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Biomedical subjects

W J Goodwin

Publications and source records attributed to W J Goodwin.

68 records · Page 4Linked to original sources
PubMed1980

Malignant neoplasms of the external auditory canal and temporal bone.

In a review of 136 patients with squamous cell, basal cell, and salivary gland cancers involving the external auditory canal and temporal bone, the majority of patients had received prior treatment and came to us with recurrent tumor. Squamous cell carcinoma of the concha and cartilaginous ear canal behaved aggressively. Five-year survival in 35 patients with deep temporal bone involvement was 29%. The major reason for failure in this group was incomplete resection of disease. Postoperative irradiation was of no benefit when the cancer could not be completely excised. When compared with surgery alone, combined therapy with postoperative irradiation did improve local control in patients with completely resected lesions but did not demonstrate a corresponding increase in five-year survival.

Adenoma, Pleomorphic↗
PubMed1979

Schwannomas of the parapharyngeal space and jugular foramen.

Schwannomas or neurilemmomas are among the most common neoplasms occupying the parapharyngeal space, yet only 107 cases have been previously reported. Neurilemmomas involving the jugular foramen are extremely rare. Only 55 cases have been reported in the world literature. The neoplasm occurred in the parapharyngeal space in three of our patients and in the jugular foramen in another patient. Of the tumors located in the parapharyngeal space, the nerve of origin in one of them was the glossopharyngeal, which is extremely rare. Adequate exposure for complete excision of parapharyngeal space tumors is best obtained through an external incision and should not be attempted transorally. In the jugular foramen case, the neoplasm arose from the vagus nerve high in the neck and extended intracranially in a "dumbbell" shape into the posterior cranial fossa. Total removal was successfully accomplished in one stage, by using a subtotal temporal bone resection--upper neck--posterior cranial fossa approach. Surgical removal is the treatment of choice. Schwannomas rarely recur following complete excision.

Adult↗
PubMed1978

Indications for radical neck dissection following radiation therapy.

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.

Evaluation Studies as Topic↗
PubMed1976

Hypercalcemia in epidermoid carcinoma of the head and neck.

Hypercalcemia occurs rarely at the time of diagnosis in patients found to have epidermoid carcinoma of the head and neck. It is particularly unlike in those patients who present with potentially curable lesions. Only 2 of our 307 patients who presented with potentially curable lesions were hypercalcemic at the time of diagnosis. Two hundred thirty-eight of these patients were followed up for two years or until death. Of the 139 who did not remain free of disease, hypercalcemia of clinical significance developed in ten (7.2 per cent). Pseudohyperparathyroidism was the suspected cause in seven of twelve patients. Debilitating symptoms were present in all patients with serum calcium levels greater thn 12.0 mg/100 ml. Treatment, when given, was effective in alleviating gastrointestinal and central nervous system problems. Although usually temporary, symptomatic improvement was appreciated by most patients and family members.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Tracheogastric puncture for vocal rehabilitation following total pharyngolaryngoesophagectomy.

Speech rehabilitation postpharyngolaryngoesophagectomy has not received significant emphasis. We describe our experience with five patients who underwent a delayed tracheogastric puncture (TGP) after pharyngogastric anastomosis. When compared to patients who had undergone tracheoesophageal puncture (TEP) after laryngectomy, speech intelligibility and fluency were adequate for conversational speech, but voice quality was characterized by lower pitch, reduced intensity, slower rate, and a "wet" quality. There were no complications related to the TGP. TGP is a safe and often useful procedure for voice and speech restoration in patients who have undergone total pharyngolaryngoesophagectomy and pharyngogastric anastomosis.

Aged↗
PubMedDate not supplied

The value of the prognostic nutritional index in the management of patients with advanced carcinoma of the head and neck.

Nutritional status was evaluated in 50 consecutive patients with advanced squamous cell carcinoma of the head and neck. Using a linear equation developed by Busby , the prognostic nutritional index ( PNI ) was calculated from the serum albumin, triceps skin-fold thickness, serum transferrin, and delayed hypersensitivity reaction. The treatment plan was determined by the patient's attending physician and complications were retrospectively evaluated. The patients were divided into three groups by the value of the PNI . The complication rate was not significantly higher in patients with moderate malnutrition ( PNI between 20% and 39%). However, with severe malnutrition ( PNI greater than 39%), the incidence of iatrogenic complications was prohibitive and 12 of 14 patients were dead within 6 months. We conclude that the PNI is a simple, objective measure of nutritional status that will identify patients at high risk for therapy-related complications and early death.

Adult↗
PubMedDate not supplied

Giant acquired tracheoesophageal fistulas: strategy for successful management.

Giant tracheoesophageal fistulas (TEF) present a significant management problem for the head and neck surgeon. Chronic aspiration and sepsis are associated complications that occur in these patients, who are frequently already debilitated from pre-existing medical calamities. The combination results in prolonged morbidity and frequent mortality. Recently, we have managed two patients with this difficult problem. The first patient was managed using conventional methods well described in the literature with an unsuccessful outcome. The second was managed differently using a two-stage approach. The esophageal stream was first excluded from the respiratory system via a surgical approach, which to the best of our knowledge has not been previously described in the literature. After a period of convalescence, the patient's alimentary tract is reconstituted with a gastric pull-up, reversed gastric tube, or colon interposition. We propose this as an alternative method of management for TEF.

Adult↗
PubMedDate not supplied

Distant metastases from oropharyngeal cancer.

Distant metastasis is a significant problem in patients with carcinoma of the oropharynx, occurring in approximately 15-20% off all patients over the course of the disease. It is, however, a relatively uncommon first site of failure, as compared to local and regional recurrence. Distant spread occurs most commonly to the lungs, in patients who present with advanced disease, and especially in those with pathologically proven lymph nodes at multiple levels of the neck or in the lower neck. Metastasis to distant sites also occurs more often in patients who recur locally or in the neck.

Carcinoma↗
PubMedDate not supplied

Inhibition of hamster tongue carcinogenesis by selenium and retinoic acid.

The inhibitory effect of selenium, 13-cis-retinoic acid, and their combination was studied in an animal model in which squamous cell carcinoma of the tongue was induced by 0.5% 9,10 dimethyl-1,2 benzanthracene (DMBA). A controlled, blinded experiment was carried out using 60 Syrian hamsters divided into four groups of 15 each. When compared to controls, the mean day of carcinoma onset was delayed 3 weeks for animals given selenium, 6 weeks for animals given retinoic acid, and 5.5 weeks for animals given selenium plus retinoic acid. The differences between each experimental group and the control group are statistically significant. We conclude that both selenium and retinoic acid inhibit the development of DMBA-induced squamous cell carcinoma of the tongue in hamsters. The dose of retinoic acid used produces a stronger inhibitory effect, but is associated with significant toxicity. At the doses used, combined inhibitory effect is no greater than that for retinoic acid alone.

9,10-Dimethyl-1,2-benzanthracene↗