Head and neck cancer. An overview for the perioperative nurse.
Explore the source record for details and available documents.
Combined Modality Therapy↗
Biomedical subjects
D G McQuarrie
Publications and source records attributed to D G McQuarrie.
Laminar airflow systems. Issues surrounding their effectiveness.
Explore the source record for details and available documents.
Air Microbiology↗
Cancer of the tongue: selecting appropriate therapy.
Explore the source record for details and available documents.
Antineoplastic Combined Chemotherapy Protocols↗
Preoperative hair removal with clippers does not increase infection rate in clean surgical wounds.
For a one year period, hair was removed from the operative site with clippers rather than by shaving with a razor or by application of depilatories. The study involved comparison of clean (Class I) wound infection rates in 2,580 patients after clipping was instituted compared with 17,424 patients studied in seven preceding years. There was no significant change in the wound infection rate (1 per cent) when compared with the three years immediately preceding. There was no change in the identified distribution of the infecting organism. Failure to show a clear reduction in wound infection rate was probably related to the low historic base line rate. There were definite benefits achieved by avoiding cancellation of elective operations, by using operating room personnel more efficiently and by expediating the surgical schedule.
Hair Removal↗
Multiple primary epidermoid carcinomas of the upper aerodigestive tract.
In a series of 405 patients with epidermoid carcinoma of the head and neck, 52 patients (13%) developed multiple epidermoid carcinomas of the upper aerodigestive tract. Subsequent primary tumors developed with nearly equal frequency in the head and neck, lung, and esophagus. Forty of the patients developed a subsequent primary carcinoma within five years of the first. Thirty-eight (73%) of the patients who developed a subsequent primary carcinoma survived less than two years from its diagnosis. The majority (34/50) of the patients died from the subsequent primary carcinoma. We recommend that panendoscopy and an esophagogram be performed on initial evaluation of patients with head and neck cancer. A thorough reexamination is warranted if new symptoms or signs develop.
Adult↗
The intramandibular sliding myoosseous graft. A simple technique for immediate reconstruction of selected anterior mandibular defects.
The intramandibular sliding myoosseous graft provides a new technique for reestablishment of mandibular continuity. It is well suited for immediate or remote reconstruction of midline or unilateral defects. Close attention to constructing smooth, confluent bone margins reduces the probability of mucosal fenestration. We have found that rigid direct osseous fixation improves the rate and quality of osteosynthesis. The technique is a useful and simple addition to the reconstructive armamentarium.
Humans↗
Aggressive surgical therapy after irradiation failure in treatment of cancer of the oral tongue.
Fifty-three consecutive unrandomized patients with squamous cell cancer of the oral tongue were retrospectively studied to compare the results of an aggressive surgical approach performed as primary therapy or as salvage after irradiation failure. Twenty-five patients underwent surgery primarily, while 23 of 28 patients treated with curative irradiation required surgical salvage. Tumor staging was equivalent between the two groups. Local recurrences at the site of origin of the tumor within two years postoperatively were significantly more frequent in salvage patients (10.0%) than in primary surgical patients (5.5%). Cervical lymph node recurrences within five years were more frequent in the salvage surgery group (74.8% v 36.7%). Systemic metastases developed in a similar proportion in both groups. Determinate five-year survivals were nearly identical (55.2% v 55.5%). Although recurrence rates were significantly higher after irradiation and salvage surgery, an aggressive surgical effort in patients who are irradiation failures can result in five-year survival rates matching those of surgical patients.
Adult↗
Hospitalization utilization levels. The application of queuing. Theory to a controversial medical economic problem.
Explore the source record for details and available documents.
Appointments and Schedules↗
Acute bacterial cholangitis: an analysis of clinical manifestation.
A retrospective study of 65 patients with biliary sepsis and mechanical biliary obstruction, 19 of them with suppurative cholangitis (SC) and 46 with nonsuppurative cholangitis (NSC), was undertaken to identify distinguishing characteristics of the two forms of the disease. There were no statistically significant differences between SC and NSC based on histologic data, physical findings, or preoperative laboratory values. Mortality was significantly increased in patients with SC and in those with both forms of the disease who were given medical therapy alone. The treatment of choice for cholangitis with mechanical biliary obstruction is early operative drainage of the biliary tree, regardless of the presence or absence of suppuration in the common bile duct.
Adult↗
Limits to efficient operating room scheduling. Lessons from computer-use models.
It is not a trivial matter to achieve a high level of utilization in the operation room (OR). The surgeon must give attention to schedule efficiency to contain medical costs. Surgeons should also be aware that 100% utilization of OR time is unrealistic except when there are repetitive, uniform-length procedures. A regular utilization rate below 50% should suggest overstaffing, overbuilding, or poor schedule management. Lessons from scheduling computer use can help make OR utilization more efficient. If a selective, effective algorithm is used in scheduling, norms of utilization should be above 60% and peaks should exceed 75%. For efficiency of scheduling, all ORs should be completely modular and should be large enough to accommodate any type of surgery.
