PubMed Health⌕ Search

Biomedical subjects

R D Nichols

Publications and source records attributed to R D Nichols.

At least 19 recordsLinked to original sources
PubMed1991

Partial laryngectomy after irradiation failure.

Forty-three patients who had partial laryngectomies after radiotherapy were evaluated. Forty-two had failed irradiation for laryngeal carcinoma. Nine had supraglottic procedures, 3 endoscopic, and 31 vertical partial. Twelve (28%) required subsequent completion laryngectomy. Major complications included laryngeal stenosis in 1, incompetent laryngeal sphincters in 2, mucocutaneous fistulas in 3, and delayed deglutition in 3. Six patients had positive permanent section margins. In 5 of those, intraoperative frozen sections had been taken and were negative. Recurrent or persistent disease was eventually demonstrated in all patients with positive margins. The 2-year determinant disease-free survival rate for stage I and II disease was 85%. Three-year disease-free survival was 50% for stage III and IV disease. Partial laryngectomies, including supraglottic, can be done after irradiation failure with a high expectation of cure and acceptable morbidity. Immediate additional operation should be considered in patients with positive margins.

Adult↗
PubMed1990

Denker rhinotomy for inverted papilloma of the nose and paranasal sinuses.

Inverted papilloma of the nose and paranasal sinuses is an unusual benign neoplasm that has the propensity for local tissue destruction and an association with malignant degeneration. The tumor represents an inverted growth of epithelium rather than outward proliferation. It most commonly arises from the lateral nasal wall with growth into the nose and paranasal sinuses and only rarely originates from the septum. Presenting symptoms are usually unilateral nasal obstruction and clear rhinorrhea. Surgical excision is the recommended treatment though the aggressiveness of the approach has varied. Transnasal local excision has been associated with a high recurrence rate. Lateral rhinotomy with removal of the lateral nasal wall and wide local excision has a low recurrence rate and has been the recommended treatment by most authors since 1980. However, the poor cosmetic results in some patients due to the visible external scar is especially undesirable in young females. We present a series of 23 patients treated over a ten-year period. Fifteen underwent a Denker rhinotomy and medial maxillectomy through a sublabial approach without an external incision. The recurrence rate in our group is 27% with a mean 4.7 year follow-up. This recurrence rate lies between that reported for lateral rhinotomy and local transnasal excision.

Adult↗
PubMed1989

Extracranial skull base chondrosarcoma.

Chondrosarcoma of the skull base is a rare neoplasm. The most common presenting symptoms are hoarseness, dysphagia, and diplopia, which is associated with palsies of cranial nerves X, IX, and VI. The temporal bone is the most common site of tumor origin, followed by the sphenoid bone. These tumors must be differentiated from chordoma, chondroid chordoma, osteogenic sarcoma, enchondroma, and meningioma. Diagnosis is made by patient history, radiologic imaging, and biopsy. The treatment is surgical excision followed by radiation therapy. Five-year survival rates for grades I, II, and III are 90, 81, and 43%, respectively.

Adult↗
PubMed1988

Comparison of survival in cardiac surgery at a Veterans Administration hospital and its affiliated university hospital.

Survival data were reviewed for 3330 open cardiac procedures from 1975 through 1984 at the William S. Middleton Memorial Veterans Hospital, Madison, Wis, and the University of Wisconsin Hospitals and Clinics, Madison. Respective operative survivals were 98.6% and 98.7% for myocardial revascularizations with vein graft or internal mammary artery (CABG), 96.2% and 96.8% for CABG reoperation, 97.8% and 95.9% for aortic valve replacement, 96.3% and 90.3% for aortic valve replacement plus CABG, 100.0% and 94.9% for mitral valve replacement, and 100.0% and 82.9% for mitral valve replacement plus CABG. There were no significant differences in six-year survival curves between hospitals despite threefold differences in average annual caseload (88 vs 294). This suggest that residency-directed cardiac surgery programs can function equally as well at a Veterans Administration hospital as at an affiliated university hospital.

Cardiac Surgical Procedures↗
PubMed1988

Concentration and distribution of thioridazine and metabolites in schizophrenic post-mortem brain tissue.

Thioridazine (THD) and its major metabolites, mesoridazine (MES), sulforidazine (SULF), and northioridazine (norTHD) accumulate at a predictable rate in human brain tissue after chronic medication. Although the concentration of THD is normally lower than or the same as its major metabolite, MES, in the plasma, it was found to be up to five times as concentrated in the brain tissue of treated patients. THD and its metabolites were evenly distributed throughout all regions of the brain in chronically medicated patients. Brain concentrations of THD were also compared with those of chlorpromazine (CPZ) when both drugs had been given at the same dose before death, and were shown to be up to 10 times more concentrated in brain at doses greater than 300 mg/day. Because some of the metabolites of THD are pharmacologically active, it is important to know how they accumulate in the brain in relation to the parent compound to understand how this drug mediates its clinical effect.

Aged↗
PubMed1987

Meningioma in the parotid region.

