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Biomedical subjects

S R Fisher

Publications and source records attributed to S R Fisher.

At least 37 records · Page 2Linked to original sources
PubMed1989

Mucosal melanoma of the head and neck.

From 1972 to 1988, 15 patients presented to the Duke University Melanoma Clinic, Durham, NC, with malignant melanoma of the mucus membranes of the upper aerodigestive tract. Eleven patients had a nasopharyngeal origin of their melanoma, while 4 patients had oropharyngeal lesions. The average age of the patients was 58.4 years. Median survival for the patients was 1.8 years, with a 5-year survival of approximately 10%. Survival was found to be independent of sex, tumor site, and extent of disease at presentation. Recurrence occurred in 80% of the patients and the median time to recurrence was 10 months. The median survival following recurrence was 13 months and was independent of the site of recurrence. Mucosal melanoma of the head and neck continues to result in a poor prognosis in spite of aggressive treatment.

Adult↗
PubMed1989

Survival following recurrent malignant melanoma of the head and neck.

A retrospective analysis of 877 patients who had malignant melanoma of the head and neck identified 366 patients who developed recurrent disease. Sex, race, age, histology, Clark level, thickness, ulceration, lymph node status, lymph node dissection, site of recurrence, and time to recurrence were analyzed to determine their effect on survival following the development of recurrent disease. Survival following the development of recurrence was found to be influenced by the site of first recurrence and the age of the patient at the time of recurrence. For a given age, patients who had initial recurrences at distant sites were three times as likely to die following recurrence than patients with local recurrence. Patients who had initial recurrences at distant sites were twice as likely to die following recurrence than patients with regional sites of recurrence (p less than 0.001).

Adult↗
PubMed1989

Cutaneous malignant melanoma of the head and neck.

A computer-aided analysis of 5,109 patients with malignant melanoma was performed. Patient population characteristics according to body site (head and neck, extremity, and trunk) were determined for the following parameters: sex, histologic type of melanoma, Clark's level, Breslow thickness, age, clinical status of regional nodes, presence or absence of ulceration, and recurrence. Head and neck melanomas accounted for 17% of the total population (N = 877). A detailed analysis of general population characteristics according to subsites within the head and neck region (ear, face, neck, nose, and scalp) was performed. Survival characteristics were determined for head and neck patients according to lymph node surgery, histologic type of tumor, and tumor thickness. The effect on survival of lymph node dissection (elective for stage I disease and therapeutic for stage II disease) was analyzed by univariate and multivariate methods. Elective lymph node dissection (ELND) was performed on 77 patients and 39 patients underwent therapeutic nodal dissection (TLND). Overall, survival was significantly improved following ELND as compared to TLND; however, multivariate analysis indicated the improved survival was related to variations of age within the population rather than the beneficial effect of lymph node surgery. Elective lymph node dissection did significantly reduce the incidence of recurrence for head and neck patients (p = 0.002). Since recurrence was demonstrated to be directly related to survival, the trend toward improved survival following ELND after 5 years was felt to be important. There was no difference in survival according to the histologic type of melanoma.

Adolescent↗
PubMed1988

Juvenile malignant melanoma of the head and neck.

Malignant melanoma of the head and neck is a potentially lethal disease and considered rare among juveniles. Treatment patterns have historically been dictated by experience with adults, however a paucity of data is available to determine the natural history and treatment guidelines for juveniles and children with malignant melanoma. Therefore a retrospective computer-aided analysis of patients less than 20 years of age having malignant melanoma were obtained from the records of 4,843 patients with malignant melanoma recorded from 1972 through 1986. Eighty-seven patients were identified from this group with 17 patients having primary malignant melanomas confined to the head and neck. Parameters evaluated were age at diagnosis, sex, type of melanoma, Clark Level, Breslow depth of invasion, pathologic classification, site of primary, nodal status at diagnosis, surgical treatment, recurrence rate and site of recurrence, and follow-up status. Two of 17 patients had stage II disease and were treated with wide local excision and therapeutic radical neck dissection. Fifteen of 17 patients initially presented with stage I disease were treated with wide local excision. Two of these patients underwent elective radical neck dissection both of which proved to have positive occult nodal disease. Both are alive without evidence of disease 2 1/2 to 7 years later. Of the 13 patients who were initially treated with only wide local excision, nine patients developed local (3), regional (3), or systemic (3) disease within 3 months to 9 years from the date of diagnosis. Seven of the nine died of their disease 5 months to 20 years later. When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survival time, but shorter disease-free intervals, even though the adult population had a higher percent of poor prognostic indices (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survival rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive approach for better control of local and regional disease and, hopefully, survival.

