摘要:

AbstractDentaScan is a unique new computer software program which provides computed tomographic (CT) imaging of the mandible and maxilla in three planes of reference: axial, panoramic, and oblique sagittal (or cross‐sectional). The clarity and identical scale between the various views permits uniformity of measurements and cross‐referencing of anatomic structures through all three planes. Unlike previous imaging techniques, the oblique sagittal view permits the evaluation of distinct buccal and lingual cortical bone margins, as well as clear visualization of internal structures, such as the incisive and inferior alveolar canals. Several case reports are presented to demonstrate the clinical usefulness of DentaS

ISSN:1043-3074    

DOI:10.1002/hed.2880150102

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

年代:1993

数据来源: WILEY

摘要:

AbstractThis study was designed to determine if long‐term palliation could be obtained in pre‐irradiated locoregional recurrent squamous head and neck cancer patients, with the administration of simultaneous chemoradiotherapy. Mandatory eligibility criteria were histologically documented squamous head and neck cancer in previously irradiated territory, surgical or brachytherapy salvage unfeasibility, or patient refusal. The protocol consisted of radiotherapy, at a rate of 5 daily fractions of 2 Gy on altermate weeks, with simultaneous continuous intravenous infusion of 5‐fluorouracil (5FU) at 800 mg/m2and oral hydroxyurea (HU) at 1.000–1,500 mg/day for 5 days. Tolerance was good. Acute toxicity was low with no grade ‐⩾ III WHO hematologic toxicity observed. Nine patients had grade III mucositis, one had grade IV, three had grade III skin toxicity, and only four patients required a 20% to 30% 5FU dose reduction because of it. Two patients had hand and foot syndrome, and two had asymptomatic 5FU‐related cardiac signs (1 ECG, 1 echographic + ECG). Chronic radiotherapy‐related effects consisted of Her mitte's sign observed in two patients. Of 34 registered patients, 33 were evaluable for response. An overall rate of 55% (18 patients) of objective responses [complete response (CR) + partial response (PR)] was obtained, with 12 patients (36%) achieving local control of disease. The median survival was 11 months. These data show that palliation could be obtained for the majority of responding patients, and also suggest an improvement in the immediate prognosis with this type of salvage procedure for a selected group of recurrent squamous head and neck

ISSN:1043-3074    

DOI:10.1002/hed.2880150103

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

年代:1993

数据来源: WILEY

摘要:

AbstractBetween 1964 and 1987, 194 patients with previously untreated squamous cell carcinoma of the floor of mouth were managed at the University of Florida. A retrospective analysis was undertaken in order to evaluate the treatment results and associated complication rates. Surgery or irradiation alone was found to result in similar local control rates for stage I and II lesions, whereas more advanced tumors had better local control rates with a combination of surgery and irradiation. Radiotherapy had a higher incidence of minor and moderate complications, whereas a greater number of severe complications occurred after surgery. We recommend surgery for early lesions due to the lower overall incidence of associated complications. Despite a higher risk of severe complications, combination therapy is recommended for more advanced lesions due to improved local control as compared to single modality therapy.

ISSN:1043-3074    

DOI:10.1002/hed.2880150104

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

年代:1993

数据来源: WILEY

摘要:

AbstractIn a series of 948 patients operated on for primary hyperparathyroidism (HPT) by one surgeon (JNA) from 1952 to 1992, there were 242 (26%) instances of coincidental thyroid and parathyroid disease. Of these, 211 had benign thyroid lesions. In the remaining 31 cases HPT was associated with nonmedullary thyroid carcinoma; all were treated by resection of parathyroid adenomas and thyroidectomy. One patient died of unrelated cause (carcinoma of breast) 11 years following surgery. The remaining 30 patients are living and well 2 to 20 (mean 8.2 years) years after surgery; there was no recurrence or thyroid cancerrelated mortality in the series. In contrast to prior reports, only six (20%) of our patients had a history of prior radiotherapy. We suggest that during neck exploration for HPT, the entire thyroid gland be evaluated and all palpable nodules resected and submitted to pathologic study.

