Biomedical subjects

Jeffrey S Moyer

Publications and source records attributed to Jeffrey S Moyer.

6 recordsLinked to original sources

PubMed2006

Sclerosing mucoepidermoid carcinoma of the parotid gland.

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland. Its clinical behavior is determined by the relative ratio of mucous and epidermoid cells with pathologic high-grade tumors containing a greater proportion of epidermoid cells. Sclerosing mucoepidermoid carcinoma is a rarely reported variant with unclear long-term clinical behavior. A 23-year-old female was found to have a deep lobe parotid mass on imaging studies. Preoperative evaluation was non-diagnostic. Intraoperatively, the tumor was found to be adherent to the lower division of the facial nerve and portions of the posterior digastric muscle. Frozen section specimens showed only squamous metaplasia with background inflammatory fibrosis. Final pathological analysis demonstrated multiple solid and cystic nests and glands within a background of dense, sclerotic, collagenized stroma and inflammatory infiltrate consistent with low-grade sclerosing mucoepidermoid carcinoma. Sclerosing mucoepidermoid carcinoma is a very rare salivary gland tumor with uncertain behavior. Complete surgical excision with tumor-free margins with preservation of the facial nerve (in the absence of clinical invasion) is recommended. Postoperative radiation therapy is suggested for positive or close margins given the adherent nature of the tumor and the risk of recurrence and distant disease found in some case reports. Patients should be followed closely with serial MRI imaging studies of the tumor bed with complete clinical evaluation of the regional lymphatics and chest to evaluate for evidence of recurrence or metastasis.

Adult↗

PubMed2006

Early vaccination with tumor-lysate-pulsed dendritic cells after allogeneic bone marrow transplantation has antitumor effects.

Allogeneic bone marrow transplantation (BMT) remains the primary treatment for many hematologic malignancies but has had limited success against solid tumors. The antitumor activity of this treatment approach involves the tumoricidal activity of chemoradiation and the additive graft-versus-tumor activity of donor T cells. However, even with current protocols, some tumors develop resistance and become unresponsive to current therapeutic regimens. To address the problem of resistance and lack of solid tumor activity in allogeneic BMT, we undertook experiments to determine whether the graft-versus-tumor activity of donor T cells could be enhanced in the period immediately after allogeneic BMT with tumor lysate-pulsed dendritic cell (DC) vaccines. Using the B16 melanoma model, we found that the treatment of 6-day tumors with allogeneic BMT and 3 weekly vaccinations of tumor lysate-pulsed DCs starting 3 days after BMT had a significant effect on the growth of murine flank melanomas. This effect was tumor specific and occurred in the absence of full immune reconstitution as measured by donor T cell engraftment and cytotoxic T lymphocyte activity. In addition, DC vaccinations did not appear to exacerbate graft-versus-host disease. These experiments support the feasibility of DC vaccine strategies in the setting of allogeneic BMT.

Animals↗

PubMed2005

Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects.

OBJECTIVE: To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap (OCRFFF) used for midface reconstruction. DESIGN: Prospective case series and a retrospective review of results. PATIENTS: Ten patients from an academic practice who underwent reconstruction at the University of Michigan Hospitals between 1995 and 2001. INTERVENTIONS: All patients had maxillectomy defects in which the entire infraorbital rim was reconstructed with an OCRFFF. Of the 10 patients included in the study, 3 underwent a total maxillectomy with orbital exenteration, 4 had a total maxillectomy without orbital exenteration, and 3 had a limited maxillectomy that did not involve the palate. Patients with palatal defects underwent reconstruction with a prosthetic palatal obturator. MAIN OUTCOME MEASURES: Facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success, donor site morbidity, and orbital complications were also studied. RESULTS: Mean +/- SEM follow-up was 23.2 +/- 5.0 months. A modified Funk facial deformity scale was used, and 7 of the 10 patients had either no deformity or minimal deformity. The mean aesthetic score for these reconstructions was 2.1 +/- 0.3 on a scale of 1 to 4, with 1 representing no deformity and 4 representing a severe deformity. All patients returned to a solid diet and had understandable speech, although patients who had an orbital exenteration trended to poorer scores. All patients socialized either frequently or occasionally outside the home, and all patients not retired or disabled prior to surgery returned to work. CONCLUSION: The OCRFFF reconstruction of the infraorbital rim in patients with total maxillectomy defects and obturator of the palatal defect controls orbital complications and optimizes aesthetic outcome while achieving nearly normal palatal function.

Adult↗

PubMed2005

Complications of rhytidectomy.

Complications after rhytidectomy can be distressing for the patient and surgeon. Although meticulous surgical technique and a complete understanding of the causes of adverse outcomes can minimize the risk for severe complications, an open and honest rapport with the patient when complications do occur is essential for effective management. This article discusses the likely etiologies of face-lift complications, techniques to prevent them, and helpful treatments when complications occur.

Aging↗

PubMed2004

Current thoughts on the role of chemotherapy and radiation in advanced head and neck cancer.

PURPOSE OF REVIEW: The management of advanced malignancies of the head and neck continues to be a challenging clinical problem. During the last three decades, the traditional treatments of surgery and/or radiation have not yielded significant improvements in survival in this patient population. In addition, surgery for advanced disease can create significant functional and cosmetic defects that adversely impact a patient's quality of life. Newer "organ preservation" approaches using chemotherapy and radiation are currently being studied in an attempt to improve survival while maintaining the functional integrity of the disease site. RECENT FINDINGS: Recent studies have demonstrated that for advanced head and neck squamous cell cancers, concurrent chemoradiation is superior to radiation alone for local tumor control and perhaps overall survival. With the exception of laryngeal cancer, phase III data comparing chemoradiation with surgery is lacking for most head and neck subsites. However, comparisons with historical controls suggest that chemoradiation strategies may offer improved outcomes when compared with more traditional treatment regimens. SUMMARY: This review emphasizes recent phase III trials that support the use of chemoradiation strategies in the treatment of advanced head and neck squamous cell cancers.

Carcinoma, Squamous Cell↗

PubMed2004

Contemporary skull base reconstruction.

PURPOSE OF REVIEW: Tumors of the skull base that would have been considered inoperable thirty or forty years ago are now routinely resected with reliable results due to the advancement of modern reconstructive techniques. High mortality rates were common prior to the use of vascularized tissue for skull base repair. However, the advent of local flap reconstruction for skull base defects in the 1960s revolutionized skull base surgery. The use of regional flaps in the 1970s and 1980s allowed skull base surgeons to perform more extensive surgeries, but complication rates were still quite high. RECENT FINDINGS: Experience with free tissue reconstruction increased through the 1980s and 1990s and has become a reliable method to separate the intracranial from extracranial environments. Free tissue transfer has allowed surgeons to address the large volume defects created by extensive skull base resections and has provided dependable, vascularized tissue that is relatively resistant to adjuvant radiation. Local flaps have also become a powerful reconstructive tool in conjunction with free tissue transfer, and in some select cases, may be sufficient alone for reconstruction. SUMMARY: The prevention of serious complications after skull surgery has improved with the use of vascularized tissue. Depending on the anatomic site, the extent of the defect, and the quality of local tissues, either free tissue transfer and/or local flap reconstruction is preferred. Regional flap reconstruction should be reserved for cases where alternative reconstructive techniques are not available.

Bone Transplantation↗