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Biomedical subjects

R W Gilbert

Publications and source records attributed to R W Gilbert.

At least 19 recordsLinked to original sources
PubMed2001

Prospective evaluation of eyelid function with gold weight implant and lower eyelid shortening for facial paralysis.

OBJECTIVES: To assess which signs and symptoms were relieved by gold weight implantation and which signs and symptoms persisted. DESIGN: Prospective observational cohort. SETTING: Tertiary care neurotology and oncology center. PATIENTS: Sixteen (4 males and 12 females) consecutive patients whose average age was 56 years (age range, 31-76 years). Inclusion criteria were gold weight implant, lagophthalmos of 2 mm or more, and a House-Brackmann score of 3 or less at the completion of follow-up. Mean follow-up was 13 months. INTERVENTIONS: Each patient received a gold weight implant. Six of these patients underwent a lower eyelid procedure. MAIN OUTCOME MEASURES: Surgical complications, static and dynamic lagophthalmos, static and dynamic corneal coverage, visual acuity, keratitis, topical treatment, and patient satisfaction. RESULTS: There were no extrusions. The preoperative mean lagophthalmos was 7.5 mm and the postoperative mean was 0.5 mm, (P<.001). Corneal coverage with eye closure before implantation was 73% and after implantation was 100%, (P<.001). Corneal coverage with normal (reflex) blink was less than 50% in 9 of 14 patients. When wearing correction, no patients had 20/20 visual acuity. The mean patient satisfaction score before the procedure was 3.5 and after was 7.1, (P<.001). Patient satisfaction was most closely related to visual acuity. The relationship was linear and statistically significant (P<.04). CONCLUSIONS: Gold weight implantation provides significant reduction in lagophthalmos and significant improvement in corneal coverage. But owing to delayed closure time and disrupted tear film, irritation may persist. As a result, some patients require ongoing topical treatment of the eye, which can compromise visual acuity.

Adult↗
PubMed2000

Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery.

PURPOSE: The use of radical radiotherapy and surgery for salvage (RRSS) in locally advanced squamous cell carcinoma (SCC) of the larynx is controversial. In the absence of randomized studies, it is unclear if RRSS can match the rates of locoregional control and survival reported for primary surgery in this setting. The aim of this study was to compare treatment outcomes of radiotherapy and surgery in comparable patients with CS III-IV SCC of the larynx. METHODS AND MATERIALS: Eighty-two patients with untreated T2N+M0 or T3T4NM0 SCC of the larynx were treated with a policy RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990. The medical records at presentation were reviewed independently by a panel of three surgical oncologists blinded as to treatment outcome to determine patient suitability for laryngectomy and neck dissection using eligibility criteria adopted by recent clinical trials. Treatment outcomes for surgery-eligible patients were compared to results of comparably staged patients in the surgical literature since 1980. RESULTS: Sixty-three patients (77%) were eligible for study. With a median follow-up of 3 years, radiotherapy controlled the primary in 8/20 evaluable glottic primaries and 21/41 evaluable supraglottic primaries. Forty-five percent of patients surviving 5 years retained a functional larynx. Sixteen of 29 relapsing patients were salvaged with surgery. Disease above the clavicles was controlled in 65% of T3T4N0N+ glottic primaries (compared to a published range of 53% to 79%) and 82% of T3N0 glottic primaries (compared to a published range of 69% to 84%). The 5-year overall survival of patients with T3T4 glottic cancer was 54% compared to a published range of 50% to 63%. The cause-specific survival (CSS) of patients with T3N0 glottic primaries (86% at 1 year and 73% at 2 years) was identical to the only published report of CSS in the surgical literature. CONCLUSION: A policy of RRSS offers a good chance of laryngeal conservation without compromising ultimate locoregional control or survival when compared to primary laryngectomy and neck dissection in patients with locally advanced carcinoma of the larynx meeting the surgical eligibility of clinical trials.

Aged↗
PubMed2000

Blood flow rate effects in continuous venovenous hemodiafiltration on blood urea nitrogen and creatinine reduction.

