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Biomedical subjects

B Leipzig

Publications and source records attributed to B Leipzig.

14 recordsLinked to original sources
PubMed1986

Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs. five-day therapy.

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Cefoperazone↗
PubMed1985

Assessment of mandibular invasion by carcinoma.

In this prospective study of 31 patients, the most sensitive assessment of malignant invasion of the mandible was by physical examination. Bone scanning and conventional roentgenographs are useful adjuncts in the staging evaluation of patients when clinical involvement is suspected and to determine the extent of disease in order to aid in treatment planning. However, they are frequently subject to false-positive interpretive errors, especially due to increased osteoblastic activity associated with dental disease and occasional tumor adjacent to the mandible. When appropriate, the radiographs ordered should be those that allow for the most accurate assessment of the particular lesion as determined by its location. Until a more specific and accurate method for detecting and measuring malignant invasion of the mandible is developed, the physical findings and the judgment of the head and neck surgeon remains our most valuable tool.

Humans↗
PubMed1985

Cisplatin potentiation of radiotherapy. Long-term follow-up.

Thirty-three patients with inoperable squamous cell carcinoma of the head and neck were treated with cisplatin, 15 mg/sq m, administered synchronously with high-dose radiation therapy. Twenty-nine patients (88%) responded to the regimen; of these, 20 had complete regression of all disease. Eight of the 20 had a relapse in less than one year of their treatment. Among those patients who did not have a relapse, the follow-up period was short. It is concluded that a clinical regression response is more likely with this treatment regimen than with radiation therapy alone, and that that response may be a better palliation. Further study of this combination of treatment modalities is warranted.

Carcinoma, Squamous Cell↗
PubMed1985

The role of endoscopy in evaluating patients with head and neck cancer. A multi-institutional prospective study.

In a prospective multi-institutional study of 384 patients undergoing endoscopy, an 8.9% incidence of second primary neoplasms was discovered simultaneously in the lung (3.3%), esophagus (1.8%), and other head and neck sites (3.6%). The endoscopy was the only source of detection of these tumors in 58% of cases. A trend indicates that flexible fiberoptic bronchoscopy was more effective than rigid bronchoscopy in discovering lung tumors (7.5% vs 2.3%). Nevertheless, the chest roentgenogram remains an important tool in the diagnosis of second primary lesions in the lung. Panendoscopy is safe, takes little time, and can add invaluable information concerning therapy in patients with head and neck cancers.

Bronchoscopy↗
PubMed1984

Nasal papillomas and squamous carcinoma.

There is a known association between carcinoma and nasal papillomatosis when benign nasal papillary lesions have been treated by radiotherapy or by chemotherapy. Invasive carcinoma was found in a patient with nasal papillomatosis that had not been treated previously. Ordinary inflammatory polyps involving the nasal and sinus cavities are extremely common and may mask papillomatosis. Polypoid lesions resected from the nasal ans sinus cavities should always be examined histologically.

Carcinoma, Squamous Cell↗
PubMed1983

Cisplatin sensitization to radiotherapy of squamous cell carcinomas of the head and neck.

A combined modality of treatment utilizing cisplatin as a radiosensitizing agent concomitantly with full-course radical irradiation has been studied in 14 patients. Cisplatin at a dose of 15 mg/M2 body surface area was given intravenously on days 1 through 5 and 21 through 25 of the radiation therapy course. Among the 14 patients so treated, 11 patients had evidence of complete clinical regression of their tumors. Most remained in remission without evidence of recurrent disease for as long as 18 months. Recurrence in the field of treatment was even more rare. Symptomatic improvement was very encouraging in these patients. Most of them have had a significant improvement in their tolerance of pain and in the ability to swallow foods and maintain weight without a nasogastric feeding tube. Decannulation of the tracheostomy is usual. Problems included four patients with renal toxicity, one of whom died with renal failure. No patient required interruption of therapy due to mocositis or dysphagia. Nausea was rare. This encouraging data in our pilot study of a new therapeutic regimen justifies a full-scale clinical trial.

Carcinoma, Squamous Cell↗
PubMed1982

Small cell epidermoid carcinoma of salivary glands. 'Pseudo'-oat cell carcinoma.

Two patients had small cell carcinomas of the salivary glands, with pathological features indicating squamous differentiation, heretofore not described. One is free of disease at seven years, and the second is alive, with regional metastases at four years. Sections from one tumor were studied by electron microscopy and revealed tonofilaments and desmosomes. Most cases of small cell carcinomas of the salivary glands have been considered akin to bronchogenic oat cell carcinoma. Their less aggressive behavior, however, suggests that at least some of these tumors were not true oat cell carcinomas. Our findings, and those of others, indicate that small cell carcinomas of the salivary glands (or head and neck) represent a heterogeneous group. Electron microscopy should be used to determine the exact nature of these neoplasms. If an oat cell nature is ruled out, local and regional treatment should be aggressive, since small cell carcinomas other than oat cell appear not to have a dismal prognosis.

