Biomedical subjects
J M Conoyer
Publications and source records attributed to J M Conoyer.
Nutritional concepts in the management of the head and neck cancer patient. I. Basic concepts.
Proper nutritional management has assumed an increasingly important role in the care of cancer patients in recent years. Head and neck cancer creates disturbances in host nutritional balances. Profound nutritional depletion and cachexia are induced by local and distant effects of head and neck carcinoma. Radiation, chemotherapy and surgery tend to compromise the host further by compounding these nutritional deficits. This paper reviews the factors responsible for the malnutrition associated with head and neck malignancy, and discusses the current methods available for identifying and following the nutritionally depleted patient.
Nutritional concepts in the management of the head and neck cancer patient. II. Management concepts.
Essential to the management of the head and neck cancer patient is carefully monitored nutritional support. Traditionally, enteral alimentation, using the nasogastric feeding tube, has been the mainstay of treatment. Tube feedings should provide ample amounts of essential nutrients, minerals, vitamins, and adequate calories and protein. Knowledge of the tube feedings available and problems associated with their administration helps to avoid the pitfalls which limit their effectiveness. The inadequacies of enteral alimentation preclude its use in selected circumstances of severe nutritional depletion. Parenteral hyperalimentation, as a primary or adjuvant mode of therapy, may be capable of rapidly reversing deficits, improving postoperative morbidity and increasing tolerance to radiation and chemotherapy. Postoperative deglutition abnormalities may prolong the nutritional problems of head and neck cancer patients as well.
Dorsal skin flaps in rats as an experimental model.
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Enteral and parenteral nutrition in patients with head and neck cancer.
Head and neck cancer patients present with special problems in nutritional homoeostasis because of local phayngeal discomfort and obstruction and difficulty with deglutition due to either the neoplasm or the surgical alterations in the upper aerodigestive tract. Pretreatment malnutrition and vitamin deficiency are only compounded by the nutritional stress imposed by radiation and surgery. Reduced wound complications occur if the patients are nutritionally replenished before treatment. While nasogastric feedings will suffice in many patients, rapid nutritional restoration by this method is limited, and positive nitrogen balance may be difficult to achieve in the severely malnourished patient. Intravenous hyperalimentation offers a rapid and efficacious alternative in selected cases. The case histories of two patients are presented to illustrate these concepts.
Vasodilating agents in augmentation of skin flap survival.
Skin flap necrosis is a serious problem in reconstructive head and neck surgery. Currently, the only clinically effective means of preventing flap necrosis is delay. Hypothesized mechanisms of delayed and experimental methods of increasing flap survival are discussed. Investigative data supporting the use of phentolamine to augment flap survival are presented.
Glossopharyngeal neuralgia-asystole syndrome secondary to parapharyngeal space lesions.
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