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Biomedical subjects

M I Singer

Publications and source records attributed to M I Singer.

At least 55 records · Page 3Linked to original sources
PubMed1994

Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the neopharynx.

Tracheoesophageal voice restoration after laryngectomy is possible with a variety of neopharyngeal reconstructions. We have used the tubed radial forearm free flap for neopharyngeal reconstruction since 1991. Six patients have undergone voice restoration with the Blom-Singer prosthesis and were available for quantitative and qualitative speech analysis. These patients were compared to five laryngectomy patients with standard pharyngeal closures and similar voice restorations. The free flap patients produced similar loudness levels compared to the standards with soft speech (52.06 dB and 47.19 dB, respectively) and loud speech (62.66 dB and 60.91 dB, respectively). The free flap patients demonstrated adequate intelligibility, with fundamental frequencies comparable to standards (124.82 Hz and 135.66 Hz, respectively), although with increased jitter (5.00% versus 1.96%). No differences were statistically significant, but evaluation by trained and naive listeners demonstrated significant differences in voice quality. This quantitative and qualitative and qualitative analysis of tracheoesophageal speech after radial forearm free flap reconstruction of the neopharynx demonstrates that acceptable voice can be achieved, but with limitations.

Aged↗
PubMed1994

Pharyngoesophageal reconstruction using the tubed free radial forearm flap.

Patients undergoing laryngopharyngectomy require the restoration of both deglutition and voice. We believe the tubed radial free flap offers the combined advantages of a rapid harvest with minimal morbidity, a long flap pedicle, extraordinary reliability, and the possibility of customization to fit virtually any size of defect. This flap does have a somewhat higher leakage rate; however, such leaks are relatively minor and nearly all will resolve with a brief period of conservative treatment. Postoperatively, this flap tolerates radiation therapy very well. Most importantly, it maximizes the functional rehabilitation of the patient by providing the best speech and swallowing results available. For these reasons we consider the tubed radial forearm free flap to be the flap of choice for circumferential pharyngoesophageal reconstruction.

Esophageal Neoplasms↗
PubMed1993

Enhancing fibula free flap skin island reliability and versatility for mandibular reconstruction.

Although the fibula osteocutaneous free flap has many advantages when used in mandibular reconstruction, many investigators have found the skin island is not always reliable. We present a technique that enhances skin island reliability by including a maximal number of skin perforators. This method has been used in 10 consecutive osteocutaneous free flaps without any skin loss. This technique also expands the usefulness of the fibula free flap, allowing it to be used for shorter bone defects or in cases when skin coverage is needed at a distance from the bone. In addition, this method provides additional vascularized soft tissue for neck contour restoration and coverage of fixation plates.

Bone Plates↗
PubMed1991

Intraoperative radiotherapy of skull base cancer.

As the head and neck surgeon expands the boundaries of resectability into the skull base, the margin of tumor clearance diminishes. Intraoperative radiotherapy (IORT) can be used as an adjunct to skull base surgery and external beam radiation to enhance local control in areas with close margins or remaining microscopic disease. During the period from May 1982 to May 1988, 25 patients underwent IORT of the skull base following resection and prior to closure to treat microscopic disease in 9 patients, sterilize close margins in 14 patients, and attempt to eliminate remaining gross disease in 2 patients. The types of tumors treated were 13 squamous cell carcinomas, 4 adenoid cystic carcinomas, 3 high-grade mucoepidermoid carcinomas, 3 sarcomas, 1 malignant mixed tumor, and an oncocytic adenocarcinoma. The majority of the tumors either originated in the sinuses or were skull base extensions of oral cavity or oropharyngeal cancers. In 22 patients with 1-year follow-up, IORT prevented local recurrence in 14 (64%) patients. This may represent improved control of local disease in patients who historically have a very dismal prognosis. The indications, techniques, and complications of this exciting therapeutic modality are also reviewed.

Adolescent↗
PubMed1990

Intraoperative radiotherapy of head and neck cancer.

Intraoperative radiotherapy (IORT) was developed as an adjuvant to surgery and external beam radiation for aggressive, extensive, or recurrent cancers of the head and neck. This report reviews the indications, technique, response, and complications of IORT. From May 1982 to May 1988, 104 patients received 15 to 20 Gy of radiation delivered through a Lucite cone to areas of high risk of recurrence following resection and prior to closure. The indications for treatment were (1) aggressive primary or recurrent cancer; (2) disease fixed to deep muscle, carotid, or bone; or (3) close margins in an effort to preserve vital structures or function. The IORT was effective in preventing local recurrence in 14 (40%) of 35 patients with 2-year follow-up of squamous cell carcinoma. The complication rate was acceptable. Intraoperative radiotherapy appears to be a safe and beneficial adjunctive therapy for cancers that historically have extremely dismal prognoses.

