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Biomedical subjects

R S Weber

Publications and source records attributed to R S Weber.

At least 73 records · Page 4Linked to original sources
PubMed1993

Nonwound infections following head and neck oncologic surgery.

Little information exists regarding the comorbidity of postoperative nonwound infections (NWIs) in patients with head and neck cancer. Prospectively, 225 patients were randomized in a double-blind fashion to receive either clindamycin or ampicillin sodium/sulbactam sodium for prevention of postoperative wound infection. Of the 113 patients receiving clindamycin, 14 developed nonwound infections, compared with 10 of 112 patients receiving ampicillin/sulbactam. A single site of nonwound infection occurred in 21 patients, and 2 sites occurred in 3 patients. The majority of infections were pulmonary (22), followed by urinary tract (3), septic phlebitis (1), and acute sinusitis (1). Gram-negative organisms were isolated more frequently among patients on clindamycin (18) versus ampicillin/sulbactam (6) (P = .014). Risk factors for pulmonary nonwound infection included: longer surgery, a greater than 70 packs per year smoking history, blood transfusion, and hypoalbuminemia (P < .05). Nonwound infections produce significant postoperative morbidity and the predominance of gram-negative organisms isolated from these infections has therapeutic implications.

Adolescent↗
PubMed1992

13-cis-retinoic acid and interferon alpha-2a: effective combination therapy for advanced squamous cell carcinoma of the skin.

BACKGROUND: Retinoids (vitamin A derivatives) and interferon-alpha (IFN-alpha) are potent regulators of malignant cell differentiation and proliferation, and both have immunomodulatory and antiangiogenesis activity. A large body of preclinical and clinical data supports the use of combination therapy with 13-cis-retinoic acid (13-cRA) and IFN-alpha in patients with squamous cell carcinoma of the skin. This carcinoma is an extremely common and frequently severely disfiguring cancer, for which about 10% of patients remain uncured following standard local therapy. PURPOSE: Our purpose was to test whether a 20% or greater complete response rate could be achieved using a combination of these two agents in patients with advanced squamous cell carcinoma of the skin in whom local therapy had failed or was unfeasible or who had regional and/or distant metastases. METHODS: Thirty-two patients with heavily pretreated, advanced inoperable cutaneous squamous cell carcinoma of the skin were given a combination of oral 13-cRA (1 mg/kg per day) and subcutaneous recombinant human IFN alpha-2a (3 million units per day) for at least 2 months, unless disease progressed earlier, in a phase II trial. RESULTS: Nineteen (68%) of the 28 assessable patients responded, seven (25%) of whom had complete responses. Response rates were 93% (13 of 14) in patients with advanced local disease (six complete responses), 67% (four of six) in patients with regional disease (no complete responses), and 25% (two of eight) in patients with distant metastases (one complete response). The relationship between decreased response rate and increased extent of disease was highly statistically significant (P less than .005, chi-square test). The median response duration was greater than 5 months. No life-threatening toxic effects occurred in assessable patients treated with this combination, although dose reductions were required in 18 patients. The major limiting side effect in this elderly patient population (median age, 67 years) was cumulative fatigue. CONCLUSION: These results indicate that combined systemic therapy with 13-cRA and IFN alpha-2a is highly effective in patients with advanced squamous cell carcinoma of the skin.

Aged↗
PubMed1992

Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery. The need for gram-negative coverage.

This study was undertaken to assess whether gram-negative antimicrobial coverage is required in patients undergoing head and neck oncologic surgery. Ampicillin sodium-sulbactam sodium and clindamycin phosphate were compared in a prospective, randomized, parallel, double-blind trial of 212 patients undergoing head and neck procedures involving clean-contaminated wounds. Both antibiotics were given up to 1 hour before surgery and continued at 6-hour intervals after surgery for an additional eight doses. Fourteen infections occurred in the ampicillin-sulbactam-treated group (13.3%) and 29 infections in the clindamycin-treated group (27.1%). From patients receiving clindamycin, 29 gram-negative organisms were isolated, compared with six from those patients receiving ampicillin-sulbactam. This finding supports the need for gram-negative coverage in patients undergoing clean-contaminated head and neck oncologic surgery.

Adult↗
PubMed1992

Antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery.

