PubMed Health⌕ Search

Biomedical subjects

T M McCulloch

Publications and source records attributed to T M McCulloch.

46 records · Page 3Linked to original sources
PubMed1989

Blood use in head and neck tumor surgery. Potential for autologous blood.

Recent increased concern regarding the risks of homologous blood transfusion led us to examine the use of blood products for head and neck tumor surgery. Major head and neck surgical procedures at three University of Washington (Seattle)-affiliated hospitals during 1987 were reviewed. Seventy-seven patients were identified. Parameters studied included the following: tumor site and stage, prior treatment, surgical procedure, preoperative and postoperative hematocrit values, estimated blood loss, operative and postoperative blood product use, and operative time. Data were grouped by procedure. Maxillectomy/midface procedures showed the highest average estimated blood loss (1037 mL) and the highest average blood use (1.5 units), followed by composite resections (883 mL and 0.8 units) and laryngectomies (724 mL and 0.9 units). When the data were subgrouped, larynogopharyngectomy (1450 mL and 4.0 units) and composite resection with mandibular swing (1300 mL and 1.0 units) showed the highest blood loss and blood product use. In the assessable groups, previous administration of radiation did not make a significant difference in blood loss or procedure time. However, blood loss correlated well with procedure time in all groups. The great majority of patients met all requirements to function as blood donors (84%). Sixty-five percent of patients met all criteria and used less than 2 units of blood, making autologous blood a reasonable option for the majority of patients with head and neck tumors.

Blood Transfusion, Autologous↗
PubMed1989

Perioperative complications and risk factors in the surgical treatment of obstructive sleep apnea syndrome.

A retrospective review of 135 patients surgically treated for obstructive sleep apnea syndrome (OSAS) from 1982 to 1987 was performed to identify perioperative complications and potential risk factors. The incidence of complications was 13% (18/135). Airway problems comprised 77% (14/18) of these complications, resulting in one death. There were three postoperative hemorrhages and one postoperative arrhythmia. Comparison of the complication group versus the noncomplication group showed a statistically significant difference in the minimum oxygen saturation (66% vs. 79%) and apnea index (75 vs. 57) on the pre-operative sleep study and in the amount of narcotic administered intraoperatively. Patients with intubation complications tended to be heavier, whereas patients with extubation complications received significantly more narcotic analgesia intraoperatively. Risk for a perioperative complication was not related to age, type of obstructive symptoms, medical problems, or concurrent septoplasty/tonsillectomy. A protocol for perioperative airway management is presented.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Neurotoxicity in a phase I trial of continuous infusion cisplatin with hyperfractionated radiotherapy for locally advanced head and neck cancer.

BACKGROUND: Both twice daily fractionated radiotherapy and concurrent cisplatin with once-daily radiotherapy have been shown to improve local disease control in patients with head and neck cancer. The objective of this phase I trial was to determine the maximum tolerated dose of cisplatin which could be given as a continuous infusion concurrent with twice-daily radiotherapy to patients with locally advanced head and neck cancer. METHODS: Patients were treated with radiotherapy at doses of 110 cGy twice daily for 5 days per week to a total dose of 7040-7590 cGy. Concurrent with radiotherapy, patients received continuous-infusion cisplatin for 5 days per week. Groups of 3-6 patients were treated with doses of 1-3 mg/m2/day. RESULTS: Central nervous system toxicity became dose-limiting. At 1 mg/m2, 2 mg/m2, and 3 mg/m2 confusion was observed and one patient had a seizure. At 3 mg/m2, another patient suffered severe sensory and motor neuropathy. Despite bulky tumors, 12 of the 14 patients had an objective response and 3 achieved a complete response. CONCLUSION: the combination of twice-daily fractionated radiotherapy and concurrent cisplatin by continuous infusion is severely toxic and achieves results similar to less toxic programs. It is not recommended for further investigation or therapy.

Adult↗
PubMedDate not supplied

Predictors of carcinomatous invasion of the mandible.

The preoperative assessment of mandibular invasion by oral or oropharyngeal squamous cell carcinoma poses a challenge for the head and neck surgeon. A study of 64 composite resection patients was performed to determine which variables in the patient's history, physical exam, and diagnostic workup had a predictive association with carcinomatous mandibular invasion. Four postoperative variables were included in this analysis. Thirty-nine percent of the mandibular specimens demonstrated cancerous involvement. A multivariate recursive partitioning statistical analysis was performed to create a decision tree. Branching was based on the two statistically predictive variables: computed tomographic (CT) scan results and primary tumor location. The guide provides improved predictive accuracy with a 100% negative predictive value (NPV) and a 46% positive predictive value (PPV). This decision guide should help the surgeon provide accurate patient counseling, anticipate reconstructive needs, and maximize surgical oncologic effectiveness.

Adult↗
PubMedDate not supplied

Risk factors for complications in clean-contaminated head and neck surgical procedures.

