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Biomedical subjects

Neal Futran

Publications and source records attributed to Neal Futran.

7 recordsLinked to original sources
PubMed2006

Clinical utility of somatostatin receptor scintigraphic imaging (octreoscan) in esthesioneuroblastoma: a case study and survey of somatostatin receptor subtype expression.

BACKGROUND: For tumors that express somatostatin receptors (SSTR), radiolabeled somatostatin analogs, such as 111In-pentetreotide, can demonstrate the presence of tumor by radioligand uptake using somatostatin receptor scintigraphy (SRS). The use of 111In-pentetreotide for SRS depends on the specific high affinity of octreotide for SSTR subtypes 2, 3, and 5. Of these, SSTR2 has the greatest affinity for octreotide and the greatest relevance for tumor detection with Octreoscan imaging. Discriminating between postoperative changes and residual or recurrent tumor after extensive skull base surgery is often difficult, but in a case of recurrent esthesioneuroblastoma (ENB) we found the use of Octreoscan imaging clinically useful. To better define the general relevance of this imaging technique in this setting, we analyzed SSTR subtype expression in a panel of ENB tumors. METHODS: The case history and correlations between MRI and 111In-pentetreotide SRS of a patient with recurrent ENB were reviewed. The expression pattern of the SSTR subtypes in a panel of ENB tumors was then analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) to better define the potential of more general use of Octreoscan for imaging ENB. To correlate SSTR2 protein expression with 111In-pentetreotide uptake, immunohistochemistry to detect SSTR2 was performed on tumor samples from regions of increased uptake on Octreoscan. RESULTS: The SSTR2 message was expressed at high levels in all five ENB tumor samples, and either SSTR2 protein or histologic findings typical for ENB were found in all tumor tissue obtained from regions of increased 111In-pentetreotide uptake. Furthermore, Octreoscan imaging in this case proved useful in clinical decision making. CONCLUSION: The expression pattern of SSTR2 and the specificity of the Octreoscan for regions of active tumor growth support further investigation of the utility of Octreoscan imaging in the diagnosis and surveillance of ENB. Recent advances in novel therapies based on SSTR ligand binding also provide the rationale to consider such novel therapeutic approaches in patients with ENB.

Biomarkers, Tumor↗
PubMed2004

Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer.

OBJECTIVE: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. DESIGN: Retrospective cohort study. SETTING: University of Washington Medical Center, Seattle, a tertiary care hospital. PATIENTS: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). MAIN OUTCOME MEASURES: Rate and severity of local postoperative complications. RESULTS: Fifty-four patients (54%) had at least 1 postoperative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P = .26, chi(2) analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use. CONCLUSIONS: Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.

Adult↗
PubMed2002

Laparoscopic harvest of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects.

BACKGROUND: Reconstruction of hypopharyngeal and cervical esophageal defects remains one of the greatest challenges to head and neck and reconstructive surgeons. Although the jejunal free flap is a well-known reconstructive choice, many authors prefer alternative methods because of the complication rates and donor site morbidity associated with traditional jejunal flap harvest. Laparoscopic resection of the small intestine is a well-documented surgical technique. However, laparoscopic harvest of a jejunal segment for use in free tissue transfer reconstruction of defects of the hypopharynx and cervical esophagus has primarily been described in animal models, with only a few clinical studies existent in the recent literature. OBJECTIVE: To evaluate the use of a laparoscopic technique for harvesting jejunal segments for use in free tissue transfer reconstruction of pharyngoesophageal defects. PATIENTS AND METHODS: The records of 12 patients who underwent laparoscopic jejunal flap harvest for reconstruction of large hypopharyngeal or cervical esophageal defects at the University of Washington, Seattle, from January 1998 through April 2001 were retrospectively reviewed. Time of harvest, need to convert to "open" technique, failure rate, complications, and length of hospital stay were evaluated. RESULTS: All harvests were completed laparoscopically. The average operative time for the abdominal portion of the procedure was 2.4 hours. Warm ischemia time required for flap removal from the peritoneal cavity was less than 4 minutes. Each patient received a completely endoscopic jejunum harvest, bowel reanastomosis, and placement of a feeding jejunostomy tube. Enteral feedings began on the first postoperative day. No major complications were seen resulting from this technique, and no donor site morbidity was identified. All flaps were viable, with no revisions required. Activity in hospital and time to discharge were independent of the abdominal procedure. CONCLUSION: Given the low complication rate and relative ease of harvest, we conclude that this new technique is currently the best way to harvest jejunal flaps for reconstructing these challenging defects and should renew enthusiasm for this versatile flap.