The use of antibiotic prophylaxis in head and neck oncologic surgery has greatly reduced the risk of postoperative wound infection and the corresponding increase in morbidity and health care costs. Conversely, inappropriate perioperative use of antibiotics increases costs and risk to patients. Antibiotic prophylaxis is beneficial only in clean-contaminated head and neck surgery; targets are the bacterial flora that commonly inhabit the skin and upper aerodigestive tract, with antibiotics effective against gram-positive aerobic organisms and anaerobic organisms providing the best coverage. Maximum efficacy is achieved with immediate preoperative and short-term (less than 48 hours) postoperative antimicrobial administration in adequate doses. Optimum benefit from prophylaxis in head and neck oncologic surgery depends on appropriate selection and administration of antibiotics in combination with sound, established surgical principles.

Anti-Bacterial Agents↗
PubMed1991

Functional results after total or near total glossectomy with laryngeal preservation.

Locally advanced tongue cancer is a devastating disease for which there are limited therapeutic options that will result in a high rate of cure while preserving function. To determine the oncologic effectiveness of total or near total glossectomy with laryngeal preservation and the possibility of speech and swallowing rehabilitation following treatment, we reviewed our experience with 27 patients treated between 1982 and 1989. Twenty-four patients were eligible for 2-year follow-up and their disease-specific survival was 51%. Swallowing was achieved initially in 18 patients (67%), while 12 had successful long-term deglutition (44%). Oral communication was accomplished in 25 patients (92%). Significant aspiration occurred in three patients and was severe enough to require interval laryngectomy in two patients. The role of laryngeal suspension, palatal augmentation prosthesis, and videofluoroscopy as rehabilitation adjuncts for the total glossectomy patient are described.

Adult↗
PubMed1991

Intraoral soft tissue reconstruction after cancer ablation: a comparison of the pectoralis major flap and the free radial forearm flap.

We compared, by retrospective chart review, the free radial forearm flap and the pectoralis major flap in repairing intraoral soft tissue defects resulting from tumor ablation. Statistical significance of differences was determined using Fisher's exact test and chi-square analysis. Fifty-one free flap and 126 musculocutaneous flap transfers were analyzed. The former were used more often for defects in the anterior part of the oral cavity, whereas the latter were used more frequently in the posterior part. Significantly more patients with pectoralis major flap transfers had late-stage (T3 and T4) disease than did those in the free radial forearm flap group (p = 0.004). Also, the complication rate was significantly higher in the pectoralis major flap group (p = 0.01); this was due to differences in the rates of dehiscence, fistula formation, and flap loss. We thus conclude that, despite the need for microsurgery, the free radial forearm flap is at least as reliable as the pectoralis major flap and that the choice of flap should be based on defect considerations rather than on the perceived reliability of the reconstructive method.

Chi-Square Distribution↗
PubMed1990

Basaloid squamous carcinoma of the upper aerodigestive tract. Clinicopathologic and DNA flow cytometric analysis.

This report adds nine basaloid squamous carcinomas (BSC) of the upper aerodigestive tract to the 11 already recorded in the literature. It includes the first flow cytometric analysis of their DNA content and compares the clinical behavior of BSC with conventional squamous cell carcinoma (SCC). An uncommon variant of squamous carcinoma, BSC manifests a predilection for the hypopharynx and base of tongue of men in the sixth decade of life. Histologically, the carcinoma is characterized by a basaloid pattern often in an intimate association with focal squamous differentiation, comedonecrosis, and stromal hyalinization. It is an aggressive neoplasm: seven of the nine patients had metastases to cervical lymph nodes at time of initial surgery and three of the five deaths occurred within 24 months after primary surgery followed by radiotherapy. Its aggressiveness notwithstanding, the biologic course of BSC is similar to that of conventional SCC when clinical stage, site, and treatment are matched. Patients with aneuploid BSC had a better mean survival time (39.5 months) than those with diploid carcinomas (16.3 months). Surgery followed by radiotherapy appears to be the treatment of choice. Because of a high incidence of distant metastases, adjuvant chemotherapy may be warranted.

Adult↗
PubMed1990

Submandibular gland tumors. Adverse histologic factors and therapeutic implications.

