a high-speed electric drill and electrocautery. Twelve animals served as the experimental group and two animals were controls. Obstructing lesions developed in all the animals within 7 to 21 days. When at least a 50% obstruction developed in an animal, a treatment plan was instituted that included at least weekly dilatation, removal of granulations, and administration of intralesional steroids and/or systemic steroids and antibiotics. The two control animals became totally obstructed and were killed. Varying degrees of subglottic stenosis developed in all twelve experimental animals after 8 weeks of dilatation, but none required a tracheotomy. These twelve animals were then subjected to 8 additional weeks of dilatation and antibiotics, and supplemental steroids were used in some animals from this study. It can be concluded that early periodic dilatation and granulation removal in the acutely injured subglottis is effective in prevention of severe stenosis, late periodic dilatations in chronic subglottic stenosis are not helpful in further alleviation of obstruction, the concomitant use of antibiotics and systemic steroids did not appreciably prevent or alter the development of subglottic stenosis, and the concomitant use of intralesional steroids appeared to be of benefit in the management of chronic acquired subglottic stenosis.

Animals↗
PubMed1986

Wound healing of true vocal cord squamous epithelium after CO2 laser ablation and cup forceps stripping.

A study was conducted on the effect of deepithelization of the true vocal cords; microcup forceps were used, as opposed to CO2 laser ablation. A CO2 laser, coupled to an operating microscope, was used to ablate the surface epithelium of the right true vocal cords in eight canines, while conventional microlaryngeal stripping was performed on the left true cords in the same animals. Photographs were taken immediately after injury and again before the animals were killed. Histologically, the series of true vocal cords ablated by the CO2 laser revealed granulation formation at day 5, whereas those treated with conventional stripping developed granulation at day 3, thus indicating delayed healing. Charred carbonaceous debris of CO2 laser ablation was found to cause a giant cell reaction that persisted after reepithelization. Despite the precise control offered by the laser, many of the laser-injured true vocal cords revealed vocalis muscle edema and muscle destruction. After healing occurred, dense fibrosis was found in the vocal muscle injured during CO2 laser ablation of the overlying squamous epithelium.

Animals↗
PubMed1985

Radioisotope measurement of the velocity of tracheal mucus.

A radioisotope scanning technique for measuring the velocity of tracheal mucus has been developed utilizing a canine model. A solution of stannous phytate labeled with 99mTc is introduced percutaneously into the lower trachea and the upward movement of the leading edge of the radioactivity is followed by repeat scanning at 2-minute intervals using a modified rectilinear scanner, thus allowing calculation of the velocity of the mucus. It is believed that this technique may be of value in studying the effect of experimentally induced tracheal injuries on mucus velocity. Possible applications of the technique for the study of the velocity of mucus in the human trachea are discussed.

Animals↗
PubMed1985

Randomized study of adjuvant chemotherapy for head and neck cancer.

The ability of surgery and radiotherapy to control advanced squamous cell carcinoma of the head and neck has reached its maximal potential. We initiated a randomized, prospective, stratified study of adjuvant chemotherapy. Patients with stage II disease of the pyriform sinus and stage II and IV disease of the oral cavity, larynx, hypopharynx, oropharynx, nasopharynx, and paranasal sinuses were eligible. Patients were randomized to receive either standard therapy alone or two courses of 5-fluorouracil (B-CMF) chemotherapy prior to and two courses after the completion of standard therapy. Standard therapy consisted of preoperative irradiation followed by radical surgery. Of 133 patients with advanced disease, 83 were included in the study--43 in the chemotherapy group and 40 in the control group. Rates of residual and recurrent disease, as well as distant metastases, were similar for the two groups. The survival rates of patients without persistent disease at the end of treatment showed no significant difference for the two groups. The study has been discontinued because statistical analysis indicated that the addition of more patients would not materially increase the statistical significance of the study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Dilemmas in the management of chronic nasal and sinus inflammatory diseases of unknown etiology.

The diagnostic criteria and therapeutic regimens for upper airway necrotizing diseases such as Wegener's granulomatosis, polymorphic reticulosis, and the recently described idiopathic midline destructive disease have been better defined and clarified in the past decades. Despite an improved understanding of the various disease processes, there continues to be difficulty in establishing an early diagnosis before proceeding with prompt treatment to minimize loss of function and cosmetic deformity. To achieve these goals, we have expanded the indications for the use of the cytotoxic drug, cyclophosphamide, in those patients whose clinical and histologic presentations are suggestive of Wegener's granulomatosis, but in whom a specific diagnosis has not been confirmed by biopsy specimen. We have seen ten patients with upper airway lesions of a chronic inflammatory nature over the past six years at the Medical College of Wisconsin affiliated hospitals. Only three of these have had a definitive histopathologic diagnosis of Wegener's granulomatosis made prior to the initiation of cytotoxic therapy. Six have undergone treatment under our expanded criteria without a prior definitive diagnosis. Five of these have had arrest of the disease process, and one has had no response to therapy. One patient was not treated. There have been no serious side-effects from cyclophosphamide therapy in these patients.

Adult↗
PubMed1985

Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea.

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2-year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser. Eight of 14 patients were successfully managed in this study; retrospective analysis of our results revealed that the presence of one or more of the following four factors was extremely important in predicting an unfavorable prognosis of patients with tracheal stenosis managed endoscopically with the carbon dioxide laser: 1. loss of cartilaginous support; 2. stenosis length greater than 1 cm; 3. circumferential scarring; and 4. carinal involvement.

Adolescent↗
PubMed1985

Diagnostic techniques in head and neck cancer.

The evaluation of a patient with a cancer in the head and neck should begin with a complete history. A thorough physical examination will aid in determining the tumor extent. Finally, diagnostic techniques have been outlined that can help in determining the extent of the primary tumor and metastases.

Angiography↗
PubMed1984

Injuries to the bronchi and lungs caused by laser-ignited endotracheal tube fires.

A CO2 laser attached to an operating room microscope was used to produce extraluminal and intraluminal ignition of various endotracheal tubes in dogs. Extraluminal ignition was produced in Silastic and red rubber endotracheal tubes. The red rubber tube ignited before the tube lumen was penetrated. The Silastic tube failed to ignite while the cuff was inflated. When the cuff was deflated, ignition occurred before the lumen was penetrated. No lung or bronchial injuries were detected in the red rubber or Silastic endotracheal tube extraluminal fires. Intraluminal fires were produced in Silastic, red rubber, and polyvinylchloride (PVC) endotracheal tubes. Microscopic examination of the bronchi and lungs revealed severe injuries in dogs intubated with the PVC and red rubber endotracheal tubes. No injuries to the bronchi and lungs were detected in the Silastic tube group, although the potentially toxic effects of silica ash require further investigation.

Animals↗