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Biomedical subjects

D P Bryce

Publications and source records attributed to D P Bryce.

At least 19 recordsLinked to original sources
PubMed1979

Conservation surgery in laryngeal cancer and its role following failed radiotherapy. A histopathological and clinical study of 32 cases.

The partial laryngectomy specimens from 32 patients with laryngeal carcinoma were histologically examined by the technique of whole organ sectioning. Twenty-three of these patients had previous irradiation therapy. We identify local criteria for performing conservation laryngeal surgery based on clinical and histopathological studies. These criteria are borne out as success or failure, and outcome could be accurately predicted when adhered to. The salvage rate for patients receiving conservation surgery after failed radiotherapy was 60%, while 43% retained a functional larynx.

Adenocarcinoma↗
PubMed1979

Laryngotracheal trauma: observations on its pathogenesis and its prevention following prolonged orotracheal intubation in the adult.

The authors have clinically examined the larynges of 117 patients who were successfully extubated in a Respiratory Care Unit, and have examined the larynges at autopsy from an additional 68 patients who failed to survive in the same Respiratory Care Unit. Based on these observations, our understanding of the pathogenesis of laryngotracheal trauma has allowed us to modify our clinical management in order to minimize such damage. Influence of this study on the management of patients is described.

Adult↗
PubMed1979

The art is long.

Explore the source record for details and available documents.

Canada↗
PubMed1979

The management of laryngeal cancer.

Carcinoma of the larynx is best managed in an interdisciplinary centre with wide therapeutic and rehabilitative services. Current management is confused, but may be simplified by consideration of three groups: 1) no fixation of laryngeal structures, 2) fixation of laryngeal structures and extension beyond the larynx, 3) all others including carcinoma in situ, verrucous carcinoma, transglottic tumor, and squamous carcinoma with marked airway obstruction. The rational treatment of Group 1 glottic tumors is primary radiation, which produces 75% crude and 92% corrected five year tumor free survival. If surgery is undertaken as primary treatment or for salvage, a vertical hemilaryngectomy may preserve the voice. Group 1 supraglottic carcinomas may be divided into supraglottic and marginal. Thirty per cent have palpable nodes at diagnosis and a further 20% occult disease in the cervical chain. Irradiation of neck nodes or block dissection is an integral part of treatment. The indications for a supraglottic horizontal partial laryngectomy are outlined. Where indicated this has five year survival figures of 70%. Recurrence is usually in the neck. Marginal tumors have a 50% five year survival rate when treated by conservation surgery combined with pre-operative radiation. Recent radiotherapeutic advances have improved treatment of these lesions. Thirty to 40% of patients with Group 2 tumors have regional metastases at presentation. There are no fixed protocols for treatment of these patients, less than 50% of whom will survive five years tumor free. The difficulty in carrying out a protocol based on pre-operative radiation with planned surgery is outlined. Under optimum conditions treatment should be primary radiation with salvage surgery for failures or recurrence, for the results are almost as good as primary surgery but 30% of larynges are saved. The difficulties of diagnosing recurrent tumor in irradiated tissue are discussed. Care must be taken to recognize that group of patients in whom tissue edema is the result of perichondritis rather than tumor recurrence, because in these patients surgery is extremely hazardous. Problems of diagnosis and methods of treatment of carcinoma in situ, and verrucous carcinoma are described. Transglottic carcinomas are defined and treatment is primary total laryngectomy with appropriate neck dissection. Similarly if tumors are causing major airway obstruction, treatment is by primary laryngectomy.

Airway Obstruction↗
PubMed1978

Carcinom of the paranasal sinuses--a review of 158 cases.

One hundred and fifty-eight cases of paranasal sinus cancer have been reviewed retrospectively. The actuarial survival at five years for the whole group was 33%. The American Joint Committee (AJC) classification for maxillary cancer was used. T1 and T2 cases, with an actuarial survival of 44% at five years, had a significantly better prognosis than T3 cases (31%) and T4 cases (10%). Anemia of presentation and the presence of persistent disease when surgery followed pre-operative irradiation were poor prognostic indicators. The policy of combined pre-operative irradiation followed by surgery is advocated; patients with anemia should have this corrected before and during treatment.

Adult↗
PubMed1977

Hearing under stress: II. Effect of hyperventilation and hypercapnia on speech discrimination.

