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D P Shedd

Publications and source records attributed to D P Shedd.

At least 19 recordsLinked to original sources
PubMed1992

Results of surgical resection of pulmonary metastases of squamous cell carcinoma of the head and neck.

In this retrospective review of 58 patients (12 females and 46 males) with pulmonary metastases of squamous cell carcinoma of the head and neck treated between January 1, 1970, and December 31, 1989, we evaluated their clinical courses and analyzed the outcomes of those who underwent pulmonary resection. For the entire group of patients, factors predictive of survival in those patients with a diagnosis of pulmonary metastases included pulmonary resection of metastases (p = 0.0001), locoregional control of the head and neck primary tumor at the time of diagnosis of pulmonary metastases (p = 0.007), TNM stage of the head and neck primary tumor (p = 0.02), a single nodule seen on the chest radiograph (p = 0.02), and disease-free interval (DFI) from the primary tumor of the head and neck of 2 years or more (p = 0.05). Twenty-four of 58 patients underwent thoracotomy for resection of metastases. Four (17%) were found to have a second primary tumor of the lung. Of the 20 remaining patients who underwent explorative surgery for possible pulmonary resection, 18 (90%) underwent complete resection of all malignant disease with an estimated 5-year survival of 29%. In these patients, a DFI of less than 1 year was associated with a 5-year survival rate of 0%, whereas a DFI of 1 to 2 years was associated with a 5-year survival rate of 43% and a DFI of 2 years or longer had a 5-year survival rate of 33%. The number of malignant pulmonary nodules that were resected ranged from one to five and was not significant in predicting survival (p = 0.19). Of eight patients who underwent the resection of more than one malignant pulmonary nodule, 50% survived 2 years, but none survived 5 years. Resection of a solitary pulmonary metastasis from squamous cell carcinoma of the head and neck resulted in long-term survival in selected patients. Important prognostic factors included locoregional control of the head and neck primary tumor, the number of nodules seen on chest radiograph, the TNM stage of the primary tumor, and the DFI from the head and neck primary tumor. The value of resection in patients with more than one malignant pulmonary nodule remains to be defined for this group of patients.

Carcinoma, Squamous Cell↗
PubMed1991

Benign parotid tumors: a 24-year experience.

The medical records of 125 patients benign parotid neoplasms surgically treated over a 24-year period were retrospectively reviewed; 128 tumors were excised. These included 90 pleomorphic adenomas, 33 Warthin's tumors, 3 benign lymphoepitheliomas, and 2 oncocytomas. The surgical procedures consisted of 2 local excisions, 6 enucleations, 88 superficial parotidectomies, 13 subtotal parotidectomies, and 3 radical parotidectomies. The morbidity rate was 49%. There was one total permanent facial nerve paralysis (0.7%), four (3%) partial permanent facial nerve paralysis, five (5%) transient total facial nerve paralysis, and 32 (25%) partial transient facial nerve paralysis. After a median follow-up of 84 months, there was one recurrence (0.7%). A superficial parotidectomy is the minimum procedure that should be performed for the treatment of a benign parotid neoplasm.

Adolescent↗
PubMed1989

Recurrent malignant salivary gland neoplasms.

Recurrent salivary gland malignancies present difficult therapeutic decisions and poor prognosis in many instances, and treatment becomes of a palliative nature only. As many of the salivary gland malignancies we see are of the recurrent type, the following study was done to determine the efficacy of a vigorous attempt at retreatment. During the period January 1, 1960, through December 31, 1984, 352 patients with major and minor salivary gland tumors were evaluated at our institution. There were 149 benign lesions and 203 patients with malignant tumors. Of these, 99 patients had recurrent and metastatic tumors that had been treated initially elsewhere. Thirty-three of these patients were able to be treated with curative intent: surgery, 21; surgery plus radiation, 9; radiation therapy alone, 2; and radiation plus chemotherapy, 1. The 5 year survival with no evidence of disease was achieved in three patients with surgery alone and two patients with surgery plus radiation therapy. The group of five patients was comprised of two patients with adenoid cystic carcinomas of the parotid, one with intermediate grade mucoepidermoid carcinoma of the parotid, one, sebaceous cell carcinoma of the parotid, and one, adenoid cystic carcinoma of an accessory salivary gland. The results of this study serve to re-emphasize the relative poor yield of attempts at retreatment of loco-regional recurrence of salivary gland tumors.

Adult↗
PubMed1989

Surgical management of squamous cell carcinoma of the floor of the mouth.

