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Sample records for radical neck dissection

  1. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

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    Henry Y. Lin

    2015-03-01

    Conclusion: Improved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

  2. Selective neck dissection: a review of the evidence.

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    Pagedar, Nitin A; Gilbert, Ralph W

    2009-01-01

    The management of regional metastatic disease in patients with oral cancer is a topic of controversy. Comprehensive neck dissection has been the mainstay of treatment historically, but clinicians have sought alternatives to limit the morbidity of the classic radical neck dissection. This article will review evidence on the applicability of selective neck dissection in two settings: as primary treatment of the clinically positive neck and as salvage treatment of recurrent neck disease after radiotherapy. In the text, for each article cited we supply the level of evidence thereof according to the Oxford Centre for Evidence-based medicine.

  3. Review of patients with dysphasia after a neck dissection

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    Yokoyama, Junkichi

    2007-01-01

    The most useful modality for treating neck metastasis is a neck dissection. A neck dissection was previously performed as a radical neck dissection. However, disabilities in shoulder movement and swallowing function often occur after this procedure. Recently, a functional neck dissection has therefore been performed in order to avoid such postoperative complications. The current study for dysphasia after a neck dissection investigates patients with primary unknown neck metastasis and neck recurrence after chemoradiation. Eleven cases of dysphasia occurred after a neck dissection between 2003 and 2006. These cases resected the lower cranial nerves (IX, X, XII), or paralysis of these nerves occurred despite their preservation after surgery. Patients with dysphasia underwent rehabilitation to regain their swallowing function. However, rehabilitation was unsuccessful and the patients were thus required to undergo further surgery. A neck dissection with resection of the lower cranial nerves (IX, X, XII) may sometimes result in dysphasia. Consequently, surgery to prevent dysphasia should be performed simultaneously so that timely postoperative therapy can be carried out. (author)

  4. Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer

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    Kim, Jinu; Shin, Eun Seow; Kim, Jeong Eon; Yoon, Sang Pil [Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Young Suk [Dept. of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2015-12-15

    Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.

  5. Quality of life after neck dissection. Multicenter study

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    Nibu, Ken-ichi; Onitsuka, Tetsuo; Kawabata, Kazuyoshi

    2010-01-01

    To assess the impact of modifications to radical neck dissection and radiotherapy on the postoperative quality of life, the study group 'Study on Standardization of Treatment for Lymph Node Metastasis of Head and Neck Cancer' performed a multicenter cross-sectional study using our self-administered neck dissection questionnaire and arm abduction test. While sparing levels IV and V improved most postoperative symptoms, such as stiffness and constriction of the neck were avoided as long as the sternocleidmastoid muscle (SCM) and the spinal accessory nerve were preserved. Resection of the SCM and spinal accessory nerve resulted in a drop shoulder and neck pain, respectively. Irradiation with a total dose of 50 Gy or more worsened stiffness of neck and shoulder. (author)

  6. Clinical analysis of neck dissection patients

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    Sato, Katsuro; Takahashi, Sugata

    2008-01-01

    Neck dissection is a highly important surgical procedure in the treatment of squamous cell carcinoma (SCC) of the head and neck since the control of the nodal disease is highly important in these patients. In this paper, 131 patients (210 necks) treated in our department were analyzed. The most frequent primary lesion site was the oral cavity, followed by larynx, hypopharynx and mesopharynx, and treatment of metastatic nodes was considered important especially in patients with SCC in those regions. As the surgical procedure for neck dissection, (modified) radical neck dissection was chosen for higher N stage cases, although it was also applied to lower N stage cases. Postoperative irradiation was performed for 70% of the patients, and control of the neck was considered good as recurrent neck disease occurred in 8% of the patients, and only 20% of those died of recurrent neck disease. The most common primary site showing cervical recurrence was the oral cavity, and control of neck disease is considered important, especially in patients with SCC of the oral cavity. Patients with ≤number of pN 1 receiving postoperative irradiation, and patients with pN (-) and ≤number of pN 1 without postoperative irradiation showed significantly higher survival rates. Postoperative irradiation should be done for patients with ≥number of pN 2, and follow-up without postoperative treatment should be considered for the cases of ≤number of pN 1. Further consideration of patient selection with regard to the area of dissection and the indication for postoperative irradiation without decreasing the survival rate is needed to further improve the treatment of head and neck SCCs. (author)

  7. Electrophysiologic analysis of injury to cranial nerve XI during neck dissection.

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    Lanisnik, Bostjan; Zargi, Miha; Rodi, Zoran

    2016-04-01

    Despite preservation of the accessory nerve, a considerable number of patients report partial nerve damage after modified radical neck dissection (MRND) and selective neck dissection. Accessory nerve branches for the trapezius muscle were stimulated during neck dissection, and the M wave amplitude was measured during distinct surgical phases. The accessory nerve was mapped in 20 patients. The M wave recordings indicated that major nerve damage occurred during dissection at levels IIa and IIb in the most proximal segment of the nerve. The M waves evoked from this nerve segment decreased significantly during surgery (analysis of variance; p = .001). The most significant intraoperative injury to the accessory nerve during neck dissection occurs at anatomic nerve levels IIa and IIb. © 2015 Wiley Periodicals, Inc. Head Neck 38: E372-E376, 2016. © 2015 Wiley Periodicals, Inc.

  8. Preservation of the External Jugular Vein in Bilateral Radical Neck Dissections: Technique in Two Cases and Review of the Literature

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    Rodrigo Lima Bastos da Rocha

    2015-01-01

    Full Text Available Context. The possibility of cephalic venous hypertension with the resultant facial edema and elevated cerebrospinal fluid pressure continues to challenge head and neck surgeons who perform bilateral radical neck dissections during simultaneous or staged procedures. Case Report. The staged procedure in patients who require bilateral neck dissections allows collateral venous drainage to develop, mainly through the internal and external vertebral plexuses, thereby minimizing the risks of deleterious consequences. Nevertheless, this procedure has disadvantages, such as a delay in definitive therapy, the need for a second hospitalization and anesthesia, and the risk of cutting lymphatic vessels and spreading viable cancer cells. In this paper, we discuss the rationale and feasibility of preserving the external jugular vein. Considering the limited number of similar reports in the literature, two cases in which this procedure was accomplished are described. The relevant anatomy and technique are reviewed and the patients’ outcomes are discussed. Conclusion. Preservation of the EJV during bilateral neck dissections is technically feasible, fast, and safe, with clinically and radiologically demonstrated patency.

  9. [Selective neck dissection for treating recurrent branchial anomalies].

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    Chen, Liangsi; Song, Xinhan; Zhang, Siyi; Han, Zhijuan; Luo, Xiaoning; Chen, Shaohua; Zhan, Jiandong

    2011-01-01

    To evaluate the role of selective neck dissection in the treatment of recurrent branchial anomalies. The clinical data of 18 patients with recurrent branchial anomalies were retrospectively analyzed. In accordance with the embryologic and anatomic features of branchial anomalies, different types of selective neck dissection were applied. With dissection and protection of important vessels, nerves and other structures, enbloc resection principles were applied to extirpate branchial lesions, scarrings and inflammatory granuloma during the operation. Of all 18 patients, 16 cases were healed with primary healing, 2 cases with local incision infection were healed after dressing changes. A temporary facial nerve paralysis occurred in 1 case with recurrent first branchial cleft fistula postoperatively, and completely recovered 2 months after operation. A postoperative temporary vocal cord paralysis occurred in 1 case with recurrent fourth branchial cleft fistula, and totally recuperated 1 month after operation. No recurrences were found in all 18 cases with a follow-up period of 12-78 months (average 35 months). Selective neck dissection is a safe and effective surgical procedure for the radical treatment of recurrent branchial anomalies.

  10. The utility of intraoperative ultrasound in modified radical neck dissection: a pilot study.

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    Agcaoglu, Orhan; Aliyev, Shamil; Taskin, Halit Eren; Aksoy, Erol; Siperstein, Allan; Berber, Eren

    2014-04-01

    Although the value of surgeon-performed neck ultrasound (SPUS) for thyroid nodules has been validated, the utility of intraoperative ultrasound (US) in modified radical neck dissection (MRND) has not been reported in the literature. The aim of this study was to analyze the utility of intraoperative SPUS in assessing the completeness of MRND for thyroid cancer. Between 2007 and 2011, a total of 25 patients underwent MRND by 1 surgeon for thyroid cancer. All patients underwent intraoperative SPUS, which was repeated at the end of the neck dissection (completion US) to look for missed lymph nodes (LNs). There were 10 male and 15 female patients. Pathology included 23 papillary and 2 medullary carcinomas. The number of LNs removed per case was 23 ± 2, and the number of positive was LNs 5 ± 1. In 4 (16%) cases, intraoperative US detected 7 residual LNs, which would have been missed, if completion US were not done. These missed LNs were located in low-level IV (3 nodes), high-level II (2 nodes), and posterior level V (2 nodes) and measured 1.4 ± 0.2 cm. At follow-up, recurrence was seen in 2 (8%) patients, including a superior mediastinal recurrence in a patient with tall cell cancer and a jugular LN recurrence at level II in another patient with papillary thyroid cancer. This pilot study shows that intraoperative SPUS can help assess the completeness of MRND. According to our results, intraoperative completion US identifies LNs missed by palpation 16% of the time.

  11. Internal jugular vein patency and treatment methods after neck dissection in patients with oral cancer

    International Nuclear Information System (INIS)

    Makiguchi, Takaya; Yokoo, Satoshi; Miyazaki, Hidetaka; Ogawa, Masaru; Takayama, Yu; Negishi, Akihide

    2014-01-01

    Stenosis and obstruction of the internal jugular vein (IJV) sometimes occur following modified radical neck dissection or selective neck dissection, in which the IJV is preserved. The objective of this study was to assess risk factors for stenosis or obstruction of the IJV following neck dissection. A total of 58 neck dissections performed in 51 patients by the same surgeon at Gunma University Hospital were retrospectively reviewed. The relationships of the patency of the IJV with gender, side of dissection, number of lymph node metastases, invasion out of the lymph node, radiotherapy, and reconstructive method were examined. The patency of the IJV was evaluated postoperatively using enhanced computed tomography. All cases with obstruction of the IJV received postoperative radiotherapy and neck dissection on the left side. Postoperative radiotherapy was a significant risk factor for obstruction of the IJV. Free flap reconstruction was not a risk factor for stenosis and obstruction. The rate of obstruction of the IJV was significantly decreased in cases with pectoral major musculocutaneous flap reconstruction or extended supraomohyoid neck dissection in which the muscle extensively covered the IJV. (author)

  12. Quality of life after planned neck dissection

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    Iwae, Shigemichi; Hirayama, Yuji; Komatsu, Hirokazu

    2009-01-01

    We evaluated the effect of planned neck dissection (PND) after concurrent chemoradiotherapy (CCRT) on quality of life (QOL) by using a self-administered neck dissection questionnaire and an arm abduction test. Subjects are fourteen patients who had undergone CCRT followed by planned selective neck dissection for the treatment of mesopharyngeal and hypopharyngeal cancer. The findings of the survey were compared with thirty-two patients who had undergone CCRT alone. Patients without PND had better scores on measures of pain, constriction, numbness and appearance of the neck, but had no advantage about arm abduction. After PND, the patients who had dissected dominant hand side had lower satisfaction compared with those who had dissected non-dominant hand side. (author)

  13. Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers

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    Jang, Na Young; Lee, Keun-Wook; Ahn, Soon-Hyun; Kim, Jae-Sung; Ah Kim, In

    2012-01-01

    The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer. We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy. Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC. The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy

  14. The impact on post-operative shoulder function of intraoperative nerve monitoring of cranial nerve XI during modified radical neck dissection.

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    Lanišnik, Boštjan; Žitnik, Lidija; Levart, Primož; Žargi, Miha; Rodi, Zoran

    2016-12-01

    Intraoperative monitoring of the cranial nerve XI (CN XI) may decrease shoulder disability following modified radical neck dissection. Prospective study was designed comparing results of Constant Shoulder Score (CSS), Shoulder Pain and Disability Index (SPADI) and EMG score of the trapezius muscle (mT) before and after surgery. One side of the neck was monitored during surgery with intraoperative nerve monitor. EMG scores of the mT 6 months postoperatively were statistically better on monitored as compared to the non-monitored side of the neck (p = 0.041), while the differences of the CSS and SPADI were not statistically significant. Patients with better EMG scores of the mT at 6 weeks recuperated better and with smaller decrease of the CSS. Intraoperative monitoring is beneficial at the beginning of the surgeon's learning curve and in the process of familiarizing with anatomical variation of the CN XI.

  15. Neck dissection following chemo radiation for node positive head and neck carcinomas

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    Thariat, J.; Thariat, J.; Marcy, P.Y.; Bozec, A.; Peyrade, F.; Hofman, P.; Hamoir, M.; Janot, F.; De Mones, E.; Marcy, P.Y.; Carrier, P.; Bozec, I.; Guevara, J.; Santini, J.; Albert, S.; Vedrine, P.O.; Graff, P.; Peyrade, F.; Hofman, P.; Bourhis, J.; Lapeyre, M.

    2009-01-01

    The optimal timing and extent of neck dissection in the context of chemo radiation for head and neck cancer remains controversial. For some institutions, it is uncertain whether neck dissection should still be performed up front especially for cystic nodes. For others, neck dissection can be performed after chemo radiation and can be omitted for N1 disease as long as a complete response to chemo radiation is obtained. The question is debated for N2 and N3 disease even after a complete response as the correlation between radiological and clinical assessment and pathology may not be reliable. Response rates are greater than or equal to 60% and isolated neck failures are less than or equal to 10% with current chemo radiation protocols. Some therefore consider that systematic up front or planned neck dissection would lead to greater than or equal to 50% unnecessary neck dissections for N2-N3 disease. Positron-emission tomography (PET) scanning to assess treatment response and have shown a very high negative predictive value of greater than or equal to 95% when using a standard uptake value of 3 for patients with a negative PET at four months after the completion of therapy. These data may support the practice of observing PET-negative necks. More evidence-based data are awaited to assess the need for neck dissection on PET. Selective neck dissection based on radiological assessment and preoperative findings and not exclusively on initial nodal stage may help to limit morbidity and to improve the quality of life without increasing the risk of neck failure. Adjuvant regional radiation boosts might be discussed on an individual basis for aggressive residual nodal disease with extra-capsular spread and uncertain margins but evidence is missing. Medical treatments aiming at reducing the metastatic risk especially for N3 disease are to be evaluated

  16. Planned neck dissection for oropharyngeal and hypopharyngeal cancers

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    Hanai, Nobuhiro; Hasegawa, Yasuhisa; Terada, Akihiro; Ozawa, Taijiro; Hirakawa, Hitoshi; Kawakita, Daisuke; Maruo, Takashi; Mikami, Shinnji

    2010-01-01

    Recently, the use of chemoradiotherapy for preserving organs in the treatment of head and neck cancer is increasing. However, there is controversy about advanced neck node management in post-chemoradiation cases. We retrospectively analyzed our 119 cases of chemoradiotherapy for oropharyngeal and hypopharyngeal cancer to examine the effectiveness and indications of planned neck dissection. Regional control rate and survival rate were superior in the neck dissection group. If the cases did not achieve complete response (CR) in imaging, planned neck dissection improved the regional control rate significantly. We should perform planned neck dissection immediately rather than 'wait and see' for this persistent disease. However, in the cases achieving radiological CR, it is possible to omit planned neck dissection because of the high salvage rate of neck disease. However, in these cases, careful observation is essential. We clarified that the presence of pathologically positive lymph node is a prognostic factor. For evaluating persistent disease of cervical lymph nodes, positron emission tomography (PET)-CT was the most accurate method of imaging. (author)

  17. [Postextubation laryngeal edema seven years after undergoing neck dissection].

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    Daijo, Hiroki; Habara, Toshie; Katagawa, Tomoko; Yoshikawa, Yukiko; Shinomura, Tetsutaro

    2008-05-01

    We report a case of upper airway obstruction after extubation in a 69-year-old female patient who underwent transurethral ureterolithotripsy (TUL). She had underwent bilateral modified radical neck dissection 7 years previously. TUL went smoothly in Trenderenburg position, and the extubation was performed after antagonism of neuromuscular block. The patient was closely observed in the operating theater, but about 10 minutes after extubation, she was noted to have dyspnea and tracheal tug. Dexamathasone 2 mg IV was given but was unsuccessful. Although we could support the airway with bag-mask ventilation, continuous stridor required re-intubation. Direct laryngoscopy revealed severe obstruction caused by laryngeal edema. An otolaryngologist was consulted and he performed tracheostomy. We transferred the patient to the intensive care unit for observation. Flexible fiberoptic scope examination performed on postoperative day (POD) 1 showed the decrease of the laryngeal edema. Tacheal tube was removed on POD 7 and she was discharged from the hospital POD 10 without further complications. Patients after a neck dissection may be at elevated risk for postoperative laryngeal edema caused by lymphatic destruction or venous congestion of the neck.

  18. Intraoperative monitoring of marginal mandibular nerve during neck dissection.

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    Tirelli, Giancarlo; Bergamini, Pier Riccardo; Scardoni, Alessandro; Gatto, Annalisa; Boscolo Nata, Francesca; Marcuzzo, Alberto Vito

    2018-05-01

    The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection. This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor. The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy. In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection. © 2018 Wiley Periodicals, Inc.

  19. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

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    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  20. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review.

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    Gane, E M; Michaleff, Z A; Cottrell, M A; McPhail, S M; Hatton, A L; Panizza, B J; O'Leary, S P

    2017-07-01

    Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form - Quantitative Studies. Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10-100%) compared with MRND (range, 0-100%) and SND (range, 9-25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5-20%). The prevalence of reduced neck active range of motion after neck dissection was 1-13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  1. Prediction of Neck Dissection Requirement After Definitive Radiotherapy for Head-and-Neck Squamous Cell Carcinoma

    International Nuclear Information System (INIS)

    Thariat, Juliette; Ang, K. Kian; Allen, Pamela K.; Ahamad, Anesa; Williams, Michelle D.; Myers, Jeffrey N.; El-Naggar, Adel K.; Ginsberg, Lawrence E.; Rosenthal, David I.; Glisson, Bonnie S.; Morrison, William H.; Weber, Randal S.; Garden, Adam S.

    2012-01-01

    Background: This analysis was undertaken to assess the need for planned neck dissection in patients with a complete response (CR) of involved nodes after irradiation and to determine the benefit of a neck dissection in those with less than CR by tumor site. Methods: Our cohort included 880 patients with T1-4, N1-3M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received treatment between 1994 and 2004. Survival curves were calculated by the Kaplan-Meier Method, comparisons of rates with the log–rank test and prognostic factors by Cox's proportional hazard model. Results: Nodal CR occurred in 377 (43%) patients, of whom 365 patients did not undergo nodal dissection. The 5-year actuarial regional control rate of patients with CR was 92%. Two hundred sixty-eight of the remaining patients (53%) underwent neck dissections. The 5-year actuarial regional control rate for patients without a CR was 84%. Those who had a neck dissection fared better with 5-year actuarial regional control rates of 90% and 76% for those operated and those not operated (p < 0.001). Variables associated with poorer regional control rates included higher T and N stage, non-oropharynx cancers, non-CR, both clinical and pathological. Conclusions: With 92% 5-year neck control rate without neck dissection after CR, there is little justification for systematic neck dissection. The addition of a neck dissection resulted in higher neck control after partial response though patients with viable tumor on pathology specimens had poorer outcomes. The identification of that subgroup that benefits from additional treatment remains a challenge.

  2. Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-Modulated Radiotherapy?

    International Nuclear Information System (INIS)

    Yao Min; Hoffman, Henry T.; Chang, Kristi; Funk, Gerry F.; Smith, Russell B.; Tan Huaming; Clamon, Gerald H.; Dornfeld, Ken; Buatti, John M.

    2007-01-01

    Purpose: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. Methods and Materials: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography in recent years. Results: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. Conclusions: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection

  3. Neck and Upper Limb Dysfunction in Patients following Neck Dissection: Looking beyond the Shoulder.

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    Gane, Elise M; O'Leary, Shaun P; Hatton, Anna L; Panizza, Benedict J; McPhail, Steven M

    2017-10-01

    Objective To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function. Study Design Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Inclusion criteria: patients treated with neck dissection (2009-2014). aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function. Results Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98). Conclusion Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.

  4. EFFECTIVENESS OF SALVAGE SELECTIVE AND MODIFIED RADICAL NECK DISSECTION FOR REGIONAL PATHOLOGIC LYMPHADENOPATHY AFTER CHEMORADIATION

    NARCIS (Netherlands)

    van der Putten, Lisa; van den Broek, Guido B.; de Bree, Remco; van den Brekel, Michiel W. M.; Balm, Alfons J. M.; Hoebers, Frank J. P.; Doornaert, Patricia; Leemans, C. René; Rasch, Coen R. N.

    2009-01-01

    Background. The objective of this study was to evaluate the effectiveness and safety of our careful observational strategy and neck dissections and the accuracy of ultrasound-guided fine-needle aspiration cytology, and to determine the prognostic factors for outcome and regional control after

  5. Validity and QOL of neck dissection preceding radiation therapy for hypopharyngeal cancer

    International Nuclear Information System (INIS)

    Uemura, Hirokazu; Yoshino, Kunitoshi; Fujii, Takashi; Suzuki, Motoyuki

    2009-01-01

    Thirty-one cases of hypopharyngeal cancer with neck dissection preceding radiation and 16 cases of hypopharyngeal cancer with neck dissection for locoregional recurrences after radiation were reviewed in order to make comparative evaluations of difficulty in surgical operation, postoperative complications, laryngeal preservation rate, and cause specific 5-year survival rate retrospectively. And quality of life (QOL) after neck dissection was additionally evaluated through the questionnaire. Since neck dissection preceding radiation for hypopharyngeal cancer may be superior to neck dissection for radiation failure, with easy surgical approach an non-lymphoid tissue preservation, that modality can be a reasonable choice of treatment for patients with nodal lesions, which are probably difficult to treat with radiation alone. Even though further investigation on QOL questionnaire is necessary, this modality can make a contribution to the neck and shoulder condition after neck dissection. (author)

  6. The effect of neck dissection on quality of life after chemoradiation.

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    Donatelli-Lassig, Amy Anne; Duffy, Sonia A; Fowler, Karen E; Ronis, David L; Chepeha, Douglas B; Terrell, Jeffrey E

    2008-10-01

    To determine differences in quality of life (QOL) between patients with head and neck cancer who receive chemoradiation versus chemoradiation and neck dissection. A prospective cohort study was conducted at two tertiary otolaryngology clinics and a Veterans Administration hospital. 103 oropharyngeal patients with Stage IV squamous cell carcinoma treated via chemoradiation +/- neck dissection. self-administered health survey to collect health, demographic, and QOL information pretreatment and 1 year later. QOL via SF-36 and HNQoL. Descriptive statistics were calculated for health/clinical characteristics, demographics, and QOL scores. t tests evaluated changes in QOL over time. Sixty-five patients underwent chemoradiation and 38 patients underwent chemoradiation and neck dissection. Only the pain index of the SF-36 showed a significant difference between groups (P < 0.05) with the neck dissection group reporting greater pain. After post-treatment neck dissection, patients experience statistically significant decrement in bodily pain domain scores, but other QOL scores are similar to those of patients who underwent chemoradiation alone.

  7. Scoping review of the literature on shoulder impairments and disability after neck dissection.

    Science.gov (United States)

    Goldstein, David P; Ringash, Jolie; Bissada, Eric; Jaquet, Yves; Irish, Jonathan; Chepeha, Douglas; Davis, Aileen M

    2014-02-01

    The purpose of this article was to provide a review of the literature on shoulder disability after neck dissection. A literature review was performed using Ovid Medline and Embase databases. A total of 306 abstracts and 78 full-text articles were reviewed. Forty-two articles were eligible for inclusion. Patients undergoing nerve-sacrifice neck dissections have greater disability and lower quality of life scores than those undergoing neck dissections with the least manipulation (ie, selective neck dissections). Shoulder impairments can still occur in patients undergoing selective neck dissections. Disability typically improves over time in patients undergoing nerve-sparing neck dissections. There was significant variability in the literature in terms of the prevalence and recovery of shoulder morbidity after neck dissection. This variability may not just be related to surgical technique or rehabilitation, but also to study design, definitions, and the variability in disability questionnaires used. Copyright © 2013 Wiley Periodicals, Inc.

  8. Combined neck dissection and postoperative radiation therapy in the management of the high-risk neck: a matched-pair analysis

    International Nuclear Information System (INIS)

    Lundahl, Robert E.; Foote, Robert L.; Bonner, James A.; Suman, Vera J.; Lewis, Jean E.; Kasperbauer, Jan L.; McCaffrey, Thomas V.; Olsen, Kerry D.

    1998-01-01

    Purpose: The purpose of this study was to determine the efficacy of postoperative adjuvant radiation therapy with regard to reducing the rate of recurrence in the neck, cancer-related death, and death from any cause in patients with squamous cell carcinoma of the head and neck region metastatic to neck nodes. Methods: This was a retrospective review of patients with pathologically confirmed nodal metastases who underwent neck dissection and postoperative adjuvant radiation therapy for squamous cell carcinoma of the head and neck region. Time to recurrence in the dissected area of the neck, any recurrence in the neck, cancer-related death, and death from any cause were estimated with the Kaplan-Meier method. A matched-pair analysis was performed utilizing a cohort of patients who underwent neck dissection without postoperative radiation therapy. The patients from the two cohorts were matched according to previously reported high-risk features for cancer recurrence and death. Cox hazards models for the matched pairs were used to evaluate the relative risk of subsequent recurrence in the dissected side of the neck, any neck recurrence, cancer-related death, and overall survival. Materials: The medical records and pathologic slides of 95 consecutive patients with pathologically confirmed nodal metastases from squamous cell carcinoma of the head and neck region who underwent neck dissection and postoperative adjuvant radiation therapy between January 1974 and December 1990 were reviewed. Previously published data from 284 patients with squamous cell carcinoma of the head and neck region treated with neck dissection alone between January 1970 and December 1980 were used for a matched-pair analysis. Results: The relative risks for recurrence in the dissected side of the neck, any neck recurrence (dissected neck or delayed undissected neck metastasis), cancer-related death, and death from any cause for patients treated with operation alone relative to those treated with

  9. Risk of marginal mandibular nerve injury in neck dissection

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Sørensen, Christian Hjort

    2012-01-01

    The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons...... in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7......% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered...

  10. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy.

    Science.gov (United States)

    Bellangino, Mariangela; Verrill, Clare; Leslie, Tom; Bell, Richard W; Hamdy, Freddie C; Lamb, Alastair D

    2017-11-07

    Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could

  11. Treatment results of neck dissection with the preservation of cervical nerves for hypopharyngeal cancer

    International Nuclear Information System (INIS)

    Hasegawa, Toshifumi; Iwae, Shigemichi; Tanaka, Hironori; Yonezawa, Kouichiro; Inoue, Kenzo

    2007-01-01

    Treatment results of neck dissection with the preservation of cervical nerves for hypopharyngeal cancer were analyzed retrospectively by comparing neck dissection with the preservation of cervical nerves and that with the resection of cervical nerves. Pharyngolaryngectomy or pharyngolaryngoesophagectomy with bilateral neck dissection was performed in 76 hypopharyngeal cancer cases between January 1992 and November 2001. Neck dissection with the resection of cervical nerves was performed on 42 sides of the neck in 21 cases (the cervical nerve-resected group). In 55 cases we attempted to employ neck dissection with the preservation of cervical nerves, but in 9 cases the cervical nerves were resected because of their nodal adhesion or involvement Neck dissection with the preservation of cervical nerves was performed on 92 sides of the neck in 46 cases (the cervical nerve-preserved group). There were significant differences between background factors of two groups about age, sex, induction chemotherapy, preservation of accessory nerve, and pN classification. The 5-year cumulative control rates of cervical lymph nodes were 81.3% for the cervical nerve-resected group and 79.7% for the cervical nerve-preserved group. There was no significant difference between the two groups. It was suggested that neck dissection with the preservation of cervical nerves for cases whose cervical nerves were able to be preserved from metastatic lymph nodes under induction chemotherapy and post-operative irradiation was as effective to control cervical lymph nodes as neck dissection with the resection of cervical nerves. (author)

  12. The role of postradiotherapy neck dissection in supraglottic carcinoma

    International Nuclear Information System (INIS)

    Chan, Annie W.; Ancukiewicz, Marek; Carballo, Natalia; Montgomery, William; Wang, C.C.

    2001-01-01

    Purpose: To evaluate our policy of performing neck dissection based on regional response after definitive radiotherapy in patients with supraglottic carcinoma and to identify the prognostic factors in this group of patients. Methods and Materials: Between 1970 and 1995, 121 patients with node-positive squamous cell carcinoma of the supraglottic larynx were treated with definitive radiotherapy. Sixty-nine percent of patients presented with 1997 AJCC Stage IV disease. The N-stage distribution was N1, 49; N2, 62; and N3, 10. The median size of the lymph nodes was 3 cm (range, 0.5-8 cm). Forty-five patients received once-a-day treatment with a median total dose of 65 Gy (range, 58.0-70.8 Gy) in 1.8-2.0 Gy per fraction over 48 days, and 76 patients received split-course accelerated hyperfractionation with a median total dose of 67.2 Gy (range, 63.2-73.6 Gy) in 1.6 Gy twice a day over 43 days. Patients whose lymph nodes were not clinically detectable at 4-6 weeks after the completion of radiotherapy (complete response) were followed without any neck dissection. Patients with persistent neck adenopathy (partial response) underwent neck dissection whenever possible. Mean follow-up of the living patients was 6.5 years. Results: Regional response was related to the size of lymph nodes at presentation. Eighty-seven percent of patients with nodal size of 3 cm or less had a complete response, whereas 43% of patients with nodal size greater than 3 cm had a partial response. The rate of regional control at 3 years for all patients in the study was 66%. The 3-year ultimate regional control rate after salvage neck dissection was 75%. A relapse in both the primary and regional sites was the most common pattern of relapse, accounting for 39% of all the failures. Local failure was associated with subsequent regional relapse with a relative risk of 4.3. For patients with completeresponse in whom postradiotherapy neck dissection was withheld, the regional control rates were 75% and 86

  13. Neck dissection with harmonic scalpel and electrocautery? A randomised study.

    Science.gov (United States)

    Verma, Roshan K; Mathiazhagan, Arulalan; Panda, Naresh K

    2017-10-01

    Is the use of harmonic scalpel for neck dissection useful? Literature search did not show a single, prospective, randomised control trial. We intended to study the role of harmonic scalpel in neck dissection and compare it with conventional electrocautery technique for oral cavity carcinoma. 40 patients undergoing selective neck dissection for primary oral cavity malignancy were enrolled in this study. The harmonic scalpel (HS) group consisted of 20 patients, and the electrocautery technique (ET) group comprised of 20 patients. The following variables were examined: intraoperative blood loss, operative time, number of ligatures used, postoperative drain, and postoperative hospital stay. Intraoperative blood loss was found to be significantly reduced in harmonic scalpel group as compared to electrocautery group. However, we found no difference in other parameters like operative time, postop drain, postoperative hospital stay and number of ligatures used between both groups. Harmonic scalpel for neck dissection is associated with significantly lesser intraoperative blood loss as compared to electrocautery. There is no effect on operative time and postoperative hospital stay in both groups. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. OK-432 sclerotherapy of cervical chylous lymphocele after neck dissection.

    Science.gov (United States)

    Roh, Jong-Lyel; Park, Chan Il

    2008-06-01

    Postoperative cervical chylous lymphoceles are extremely rare circumscribed collections of lymph which are usually treated by drainage or surgical exploration, but rarely by sclerotherapy. We investigated the efficacy of OK-432 (Picibanil, Chungai Pharmaceutical Co., Tokyo, Japan) sclerotherapy in the treatment of cervical lymphocele after neck dissection. Four patients with postoperative lymphocele who could not be cured by repeated percutaneous needle aspiration and pressure dressing were treated with intralesional injection of 0.1-0.2 mg OK-432 after aspiration of fluid. The aspirated fluid was assessed biochemically and cytologically, and regular palpation and ultrasonography/computed tomography were used to evaluate outcomes and recurrences. Two patients with chyle leak during neck dissection had lymphoceles in the left supraclavicular region 3 weeks later. The other two patients had lymphoceles on the right neck 9 and 12 months, respectively, after neck dissection. All aspirated fluids were chylous in origin without tumor cells. OK-432 sclerotherapy scored all four lesions with no major complications except for fever and local pain for several days. No lymphocele recurrences or metastatic cancers were observed in any patient for >1 year after sclerotherapy. Intralesional injection of OK-432 may be a safe and effective alternative to surgical exploration in the treatment of cervical lymphocele after neck dissection.

  15. The relationship between physical impairments, quality of life and disability of the neck and upper limb in patients following neck dissection.

    Science.gov (United States)

    Gane, Elise M; McPhail, Steven M; Hatton, Anna L; Panizza, Benedict J; O'Leary, Shaun P

    2018-05-16

    The purpose of this study was to examine the relationship between physical impairments, quality of life and disability in patients following neck dissection, with consideration of patient and clinical characteristics. Cross-sectional study of patients < 5 years after neck dissection for head and neck cancer. Quality of life and self-reported disability were measured with the Neck Dissection Impairment Index, Quick Disabilities of the Arm, Shoulder and Hand, and Neck Disability Index. Active neck and shoulder range of motion and isometric muscle strength were also assessed. Generalised linear modelling was used to explore relationships between variables. Eighty-four participants (68% male, median age 61 years) demonstrated reduced quality of life (median (interquartile range) score = 76 (49, 93) from 0 (worst) to 100 (best)), and mild levels of upper limb (14 (2, 32)) and neck disability (14 (6, 28)) (from 0 (best) to 100 (worst)). Bilateral neck dissection was associated with reduced quality of life (coeff (95% CI) = - 12.49 (- 24.69, - 0.29)). Post-operative chemoradiation therapy was associated with reduced quality of life (- 21.46 (- 37.57, - 5.35)) and neck disability (0.71 (0.10, 1.32)). Measures of shoulder flexibility or strength were associated with quality of life and self-reported disability. Quality of life and musculoskeletal disability after neck dissection are associated with factors from multiple domains including physical motor function and treatment modality. Having reduced shoulder flexibility or strength is related to functional deficits and quality of life after neck dissection for head and neck cancer.

  16. Planned neck dissection after weekly docetaxel and concurrent radiotherapy for advanced oropharyngeal cancer

    International Nuclear Information System (INIS)

    Tomita, Toshiki; Ozawa, Hiroyuki; Sakamoto, Koji; Fujii, Ryoichi; Ogawa, Kaoru; Fujii, Masato; Yamashita, Taku; Shinden, Seiichi

    2007-01-01

    Small oropharyngeal carcinomas with advanced neck metastases (stage N2 or greater) are common. Patients with small T with large N oropharyngeal carcinoma have high rates of local control but lower rates of regional control when treated with chemoradiotherapy. Clinical assessment after chemoradiotherapy cannot ensure the absence of neck disease. In the last 5 years, we have treated patients with T1-2 with N2-3 oropharyngeal carcinoma with weekly docetaxel radiotherapy followed by planned neck dissection (PND). Our objectives were to clarify the pathologically complete response (CR) rate of neck metastasis after weekly docetaxel radiotherapy, to identify the clinical predictor of residual neck disease, and to determine the mobidity of planned neck dissection. After chemoradiotherapy, all 12 patients had a complete response at the primary site. We conducted 15 neck dissections. Of these, 6 (40%) had positive nodes. The pathological CR rate of neck metastasis was 58.3%, whereas overall 2-year neck control rate was 91.7%. These findings lend support to the role of PND after chemoradiotherapy in N2-3 neck disease. After chemoradiotherapy, clinical parameters including TN status, feasibility of chemoradiotherapy, largest lymph node size or size reduction in MRI, did not identify patients with residual neck disease. We conducted selective neck dissection (SND) in 80% of patients. SND as PND appears to be appropriate in this group of patients because of the low incidence of complications. A further cohort study including the comparison of PND nonenforcement group is necessary to clarify the validity of the addition of PND in weekly docetaxel radiotherapy. (author)

  17. Indications of elective neck dissection and postoperative radiotherapy for parotid cancers

    International Nuclear Information System (INIS)

    Shibata, Tomohisa; Yonezawa, Kouichiro; Morimoto, Koichi; Yamashita, Daisuke; Otsuki, Naoki; Nishimura, Hideki; Sasaki, Ryohei; Nibu, Ken-ichi

    2011-01-01

    Regional lymph node metastases significantly influence the prognosis of patients with parotid cancer. To assess our indications of elective neck dissection and postoperative radiotherapy for parotid cancer, a retrospective chart review was performed. Between 2001 and 2009, 35 patients with parotid cancer were initially treated at our department. The median follow-up was 30 months (range, 10-90 months). Out of all patients, 31 (89%) patients were preoperatively diagnosed as malignant, while 4 (11%) patients were initially diagnosed as benign. Mucoepidermoid carcinoma was the most common histological type (10 patients). Twenty-two tumors (63%) were pathologically diagnosed as high-grade. The numbers of patients with Stages I, II, III, and IVA were 3, 10, 7, and 15, respectively. Ipsilateral neck dissection (Level II-V) was performed in seven patients with clinically positive neck metastasis (cN+), and in ten patients without lymph node metastasis who had T4 disease, high-grade malignancy, or positive neck (Level II) metastasis during intraoperative evaluation. Postoperative radiotherapy was performed in 24 patients with pathological T4, high-grade malignancy, positive surgical margin, multiple neck metastasis and/or extranodal extension (ENI). Seven of 28 (25%) patients with clinically N0 had pathologically positive neck metastasis (pN+). Regional recurrence developed in one patient with high-grade malignancy and ENI (T4N2b). Disease-specific survival rates for Stages I, II, III, and IVA at 3 years were 100%, 73%, 100%, and 37%, respectively. Loco-regional control rates for pN0 (21 patients) and pN+ (14 patients) at 3 years were 90% and 95%, respectively. Our present favorable loco-regional control supported our current indications of elective neck dissection and postoperative radiotherapy. We also recommend intraoperative biopsy of level IIB nodes to study the need for elective neck dissection. (author)

  18. Long-term regional control after radiation therapy and neck dissection for base of tongue carcinoma

    International Nuclear Information System (INIS)

    Lee, Henry J.; Zelefsky, Michael J.; Kraus, Dennis H.; Pfister, David G.; Strong, Elliot W.; Raben, Adam; Shah, Jatin P.; Harrison, Louis B.

    1997-01-01

    Purpose: Minimal literature exists with 10-year data on neck control in advanced head and neck cancer. The purpose of this study is to determine long-term regional control for base of tongue carcinoma patients treated with primary radiation therapy plus neck dissection. Methods and Materials: Between 1981-1996, primary radiation therapy was used to treat 68 patients with squamous cell carcinoma of the base of tongue. Neck dissection was added for those who presented with palpable lymph node metastases. The T-stage distribution was T1, 17; T2, 32; T3, 17; and T4, 2. The N-stage distribution was N0, 10; N1, 24; N2a, 6; N2b, 11, N2c, 8; N3, 7; and Nx, 2. Ages ranged from 35 to 77 (median 55 years) among the 59 males and nine females. Therapy generally consisted of initial external beam irradiation to the primary site (54 Gy) and neck (50 Gy). Clinically positive necks were boosted to 60 Gy with external beam irradiation. Three weeks later, the base of tongue was boosted with an Ir-192 interstitial implant (20-30 Gy). A neck dissection was done at the same anesthesia for those who presented with clinically positive necks, even if a complete clinical neck response was achieved with external beam irradiation. Neoadjuvant cisplatin-based chemotherapy was administered to nine patients who would have required a total laryngectomy if their primary tumors had been surgically managed. The median follow-up was 36 months with a range from 1 to 151 months. Eleven patients were followed for over 8 years. No patients were lost to follow-up. Results: Actuarial 5- and 10-year neck control was 96% overall, 86% after radiation alone, and 100% after radiation plus neck dissection. Pathologically negative neck specimens were observed in 70% of necks dissected after external beam irradiation. The remaining 30% of dissected necks were pathologically positive. These specimens contained multiple positive nodes in 83% despite a 56% overall complete clinical neck response rate to irradiation

  19. Fusiform-shaped nodules along the internal carotid artery demonstrated by follow-up sonography within the dissected neck area in patients with oral cancer

    International Nuclear Information System (INIS)

    Hayashi, Takafumi; Katsura, Kouji; Taira, Shuhzou; Shingaki, Susumu; Hoshina, Hideyuki

    2004-01-01

    In order to distinguish benign from malignant nodules within the dissected neck area in patients with oral cancer during the follow-up period, we retrospectively evaluated the frequency and characteristic findings of fusiform-shaped nodules along the internal carotid artery observed by follow-up sonography. From 1997 to 2003, 52 patients with oral cancer, who underwent radical neck dissections, were enrolled in this study. The study cohort consisted of 33 males and 19 females ranging in age from 29 to 84 years (mean, 62.0 years). After neck dissection, every patient was examined repeatedly with sonography during the follow-up period at an interval of one month. CT and/or MRI were performed when clinically required. Any patient with recurrent neck mass was excluded from this study. In the 52 patients, fusiform-shaped nodules were observed in 10 patients (19%) by the follow-up sonography. The nodules were homogenously hypoechoic and the margin was well-demarcated except for the upper end. A hyperechoic core was clearly observed in every nodule, which showed a fatty density on post-contrast CT. On post-contrast MRI, the nodules enhanced markedly and the core showed hypointensity on fat saturated images. In conclusion, it was suggested that the fusiform-shaped nodules observed by follow-up sonography within the dissected neck area might be the superior cervical ganglion of sympathetic trunk. However, further studies are needed to disclose the true character of the nodules. (author)

  20. Blunt apical dissection during anatomic radical retropubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Yacoub Saif

    2009-02-01

    Full Text Available Abstract Background Meticulous apical dissection during a radical prostatectomy is imperative to achieve desirable pathologic and quality of life outcomes. Findings We describe a novel technique using careful blunt dissection to better delineate the apex of the prostate, providing a simple means to potentially lessen positive surgical margins at the apex and promote better continence and erectile function in men undergoing an anatomic radical prostatectomy. Median operative time and blood loss were 190 minutes and 675 mL, respectively. Only 10 percent of the patients with positive surgical margins were found to have apical positive surgical margins. Ninety-three percent of patients reported no urinary leakage. Conclusion We believe our technique of isolating the DVC with blunt dissection and then ligating and transecting the DVC to be feasible approach that requires larger studies to truly confirm its utility.

  1. Viable tumor in salvage neck dissections in head and neck cancer : Relation with initial treatment, change of lymph node size and human papillomavirus

    NARCIS (Netherlands)

    van den Bovenkamp, Karlijn; Dorgelo, Bart; Noordhuis, Maartje G; van der Laan, Bernard F A M; van der Vegt, Bert; Bijl, Hendrik P; Roodenburg, Jan L; van Dijk, Boukje A C; Oosting, Sjoukje F; Schuuring, Ed M D; Langendijk, Johannes A; Halmos, Gyorgy B; Plaat, Boudewijn E C

    Objectives: To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections. Materials and Methods: Retrospective analysis of 76 salvage neck dissections after radiotherapy alone (n = 22), radiotherapy in

  2. Shoulder complaints after nerve sparing neck dissections

    NARCIS (Netherlands)

    van Wilgen, CP; Dijkstra, PU; van der Laan, BFAM; Plukker, JTM; Roodenburg, JLN

    The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least I year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the

  3. Shoulder pain and disability in daily life, following supraomohyoid neck dissection : a pilot study

    NARCIS (Netherlands)

    van Wilgen, CP; Dijkstra, PU; Nauta, JM; Vermey, A; Roodenburg, JLN

    Introduction: The purpose of this pilot study was to assess shoulder morbidity; i.e. pain and disability in daily activities, at least I year after unilateral or bilateral supraomohyoid neck dissection. Patients and methods: 52 patients having been subjected to a supraomohyoid neck dissection

  4. Morbidity after neck dissection in head and neck cancer patients : a study describing shoulder and neck complaints, and quality of life

    NARCIS (Netherlands)

    Wilgen, Cornelis Paul van

    2004-01-01

    In this thesis we are aiming at more insight in morbidity after head and neck cancer treatment (resection of the primary tumour, neck dissection and pre-or post-operative radiation therapy). We will study shoulder complaints and the role of the spinal accessory nerve, pain and the underlying pain

  5. Can neck irradiation be an alternative to neck dissection in early stage carcinoma oral tongue operated for primary alone? Experience from a single institute

    Directory of Open Access Journals (Sweden)

    Sushmita Ghoshal

    2016-07-01

    Full Text Available Purpose: To study pattern of failure, locoregional control rates (LCR and disease free survival (DFS in post-operative patients of carcinoma oral tongue, and to study the impact of nodal dissection on DFS in stage I and II patients.Methods: 102 patients of carcinoma oral tongue treated between January 2009 and December 2013 were analyzed. All patients were operated for primary disease, but neck dissection was done in 78 (76.5% patients only. However, radiation to primary site along with neck region was received by all patients. Pattern of failure, LCR and DFS were estimated.Results: At median follow up of 12 months, 10.8% patients failed locally, 10.8% in nodal region, 2.9% both at local and nodal site, and 5.9% patients failed distally. 2 year LCR and DFS was 71.2%, 90.9%, 79.5%, 0% and 55.2%, 64.4%, 57.8%, 0% in stage I, II, III, IV respectively. 2 year DFS in stage I patients, who underwent nodal dissection and post-operative radiation (14 patients was 64.3% and in whom only neck irradiation was done (15 patients, it was 45.8%, however difference was not significant (p = 0.5. But in stage II patients, 33 patients who underwent nodal dissection and post-operative radiation, 2 year DFS was 85.4% and it was 21.4% in 7 patients who underwent neck radiation only, and difference showed trend towards significance (p = 0.05. 2 or more positive lymph nodes post dissection was the only poor prognostic factor that correlated with DFS (p = 0.02Conclusion: While in stage I, neck irradiation alone can be a possible alternative to neck dissection and post-operative radiation; for stage II, neck dissection is mandatory.

  6. Resection of recurrent branchial cleft deformity using selective neck dissection technique.

    Science.gov (United States)

    Cai, Qian; Pan, Yong; Xu, Yaodong; Liang, Faya; Huang, Xiaoming; Jiang, Xiaoyu; Han, Ping

    2014-07-01

    This study explores application of selective neck dissection technique in recurrent second, third, and fourth branchial cleft deformities. A total of 19 cases of recurrent second, third, and fourth branchial cleft deformities were treated using the selective neck dissection technique, during which the sternocleidomastoid muscle, cervical anterior muscle, and carotid sheath were contoured. The lesion above the prevertebral fascia was then resected en bloc. Finally, the opening of the internal fistula was ligated and sutured using the purse-string approach. Patients in this study had no injures to their internal carotid artery, jugular vein, vagus nerve, accessory nerve, hypoglossal nerve, or recurrent laryngeal nerve. There were also no complications such as poor wound healing. The patients were monitored for 7-73 months and showed no recurrences. Using selective neck dissection to treat second, third, and fourth branchial cleft deformities resulted in en bloc lesion resections and reduced the chance of recurrence. Contouring the sternocleidomastoid muscle, strap muscle, and carotid sheath is key to the surgical procedure, as it leads to en bloc lesion resection while retaining the recurrent laryngeal nerve and carotid sheath. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Predictive factors for perioperative blood transfusion in neck dissection.

    Science.gov (United States)

    Abu-Ghanem, Sara; Warshavsky, Anton; Carmel, Narin-Nard; Abu-Ghanem, Yasmin; Abergel, Avraham; Fliss, Dan M; Yehuda, Moshe

    2016-04-01

    There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND). Retrospective cohort study. Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction. Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery. Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  8. A comparison of electrothermal bipolar vessel sealing system and electrocautery in selective neck dissection.

    Science.gov (United States)

    Ozturk, Kerem; Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gursan, Gulce; Akyildiz, Serdar

    2016-11-01

    The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.

  9. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center

    DEFF Research Database (Denmark)

    Rubek, Niclas; Channir, Hani Ibrahim; Charabi, Birgitte Wittenborg

    2017-01-01

    (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September...... bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N......-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may...

  10. Squamous cell carcinomas of the soft palate treated with radiation therapy alone or followed by planned neck dissection

    International Nuclear Information System (INIS)

    Erkal, Haldun S.; Serin, Meltem; Amdur, Robert J.; Villaret, Douglas B.; Stringer, Scott P.; Mendenhall, William M.

    2001-01-01

    Purpose: The present study presents the experience at the University of Florida with treatment of unselected patients with carcinomas of the soft palate with radiation therapy (RT) alone or followed by planned neck dissection. Methods and Materials: One hundred seven patients treated with curative intent with RT alone or followed by neck dissection from 1965 to 1996 were included in the study. All patients had follow-up for at least 2 years. No patients were lost to follow-up. Results: Local control rates at 5 years were 86% for T1, 91% for T2, 67% for T3, and 36% for T4 carcinomas. T-stage and overall treatment time significantly affected local control in multivariate analysis. Nodal control rates at 5 years were 86% for N0, 76% for N1, 61% for N2, and 67% for N3 carcinomas. Overall treatment time and planned neck dissection significantly affected nodal control in multivariate analysis. Ultimate local-regional control rates at 5 years were 90% for Stage I, 92% for Stage II, 84% for Stage III, and 60% for Stage IV disease. Overall treatment time and planned neck dissection significantly affected ultimate local-regional control in multivariate analysis. The overall survival rate at 5 years was 42% for all patients. Overall stage, overall treatment time, and planned neck dissection significantly affected overall survival in multivariate analysis. The cause-specific survival rate at 5 years was 70% for all patients. Overall treatment time and planned neck dissection significantly affected cause-specific survival in multivariate analysis. Three patients sustained severe postoperative complications and 3 patients sustained severe late complications. Sixteen patients had synchronous and 14 patients had metachronous carcinomas of the head and neck mucosal sites. Conclusion: For limited carcinomas of the soft palate, RT (alone or followed by planned neck dissection) results in relatively high local-regional control and survival rates. For advanced carcinomas of the soft

  11. [Planned neck dissection in the treatment of locally advanced head and neck squamous cell carcinoma].

    Science.gov (United States)

    Jiang, L; Lou, J L; Wang, K J; Fang, M Y; Fu, Z F

    2018-02-07

    Objective: To investigate the value of planned neck dissection combined with induction chemotherapy and concurrent chemoradiotherapy in regional control and the outcome of locally advanced head and neck squamous cell carcinoma. Methods: A prospective randomized controlled study totally enrolled sixty-four patients of head and neck squamous cell carcinomas(include oropharynx, hypopharynx, and larynx) in stages Ⅳa-Ⅳb with lymph node metastase was were N2-N3. All patients firstly received 2-3 cycles of induction chemotherapy(ICT), then divided into two groups randomly, according to the efficacy of ICT. Group A(the study group) received planned neck dissection(PND) and concurrent chemoradiotherapy(CCRT). Group B(the control group) received concurrent chemoradiotherapy(CCRT). The differences in clinicopathologic features, local recurrence(LR), regional recurrence(RR), disease-free survival(DFS), and overall survival(OS) between the two groups were estimated. SPSS 19.0 software was used to analyze the data. Results: Group A enrolled twenty-one patients, and group B enrolled forty-three patients.The follow-up of all patients were 4-55 months, median follow-up time was 22 months. In study group, two-year OS and DFS were 80.9% and 68.3%, respectively. In control group, two-year OS and DFS were 90.7% and 67.1%, respectively. There was no significant difference in gender( P =0.215), age( P =0.828), primary tumor site( P =0.927), LR( P =0.126), DFS( P =0.710), and OS( P =0.402) between the two groups, while the RR(χ(2)=5.640, P squamous cell carcinoma.

  12. Anatomical study of phrenic nerve course in relation to neck dissection.

    Science.gov (United States)

    Hamada, Tomohiro; Usami, Akinobu; Kishi, Asuka; Kon, Hideki; Takada, Satoshi

    2015-04-01

    The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers (30 sides). In each, the phrenic nerves was dissected from the lateral side of the neck, and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle. In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb's point where the superficial point is 2-3 cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle. It is necessary to be aware of the supraclavian triangle below Erb's point during neck dissection procedures.

  13. Ultrasound-Guided Fine Needle Aspiration Cytology in the Assessment of Cervical Metastasis in Patients Undergoing Elective Neck Dissection

    International Nuclear Information System (INIS)

    Dabirmoghaddam, Payman; Sharifkashany, Shervin; Mashali, Leila

    2014-01-01

    In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients’ survival. To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis. Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique. Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests. In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection

  14. Shoulder complaints after neck dissection; is the spinal accessory nerve involved?

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    The purpose of the current study was to investigate the relation between shoulder morbidity (pain and range of motion), and the function of the spinal accessory nerve after neck dissection. Identifying dysfunction of the nerve gives insight in the mechanisms of post-operative shoulder complaints. In

  15. Conservative neck dissection in oral cancer patients: A 5 years retrospective study

    Directory of Open Access Journals (Sweden)

    Wan Mahadzir Wan Mustafa

    2016-06-01

    Full Text Available The impact of ablative oral cancer surgery was studied, with reference to recurrence and nodal metastasis,  survival probability and prognostic indicators and to determine if ethnicity influences the survival of patients. Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and assessed. Those with stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009 were included in this study. All individuals had a pre-operative assessment and post operative assessment. Survival distributions were analyzed using Kaplan-Meier curves. Eighty seven patients (males: 38%; females: 62% were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal and primary site recurrence was 5.7% and 20.5%. The median survival time was 57 months. One year Overall Survival (OS rate was 72.7% and three year overall survival rate 61.5%. The log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033. Recurrence-Free Survival (RFS analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. The three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001. Conservative neck effectively controls neck metastases. Ethnicity influence  survival.