BACKGROUND: Contamination of a head and neck surgical wound with oropharyngeal secretions has been shown to dramatically increase the incidence of wound complications. Appropriate perioperative antibiotic prophylaxis has significantly reduced contaminated wound infection rates in several previous reports. The current study examined multiple patient parameters to determine risk factors for all perioperative complications following clean-contaminated head and neck surgical procedures. METHODS: Retrospective review of medical records from 159 patients who underwent clean-contaminated major head and neck surgical procedures at the University of Washington between 1985 and 1991. More than 30 preoperative and operative parameters were evaluated, and all complications were recorded. The data were examined using a multivariate statistical analysis. RESULTS: An overall complication rate of 63% included 22% with wound infections (oro/pharyngocutaneous fistula or purulent drainage), 22% with other types of infections, and 51% with noninfectious complications. The overall perioperative mortality rate was 1.2% (two patients). Prior radiotherapy, operative time, perioperative transfusion, and flap reconstruction were all associated with a significantly higher overall complication rate (p < or = 0.05). Only prior radiotherapy therapy correlated with an increase in wound infection rate (p = 0.05). CONCLUSIONS: Prior radiotherapy significantly increases the risk of perioperative complications and wound infections following clean-contaminated head and neck surgical procedures. Other factors reflecting the complexity of the procedure also influence the overall complication rate.

Adult↗
PubMedDate not supplied

Anomalies of forearm vascular anatomy encountered during elevation of the radial forearm flap.

BACKGROUND: The radial forearm flap has gained considerable popularity over the past 10 years. With the increasing number of forearm flaps being used in head and neck reconstruction, it is likely that anomalous forearm vascular anatomy will be encountered by more head and neck surgeons performing this procedure. METHODS: We reviewed our experience with 52 forearm flaps; four different anomalies of forearm vascular anatomy were encountered in four patients. In this article we present each of our cases and discuss the incidence, preoperative diagnosis, and recommended management of these and the more common forearm vascular anomalies. RESULTS: The anomalies encountered in our series include: one case of distal takeoff of the radial artery deep to the pronator teres muscle, two cases of a superficial dorsal antebrachial artery, one case of bilateral hypoplastic ulnar arteries, and one case of high takeoff of the radial artery. CONCLUSIONS: There are a number of anomalies of forearm vascular anatomy of clinical significance to the surgeon performing these procedures. Most of these anomalies can be identified with a careful preoperative examination. Surgeons performing this procedure should be familiar not only with the normal vascular anatomy of the forearm flap, but also with the more common anatomic variants. Failure to recognize or appropriately manage these anomalies of forearm vascular anatomy may result in a compromised surgical outcome.

Adolescent↗
PubMedDate not supplied

Trends in the use of tracheotomy in the pediatric patient: the Iowa experience.

BACKGROUND: The role of tracheotomy in airway management in children has been widely discussed. Improved medical care and technology have resulted in improved survival rates, and increased survival rates have been associated with changes in the indications for and the use of tracheotomy. The purpose of this review was to evaluate trends in the use of tracheotomy over a 15-year period. METHODS: We reviewed the medical charts of patients who underwent tracheotomy from 1975 to 1989 and analyzed them over three 5-year time intervals: Block 1, 1975-79; Block 2, 1980-84; and Block 3, 1985-89. RESULTS: In the defined age group, 305 patients underwent tracheotomy during the study period. Records from 281 patients were analyzed; the remaining charts either were unavailable for review or did not contain adequate documentation of the tracheotomy. We observed an increase in the number of tracheotomies over time, especially in the younger population. Across blocks, median age decreased, duration of tracheotomy increased, and indications for tracheotomy changed. CONCLUSIONS: Mean age, duration of tracheotomy, and indications for tracheotomy changed over the 15-year period. Additionally, these parameters were strongly related.

Adolescent↗
PubMedDate not supplied

Mortality in the pediatric patient with tracheotomy.

BACKGROUND: The mortality rate of children with tracheotomies is estimated to be between 11% and 40%, although the incidence of tracheotomy-related deaths is only between 0% and 3.4%. The purpose of this report was to analyze the mortality rate in children with tracheotomies. METHODS: A review of the medical records of children at the University of Iowa Hospitals and Clinics who underwent tracheotomy over a 15-year period ending in 1989 was performed. Data were analyzed in 5-year time blocks (Block 1, 1975 to 1979; Block 2, 1980 to 1984; and Block 3, 1985 to 1989). RESULTS: Fifty-two patients died with tracheotomy tubes in place. In 4 patients, the cause of death was tracheotomy related. Three of these patients were under 5 years of age and died secondary to tracheotomy tube displacement or obstruction; one patient, an 18-year-old, developed a fatal tracheotomy-related vascular hemorrhage. The average age of patients who died with tracheotomies decreased significantly from Block 1 to Block 3; in Block 3, mean age at the time of tracheotomy was significantly lower in patients who died than in patients who survived. A comorbidity score (CS) based on the number of airway diagnoses showed that higher CSs were associated with a poorer prognosis. CONCLUSIONS: Mortality does not seem to be strongly related to the presence of the tracheotomy tube. Overall, two diagnostic groups were found to be independently associated with a poorer prognosis, ie, mechanical ventilation and pulmonary disease. Tracheotomies performed to provide airway access during other surgical procedures were associated with a better prognosis.

Adolescent↗