Treatment failure and survival in 209 patients with squamous cell carcinoma of the floor of the mouth treated with surgery as the single curative modality are reported. Fifty percent of the patients had stage III and IV disease. The primary tumor was excised with 1 to 2 cm margins and the mandible was resected in 73 percent of the patients; 77 percent underwent radical neck dissection. No cures were observed in 11 patients with involved surgical margins on permanent section. For 198 patients with uninvolved margins, determinate survival at 5 years for all stages was 49 percent and 69, 64, 46, and 26 percent for stages I through IV (p less than 0.01). The most common sites of initial and ultimate treatment failure were the neck (42 of 72 patients) and distant metastases (33 of 53 patients), respectively. Treatment of the neck is identified as an unresolved problem in the management of early stage disease. Recent improvements in survival for stage III and IV disease are accounted for, in part, by adequate surgical resection.

Adult↗
PubMed1989

Management of advanced glottic carcinomas.

One hundred twenty-eight patients with T3 or T4 glottic cancers were treated by initial surgery; 59 had a total laryngectomy and 69 had total laryngectomy with regional node dissection. Fifty-eight percent of the total laryngectomy group and forty-nine percent of the total laryngectomy with neck dissection group remained free of disease for 5 or more years. Forty-seven percent (60 of 128 patients) treated surgically developed regional recurrences requiring further treatment. Nine patients had evidence of widespread metastases, leaving 51 suitable for salvage radiotherapy. Twenty-three percent (12 of 51 patients) were salvaged with radiotherapy given for postoperative recurrences. Twenty-five patients received an initial 6,600 rads to larynx and neck with curative intent, 28 percent of whom remained free of disease for 5 or more years. Seventeen percent of patients were salvaged with one laryngectomy for persistent or recurring tumors. Initial total laryngectomy gave better survival figures for advanced glottic carcinoma.

Adult↗
PubMed1987

Metastatic patterns in squamous cell cancer of the head and neck.

This retrospective study on 832 head and neck cancer patients who died between 1961 and 1985 was carried out to determine the incidence and sites of distant metastases. All patients were staged prior to definitive treatment and were autopsied. The overall incidence of distant metastases was 47 percent. The hypopharynx had the highest incidence of distant metastases (60 percent), followed by the base of the tongue (53 percent) and the anterior tongue (50 percent). Of the 387 patients with distant metastases, 91 percent died with uncontrolled tumor either at the primary site or in the neck. The lung was the most common site of distant metastases (80 percent), followed by the mediastinal nodes (34 percent), the liver (31 percent), and bone (31 percent). Overall, 6 percent of the patients had stage I disease, 20 percent had stage II disease, 32 percent had stage III disease, and 43 percent had stage IV disease. The highest incidence of distant metastases was found in those patients with stage IV disease (193 of 350 patients, 55 percent). We believe that the initial stage of disease does appear to be related to the ultimate development of the distant metastases.

Carcinoma, Squamous Cell↗
PubMed1986

Major head and neck reconstruction using the deltopectoral flap. A 20 year experience.

Six hundred seventy-eight deltopectoral flaps were raised in 604 patients, 125 of which were delayed and 215 of which were used in previously irradiated beds. The rate of major flap necrosis was 16.9 percent and the overall rate of complications, 51.4 percent. Delay in creating the deltopectoral flap had no influence on the risk of complications and necrosis, whereas the use of the flap in a previously irradiated bed was associated with a significantly increased risk of major flap necrosis. The least flap loss occurred when the deltopectoral flap was used without tubulation for skin coverage only. Complications and flap necrosis occurred most frequently when flaps were tubulated in a reversed manner or used for lining of major portions of or for total oropharyngeal and hypopharyngeal reconstruction. The deltopectoral flap remains a useful, reliable, and versatile regional flap that can be used alone or in combination with other flaps in selected circumstances for major head and neck reconstruction.

Female↗
PubMed1985

Modified radical neck dissection for metastatic carcinoma of the thyroid. A reappraisal.

From January 1958 through December 1983, 56 modified radical neck dissections were performed on 47 patients with metastases to the cervical nodes from differentiated carcinomas of the thyroid. In nine patients, a second modified radical neck dissection was performed either simultaneously or at a later date. Lymph node clearance was performed on all but one surgical specimen. The number of nodes in each specimen ranged from 10 to 96, and the number of involved nodes ranged from 1 to 20. Thirty-eight of the 56 neck specimens contained four or more positive nodes. Seventeen patients were followed for 10 to 26 years, 18 patients for 5 to 9 years, and 5 patients for less than 5 years. Seven other patients died, three from other causes and four from lung metastases. There were no recurrences in the neck sides that would have been cleared if standard radical neck dissection had been performed. This reappraisal with long-term follow-up supports our initial impression that a modified radical neck dissection sparing the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, or any combination thereof is an effective procedure for differentiated cancer of the thyroid, with preservation of good shoulder function and improvement in the cosmetic appearance of the neck.

