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R D Nichols

Publications and source records attributed to R D Nichols.

45 records · Page 3Linked to original sources
PubMedDate not supplied

Symptom-directed selective endoscopy and cost containment for evaluation of head and neck cancer.

Panendoscopy is commonly used for diagnosing synchronous primary neoplasms of the head and neck, although the yield and cost effectiveness has been questioned. To compare symptom-directed selective endoscopy to panendoscopy, 100 consecutive patients with newly diagnosed and untreated squamous cell carcinoma were prospectively evaluated. Symptoms were used to select which studies might have been performed to discover synchronous primary lesions. All patients were subsequently evaluated with chest x-ray, barium esophagram, direct pharyngolaryngoscopy, esophagoscopy, and bronchoscopy with bronchial washings. Seven synchronous primary neoplasms were discovered in six patients with one patient having three separate tumors. There were five synchronous pharyngeal and one oral cavity neoplasms with two of the pharyngeal tumors being asymptomatic. Two primary cervical esophageal tumors and one synchronous esophageal tumor were found in three patients all of whom had symptoms of dysphagia and odynophagia. Two pulmonary metastasis were discovered by chest x-ray in patients with normal bronchoscopies with bronchial washings. Selective symptomatic evaluations would have resulted in one-third savings in total cost and would have minimized excessive procedures and potential morbidity. Direct pharyngolaryngoscopy and chest x-rays are recommended for patients with squamous cell carcinoma of the head and neck but esophagoscopy, esophagogram, and bronchoscopy might be reserved for patients with associated symptoms. Bronchial washings are not recommended.

Adult↗
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↗
PubMedDate not supplied

Multiple head and neck malignancies.

Case histories of 47 patients with multiple head and neck neoplasms were reviewed at the Henry Ford Hospital. Data were obtained on the site of the malignancy and treatment program. Follow-up data have been good, utilizing clinic records. Several patients have had more than two malignancies of the head and neck, and one patient has just completed treatment for his fifth epidermoid carcinoma. The incidence of carcinoma of the esophagus is high in this series (16 of 47 patients). The literature is reviewed in relation to the present findings. Follow-up care is described at the Henry Ford Hospital.

Adenocarcinoma↗