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Biomedical subjects

R T Gregor

Publications and source records attributed to R T Gregor.

At least 19 recordsLinked to original sources
PubMed2003

Conversion from a non-indwelling to a Provox2 indwelling voice prosthesis for speech rehabilitation: comparison of voice quality and patient preference.

This prospective study assessed the advantages and problems associated with converting a patient using an older generation non-indwelling voice prosthesis to a newer generation indwelling voice prosthesis, in this case the Provox2. The voice characteristics of each patient were measured using the old and then the new voice prosthesis. Technical aspects of the insertion of the indwelling prosthesis were noted. Each patient completed a questionnaire after a period of use with the indwelling prosthesis. Changing the prosthesis was simple and uncomplicated in 15 of 17 patients. Acoustic analysis showed improved parameters with the indwelling prosthesis, but no perceptual difference between the two prostheses. The questionnaire revealed that most patients preferred the indwelling prosthesis. Replacing a non-indwelling with an indwelling prosthesis is technically simple, leading to improvement in voice quality and patient satisfaction. It may be reasonable to offer this choice to patients currently using an older generation non-indwelling voice prosthesis.

Aged↗
PubMed2000

Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases.

OBJECTIVE: To assess the value of ultrasonography (US) combined with fine-needle aspiration (FNA) cytology for the investigation of lymph node metastases in patients with head and neck cancer. DESIGN: Comparison of clinical examination (palpation) and preoperative US-FNA examination results of cervical nodes in a sample of patients with head and neck cancer. The histological features of the neck dissection specimens are used to validate these 2 variables. SETTING: A head and neck oncology service in a tertiary referral hospital. PATIENTS: A consecutive sample of 56 patients with head and neck squamous cell carcinoma, first seen between April 1, 1996, and July 30, 1998, who had neck dissections performed after the US-FNA examination. INTERVENTION: Cervical US-FNA preoperatively, followed by elective or therapeutic radical modified or selective neck dissection. MAIN OUTCOME MEASURES: The histological examination results of subsequent neck dissection specimens are used to determine the sensitivity, specificity, and accuracy of US-FNA for individual nodes. Second, the results of node staging by clinical examination and US-FNA examination are compared. RESULTS: The sensitivity was 89.2%; specificity, 98.1%; and accuracy, 94.5%. Correct node stages were obtained in 52 (93%) of the patients using US-FNA compared with 34 (61%) using palpation. CONCLUSIONS: Ultrasonography combined with FNA is a highly accurate technique for the investigation of cervical lymph node metastases. A more accurate diagnosis may result in more appropriate treatment, particularly in a setting with limited resources. Retropharyngeal nodes, micrometastases, and lymph nodes smaller than 4 mm are limitations of US-FNA. Ultrasonography combined with FNA is a useful technique for the staging of head and neck cancer.

Biopsy, Needle↗
PubMed2000

Management of chyle fistulization in association with neck dissection.

Chylous fistula after neck dissection is a relatively rare but potentially lethal complication. Sequelae range from severe fluid, electrolyte, and protein loss to fistula formation, skin-flap necrosis, and carotid blowout. A thorough knowledge of the anatomy is essential to avoid injury to the thoracic duct or right lymph duct. After surgery, drainage of large amounts of fluid, particularly if milky, may alert the surgeon to the danger of chylous leakage. Certain diagnosis, however, is not so easy. Once the diagnosis is made, the management has to address the immediate and late effects of the loss of chyle into an operative site. This article seeks to examine these factors through review of the literature and personal experience with the problem. Total parenteral nutrition allows for control of the fluid and protein loss while avoiding flow of chyle, and in most cases it results in resolution. In those cases that do not resolve, fibrin glue with some type of mesh and muscle flaps usually succeed in closure.

Adult↗
PubMed1999

Correlative 201Tl SPECT, MRI and ex vivo 201Tl uptake in detecting and characterizing cervical lymphadenopathy in head and neck squamous cell carcinoma.

