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Biomedical subjects

W J Moran

Publications and source records attributed to W J Moran.

32 records · Page 2Linked to original sources
PubMed1988

Sequential administration of methotrexate, cisplatin, and 5-fluorouracil in multimodal therapy for locally advanced head and neck cancer.

Thirty-eight previously untreated patients with locally advanced head and neck cancer received three cycles of induction chemotherapy with methotrexate (120 mg/m2) followed by cisplatin (100 mg/m2) and a 5-day continuous infusion of 5-fluorouracil (1,000 mg/m2 per day). The response rate in 34 evaluable patients was 94%, with a complete response rate of 26%. Thirty-one patients underwent local therapy following induction chemotherapy, and 25 (81%) were rendered free of disease: 14 of 15 treated with surgery and radiotherapy and 11 of 16 treated with radiotherapy alone. At a median follow-up of 11 months, 8 patients have relapsed while the remaining 17 patients continue free of disease. The dose-limiting toxicity of chemotherapy was mucositis resulting in reduction of the 5-fluorouracil dose in 28 patients. This regimen is highly effective in inducing responses in patients with locally advanced head and neck cancer; 81% of the patients who complete local therapy are rendered free of disease with this multimodal approach. Due to short follow-up, the relapse rate, overall survival, and disease-free survival cannot yet be determined.

Adolescent↗
PubMed1987

The free greater omental flap for treatment of mandibular osteoradionecrosis.

Osteoradionecrosis can involve the mandible following radical irradiation for treatment of oral cavity cancer. The radionecrosis of the mandible is often associated with severe intractable pain, local or extensive deformity, including pathologic fracture, orocutaneous fistula formation, and frequent loss of function. Treatment has ranged from analgesia and antibiotics to hyperbaric oxygen treatments to local or extensive sequestrectomies with partial or total mandibulectomy and restoration of tissue losses with unirradiated tissue. To our knowledge, this is the first report of the successful use of a free greater omental flap for immediate treatment of mandibular osteoradionecrosis and concomitant reconstruction. We found the omentum to be an excellent vascular bed that rapidly resolved the osteoradionecrosis and pain, promoted healing, and restored mandibular function with minimal discomfort to the patient.

Humans↗
PubMed1987

Epithelioid hemangioendothelioma (histiocytoid hemangioma) of the palate.

The first case of epithelioid hemangioendothelioma involving the oropharynx is described. A 25-year-old woman developed a mass on the palate which noted to enlarge during the first trimester of pregnancy. Biopsy revealed a cellular tumor initially considered to be of epithelial origin. Vascular differentiation of the tumor was confirmed, however, by positive lectin histochemistry for Ulex europaeus, by evidence of immunoreactivity for factor VIII-related antigen, and by ultrastructural identification of endothelial features. The patient remains free of tumor 21 months after complete excision. Because of the potential for misdiagnosis, epithelioid hemangioendothelioma should be considered in the differential diagnosis of oropharyngeal malignancies. The effect of pregnancy on the development and growth of vascular tumors such as epithelioid hemangioendothelioma remains uncertain.

Adult↗
PubMed1986

Angiosarcoma of the head and neck: review of 11 cases.

In this report, 11 cases of angiosarcoma of the head and neck are reviewed. The patients ranged in age from newborn to 78 years; mean age was 64 years. There were eight men and three women. Sites of involvement included the scalp and forehead, cheek, nose and ethmoid sinuses, neck, and mandible. Surgery was the primary method of treatment. The 2-year survival rate was 50% (5/10) and the 5-year survival rate was 22% (2/9). Regional metastases were seen in 18% (2/11). We found that the tumors were poorly circumscribed and spread horizontally within the dermis for considerable distances, especially in the scalp. Total surgical excision using frozen section control before reconstruction may offer the best chance for control of disease.

Adolescent↗
PubMed1985

Control of epistaxis in the multiple trauma patient.

Severe epistaxis in the multiple trauma victim can be rapidly controlled with immediate insertion of the intranasal anteroposterior balloon. The patient's other life threatening injuries can then be assessed in an orderly fashion. Once the patient has been stabilized, the balloon can be deflated and removed and the patient's maxillofacial injuries assessed and treated in a controlled setting.

Catheterization↗
PubMedDate not supplied

Radioresistant tumor cell lines derived from head and neck radiation failures.

We studied the in vitro radiobiological parameters of 16 human head and neck squamous cell carcinoma tumor cell lines cultured from patients who suffered local failure after a curative course of radiotherapy. The radiobiological parameters determined included D0, n, and D. When compared with in vitro radiobiological parameters of tumor cells cultured from head and neck cancer patients prior to radiotherapy, human sarcoma cell lines, and normal human diploid fibroblasts studied in our laboratory (as well as other human tumor cell lines reported in the literature), tumor cells derived from radiotherapy failures on average are resistant to the cytotoxic effects of ionizing radiation.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Epidermal growth factor receptor gene amplification and expression in head and neck cancer cell lines.

We studied epidermal growth factor receptor (EGFR) gene amplification and expression in 11 early passage human head and neck carcinoma cell lines. Three cell lines demonstrated EGFR gene amplification and 10 lines showed an increase in EGFR mRNA when compared with normal keratinocytes, placenta, and a human skin carcinoma cell line. The effects of EGF on growth in 6 head and neck carcinoma cell lines was also studied. Growth inhibition at a concentration of 20 ng/mL was observed in one cell line but had no effect on growth in 5 cell lines. An increase in EGFR may be important in the etiology of, or progression of, head and neck carcinoma although the mechanisms need to be elucidated by further study.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Melanoma of the upper aerodigestive tract: a review of 21 cases.