Aged↗
PubMed1979

A prospective randomized study to determine the efficacy of steroids in treatment of croup.

We evaluated the use of dexamethasone in the management of acute laryngotracheobronchitis (croup). Thirty patients, ranging in age from eight to 60 months, were evaluated in a prospective, double-blind study. Patients received dexamethasone, 0.3 mg/kg at the time of admission and a similar dose 2 hours later, and were compared with a placebo group receiving saline. Sixteen patients received dexamethasone and 14 patients received the placebo. Severity of each group was scored by a standardized system. Patients receiving dexamethasone had a mean admission score of 8.46 points; patients receiving placebo, 8.14. Twenty-four hours after admission the patients in the treatment group had a mean score of 1.19 as contrasted with a score of 5.58 for the placebo group (P less than 0.01). We concluded that dexamethasone when administered in adequate dosage by an intramuscular route hastens the recovery of infants and children with acute uncomplicated croup.

Child, Preschool↗
PubMed1979

Composite resection without mandibular reconstruction.

While composite resection remains the fundamental surgical approach to carcinoma of the posterior oral cavity, removal or reconstruction of the adjacent segment of mandible remains contentious. Various grafts have been used with less than satisfactory and unpredictable results. Bone has been brought in, borrowed, reshaped, and implanted into the area of mandibular deficit; mandibular osteotomy has been attempted with primary closure as well. A review of 78 composite resections at Upstate Medical Center reveals that of this number, 61 have undergone primary lateral mandibulectomy without reconstruction while four others have undergone more extended resection without reconstruction at the time of initial surgery. In the others, mandibular reconstruction has been unsatisfactory; mandibular osteotomy in the presence of irradiated tissue has been unsuccessful in all cases. In our experience, satisfactory results, functionally and cosmetically, have been attained with partial mandibulectomy and primary closure of the wound obviating more involved reconstructive procedures. A review of therapy with attention to surgical detail, complications, and results is presented.

Bone Transplantation↗
PubMed1979

Parotid gland swelling.

The salivary glands are seldom noticed by the physician when they are functioning properly, but they cause vexing problems in diagnosis and management during times of their disordered function. One reason for this is that numerous salivary diseases have similar onsets and patterns of symptomatology. Another reason is that the clinical expression of these diseases is often similar, including pain, diffuse swelling, and altered salivary discharge. This paper enumerates useful points of differentiation which may be elicited from the history and physical examination to distinguish among parotid diseases. If management is to be successful, it must be based on (1) identification of the etiology of the pathologic process, and (2) the institution of therapeutic measures designed to eliminate the etiology of the disease, and restore, as closely as possible, the normal physiology of the gland.

Chronic Disease↗
PubMedDate not supplied

The current status of mandibular reconstruction using autogenous frozen mandibular grafts.

A review of recent developments in experimental canine surgery using autogenous frozen grafts for mandibular reconstruction has elicited enthusiasm for their human application in cancer surgery. They do reossify, even under adverse conditions of perioperative irradiation, to regenerate a mandibular graft in the dog. Our experience with six patients who underwent immediate autogenous mandibular graft reconstruction is dismal. All failed because of intraoral complications; none evidenced recurrence of tumor in bone. A delayed procedure, in which revascularization of the midportion of the bone graft may be improved, may prevent many of these problems.

Animals↗
PubMedDate not supplied

Congenital cerebrospinal otorrhea.

Four locations for congenital cerebrospinal fluid fistula in the region of a normal labyrinth are reviewed. A congenital leak may occur through the petromastoid canal, a wide cochlear aqueduct, Hyrtl's fissure, or the facial canal. A fistula through the initial segment of the fallopian canal was successfully repaired in a two-year-old boy who had three episodes of meningitis following otitis media. Knowledge of these four sites of congenital defects provides a guideline for the surgeon in the identification and repair of cerebrospinal fluid leaks in the region of the labyrinth.

Cerebrospinal Fluid Otorrhea↗
PubMedDate not supplied

Interruption of combined therapy: a factor in decreased survival.

Occasionally, during the course of combined (radiation plus surgery) treatment of head and neck malignancies, the patient experiences a profound response to radiotherapy alone and elects to decline the second phase of treatment, namely, surgery. After a variable interval, radiotherapy is reinstituted to a "curative" level. A series of 14 laryngeal and oropharyngeal carcinomas, treated in this disjointed fashion, has been examined with respect to long-term survival. The prognosis is extremely unfavorable, thus supporting a basic philosophy of continuing with the prescribed surgical treatment despite a dramatic response to noncancericidal doses of radiotherapy. The site and stage of tumor, radiation dosage, interval to completion of therapy, and incidence of local and distant metastases are examined. It appears that every effort should be made to provide continuity in the combined therapeutic protocol if the advantages of this mode of therapy are to be effective.

Carcinoma, Squamous Cell↗