Meningiomas occurring ectopically in the neck are exceptional. We report two patients who presented as parotid and parapharyngeal masses and analyze them along with 27 previously reported cases. Typical patients present with parotid or parapharyngeal masses and cranial nerve palsies. Meningioma is not considered in differential diagnosis. The tumor is an extension of an unsuspected intracranial mass, occasionally with associated multiple meningiomas or other neurogenic tumors. Ectopic meningiomas should be considered in patients with parotid and parapharyngeal masses, particularly those with cranial nerve deficits; jugular foramen syndrome is most characteristic. Associated occult intracranial and temporal bone tumors and the cranial form of neurofibromatosis should be suspected. Treatment of cervical meningiomas is excision. The most important aspect of intracranial-extracranial lesions is recognition and treatment of the intracranial portion.

Adolescent↗
PubMed1986

Ectothermic philosophy of acid-base balance to prevent fibrillation during hypothermia.

In the ectotherms, or cold-blooded animals, carbon dioxide pressure decreases (PCO2) and pH increases as body temperature falls. This tends to increase coronary blood flow and prevent fibrillation. This concept was investigated in 181 consecutive patients undergoing open heart surgery of all types. In 121 cases, endothermic (warm-blooded) temperature-corrected normal values of pH, PCO2, and oxygen pressure were maintained during extracorporeal circulation as the perfusate temperature was lowered to 24 degrees C prior to aortic cross-clamping and administration of blood cardioplegia solution. In 49 patients (40%), ventricular fibrillation occurred prior to cross-clamping. In the other 60 consecutive cases, in which the ectothermic principle of cooling was applied, the PCO2 was allowed to decrease from 50 to 40 mm Hg and the non-temperature-corrected pH rose from 7.28 to 7.42. Fibrillation occurred in only 12 (20%) of these 60 patients.

Acid-Base Equilibrium↗
PubMed1986

Cranial invasion by basal cell carcinoma.

The direct spread of basal cell carcinoma (BCC) into the bones of the cranium takes a long period. In its early stages, it may not be detectable by radiography or computerized tomography, but can be visible as pitting during surgery. Invasion through the thickness of the calvarium due to extension of a BCC of the scalp, or involvement of the cribriform plate by spread from an intranasal lesion, is serious. Examples of cranial invasion by BCC are presented. The methods used in diagnosis and treatment are outlined.

Aged↗
PubMed1979

Rhinocerebral mucormycosis.

Rhinocerebral phycomycosis is a serious and commonly fatal fungal infection. The causative organism, ordinarily a saprophyte, becomes pathogenic in persons who are made susceptible by coexisting, debilitating disease. We report a well-documented case of rhinocerebral phycomycosis where early diagnosis led to successful treatment, and we discuss important aspects of the clinical evaluation and management of such cases.

Brain Diseases↗
PubMed1979

Facial nerve function in 100 consecutive parotidectomies.

The risk of facial nerve paresis after parotidectomy is thought to be within acceptable limits, although it is difficult to find published data regarding the specific magnitude of this risk. This study reviews the subject and reports postoperative facial function in 100 consecutive patients who had parotidectomies at the Henry Ford Hospital during a 9-year period. Permanent weakness of a major branch was identified in 2 of 77 patients having lateral lobectomy for parotid disease. Both patients demonstrated marginal mandibular paresis after surgery for adenolymphoma. No weakness was noted in 16 patients undergoing total parotidectomy. No unanticipated nerve disability was noted in 4 patients having partial nerve sacrifice in extended procedures; 3 patients had complete sacrifice of the nerve.

Adenocarcinoma↗
PubMed1978

Bilateral acinous cell tumors of the parotid gland.

Acinous cell tumors are uncommon neoplasms which arise either from the secretory cells of the salivary gland acini or from pluripotential duct cells and occur almost exclusively in the parotid gland. Nine previous instances of the bilateral occurrence of this tumor in the parotid gland have been reported. We present a tenth case and illustrate several aspects of the clinical behavior of this unique tumor. The histological pattern of this type of tumor was considered universally to be benign until 1953 when attention was called to a malignant variant. It is difficult to find reference to a benign form after that time. It is, in fact, impossible to forecast the clinical behavior of an individual specimen based upon its histopathology. In order to recognize this unpredictability, the World Health Organization Classification of Epithelial Tumors of Salivary Gland Origin proposed a category, "Acinic Cell Tumors," separate from clearly benign or malignant neoplasms. Later, attention was called to the grammatical designation, "acinous cell tumor." Because acinous cell tumors are uncommon, numerically significant series are gathered from several institutions or over several decades during which treatment methods vary widely. This makes it difficult to accept the validity of conclusions based upon the reported data. There is, however, a clearly documented tendency of the tumor to recur after long symptomless intervals so that extended follow-up is necessary before "cure" is established. Treatment of acinous cell tumors is surgical. The value of radiation therapy in the management of recurrent tumors is not firmly established.

Carcinoma↗
PubMedDate not supplied

Thorotrast (thorium dioxide) granuloma of the neck: Surgical considerations.

Summary--Thorotrast (thorium dioxide) is a contrast material which was first used for angiography about 40 years ago. Its use was discontinued because of the reported incidences of malignancy following injection. Its long-term effects are related to its long half-life and slow excretion rate. Following extravasation into the soft tissues of the neck, the prolonged radiation effect results in tissue breakdown with formation of granulomas. There can also be cranial nerve palsies, occlusion of the major blood channels, laryngeal edema, pharyngeal and esophageal ulceration, and fistula formation. To avoid these late consequences, it is suggested that Thorotrast granuloma in the neck be excised radically. Partial or limited resections are inadequate.

Angiography↗