  16. Predictors of health-related quality of life in patients treated with neck dissection for head and neck cancer.

    Science.gov (United States)

    Gane, Elise M; McPhail, Steven M; Hatton, Anna L; Panizza, Benedict J; O'Leary, Shaun P

    2017-12-01

    Patients with head and neck cancer can report reduced health-related quality of life several years after treatment. The aim of this study was to identify risk factors for reduced quality of life in patients up to 5 years following neck dissection. This cross-sectional study was conducted at two hospitals in Brisbane, Australia. Patients completed two measures of quality of life: the Neck Dissection Impairment Index (NDII), a region- and disease-specific tool, and the Assessment of Quality of Life-4 Domains, a general tool. Generalised linear modelling was used to determine which demographic and clinical variables were associated with quality of life. The cohort included n = 129 patients (71% male, median age 61, median 3 years since surgery). Positive nodal disease was associated with better quality of life on the NDII [e.g. N2 vs N0 coeff (95% CI) = 22.84 (7.33, 38.37)]. Worse quality of life was associated with adjuvant treatment [e.g. Independent Living domain model: surgery with chemoradiation vs surgery only coeff (95% CI) = -0.11 (-0.22, -0.01)]. Positive nodal disease was associated with better quality of life, which may be a reflection of response shift. Multimodality treatment leads to worse quality of life compared with surgery only.

  17. Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jinbo Huang

    Full Text Available Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery.A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs with 95% confidence intervals (CIs to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs for continuous outcomes.A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01, seroma development[OR: 0.49 (0.34, 0.70; P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01 and wound complications [OR: 0.38 (0.24, 0.59; P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85.Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for

  18. Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

    NARCIS (Netherlands)

    Stuiver, Martijn M.; van Wilgen, Cornelis P.; de Boer, Erlijn M.; de Goede, Cees J. T.; Koolstra, Muriel; van Opzeeland, Anita; Venema, Piet; Sterken, Margriet W.; Vincent, Andrew; Dijkstra, Pieter U.

    OBJECTIVE: To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. STUDY DESIGN: Prospective. PATIENTS AND METHODS: Shoulder pain, shoulder mobility, and shoulder

  19. Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

    NARCIS (Netherlands)

    Stuiver, M.M.; van Wilgen, C.P.; de Boer, E.M.J.; de Goede, C.J.T.; Koolstra, M.; van Opzeeland, A.; Venema, P.; Sterken, M.W.; Vincent, A.; Dijkstra, P.U.

    2008-01-01

    Objective: To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. Study Design: Prospective. Patients and Methods: Shoulder pain, shoulder mobility, and shoulder

  20. Role of Neck Dissection in Clinical T3N0M0 Lesion of Oral Cavity: Changing Trend.

    Science.gov (United States)

    Dass, Arjun; Singhal, Surinder K; Punia, Rps; Gupta, Nitin; Verma, Hitesh; Budhiraja, Shilpi; Salaria, Minakshi

    2017-08-01

    Neck dissection is an important part in the management of head and neck malignancies especially in terms of control of nodal metastasis. The study is focused on evaluating the profile of lymph nodes in T 3 N 0 M 0 lesion of different subsides of oral cavity. To evaluate the utility of neck dissection in T 3 N 0 M 0 stage of carcinomas of the different region of oral cavity. Ninety patients aged 20 to 70 years underwent treatment for carcinoma of the oral cavity at our center between 2005 and 2013. Of these, 39 patients were stage T 3 N 0 M 0 and underwent excision of the primary lesion with neck dissection. The data were collected retrospectively from hospital record library. These patients were evaluated clinically, radiologically and compared with intra operative finding. Addition of radiotherapy was decided on final histopathology. Out of 39 patients, the site of primary tumour in 21 patients was tongue, in 13 patients was Buccal Mucosa (BM), in 2 patients was lip and in 3 patients was Floor of Mouth (FOM) with tongue. In patients with clinically negative neck nodes, ultrasonography and intra-operative examination revealed the presence of suspicious nodes in 35.9% and 30.7% cases respectively. Occult metastasis in the nodes was identified on histopathological examination in 15 patients (38.5%). A total of 14 patients of carcinoma of tongue and one patient of BM showed positive nodes on histopathology. These patients with positive neck nodes on histopathology, were sent for postoperative radiotherapy. At follow up examination, four patients showed local and distal recurrence and they were managed accordingly. Out of 39 patients, 11 patients of BM, 2 patients of lip, 1 patient of FOM and 6 patients of tongue were disease free in last follow up. Selective neck dissection is an effective therapeutic intervention in patients without clinically involved neck nodes. It can upstage the tumour and additional treatment may be advised. In patients with carcinoma of buccal

  1. Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis.

    Science.gov (United States)

    Huang, Jinbo; Yu, Yinghua; Wei, Changyuan; Qin, Qinghong; Mo, Qinguo; Yang, Weiping

    2015-01-01

    Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery. A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes. A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; Pelectrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85). Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.

  2. Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

    NARCIS (Netherlands)

    Stuiver, Martijn M.; van Wilgen, Cornelis P.; de Boer, Erlijn M.; de Goede, Cees J. T.; Koolstra, Muriel; van Opzeeland, Anita; Venema, Piet; Sterken, Margriet W.; Vincent, Andrew; Dijkstra, Pieter U.

    2008-01-01

    To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. Prospective. Shoulder pain, shoulder mobility, and shoulder droop, as well as scores on shoulder disability

  3. Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial.

    Science.gov (United States)

    Khan, Salma; Khan, Shaista; Chawla, Tabish; Murtaza, Ghulam

    2014-03-01

    To test the hypothesis that the use of a harmonic scalpel increases operative time but results in less estimated blood loss, postoperative pain, drainage volume, and duration of surgery, as well as fewer complications, such as flap necrosis, seroma, and surgical site infection (SSI), than electrocautery. This parallel-group, single-institution blinded randomized controlled trial was conducted at the department of surgery of our institute between April 2010 and July 2011. Women undergoing modified radical mastectomy were randomly allocated to either harmonic dissection (n = 76) or electrocautery (n = 76). Both the groups were comparable for baseline variables with age of 50.5 ± 12.2 and 48.5 ± 14.5 years in the harmonic and electrocautery groups, respectively. Harmonic dissection yielded better outcomes compared to electrocautery with lower estimated blood loss (100 ± 62 vs. 182 ± 92, p electrocautery (r2 = 0.28, β = 11.8, p < 0.001). The harmonic scalpel significantly reduces postoperative discomfort and morbidity to the patient without increasing operating time. We thus recommend preferential use of harmonic dissection in modified radical mastectomy. (ClinicalTrials.gov NCT01587248).

  4. The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer.

    Science.gov (United States)

    Shirley, Lawrence A; Jones, Natalie B; Phay, John E

    2017-01-01

    Papillary thyroid cancer (PTC) is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. The most common site for nodal metastases from PTC is the central compartment of the ipsilateral neck in the paratracheal and pretracheal regions. The decision to resect these lymph nodes at the time of thyroidectomy often depends on if nodes with suspected malignancy can be identified preoperatively. If nodal spread to the central neck nodes is known, then the consensus is to remove all nodes in this area. However, there remains significant controversy regarding the utility of removing central neck lymph nodes for prophylactic reasons. Herein, we review the potential utility of central neck lymph node dissection as well as the risks of performing this procedure. As well, we review the potential of molecular testing to stratify patients who would most benefit from this procedure. We advocate a selective approach in which patients undergo clinical neck examination coupled with ultrasound to detect any concerning lymph nodes that warrant additional evaluation with either fine needle aspiration or excisional biopsy in the operating room. In lieu of clinical lymphadenopathy, we suggest the use of patient and disease characteristics as identified by multiple groups, such as the American Thyroid Association and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, when deciding to perform central neck lymph node dissection. Patients should be educated on the potential long-terms risks versus the lack of known long-term benefits.

  5. The Role of Central Neck Lymph Node Dissection in the Management of Papillary Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Lawrence A. Shirley

    2017-06-01

    Full Text Available Papillary thyroid cancer (PTC is the most common thyroid malignancy, and cervical nodal metastases are frequent at presentation. The most common site for nodal metastases from PTC is the central compartment of the ipsilateral neck in the paratracheal and pretracheal regions. The decision to resect these lymph nodes at the time of thyroidectomy often depends on if nodes with suspected malignancy can be identified preoperatively. If nodal spread to the central neck nodes is known, then the consensus is to remove all nodes in this area. However, there remains significant controversy regarding the utility of removing central neck lymph nodes for prophylactic reasons. Herein, we review the potential utility of central neck lymph node dissection as well as the risks of performing this procedure. As well, we review the potential of molecular testing to stratify patients who would most benefit from this procedure. We advocate a selective approach in which patients undergo clinical neck examination coupled with ultrasound to detect any concerning lymph nodes that warrant additional evaluation with either fine needle aspiration or excisional biopsy in the operating room. In lieu of clinical lymphadenopathy, we suggest the use of patient and disease characteristics as identified by multiple groups, such as the American Thyroid Association and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, when deciding to perform central neck lymph node dissection. Patients should be educated on the potential long-terms risks versus the lack of known long-term benefits.

  6. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN

    2001-01-01

    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a

  7. Treatment results of the neck by concurrent chemoradiotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Tokumaru, Yutaka; Fujii, Masato; Habu, Noboru; Yajima, Yoko; Yorozu, Atsunori

    2009-01-01

    Concurrent chemoradiotherapy (CCRT) is one of the recent emerging modalities for advanced squamous cell carcinoma of the head and neck (HNSCC). However some of the patients treated by CCRT have residual or recurrent cervical lymph nodes. In these cases, neck dissection is considered to be useful in the point of locolegional control and disease free survival. This study aims to analyze neck control rate by CCRT and usefulness of the neck dissection after CCRT for HNSCC. The medical records of 69 consecutive patients (stage III: 4%, stage IV: 96%) treated with CCRT for SCCHN (hypopharynx: 40, oropharynx: 25, larynx: 4) from 2003 through 2007 were reviewed. Clinical complete response (CR) rates of N1, N2a, N2b, N2c and N3 were 75%, 100%, 71%, 74% and 43% respectively. Among the patients with complete neck response, only 2 patients (5%) had an isolated neck recurrence. Eleven patients underwent surgical neck procedures including 7 planned neck dissections and 4 salvage neck dissections. All the 11 patients with neck dissections had good regional control except 1 case. There were a few minor complications such as wound infection and laryngeal edema. Patients who have a complete clinical regional response to CCRT have a low probability of an isolated recurrence in the neck. Planned and salvage neck dissections can be safely performed and considered to be useful in the point of regional control after intensive CCRT. (author)

  8. A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Izadpanahi

    2014-01-01

    Full Text Available Background: Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men. Since the initial report of the anatomic radical prostatectomy, refinements in the surgical technique have been made. Several studies show that bladder neck preservation (BNP during radical prostatectomy makes improve early return of urinary continence, erectile function or both. However, some clinical trials have suggested little difference between the return of continence while using modifications. In this study, we compared outcomes of BNP and bladder neck reconstruction (BNR during radical retropubic prostatectomy (RRP. Materials and Methods: This prospective study was performed on 60 patients at a referral university hospital from March 2010 to March 2012. Study population was all patients candidate for RRP (RRP in this period. All patients divided into two groups, A and B (30 patients in each group. Group A (n = 30 who preserved bladder neck (BNP and Group B (n = 30 who had BNR. Prostate specific antigen (PSA before and at 2, 6, 9, 12 and18 months after surgery, anastomotic stricture symptoms, positive bladder neck margin, Gleason score and urine incontinence were compared between two groups. Also, we compared bladder neck contracture, urinary continence and positive surgical margin rates after BNP and BNR while retropubic prostatectomy in 24 months period follow-up. Results: The mean age of the patients was 61.81 ± 7.15 years (range, 50-74 years. After a follow-up period of 24 months, the PSA rising was not different between the two groups. After 2 months, 19 (63.33% of patients in A group and the same number in B group were continent (P = 0.78. Stricture of the bladder neck at the anastomosis site requiring transurethral dilation occurred in 7 (23.33% and 3 (10.0% patients in groups A and B, respectively (P = 0.04. Conclusion: Although there was no difference in prevalence and duration of return of urinary

  9. Preoperative hyperfractionated accelerated radiotherapy and radical surgery in advanced head and neck cancer: A prospective phase II study

    International Nuclear Information System (INIS)

    Lindholm, Paula; Valavaara, Ritva; Aitasalo, Kalle; Kulmala, Jarmo; Laine, Juhani; Elomaa, Liisa; Sillanmaeki, Lauri; Minn, Heikki; Grenman, Reidar

    2006-01-01

    Background and purpose: To evaluate whether preoperative hyperfractionated accelerated radiotherapy (RT) combined with major radical surgery is feasible and successful in the treatment of advanced primary head and neck cancer. Patients and methods: Ninety four patients with histologically confirmed head and neck squamous cell cancer (HNSCC) in the oral cavity (41/96; 43%), supraglottis (14/96; 15%), glottis (5/96; 5%), oropharynx (16/96; 17%), nasal cavity/paranasal sinuses (8/96; 8%), nasopharynx (3/96; 3%), hypopharynx (7/96; 7%) and two (2%) with unknown primary tumour and large cervical lymph nodes entered into the study. 21/96 patients (22%) had stage II, 17/96 (18%) stage III and 58/96 patients (60%) stage IV disease. The patients received preoperative hyperfractionated RT 1.6 Gy twice a day, 5 days a week to a median tumour dose of 63 Gy with a planned break for 11 days (median) after the median dose of 37 Gy. Then, after a median of 27 days the patients underwent major radical surgery of the primary tumour and metastatic lymph nodes including reconstructions with pedicled or microvascular free flaps when indicated as a part of the scheduled therapy. 12/96 patients had only ipsilateral or bilateral neck dissections. Results: After a median follow-up time of 37.2 mos 77/96 (80.2%) patients had complete locoregional control. All but 2 patients had complete histological remission after surgery. 40/96 pts were alive without disease, two of them after salvage surgery. 32/96 patients had relapsed; 15 had locoregional and 13 distant relapses, 4 patients relapsed both locoregionally and distantly. Fifty patients have died; 29 with locoregional and/or distant relapse, eight patients died of second malignancy, and 19 had intercurrent diseases. Disease-specific and overall survival at 3 years was 67.7 and 51%, respectively. Acute grade three mucosal reactions were common, but transient and tolerable. Late grade 3-4 adverse effects were few. Conclusions: Preoperative

  10. Multidisciplinary treatment of the neck

    NARCIS (Netherlands)

    de Bree, Remco; Langendijk, Johannes A.; Leemans, C. R.

    2016-01-01

    Since lymph node metastases are one of the most important prognostic factors, treatment of the neck is challenging. In clinically N0 neck, (super)selective neck dissection is indicated, whereas a more extensive neck dissection with preservation of important structures is performed in N2-N3 disease.

  11. Evaluation of perception performance in neck dissection planning using eye tracking and attention landscapes

    Science.gov (United States)

    Burgert, Oliver; Örn, Veronika; Velichkovsky, Boris M.; Gessat, Michael; Joos, Markus; Strauß, Gero; Tietjen, Christian; Preim, Bernhard; Hertel, Ilka

    2007-03-01

    Neck dissection is a surgical intervention at which cervical lymph node metastases are removed. Accurate surgical planning is of high importance because wrong judgment of the situation causes severe harm for the patient. Diagnostic perception of radiological images by a surgeon is an acquired skill that can be enhanced by training and experience. To improve accuracy in detecting pathological lymph nodes by newcomers and less experienced professionals, it is essential to understand how surgical experts solve relevant visual and recognition tasks. By using eye tracking and especially the newly-developed attention landscapes visualizations, it could be determined whether visualization options, for example 3D models instead of CT data, help in increasing accuracy and speed of neck dissection planning. Thirteen ORL surgeons with different levels of expertise participated in this study. They inspected different visualizations of 3D models and original CT datasets of patients. Among others, we used scanpath analysis and attention landscapes to interpret the inspection strategies. It was possible to distinguish different patterns of visual exploratory activity. The experienced surgeons exhibited a higher concentration of attention on the limited number of areas of interest and demonstrated less saccadic eye movements indicating a better orientation.

  12. The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment

    International Nuclear Information System (INIS)

    Yao Min; Smith, Russell B.; Graham, Michael M.; Hoffman, Henry T.; Tan Huaming; Funk, Gerry F.; Graham, Scott M.; Chang, Kristi; Dornfeld, Kenneth J.; Menda, Yusuf; Buatti, John M.

    2005-01-01

    Purpose: The role of neck dissection after definitive radiation for head-and-neck cancer is controversial. We select patients for neck dissection based on postradiation therapy (post-RT), computed tomography (CT), and [ 18 F] fluorodeoxyglucose positron emission tomography (FDG PET). We summarize the clinical outcomes of patients treated with this policy to further elucidate the role of FDG PET in decision making for neck dissection after primary radiotherapy. Methods and Materials: Between December 1999 and February 2004, 53 eligible patients were identified. These patients had stage N2A or higher head-and-neck squamous cell carcinoma and had complete response of the primary tumor after definitive radiation with or without chemotherapy. PET or computed tomography (CT) scans were performed within 6 months after treatment. Neck dissection was performed in patients with residual lymphadenopathy (identified by clinical examination or CT) and a positive PET scan. Those without residual lymph nodes and a negative PET were observed without neck dissection. For patients with residual lymphadenopathy, but a negative PET scan, neck dissection was performed at the discretion of the attending surgeon and decision of the patient. There was a total of 70 heminecks available for analysis (17 patients had bilateral neck disease). Results: There were 21 heminecks with residual lymphadenopathy identified on CT imaging or clinical examination and negative PET. Of these, 4 had neck dissection and were pathologically negative. The remaining 17 were observed without neck dissection. There was a total of 42 heminecks without residual lymph nodes on post-RT CT imaging or clinical examination with a negative PET. They were also observed without neck dissection. Seven heminecks had a positive PET scan and residual lymphadenopathy. Six of them had neck dissection and 1 had fine-needle aspiration of a residual node; 3 contained residual viable cancer and 4 were pathologically negative. At

  13. Post-RT CT results as a predictive model for the necessity of planned post-RT neck dissection in patients with cervical metastatic disease from squamous cell carcinoma

    International Nuclear Information System (INIS)

    Ojiri, Hiroya; Mendenhall, William M.; Stringer, Scott P.; Johnson, Patches L.; Mancuso, Anthony A.

    2002-01-01

    Purpose: To establish whether the extent of neck disease on postradiation therapy (RT) computed tomography (CT) can predict the likelihood of positive neck nodes and, thereby, the necessity of planned post-RT neck dissection. Methods and Materials: Ninety-five patients who underwent post-RT neck dissection within 2 months for squamous cell carcinoma of the head and neck were eligible. Of the 95 patients, 37 (32.7%) of 113 hemineck specimens were pathologically positive. On post-RT CT imaging studies, the number and size of lymph nodes >1 cm were recorded. Internal focal defects and the likelihood of extracapsular spread were graded. Results: If lymph nodes on post-RT CT were ≤15 mm, free of significant internal focal low-attenuation or calcification, and without imaging evidence of extracapsular spread, the surgical hemineck specimen was positive in 1 (3.4%) of the 29 hemineck specimens. A focal low-attenuation defect (p=0.0078) and evidence of extracapsular spread (p=0.0721) seen in the residual nodal mass on CT were independent predictors of a positive surgical specimen by multivariate analysis. Conclusion: CT findings on post-RT neck studies can help predict the likelihood of residual disease and, thereby, the necessity of planned post-RT neck dissection

  14. Temple and Postauricular Dissection in Face and Neck Lift Surgery

    Directory of Open Access Journals (Sweden)

    Joo Heon Lee

    2017-07-01

    Full Text Available Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area. To prevent damage to the auriculotemporal nerve and to protect the temporal hair follicle, the dissection plane should be kept just above the thin fascia covering the auriculotemporal nerve. Around the McKinney point, the adipose tissue covering the deep fascia is apt to be elevated from the deep fascia due to its denser fascial relationship with the skin, which leaves the great auricular nerve open to exposure. In order to prevent damage to the posterior branches of the great auricular nerve, the skin flap at the posterior auricular sulcus should be elevated above the auricularis posterior muscle. Fixating the superficial muscular aponeurotic system flap deeper and higher to the tympano-parotid fascia is recommended in order to avoid compromising the lobular branch of the great auricular nerve. The lesser occipital nerve (C2, C3 travels superficially at a proximal and variable level that makes it vulnerable to compromise in the mastoid dissection. Leaving the adipose tissue at the level of the deep fascia puts the branches of the great auricular nerve and lesser occipital nerve at less risk, and has been confirmed not to compromise either tissue perfusion or hair follicles.

  15. The Use of Harmonic Scalpel for Free Flap Dissection in Head and Neck Reconstructive Surgery

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    Sebastien Albert

    2012-01-01

    Full Text Available Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group, and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group. The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group, blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps.

  16. Cervical artery dissection following a turbulent flight.

    LENUS (Irish Health Repository)

    Quinn, Colin

    2012-01-31

    BACKGROUND: Cervical artery dissection is a common cause of stroke in young patients without vascular risk factors and may affect the carotid or vertebral arteries. The risk of spontaneous dissection is higher in those with genetic predisposing factors while other cases may be precipitated by an event involving head or neck movement or associated with direct neck trauma. CASE REPORT: We present the case of a previously well young woman with a history of migraine who developed internal carotid artery dissection following a turbulent short-haul commercial flight while restrained using a seatbelt. DISCUSSION: We propose that repetitive flexion-hyperextension neck movements encountered during the flight were the most likely precipitant of carotid artery dissection in this case and review the therapeutic options available.

  17. Radiographically occult perforation and dissection of the common carotid artery following stab injury to the neck

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    Sebastian Gamba

    2017-06-01

    Full Text Available In recent years, many diagnostic algorithms have been devised to reduce the rate of negative explorations associated with indiscriminate surgical management of penetrating neck injuries. In hemodynamically stable patients, the need for surgical intervention is usually determined by integrating both clinical signs and radiological findings; if such investigations remain unremarkable, recommended treatment consists in close observation and sequential physical examinations. We report on a 29-year-old male who was admitted to a Swiss tertiary care hospital after sustaining a penetrating injury to his left neck following a knife attack. Disregarding a pre-hospital account of hemorrhage from the wound and slight dysphagia, no manifest symptoms or signs of internal organ damage were present on primary survey. Moreover, there was no evidence of vascular or aerodigestive tract injury on initial CT angiography. We nonetheless proceeded with immediate surgical exploration, exposing a significant perforation of the left common carotid artery with concomitant dissection of the said vessel. Surgical repair was successfully performed and the patient suffered no long-term sequelae. We thus recommend that a high level of suspicion be upheld in both asymptomatic and oligosymptomatic patients with PNI and that clinical practitioners remain cautious in the face of deceptively reassuring radiologic findings. Keywords: Penetrating neck injury, Carotid artery perforation, Carotid artery dissection, CT angiography

  18. Neck nodes metastases in carcinoma of the larynx - results of treatment

    International Nuclear Information System (INIS)

    Hassmann-Poznanska, E.; Bucko, M.E.

    1994-01-01

    584 patients with carcinoma of the larynx treated with surgery of the larynx and bilateral functional neck dissection, between 1980 and 1989, were reviewed. 127 of them had histopathologically proven metastases to the lymph nodes. Pathologic stating of cervical metastases was as followed: pN1 - 24.5%, pN2a - 10.2%, pN2b - 26%, pN2c - 29.1%, pN3 - 10.2%. Of the 127 patients 89% were treated by surgery and postoperative radiation, 20% had surgery alone, that means radical or conservative neck dissection. In the group with combined treatment the results were much better than in cases of surgery alone, in advanced cases (pN2c, pN3) - 43.2% and 10% 5-year survival rate respectively. In the group of less advanced changes in the neck the difference in survival rate in the group with and without radiotherapy was very small. The results indicate that postoperative radiotherapy has great effect on survival rate in advanced cases of cervical metastases. (author)

  19. A Planned Neck Dissection Is Not Necessary in All Patients With N2-3 Head-and-Neck Cancer After Sequential Chemoradiotherapy

    International Nuclear Information System (INIS)

    Soltys, Scott G.; Choi, Clara Y.H.; Fee, Willard E.; Pinto, Harlan A.; Le, Quynh-Thu

    2012-01-01

    Purpose: To assess the role of a planned neck dissection (PND) after sequential chemoradiotherapy for patients with head-and-neck cancer with N2–N3 nodal disease. Methods and Materials: We reviewed 90 patients with N2–N3 head-and-neck squamous cell carcinoma treated between 1991 and 2001 on two sequential chemoradiotherapy protocols. All patients received induction and concurrent chemotherapy with cisplatin and 5-fluorocuracil, with or without tirapazamine. Patients with less than a clinical complete response (cCR) in the neck proceeded to a PND after chemoradiation. The primary endpoint was nodal response. Clinical outcomes and patterns of failure were analyzed. Results: The median follow-up durations for living and all patients were 8.3 years (range, 1.5–16.3 year) and 5.4 years (range, 0.6–16.3 years), respectively. Of the 48 patients with nodal cCR whose necks were observed, 5 patients had neck failures as a component of their recurrence [neck and primary (n = 2); neck, primary, and distant (n = 1); neck only (n = 1); neck and distant (n = 1)]. Therefore, PND may have benefited only 2 patients (4%) [neck only failure (n = 1); neck and distant failure (n = 1)]. The pathologic complete response (pCR) rate for those with a clinical partial response (cPR) undergoing PND (n = 30) was 53%. The 5-year neck control rates after cCR, cPR→pCR, and cPR→pPR were 90%, 93%, and 78%, respectively (p = 0.36). The 5-year disease-free survival rates for the cCR, cPR→pCR, and cPR→pPR groups were 53%, 75%, and 42%, respectively (p = 0.04). Conclusion: In our series, patients with N2–N3 neck disease achieving a cCR in the neck, PND would have benefited only 4% and, therefore, is not recommended. Patients with a cPR should be treated with PND. Residual tumor in the PND specimens was associated with poor outcomes; therefore, aggressive therapy is recommended. Studies using novel imaging modalities are needed to better assess treatment response.

  20. Neck dissection - discharge

    Science.gov (United States)

    ... drain in your neck when you leave the hospital. The provider will tell you how to care for it. Healing time will depend on how much tissue was removed. Diet and Nutrition You can eat your regular foods ...

  1. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of

  2. Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.

    Science.gov (United States)

    Nilsson, Andreas E; Carlsson, Stefan; Laven, Brett A; Wiklund, N Peter

    2006-01-01

    The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy. The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002. Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed. Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.

  3. The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Hasan Hüseyin Tavukçu

    2015-06-01

    Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.

  4. Head and neck cancer: Radiotherapeutic precepts in the management of the neck

    International Nuclear Information System (INIS)

    Million, R.R.; Cassisi, N.J.; Parsons, J.T.; Mendenhall, W.M.

    1986-01-01

    The authors provide a series of statements regarding the use of radiotherapy and surgery for metastatic squamous cancer to the neck. Some of these precepts are established facts requiring no additional documentation - for example, the combination of radiation and neck dissection for effective treatment of N2B neck disease or for subclinical disease, depending on extracapsular spread. Other precepts of the authors are not as generally accepted by head and neck surgeons, such as the mandatory staging of neck dissections following curative radiation therapy or the routine use of computerized tomography (CT) to confirm pathologic adenopathy. Most of the authors' precepts are supported by a combination of their personal clinical experience and hard data from the University of Florida, Gainesville

  5. Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review.

    Science.gov (United States)

    McLean, Timothy; Kerr, Stephen J; Giddings, Charles E B

    2017-09-01

    To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis. The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29-3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications. Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 127:2074-2080, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Subcutaneous fibrosis after whole neck irradiation

    International Nuclear Information System (INIS)

    Hirota, Saeko; Tsujino, Kayoko; Oshitani, Takashi; Hishikawa, Yoshio; Takada, Yoshiki; Kono, Michio; Abe, Mitsuyuki

    2002-01-01

    Purpose: To identify the risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. Methods and Materials: We analyzed 233 cases of patients who had undergone whole neck irradiation with 4-MV X-ray or 8-10-MeV electrons, or both, and had been followed with regard to their skin condition for at least 1 year. The prescribed dose to the whole neck ranged from 19.2 to 72.4 Gy (median 50). The skin-absorbed dose was specified as that at a depth of 4.1 mm (d4.1-mm depth ), and a biologically equivalent dose (BED) of d4.1-mm depth was also estimated (BED 1.8 4.1-mm depth ). Results: Univariate analysis revealed that previous neck dissection, concurrent chemotherapy, corticosteroid administration as a part of chemotherapy, fractionation, and BED 1.8 4.1-mm depth were significant prognostic variables. Multivariate analysis showed that BED 1.8 4.1-mm depth and previous neck dissection were the only prognostic variables for moderate to severe subcutaneous fibrosis. Conclusion: A high dose to a 4.1-mm depth of the skin and a history of neck dissection were identified as the predominant risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. A subcutaneous dose should be considered in radiotherapy treatment planning involving the whole neck, especially in cases in which patients have undergone previous neck dissection

  7. Can tissue spectrophotometry and laser Doppler flowmetry help to identify patients at risk for wound healing disorders after neck dissection?

    Science.gov (United States)

    Rohleder, Nils H; Flensberg, Sandra; Bauer, Florian; Wagenpfeil, Stefan; Wales, Craig J; Koerdt, Steffen; Wolff, Klaus D; Hölzle, Frank; Steiner, Timm; Kesting, Marco R

    2014-03-01

    Microcirculation and oxygen supply in cervical skin were measured with an optical, noninvasive method in patients with or without radiotherapy before neck dissection. The course of wound healing was monitored after the surgical procedure to identify predictive factors for postoperative wound healing disorders. Tissue spectrophotometry and laser Doppler flowmetry were used to determine capillary oxygen saturation, hemoglobin concentration, blood flow, and blood velocity at 2-mm and 8-mm depths in the cervical skin of 91 patients before neck dissection in a maxillofacial unit of a university hospital in Munich, Germany. Parameters were evaluated for differences between patients with irradiation (24) and without (67) and patients with wound healing disorders (25) and without (66) (univariate or multivariate statistical analyses). Velocity at 2 mm was lower in irradiated skin (P = .016). Flow at 2 mm was higher in patients with wound healing disorders (P = .018). High flow values could help to identify patients at risk for cervical wound healing disorders. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Neck lymph node metastases from an unknown primary tumor. Retrospective study and review of literature

    International Nuclear Information System (INIS)

    Christiansen, H.; Hermann, R.M.; Nitsche, M.; Schmidberger, H.; Pradier, O.; Martin, A.

    2005-01-01

    Background and purpose: up to 10% of all neck lymph node metastases present without a known primary site. The optimal treatment strategy for these patients is still undefined. The purpose of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor (CUP). Furthermore, prognostic factors and treatment modalities are discussed. Patients and methods: from 1984 to 2003, 28 patients with squamous cell neck metastases from a CUP were treated at the authors' institution. In 17 patients, neck dissection (twelve radical, five modified radical) was performed. In that case, adjuvant radiotherapy was carried out with a mean of 56.7 Gy. In eleven patients, only biopsies were done. These patients received definitive radiotherapy with a mean of 66.8 Gy. In summary, 25 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites. Additional chemotherapy was administered to five patients. Results: the duration of follow-up was 4.1-189.5 months (median 45.1 months). After this period of time, ten patients (36%) remained alive. 5-year overall survival was 40.1%, neck control rate 72.7%. No subsequent primary could be detected. Extracapsular extension and surgery had significant influence on prognosis. Grade 3 toxicity (mucositis or skin reactions) was seen in three patients; no hematologic toxicity > grade 2 was observed. 19 patients suffered from grade 2 xerostomia. Conclusion: with radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials. (orig.)

  9. A "crick" in the neck followed by massage offered him a stroke: An uncommon case of vertebral artery dissection.

    Science.gov (United States)

    Dutta, Gautam; Jagetia, Anita; Srivastava, Arvind K; Singh, Daljit; Singh, Hukum; Saran, Ravindra K

    2018-04-10

    We present an unusual case of vertebral artery dissection in a 30-year-old male patient following an episode of neck massage. He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. We also discuss a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this rare entity. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Lateral view dissection of the prostato-urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy.

    Science.gov (United States)

    Sasaki, Hiroshi; Miki, Jun; Kimura, Takahiro; Sanuki, Kunitaro; Miki, Kenta; Takahashi, Hiroyuki; Egawa, Shin

    2009-08-01

    To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence. One hundred and forty-four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato-urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups. Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso-apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P Lateral view dissection of the prostato-urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.

  11. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu; Yea, Ji Woon

    2010-01-01

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  12. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  13. Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it?

    Science.gov (United States)

    Duque, Carlos S; Dueñas, Juan P; Marulanda, Marcela; Pérez, Diana; Londoňo, Andres; Roy, Soham; Khadem, Mai Al

    2017-03-01

    During thyroidectomy and neck dissection surgery for advanced or recurrent metastatic thyroid cancer under intraoperative monitoring, we used the available technology to assess the feasibility of such an intervention to monitor those patients with phrenic nerves at risk. A retrospective review of patients operated on from January 2009 to December 2015 by a single surgeon (CSD) was conducted. Patients who had neck and mediastinal dissection, with or without total thyroidectomy, due to advanced or recurrent metastatic disease to the neck were selected. The procedures were done under intraoperative nerve monitoring using nerve monitoring systems (NIM 2.0 or 3.0; Medtronic, Jacksonville, FL, USA). A total of 19 patients were included in the study, with a mean age of 57.6 years ± 16.3 and a male/female ratio of 10:9. Overall, all patients had an intact phrenic nerve at the conclusion of the surgery. One patient had an aggressive tumor that precluded sacrifice of the left recurrent laryngeal nerve and ipsilateral thoracic duct. The procedure was complicated by a temporary impairment of the diaphragm contraction with intraoperative nerve monitoring as well as a chyle fistula. This was due to the manipulation of the tissue surrounding the phrenic nerve. Intraoperative nerve monitoring of the phrenic nerve offers the surgeon a "potential" method of ensuring phrenic nerve integrity in cases of advanced thyroid cancers with gross level IV metastatic disease. Further prospective studies are needed to assess the risks of this intervention and evaluate the method of recording diaphragm contraction movement.

  14. Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer?

    Directory of Open Access Journals (Sweden)

    Arjun Sivaraman

    2018-03-01

    Full Text Available Purpose: To verify the quality of pelvic lymph node dissection (PLND performed at radical prostatectomy (RP and its impact on nodal recurrence in patients undergoing salvage lymph node dissection (sLND. Materials and Methods: Retrospective review of 48 patients who underwent sLND for presumed nodal recurrence, to describe the PLND characteristics at RP and correlate the anatomical sites and number of suspicious nodes reported in radiological imaging and final pathology of sLND. Results: Overall, at RP, 8 (16.7% did not undergo PLND, 32 (66.7% and 8 (16.7% received a “limited” (between external iliac vein and obturator nerve and an “extended” (external iliac, hypogastric, and obturator dissection, respectively. Median nodes removed during limited and extended dissection were 2 and 24, respectively. At sLND, the mean age was 61.3 years and median prostate specific antigen (PSA was 1.07 ng/mL. Median nodes removed at sLND were 17 with a median of 2 positive nodes. Recurrent nodes were identified within the template of an extended PLND in 62.5%, 50.0% and 12.5% patients, respectively, following prior no, limited and extended dissection at RP. Recurrence outside the expected lymphatic drainage pathway was noted in 37.5% patients with prior extended dissection at RP. There was a correlation between imaging and pathology specimen in 83% for node location and 58.3% for number of anatomical sites involved. Conclusions: In prostate cancer patients undergoing sLND, most had inadequate PLND at the original RP. Pattern of nodal recurrence may be influenced by the prior dissection and pre sLND imaging appears to underestimate the nodal recurrence.

  15. Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer?

    Science.gov (United States)

    Sivaraman, Arjun; Benfante, Nicole; Touijer, Karim; Coleman, Jonathan; Scardino, Peter; Laudone, Vincent; Eastham, James

    2018-03-01

    To verify the quality of pelvic lymph node dissection (PLND) performed at radical prostatectomy (RP) and its impact on nodal recurrence in patients undergoing salvage lymph node dissection (sLND). Retrospective review of 48 patients who underwent sLND for presumed nodal recurrence, to describe the PLND characteristics at RP and correlate the anatomical sites and number of suspicious nodes reported in radiological imaging and final pathology of sLND. Overall, at RP, 8 (16.7%) did not undergo PLND, 32 (66.7%) and 8 (16.7%) received a "limited" (between external iliac vein and obturator nerve) and an "extended" (external iliac, hypogastric, and obturator) dissection, respectively. Median nodes removed during limited and extended dissection were 2 and 24, respectively. At sLND, the mean age was 61.3 years and median prostate specific antigen (PSA) was 1.07 ng/mL. Median nodes removed at sLND were 17 with a median of 2 positive nodes. Recurrent nodes were identified within the template of an extended PLND in 62.5%, 50.0% and 12.5% patients, respectively, following prior no, limited and extended dissection at RP. Recurrence outside the expected lymphatic drainage pathway was noted in 37.5% patients with prior extended dissection at RP. There was a correlation between imaging and pathology specimen in 83% for node location and 58.3% for number of anatomical sites involved. In prostate cancer patients undergoing sLND, most had inadequate PLND at the original RP. Pattern of nodal recurrence may be influenced by the prior dissection and pre sLND imaging appears to underestimate the nodal recurrence.

  16. Pathogenesis Concept Of Extracranial Dissections In Iran

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    Kavian Ghandehari

    2017-02-01

    Full Text Available Background: Dissection of Extracranial Internal Carotid Artery (EICA and Extracranial Vertebral Artery (EVA is an amportant cause of brain infarction with miscellaneous etiologies around the world. Methods: A prospective observational clinical study was conducted in Ghaem Hospital, Mashhad, Iran between 2008-2016. Diagnosis of brain infarction and TIA was made by stroke neurologist. Detection of EICA and EVA dissections were made by performing CT angiography  and MR angiography  or DSA in the suspected patients. Demographic features, clinical manifestations, territorial involvement, pathophysiology and pathogenesis of dissections were assessed in all of the patients. Pathogenesis of dissections was classified as Idiopathic, Trumatic, Postural and Genetic categories. Results: Twenty eight patients (21 males, 7 females were admitted with extracranial arterial dissection. Mean age of males and females with dissection was 39.81± 4.2 and 35.71±6.1 years respectively. Influence of gender on age of the patients was not significant, p>0.05. Among patients with extracranial dissection only 3.6% had atherosclerosis risk factors and 96.4% had no other cause for brain infarction. 100% of extracranial dissections in males occured in carotid territory, while 28.6% of females had dissection in the EVA. The influence of gender in territory of dissection was significant, p<0.05. Idiopathic dissections and genetic susceptibility was found in 10.7% and 3.6% of extracranial dissections respectively. 53.5% of the patienrs had trumatic pathogenesis for extracranial dissections and 32.1% developed dissection due to special neck  postures. Important details in pathophysiology and pathogenesis of extracranial dissections will be presented in the lecture. Conclusion: Stroke patients with extracranial dissections have characteristic demographic and  territorial involvement. Trumatic pathogenesis is the most frequent cause of dissection in Iran followed by neck

  17. Extracranial vertebral artery rupture likely secondary to "cupping therapy" superimposed on spontaneous dissection.

    Science.gov (United States)

    Choi, Jae Young; Huh, Chae Wook; Choi, Chang Hwa; Lee, Jae Il

    2016-12-01

    The extracranial vertebral artery (VA) is vulnerable to dissection and the V3 segment is the most common location for dissection. Dissection accounts for about 2% of all ischemic strokes and can occur after trauma or chiropractic neck maneuvers. We report an extremely rare case of spontaneous extracranial VA dissection presenting with posterior neck hematoma aggravated after cupping therapy, a treatment in traditional Oriental medicine. We treated the patient successfully by endovascular treatment without any complication. © The Author(s) 2016.

  18. Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature.

    Science.gov (United States)

    Ploussard, Guillaume; Briganti, Alberto; de la Taille, Alexandre; Haese, Alexander; Heidenreich, Axel; Menon, Mani; Sulser, Tullio; Tewari, Ashutosh K; Eastham, James A

    2014-01-01

    Pelvic lymph node dissection (PLND) in prostate cancer is the most effective method for detecting lymph node metastases. However, a decline in the rate of PLND during radical prostatectomy (RP) has been noted. This is likely the result of prostate cancer stage migration in the prostate-specific antigen-screening era, and the introduction of minimally invasive approaches such as robot-assisted radical prostatectomy (RARP). To assess the efficacy, limitations, and complications of PLND during RARP. A review of the literature was performed using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1990 to December 2012. The literature search used the following terms: prostate cancer, radical prostatectomy, robot-assisted, and lymph node dissection. The median value of nodal yield at PLND during RARP ranged from 3 to 24 nodes. As seen in open and laparoscopic RP series, the lymph node positivity rate increased with the extent of dissection during RARP. Overall, PLND-only related complications are rare. The most frequent complication after PLND is symptomatic pelvic lymphocele, with occurrence ranging from 0% to 8% of cases. The rate of PLND-associated grade 3-4 complications ranged from 0% to 5%. PLND is associated with increased operative time. Available data suggest equivalence of PLND between RARP and other surgical approaches in terms of nodal yield, node positivity, and intraoperative and postoperative complications. PLND during RARP can be performed effectively and safely. The overall number of nodes removed, the likelihood of node positivity, and the types and rates of complications of PLND are similar to pure laparoscopic and open retropubic procedures. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  19. A Limb-Threatening Long Arterial Dissection Caused by Humerus Neck Fracture: A Case Report

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    Kurnaz R

    2018-03-01

    Full Text Available Proximal humerus fracture is a common arm trauma and rarely occurs with vascular injury which however is a serious complication. In this case report, we present a long segment dissection of the axillary and brachial arteries as a rare complication due to fragmented proximal humerus fracture and shoulder dislocation. An 80-year old female patient was seen at the emergency department. Radiograph examination has revealed a fragmented proximal humerus fracture besides dislocation of the head of humerus towards the axillary area. On vascular examination, acute arterial occlusion such as absence of radial and ulnar pulses were observed in her left hand. The patient was immediately taken to the operating room. The dissection included the entire segment approximately 20cm between the distal subclavian artery and the distal brachial artery. This injured segment was removed and a 6mm Polytetrafluroethylene (PTFE graft with rings was interpositoned between subclavian and brachial arteries. This case is a rarity because of such a significant complication after a small injury. Axillary artery injuries caused by humeral neck fractures are rare but should not be missed by the physician.

  20. Salvage surgery for lymph node metastasis after concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Kataoka, Hideyuki; Takeuchi, Eiji; Kawamoto, Katsuyuki; Fujiwara, Kazunori; Fukuhara, Takahiro; Miyake, Naritomo; Kitano, Hiroya

    2009-01-01

    Concurrent chemoradiation (CCRT) for advanced head and neck cancer is becoming more widely used. CCRT represents an effective treatment for patients with advanced head and neck cancer, and possibly improves survival. In the present study, all of 25 patients underwent planned neck dissection 6-8 weeks after the completion of radiation. Selective neck dissection was performed whenever possible. Radical neck dissection was carried out for patients with residual adenopathy that had invaded the surrounding structures and/or enclosed the carotid arteries. A complete response at the primary sites was achieved in all patients. Of the 25 cases, 7 (28%) showed viable cancer cells within their neck dissection specimens. Local and regional disease control was excellent after CCRT with neck dissection. Unfortunately, CCRT followed by neck dissection sometimes induces stomal infection and swallowing dysfunction. We have been performing additional surgery to improve the swallowing function and bilateral neck dissection simultaneously. (author)

  1. A case of radiation-induced skin cancer of the neck

    International Nuclear Information System (INIS)

    Matsushita, Tetsuya; Susuki, Takeo; Kikui, Tomoko; Masada, Yoshiko; Tahara, Shinya.

    1994-01-01

    The authors discuss the case of radiation-induced skin cancer of the neck in a 76-year-old woman who had undergone irradiation of tubercular lymphadenitis of the cervix while in her low teens. Some fifty years later, a squamous cell carcinoma developed in the irradiated region and in due course deeply invaded the sternocleidomastoidous muscle. Thus, a radical neck dissection was performed and the tumor and the lymph tissue removed en bloc, after which reconstruction was accomplished by using a latissimus dorsi musculocutaneous flap. With regard to the lessons learned from treating this case, three points are considered important and are listed below. When treating radiation-induced skin cancer patients, the head and neck regions should be examined in detail for the presence of other tumors. The excision of the skin surrounding the tumor should be as wide as possible, so as to remove skin that may have been also over-subjected to irradiation. The remaining skin surrounding the defect left by the excision is atrophic and thin. (author)

  2. Clinical and radiological evaluation in vertebral artery dissections

    Directory of Open Access Journals (Sweden)

    Murat Çabalar

    2013-04-01

    Full Text Available In recent years, vertebral artery dissection (VAD is reported more frequently as a cause of young cerebrovascular accidents. It can occur spontaneously or following a neck manipulation and trauma. The patients were 3 females (mean age: 35±26 years and 7 males (mean age: 37.71±4.96 years. Only 2 patients described neck trauma. Cerebellar findings were prominent in all cases. On radiological investigation, vascular changes of vertebral arteries were detected bilaterally in 2 cases, right in 5 and left in 3 cases. All the cases were treated with anticoagulant therapy and cured but 1 with sequela. Prognosis of vertebral artery dissection is generally good by early diagnosis and treatment. In this article, we reported clinical and radiological properties of 10 vertebral artery dissection cases.

  3. Swing of the Surgical Pendulum: A Return to Surgery for Treatment of Head and Neck Cancer in the 21st Century?

    International Nuclear Information System (INIS)

    Holsinger, F. Christopher; Weber, Randal S.

    2007-01-01

    Treatment for head and neck cancer has evolved significantly during the past 100 years. Beginning with Bilroth's total laryngectomy on New Year's Day in 1873, 'radical' surgery remained the only accepted treatment for head and neck cancer when optimal local and regional control was the goal. Bigger was still better when it came to managing the primary tumor and the neck. The 'commando' procedure and radical neck dissection were the hallmarks of this first generation of treatments of head-and-neck cancer. With the advent of microvascular reconstructive techniques, larger and more comprehensive resections could be performed. Despite these large resections and their 'mutilating' sequelae, overall survival did not improve. Even for intermediate-stage disease in head-and-neck cancer, the 5-year survival rate did not improve >50%. Many concluded that more than the scalpel was needed for optimal local and regional control, especially for intermediate- and advanced-stage disease. Most important, the multidisciplinary teams must identify and correlate biomarkers in the tumor and host that predict for a response to therapy and for optimal functional recovery. As the pendulum swings back, a scientific approach using tissue biomarkers for the response to treatment in the setting of multidisciplinary trials must emerge as the new paradigm. In the postgenomic era, treatment decisions should be made based on functional and oncologic parameters-not just to avoid perceived morbidity

  4. Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy?

    International Nuclear Information System (INIS)

    Rudoltz, Marc S.; Benammar, Alia; Mohiuddin, Mohammed

    1995-01-01

    Purpose: To evaluate the effect of pathologic lymph node status and nodal stage on local control at the primary site in patients with advanced squamous cell carcinomas of the head and neck, treated with radical surgery and postoperative irradiation. Methods and Materials: Fifty-seven patients with advanced squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, and supraglottic larynx were analyzed. All patients underwent resection of the primary lesion, neck dissection, and postoperative radiotherapy. Minimum follow-up was 2 years. The median dose to the primary tumor bed was 60.4 Gray (range 39.7-72.0). Besides pathologic nodal status (pN0 vs. pN+) and nodal stage, the following factors were analyzed for their impact on local control: age, gender, T stage, tumor grade, resection margins, interval from surgery to irradiation, dose to the primary site, and overall treatment time. Results: The 3-year actuarial local control rate was 78%. When all patients were analyzed, nodal status (pN0 vs. pN+) did not affect control at the primary site (71% vs. 82%, p = 0.42). Nodal stage (pN0-N2a va. pN2b-N2c) was also not a significant factor for local control (74% vs. 82%, p = 0.57). When only patients with negative margins were analyzed, nodal status again did not impact on local control (79% vs. 90% for pN0 vs. pN+, p = 0.39). On univariate analysis, only tumor grade, margin status, and elapsed days were significant factors for local control. Local control was 85% for patients with negative margins vs. 60% for those with positive margins (p = 0.016). For patients with moderately and poorly differentiated tumors, local control was 86% as compared to 50% for patients with well-differentiated tumors (p = 0.007). When radiotherapy was completed within 50 days, local control was 93% as opposed to 63% for >50 days (p 0.016). On multivariate analysis, only margin status (p = 0.002) and tumor grade (p = 0.007) remained significant. Conclusion: We conclude that

  5. Does pathologic node status affect local control in patients with carcinoma of the head and neck treated with radical surgery and postoperative radiotherapy?

    Energy Technology Data Exchange (ETDEWEB)

    Rudoltz, Marc S; Benammar, Alia; Mohiuddin, Mohammed

    1995-02-01

    Purpose: To evaluate the effect of pathologic lymph node status and nodal stage on local control at the primary site in patients with advanced squamous cell carcinomas of the head and neck, treated with radical surgery and postoperative irradiation. Methods and Materials: Fifty-seven patients with advanced squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, and supraglottic larynx were analyzed. All patients underwent resection of the primary lesion, neck dissection, and postoperative radiotherapy. Minimum follow-up was 2 years. The median dose to the primary tumor bed was 60.4 Gray (range 39.7-72.0). Besides pathologic nodal status (pN0 vs. pN+) and nodal stage, the following factors were analyzed for their impact on local control: age, gender, T stage, tumor grade, resection margins, interval from surgery to irradiation, dose to the primary site, and overall treatment time. Results: The 3-year actuarial local control rate was 78%. When all patients were analyzed, nodal status (pN0 vs. pN+) did not affect control at the primary site (71% vs. 82%, p = 0.42). Nodal stage (pN0-N2a va. pN2b-N2c) was also not a significant factor for local control (74% vs. 82%, p = 0.57). When only patients with negative margins were analyzed, nodal status again did not impact on local control (79% vs. 90% for pN0 vs. pN+, p = 0.39). On univariate analysis, only tumor grade, margin status, and elapsed days were significant factors for local control. Local control was 85% for patients with negative margins vs. 60% for those with positive margins (p = 0.016). For patients with moderately and poorly differentiated tumors, local control was 86% as compared to 50% for patients with well-differentiated tumors (p = 0.007). When radiotherapy was completed within 50 days, local control was 93% as opposed to 63% for >50 days (p 0.016). On multivariate analysis, only margin status (p = 0.002) and tumor grade (p = 0.007) remained significant. Conclusion: We conclude that

  6. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer.

    Science.gov (United States)

    Park, Inhye; Her, Nayoon; Choe, Jun-Ho; Kim, Jee Soo; Kim, Jung-Han

    2018-01-01

    The purpose of this study was to evaluate the incidence and pattern of chyle leakage after thyroidectomy and/or cervical lymph node dissection and to establish management protocols for chyle leakage. Patients who underwent surgical management for thyroid cancer were analyzed retrospectively. For this study, 131 patients with chyle leakage were identified; the overall incidence was 0.9%. Of them, 43.7% of patients underwent central neck dissection without lateral neck dissection, and chyle leakage was easily controlled with conservative management. Patients whose chyle drainage was reduced by >50% after dietary modification had a significantly shorter hospital stay (P leakage after central compartment dissection even without lateral neck dissection was not rare, but was easily controlled with conservative management. Surgical management should be considered if the drainage amount does not decrease by >50% of the original amount of the day of detection after 2 days of NPO. © 2017 Wiley Periodicals, Inc.

  7. Shoulder morbidity after non-surgical treatment of the neck

    International Nuclear Information System (INIS)

    Wouwe, Merian van; Bree, Remco de; Kuik, Dirk J.; Goede, Cees J.T. de; Verdonck-de Leeuw, Irma M.; Doornaert, Patricia; Rene Leemans, C.

    2009-01-01

    Background and purpose: Reports on shoulder function after non-surgical treatment are not available. In the present study shoulder morbidity after surgical and non-surgical treatment of the neck is determined and compared. Materials and methods: In 100 head and neck cancer patients 174 neck sides were treated by surgery (n = 51) or (chemo)radiation (n = 123). Abduction, anteflexion, endorotation and exorotation were assessed. Subjective measurements were performed using the Visual Analogue Scale for pain, the Shoulder Disability Questionnaire (SDQ) and stiffness reporting. Results: Predictive factors for SDQ-score > 0 (n = 54) were VAS pain score, stiffness, abduction, anteflexion, physiotherapy, low shoulder position and surgical treatment. The SDQ, stiffness and pain scores were significantly higher in the surgically treated group than in the non-surgical group (p < 0.01). Anteflexion, abduction and exorotation were less impaired in the non-surgically treated group than in the surgically treated group (p < 0.01). No differences between neck dissection and neck dissection with post-operative radiotherapy, and radiotherapy and chemoradiation were found for these movements. Conclusions: Shoulder morbidity is often present after non-surgical treatment of the neck, but to a lesser extent compared to surgical treatment. Radiotherapy adds no morbidity to neck dissection and chemotherapy does not add extra morbidity to primary radiation

  8. Re-irradiation of metastatic disease in the neck from xeroderma pigmentosum.

    Science.gov (United States)

    Wei, C C; Sanfilippo, N J; Myssiorek, D

    2010-06-01

    Xeroderma pigmentosum, an autosomal recessive disease that occurs with a frequency of 1:250,000, is caused by a genetic defect in nucleotide excision repair enzymes. Mutation of these enzymes leads to the development of multiple basal cell and squamous cell carcinomas. We present a case of xeroderma pigmentosum in a patient with cervical and intraparotid metastatic disease from recurrent cutaneous squamous cell carcinomas of the face and scalp, treated with neck dissection and re-irradiation. With the illustrative case report, we include a literature review of diagnosis, prognostic factors, and treatment, with emphasis on surgical and radiation treatment of cervical metastatic disease from recurrent skin carcinomas. A xeroderma pigmentosum patient presented to our clinic with a 2-cm right submental and 1-cm right infra-auricular mass after resection of multiple squamous cell carcinomas of the scalp and face, and external-beam radiation therapy to the right face and neck. Fine-needle aspiration biopsy of the submental mass revealed poorly differentiated squamous cell carcinoma. The patient was brought to the operating room for a right modified radical neck dissection and excision of the right submental and intraparotid mass. Surgical pathology revealed 3 level ia and supraclavicular lymph nodes that were positive for metastatic squamous cell carcinoma. Re-irradiation to the entire right hemi-neck and left submandibular nodal region was performed using opposed oblique portals for the upper neck and a low anterior en face hemi-neck portal. The left parotid region was also included in the re-irradiation volume. Treatment was completed without delayed complications or recurrences to date. To our knowledge, this is the first case report in the literature of a patient with xeroderma pigmentosum who subsequently developed metastatic disease from recurrent cutaneous squamous cell carcinoma. Because of the rarity of xeroderma pigmentosum, this case report is also the first

  9. The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

    Science.gov (United States)

    Tavukçu, Hasan Hüseyin; Aytaç, Ömer; Balcı, Numan Cem; Kulaksızoğlu, Haluk; Atuğ, Fatih

    2017-12-01

    We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.