Adolescent↗
PubMed1987

A prospective study of squamous head and neck carcinoma. Immunologic aberrations in patients who develop recurrent disease.

In a prospective study of squamous head and neck cancer, the pretreatment peripheral blood of 125 patients was examined for lymphocyte subclass and in vitro immunologic function. After 4 years of follow-up, 49 recurrences of disease were observed. Lymphocytes from patients with recurrent disease showed elevated interleukin-2 (IL-2) production and a tendency towards increased response to mitogens in comparison to those without recurrence. When disease-free survival is analyzed on the basis of IL-2 levels, patients with high relative IL-2 synthesis (greater than or equal to 1) had a 40% poorer prognosis than patients with low relative IL-2 levels (less than 1). The difference is significant at a P value of 0.02. Since IL-2 synthesis occurs with antigenic stimulation, it is postulated that patients who have a high IL-2 synthesis in their pretreatment lymphocytes may have had prior stimulation by circulating tumor antigen. Such immune response by the host may be successful in destroying the antigenic tumor cells but may leave the undifferentiated, less antigenic tumor cells to grow and metastasize. Thus, elevated IL-2 synthesis in pretreatment lymphocytes predicts a poorer prognosis.

Carcinoma, Squamous Cell↗
PubMed1987

Sleep apnea and vocal cord paralysis secondary to type I Chiari malformation.

A previously healthy 13-year-old boy without myelodysplasia who had mild scoliosis was seen with complaints of nasal congestion, noisy nighttime breathing, and difficulty sleeping. Flattening of the inspiratory loop on the flow-volume curve was found on pulmonary function testing, suggesting a variable extrathoracic obstruction due to a laryngeal lesion. Bilateral abductor vocal cord paralysis and sleep apnea developed precipitously following general anesthesia. Further workup demonstrated a type-I Chiari malformation with syringomyelia. Brainstem abnormalities such as Chiari malformation with secondary tenth cranial nerve deficits should be considered in previously healthy children and adolescents with signs and symptoms of upper airway obstruction and apnea.

Adolescent↗
PubMed1986

Primary cutaneous lymphoma of the head and neck.

One hundred three patients with Stage I and II extranodal primary lymphomas of the head and neck were reviewed. Six patients (5%) presented with cutaneous lesions, five with single site and one with multiple sites of involvement. Histopathology was malignant lymphoma (ML) large cell (3), ML small cleaved cell (1), ML small lymphocytic (1), and ML mixed large and small cell (1). Five of six patients relapsed following initial treatment. Four patients were treated with primary radiation therapy, three of which had relapses outside the treatment area. One patient was treated with intralesional steroid injection and also recurred outside the treated area. One patient was treated with radiation and chemotherapy and recurred outside the treatment area. Three patients are alive without disease, two died of disseminated disease, and one died of unrelated causes. Isolated cutaneous presentation of head and neck lymphoma is uncommon. Radiation therapy appears to have been curative in one patient with localized disease. Four patients recurred outside the radiation portals despite careful staging, suggesting that systemic therapy may be necessary for disease control.

Aged↗
PubMed1985

Pharyngoesophageal reconstruction using free jejunal interposition grafts.

