PubMed Health⌕ Search

Biomedical subjects

J R Haller

Publications and source records attributed to J R Haller.

12 recordsLinked to original sources
PubMed1997

Intensified regimen for advanced head and neck squamous cell carcinomas.

OBJECTIVE: To devise an intensified treatment regimen for patients with advanced, resectable head and neck squamous cell carcinomas. DESIGN: Phase I/II clinical trial consisting of perioperative cisplatin chemoradiotherapy, surgical resection, intraoperative radiotherapy, and postoperative cisplatin chemoradiotherapy. SETTING: The Ohio State University Comprehensive Cancer Center, Columbus. PATIENTS: Thirty-seven patients (median age, 63 years) with advanced oral cavity, oropharyngeal, or hypopharyngeal carcinomas. RESULTS: The range of time at risk was 1 to 30 months (median, 21 months). Thirty of the 37 registered patients were analyzable; 11 have died (5 with distant metastases; 1 of lung carcinoma; and 5 were cancer-free); 2 experienced second primary tumors in the oral cavity (out of or adjacent to the previous radiotherapy portals). Treatment compliance was excellent (92%), morbidity was low, and excellent locoregional control was achieved. CONCLUSIONS: The initial results are encouraging; the future strategy will intensify the systemic component of therapy based on results from concurrent laboratory studies.

Antineoplastic Agents↗
PubMed1997

Medial antebrachial cutaneous nerve: a new donor graft for repair of facial nerve defects at the skull base.

When grafting a facial nerve defect after resection of a skull base cancer, the use of the greater auricular nerve is generally contraindicated because of concern of malignant involvement. In the past, the sural nerve was used as a donor graft for reconstruction of the facial nerve. We have found a sensory branch of the median nerve of the upper arm, the medial antebrachial cutaneous (MAC) nerve, to be a suitable option for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction of the distal facial nerve in the parotid bed. The length is adequate to graft from the brainstem to the distal facial branches. Loss of sensation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facial nerve defects. No complications have been encountered, and the functional return appears to be similar to other grafts. In our practice the MAC nerve is a valuable option for facial nerve repair at the skull base.

Adult↗
PubMed1997

Concepts in pharyngoesophageal reconstruction.

Pharyngoesophageal reconstruction remains a challenge in head and neck surgery. The anatomical defect dictates different reconstruction options possible for closure. This article highlights concepts in pharyngoesophageal reconstruction emphasizing a thought process used when choosing reconstruction options based on the anatomical defect. Both the partial pharyngoesophageal and total circumferential defects are discussed.

Colon↗
PubMed1996

Hemangiopericytoma of the masticator space.

Hemangiopericytomas are rare tumors of the head and neck. The benign presentation of this tumor belies its high local recurrence rate, local aggressiveness, and malignant potential. In view of these characteristics, workup to provide a diagnosis preoperatively is of significant importance. Diagnostic imaging is helpful in planning operative management, detecting metastases, and narrowing the list of differential diagnoses. However, because of the variety and lack of specificity of radiologic findings, it is generally difficult to provide a diagnosis. A history of a painless, slowly growing, otherwise asymptomatic mass, together with the radiologic findings of a vascular neoplasm, should enhance the suspicion of an HPC as a diagnosis. Hemangiopericytoma should be included in the differential diagnosis of any vascular soft tissue lesion presenting in the head and neck, and plans for surgical intervention should include the possibility of aggressive, wide local resection in order to adequately treat such a lesion should it be encountered.

Diagnosis, Differential↗
PubMed1995

Evaluation of maxillary sinus aspiration in patients with fever of unknown origin.

The value of diagnostic maxillary sinus aspiration in patients with abnormal findings on sinus radiographs and fever of unknown origin is unclear. To better define indications for this procedure, the results of 51 sinus aspirations in 34 patients with fevers of unknown origin and abnormal findings on sinus radiographs were analyzed retrospectively. Results of aerobic and anaerobic cultures were evaluated in the context of clinical signs and symptoms at the time of the maxillary sinus puncture. Typical symptoms of paranasal sinus disease were found to be the best predictor of a positive culture. Of patients with sinusitis complaints, 86.4% had culture-positive aspirations, whereas only 8.3% of patients without clinical symptoms of sinusitis had culture-positive aspirations. This study indicates that symptoms of sinus disease play an important role in determining the benefit of sinus aspiration in this group of patients.

Adolescent↗
PubMed1993

Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps.

Primary and secondary reconstruction of mandibular continuity defects with vascularized bone is currently the standard of care at many institutions. The most commonly utilized donor sites for such bone flaps include the scapula, iliac crest, fibula, and radius. Recently, interest has grown in the placement of osseointegrated implants into these flaps to facilitate functional dental rehabilitation. There are no studies comparing the bone available from each of these flaps into which osseointegrated implants can be placed. In this cadaver study, the dimensions of bone available for implant placement from the iliac crest, scapula, fibula, and radius osseous flaps were measured. The iliac crest and fibula flaps had bone dimensions consistently adequate for implant placement. Bone available for the safe placement of implants into the scapula flap was found in the majority of specimens. The radius flap group had the highest number of specimens that were inadequate for implant placement. The majority of the specimens with bone inadequate for implantation were from females. Clinical implications of this study regarding flap selection are discussed.

Aged↗
PubMedDate not supplied

Mortality and morbidity with intraoperative radiotherapy for head and neck cancer.

OBJECTIVE: To critically evaluate the morbidity and mortality associated with intraoperative radiation therapy (IORT). IORT allows the delivery of large single-doses of radiation to a visible tumor bed with exclusion (or shielding) of critical normal structures from the treatment field. Morbidity and mortality associated with IORT has been directly studied in abdominal malignancies, but only briefly mentioned in the head and neck literature. PATIENTS AND METHODS: At the Arthur G. James Cancer Hospital, The Ohio State University Medical Center, 53 patients with advanced head and neck cancer were treated with surgical resection and IORT. Twenty of these patients had intraoperative high-dose-rate (HDR) brachytherapy, whereas the remaining 33 received intraoperative electron beam therapy. All patients received 7.5 to 20 Gy of radiation. Those treated were reviewed evaluating perioperative mortality, major and minor complications, and length of hospital stay. All patients have been followed at least 3 months postoperatively. RESULTS: There were no perioperative deaths. Additionally, there was no increase in the number of complications or length of hospital stay associated with the use of IORT. The mean length of hospital stay was 13.0 days. The major complication rate was 16.8%. Of the major complications, 9% were medical and not related to the surgical site. The minor complication rate was 8%. CONCLUSION: As we strive to increase control of advanced head and neck cancer, IORT may play an exciting role for intensifying the therapy. At this institution, IORT did not add to the mortality or morbidity of an aggressive multimodality treatment schema.

Head and Neck Neoplasms↗