ISSN:1043-3074    

DOI:10.1002/hed.2880150105

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

年代:1993

数据来源: WILEY

摘要:

AbstractRecent histopathologic evidence challenges the teaching that enlargement of a solitary parathyroid gland is invariably caused by an adenoma, whereas multiple gland enlargement results from hyperplasia. We have re‐examined the parathyroid tissue obtained from 152 consecutive patients undergoing surgery for primary hyperparathyroidism and compared it with their clinical outcome. Our approach was to excise enlarged glands and biopsy the remainder. In 124 patients (82%) at least three glands were biopsied or removed. The ratio of adenoma to hyperplasia was reversed by our histologic re‐examination; adenomas were found in only 27 patients (25 single, two double), whereas hyperplasia was found in 117 patients (one gland, 87 patients; two glands, 16 patients; three glands, five patients; four glands, nine patients). Normal tissue only was reported in eight patients. During a 2‐year follow‐up, five patients (3%) developed hypocalcemia and none developed recurrent hypercalcemia. Our results indicate that a full neck exploration with removal of all enlarged glands is more important than the histologic diagnosis in planning a successful surgical strategy for primary hyperparathy

ISSN:1043-3074    

DOI:10.1002/hed.2880150106

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe records of 130 consecutive patients undergoing marginal or segmental mandibulectomy for squamous cell carcinoma of the oral cavity or oropharynx were reviewed. An attempt was made to correlate incidence of recurrence with characteristics of the primary tumor and extent of mandibulectomy. The local recurrence rate was 19% following marginal mandibulectomy and 6% following segmental mandibulectomy. The incidence of local recurrence was independent of the size of the primary tumor or the extent of lymph node metastases. Neither mandibular invasion by tumor nor the addition of radiotherapy influenced local recurrence. Ten of 15 patients recurring locally after marginal mandibulectomy were salvaged by further surgery. This study suggests that local control following marginal mandibulectomy is comparable to that following segmental mandibulectomy regardless of the size of the tumor. Segmental mandibulectomy should be reserved for those tumors invading deeply into the mandible or wrapping around it.

ISSN:1043-3074    

DOI:10.1002/hed.2880150107

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

年代:1993

数据来源: WILEY

摘要:

AbstractWe performed 2,210 intraoperative frozen sections on 258 patients from the Otolaryngology–Head and Neck Surgery Service in 1990 and 1991. Surgery involved a wide variety of benign and malignant lesions. Techniques included biopsies for diagnosis, simple excisions, thyroid and salivary gland surgeries, lymph node biopsies, composite resections with radical neck dissections, laryngectomies, and skull base surgeries. During the 2‐year period, 1,947 (88.1%) sections were requested for evaluation of surgical margins, 258 (11.7%) for diagnosis, and five (0.2%) cases for tissue identification. There was disagreement between the frozen section and permanent section in 46 (2.1%) cases, and the deferral diagnosis rate was 0.8%. Disagreements were the result of sampling errors in 33 and interpretive errors in 13 cases. There were six (0.3%) false‐negative diagnosis of malignancy and four (0.2%) false‐positive diagnoses of malignancy. Three of these had an impact on patient care as discussed. We recommend careful sampling and sectioning of small biopsies and the need for vigilant communication between surgeon and path

ISSN:1043-3074    

DOI:10.1002/hed.2880150108

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

年代:1993

数据来源: WILEY

摘要:

AbstractBetween 1975 and 1985, 29 patients with the diagnosis of carcinoma of the petrous temporal bone were seen at the Princess Margaret Hospital. Twenty‐seven carcinomas were graded: 13 were well‐differentiated; the remaining 14 were either moderately or poorly differentiated tumors. Fifteen patients were managed with a combination of surgery and radiotherapy, 13 were treated with radiotherapy only, and one patient was treated by surgery alone. Median follow‐up time was 6.1 years, and the 5‐year actuarial local control and cause‐specific survival rates for the entire group were 40% and 50%, respectively. Age greater than 60 years, poor grade of tumor, and involvement of the facial nerve were three significant variables associated with poor outcome. A superior 5‐year actuarial local control was achieved with surgery plus postoperative radiotherapy (54%) compared to other treatment approaches. Based on the results from this review, we would continue to recommend a combined modality approach of surgery followed by postoperative radiotherapy in the management of this rare, but life‐threat

ISSN:1043-3074    

DOI:10.1002/hed.2880150109

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

年代:1993

数据来源: WILEY

摘要:

AbstractTen laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High‐resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstructio

ISSN:1043-3074    

DOI:10.1002/hed.2880150110

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

年代:1993

数据来源: WILEY

摘要:

AbstractActinomycotic infections of the cervicofacial area are rare and frequently show a confusing clinical picture. We report a case of actinomycosis that mimicked a neoplasm of the tongue. The clinical and pathologic features and the differential diagnosis of this unusual oral infection are discussed.

ISSN:1043-3074    

DOI:10.1002/hed.2880150111

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

年代:1993

数据来源: WILEY