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Biomedical subjects

W R Panje

Publications and source records attributed to W R Panje.

At least 37 records · Page 2Linked to original sources
PubMed1996

Implant-retained prosthetic rehabilitation of orbital defects.

OBJECTIVE: To evaluate the use of endosseous transcutaneous implants to retain removable facial prostheses for the rehabilitation of orbital defects. SETTING: Tertiary referral center. PATIENTS: Six patients with a history of facial defects secondary to orbital exenteration for cancer ablation. OUTCOME MEASURES: Clinically noted functional and cosmetic results, patient reports of satisfaction, and complications encountered. RESULTS: Twenty-three of 25 implants were integrated (postoperative period, 13 to 65 months; mean, 44.2 months), representing an integration success rate of 92%. All patients were successfully wearing implant-retained prostheses after 48.3 months (post-prosthesis delivery period, 1 to 48.3 months; mean, 24.5 months). Overall patient satisfaction was very high. CONCLUSIONS: Implant-retained prosthetics represent a safe and effective treatment option. It is anticipated that this treatment will become the standard of rehabilitative care for patients with orbital defects.

Adult↗
PubMed1996

Onlay bone augmentation with an osteoinductive implant.

The repair of contour defects of craniofacial bone can be accomplished by several methods, including autogenous bone grafts, demineralized bone, and alloplastic materials. The objective of this study was to assess a biodegradable, xenogeneic, osteoinductive implant for craniofacial onlay bone augmentation. Twelve New Zealand White rabbits each had craniofacial onlays consisting of three experimental materials: 1) autograft; 2) allogeneic, demineralized block implant; and 3) partially purified osteoinductive protein (osteogenin) with allogeneic collagen and 50:50 poly (DL-lactide-co-glycolide). Implants with host bone were recovered after 20 weeks and assessed by histomorphometric methods. There was no evidence of adverse local reaction to the three treatments. No significant difference in bone replacement or bone density resulting from each of the implant types was demonstrated. In conclusion, the osteoinductive implants were well tolerated, and over the 20-week period they appeared to maintain their contour as onlays.

Animals↗
PubMed1995

Bilateral maxillectomy and midfacial reconstruction.

Extensive bilateral midfacial defects including the upper jaw, palate, and sinuses present a formidable reconstructive challenge. Prosthetic restorations require a solid anchor point to be successful, since orofacial motion would otherwise cause instability of the prosthesis. We report on a series of eight patients who underwent transmalar placement of a Steinmann pin at the time of definitive tumor resection. The Steinmann pin was used immediately to securely anchor a prosthesis to the skull base. The maximum follow-up time is 9 years. The Steinmann pin has remained firmly anchored without significant loosening in six of these eight patients, and no major complications have resulted from its use. In conclusion, the transmalar Steinmann pin is an effective and immediate single-stage method of permanently retaining a midface prosthesis.

Adolescent↗
PubMed1995

Surgical management of the head and neck cancer patient following concomitant multimodality therapy.

The simultaneous use of chemotherapy and radiotherapy (concomitant therapy) has exceptional promise in the treatment of head and neck cancer. In this limited review, seven head and neck cancer patients who underwent prior concomitant therapy and subsequent surgery developed wound-healing complications that were delayed (22-day average) in onset. Paranasal sinus and base of skull operations had less significant wound morbidity than those cases requiring simultaneous transgression of the neck and upper aerodigestive tract. The use of arterialized flaps did not in itself prevent wound breakdown. The formation of controlled fistulae, delay of reconstruction, and avoidance of simultaneous neck and upper aerodigestive tract entry are important considerations in avoiding wound-healing complications after concomitant therapy. In this select group of patients, surgery should be approached with extreme caution and conservatism.

Adult↗
PubMed1995

Use of stainless steel implants in facial bone reconstruction.

Stainless steel has adequate strength, flexibility, ductility, and bio-compatibility for most maxillofacial implant applications. In addition, it is relatively cheap and easy to manufacture. Stainless steel may be effectively used in the maxillofacial region in the form of wires, pins, and plates. This article presents a technique for using a transmalar Steinmann pin to secure a midface prosthesis in cases of bilateral midfacial, bilateral maxillectomy, and total rhinectomy defects. The stainless steel pin may serve as a stable long-term anchoring if used for retention rather than load bearing. This method offers the potential for single-stage reconstruction and allows for prosthesis removal to inspect the surgical defect for early evidence of recurrence.

Face↗
PubMed1994

Jejunal graft reconstruction of pharyngoesophageal defects without microvascular anastomoses.