  10. The incidence of late neck recurrence in N0 maxillary sinus squamous cell carcinomas after superselective intra-arterial chemoradiotherapy without prophylactic neck irradiation.

    Science.gov (United States)

    Sakashita, Tomohiro; Homma, Akihiro; Hatakeyama, Hiromitsu; Kano, Satoshi; Mizumachi, Takatsugu; Furusawa, Jun; Yoshida, Daisuke; Fujima, Noriyuki; Onimaru, Rikiya; Tsuchiya, Kazuhiko; Yasuda, Koichi; Shirato, Hiroki; Fukuda, Satoshi

    2014-10-01

    The efficacy of elective neck irradiation (ENI) for patients with N0 carcinoma of the maxillary sinus has been controversial. The purpose of our study was to investigate the incidence of late neck recurrence and the mortality rate from regional disease in patients with N0 maxillary sinus cancer after superselective cisplatin infusion and concomitant radiotherapy (RADPLAT) without ENI. We retrospectively analyzed 48 patients with N0 maxillary sinus cancer who underwent RADPLAT. Chemotherapy consisted of 100-120 mg/m(2) superselective intra-arterial cisplatin administered at a median rate of four times weekly. Concurrent radiation therapy was administered at a median dose of 65 Gy without ENI. Late neck recurrence was observed in 8.3% (4/48). Three patients underwent salvage neck dissection and survived without any evidence of disease. The remaining patient did not undergo neck dissection due to coexistence with distant metastasis, and he died of regional disease. The mortality rate from regional disease was calculated to be 2% (1/48). The incidence of late neck recurrence was not frequent, and the mortality rate from regional disease was low. Salvage neck dissection was considered to be feasible for patients with late neck recurrence. When definitive radiotherapy and concomitant chemotherapy are applied, it is considered that ENI is not required for cases of N0 maxillary sinus cancer.

  11. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection

    NARCIS (Netherlands)

    Rodrigo, J.P.; Shah, J.P.; Silver, C.E.; Medina, J.E.; Takes, R.P.; Robbins, K.T.; Rinaldo, A.; Werner, J.A.; Ferlito, A.

    2011-01-01

    The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this

  12. Safety of thyroidectomy and cervical neck dissection without drains

    Science.gov (United States)

    Abboud, Bassam; Sleilaty, Ghassan; Rizk, Habib; Abadjian, Gerard; Ghorra, Claude

    2012-01-01

    Background Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. Methods The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. Results We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. Conclusion Thyroidectomy without drains is safe and effective, even in combination with CND. PMID:22449723

  13. Acute headache and persistent headache attributed to cervical artery dissection

    DEFF Research Database (Denmark)

    Schytz, Henrik W; Ashina, Messoud; Magyari, Melinda

    2014-01-01

    for Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection or Headache attributed to intracranial arterial dissection. Six months after dissection five of 19 patients still reported persistent headache attributed to dissection. The study demonstrates that the ICHD......The criteria for headache attributed to cervical artery dissection have been changed in the new third edition of the International Classification of Headache Disorders (ICHD-III beta). We have retrospectively investigated 19 patients diagnosed from 2001 to 2006 with cervical artery dissection......-III beta criteria for cervical artery dissection are useful for classifying patients at the first encounter. We show for the first time that persistent headache attributed to arterial dissection is frequent....

  14. Vertebral Artery Dissection Causing Stroke After Trampoline Use.

    Science.gov (United States)

    Casserly, Courtney S; Lim, Rodrick K; Prasad, Asuri Narayan

    2015-11-01

    The aim of this study was to report a case of a 4-year-old boy who had been playing on the trampoline and presented to the emergency department (ED) with vomiting and ataxia, and had a vertebral artery dissection with subsequent posterior circulation infarcts. This study is a chart review. The patient presented to the emergency department with a 4-day history of vomiting and gait unsteadiness. A computed tomography scan of his head revealed multiple left cerebellar infarcts. Subsequent magnetic resonance imaging/magnetic resonance angiogram of his head and neck demonstrated multiple infarcts involving the left cerebellum, bilateral thalami, and left occipital lobe. A computed tomography angiogram confirmed the presence of a left vertebral artery dissection. Vertebral artery dissection is a relatively common cause of stroke in the pediatric age group. Trampoline use has been associated with significant risk of injury to the head and neck. Patients who are small and/or young are most at risk. In this case, minor trauma secondary to trampoline use could be a possible mechanism for vertebral artery dissection and subsequent strokes. The association in this case warrants careful consideration because trampoline use could pose a significant risk to pediatric users.

  15. Mastectomy using ultrasonic dissection

    DEFF Research Database (Denmark)

    Galatius, Hanne; Okholm, Mette; Hoffmann, Jack

    2003-01-01

    on seroma formation and other complications: 59 patients with operable breast cancer underwent modified radical mastectomy, performed in 30 of them with an Ultracision Harmonic scalpel and in 29 with scissors and electrocautery. In all cases a standard level II axillary dissection was performed...

  16. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial.

    Science.gov (United States)

    Nyarangi-Dix, Joanne N; Radtke, Jan Philipp; Hadaschik, Boris; Pahernik, Sascha; Hohenfellner, Markus

    2013-03-01

    We investigated the influence of bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy. A total of 208 men who presented for radical prostatectomy were randomized to complete bladder neck preservation with subsequent urethro-urethral anastomosis or to no preservation as controls. Patients with failed bladder neck preservation were not included in study. We documented objective continence by the 24-hour pad test, social continence by the number of pads per day and quality of life outcomes by the validated Incontinence Quality of Life questionnaire in a single blind setting. Cancer resection was assessed by surgical margin status. At 0, 3, 6 and 12 months mean urine loss in the control vs the bladder neck preservation group was 713.3 vs 237.0, 49.6 vs 15.6, 44.4 vs 5.5 and 25.4 vs 3.1 gm, respectively (each p <0.001). At 3, 6 and 12 months in the control vs the preservation group the social continence rate was 55.3% vs 84.2% (p <0.001), 74.8% vs 89.5% (p = 0.05) and 81.4% vs 94.7% (p = 0.027), and the quality of life score was 80.4 vs 90.3 (p <0.001), 85.4 vs 91.7 (p = 0.016) and 86.0 vs 93.8 (p = 0.001), respectively. We noted significantly less urine loss, higher objective and social continence rates, and higher quality of life scores after complete bladder neck preservation at all followup points. On multiple logistic regression analysis complete bladder neck preservation was an independent positive predictor of continence. No significant difference was found in surgical margin status between the control and bladder neck preservation groups (12.5% vs 14.7%, p = 0.65). In what is to our knowledge the first prospective, randomized, controlled, single blind trial complete bladder neck preservation during radical prostatectomy was associated with a significantly higher urinary continence rate and increased patient satisfaction without compromising resection margins. Copyright © 2013 American Urological

  17. Clinical study on N0-stage tongue cancer

    International Nuclear Information System (INIS)

    Maruoka, Yasubumi; Ando, Tomohiro; Hoshino, Makoto; Sangu, Yoshikuni; Ogiuchi, Hideki

    2003-01-01

    We retrospectively analyzed the cases of N0-stage tongue cancer patients treated at the Department of Oral Maxillofacial Surgery, Tokyo Women's Medical University Hospital, between January 1980 and December 2000. Primary tongue cancers were treated by surgery (52%) and radiotherapy (48%). In principle, we did not perform elective neck dissection for N0-stage necks. Instead, a policy of careful observation was adopted for the management of N0-stage necks in patients with tongue cancer, and a radical neck dissection or modified radical neck dissection was performed in the event of a secondary neck metastasis. A local recurrence was confirmed in 25 patients. Twenty of the 25 local recurrences were successfully controlled by a therapy. The incidence of secondary neck metastasis was 4/46 (8%) for T1 patients, 21/48 (45%) for T2 patients, and 9/15 (60%) for T3/T4 patients. Overall, secondary neck metastases occurred in 34 out of 109 (32%) patients, and eventually 12 patients died from uncontrolled tumors. As for the distribution of involved lymph nodes, level I to level III nodes were involved in 30 (88%) patients, and level IV nodes were involved in 4 patients. (author)

  18. Radiotherapeutic factors related to the control of cervical lymph node metastases in patients with oro- and hypopharyngeal carcinoma treated with chemoradiotherapy followed by planned neck dissection

    International Nuclear Information System (INIS)

    Fujii, Osamu; Ota, Yosuke; Kuwatsuka, Yoko

    2009-01-01

    To clarify radiotherapeutic factors related to the control of cervical lymph node metastases, we retrospectively reviewed 29 patients with N2-3 oro- and hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy followed by planned neck dissection between April 2004 and March 2008. Pretreatment assessment of all patients revealed cervical metastases in a total of 63 neck levels. Planning target volume (PTV) was defined as lymph node metastases by neck level with a 5-mm margin, and a dose-volume histogram (DVH) was used to evaluate the maximum (PTV max), minimum (PTV min) and mean radiation dose to the PTV (PTV mean). Overall, 59% of the patients attained a pathologic complete response (pCR) in the neck. Evidence of residual pathologic tumor by neck level was found most commonly in Level V and retropharyngeal lymph nodes. On univariate analysis, primary site (oropharynx) and the effect of induction chemotherapy (partial response) were significant predictors of a neck disease specimen with negative pathology. PTV max and PTV mean in Level V were found to be significantly lower than those in Levels II and III. Furthermore, there was a significant association between radiation dose and pathologic status on the neck. Our data thus suggested that excellent dose coverage for cervical lymph nodes might lead to better regional control. (author)

  19. PET-CT–Guided Surveillance of Head and Neck Cancers

    Science.gov (United States)

    Patients with advanced squamous cell carcinoma of the head and neck who underwent PET-CT–guided surveillance had fewer operations but similar overall survival rates to those of patients who underwent planned neck dissection.

  20. Carcinoma of the tonsillar fossa and faucial arch

    International Nuclear Information System (INIS)

    Perez, C.A.

    1987-01-01

    In patients with clinically negative necks a lymph node dissection is not warranted, for elective irradiation of the neck (5000 cGy) will control subclinical disease in more than 98% of patients. In patients with small, mobile lymph nodes, it is possible to control the tumor with radiation therapy alone, although a radical neck dissection is equally effective. For multiple lymph nodes larger than 5 cm in diameter or fixed to the soft tissues, the preferred method of treatment is radical neck dissection and postoperative irradiation. In many instances a composite resection of the primary tumor and a neck dissection can be followed by postoperative radiation therapy. The potential benefit of neoadjuvant chemotherapy combined with irradiation and surgery in the treatment of these advanced lesions should be further evaluated. The benefit of adjuvant chemotherapy has not been documented. Advanced tumors of the oropharynx will continue to be a challenge to radiation and medical oncologists and surgeons. Prospective clinical trials should be encouraged to identify the therapeutic approach that will yield the highest survival and local tumor control rates with the lowest morbidity, including anatomical and functional deficits

  1. Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation

    International Nuclear Information System (INIS)

    Reddy, Sarada P.; Marks, James E.

    1997-01-01

    Purpose: To compare the outcome for patients with squamous cell carcinoma of cervical lymph nodes metastatic from an unknown primary site who were irradiated to both sides of the neck and potential mucosal sites with opposed photon beams, and for those irradiated to the ipsilateral side of the neck alone with an electron beam. Methods and Materials: Fifty-two patients with squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site were irradiated by two different methods. Thirty-six were irradiated with a bilateral technique (BT), i.e., to both sides of the neck, including the naso-oro-hypopharyngeal mucosa, and 16 were irradiated with an electron beam (EB) to the ipsilateral side of the neck alone. Twenty patients of the BT group and 11 of the EB group had cervical lymph node dissections, and the remaining 21 patients had lymph node biopsies, prior to radiotherapy. Results: Tumor control in the ipsilateral side of the neck did not differ for either radiation technique, but was significantly higher after lymph node dissection than after biopsy (90 vs. 48%; p = 0.0004). Control of subclinical metastases in the contralateral cervical lymph nodes was higher for patients irradiated with BT than for patients irradiated with EB (86 vs. 56%; p 0.03). The occult primary was later discovered in 8% of the patients in the BT group and 44% of the EB group (p = 0.0005). The disease-free survival rate at 5 years for patients who had lymph node dissection prior to irradiation was 61%, and was 37% for those who had biopsy (p = 0.05). Only 20% of patients who subsequently developed an occult primary were salvaged and survived for 5 years after salvage treatment. Conclusion: Bilateral neck and mucosal irradiation is superior to ipsilateral neck irradiation in preventing contralateral cervical lymph node metastases and the subsequent appearance of an occult primary cancer. Both techniques combined with cervical lymph node dissection were equally effective

  2. Hypothyroidism following surgery and radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    Park, I. K.; Kim, J. C.

    1997-01-01

    Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer. We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy. The follow-up duration was 3 to 80 months. The overall incidence of hypothyroidism was 56.3% (40/71); 7 out of 71 patients (9.9%) developed clinical hypothyroidism and 33 patients (46.4%) developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000). Four of 26 patients (15.4%) with neck dissection alone developed hypothyroidism while 36 of 45 patients (80%) with laryngectomy and neck dissection developed hypothyroidism. The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced the incidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is

  3. Hypothyroidism following surgery and radiation therapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, I. K.; Kim, J. C. [Kyungpook National Univ., Taegu (Korea, Republic of). Coll. of Medicine

    1997-09-01

    Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer. We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients` age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy. The follow-up duration was 3 to 80 months. The overall incidence of hypothyroidism was 56.3% (40/71); 7 out of 71 patients (9.9%) developed clinical hypothyroidism and 33 patients (46.4%) developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000). Four of 26 patients (15.4%) with neck dissection alone developed hypothyroidism while 36 of 45 patients (80%) with laryngectomy and neck dissection developed hypothyroidism. The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced the incidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is

  4. Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy.

    Science.gov (United States)

    Adams, Gerard; Porceddu, Sandro V; Pryor, David I; Panizza, Benedict; Foote, Matthew; Rowan, Ann; Burmeister, Bryan

    2014-08-01

    The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC). All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome. Median follow-up from diagnosis for 33 patients was 30 months (range, 6-76 months). INF occurred in 2 patients (6%) with neck dissections performed in 4 cases (12%). First failure was predominantly distant metastatic (10; 30%). The rate of INF remains low when following a PET-directed neck management policy after definitive CRT for N3 (>6 cm) HNSCC. Copyright © 2013 Wiley Periodicals, Inc.

  5. The role of neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

    International Nuclear Information System (INIS)

    Peters, Lester J.; Weber, Randal S.; Morrison, William H.; Byers, Robert M.; Garden, Adam S.; Goepfert, Helmuth

    1996-01-01

    Purpose: The role of neck surgery in node- positive patients whose primary tumours are treated by definitive radiotherapy is controversial. A planned neck dissection following radiotherapy is frequently recommended regardless of response of the neck nodes to treatment. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Materials and Methods: The analysis is based on all 100 patients treated using the concomitant boost protocol described below who presented between 1984 and 1993 with primary squamous cell carcinomas of the oropharynx and clinically positive cervical lymphadenopathy. There were 73 males and 27 females with a median age of 59. Primary disease site was base of tongue 39, tonsil 40, soft palate 14 and pharyngeal wall 7. Nodal stages were N1: 35, N2: 51 and N3: 15. Nodal size varied from 1 - 9 cm with a median of 3 cm. Radiotherapy consisted of 54 Gy in 30 fractions over 6 weeks to large fields with a boost to gross disease of 18 Gy in 12 fractions being delivered as a second daily fraction during the last 2.4 weeks of treatment. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while the remaining 13 underwent neck dissection for presumed residual disease. Twenty-five patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who were operated for presumed residual disease (pathologically negative in 7) and 5 in the 25 patients who had initial neck surgery. Of the 62 patients who had a complete response to radiotherapy, the two year probability of neck control was 87% if the initial nodal size was ≤ 3 cm versus 85% for nodes > 3 cm. However the likelihood of

  6. Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Lyudmila Andreevna Kalashnikova

    2013-01-01

    Full Text Available The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA. Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH. The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.. The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases and in ICA dissection less frequently (about 5%. Magnetic resonance (MR angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

  7. Cervical Artery Dissection and Choosing Appropriate Therapy.

    Science.gov (United States)

    Lau, Jonathan T; Hunt, John S; Bruner, David I; Austin, Andrea L

    2017-08-01

    Cervical artery dissection is a common cause of stroke in young adults. This may result from head and neck trauma; it can also occur spontaneously or secondary to genetic connective tissue or vascular disorders. Neurologic symptoms arise as a result of thromboembolism and hypoperfusion causing cerebral ischemia. We present a case of a previously healthy male who was found to have a cervical internal carotid artery dissection and the decision to use antiplatelet therapy instead of anticoagulation to prevent stroke. Data is lacking regarding the efficacy of one therapy over the other.

  8. Cervical Artery Dissection and Choosing Appropriate Therapy

    Directory of Open Access Journals (Sweden)

    Jonathan T. Lau

    2017-07-01

    Full Text Available Cervical artery dissection is a common cause of stroke in young adults. This may result from head and neck trauma; it can also occur spontaneously or secondary to genetic connective tissue or vascular disorders. Neurologic symptoms arise as a result of thromboembolism and hypoperfusion causing cerebral ischemia. We present a case of a previously healthy male who was found to have a cervical internal carotid artery dissection and the decision to use antiplatelet therapy instead of anticoagulation to prevent stroke. Data is lacking regarding the efficacy of one therapy over the other.

  9. A new technique of bladder neck reconstruction during radical prostatectomy in patients with prostate cancer

    Directory of Open Access Journals (Sweden)

    Yuri Tolkach

    2015-06-01

    Full Text Available ABSTRACTPurpose:To evaluate continence after radical prostatectomy in prostate cancer patients, in whom a new method of the bladder neck reconstruction (BNR using deep dorsal stitch was implemented (deep single stitch through all bladder layers directly dorsal to the bladder opening after “tennis racket” reconstruction and to provide justification for its use by means of anatomical study in cadavers.Material and Methods:Open radical retropubic prostatectomy was performed in 84 patients: 39 patients with a new BNR method used to improve continence and control group of 45 patients with standard “tennis racket” BNR. Median follow-up was 14 months in control group and 12 months in study group. Continence recovery was accessed early postoperatively and every 3 months thereafter. Anatomical study was performed on 2 male fresh cadavers reproducing two different BNR techniques to clarify any underlying continence related mechanisms.Results:Patients with new BNR achieved full continence significantly faster (p=0.041, but the continence rates after 12 months were similar between groups. The severity of incontinence up to month 9 was significantly reduced in BNR group. The anastomotic stricture rate was not affected. Applying new BNR to the cadaver model revealed effects on early continence, namely presence of proximal passive closure mechanism in area of bladder neck.Conclusions:Continence in patients with the new BNR method using deep dorsal stitch recovered significantly faster. Moreover, a reduced grade of residual incontinence was documented. The effect was non-significant at month 12 of follow-up, meaning that only early effect was present.

  10. [Case report: Iatrogenic shoulder pain syndrome following spinal accessory nerve injury during lateral cervical neck dissection for tongue cancer: the role of rehabilitation and ethical-deontological issues].

    Science.gov (United States)

    Ronconi, Gianpaolo; Spagnolo, Antonio Gioacchino; Ferriero, Giorgio; Giovannini, Silvia; Amabile, Eugenia; Maccauro, Giulio; Ferrara, Paola Emilia

    2017-01-01

    The shoulder pain syndrome is the most frequent complication of lateral cervical neck dissection and may be caused by iatrogenic injury to the spinal accessory nerve, causing pain and functional limitation of the upper limb and of the cervical spine. Interdisciplinary collaboration and early rehabilitation can reduce the consequences of disability and the possible issues that can arise due to inadequate management of the problem.

  11. Elective neck management for high-grade salivary gland carcinoma.

    Science.gov (United States)

    Herman, Michael P; Werning, John W; Morris, Christopher G; Kirwan, Jessica M; Amdur, Robert J; Mendenhall, William M

    2013-01-01

    To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT). Between October 1964 and October 2009, 59 previously untreated patients with cNo high-grade salivary gland carcinomas (squamous cell carcinomas were excluded) were treated with curative intent using elective neck dissection (END; n=41), or elective neck irradiation (ENI; n=18) at the University of Florida College of Medicine (Gainesville, FL). All patients underwent resection of the primary cancer followed by postoperative RT. The median follow-up period was 5.2years (range, 0.3-34years). Occult metastases were found in 18 (44%) of the 41 patients in the END group. There were 4 recurrences (10%) in the END group and 0 recurrence in the ENI group. Neck control rates at 5years were: END, 90%; ENI, 100%; and overall, 93% (p=0.1879). Cause-specific survival was 94% in the ENI group, 84% in the END group, and 86% for all patients (p=0.6998). There were 3 reported grade 3 or 4 toxicities. Two patients had a postoperative fistula and one patient had a grade 4 osteoradionecrosis that required a partial mandibulectomy. Patients with cNo high grade salivary gland carcinomas who are planned to undergo surgery and postoperative RT likely do not benefit from a planned neck dissection. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. The Effectiveness of Prophylactic Modified Neck Dissection for Reducing the Development of Lymph Node Recurrence of Papillary Thyroid Carcinoma.

    Science.gov (United States)

    Ito, Yasuhiro; Miyauchi, Akira; Kudo, Takumi; Kihara, Minoru; Fukushima, Mitsuhiro; Miya, Akihiro

    2017-09-01

    The most frequent recurrence site of papillary thyroid carcinoma (PTC) is the cervical lymph nodes. The introduction of an electric linear probe for use with ultrasonography in 1996 improved preoperative lateral neck evaluations. Before 2006, however, our hospital routinely performed prophylactic modified neck dissection (p-MND) for N0 or N1a PTCs >1 cm to prevent node recurrence. In 2006, we changed our policy and the indications for p-MND to PTCs >3 cm and/or with significant extrathyroid extension. Here, we retrospectively compared lymph node recurrence-free survival between PTCs with/without p-MND. We examined the cases of N0 or N1 and M0 PTC patients who underwent initial surgery in 1992-2012. To compare lymph node recurrence-free survival between patients who did/did not undergo p-MND, we divided these patients into three groups (excluding those whose surgery was in 2006): the 2045 patients whose surgery was performed in 1992-1996 (Group 1), the 2989 with surgery between 1997 (post-introduction of ultrasound electric linear probes) and 2005 (Group 2), and the 5332 operated on in 2007-2012 (Group 3). The p-MND performance rate of Group 3 (9%) was much lower than that of Group 1 (80%), but the lymph node recurrence-free survival of the former was significantly better, probably due to differences in clinical features and neck evaluations by ultrasound between the two groups. Our analysis of the patients aged Abolishing routine p-MND for PTCs in 2006 did not decrease lymph node recurrence-free survival, probably due to improved ultrasound preoperative neck evaluations and clinical feature changes. Selective p-MND for high-risk cases improved lymph node recurrence-free survival.

  13. Hyperfractionated-accelerated radiotherapy followed by radical surgery in locally advanced tumors of the oral cavity

    International Nuclear Information System (INIS)

    Hoeller, U.; Biertz, I.; Tribius, S.; Alberti, W.; Flinzberg, S.; Schmelzle, R.

    2006-01-01

    Purpose: to evaluate the outcome of hyperfractionated-accelerated radiotherapy and subsequent planned primary tumor resection and radical neck dissection in locally advanced tumors of the oral cavity. Patients and Methods: this retrospective analysis evaluates 126 subsequent patients who were treated between 1988 and 1997 for locally advanced tumors of the oral cavity (with extension into the oropharynx in 17 patients), 34 (27%) AJCC stage III and 92 (73%) stage IV. Primary tumor and nodal metastases were irradiated with 1.4 Gy bid to a median total dose of 72.8 Gy (range 58.8-75.6 Gy). Then, planned radical surgery of the primary site according to the initial tumor extent and cervical nodes was performed. Median follow-up of living patients was 6 years (range 1-11 years). Results: 4 weeks after radiotherapy, 14 patients (11%) had complete tumor remission, 92 (73%) partial remission, 15 (12%) no change, and five (4%) progressive disease. Complete resection was achieved in 117 (93%) patients (nine incomplete resections). 5-year locoregional control rate was 62 ± 9%, overall survival 36 ± 9%. Surgery-related morbidity occurred in 42 patients (33%; mainly delayed wound healing and fistulae), overall severe treatment-related morbidity in 46 patients (36%). 24/84 relapse-free patients (29%) required a percutaneous gastrostomy or nasal tube ≥ 1 year after therapy. Conclusion: in this study, the outcome of combined curative radiotherapy and planned surgery of the primary tumor and neck nodes was comparable to reported results of hyperfractionated radiotherapy with or without salvage surgery of the neck nodes with respect to locoregional control and overall survival. Planned surgery carries a substantial risk of morbidity and seems to offer no benefit in comparison to salvage surgery of the neck nodes only. Therefore, salvage surgery is preferred. (orig.)

  14. An interesting case report of vertebral artery dissection following polytrauma

    Directory of Open Access Journals (Sweden)

    Vikas Acharya

    2016-01-01

    Conclusion: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

  15. Regional control of melanoma neck node metastasis after selective neck dissection with or without adjuvant radiotherapy

    NARCIS (Netherlands)

    Hamming-Vrieze, Olga; Balm, Alfons J. M.; Heemsbergen, Wilma D.; Hooft van Huysduynen, Thijs; Rasch, Coen R. N.

    2009-01-01

    OBJECTIVE: To examine the effect of adjuvant radiotherapy on regional control of melanoma neck node metastasis. DESIGN: A single-institution retrospective study. SETTING: Tertiary care cancer center. PATIENTS: The study included 64 patients with melanoma neck node metastasis who were treated with

  16. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. proposal for standardizing terminology and procedure based on the surgical experience

    International Nuclear Information System (INIS)

    Gregoire, V.; Coche, E.; Cosnard, G.; Hamoir, M.; Reychler, H.

    2000-01-01

    The increasing use of 3D treatment planning in head and neck radiation oncology has created an urgent need for new guidelines for the selection and the delineation of the neck node areas to be included in the clinical target volume. Surgical literature has provided us with valuable information on the extent of pathological nodal involvement in the neck as a function of the primary tumor site. In addition, few clinical series have also reported information on radiological nodal involvement in those areas not commonly included in radical neck dissection. Taking all these data together, guidelines for the selection of the node levels to be irradiated for the major head and neck sites could be proposed. To fill the missing link between these Guidelines and the 3D treatment planning, recommendations for the delineation of these node levels (levels I-VI and retropharyngeal) on CT (or MRI) slices have been proposed using the guidelines outlined by the Committee for Head and Neck Surgery and Oncology of the American Academy for Otolarynology-Head and Neck Surgery. These guidelines were adapted to take into account specific radiological landmarks more easily identified on CT or MRI slices than in the operating field. (author)

  17. Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

    OpenAIRE

    Deniz Kamacı Şener; Özlem Taşkapılıoğlu; Nermin Kelebek Girgin; Bahattin Hakyemez; Mustafa Bakar; Yakup Tomak

    2012-01-01

    Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

  18. Combination of neck dissection for cervical metastasis and irradiation of primary tumors for carcinomas of the mesopharynx, hypopharynx, and larynx

    International Nuclear Information System (INIS)

    Sato, Katsuro; Hanazawa, Hideyuki; Takahashi, Sugata; Watanabe, Jun; Tomita, Masahiko

    2006-01-01

    Carcinomas of the mesopharynx, hypopharynx, and larynx with early-stage primary tumor and with cervical lymph node metastasis, were treated by neck dissection for cervical metastasis and definitive irradiation of the primary tumor. In this study, the primary sites of the 16 cases were the mesopharynx (10), the hypopharynx (3), and the larynx (3). Twelve cases of early T stages (T1 or T2) and 15 cases of advanced N stages (N2 or N3) were chosen for this treatment concept. Neck lesions were controlled in all cases and all the primary tumors showed complete response at the end of the initial treatment. One case of mesopharyngeal cancer died due to recurrence of the primary tumor and one case of hypopharyngeal cancer died due to complicated lung cancer. The treatment modality for cases of early primary cancer and advanced cervical lymph node metastasis requires well-balanced strategies for both lesions. In these cases, optimal prognosis was obtained because of careful patient selection. The treatment strategy described in this paper should be considered for cases of early T tumors and advanced N tumors. (author)

  19. Recurrence and survival after neck dissections in cutaneous head and neck melanoma

    DEFF Research Database (Denmark)

    Andersen, Peter Stemann; Chakera, Annette Hougaard; Thamsborg, Andreas Key Milan

    2014-01-01

    INTRODUCTION: An important prognostic factor in head and neck melanoma is the status of the regional lymph nodes since the presence of metastatic disease in the nodes greatly aggravates the prognosis. There is no consensus on the surgical treatment algorithm for this group. Our aim was to study i...

  20. Dolichoectasia and dissection of the intracranial vertebrobasilar artery

    International Nuclear Information System (INIS)

    Stoyanov, D.; Boshnjakovich, P.; Zivkovic, M.

    2001-01-01

    The purpose is to determine the clinical neuro-radiological features of dolichoectatic intracranial vertebrobasilar artery dissection. The clinical features native and post-contrast CT scans of five patients (4 men and 1 woman; age ranged from 25 to 68 years) with dolichoectatic intracranial vertebrobasilar artery dissection were analysed retrospectively for a period of 3 years. Diagnosis was confirmed by vertebral angiography. Clinical symptoms due to ischemic cerebellar and/or brain stem lesion were present in 4 patient, 2 of them had Wallenberg syndrome. Occipital and/or posterior neck pains were found in 4 patients. Subarachnoid hemorrhage was shown in 1 patient. The incidence of previously documented hypertension was 60% (3 of 5 patients). The prognosis was relatively good. Dolichoectasia was detected by native, post-contrast CT scans and reconstructions in all patients. Intimal flap was visualized with post contrast CT scans in 1 patients. Extension of the basilar artery tip into the third ventricle was detected in 3 patients. Ischemic low-density lesions were detected in 3 patients and subarachnoid hemorrhage in 1 patient. Vertebral angiography disclosed elongation and dilatation of the vertebral and basilar arteries, double lumen sign - the presence of a true and false lumen and an intimal flap, double density and retention of contrast medium. Ischemic symptoms and head and/or neck pain were the most common clinical findings. The double lumen sign considered as the only pathognomonic angiographic finding of arterial dissection, was found in all patients. Angiography is still considered the 'gold standard' for diagnosis of intracranial vertebrobasilar artery dissection. (author)

  1. THE IMPACT OF DIAGNOSTIC DISCREPANCIES IN AORTIC DISSECTION MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Abdalla Hassan

    2016-01-01

    Full Text Available Aortic dissection is uncommon with high mortality rate if untreated. We report a challenging case of long segment aortic dissection in which the dissection type was very difficult to identify due to limitations of the available imaging studies. 66-year-old male presented to us with 3 days history of chest pain and difficulty breathing. He is known to be hypertensive. In the emergency room, patient has systolic blood pressure >190. Chest X-ray showed widening of mediastinum. CT angiography of chest and abdomen showed an acute dissection of the thoracic aorta extending from the mid ascending aorta to the infra-renal aorta suggestive of Stanford type A aortic dissection. Transthoracic and Trans-esophageal echocardiography revealed a partially calcified intimal flap in the distal portion of the arch and in the descending thoracic aorta suggestive of Stanford type B aortic dissection. Medical treatment started, and repeated CT angiography was obtained and it confirmed type B aortic dissection. One week after discharge, patient was readmitted with severe neck pain and difficulty breathing. CT chest without contrast showed grossly stable appearance of type A dissection consistent with the first CT angiography. Cardiothoracic surgery immediately reevaluated the situation and recommended surgical intervention.

  2. Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

    Directory of Open Access Journals (Sweden)

    Deniz Kamacı Şener

    2012-12-01

    Full Text Available Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

  3. Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration.

    Science.gov (United States)

    Stolzenburg, Jens-Uwe; Wasserscheid, Johanna; Rabenalt, Robert; Do, Minh; Schwalenberg, Thilo; McNeill, Alan; Constantinides, Costantinos; Kallidonis, Panagiotis; Ganzer, Roman; Liatsikos, Evangelos

    2008-12-01

    In our series of 1,900 endoscopic extraperitoneal radical prostatectomies (EERPE) the incidence of symptomatic lymphocele following simultaneous pelvic lymph node dissection (PLND) is between 3 and 14% depending on the extent of lymph node dissection. We report the impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele, postoperative pain and complications. A total of 100 consecutive patients undergoing EERPE and extended PLND were allocated into two groups. In Group A (n = 50) a 4-6 cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure. In Group B (n = 50) no peritoneal incisions were made. The postoperative assessment protocol included a visual analogue pain scale administered three times daily for 6 days, analgesia requirement, and ultrasound examination on 4th and 8th days, and 3 months postoperatively. CRP and leucocyte counts were measured on 1st and 2nd postoperative days. Complications were recorded according to our standard protocol using the Clavien classification. Three patients (6%) in Group A were found to have lymphoceles, none of which were symptomatic. Significantly more patients in Group B developed a lymphocele, (n = 16, 32%, P < 0.001) of which a significant number were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic fenestration. No significant difference was observed between the pain score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and 0.8 versus 1.1 at 6 days, respectively. No difference in analgesia requirement, serum inflammatory markers and return to normal bowel activity was observed between the groups. This study demonstrates that peritoneal fenestration significantly reduces the incidence of both symptomatic and asymptomatic lymphocele, without an increase in postoperative morbidity. As symptomatic lymphocele is one of the most common

  4. Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

    Science.gov (United States)

    Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

    2015-12-01

    Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

  5. Cervical artery dissection: early recognition and stroke prevention [digest].

    Science.gov (United States)

    Cadena, Rhonda; Kim, Jeremy

    2016-07-22

    Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke. [Points & Pearls is a digest of Emergency Medicine Practice].

  6. Long-term results of positron emission tomography-directed management of the neck in node-positive head and neck cancer after organ preservation therapy.

    Science.gov (United States)

    Sjövall, Johanna; Chua, Benjamin; Pryor, David; Burmeister, Elizabeth; Foote, Matthew C; Panizza, Benedict; Burmeister, Bryan H; Porceddu, Sandro V

    2015-03-01

    The current study presents the long-term results from a study designed to evaluate a restaging positron emission tomography (PET) directed policy whereby neck dissections were omitted in all node positive head and neck squamous cell carcinoma (N+HNSCC) patients with PET-negative lymph nodes after definitive radiotherapy (RT), with or without chemotherapy. A post-therapy nodal response assessment with PET and computed tomography (CT) was performed in patients who achieved a complete response at the primary site after definitive radiotherapy. Patients with PET-negative lymph nodes were observed regardless of residual CT abnormalities. One hundred and twelve patients, the majority of whom (83 patients, 74%) had oropharyngeal primaries, were treated on protocol. Median follow-up was 62months. Negative and positive predictive values for the restaging PET was 97.1% and 77.8% respectively, with only one patient who was PET-negative after treatment experiencing an isolated nodal relapse. PET-guided management of the neck following organ preservation therapy effectively spares neck dissections in patients with N+HNSCC without compromising isolated nodal control or overall survival. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  7. MRI and MR angiography of vertebral artery dissection

    International Nuclear Information System (INIS)

    Mascalchi, M.; Bianchi, M.C.; Mangiafico, S.; Ferrito, G.; Puglioli, M.; Marin, E.; Mugnai, S.; Canapicchi, R.; Quilici, N.; Inzitari, D.

    1997-01-01

    A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3-20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients. (orig.). With 7 figs., 3 tabs

  8. A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies

    International Nuclear Information System (INIS)

    Brown, Paul D.; Foote, Robert L.; McLaughlin, Mark P.; Halyard, Michele Y.; Ballman, Karla V.; Collie, A. Craig; Miller, Robert C.; Flemming, Kelly D.; Hallett, John W.

    2005-01-01

    Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. Methods and Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. Results: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk of ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. Conclusions: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered

  9. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report.

    Science.gov (United States)

    Peric, Barbara; Marinsek, Ziva Pohar; Skrbinc, Breda; Music, Maja; Zagar, Ivana; Hocevar, Marko

    2014-08-20

    Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine [F-18]-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions.

  10. Neurorehabilitation in stroke produced by vertebral artery dissection: case presentation

    Directory of Open Access Journals (Sweden)

    Stanescu Ioana

    2018-02-01

    Full Text Available Arterial dissections are a common cause of stroke in the young (mean age 44 to 46 years. Primary lesion is a tear of the arterial intima, which promotes platelet aggregation, thrombus formation, which further produced vessel stenosis / occlusion, distal embolism or vessel wall rupture. Vertebral artery (VA dissection appear most commonly in extracranial segments V2 and V3, and could be spontaneous (with underlying predispositions or triggered by various traumatisms. Clinicaly, VA dissection produces an ischemic stroke or transient ischemic attack , preceded by local symptoms such as neck pain or headache. The diagnosis is confirmed by neurovascular imaging. Treatment of symptomatic VA dissections respect indications of treatment in ischemic strokes. Prognosis is mostly favorable in extracranial dissections. We present the case of a left VA dissection in V2 segment, produced by physical effort (swimming, which causes 2 ischemic lesions, one in the territory of the left posterior cerebral artery and the other in the territory of the left posterolateral chorroidal artery. Patient’s treatment included antiplatelet agents, statines, and an adapted physical rehabilitation program. At three months he showed significant clinical improvement with regain of autonomy and partial recanalisation at angio-MRI of the V2 segment of the dissected artery.

  11. Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India.

    Science.gov (United States)

    Chalissery, J R; Sudheeran, P C; Varghese, K M; Venkatesan, K

    2016-01-01

    To assess the feasibility, tolerance and response of radical chemo irradiation using Intensity modulated Radiotherapy [IMRT] in elderly patients [age >65] with locally advanced head and neck cancer. Patients aged 65 and above [range 65 to 84years] registered in oncology outpatient unit in our institution between December 2011 to 2014, with stage III and IV head and neck cancer were treated with radical dose of radiotherapy using IMRT and concurrent chemotherapy with cisplatin 40mg/sq.m weekly. Response evaluation and toxicity profile assessment was done 6 to 8 weeks after completion of treatment and 3 monthly thereafter with median follow up of 3 years. Total number of patients analysed were 47. 43(91.5%) patients tolerated 66-.70Gy of radiotherapy and 4 or more cycles of weekly chemotherapy with cisplatin. First follow up evaluation at 6 to 8 weeks showed 81% patients having complete loco regional response. Grade III skin reaction and mucositis was noticed in 24% and 47% respectively. No grade III neutropenia observed. Median follow up of 3 years showed a complete local control in 53% and overall survival of 60%. Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.

  12. Clinical features of 10 patients with spontaneous cervical internal carotid artery dissection

    International Nuclear Information System (INIS)

    Nagoya, Harumitsu; Takeda, Hidetaka; Dembo, Tomohisa; Kato, Yuzi; Deguchi, Ichiro; Fukuoka, Takuya; Maruyama, Hazime; Horiuchi, Yohsuke; Tanahashi, Norio

    2011-01-01

    We clinically investigated 10 patients with spontaneous cervical internal carotid artery dissections (age range 36-70, mean 52±12 years; 8 male and 2 female) who were admitted to our university hospital between August 2002 and 2009. Cervical internal carotid artery dissection was diagnosed using findings from MRI, MR angiography (MRA), 3D-CTA, cerebral angiography, and carotid artery ultrasonography according to the diagnostic criteria of brain artery dissociation defined by the brain artery dissociation working group of the Strategies Against Stroke Study for Young Adults in Japan. The initial symptoms were stroke in eight patients, only neck pain in another, and no symptoms in the last. Four patients (40%) had neck pain or headache at onset. Five of the 10 patients had radiological improvements within three months after onset. The outcomes at three months were relatively good, with seven and three patients scoring 1 and 2, respectively, on the modified Rankin Scale. Disease did not recur in any patients during an average of 17.2 months of follow up. Spontaneous cervical internal carotid artery dissection is not rare in Japan. This condition should be considered when patients present with internal carotid artery occlusion or stenosis. (author)

  13. Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2004-06-01

    Full Text Available INTRODUCTION: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex. The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps. SURGICAL TECHNIQUE: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.

  14. Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection – case report

    International Nuclear Information System (INIS)

    Nesteruk, Tomasz; Nesteruk, Marta; Bulik-Pasińska, Marta; Boroszko, Dariusz; Ostrowska, Monika

    2012-01-01

    Internal carotid artery dissection (ICAD) is a frequent cause of a stroke in young patients. Risk factors which can lead to dissection include neck injury and diseases of the inner wall of the artery. Common symptoms in ICAD are cervical pain and headache, Horner’s syndrome, paralysis of the cranial nerves and subsequently cerebral and retinal ischemia. MR angiography in TOF technique and brain MRI in T1- and T2-weighted images, FLAIR and DWI sequences are the method of choice in patients with ICAD but contrast-enhanced multislice computed tomography remains the fastest and the most available diagnostic method. A 39-year old woman, previously healthy, presented to the Hospital Emergency Department because of increasing neck pain on the right side and difficulty in swallowing. The neurological examination revealed: drooping of the right eyelid with narrow palpebral fissure, dysarthria, anisocoria (narrower pupil on the right side), unilateral hypoesthesia on the left side, weak palatal and pharyngeal reflexes on both sides, paresthesia within the left half of the body. Seven days before, the patient felt a sudden, severe neck pain radiating to the temporal apophysis. CT angiography revealed a defect in contrast filling within the left internal carotid artery and right vertebral artery. MRI of the head with MR angiography showed internal carotid artery dissection on the left side and dissection of the right vertebral artery and no ischemic changes within the brain. CT and MR angiography are methods characterized by high sensitivity in detecting dissection of the cervical arteries

  15. An electronic instructor for gross anatomy dissection.

    Science.gov (United States)

    Josephson, Eleanor M; Moore, Larry J

    2006-01-01

    Gross anatomy is time consuming to teach and to learn. Because the process of dissection takes up so much student time, assistance in the form of an in-lab instructional DVD program might improve student performance. The DVD could be viewed with a portable device by individual dissection groups at their tables. Groups could dissect at their own pace, with access to step-by-step demonstrations and answers to frequently asked anatomical questions. We created an instructional DVD program demonstrating dissection of the canine ventral neck and thoracic limb. The effect on student exam scores of using the DVD versus not using it was measured in a controlled, two-sample study using incoming first-year veterinary students as volunteers. Volunteers were told the study was of two different dissection methods; the DVD was not specifically mentioned until after the students were separated into two groups (Blue/DVD group and Orange/No DVD group), and then only to volunteers in the Blue group. Except for the DVD, the two groups had the same resources. The difference in scores on an exam given after a single dissection period did not differ sufficiently to conclude that DVD use raised the mean score; however, 73% of the DVD group scored 60% or higher, while only 38% of the No DVD group scored 60% or higher. The difference in mean scores overall was 2.3 points out of a possible 49, suggesting that the DVD helped students, especially those with lower scores, to earn two to three more points than they would have otherwise.

  16. Partial axillary dissection in early breast cancer | El-Fayoumi ...

    African Journals Online (AJOL)

    ... of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning axillary dissection is an important operative procedure. ... Methods: Eighteen patients underwent modified radical mastectomy, while the other two patients who were fulfilling the criteria for conservative breast surgery ...

  17. [Neck lymphatic metastasis, surgical methods and prognosis in early tongue squamous cell carcinoma].

    Science.gov (United States)

    Wang, L S; Zhou, F T; Han, C B; He, X P; Zhang, Z X

    2018-02-09

    Objective: To investigate the different pattern of neck lymph node metastasis, the choice of surgical methods and prognosis in early tongue squamous cell carcinoma. Methods: A total of 157 patients with early oral tongue squamous cell carcinoma were included in this study. Statistical analysis was performed to identify the pattern of lymph node metastasis, to determine the best surgical procedure and to analyze the prognosis. Results: The occurrence of cervical lymph node metastasis rate was 31%(48/157). Neck lymphatic metastasis was significantly related to tumor size ( P= 0.026) and histology differentiation type ( P= 0.022). The rate of metastasis was highest in level Ⅱ [33% (16/48)]. In level Ⅳ, the incidence of lymph node metastasis was 5%(7/157), and there was no skip metastases. The possibility of level Ⅳ metastasis was higher, when level Ⅱ ( P= 0.000) or Ⅲ ( P= 0.000) involved. The differentiation tumor recurrence, neck lymphatic metastasis and adjuvant radiotherapy were prognostic factors ( Psquamous cell carcinoma, simultaneous glossectomy and neck dissection should be performed. Level Ⅳ metastasis rate is extremely low, so supraomohyoid neck dissection is sufficient for most of the time. The histology differentiation type, neck lymphatic metastasis and adjuvant radiotherapy are independent prognostic factors.

  18. Dissection of internal carotid artery presenting as isolated ischaemic optic neuropathy

    Directory of Open Access Journals (Sweden)

    Serdar Oruc

    2016-08-01

    Full Text Available Carotid artery dissections are one of the important reasons of cerebrovascular events that are observed before the age of 45. Besides the local findings such as head, neck and face pains, Horner syndrome findings, pulsatile tinnitus and cranial nerve involvements, some other symptoms such as ischemic stroke, transient ischemic attacks and amaurosis fugax can also be observed in the approximately three quarters of patients. Ischemic optic neuropathy may be seen as %4 in the carotid artery dissections and it mostly accompanies other ischemic local symptoms. It is rare to observe the ischemic optic neuropathy as the first and unique finding in the carotid artery dissections. In this study, a 55 year old male patient with carotid artery dissection was represented. He did not have any other complaint, except the sudden unilateral visual loss and he was sent to our clinics from the opthalmology clinics in order to search for the etiology of ischemic optic neuropathy. It should be kept in mind that there can be a possibility to have carotid artery dissections in patients with unilateral visual loss.

  19. Laparoscopic radical trachelectomy.

    Science.gov (United States)

    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  20. Prognostic Value of p16 Status on the Development of a Complete Response in Involved Oropharynx Cancer Neck Nodes After Cisplatin-Based Chemoradiation: A Secondary Analysis of NRG Oncology RTOG 0129

    Energy Technology Data Exchange (ETDEWEB)

    Galloway, Thomas J., E-mail: thomas.galloway@fccc.edu [Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Zhang, Qiang [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Nguyen-Tan, Phuc Felix [Centre Hospitalier de l' Universite de Montreal-Notre Dame, Montréal, Québec (Canada); Rosenthal, David I. [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Soulieres, Denis [Centre Hospitalier de l' Universite de Montreal-Notre Dame, Montréal, Québec (Canada); Fortin, André [L Hotel-Dieu de Quebec, Québec City, Québec (Canada); Silverman, Craig L. [The James Brown Cancer Center–University of Louisville, Louisville, Kentucky (United States); Daly, Megan E. [University of California Davis Medical Center, Sacramento, California (United States); Ridge, John A. [Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Hammond, J. Alexander [London Regional Cancer Program, London, Ontario (Canada); Le, Quynh-Thu [Stanford University Medical Center, Stanford, California (United States)

    2016-10-01

    Purpose: To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. Methods and Materials: Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. Results: Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n=69; p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P=.71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P=.42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P=.02) and was associated with a reduced incidence of local–regional failure (hazard ratio 0.33, P=.003). On multivariate analysis of local–regional failure, a test for interaction between pCR and p16 status was not significant (P=.37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P=.42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. Conclusions: Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.

  1. Head and neck: treatment of primary and relapsed nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Wang, C.C.

    1995-01-01

    Purpose/Objective: Nasopharyngeal carcinoma (NPC) is not a common malignancy of the head and neck in the United States and presents a great challenge to the radiation oncologists in this country. Its management is radiotherapeutic and technically demanding and calls for careful treatment techniques to include the primary and the lymphatic drainage areas to high doses while sparing the neighboring organs such as the spinal cord, eyes, temporal lobes and midrain. This refresher course will review the clinical course, pattern of spread with manifestations of various neurologic syndromes of the disease. The radiotherapeutic management of primary lesion will be discussed in detail including the treatment techniques, placement of the irradiation portals, dose levels, etc. Treatment results as reported in the literature as well as those achieved at the MGH will be presented. Special emphasis will be placed on the routine use of intracavitary implant to boost the primary site and its technical aspects. Relapsed NPC after previous radiation therapy presents a difficult problem in management, but can be re-irradiated with occasional success by observing careful technique and fractionated intracavitary brachytherapy and the local control rates will be briefly covered. Recurrent disease in the neck will be managed by neck dissection. Xerostomia is undesirable and common sequelae following radical radiation therapy for NPC. Efforts are being made to decrease its magnitude by using higher energies of photons, i.e. 10 MV to spare a portion of the parotid glands with some promising results. Because of the unique location of the primary lesion, currently a modified BID program (MBID) is used and its techniques and treatment concept are discussed

  2. Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence.

    Science.gov (United States)

    Locketz, Garrett D; Lui, Justin T; Chan, Sonny; Salisbury, Kenneth; Dort, Joseph C; Youngblood, Patricia; Blevins, Nikolas H

    2017-06-01

    Objective To evaluate the effect of anatomy-specific virtual reality (VR) surgical rehearsal on surgeon confidence and temporal bone dissection performance. Study Design Prospective pre- and poststudy of a novel virtual surgical rehearsal platform. Setting Academic otolaryngology-head and neck surgery residency training programs. Subjects and Methods Sixteen otolaryngology-head and neck surgery residents from 2 North American training institutions were recruited. Surveys were administered to assess subjects' baseline confidence in performing 12 subtasks of cortical mastoidectomy with facial recess. A cadaver temporal bone was randomly assigned to each subject. Cadaver specimens were scanned with a clinical computed tomography protocol, allowing the creation of anatomy-specific models for use in a VR surgical rehearsal platform. Subjects then rehearsed a virtual mastoidectomy on data sets derived from their specimens. Surgical confidence surveys were administered again. Subjects then dissected assigned cadaver specimens, which were blindly graded with a modified Welling scale. A final survey assessed the perceived utility of rehearsal on dissection performance. Results Of 16 subjects, 14 (87.5%) reported a significant increase in overall confidence after conducting an anatomy-specific VR rehearsal. A significant correlation existed between perceived utility of rehearsal and confidence improvement. The effect of rehearsal on confidence was dependent on trainee experience and the inherent difficulty of the surgical subtask. Postrehearsal confidence correlated strongly with graded dissection performance. Subjects rated anatomy-specific rehearsal as having a moderate to high contribution to their dissection performance. Conclusion Anatomy-specific virtual rehearsal improves surgeon confidence in performing mastoid dissection, dependent on surgeon experience and task difficulty. The subjective confidence gained through rehearsal correlates positively with subsequent

  3. Predictors of Pain among Head and Neck Cancer Patients

    Science.gov (United States)

    Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A.; Duffy, Sonia A.

    2014-01-01

    Objective Pain is a strong contributor to cancer patients’ quality of life. The objective of this study was to determine predictors of pain 1 year after the diagnosis of head and neck cancer. Design Prospective, multi-site cohort study. Setting Three academically-affiliated medical centers. Patients Previously untreated patients with carcinoma of the upper aerodigestive tract (n=374). Main Outcome Measures Participants were surveyed pre-treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the SF-36 bodily pain score 1 year after diagnosis. Results The mean SF-36 bodily pain score at 1 year was 65, compared to 61 at diagnosis (p=.004), compared to 75 among population norms (lower scores indicate worse pain). Variables independently associated with pain included pre-treatment pain score (p<0.001), less education (p=0.02), neck dissection (p=0.001), feeding tube (p=0.05), xerostomia (p<0.001), depressive symptoms (p<0.001), taking more pain medication (p<0.001), less physical activity (p=.02), and poor sleep quality (p=0.006). Current smoking and problem drinking were marginally significant (p=0.07 and 0.08, respectively). Conclusions Aggressive pain management may be indicated for head and neck cancer patients who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco and alcohol abuse may also reduce pain and improve quality of life among head and neck cancer patients. PMID:23165353

  4. Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy.

    Science.gov (United States)

    Feifer, Andrew H; Elkin, Elena B; Lowrance, William T; Denton, Brian; Jacks, Lindsay; Yee, David S; Coleman, Jonathan A; Laudone, Vincent P; Scardino, Peter T; Eastham, James A

    2011-09-01

    Pelvic lymph node dissection (PLND) is an important component of prostate cancer staging and treatment, especially for surgical patients who have high-risk tumor features. It is not clear how the shift from open radical prostatectomy (ORP) to minimally invasive radical prostatectomy (MIRP) has affected the use of PLND. The objectives of this study were to identify predictors of PLND and to assess the impact of surgical technique in a contemporary, population-based cohort. In Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, the authors identified men who underwent ORP or MIRP for prostate cancer during 2003 to 2007. The impact of surgical approach on PLND was evaluated, and interactions were examined between surgical procedure, prostate-specific antigen (PSA), and Gleason score with the analysis controlled for patient and tumor characteristics. Of 6608 men who underwent ORP or MIRP, 70% (n = 4600) underwent PLND. The use of PLND declined over time both overall and within subgroups defined by procedure type. PLND was 5 times more likely in men who underwent ORP than in men who underwent MIRP when the analysis was controlled for patient and tumor characteristics. Elevated PSA and biopsy Gleason score, but not clinical stage, were associated with a greater odds of PLND in both the ORP group and the MIRP group. However, the magnitude of the association between these factors and PLND was significantly greater for patients in the ORP group. PLND was less common among men who underwent MIRP, independent of tumor risk factors. A decline in PLND rates was not fully explained by an increase in MIRP. The authors concluded that these trends may signal a surgical approach-dependent disparity in prostate cancer staging and therapy. Cancer 2011 © 2011 American Cancer Society.

  5. Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?

    DEFF Research Database (Denmark)

    Alkureishi, Lee; Ross, Gary; Shoaib, Taimur

    2007-01-01

    AND METHODS:: One hundred seventy-two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB-assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin...