The effect of blood flow rates (BFRs) in continuous venovenous hemodiafiltration (CVVHDF) on the clearances of blood urea nitrogen (BUN) and creatinine was studied using a retrospective chart review. Fifteen patients, 9 males and 6 females aged 50-85 years, were included in the study. Each patient had a primary cardiovascular diagnosis with acute renal failure (ARF) and was treated with CVVHDF on the Gambro PRISMA continuous renal replacement therapy (CRRT) machine using the COBE AN69 filter. Independent sample t-test, simple linear regression, ANOVA, and multiple comparisons were used. Simple linear regression revealed that BUN, creatinine, and difference in creatinine (DIFFCRTN) were best predicted by the number of hours of treatment. For every hour of treatment the BUN decreased by .08 mg/dl, the creatinine decreased by .01 mg/dl, and the DIFFCRTN increased by .01 mg/dl. The study concluded that patients on CVVHDF for greater than 72 hours had the greatest changes in BUN and creatinine when a BFR between 135-145 cc/min was used.

Acute Kidney Injury↗
PubMed1999

Solitary fibrous tumor of the oral cavity: an uncommon location for a ubiquitous neoplasm.

Solitary fibrous tumor is an uncommon soft tissue tumor initially reported in the pleura but recently described in other sites of the body. To date, only 5 examples of oral solitary fibrous tumor have been reported. Here, we describe 2 additional cases of this tumor in the oral cavity. The tumors were composed of small to medium-sized spindle cells with bland cytologic features; these cells were haphazardly arranged in highly cellular sheets or ill-formed fascicles as well as in hypocellular areas with hyalinized blood vessels. Both tumors contained blood vessels with a hemangiopericytomalike appearance and expressed vimentin, CD34, and CD99. One case was also strongly positive for bcl-2. The diagnosis of solitary fibrous tumor may be difficult inasmuch as it shares a number of histologic features with other soft tissue tumors. Awareness of its occurrence in the oral cavity is important so that confusion with other spindle cell neoplasms can be avoided.

Adult↗
PubMed1997

Predicting postlaryngectomy voice outcome in an era of primary tracheoesophageal fistulization: a retrospective evaluation.

OBJECTIVES: Not all laryngectomees appear to have the same potential to develop functional spoken communication. Our goal was to evaluate voice outcome in different functional subgroups of laryngectomees and to identify physical and demographic factors associated with success and failure to achieve functional spoken communication. DESIGN: Retrospective chart review. SETTING: Surgery was performed at a tertiary care hospital. Multidisciplinary follow-up was conducted at weekly head and neck clinics held at the associated regional cancer centre. Voice rehabilitation procedures took place in both settings. PATIENTS: Sixty-four consecutive patients who had undergone total laryngectomy during the era of primary tracheoesophageal fistulization (TEF) at this facility. Patients were subdivided into four groups according to whether they had undergone primary TEF, or whether this had been contraindicated by locoregional factors of TEF candidacy/performance status, or both. INTERVENTIONS: Primary TEF was performed whenever technically feasible and traditional TEF candidacy criteria were met. Voice rehabilitation procedures were initiated prior to discharge. OUTCOME MEASURES: A judgement of voice outcome was assigned based on documentation on at least one of three patient treatment records by a physician or speech-language pathologist that a patient had demonstrated functional spoken communication within the clinical setting. RESULTS: Forty-five of 64 patients (70%) achieved functional spoken communication. Six laryngectomized subgroups were ultimately identified and characterized. Voice outcome varied considerably between these subgroups. Prelaryngectomy communication status and age emerged as predictors of voice outcome. CONCLUSIONS: Voice outcome is related to several factors present prior to or at laryngectomy. Different combinations of such factors create various postlaryngectomy recovery streams for which voice outcome may be predicted more specifically.

Adult↗
PubMed1995

Free forearm flap in oral reconstruction. Functional outcome.

OBJECTIVE: To examine functional outcome associated with free radical forearm flap reconstruction of oral cavity and oropharyngeal defects. DESIGN AND SETTING: Case series obtained from a head and neck clinic conducted at a regional cancer center. Patients underwent surgery at the associated tertiary care center. PATIENTS: Thirty consecutive patients treated for oral and oropharyngeal malignant neoplasms staged from T1 to T4 were studied. Subjects were assigned to five groups based on the site and extent of their surgical resections, as specified on a resection template. INTERVENTION: All patients had undergone free radial forearm flap reconstruction of their surgical defects. OUTCOME MEASURES: Ten factors reflecting functional properties and processes of the upper aerodigestive tract were evaluated clinically or with videofluoroscopy or both. RESULTS: Near-normal and fair oral and oropharyngeal function wholly characterized the sample. Patients who underwent reconstruction of unilateral tongue, floor of mouth-ventral tongue, and retromolar trigone-buccal defects functioned well on most measures; the function of patients with anterior tongue-jaw and tongue base-tonsil defects varied. CONCLUSIONS: Functional outcome with free radial forearm flap reconstruction was favorable for three of five subgroups of oral and oropharyngeal cancer patients. Qualitatively different functional profiles emerged for subgroups based on resection site. Methodologic issues for research on surgical reconstruction and functional outcome include the need for a meaningful, reliable system of classifying oral and oropharyngeal resections, and the development of standardized procedures for evaluating functional outcome.