The purpose of this article is to describe transplantation of jejunal grafts without microvascular anastomoses for reconstruction of the pharynx and/or upper esophagus following oncologic resections. Even though use of free flaps including jejunum, a method that requires revascularization, continues to offer superior results in pharyngoesophageal reconstruction, the technique described in this article provides a readily available alternative. This timesaving technique is particularly useful if the surgeon encounters intraoperative complications related to either the microvascular anastomoses or to an unstable patient. The principal advantages of jejunal graft reconstruction include the absence of a need for microvascular anastomoses, a decreased operating time, a one-stage operation, and the replacement of pharyngoesophageal mucosa with like tissue. The disadvantages include the need for laparotomy, the requirement for a well-vascularized tissue bed, delayed wound healing, the need for stenting, and delayed initiation of oral intake.

Adult↗
PubMed1993

Locoregionally advanced paranasal sinus carcinoma. Favorable survival with multimodality therapy.

To determine the efficacy of multimodality treatment for stage III and IV, advanced paranasal carcinoma, we have retrospectively reviewed local control rate and disease-free survival in patients treated at the University of Chicago (Ill). Twelve consecutive patients with stage III or IV, newly diagnosed paranasal sinus carcinoma treated between 1984 and 1991 were included in this study. Multimodality therapy was composed of a sequence of fluorouracil-cisplatin-based neoadjuvant chemotherapy (in 12 of 12 patients) followed by standard surgical resection (11 of 12 patients) and radiotherapy (12 of 12 patients, 45 to 73 Gy) with or without concomitant chemotherapy. Eleven patients (92%) are currently alive and free of disease, with a median follow-up of 55 months (range, 13 to 105 months). One patient died of persistent disease. Failure was attributed to incomplete surgical resection. There was only one major irreversible treatment complication (cisplatin ototoxic reaction). Our preliminary data suggest improved local control and survival with multimodality therapy that includes systemic neoadjuvant chemotherapy and standard tumor resection in patients with advanced paranasal sinus carcinoma. These results are superior to the reported 40% survival with bimodal therapy and are better than those achieved in our institution for other head and neck primaries with the same treatment regimens.

Adult↗
PubMed1993

Cisplatin, fluorouracil, and leucovorin augmented by interferon alfa-2b in head and neck cancer: a clinical and pharmacologic analysis.

PURPOSE: To increase the activity of cisplatin, fluorouracil (5-FU), and leucovorin (PFL) through further biochemical modulation and study the pharmacologic interaction of 5-FU and interferon alfa-2b (IFN). PATIENTS AND METHODS: Escalating doses of IFN (0.5 to 4.0 x 10(6) U/m2/d x 6) were added to cisplatin 100 mg/m2, continuous infusion 5-FU 800 or 640 mg/m2/d x 5, and leucovorin 100 mg orally every 4 hours. Forty-eight previously untreated patients with locoregionally advanced head and neck cancer received up to three cycles of PFL-IFN. RESULTS: Twenty-one patients were treated during a phase I cohort study. Dose-limiting mucositis was seen with 800 mg/m2/d of 5-FU and 0.5 x 10(6) U/m2/d of IFN. After decreasing the 5-FU dose to 640 mg/m2/d, the maximally tolerated dose (MTD) of IFN was 2.0 x 10(6) U/m2/d. Mucositis and myelosuppression were dose-limiting. Of 34 patients treated at this MTD, 56% (95% confidence interval, 39% to 73%) had a complete remission. There was no correlation between 5-FU clearance and IFN dose. Pharmacodynamic analyses at the MTD showed that older age, female sex, and higher 5-FU area under the time versus concentration curve (AUC) were associated with lower nadir counts and/or increased mucositis. Seven patients with diabetes mellitus had significantly increased myelosuppression, serum creatinine, hypocalcemia, higher 5-FU concentrations, and lower 5-FU clearance compared with nondiabetics. CONCLUSION: The recommended doses for PFL-IFN are 640 mg/m2/d for 5-FU and 2.0 x 10(6) U/m2/d for IFN. Sex, age, 5-FU AUC, and diabetes mellitus may have an impact on the pharmacodynamics of this regimen.

Adolescent↗
PubMed1993

Malignant neoplasms of the scalp. Etiology, resection, and reconstruction.

Malignant scalp neoplasms initially spread by radial extension with deep invasion occurring relatively late in the course of disease. Basal cell carcinomas have the highest incidence followed by squamous cell carcinomas and melanomas. Surgical excision provides the best chance of cure in the majority of cases. Tumor histology influences decisions about margins of resection and regional lymph node dissection. Primary closure usually can be obtained for scalp defects measuring up to 3 cm in diameter. Larger defects can be reconstructed with skin grafts, local flaps, musculocutaneous flaps, free flaps, or transposition flaps following tissue expansion.

