Biomedical subjects

J R Spires

Publications and source records attributed to J R Spires.

7 recordsLinked to original sources

PubMed1989

Pulmonary thromboembolism after head and neck surgery.

In a retrospective study of all patients who had pulmonary embolism during a 37-year span at M. D. Anderson Hospital, we identified 502 patients, 30 of whom had a primary malignancy in the head and neck region. Only five of these patients had a clinically significant pulmonary embolus during the immediate postoperative period; these patients are the subject of a more detailed review with a case study as an example. Three of these patients died. Heart disease was identified as the most common predisposing factor. We review the results of this clinical study of pulmonary thromboembolism in patients having head and neck surgery as well as the natural history, diagnosis, and current treatment of pulmonary embolism.

Acute Disease↗

PubMed1988

Anaplastic thyroid carcinoma. Association with differentiated thyroid cancer.

Fourteen cases of anaplastic thyroid carcinoma (ATC) treated at Baylor College of Medicine, Houston, during a 19-year period were reviewed. There was a 1.3:1 female preponderance, and the median patient age was 62 years. Ten (71%) of the anaplastic tumors either followed or occurred simultaneously with a well-differentiated thyroid carcinoma. This finding adds support to the theory that ATC usually results from the transformation of well-differentiated thyroid carcinoma. A combination of surgery, radiation therapy, and chemotherapy was utilized for most patients. In this series of patients, the median duration of survival was four months following diagnosis, with only three patients (21%) alive at one year. Despite aggressive therapy, the prognosis for ATC remains poor.

Adult↗

PubMed1987

Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage.

A prospective clinical study was performed on 62 patients with peritonsillar abscesses at Ben Taub General Hospital, Houston. The abscesses were treated with either incision and drainage or needle aspiration alone. The recovery period was similar in both groups, but two of the 41 patients initially treated with aspiration had an immediate recurrence. These were successfully treated with subsequent incision and drainage. The advantages of needle aspiration alone as the primary drainage procedure outweigh the acceptably low failure rate, making it the initial procedure of choice.

Abscess↗

PubMed1986

Cat-scratch disease.

Cat-scratch disease has been reported with increasing frequency since its initial description in 1931. It is now recognized as being so prevalent that it probably represents the most common cause of unilateral lymphadenopathy in children, once nonspecific viral diseases and cutaneous infections have been excluded. The cardinal feature of the disease is a subacute regional granulomatous lymphadenitis. Because of its relatively mild natural course, most cases are treated on an outpatient basis. Forty-four children, representing the more seriously ill portion of the disease spectrum, were treated at Texas Children's Hospital from 1972 to 1984 and constitute the data base for this article. Most patients were symptomatic for nearly 1 month prior to admission, typically complaining of low-grade fever and regional lymphadenopathy. The two most common sites of lymph node involvement were the axilla (54%) and the neck (46%). Although there is, at this time, no specifically recommended treatment, 80% of patients received antibiotics and 70% underwent a surgical procedure--usually total nodal excision. Nodal excision was followed by rapid resolution of symptoms. Because cat-scratch disease is benign, surgery should be reserved for severe cases with signs of significant suppuration. Generally, symptomatic relief can be afforded by warm soaks and analgesics and recovery over the course of several weeks is uneventful.

Adolescent↗

PubMed1986

Bacterial infections of the orbital and periorbital soft-tissues in children.

Periorbital soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy usually resolve quickly. Orbital soft-tissue infections, in contrast, are rare and frequently cause serious morbidity. Two hundred forty-one children with periorbital or orbital soft-tissue infections have been hospitalized since 1962 and constitute the data base for this study. Two hundred twenty-six children, half under 1 year of age, had periorbital soft-tissue infections. Response to antimicrobials was prompt and only two children (1%) developed complications. True orbital infections occurred in the remaining 15 children, three of whom were under 6 years of age. Eleven children had orbital cellulitis, 3 had subperiosteal abscesses, and 1 had cavernous sinus thrombosis. Antecedent sinusitis was present in 12 cases and, in seven, effective treatment required surgical drainage in addition to intensive antimicrobial therapy. Three children (20%) developed significant complications.

Abscess↗

PubMed1985

Brain abscesses in the young.

Brain abscesses in the young are rare. Only 14 such abscesses have been seen at Texas Children's Hospital since 1968. Most abscesses developed in association with congenital heart disease (5), although sinusitis and mastoiditis were precipitating causes in two patients and one patient, respectively. The latter three patients' cases are reviewed in detail. Clinical and bacteriologic findings in all patients are discussed. There were signs of increased intracranial pressure in nine patients (64%). All abscesses were drained; in several, repeated drainage was necessary. Anaerobic organisms were recovered in six patients (43%), aerobic organisms were recovered in five (36%), and both were recovered in two (14%). In one patient no growth was reported. Antimicrobial therapy was administered to all patients but one, whose abscess was completely excised. Morbidity and mortality remained significant: three patients (21%) died and one has a residual hemiparesis.

Adolescent↗

PubMedDate not supplied

Metastatic papillary carcinoma of the thyroid: the significance of extranodal extension.

A retrospective study of patients with papillary carcinoma of the thyroid was conducted at The University of Texas M. D. Anderson Cancer Center to determine the significance of cervical nodal metastases in which the cancer has extended beyond the capsule of the node. The survival of 25 patients with extracapsular invasion was compared to 63 controls. There was no statistically significant difference in regional recurrence, distant metastases, death from cancer, or recurrence-free survival between the two groups. Surgically resectable extrathyroid extension of tumor at the primary site and the clinical stage of cervical metastases also had no prognostic significance. The most important prognostic factors for differentiated thyroid carcinoma remain the age and sex of the patient, the histology of the cancer, and the presence of distant metastatic disease.

Adenocarcinoma↗