ISSN:1043-3074    

DOI:10.1002/hed.2880150602

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractSeventy‐five consecutive patients were selected to evaluate a disease‐specific quality‐of‐life questionnaire (UW QOL). The new test was compared to two established equality of life evaluation tools, the Karnofsky scale and the Sickness Impact Profile (SIP). Each test was administered on three separate occasions: (1) several days preoperatively; (2) immediately postoperatively; and (3) 3 months postoperatively.The Karnofsky scale is relatively crude and lacks the ability to measure subtle changes. The SIP is a detailed questionnaire that is quite sensitive to change. However, due to its length, the SIP is inefficient and expensive to administer, and patient noncompliance is often a problem.The three questionnaires were compared according to the following factors:Acceptability: 97% of the patients favored the UW QOL scale compared with the SIP because it was more concise and easier to complete.Validity: Validity indicates the ability of the test under investigation to measure what it was intended to measure. Using the SIP as a gold standard, the UW QOL scale demonstrated an average criterion validity of 0.849, whereas the Karnofsky average criterion validity was 0.826.Reliability: Reliability is a measurement of the reproducibility of the data. The UW QOL questionnaire scored>0.90 on reliability coefficients versus 0.80 for the Karnofsky and 0.87 for the SIP scale.Responsiveness: Responsiveness is the ability of the test to measure clinical change. The UW QOL scale faired better than the Karnofsky and the SIP scale in detecting change.The UW QOL scale is comparable to the Karnofsky and SIP scales when tested for validity and reliability. It was the preferred test format of 97% of patients and provided the greatest responsiveness to clinical

ISSN:1043-3074    

DOI:10.1002/hed.2880150603

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThe 1987 TNM classification system modified T and N definitions for squamous cell carcinomas of the head and neck. It did not change stage groupings (I through IV). The primary purpose of clinical staging is to divide patients into prognostically meaningful groups. The 1987 changes to the TNM T and N descriptions may not have removed the previously established heterogeneity within stage groups III and IV which existed before 1987. The development of a stage grouping system called TANIS (the T And N Integer Score), which is formed by adding the integer values of the T and N classifications, is reported herein.We compared the prognostic performance of T, N, TNM stage group, and TANIS stage for radiotherapy response and survival using data from 86 patients with newly diagnosed, measurable TNM II (oral cavity), and localized TNM III‐IV squamous cell carcinomas of the head and neck, excluding nasopharynx, who were randomized to test 5‐fluorouracil‐methotrexate sequencing. The sequencing of chemotherapy was shown to make no difference to prognosis. All patients received 60 Gy of radiotherapy in 6 weeks.As compared to T, N, and the TNM stage group system, TANIS was the single best predictor for a complete response to radiotherapy (p = 0.0005). TANIS was also the single best predictor for survival from randomization (p= 5 × 10−6). With the 86 patients divided into three groups (TANIS 2 to 3, 4, and 5 to 7), TANIS provided a better prognostic discrimination than did the TNM stage grouping method (TNM II, III, and IV). TANIS is a single index that combines T and N information in a simple way which was more strongly associated with radiotherapy response and survival than the traditional TNM stag

ISSN:1043-3074    

DOI:10.1002/hed.2880150604

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThe antiviral drug ribavirin was used as an adjunct to laser surgery for the treatment of patients with laryngeal papillomatosis (LP). An uncontrolled clinical trial for four patients with ribavirin treatment at a daily dose of 23 mg/kg was performed. Three adults received drug prior to laser surgery and continuing orally for 6 months. One infant was treated for 3 months. Two adults achieved complete remissions for at least 2 consecutive months, and both patients developed only minimal recurrent disease in 4 months of follow‐up. The other adult and the child sustained a partial response and an increased interval between the required surgeries. Ribavirin caused only a mild, reversible reduction in hemoglobin and reticulocytosis. This preliminary trial shows that ribavirin may be an effective therapy in combination with surgery for LP in a larger controlled clinical tria