  6. Dissecting Dissection.

    Science.gov (United States)

    AV Magazine, 1996

    1996-01-01

    This journal features articles covering various aspects of dissection. "Biology--The Study of Life" (George Russell) offers students experiments that do not require using invasive procedures. "Animal Cruelty--Behind the Scenes" (Zoe Weil) describes sources of laboratory animals. "Doing without Dissection" (Juliana…

  7. The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; Results from a high volume centre

    Directory of Open Access Journals (Sweden)

    Ali Serdar Gozen

    2017-10-01

    Full Text Available Objective: To evaluate the effects of bladder neck reconstruction techniques on early continence after laparoscopic radical prostatectomy (LRP. Materials and methods: This non-randomized retrospective study analyzed prospectively collected data concerning LRP. In total, 3107 patients underwent LRP between March 1999 and December 2016. Exclusion criteria were preoperative urinary incontinence, previous history of external beam radiotherapy, co-morbities which may affect urinary continence such as diabetes mellitus and/or neurogenic disorders, irregular followup, and follow-up shorter than 24 months. All patients were divided into one of three groups, posterior reconstruction being performed in Group 1 (n = 112, anterior reconstruction in Group 2 (n = 762, and bladder neck sparing (BNS in Group 3 (n = 987. Demographic and pre-, peri-, and postoperative data were collected. Multivariate analyses were performed to determine factors affecting early continence after LRP. Results: 1861 patients were enrolled in the study. The mean follow-up period was 48.12 ± 29.8 months, and subjects’ mean age was 63.6 ± 6.2 years. There was no significant difference among the groups in terms of demographic or preoperative data. Postoperative data, including oncological outcomes, were similar among the groups. The level of early continence was higher in Group 3 than in the other groups (p < 0.001. Multivariate analyses identified BNS and age as parameters significantly affecting early continence levels after LRP (p < 0.001 and p < 0.001, respectively. Bladder neck reconstruction provided less earlier continence than BNS.

  8. Versatality of supraclavicular flap in neck, face, and upper chest region coverage

    International Nuclear Information System (INIS)

    Almas, D.; Masood, T.; Dar, M.F.; Noman, B.

    2015-01-01

    The objective is to analyze the utility of the island supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Study Design: Prospective descriptive study. Place and Duration of Study: The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. Material and Patients: An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Results: A total of 30 patients were included 20 (66.6%) male and 10 (33.3%) were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 (73.3%) while 8 (26.6%) require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4(13.3%) cases. 1 (3.3%) flap failed completely and the defect was covered with a skin graft. We had 01 (3.3%) mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 (60%). Conclusion: Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent

  9. Value of MR and CT Imaging for Assessment of Internal Carotid Artery Encasement in Head and Neck Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    W. L. Lodder

    2013-01-01

    Full Text Available Objective. This study was conducted to assess the value of CT and MR imaging in the preoperative evaluation of ICA encasement. Methods. Based upon three patient groups this study was performed. Retrospective analysis of 260 neck dissection reports from 2001 to 2010 was performed to determine unexpected peroperative-diagnosed encasement. Two experienced head and neck radiologists reviewed 12 scans for encasement. Results. In four out of 260 (1.5% patients undergoing neck dissection, preoperative imaging was false negative as there was peroperative encasement of the ICA. Of 380 patients undergoing preoperative imaging, the radiologist reported encasement of the ICA in 25 cases. In 342 cases no encasement was described, 125 of these underwent neck dissection, and 2 had encasement peroperatively. The interobserver variation kappa varied from 0.273 to 1 for the different characteristics studied. Conclusion. These retrospectively studied cohorts demonstrate that preoperative assessment of encasement of the ICA using MRI and/or CT was of value in evaluation of ICA encasement and therefore contributively in selecting operable patients (without ICA encasement, since in only 1.5% encasement was missed. However, observer variation affects the reliability of this feature.

  10. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review.

    Science.gov (United States)

    Shanmugalingam, Renuka; Reza Pour, Nina; Chuah, Siang Chye; Vo, Thi Mong; Beran, Roy; Hennessy, Annemarie; Makris, Angela

    2016-07-16

    Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected. We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it. Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.

  11. ''Watch-and-see'' policy for the clinically positive neck in head and neck cancer treated with chemoradiotherapy

    International Nuclear Information System (INIS)

    Homma, Akihiro; Furuta, Yasushi; Oridate, Nobuhiko

    2006-01-01

    Chemoradiotherapy (CRT) is becoming more widely used for head and neck cancer. However, there are conflicting theories regarding the best management options for patients with advanced nodal disease. From 1990 to 1999, we treated 96 patients with N1-N2 neck disease by concomitant CRT for organ preservation, using weekly carboplatin or a low daily dose of cisplatin, followed by a ''watch-and-see'' policy for the neck. In the present study, we retrospectively analyzed the treatment outcome in 63 of these patients who received definitive CRT for primary and neck diseases and were monitored for neck disease for more than 2 years. In 12 of the 22 (55%) N1 patients, CRT successfully controlled the neck disease. CRT was successful in 18 of the 41(44%) patients with N2 disease. In 6 (60%) of 10 patients with residual or recurrent N1 disease, salvage surgery was successful. Of the 23 patients with residual or recurrent N2 disease, salvage surgery was successful in 8 patients (35%). The group of patients who showed a clinical complete response (CCR) to CRT had an overall survival rate of 62.4% (33 patients), whereas for those with a less than complete response (< CCR), the figure was 13.3% (30 patients; P<0.001). Among the < CCR-neck group, patients who underwent neck dissection (ND) as well (n=20) did not have a significantly better overall survival than those who did not undergo ND (n=10; P=0.069). We propose a treatment plan for neck disease that involves observing the neck closely following CRT. ND should be planned only when there is evidence that neck disease exists. (author)

  12. PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer.

    Science.gov (United States)

    Mehanna, Hisham; McConkey, Chris C; Rahman, Joy K; Wong, Wai-Lup; Smith, Alison F; Nutting, Chris; Hartley, Andrew Gj; Hall, Peter; Hulme, Claire; Patel, Dharmesh K; Zeidler, Sandra Ventorin von; Robinson, Max; Sanghera, Bal; Fresco, Lydia; Dunn, Janet A

    2017-04-01

    Planned neck dissection (ND) after radical chemoradiotherapy (CRT) for locally advanced nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. Thirty per cent of ND specimens show histological evidence of tumour. Consequently, a significant proportion of clinicians still practise planned ND. Fludeoxyglucose positron emission tomography (PET)-computerised tomography (CT) scanning demonstrated high negative predictive values for persistent nodal disease, providing a possible alternative paradigm to ND. Evidence is sparse and drawn mainly from retrospective single-institution studies, illustrating the need for a prospective randomised controlled trial. To determine the efficacy and cost-effectiveness of PET-CT-guided surveillance, compared with planned ND, in a multicentre, prospective, randomised setting. A pragmatic randomised non-inferiority trial comparing PET-CT-guided watch-and-wait policy with the current planned ND policy in HNSCC patients with locally advanced nodal metastases and treated with radical CRT. Patients were randomised in a 1 : 1 ratio. Primary outcomes were overall survival (OS) and cost-effectiveness [incremental cost per incremental quality-adjusted life-year (QALY)]. Cost-effectiveness was assessed over the trial period using individual patient data, and over a lifetime horizon using a decision-analytic model. Secondary outcomes were recurrence in the neck, complication rates and quality of life. The recruitment of 560 patients was planned to detect non-inferior OS in the intervention arm with a 90% power and a type I error of 5%, with non-inferiority defined as having a hazard ratio (HR) of no higher than 1.50. An intention-to-treat analysis was performed by Cox's proportional hazards model. Thirty-seven head and neck cancer-treating centres (43 NHS hospitals) throughout the UK. Patients with locally advanced nodal metastases of oropharynx, hypopharynx, larynx, oral or occult HNSCC receiving

  13. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial

    DEFF Research Database (Denmark)

    Alkureishi, Lee W T; Ross, Gary L; Shoaib, Taimur

    2010-01-01

    Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes...

  14. A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

    Science.gov (United States)

    Fan, Song; Tang, Qiong-lan; Lin, Ying-jin; Chen, Wei-liang; Li, Jin-song; Huang, Zhi-quan; Yang, Zhao-hui; Wang, You-yuan; Zhang, Da-ming; Wang, Hui-jing; Dias-Ribeiro, Eduardo; Cai, Qiang; Wang, Lei

    2011-01-01

    Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently. PMID:22010576

  15. Neck lift my way: an update.

    Science.gov (United States)

    Feldman, Joel J

    2014-12-01

    The author updates prior descriptions of an approach to the surgical neck lift that aims for a maximum degree of control over the size, shape, and position of every anatomical feature of the neck that is negatively affecting its appearance. A 38-year clinical experience guided the development of the operative tactics that define the strategy. Data collected from a records review of 522 consecutive neck lifts performed during the 10-year period 2004 through 2013 further inform the report. The approach has eight features: (1) nearly routine use of open submental access to all tissue layers of the central neck, including a regimen that curbed the problems that may attend an extensive tissue dissection; (2) management of lax neck skin by lateral excision using a specific postauricular incision, or by using the nonexcisional method of redistribution; (3) open lipectomy for precise removal of excess subcutaneous neck and jawline fat; (4) individualized modifications to subplatysmal fat, perihyoid fascia, and anterior digastric muscles; (5) treatment of large, ptotic, or malpositioned submandibular salivary glands by partial excision using a transcutaneous traction suture; (6) the current version of the corset platysmaplasty, which is used to treat static paramedian platysma muscle bands, and to avoid contour imperfections following subplatysmal maneuvers; (7) an approach that facilitates an isolated neck lift; and (8) durable results. Case examples demonstrate outcomes. Although the updated approach remains relatively complex and invasive, the author believes that the ends justify the means.

  16. Lymphatic mapping to tailor selective lymphadenectomy in squamous cell carcinoma of oral cavity

    International Nuclear Information System (INIS)

    Haq, M.E.U.; Warraich, R.A.; Abid, H.

    2010-01-01

    Objective: The purpose of this study was to determine the distribution of cervical lymph node metastases in the Squamous cell carcinoma of oral tongue and or floor of mouth; hence to improve the pretreatment evaluation of these patients. Study design: Descriptive study. Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital Lahore. From July 1, 2008 to December 31, 2009. Methods: This study was carried out on 50 consecutive patients who were having Squamous cell carcinoma of oral tongue and or floor of the mouth with T1 - T4 lesions. Results: Neck lymph node levels I and II were the most common sites of cervical lymph node metastases that was, 30%. Levels IV and V were involved very rarely. The overall metastases to cervical lymph node levels I - III combined was seen in 90% cases of oral tongue or floor of the mouth. Conclusion: The most common region for cervical lymph node metastases in Squamous Cell Carcinoma of oral tongue and floor of mouth is levels I - III in the ipsilateral neck, so based on pattern of metastases, supraomohyoid neck dissection for cN+ and functional neck dissection for cN+ necks are suggested. Key Words: Oral Squamous cell carcinoma (OSCC), cervical lymph node metastasis, cN+ (clinically lymph node negative), cN+ (clinically lymph node positive) (N1 - N/sub 3/), pN+ (pathologically lymph node metastases found), elective neck dissection, occult metastasis, radical neck dissection (RND). (author)

  17. Multislice Helical CT Angiography in Diagnostic of Intracranial and Extracranial Arterial Dissection

    International Nuclear Information System (INIS)

    Radzina, M.; Krumina, G.; Pupols, J.

    2007-01-01

    Arterial dissection is detachment of inner layer of the vessel wall. Head-neck trauma, congenital connectives tissue disorders like fibromuscular dysplasia, infectious diseases, hypertension, migraine, alcohol abuse and oral contraception are the typical causes. Urgent, complete, detailed verification is essential for successful treatment decision. Purpose. Aim of the study was to develop new appropriate CTA (angiography) protocols for patients with intracranial and extracranial arterial dissections using high speed multislice CT; to evaluate its clinical value in different locations and stages of disease, perspectives, advantages and disadvantages of new method. Materials and methods. 30 adult patients with suspected intra- or extracranial arterial blood vessels dissections were investigated in the clinical hospital 'Gailezers' using following algorithm: native CT; contrast CTA with post processing on the workstation. 80 ml iodine contrast media was administered intravenously, line speed 3-4 ml/sec, delay 10-15 seconds. For detection of maximum contrast intensity in the vessel the test contrast injection was performed before. Primary scan series were post processed in different kind of reconstructions - MPR (Multiplanar Reconstructions), MIP (Maximal Intensity Projection), VR (Volume Rendering), CR (Curved Reformat) and vessel analysis. Two different types of protocols were used - for intracranial and brachiocefalic arteries examinations. Results and Discussion. Following CTA symptoms of dissection were verified: 1) irregular vessel contour changes - narrowing, 'string' sign above dissection level; 2) tapered stenosis and/or distal occlusion; 3) double contour and/or double lumen sign; 4) fusiform aneurysmal dilatation. Clinical cases of different arterial dissection localization will be demonstrated during the presentation Advantages and disadvantages of CTA will be presented and disputed. Conclusions. CTA is non-invasive radiologic diagnostic method that yields

  18. Concurrent platinum-based chemotherapy and hyperfractionated radiotherapy with late intensification in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Glicksman, Arvin S.; Wanebo, Harold J.; Slotman, Gus; Liu Li; Landmann, Christine; Clark, Jeffrey; Zhu, Timothy C.; Lohri, Andreas; Probst, Rudolf

    1997-01-01

    Purpose: To determine whether a course of hyperfractionated radiation therapy concomitant with escalated radiosensitizing platinum compounds can be administered with acceptable morbidity and achieve a high rate of loco-regional control for Stage III and IV head and neck cancer and whether the patients can be tumor free at the primary site after initial therapy and cured by the additional chemoradiation without radical resection of the primary tumor. Methods and Materials: Patients with Stage III/IV head and neck cancer were treated in this multicenter Phase II Study with 1.8 Gy fraction radiotherapy for 2 weeks, with escalation to 1.2 Gy b.i.d. hyperfractionation to 46.8 Gy. Concomitant continuous infusion cisplatinum (CDDP) 20 mg per meter square on day 1 to 4 and 22 to 25 was given. Reassessment by biopsy of primary and nodes was done. Patients with a complete response continued with hyperfractionated radiotherapy to 75.6 Gy with simultaneous carboplatinum (Carbo), 25 mg per meter square b.i.d. for 12 consecutive treatment days. Patients with residual disease at 46.8 Gy required curative surgery. Seventy-four patients were treated at the three institutions; 20 were Stage III and 54 were Stage IV. All patients had daily mouth care, nutritional, and psychosocial support. Results: This regime was well tolerated. Eighty-five percent of toxicities were Grade 1 or 2 and there was only one Grade 4 hematologic toxicity. Late toxicities included xerostomia in 25 patients, dysplasia in 18, and mild speech impediment in 11. Biopsies of primary site were done after the first course of treatment in 59 patients. Neck dissections were performed in 35 patients. Forty-four of 59 (75%) primary sites and 16 of 35 (46%) lymph nodes had pathologically complete response (CR). Of the 74 patients, only 12 required surgical resection of the primary site. Thirty-five of the 50 node positive patients had neck dissections, 16 of these were CRs at surgery. At 4 years (median follow-up of 26

  19. FUNCTIONAL RESULTS OF ENDOSCOPIC EXTRAPERITONEAL RADICAL INTRAFASCIAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    D. V. Perlin

    2014-01-01

    Full Text Available Introduction. Endoscopic radical prostatectomy is a highly effective treatment for localized prostate cancer. Intrafascial prostate dissection ensures early recovery of urine continence function and erectile function. This article sums up our own experience of performing intrafascial endoscopic prostatectomy.Materials and methods. 25 patients have undergone this procedure. 12 months after surgery 88.2 % of the patients were fully continent, 11.7 % had symptoms of minimal stress urinary incontinence. We encountered no cases of positive surgical margins and one case of bio-chemical recurrence of the disease.Conclusion. Oncologically, intrafascial endoscopic radical prostatectomy is as effective as other modifications of radical prostatectomy and has the benefits of early recovery of urine continence function and erectile function. 

  20. Isolated perifacial lymph node metastasis in oral squamous cell carcinoma with clinically node-negative neck.

    Science.gov (United States)

    Agarwal, Sangeet Kumar; Arora, Sowrabh Kumar; Kumar, Gopal; Sarin, Deepak

    2016-10-01

    The incidence of occult perifacial nodal disease in oral cavity squamous cell carcinoma is not well reported. The purpose of this study was to evaluate the incidence of isolated perifacial lymph node metastasis in patients with oral squamous cell carcinoma with a clinically node-negative neck. The study will shed light on current controversies and will provide valuable clinical and pathological information in the practice of routine comprehensive removal of these lymph node pads in selective neck dissection in the node-negative neck. Prospective analysis. This study was started in August 2011 when intraoperatively we routinely separated the lymph node levels from the main specimen for evaluation of the metastatic rate to different lymph node levels in 231 patients of oral squamous cell cancer with a clinically node-negative neck. The current study demonstrated that 19 (8.22%) out of 231 patients showed ipsilateral isolated perifacial lymph node involvement. The incidence of isolated perifacial nodes did not differ significantly between the oral tongue (7.14%) and buccal mucosa (7.75%). Incidence was statistically significant in cases with lower age group (oral squamous cell carcinoma with a clinically node-negative neck. The incidence of isolated perifacial involvement is high in cases of buccal mucosal and tongue cancers. A meticulous dissection of the perifacial nodes seems prudent when treating the neck in oral cavity squamous cell carcinoma. 4 Laryngoscope, 126:2252-2256, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Clinical and Surgical Anatomy of the Neck

    OpenAIRE

    Fernández Russo, Gustavo A.H.

    2012-01-01

    Introduction: to bring relevance on morphological details pertaining to medical and surgical applicability and demonstrate its value as an unavoidable mainstay for diagnosis and mangement of head and neck pathology.Materials and method: a. standarized dissections, of preserved adult human corpses, to obtain anatomical pieces for teaching purposes in school of medicine, axial slices and its comparative study with computed tomography (CT) images. b.application of normalized surgical techniques...

  2. The Effect of Ureteral Stent Placement Before Radical Prostatectomy on the Safety of Ureteral Dissection and the Surgeon’s Comfort

    Directory of Open Access Journals (Sweden)

    Fatih Akdemir

    2017-09-01

    Full Text Available Objective: This study investigated the role of preoperative ureteral stent placement in reducing the risk of ureteral injury, an intraoperative complication of radical retropubic prostatectomy (RRP, and its contribution to the surgeon’s comfort. Materials and Methods: Open RRP was performed in 66 patients diagnosed with localized prostate cancer in our clinic between 2010 and 2015. The patients were divided into two groups; group 1 (n=34 underwent surgery without ureteral stent placement and group 2 (n=32 had surgery following the placement of a ureteral stent. The cases were preoperatively evaluated by suprapubic and transrectal ultrasonography. Perioperative and postoperative complications of all cases were determined. Both groups were assessed in terms of ureteral injury, operative time, and surgeon’s comfort. Results: The mean age of the patients in group 1 and group 2 was 61.12±5.92 (50-72 years and 63.58±6.2 (51-75 years, respectively. The mean prostate volume was 76.8±2.41 and 72.4±3.53 cc in groups 1 and 2, respectively. The mean operative time was 143.9±3.06 minutes in group 1 and 136.8±2.83 minutes in group 2. Partial ureteral injury occurred in three patients in group 1 and was repaired intraoperatively. Of these patients, two had previously undergone radiotherapy for prostate cancer and it was difficult to perform prostate dissection intraoperatively. The remaining patient had a history of transurethral resection of the prostate. No ureteral injury was observed in any of the patients in group 2. Conclusion: Preoperative ureteral stent placement in selected patients can facilitate ureteral dissection and reduce ureteral injury risk.

  3. Scalpel Versus Electrocautery Dissections: The Effect on Wound Complications and Pro-Inflammatory Cytokine Levels in Wound Fluid

    OpenAIRE

    ÖZDOĞAN, Mehmet

    2008-01-01

    Aim: Electrocautery has been postulated as a risk factor for wound complications. This study was conducted to evaluate the effects of electrocautery and scalpel dissections on wound complications and local cytokine levels. Materials and Methods: Patients undergoing modified radical mastectomy were assigned to flap dissection with either electrocautery (n = 18) or scalpel (n = 20). Blood loss, drain volume and duration, seroma formation and wound complications were recorded. Tumor necrosis f...

  4. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection

    International Nuclear Information System (INIS)

    Erkal, Haldun S.; Mendenhall, William M.; Amdur, Robert J.; Villaret, Douglas B.; Stringer, Scott P.

    2001-01-01

    Purpose: The present study presents the experience at the University of Florida with treatment of patients with squamous cell carcinomas (SCC) metastatic to cervical lymph nodes from an unknown head-and-neck mucosal (H and NM) site with radiotherapy (RT) alone or in combination with neck dissection (ND). Methods and Materials: The study included 126 patients treated with curative intent from 1964 to 1997. All patients had follow-up for at least 2 years. No patients were lost to follow-up. Results: Twelve patients (10%) developed SCC in H and NM sites at 0.5 to 10.9 years (median, 1.8 years). The rate of developing carcinomas in H and NM sites at 5 years was 13%. Histologic differentiation significantly affected the rate of developing carcinomas in H and NM sites in multivariate analysis. Sixteen patients (13%) had persistent nodal disease and 12 patients (10%) developed recurrent nodal disease at 0.5 to 10.9 years (median, 1.1 years). The nodal control rate at 5 years was 78%. Nodal size, N stage, and planned ND significantly affected the rate of nodal control in multivariate analysis. Nineteen patients (15%) developed distant metastasis at 0.2-5.1 years (median, 0.9 years). The distant metastases rate at 5 years was 14%. Extracapsular extension and RT dose significantly affected the risk of distant metastases in multivariate analysis. The overall absolute survival rate at 5 years was 47%. Extracapsular extension, N stage, RT dose for H and NM sites, and planned ND significantly affected absolute survival in multivariate analysis. The rate of cause-specific survival at 5 years was 67%. Extracapsular extension, nodal size, N stage, overall treatment time, and planned ND significantly affected cause-specific survival in multivariate analysis. Eight patients (6%) had severe postoperative complications and 6 patients (5%) had severe late complications. Conclusion: The present study supports the effectiveness of RT in lowering the rate of developing carcinomas in the H

  5. Neoadjuvant radiochemotherapy and radical resection for advanced squamous cell carcinoma of the oral cavity. Outcome of 134 patients

    International Nuclear Information System (INIS)

    Eich, H.T.; Loeschcke, M.; Kocher, M.; Bongartz, R.; Mueller, R.P.; Scheer, M.; Zoeller, J.E.; Wacker, S.

    2008-01-01

    Background and purpose: several multimodal strategies have been developed to treat patients with squamous cell carcinoma of the oral cavity. The advantages of preoperative radiochemotherapy are downstaging of the primary tumor, an increased resectability rate, and the elimination of micrometastases. After successful phase II trials, the following therapy regimen for resectable advanced oral carcinoma was applied. Patients and methods: 134 patients with resectable squamous cell carcinoma of the oral cavity stage II-IV received neoadjuvant radiochemotherapy consisting of 39.6 Gy in daily fractions of 1.8 Gy and concomitant carboplatin (70 mg/m 2 days 1-5). Radical resection and neck dissection were carried out afterwards. Results: after a median follow-up of 73 months, 82 patients (61%) had died. 54 patients (40%) experienced locoregional relapses or distant metastases. The overall survival was 65% ± 4% after 2 years and 45% ± 4% after 5 years. Cox regression survival analysis identified tumor regression, extracapsular lymph node spread and resection state as prognostic factors. Side effects of grade 3-4 were rare. Conclusion: neoadjuvant radiochemotherapy with subsequent radical surgery can be recommended as an effective and safe treatment for primary resectable advanced tumors of the oral cavity. Acute and long-term toxicities appear to be moderate. (orig.)

  6. Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients

    Directory of Open Access Journals (Sweden)

    Schicho A

    2018-01-01

    Full Text Available Andreas Schicho,1 Lukas Luerken,1 Ramona Meier,1 Antonio Ernstberger,2 Christian Stroszczynski,1 Andreas Schreyer,1 Lena-Marie Dendl,1 Stephan Schleder1 1Department of Radiology, 2Department of Trauma Surgery, University Medical Center, Regensburg, Germany Purpose: The aim of this study was to evaluate the true incidence of cervical artery dissections (CeADs in trauma patients with an Injury Severity Score (ISS of ≥16, since head-and-neck computed tomography angiogram (CTA is not a compulsory component of whole-body trauma computed tomography (CT protocols. Patients and methods: A total of 230 consecutive trauma patients with an ISS of ≥16 admitted to our Level I trauma center during a 24-month period were prospectively included. Standardized whole-body CT in a 256-detector row scanner included a head-and-neck CTA. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed retrospectively in patients with carotid artery dissection (CAD and vertebral artery dissection (VAD. Results: Of the 230 patients included, 6.5% had a CeAD, 5.2% had a CAD, and 1.7% had a VAD. One patient had both CAD and VAD. For both, CAD and VAD, mortality is 25%. One death was caused by fatal cerebral ischemia due to high-grade CAD. A total of 41.6% of the patients with traumatic CAD and 25% of the patients with VAD had neurological sequelae. Conclusion: Mandatory head-and-neck CTA yields higher CeAD incidence than reported before. We highly recommend the compulsory inclusion of a head-and-neck CTA to whole-body CT routines for severely injured patients. Keywords: polytrauma, carotid artery, vertebral artery, dissection, blunt trauma, computed tomography angiogram

  7. Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients.

    Science.gov (United States)

    Fayek, Ihab Samy

    2015-01-01

    Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinoma has been highlighted. A total of 27 patients with papillary thyroid carcinoma with N0 neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision. Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separate and independent prognostic factors for DFS at 24 months. 21 females and 6 males with a mean age of 34.6 years old, tumor size was 5-24 mm. (mean 12.4 mm.), multicentricity in 11 patients 2-4 foci (mean 2.7), bilaterality in 8 patients and extrathyroidal extension in 8 patients. Dissected level VI LNs 2-8 (mean 5 LNs) and level VII LNs 1-4 (mean 1.9). Metastatic level VI LNs 0-3 (mean 1) and level VII LNs 0-2 (mean 0.5). Follow-up from 6-51 months (mean 25.6) with 7 patients showed recurrence (3 local and 4 distant). Cumulative DFS at 24 months was 87.8% and was significantly affected in relation to bilaterality (p-valueVII positive ((p-valueVII nodal involvement. Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillary thyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessity and safety of this approach.

  8. Extracranial internal carotid artery dissection caused by compression from a giant osteophyte due to atlantoaxial osteoarthritis: case report.

    Science.gov (United States)

    Ikedo, Taichi; Nakamura, Kazuhito; Sano, Noritaka; Nagata, Manabu; Okada, Yumiko; Kawakami, Taichiro; Murata, Takaho

    2017-10-01

    Deformed osseous structures have been reported as rare causes of extracranial internal carotid artery (ICA) dissection, including the styloid process and the hyoid bone. Here, the authors describe the first known case of symptomatic ICA dissection caused by a giant osteophyte due to atlantoaxial osteoarthritis. The left ICA was fixed at the skull base and at the ICA portion compressed by the osteophyte, and it was highly stretched and injured between the two portions during neck rotation. The patient was successfully treated with ligation of the affected ICA following balloon test occlusion. Atlantoaxial osteoarthritis should be considered in the differential diagnosis of ICA dissection in patients with a severely deformed cervical spine.

  9. Partial axillary dissection in early breast cancer

    Directory of Open Access Journals (Sweden)

    Tarek Abdel Halim El-Fayoumi

    2013-09-01

    Full Text Available Background: In order to reduce the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning axillary dissection is an important operative procedure. So, partial axillary dissection has been applied to decrease the morbidity and postoperative axillary complications.Aim of the work was to study the reliability of partial axillary lymph node dissection in patients with breast carcinoma with clinically negative axilla. Methods: Eighteen patients underwent modified radical mastectomy, while the other two patients who were fulfilling the criteria for conservative breast surgery underwent lumpectomy. All patients did complete axillary lymph nodes dissection. Intraoperative leveling of the axilla was performed and level I axillary lymph nodes were identified according to their relation to pectoralis minor muscle; then they were subjected to intraoperative pathological examination by frozen section examination followed by complete axillary clearance. Then post operative histopathological examination of the tumor and all lymph nodes was done. Results: By intraoperative pathological examination; five patients (25% were found positive for malignant invasion, while 15 patients (75% were pathologically free. While paraffin section showed six patients (30% with malignant invasion, and 14 patients (70% were pathologically free. There was a false negative rate of 5% in level I axillary lymph nodes by intraoperative pathological examination which was positive for metastasis by paraffin section that revealed microinvasion in one lymph node out of 8 in level I. Only two cases out of 20 were found positive for metastasis in level II and III. Conclusion: Partial axillary lymph node dissection is a minimally invasive, feasible and sufficient technique that can predict the axillary lymph node status. KEYWORDS: Breast cancer, Axillary lymph nodes clearance

  10. Angiosarcoma of the Thyroid and Regional Lymph Node Metastasis

    Directory of Open Access Journals (Sweden)

    Lutfi Dogan

    2013-10-01

    Full Text Available Thyroid angiosarcomas are typically infiltrative and large tumors with very similar clinical findings of anaplastic carcinoma of thyroid. Early hematogenous metastasis is very frequent, but regional lymph node metastasis is quite rare. We present a case of angiosarcoma of the thyroid gland in a 68 years old man with regional lymph node metastasis. Total thyroidectomy with right modified radical neck dissection was applied. Four out of 19 lymph nodes dissected were seen to contain metastasis. Metastatic tumor was composed of sarcomatous areas containing large numbers of blood filled clefts. There after the surgery PET-CT was performed and multiple metastatic involvements were reported. Thyroid angiosarcomas are completely different tumors from angiomatoid anaplastic carcinomas. Longer survival with these tumors is only possible with agressive surgery and in case of regional LN metastasis, neck dissection should be done.

  11. The Role of Positron Emission Tomography/Computed Tomography Imaging in Head and Neck Cancer after Radical Chemoradiotherapy: a Single Institution Experience.

    Science.gov (United States)

    Nelissen, C; Sherriff, J; Jones, T; Guest, P; Colley, S; Sanghera, P; Hartley, A

    2017-11-01

    Positron emission tomography/computed tomography (PET/CT) is used to restage head and neck cancer 3 months after chemoradiotherapy. The purpose of this study was to determine the negative predictive value (NPV) of a scan reported as having no abnormal uptake and the positive predictive values (PPV) for different maximum standardised uptake value (SUVmax) thresholds. Patients with squamous cell carcinoma of the oro-/hypopharynx/larynx (n = 206) were included. SUVmax and subsequent locoregional recurrence were documented. The median SUVmax was 11.2 (range 4-33)/4.6 (range 2-30), respectively, in patients with/without definite primary site recurrence (P = 0.004). The median SUVmax was 4.4 (range 2.6-15.6)/3.1 (range 2.1-4.6), respectively, in patients with/without definite nodal recurrence (P = 0.003). The NPV for a scan reported as having no abnormal uptake was 92%. The PPV for the SUVmax thresholds 4, 6 and 8, respectively, were 53, 65 and 92% (primary site) and 93, 100 and 100% (nodes). The NPV of PET/CT after chemoradiation is consistent with the literature and underlines the importance of PET/CT in restaging the primary site if salvage neck dissection is considered. The overall PPV of PET/CT remains low but is high for nodal SUVmax > 4. These data could be used to design risk-stratified follow-up schedules. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Visual Hallucinations in a Patient with Horner's Syndrome Secondary to Internal Carotid Dissection

    OpenAIRE

    Amardeep Singh; Panteleimon Mortzos; Torben Lykke Sørensen

    2014-01-01

    A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the ...

  13. CONTINENT RADICAL PROSTATECTOMY

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    Yu. P. Sernyak

    2013-01-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  14. CONTINENT RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. P. Sernyak

    2014-07-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  15. Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma

    International Nuclear Information System (INIS)

    Correa, P.D.; Laskar, S.G.; Shrivastava, S.K.; Dinshaw, K.A.; Gupta, T.; Agarwal, J.P.; Arya, S.

    2005-01-01

    Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered Copyright (2005) Blackwell Publishing Asia Pty Ltd

  16. National evaluation of multidisciplinary quality metrics for head and neck cancer.

    Science.gov (United States)

    Cramer, John D; Speedy, Sedona E; Ferris, Robert L; Rademaker, Alfred W; Patel, Urjeet A; Samant, Sandeep

    2017-11-15

    The National Quality Forum has endorsed quality-improvement measures for multiple cancer types that are being developed into actionable tools to improve cancer care. No nationally endorsed quality metrics currently exist for head and neck cancer. The authors identified patients with surgically treated, invasive, head and neck squamous cell carcinoma in the National Cancer Data Base from 2004 to 2014 and compared the rate of adherence to 5 different quality metrics and whether compliance with these quality metrics impacted overall survival. The metrics examined included negative surgical margins, neck dissection lymph node (LN) yield ≥ 18, appropriate adjuvant radiation, appropriate adjuvant chemoradiation, adjuvant therapy within 6 weeks, as well as overall quality. In total, 76,853 eligible patients were identified. There was substantial variability in patient-level adherence, which was 80% for negative surgical margins, 73.1% for neck dissection LN yield, 69% for adjuvant radiation, 42.6% for adjuvant chemoradiation, and 44.5% for adjuvant therapy within 6 weeks. Risk-adjusted Cox proportional-hazard models indicated that all metrics were associated with a reduced risk of death: negative margins (hazard ratio [HR] 0.73; 95% confidence interval [CI], 0.71-0.76), LN yield ≥ 18 (HR, 0.93; 95% CI, 0.89-0.96), adjuvant radiation (HR, 0.67; 95% CI, 0.64-0.70), adjuvant chemoradiation (HR, 0.84; 95% CI, 0.79-0.88), and adjuvant therapy ≤6 weeks (HR, 0.92; 95% CI, 0.89-0.96). Patients who received high-quality care had a 19% reduced adjusted hazard of mortality (HR, 0.81; 95% CI, 0.79-0.83). Five head and neck cancer quality metrics were identified that have substantial variability in adherence and meaningfully impact overall survival. These metrics are appropriate candidates for national adoption. Cancer 2017;123:4372-81. © 2017 American Cancer Society. © 2017 American Cancer Society.

  17. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    Science.gov (United States)

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

  18. Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection

    OpenAIRE

    Mantsopoulos, Konstantinos; Velegrakis, Stylianos; Iro, Heinrich

    2015-01-01

    Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were...

  19. Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer.

    Science.gov (United States)

    Williams, Stephen B; Huo, Jinhai; Kosarek, Christopher D; Chamie, Karim; Rogers, Selwyn O; Williams, Michele A; Giordano, Sharon H; Kim, Simon P; Kamat, Ashish M

    2017-07-01

    Radical cystectomy is a surgical treatment for recurrent non-muscle-invasive and muscle-invasive bladder cancer; however, many patients may not receive this treatment. A total of 27,578 patients diagnosed with clinical stage I-IV bladder cancer from 1 January 2007 to 31 December 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database. We used multivariable regression analyses to identify factors predicting the use of radical cystectomy and pelvic lymph node dissection. Cox proportional hazards models were used to analyze survival outcomes. A total of 1,693 (6.1%) patients with bladder cancer underwent radical cystectomy. Most patients (92.4%) who underwent radical cystectomy also underwent pelvic lymph node dissection. When compared with white patients, non-Hispanic blacks were less likely to undergo a radical cystectomy [odds ratio (OR) 0.79, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. Moreover, recent year of surgery 2013 versus 2007 (OR 2.32, 95% CI 1.90-2.83, p groups diagnosed with bladder cancer, especially among older, non-Hispanic black patients.

  20. The pattern of relapse and survival of elective irradiation of the upper neck for stage N0 nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    He, Xiayun; Pan, Ziqiang; Guo, Xiaomao; Ye, Ming; Zhang, Zhen; He, Shaoqin; Liu, Taifu

    2012-01-01

    To investigate patterns of failure and survival rates of elective irradiation of upper neck in N0 nasopharyngeal carcinoma patients. From February 1996 to November 2002, 97 patients without cervical lymph node involvement were admitted for radiotherapy alone. Before treatment, each patient underwent enhanced CT of nasopharynx and neck. All patients received radiotherapy to the nasopharynx, skull base, and upper neck drainage areas (including levels II, III, and VA). The upper neck was irradiated to a total dose of 50-56 Gy/25-28 fractions/5-5.6 weeks. For the primary tumor, 22 patients used conventional fractionation for a total dose of 70 Gy/35 fractions/7 weeks, and 75 patients used an accelerated hyperfractionationated schedule for a total dose of 78 Gy/60 fractions/6 weeks. The median follow-up of these 97 patients was 7.75 years. 10 patients had recurrences in the nasopharynx, 8 had distant metastasis, and 5 had recurrences in the cervical lymph nodes. Among the cervical lymph node failures, the areas of recurrence were in the II drainage areas in 4 patients who had neck dissections afterwards, and in IA drainage areas in 1 patient who also had recurrence in the nasopharynx. The causes of death were recurrence in the nasopharynx for 8 patients, 1 of these also had recurrence in the neck, distant metastases in 8 patients, and non-neoplastic diseases in 3 patients. The causes of failure of N0 patients with nasopharyngeal carcinoma after radiotherapy alone to the nasopharynx and upper neck were nasopharyngeal recurrence, distant metastasis, and cervical recurrence in order of frequency. Elective irradiation of upper neck (II, III, VA) is advised for stage N0 patients diagnosed by enhanced CT of neck. Cervical recurrence alone is rare, which did not greatly affect the long-term survival after salvage neck dissection

  1. The Role of 3 Tesla Diffusion-Weighted Imaging in the Differential Diagnosis of Benign versus Malignant Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Flavio Barchetti

    2014-01-01

    Full Text Available Objective. The aim of this study was to validate the role of diffusion-weighted imaging (DWI at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC. Materials and Methods. Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se and specificity (Spe of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. Results. In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC value was 0.903 × 10−3 mm2/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10−3 mm2/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC of 0.964, while morphological criteria displayed an AUC of 0.715. Conclusions. In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.

  2. Thoracic aortic aneurysms and dissections: endovascular treatment.

    Science.gov (United States)

    Baril, Donald T; Cho, Jae S; Chaer, Rabih A; Makaroun, Michel S

    2010-01-01

    The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.

  3. Diagnosis of vertebral artery dissection with basiparallel anatomical scanning magnetic resonance imaging

    International Nuclear Information System (INIS)

    Katsuno, Makoto; Kobayashi, Shiro

    2011-01-01

    There is no consensus regarding the optimal method for diagnosing the dissection of intracranial arteries. We have developed a rapid and accurate examination method to diagnose vertebral artery dissection in the acute stage of cerebral infarction. Twenty-two patients with severe headache and neck pain and/or symptoms of brain stem or cerebellar ischemia underwent magnetic resonance imaging (MRI) with a 1.5-T scanner. Our protocol generated 3 contrast-weighted scans (T2-weighted, diffusion-weighted, and basi-parallel anatomical scanning [BPAS]-MRI) and conventional angiographs within 3 hours of the onset of symptoms. Then, we retrospectively analyzed the findings to identify the most reliable imaging method for diagnosing vertebral artery dissection in the acute stage of cerebral infarction. Based on the symptoms and the findings of T2-weighted imaging and conventional angiography, the initial diagnosis was dissection in 17 patients, lacunar infarction in 3 patients, and atherothrombosis in 2 patients. After follow-up studies the diagnosis was changed in 7 patients. The diagnosis based on symptoms and the findings of T2-weighted MRI and BPAS-MRI was dissection in 13 patients, atherothrombosis in 6 patients, and lacunar infarction in 3 patients. In 3 patients the diagnosis was changed during the follow-up phase. The diagnostic accuracy rate was higher with T2-weighted MRI and BPAS-MRI than with T2-weighted MRI and conventional angiography. We suggest that when intracranial vascular dissection is suspected, both the inner and outer contours of vessels must be inspected and that BPAS-MRI should be performed instead of conventional angiography to establish the definite diagnosis. (author)

  4. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel; Farwell, D. Gregory; Lau, Derick H.; Purdy, James A.

    2012-01-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus–associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6–135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus–associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose–response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

  5. Breast Cancer Metastasis to the Stomach That Was Diagnosed after Endoscopic Submucosal Dissection

    Directory of Open Access Journals (Sweden)

    Masahide Kita

    2016-01-01

    Full Text Available A 52-year-old woman presented with stage IIB primary breast cancer (cT2N1M0, which was treated using neoadjuvant chemotherapy (epirubicin, cyclophosphamide, and paclitaxel. However, the tumor persisted in patchy areas; therefore, we performed modified radical mastectomy and axillary lymph node dissection. Routine endoscopy at 8 months revealed a depressed lesion on the gastric angle’s greater curvature, and histology revealed signet ring cell proliferation. We performed endoscopic submucosal dissection for gastric cancer, although immunohistochemistry revealed that the tumor was positive for estrogen receptor, mammaglobin, and gross cystic disease fluid protein-15 (E-cadherin-negative. Therefore, we revised the diagnosis to gastric metastasis from the breast cancer.

  6. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study

    International Nuclear Information System (INIS)

    Welsh, Liam; Panek, Rafal; McQuaid, Dualta; Dunlop, Alex; Schmidt, Maria; Riddell, Angela; Koh, Dow-Mu; Doran, Simon; Murray, Iain; Du, Yong; Chua, Sue; Hansen, Vibeke; Wong, Kee H.; Dean, Jamie; Gulliford, Sarah; Bhide, Shreerang; Leach, Martin O.; Nutting, Christopher; Harrington, Kevin; Newbold, Kate

    2015-01-01

    Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients’ tumour, potentially leading to improved treatment outcomes. The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust

  7. The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel-depleted neck.

    Science.gov (United States)

    Ciudad, Pedro; Agko, Mouchammed; Manrique, Oscar J; Date, Shivprasad; Kiranantawat, Kidakorn; Chang, Wei Ling; Nicoli, Fabio; Lo Torto, Federico; Maruccia, Michele; Orfaniotis, Georgios; Chen, Hung-Chi

    2017-11-01

    Reconstruction in a vessel-depleted neck is challenging. The success rates can be markedly decreased because of unavailability of suitable recipient vessels. In order to obtain a reliable flow, recipient vessels away from the zone of fibrosis, radiation, or infection need to be explored. The aim of this report is to present our experience and clinical outcomes using the retrograde flow coming from the distal transverse cervical artery (TCA) as a source for arterial inflow for complex head and neck reconstruction in patients with a vessel-depleted neck. Between July 2010 and June 2016, nine patients with a vessel-depleted neck underwent secondary head and neck reconstruction using the retrograde TCA as recipient vessel for microanastomosis. The mean age was 49.6 years (range, 36 to 68 years). All patients had previous bilateral neck dissections and all, except one, had also received radiotherapy. Indications included neck contracture release (n = 3), oral (n = 1), mandibular (n = 3) and pharyngoesophageal (n = 2) reconstruction necessitating free anterolateral thigh (n = 3) and medial sural artery (n = 1) perforator flaps, fibula (n = 3) and ileocolon (n = 2) flaps respectively. There was 100% flap survival rate with no re-exploration or any partial flap loss. One case of intra-operative arterial vasospasm at the anastomotic suture line was managed intra-operatively with vein graft interposition. There were no other complications or donor site morbidity during the follow-up period. In a vessel-depleted neck, the reverse flow of the TCA may be a reliable option for complex secondary head and neck reconstruction in selected patients. © 2017 Wiley Periodicals, Inc.

  8. Post traumatic vertebro basilar dissection: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Karthikeyan Y.R.

    2017-09-01

    Full Text Available Posterior circulation territory stroke following mild head injury is a known entity although rarely seen. Numerous case reports appear in literature from time to time highlighting this complication. Blunt trauma to the head and neck possibly causes injury to the vertebrobasilar system in the form of angiorrhexis, subintimal, intramural and perivascular hemorrhage which causes secondary narrowing of the injured vessel. These processes can be complicated by progressive thrombosis & vascular occlusion. Here we are reporting a case of post traumatic vertebra-basilar dissection causing bilateral cerebellar and brainstem infarct.

  9. Comparison of FDG PET and CT/MRI in the diagnosis of cervical lymph node metastasis of head and neck cancer: a level-by-level based study

    International Nuclear Information System (INIS)

    Yang, You Jung; Kim, J. S.; Kim, S. Y.; Nam, S. Y.; Lee, W. W.; Ryu, J. S.; Yeo, J. S.; Moon, D. H.

    2002-01-01

    We compared diagnostic accuracy of FDG PET and CT/MRI for regional lymph node metastasis of head and neck cancer according to the level of cervical lymph node. Thirty-two patients (M/F=27/5, 56±10yr) with head and neck cancer (glottic cancer; 16, tongue cancer; 9, others; 7) uncerwent FDG PET and CT/MRI (29/3) within 1 month before elective surgery with neck dissection (bilateral in 21, unilateral in 11). Whole body and additional regional neck images were acquired 1 hr after injection of FDG (555 MBq). PET images were visually interpreted according to the cervical lymph node level by 2 nuclear physicians independently without CT/MRI information. The findings of PET and CT/MRI were confirmed by the surgical pathology(153 levels of 43 neck dissections). There were 32 positive levels and 121 negative levels for metastatic lymph node lesions in pathology. The diagnostic sensitivity of PET [88%(28/32)] was significantly higher than that of CT/MRI [63%(20/32)] (p=0.021), whereas the specificity of PET [93%(113/121)] was similar to that of CT/MRI [92%(111/121)] (p>0.05). FDG PET was more sensitive than conventional CT/MRI in detecting metastatic lymph node of head and neck cancer

  10. Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

    LENUS (Irish Health Repository)

    Edmundson, S P

    2012-01-31

    We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

  11. Isolated neck-lifting procedure: isolated stork lift.

    Science.gov (United States)

    Barbarino, Sheila C; Wu, Allan Y; Morrow, David M

    2013-04-01

    along the mastoid and posterior hairline to the midline nape of the neck. Long skin flaps were developed by dissecting the anterior neck from the mentum to the anterior clavicles, the lateral neck from the mastoid to the lateral clavicles, and the posterior neck from the hairline to the base of the nape of the neck, all with a combination of sharp and blunt dissection. Suspension sutures of the SMAS were placed at various strategic locations along the lateral neck in a superior posterior vector. The dog ears were walked posteriorly around the hairline, with final trimming at the midline nape using an A-to-T flap closure. The skin closure was affected by a combination of deep and superficial sutures as well as staples. No drains were used on any of the cases. Of the 273 patients (59 males and 214 females) who had the ISL, 240 rated their satisfaction with the results as very high, 21 rated it as high, and 12 rated it as some what satisfied. The average age of the patients was 58.7 years (range=45-79 years). There were two patients who needed a minimal amount of submental liposuction after the procedure. No patients had vertical/diagonal skin folds after this procedure. Five patients reported being slightly bothered by the appearance of the midline posterior scar for the first 6 months. Three of these cases involved hypertrophic scarring and were treated with intralesional triamcinolone suspension 40 mg per cc dilution; doses ranged from 20 to 40 mg per session and no more than two sessions were required. All five cases rated their scar appearance after 6 months to be acceptable. All of the remaining 268 patients reported that the final posterior scar was virtually undetectable. Ten patients needed scar revision for secondary widening of the scar at various locations of the lateral, posterior, and or nape of the neck. There were no other significant complications. Most patients were satisfied with their cosmetic result 2 years after their operation. An ISL procedure

  12. Robot-assisted Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer.

    Science.gov (United States)

    Montorsi, Francesco; Gandaglia, Giorgio; Fossati, Nicola; Suardi, Nazareno; Pultrone, Cristian; De Groote, Ruben; Dovey, Zach; Umari, Paolo; Gallina, Andrea; Briganti, Alberto; Mottrie, Alexandre

    2017-09-01

    Salvage lymph node dissection has been described as a feasible treatment for the management of prostate cancer patients with nodal recurrence after primary treatment. To report perioperative, pathologic, and oncologic outcomes of robot-assisted salvage nodal dissection (RASND) in patients with nodal recurrence after radical prostatectomy (RP). We retrospectively evaluated 16 patients affected by nodal recurrence following RP documented by positive positron emission tomography/computed tomography scan. Surgery was performed using DaVinci Si and Xi systems. A pelvic nodal dissection that included lymphatic stations overlying the external, internal, and common iliac vessels, the obturator fossa, and the presacral nodes was performed. In 13 (81.3%) patients a retroperitoneal lymph node dissection that included all nodal tissue located between the aortic bifurcation and the renal vessels was performed. Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications occurred within 30 d after surgery. Biochemical response (BR) was defined as a prostate-specific antigen level <0.2 ng/ml at 40 d after RASND. Median operative time, blood loss, and length of hospital stay were 210min, 250ml, and 3.5 d. The median number of nodes removed was 16.5. Positive lymph nodes were detected in 11 (68.8%) patients. Overall, four (25.0%) and five (31.2%) patients experienced intraoperative and postoperative complications, respectively. Overall, one (6.3%) and four (25.0%) patients had Clavien I and II complications within 30 d after RASND, respectively. Overall, five (33.3%) patients experienced BR after surgery. Our study is limited by the small cohort of patients evaluated and by the follow-up duration. RASND represents a feasible procedure in patients with nodal recurrence after RP and provides acceptable short-term oncologic outcomes, where one out of three patients experience BR immediately after surgery. Long-term data are needed to

  13. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup

    International Nuclear Information System (INIS)

    Ashraf, M.; Biswas, J.; Jha, J.; Nayak, S.; Singh, V.; Majumdar, S.; Bhowmick, A.; Dam, A.

    2011-01-01

    Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%. This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region. Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n=148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n=148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively. The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India. (author)

  14. High response rates following paclitaxel/5-FU and simultaneous radiotherapy in advanced head and neck carcinoma

    International Nuclear Information System (INIS)

    Schroeder, M.; Westerhausen, M.; Makoski, H.B.; Sesterhenn, K.; Schroeder, R.

    1997-01-01

    The main stay of treatment for head and neck cancer patients with advanced disease has been chemotherapy with Cisplatin/5-FU and simultaneous applied radiotherapy. With this multimodality treatment including radical surgery after two cycles of neoadjuvant chemotherapy and 40 Gy radiotherapy we reported 60% complete remission after 5 years for patients with stage III/IV of head and neck cancer. Paclitaxel, a new plant product, has demonstrated significant antineoplastic activity in head and neck tumors (ECOG-Study: 40% RR). Therefore we performed a trial with Taxol/5-FU and simultaneous radiation in a neoadjuvant and postoperative adjuvant setting of stage III/IV squamous cell carcinoma of the head and neck with pre-existent contraindication against Cisplatin. Patients and Methods: 30 patients with a primarily inoperable stage III/IV of SCC of the head and neck were enrolled to receive day 1 and 29 Taxol 175 mg/m 2 as a 3-hour-infusion, followed by 120-hour-cvi of 1000 mg/m 2 /d 5-FU. Locally irradiation was given ad 40 Gy (2 Gy/d/day 1-26). Radical surgery followed about day 56. Postoperatively patients received again 2 cycles of Taxol/5-FU and simultaneous irradiation with 30 Gy. Results: So far 30 patients were treated and all patients reached a CR after complete treatment, ongoing for 23/30 patients for 6 till 34 months: 4 patients developed a second neoplasia, and 3 patients gloved a local relapse. The principal toxicity was moderate (neutropenia, peripheral neuropathy, arthralgia/myalgia) and sensible with supportive care (e.g. PEG). Conclusions: The results suggest that the treatment of SCC of the head and neck with Taxol/5-FU and simultaneous radiation and radical surgery is a highly effective schedule and comparable with the treatment with Cisplatin/5-FU. (orig.) [de

  15. Dissecting aneurysm of the cervical internal carotid artery

    International Nuclear Information System (INIS)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi.

    1987-01-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm. (author)

  16. Laparoscopic radical prostatectomy: omitting a pelvic drain

    Directory of Open Access Journals (Sweden)

    David Canes

    2008-03-01

    Full Text Available PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP with a running urethrovesical anastomosis (RUVA using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6% had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%. The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002. Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained. Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity.

  17. The impact of virus in N3 node dissection for head and neck cancer.

    Science.gov (United States)

    Armas, Gian Luca; Su, Chih-Ying; Huang, Chao-Cheng; Fang, Fu-Min; Chen, Ching-Mei; Chien, Chih-Yen

    2008-11-01

    This study is to determine the impact of virus in surgical outcomes among patients of head and neck cancer with N3 lymph node metastasis. A retrospective analysis was conducted for 32 patients with operable N3 neck metastasis undergoing surgical treatment between January 1987 and October 2006. The nuclei of the tumor cells were investigated for the presence of human papillomavirus (HPV) and Epstein-Barr virus (EBV) DNAs and were taken into account as the variable for survival analysis. The primary sites were oropharynx in 11 patients, tongue in 3, buccal mucosa in 1, hypopharynx in 8 and unknown primary in 9. The five-year cumulative overall survival rate was 40.7% and 5-year cumulative regional control rate was 55.8%. The 5-year cumulative overall survival rate of patients with unknown primary site (72.9%) and HPV or EBV positive in the tumor (77.8%) were significantly higher than those patients with known primary site (31.3%) and HPV or EBV negative in the tumor (27.4%), respectively (P = 0.0335 and P = 0.0348, log rank test). In conclusion, surgery with adjuvant therapy offers reasonable outcomes for operable N3 node in head and neck cancer in our cohort. In addition, patients with HPV or EBV positive in the tumor have a better survival.

  18. Morbidity And Quality Of Life Among Head And Neck Cancer ...

    African Journals Online (AJOL)

    Objectives: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: Thirty eight patients comprising 28 males and ...

  19. Clinicopathological characteristics of head and neck Merkel cell carcinomas.

    Science.gov (United States)

    Knopf, Andreas; Bas, Murat; Hofauer, Benedikt; Mansour, Naglaa; Stark, Thomas

    2017-01-01

    There are still controversies about the therapeutic strategies and subsequent outcome in head and neck Merkel cell carcinoma. Clinicopathological data of 23 Merkel cell carcinomas, 93 cutaneous head and neck squamous cell carcinomas (HNSCCs), 126 malignant melanomas, and 91 primary parotid gland carcinomas were comprehensively analyzed. Merkel cell carcinomas were cytokeratin 20 (CK20)/neuron-specific enolase (NSE)/chromogranin A (CgA)/synaptophysin (Syn)/thyroid transcription factor-1 (TTF-1)/MIB1 immunostained. All Merkel cell carcinomas underwent wide local excision. Parotidectomy/neck dissection was performed in 40%/33% cutaneous Merkel cell carcinoma and 100%/100% in parotid gland Merkel cell carcinoma. Five-year recurrence-free interval (RFI)/overall survival (OS) was significantly higher in malignant melanoma (81/80%) than in cutaneous Merkel cell carcinoma/HNSCC. Interestingly, 5-year RFI/OS was significantly higher in Merkel cell carcinoma (61%/79%) than in HNSCC (33%/65%; p Merkel cell carcinoma and parotid gland carcinomas, nor in the immunohistochemical profile. Five-year RFI/OS was significantly better in cutaneous Merkel cell carcinoma when compared with TNM classification matched HNSCC. Five-year RFI/OS was comparable in parotid gland Merkel cell carcinoma and other primary parotid gland malignancies. © 2016 Wiley Periodicals, Inc. Head Neck 39: 92-97, 2017. © 2016 Wiley Periodicals, Inc.