Aged↗
PubMed2002

Pulmonary atelectasis after reconstruction with a rectus abdominis free tissue transfer.

BACKGROUND: Atelectasis is one of the most common postoperative complications encountered in head and neck surgery. Risk factors include preexisting pulmonary disease, the procedure performed, and the length of anesthetic. Regional flaps used to reconstruct defects in the head and neck predispose to radiographic atelectasis. The rectus abdominis myocutaneous flap is usually transferred as a free tissue transfer. Harvesting the flap results in abdominal wall pain and postoperative splinting that may contribute to an increased development of atelectasis. To our knowledge, this issue has not been previously examined. DESIGN: Retrospective review. RESULTS: Fifty-three patients underwent rectus abdominis myocutaneous free flap reconstruction following major ablative procedures for head and neck cancer. The flap size ranged from 5 x 7 to 25 x 27 cm. Most flaps were 8 x 15 cm. The cutaneous area transferred ranged from 35 to 600 cm(2) (mean, 120 cm(2)). These patients were compared with a group of 53 patients who were matched for age, sex, length of the procedure, and stage of disease. Postoperative atelectasis was radiographically detected in 37 (70%) of the patients who underwent rectus abdominis myocutaneous free flap reconstruction vs 41 (77%) of the controls. Major atelectasis was not encountered in any patient in either group. Patients with a larger cutaneous paddle (>120 cm(2)) had a higher atelectasis score than patients with smaller cutaneous paddles (< or =120 cm(2)) (P =.02). CONCLUSIONS: The incidence of radiographic postoperative atelectasis in patients undergoing rectus abdominis myocutaneous free tissue transfer is high. The degree of atelectasis is small, and the clinical correlation and relevance are minimal.

Head and Neck Neoplasms↗
PubMed2002

A multicenter phase II study of tgDCC-E1A for the intratumoral treatment of patients with recurrent head and neck squamous cell carcinoma.

BACKGROUND: The anti-cancer gene, E1A, can be complexed to a lipid carrier, DC-Cholesterol:DOPE, to form tgDCC-E1A, which can be injected directly into tumors. METHODS: Twenty-four patients with recurrent, unresectable, head and neck cancer were treated with intratumoral injections of tgDCC-E1A over 8 weeks. Tumor response was assessed using CT scans. Time to progression and overall survival were calculated. RESULTS: Intratumoral tgDCC-E1A was well tolerated in all patients. No significant toxicities related to tgDCC-E1A were reported. One patient (4.2%) had a complete response, two patients (8.3%) had minor response, and seven patients (29.2%) had stable disease by two-dimensional cross-products on blinded CT scans. The median time to progression was 8.6 weeks (range, 3.3-43.7 weeks), and median survival was 4.6 months (range, 1.3-15.6 months). CONCLUSIONS: Intratumoral injections of tgDCC-E1A were safe and well tolerated. Modest tumor response was observed. Further development of tgDCC-E1A is warranted in combination with other treatment modalities.

Adenovirus E1A Proteins↗
PubMed2002

Cosmetic concerns in posterior fossa skull base surgery.

Although cosmetic defects produced by posterior fossa surgery may not seem obvious, a poor cosmetic result can overshadow an otherwise successful operation. It is important to approach the operation with knowledge that each phase of a surgical procedure either directly or indirectly influences the eventual cosmetic result. The careful use of anatomic dissection and repair and attempts to reconstitute bony defects to their native contour as well as avoidance of complications all contribute to excellent cosmetic outcomes.

Cranial Fossa, Posterior↗