Adolescent↗
PubMed1990

Reconstructive and rehabilitative aspects of head and neck cancer in the elderly.

Age should not be considered a contraindication to adequate head and neck oncologic surgery. Reconstructive efforts should be by the most direct means to attain restoration of form and function in one stage. The next significant breakthroughs in the battle against cancer may well come on the cellular or molecular level. We endorse the plea of Endicott for increased education and research directed at the problem of head and neck cancer and rehabilitation as they relate to the geriatric patient.

Aged↗
PubMed1989

The relationship between sexual abuse and substance abuse among psychiatrically hospitalized adolescents.

A comparative study using matched samples was conducted to investigate the relationship between sexual abuse and substance abuse. The sample included 48 adolescent psychiatric inpatients who had been sexually abused (abuse group) and 48 psychiatric inpatients without a known history of such abuse (control group) matched by age, race, sex, and primary psychiatric diagnosis. Statistically significant differences emerged between the groups in several areas. Abuse group subjects indicated more regular use of cocaine and stimulants, greater frequencies of alcohol and drug use, and more reported drunkenness and times high on drugs than their control counterparts. Explanations of the association between substance abuse and sexual victimization are explored. Discussion suggests the possibility of earlier coping strategies being related to later chemical use patterns. Implications for service delivery are offered.

Adolescent↗
PubMed1989

Applications of the voice prosthesis during laryngectomy.

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented. Eighty percent of the population achieved a durable voice, and the complications were infrequent. The results support the primary use of tracheoesophageal phonation as a relatively safe and reliable alternative to total laryngectomy alone.

Adult↗
PubMed1989

What is the role of carotid arterial resection in the management of advanced cervical cancer?

From 1977 through 1988, 16 patients underwent carotid artery resection and reconstruction or simple ligation in the treatment of advanced cervical carcinomas. Three patients underwent carotid artery ligation, with postoperative transient ischemic attacks, which resolved, in one patient. In the remaining 13 patients, interposition saphenous vein grafts were used to reconstruct the resected carotid arteries. In one of these 13 patients, the previously unresected carotid artery ruptured and was treated by carotid artery resection with interposition vein grafting and coverage by a myocutaneous flap. There were two immediate postoperative strokes, with excellent neurologic recovery in one, and one late postoperative stroke (6 months). There was one postoperative death. Adjunctive intraoperative irradiation (1500 to 2000 rad) was employed in 15 patients to decrease the risk of recurrent disease. Since 1982, pectoralis major muscle flaps have been constructed in all patients to cover the vein grafts, with no subsequent carotid artery blowouts. Seven patients are free of cancer more than 1 year after surgery. In conclusion, carotid artery resection for the treatment of advanced cervical carcinomas may be accomplished with acceptable morbidity and mortality rates in carefully selected cases. Coverage of the vein graft by a myocutaneous flap appears to protect against carotid artery blowout. Intraoperative irradiation appears to decrease significantly the local recurrence rate of these aggressive tumors.

Aged↗
PubMed1988

The hospital merger: its effect on employees.

Hospital closings are occurring with increasing frequency, yet little is known about their impact on employees. A study was conducted to assess the impact of a psychiatric hospital's closing on employees' perceptions of and preparation for the closing process, as well as the impact on employment outcomes.

Adult↗
PubMed1988

Revalidation and expansion of an adolescent substance abuse screening measure.

The perceived-benefit-of-drinking scale has been developed to assess reasons for drinking in an adolescent population. In this study, the self-administered questionnaire, which has been expanded to include a reason-for-drug-use scale, was completed by 1363 junior and senior high school students. A comprehensive battery of analytic techniques was used to investigate the performance of these perceived-benefit scales on this larger and wider age-range sample. The results confirmed the reliability and validity of the instrument. The findings showed the two scales to perform well across a range of sociodemographic and age groups. These data reassert the strength of the approach and support the instrument's potential as a tool for clinically assessing adolescent substance use.

Adolescent↗
PubMed1987

Perceived-Benefit-of-Drinking Scale: approach to screening for adolescent alcohol abuse.

An index that measures adolescents' perceived benefits of drinking, the self-administered Perceived-Benefit-of-Drinking Scale, has been tested on a high school population. Results indicate that the instrument is practical and that it generates a scalable, reliable, and valid measure of reasons for drinking. The scale's strong relationship with other drinking behavior indicators makes it a potentially useful clinical screening device because it can serve as a proxy measure to assess the drinking behaviors of adolescents.

Adolescent↗