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Biomedical subjects

J R Chandler

Publications and source records attributed to J R Chandler.

11 recordsLinked to original sources
PubMed1979

Randomized study of local control and survival following radical surgery or radiation therapy in oral and laryngeal carcinomas.

From 1971 to 1975, 100 patients with glottic, supraglottic, and oral cavity lesions were prospectively randomized between primary radiation treatment and primary surgery. Local control and survival were similar with either treatment for lesions of the oral cavity or supraglottic larynx. Comparison between radiation alone and surgery alone for T1 and T2 glottic laryngeal lesions showed local control rates of 76% and 100% (P=0.32); after secondary salvage attempts, local control rates were 82% and 100%, respectively (P= 0.52). Neither result approached statistical significance. Successful radiation for early glottic larynx lesions resulted in superior deglutition and equivalent voice function compared to successful primary treatment with conservation laryngectomy. For oral cavity lesions, swallowing was impaired in the same percentage of radiated and operated patients, but fewer primary radiation patients had articulation difficulties. Among the patients with supraglottic larynx lesions, aspiration was not a problem with either radiation or surgery, but successful radiation perhaps maintained a slightly better voice quality.

Carcinoma, Squamous Cell↗
PubMed1979

Randomized study of control of the primary tumor and survival using preoperative radiation, radiation alone, or surgery alone in head and neck carcinomas.

Fifty-five selected patients with previously untreated squamous cell carcinoma of the head and neck regions were studied in a randomized, prospective manner. The three treatment categories were primary radiation (Gp R), primary surgery (Gp S), and preoperative radiation of 4000 rads in four weeks (Gp R/S). The local control rates for the 44 evaluable patients with a two-year minimum followup were 24%, 39%, and 43% respectively. Further treatment attempts in patients failing initial therapy yielded local control rates of 35%, 39%, and 43% for Gp R, Gp S, and Gp R/S, respectively. None of the local control rates nor the corresponding survival curves were significantly different at P less than 0.10. However, the group sizes were sufficiently small that true differences might not have been detected. Postoperative complications were higher in the primary radiation failures subsequently operated upon compared to the primary surgery group (P = 0.07).

Carcinoma, Squamous Cell↗
PubMed1979

Schwannomas of the parapharyngeal space and jugular foramen.

Schwannomas or neurilemmomas are among the most common neoplasms occupying the parapharyngeal space, yet only 107 cases have been previously reported. Neurilemmomas involving the jugular foramen are extremely rare. Only 55 cases have been reported in the world literature. The neoplasm occurred in the parapharyngeal space in three of our patients and in the jugular foramen in another patient. Of the tumors located in the parapharyngeal space, the nerve of origin in one of them was the glossopharyngeal, which is extremely rare. Adequate exposure for complete excision of parapharyngeal space tumors is best obtained through an external incision and should not be attempted transorally. In the jugular foramen case, the neoplasm arose from the vagus nerve high in the neck and extended intracranially in a "dumbbell" shape into the posterior cranial fossa. Total removal was successfully accomplished in one stage, by using a subtotal temporal bone resection--upper neck--posterior cranial fossa approach. Surgical removal is the treatment of choice. Schwannomas rarely recur following complete excision.

Adult↗
PubMed1978

Indications for radical neck dissection following radiation therapy.

The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.

Evaluation Studies as Topic↗
PubMed1977

Anatomical variations of the stylohyoid complex and their clinical significance.

Anatomical variations of the styloid process and its ligaments may be responsible in some patients for vague symptoms referrable to the throat and neck. On occasions, they result in some diagnostic and therapeutic quandaries. The anatomy is reviewed and five case reports used to illustrate typical and unusual problems.

Aged↗
PubMed1976

Hypercalcemia in epidermoid carcinoma of the head and neck.

Hypercalcemia occurs rarely at the time of diagnosis in patients found to have epidermoid carcinoma of the head and neck. It is particularly unlike in those patients who present with potentially curable lesions. Only 2 of our 307 patients who presented with potentially curable lesions were hypercalcemic at the time of diagnosis. Two hundred thirty-eight of these patients were followed up for two years or until death. Of the 139 who did not remain free of disease, hypercalcemia of clinical significance developed in ten (7.2 per cent). Pseudohyperparathyroidism was the suspected cause in seven of twelve patients. Debilitating symptoms were present in all patients with serum calcium levels greater thn 12.0 mg/100 ml. Treatment, when given, was effective in alleviating gastrointestinal and central nervous system problems. Although usually temporary, symptomatic improvement was appreciated by most patients and family members.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Malignant external otitis: further considerations.

Malignant external otitis is an infection which begins in the external auditory canal. It is uniformly caused by the Gram negative Pseudomonas aeruginosa organism and mainly affects elderly diabetics. It spreads to the soft tissues beneath the temporal bone and, if not properly treated leads to facial nerve palsy, mastoiditis, sepsis, osteomyelitis of the base of the skull, sigmoid sinus thrombosis, multiple cranial nerve palsies and death. Experience with 72 patients in varying stages of the disease is summarized. Stressed are the diagnostic criteria of nonresponsiveness to the usual methods of treatment, continued suppuration, and the continuing reformation of granulation tissue in the floor of the external auditory canal. Medical treatment is recommended with hospitalization and intravenous carbenicillin and gentamicin. Minor surgical debridement is helpful. All patients should be treated medically for as long as improvement continues, reserving surgical intervention only in the event a plateau is reached or symptoms and signs become worse under treatment. With or without a major surgical procedure, it is imperative to continue treatment for at least seven days after apparent cure in order to avoid recurrent disease possibly at a site distant from the canal.

Adult↗
PubMedDate not supplied

Radiation fibrosis and necrosis of the larynx.

The deleterious effects of ionizing radiation upon the normal tissues of the larynx, even when it is not the specific target of the radiation therapist, are always apparent to the observant and experienced laryngologist. On occasions they are so marked as to obscure the diagnosis of concomitant persistent or recurrent cancer. There is a direct relationship between the number of rads delivered and the severity of the subsequent radiation reaction. A system of classifying such reactions is proposed. Grade 0 is normal. Grades I and II are expected. Grades III and IV may be considered complications and require specific and even energetic treatment. In grade IV reactions, which require operative intervention, laryngectomy may be the treatment of choice.

Adolescent↗