UNLABELLED: The value of SPECT with 201Tl chloride, in combination with MRI (particularly short inversion-time inversion recovery [STIR] sequences that suppress fat signals) to detect and characterize cervical lymphadenopathies (nodes > or = 1 cm), and ex vivo lymph node 201Tl uptake were studied in patients with squamous cell carcinoma of the head and neck. METHODS: Preoperative SPECT and MRI, displayed in similar planes, were compared with the histologic findings in 15 neck dissection specimens from 12 patients with squamous cell carcinoma of the head and neck (9 with unilateral and 3 with bilateral neck dissection). Results were evaluated topographically with regard to the lymph node compartments (levels) of the neck. In addition, in 8 of these patients, the 201Tl activity of dissected lymph nodes of 10 neck sides was measured immediately after surgery in a gamma counter and expressed as percentage of the injected dose per gram tissue (%ID/g). RESULTS: Sixty-two lymph node levels were evaluated histologically. The high sensitivity of MRI (92% versus 71% for 201Tl SPECT), which correctly detected lymph node involvement in 22 of 24 levels, and the high specificity of 201Tl SPECT (92% versus 71% for MRI), which correctly characterized as negative 35 of 38 lymph node levels without metastasis on histology, led to a combined 201Tl SPECT/MRI accuracy of 92%. 201Tl SPECT was particularly effective in excluding involvement in 9 tumor-free neck levels with pathologically enlarged lymph nodes on MRI but failed to confirm involvement in 5 other tumor-positive levels. Mean 201Tl uptake in 53 lymph nodes with confirmed histologic involvement was significantly higher than uptake in 145 tumor-free lymph nodes (0.0043+/-0.0022 %ID/g versus 0.0023+/-0.0014 %ID/g, P = 0.0001), muscle and fat tissue but clearly lower than salivary gland uptake. CONCLUSION: Although 201Tl SPECT is not sensitive enough to be used as an independent imaging modality for staging of the neck, its correlative application with MRI appears to be an accurate method for the assessment of regional spread in head and neck squamous cell carcinoma. The ability of 201Tl SPECT to characterize neck lymphadenopathies detected by MRI appears to be based on the difference in 201Tl concentration found in lymph nodes with and without tumor involvement.

Adult↗
PubMed1997

Luc's abscess--a rare complication of middle-ear infection.

A case of subperiosteal temporal abscess of otitic origin is presented. This is an unusual complication of otitis media. The pathogenesis of Luc's abscess is different from other extracranial complications of middle-ear infections in that it is not associated with mastoid infection which results in subperiosteal pus formation. Based on our experience and the reports from the turn of the century, we present the presumptive pathogenesis and clinical features. We contend that these patients run an unexpectedly benign course, and require concomitantly more conservative treatment than other otitic abscesses.

Abscess↗
PubMed1997

Thallium-201 SPECT in the diagnosis of head and neck cancer.