In this report 21 cases of primary malignant melanoma arising from the mucosa of the upper aerodigestive tract are reviewed. The patients ranged in age from 30 to 86; mean age was 67 years. There were 10 men and 11 women. All but one patient were white. Sites of involvement were: nose and paranasal sinuses, oral cavity and labial mucosa, parotid duct, and larynx. Surgery was the primary method of treatment. The 2-year survival rate was 44% (7/16) and the 5-year survival rate was 13% (2/15). Regional metastases were seen in 19% (4/21) while distant metastases was seen in 55% (11/21). The local recurrence rate was 69% (11/16). Distant metastases were usually associated with uncontrolled disease at the primary site. This fact as well as the low incidence of regional metastases lead us to conclude that better local control rather than regional lymphatic control is necessary if decreased distant metastases and increased survival are to be achieved.

Adult↗
PubMedDate not supplied

Free gastroomental flap for head and neck reconstruction: assessment in an animal model.

This study was performed to evaluate the free gastroomental flap for the reconstruction of mucosal and soft tissue defects after ablative surgery for head and neck cancer. Its use in a dog model was assessed in terms of the feasability of the surgical technique, acid secretion by the gastric mucosa, changes in the cell population of the graft, and the possibility that the omentum may augment lymphatic drainage after cervical node dissection. Gastroomental flaps were harvested, based on the gastroepiploic artery, and transplanted to the neck in ten dogs. Neck dissection and creation of a defect in the floor of the mouth were followed by microvascular anastamosis of the gastroepiploic vessels to suitable recipient vessels in the neck. Following this, the flap was sutured into place, reconstructing the defect in the floor of the mouth. The omentum was draped over the carotid artery and into the upper mediastinum. Intraoral pH remained stable during a 6-month follow-up period and there was no stomatitis noted. Radionuclide images suggested that the omental lymphatics contributed to regional lymphatic drainage. Histologic examination following sacrifice at 6 months showed atrophy of gastric glands but no epithelial metaplasia. We conclude that the free gastroomental flap is feasible, provides immediate restoration of soft tissue bulk, supplies a mucosal surface that adapts to the oral environment, and may augment regional lymphatic drainage.

Animals↗
PubMedDate not supplied

Immediate free gastro-omental flap reconstruction of the mouth and throat.

A portion of the greater curve of the stomach with its attached omentum was transplanted to reconstruct the pharynx and oral cavity after ablation of upper aerodigestive tract cancer. The tissue characteristics of the transplanted material were similar to those of the removed oropharyngeal tissue. The gastro-omental free flap produced a moist mucosal surface that was self-cleaning and distensible. The free gastro-omental flap was successful in five of seven patients. Because of excessive flap secretions during the early postoperative period, all patients had tracheotomies to protect the lower airway from aspiration.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Osteoradionecrosis of the jaws as a risk factor in radiotherapy: a report of an eight-year retrospective review.

Osteoradionecrosis of the jaws is a severe complication of radiotherapy in the treatment of the head and neck neoplasms. The literature indicates a recent decline in the reported incidence of this complication. The purpose of this study was to further assess the incidence rate for osteoradionecrosis. Factors previously associated with an increased risk for osteoradionecrosis were evaluated to determine possible relationships. A retrospective chart review was conducted for 193 patients treated with radiotherapy for malignant head and neck tumors over an eight-year period. Recorded diagnoses of osteoradionecrosis were noted. Factors previously correlated with the development of osteoradionecrosis were assessed. Of the 193 charts reviewed, 9 diagnoses of osteoradionecrosis of the jaws were made representing an incidence rate of 4.7% for the period evaluated. No single factor was noted to be associated with the development of osteoradionecrosis. The results indicate a low incidence rate for osteoradionecrosis as a post-radiation treatment complication. No single causative factor could be identified suggesting a multifactorial interaction responsible for osteoradionecrosis.

Aged↗
PubMedDate not supplied

Microflora associated with percutaneous craniofacial implants used for the retention of facial prostheses: a pilot study.

Craniofacial implants have been used successfully for the retention of facial prostheses. However, complications occur that can lead to the loss of implant integration. One such complication is infection possibly resulting from crevicular microflora activity. As part of an ongoing study, samples from crevicular sites surrounding 17 craniofacial implants were collected and submitted for microbiological assay. The results demonstrated the presence of opportunistic pathogens in many sites regardless of subjects' hygiene efforts. The significance of the findings is reviewed.

Colony Count, Microbial↗
PubMedDate not supplied

The use of percutaneous implants for the prosthetic rehabilitation of orbital defects in irradiated cancer patients: a report of clinical outcomes and complications.

This retrospective study evaluated the use of percutaneous craniofacial implants for the prosthetic rehabilitation of patients with a history of orbital exenteration and irradiation for oncologic tumors of the head and neck. A total of 24 implants were placed in six patients. All implants were determined to be osseointegrated at the time of uncovering. Three implants were subsequently resubmerged beneath the soft tissue because of positional interferences with prosthesis fabrication. The remaining 21 implants were ultimately used to retain six orbital prostheses. Two implants failed to maintain osseointegration during the follow-up period and were subsequently removed without complications. This represents an overall integration success rate of 90.5% over a mean follow-up period of 32.8 months (range = 11 to 68 months). The significance of these findings and their relationship to comparable reports in the literature are discussed.

Adult↗