Adenocarcinoma↗
PubMed1978

Significance of site and nodal metastases in squamous cell carcinoma of the epiglottis.

One hundred twelve patients treated by surgery alone for squamous cell carcinoma of the epiglottis were retrospectively reviewed. The results showed: (1) 27 per cent of patients with N0 disease had microscopic nodal metastases; (2) 35 to 47 per cent of patients with N0 and N1 disease and histologically positive nodes (micrometastases) in the initial neck dissection developed contralateral nodal metastases; (3) 36.9 per cent of the patients who had nodal micrometastases (histologically positive) survived five years, as contrasted with 94.5 per cent of those who did not have node involvement; (4) 53.2 per cent of the patients who had nodal metastases in one neck and 16 per cent of those who had metastases in both necks survived five years; (5) when the primary tumor in the epiglottis was located in the midline or there was bilateral supraglottic involvement, 18 to 50 per cent of patients developed contralateral ("second") neck nodal metastases; (6) performing early elective contralateral ("second") neck dissection shortly after recovery from the initial surgery may improve survival of patients in whom either the "first" neck dissection showed microscopic nodal metastases and/or the primary tumor was located either in midline or there was bilateral supraglottic involvement.

Adult↗
PubMed1978

Squamous-cell carcinoma of the floor of the mouth.

This study was based on the analysis of 100 cases of squamous-cell carcinoma of the floor of the mouth. The male/female ratio was 4.25:1. The peak incidence in women was in the 50 to 59 year age group; in men there was equal frequency in each age group above 50. The five-year survival rate decreased from 86 per cent to 0 as the stage of disease progressed from I to IV. The five-year survival for all stages of disease was 52.7 per cent. Thirty-three per cent developed new primary malignancies; 22 per cent were of the upper alimentary and respiratory tracts. Distant metastases were present in 21 per cent. Fifty per cent were heavy smokers, 33 per cent were heavy drinkers, 28 per cent were both heavy smokers and heavy drinkers, and 21 per cent were nonsmokers and nondrinkers.

Adult↗
PubMed1978

THe hazards of injecting local anesthetic solutions with epinephrine into flaps: experimental study.

In a study using paired longitudinal flaps on the back of the rat, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps. Epinephrine concentrations of 1:200,000 and 1:400,000 were demonstrated to significantly increase losses in these flaps. Epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 were not demonstrated to be harmful to undelayed flaps, in the dosages used.

Aged↗
PubMed1977

Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity.

Accurate histologic determination of lymph node metastasis is most important in predicting prognosis in patients who undergo radical neck dissection. In this study of 340 determinate patients, the five year survival was 75 per cent when lymph nodes were histologically negative, 49 per cent when one lymph node was positive, 30 per cent when two lymph nodes were positive, and 13 per cent when three or more nodes were positive. Other factors useful in predicting prognosis are, to some extent, the level of lymph node metastasis in the neck, and the presence or absence of capsule penetration and soft tissue involvement. Those patients with metastasis to three or more lymph nodes had a five year survival of 13 per cent and belong to a high risk group. In this high risk group among those who died, the incidence of recurrence in the neck was 72 per cent, and the incidence of distant metastasis was 70 per cent. When autopsy was performed, more still were found to have distant metastasis, 75 to 80 per cent. Most of these high risk patients already have systemic dissemination of cancer at the time of their initial therapy; therefore, the addition of a systemic form of adjuvant therapy, such as chemotherapy and/or immunotherapy, is justified.

Adult↗
PubMed1976

Rehabilitation problems of head and neck cancer patients.

Head and neck cancer and its treatment result in varying degrees of disability affecting various organ systems. Ideal treatment of such patients requires a unit capable of managing problems in the areas of: Reconstructive surgery, maxillofacial prosthodontia, dentistry, deglutition disorders, and psychological, social, and vocational rehabilitation. Provision of such facilities in an integrated manner will give the patient the optimal chance for rehabilitation from the complex disabilities occurring in head and neck cancer.

Carcinoma, Squamous Cell↗