UNLABELLED: The accuracy of SPECT with 201Tl-chloride for the diagnosis of primary tumors, lymph node metastases and recurrences in head and neck cancer was evaluated for clinical applicability. METHODS: SPECT images, obtained 60 min after administration of 150 MBq 201Tl-chloride, were compared with clinical, CT and/or MRI and histology results. In addition, whole-body images were obtained to detect distant metastases. RESULTS: In 79 patients studied for primary tumors (principally larynix, hypopharynx, oropharynx, nasopharynx and oral cavity), 201Tl SPECT correctly identified 69 of 73 (95% versus 88% for CT/MRI) histologically confirmed malignancies including 63 squamous-cell carcinomas. The method localized four occult naso- and oropharynx carcinomas not seen on CT/MRI and was correctly negative in two patients without tumor and in three of four patients with no confirmed primary tumor in the head and neck. With respect to regional spread, only patients who had cervical lymph node dissection were evaluated, and the findings were recorded per side of the neck. Thallium-201 SPECT correctly identified metastases in 31 of 36 neck dissections with proven lymph node involvement (86%), was correctly negative in nine and false-positive in one. Although the sensitivity of CT/MRI was clearly higher (97%), considerably more false-positive cases affected its accuracy (81% versus 87% for SPECT). In 30 patients investigated for recurrences, 201Tl SPECT correctly identified 27 of 29 microscopically confirmed tumor sites (93%) and was correctly negative in seven. Sensitivity of CT/MRI was lower (76%), and a greater number of false-positives (seven versus three for SPECT) further decreased its accuracy (64% versus 87% for SPECT). Distant metastases were detected in five patients. CONCLUSION: Thallium-201 SPECT appears to be an accurate method for the diagnosis of head and neck cancer. The method is particularly useful for detection of occult head and neck tumors and for assessing recurrences. It also may be of complementary value in the staging of primary tumors, in the differentiation of metastatic from reactive lymph nodes in the neck and, on the basis of whole-body scanning, for screening of distant metastases.

Carcinoma, Large Cell↗
PubMed1997

The use of the flow-volume loop in assessing the results of laryngotracheal reconstruction.

The difficult problem of assessing pre- and postoperative airway function in patients with laryngotracheal upper airway obstruction is discussed. A series of 26 patients with various forms of this problem is presented. The method of performing the flow-volume loop (FVL) is described and the theory behind the investigation is reviewed. Five of the series of 26 patients are described in detail as examples, and the advantages and disadvantages of this investigation are discussed fully. The FVL appears to be the only really objective test to assist the laryngotracheal reconstructive surgeon. It is easily performed in most cases and should form part of the diagnostic and postoperative workup.

Adolescent↗
PubMed1996

Preliminary experience with thallous chloride T1 201-labeled single-photon emission computed tomography scanning in head and neck cancer.

OBJECTIVES: To test the feasibility of single-photon emission computed tomography (SPECT) scanning with the use of thallous chloride T1 201 in patients with head and neck cancer and to decide its possible applications to improve the diagnosis and staging of head and neck cancer. DESIGN: Findings from SPECT with the use of 4.32 mCi of thallous chloride T1 201 were compared with those from clinical examination, computed tomography (CT), magnetic resonance imaging, ultrasound-guided fine-needle aspiration, and histologic studies. Primary sites and neck nodes were separately studied. Accuracy, sensitivity, and specifically were calculated for 19 patients who were being assessed for initial treatment (primary sites) and for 12 neck node dissections in 10 patients. SETTING: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam. PATIENTS: A consecutive sample of 25 patients with head and neck cancers of different sites. The average age of the patients was 60.2 years, and there were 19 men and six women. The sites of the primary lesions were as follows: oropharynx (n = 5), larynx (n = 9), oral cavity (n = 4), nasopharynx (n = 1), hypopharynx (n = 3), and unknown (n = 3). RESULTS: For the primary lesions, SPECT identified 94% of the lesions; SPECT was more accurate in delineating four oropharyngeal lesions and one nasopharyngeal lesion. In 12 neck node dissections, SPECT identified all of the positive lesions and two negative lesions, whereas CT detected two false-positive lesions. Single-photon emission computed tomography gave less information about the number of nodes and the anatomy than did CT or magnetic resonance imaging. CONCLUSIONS: Single-photon emission computed tomography with the use of thallous chloride T1 201 appears to be useful in helping to identify occult primary lesions, particularly in the oropharynx. It may assist CT or magnetic resonance imaging in identifying a recurrence of cancer in tissues or in lymph nodes, and in screening for distant metastases. Although no nodes were identified that were not already seen with the use of CT or magnetic resonance imaging, SPECT may help to eliminate the false-positive lesions, and SPECT with the use of thallous chloride T1 201 appears to be a valuable new tool in helping to diagnose and stage head and neck cancer.