Adult↗
PubMed1995

Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases.

Fifty-one patients undergoing surgical reconstruction of mandibular defects with the titanium hollow screw reconstruction plate over a 4-year period were analyzed. Plate failure was defined as flap necrosis, plate extrusion, or plate fracture necessitating a further surgical procedure and occurred in 12 patients (24 percent). The incidence was highest for patients who had more than three mandibular regions resected. It was not affected by the primary site of the tumor or whether the patient had received radiation therapy. Although the failure rate was the same whether the patient attained full oral function or was fed by gastrostomy, plate fracture was limited to the former group. The overall cause-specific survival rate for this group of patients was 68 and 56 percent at 1 and 2 years, respectively. In addition, 81 percent of patients attained a full oral diet.

Adult↗
PubMed1991

Analysis and correction of the crooked nose.

The crooked nose is defined as a nose in which the midline is off center without tissue loss. This leaves a nose that is angulated at the nasion or the rhinion. Surgical correction with angulation of the nasion includes medial osteotomies, two transverse oblique osteotomies, one transverse root osteotomy and one lateral osteotomy. Angulation at the rhinion includes separation of one upper lateral cartilage from the septum, shortening of one upper lateral cartilage, weakening of the dorsal strut with a double cut technique and resuturing the upper lateral cartilage septal complex back together.

Humans↗
PubMed1989

Microvenous grafts to arterial defects. The use of mechanical or suture anastomoses.

A mechanical microvascular anastomotic device, the Unilink system, was compared with sutures in terms of patency, anastomotic time, and histologic changes when a microvenous graft is placed in an arterial defect. Twenty rabbits underwent grafting of a 1.0-cm defect in both carotid arteries with a 1.5-cm reversed femoral vein graft. Anastomoses were performed with the Unilink system on one side and sutures on the other. Animals were killed at 2 weeks (10 animals) and 16 weeks (10 animals) with the vein grafts being assessed with clinical patency tests and then fixated for histologic evaluation. All 20 grafts (100%) interposed with the Unilink system were fully patent while 17 (85%) of the 20 grafts interposed with sutures were fully patent. The grafting procedure with the Unilink anastomoses averaged 12.5 minutes while the sutured anastomoses averaged 41.9 minutes. No differences in the histologic appearance of the vein grafts were noted between the two types of anastomoses. All grafts showed endothelialization at 2 weeks with intimal hyperplasia or "arterialization" being a constant finding.

Anastomosis, Surgical↗
PubMed1989

Strength of microvascular anastomoses: comparison between the unilink anastomotic system and sutures.

The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty-five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded. All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.

Anastomosis, Surgical↗
PubMed1989

Arterial end-to-side anastomosis with the UNILINK system.

A new technique for mechanical end-to-side anastomoses using the UNILINK anastomotic system is presented. The technique, based on the concept of vessel wall eversion over paired ring pins, is described as is a new device for vessel expansion. To evaluate the technique of end-to-side anastomosis, we detached the left renal artery in 18 rabbits and then reanastomosed them end-to-side to the aorta using the UNILINK anastomotic system. Renal blood flow was evaluated before and after anastomoses with a laser Doppler flowmeter. Animals were separated into three groups of 6 and were killed at 24 hours, 2 weeks, and 16 weeks, respectively. To evaluate the acute effects of vessel expansion, 7 additional rabbits underwent expansion of the aorta without subsequent anastomosis. All vessels were evaluated with light and scanning electron microscopy. A patency rate of 100% was achieved in the 18 animals; histological changes at the anastomotic site were comparable to those described previously for this mechanical anastomotic system. The animal model demonstrates that it is both technically possible and efficacious to perform end-to-side anastomoses of arteries with the UNILINK anastomotic system.

Anastomosis, Surgical↗
PubMed1988

T3N0M0 glottic carcinoma--a failure analysis.

