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T F Nealon

Publications and source records attributed to T F Nealon.

78 records · Page 5Linked to original sources
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Correlation of pharyngeal fistulization with preoperative radiotherapy, reduced serum albumen, and dietary obstruction.

The clinical courses of patients on the Head and Neck Service undergoing radical procedures were reviewed in retrospect. Factors that appeared to influence the courses such as preoperative radiotherapy, reduced serum albumen, and preoperative oropharyngeal obstruction were correlated with fistulization rate, flap necrosis, and other complications. The study included 105 radical procedures performed over a seven-month period. Sixty-six of these operations included laryngectomies, laryngopharyngectomies, and composite resections. The overall complication rate was 37%, with major complications accounting for 9%. A fistula rate of 20% was found in the pharyngeal group and ranged from 12% in the nonirradiated patients to 44% in the irradiated group. Thos patients with preoperative obstruction secondary to tumor bulk had a complication rate of 58%. Patients with reduced serum albumen levels had a higher complication rate of 55% compared with 35% for the group with normal albumen levels. This study suggests that preoperative replenishment of protein, particularly in the obstructed patient or in those with reduced serum albumen levels, would correlate with a more favorable clinical course.

Body Weight↗
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Use of profound hypothermia and circulatory arrest in complex intra-cardiac repair in adults.

Profound hypothermia and circulatory arrest is a well worked out technique for total repair of congenital defects in infants. Recently, it has been popularized for the repair of aneurysms of the transverse aortic arch. We have applied this technique of profound hypothermia and circulatory arrest in three other adult patients in whom conventional techniques would not allow safe and adequate complete repair of acquired intra-cardiac defects. The first patient, a 76-year-old female, had a large chronic ascending aortic aneurysm involving the aortic valve, as well as the innominate and left common carotid arteries. Resuspension of the aortic valve, resection of the ascending aneurysm, and reconstruction of the ascending and transverse aorta were performed under profound circulatory arrest. In addition, multi-dose hypothermic blood K+ cardioplegia was utilized to protect the myocardium. The second patient underwent valve replacement during a period of circulatory arrest because of extensive calcification of the entire ascending aorta and transverse aortic arch. Arrest time was 56 minutes. The third patient was a 54-year-old female and had a large patent ductus arteriosus with a 3:1 left-to-right shunt as well as significant aortic and mitral valve disease. The ductus was closed through an incision in the pulmonary artery during a 13-minute period of profound hypothermia and circulatory arrest. Aortic valve replacement and mitral repair were also performed at the same time, utilizing conventional techniques. All three patients recovered uneventfully with no evidence of any significant neurologic defect. Long-term follow-up has shown improvement in functional classification in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
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Phase II study of 5-azacytidine in solid tumors.

One hundred and seventy-seven patients were evaluated after therapy with 5-azacytidine using a dose of 1.6 mg/kg/day X 10 days followed by a maintenance regimen. One hundred and forty-eight of the patients received the drug by rapid iv infusion and 29 received the drug daily by and infusion that lasted between 18 and 24 hours. Hematologic toxicity was significant but transient in both groups. Nausea was severe using the rapid iv infusion and minimal with the slow infusion. Antitumor effect was seen in 17% of the evaluable patients with carcinoma of the breast and 21% of the patients with malignant lymphomas. Occasional responses were seen with a variety of other solid tumors. The responses were transient, and clinically, resistance to 5-azacytidine appeared to develop quite rapidly. No clear-cut difference was seen in response rates or duration of response between the two groups of patients. Cross resistance to other anticancer agents was not noted. It is believed that the drug is only of minimal value as a single agent in solid tumors using either of the methods of administration described.

Adolescent↗