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Biomedical subjects

D H Rice

Publications and source records attributed to D H Rice.

At least 19 recordsLinked to original sources
PubMed1992

Flutamide-induced regression of angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) appears to be an endocrine-responsive tumor. This concept was tested in five young men with JNA by treating them with a testosterone receptor blocker (flutamide) for 6 weeks preoperatively. Tumor size was evaluated by axial computed tomography both before and after flutamide therapy. Four of the five patients had an average tumor shrinkage of 44%. The patients tolerated the drug well, and the serum testosterone levels 2 or more years posttherapy were normal. This pilot study demonstrate that preoperative hormonal pharmacoreduction of JNA is a feasible adjunct to surgical therapy that offers the possibility of reduced blood loss. However, the authors believe that a formal clinical trial of this treatment approach is warranted and should be done before widespread adoption of this agent.

Adolescent↗
PubMed1991

Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception.

OBJECTIVE: --To analyze the working environment and work hours of a cohort of otolaryngology--head and neck surgery residents. DESIGN: --Environmental analysis questionnaire and a log of daily activities. SETTING: --Residents were on a clinical rotation system. PARTICIPANTS: --Fifty-nine residents from six programs, including three public and three private institutions, from geographically diverse regions of the country were involved in the study. Residents were equally distributed from their second year through their fifth year of postgraduate work. All eligible residents participated in and completed the study. INTERVENTION: --The environmental analysis survey was designed to elicit resident perception of different aspects of their working environment. The daily activity log required the resident to report on activities for each half-hour period for 7 consecutive days. RESULTS: --Residents were on call an average of 52.8 hours (2.2 days) and worked 79.4 hours per week. Seventy-five percent believed that the level of faculty supervision and the degree of resident responsibility was about right. Two major inefficiencies were the time involved in completion of paperwork and the lack of nonmedical support services. Thirty-one percent of the residents responded that fatigue resulted in substandard patient care 10% of the time. Forty-seven percent responded that their educational experience was substandard 25% of the time secondary to fatigue. Two thirds responded that the demands of residency training had a negative impact on their family and personal life. CONCLUSIONS: --Seventy percent of the otolaryngology--head and neck surgery residents surveyed at six institutions believe that an 80-hour workweek, including being on call every third night with no more than 24 hours of continuous work without sleep, approximates a reasonable, maximum work schedule. Residents working the longest hours expressed concern about rendering substandard care and developing negative attitudes toward patients. Noneducational inefficiencies were identified and solutions were proposed. Demands of residency training, even within guidelines established as reasonable, can have detrimental effects on residents' educational activities and personal life.

Attitude↗
PubMed1979

Neurogenic tumors of the head and neck in children.

A retrospective analysis of deep-seated neurogenic tumors of the head and neck in children seen at the University of Michigan Medical Center was done. There were 22 patients--10 with plexiform neurofibromas, 3 with neurofibromas, 2 with esthesioneuroblastomas, 2 with neurilemmomas, 1 with neurogenous sarcoma, and 4 with neuroblastomas who presented with a mass in the head and neck. Delay in diagnosis and treatment was common, and merely allowed the tumor to enlarge. We feel that surgical extirpation is the preferred treatment for benign or malignant neurogenous tumors, with adjuvant therapy in other forms for malignant tumors only.

Adolescent↗
PubMed1979

The effect of irradiation upon the bacterial flora in patients with head and neck cancer.

Twenty-two consecutive patients with cancer of the head and neck, who were to receive a full tumoricidal dose of irradiation to a field that included the oral cavity and pharynx, were studied to determine the effect of the irradiation on their local bacterial flora. Aerobic cultures were taken prior to, at the completion of, and one month after the completion of their irradiation. The percentage of patients with potentially pathogenic organisms increased dramatically as the effect of the irradiation increased. This change in the local flora has obvious implications concerning the increased incidence of postoperative wound infections in patients who have received prior irradiation.

Bacteria↗
PubMed1978

Unusual vascular lesions of the neck.

Vascular lesions of the neck may initially appear atypically, without the expected findings of a bluish discoloration, pulsations, or a bruit. The initial characteristics may mimic that of a metastatic carcinoma. The true nature of the lesion may remain obscure, despite a thorough preoperative evaluation, including angiography. The head and neck surgeon must be aware of the occasional unusual appearance and must be prepared to treat whatever vascular lesion he might encounter.

Adult↗
PubMed1978

Carcinomas of the nasal septum.