  20. Intraoperative registered transrectal ultrasound guidance for robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Mohareri, Omid; Ischia, Joseph; Black, Peter C; Schneider, Caitlin; Lobo, Julio; Goldenberg, Larry; Salcudean, Septimiu E

    2015-01-01

    To provide unencumbered real-time ultrasound image guidance during robot-assisted laparoscopic radical prostatectomy, we developed a robotic transrectal ultrasound system that tracks the da Vinci® Surgical System instruments. We describe our initial clinical experience with this system. After an evaluation in a canine model, 20 patients were enrolled in the study. During each procedure the transrectal ultrasound transducer was manually positioned using a brachytherapy stabilizer to provide good imaging of the prostate. Then the transrectal ultrasound was registered to the da Vinci robot by a previously validated procedure. Finally, automatic rotation of the transrectal ultrasound was enabled such that the transrectal ultrasound imaging plane safely tracked the tip of the da Vinci instrument controlled by the surgeon, while real-time transrectal ultrasound images were relayed to the surgeon at the da Vinci console. Tracking was activated during all critical stages of the surgery. The transrectal ultrasound robot was easy to set up and use, adding 7 minutes (range 5 to 14) to the procedure. It did not require an assistant or additional control devices. Qualitative feedback was acquired from the surgeons, who found transrectal ultrasound useful in identifying the urethra while passing the dorsal venous complex suture, defining the prostate-bladder interface during bladder neck dissection, identifying the seminal vesicles and their location with respect to the rectal wall, and identifying the distal prostate boundary at the apex. Real-time, registered robotic transrectal ultrasound guidance with automatic instrument tracking during robot-assisted laparoscopic radical prostatectomy is feasible and potentially useful. The results justify further studies to establish whether the approach can improve procedure outcomes. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Factors Associated With Neck Hematoma After Thyroidectomy

    Science.gov (United States)

    Suzuki, Sayaka; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Saito, Yuki; Yamasoba, Tatsuya

    2016-01-01

    Abstract To identify risk factors for post-thyroidectomy hematoma requiring airway intervention or surgery (“wound hematoma”) and determine post-thyroidectomy time to intervention. Post-thyroidectomy hematoma is rare but potentially lethal. Information on wound hematoma in a nationwide clinical setting is scarce. Using the Japanese Diagnosis Procedure Combination database, we extracted data from records of patients undergoing thyroidectomy from July 2010 to March 2014. Patients with clinical stage IV cancer or those with bilateral neck dissection were excluded because they could have undergone planned tracheotomy on the day of thyroidectomy. We assessed the association between background characteristics and wound hematoma ≤2 days post-thyroidectomy, using multivariable logistic regression analysis. Among 51,968 patients from 880 hospitals, wound hematoma occurred in 920 (1.8%) ≤2 days post-thyroidectomy and in 203 (0.4%) ≥3 days post-thyroidectomy (in-hospital mortality = 0.05%). Factors significantly associated with wound hematoma ≤2 days post-thyroidectomy were male sex (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.30–1.77); higher age (OR 1.01, 95% CI 1.00–1.02); overweight or obese (OR 1.22, 95% CI 1.04–1.44); type of surgery (partial thyroidectomy for benign tumor compared with: total thyroidectomy, benign tumor [OR 1.95, 95% CI 1.45–2.63]; partial thyroidectomy, malignant tumor [OR 1.21, 95% CI 1.00–1.46]; total thyroidectomy, malignant tumor [OR 2.49, 95% CI 1.82–3.49]; and thyroidectomy for Graves disease [OR 3.88, 95% CI 2.59–5.82]); neck dissection (OR, 1.53, 95% CI 1.05–2.23); antithrombotic agents (OR 1.58, 95% CI 1.15–2.17); and blood transfusion (OR 5.33, 95% CI 2.39–11.91). Closer monitoring of airway and neck is recommended for patients with risk factors, and further cautious monitoring beyond 3 days post-thyroidectomy. PMID:26886632

  2. Late onset of chylous ascites following distal gastrectomy with D1(+ dissection for gastric cancer: A case report

    Directory of Open Access Journals (Sweden)

    Hüseyin Çiyiltepe

    2015-12-01

    Full Text Available Chyloperitoneum is the accumulation of lymphatic fluid in the peritoneal cavity. Chylous ascites can occur if it is not recognized during surgery. The incidence of chylous ascites after oncological surgery was approximately 7.4% however, the incidence of lymphorrhea after radical gastrectomy for gastric cancer is so low. Extensive lymph node dissection leads to a higher incidence of lymphorrhea. There have been few cases associated with D1 dissection In most patients conservative treatment is recommended that includes paracentesis, total parenteral nutrition (TPN, a medium chain triglyceride (MCT based diet, and somatostatin. Surgery is the last choice only when conservative treatment fails. In this case we aimed to present a late onset of chylous ascites after subtotal gastrectomy and D1+ dissection that was treated with percutaneous drainage and conservative management.

  3. Evaluation of Educator & Student Use of & Attitudes toward Dissection & Dissection Alternatives

    Science.gov (United States)

    Osenkowski, Pamela; Green, Che; Tjaden, Anne; Cunniff, Peggy

    2015-01-01

    Animal dissection has been routinely practiced in American biology classrooms for decades. With technological advancements, more states adopting student choice measures, and increased awareness about ethical concerns surrounding dissection, many useful dissection alternatives have been developed. To understand the current use of animal dissection…

  4. Seminal vesicle sparing laparoscopic radical prostatectomy using a low-energy source: Better continence and potency

    Directory of Open Access Journals (Sweden)

    Shrenik J Shah

    2009-01-01

    Full Text Available Objectives: Ongoing with the newer developments in laparoscopic radical prostatectomy (LRP, we report our experience in a consecutive series of 42 patients with a mean 18-month follow-up. We also studied the use of a low-energy source, especially in the region of the prostatic apex and the neurovascular bundle and evaluated its outcome on continence and potency. Materials and Methods: Between November 2003 and December 2008, 50 patients aged 50-80 yrs underwent LRP with vesicourethral anastomosis and of these, 42 patients who had a minimum follow-up of 3 months were selected for the study. Of these, the initial 16 patients were operated by the routine method and the 26 patients operated in the later part of our experience were operated upon using a minimal energy source. Results: The mean follow-up was 18 months (range 3-60. Continence was evaluated at 1, 3, 6, and 12 months. Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II. The difference in continence rates was mainly due to less use of electrocautery and harmonic scalpel at the bladder neck. Of the eight patients who were potent pre-operatively in Group I, four remained potent 3 months after LRP. In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP. Conclusions: Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

  5. Comparison of Functional Outcome after Extended versus Super-Extended Pelvic Lymph Node Dissection during Radical Prostatectomy in High-Risk Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Heikki Seikkula

    2017-11-01

    Full Text Available BackgroundUrinary continence and erectile function (EF are best preserved when meticulous dissection of prostate and nerve sparing technique are used during radical prostatectomy (RP. However, extent of lymph node dissection (LND may also adversely affect functional results.ObjectiveTo determine whether performing a super-extended LND (seLND has a significant effect on recovery of urinary continence and EF after RP.Design, setting, and participantsAll patients who underwent RP from January 2007 until December 2013 were handed questionnaires assessing continence and EF. All patients in whom at least an extended LND (eLND was performed were selected. This search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires and were included in our analysis.Outcome measurements and statistical analysisAll questionnaires were reviewed. We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full recovery of continence (no loss of urine and full recovery of EF (successful intercourse possible. Patients who did not reach the endpoint when the last questionnaire was filled out were censored at that time. Median follow-up was 12.43 months for continence, and 18.97 months for EF.Results and limitationsPatients undergoing seLND have a lower chance of regaining both urinary continence [hazard ratio (HR 0.59, 95% CI 0.39–0.90, p = 0.026] and EF (HR 0.28, 95% CI 0.13–0.57, p = 0.009. Age at surgery had a significant influence on both continence and EF in multivariate analysis. Major limitation of the study was that no formal preoperative assessment of continence and potency was done.ConclusionExtending the LND template beyond the eLND template may cause at least a significant delay in recovery of urinary continence and leads to less recovery of EF.

  6. Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit.

    Science.gov (United States)

    Lansaat, Liset; van der Noort, Vincent; Bernard, Simone E; Eerenstein, Simone E J; Plaat, Boudewijn E C; Langeveld, Ton A P M; Lacko, Martin; Hilgers, Frans J M; de Bree, Remco; Takes, Robert P; van den Brekel, Michiel W M

    2018-03-01

    Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated. A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out. Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF. This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.

  7. Clindamycin-induced Anaphylactic Shock During General Anesthesia

    OpenAIRE

    Chiuan-Shiou Chiou; Su-Man Lin; Shih-Pin Lin; Wen-Guei Chang; Kwok-Hon Chan; Chien-Kun Ting

    2006-01-01

    Clindamycin-related anaphylactic reaction is rarely reported. We report a male patient with buccal cancer who was undergoing radical neck dissection when life-threatening anaphylactic shock developed soon after intravenous infusion of clin-damycin. Immediate cardiopulmonary resuscitation was performed, and the patient recovered uneventfully. Perioperative anaphylactic shock is a serious problem due to the difficulty of judgment and potentially disastrous outcome. Immediate diagnosis and halti...

  8. Preliminary results using twice-a-day fractionation in the radiotherapeutic management of advanced cancers of the head and neck

    International Nuclear Information System (INIS)

    Jampolis, S.; Pipard, G.; Horiot, J.C.; Bolla, M.; Le Dorze, C.

    1977-01-01

    Twenty-four cases of advanced T4 cancers of the head and neck were treated using a twice-a-day treatment fractionation delivering a 1,200 rad weekly tumor dose and 7,000 rad total tumor dose in 5 1 / 2 to 6 weeks. Acute normal mucosal reactions and skin reactions were plotted weekly and corresponded to reactions observed when delivering 1,000 rad per week in five treatment sessions. Chronic problems have been limited to severe neck fibrosis appearing in three of five patients who underwent a planned neck dissection 6 weeks after the completion of radiotherapy. Local control was observed in 14 of 23 patients (61%) and regional control in 22 of 23 patients

  9. Resection and reconstruction of giant cervical metastatic cancer using a pectoralis major muscular flap transfer: A prospective study of 16 patients.

    Science.gov (United States)

    Zhang, Xiangmin; Liu, Folin; Lan, Xiaolin; Huang, Jing; Luo, Keqing; Li, Shaojin

    2015-07-01

    If not promptly or properly treated, certain cervical metastatic cancers that develop from unknown primary tumors may rapidly grow into giant tumors that can invade the blood vessels, muscle and skin. The present study examined the feasibility and efficacy of radical neck dissection combined with reconstruction using the pectoralis major myocutaneous flap for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. A total of 16 patients who met the inclusion criteria were subjected to radical neck dissection to adequately resect invaded skin, and the pectoralis major myocutaneous flap was used to repair the large skin defect created in the cervical region. Following the surgery, the patients received concurrent chemoradiotherapy. The pectoralis major myocutaneous flap survived in all 16 patients, with no cases of flap necrosis. In addition, no post-operative lymphedema, paresthesia or dysfunction of an upper extremity occurred due to the cutting of a pectoralis major muscle. In 9 cases, patients were satisfied with their post-operative shoulder movement at the donor site; in the remaining 7 cases, patients felt greater weakness in this region following surgery relative to prior to surgery. The 14 male patients were generally satisfied with the post-operative appearance of the donor region, whereas the 2 female patients were dissatisfied with the appearance of this region. Follow-up for 6-53 months after the patients were discharged following surgery and chemotherapy revealed that the recurrence of cervical tumors in 6 cases. Overall, radical neck dissection combined with the use of the pectoralis major myocutaneous flap for reconstruction is a feasible approach for the treatment of giant cervical metastatic cancers that have developed from unknown primary tumors and have invaded the skin. Post-operative concurrent chemoradiotherapy should be administered to improve the local control rate and

  10. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection.

    Science.gov (United States)

    Dake, M D; Thompson, M; van Sambeek, M; Vermassen, F; Morales, J P

    2013-08-01

    Classification systems for aortic dissection provide important guides to clinical decision-making, but the relevance of traditional categorization schemes is being questioned in an era when endovascular techniques are assuming a growing role in the management of this frequently complex and catastrophic entity. In recognition of the expanding range of interventional therapies now used as alternatives to conventional treatment approaches, the Working Group on Aortic Diseases of the DEFINE Project developed a categorization system that features the specific anatomic and clinical manifestations of the disease process that are most relevant to contemporary decision-making. The DISSECT classification system is a mnemonic-based approach to the evaluation of aortic dissection. It guides clinicians through an assessment of six critical characteristics that facilitate optimal communication of the most salient details that currently influence the selection of a therapeutic option, including those findings that are key when considering an endovascular procedure, but are not taken into account by the DeBakey or Stanford categorization schemes. The six features of aortic dissection include: duration of disease; intimal tear location; size of the dissected aorta; segmental extent of aortic involvement; clinical complications of the dissection, and thrombus within the aortic false lumen. In current clinical practice, endovascular therapy is increasingly considered as an alternative to medical management or open surgical repair in select cases of type B aortic dissection. Currently, endovascular aortic repair is not used for patients with type A aortic dissection, but catheter-based techniques directed at peripheral branch vessel ischemia that may complicate type A dissection are considered valuable adjunctive interventions, when indicated. The use of a new system for categorization of aortic dissection, DISSECT, addresses the shortcomings of well-known established schemes devised

  11. [Diagnosis and treatment of congenital fourth branchial anomaly].

    Science.gov (United States)

    Chen, Liang-si; Zhang, Si-yi; Luo, Xiao-ning; Song, Xin-han; Zhan, Jian-dong; Chen, Shao-hua; Lu, Zhong-ming

    2010-10-01

    To discuss the anatomic features, clinical presentations, diagnosis, differentiations and treatments of congenital fourth branchial anomaly(CFBA). The clinical data of 8 patients with CFBA were retrospectively analyzed. Of the 8 patients aging from 27 to 300 months (median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on. The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma. Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months). CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA. The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve, partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence. For recurrent cases, selective neck dissection is a safe and effective surgical

  12. Laparoscopic radical prostatectomy in the canine model.

    Science.gov (United States)

    Price, D T; Chari, R S; Neighbors, J D; Eubanks, S; Schuessler, W W; Preminger, G M

    1996-12-01

    The purpose of this study was to determine the feasibility of performing laparoscopic radical prostatectomy in a canine model. Laparoscopic radical prostatectomy was performed on six adult male canines. A new endoscopic needle driver was used to construct a secure vesicourethral anastomosis. Average operative time required to complete the procedure was 304 min (range 270-345 min). Dissection of the prostate gland took an average of 67 min (range 35-90 min), and construction of the vesicourethral anastomosis took 154 min (rage 80-240 min). There were no intraoperative complications and only one postoperative complication (anastomotic leak). Five of the six animals recovered uneventfully from the procedure, and their foley catheters were removed 10-14 days postoperatively after a retrograde cystourethrogram demonstrated an intact vesicourethral anastomosis. Four (80%) of the surviving animals were clinically continent within 10 days after catheter removal. Post mortem examination confirmed that the vesicourethral anastomosis was intact with no evidence of urine extravasation. These data demonstrate the feasibility of laparoscopic radical prostatectomy in a canine model, and suggest that additional work with this technique should be continued to develop its potential clinical application.

  13. Brachial plexus endoscopic dissection and correlation with open dissection.

    Science.gov (United States)

    Lafosse, T; Masmejean, E; Bihel, T; Lafosse, L

    2015-12-01

    Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are taking place in the area of the brachial plexus (BP). We carried out an anatomical study to describe the endoscopic anatomy of the BP and the technique used to dissect and expose the BP endoscopically. Thirteen fresh cadavers were dissected. We first performed an endoscopic dissection of the BP, using classical extra-articular shoulder arthroscopy portals. Through each portal, we dissected as many structures as possible and identified them. We then did an open dissection to corroborate the endoscopic findings and to look for damage to the neighboring structures. In the supraclavicular area, we were able to expose the C5, C6 and C7 roots, and the superior and middle trunks in 11 of 13 specimens through two transtrapezial portals by following the suprascapular nerve. The entire infraclavicular portion of the BP (except the medial cord and its branches) was exposed in 11 of 13 specimens. The approach to the infraclavicular portion of the BP led directly to the lateral and posterior cords, but the axillary artery hid the medial cord. The musculocutaneous nerve was the first nerve encountered when dissecting medially from the anterior aspect of the coracoid process. The axillary nerve was the first nerve encountered when following the anterior border of the subscapularis medially from the posterior aspect of the coracoid process. Knowledge of the endoscopic anatomy of the BP is mandatory to expose and protect this structure while performing advanced arthroscopic shoulder procedures. Copyright © 2015 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  14. HYDRODISSECTION FOR PRESERVATION OF NEUROVASCULAR BUNDLE DURING RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    H. S. Gevorgyan

    2016-01-01

    Full Text Available Nerve-sparing radical prostatectomy is one of the high-tech operations in urology, and the challenge of the surgeon is not only to remove the prostate tumor, but also to provide a high quality of life. The fact that most questions devoted from patients in a conversation with the surgeon before the operation are devoted to this issue, shows the importance and relevance. At present, the diagnostic methods allow significantly more likely to detect early  prostate cancer, making finding and treatment of these patients more affordable and allows to apply this operation.Lately, it seems urgent to explore the possibility of water jet dissection in the field of urology, in particular, for nerve-sparing prostatectomy. Preservation of erectile function depends largely on the quality of separating the neurovascular bundle. Standard use of electrocautery is associated with damage to the neurovascular bundle.  When performing operations using water-jet mobilization of prostate the selective dissection of tissue is performed. This avoids injury of neurovascular bundle and further postoperative complications. The use of this technique may allow the surgeon to provide a more accurate mobilization prostate and selectively controlled intersection vessels heading to the prostate from the neurovascular bundle, reduce intraoperative blood loss,  maintaining continence, erectile function.This literature review is considered by the experience of using nerve-sparing radical prostatectomy using a water-jet dissector, estimated intraoperative parameters using this method.However, we have the lack of extensive research capabilities of this technique when performing nerve-preserving radical prostatectomy, that does not allow to make a comprehensive presentation on the benefits of this technique and its effects on erectile function and quality of urination, further study of this issue in such a difficult category of patients.

  15. Hearing Status after Radical Mastoidectomy without Tympanoplasty.

    Science.gov (United States)

    Khan, Shamaila Nawaz; Udaipurwala, Iqbal Hussain; Mehmood, Talat; Rahat, Zahid Mehmood

    2017-12-01

    To find out the impairment of hearing associated with radical mastoidectomy by measuring the quantitative difference in the functional hearing level before and after radical mastoidectomy operation without tympanoplasty. Cross-sectional comparative study. Department of Otorhinolaryngology and Head Neck Surgery, Bahawal Victoria Hospital, Bahawalpur and PNS Shifa Hospital, Karachi, from November 2009 to January 2013. Eighty-five patients, diagnosed clinically as chronic suppurative otitis media with extensive cholesteatoma having history of ear discharge and hearing impairment for more than 6 weeks duration and requiring radical mastoidectomy for treatment, were included in this study. Pure tone audiogram was done before and after radical mastoidectomy. Hearing impairment was compared in each patient before and after the operation. Among the 85 patients, 54 (63.5%) were males and 31 (36.5%) were females, with the age ranged between 18 to 63 years, mean age being 42.31 4.8 years. The mean increase in hearing loss after radical mastoidectomy in air conduction was 7.19 dB, bone conduction was 4.16 dB, and air-bone gap was 3.75 dB (0.001). The ear became dry and safe in 82 patients (96.5%) out of a total of 85, and only 3 patients required revision surgery at a second stage. Radical mastoidectomy has a least negligible effect on hearing status and one should not limit this technique due to the concern of aggravated hearing in patients with extensive cholesteatoma at the cost of dry and safe ears, which should be of prime importance.

  16. Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes

    International Nuclear Information System (INIS)

    Apisarnthanarax, Smith; Elliott, Danielle D.; El-Naggar, Adel K.; Asper, Joshua A. P.A.; Blanco, Angel; Ang, K. Kian; Garden, Adam S.; Morrison, William H.; Rosenthal, David; Weber, Randal S.; Chao, K.S. Clifford

    2006-01-01

    Purpose: To determine the optimal clinical target volume margins around the gross nodal tumor volume in head-and-neck cancer by assessing microscopic tumor extension beyond cervical lymph node capsules. Methods and Materials: Histologic sections of 96 dissected cervical lymph nodes with extracapsular extension (ECE) from 48 patients with head-and-neck squamous cell carcinoma were examined. The maximum linear distance from the external capsule border to the farthest extent of the tumor or tumoral reaction was measured. The trends of ECE as a function of the distance from the capsule and lymph node size were analyzed. Results: The median diameter of all lymph nodes was 11.0 mm (range: 3.0-30.0 mm). The mean and median ECE extent was 2.2 mm and 1.6 mm, respectively (range: 0.4-9.0 mm). The ECE was <5 mm from the capsule in 96% of the nodes. As the distance from the capsule increased, the probability of tumor extension declined. No significant difference between the extent of ECE and lymph node size was observed. Conclusion: For N1 nodes that are at high risk for ECE but not grossly infiltrating musculature, 1 cm clinical target volume margins around the nodal gross tumor volume are recommended to cover microscopic nodal extension in head-and-neck cancer

  17. The Problems of Dissection.

    Science.gov (United States)

    Davis, Pat

    1997-01-01

    Describes some problems of classroom dissection including the cruelty that animals destined for the laboratory suffer. Discusses the multilevel approach that the National Anti-Vivisection Society (NAVS) has developed to address the problems of animal dissection such as offering a dissection hotline, exhibiting at science teacher conferences, and…

  18. Peroperative diagnosis and treatment of metastases to the regional lymph nodes in papillary carcinoma of the thyroid gland

    International Nuclear Information System (INIS)

    Hamming, J.F.; van de Velde, C.J.; Goslings, B.M.; Fleuren, G.J.; Hermans, J.; Delemarre, J.F.; van Slooten, E.A.

    1989-01-01

    The management of two groups of patients with papillary carcinoma of the thyroid gland (n = 165) was evaluated retrospectively. Total thyroidectomy was the standard procedure in both groups, but the peroperative diagnosis and treatment of metastases to the regional lymph nodes differed. In group 1 (n = 84), only clinically positive lymph nodes were resected, and if residual postoperative 131I uptake was found, an ablation dose of 131 I was given. In group 2 (n = 81), all of the tissue in the tracheoesophageal groove was removed routinely at total thyroidectomy and frozen section was done of the lymph nodes lying along the internal jugular vein. If metastases were found, a modified radical dissection of the neck was performed on the affected side. The two patient groups were comparable with regard to risk factors--local tumor stage, age and sex. Almost twice as many patients were found to have metastases to the lymph nodes in group 2. There was no significant difference in the ten year over-all or recurrence free survival time between the two groups. In group 1, there were more recurrences on the explored side of the neck but fewer distant metastases; however, both findings were not significant. In group 2, significantly more instances of hypoparathyroidism and palsy of the accessory nerve were found (p less than 0.05). Thus, when a more extensive search was carried out, more metastases to the lymph node were discovered and treated, but this did not prevent recurrences in the neck nor did it improve survival time. This approach resulted in more postoperative morbidity. There seems to be no justification for prophylactic removal of regional lymph nodes in instances of papillary carcinoma of the thyroid gland, but modified radical neck dissection may be beneficial if clinically suspect regional lymph nodes are present in the lateral part of the neck. 52 references

  19. The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck.

    Science.gov (United States)

    Jiang, Wen; Mohamed, Abdallah S R; Fuller, Clifton David; Kim, Betty Y S; Tang, Chad; Gunn, G Brandon; Hanna, Ehab Y; Frank, Steven J; Su, Shirley Y; Diaz, Eduardo; Kupferman, Michael E; Beadle, Beth M; Morrison, William H; Skinner, Heath; Lai, Stephen Y; El-Naggar, Adel K; DeMonte, Franco; Rosenthal, David I; Garden, Adam S; Phan, Jack

    2016-01-01

    Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment. Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI. The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months. ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  20. The role of elective-nodal irradiation for esthesioneuroblastoma patients with clinically negative neck

    Science.gov (United States)

    Jiang, Wen; Mohamed, Abdallah Sherif; Fuller, Clifton David; Kim, Betty Y.S.; Tang, Chad; Gunn, G. Brandon; Hanna, Ehab Y.; Frank, Steven J.; Su, Shirley Y.; Diaz, Eduardo; Kupferman, Michael E.; Beadle, Beth M.; Morrison, William H.; Skinner, Heath; Lai, Stephen Y.; El-Naggar, Adel K.; DeMonte, Franco; Rosenthal, David I.; Garden, Adam S.; Phan, Jack

    2017-01-01

    Purpose Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiotherapy as a component of multi-modality treatment. Methods and Materials Seventy-one N0 ENB patients irradiated at XXXXXXXXX between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI. Results The median follow up time for our cohort is 80.8 months (range 6 – 350 month). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5-year (regional control rate of 100% for ENI vs 82%, p ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n=10), radiation (n=10), or chemotherapy (n=5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow up of 55.5 month. Conclusion ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings. PMID:26979544

  1. MR imaging in squamous cell carcinoma of the head and neck with no palpable lymph nodes

    International Nuclear Information System (INIS)

    Yucel, T.; Sennaroglu, L.; Kaya, S.; Saatci, I.; Cekirge, S.; Aydingoz, U.

    1997-01-01

    Purpose: To assess the efficacy of MR imaging in the detection of lymph node metastasis in patients with no palpable lymph nodes ('N 0 neck') who have squamous cell carcinoma of the head and neck region. Material and Methods: MR neck imagings in 18 patients who underwent neck dissection (bilaterally in 2) for squamous cell carcinoma of the head and neck region were examined preoperatively for the purpose of detecting lymph node metastases. The imaging features taken into consideration were: size (cutoff point 10 mm), grouping, presence of central necrosis, and appearance of extracapsular spread. The MR examinations comprised spin-echo T1- and T2-weighted sequences. The MR findings were compared with those of surgery and histopathological examination. Results: MR suggested metastatic lymph node involvement in 5 necks. In 2 of these, central necrosis was seen in the enlarged lymph nodes. In a third, a grouping of the lymph nodes was noted. Extracapsular spread was not present. Histopathological examination revealed metastatic lymph nodes in 7 of 20 necks, the rate of clinically occult disease being 35%, and 4 of then had been accurately graded by MR. There was one false-positive MR examination. The MR sensitivity was 57.1% and specificity 92.3%. Conclusion: MR may reveal metastatic lymph nodes in patients with no clinical evidence of metastasis. However, conventional MR techniques are not always sufficient for decision-making on surgery in cases of 'N 0 neck'. (orig.)

  2. Comparison of learning anatomy with cadaveric dissection and plastic models by medical students

    International Nuclear Information System (INIS)

    Qamar, K.; Ashar, A.

    2014-01-01

    The purpose of this study at Army Medical College was to assess differences in learning of students from cadaveric dissection or plastic models; and explore their perceptions about efficacy of various Instructional tools used during the gross anatomy practical time. Study Design: Two phase mixed methods sequential study. Place and Duration of Study: This study was conducted at anatomy department Arm y Medical College, Rawalpindi, Pakistan over a period of three weeks In July 2013 after approval from the ethical review board. Participants and Methods: Quantiative phase 1 involved 50 second year MBBS students, selected through non probability convenience sampling. They were divided into two groups of 25 students. Group A covered head and neck gross anatomy dissection course through cadaveric dissection and group B using plastic models. At the end of course MCQ based assessment were conducted and statistically analyzed for both groups. In qualitative phase 2, two focus group discussions (FGD) with 10 second year MBBS students were conducted to explore students perspectives about and their preferences of various instructional tools used during the gross anatomy practical time. The FGDs were audio taped, transcribed, and analyzed through thematic analysis. Results: The results of a post test of group A was 24.1 +-.26 and group B 30.96 +- 6.23 (p = 0.024). Focus group discussions generated three themes (Learning techniques used by students during gross anatomy practical time; Preferred learning techniques and Non-preferred learning techniques). Students prefered small-group learning method over completely self-directed studies as the study materials were carefully chosen and objectives were clearly demonstrated with directions. Cadaveric dissection and didactic teachings were not preferred. (author)

  3. Anatomical landmarks of radical prostatecomy.

    Science.gov (United States)

    Stolzenburg, Jens-Uwe; Schwalenberg, Thilo; Horn, Lars-Christian; Neuhaus, Jochen; Constantinides, Costantinos; Liatsikos, Evangelos N

    2007-03-01

    In the present study, we review current literature and based on our experience, we present the anatomical landmarks of open and laparoscopic/endoscopic radical prostatectomy. A thorough literature search was performed with the Medline database on the anatomy and the nomenclature of the structures surrounding the prostate gland. The correct handling of puboprostatic ligaments, external urethral sphincter, prostatic fascias and neurovascular bundle is necessary for avoiding malfunction of the urogenital system after radical prostatectomy. When evaluating new prostatectomy techniques, we should always take into account both clinical and final oncological outcomes. The present review adds further knowledge to the existing "postprostatectomy anatomical hazard" debate. It emphasizes upon the role of the puboprostatic ligaments and the course of the external urethral sphincter for urinary continence. When performing an intrafascial nerve sparing prostatectomy most urologists tend to approach as close to the prostatic capsula as possible, even though there is no concurrence regarding the nomenclature of the surrounding fascias and the course of the actual neurovascular bundles. After completion of an intrafascial technique the specimen does not contain any periprostatic tissue and thus the detection of pT3a disease is not feasible. This especially becomes problematic if the tumour reaches the resection margin. Nerve sparing open and laparoscopic radical prostatectomy should aim in maintaining sexual function, recuperating early continence after surgery, without hindering the final oncological outcome to the procedure. Despite the different approaches for radical prostatectomy the key for better results is the understanding of the anatomy of the bladder neck and the urethra.

  4. Utility of Indocyanine Green Video Angiography for Sylvian Fissure Dissection in Subarachnoid Hemorrhage Patients - Sylvian ICG Technique.

    Science.gov (United States)

    Toi, Hiroyuki; Matsushita, Nobuhisa; Ogawa, Yukari; Kinoshita, Keita; Satoh, Kohei; Takai, Hiroki; Hirai, Satoshi; Hara, Keijiro; Matsubara, Shunji; Uno, Masaaki

    2018-02-15

    Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes. This procedure was termed "Sylvian ICG". We observed ICG fluorescence quickly in all cases. Sylvian veins that appeared unclear in the standard microscopic operative field covered with subarachnoid hemorrhage were extremely clearly depicted. These Sylvian ICG findings were helpful in identifying entry points and the dissecting course of the Sylvian fissure. At the time of clipping, no residual fluorescence from Sylvian ICG was present, and aneurysm clipping was not impeded. Sylvian ICG for SAH patients is a novel technique to facilitate dissection of the Sylvian fissure. We believe that this technique will contribute to improved safety of clipping surgery for ruptured aneurysms.

  5. Acute severe neck pain and dysphagia following cervical maneuver: diagnostic approach.

    Science.gov (United States)

    Trendel, D; Bonfort, G; Lapierre-Combes, M; Salf, E; Barberot, J-P

    2014-04-01

    Overlooking an etiologic hypothesis in acute neck pain with dysphagia may lead to misdiagnosis. A 51-year-old man who had received cervical manipulation came to the emergency unit with evolutive acute neck pain, cervical spine stiffness and odynophagia, without fever or other signs of identified pathology. Cervical X-ray and CT angiography of the supra-aortic vessels ruled out traumatic etiology (fracture or arterial dissection) and revealed an accessory bone, orienting diagnosis toward retropharyngeal abscess, which was, however, belied by endoscopy performed under general anesthesia. A second CT scan with contrast injection and tissue phase ruled out infection, revealing a retropharyngeal calcification inducing retropharyngeal edema. Evolution under analgesics was favorable within 13 days. Given a clinical triad associating acute neck pain, cervical spine stiffness and odynophagia, traumatic or infectious etiology was initially suspected. Cervical CT diagnosed calcific tendinitis of the longus colli, revealing a pathognomic retropharyngeal calcification. Secondary to hydroxyapatite deposits anterior to the odontoid process of the axis, this is a rare form of tendinopathy, usually showing favorable evolution in 10-15 days under analgesic and anti-inflammatory treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. [Bladder neck sclerosis following prostate surgery : Which therapy when?

    Science.gov (United States)

    Rassweiler, J J; Weiss, H; Heinze, A; Elmussareh, M; Fiedler, M; Goezen, A S

    2017-09-01

    Secondary bladder neck sclerosis represents one of the more frequent complications following endoscopic, open, and other forms of minimally invasive prostate surgery. Therapeutic decisions depend on the type of previous intervention (e.g., radical prostatectomy, TURP, HoLEP, radiotherapy, HIFU) and on associated complications (e.g., incontinence, fistula). Primary treatment in most cases represents an endoscopic bilateral incision. No specific advantages of any type of the applied energy (i.e., mono-/bipolar HF current, cold incision, holmium/thulium YAG laser) could be documented. Adjuvant measures such as injection of corticosteroids or mitomycin C have not been helpful in clinical routine. In case of first recurrence, a transurethral monopolar or bipolar resection can usually be performed. Recently, the ablation of the scared tissue using bipolar vaporization has been recommended providing slightly better long-term results. Thereafter, surgical reconstruction is strongly recommended using an open, laparoscopic, or robot-assisted approach. Depending on the extent of the bladder neck sclerosis and the underlying prostate surgery, a Y-V/T-plasty, urethral reanastomosis, or even a radical prostatectomy with new urethravesical anastomosis should be performed. Stent implantation should be reserved for patients who are not suitable for surgery. The final palliative measure is a cystectomy with urinary diversion or a (continent) cystostomy.

  7. [Submucosal endoscopic dissection in the treatment of early esophageal cancer].

    Science.gov (United States)

    Ughelli, Liliana; Miranda, Carolina; Galeano, Carlos; Blasco, María Del Carmen; Boselli, Guliano; Cubilla, Antonio; Sakai, Paulo; Blasco, Carmelo

    2017-01-01

    We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

  8. Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

    OpenAIRE

    Corradino, Bartolo; Lorenzo, Sara Di; Moschella, Francesco

    2012-01-01

    In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complicat...

  9. Clindamycin-induced anaphylactic shock during general anesthesia.

    Science.gov (United States)

    Chiou, Chiuan-Shiou; Lin, Su-Man; Lin, Shih-Pin; Chang, Wen-Guei; Chan, Kwok-Hon; Ting, Chien-Kun

    2006-11-01

    Clindamycin-related anaphylactic reaction is rarely reported. We report a male patient with buccal cancer who was undergoing radical neck dissection when life-threatening anaphylactic shock developed soon after intravenous infusion of clindamycin. Immediate cardiopulmonary resuscitation was performed, and the patient recovered uneventfully. Perioperative anaphylactic shock is a serious problem due to the difficulty of judgment and potentially disastrous outcome. Immediate diagnosis and halting of drug infusion should be the first actions taken.

  10. Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

    International Nuclear Information System (INIS)

    Kanda, Tomonori; Kitajima, Kazuhiro; Suenaga, Yuko; Konishi, Jyunya; Sasaki, Ryohei; Morimoto, Koichi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi; Sugimura, Kazuro

    2013-01-01

    Purpose: To assess the clinical value of retrospective image fusion of neck MRI and 18 F-fluorodeoxyglucose ( 18 F-FDG) PET for locoregional extension and nodal staging of neck cancer. Materials and methods: Thirty patients with carcinoma of the oral cavity or hypopharynx underwent PET/CT and contrast-enhanced neck MRI for initial staging before surgery including primary tumor resection and neck dissection. Diagnostic performance of PET/CT, MRI, and retrospective image fusion of PET and MRI (fused PET/MRI) for assessment of the extent of the primary tumor (T stage) and metastasis to regional lymph nodes (N stage) was evaluated. Results: Accuracy for T status was 87% for fused PET/MRI and 90% for MRI, thus proving significantly superior to PET/CT, which had an accuracy of 67% (p = 0.041 and p = 0.023, respectively). Accuracy for N status was 77% for both fused PET/MRI and PET/CT, being superior to MRI, which had an accuracy of 63%, although the difference was not significant (p = 0.13). On a per-level basis, the sensitivity, specificity and accuracy for detection of nodal metastasis were 77%, 96% and 93% for both fused PET/MRI and PET/CT, compared with 49%, 99% and 91% for MRI, respectively. The differences for sensitivity (p = 0.0026) and accuracy (p = 0.041) were significant. Conclusion: Fused PET/MRI combining the individual advantages of MRI and PET is a valuable technique for assessment of staging neck cancer

  11. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy.

    Science.gov (United States)

    Costa Cruz, Danilo Souza Lima da; D'Ancona, Carlos Arturo Levi; Baracat, Jamal; Alves, Marco Antonio Dionisio; Cartapatti, Marcelo; Damião, Ronaldo

    2014-01-01

    Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008). We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

  12. Imaging of thoracic aortic dissection

    International Nuclear Information System (INIS)

    Vu, F.H.; Young, N.; Soo, Y.S.

    1994-01-01

    Acute thoracic aortic dissection has a high mortality rate if untreated, so the diagnosis must be rapidly made. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause of death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 out of 12 patients studied and correctly classified the type in only five. Aortography was preformed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were preformed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention. 17 refs., 4 tabs., 4 figs

  13. An overview of head and neck treatment at the KNH radiotherapy, Nairobi

    International Nuclear Information System (INIS)

    Mucheusi, L.

    2006-01-01

    It is known from several studies that precise radical radiotherapy leads to better local control thus increasing overall survival of patients suffering from Head and Neck malignancies if diagnosed early enough. The wide gap in the techniques and equipment used between the developed and the developing world are a source of concern especially in Sub Saharan africa which hardly boasts of even a single linear accelerator. in this presentation, common Head and Neck condition treatment is examined as it is done at the Kenyatta National Hospital. The treatment techniques used the planning process/innovations improvisations-adopted by radiographers at the institution to achieve the prescribed treatment

  14. Dynamic MRI evaluation of urethral hypermobility post-radical prostatectomy.

    Science.gov (United States)

    Suskind, Anne M; DeLancey, John O L; Hussain, Hero K; Montgomery, Jeffrey S; Latini, Jerilyn M; Cameron, Anne P

    2014-03-01

    One postulated cause of post-prostatectomy incontinence is urethral and bladder neck hypermobility. The objective of this study was to determine the magnitude of anatomical differences of urethral and bladder neck position at rest and with valsalva in continent and incontinent men post-prostatectomy based on dynamic MRI. All subjects underwent a dynamic MRI protocol with valsalva and non-valsalva images and a standard urodynamic evaluation. MRI measurements were taken at rest and with valsalva, including (1) bladder neck to sacrococcygeal inferior pubic point line (SCIPP), (2) urethra to pubis, and (3) bulbar urethra to SCIPP. Data were analyzed in SAS using two-tailed t tests. A total of 21 subjects (13 incontinent and 8 continent) had complete data and were included in the final analysis. The two groups had similar demographic characteristics. On MRI, there were no statistically significant differences in anatomic position of the bladder neck or urethra either at rest or with valsalva. The amount of hypermobility ranged from 0.8 to 2 mm in all measures. There were also no differences in the amount of hypermobility (position at rest minus position at valsalva) between groups. We found no statistically significant differences in bladder neck and urethral position or mobility on dynamic MRI evaluation between continent and incontinent men status post-radical prostatectomy. A more complex mechanism for post-prostatectomy incontinence needs to be modeled in order to better understand the continence mechanism in this select group of men. © 2013 Wiley Periodicals, Inc.

  15. Positive family history of aortic dissection dramatically increases dissection risk in family members.

    Science.gov (United States)

    Ma, Wei-Guo; Chou, Alan S; Mok, Salvior C M; Ziganshin, Bulat A; Charilaou, Paris; Zafar, Mohammad A; Sieller, Richard S; Tranquilli, Maryann; Rizzo, John A; Elefteriades, John A

    2017-08-01

    Although family members of patients with aortic dissection (AoD) are believed to be at higher risk of AoD, the prognostic value of family history (FH) of aortic dissection (FHAD) in family members of patients with AoD has not been studied rigorously. We seek examine how much a positive FHAD increases the risk of developing new aortic dissection (AoD) among first-degree relatives. Patients with AoD at our institution were analyzed for information of FHAD. Positive FHAD referred to that AoD occurred in index patient and one or more first-degree relatives. Negative FHAD was defined as the condition in which only one case of AoD (the index patient) occurred in the family. The age at AoD, exposure years in adulthood before AoD, and annual probability of AoD among first-degree relatives were compared between patients with negative and positive FHADs. FHAD was positive in 32 and negative in 68 among the 100 AoD patients with detailed family history information. Mean age at dissection was 59.9±14.7years. Compared to negative FHAD, patients with positive FHAD dissected at significantly younger age (54.7±16.8 vs 62.4±13.0years, p=0.013), had more AoD events in first-degree relatives (2.3±0.6 vs 1.0±0.0, pfamily members, with a higher annual probability of aortic dissection, a shorter duration of "exposure time" before dissection occurs and a lower mean age at time of dissection. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  16. Postoperative radiation therapy following laser surgery in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Pradier, O.; Schmidberger, H.; Christiansen, H.; Florez, R.; Hess, C.F.; Jackel, M.C.; Steiner, W.

    2002-01-01

    The results achieved with trans oral micro-surgery in advanced head and neck carcinoma with adjuvant radiotherapy are comparable to those with radical surgery. The haemoglobin level has an important role in the loco regional control and on survival. Split course radiation therapy regimen has not a place in the adjuvant situation. (author)

  17. Evaluating dissection in the gross anatomy course: Correlation between quality of laboratory dissection and students outcomes.

    Science.gov (United States)

    Nwachukwu, Chika; Lachman, Nirusha; Pawlina, Wojciech

    2015-01-01

    Anatomy learned by active exploration through dissection has many proven benefits including improvement of anatomic knowledge. Decreased laboratory time may affect the quality of dissection and ultimately lower student performance in anatomy translating to lower knowledge acquisition. The aim of this study was to determine whether the quality of students' dissection in teams correlates with their performance in the gross anatomy course. Quality of dissections for each team enrolled in a gross anatomy course at Mayo Medical School was evaluated biweekly using a five-point rubric based on course learning objectives. Assessment of anatomic knowledge was based on sequential laboratory practice practical examination scores, achievements on daily audience response system (ARS) quizzes, and final practical, written, and National Board of Medical Examiners(®) (NBME(®) ) Gross Anatomy and Embryology Subject Examinations. Twelve teams comprising 48 students were included in the study. There was a positive correlation between dissection quality and practice practical examination score (R = 0.83) and a negative correlation between dissection quality and ARS quizzes (R = -0.985). Dissection teams with a passing score on their dissection evaluations (>70%) performed better on their final examinations. Based on an end of course survey, students agreed that dissection evaluations should continue to be a part of the course. This study showed that better quality of dissection was associated with higher scores on practice practical examinations, final practical, written, and NBME examinations. The study demonstrated a positive correlation between dissection evaluations, accompanied by formative feedback during the course, and higher scores on final course assessments. © 2014 American Association of Anatomists.

  18. Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study.

    Science.gov (United States)

    Alba, J R; Basterra, J; Ferrer, J C; Santonja, F; Zapater, E

    2016-05-01

    Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients. Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma. Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology). Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

  19. Collagen Type III Metabolism Evaluation in Patients with Malignant Head and Neck Cancer Treated with Radiotherapy

    Directory of Open Access Journals (Sweden)

    Klaudia Mazurek

    2018-01-01

    Full Text Available Ionizing radiation affects the metabolism of key proteins of extracellular matrix including type III collagen, an important component of human skin. The aim of the work is an analysis of the impact of radical and palliative radiotherapy on collagen type III synthesis in patients with head and neck cancer. The test group consisted of 56 males with histopathologically confirmed head and neck cancer, for whom radiotherapy was applied as a form of radical or palliative treatment. The level of procollagen III aminoterminal propeptide (PIIINP, which is a marker of collagen type III synthesis, was determined in blood serum before radiotherapy, immediately following radiotherapy, and 3 months after it was finished. As a result of radical radiotherapy a statistically significant decrease of PIIINP levels in serum (p<0.0001 was observed, both immediately after the radiotherapy and 3 months after the end of the treatment. Also the palliative radiotherapy caused a significant decrease of PIIINP right after the treatment (p=0.0052, as well as during the examination performed 3 months later (p=0.0004. The achieved results suggest that PIIINP can be used as a marker helpful in assessing radiation damage to connective tissue.

  20. Value of retrospective image fusion of {sup 18}F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kanda, Tomonori [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Department of Radiology, Hyogo Cancer Center, Hyogo (Japan); Kitajima, Kazuhiro, E-mail: kitajima@med.kobe-u.ac.jp [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Suenaga, Yuko; Konishi, Jyunya [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Sasaki, Ryohei [Division of Radiation Oncology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Morimoto, Koichi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi [Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan)

    2013-11-01

    Purpose: To assess the clinical value of retrospective image fusion of neck MRI and {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) PET for locoregional extension and nodal staging of neck cancer. Materials and methods: Thirty patients with carcinoma of the oral cavity or hypopharynx underwent PET/CT and contrast-enhanced neck MRI for initial staging before surgery including primary tumor resection and neck dissection. Diagnostic performance of PET/CT, MRI, and retrospective image fusion of PET and MRI (fused PET/MRI) for assessment of the extent of the primary tumor (T stage) and metastasis to regional lymph nodes (N stage) was evaluated. Results: Accuracy for T status was 87% for fused PET/MRI and 90% for MRI, thus proving significantly superior to PET/CT, which had an accuracy of 67% (p = 0.041 and p = 0.023, respectively). Accuracy for N status was 77% for both fused PET/MRI and PET/CT, being superior to MRI, which had an accuracy of 63%, although the difference was not significant (p = 0.13). On a per-level basis, the sensitivity, specificity and accuracy for detection of nodal metastasis were 77%, 96% and 93% for both fused PET/MRI and PET/CT, compared with 49%, 99% and 91% for MRI, respectively. The differences for sensitivity (p = 0.0026) and accuracy (p = 0.041) were significant. Conclusion: Fused PET/MRI combining the individual advantages of MRI and PET is a valuable technique for assessment of staging neck cancer.

  1. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique

    Directory of Open Access Journals (Sweden)

    Jaspreet Singh Parihar

    2014-03-01

    Conclusions: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen.

  2. 3D printed reproductions of orbital dissections: a novel mode of visualising anatomy for trainees in ophthalmology or optometry.

    Science.gov (United States)

    Adams, Justin W; Paxton, Lisa; Dawes, Kathryn; Burlak, Kateryna; Quayle, Michelle; McMenamin, Paul G

    2015-09-01

    The teaching of human head, neck and orbital anatomy forms a critical part of undergraduate and postgraduate medical and allied health professional training, including optometry. While still largely grounded in cadaveric dissection, this method of instruction is constrained in some countries and regional areas by access to real human cadavers, costs of cadaver bequest programmes, health and safety of students and staff and the shortage of adequate time in modern curricula. Many candidates choosing a postgraduate pathway in ophthalmological training, such as those accepted into the Royal Colleges of Ophthalmology in the UK, Australia and New Zealand programmes and the American Academy of Ophthalmologists in the USA, are compelled as adult learners to revise or revisit human orbital anatomy, ocular anatomy and select areas of head and neck anatomy. These candidates are often then faced with the issue of accessing facilities with dissected human cadaveric material. In light of these difficulties, we developed a novel means of creating high-resolution reproductions of prosected human cadaver orbits suitable for education and training. 3D printed copies of cadaveric orbital dissections (superior, lateral and medial views) showing a range of anatomical features were created. These 3D prints offer many advantages over plastinated specimens as they are suitable for rapid reproduction and as they are not human tissue they avoid cultural and ethical issues associated with viewing cadaver specimens. In addition, they are suitable for use in the office, home, laboratory or clinical setting in any part of the world for patient and doctor education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. The Use of Tissue Plasminogen Activator in the Treatment of Wallenberg Syndrome Caused by Vertebral Artery Dissection.

    Science.gov (United States)

    Salerno, Alexis; Cotter, Bradford V; Winters, Michael E

    2017-05-01

    Acute cerebrovascular accident (CVA) is a devastating cause of patient morbidity and mortality. Up to 10% of acute CVAs in young patients are caused by dissection of the vertebral or carotid artery. Wallenberg syndrome results from a CVA in the vertebral or posterior inferior artery of the cerebellum and manifests as various degrees of cerebellar dysfunction. The administration of a thrombolytic medication has been recommended in the treatment of patients with stroke caused by cervical artery dissection. Surprisingly, there is scant literature on the use of this medication in the treatment of this condition. We describe a 42-year-old man with the sudden onset of headache, left-sided neck pain, vomiting, nystagmus, and ataxia 1 h after completing a weightlifting routine. Computed tomography angiography revealed a grade IV left vertebral artery injury with a dissection flap extending distally and resulting in complete occlusion. Subsequent magnetic resonance imaging and angiography demonstrated acute left cerebellar and lateral medullary infarcts, consistent with Wallenberg syndrome. The patient was treated with tissue plasminogen activator, which failed to resolve his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently manage patients with acute CVAs. For select patients, the administration of tissue plasminogen activator can improve outcomes. However, the risk of major hemorrhage with this medication is significant. Cervical artery dissection is an important cause of acute stroke in young patients and is often missed on initial presentation. It is imperative for the emergency physician to consider acute cervical artery dissection as a cause of stroke and to be knowledgeable regarding the efficacy of thrombolytic medications for this condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation

    International Nuclear Information System (INIS)

    Fisher, B.; Redmond, C.; Fisher, E.R.

    1985-01-01

    In 1971 a randomized trial was begun to compare alternative local and regional treatments of breast cancer, all of which employ breast removal. Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months. There were no significant differences among three groups of patients with clinically negative auxillary nodes, with respect to disease-free survival, distant-disease-free survival, or overall survival (about 57%) at 10 years. The patients were treated by radical mastectomy, total (simple) mastectomy without auxillary dissection but with regional irradiation, or total mastectomy without irradiation plus auxillary dissection only if nodes were subsequently positive. Similarly, no differences, were observed between patients with clinically positive nodes treated by radical mastectomy or by total mastectomy without auxillary dissection but with regional irradiation. Survival at 10 years was about 38% in both groups. Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival. The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years. It was concluded that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer. 25 references, 6 figures, 1 table

  5. Digital dissection - using contrast-enhanced computed tomography scanning to elucidate hard- and soft-tissue anatomy in the Common Buzzard Buteo buteo.

    Science.gov (United States)

    Lautenschlager, Stephan; Bright, Jen A; Rayfield, Emily J

    2014-04-01

    Gross dissection has a long history as a tool for the study of human or animal soft- and hard-tissue anatomy. However, apart from being a time-consuming and invasive method, dissection is often unsuitable for very small specimens and often cannot capture spatial relationships of the individual soft-tissue structures. The handful of comprehensive studies on avian anatomy using traditional dissection techniques focus nearly exclusively on domestic birds, whereas raptorial birds, and in particular their cranial soft tissues, are essentially absent from the literature. Here, we digitally dissect, identify, and document the soft-tissue anatomy of the Common Buzzard (Buteo buteo) in detail, using the new approach of contrast-enhanced computed tomography using Lugol's iodine. The architecture of different muscle systems (adductor, depressor, ocular, hyoid, neck musculature), neurovascular, and other soft-tissue structures is three-dimensionally visualised and described in unprecedented detail. The three-dimensional model is further presented as an interactive PDF to facilitate the dissemination and accessibility of anatomical data. Due to the digital nature of the data derived from the computed tomography scanning and segmentation processes, these methods hold the potential for further computational analyses beyond descriptive and illustrative proposes. © 2013 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

  6. [Laparoscopic radical trachelectomy for preservation of fertility in early cervical cancer. A case report].

    Science.gov (United States)

    Isla Ortiz, David; Montalvo-Esquivel, Gonzalo; Chanona-Vilchis, José Gregorio; Herrera Gómez, Ángel; Ñamendys Silva, Silvio Antonio; Pareja Franco, Luis René

    2016-01-01

    Radical hysterectomy is the standard treatment for patients with early-stage cervical cancer. However, for women who wish to preserve fertility, radical trachelectomy is a safe and viable option. To present the first case of laparoscopic radical trachelectomy performed in the National Cancer Institute, and published in Mexico. Patient, 34 years old, gravid 1, caesarean 1, stage IB1 cervical cancer, squamous, wishing to preserve fertility. She underwent a laparoscopic radical trachelectomy and bilateral dissection of the pelvic lymph nodes. Operation time was 330minutes, and the estimated blood loss was 100ml. There were no intraoperative or postoperative complications. The final pathology reported a tumour of 15mm with infiltration of 7mm, surgical margins without injury, and pelvic nodes without tumour. After a 12 month follow-up, the patient is having regular periods, but has not yet tried to get pregnant. No evidence of recurrence. Laparoscopic radical trachelectomy and bilateral pelvic lymphadenectomy is a safe alternative in young patients who wish to preserve fertility with early stage cervical cancer. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Clindamycin-induced Anaphylactic Shock During General Anesthesia

    Directory of Open Access Journals (Sweden)

    Chiuan-Shiou Chiou

    2006-11-01

    Full Text Available Clindamycin-related anaphylactic reaction is rarely reported. We report a male patient with buccal cancer who was undergoing radical neck dissection when life-threatening anaphylactic shock developed soon after intravenous infusion of clin-damycin. Immediate cardiopulmonary resuscitation was performed, and the patient recovered uneventfully. Perioperative anaphylactic shock is a serious problem due to the difficulty of judgment and potentially disastrous outcome. Immediate diagnosis and halting of drug infusion should be the first actions taken.

  8. The Effect of Animal Dissections on Student Acquisition of Knowledge of and Attitudes toward the Animals Dissected.

    Science.gov (United States)

    McCollum, Terry L.