Changes in the ability to discriminate speech from a eucapnic state to hyperventilation and hypercapnia were investigated. Standard speech audiometric techniques were employed to determine the speech reception threshold and the speech discrimination values, while respiratory conditions were varied and measured utilizing a mixed-gas breathing method. Respiratory parameters were similar to those encountered in aircraft personnel who experience oxygen/pressure system malfunction. The results of the study suggest no significant change in the speech reception threshold while in a hyperventilated or hypercapnic state. The speech discrimination results, however, suggest a significant performance decrement while in a state of hyperventilation.

Auditory Perception↗
PubMed1977

Carcinoma of the hypopharynx--a five year follow-up.

This is a study of 339 patients with carcinoma of the hypopharynx, seen in Toronto from 1960-72. Patients were grouped according to the U.I.C.C., T.M.N. classification but a modified staging method was employed since there is no generally accepted procedure for stage-grouping at the present time. Patients treated by primary radiation were compared to a group treated by combined therapy (radiation followed by surgery). The results show that the overall crude survival of all hypopharyngeal lesions was approximately 20 per cent. A high percentage of patients had advanced lesions at first presentation and almost 30 per cent of patients were treated palliatively. Analysis indicated that combined therapy is the treatment choice for Stage I and II hypopharyngeal lesions. Patients with more advanced lesions do poorly regardless of the treatment modality. The morbidity and mortality rates are high in the combined therapy group but the risks were doubled when salvage surgery was undertaken for failed primary radiotherapy.

Adult↗
PubMed1976

An implantable electromagnetic sound source for speech production.

Many operative and nonsurgical procedures have been designed for vocal rehabilitation following laryngectomy, but as yet a consistently successful solution with a negligible complication rate has failed to materialize. In our laboratory during the last two years, experiments have been carried out in dogs using active electromagnetic devices placed in the retropharynx as an energy source for speech production. An implantable porous coated stainless steel electromagnetic device energized from an externally controlled oscillator has been developed. Factors under investigation included biocompatibility of materials, durability, noise quality and intensity, together with the efficiency of the system. As a result of the favorable findings, it is envisaged that this system will soon be used in a carefully designed restricted clinical trial as a secondary procedure in those consenting cured laryngeal cancer patients who have failed to develop esophageal speech.

Animals↗
PubMed1976

Hearing under stress: III. The effect of external auditory meatal pressure on speech discrimination.

It has been well established that unequal air pressure across the tympanic membrane causes an increase in puretone thresholds. Very little information is available, however, concerning concommitant effects on reception and discrimination of speech material. This study was designed to determine whether or not further detrimental effects upon the communication process might occur in the form of decreased speech discrimination ability. The findings established that a high positive pressure in the external meatus can result in a deterioration of the individual's ability to discriminate speech sounds.

Adult↗
PubMed1976

Hearing under stress: IV. a speech delivery communication system for utilization in high ambient noise environments.

Many communication systems have been devised to improve the individual's ability to receive speech information in the presence of ambient noise. The purpose of this study was to determine the effectiveness of a speech delivery system which combined a high degree of ambient noise attenuation with the ear's own natural amplification phenomenon--the occlusion effect. It was demonstrated that occlusion of the auditory system at the level of the external auditory meatus, in conjuction with bone-conducted speech stimuli presented at the mastoid, was most effective in providing high speech discrimination ability with significant attenuation of ambient noise.

Adult↗
PubMed1976

Vocal restoration following laryngectomy.

Methods of vocal restoration after laryngectomy are summarized and a new approach briefly described. It is emphasized that surgical procedures should only be contemplated when a satisfactory esophageal voice has not been achieved.

Electronics, Medical↗
PubMed1975

Management of traumatic tracheoesophageal fistula.

Traumatic injury to the trachea most commonly results in separation of the trachea from the cricoid cartillage. In severe cases, this injury is complicated by an esophageal injury that is seriously complicated by a tracheoesophageal fistula. The repair of such a fistula is a prime priority. Surgical repair of the tracheal injury must be associated with esophageal repair and this is best accomplished by the interposition of the sternothyroid muscles between the trachea and the esophagus to strengthen the esophageal repair. The use of a laryngeal drop will also be of value in relieving the tension on the esophageal suture.

Adolescent↗