Biomedical subjects

C W Cummings

Publications and source records attributed to C W Cummings.

At least 91 records · Page 5Linked to original sources

PubMedDate not supplied

Pregnant woman with a neck mass.

None of the consultants was comfortable with the idea of proceeding with the biopsy of a neck mass in an outpatient clinic setting. All warned about the possible relationship of the mass with important anatomic structures. With regard to needing further information, physicians requested an imaging study of the neck, thoracic cavity, and mediastinum (Dr. Cummings); pelvic examination, breast examination with mammography, chest x-ray, and CBC (Dr. Weymuller); flexible endoscopy, chest x-ray, CBC, and MRI (Dr. Woodson). All three experts advised her to put IVF on hold. After the work-up, they would proceed with a biopsy of the mass and send the tissue to the pathologist in saline. In addition, tissue should be examined for fungus and AFB (Drs. Weymuller and Woodson). Because the patient proceeded with IVF and became pregnant, two experts advised her to abort and proceed with treatment for her Hodgkin's disease (Drs. Cummings and Woodson). The other option was for her to continue her pregnancy and proceed with radiotherapy to her neck, with shielding of the abdomen (Dr. Weymuller).

Adult↗

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

A model for staged compression of the vascular pedicle in a porcine myocutaneous flap.

There is a need for a laboratory model that would allow assessment of the effects of vascular pedicle compression in the myocutaneous flap. We describe a technique as used in the pig that responds to the needs of technical reproducibility and sequential compromise of vascular flow as measured by laser velocimetry and dermofluorometry.

Animals↗

PubMedDate not supplied

Follicular carcinoma of Hürthle cell type as cause of hemoptysis.

Summary--A patient with follicular carcinoma, Hürthle cell type, who developed subglottic extension and uncontrollable hemoptysis is presented . In consideration of the patient's age a conservative therapeutic program was instituted with a definite response to I-131 therapy despite poor radioactive iodine (RAI) uptake by the tumor. Laryngectomy and thyroidectomy were eventually required to control hemoptysis; the patient remains socially functional and asymptomatic after a 30-month period. The two-year period of weekly office visits and temporizing treatment as occurred in this patient cannot be recommended. It seems appropriate to advocate surgical treatment including laryngectomy for follicular carcinoma, Hürthle cell type, localized to the laryngotracheal area without regard for the age of the patient.

Adenocarcinoma↗

PubMedDate not supplied

Adenoidcystic carcinoma (cylindroma) of the parotid gland.

Adenoidcystic carcinoma or cylindroma of the parotid gland is a slow-growing, relentless, and often lethal disease which kills usually by local occurrence and direct extension of the disease. The reported incidence of adenoidcystic carcinoma with reference to other parotid malignancies varies from 5% to 37%. The incidence in this series is 36%. The presence of facial nerve involvement adversely affects the long-term survival. Some authors regard facial nerve involvement as an indication of noncurability. The incidence of local pain is reported to be as high as 50% and is thought to be caused by perineural invasion by the tumor. This is well-documented histopathologically. There is no uniform or standard treatment for this disorder. Extensive resection of the parotid gland (including the facial nerve if there is any indication of involvement), followed by external irradiation to the parotid area and upper neck is the most rational approach to the problem. This is supported both in the review of the literature and from the present series. A radical neck dissection is not included as part of initial therapy unless there are clinically suspicious cervical nodes. Postoperative radiotherapy appears indicated in all cases of adenoidcystic carcinoma of the parotid gland. Four case histories are presented which demonstrate the hallmark characteristics of the disease, i.e. multiple cranial nerve deficits, facial pain and subsequent death by direct intracranial extension of disease. The protracted, relentless course of the disease is well-documented in one case in which 25 local recurrences developed over an 18-year period.

Adult↗

PubMedDate not supplied

Complications of laryngectomy and neck dissection following planned preoperative radiotherapy.

One hundred sixty-nine patients with carcinoma involving the larynx treated with surgery, combined preoperative radiotherapy plus surgery, or failed curative radiotherapy with surgical salvage have been evaluated with respect to complications. Major complications occurred at approximately the same rate with all three modes of therapy. Major complications had generally a later onset and healed less rapidly in the preoperative radiotherapy group. Minor complications occurred more frequently in irradiated patients than in nonirradiated patients. When evaluating postoperative complications in irradiated patients the time interval must be extended beyond the immediate span because of delayed onset.