ISSN:1043-3074    

DOI:10.1002/hed.2880150605

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:1043-3074    

DOI:10.1002/hed.2880150606

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractIntratumor DNA heterogeneity was investigated by flow cytometric analysis of multiple samples taken from different sites of 8 benign and 16 malignant primarily resected salivary gland tumors. All benign tumors had diploid DNA content. The overall incidence of DNA diploidy in 16 malignant cases examined was 50%. Intratumor differences in DNA ploidy were observed in four malignant tumors (25%); 2 of these 4 heterogenous tumors contained both aneuploid and diploid cell clones. The remaining 12 tumors showed a homogeneous DNA content in the different specimens; 8 were diploid, 3 aneuploid, and 1 was polypoid. The DNA nondiploid tumors were clinically more advanced than the DNA diploid ones (p<0.01). The tumor proliferation rate (fraction of cells in S‐phase) was higher in DNA nondiploid samples than in diploid ones (p<0.01). The DNA nondiploid tumors seemed to recur more often than DNA diploid ones did. The data emphasize the usefulness of DNA measurements for the characterization of malignant salivary gland tumors but also the importance of adequate sampling in assessing their DNA ploid

ISSN:1043-3074    

DOI:10.1002/hed.2880150607

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractInfrahyoid myocutaneous flap is one of the alternatives to be considered for the reconstruction of moderate defects following resection of the oral cavity, oropharynx, or hypopharynx cancers. The flap is based on the uni‐or bilateral superior thyroid pedicle; its major limitations are due to small flap volume and arc of rotation. The authors reviewed a series of 15 consecutive patients with carcinomas of the oral cavity or pharynx who underwent radical surgical resections followed by immediate reconstruction using an infrahyoid myocutaneous flap. Four of five cases with prior irradiation presented complications. The incidence of flap necrosis in this series (47%) was higher than that reported by others (10%). We consider the presence of massive neck metastasis and prior irradiation contraindications to the use of this fla

ISSN:1043-3074    

DOI:10.1002/hed.2880150608

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractWound infections resulting from contamination during major head and neck surgery continue to be a critical issue. In this study, specimens of pus or draining fluids from the wounds of 43 surgical patients who received perioperative administration of ampicillin/sulbactam or clindamycin were cultured for aerobic and anaerobic isolates to the species level. Polymicrobial infections were identified in 13 of 43 patients (30%); 82% of isolates were aerobic organisms (45 of 55), and 18% were anaerobic or facultative species (10 of 55). Nine of 43 patients (21%) showed no bacterial isolates from cultured material. Independent of the primary site of malignancy or antibiotics used, nine of 25 isolates (36%) obtained from patients who underwent concomitant dental extractions, but only one of 24 (4%) who did not, developed anaerobic infections, (p<0.001). The minimum inhibitory concentration of anaerobic isolates suggested sensitivity to the antibiotics used, and minimum bactericidal concentration data suggested that further postoperative doses may be required to adequately treat the heavily contaminated wounds. These data suggest that wound colonization following dental extraction procedures in clean contaminated head and neck surgery increases the risk of anaerobic infections. The use of a therapeutic dose and longer duration of perioperative antibiotics may be warranted.

ISSN:1043-3074    

DOI:10.1002/hed.2880150609

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractPanendoscopy 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 re

ISSN:1043-3074    

DOI:10.1002/hed.2880150610

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThis is a retrospective review of 409 cases of papillary thyroid cancer treated at the Hospital of Oncologia, National Medical Center, IMSS in Mexico City. The clinical features, histopathologic findings, analysis of recurrences and survivals according to age, sex, tumor size, and modality of treatment are described. The results showed that tumoral diameter>5 cm, distant metastasis at diagnosis, age>40 years, and tumoral infiltration beyond the thyroid capsule significantly affect the patient's survival.

ISSN:1043-3074    

DOI:10.1002/hed.2880150611

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY