摘要:

AbstractBackground.Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding.Methods.Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double‐blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later.Results.Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 ± 106 mL and 602 ± 106 mL (p= 0.76), respectively. Six hours after surgery, blood collected was 159.3 ± 25.7 mL in the placebo group vs 151.4 ± 21 mL in the enoxaparin group (p= 0.81).Conclusion.Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism. © 1995 Jons Wiley&Son

ISSN:1043-3074    

DOI:10.1002/hed.2880170102

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.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≤ 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. © 1995 Jons Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880170103

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Patients with locally recurrent nasopharyngeal carcinoma benefit from reirradiation. A main barrier to successful palliation or cure is dose limitation secondary to normal tissue tolerance. There are many strategies to increase the tolerated dose to the recurrent lesions. Stereotactic radiosurgery for the treatment of these lesions has rarely been reported.Methods.Three patients with recurrent nasopharyngeal carcinoma were treated with linac‐based stereotactic radiosurgery.Results.One patient remained disease‐free 1 year after radiosurgery; the second patient had neurologic deterioration of uncertain etiology (complication vs recurrence) 6 months after radiosurgery; and the third patient had local recurrence 6 months after radiosurgery.Conclusion.Stereotactic radiosurgery can be used to deliver a boost dose of radiation to recurrent nasopharyngeal carcinomas. The technique is increasingly available and may offer some advantages compared with other techniques. Treatment recommendations are presented. © 1995 Jons Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880170104

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Conventional techniques of laryngoscopy for vocal cord palsy can sometimes be difficult or impossible to perform, and B‐mode real‐time ultrasonography has been previously reported by the authors to be helpful in these situations. In some cases, however, B‐mode ultrasonography can be inconclusive. We investigated whether color Doppler imaging can significantly improve vocal cord examination in these cases.Method.Ten normal volunteers were examined using the Acuson 128XP/5 with a 7‐MHz L7384 linear transducer. The thyroid cartilage was used as an acoustic window. Several distinct color flow patterns were observed with the subjects breathing quietly at rest, at the start of vocalization, and in prolonged phonation. Eight patients with hoarseness of voice were then examined by two separate observers in a double‐blinded fashion. The first observer performed B‐mode ultrasonography and color Doppler imaging, while the second observer performed indirect laryngoscopy and direct fiberoptic laryngoscopy.Results.Laryngoscopy was used as the standard for comparison. B‐mode real‐time ultrasonography correctly identified vocal cord palsy in three patients and normal vocal cords in one. The remaining four patients were reported as equivocal or normal. Color Doppler imaging correctly identified the problem in all eight patients.Conclusion.Color Doppler imaging for vocal cord examination is more sensitive than B‐mode real‐time ultrasonography, and seems to be as accurate as laryngoscopy in determining vocal cord palsy or paresis. © 1995

ISSN:1043-3074    

DOI:10.1002/hed.2880170105

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Vocal cord paralysis is generally associated with advanced thyroid malignancy. It may also be present in the setting of benign thyroid disease. This association may be incidental as well as causal.Methods.Retrospective review of cases with concurrent diagnosis of vocal cord paralysis and benign thyroid disease.Results.Eight cases found, all with documented vocal cord paralysis, by laryngoscopy. Four patients had nodular thyroid disease, but in two it was contralateral to the recurrent laryngeal nerve paralysis. The remaining patients had goiters of various sizes. Six patients were euthyroid, two on thyroid hormone replacement. Two patients were thyrotoxic: one had Graves' disease and the other had subacute thyroiditis.Conclusions.Vocal cord paralysis can be the result of benign thyroid disease by such mechanisms as compression, stretching, or inflammation. Malignant thyroid disease should always be ruled out in structural thyroid abnormalities. Vocal cord paralysis can also be an incidental finding unrelated to thyroid abnormality. © 1995 Jons Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880170106