Humans↗
PubMed1992

Favorable long-term survival following induction chemotherapy with cisplatin, fluorouracil, and leucovorin and concomitant chemoradiotherapy for locally advanced head and neck cancer.

BACKGROUND: The majority of patients with head and neck cancer die of locoregional recurrence of disease following surgery and/or radiotherapy. PURPOSE: Our purpose was to administer induction chemotherapy, perform surgery, and administer concomitant chemoradiotherapy in rapid sequence and to evaluate their impact on locoregional and distant tumor control. METHODS: Sixty-four patients with previously untreated, locoregionally advanced head and neck cancer received two cycles of cisplatin, bleomycin, and methotrexate (PBM) (33 patients) or cisplatin, fluorouracil (5-FU), and leucovorin (PFL) (31 patients). PFL was given to patients who were unable to receive bleomycin. Local therapy consisted of surgery and/or concomitant chemoradiotherapy with 5-FU, hydroxyurea, leucovorin, and radiotherapy (FHX-L), all administered every other week. RESULTS: Complete and overall induction response rates were 21% and 79%, respectively, for PBM and 29% and 81%, respectively, for PFL. At completion of local therapy, 81% of the patients were disease-free. With a median follow-up of 35 months, the median survival and time to progression are 22 and 17 months, respectively, for PBM and have not been reached for PFL. Locoregional recurrence of disease is 30% for PBM and 26% for PFL. Distant disease progression is 24% for PBM and only 3% for PFL. CONCLUSIONS: The sequencing of induction chemotherapy and concomitant chemoradiotherapy is feasible and results in a high local control rate and in an encouraging survival rate with PFL. The high distant failure (i.e., outside the head and neck area) rate of PBM suggests insufficient systemic activity for that regimen. IMPLICATIONS: Concomitant FHX-L chemoradiotherapy may improve regional control rates of advanced head and neck cancer. Effective systemic therapy may be needed to control systemic micrometastases. PFL, but not PBM, appears to be suitable to accomplish that goal.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Positron emission tomographic evaluation of patients with head and neck cancer undergoing occlusion and removal of the carotid artery.

We used positron emission tomography (PET) to evaluate cerebral metabolic changes in five patients who underwent resection of the internal carotid artery (ICA) for malignant tumors of the head and neck. These patients received a thorough clinical neurologic examination as well as neuroradiologic evaluation, including computed tomography (CT), magnetic resonance imaging (MRI), and PET of the head, before and after balloon occlusion of the ICA. All five were free of cerebral or peripheral vascular disease. In addition, each patient was evaluated with an electroencephalogram (EEG) before and during the balloon occlusion for signs of ischemic changes. No abnormalities were noted on clinical neurologic examination, CT, MRI, or EEG, either before or after occlusion, and excision of the ICA. The PET examination showed a mean preoperative metabolic rate of 7.52 mg of glucose/min/100 gm of brain tissue and a mean postoperative rate of 6.32 mg/min/100 gm of brain tissue; these values were within the normal range of 5.00 to 9.00 mg of glucose/min/100 gm of tissue observed at this center. Only one subject showed asymmetry of glucose metabolism; this subject had received radiation treatment to one side of the brain after the initial PET evaluation. The results of this study support our clinical experience with occlusion and resection of the ICA in patients with head and neck tumors that in the past have been considered inoperable.

Journal Article↗
PubMed1992

Rounded atelectasis.

Explore the source record for details and available documents.

Carcinoma, Squamous Cell↗
PubMed1992

Concomitant chemoradiotherapy with cisplatin, 5-fluorouracil and hydroxyurea in poor-prognosis head and neck cancer.

