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Biomedical subjects

Jesus E Medina

Publications and source records attributed to Jesus E Medina.

12 recordsLinked to original sources
PubMed2003

Current management of mucosal melanoma of the head and neck.

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies.

Head and Neck Neoplasms↗
PubMed2003

Current issues in hyperparathyroidism.

There has been a shift in the referral patterns in recent years that has resulted in increasing numbers of patients being referred to surgeons with a diagnosis of hypercalcemia rather than primary hyperparathyroidism. The surgeon must perform a thorough history, including medications, and laboratory assessment, including serum calcium and parathyroid hormone measurements. A 24-hour urinary calcium excretion should be routinely ordered to exclude FHH. After the diagnosis of primary hyperparathyroidism is made, preoperative localization studies will benefit 78% to 90% of patients, with sestamibi scan being the most commonly used.

Adenoma↗
PubMed2003

Surgical management of the parathyroids.

The recent advance of intraoperative PTH monitoring combined with preoperative localization techniques allow for minimally invasive parathyroid surgery in 75% to 85% of cases. In cases where a single adenoma is identified, minimally invasive techniques should result in a need for repeat surgery in only 2% of cases. The cost of intraoperative PTH assays of localization and gamma probes limits their availability. Complications of parathyroidectomy are uncommon, but appropriate management is important, particularly for patients with hypocalcemia.

Cysts↗
PubMed2002

Acute pain management following laryngectomy.

OBJECTIVES: To evaluate the adequacy of as-needed (prn) dosing of narcotics during the acute postoperative period following laryngectomy and to evaluate the role of nurses' interpretation and implementation of narcotic orders in postoperative pain management. STUDY DESIGN: A retrospective review of the medical records of 37 patients who underwent laryngectomy at the University of Oklahoma. The postoperative care was standardized through a clinical pathway to provide a uniform level of care. METHODS: The parameters reviewed include (1) the type and dose of analgesic prescribed, (2) the quantity and frequency of analgesic administered to each patient, and (3) the adequacy of the initial pain-control prescription. RESULTS: All physician orders for narcotics were at or above the minimum dosing guidelines; 68% met a recommended adequate postoperative prescription for moderate pain. However, none of the patients actually received the intended dose during a 24-hour period while hospitalized. Physicians were contacted about 13 patients (35%) because of inadequate pain relief, but only 8 patients (22%) had their narcotic dose increased appropriately. Patients were dosed below the minimum prescribed dose 19 times (2.8%), and in 24 instances (3.6%) the backup analgesic, designated as "prn breakthrough pain," was given as the primary analgesic. CONCLUSIONS: As-needed dosing of analgesia resulted in suboptimal pain control for at least 35% of patients undergoing laryngectomy. Inadequate prescription and variable implementation of prn orders contributed to this.

Adult↗
PubMed2002

The syndrome of inappropriate antidiuretic hormone secretion after bilateral radical neck dissections.

OBJECTIVE: It is commonly believed that synchronous, bilateral radical neck dissection causes the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), presumably as a result of increased intracranial pressure. This belief is based mainly on the results of an experimental study published in 1978 in which occlusion of the superior vena cava in dogs resulted in increased intracranial pressure and SIADH. The purpose of the present study was to test this assumption in an animal model that more closely resembles the clinical condition of bilateral radical neck dissection, in an attempt to discover possible surgical methods for preventing SIADH. MATERIALS AND METHODS: The experiments were carried out in six adult mongrel dogs. In two animals the internal and external jugular veins were ligated on both sides of the neck, high in the neck and at the thoracic inlet, respectively. In four animals, a formal radical neck dissection was performed on both sides of the neck. Urine and serum osmolarity and serum electrolyte levels were measured prior to surgery and at 2.5, 24, 48 and 120 h after surgery, in order to monitor the development of SIADH. RESULTS: No significant changes in serum osmolarity, urine osmolarity or serum sodium levels were observed in any of the animals studied. CONCLUSIONS: Bilateral synchronous jugular vein ligation and bilateral radical neck dissections did not result in SIADH in a dog model. As these results contradict a commonly held belief in clinical practice, a prospective evaluation of the physiologic changes after bilateral radical neck dissections is warranted.

Animals↗
PubMedDate not supplied

Results of phase I-II trial of concomitant hyperfractionated radiation and oral etoposide (VP-16) in patients with unresectable squamous cell carcinoma of the head and neck.

PURPOSE: The purpose of the current study was to investigate the efficacy of concomitant oral etoposide and hyperfractionated radiation for patients with unresectable head and neck squamous cell carcinoma. METHODS: A prospective nonrandomized phase I-II study was conducted using concomitant oral etoposide (50 mg/d for 13-27 days) and hyperfractionated radiotherapy (1.2 Gy twice daily to a total of 7440 rads) for patients with unresectable squamous cell carcinoma of the head and neck. Toxicity was graded according to the NCI common toxicity criteria. Patients were followed for a minimal period of 2 years. Endpoints for follow-up were recurrence or death. RESULTS: Seventeen patients were enrolled in the study. Grade III hematological toxicity occurred in 1 patient and moderate to severe mucositis occurred in all but 2 patients requiring a gastrostomy tube (n = 13) or intravenous fluids hydration (n = 2). One patient died of cardiac arrest unrelated to the treatment regimen. The overall response rates in patients that finished the protocol were 80% for the primary site and 100% for the neck. A complete response was observed in 47% at the primary site and 33% in the neck. Local control and disease-free survival (DFS) at an average follow-up of 3.7 years were 47% and 29%, respectively. CONCLUSIONS: Concomitant etoposide and hyperfractionated radiation is well tolerated and seems to be effective in the treatment of unresectable HNSCC with acceptable mucosal toxicity.

Administration, Oral↗