We reviewed our 41-year experience with tumors of the submandibular gland to determine what factors influence outcome and their implications for treatment. The most common benign neoplasm was pleomorphic adenoma (21), while among malignant tumors the adenoid cystic variety (37) predominated. For the 86 patients who had malignant tumors, the 2- and 5-year survivals by the life table method were 82% and 69%, respectively. For patients with malignant tumors, histology, size, perineural invasion, and prior treatment did not affect overall survival. Factors adversely affecting outcome were extraglandular soft-tissue extension and lymph node metastasis. Local-regional control was enhanced in patients with soft-tissue extension if they were treated by surgery followed by radiotherapy rather than by surgery alone.

Adenocarcinoma↗
PubMed1990

Flow cytometric DNA content of adenoid cystic carcinoma of submandibular gland. Correlation of histologic features and prognosis.

Flow cytometric analysis of nuclear DNA content was performed in 26 adenoid cystic carcinomas of the submandibular gland using archived, paraffin-embedded tissues. The DNA content was compared with multiple histologic parameters and clinical course. Ten carcinomas (38%) were aneuploid and 16 (62%) diploid. Aneuploid carcinomas demonstrated a higher frequency of solid cytoarchitecture, lymph node metastases, and advanced clinical stage, as compared with diploid carcinomas. Other histologic features predicting aggressive clinical behavior also correlated with abnormal DNA content and included invasion of nerves larger than 0.25 mm and intravascular extension. Our data suggest that DNA content analysis can be an effective objective parameter in the clinicopathologic assessment of adenoid cystic carcinoma.

Adolescent↗
PubMed1990

Concomitant boost radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx.

Concomitant boost schedules are characterized by delivering the boost (10-12 fractions) as second daily treatments during rather than following the basic wide field irradiations. This results in shortening the overall time to administer 69-72 Gy from 7 1/2-8 weeks to 6 weeks, which we hoped would improve the tumor control rate by reducing the opportunity for tumor clonogens to regenerate during treatment. From August 1985 to August 1988, 79 patients with T2-4 carcinomas of the oropharynx (72 patients) or nasopharynx (7 patients) were treated according to 1 of the 3 variants of the concomitant boost technique. The median age of patients was 60 years (range: 19-84 years) and the male-to-female ratio was 2.6. The overall 2-year actuarial primary and nodal control rates by radiotherapy alone were 74% and 76%, respectively. The ultimate 2-year control rates after surgical salvage were 82% and 84%, respectively. If the boost given during the last 2-2 1/2 weeks of basic treatment, a slightly better primary control rate (p = 0.11) resulted than if the boost was delivered during the first 2-2 1/2 weeks or twice a week throughout the basic treatment. The 2-year actuarial primary control rate of the 13 patients receiving induction chemotherapy prior to radiotherapy was significantly lower than that of patients treated with radiation only (81% vs 34%, p = 0.01), but this could be partly attributed to a more advanced stage in the chemotherapy group. The acute mucosal reactions were, as expected, more severe than those observed with conventional fractionation. Fifty patients developed confluent mucositis covering more than half of the boost area. Such reactions lasted for more than 6 weeks in seven patients. Late complications, however, so far observed, have been few. Three patients experienced chronic mucosal tenderness, 1 chronic mucosal ulceration, 2 transient bone exposure, and 1 carotid rupture following salvage surgery. The results so far appear to be better than the outcome of conventional radiotherapy. Its real value will be determined in a prospective randomized study.

Adult↗
PubMed1990

Treatment selection for carcinoma of the base of the tongue.

Between 1974 and 1984, 173 patients were treated for squamous cell carcinoma of the tongue base. Fifty-four patients had T1 or T2 primaries, while 115 patients had T3 or T4 tumors (4 were not staged). Lymph node metastasis was present in 120 patients. Early primary tumors treated with surgery or radiotherapy had a control rate of 83% (5 of 6 tumors) and 89% (40 of 45 tumors), respectively. For advanced primary tumors, definitive radiotherapy produced a local control rate of 55% (42 of 76 tumors), compared with 79% (23 of 29 tumors) for surgery and postoperative radiotherapy. If primary control was obtained, the regional failure rate was less than 10%. Tumor growth patterns were predictive of the response to radiotherapy. The primary control rate at 2 years for 21 patients with exophytic tumors was 84% as opposed to 58% for 62 patients with ulcerative-infiltrative tumors (p = 0.04). Radiotherapy is effective for early stage or exophytic tumors, whereas for advanced or deeply invasive tumors combined therapy enhances local control.

