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Biomedical subjects

W E Fee

Publications and source records attributed to W E Fee.

At least 19 recordsLinked to original sources
PubMed1992

Radiosurgery for palliation of base of skull recurrences from head and neck cancers.

BACKGROUND: Seven patients received stereotaxic radiosurgery for 10 lesions at the base of the skull (BOS) from recurrent head and neck malignant neoplasms. METHODS: A radiation dose of 17.5-35.0 Gy was delivered as a single fraction. Follow-up ranged from 1 to 14 months. RESULTS: Nine lesions were symptomatic, and the symptoms improved in five and stabilized in four lesions. In addition, a significant radiographic response was observed in 4 of 10 recurrences. Cranial nerve signs developed in two patients, and an area of asymptomatic necrosis developed in one patient in the temporal lobe tip. CONCLUSIONS: From their brief experience, the authors conclude that stereotaxic radiosurgery may be a promising treatment in locally controlling recurrent head and neck cancers that involve the BOS.

Aged↗
PubMed1992

The electrophysiologic and histologic effects of the Argon Beam Coagulator on peripheral nerves.

The electrophysiologic and histologic effects of the Bard Argon Beam Coagulator (ABC) were investigated in the New Zealand White rabbit. Thirty-four rabbits were divided into three groups. Controls underwent simple femoral exploration and closure. The remaining rabbits' femoral nerves were spot coagulated with either the ABC or standard electrosurgical unit (ESU). Stimulus thresholds were recorded before treatment and again prior to sacrifice at 0, 30, 60, or 120 days. Thresholds were significantly elevated for the ABC and ESU compared to controls (P = .0077 and .0351, respectively). Changes in threshold were greater for the ABC than for the ESU, but were not significant. All ABC- and ESU-treated nerves had significant histologic injury when compared to controls (P < .0002). Although the ABC may be clinically safe, significant injury to rabbit femoral nerves occurs when they are exposed to energy emitted by this instrument.

Animals↗
PubMed1991

Thyroidectomy under local anesthesia.

Thyroidectomy for benign and malignant disease is most commonly performed with the patient under general anesthesia, although the literature is sprinkled with reports of series of operations performed using local anesthetic techniques. A retrospective review of 43 sequential thyroidectomies compares 21 performed using local anesthesia with 22 performed using general anesthesia. No significant difference was demonstrated in the incidence of major complications. All patients who required a second operation to remove the remaining hemithyroid after the final pathology reports were reviewed elected local anesthesia for their second procedure, attesting to patient satisfaction. Some hemithyroidectomies performed using local anesthesia were outpatient procedures. The indications, guidelines for patient selection, and operative technique of this effective alternative approach to thyroid surgery are presented.

Ambulatory Surgical Procedures↗
PubMed1991

Long-term survival after surgical resection for recurrent nasopharyngeal cancer after radiotherapy failure.

Results are reported of transpalatal, transcervical, and transmaxillary resection in 15 patients with recurrent nasopharyngeal cancer after failure of primary radiotherapy. Seven patients treated for cure have been followed up for more than 3 years (mean, 55 months; range, 40 to 82 months), with three (43%) remaining free of disease. Two patients are living with local disease (59 and 40 months postoperatively), while two have died of their local and regional recurrence (40 and 17 months postoperatively). Two additional patients underwent nasopharyngectomy for palliation. One of these patients died of uncontrolled disease 12 months postoperatively; the other remains alive with disease 70 months after resection. Six patients have been followed up for less than 3 years (mean, 22.3 months; range, 16 to 32 months). Of this group, one (17%) is without evidence of disease, four are living with local disease (13, 16, 17, and 27 months postoperatively), and one has died of disease (13 months postoperatively). Recurrence (10 of 13 patients) has occurred an average of 8 months after surgery (range, 4 to 17 months). Complications include transient marginal mandibular nerve weakness (one), permanent cranial nerve paralysis (two), nasopharyngitis and/or osteomyelitis of the cervical vertebrae or base of skull requiring intravenous antibiotics (two), aspiration pneumonia (two), prolonged nasogastric tube feeding (two), and intraoperative thyroid storm (one). No cerbrospinal fluid leaks or perioperative deaths occurred. The long-term cure rate and disease-free interval of transpalatal nasopharyngectomy lead us to believe that this technique is probably only slightly better than reirradiation in the appropriately selected patient.

Adult↗
PubMed1991

Conservation surgery for laryngeal carcinoma.

Partial laryngeal surgery as a treatment for certain laryngeal carcinomas is sound in principle and practice. Knowledge of intralaryngeal barriers to spread is necessary for selection of appropriate patients and for surgical planning. Ten partial laryngeal procedures are discussed including selection criteria and cure rates for each. With meticulously accurate tumour staging and mapping, the practitioner can perform partial laryngeal surgery safely. Results equal or better those achieved by radiation therapy or total laryngectomy while preserving vocal function.

