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Biomedical subjects

C W Vaughan

Publications and source records attributed to C W Vaughan.

At least 73 records · Page 4Linked to original sources
PubMed1985

Plasma exchange in six patients with advanced cancers of the head and neck.

Six patients with advanced squamous cell cancers of the head and neck, with serum IgA greater than or equal to 400 mg/dl and IgE less than or equal to 1000 IU/ml, underwent a trial of six 2-liter plasma exchanges over a 2-3-week period. Disease progressed in patients 1, 2, and 4, who died on days 44, 72, and 159. The tumor in patients 3 and 6 regressed significantly, repeatedly in patient 3 over each of four courses of apheresis. Tumor recurred in both patients after cessation of treatment, and they died at days 420 and 79. Patient 5, with inoperable disease, received full-dose radiotherapy immediately following the course of apheresis, and showed complete response in the primary lesion and a major response in the extensive lymph node metastases, dying on day 421 of apparently unrelated causes. Serum IgE in the three patients experiencing tumor regression rose paradoxically during plasmapheresis. Only patient 3 had an elevated level of soluble E-receptor suppressor factor prepheresis; the serum of patient 6 was lymphocytotoxic prepheresis but this activity decreased or disappeared during each of the exchanges studied. Controlled trials are now indicated.

Aged↗
PubMed1984

The incidence of hypercalcemia in squamous cell carcinoma of the head and neck.

Hypercalcemia is a well-recognized phenomenon in squamous cell carcinoma of the head and neck, but the incidence of hypercalcemia in this group of patients is not clear. We have reviewed the records of 166 patients with squamous cell carcinoma of the head and neck presented at the Boston VA Medical Center over a 2-year period (October 1981 to September 1983). Hypercalcemia (greater than 11 mg/dl), for which a benign etiology could not be identified, occurred in the clinical course of seven patients (4.2%). Of the hypercalcemic patients, 5/7 (71.4%) had advanced stage IV disease and serum calcium levels ranging from 11.2 to 15 mg/dl at presentation. The incidence of hypercalcemia in this stage IV group was 5/78 (6.4%). On the basis of concomitant serum alkaline phosphatase, x-ray films, and radionuclide bone scans in these patients, bone metastases or a humoral factor were felt to be the etiologic agent. Six of the seven patients died within 77 days of the onset of the hypercalcemia despite vigorous antihypercalcemic and chemotherapeutic measures, and the remaining patient is under chemotherapy at present. We conclude that hypercalcemia is a late manifestation of advanced squamous cell carcinoma of the head and neck and is an ominous prognostic sign. Hypercalcemia without bone metastases is presumably due to the production of ectopic parathormone (PTH)-like substances from the tumor. To control this hypercalcemia, the underlying tumor must be treated vigorously in conjunction with symptomatic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Induction bleomycin infusion in head and neck cancer.

Twenty-one male patients with previously untreated advanced squamous cell carcinoma of the head and neck were treated with an induction regimen of bleomycin 15 mg/m2 I.V. bolus followed by a continuous 24-hour I.V. infusion at a dose of 15 mg/m2/day for 7 days. One week following induction therapy, patients were reevaluated for response and then received definitive therapy with surgery and/or radiation therapy. The chemotherapy yielded a major response rate of 33% (one CR, six PR). Toxic manifestations of this regimen were mild, consisting of fever, alopecia, rash, and mucositis. There was no pulmonary toxicity detected. The response rate obtained with bleomycin infusion is inferior to the combination of cis-platinum with a bleomycin infusion as induction therapy in previously untreated patients with squamous cell carcinoma of the head and neck.

Adult↗
PubMed1984

Excisional biopsy in the selective management of T1 glottic cancer: a three-year follow-up study.

Transoral excisional biopsy has been used in the evaluation and management of 103 T1 glottic cancers. A 3-year follow-up on these patients indicates that excisional biopsy unequivocally established the diagnosis and stage of the disease and that it is adequate treatment for micro and mini squamous cell cancers of the glottis in which the margins of excision are clear. Excisional biopsy with positive margins and larger T1 tumors establishes the absolute need for radiotherapy. Excisional biopsy is ideal for the diagnosis and management of verrucous carcinoma and spindle cell carcinoma. Recurrent/residual squamous cell carcinoma after radiotherapy should be explored by excisional biopsy which may be curative or will establish the need for partial or total laryngectomy. The appropriate use of excisional biopsy in the selective management of early T1 glottic cancers requires attention to detail by the surgeon and the pathologist and sound clinical judgment.

Biopsy↗
PubMed1984

Medical management of organic laryngeal disorders.

Medical management of organic laryngeal disorders always involves evaluation and advice; it frequently includes reassurance and sometimes voice therapy. Occasionally medication is also necessary.

Combined Modality Therapy↗
PubMed1984

Field cancerization in the aerodigestive tract--its etiology, manifestation, and significance.

Field cancerization of the mucous membranes of the aerodigestive tract frequently develops in response to tobacco and alcohol usage; it is characterized by a variety of premalignant and frankly malignant epithelial changes that may lead to the development of multiple primary cancers of the aerodigestive tract. Field cancerization can be demonstrated by supravital staining with toluidine blue or by electron microscopic study of random biopsies taken from apparently normal mucosa. Field cancerization should be taken into account in treatment planning of a patient with cancer so that all treatment options, including the use of radiation therapy, be kept open for as long as possible in the event that the patient may develop multiple primary tumors.

Alcoholism↗
PubMed1983

Natural history and management of keratosis, atypia, carcinoma-in situ, and microinvasive cancer of the larynx.

Keratosis, atypia, carcinoma in situ, and microinvasive cancer occurring as white or red patches on the vocal cords are part of the diathesis of cancer of the aerodigestive tract and represented a sequential continuum. Excisional biopsy is the preferred treatment for identification and potential cure of the lesion. If the margins of excision are inadequate, further treatment options are either reexcision or radiotherapy. Radiotherapy should be used only when the need for voice conservation prevails. Cessation of smoking does not remove the potential for progression of the disease, therefore, all patients must be followed indefinitely. Excisional biopsy of keratosis, carcinoma in situ, and microinvasive cancer of the larynx offers an excellent prognosis for voice preservation and survival.

Adult↗
PubMed1983

Continuous vindesine infusion in advanced head and neck cancer.

Sixteen patients with advanced squamous cell carcinoma of the head and neck were treated with a 48-hour I.V. vindesine infusion. The dosage was 3 mg/m2/48 hours every 2 weeks. Toxicity consisted of leukopenia, paresthesias, and phlebitis. Major objective responses were seen in four patients (one CR, three PR), with a median duration of 4 months.

Aged↗
PubMed1983

A safe, nonflammable, all-metal, cuffless endotracheal Venturi ventilation system for use in laser surgery.

In this preliminary study with seven dogs, ventilation with a Sanders bronchoscope attachment coupled to the Norton metal endotracheal tube and use of a jet O2 injector system proved adequate for sustained oxygenation and acid-base balance. This system is shown to be superior to the conventional anesthesia volume ventilator when used with the cuffless metal endotracheal tube. The ventilatory capability can be easily adjusted upward and downward by changing the driving pressures of the reducing valve. Peak intratracheal and transtracheal pressure measurements show the pressures encountered to be similar to those of conventional volume ventilation techniques. The use of the all-metal endotracheal tube in endolaryngeal laser surgery is discussed. The advantages of such a system lie in the elimination of a flammable endotracheal tube during laser endolaryngeal surgery while preserving adequate and stable ventilation.

Animals↗
PubMed1983

Palliation of airway obstruction from tracheobronchial malignancy: use of the CO2 laser bronchoscope.

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty-nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.

Aged↗
PubMed1983

Laser bronchoscopic surgery.

Endoscopic laser bronchoscopy can be used to effectively palliate patients with compromised airways. The CO2 laser was utilized with a ventilating bronchoscope. This form of endoscopic surgery has the advantage of less postoperative edema, better hemostasis, more accurate tumor vaporization, and shortened operating time. Between 1975-79 33 laser bronchoscopies were carried out for airway obstruction. Palliation was achieved in most cases. Complications included intra-operative bleeding, tissue fragment occlusion of the airway, and an endotracheal fire. Laser bronchoscopy should be avoided in the presence of widespread metastatic disease, poorly differentiated or rapidly growing tumors, extrinsic tumor compression, or highly vascular tumors. A preliminary report is presented on the soft tissue effects of the argon laser, passed through a flexible coaxial cable in the canine trachea. Multiple transmural lesions were created. The use of the argon laser in the field of bronchoscopy remains controversial.

Adult↗
PubMed1982

Premalignant changes in normal appearing epithelium in patients with squamous cell carcinoma of the upper aerodigestive tract.

Biopsy specimens of "normal" mucous membrane of patients susceptible to the effects of the carcinogens of tobacco revealed morphologic abnormalities on electron microscopic examination that were consistent with the concept that carcinogenesis is a multistep process of sequential neoplastic development extending over a long period of time. Such changes in the upper aerodigestive tract are probably tobacco induced and may be reversible if tobacco exposure is eliminated. Use of the electron microscope can provide the clinician with an accurate assay of the severity of mucosal alterations induced by tobacco. The ability to detect such morphologic abnormalities should provide another deterrant to smoking and a useful tool in the further study of these phenomena.

Adult↗