Adult↗
PubMed1989

Minor salivary gland tumors of the lip and buccal mucosa.

Between 1944 and 1985, 50 patients with minor salivary gland tumors of the lip and buccal mucosa were treated at M.D. Anderson Cancer Center: 19 with lip and 31 with buccal mucosa tumors. The male-to-female ratios were 2.8:1 for lip and 1:2.9 for the buccal mucosa tumors. Patient age at presentation ranged from 18 to 98 years with a median of 55 years. Treatment consisted of surgery alone for 28 patients, radiotherapy in 9 patients, and combined therapy for 13. Adenoid cystic carcinoma was the predominant histologic type, accounting for 21 (42%) tumors. Risk for recurrence was influenced by histology, the presence of perineural invasion, and the location of the primary tumor. Six patients developed recurrent disease; all six had adenoid cystic carcinoma. The therapeutic approach and the rationale for combined treatment of these neoplasms are discussed.

Adult↗
PubMed1989

Transcranial resection of tumors of the paranasal sinuses and nasal cavity.

Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.

Adolescent↗
PubMed1988

Prevalence of human papillomavirus in inverted nasal papillomas.

Human papillomaviruses (HPVs) have been associated with both benign and malignant neoplasms of the head and neck. To determine the prevalence and types of HPVs in this neoplasm, we examined fixed tissue from 21 patients by in situ hybridization. Human papillomavirus types 6b and 11 probes were used, and hybridization was positive to both types in lesions from 16 (76%) of 21 patients. Hybridization to the HPV-11 probe resulted in the most intense nuclear staining throughout the epithelium, probably indicating a high copy number. The high incidence of viral DNA sequences found in this tumor suggests a potential etiologic role. Therapeutic implications are briefly discussed.

Adult↗
PubMed1988

Renal-cell carcinoma with intranuclear inclusions metastatic to thyroid: a diagnostic problem in aspiration cytology.

A case of renal-cell carcinoma (RCC) exhibiting prominent intranuclear inclusions in a metastasis to the thyroid is presented. RCC had been treated in this patient by right nephrectomy 7 yr earlier and by left partial nephrectomy 5 yr earlier; the patient had also received radiation to the neck 4 yr earlier for carcinoma in situ of the left true vocal cord. Aspiration performed on a rapidly enlarging mass in the left lobe of the thyroid revealed both clusters of tumor cells and single tumor cells with prominent intranuclear inclusions. Definitive distinction between a primary and metastatic neoplasm was difficult on the aspiration specimen. Subsequent thyroidectomy confirmed the diagnosis of metastatic renal-cell carcinoma with intranuclear inclusions by histologic, immunohistochemical, and ultrastructural analysis. The differential diagnosis by aspiration cytology of thyroid neoplasms that contain intranuclear inclusions is discussed.

Aged↗
PubMed1988

Squamous cell carcinoma of the soft palate, uvula, and anterior faucial pillar.

This retrospective study concerns 188 patients with squamous cell carcinoma of the soft palate, uvula, and anterior faucial pillar treated for cure between 1970 and 1983. Men predominated in the group (1.9:1) and 55% of the patients were between 60 and 70 years old. Mean duration of followup was 56.7 months. TNM stage distribution was 29, 67, 37, and 49 patients for stages I, II, III, and IV respectively; six patients were unstaged because of previous excisional biopsy. Treatment to the primary site consisted of radiotherapy for 150 patients, surgery alone for 28 patients, and combined therapy for 10 patients. Primary control for T stages 1 through 4 was: 91% (31 of 34), 77% (71 of 92), 77% (30 of 39), and 35% (6 of 17), respectively. One hundred twenty-eight patients were N0 at presentation, as compared to 60 patients with regional nodal metastasis. Regional control was obtained in 87.5% of patients with N0 necks and in 76.7% of those with nodal involvement. In patients with primary control, these figures were 89% and 81%. Overall determinant survival was 80% at 2 years, but fell to 67% at 5 years. In addition to advanced tumor stage, the survival rate was reduced by regional lymph node metastasis. Tumor extension to the tongue base diminished survival. Survival was poorer among patients with midline tumors or tumors that extended across the palatine arch (37 patients) than for those with unilateral primary tumors (151 patients) (p less than 0.05). Despite similar T-stage distribution, the incidence of regional nodal metastasis was 49% in the former group, compared with 28% in the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