    A conflict exists over the use of animals in the classroom. One aspect of this use involved the dissection of animals. Animal protection advocates report that dissections constitute abuse of the animals dissected. The advocates state that what is learned by dissection could be more effectively learned by other means. Some science educators state…

  9. Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

    Science.gov (United States)

    Hao, Zhang; Zhenya, Shen; Lei, Wang

    2014-10-01

    To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

  10. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Danilo Souza Lima da Costa Cruz

    2014-10-01

    Full Text Available Introduction Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period. Materials and Methods This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil. Results Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002. We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008. Conclusions We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

  11. Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Best Anyama

    2017-01-01

    Full Text Available Blunt cerebrovascular injury (BCVI to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA and concussion. The patient’s symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT scan of the brain was normal; a CT angiogram (CTA of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases.

  12. Literature review of factors affecting continence after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Dalibor Pacik

    2017-01-01

    Full Text Available Radical prostatectomy (RP is the most common cause of stress urinary incontinence (UI in men. Several anatomic structures affect or may affect urinary continence - urethral sphincter, levator ani muscle, puboprostatic ligaments, bladder neck, endopelvic fascia, neurovascular bundle - and understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome of the procedure. Surgical techniques implemented to improve continence rates include nerve-sparing procedure, bladder neck preservation/plication, urethral length preservation, musculofascial reconstruction, puboprostatic ligaments preservation or seminal vesicle preservation. Perioperative (preoperative and postoperative pelvic floor muscle training (PFMT aims to shorten the duration of postoperative UI and thus, improve early continence rates postoperatively. In the review, complex information regarding anatomical, intra- and perioperative factors affecting urinary continence after RP is provided, including description of important anatomical structures, possible implications for surgical technique and evaluation of different PFMT strategies in perioperative period.

  13. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: a prospective study.

    Science.gov (United States)

    Hitier-Berthault, Maryam; Ansquer, Catherine; Branchereau, Julien; Renaudin, Karine; Bodere, Françoise; Bouchot, Olivier; Rigaud, Jérôme

    2013-08-01

    The objective of our study was to analyze the diagnostic performance of (18) F-fluorodeoxyglucose positron emission tomography-computed tomography for lymph node staging in patients with bladder cancer before radical cystectomy and to compare it with that of computed tomography. A total of 52 patients operated on between 2005 and 2010 were prospectively included in this prospective, mono-institutional, open, non-randomized pilot study. Patients who had received neoadjuvant chemotherapy or radiotherapy were excluded. (18) F-fluorodeoxyglucose positron emission tomography-computed tomography in addition to computed tomography was carried out for lymph node staging of bladder cancer before radical cystectomy. Lymph node dissection during radical cystectomy was carried out. Findings from (18) F-fluorodeoxyglucose positron emission tomography-computed tomography and computed tomography were compared with the results of definitive histological examination of the lymph node dissection. The diagnostic performance of the two imaging modalities was assessed and compared. The mean number of lymph nodes removed during lymph node dissection was 16.5 ± 10.9. Lymph node metastasis was confirmed on histological examination in 22 cases (42.3%). This had been suspected in five cases (9.6%) on computed tomography and in 12 cases (23.1%) on (18) F-fluorodeoxyglucose positron emission tomography-computed tomography. Sensitivity, specificity, positive predictive value, negative predictive value, relative risk and accuracy were 9.1%, 90%, 40%, 57.4%, 0.91 and 55.7%, respectively, for computed tomography, and 36.4%, 86.7%, 66.7%, 65%, 2.72, 65.4%, respectively, for (18) F-fluorodeoxyglucose positron emission tomography-computed tomography. (18) F-fluorodeoxyglucose positron emission tomography-computed tomography is more reliable than computed tomography for preoperative lymph node staging in patients with invasive bladder carcinoma undergoing radical cystectomy. © 2012 The Japanese

  14. Dynamic CT in dissecting aortic aneurysm

    International Nuclear Information System (INIS)

    Fujita, Nobuyuki; Matsuoka, Yosuke; Mizuo, Hideyo; Shirato, Hiroki; Irie, Goro

    1985-01-01

    especially about the branching of major vessels Eight cases of aortic dissection were analysed to evaluate detectability of the branching of major vessels from a ture or false lumen, by dynamic CT. Although recognition of the branching is easy when the direct continuity to a dissected lumen is demonstrated, but without visualization of direct continuity or with no information about dissected lumens, it is sometimes difficult or leads us to misdiagnosis. The diagnostic accuracy is 100% when direct continuity to a dissected lumen is demonstrated, or dynamic CT revealed branching pattern distinctly. Dynamic CT is useful for a diagnosis of dissecting aneurysm and branching pattern of major vessels. (author)

  15. Dose–Volume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    International Nuclear Information System (INIS)

    Chen, Allen M.; Wang, Pin-Chieh; Daly, Megan E.; Cui, Jing; Hall, William H.; Vijayakumar, Srinivasan; Phillips, Theodore L.; Farwell, D. Gregory; Purdy, James A.

    2014-01-01

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose–volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dose–volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies

  16. Dose–Volume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: amchen@mednet.ucla.edu [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California (United States); Wang, Pin-Chieh [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California (United States); Daly, Megan E.; Cui, Jing; Hall, William H. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Vijayakumar, Srinivasan [Department of Radiation Oncology, University of Mississippi School of Medicine, Jackson, Mississippi (United States); Phillips, Theodore L. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Farwell, D. Gregory [Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States); Purdy, James A. [Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, California (United States)

    2014-03-15

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose–volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dose–volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.

  17. [Modern treatment of type B dissections

    DEFF Research Database (Denmark)

    Klitfod, L.; Baekgaard, N.; Just, S.

    2008-01-01

    Rapid classification is essential in the management of aortic dissections, as Type A dissections require surgery, while the optimal treatment of Type B dissections is controversial. Medical treatment with antihypertensive medication and analgesics has so far been the main treatment of uncomplicated...... Type B dissections, while surgery has been reserved for complications and persistent pain in spite of medical treatment. Endovascular techniques are less invasive than open repair and show promising early results Udgivelsesdato: 2008/9/8...

  18. Neck curve polynomials in neck rupture model

    International Nuclear Information System (INIS)

    Kurniadi, Rizal; Perkasa, Yudha S.; Waris, Abdul

    2012-01-01

    The Neck Rupture Model is a model that explains the scission process which has smallest radius in liquid drop at certain position. Old fashion of rupture position is determined randomly so that has been called as Random Neck Rupture Model (RNRM). The neck curve polynomials have been employed in the Neck Rupture Model for calculation the fission yield of neutron induced fission reaction of 280 X 90 with changing of order of polynomials as well as temperature. The neck curve polynomials approximation shows the important effects in shaping of fission yield curve.

  19. Vertebral Artery Dissection in a Bouncy Castle Injury: Case Report and Literature Review.

    Science.gov (United States)

    Ripa, Valeria; Urakov, Timur M; Jernigan, Sarah C

    2017-01-01

    There is an increased rate of injuries associated with activities on bouncy castles. The purpose of this article was to describe the case of a 6-year-old boy who sustained a brain infarct as a consequence of a left posterior inferior cerebellar artery dissection due to improper landing in a bouncy castle and who required a suboccipital craniotomy. The second goal was to outline the literature review regarding cervical trauma related to trampoline or bouncy castle accidents in pediatric populations. Based on the described case and reviewed studies, bouncy castle or any other activity resulting in hyperflexion or hyperextension of the neck should be carefully evaluated for cervical spine fractures and vascular injuries. © 2017 S. Karger AG, Basel.

  20. Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis.

    Science.gov (United States)

    Zhu, Yun; Wang, Gangpu; Liu, Shengwen; Zhou, Shanghui; Lian, Ying; Zhang, Chenping; Yang, Wenjun

    2017-06-01

    Postoperative delirium is common after extensive surgery. This study aimed to collate and synthesize published literature on risk factors for delirium in patients with head and neck cancer surgery. Three databases were searched (MEDLINE, Embase, and Cochrane Library) between January 1987 and July 2016. The Newcastle Ottawa Scale (NOS) was adopted to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. They provided a total of 1940 patients (286 with delirium and 1654 without), and predominantly included patients undergoing head and neck cancer surgery. The incidence of postoperative delirium ranged from 11.50% to 36.11%. Ten statistically significant risk factors were identified in pooled analysis. Old age, age >70 years, male sex, duration of surgery, history of hypertension, blood transfusions, tracheotomy, American Society of Anesthesiologists physical status grade at least III, flap reconstruction and neck dissection were more likely to sustain delirium after head and neck cancer surgery. Delirium is common in patients undergoing major head neck cancer surgery. Several risk factors were consistently associated with postoperative delirium. These factors help to highlight patients at risk of developing delirium and are suitable for preventive action. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  1. Spontaneous Dissection of the Superior Mesenteric Artery

    International Nuclear Information System (INIS)

    Sheldon, Patrick J.; Esther, James B.; Sheldon, Elana L.; Sparks, Steven R.; Brophy, David P.; Oglevie, Steven B.

    2001-01-01

    Spontaneous dissection of the superior mesenteric artery (SMA) is a rare occurrence, especially when not associated with aortic dissection. Currently, only 28 cases appear to have been reported. Due to the scarcity of cases in the literature, the natural history of isolated, spontaneous SMA dissection is unclear. CT has been reported to be useful for the initial diagnosis of SMA dissection [2-5]. We present two recent cases of spontaneous SMA dissection in which enhanced spiral CT was instrumental in following the disease process and guiding clinical decision making

  2. Atlas of postsurgical neuroradiology. Imaging of the brain, spine, and neck

    International Nuclear Information System (INIS)

    Ginat, Daniel Thomas; Westesson, Per-Lennart A.

    2012-01-01

    Covers the normal appearances and complications that may be encountered on neuroradiological examinations following surgery to the head, neck, and spine. Contains numerous images and to-the-point case descriptions. Serves as an invaluable and convenient resource for both neuroradiologists and neurosurgeons. The number of surgical procedures performed on the brain, head, neck, and spine has increased markedly in recent decades. As a result, postoperative changes are being encountered more frequently on neuroradiological examinations and constitute an important part of the workflow. However, the imaging correlates of postsurgical changes can be unfamiliar to neuroradiologists and neurosurgeons and are sometimes difficult to interpret. This book is written by experts in the field and contains an abundance of high-quality images and concise descriptions, which should serve as a useful guide to postsurgical neuroradiology. It will familiarize the reader with the various types of surgical procedure, implanted hardware, and complications. Indeed, this work represents the first text dedicated to the realm of postoperative neuroimaging. Topics reviewed include imaging after facial cosmetic surgery; orbital and oculoplastic surgery; sinus surgery; scalp and cranial surgery; brain tumor treatment; psychosurgery, neurodegenerative surgery, and epilepsy surgery; skull base surgery including transsphenoidal pituitary resection; temporal bone surgery including various ossicular prostheses; orthognathic surgery; surgery of the neck including the types of dissection and flap reconstruction; CSF diversion procedures and devices; spine surgery; and vascular and endovascular neurosurgery.

  3. Atlas of postsurgical neuroradiology. Imaging of the brain, spine, and neck

    Energy Technology Data Exchange (ETDEWEB)

    Ginat, Daniel Thomas [Massachusetts General Hospital, Boston, MA (United States). Harvard Medical School; Westesson, Per-Lennart A. [Univ. of Rochester Medical Center, Rochester, NY (United States). Div. of Neuroradiology

    2012-11-01

    Covers the normal appearances and complications that may be encountered on neuroradiological examinations following surgery to the head, neck, and spine. Contains numerous images and to-the-point case descriptions. Serves as an invaluable and convenient resource for both neuroradiologists and neurosurgeons. The number of surgical procedures performed on the brain, head, neck, and spine has increased markedly in recent decades. As a result, postoperative changes are being encountered more frequently on neuroradiological examinations and constitute an important part of the workflow. However, the imaging correlates of postsurgical changes can be unfamiliar to neuroradiologists and neurosurgeons and are sometimes difficult to interpret. This book is written by experts in the field and contains an abundance of high-quality images and concise descriptions, which should serve as a useful guide to postsurgical neuroradiology. It will familiarize the reader with the various types of surgical procedure, implanted hardware, and complications. Indeed, this work represents the first text dedicated to the realm of postoperative neuroimaging. Topics reviewed include imaging after facial cosmetic surgery; orbital and oculoplastic surgery; sinus surgery; scalp and cranial surgery; brain tumor treatment; psychosurgery, neurodegenerative surgery, and epilepsy surgery; skull base surgery including transsphenoidal pituitary resection; temporal bone surgery including various ossicular prostheses; orthognathic surgery; surgery of the neck including the types of dissection and flap reconstruction; CSF diversion procedures and devices; spine surgery; and vascular and endovascular neurosurgery.

  4. An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

    Directory of Open Access Journals (Sweden)

    E. W. Lee

    2013-01-01

    Full Text Available We present a rare case of continuous, extensive aortic dissection (AD involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke. Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

  5. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease.

    Science.gov (United States)

    Zenga, Joseph; Haughey, Bruce H; Jackson, Ryan S; Adkins, Douglas R; Aranake-Chrisinger, John; Bhatt, Neel; Gay, Hiram A; Kallogjeri, Dorina; Martin, Eliot J; Moore, Eric J; Paniello, Randal C; Rich, Jason T; Thorstad, Wade L; Nussenbaum, Brian

    2017-09-01

    To evaluate outcomes for patients with pathological N3 (pN3) neck disease from human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and determine variables predictive of survival. Retrospective case series with chart review. This study was conducted between 1998 and 2013 and included patients with HPV-related OPSCC treated with surgery with or without adjuvant therapy and who had pN3 nodal disease. The primary outcome was disease-specific survival (DSS). Secondary outcomes included overall survival (OS), disease-free survival (DFS), adverse events, and gastrostomy tube rates. Thirty-nine patients were included, of whom 36 (90%) underwent adjuvant therapy. Median follow-up was 39 months (range, 2-147 months). Mean age was 56 years, and 87% were male. Seventeen patients (44%) underwent selective neck dissection, whereas six (15%) underwent radical (n = 2) or extended radical (n = 4) neck dissection. Ninety-two percent had extracapsular extension. Five-year Kaplan-Meier estimated DSS, OS, and DFS were 89% (95% confidence interval [CI]: 79%-99%), 87% (95% CI: 75%-99%), and 84% (95% CI: 72%-96%), respectively. The disease recurrence rate was 10% (5% regional, 5% distant metastasis). Patients with less than 5 pathologically positive lymph nodes (P = .041) had improved DFS. Patients with HPV-related OPSCC and pN3 nodal disease treated with surgery and adjuvant therapy have very favorable long-term survival and regional control. Patients with five or more pathologically positive lymph nodes may be at higher risk for recurrence. 4. Laryngoscope, 127:2033-2037, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Esophageal - Gastric Anastomosis in Radical Resection of Esophageal Cancer under Thoracoscopy Combined with Laparoscopy

    International Nuclear Information System (INIS)

    Hao, Z.; Lei, W.; Zhenya, S.

    2014-01-01

    Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)

  7. Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome.

    Science.gov (United States)

    Lee, Seok-Soo; Jung, Tae-Eun; Lee, Dong Hyup

    2012-12-01

    Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

  8. Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

    Directory of Open Access Journals (Sweden)

    Popović Rade

    2016-01-01

    Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

  9. Detailed histological investigation of the female urethra: application to radical cystectomy.

    Science.gov (United States)

    Hinata, Nobuyuki; Murakami, Gen; Abe, Shin-ichi; Honda, Masashi; Isoyama, Tadahiro; Sejima, Takehiro; Takenaka, Atsushi

    2012-02-01

    We histologically examined the urethral anatomy to assess whether the surgical procedure for radical cystectomy should be modified in females. Anatomical and histological studies were performed on 20 adult female cadavers. Semiserial sections were processed for histological examination and immunohistochemistry. To assess the clinical value of the antegrade approach we examined blood loss and function in 12 consecutive patients who underwent radical cystectomy by this approach. Vaginal wall smooth muscle contributed to urethral wall formation, in addition to a thin layer of proper urethral smooth muscle, particularly when the bladder detrusor was poorly developed or degenerated. The middle urethra was attached tightly to the vaginal smooth muscles with abundant veins running at the interface. The urethral sphincter and its inferoposterior continuation (urethrovaginal sphincter) were embedded in the elastic fiber rich perineal membrane. The membrane was U shaped, wrapping around the anterior aspect of the middle urethra and extending posterior along the distal vagina to end at the lateral extension of the perineal body near the external anal sphincter. Mean estimated blood loss was 965 ml. Of patients who received a neobladder hypercontinence was observed in 14.3% and 57.1% achieved continence. There is topographical variation in the anatomy of tissues surrounding the female urethra. Care should be taken when dissecting the tissues dorsal or lateral to the urethra. The antegrade approach is useful since the urethra can be dissected under direct vision and traction can be applied to these structures. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Current state and future of photodynamic therapy for the treatment of head and neck squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Christina Mimikos

    2016-06-01

    Full Text Available Photodynamic therapy has shown promise in the treatment of early head and neck squamous cell carcinoma (SCC. In photodynamic therapy (PDT, a light sensitive drug (photosensitizer and visible light cause cancer cell death by the creation of singlet oxygen and free radicals, inciting an immune response, and vascular collapse. In this paper, we review several studies that demonstrate the effectiveness of PDT in the treatment of early stage SCC of the head and neck, with some showing a similar response rate to surgery. Two cases are presented to illustrate the effectiveness of PDT. Then, new advances are discussed including the discovery of STAT3 crosslinking as a potential biomarker for PDT response and interstitial PDT for locally advanced cancers. Keywords: Photodynamic therapy, PDT, Squamous cell carcinoma, Head and neck cancer

  11. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study.

    Science.gov (United States)

    Brunocilla, Eugenio; Schiavina, Riccardo; Pultrone, Cristian Vincenzo; Borghesi, Marco; Rossi, Martina; Cevenini, Matteo; Martorana, Giuseppe

    2014-02-01

    To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy. This was a prospective single-center, case-control study. A total of 40 consecutive patients with organ-confined prostate cancer were submitted to radical prostatectomy with the preservation of the muscular internal sphincter and the proximal urethra (group 1), and their outcomes were compared with those of 40 patients submitted to a standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7 and 30 days, and 3 and 12 months after removal of the catheter. Group 1 had a faster recovery of early continence than group 2 at day 3 (45% vs 22%; P = 0.029) and at day 7 (75% vs 50%; P = 0.018). Considering the number of pads, group 1 had a faster recovery of continence at 3, 7 and 30 days, and also had less incidence of severe incontinence. There was no statistically significant difference in terms of continence at 3 and 12 months among the two groups. Multivariate logistic regression analysis showed that surgical technique and young age were significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins. Our modified technique of radical retropubic prostatectomy with preservation of the smooth muscular internal sphincter, as well as of the proximal urethra during bladder neck dissection, results in a significantly increased urinary continence at 3, 7 and 30 days after catheter removal, with a minor incidence of severe incontinence. The technique is also oncologically safe, and it does not increase the operative duration of the procedure. © 2013 The Japanese Urological Association.

  12. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  13. Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

    1987-06-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

  14. PET-CT in the evaluation of metastatic breast cancer

    International Nuclear Information System (INIS)

    Sullivan, A.M.; Fulham, M.J.

    2005-01-01

    A 44-year-old woman underwent two PET-CT scans for the evaluation of metastatic breast cancer. A radical left mastectomy with axillary dissection (1 of 43 nodes positive) followed by chemotherapy, was performed in 1998. She represented in October 2003 with a left supraclavicular fossa mass. This was confirmed to be recurrent breast cancer on FNAB. She was considered for a radical neck dissection and the surgeon requested a PET scan. Other imaging at this time included a normal bone scan and CT brain. CT neck/chest/abdomen/pelvis showed soft tissue thickening in the left lower neck. The PET-CT scan showed multiple glucose avid lesions in the sternum, mediastinum and neck lymph nodes as well as a small lesion in the proximal left femur consistent with extensive metastatic disease. Surgery was cancelled and Femara chemotherapy commenced. Femara was stopped in March 2004 and the patient began alternative therapies. In October 2004 she presented to her surgeon with new back and chest pain. CT of the neck/chest/abdomen/pelvis showed a soft tissue mass in the upper sternum and a lymph node at the base of the neck highly suspicious for metastatic disease. There were also 2 suspicious lung nodules and a lesion in the proximal left femur reported as an osteoid osteoma. Wholebody PET-CT scans were performed on a Siemens LSO Biograph, 60mins after the injection of 350Mbq of Fl 8-Fag, with arms at the patient's side and head in the field-of-view. On both occasions the patient had to pay for the scan. On the 2004 PET-CT scan, the CT brain revealed multiple hyperdense lesions consistent with hemorrhagic metastases. In addition, there were innumerable glucose avid foci involving viscera, nodes and skeleton consistent with disseminated disease. Our case illustrates: (i) the value of PET in the management of metastatic breast cancer; (ii) the improved accuracy of PET-CT in delineating sites of disease; (iii) the issues of head movement in PET-CT and. (iv) the problem with lack of

  15. Lymphoscintigraphy and identification of lymph nodes in patients with cervix carcinoma undergoing radical hysterectomy

    International Nuclear Information System (INIS)

    Alonso, Omar; Lago, Graciela; Juri, Cecilia; Touya, Eduardo; Arribeltz, Gualberto; Dabezies, Luis; Alvarez, Carmen; Sotero, Gonzalo; Martinez, Jorge

    2003-01-01

    One of the most important prognostic features of early cervix cancer is the involvement of regional lymph nodes (LN). Although not fully studied, the sentinel node (SN) strategy has the potential of preventing unnecessary extensive LN dissections in these patients. The aim of this study was to determine the feasibility of SN identification by means of preoperative lymphoscintigraphy (PL) and intraoperative gamma probe detection (IGPD) in patients undergoing radical hysterectomy and pelvic/para-aortic lymphadenectomy for the treatment of early cervix carcinoma. (author)

  16. Postoperative drainage in head and neck surgery.

    Science.gov (United States)

    Amir, Ida; Morar, Pradeep; Belloso, Antonio

    2010-11-01

    A major factor affecting patients' length of hospitalisation following head and neck surgery remains the use of surgical drains. The optimal time to remove these drains has not been well defined. A routine practice is to measure the drainage every 24 h and remove the drain when daily drainage falls below 25 ml. This study aims to determine whether drainage measurement at shorter intervals decreases the time to drain removal and hence the length of in-patient stays. A 6-month prospective observational study was performed. The inclusion criteria were patients who underwent head and neck surgery without neck dissection and had a closed suction drain inserted. Drainage rates were measured at 8-hourly intervals. Drains were removed when drainage-rate was ≤ 1 ml/h over an 8-h period. A total of 43 patients were evaluated. The highest drainage rate occurred in the first 8 postoperative hours and decreased significantly in the subsequent hours. The median drainage rates at 8, 16, 24, 32 and 40 postoperative hours were 3.375, 1, 0, 0 and 0 ml/h, respectively. Applying our new removal criteria of ≤ 1 ml/h drainage rate, the drains were removed in 22 (51%) patients at the 16th postoperative hour; 37 (86%) were removed by 24 h after operation. In comparison, only nine (20.9%) patients could potentially be discharged the day after surgery if previous criteria of ≤ 25 ml/24-h were used to decide on drain removal. Our 8-hourly drainage-rate monitoring has facilitated safe earlier discharge of an additional 28 (65%) patients on the day after surgery. This has led to improvement in patient care, better optimisation of hospital resources and resulted in positive economic implications to the department.

  17. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy for endometrial cancer.

    Science.gov (United States)

    Vasilescu, C; Stănciulea, Oana; Popa, Monica; Anghel, Rodica; Herlea, V; Florescu, Arleziana

    2008-01-01

    The surgical treatment of endometrial cancer is still a matter of debate. Two of the most controversial issues are the beneficial effect of lymphadenectomy and the feasibility of laparoscopy. The aim of the case report was to describe the feasibility of total laparoscopic radical hysterectomy with pelvic lymphadenectomy in a 56-years-old Caucasian woman diagnosed with endometrial cancer. After a CO2 pneumoperitoneum was created the peritoneum was incised cranially to the para-colic fossa just above the external iliac vessels until the psoas muscle is visualized. The external iliac vessels were identified and lymph nodes from the anterior and the medial surface were removed until the iliac bifurcation and placed in an Endo-bag. The procedure continued with the identification of the hypo-gastric and the umbilical artery which were pulled medially in order to open the obturator fossa and remove the lymphatic tissue superior to the obturator nerve. The next step was the opening of the para-vesical and pararectal spaces by using blunt dissection; this maneuver was facilitated by pulling the uterine fundus towards the opposite direction with the uterine manipulator. The parametrium being isolated between the two spaces can be safely divided. At the superior limit of the parametrium the uterine artery is identified and divided at its origin. Thereafter, by placing the uterine fundus in median and posterior position, the vesicouterine peritoneal fold was opened by scissors and a bladder dissection from the low uterine segment down to the vagina was performed. Then the ureter is dissected, freed from its attachments to the parametria and de-crossed from the uterine artery down to its entry into the bladder. Next the rectovaginal space is opened and the utero-sacral ligaments divided; this allows the division of para-vaginal attachments. The vagina is sectioned and the specimen is extracted transvaginally. Then the vaginal stump was sutured by laparoscopy. Total laparoscopic

  18. FDG PET/MR for lymph node staging in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan, E-mail: ivan.platzek@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Beuthien-Baumann, Bettina, E-mail: bettina.beuthien-baumann3@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Schneider, Matthias, E-mail: m.schneider@mkgdresden.de [Dresden University Hospital, Department of Oral and Maxillofacial Surgery, Fetscherstr. 74, 01307 Dresden (Germany); Gudziol, Volker, E-mail: volker.gudziol@uniklinikum-dresden.de [Dresden University Hospital, Department of Otolaryngology, Fetscherstr. 74, 01307 Dresden (Germany); Kitzler, Hagen H., E-mail: hagen.kitzler@uniklinikum-dresden.de [Dresden University Hospital, Department of Neuroradiology, Fetscherstr. 74, 01307 Dresden (Germany); Maus, Jens, E-mail: j.maus@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Schramm, Georg, E-mail: g.schramm@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Popp, Manuel, E-mail: manuel.popp@praxisklinik-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Laniado, Michael, E-mail: michael.laniado@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Kotzerke, Jörg, E-mail: Joerg.Kotzerke@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Hoff, Jörg van den, E-mail: j.van_den_hoff@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany)

    2014-07-15

    Objective: To assess the diagnostic value of PET/MR (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for lymph node staging in head and neck cancer. Materials and methods: This prospective study was approved by the local ethics committee; all patients signed informed consent. Thirty-eight patients with squamous cell carcinoma of the head and neck region underwent a PET scan on a conventional scanner and a subsequent PET/MR on a whole-body hybrid system after a single intravenous injection of FDG. The accuracy of PET, MR and PET/MR for lymph node metastases were compared using receiver operating characteristic (ROC) analysis. Histology served as the reference standard. Results: Metastatic disease was confirmed in 16 (42.1%) of 38 patients and 38 (9.7%) of 391 dissected lymph node levels. There were no significant differences between PET/MR, MR and PET and MR (p > 0.05) regarding accuracy for cervical metastatic disease. Based on lymph node levels, sensitivity and specificity for metastatic involvement were 65.8% and 97.2% for MR, 86.8% and 97.0% for PET and 89.5% and 95.2% for PET/MR. Conclusions: In head and neck cancer, FDG PET/MR does not significantly improve accuracy for cervical lymph node metastases in comparison to MR or PET.

  19. Aortic Dissection Type A in Alpine Skiers

    Directory of Open Access Journals (Sweden)

    Thomas Schachner

    2013-01-01

    Full Text Available Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April. We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200 cm versus 175 (157–191 cm, and heavier (90 (68–125 kg versus 80 (45–110 kg, than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (. Hospital mortality of skiers was 6% versus 13% in nonskiers (. The skiers live at an altitude of 170 (0–853 m.a.s.l. and experience their dissection at 1602 (1185–3105; m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good.

  20. Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer.

    Science.gov (United States)

    Nicholson, Helen L; Al-Hakeem, Yasser; Maldonado, Javier J; Tse, Vincent

    2017-07-01

    The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

  1. Quality assurance in head and neck surgical oncology: EORTC 24954 trial on larynx preservation.

    Science.gov (United States)

    Leemans, C R; Tijink, B M; Langendijk, J A; Andry, G; Hamoir, M; Lefebvre, J L

    2013-09-01

    The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the EORTC 24954 trial on larynx preservation. In this multicentre study, patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx were randomly assigned for treatment with sequential or alternating chemoradiation. The need for a quality assurance program is the evaluation and prevention of differences in treatments between centres in this multidisciplinary study. The surgical subcommittee of the HNCG prepared a questionnaire, and clinical records of all patients were verified during audits of independent teams. Data relating institutional practices were collected during a face to face interview with members of the local team. 271 clinical records from the nine main contributing centres were reviewed. The main difference between centres was the time interval between first consultation and treatment initiation, with a mean of 45 days. On the pathology report the nodal involvement was described by level in 36% of the cases according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Extranodal spread was not always described in neck dissection specimens. The EORTC 24954 trial on larynx preservation was the first prospective trial with a quality assurance program in head and neck surgical oncology. The analysis shows similarities in practices, but also points out some important differences between centres. Operation reports were fairly complete, but uniformity in pathology reports should be improved. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. CT diagnosis of acute aortic dissection

    International Nuclear Information System (INIS)

    Ogawa, Noriko; Kobayashi, Takeshi

    1989-01-01

    Sixteen (47.5%) of 35 patients with acute aortic dissection showed a non-opacified crescent in the aorta on an initial contrast CT. Seven of these 16 patients underwent cineangiography soon after the initial CT, and in all 7 patients, neither an intimal tear nor an intimal flap was obtained. All but one of above 16 patients were followed by CT. Mean duration of follow-up was 9.6 months. In 10 of 15 patients with non-opacified false lumen, the false lumen remained non-opacified until the last examination. Moreover, in 6 of these 10 patients, the false lumen shrunk, and in the other 3, it disappeared completely on follow-up CT. On the other hand, in remaining 5 of these 15 patients who were initially diagnosed to have non-opacified false lumen, the false lumen became opacified and enlarged in size on follow-up CT performed in the first 14 weeks. Moreover, in 4 of these 5 patients, the false lumen became opacified in the only first 6 weeks. No matter how intensive care should be paid at least for the first 6 weeks, it seems that patients with aortic dissection which have non-opacified false lumen had good prognosis in comparison to patients with ordinary aortic dissections which have opacified false lumen. We believe aortic dissection with non-opacified false lumen may consist of two type of aortic dissection, one has no intimal tear, the other has some intimal tears and a thrombosed false lumen. In conclusion, CT is the most useful modality in diagnosing acute aortic dissection. The reasons are the incidence of acute aortic dissection with non-opacified false lumen was high, patients with non-opacified false lumen had good prognosis, and it was difficult to diagnose aortic dissection with non-opacified false lumen by conventional cineangiography and/or DSA. (author)

  3. Validation of the sentinel lymph node biopsy technique in head and neck cancers of the oral cavity.

    Science.gov (United States)

    Radkani, Pejman; Mesko, Thomas W; Paramo, Juan C

    2013-12-01

    The purpose of this study was to present our experience and validate the use of sentinel lymph node (SLN) mapping in patients with head and neck cancers. A retrospective review of a prospectively collected database of patients with a diagnosis of squamous cell carcinomas of the head and neck from 2008 to 2011 was done. The group consisted of a total of 20 patients. The first node(s) highlighted with blue, or identified as radioactive by Tc99-sulfur radioactive colloid, was (were) identified as the SLNs. In the first seven patients, formal modified neck dissection was performed. In the remaining 13 patients, only a SLN biopsy procedure was done. At least one SLN was identified in all 20 patients (100%). Only one patient (5%) had positive nodes. In this case, the SLN was also positive. In the remaining 19 cases, all lymph nodes were negative. After an average of 24 months of follow-up, there have been three local recurrences (15%) but no evidence of distant metastatic disease. SLN mapping in head and neck cancers is a feasible technique with a high identification rate and a low false-negative rate. Although the detection rate of regional metastatic disease compares favorably with published data as well as the disease-free and overall survival, further studies are warranted before considering this technique to be the "gold standard" in patients with oral squamous cell carcinoma and a negative neck by clinical examination and imaging studies.

  4. Surgical complications of radical retropubic prostatectomy: A single institutional experience of seven years

    Directory of Open Access Journals (Sweden)

    Neeraj K Goyal

    2007-01-01

    Full Text Available Aim: To determine the surgical complications of open retropubic radical prostatectomy. Materials and Methods: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence were noted. Result: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. Conclusion: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.

  5. Adenocarcinoma of the ethmoid following radiotherapy for bilateral retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Rowe, L.D.; Lane, R.; Snow, J.B. Jr.

    1980-01-01

    Adenocarcinoma of the ethmoid sinus is rare, representing only 4 to 8% of malignancies of the paranasal sinuses. An extraordinary case of papillary adenocarcinoma of the ethmoid sinus arising 30 years following high-dose radiotherapy for bilateral retinoblastoma is presented. Second fatal mesenchymal and epithelial primaries have been described in 8.5% of patients with bilateral retinoblastomas previously treated with radiotherapy; however, papillary adenocarcinoma arising within the paranasal sinuses has not been reported. Aggressive treatment including partial maxillectomy, radical pansinusectomy, radical neck dissection followed by regional radiotherapy and systemic chemotherapy failed to prevent the development of fatal hepatic metastases. The high incidence of second fatal primary neoplasms in patients with bilateral retinoblastomas receiving radiation suggests an innate susceptibility that may add to the risk of radiotherapy.

  6. Adenocarcinoma of the ethmoid following radiotherapy for bilateral retinoblastoma

    International Nuclear Information System (INIS)

    Rowe, L.D.; Lane, R.; Snow, J.B. Jr.

    1980-01-01

    Adenocarcinoma of the ethmoid sinus is rare, representing only 4 to 8% of malignancies of the paranasal sinuses. An extraordinary case of papillary adenocarcinoma of the ethmoid sinus arising 30 years following high-dose radiotherapy for bilateral retinoblastoma is presented. Second fatal mesenchymal and epithelial primaries have been described in 8.5% of patients with bilateral retinoblastomas previously treated with radiotherapy; however, papillary adenocarcinoma arising within the paranasal sinuses has not been reported. Aggressive treatment including partial maxillectomy, radical pansinusectomy, radical neck dissection followed by regional radiotherapy and systemic chemotherapy failed to prevent the development of fatal hepatic metastases. The high incidence of second fatal primary neoplasms in patients with bilateral retinoblastomas receiving radiation suggests an innate susceptibility that may add to the risk of radiotherapy

  7. Radical fashion and radical fashion innovation

    NARCIS (Netherlands)

    Zhang, D.; Benedetto, Di A.C.

    2010-01-01

    This is a study of the related concepts of radical fashion and radical fashion innovation. Radical fashions are defined here as those that may never enter the market at all, and exist primarily on runway shows, in exhibitions and in publicity; by contrast, radical fashion innovations may be very

  8. Aortic Dissection Type A in Alpine Skiers

    Science.gov (United States)

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  9. Malignant fibrous histiocytoma of the face: report of a case

    Directory of Open Access Journals (Sweden)

    Bánkfalvi Ágnes

    2007-10-01

    Full Text Available Abstract Background Soft tissue sarcomas in the head and neck region are rare and often present a difficult differential diagnosis. The aim of our presentation is to point out the complexity of the diagnosis, treatment and follow up. Case presentation An eighty-seven year old female patient was referred to our unit with a fast growing brownish lump on the face. Four months beforehand, a benign fibrous histiocytoma (BFH had been removed from the same location by excision biopsy with wide tumour-free resection margins. Excision biopsy of the recurrent lesion revealed a malignant fibrous histiocytoma (MFH. Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap. No adjuvant radio- or chemotherapy was administered. Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively. Discussion Malignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

  10. Role of CT/PET in predicting nodal disease in head and neck cancers

    International Nuclear Information System (INIS)

    Singham, S.; Iyer, G.; Clark, J.

    2009-01-01

    Full text:Introduction: Pre-treatment evaluation of the presence of cervical nodal metastases is important in head and neck cancers and has major prognostic implications. In this study, we aim to determine the accuracy of CT/PET as a tool for identifying such metastases. Methods: All patients from Royal Prince Alfred and Liverpool Hospitals, who underwent CT/PET for any cancer arising from the head and neck, and who underwent subsequent surgery (which included a neck dissection) within 8 weeks of the CT/PET were included. Nodal staging was undertaken by utilising imaging-based nodal classification, and comparison with pathologic data from the surgical specimen was made. PET was considered positive if the SUV was greater than 2. Results: We identified 111 patients from the above criteria. 80 of such patients were treated for squamous cell carcinoma (SCC). CT/PET identified unsuspected metastatic disease in 6 patients. Correlation of CT/PET findings and the presence of disease at the primary site: sensitivity: 98%, specificity: 93%, positive predictive value (PPV): 98% and negative predictive value (NPV): 93%. Correlating CT/PET findings with the presence of nodal disease at any level: sensitivity: 95%, specificity: 88%, PPV: 95% and NPV: 88%. CT/PET was anatomically accurate in predicting the site of metastases in 62/74 (84%). Conclusion: PET is accurate in predicting both presence of nodal metastases and the level of involvement. CT/PET should be undertaken as a pre-operative tool to assist in planning the extent of surgery required in head and neck cancers.

  11. Endoluminal treatment of aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, Ajay; Lotz, Joachim; Galanski, Michael [Department of Diagnostic Radiology, Hannover Medical School, Carl Neuberg Strasse 1, 30625, Hannover (Germany); Oelert, Frank; Haverich, Axel; Karck, Matthias [Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Strasse 1, 30625, Hannover (Germany)

    2003-11-01

    Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature. (orig.)

  12. Endoluminal treatment of aortic dissection

    International Nuclear Information System (INIS)

    Chavan, Ajay; Lotz, Joachim; Galanski, Michael; Oelert, Frank; Haverich, Axel; Karck, Matthias

    2003-01-01

    Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature. (orig.)

  13. Cine MRI of dissecting aneurysm

    International Nuclear Information System (INIS)

    Takaki, Hajime

    1991-01-01

    Cine MRI was performed in 25 cases of aortic dissection and comparative study among cine MRI, spin-echo static MRI, contrast-enhanced CT and intravenous digital subtraction angiography (IVDSA) was made. Cine MRI accurately detected aortic dissection. It was most accurate among various diagnostic methods in demonstration of entry site of dissection. Take-off of renal artery and its relation to true and false channels was also accurately demonstrated by cine MRI. The above results suggest that cine MRI can be an important diagnostic modality with almost equal diagnostic quality to those of conventional angiography. However, further technical improvement to shorten the imaging time seems necessary to replace angiography. (author)

  14. Misonidazole in patients receiving radical radiotherapy: pharmacokinetic effects of phenytoin tumor response and neurotoxicity

    International Nuclear Information System (INIS)

    Moore, J.L.; Biol, F.I.; Patterson, I.C.M.; Dawes, P.J.D.K.; Henk, J.M.

    1982-01-01

    In 1978, a pilot study began of 29 patients with advanced tumors of the head and neck. The study showed an initial peripheral neuropathy rate of 55%, despite a dose limitation of 12 g/m 2 of misonidazole. Tumor response at 9 months was most encouraging. We are now able to examine tumor response and persistence of neuropathy in these patients 2 1/2 years after radical radiotherapy. The results are comparable with those obtained with hyperbaric oxygen in a clinical trial at this center during the 1970's. Neuropathy was a serious side effect but the drug phenytoin has been shown to shorten the half-life of misonidazole. We have examined the effect of phenytoin on the pharmacokinetics of misonidazole in 13 patients who received radical radiotherapy for advanced head and neck tumors or oesophageal tumors. Misonidazole was given in multiple doses, i.e. daily or weekly as it would be used in conventional therapy. Phenytoin was given either daily throughout treatment, or it was withdrawn during treatment. There were dramatic changes in the half-life of misonidazole, but the concentration at the time of irradiation was little affected. The significant changes in the half-life of misonidazole and the increased concentration of the metabolite desmethylmisonidazole are discussed

  15. Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome

    OpenAIRE

    Lee, Seok-Soo; Jung, Tae-Eun; Lee, Dong Hyup

    2012-01-01

    Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitat...

  16. Assessment of stent edge dissections by fractional flow reserve.

    Science.gov (United States)

    Chung, Ju-Hyun; Ann, Soe Hee; Koo, Bon-Kwon; Nam, Chang-Wook; Doh, Joon-Hyung; Singh, Gillian Balbir; Kim, Hyung Il; Shin, Eun-Seok

    2015-04-15

    Edge dissections after intervention have been studied with imaging techniques, however, functional assessment has not been studied yet. We investigated the relationship between fractional flow reserve (FFR) and the angiographic type of stent edge dissections and tried to assess the use of FFR-guided management for edge dissection. 51 edge dissections assessed by FFR were included in this prospective observational study. FFR was measured for each type of edge dissection and compared with quantitative coronary angiographic findings. Clinical outcomes were evaluated based on FFR measurements. Edge dissections were classified as type A (47.1%; 24/51), type B (41.2%; 21/51), type C (2.0%; 1/51) and type D (9.8%; 5/51). Mean FFR in type A dissection was 0.87 ± 0.09, in type B 0.86 ± 0.07, in type C 0.72 and in type D 0.57 ± 0.08. All type C and D dissections (6/51) had FFR ≤ 0.8 and were treated with additional stents. Among the 45 type A and B dissections, 8 had a FFR ≤ 0.8 (17.8%), and 50% received additional stenting. All dissections with FFR >0.8 were left untreated except one long dissection case. There was no death, myocardial infarction or target lesion revascularization during hospitalization or the follow-up period (median 152 days; IQR 42-352 days). FFR correlates well with an angiographic type of edge dissection. Angiographic findings are sufficient for deciding the treatment of severe dissections such as types C and D, while FFR-guided management may be safe and effective for mild edge dissections such as types A and B. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Compliance and toxicity of the hypoxic radiosensitizer nimorazole in the treatment of patients with head and neck squamous cell carcinoma (HNSCC)

    DEFF Research Database (Denmark)

    Metwally, Mohamed Ahmed Hassan; Frederiksen, Katrine Diemer; Overgaard, Jens

    2014-01-01

    Abstract Purpose. To evaluate the compliance and toxicity of the hypoxic radiosensitizer nimorazole in head and neck cancer patients. Methods. A retrospective study of patients with head and neck squamous cell carcinoma (HNSCC), treated in Denmark between 1990 and 2013. All patients treated...... with radical radiotherapy (± chemotherapy) [66-70 Gy; 33-35 fractions; 2 Gy/fraction; 5-6 fractions/week] concomitant with the hypoxic radiosensitizer nimorazole. Nimorazole was administered as oral tablets in doses of approximately 1.2 g/m(2) body surface area in connection with the first of each daily...

  18. Recurrent post-partum coronary artery dissection

    Directory of Open Access Journals (Sweden)

    Resnic Frederic S

    2010-10-01

    Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  19. Training programme impact on thermoplastic immobilization for head and neck radiation therapy

    International Nuclear Information System (INIS)

    Outhwaite, Julie-Anne; McDowall, W. Robert; Marquart, Louise; Rattray, Gregory; Fielding, Andrew; Hargrave, Catriona

    2013-01-01

    Purpose: To determine whether uniform guidelines and training in the stabilization and formation of thermoplastic shells can improve the reproducibility of set-up for Head and Neck cancer patients. Methods and materials: Image based measurements of the planning and treatment positions for 35 head and neck cancer patients undergoing radical radiotherapy were analysed to provide a baseline of the reproducibility of thermoplastic immobilization. Radiation therapists (RT) were surveyed to establish a perception of their confidence in thermoplastic procedures. An evidence based staff training programme was created and implemented. Set-up reproduction and staff perception were reviewed to measure the impact of the training programme. Results: The mean (SD) 3D vectors of anatomical displacement, measured on the patient images, improved from 4.64 (2.03) for the baseline group compared to 3.02 (1.65) following training (p < 0.01). The proportion of 3D displacements of patient data exceeding 5 mm 3D vector was decreased from 37.1% to 5.7% (p < 0.001) and the 3 mm vector from 85.7% to 42.9% (p < 0.001). The post-training survey scores demonstrated improved confidence in reproducibility of set-up for head and neck patients. Conclusion: The Thermoplastic Shells Training Program has been found to improve the treatment reproducibility for head and neck radiation therapy patients. Uniform guidelines have increased RT confidence in thermoplastic procedures.

  20. Melanoma Metastases to the Neck Nodes: Role of Adjuvant Irradiation

    International Nuclear Information System (INIS)

    Strojan, Primoz; Jancar, Boris; Cemazar, Maja; Perme, Maja Pohar; Hocevar, Marko

    2010-01-01

    Purpose: To review experiences in the treatment of regionally advanced melanoma to the neck and/or parotid with emphasis on the role of adjuvant radiotherapy. Patients and Methods: Clinical and histopathologic data, treatment details, and outcomes in patients treated during the period 2000-2006 at the Institute of Oncology, Ljubljana, Slovenia, were reviewed. Results: A total of 40 patients with 42 dissections underwent surgery, and 43 patients with 45 dissections received irradiation postoperatively to a median equivalent dose (eqTD 2 : 2 Gy/fraction, 1 fraction/day, 5 fractions/week) of 60 Gy (range, 47.8-78.8). Regional control 2 years after surgery was 56% (95% confidence interval [CI] 40-72%) and after postoperative radiotherapy 78% (CI 63-92%) (p = 0.015). On multivariate analysis, postoperative radiotherapy (yes vs. no: hazard ratio [HR] 6.3, CI 2.0-20.6) and sum of the risk factors present (i.e., risk factor score; HR 1.7 per score point, CI 1.2-2.6) were predictive for regional control. On logistic regression testing, the number of involved nodes was associated with the probability of distant metastases (p = 0.021). The incidence of late toxicity did not correlate with the mode of therapy, eqTD 2 , or fractionation pattern. Conclusions: Adjuvant radiotherapy has the potential to compensate effectively for the negative impact of adverse histopatologic features to disease control in a dissected nodal basin. More conventionally fractionated radiotherapy regimens using fraction doses of 2-2.5 Gy, with cumulative eqTD 2 ≥60 Gy, are recommended. The number of involved lymph nodes is proposed as an additional criterion for limiting the implementation of adjuvant irradiation.

  1. Text neck and neck pain in 18-21-year-old young adults.

    Science.gov (United States)

    Damasceno, Gerson Moreira; Ferreira, Arthur Sá; Nogueira, Leandro Alberto Calazans; Reis, Felipe José Jandre; Andrade, Igor Caio Santana; Meziat-Filho, Ney

    2018-06-01

    The aim of this study was to investigate whether there is an association between text neck and neck pain in young adults. Observational cross-sectional study with 150 18-21-year-old young adults from a public high school in the state of Rio de Janeiro was performed. In the self-report questionnaire, the participants answered questions on sociodemographic factors, anthropometric factors, time spent texting or playing on a mobile phone, visual impairments, and concern with the body posture. The neck posture was assessed by participants' self-perception and physiotherapists' judgment during a mobile phone texting message task. The Young Spine Questionnaire was used to evaluate the neck pain. Four multivariate logistic regression models were fitted to investigate the association between neck posture during mobile phone texting and neck pain, considering potential confounding factors. There is no association between neck posture, assessed by self-perception, and neck pain (OR = 1.66, p = 0.29), nor between neck posture, assessed by physiotherapists' judgment, and neck pain (OR = 1.23, p = 0.61). There was also no association between neck posture, assessed by self-perception, and frequency of neck pain (OR = 2.19, p = 0.09), nor between neck posture, assessed by physiotherapists' judgment, and frequency of neck pain (OR = 1.17, p = 0.68). This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

  2. Failure pattern and salvage treatment after radical treatment of head and neck cancer

    DEFF Research Database (Denmark)

    Pagh, Anja; Grau, Cai; Overgaard, Jens

    2016-01-01

    Purpose The aim of the study was to test the hypothesis that head and neck cancer (HNC) patients benefit from specialized follow-up (FU), as this strategy ensures timely detection of relapses for successful salvage treatment. This was done by evaluation of the pattern of failure, the temporal...... recordings of recurrent disease in 567 patients with primary tumors of the larynx, pharynx, oral cavity, nasal cavity, paranasal sinuses and salivary glands. A review of medical records was performed in order to update and supplement the database. Results Failures of the 567 patients were primarily in T...

  3. Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy.

    Science.gov (United States)

    von Bodman, Christian; Godoy, Guilherme; Chade, Daher C; Cronin, Angel; Tafe, Laura J; Fine, Samson W; Laudone, Vincent; Scardino, Peter T; Eastham, James A

    2010-07-01

    We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy. Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method. A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes. Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Association of cytochrome P450 2C9 polymorphism with locally advanced head and neck squamous cell carcinoma and response to concurrent cisplatin-based radical chemoradiation

    Directory of Open Access Journals (Sweden)

    Sayan Paul

    2014-01-01

    Full Text Available Aims: The aim of the present study is to investigate the association between polymorphism of cytochrome P450 2C9 (CYP2C9 enzyme with head and neck squamous cell carcinoma (HNSCC and response in patients receiving cisplatin-based radical chemoradiation (CT-RT. Materials and Methods: Four hundred and sixty patients suffering from locally advanced HNSCC and an equal number of healthy controls were genotyped for CYP2C9FNx012 and CYP2C9FNx013, leading to poor metabolizers (PMs by polymerase chain reaction (PCR-based restriction fragment length polymorphism (RFLP. Each case was assessed thoroughly for treatment response as per the World Health Organization (WHO criteria. Results and Analysis: The frequency of heterozygous genotypes of both CYP2C9FNx012 (27.8% and CYP2C9FNx013 (25% were found to be significantly higher in the HNSCC cases as compared to the healthy controls. Tobacco intake in the form of chewing or smoking and alcohol intake resulted in several folds increase in the risk to HNSCC in the cases carrying variant genotypes of CYP2C9FNx012 or CYP2C9FNx013. Further, majority of the cases assessed for response (n = 436 carrying variant alleles of CYP2C9FNx012 (69.6% or CYP2C9FNx013 (65.2% were found to respond poorly to cisplatin-based radical CT-RT. Conclusion: The data suggests a significant association of the CYP2C9 polymorphism with HNSCC and treatment outcome underlining the importance of pretherapeutic genotyping in determining the treatment protocol.

  5. Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

    1987-06-01

    On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

  6. Neck muscle function in violinists/violists with and without neck pain.

    Science.gov (United States)

    Steinmetz, Anke; Claus, Andrew; Hodges, Paul W; Jull, Gwendolen A

    2016-04-01

    Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG amplitudes during CCFT than the pain-free musicians and non-musicians (P neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.

  7. Are all hands-on activities equally effective? Effect of using plastic models, organ dissections, and virtual dissections on student learning and perceptions.

    Science.gov (United States)

    Lombardi, Sara A; Hicks, Reimi E; Thompson, Katerina V; Marbach-Ad, Gili

    2014-03-01

    This study investigated the impact of three commonly used cardiovascular model-assisted activities on student learning and student attitudes and perspectives about science. College students enrolled in a Human Anatomy and Physiology course were randomly assigned to one of three experimental groups (organ dissections, virtual dissections, or plastic models). Each group received a 15-min lecture followed by a 45-min activity with one of the treatments. Immediately after the lesson and then 2 mo later, students were tested on anatomy and physiology knowledge and completed an attitude survey. Students who used plastic models achieved significantly higher overall scores on both the initial and followup exams than students who performed organ or virtual dissections. On the initial exam, students in the plastic model and organ dissection treatments scored higher on anatomy questions than students who performed virtual dissections. Students in the plastic model group scored higher than students who performed organ dissections on physiology questions. On the followup exam, when asked anatomy questions, students in the plastic model group scored higher than dissection students and virtual dissection students. On attitude surveys, organ dissections had higher perceived value and were requested for inclusion in curricula twice as often as any other activity. Students who performed organ dissections were more likely than the other treatment groups to agree with the statement that "science is fun," suggesting that organ dissections may promote positive attitudes toward science. The findings of this study provide evidence for the importance of multiple types of hands-on activities in anatomy laboratory courses.

  8. Cervicocephalic arterial dissection

    International Nuclear Information System (INIS)

    Suyama, Kazuhiko; Hayashi, Kentaro; Nagata, Izumi

    2008-01-01

    The authors review the clinical and neuroradiological features of cervicocephalic arterial dissection, which is occasionally seen in young adults, with special reference to the differences in the region of occurrence of these lesions between patients in Western countries and Japan. In Western countries, the cervical internal carotid artery is the most common site of occurrence of these lesions; however, in Japan, these lesions have been frequently reported to occure in the intracranial vertebral artery. Most clinical manifestations of cervical arterial dissection are non-hemorrhagic events such as headaches associated with arterial dissection or cerebral ischemia caused by a distal embolism following thrombus formation in the cervical lesion. On the other hand, a subarachnoid hemorrhage and cerebral infarction are frequently observed in intracranial arterial dissections. Non-invasive procedures, including MR imaging, are useful for demonstrating characteristic features of this condition such as the presence of an intimal flap or a double lumen, and for monitoring the chronological changes in the lesions, which may regress spontaneously. Since the pathological mechanisms underlying the progression and/or the regression of this condition are still unknown, the clinical evidence indicating the optimal therapeutic strategies has not yet been reported. Nevertheless, conservative therapy, including antithrombotic treatment, is widely used for the treatment of non-hemorrhagic lesions, which generally results in good clinical outcomes. Further, surgical intervention is essential for the treatment of lesions with a subarachnoid hemorrhage to prevent fatal rebleeding, and it is also required for the treatment of certain non-hemorrhagic lesions. Recent advancements in surgical procedures, especially endovascular treatments, may therefore be helpful in the management of similar complicated vascular conditions. (author)

  9. Perceptions of cadaveric dissection in anatomy teaching.

    Science.gov (United States)

    Naz, Saima; Nazir, Ghazala; Iram, Samia; Mohammad, Malik; Umair; Qari, Iftikhar Hussain; Mohammad, Shaheen

    2011-01-01

    Anatomy professors world over are lamenting about medical students' lack of interest in dissections and its diminishing utilisation in medical studies. The objective of our study was to find out the reasons why some of the Pakistani medical students were avoiding dissections. We conducted this study in 5 medical colleges of Pakistan from Dec 2010-Oct 2011. Questionnaires were prepared and administered to more than 500 Pakistani medical students, at least 6 months after their first cadaver dissecting session. Mostly 1st and 2nd year medical students participated in this study. Around 43% students have actually performed dissections in some form, whereas around 57% had never touched the cadaver. Further evaluation of these results revealed that out of 57% of students, 45% avoided dissection due to bad smell of formaldehyde, 37% due to moral/ethical grounds, 22% due to low motivation and respect of human body, 19.4% due to anxiety, 18.6% due to religious reason, 16% due to fear, asthma and emotional reaction, 9.4% due to toxic chemical, 8.6% due to laziness and 7% due to nightmares. In spite of availability of required number of cadavers in all 5 medical colleges and a clear realisation amongst the students that dissecting cadaver is an effective way of learning anatomy; majority of students were not very keen and had therefore not performed dissection even once.

