Biomedical subjects

E M Myers

Publications and source records attributed to E M Myers.

7 recordsLinked to original sources

PubMed1992

Induction chemotherapy for advanced head and neck cancer: modification of response to chemotherapy by antiemetics.

Forty Stage IV head and neck cancer patients were entered on a multimodality trial of induction chemotherapy (cisplatin + infusional 5-fluorouracil), surgery, and radiation. During chemotherapy, the patients of Group A (the first 19 patients) were medicated with metoclopramide. The patients of Group B (the next 21 patients) were medicated with droperidol. The groups were comparable. The response rate (complete + partial) was 32% for Group A and 52% for Group B (p = 0.16). Primary site (p = 0.08) and surgical margin (p = 0.005) clearance of tumor were better in Group B. Nodal disease responded poorly to chemotherapy in both groups. Tumor necrosis (p = 0.006) and granulation tissue (p = 0.07) were reduced in surgical specimens after chemotherapy in Group B. The drugs were well tolerated with reversible toxicity; nausea/vomiting (p = 0.01) and weight loss (p = 0.07) after chemotherapy, were increased in Group B. The 2-year survival was 26% for Group A and 62% for Group B (p = 0.027). The median survival was 15 months for Group A and 33 months for Group B (p = 0.05). Progression-free survival improved in Group B (p greater than 0.17). These improvements in response and survival did not appear to reflect changes in surgical or radiotherapy management, but may have reflected an uninhibited effect of cisplatin in Group B. It is theorized that the metabisulfite formulated with metoclopramide altered the pharmacokinetics or pharmacodynamics of cisplatin. This resulted in the poor response to chemotherapy and poor survival in Group A. An analysis of a randomized trial comparing metoclopramide (formulated with metabisulfite) versus a control antiemetic can confirm the data presented in this pilot study. Overall, our patients survived as well as others in comparable multimodality studies in Europe and the United States.

Adult↗

PubMed1992

Paranasal sinus carcinoma--diagnosis, treatment, and prognosis.

Sinonasal malignancies account for only 3% of all cancers of the head and neck and typically affect Caucasian males who are 50 to 70 years of age. This report identifies a number of risk and environmental factors that have been linked with the development of such malignancies, the clinical presentation of these tumors, clues to the diagnosis, and the pathology of the most commonly encountered types. Treatment of sinonasal malignancies is controversial and depends largely on the type of tumor encountered. The authors describe surgical and chemotherapeutic modalities, used alone and in combination. The controversy surrounding the utility of radiotherapy before or after surgery is also discussed.

Carcinoma↗

PubMed1985

Ameloblastomas of the jaws: radiological diagnosis and follow-up.

Eleven of 57 tumours and cysts (19 per cent) seen at two major centres over a 4-year period were ameloblastomas, primary in eight and recurrent in three. Computed Tomography (CT) was the most sensitive imaging technique for detecting ameloblastomas. The radiological features were distinctive maxillary and mandibular pathology in primary cases and soft-tissue, maxillary sinus and asymmetrical deep tissue involvement in both primary and recurrent ameloblastomas. Following surgery and pathological confirmation, serial scans were combined with periodic clinical re-evaluation. We identified clinically occult recurrences in two cases and confirmed a clinically-suspected recurrence in one on the basis of the CT findings. Our protocol appears efficacious and is suggested for the necessary long-term follow-up in all pathologically verified ameloblastomas.

Adult↗

PubMed1979

Maxillary chondrosarcoma.

Chondrosarcoma is a malignant tumor that arises from cartilage. In the maxillary area, the tumors spread locally but may also invade blood vessels and metastasize systemically. Initial surgical resection is the treatment of choice.

Chondrosarcoma↗

PubMed1979

Stomal recurrences: a clinicopathological analysis and protocol for future management.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Mo. During this period, 33 stomal recurrences were diagnosed. These are clinicopathologically analyzed with regard to tumor size, site, histopathology and original surgical procedure. An association with transglottic tumors, emergency tracheotomy and, surprisingly, hemilaryngectomy is noted. Three theories of etiology are discussed. Since treatment to date is disappointing, several proposed methods of prophylaxis are presented. These include emergency laryngectomy, recurrent laryngeal lymphatic dissection and postoperative radiotherapy. The role of wide local excision and mediastinal dissection is also examined. Based upon the analysis and the proposed methods of prophylaxis, a protocol is suggested for the future management of this dreaded complication.

Aged↗

PubMedDate not supplied

Completion laryngectomy.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Missouri. Forty-two or 9.4% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed in regards to original conservation surgery, clinical presentation, histopathology and salvage rate. The most common indications for completion laryngectomy were : 1) local recurrence, 2) local recurrence with associated severe upper respiratory obstruction, and 3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44%), and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or 10 patients) associated with completion laryngectomy, particularly in patients with anticedent hemilaryngectomy. Most indications for completion laryngectomy present early, however, all patients must be carefully followed. Both the patient and the otolaryngologist must be ever vigilant following conservation surgery.

Adult↗

PubMedDate not supplied

Completion laryngectomy.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St Louis. Forty-two or 9% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed with regard to original conservation surgery, clinical presentation, histopathology, and salvage rate. The most common indications for completion laryngectomy were (1) local recurrence, (2) local recurrence with associated severe upper respiratory obstruction, and (3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44% and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or ten patients) associated with completion laryngectomy, particularly in patients with antecedent hemilaryngectomy. Most indications for completion laryngectomy appear early; however, all patients must be carefully followed up after conservation surgery.

Adult↗