Fistula↗

PubMedDate not supplied

High dose preoperative irradiation for advanced laryngeal-hypopharyngeal cancer.

Combined therapy, consisting of 5000 rads delivered in five weeks by total laryngectomy +/- radical neck dissection, was compared with treatment by irradiation (6000-7000 rads) with surgical salvage when clinically possible for radiation failure. Patients were categorized according to site of primary cancer (glottic, supraglottic and pyriform sinus) and staged (T, N, M). Survival was equally good in the two programs for glottic and supraglottic lesions, N0 or N1. The combined treatment program was judged superior for supraglottic and pyriform sinus lesions, N2 or N3.

Adult↗

PubMedDate not supplied

Horseradish peroxidase studies in animals with neuromuscular transpositions.

Horseradish peroxidase (HRP) is used to trace axonal connections from the motor end-plate to the driving neuron. This technique has confirmed that the neurons activating the sternothyroid muscle are located in the cervical spinal cord, while those controlling the posterior cricoarytenoid (PCA) are found in the nucleus ambiguus ipsilaterally. Eight rabbits underwent a sternothyroid ansa pedicle implantation to the PCA at the time of sectioning the recurrent laryngeal nerve ipsilaterally. After two months, four of these animals received HRP injections into the previously implanted PCA. Brainstem staining HRP did not reveal any retrograde transport to the motor neurons that were known to control the sternothyroid. Possible for the failure of retrograde transport are discussed.

Animals↗

PubMedDate not supplied

Carcinoma of the anterior tongue.

We have reviewed 126 patients with squamous cell carcinoma of the anterior tongue. Our experience suggests that carcinoma of the anterior tongue is a highly aggressive disease. It is no less aggressive and dangerous than carcinoma of the posterior tongue. The clinically negative neck is a problem. Many clinical stage I and II cancers are, in fact, stage III when analyzed by the pathologist. This difficulty in clinical staging results in a significant management problem when stage III carcinomas are treated as stage I and stage II disease. Management, if it is to cure, must be aggressive. An adequate, wide surgical resection will control early carcinoma of the anterior tongue. Advanced cancers of the anterior tongue, clinical stages III and IV, should be widely excised; the cervical lymph nodes on the side of the primary lesion must be treated by surgery and radiation therapy. Treatment of the opposite side of the neck is indicated based on a high rate of metastases to contralateral lymph nodes in this series. Those patients treated with irradiation who had recurrence did so predominantly at the primary site of disease. Patients treated surgically tended to have recurrence in the regional cervical lymphatics.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Age-related changes in the epithelium of the monkey larynx.

An experiment was designed to measure the area of subglottic squamous epithelium in a group of 14 adult monkeys. The animals were much older than any so far available for medical research. The larynges were strained using pyronin Y, which stains respiratory epithelium magenta and squamous epithelium pale pink. The areas of squamous epithelium inferior to the free margin of the vocal cord were measured. The results showed that the subglottic epithelium increased with age (r = +0.61, p = less than 0.05). This finding may have importance in the staging of laryngeal carcinoma.

Aging↗

PubMedDate not supplied

Cricothyroidotomy: the impact of antecedent endotracheal intubation.

In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. The report reviews 15 consecutive cricothyroidotomies. Five (33%) developed significant complications requiring surgical intervention. Of the five, two had life-threatening airway obstruction. The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.

Airway Obstruction↗

PubMedDate not supplied

Muscle transposition in the rehabilitation of the paralyzed larynx.

Muscle transposition of the innervated omohyoid muscle into the tendon of the paralyzed posterior cricoarytenoid muscle was studied in a small series of subhuman primates. A similar procedure was described previously by King for treatment of bilateral recurrent nerve injuries. Our studies confirm that this procedure adequately enlarges the airway to allow normal activity without a tracheostomy. Histologic studies appear to show nerve ingrowth occurring at 6 months as in other neuromuscular pedicle procedures. The procedure is easily performed and causes no other muscle denervation.