Fourteen new cases of primary squamous cell carcinoma of the nasal septum are presented. Their inclusion brings the total reported in the literature to 97. Early, confined neoplasms are amenable to cure by surgical excision, external irradiation or radium implants. Prognosis does not correlate with histological grade of the neoplasm but is inversely related to the size of the carcinoma at the time of diagnosis and the presence of metastases.

Adult↗
PubMed1978

The growth of cartilage from a free perichondrial graft in the larynx.

An attempt was made to promote the growth of new cartilage from a frlage. Three dogs had the perichondrial grafting alone, while two had both the perichondrial grafting and a full thickness buccal mucosal graft. In all these dogs new cartilage was found as early as four weeks postoperative.

Animals↗
PubMed1978

Altered bacterial flora and clinical course with intraoral cancer.

Nineteen consecutive patients with intraoral cancer were cultured and tested for cell-mediated immunity. They were then treated and followed for three years. The recurrence rate for those patients with normal flora was similar to that reported for dinitrochlorobenzene (DNCB) reactors; and the recurrence rate for those patients with abnormal microorganisms was similar to that reported for DNCB non-reactors.

Carcinoma, Squamous Cell↗
PubMed1978

The microbiology of paranasal sinus infections: diagnosis and management.

Study of the bacteriology of sinusitis and its diagnosis and treatment has been difficult. One problem is the anatomy of the paranasal sinuses; all communicate with a bacteriologically contaminated cavity. Access to all but the frontal sinus involves traversing either the nasal or oral cavity, both of which are teeming with aerobic and anaerobic bacteria. The criteria used to establish the diagnosis of sinusitis has varied widely. There are a number of examination techniques available, but none are foolproof. Therefore, patient populations may not be comparable. The absolute elimination of the possibility of contamination of culture specimens is impossible. Investigators have taken cultures in several ways: of the purulent secretions within the nose, of the contents lavaged from the sinus into the nose, of material aspirated from the sinus, and of tissue removed from the sinus. In most studies prior to 1974, anaerobic cultures were not performed. Studies of various treatment programs have used differing criteria to monitor the progress of treatment. No single method is completely reliable. Clinical signs and symptoms, radiologic appearance, the results of irrigation, and thermography have been used to follow patients. Many studies have used multiple therapeutic maneuvers concurrently, for example, antibiotics, lavage, and a decongestant. In some there were no controls. Because of these problems, as is true in many clinical areas of investigation, meaningful comparisons of various studies are difficult. Despite this, there are some areas of consensus in the literature.

Humans↗
PubMed1978

The mass in the neck.

A cervical mass should be approached in a systematic manner with a full knowledge of the possible etiologies and their consequences. The approach taken with a child differs markedly from that taken with an adult. Cervical masses in children are likely to be congenital or inflammatory. In adults, neoplastic masses are most common; most of these are metastatic. Indirect laryngoscopy, important in the search for the primary lesion, should be performed on all patients.

Adult↗
PubMed1977

Retropharyngeal abscess caused by atypical mycobacterium.

Mycobacterial retropharyngeal abscesses are usually secondary to cervical tuberculous osteomyelitis. A case is presented of a retropharyngeal abscess that was caused by the atypical mycobacteria with no mucous membrane or cervical spine involvement. The operative and medical management is discussed.

Abscess↗
PubMed1977

Malignant melanoma of conjunctiva metastatic to parotid gland. Reports of cases and discussion of surgical management.

Invasive malignant melanoma of the conjunctiva is a rare neoplasm fatal in 40% of cases. Accepted techniques of surgical management include wide local excision, conjunctivectomy, and exenteration. Recently lymphatic dissections have been proposed, but not described, for invasive conjunctival melanoma. We present five cases of invasive conjunctival melanoma, including two with intraglandular parotid metastases. The surgical management of these patients is presented, and a proposal is made for radical bloc dissection of the orbital contents and regional lymphatics. The histology of conjunctival melanoma is discussed, and a classification proposed to assist the head and neck surgical team in the management of this disease.

Aged↗
PubMed1976

Abnormal microorganisms and cell-mediated immunity in patients with intraoral cancer.

A substantial number of patients with intraoral malignant neoplasms have abnormal bacterial flora of skin, nasopharynx, and oropharynx, without a demonstrable relationship between tumor size, location, or degree of ulceration. Seventeen consecutive patients were studied to determine what relationship, if any, exists between the presence of abnormal microorganisms and the patients' immunological competence. Ten of 17 patients grew potentially pathogenic organisms, and all reacted to specific skin tests used to infer immunological competence. Thus, there appeared to be no relationship between cellular immunity and the presence of abnormal bacteria in patients with intraoral malignant neoplasms.

Bacteria↗