Adult↗
PubMed1996

A new heat and moisture exchanger with speech valve (Provox stomafilter).

In previous studies investigating the influence of a heat and moisture exchanger on the respiratory and psychosocial problems of laryngectomized patients, the value of regular use of such a device could clearly be established. However, the compliance with the use of these devices was not optimal, mainly due to problems related to the plaster and to the often troublesome combination of these HMEs with a voice prosthesis. Therefore, a prospective, clinical trial was undertaken to investigate whether the use of a newly developed heat and moisture exchanger (HME, Provox stomafilter) could improve the acceptibility of such a device. In total, 19 patients participated in this study, 13 men and six women. Vocal rehabilitation was achieved with a Provox voice prosthesis in all patients. Each of the patients was provided with a supply of HMEs for a 3-week trial period. The results showed that all patients were clearly positive about the valve used for digital occlusion of the stoma. Voicing was considerably facilitated and the intelligibility improved. Problems experienced in previous studies related to the adhesive tape, such as skin irritation, inadequate adherence and loosening of the plaster by coughing or forced expectoration, could be solved by the availability of the different adhesives included in this system.

Adhesives↗
PubMed1996

Survival of adult patients with head and neck soft tissue sarcomas.

A retrospective review and survival analysis is presented of 58 adult patients referred between 1963 and 1993 for treatment of a head and neck soft tissue sarcoma. The 5 year overall and disease-free survival was 60% and 52% respectively. Univariate analysis indicated that age, positive margins, bone invasion, distant metastases, single modality treatment, histological grading, sites below the deep fascia and size might be predictors of survival. On multivariate analysis, age, histological grade, distant metastases, site and referral for recurrent disease emerged as prognostic factors known before treatment. By including variables known after treatment, age remained the most important independent prognostic factor followed by the presence of free margins, histological grading and distant metastases at presentation.

Adolescent↗
PubMed1996

Management of cervical metastases in supraglottic cancer.

A retrospective review of patients from 1979 to 1988 was performed to assess the efficacy of neck dissection, prognostic factors, and the philosophy of treatment of the neck in supraglottic cancer. Of the 89 patients available for analysis, 26 were managed by horizontal partial laryngectomy (HPL), 44 by primary radiotherapy (RT), and 19 by total laryngectomy (TL). A total of 41 patients from the group had 63 neck dissections (NDs); 22 had bilateral and 19 unilateral dissections. A correlation of the pN with N staging revealed that when presenting with N2a nodes (> 3 cm), one third had contralateral metastases, and with N2b (multiple), 100% had contralateral metastases. In multivariate analysis of the disease-free interval, age and staging emerged as independent prognostic variables. Although we observed no increased morbidity by dissecting the opposite side, our results did not support routine bilateral neck dissection in NO patients. However, when the nodes are larger than 3 cm, or ipsilateral and multiple, bilateral neck dissection is recommended.

Carcinoma, Squamous Cell↗
PubMed1995

Report of a symposium on diagnosis and treatment of adult soft tissue sarcomas in the head and neck.

A series of presentations and discussions was held during a symposium on the diagnosis and treatment of adult soft tissue sarcomas in the head and neck (HNSTS). The purpose of this meeting was to define guidelines on diagnosis and treatment of HNSTS. The results of this symposium are summarized and condensed in this report. Recommendations are made for diagnostic strategies and for treatment. Diagnostic efforts in PET scanning and dynamic MRI need to be expanded to detect early recurrences. Firm pathological diagnosis remains the basis for further treatment strategy. Wide surgical excision, if feasible, in combination with radiotherapy is the treatment of choice.

Adult↗
PubMed1995

Soft tissue sarcomas of the head and neck associated with surgical trauma.

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausen's disease and with irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.

Aged↗
PubMed1995

Radiation-induced tumours of the head and neck.

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly, in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

Adenoma, Pleomorphic↗
PubMed1995

Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage.

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.

Adult↗