Based on encouraging results with 5-fluorouracil (5-FU), hydroxyurea, and concomitant radiotherapy in patients with advanced or recurrent head and neck cancer, an attempt was made to modulate the regimen by the addition of cisplatin as a third active agent. A cohort of 26 patients with head and neck cancer of all histologies were entered into a broad phase I study investigating simultaneous radiation therapy, 5-FU (with or without leucovorin), HU, and infusional cisplatin administered on an alternate-week schedule. Eleven patients (group 1) had failed prior curative local therapy and 15 patients (group 2) were considered to have a poor prognosis with standard therapy. The median follow-up was 30 months. The response rate for all evaluable patients was 82% (14/17), and the complete response rate was 65% (11/17). Patients in group 1 demonstrated a high failure rate (9/11), while few group 2 patients failed after treatment (2/15). The median time to progression was 4.4 months in group 1 and has not been reached in group 2. Patients in group 1 failed locally (7/11), while no local failures were observed in group 2. Acute and cumulative hematologic toxicity was encountered at all dose levels and schedules tested and prevented escalation of the cisplatin dose beyond the desired level of 100 mg/m2 per months. Mucositis was a second significant toxicity in patients with head and neck cancer and was more pronounced during cycles containing leucovorin. A detailed analysis of survival, time to progression, and site of failure is presented.

Adult↗
PubMed1992

Perspectives on combination chemotherapy with concomitant radiotherapy for poor-prognosis head and neck cancer.

Concomitant chemoradiotherapy has resulted in small increases in disease-free or overall survival for patients with advanced head and neck cancer when single-agent chemotherapy is used. To increase the efficacy of this approach, combination chemotherapy also has been explored. In this setting, acute toxicities are frequently increased, necessitating interruption or protraction of radiotherapy. Despite this fact, pilot trials using 5-fluorouracil-based chemotherapy have indicated high response and encouraging survival rates. Some of these trials will be reviewed, with a focus on studies with 5-fluorouracil, hydroxyurea, and cisplatin conducted at the University of Chicago.

Adult↗
PubMed1992

Hydroxyurea with concomitant radiotherapy for locally advanced head and neck cancer.

Hydroxyurea is an active single agent in squamous cell cancer of the head and neck. It has been used clinically, most frequently as a radiation-enhancing agent with concomitant radiotherapy. Pilot trials testing hydroxyurea in this setting reported encouraging results. Two randomized trials have been conducted with inconclusive results, possibly relating to study cohort size and short period of follow-up. More recently, hydroxyurea has been investigated with 5-fluorouracil and concomitant radiotherapy. A sound theoretic rationale can be made for this approach and data derived from a phase I/II study are presented. These support the further investigation of this regimen.

Administration, Oral↗
PubMed1991

Survival and analysis of failure following hydroxyurea, 5-fluorouracil and concomitant radiation therapy in poor prognosis head and neck cancer.

Thirty-nine patients with head and neck cancer were entered into Phase I-II study of simultaneous radiation therapy with continuous infusion fluorouracil at 800 mg/m2/day and escalating doses of hydroxyurea. Twenty of these patients had recurrent disease after previous surgery and/or radiation therapy (group 1). Nineteen patients had not received prior local therapy but had advanced-stage disease (group 2). Cycles were repeated every other week until the completion of radiation therapy. The median follow-up was 32 months. Patients with recurrent disease were generally treated with palliative doses of radiation (median dose 5,000 cGy) while previously untreated patients received radiation with curative intent (median dose 7,040 cGy). The response rate for 15 evaluable patients with recurrent disease was 93% with 40% of patients achieving a complete response. For 17 evaluable patients without recurrent disease the response rate was 100%, with a complete response rate of 71%. This regimen exhibited a high activity and significant palliative benefit in group 1 patients. However the local control rate was 25% (5/20) because the majority of patients in this group eventually developed a local recurrence. The local control rate for group 2 patients was 84% (16/19). The higher local failure rate in group 1 patients appeared to be attributable to the palliative doses of radiation delivered and the fewer cycles of treatment received. We conclude that this regimen has palliative benefit in patients who have failed prior local therapy and has the potential for cure in patients with poor prognosis advanced stage disease as well.

Adult↗
PubMed1991

Head and neck cancer: an analysis of the incidence, patterns of treatment, and survival at the University of Iowa.

A retrospective study was performed with use of tumor registry data to evaluate tumor population characteristics, the patterns of care, and patient survival in 4,506 patients with head and neck cancers seen at The University of Iowa Hospitals and Clinics between 1960 and 1985. The total number of patients with head and neck cancers seen per year and the distribution by anatomic site remained relatively stable over the 26-year period. However, there was a general trend toward more advanced stages in later years. The selection of a treatment modality for this patient population correlated well with the site and stage of the disease and with the treatment philosophy of the managing physicians. Patient survival rates correlated well with the site and stage of the disease. There was a gradual improvement in 5-year survival rates over the 26-year period, from approximately 39% in 1960 to approximately 47% in 1984. This was principally due to an improvement in the 5-year survival rate for patients with "regional stage" disease, from approximately 22% in 1960 to approximately 41% in 1985.

Combined Modality Therapy↗