  10. A case of radiation ulcer of the neck treated by a lower trapezius myocutaneous flap

    International Nuclear Information System (INIS)

    Shimbashi, Takeshi; Satomi, Takao; Okuyama, Toshio.

    1981-01-01

    A case of radiation ulcer of the neck is reported. The patient is a 50-year-old male. He had been treated for a malignant parotid tumor 12 years earlier. Extirpation of the tumor and radical neck disection had been performed and after the operation he received radiation therapy. On 1979, erosion appeared and developed into an ulcer. On October 14, massive hemorrhage and cardiac arrest suddenly occurred. Immediate emergency treatment was administered and he was resuscitated. He was admitted to our division for the reconstruction of his ulcer. The operation was successfully performed on his ulcer using a lower trapezius myocutaneous flap. He has been followed up for 9 months. The effect of the operation is esthetically and functionally satisfactory. (author)

  11. Magnetic resonance diagnosis of aortic dissection

    International Nuclear Information System (INIS)

    Mukohara, Nobuhiko; Yoshida, Yutaka; Nakamura, Kazuo

    1986-01-01

    Magnetic resonance imaging (MRI) was performed in thirty-one patients with aortic dissection to evaluate its usefulness in diagnosing the site of communicating orifice between the true and false lumens and the presence of retrograde dissection. 1. MRI revealed the site of the entry as a defect in the intimal flap in the images of 12 of 15 patients (80 %). 2. The site of the communicating orifice between the true and false lumens in the abdominal aorta could be determined in six of eight patients (75 %). 3. MRI diagnosis of retrograde dissection was successful in three patients. 4. Cross-sectional analysis of the abdominal aorta based on the location of the true lumen revealed that the celiac and superior mesenteric arteries tended to arise from the true lumen when the latter was situated in the anterior part of the abdominal aorta. The right and left renal arteries arose from the true lumen when it was positioned anterolaterally. In conclusion, MRI was a useful diagnostic method for aortic dissection, especially for determining the site of entry in the thoracic aorta. The changes in signal intensity in the false lumen provided useful information for locating the communicating orifice between the true and false lumens and for diagnosis of retrograde dissection. Cross-sectional analysis of dissection in the abdominal aorta was useful for predicting the branching of the main arteries from the true or false lumen. (author)

  12. A comparison of retention of anatomical knowledge in an introductory college biology course: Traditional dissection vs. virtual dissection

    Science.gov (United States)

    Taeger, Kelli Rae

    Dissection has always played a crucial role in biology and anatomy courses at all levels of education. However, in recent years, ethical concerns, as well as improved technology, have brought to the forefront the issue of whether virtual dissection is as effective or whether it is more effective than traditional dissection. Most prior research indicated the two methods produced equal results. However, none of those studies examined retention of information past the initial test of knowledge. Two groups of college students currently enrolled in an introductory level college biology course were given one hour to complete a frog dissection. One group performed a traditional frog dissection, making cuts in an actual preserved frog specimen with scalpels and scissors. The other group performed a virtual frog dissection, using "The Digital Frog 2" software. Immediately after the dissections were completed, each group was given an examination consisting of questions on actual specimens, pictures generated from the computer software, and illustrations that neither group had seen. Two weeks later, unannounced, the groups took the same exam in order to test retention. The traditional dissection group scored significantly higher on two of the three sections, as well as the total score on the initial exam. However, with the exception of specimen questions (on which the traditional group retained significantly more information), there was no significant difference in the retention from exam 1 to exam 2 between the two groups. These results, along with the majority of prior studies, show that the two methods produce, for the most part, the same end results. Therefore, the decision of which method to employ should be based on the goals and preferences of the instructor(s) and the department. If that department's goals include: Being at the forefront of new technology, increasing time management, increasing student: teacher ratio for economic reasons, and/or ethical issues, then

  13. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden.

    Science.gov (United States)

    Carlsson, Stefan; Nilsson, Andreas E; Schumacher, Martin C; Jonsson, Martin N; Volz, Daniela S; Steineck, Gunnar; Wiklund, Peter N

    2010-05-01

    To quantify complications to surgery in patients treated with robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) at our institution. Radical prostatectomy is associated with specific complications that can affect outcome results in patients. Between January 2002 and August 2007, a series of 1738 consecutive patients underwent RARP (n = 1253) or RRP (n = 485) for clinically localized prostate cancer. Surgery-related complications were assessed using a prospective hospital-based complication registry. The baseline characteristics of all patients were documented preoperatively. Overall, 170 patients required blood transfusions (9.7%), 112 patients (23%) in the RRP group compared with 58 patients (4.8%) in the RARP group. Infectious complications occurred in 44 RRP patients (9%) compared with 18 (1%) in the RARP group. Bladder neck contracture was treated in 22 (4.5%) patients who had undergone RRP compared with 3 (0.2%) in the RARP group. Clavien grade IIIb-V complications were more common in RRP patients (n = 63; 12.9%) than in RARP patients (n = 46; 3.7%). The introduction of RARP at our institution has resulted in decreased number of patients with Clavien grade IIIb-V complications, such as bladder neck contractures, a decrease in the number of patients who require blood transfusions, and decreased numbers of patients with postoperative wound infections. Copyright 2010 Elsevier Inc. All rights reserved.

  14. Sinonasal squamous cell carcinoma without clinical lymph node involvement : Which neck management is best?

    Science.gov (United States)

    Castelnau-Marchand, Pauline; Levy, Antonin; Moya-Plana, Antoine; Mirghani, Haïtham; Nguyen, France; Del Campo, Eleonor Rivin; Janot, François; Kolb, Frédéric; Ferrand, François-Régis; Temam, Stéphane; Blanchard, Pierre; Tao, Yungan

    2016-08-01

    The purpose of this work was to report outcomes of patients with nonmetastatic sinonasal squamous cell carcinoma (SNSCC) and to discuss the impact of elective neck irradiation (ENI) and selective neck dissection (SND) in clinically negative lymph node (N0) patients. Data from 104 nonmetastatic SNSCC patients treated with curative intent were retrospectively analysed. Uni- and multivariate analyses were used to assess prognostic factors of overall survival (OS) and locoregional control (LRC). Median follow-up was 4.5 years. Eighty-five percent of tumours were stage III-IV. Treatments included induction chemotherapy (52.9 %), surgery (72 %) and radiotherapy (RT; 87 %). The 5‑year OS, progression-free survival, and LRC rates were 48, 44 and 57 %, respectively. Absence of surgery predicted a decrease of OS (hazard ratio [HR] 2.6; 95 % confidence interval [CI] 1.4-4.7), and LRC (HR 3.5; 95 % CI 1.8-6.8). Regional relapse was observed in 13/104 (13 %) patients and most common sites were level II (n = 12; 70.6 %), level III (n = 5; 29.4 %) and level Ib (n = 4; 23.5 %). Management of the neck in N0 patients (n = 87) included 11 % SND alone, 32 % ENI alone, 20 % SND + ENI and 37 % no neck treatment. In this population, a better LRC was found according to the management of the neck in favour of SND (94 % vs. 47 %; p = 0.002) but not ENI. SND may detect occult cervical positive nodes, allowing selective postoperative RT. ENI (ipsilateral level II, ±Ib and III or bilateral) needs to be proposed in selected patients, especially when SND has not been performed.

  15. Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients.

    Science.gov (United States)

    Matsumoto, Fumihiko; Mori, Taisuke; Matsumura, Satoko; Matsumoto, Yoshifumi; Fukasawa, Masahiko; Teshima, Masanori; Kobayashi, Kenya; Yoshimoto, Seiichi

    2017-08-01

    Lymph node metastasis with extranodal extension represents one of the most important adverse prognostic factors for survival in patients with head and neck squamous cell carcinoma. We propose that extranodal extension occurs to differing extents. The aim of this study was to determine the prognostic significance of extranodal extension in patients with head and neck squamous cell carcinoma. Two hundred and ninety-eight patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection were included. Cervical lymph nodes were classified into four categories: (i) pathological N negative, (ii) extranodal extension negative, (iii) non-surgical extranodal extension and (iv) surgical extranodal extension. Lymph node metastases were detected in 67.1% of laryngeal/hypopharyngeal cancer patients and 52.7% of oral cancer patients. The 3-year disease-specific survival rates for patients in the pathological N negative, extranodal extension negative, non-surgical extranodal extension and surgical extranodal extension groups were 90.9%, 79.6%, 63.8% and 48.3%, respectively. In laryngeal/hypopharyngeal cancer patients, surgical extranodal extension was associated with a significantly poorer disease-specific survival than a pathological N negative, extranodal extension negative or non-surgical extranodal extension status. In oral cancer patients, no significant differences were observed between the non-surgical and surgical extranodal extension groups. However, non-surgical extranodal extension was associated with a poorer disease-specific survival than a pathological N negative or extranodal extension negative status. Surgical extranodal extension was a poor prognostic factor in patients with head and neck squamous cell carcinoma. The prognostic significance of surgical extranodal extension differed between laryngeal/hypopharyngeal and oral cancer patients. The clinical significance of surgical extranodal extension was much greater for

  16. Clinical value of sentinel lymph node diagnostics in head and neck cancer

    International Nuclear Information System (INIS)

    Kampen, W.U.; Hoeft, S.; Maune, S.

    2006-01-01

    The concept of the so-called sentinel lymph node (SLN), being the first node draining a malignant tumor and thus carrying the highest risk of metastatic disease, is already frequently applied in patients suffering from malignant melanoma and breast cancer. It is the aim of this concept, to reduce postoperative morbidity by omitting a conventional lymph node dissection if the SLN is proven to be free of any tumor cells. First clinical studies showed promising results also in patients with head and neck cancer. However, both the anatomical localization of the primary tumor and the very complex lymphatic, frequently bilateral drainage pattern may lead to significant methodological problems. Besides a skilful intraoperative usage of the gamma probe, the precise preoperative staging of the respective patient for determination of the N0 status and the assiduous histopathological analysis of the excised SLN are extremely important to reach a maximum of sensitivity in this clinical setting. This paper summarizes the data published on the SLN concept in patients with head and neck cancer, describes the several methodological aspects of labeling the SLN with radiocolloides and reviews the today's impact of the SLN method in clinical routine. (orig.)

  17. An unusual localization of seven months delayed pelvic lymphocele following radical retropubic prostatectomy: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Berk Hazır

    Full Text Available Introduction: A pelvic lymphocele is a collection of lymphatic fluid that develops after extensive lymphadenectomies in surgeries such as urological malignancies or renal transplantation. Pelvic lymphoceles may cause complications such as fever, abdominal pain, leg swelling, genital swelling and flank pain. This report summarizes the management of a pelvic lymphocele after open radical retropubic prostatectomy with bilateral lymphadenectomy. Presentation of case: Herein, we present a case in which a pelvic lymphocele developed seven months post-radical open retropubic prostatectomy and through this patient we discussed the lymphocele following radical prostatectomy. The pelvic lymphocele occurred along the sciatic nerve from the sciatica foramen to the intergluteal muscles. The patient was treated with three drainage catheters. This localization is an atypical and unusual for lymphocele after radical retropubic prostatectomy. Discussion: Lymphocele formation that leads to major complications after radical prostatectomy is rare. Lymphocele formation is most commonly seen in the early postoperative period, but it should be considered in patients with fever, abdominal pain or leg swelling during the late postoperative period. Lymphocele formation was the most common cause of hospital readmission after radical prostatectomy. Conclusion: Lymphocele formation can be seen in atypical regions and can lead to unexpected complications after radical prostatectomy. Therefore, it should be brought to mind when complaints such as fever and lower extremity swelling occurred in patients underwent extensive lymph node dissection. Surgical treatment options are available, but percutaneous interventions can also be used. Keywords: Radical retropubic prostatectomy, Pelvic lymphocele, Percutaneous drainage, Prostate cancer, Case-report

  18. A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial.

    Science.gov (United States)

    Faisal, Mohammed; Fathy, Hamada; Shaban, Hamdy; Abuelela, Sameh T; Marie, Ahmed; Khaled, Islam

    2018-01-01

    Seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance. A prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection ( n  = 36) or electrocautery ( n  = 36). The mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p  < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p  = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p  = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p  = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p  = 0.003] in the harmonic group compared with those in the electrocautery group. Harmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance.

  19. Medical Student Dissection of CadaversImproves Performance on Practical Exams, but not Dissection-Relevant Questions in the NBME Gross Anatomy and Embryology Final Exam

    Directory of Open Access Journals (Sweden)

    Leslie Sargent Jones

    2001-03-01

    Full Text Available We have examined whether cadaver dissection by first year medical students (MIs affected their performance in two test measures: the NBME Gross Anatomy and Embryology Subject Exam (dissection-relevant questions only, and practical exams given at the end of each major section within the course. The dissections for the entire course were divided into 18 regional dissection units and each student was assigned to dissect one third of the regional units; the other two-thirds of the material was learned from the partner-prosected cadavers. Performance for each student on the exams was then assessed as a function of the regions those students actually dissected. While the results indicated a small performance advantage for MIs answering questions on material they had dissected on the NBME Subject Exam questions relevant to dissection (78-88% of total exam, the results were not statistically significant. However, a similar, small performance advantage on the course practical exams was highly significant.

  20. Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Pradier, Olivier; Christiansen, Hans; Schmidberger, Heinz; Martin, Alexios; Jaeckel, Martin C.; Steiner, Wolfgang; Ambrosch, Petra; Kahler, Elke; Hess, Clemens F.

    2005-01-01

    Purpose: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. Patients and Methods: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO 2 laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). Results: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). Conclusion: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy

  1. Retrograde type A dissection: a serious complication due to thoracic aortic endovascular stent-graft repair for Stanford type B aortic dissection

    International Nuclear Information System (INIS)

    Wang Guoquan; Zhai Shuiting; Li Tianxiao; Shi Shuaitao; Zhang Kewei; Li Kun

    2011-01-01

    Objective: to discuss the possible causes and prevention of retrograde type A dissection occurred after thoracic aortic endovascular stent-graft repair (TEVAR) for symptomatic type B dissection. Methods: During the period from January 2005 to January 2011, TEVAR was carried out in 189 patients (157 males and 32 females) with symptomatic type B dissection. The average age of the patients was (51.2±13.5) years, ranged from 26 to 78 years. A follow-up lasting for 3-63 months (mean 32 months) was conducted in 135 patients (71.43%). Fifty-four patients lost in touch with the authors (28.57%). The occurrence of retrograde type A dissection after TEVAR was calculated and the possible causes were analyzed. Results: After TEVAR retrograde type A dissection occurred in two patients (1.48%), and both were males. One patient developed retrograde type A dissection in perioperative period, and the patient refused to have surgery. Conservative treatment was employed for over three years and be was still alive so far. The other patient developed retrograde type A dissection one month after TEVAR, and emergency surgery was performed. The patient was followed up for three months and he was still alive. Conclusion: The retrograde type A dissection occurred after TEVAR may be closely related to the stent-graft device, to the interventional manipulations and to the vascular disorders. Close attention should be paid to the direct damage produced by the stent-graft device to the vascular wall. (authors)

  2. Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

    Directory of Open Access Journals (Sweden)

    Renato B. Corradi

    2016-06-01

    Full Text Available ABSTRACT Introduction and Objective Radical cystectomy (RC with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil. We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%. The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5 within 30 days of cystectomy occurred in 33/128 (25.7% patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

  3. Muscular Variation In The Neck Region With Narrowing Of The Minor And Major Supraclavicular Fossa

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    Humberto Ferreira Arquez

    2017-06-01

    Full Text Available Background: The sternocleidomastoideus muscle is the most prominent landmarks of the surface anatomy of the neck, separates the anterior part of the neck (anterior triangle from the posterior part of the neck (posterior triangle. An accessory head of sternocleidomastoideus muscle may cause complications while trying to access vital neurovascular structures that are located in the minor and major supraclavicular fossa. The purpose of this study is to describe an anatomical variation of the sternocleidomastoideus muscle and clinical impact. Methods and Findings: The anatomical variations described were found during routine dissection conducted in the laboratory of Morphology of the University of Pamplona in two male cadavers of 47 and 75 years respectively. Measurements were taken using a Vernier caliper. Topographic details of the variations were examined, recorded and photographed. The morphological variations in the number of heads (three and four of origin of sternocleidomastoideus muscle was found in two male subjects in right and left neck, bilaterally.  The posterior cervical triangle was diminished. The bilateral narrowing of the minor and major supraclavicular fossa minimizing space needed for potential surgical access. The branching patterns of the spinal accessory nerve and arterial patterns were normal. Conclusions: The Knowledge of the presence of additional heads of sternocleidomastoideus muscle it might cause difficulties in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoideus muscle. These variations must be kept in mind while approaching the region to avoid complications as the classical anatomical landmarks might be misinterpreted and confuse.

  4. The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

    LENUS (Irish Health Repository)

    Sasi, Walid

    2010-04-01

    Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.

  5. Identification and Management of Iatrogenic Aortocoronary Dissection

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    Shao-Ping Nie, MD, PhD, FESC, FSCAI

    2016-05-01

    Full Text Available Iatrogenic aortocoronary dissection (IACD is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap” or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.

  6. Late sequelae of whiplash injury with dissection of cervical arteries.

    Science.gov (United States)

    Hauser, Vital; Zangger, Peter; Winter, Yaroslav; Oertel, Wolfgang; Kesselring, Jürg

    2010-01-01

    The objective of our study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. We performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population (1.6 vs. 0.0041%). The risk of cerebrovascular events was still increased 4-12 months after whiplash injury (0.6 vs. 0.003075% in the general population). There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections. Copyright © 2010 S. Karger AG, Basel.

  7. Is there a superior simulator for human anatomy education? How virtual dissection can overcome the anatomic and pedagogic limitations of cadaveric dissection.

    Science.gov (United States)

    Darras, Kathryn E; de Bruin, Anique B H; Nicolaou, Savvas; Dahlström, Nils; Persson, Anders; van Merriënboer, Jeroen; Forster, Bruce B

    2018-03-23

    Educators must select the best tools to teach anatomy to future physicians and traditionally, cadavers have always been considered the "gold standard" simulator for living anatomy. However, new advances in technology and radiology have created new teaching tools, such as virtual dissection, which provide students with new learning opportunities. Virtual dissection is a novel way of studying human anatomy through patient computed tomography (CT) scans. Through touchscreen technology, students can work together in groups to "virtually dissect" the CT scans to better understand complex anatomic relationships. This article presents the anatomic and pedagogic limitations of cadaveric dissection and explains what virtual dissection is and how this new technology may be used to overcome these limitations.

  8. Asymmetry of neck motion and activation of the cervical paraspinal muscles during prone neck extension in subjects with unilateral posterior neck pain.

    Science.gov (United States)

    Park, Kyue-Nam; Kwon, Oh-Yun; Kim, Su-Jung; Kim, Si-Hyun

    2017-01-01

    Although unilateral posterior neck pain (UPNP) is more prevalent than central neck pain, little is known about how UPNP affects neck motion and the muscle activation pattern during prone neck extension. To investigate whether deviation in neck motion and asymmetry of activation of the bilateral cervical paraspinal muscles occur during prone neck extension in subjects with UPNP compared to subjects without UPNP. This study recruited 20 subjects with UPNP and 20 age- and sex-matched control subjects without such pain. Neck motion and muscle onset time during prone neck extension were measured using a three-dimensional motion-analysis system and surface electromyography. The deviation during prone neck extension was greater in the UPNP group than in the controls (p cervical extensor muscle activation in the UPNP group was significantly delayed on the painful side during prone neck extension (p cervical extensors, triggering a need for specific evaluation and exercises in the management of patients with UPNP.

  9. Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

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    Alexander L. Pan

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

  10. Type A dissection following endovascular repair of type B dissection

    International Nuclear Information System (INIS)

    Juszkat, R.; Zabicki, M.; Jemielity, M.; Buczkowski, P.; Urbanowicz, T.

    2009-01-01

    Background: We present a patient, who was treated with thoracic stentgraft implantation, because of acute type B aortic dissection (according to Stanford classification). The endovascular procedure was performed without any complications. Case Report: The patient was discharged in the 3 rd postprocedural day and was transferred to another hospital for further recovery. Nine days after the procedure, the patient was readmitted in cardiogenic shock to the Cardiac Surgery Department. The patient was immediately operated on, after dissection of the ascending aorta and pericardial tamponade had been diagnosed in transthoracic echocardiography. Conclusions: Total replacement of the aortic arch and its ascending part was performed successfully. The surgery was carried out in deep hypothermia with temporary circulatory arrest. The patient was discharged from the Cardiac Surgery Unit 15 days after the surgery, and transferred to another unit for further recovery. (authors)

  11. Virtual reality haptic dissection.

    Science.gov (United States)

    Erolin, Caroline; Wilkinson, Caroline; Soames, Roger

    2011-12-01

    This project aims to create a three-dimensional digital model of the human hand and wrist which can be virtually 'dissected' through a haptic interface. Tissue properties will be added to the various anatomical structures to replicate a realistic look and feel. The project will explore the role of the medical artist, and investigate cross-discipline collaborations in the field of virtual anatomy. The software will be used to train anatomy students in dissection skills, before experience on a real cadaver. The effectiveness of the software will be evaluated and assessed both quantitatively as well as qualitatively.

  12. Extrathyroidal Radioiodine Accumulation in a Fibroadenoma of the Breast.

    Science.gov (United States)

    Kim, Myoung Hyoun; Kim, Hun Soo; Park, Soon-Ah

    2017-02-01

    A 45-year-old woman with a differentiated thyroid carcinoma received adjuvant radioiodine therapy following total thyroidectomy and left modified radical neck dissection. A posttherapy planar radioiodine scan showed multifocal uptake in the thyroid bed and left chest. SPECT/CT revealed a fibroadenoma in the left breast. Six months later, an I scan showed no iodine avidity in the breast fibroadenoma, whereas ultrasonography showed no significant change in the size of the fibroadenoma. Altered radioiodine uptake of a breast fibroadenoma can be observed on follow-up scans after cytotoxic radioiodide treatment in patients with differentiated thyroid carcinoma.

  13. What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study

    Directory of Open Access Journals (Sweden)

    Arthur de Góes Ribeiro

    2016-04-01

    Full Text Available OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

  14. Head and Neck Cancer

    International Nuclear Information System (INIS)

    Tomita, Toshiki; Imanishi, Yorihisa

    2008-01-01

    The limitation of concurrent chemo-radiotherapy (CCRT) in head and neck cancer (HNC) as the primary treatment is described based on recent findings. Limits in the application/indication involve factors of age, performance status (PS) and renal function. The first is that, as deaths in >71 years old patients are derived from other causes (41%) than HNC, CCRT is only useful for younger population; the second, patients with PS 0-1 or Karnofsky performance score >60-70 can be indicated; and third, contraindicated are those with creatinine clearance (CCr) <60 mL/min as the key drug cisplatin in CCRT has a high renal toxicity. It should be recognized that completion rates of chemotherapy and RT are as low as 66-85% and 84-92%, respectively, in CCRT. CCRT has such limiting adverse events as mucitis, dry mouth, dysohagia, weight loss, neutropenia, sepsis, etc., which are most important in CCRT application. CCRT is recommended for the primary cancers of larynx and hypopharynx because they are significantly better conserved than middle pharyngeal, oral and upper jaw cancers. Evidence of CCRT is poor for cancers in paranasal sinuses. Planned neck dissection (PND) is for the cervical metastatic lymph nodes and conducted 6-12 weeks after CCRT regardless to its outcome. In fluorodeoxyglucose-positron emission tomography (FDG-PET) negative cases, PND can be omitted. Necessity of PND is possibly inversely proportional to CCRT intensity performed. For control of remote metastasis, CCRT has obvious limits and inductive chemotherapy before it is currently considered. Salvage surgery post CCRT does not always yield a relief because of complication. Patients with advanced laryngeal cancer can be selected either to surgery or CCRT depending on results of the inductive chemotherapy. To predict the sensitivity to CCRT, some biomarkers like HPV, EGFR and VEGF have been suggested to be useful by retrospective studies. Understanding the limitation is as important as knowing the usefulness in

  15. Double blind randomized trial of sucralfate vs. placebo during a course of radical radiotherapy for head and neck squamous carcinoma

    International Nuclear Information System (INIS)

    Carter, D.L.; Hebert, M.E.; Leopold, K.L.; Brizel, D.M.

    1997-01-01

    Purpose: To determine if sucralfate prophylaxis during a course of high dose radiation therapy (RT) for head and neck cancer decreases acute side effects including mucositis and weight loss. Methods: Ninety-eight patients receiving curative intent RT for advanced head and neck cancers participated in a single institution double blind randomized trial comparing sucralfate to placebo. Patients were stratified according to fractionation (QD or BID), use of concurrent chemotherapy (yes or no), Karnofsky performance status (KPS 5 % or > 10 % occurred more frequently in patients receiving chemotherapy (p<0.01 and p=0.05 respectively). Grade 3 mucositis was more common in patients receiving BID fractionation (p=0.04) or having a poor KPS status (continuous variable: p=0.01). Pain uncontrolled by narcotics was more common in patients who drank alcohol during therapy (p<0.01). No subset appeared to benefit from the use of sucralfate. Conclusions: Prophylactic treatment with sucralfate during high dose head and neck RT does not decrease acute treatment side effects. Other modalities should be investigated

  16. CrossFit-related cervical internal carotid artery dissection.

    Science.gov (United States)

    Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

    2015-08-01

    CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients.

  17. Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection.

    Science.gov (United States)

    Axelsson, Lars; Nyman, Jan; Haugen-Cange, Hedda; Bove, Mogens; Johansson, Leif; De Lara, Shahin; Kovács, Anikó; Hammerlid, Eva

    2017-06-10

    Head and neck cancer of unknown primary (HNCUP) is rare and prospective studies are lacking. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus (HPV) has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP. The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival. A search for HNCUP was performed in the Swedish Cancer Registry, Western health district, between the years 1992-2009. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included. The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining. Sixty-eight patients were included. The mean age was 59 years. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. Patients who were older than 70 years, patients with N3-stage tumors, and patients with tumors that were p16 negative had a significantly worse prognosis. The overall 5-year survival rate for patients with p16-positive tumors was 88% vs 61% for p16-negative tumors. Treatment with neck dissection and postoperative radiation or (chemo) radiation had 81 and 88% 5-year survival rates, respectively. The overall and disease-free 5-year survival rates for all patients in the study were 82 and 74%. Curatively treated HNCUP had good survival. HPV infection was common. Independent prognostic factors for survival were age over 70 years, HPV status and N3 stage. We recommend that HPV analysis should be performed routinely for HNCUP. Treatment with neck dissection and postoperative radiation or

  18. The risk for type B aortic dissection in Marfan syndrome.

    Science.gov (United States)

    den Hartog, Alexander W; Franken, Romy; Zwinderman, Aeilko H; Timmermans, Janneke; Scholte, Arthur J; van den Berg, Maarten P; de Waard, Vivian; Pals, Gerard; Mulder, Barbara J M; Groenink, Maarten

    2015-01-27

    Aortic dissections involving the descending aorta are a major clinical problem in patients with Marfan syndrome. The purpose of this study was to identify clinical parameters associated with type B aortic dissection and to develop a risk model to predict type B aortic dissection in patients with Marfan syndrome. Patients with the diagnosis of Marfan syndrome and magnetic resonance imaging or computed tomographic imaging of the aorta were followed for a median of 6 years for the occurrence of type B dissection or the combined end point of type B aortic dissection, distal aortic surgery, and death. A model using various clinical parameters as well as genotyping was developed to predict the risk for type B dissection in patients with Marfan syndrome. Between 1998 and 2013, 54 type B aortic dissections occurred in 600 patients with Marfan syndrome (mean age 36 ± 14 years, 52% male). Independent variables associated with type B aortic dissection were prior prophylactic aortic surgery (hazard ratio: 2.1; 95% confidence interval: 1.2 to 3.8; p = 0.010) and a proximal descending aorta diameter ≥27 mm (hazard ratio: 2.2; 95% confidence interval: 1.1 to 4.3; p = 0.020). In the risk model, the 10-year occurrence of type B aortic dissection in low-, moderate-, and high-risk patients was 6%, 19%, and 34%, respectively. Angiotensin II receptor blocker therapy was associated with fewer type B aortic dissections (hazard ratio: 0.3; 95% confidence interval: 0.1 to 0.9; p = 0.030). Patients with Marfan syndrome with prior prophylactic aortic surgery are at substantial risk for type B aortic dissection, even when the descending aorta is only slightly dilated. Angiotensin II receptor blocker therapy may be protective in the prevention of type B aortic dissections. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy.

    Science.gov (United States)

    Stolzenburg, Jens-Uwe; Rabenalt, Robert; Do, Minh; Schwalenberg, Thilo; Winkler, Mathias; Dietel, Anja; Liatsikos, Evangelos

    2008-05-01

    Based on our recently published anatomic studies, we present the most recent refinement of the endoscopic extraperitoneal radical prostatectomy (EERPE), the intrafascial nerve-sparing EERPE (nsEERPE). As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule, freeing the prostate laterally from its thin surrounding fascia that contains small vessels and nerves. The technique enables puboprostatic ligament preservation, leaving intact endopelvic fascia, periprostatic fascia, and neurovascular bundles. The operation was performed in 150 patients with indications for nerve-sparing procedure. The mean operative time was 131 min (range: 50-210 min) and the mean catheterization time was 5.9 d (range: 4-20 d). Twelve months postoperatively, 94.3% of the patients were continent (no need for pads), 4.6% had minimal stress incontinence, and one patient required >2 pads/d. At the 12-mo follow-up, the potency rates (erections sufficient for intercourse with or without the use of phosphodiesterase 5 [PDE5] inhibitors) of the patients who underwent bilateral intrafascial nsEERPE were 89.7% (age: 44-55 yr), 81.1% (age: 56-65 yr), and 61.9% (age: >65 yr). Positive surgical margins in pT2 and pT3 tumors were 4.5% and 29.4%, respectively. The intrafascial nsEERPE enables the dissection of the prostate with limited trauma to the surrounding fascias and the enclosed neurovascular bundles. We propose that the preserved neurovascular bundles with intrafascial nsEERPE are more viable. The results advocate this proposition.

  20. Spontaneous aortic dissecting hematoma in two dogs.

    Science.gov (United States)

    Boulineau, Theresa Marie; Andrews-Jones, Lydia; Van Alstine, William

    2005-09-01

    This report describes 2 cases of spontaneous aortic dissecting hematoma in young Border Collie and Border Collie crossbred dogs. Histology was performed in one of the cases involving an unusual splitting of the elastin present within the wall of the aorta, consistent with elastin dysplasia as described in Marfan syndrome in humans. The first case involved a young purebred Border Collie that died suddenly and the second case involved a Border Collie crossbred dog that died after a 1-month history of seizures. Gross lesions included pericardial tamponade with dissection of the ascending aorta in the former case and thoracic cavity hemorrhage, mediastinal hematoma, and aortic dissection in the latter. Histologic lesions in the case of the Border Collie crossbred dog included a dissecting hematoma of the ascending aorta with elastin dysplasia and right axillary arterial intimal proliferation.

  1. Diagnostic imaging of acute aortic dissection; Evaluation of thrombosed type aortic dissection by CT and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Ohya, Tohru; Kumazaki, Tatsuo (Nippon Medical School, Tokyo (Japan))

    1991-01-01

    One hundred and nineteen patients with aortic dissection who underwent diagnostic imaging were reviewed and angiographic findings as well as those of CT were analysed. Thirty eight cases (43.1%) had non-contrast opacified false lumen, the type of which we call 'thrombosed type aortic dissection'. A comparative study of the thrombosed type with the patent type of false lumens was made particularly from the stand point of the characteristic diagnostic imagings (CT and angiography). At the same time, the pitfalls of these imagings in thrombosed type aortic dissection were studied. At the onset the average age of thrombosed type was 62.3 years old, while that of the patent type was 57.3. A statistical significance between the two groups was p<0.05. Thrombosed type in all cases was caused by atherosclerosis, whereas patent type was caused by the Marfan's syndrome in 11 cases. Other clinical findings, such as initial symptoms and blood pressure revealed no significant differences between the two groups. Pre-contrast CT in acute thrombosed type aortic dissection showed 'hyperdense crescent sign' in 89.4%. However, in 3 cases with thrombosed type in which the pre-contrast CT showed 'hyperdense crescent sign' contrast-enhanced CT detected no clear evidence of aortic dissection in the same site. This was due to obscurity induced by contrast medium. Angiographic findings of thrombosed type were classified into 3 groups: normal type, stenosed true lumen type and ulcer-like projection type. The incidence of normal type was estimated to be 48.4%, whereas stenosed true lumen type was 24.2% and ulcer-like projection was 27.7%. The present study concluded that thrombosed type is not rare in acute aortic dissection and contrast-enhanced CT as well as pre-contrast CT, is of great value in diagnosing thrombosed type. 'Hyperdense crescent sign' in pre-contrast CT is characteristic of intramural hematoma. (author).

  2. [Value of angiography and embolisation in treatment of head and neck vascular malformations at Otolaryngology Department, Poznań University of Medical Sciences, Poland].

    Science.gov (United States)

    Wróbel, Maciej; Kopeć, Tomasz; Juszkat, Robert; Szyfterl, Witold; Borucki, Łukasz

    2008-01-01

    Angiography is an invasive, radiological investigation of vascular system. It plays an important role within variety of diagnostic tools in head and neck pathologies. In selected cases with well defined tumor supply vessels, angiography may be combined with intravascular obliteration. This possibility widen indications, which comprise diagnostic arteriographies - visualization of blood supply and extension of vascularization; therapeutic and diagnostic arteriographies - palliative or radical in character, dependent on pathology; and therapeutic angiographies as adjuvant therapy prior to surgical treatment. Authors present their experience with endovascular techniques application in head and neck pathologies. Material comprised 59 angiographies performed in patients treated at Otolaryngology Department at Poznań University of Medical Sciences between 2000-2007. In conclusion authors emphasize advantages and disadvantages, as well as, the role of the endovascular treatment in head and neck surgery.

  3. Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Daniar K. Osmonov

    2014-01-01

    Full Text Available Background. Treatment of patients with a biochemical recurrence (BCR of prostate cancer (PCa is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients. Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of 40.3±20.8 months. Group 1 (n=10: salvage radical prostatectomy (sRP with SePLND (salvage extended pelvic lymph nodes dissection (initial treatment: combined brachytherapy. Group 2 (n=22: SePLND (initial treatment: radical prostatectomy (RP. Group 3 (n=9: SePLND (initial treatment: RP and adjuvant radiation therapy (RT. We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response. Results. Group 1: 60% with BCR-freedom (mean 27.2 months. Group 2: 63.6% with BCR-freedom (mean 17.5 months. Group 3: 33.3% with BCR-freedom (mean 17.6 months. In total, BCR-freedom was observed in 23 of 41 patients (56.1% after salvage surgery. 75.6% of all patients showed a BR. 765 LNs were removed and 14.8% of these were LN+. Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output.

  4. Diagnosis of Aortic Dissection in Emergency Department Patients is Rare

    Directory of Open Access Journals (Sweden)

    Scott M. Alter

    2015-10-01

    Full Text Available Introduction: Aortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians. Methods: Design: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs. Results: From a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400-13,100] visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8% with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910-1,050] atraumatic chest pain patients. Conclusion: The diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years.

  5. Medical Students' Attitudinal Changes towards Cadaver Dissection ...

    African Journals Online (AJOL)

    Background: Recently, not only the medical school curriculum but also medical students' attitude towards cadaver-based learning of anatomy has changed. This investigation is therefore designed to analyse students' attitudes towards human cadaveric dissection before and after exposure to dissection. Methods: A ...

  6. Head and neck cancer

    International Nuclear Information System (INIS)

    Vogl, S.E.

    1988-01-01

    This book contains 10 chapters. Some of the titles are: Combined Surgical Resection and Irradiation for Head and Neck Cancers; Analysis of Radiation Therapy Oncology Group Head and Neck Database: Identification of Prognostic Factors and the Re-evaluation of American Joint Committee Stages; Combined Modality Approach to Head and Neck Cancer; Induction Combination Chemotherapy of Regionally Advanced Head and Neck Cancer; and Outcome after Complete Remission to Induction Chemotherapy in Head and Neck Cancer

  7. Extended Lymphadenectomy to the Lower Paraortic Nodes During Radical Cystectomy

    International Nuclear Information System (INIS)

    El-Shazli, S.; Anwar, H.; Ramzy, S.; Al-Didi, M.

    2004-01-01

    Evaluation of the diagnostic, prognostic and possible therapeutic role of extended lymphadenectomy to lower para-aortic area in operable bladder cancer patients. Patients and Methods: One hundred and nine patients were subjected to the procedure in the National Cancer Institute, Cairo University, and in Minea Oncology Center, Ministry of Health by the same group of surgeons, during the period from September 2000 to March 2003. The lymph nodes dissected were labeled to the following groups: perivesical, lymph node of Cloquet, external iliac, internal iliac and obturator, common iliac and paraortic groups both right and left. These nodes were subjected with the primary tumor to serial sectioning for histopathologic examination. Preoperatively, all patients were subjected to routine laboratory investigations. [n addition to cystoscopy, biopsy and histopathologic examination, bone scan, chest X-Ray and computerized tomography with l. V. contrast examination for the abdomen and pelvis were done for clinical staging of the disease. 34.4% of the node positive patients have been found to harbor the disease in the para-aortic lymph nodes above the common iliac bifurcation. Obturator, external iliac, internal iliac, para-aortic, common iliac, perivesical and lymph node of Cloquet are the higher incidence groups of positive lymph nodes sequentially. The clinical and c.T. staging are inaccurate methods of diagnosis due to high overall error in up to 70.6% of patients. There is no higher incidence of morbidity, mortality, operative time or intraoperative blood loss related to the addition of lower para-aortic dissection to the routine radical cystectomy. Extension of lymphadenectomy to include the lower para-aortic area in addition to the standard pelvic lymphadenectomy during radical cystectomy for bladder cancer is a more accurate technique for diagnosis and staging of bladder cancer patients and it may help in determining the benefit of adjuvant chemotherapy ± radiotherapy

  8. Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain.

    Science.gov (United States)

    Oliveira, Ana Carolina; Silva, Anabela G

    2016-04-01

    The main aims of this study were to compare the neck flexor and extensor endurance and forward head posture between adolescents with and without neck pain. The secondary aims were to explore potential associations between muscles endurance, head posture and neck pain characteristics and to assess intra-rater reliability of the measurements used. Adolescents with neck pain (n = 35) and age-matched asymptomatic adolescents (n = 35) had their forward head posture, neck flexor endurance and neck extensor endurance measured using clinical tests. Intra-rater reliability was also assessed. Forward head posture and neck flexor and extensor endurance tests showed moderate to almost perfect intra-rater reliability (ICC between 0.58 and 0.88). Adolescents with neck pain showed significantly less forward head posture (neck pain = 46.62 ± 4.92; asymptomatic = 44.18°± 3.64°, p > 0.05) and less neck flexor (neck pain = 24.50 ± 23.03s; asymptomatic = 35.89 ± 21.53s, p > 0.05) and extensor endurance (neck pain = 12.6.64 ± 77.94s; asymptomatic = 168.66 ± 74.77s, p > 0.05) than asymptomatic adolescents. Results suggest that changes in posture and neck muscle endurance are a feature of adolescents with neck pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Three-dimensional measurement of femoral neck anteversion and neck shaft angle.

    Science.gov (United States)

    Sangeux, Morgan; Pascoe, Jessica; Graham, H Kerr; Ramanauskas, Fiona; Cain, Tim

    2015-01-01

    We present a three-dimensional measurement technique for femoral neck anteversion and neck shaft angles which do not require alignment of the femoral and scanner axes. Two assessors performed the measurements on 11 patients (22 femurs). Repeatability between assessors was 2.7 degrees for femoral neck anteversion and 4.8 degrees for neck shaft angle. Measurements compared with an alternative single slice method were different by 2 degrees (3 degrees) in average. The method was repeatable and appropriate for clinical practice.

  10. Monopolar electrodissection versus cold dissection tonsillectomy among children

    International Nuclear Information System (INIS)

    Bukhari, Manal A.; Al-Ammar, Ahmed Y.

    2007-01-01

    To compare cold dissection to monopolar tonsillectomy in terms of operative time, intraoperative bleeding, post operative bleeding. The study included 100 children who underwent tonsillectomy between January 2002 and January 2004. This study was carried out at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Patients were randomly selected to have either the right or left tonsils removed by either technique (cold dissection or monopolar dissection technique). We compared both techniques in each side on the same patient. There was no significant difference in operative time between both sides by either technique, however, when the patients were grouped into 3 minute groups, the result showed that a greater number of patients were operated up on <-3 minutes by diathermy procedure compared to dissection method (44 versus 67) (p=0.0011). Blood loss was minimal with the diathermy technique, averaging 25.37 ml compared to 88.5 for cold dissection tonsillectomy. There was a significant increase in postoperative pain on the first postoperative day in the diathermy group compared to the cold dissection group (27% versus 12%) (p=0.0151). However, there was no significant difference in pain between both sides in the first 24 hours and from the 2nd to 10th postoperative days. Monopolar dissection tonsillectomy is a safe technique. It significantly reduces the operative time and intraoperative blood loss. However, it causes more pain on the 1st postoperative day, while on the rest of the days until the 10th postoperative day, there was no significant difference in pain between two sides. (author)

  11. Neck Pain

    Science.gov (United States)

    ... too many hours hunched over your computer or smartphone, often triggers muscle strains. Even minor things, such ... your shoulder. The weight can strain your neck. Sleep in a good position. Your head and neck ...

  12. Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique.

    Science.gov (United States)

    Abreu, Andre Luis de Castro; Chopra, Sameer; Azhar, Raed A; Berger, Andre K; Miranda, Gus; Cai, Jie; Gill, Inderbir S; Aron, Monish; Desai, Mihir M

    2014-07-01

    Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results. Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC) and neobladders (NB). SAS(®) Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05. Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57). All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01) and orthotopic NB (13 vs. 7.5-day, P < 0.01) when comparing the first third of the cohort with the rest of the group. Overall median (range) operative time and estimated blood loss was 7 h (4.8-13) and 200 mL (50-1200), respectively. Within 30-day postoperatively, complications occurred in 61 (59%) patients, with the majority being low grade (n = 43), and no patient died. Median (range) nodes yield was 36 (0-106) and 4 (3.9%) specimens had positive surgical margins. Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.

  13. Silent Aortic Dissection Presenting as Transient Locked-In Syndrome

    Science.gov (United States)

    Nadour, Wadih; Goldwasser, Brian; Biederman, Robert W.; Taffe, Kevin

    2008-01-01

    Acute aortic dissection is a medical emergency. Without prompt recognition and treatment, the mortality rate is high. An atypical presentation makes timely diagnosis difficult, especially if the patient is experiencing no characteristic pain. Many patients with aortic dissection are reported to have presented with various neurologic manifestations, but none with only a presentation of transient locked-in syndrome. Herein, we report a case of completely painless aortic dissection in a woman who presented with a transient episode of anarthria, quadriplegia, and preserved consciousness. On physical examination, she had a 40-point difference in blood pressure between her left and right arms, and a loud diastolic murmur. The diagnosis of acute aortic dissection was reached via a combination of radiography, computed tomography, echocardiography, and a high index of clinical suspicion. The patient underwent emergency surgery and ultimately experienced a successful outcome. To our knowledge, this is the 1st report of aortic dissection that presented solely as locked-in syndrome. We suggest that silent aortic dissection be added to the differential diagnosis for transient locked-in syndrome. PMID:18941610

  14. Diagnostic imaging of acute aortic dissection

    International Nuclear Information System (INIS)

    Ohya, Tohru; Kumazaki, Tatsuo

    1991-01-01

    One hundred and nineteen patients with aortic dissection who underwent diagnostic imaging were reviewed and angiographic findings as well as those of CT were analysed. Thirty eight cases (43.1%) had non-contrast opacified false lumen, the type of which we call 'thrombosed type aortic dissection'. A comparative study of the thrombosed type with the patent type of false lumens was made particularly from the stand point of the characteristic diagnostic imagings (CT and angiography). At the same time, the pitfalls of these imagings in thrombosed type aortic dissection were studied. At the onset the average age of thrombosed type was 62.3 years old, while that of the patent type was 57.3. A statistical significance between the two groups was p<0.05. Thrombosed type in all cases was caused by atherosclerosis, whereas patent type was caused by the Marfan's syndrome in 11 cases. Other clinical findings, such as initial symptoms and blood pressure revealed no significant differences between the two groups. Pre-contrast CT in acute thrombosed type aortic dissection showed 'hyperdense crescent sign' in 89.4%. However, in 3 cases with thrombosed type in which the pre-contrast CT showed 'hyperdense crescent sign' contrast-enhanced CT detected no clear evidence of aortic dissection in the same site. This was due to obscurity induced by contrast medium. Angiographic findings of thrombosed type were classified into 3 groups: normal type, stenosed true lumen type and ulcer-like projection type. The incidence of normal type was estimated to be 48.4%, whereas stenosed true lumen type was 24.2% and ulcer-like projection was 27.7%. The present study concluded that thrombosed type is not rare in acute aortic dissection and contrast-enhanced CT as well as pre-contrast CT, is of great value in diagnosing thrombosed type. 'Hyperdense crescent sign' in pre-contrast CT is characteristic of intramural hematoma. (author)

  15. Thrombosed false channel in acute aortic dissections

    International Nuclear Information System (INIS)

    Alerci, M.; Dore, R.; Kluzer, A.; Digiulio, G.; D'Andrea, F.; De Agostini, A.

    1987-01-01

    Three cases are reported of acute dissection with complete thrombosis of the false channel, which is a very uncommonevent in DeBakey's I and II type aortic dissections. The 3 patients entered hospital because of severe thoracic pain without any ECG sign of myocardial infarction. Emergency CT showed evidence of pericardial effusion suggesting hemopericardium, enlargement of the ascending aorta and a peripheral semilunar filling defect which caused a slight deformation of the true channel. On precontrast scans, only one case showed inward displacement of peripheral calcifications and high-density aortic wall. No tipical signs of aortic dissection were reported, expect in the first patient - where a double contrast filled lumen, separated by an intimal flap was seen. CT findings are individually discussed. It is emphasized that in all patients more than one CT sign was present at a time. The correct evaluation of these signs together with the clinacal data could lead to the right diagnosis of aortic dissection in spite of the lack of a f???

  16. Self-limiting Spontaneous Isolated Celiac Artery Dissection: A Case Report

    Directory of Open Access Journals (Sweden)

    A.D. Morzycki

    Full Text Available : Introduction: Isolated dissection of the celiac artery is rare, with less then 100 cases reported to date. Although some patients present with epigastric pain and tenderness, many cases are asymptomatic and found incidentally on CT. The appropriate management of isolated celiac artery dissections is unclear. This report illustrates an observational approach to a symptomatic case of isolated celiac artery dissection. Report: A 55-year-old Caucassian male presented to the emergency department with epigastric pain. His Initial CT revealed possible celiac artery dissection with associated intramural hematoma. Due to continued pain, a subsequent CTA was ordered. This scan showed progression of the intramural hematoma to near occlusion of the hepatic artery. Despite this, there were no signs of ischemic hepatitis as indicated by normal levels of liver transaminases. There was also no evidence to suggest propagation of the dissection or pseudo-aneurysm formation. We therefore choose a conservative and observational approach to this isolated celiac artery dissection. His dissection was managed with ASA and metoprolol, and he was discharged after 1 week of observation. 3 week follow-up CTA showed spontaneous resolution of the intramural hematoma and improved patency of the hepatic artery. There was no change at 3 months follow-up. Conclusion: This case highlights that an observational approach to cases of isolated celiac artery dissection may be indicated if there is no evident end organ disease or malperfusion. Keywords: Celiac artery, Dissection, Management

  17. Beyond Dissection: Innovative Tools for Biology Education.

    Science.gov (United States)

    Larson, Sandra, Ed.

    This catalog lists resources available for classroom use in teaching about anatomy and physiology which are alternatives to dissection. The entries are provided under three main categories: (1) Whole Animal Dissection/Vivisection; (2) Animal Organ or System Anatomy and Physiology; and (3) Other, including animal behavior, biotechnology,…

  18. Inter-vertebral flexibility of the ostrich neck: implications for estimating sauropod neck flexibility.

    Science.gov (United States)

    Cobley, Matthew J; Rayfield, Emily J; Barrett, Paul M

    2013-01-01

    The flexibility and posture of the neck in sauropod dinosaurs has long been contentious. Improved constraints on sauropod neck function will have major implications for what we know of their foraging strategies, ecology and overall biology. Several hypotheses have been proposed, based primarily on osteological data, suggesting different degrees of neck flexibility. This study attempts to assess the effects of reconstructed soft tissues on sauropod neck flexibility through systematic removal of muscle groups and measures of flexibility of the neck in a living analogue, the ostrich (Struthio camelus). The possible effect of cartilage on flexibility is also examined, as this was previously overlooked in osteological estimates of sauropod neck function. These comparisons show that soft tissues are likely to have limited the flexibility of the neck beyond the limits suggested by osteology alone. In addition, the inferred presence of cartilage, and varying the inter-vertebral spacing within the synovial capsule, also affect neck flexibility. One hypothesis proposed that flexibility is constrained by requiring a minimum overlap between successive zygapophyses equivalent to 50% of zygapophyseal articular surface length (ONP50). This assumption is tested by comparing the maximum flexibility of the articulated cervical column in ONP50 and the flexibility of the complete neck with all tissues intact. It is found that this model does not adequately convey the pattern of flexibility in the ostrich neck, suggesting that the ONP50 model may not be useful in determining neck function if considered in isolation from myological and other soft tissue data.

  19. Inter-vertebral flexibility of the ostrich neck: implications for estimating sauropod neck flexibility.

    Directory of Open Access Journals (Sweden)

    Matthew J Cobley

    Full Text Available The flexibility and posture of the neck in sauropod dinosaurs has long been contentious. Improved constraints on sauropod neck function will have major implications for what we know of their foraging strategies, ecology and overall biology. Several hypotheses have been proposed, based primarily on osteological data, suggesting different degrees of neck flexibility. This study attempts to assess the effects of reconstructed soft tissues on sauropod neck flexibility through systematic removal of muscle groups and measures of flexibility of the neck in a living analogue, the ostrich (Struthio camelus. The possible effect of cartilage on flexibility is also examined, as this was previously overlooked in osteological estimates of sauropod neck function. These comparisons show that soft tissues are likely to have limited the flexibility of the neck beyond the limits suggested by osteology alone. In addition, the inferred presence of cartilage, and varying the inter-vertebral spacing within the synovial capsule, also affect neck flexibility. One hypothesis proposed that flexibility is constrained by requiring a minimum overlap between successive zygapophyses equivalent to 50% of zygapophyseal articular surface length (ONP50. This assumption is tested by comparing the maximum flexibility of the articulated cervical column in ONP50 and the flexibility of the complete neck with all tissues intact. It is found that this model does not adequately convey the pattern of flexibility in the ostrich neck, suggesting that the ONP50 model may not be useful in determining neck function if considered in isolation from myological and other soft tissue data.

  20. Impact of lymph node burden on survival of high-risk prostate cancer patients following radical prostatectomy and pelvic lymph node dissection

    Directory of Open Access Journals (Sweden)

    Lisa Moris

    2016-12-01

    Full Text Available Aim: To determine the impact of the extent of lymph node invasion (LNI, on long-term oncological outcomes after radical prostatectomy (RP. Material and methods: In this retrospective study we examined the data of 1249 high-risk, non-metastatic PCa patients treated with RP and pelvic lymph node dissection (PLND between 1989 and 2011 at 8 different tertiary institutions. We fitted univariate and multivariate cox models to assess independent predictors of cancer specific survival (CSS and overall survival (OS. The number of positive LN was dichotomized according to the most informative cut-off predicting CSS. Kaplan-Meier curves assessed CSS and OS rates. Only patients with at least 10 LNs removed at PLND were included. This cut-off was chosen as a surrogate for a well performed PNLD.Results: Mean age was 65 years (median: 66, IQR 60-70. Positive surgical margins were present in 53.7% (n=671. Final Gleason score was 2-6 in 12.7% (n=158, 7 in 52% (n=649 and 8-10 in 35.4% (n=442. The median number of LNs removed during PLND was 15 (IQR 12-17. Of all patients, 1128 (90.3% had 0-3 positive LNs, while 126 (9.7% had ≥4 positive LNs. Patients with 0-3 positive LNs had significantly better CSS outcome at 10-year follow-up compared to patients with ≥4 positive LNs (87% vs. 50%; p < 0.0001. Similar results were obtained for OS, with a 72% vs. 37% (p <0.0001 survival at 10 years for patients with 0-3 vs. ≥4 positive LNs, respectively. At multivariate analysis, final Gleason score 8-10, salvage ADT therapy and ≥4 (vs <4 positive LNs were predictors of worse CSS and OS. Pathological stage pT4 was an additional predictor of worse CSS. Conclusions: Four or more positive LNs, pathological stage pT4 and final Gleason score 8-10 represent independent predictors for worse CSS in patients with high-risk PCa. Primary tumor biology remains a strong driver of tumor progression and patients having ≥4 positive LNs could be considered an enriched patient group in

  1. Six years of evidence-based adult dissection tonsillectomy with ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or 'cold steel' dissection.

    Science.gov (United States)

    Ragab, S M

    2012-10-01

    To conduct an adequately powered, prospective, randomised, controlled trial comparing adult dissection tonsillectomy using either ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or 'cold steel' dissection. Three hundred patients were randomised into four tonsillectomy technique groups. The operative time, intra-operative bleeding, post-operative pain, tonsillar fossa healing, return to full diet, return to work and post-operative complications were recorded. The bipolar radiofrequency group had a shorter mean operative time. The mean intra-operative blood loss during bipolar radiofrequency tonsillectomy was significantly less compared with cold dissection and ultrasonic scalpel tonsillectomy. Pain scores were significantly higher after bipolar electrocautery tonsillectomy. Patients undergoing bipolar electrocautery tonsillectomy required significantly more days to return to full diet and work. The bipolar electrocautery group showed significantly reduced tonsillar fossa healing during the first and second post-operative weeks. In this adult series, bipolar radiofrequency tonsillectomy was superior to ultrasonic, bipolar electrocautery and cold dissection tonsillectomies. This method combines the advantages of 'hot' and 'cold' tonsillectomy.