Computers↗
Cholangitis due to malignant obstruction of biliary outflow.
This study reports the clinical presentation and hospital course of 21 patients with cholangitis and malignant diseases, obstructing the biliary tree. Eleven of 21 patients had cholangitis as the initial presentation of biliary disease, and the diagnosis of carcinoma was made at operation or autopsy examination. A total of 14 patients with cholangitis had no prior biliary surgery. Patients who underwent operations to relieve biliary obstructions during episodes of cholangitis had greater incidences of resolution of cholangitis (eight of 14 patients) than those patients treated non-operatively (none of eight patients). Only five patients survived long enough to leave the hospital, but each of these patients were palliated by some sort of drainage procedure. These data suggest that a small portion of this high risk group of patients may benefit significantly from early operative therapy of their cholangitis.
Biliary Tract Neoplasms↗
Surgical management of esophageal perforation.
When there is a delay in recognition of esophageal perforation, defunctionalization of the esophagus may promote healing. Defunctionalization is accomplished by loop cervical esophagostomy and banding of the lower esophagus at the gastroesophageal junction.
Esophageal Perforation↗
Reduction of free water clearance with cephalic venous hypertension.
A laboratory model was developed in the dog to quantitate the effects of cerebral venous hypertension on inappropriate antidiuretic hormone (ADH) secretion. When cerebral venous pressure was abruptly increased during continuous water loading, there was a sharp rise in urine osmolality within 30 minutes. Urine osmolality continued to increase during, and ten minutes after, the period of hypertension. On lowering cerebral venous pressure, the osmolality returned to baseline within 60 minutes. The effects could be extended for at least three hours and presumably longer. A 50% response threshold for this ADH effect occurred at a cerebral venous pressure between 18 and 19 cm of water. The effect correlated with plasma ADH levels. The study paralled documented clinical observations. The results are discussed in light of the recognition and management of surgical states where increased cerebral venous pressure might produce a severe antidiuretic effect.
Animals↗
A physiologic approach to the problems of simutaneous bilateral neck dissection.
A number of physiologic derangements have been observed resulting from the management of head and neck cancer with resection and simultaneous bilateral neck dissection. A protocol evolved to minimize morbidity from these complications was used on seventeen patients. Eleven are alive and free of disease and there was no mortality.
Animals↗
Application of contemporary reconstructive techniques in head and neck surgery for anterior oral-facial cancers.
One hundred and seventy-eight patients underwent surgical therapy for oral and cervical cancers from 1964 to 1975. About 25 percent of the patients underwent neck dissection and/or "pull-through" procedures. However, majority of patients required a spectrum of reconstructive techniques extending from marginal mandibulectomy with or without skin flaps (39), partial mandibulectomy with immediate prosthetic mandible reconstruction (36), to extended resections with skin flaps or staged reconstructive procedures (48). The advantages and disadvantages of each reconstructive procedure have been observed and a scheme of graded management has been developed. The therapeutic goal is to maximize functional oral reconstruction without compromising tumor cure. There were two operative deaths--one from myocardial infarction after operation and one from halothane hepatitis. The tumors were grouped according to TNM classification. In the follow-up of the 178 patients, 47 per cent are known to be alive and free of tumor. The better results (greater than 70% free of tumor) are in the group with smaller tumors (less than 2 cm.) and no node involvement, and there are less favorable rates for those patients with larger tumors and nodal metastasis or invasion of adjacent structures. There was a 49 percent 2 year survival rate and 12 of the deaths were from nontumor causes. Ninety percent of these patients smoked more than one pack of cigarettes per day, accounting for the high rate of synchronous or subsequent oroairway cancers (7 percent). Seventy-five percent were considered to be "heavy alcoholics" with evidence of cirrhotic liver disease. These two factors significantly decreased the survival from rate 54 to 47 percent. The series shows that planned primary reconstructive surgery can be done at a low risk, that it can enhance resectability of head and neck cancers, and that it does improve oral function after operation.
Adenocarcinoma↗
Cervical-pectoral flaps in the treatment of advanced oral cancer.
Twenty-two of 90 patients with carcinoma of the anterior oral cavity treated at the Minneapolis Veterans Administration Hospital from 1965 through 1973 had advanced lesions - tumors attached to the mandible and/or more than 3 cm in size. These patients were treated by primary radical neck dissection, en bloc excision, and segmental mandibulectomy. A cervical-pectoral flap combination was used for reconstruction. The functional and cosmetic results were excellent. Patient survival and cure rate compare favorably with other series. We emphasize the need for wide initial resection with immediate reconstruction.
Adult↗
Surgical management of shotgun injuries of the face.
The surgical reconstruction of patients with self-inflicted gun blast injuries to the face requires the most efficient management. There was a uniform pattern of tissue loss in the patients studied. The repair sequence was subjected to a retrospective analysis to indicate the most efficient co-ordination and return to a functional state. Emphasis must be upon the principle of initial salvage of as much bony structure as possible. Primary flap transfer or early mobilization of flaps for soft tissue repair are desirable in speeding restoration.
Adult↗