Animals↗

PubMedDate not supplied

Management of difficult airway problems with percutaneous transtracheal ventilation.

Percutaneous transtracheal jet ventilation was used in the management of 13 cases of upper airway obstruction. Cases are subdivided according to the nature of the presenting airway problem. The first group had stable upper airway abnormalities; the second group presented as emergencies with rapidly evolving upper airway obstruction. This technique has two major advantages: 1) it provides rapid access to the airway during acute emergencies; and 2) it provides control of the airway where tissue distortion from head and neck trauma or tumor surgery makes standard anesthetic techniques difficult. Complications including catheter displacement, total expiratory obstruction, pneumothorax, and subcutaneous emphysema have been encountered. The authors conclude that percutaneous transtracheal jet ventilation is effective. However, potential problems exist and an in-depth understanding of the technique is necessary for its appropriate application and successful use.

Adult↗

PubMedDate not supplied

Reinnervation of skeletal muscle: a comparison of nerve implantation with neuromuscular pedicle transfer in an animal model.

In recent years there has been increased interest in the possibility of reinnervating paralyzed muscles, particularly the muscles of the face and of the larynx. There has been dispute over the relative effectiveness of different approaches. This study was undertaken to compare direct nerve implantation with the transfer of a neuromuscular pedicle using denervated strap muscles in a rabbit model. Reinnervation was carried out both immediately after denervation and after a delay period. Evidence of return of function was obtained by a method of long-term electromyographic monitoring and was confirmed electrically by evoked electromyography and muscle tension measurement and histologically by brain stem uptake of horseradish peroxidase. Both methods of nerve transfer produced consistently functional neuromuscular units, with physiological activity and muscle strength comparable with those in normally innervated controls. Return of function was apparent within 6 weeks of both nerve implantation and neuromuscular transfer; with this model, neither method showed a clear advantage over the other.

Animals↗

PubMedDate not supplied

Facial muscle reinnervation: a comparison of neuromuscular pedicle with direct nerve implant.

Two methods of reinnervation, the neuromuscular pedicle (NMP) and the nerve implant (NI), were compared in a model using the rabbit's denervated mentalis muscle. Results from evoked electromyographic (EMG) and muscle tension studies (twitch and tetanic contraction) provided the basis of comparison. In addition, the timing of denervation was studied (ie, at the time of implantation of the NMP or NI, or 2 weeks following implantation). The NMP achieved more rapid reinnervation and produced stronger contractions than the NI. Demonstrable reinnervation with an NMP was accelerated when the implantation occurred prior to the denervation. This was not the case with the NI. There was poor correlation between the evoked EMG potential and the strength of both twitch and tetanic contraction. It was concluded on the basis of this study that muscle tension provided a more accurate means of assessing reinnervated muscle function. Of the two methods, the NMP would seem, therefore, to be the technique of choice when it is available. The NI is certainly effective and should be used when a satisfactory NMP is not available.

Animals↗

PubMedDate not supplied

Hematoma after head and neck surgery--a major complication?

The role of hematoma formation in the development of complications after major head and neck surgery is surveyed retrospectively. An incidence of 4.2% was encountered. In all cases, the hematoma was identified within 12 hours postoperatively. Prompt surgical clot evacuation and reinstitution of drainage did not adversely effect the patient's subsequent course. Failure to adequately drain the hematoma resulted in increased wound dehiscence, major infection, and fistula. When properly treated, postoperative hematoma formation offers only the risks attendant with a second anesthesia; no subsequent related morbidity need be anticipated.

Head and Neck Neoplasms↗

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↗

PubMedDate not supplied

Delayed reinnervation of unilateral vocal cord paralysis in dogs.

The neuromuscular implantation technique for rehabilitation of unilateral vocal cord paralysis was performed in four dogs at the time of denervation and in six dogs after varying intervals of chronic denervation. As would be expected, the chronically denervated animals did not achieve the vocal cord excursion of the acute denervations, but some return of motion was noted even after six months. Histologic examination of the posterior cricoarytenoid muscle was correlated with the return of movement.

Animals↗