There is at present considerable controversy regarding the appropriate management of a patient who presents with a T3N0M0 glottic carcinoma. This paper presents the results for 141 patients presenting clinically with T3N0M0 glottic carcinoma between 1964 and 1981 and treated with primary radiotherapy reserving surgery for residual or recurrent disease. The actuarial survival for the entire group of patients was 50.5% at 5 yr; 28% of the patients died of glottic cancer. The local relapse-free rate achieved with radiotherapy was higher in female patients (68%) than male patients (41%) (P = 0.04); the local relapse-free rate was higher in males 60 yr of age or older (46%) than in males 59 yr of age or younger (31%) (P = 0.02). Involvement of all three laryngeal regions and initial tracheotomy were associated with a high primary failure rate. Fifty-nine per cent of patients alive at 5 yr retained and intact and functioning larynx. The time up until diagnosis of recurrence and the number of endoscopies required to establish recurrent or residual disease were all assessed with respect to their effects on survival and were shown to have no significant impact. Methods of improving the results of treatment for those patients with a high primary failure rate following radiotherapy are discussed.

Adult↗
PubMed1988

T3N0M0 glottic carcinoma--a pathologic analysis of 41 patients treated surgically following radiotherapy.

Forty-one patients undergoing surgery for recurrent or residual tumour following radical radiotherapy for T3N0M0 glottic carcinoma had their larynges evaluated pathologically by whole organ laryngeal sectioning. All patients had been staged initially as T3N0M0 glottic carcinoma and treated according to a protocol of radical radiotherapy (50-55 Gy in 4-5 weeks) with surgery reserved for radiation failure. Seventeen of the 41 patients died as a result of locoregional or distant recurrence or complications following surgery. Twenty-four patients were either alive or dead with intercurrent disease. Pathologic staging demonstrated 58% of these tumours to be rpT4, 29% rpT3 and the remainder rpT0-2. The incidence of major cartilage invasion, vascular or perineural invasion, and subglottic extension greater than 15 mm was more frequent in patients with locoregional recurrence than in patients without recurrence. The presence of these pathologic features had a positive predictive value of 0.78 in relation to probability of locoregional failure. In addition, there was a significant difference in the frequency of these pathologic features between patients with and without locoregional recurrence (P less than 0.001). The frequency of positive margins (19%) and pattern of involvement are described. The incidence of occult nodes (0%) in patients undergoing neck dissection is presented. The frequency (23%) and pattern of osteo-chondroradionecrosis are also described. The patterns of growth and spread observed were similar to those described previously. The importance of performing wide surgical resections in patients with recurrence following radiotherapy is emphasized.

Carcinoma, Squamous Cell↗
PubMed1987

The anatomy of external rhinoplasty.

The results achieved in rhinoplasty are directly related to the surgeon's ability to elucidate how subtle changes in the bony and cartilaginous supports of the nose will alter its appearance. Therefore, any surgeon who performs rhinoplastic procedures requires a sophisticated knowledge and understanding of the anatomy of the nose. This article reviews the anatomy of the nose from the perspective of the external rhinoplasty approach.

Humans↗
PubMed1987

Cryptic otalgia: a case of Munchausen syndrome in a pediatric patient.

This paper reports a case of Munchausen syndrome in a pediatric patient. The patient, a 13-year-old boy, presented with a complaint of persistent otalgia. As a result of the patient's deception of his physicians, he underwent numerous unnecessary investigations and two unnecessary operative procedures. The patient's deception included the simulation of a cerebrospinal fluid leak. The literature with respect to Munchausen syndrome in the pediatric patient is reviewed. Emphasis is placed on the fact that physicians, by their investigations and treatments, inflict most of the morbidity on this group of patients. Specific warning signals as well as an approach for management of these patients are also reviewed.

Adolescent↗
PubMed1986

Prognostic significance of thyroid gland involvement in laryngeal carcinoma.

We reviewed 173 laryngeal specimens that included thyroid tissue received from patients undergoing laryngectomy between 1966 and 1980 for evidence of thyroid gland invasion. Twenty-three (14%) of the larynges demonstrated thyroid involvement. In 15 specimens, involvement of the thyroid gland was by direct extension, and in eight the thyroid was involved metastatically. The survival in this group of patients was poor, with 18 patients dying of their disease within three years. Subglottic extension of 10 mm or greater was noted in 21 of 23 patients, and local recurrence was noted in 15 of 18 patients dying of their disease. The importance of removing one or both lobes of the thyroid gland in advanced laryngeal cancer is restated, and a surgically aggressive approach to the paratracheal nodes is recommended in patients with extensive subglottic involvement.

Adult↗