Forty patients underwent pharyngoesophageal reconstruction with a free jejunal interposition graft (FJIG). Three categories of disease were treated: (1) primary upper aerodigestive tract carcinomas, (2) recurrent carcinomas, and (3) benign pharyngoesophageal stenosis. There were no intraoperative graft failures. Postoperative complications included four perioperative deaths, eight late graft failures, three transient fistulas, eight distal graft strictures, one prolonged ileus, two postoperative hematomas, one abdominal wound dehiscence, one abdominal abscess, and one hypoglossal nerve palsy. Of the eight patients with late graft failures, three underwent successful jejunal reimplantation, yielding an overall success rate of 88% (35/40). The advantages of an FJIG are as follows: (1) a single-stage procedure for large defects, (2) a jejunal segment approximately the size of the pharyngoesophagus, (3) tissue that is able to tolerate radiation therapy, (4) maintenance of near-physiologic swallowing mechanism, (5) denervated small-bowel model, (6) excellent palliative procedure, and (7) shortened hospitalization. Disadvantages include (1) microvascular surgical technique, (2) abdominal procedure, and (3) limited esophageal speech.

Adult↗
PubMed1985

Revascularized jejunal graft replacing the cervical esophagus: radiographic evaluation.

Free jejunal autotransplantation is a successful surgical procedure for reconstruction of the cervical esophagus in treatment of carcinoma of the pharyngoesophagus. Radiographic assessment is essential in the postoperative evaluation of these patients. Twenty-two patients with jejunal autotransplants have been followed with radiographic examinations. Eleven of them have had normal postoperative studies. Acute and delayed complications characterized by anastomotic leaks, fistulae, and strictures have been observed in the other 11 patients. The techniques of radiographic examination and the radiographic features of the normal graft and associated complications are described.

Esophageal Neoplasms↗
PubMed1984

Carcinoma of the larynx and hypopharynx: computed tomographic-histopathologic correlations.

Twenty consecutive patients underwent computed tomography (CT) prior to total laryngectomy in order to assess the accuracy of CT scanning in the evaluation of carcinoma of the larynx and hypopharynx. CT scans were prospectively interpreted and the extent of tumor was recorded graphically at five major levels of the larynx. The extent of tumor was similarly evaluated on whole-mount histologic sections of the laryngeal specimens prepared in the horizontal plane similar to the CT scans. The results were compared to assess the ability of CT to identify tumor extent accurately. Despite good correlation of gross tumor extent between histologic specimens and CT scanning, specific pitfalls in CT diagnosis were identified. Overestimation of tumor extent was caused by edematous changes in six patients and tumor-associated inflammatory changes in three patients. In seven patients, mass effect from adjacent bulky tumor significantly distorted normal structures, mimicking tumor involvement. Small foci of mucosal tumor in three patients and microscopic cartilage involvement in two patients were not identified on CT scanning, causing underestimation of tumor extent.

Diagnostic Errors↗
PubMed1983

Cutaneous melanoma of the head and neck. A review of 399 cases.

A retrospective search of the Duke University Melanoma Clinic patients identified 399 cases with primary malignant melanoma located in the head and neck region. Ninety-five percent of the deaths in this series were from metastatic melanoma. Various clinical and pathological data were examined and their effects on survivability and disease-free intervals were evaluated. The characteristics noted included sex, age, depth of the invasion, thickness, site of the lesion, histologic type, and nodal status. A multivariate regression analysis identified the following factors as having a negative effect on survival: nodular histologic type, scalp primary, increasing Clark level, and male sex. In comparing head and neck, extremity, and truncal primary sites, the median survival for patients with head and neck malignant melanomas was notably less. These differences correlated with a higher incidence for male patients, for patients with thicker lesions, and for patients with an increased frequency of nodular histologic type.

Adolescent↗
PubMed1983

Application of posterior neck dissection in treating malignant melanoma of the posterior scalp.

Utilization of a posterior neck dissection in the treatment of nine patients with malignant melanoma of the posterior scalp is presented. Seven of nine patients presented with metastatic disease present in the posterior neck after initial treatment elsewhere. Four of the seven patients developed regional disease 4 months to 4 years following initial diagnosis. Variables dictating surgical treatment included the Clark's level, Breslow depth of invasion of original lesion, evidence of metastatic disease, and type of melanoma. The surgical technique of the posterior neck dissection is graphically depicted and the indications outlined. The posterior neck dissection is mandatory to adequately resect the primary lymphatics of the posterior scalp. Controlled studies are urged to determine the efficacy of prophylactic surgical lymphadenectomy in malignant melanoma of the head and neck.

Adult↗