Carcinoma, Squamous Cell↗
PubMed1990

Esophagography and esophagoscopy. Comparison in the examination of patients with head and neck carcinoma.

We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

Adult↗
PubMed1988

Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site.

Nine patients have undergone transpalatal resection of recurrent nasopharynx cancer 10 to 56 months following a full course of external beam irradiation. Seven patients were treated for cure, and two were treated palliatively because of nasal airway obstruction, recurrent epistaxis, and severe headaches. Of the patients treated for cure, five are living free of disease 6 to 48 months (mean, 22.2 months) after their surgery. Disease recurred in two patients at 5 and 7 months. Both underwent secondary procedures and are alive with disease at 25 months and 11 months, respectively. The mean hospital stay was 8.7 days (range, 2 to 30 days) for all patients. The average time to swallowing was 2 days (range, 1 to 3 days). Six patients required resection of their soft palate and a soft palate obturator; two patients had intact functioning soft palates without velopharyngeal insufficiency. Of the two patients treated for palliation, one patient died 1 year postoperatively and, although she received some benefit from the resection (diminished headaches), in retrospect, surgery was not worthwhile. The second patient is alive 3 years following her resection and remained symptom-free for 2 years.

Adult↗
PubMed1987

A monoclonal antibody to squamous cell carcinoma.

Monoclonal antibody 17.13.Cl.10 is a murine IgM kappa monoclonal antibody (Mab) that stains frozen section squamous cell carcinoma (SCC) homogeneously and intensely with a sensitivity greater than 98%, including 106/107 SCC specimens from the head and neck. It was produced using a human laryngeal SCC as immunogen and screened using frozen section human tissue. Monoclonal antibody 17.13.Cl.10 faintly stains the basal layer of normal squamous epithelium, does not stain normal organ tissue other than myoepithelial cells, and reacts with few non-SCC tumors. It, therefore, may be a useful adjunct to standard histopathologic criteria for the diagnosis of SCC. It may prove helpful in the investigation of tumor-associated antigens. Despite major technical and immunologic problems, monoclonal antibodies to functional tissue-specific tumor-associated antigens have the potential to play a major role in imaging and in treatment in the future.

Animals↗
PubMed1979

Squamous cell carcinoma of the soft palate.

We performed a retrospective study of 106 patients with carcinoma of the soft palate who were treated at two university hospitals. Computer analysis using a new interactive data base program called MING was made to determine Berkson-Gage survival and Gehan tests of statistical significance. Statistically significant associations with an increased survival included the following: smaller lesions, a clinically negative neck examination. well- and moderately well-differentiated histopathologic features, radiation therapy dose of less than or equal to 6,300 rads, absence of a simultaneous primary, and surgical salvage. No statistically significant differences were seen with age, sex, stage, or the number of days during which patients were treated with radiation therapy. There appears to be a need for a prospective, multi-institutional, randomized therapy study to solidify treatment policy. Consideration should be given to combine surgery-radiation vs radiation therapy alone.

Adult↗
PubMed1979

Tracheoesophageal space abscess.

Two cases of a newly described complication of endotracheal intubation are presented with a discussion of the pathophysiology, clinical symptoms, and treatment evaluation. Treated late, bilateral arytenoid fixation associated with subglottic stenosis is the eventual outcome. Reconstructive efforts in one patient have allowed decannulation two years after onset of his disease following bilateral arytenoidectomy. No reconstructive efforts were attempted in the second patient because of her basic underlying disease process. Early recognition is important and exploratory laryngotracheal-fissure advocated for suspected cases in order to perhaps decrease the devastating consequences of late treatment.

Abscess↗
PubMed1979

Effect of prophylactic antibiotics in radical head and neck surgery.

One hundred major head and neck operations performed on 77 patients were evaluated regarding the effectiveness of an aminoglycoside and cephalosporin antibiotic combination given prophylactically to prevent postoperative infection. The postoperative infection incidence was 6%, significantly lower than that reported in similar series where no antibiotics were used. The addition of the aminoglycoside did not appear to provide any additional protection compared with the use of cephalosporin alone.

Aminoglycosides↗
PubMed1978

Thyroid surgery: surgical and metabolic causes of hypocalcemia.

Patients undergoing radical surgical treatment of head and neck neoplasms often are seen with a history of cirrhotic liver disease, electrolyte abnormalities, and other stigma of chronic disease. Despite skillful thyroid surgical technique performed as an isolated procedure or in combination with other procedures such as laryngectomy, hypocalcemia can occur. Common causes of lowered serum calcium levels secondary to removal of parathyroid glands, blood transfusions, hypoalbuminemia, gastrointestinal malabsorption, and renal insufficiency are well known. Less well known is the recently elucidated role of dependence of calcium metabolism on magnesium. Recently, it has been well documented that alcoholism directly lowers serum magnesium levels in both human and animal models without prior liver disease or malabsorption. The fact that three mechanisms are needed to explain calcium homeostasis implies that the magnesium-calcium interdependence is not clearly understood.

Calcium↗