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Multicystic benign lymphoepithelial lesions of the parotid gland (BLL) seen in patients with human immunodeficiency virus (HIV) can produce considerable cosmetic deformity as well as physical discomfort. We previously reported our preliminary results with low‐dose radiotherapy in this disease, and all 8 patients were satisfied with the initial improvement in their appearance. We now report the long‐term follow‐up of those patients and additional patients.Methods.Twelve HIV‐positive patients with BLL were treated with 8–10 Gy of external radiation using 2‐Gy daily fractions. Objective responses and subjective duration of patient‐defined cosmetic control were recorded.Results.All 12 patients (100%) had at least a 50% decrease in the size of their parotid masses. Five of 12 (42%) had a complete response and 7 (58%) had a partial response. Persisting complete response was achieved in only 1 patient, however, with relapse in the other 11 patients. Cosmetic palliation, as judged by the patients, was achieved for a median of 9.5 months. Eight patients were subsequently retreated with doses of 6–16 Gy (median and mode: 10 Gy). None (0%) of the 8 patients retreated achieved local control.Conclusions.Very low‐dose radiation (8–10 Gy) provides reliable but temporary cosmetic palliation for BLL. Retreatment was unsatisfactory, and we are now investigating higher initial doses of radiation to prolong palliation and eliminate recurrences. © 1995

ISSN:1043-3074    

DOI:10.1002/hed.2880170107

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Injury to the recurrent laryngeal nerve is a well‐recognized complication of thyroid surgery. Injury to the superior laryngeal nerve is less documented, perhaps due to the difficulty in recognizing its manifestations. This study was designed to document the incidence of injury to the superior laryngeal nerve in a series of patients who underwent thyroidectomy.Methods.Twenty consecutive patients with thyroidectomy during a 9‐month period underwent evaluation for superior laryngeal nerve injury 3 months postoperatively. Methods for evaluation included laryngeal videostroboscopy, laryngeal electromyography, and a subjective interview.Results.One patient (5%) was diagnosed with unilateral superior laryngeal nerve injury.Conclusions.The risk of injury to the superior laryngeal nerve during thyroidectomy is significant, and the result may be devastating to those patients who rely on their voices professionally. Laryngeal videostroboscopy and electromyography may be necessary to diagnose superior laryngeal nerve injury. © 1995 Jons Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880170108

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Anaplastic carcinoma of the thyroid gland is a lethal entity; few patients live more than 12 months following diagnosis. We retrospectively reviewed the experience with this entity at our cancer institute and identified a subgroup of patients with complete resection who have a 60% 5‐year survival.Methods.Twenty‐one cases of anaplastic carcinoma of the thyroid gland were analyzed retorspectively with respect to prognostic factors influencing survival. This represents 2.7% of 771 cases of thyroid cancer seen at our institution from 1968 to 1992. The median age at presentation was 65.1 years; male/female ratio was 1:1.1; and the most common symptom was a rapidly enlarging neck mass (76%).Results.Estimated 5‐year survival was 10% (median: 4.5 months). Tumor size less than 6.0 cm (p= .004) and female gender (p= .02) were significant prognostic factors. Five patients who underwent complete resection had an estimated 5‐year survival of 60% (median: 131 months). Four of these patients had postoperative radiotherapy with or without sequential chemotherapy. Two of these patients survived more than 10 years, and a third remains alive without disease at 26 months.Conclusions.Complete resection and multimodality therapy result in long‐term survival for a subgroup of patients with anaplastic thyroid carcinoma. © 1995 Jons Wiley

ISSN:1043-3074    

DOI:10.1002/hed.2880170109

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

年代:1995

数据来源: WILEY

ISSN:1043-3074    

DOI:10.1002/hed.2880170110

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

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.A retrospective study was performed on 51 patients with adenoid cystic carcinomas to see whether DNA ploidy, tumor stage, and histopathologic grading correlated with prognosis.Methods.Histopathologic grading was performed according to Szanto et al and DNA content was estimated from archived material using the technique by Hedley et al.Results.Thirty‐nine tumors were DNA diploid and 12 were DNA aneuploid. Histologic grade III was more often associated with DNA aneuploidy than the lower grades (p= 0.011). DNA ploidy also correlated with clinical stage (p= 0.011). Log‐rank analysis and Cox regression analysis of treatment failures revealed significant findings for S‐phase value and DNA ploidy.Conclusions.Our results indicate that DNA ploidy estimations, S‐phase value, and histologic grading are prognostic factors in adenoid cystic carcinomas. These examinations should therefore be incorporated in the evaluation of patients with adenoid cystic carcinomas. © 1995 Jons Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880170111

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

年代:1995

数据来源: WILEY