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Biomedical subjects

C W Vaughan

Publications and source records attributed to C W Vaughan.

At least 109 records · Page 6Linked to original sources
PubMed1976

Laser surgery in otolaryngology: interaction of CO2 laser and soft tissue.

The sequence of histological change induced by CO2 laser irradiation was discussed in terms of two factors: the physiomechanical factor and the physiochemical factor. At sufficiently high heat energy levels, the immediate findings are characterized by crater formation resulting from rapid vaporization of the water and ejection of the solid component. In the immediate vicinity of the crater edge, the maximum tissue temperature rise is 65 degrees C above the 32 degrees C ambient tissue temperature and it decreases to the primary tissue temperature within a distance of 2 mm. The healing process of CO2 laser induced lesions proceeds with minimal delay. The lymphatic and vascular channels are occluded in the marginal area of coagulation resulting in a marked hemostatic effect. This sealing effect increases the margin of safety in preventing possible dissemination of tumor cells. By selecting the appropriate power, time, and focus cone angle, precise destruction of preselected areas of tissue can be achieved with an extraordinary hemostatic effect without damaging the underlying tissue. These advantages are especially helpful in function-preserving surgery.

Animals↗
PubMed1976

Carcinoma of the palatine arch.

1. Carcinoma of the palatine arch is part of a regional diathesis of carcinoma of the mucosa of the upper aerodigestive tract and this concept has a definite influence on the choice of treatment. 2. Surgery has an important role in the management of both the primary tumors and the regional metastatic nodes. 3. Radiation therapy is indispensible in the management of carcinoma of the tonsillar crypts, stage IV tumors of the palatine arch, and primary tumors of the palatine arch with certain specific extensions. 4. Comprehensive management of carcinoma of the palatine arch requires careful evaluation of each patient and his disease, vigorous application of the chosen method of treatment by either the surgeon or the radiotherapist, and continuous follow-up study and supportive treatment for the rest of the patient's life.

Carcinoma, Squamous Cell↗
PubMed1975

Role of surgery in head and neck cancer with fixed nodes.

In a series of 51 cases of Stage IV head and neck carcinomas, 12 selected patients were studied retrospectively, in order to determine the role of surgery in their management. Two patients who received a tumoricidal dose of radiation prior to radical neck dissection survived over five years, but no viable tumor was found in either specimen, suggesting a radiation cure. Nine patients died within three years, with either local recurrence or distant metastases; one patient died of asphyxiation, without disease, within five months. It appeared that surgery played no substantial role in improving the survival of the patients with head and neck cancer with fixed nodes.

Adult↗
PubMedDate not supplied

Diagnosis of infratemporal fossa tumors using percutaneous core needle biopsy.

Three patients with infratemporal fossa carcinomas presented with severe, unrelenting facial pain, weight loss, and 5th cranial nerve deficit. Erosion of the base of the skull at the foramen ovale was present in two of these patients. Histologic diagnosis of infratemporal fossa malignancy was obtained by needle biopsy of the foramen ovale region; the technique is described. This approach to the infratemporal fossa is preferred to the more complicated external surgical approach with its greater risk of morbidity. Surgical approaches to the infratemporal fossa are also reviewed. Two of the patients were treated with radiotherapy; the third refused further therapy. Supravoltage radiotherapy with curative intent is the recommended treatment because of the difficulty of an en bloc tumor resection in the infratemporal fossa. Radioactive gold seeds may be implanted through an external surgical approach to boost the local dose.

Adult↗
PubMedDate not supplied

Tongue-base-cancer resection with partial supraglottic laryngectomy.

INTRODUCTION: Cancer in the tongue base, which is adjacent to or invading the lingual epiglottis, requires resection of part or all of the larynx to assure adequate surgical margin. Based on whole mount laryngeal sections, a tongue base-partial supraglottic laryngectomy procedure was designed for tumors adjacent to or minimally invading the lingual epiglottis. METHODS: A group of five patients with carcinoma of the tongue base adjacent to or minimally invading the lingual epiglottis was identified. This technique requires excision of the epiglottis, hyoepiglottic ligament, and pre-epiglottic space with the lesion. The structural physiological integrity of the false vocal cords with or without the hyoid bone is preserved. RESULTS: Clear tumor margins were obtained in all five patients. In three patients who required up to 50% resection of the tongue base, decannulation and resumption of a full oral diet was achieved. Two patients with more extensive lesions required 70% resection of the tongue base. Both patients underwent completion laryngectomy months later because of persistent aspiration. CONCLUSION: This preliminary report suggests that partial supraglottic laryngectomy may be used with acceptable functional results in patients with limited tongue base lesions.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Recurrent respiratory papillomatosis: management with the CO2 laser.

Recurrent respiratory papillomatosis is most common in childhood but it affects all age groups; it represents a diathesis of the aerodigestive tract so that lesions amy develop at various sites - the nares, lips, pharynx, nasopharynx, larynx, tracheobronchial tree, approximately one-third of patients for one year or more; since relapses amy occasionally occur 2 to 20 years later, cure can never be assumed. At the present time, management is directed towards total ablation of all visble papilloma consistent with preservation of the airway and voice; reduction of the tumor burden to minimal proportions is thought to allow the maximum opportunity for remission. As the host-papilloma relationship is unraveled, it may be possible in the future to provoke an immune response so that remissions can be predicted and produced consistently.

Adolescent↗
PubMedDate not supplied

Endotracheal intubation and Venturi (jet) ventilation for laser microsurgery of the larynx.

Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish, the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator, neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves the further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.

Adolescent↗
PubMedDate not supplied

Management of choanal atresia with the carbon dioxide laser.

Congenital choanal atresia frequently demands immediate recognition in the newborn, and provision of a nasal airway as soon as possible. A variety of techniques are available to correct this problem, but none is entirely satisfactory. Transpalatal procedures are associated with significant morbidity in the newborn, and transnasal microsurgical procedures are less predictable when a thick bony plate is present in the choanal obstruction. Transnasal resection with the CO2 laser has been carried out in seven patients (ten sides), whose ages ranged from 16 hours to 14 years. From this early experience, it appears that the procedure is entirely feasible and convenient. It seems to have significant advantages over conventional microsurgical techniques. Eight out of ten choanae have remained patent for four months or more. A lumen keeper is needed during the immediate postoperative period for at least two to three weeks. The procedure is associated with minimal morbidity.

Adolescent↗
PubMedDate not supplied

Topical chemotherapy of recurrent respiratory papillomatosis. A preliminary report.

Topical chemotherapy with the antimetabolite 5-fluorouracil (5-FU) has been used as an adjunct to surgical laser excision of squamous papillomas arising in the larynx and in the tracheobronchial tree. The drug has been administered intensively to eight patients with tracheotomies and disease in both anatomic regions. These patients received repeated instillations of 5-FU at concentrations from 0.5 to 5% into the larynx and tracheobronchial tree while in the hospital and at home. More than 4,500 doses of the drug have been administered during our phase 1 study. There has been no significant toxicity associated with repeated 5-FU instillation into the airway. Several patients developed blood-tinged tracheal secretions after the repeated use of high concentrations of the agent. Other complications included coughing, bronchospasm, and peristomal irritation. These symptoms all disappeared after temporary discontinuation of the drug. No patient has developed a systemic hypersensitivity response to the drug either detectable clinically or by repeated skin testing. There were no adverse effects on the hematologic or hepatic systems. Use of 5-FU was associated with inhibition of papilloma regrowth in six of eight patients. The major limitation to drug effectiveness is the requirement for its frequent administration.

Administration, Topical↗