  2. Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma

    International Nuclear Information System (INIS)

    Murakami, Naoya; Matsumoto, Fumihiko; Yoshimoto, Seiichi; Ito, Yoshinori; Mori, Taisuke; Ueno, Takao; Tuchida, Keisuke; Kashihara, Tairo; Kobayashi, Kazuma; Harada, Ken; Kitaguchi, Mayuka; Sekii, Shuhei; Umezawa, Rei; Takahashi, Kana; Inaba, Koji; Igaki, Hiroshi; Itami, Jun

    2016-01-01

    The radiation field for patients with postoperative head and neck squamous cell carcinoma is narrower in our institution than in Western countries to reduce late radiation related toxicities. This strategy is at a risk of loco-regional or distant metastasis. However, because patients are more closely checked than in Western countries by every 1 to 2 months intervals and it is supposed that regional recurrences are identified and salvage surgeries are performed more quickly. Therefore, it is considered that patient survival would not be compromised with this strategy. The aim of this study was to investigate the feasibility of this strategy retrospectively. Patients who underwent neck dissection with close or positive margin, extra-capsular spread (ECS), multiple regional lymph node metastasis, pT4, with or without primary tumor resection were treated with postoperative radiation therapy. The volume of radiation field, especially the coverage of prophylactic regional lymph node area, was discussed among head and neck surgeons and radiation oncologists taking into account the clinical factors including patient’s age, performance status, number of positive lymph nodes, size of metastatic lymph nodes, extension of primary tumor beyond the midline, and existence of ECS. Seventy-two patients were identified who were treated with postoperative radiation therapy for head and neck squamous cell carcinoma between November 2005 and December 2014. There were 20 patients with oropharynx, 19 with hypopharynx, 7 with larynx, 23 with oral cavity, and 3 with other sites. Thirty eight patients had their neck irradiated bilaterally and 34 unilaterally. Median follow-up period for patients without relapse was 20.7 months (5.1–100.7). Thirty two patients had disease relapse after treatment including 22 loco-regional recurrence and 14 distant metastases. Among 22 loco-regional recurrence, seven patients underwent salvage surgery and one of them was no relapse at the time of the

  3. REHABILITATION OF PATIENTS AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    V. N. Pavlov

    2014-07-01

    Full Text Available According to the data obtained by Russian and foreign investigators, the major complication after radical prostatectomy (RPE is urinaryincontinence that is recorded in 20-30% of cases.Objective. To improve the results of surgical treatment in patients with prostate cancer, by developing and introducing a well-rounded post-operative rehabilitation program.Subjects and methods. Seventy-four patients who were treated at the urology clinic, Bashkir State Medical University, and underwent RPEin 2005 to 2007 have been examined; 27 of them were diagnosed as having urinary incontinence (UI. After discharge from the clinic, acontrol group received rehabilitative treatment at the sanatorium “Krasnousolsk” of the Republic of Bashkortostan. Results and discussion. Therapeutic exercises and pelvic floor electrostimulation halve the number of day urinations and paddings used inpatients with UI, by increasing the bladder capacity from 138.2±12.7 to 196±11.2 ml and improving the trophism of the bladder neck andurethra in the sphincteral area. 

  4. Defining the target volume for post-operative radiotherapy after D2 dissection in gastric cancer by CT-based vessel-guided delineation

    International Nuclear Information System (INIS)

    Yoon, Hong In; Chang, Jee Suk; Lim, Joon Seok; Noh, Sung Hoon; Hyung, Woo Jin; An, Ji Yeong; Lee, Yong Chan; Rha, Sun Young; Kim, Kyung Hwan; Koom, Woong Sub

    2013-01-01

    Purpose: To determine the recurrent nodal gross tumor volume (rnGTV) based on CT-guided vascular structure to refine the clinical target volume (CTV) delineation in postoperative radiotherapy for advanced gastric cancer following radical gastrectomy with D2 dissection. Materials and methods: We retrospectively reviewed follow-up images from 91 patients with their first regional recurrence after D2 dissection in stage III gastric cancer with N3 disease. We defined rnGTV as recurrent nodes shown in follow-up CT images, in which one diagnostic radiologist with specialty of gastrointestinal tract investigated. We drew rnGTVs at the equivalent location based on the same vessels of reference comparing CT images to recurrence CT images. Results: We propose vessel-based locations of rnGTVs on CT images with axial and coronal views. We show different patterns of regional recurrence according to the location of primary gastric cancer using CT and digitally reconstructed radiograph (DRR) images. Frequently recurred sites, overlapped by more than five rnGTVs, are depicted in a DRR image. Conclusions: This study suggests vessel-based delineations of rnGTVs on CT images depending on nodal recurrence sites from follow-up images after D2 lymphadenectomy. Our results could help reduce the inter-observer variation of CTV delineation after D2 dissection in gastric cancer

  5. Neck movement and muscle activity characteristics in female office workers with neck pain.

    Science.gov (United States)

    Johnston, V; Jull, G; Souvlis, T; Jimmieson, N L

    2008-03-01

    Cross-sectional study. To explore aspects of cervical musculoskeletal function in female office workers with neck pain. Evidence of physical characteristics that differentiate computer workers with and without neck pain is sparse. Patients with chronic neck pain demonstrate reduced motion and altered patterns of muscle control in the cervical flexor and upper trapezius (UT) muscles during specific tasks. Understanding cervical musculoskeletal function in office workers will better direct intervention and prevention strategies. Measures included neck range of motion; superficial neck flexor muscle activity during a clinical test, the craniocervical flexion test; and a motor task, a unilateral muscle coordination task, to assess the activity of both the anterior and posterior neck muscles. Office workers with and without neck pain were formed into 3 groups based on their scores on the Neck Disability Index. Nonworking women without neck pain formed the control group. Surface electromyographic activity was recorded bilaterally from the sternocleidomastoid, anterior scalene (AS), cervical extensor (CE) and UT muscles. Workers with neck pain had reduced rotation range and increased activity of the superficial cervical flexors during the craniocervical flexion test. During the coordination task, workers with pain demonstrated greater activity in the CE muscles bilaterally. On completion of the task, the UT and dominant CE and AS muscles demonstrated an inability to relax in workers with pain. In general, there was a linear relationship between the workers' self-reported levels of pain and disability and the movement and muscle changes. These results are consistent with those found in other cervical musculoskeletal disorders and may represent an altered muscle recruitment strategy to stabilize the head and neck. An exercise program including motor reeducation may assist in the management of neck pain in office workers.

  6. Dysphagia and mucositis after concurrent chemoradiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Tsuneyuki, Miki; Maeda, Tatsuyoshi; Yonezawa, Koichiro; Morimoto, Koichi; Tanimoto, Hitoshi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi

    2010-01-01

    A speech therapist performs swallowing rehabilitation in this hospital because concurrent chemoradiotherapy (CCRT) for head and neck cancer is commonly associated with, dysphagia. An evaluation of oral mucositis and dysphagia after CCRT was conducted to determine the relationship between swallowing rehabilitation and swallowing disability. A total of 51 patients (44 males and 7 females) with a mean age of 63 years (range, 39 to 80), underwent CCRT with or without neck dissection between April 2008 and November 2009. Oral mucositis and dysphagia were graded at the end of CCRT according to Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Seventeen of 51 patients underwent swallowing rehabilitation, exercise and education on muscle strengthening programs before and during CCRT. The average grades of oral mucositis of patients with nasopharyngeal, oropharyngeal, hypopharyngeal, and laryngeal cancer patients were 1.8, 2.1, 1.8, and 0.8, respectively. There was a lower incidence of oral mucositis in patients with laryngeal cancer than in those with oropharyngeal or hypopharyngeal cancer. The average grades of dysphagia of patients with nasopharyngeal, oropharyngeal, hypopharyngeal, and laryngeal cancer were 2.4, 2.7, 2.2, and 1.2. Dysphagia was most severe in the patients with oropharyngeal cancer, while it was minimal in those with laryngeal cancer. Seventeen diligent patients that underwent swallowing rehabilitation every day rarely developed severe dysphagia. (author)

  7. Fractionated BNCT for locally recurrent head and neck cancer: Experience from a phase I/II clinical trial at Tsing Hua Open-Pool Reactor

    International Nuclear Information System (INIS)

    Wang, Ling-Wei; Chen, Yi-Wei; Ho, Ching-Yin; Hsueh Liu, Yen-Wan; Chou, Fong-In; Liu, Yuan-Hao; Liu, Hong-Ming; Peir, Jinn-Jer; Jiang, Shiang-Huei; Chang, Chi-Wei; Liu, Ching-Sheng; Wang, Shyh-Jen; Chu, Pen-Yuan; Yen, Sang-Hue

    2014-01-01

    To introduce our experience of treating locally and regionally recurrent head and neck cancer patients with BNCT at Tsing Hua Open-Pool Reactor in Taiwan, 12 patients (M/F=10/2, median age 55.5 Y/O) were enrolled and 11 received two fractions of treatment. Fractionated BNCT at 30-day interval with adaptive planning according to changed T/N ratios was feasible, effective and safe for selected recurrent head and neck cancer in this trial. - Highlights: • We treated 12 patients with recurrent Head and Neck (H and N) cancer after radical surgery and radiotherapy since 2010. • Four complete response (CR) and 3 partial response (PR) were found. Total response rate was 58%. • Two patients had local control longer than one year. • No grade 4 or higher toxicity was noted for both acute and chronic effects

  8. Renal Infarction from Type B Aortic Dissection

    Directory of Open Access Journals (Sweden)

    Marit Tweet

    2017-07-01

    Full Text Available History of present illness: A 69-year-old-female with a medical history of hypertension presented to the emergency department (ED complaining of sudden onset of lower back and abdominal pain. Eight hours prior to presentation she reported turning to grab something on another counter and felt a sudden onset sharp pain in her lower back. She began to notice ill-defined abdominal pain, although she denied any shortness of breath, chest pain, numbness, weakness, or urologic symptoms. Her vital signs on presentation to the ED were temperature 36.5˚C, blood pressure 143/88, heart rate 84, respiratory rate 14, and oxygen saturation 93% on room air. On arrival, the patient was in significant discomfort and was rolling on the bed due to pain. Although she appeared to be in moderate distress she had minimal, if any, tenderness on abdominal exam, and only mild left lower back tenderness to palpation. This disconnect between the patient’s apparent discomfort and the lack of physical exam findings prompted the ordering of a computed tomography angiography (CTA of the abdomen/pelvis with greatest suspicion for abdominal aortic aneurysm. Significant findings: Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain. Discussion: Aortic dissection is defined as a tear within the wall of the aorta that allows blood to track between intima and media layers. A dissection is classified as Stanford Type A if it involves any portion of the

  9. Digital dissection system for medical school anatomy training

    Science.gov (United States)

    Augustine, Kurt E.; Pawlina, Wojciech; Carmichael, Stephen W.; Korinek, Mark J.; Schroeder, Kathryn K.; Segovis, Colin M.; Robb, Richard A.

    2003-05-01

    As technology advances, new and innovative ways of viewing and visualizing the human body are developed. Medicine has benefited greatly from imaging modalities that provide ways for us to visualize anatomy that cannot be seen without invasive procedures. As long as medical procedures include invasive operations, students of anatomy will benefit from the cadaveric dissection experience. Teaching proper technique for dissection of human cadavers is a challenging task for anatomy educators. Traditional methods, which have not changed significantly for centuries, include the use of textbooks and pictures to show students what a particular dissection specimen should look like. The ability to properly carry out such highly visual and interactive procedures is significantly constrained by these methods. The student receives a single view and has no idea how the procedure was carried out. The Department of Anatomy at Mayo Medical School recently built a new, state-of-the-art teaching laboratory, including data ports and power sources above each dissection table. This feature allows students to access the Mayo intranet from a computer mounted on each table. The vision of the Department of Anatomy is to replace all paper-based resources in the laboratory (dissection manuals, anatomic atlases, etc.) with a more dynamic medium that will direct students in dissection and in learning human anatomy. Part of that vision includes the use of interactive 3-D visualization technology. The Biomedical Imaging Resource (BIR) at Mayo Clinic has developed, in collaboration with the Department of Anatomy, a system for the control and capture of high resolution digital photographic sequences which can be used to create 3-D interactive visualizations of specimen dissections. The primary components of the system include a Kodak DC290 digital camera, a motorized controller rig from Kaidan, a PC, and custom software to synchronize and control the components. For each dissection procedure, the

  10. High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

    Energy Technology Data Exchange (ETDEWEB)

    Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine [Paris-Descartes University, Department of Neuroradiology, Paris (France); Touze, Emmanuel; Mas, Jean-Louis [Paris-Descartes University, Department of Neurology, Paris (France); Leclerc, Xavier; Pruvo, Jean-Pierre [University Hospital Roger Salengro, Department of Neuroradiology, Lille (France); Nguyen, Thanh [Boston University Medical Center, Department of Neurology, Neurosurgery, and Radiology, Boston, MA (United States)

    2009-09-15

    It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [{sub 95%}CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [{sub 95%}CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [{sub 95%}CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [{sub 95%}CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

  11. High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

    International Nuclear Information System (INIS)

    Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine; Touze, Emmanuel; Mas, Jean-Louis; Leclerc, Xavier; Pruvo, Jean-Pierre; Nguyen, Thanh

    2009-01-01

    It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [ 95% CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [ 95% CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [ 95% CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [ 95% CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

  12. Human papillomavirus and p53 expression in cancer of unknown primary in the head and neck region in relation to clinical outcome

    International Nuclear Information System (INIS)

    Sivars, Lars; Näsman, Anders; Tertipis, Nikolaos; Vlastos, Andrea; Ramqvist, Torbjörn; Dalianis, Tina; Munck-Wikland, Eva; Nordemar, Sushma

    2014-01-01

    Patients with cancer of unknown primary (CUP) in the head neck region are generally treated with neck dissection followed by radiotherapy at times combined with chemotherapy, a treatment associated with considerable side effects. Some of these tumors may originate as human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OSCC), with better clinical outcome than head neck squamous cell cancer (HNSCC) in general, and could potentially do well with less treatment. Here, we therefore investigated whether HPV status and p53-expression correlated to clinical outcome in patients with CUP in the head neck region. Fifty metastases were analyzed for presence of HPV DNA, and expression of p16 INK4A and p53 and the data were correlated to clinical outcome. Patients with HPV DNA-positive (HPV DNA+ ) metastases had significantly better 5-year overall survival (OS) compared to those with HPV DNA− metastases (80.0% vs. 36.7%, respectively; P = 0.004), with a similar tendency for disease-free survival (DFS). These survival rates showed excellent concordance with those of HPV DNA+ and HPV DNA− OSCC in Sweden during the same time period, strengthening the hypothesis that HPV DNA+ head and neck CUP may originate from HPV DNA+ OSCC. In addition, having absent/intermediary-low as compared to high expression of p53 correlated to a better prognosis with a 69% as compared to 14% 5-year OS, respectively (P < 0.001), and for DFS the tendency was analogous. In conclusion, both HPV status and p53 expression are valuable prognostic factors in patients with CUP in the head and neck region and should be further explored for clinical use

  13. Neck Pain

    Science.gov (United States)

    ... Vomiting Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath ... worse or doesn’t get better. Start OverDiagnosisYour pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  14. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study

    NARCIS (Netherlands)

    Ariens, G.A.M.; Bongers, P.M.; Douwes, M.; Miedema, M.C.; Hoogendoorn, W.E.; van der Wal, G.; Bouter, L.M.; van Mechelen, W.

    2001-01-01

    Objective: To study the relation between neck pain and work related neck flexion, neck rotation, and sitting. Methods: A prospective cohort study was performed with a follow up of 3 years among 1334 workers from 34 companies. Work related physical load was assessed by analysing objectively measured

  15. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? : Results of a prospective cohort study

    NARCIS (Netherlands)

    Ariëns, G A; Bongers, P M; Douwes, M; Miedema, M C; Hoogendoorn, W E; van der Wal, G; Bouter, L M; van Mechelen, W

    OBJECTIVE: To study the relation between neck pain and work related neck flexion, neck rotation, and sitting. METHODS: A prospective cohort study was performed with a follow up of 3 years among 1334 workers from 34 companies. Work related physical load was assessed by analysing objectively measured

  16. "And afterwards your body to be given for public dissection": a history of the murderers dissected in Glasgow and the west of Scotland.

    Science.gov (United States)

    Kennedy, S S; McLeod, K J; McDonald, S W

    2001-02-01

    Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.

  17. CT and MR angiographic findings in dissection of cervical vessels

    International Nuclear Information System (INIS)

    Link, J.; Brinkmann, G.; Heuser, K.; Heller, M.

    1996-01-01

    Purpose: To determine the usefulness of CT angiography (CTA) and MR angiography (MRA) for evaluation of dissection in cervical vessels. Material and methods: Dissection of cervical vessels was revealed by conventional angiography in 4 patients (two female, two male) of 30-62 years of age. Dissection was located in the carotid artery (n=3) and in the vertebral artery (n=1). In two patients CTA and in two patients MRA was performed. Results: Diagnosis of dissection was possible by CTA (internal carotid artery: n=2) and by MRA (internal carotid artery and vertebral artery). Imaging of the dissection membrane of the vessel wall was possible in one case with MRA. Conclusion: CT and MR angiography was successful for detection of typical morphology of dissection in all cases. If results in a greater number can be obtained it seems to be conceivable that both methods can be used in primary diagnosis. (orig.) [de

  18. Surgical management of epithelial parotid tumours

    International Nuclear Information System (INIS)

    Obaid, M.A.; Yusuf, A.

    2004-01-01

    Objective: To describe the clinicopathological presentation and treatment options in epithelial parotid tumours with emphasis on surgery. Subjects and Methods: Epithelial parotid tumours diagnosed and operated by an ENT surgeon and a general surgeon in 10 years during their posting in different teaching hospitals were included in the study. Clinical presentation, preoperative investigations, operative procedure, histopathology report, postoperative complications and further management were recorded. The data was collected and reviewed from the records of all the patients maintained by the authors. Results: Fifty-two patients presented with parotid tumour. Average age was 38 years. Commonest presentation was painless lump over the parotid region (85%), pain (15%), facial palsy, and enlarged neck nodes. Majority of tumours were benign, only two were recurrent. Parotid pleomorphic Adenoma (PPA) was the commonest benign tumour, others being Warthin's tumour and monomorphic adenoma. Adenoid cystic carcinoma was the commonest malignant tumour 29% followed by mucoepidermoid carcinoma. Others were carcinoma in PPA squamous cell carcinoma, malignant mixed tumour, malignant Iymphoepithelioma and undifferentiated carcinoma. Superficial parotidectomy (SP) was the commonest operation performed in 69%. Other procedures were total conservative parotidectomy in 11%, total radical surgery in 9% and enucleation in only one patient earliest in the series. Neck node dissection was done in 2 patients. Except for one child, rest of the 13 patients received postoperative radiotherapy and one patient of Iymphoepithelioma received chemotherapy in addition. Commonest postoperative complication was temporary facial weakness in 35% (18/52). Permanent facial palsy occurred in 08 patients. Of these 07 had a malignant process and only one patient had excision biopsy. Conclusion: Benign and malignant epithelial parotid tumours can be diagnosed by there clinical presentation . supplemented with

  19. Effects of neck strength training on isometric neck strength in rugby union players.

    Science.gov (United States)

    Geary, Kevin; Green, Brian S; Delahunt, Eamonn

    2014-11-01

    To investigate the effectiveness of a neck strengthening program on the isometric neck strength profile of male rugby union players. Controlled laboratory study. Professional rugby union club. Fifteen professional and 10 semiprofessional rugby union players. The 15 professional players undertook a 5-week neck strengthening intervention, which was performed twice per week, whereas the 10 semiprofessional players acted as the control group. Isometric strength of the neck musculature was tested using a hand-held dynamometer, for flexion (F), extension (E), left-side flexion (LSF), and right-side flexion (RSF). Preintervention and postintervention evaluations were undertaken. No significant between-group differences in isometric neck strength were noted preintervention. A significant main effect for time was observed (P isometric neck strength in all planes after the 5-week intervention (F preintervention = 334.45 ± 39.31 N vs F postintervention 396.05 ± 75.55 N; E preintervention = 606.19 ± 97.34 vs E postintervention = 733.88 ± 127.16 N; LSF preintervention = 555.56 ± 88.34 N vs LSF postintervention = 657.14 ± 122.99 N; RSF preintervention = 570.00 ± 106.53 N vs RSF postintervention = 668.00 ± 142.18 N). No significant improvement in neck strength was observed for control group participants. The results of the present study indicate that a 5-week neck strengthening program improves isometric neck strength in rugby union players, which may have implications for injury prevention, screening, and rehabilitation. The strengthening program described in the present study may facilitate rehabilitation specialists in the development of neck injury prevention, screening, and rehabilitation protocols.

  20. Preoperative percutaneous cranial nerve mapping in head and neck surgery.

    Science.gov (United States)

    Park, Jung I

    2003-01-01

    To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

  1. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  2. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ... and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed with ...

  3. Neck muscle vibration can improve sensorimotor function in patients with neck pain.

    Science.gov (United States)

    Beinert, Konstantin; Keller, Martin; Taube, Wolfgang

    2015-03-01

    People with neck pain display a diminished joint position sense and disturbed postural control, which is thought to be a result of impaired somatosensory afferent activity and/or integration. Afferent processing can be artificially manipulated by vibration and was shown to reduce motor performance in healthy subjects. However, the effect of vibration on sensorimotor function in neck pain patients is scarcely investigated. To assess the effect of neck muscle vibration on joint position sense and postural control in neck pain subjects and healthy controls. Case control study. Thirteen neck pain patients and 10 healthy controls participated in the present study. Cervical joint position sense and dynamic and static postural stability. Short-term, targeted neck muscle vibration with 100 Hz was applied after baseline measurement. Vibration had opposite effects in patients and healthy subjects. Patients showed improved joint position sense (pneck pain. Thus, vibration may be used to counteract sensorimotor impairment of the cervical spine. Potential underlying mechanisms are discussed. Copyright © 2015. Published by Elsevier Inc.

  4. Virtual reality haptic human dissection.

    Science.gov (United States)

    Needham, Caroline; Wilkinson, Caroline; Soames, Roger

    2011-01-01

    This project aims to create a three-dimensional digital model of the human hand and wrist which can be virtually 'dissected' through a haptic interface. Tissue properties will be added to the various anatomical structures to replicate a realistic look and feel. The project will explore the role of the medical artist and investigate the cross-discipline collaborations required in the field of virtual anatomy. The software will be used to train anatomy students in dissection skills before experience on a real cadaver. The effectiveness of the software will be evaluated and assessed both quantitatively as well as qualitatively.

  5. Robotic Y-V Plasty for Recalcitrant Bladder Neck Contracture.

    Science.gov (United States)

    Granieri, Michael A; Weinberg, Aaron C; Sun, Jeffrey Y; Stifleman, Michael; Zhao, Lee

    2018-07-01

    To demonstrate the technique and the outcomes of robot assisted Y-V plasty bladder neck reconstruction (RYVBNR). We present our technique for treatment of recalcitrant bladder neck contracture (BNC) in 7 patients who underwent RYVBNR at our institution between March 2016 and September 2017. Indication for the procedure was incomplete emptying, recurrent urinary tract infections, and dysuria. On follow-up, patients were assessed for clinical success by absence of infections, symptoms, and cystoscopic evaluation. Robotic assisted dissection is performed to open the space of Retzius and mobilize the bladder. The cystoscope is passed to the level of the BNC, and Firefly technology is used to localize the BNC. The BNC is incised anteriorly, and a V-shaped bladder flap is advanced into the BNC in a Y-V plasty fashion. We place a perioperative closed suction drain, which is removed before discharge, and a 22 Fr catheter, which that will be removed in the office at approximately 2 weeks. Six men developed recalcitrant BNCs and 1 developed a recalcitrant vesicourethral anastomotic stenosis. All patients had previously undergone an endoscopic procedure. Median time for last attempt at endoscopic management to robot-assisted bladder neck repair was 4.7 months. The average number of prior attempts at endoscopic management was 2. All patients underwent RYVBNR without conversion to open surgery. The median operative time was 240 minutes, estimated blood loss was 67 mL, and length of stay was 1 day. There were no intraoperative complications. Catheters were removed in the office at a median time of 15 days. At a median follow-up of 8 months, all cases were successful with no evidence of recurrence. Only 2 patients had persistent urinary incontinence at 1 pad per day. RYVBNR with a Y-V plasty is a feasible and effective technique for managing a difficult reconstructive problem. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Arterial occlusion to treat basilar artery dissecting aneurysm

    NARCIS (Netherlands)

    Cui, Qing Ke; Liu, Wei Dong; Liu, Peng; Li, Xue Yuan; Zhang, Lian Qun; Ma, Long Jia; Ren, Yun Fei; Wu, Ya Ping; Wang, Zhi Gang

    2015-01-01

    Object: To explore the clinical feasibility of employing occlusion to treat basilar artery dissecting aneurysm. Methods: One patient, male and 46 years old, suffered transient numbness and weakness on the right limbs. Cerebral angiography indicated basilar artery dissecting aneurysm. The patient

  7. Long term outcome of ruptured vertebrobasilar artery dissection treated non-surgically

    International Nuclear Information System (INIS)

    Nakano, Takahiro; Ohkuma, Hiroki; Shimamura, Norihito; Munakata, Akira; Kikkawa, Tomoshige

    2010-01-01

    Vertebrobasilar artery dissection began to attract attention as a cause of subarachnoid hemorrhage (SAH) in the late 1970s. Although reports on this disease have gradually increased, the natural history of vertebrobasilar artery dissection remains obscure, and long-term follow-up of patients without surgical treatment is necessary to determine appropriate treatment. We describe the long-term clinical course of ruptured vertebrobasilar artery dissection treated non-surgically. Fourteen subjects with ruptured vertebrobasilar artery dissection were treated conservatively in 7 neurosurgical departments. We reviewed their clinical outcomes, image findings and the chronological changes at the dissection site from their charts. The modified Rankin Scale was Grade 0 in 13 of 14 cases, and Grade 2 in 1 case. The configuration of dissection did not change during the follow-up period in 12 of 14 cases, but occlusion and restoration were recognized in a single case each. Good prognosis was common in the patients with ruptured vertebrobasilar artery dissection who were treated non-surgically. It is essential to accumulate more data on the clinical course and changes in image findings of long-term survival cases to establish a definite strategy for ruptured vertebrobasilar artery dissection. (author)

  8. Sport related stress fracture of the clavicle with non-union: Case report and review

    Science.gov (United States)

    Constantinou, Demitri; Kastanos, Konstantinos

    2008-01-01

    Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery. PMID:21264151

  9. Decreased expression of fibulin-4 in aortic wall of aortic dissection.

    Science.gov (United States)

    Huawei, P; Qian, C; Chuan, T; Lei, L; Laing, W; Wenlong, X; Wenzhi, L

    2014-02-01

    In this research, we will examine the expression of Fibulin-4 in aortic wall to find out its role in aortic dissection development. The samples of aortic wall were obtained from 10 patients operated for acute ascending aortic dissection and five patients for chronic ascending aortic dissection. Another 15 pieces of samples from patients who had coronary artery bypass were as controls. The aortic samples were stained with aldehyde magenta dyeing to evaluate the arrangement of elastic fibers. The Fibulin-4 protein and mRNA expression were both determined by Western blot and realtime quantitative polymerase chain reaction. Compared with the control group, both in acute and chronic ascending aortic dissection, elastic fiber fragments increased and the expression of fibulin-4 protein significantly decreased (P= 0.045 < 0.05). The level of fibulin-4 mRNA decreased in acute ascending aortic dissection (P= 0.034 < 0.05), while it increased in chronic ascending aortic dissection (P=0.004 < 0.05). The increased amounts of elastic fiber fragments were negatively correlated with the expression of fibulin-4 mRNA in acute ascending aortic dissection. In conclusion, in aortic wall of ascending aortic dissection, the expression of fibulin-4 protein decreased and the expression of fibulin-4 mRNA was abnormal. Fibulin-4 may play an important role in the pathogenesis of aortic dissection.

  10. Inter-Vertebral Flexibility of the Ostrich Neck: Implications for Estimating Sauropod Neck Flexibility

    OpenAIRE

    Cobley, Matthew J.; Rayfield, Emily J.; Barrett, Paul M.

    2013-01-01

    The flexibility and posture of the neck in sauropod dinosaurs has long been contentious. Improved constraints on sauropod neck function will have major implications for what we know of their foraging strategies, ecology and overall biology. Several hypotheses have been proposed, based primarily on osteological data, suggesting different degrees of neck flexibility. This study attempts to assess the effects of reconstructed soft tissues on sauropod neck flexibility through systematic removal o...

  11. Head, Neck, and Oral Cancer

    Science.gov (United States)

    ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  12. Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

    Directory of Open Access Journals (Sweden)

    René Hako

    2017-01-01

    Full Text Available Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

  13. Consumption coagulopathy in acute aortic dissection: principles of management.

    Science.gov (United States)

    Liu, Yuyong; Han, Lu; Li, Jiachen; Gong, Ming; Zhang, Hongjia; Guan, Xinliang

    2017-06-12

    The effect of acute aortic dissection itself on coagulopathy or surgery-related coagulopathy has never been specifically studied. The aim of the present study was to perioperatively describe consumption coagulopathy in patients with acute aortic dissection. Sixty-six patients with acute type A aortic dissection were enrolled in this study from January 2015 to September 2016. Thirty-six patients with thoracic aortic aneurysms were used as a control group during the same period. Consumption coagulopathy was evaluated using standard laboratory tests, enzyme-linked immunosorbent assay and thromboelastograghy at five perioperative time-points. A significant reduction in clotting factors and fibrinogen was observed at the onset of acute aortic dissection. Enzyme-linked immunosorbent assay and thromboelastograghy also revealed a persistent systemic activation of the coagulation system and the consumption of clotting factors. In contrast, although platelet counts were consistently low, we did not find that platelet function was more impaired in the acute aortic dissection group than the control group. After surgery, clotting factors and fibrinogen were more impaired than platelet function. Thus, we proposed that hemostatic therapy should focus on the rapid and sufficient supplementation of clotting factors and fibrinogen to improve consumption coagulopathy in patients with acute aortic dissection.

  14. Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique

    Directory of Open Access Journals (Sweden)

    Andre Luis de Castro Abreu

    2014-01-01

    Full Text Available Introduction: Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC and intracorporeal urinary diversion (ICUD, that replicates open surgical principles, and present our preliminary results. Materials and Methods: Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC and neobladders (NB. SAS ® Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05. Results: Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57. All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01 and orthotopic NB (13 vs. 7.5-day, P < 0.01 when comparing the first third of the cohort with the rest of the group. Overall median (range operative time and estimated blood loss was 7 h (4.8-13 and 200 mL (50-1200, respectively. Within 30-day postoperatively, complications occurred in 61 (59% patients, with the majority being low grade (n = 43, and no patient died. Median (range nodes yield was 36 (0-106 and 4 (3.9% specimens had positive surgical margins. Conclusions: Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.

  15. Hydroxyl-radical-induced oxidation of cyclic dipeptides: Reactions of free peptide radicals and their peroxyl radicals

    International Nuclear Information System (INIS)

    Mieden, O.J.

    1989-01-01

    In the course of this study investigations were carried out into the reactions of hydroxyl radicals and hydrogen atoms with cyclic dipeptides as well as the subsequent reactions of peptide radicals and their peroxyl radicals in aqueous solution. The radiolysis products formed in the absence and presence of oxygen or transient metal complexes were characterized and determined on a quantitative basis. The linking of information from product analyses to the kinetic data for transient species obtained by time-resolving UV/VIS and conductivity measurements (pulse radiolysis) as well as computer-assisted simulations of individual events during the reaction permitted an evaluation of the mechanisms underlying the various processes and an identification of interim products with short life-times, which did or did not belong to the group of radicals. Through the characterization of key reactions of radicals and peroxyl radicals of this substance class a major advance has been made towards a better understanding of the role of radicals in the peptide compound and the mechanisms involved in indirect radiation effects on long-chain peptides and proteins. (orig.) [de

  16. [Thoracic aortic dissection revealed by systemic cholesterol embolism].

    Science.gov (United States)

    Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

    2006-10-01

    Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

  17. Robotic radical perineal cystectomy and extended pelvic lymphadenectomy: initial investigation using a purpose-built single-port robotic system.

    Science.gov (United States)

    Maurice, Matthew J; Kaouk, Jihad H

    2017-12-01

    To assess the feasibility of radical perineal cystoprostatectomy using the latest generation purpose-built single-port robotic surgical system. In two male cadavers the da Vinci ® SP1098 Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform radical perineal cystoprostatectomy and bilateral extended pelvic lymph node dissection (ePLND). New features in this model include enhanced high-definition three-dimensional optics, improved instrument manoeuvrability, and a real-time instrument tracking and guidance system. The surgery was accomplished through a 3-cm perineal incision via a novel robotic single-port system, which accommodates three double-jointed articulating robotic instruments, an articulating camera, and an accessory laparoscopic instrument. The primary outcomes were technical feasibility, intraoperative complications, and total robotic operative time. The cases were completed successfully without conversion. There were no accidental punctures or lacerations. The robotic operative times were 197 and 202 min. In this preclinical model, robotic radical perineal cystoprostatectomy and ePLND was feasible using the SP1098 robotic platform. Further investigation is needed to assess the feasibility of urinary diversion using this novel approach and new technology. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  18. Head, Neck, and Oral Cancer

    Medline Plus

    Full Text Available ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ... find out more. Oral, Head and Neck Pathology Oral, Head and Neck Pathology Close to 49,750 Americans will be diagnosed ...

  19. A radical approach to radical innovation

    NARCIS (Netherlands)

    D. Deichmann (Dirk); J.C.M. van den Ende (Jan)

    2014-01-01

    textabstractInnovation pays. Amazon, Apple, Facebook, Google – nearly every one of today’s most successful companies has a talent for developing radical new ideas. But how best to encourage radical initiative taking from employees, and does their previous success or failure at it play a role?

  20. Need for intensive histopathologic analysis to determine lymph node metastases when using sentinel node biopsy in oral cancer

    DEFF Research Database (Denmark)

    Bilde, Anders; von Buchwald, Christian; Therkildsen, Marianne Hamilton

    2008-01-01

    OBJECTIVE: To determine the predictive value of sentinel node biopsy (SNB)-assisted neck dissection in patients with oral squamous cell carcinoma (SCC) stage T1 to 2N0M0 and to determine the incidence of subclinical metastases. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-one patients...... feasible in identifying subclinical metastasis, thus accurately staging the neck with a high degree of sensitivity in patients with oral SCC T1 to 2N0M0 when additional histopathology was performed. The vast majority of patients in this study would have been spared selective neck dissection had reliance...... dissection in patients with oral SCC....

  1. Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma

    DEFF Research Database (Denmark)

    Amit, Moran; Binenbaum, Yoav; Sharma, Kanika

    2015-01-01

    rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those...... undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. CONCLUSION: Our findings support the consideration of elective neck...

  2. Radicalization In Pakistan And The Spread Of Radical Islam In Pakistan

    Directory of Open Access Journals (Sweden)

    Bahir ahmad

    2015-08-01

    Full Text Available ABSTRACT It is pertinent to mention that radicalism is not intrinsic to Islam and radical interpretations of the religion or for that matter may occur within any way of life and religion Saikal 2003 and yet the question remains as to why Muslims in certain geographical regions have more radical approaches towards their religion and also that what are the causes of such radicalization. Becoming a radical Muslim is not even a matter of a day nor is it a sudden process. There are several reasons behind making a person radical peaceful angry smiling or tolerant. For knowing the reason behind radicalization or radicals persons one has to understand the causes. Tracing these causes is one of the ways to eliminate such behavior. The first step in the elimination of the radical sentiments in a person is to develop peace in his personality Fair Malhotra amp Shapiro 2010. The chapter which has been addressed here is going to shed light on the roots and symptoms of the radicalism. There will be a brief discussion on how the roots of radicalism can be traced and can be eliminated. The assessment and discussion will be conducted on the parameters of the economy media politics and theology from social cultural point of view. According to the analysis of Ahrari 2000 political factor is one of the major and direct factors which have resulted in causing of the radicalism. These factors however intertwine with one another. Radical actions cannot take place only because of the political factors.

  3. Partial lower axillary dissection for patients with clinically node-negative breast cancer.

    Science.gov (United States)

    Kodama, H; Mise, K; Kan, N

    2012-01-01

    To evaluate retrospectively the outcomes of partial lower axillary lymph node dissection caudal to the intercostobrachial nerve in patients with clinically node-negative (N(0)) breast cancer. Numbers of dissected and metastatic nodes, overall and disease-free survival rates, postoperative complication rates, and axillary recurrence were compared between patients who underwent breast cancer surgery with partial axillary node dissection (n = 1043) and historical controls who underwent conventional dissection (n = 1084). The 5-year overall and disease-free survival rates were 95.6% and 89.7%, and 94.9% and 88.4%, respectively, in the partial dissection and conventional dissection groups; the differences were not significant. Mean duration of surgery (41.6 min versus 60.9 min), intraoperative blood loss (28.0 ml versus 51.3 ml), volume of lymphatic drainage at 2 weeks postoperatively (488 ml versus 836 ml), and persistent arm lymphoedema (0.0% versus 11.8%) were significantly different between the partial and conventional dissection groups, respectively. Partial axillary lymph node dissection was associated with similar survival rates (but lower postoperative complication rates) compared with conventional axillary dissection and is recommended in patients with N(0) breast cancer.

  4. Blood groups and acute aortic dissection type III.

    Science.gov (United States)

    Fatic, Nikola; Nikolic, Aleksandar; Vukmirovic, Mihailo; Radojevic, Nemanja; Zornic, Nenad; Banzic, Igor; Ilic, Nikola; Kostic, Dusan; Pajovic, Bogdan

    2017-04-01

    Acute aortic type III dissection is one of the most catastrophic events, with in-hospital mortality ranging between 10% and 12%. The majority of patients are treated medically, but complicated dissections, which represent 15% to 20% of cases, require surgical or thoracic endovascular aortic repair (TEVAR). For the best outcomes adequate blood transfusion support is required. Interest in the relationship between blood type and vascular disease has been established. The aim of our study is to evaluate distribution of blood groups among patients with acute aortic type III dissection and to identify any kind of relationship between blood type and patient's survival. From January 2005 to December 2014, 115 patients with acute aortic type III dissection were enrolled at the Clinic of Vascular and Endovascular Surgery in Belgrade, Serbia and retrospectively analyzed. Patients were separated into two groups. The examination group consisted of patients with a lethal outcome, and the control group consisted of patients who survived. The analysis of the blood groups and RhD typing between groups did not reveal a statistically significant difference ( p = 0.220). Our results indicated no difference between different blood groups and RhD typing with respect to in-hospital mortality of patients with acute aortic dissection type III.

  5. Reconstruction of Traumatic External Iliac Artery Dissection Due to Vascular Clamping.

    Science.gov (United States)

    Kırnap, Mahir; Özçelik, Ümit; Akdur, Aydıncan; Ayvazoğlu Soy, Ebru H; Işıklar, İclal; Yarbuğ Karakayalı, Feza; Moray, Gökhan; Haberal, Mehmet

    2017-10-31

    Traumatic external iliac artery dissection after renal transplant is a rare complication, but it should be urgently managed due to its devastating effects on graft and lower limb circulation. External iliac artery dissection is seen more in recipients with diabetes mellitus and comorbid disease. Recipients with external iliac artery dissection should be treated immediately by percutaneus angioplasty or surgical reconstruction. In this study, we reported the management of 2 kidney transplant cases with external iliac artery dissection due to vascular clamping of the artery. External iliac artery dissection was diagnosed by ultrasonography in both cases. After failed percutaneous interventional angioplasty, we reconstructed the external iliac artery dissection surgically and replaced the external iliac artery with polytetra-fluoroethylene grafts in both patients. Both patients were discharged with normal functioning grafts showing 0.9 and 0.8 mg/dL serum creatinine levels at month 3 posttransplant. Close monitoring of recipients after transplant is mandatory for early diagnosis and early management of external iliac artery dissection to prevent graft loss and preserve lower limb circulation. Routine Doppler ultrasonography is an inexpensive and useful tool for early diagnosis in cases of sudden cessation or decrease in urine. In cases of failed percutaneous interventional angioplasty, reconstruction with synthetic vascular grafts can be safely applied in external iliac artery dissection.

  6. Fate of the dissecting lumen by CT study following surgical repair

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Nobuyuki; Ando, Taizo; Kawazoe, Kohei; Tomino, Tetsuo; Fujita, Takeshi; Naito, Hiroaki; Yamaguchi, Toshio

    1983-03-01

    A postoperative follow-up study on the fate of dissecting lumen by means of computer tomography has been evaluated. The materials were 21 patients who underwent surgery for dissection of the aorta, including 8 patients in type 1 of DeBakey classification, 3 in type 11, 8 in type 111 and 2 patients of localized dissection in descending and abdominal aorta. The susceptibility for thrombus formation in dissecting lumen appeared to be related to the background etiology of dissection where poor tendency for thrombus formation was observed in a group of patients with Marfan syndrome and its' incomplete form. On the other hand in the group of patients who had a history of hypertension and atherosclerosis probable, a strong tendency of thrombus formation and eventual occlusion of lumen was obtained. On the basis of above findings, it will be said that the surgical intervention for type 1 of DeBakey classification in Marfan patient is merely creating type 111 dissection, closed observation in the future change of dissecting lumen is of utmost importance especially in those groups of patients.

  7. Fate of the dissecting lumen by CT study following surgical repair

    International Nuclear Information System (INIS)

    Nakajima, Nobuyuki; Ando, Taizo; Kawazoe, Kohei; Tomino, Tetsuo; Fujita, Takeshi; Naito, Hiroaki; Yamaguchi, Toshio.

    1983-01-01

    A postoperative follow-up study on the fate of dissecting lumen by mean of computer tomography has been evaluated. The materials were 21 patients who underwent surgery for dissection of the aorta, including 8 patients in type 1 of DeBakey classification, 3 in type 11, 8 in type 111 and 2 patients of localized dissection in descending and abdominal aorta. The susceptibility for thrombus formation in dissecting lumen appeared to be relating to the background etiology of dissection where poor tendency for thrombus formation was observed in group of patients with Marfan syndrome and its' incomplete form. On the other hand in those group of patients who had a history of hypertension and atherosclerosis probable, a strong tendency of thrombus formation and eventual occlusion of lumen was obtained. On the basis of above findings, it will be said that the surgical intervention for type 1 of DeBakey classification in Marfan patient is merely creating type 111 dissection, closed observation in the future change of dissecting lumen is utmost important especially in those group of patients. (author)

  8. Why sauropods had long necks; and why giraffes have short necks.

    Science.gov (United States)

    Taylor, Michael P; Wedel, Mathew J

    2013-01-01

    The necks of the sauropod dinosaurs reached 15 m in length: six times longer than that of the world record giraffe and five times longer than those of all other terrestrial animals. Several anatomical features enabled this extreme elongation, including: absolutely large body size and quadrupedal stance providing a stable platform for a long neck; a small, light head that did not orally process food; cervical vertebrae that were both numerous and individually elongate; an efficient air-sac-based respiratory system; and distinctive cervical architecture. Relevant features of sauropod cervical vertebrae include: pneumatic chambers that enabled the bone to be positioned in a mechanically efficient way within the envelope; and muscular attachments of varying importance to the neural spines, epipophyses and cervical ribs. Other long-necked tetrapods lacked important features of sauropods, preventing the evolution of longer necks: for example, giraffes have relatively small torsos and large, heavy heads, share the usual mammalian constraint of only seven cervical vertebrae, and lack an air-sac system and pneumatic bones. Among non-sauropods, their saurischian relatives the theropod dinosaurs seem to have been best placed to evolve long necks, and indeed their necks probably surpassed those of giraffes. But 150 million years of evolution did not suffice for them to exceed a relatively modest 2.5 m.

  9. Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

    Directory of Open Access Journals (Sweden)

    Nicole Marschner-Preuth

    2013-01-01

    Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

  10. Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain

    DEFF Research Database (Denmark)

    Juul, Tina; Søgaard, Karen; Davis, Aileen M.

    2016-01-01

    Objective:To assess reliability, construct validity, responsiveness, and interpretability for Neck OutcOme Score (NOOS), Neck Disability Index (NDI), and Short Form–36 (SF-36) in neck pain patients. Study Design and Setting: Internal consistency was assessed by Cronbach alpha. Test-retest reliabi...

  11. Emotional response of undergraduates to cadaver dissection.

    Science.gov (United States)

    Wisenden, Patricia A; Budke, Katherine J; Klemetson, Chelsea J; Kurtti, Tana R; Patel, Chandi M; Schwantz, Trenda L; Wisenden, Brian D

    2018-03-01

    The most effective way to learn human anatomy is through cadaver dissection. Historically, cadaver dissection has been the provenance of professional schools. Increasingly, cadaver-based courses in human anatomy are shifting to the undergraduate level, which creates both problems and opportunities because of differences between undergraduate and graduate student populations. Anxiety associated with dissecting cadavers can create a barrier to learning, and ultimately, entry into the health and medical sciences for some demographic subpopulations of undergraduates. We surveyed 76 students in 2007 and 51 students in 2009 at four times in the semester to investigate the timing and sociodemographic predictors of anxiety over cadaver dissection. We followed this with a second survey of 44 students in 2014 to test the effect of humanization of cadaver donors (providing information about donor occupation and cause of death) to reduce student anxiety. Students experienced anxiety upon first exposure to cadaver dissection. Female students experienced greater anxiety than male students upon first exposure to cadavers but this effect was short-lived. Self-identified non-white, non-Christian students experienced sustained anxiety throughout the semester, likely because cadaver stress compounded social and financial stressors unique to international students. Humanization was effective in reducing anxiety in non-white, non-Christian students but had the unexpected effect of increasing anxiety in female students. We recommend that humanizing information be offered to students who seek it out, but not forced upon students for whom the information would only add to their stress. Clin. Anat. 31:224-230, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Robotic Assisted Radical Cystoprostatectomy and Intracorporeal Ileal Conduit Urinary Diversion for a Kidney Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Peter A. Caputo

    Full Text Available ABSTRACT Introduction and Objectives: Robotic assisted radical cystectomy (RARC is an alternative to open radical cystectomy. As experience is gained with the RARC approach the technique is being applied to more complex surgical cases. We describe here our technique for RARC with intracorporeal ileal conduit urinary diversion for a renal transplant recipient. Materials and Methods: The patient is a 60-year old man with high-grade muscle invasive bladder cancer. He has a history of renal failure due to polycystic kidney disease and received a deceased donor renal transplant in 2008. His hospital course at time of transplant was complicated by low-level BK virus viremia. Interestingly his trans-urethral bladder tumor resection specimen at time of bladder cancer diagnosis stained positive for SV40. His native kidneys were anuric so bilateral laparoscopic nephrectomy was performed in a staged fashion 2 weeks prior to RARC. Our surgical technique utilizes 6 trocars, of note a 12-mm assistant trocar is placed 1 cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the stapled enteric anastomosis. Surgical steps include: identification of native ureters bilaterally (removed en bloc with the bladder specimen; identification of the transplanted ureter at the right bladder dome; posterior bladder and prostate dissection along Denonvilliers’ fascia; development of the space of Retzius; ligation and transection of the bladder and prostate vascular bundles; apical prostate dissection and transection of urethra; left pelvic lymphadenectomy; ilium resection for creation of the ileal conduit; stapled enteric anastomosis; ureteroileal anastomosis; maturation of the ileal conduit stoma. Results: The surgery had no intraoperative complications. Operative time was 443 minutes (7.4 hours. Estimated blood loss was 250 cc. Length of hospital stay was 5 days. The patient

  13. The neck-tongue syndrome.

    Science.gov (United States)

    Orrell, R W; Marsden, C D

    1994-01-01

    The neck-tongue syndrome, consisting of pain in the neck and altered sensation in the ipsilateral half of the tongue aggravated by neck movement, has been attributed to damage to lingual afferent fibres travelling in the hypoglossal nerve to the C2 spinal roots. The lingual afferents in the hypoglossal nerve are thought to be proprioceptive. Two further cases of the neck-tongue syndrome are described, the spectrum of its clinical manifestations is explored, and the phenomenon of lingual pseudoathetosis is illustrated as a result of the presumed lingual deafferentation. Images PMID:8158185

  14. Comparison between Japanese and French interstitial brachytherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Nose, Takayuki; Koizumi, Masahiko; Nishiyama, Kinji; Inoue, Toshihiko

    2001-01-01

    Interstitial brachytherapy is the optimal radiotherapy modality for head and neck cancer because the highest dose conformity can be achieved, and implanted tubes can move synchronously with the tumor movement. Compared with radical surgery, interstitial brachytherapy can achieve equivalent local control with less morbidity and less functional deficit. In Japan, because of technical limitations, interstitial brachytherapy has been confined to treatment of small tongue cancers. To improve our head and neck cancer treatment, technical limitations should be eliminated and a wider indication for interstitial brachytherapy should be achieved. In France, interstitial brachytherapy has been technically more developed and widely indicated than in Japan. We analyzed the differences between Japanese (Osaka) and French (Lyon and Nancy) techniques, to improve our interstitial brachytherapy. Implant devices and techniques: French applicators (Longcip 1) are more flexible and more suitable for loop techniques of the soft palate, the base of the tongue, and the vallecula, than applicators available in Japan. Various implant techniques are established especially for the oropharynx in France. Mandibular protection: Lead blocks used in France can more effectively shield the mandible than our silicone spacers. We showed the dosimetric results in an experimental treatment setting. Dose specification: The five-mm dose specification method used in Japan can work only for easy cases, such as small oral tongue cancers and mouth floor cancers. For complicated implants, such as for the oropharynx, the CTV-based dose specification method used in France is essential for sufficient irradiation. Indications: The indication for head and neck interstitial brachytherapy in Japan is limited mostly to small oral tongue cancers. The indication in France is wider, including the oral cavity, the oropharynx, and postoperative cases. We can refine our head and neck cancer treatment if we combine French

  15. How to decrease the emotional impact of cadaver dissection in medical students

    Directory of Open Access Journals (Sweden)

    F Javadnia

    2009-03-01

    Full Text Available Background: Teaching anatomy is based on cadaver dissection. Working  with cadavers, whether through active dissection or by examination of prosected specimens, constitutes a potential stressor in medical  education.Purpose.To reduce the anxiety of the medical students by mentally preparing them before going to the dissection room.Methods: The questionnaires were distributed among 68 medical students. The pre-dissection questionnaire comprised questions related to demographic data and the first encounter with a cadaver. The students were randomly divided into experimental and control groups. The experimental group was prepared psychologically prior to dissection, but the control group entered the dissection room without any preparation. After the first dissection class, all students were surveyed by the second questionnaire  which surveyed physical and cognitive symptoms of anxiety, resulting from exposure to the dissection room at the first visit and six weeks later.Results: There was a significant difference (p<.05 in the rate of anxiety between experimental and control group in the initial visit. The difference in the rate of anxiety between the first exposure and six weeks later was significant in control group (p<.008, while it was not significant in the experimental group.Conclusion: The initial preparation could relatively reduce the rate of stress, so that the experimental group experienced less errs tonal effects during dissection compared to control group.Keyword: Emotional impact, cadaver dissection, medical students

  16. Biology teachers' dissection practices and the influences that lead to their adoption: An exploratory research

    Science.gov (United States)

    Milano, Regina Nicole

    The lack of resolution in the on-going animal dissection debate inspired this mixed methods study to identify Connecticut secondary biology teachers' dissection practices and the influences that lead to their adoption. Qualitative findings indicate past experiences, managing objections to dissection, school culture, goals of biology teaching and ethics as major influences on dissection practices with 58.4% (n=7) of the sample dissecting and 41.6% not dissecting (n=5). Quantitative findings reveal gender, standards and curriculum, advantages of dissection and experiences as a student as major influences on dissection practices with 71.9% (n=92) of the sample dissecting and 28.1% (n=36) not dissecting. The study concludes that dissection policies are necessary and imminent in Connecticut school districts. Furthermore, it advises teacher-initiated, qualitative and quantitative assessments to expose disparities between student dissection perspectives and their own, prior to conducting dissection. Finally, it provides suggestions for addressing potential differences including administrative involvement.

  17. perception to cadaver dissection and views on anatomy as a subject

    African Journals Online (AJOL)

    However, literature on medical students' perceptions on cadaver dissection and their opinions on anatomy as a subject is scanty ... Key words: Dissection, Perceptions, Cadaver, Anatomy. INTRODUCTION. Dissection has been the .... attention they give to the learning of anatomy, and this may possibly explain the relatively.

  18. Secondary science classroom dissections: Informing policy by evaluating cognitive outcomes and exploring affective outcomes

    Science.gov (United States)

    Allspaw, Kathleen M.

    Animal protection organizations claim that dissection is pedagogically unsound and that it will cause students to lose respect for non-human animals. Science teacher organizations support curricula that teach respect for animal life and include dissection. Prior research compared dissection to dissection alternatives. Four of the six studies revealed no difference between groups on tests of cognitive outcomes. One study revealed that dissection was superior, and one revealed that the alternative was superior. No differences in attitudes toward science, dissection or school were found. Attitudes toward non-human animals were not measured. This study focused on the dissections of earthworms and frogs in middle and high school classrooms. Pre and post-tests of conceptual understanding revealed failing scores and no significant pre/post differences. Because these tests required critical thinking skills, and the dissection activities did not, it is difficult to determine if the poor performance on these tests indicates the inability of the students to think critically, and/or if it indicates the ineffectiveness of dissection. Further studies of dissections that focus on critical thinking would be necessary to make this distinction. Classroom observations, student written narratives, and student and adult interviews revealed mixed attitudes toward non-human animals. Student behaviors during dissection were similar to those behaviors exhibited during non-dissection activities. Most students and adults readily supported worm dissections while they expressed some trepidation about frog dissections. Students and adults universally expressed affection for their pets and opposed the use of their own pets for dissection/research. There was slight support for the use of dogs and cats for dissection/research, but only those students who expressed hate for cats said that they could dissect cats. None of the students or adults expressed a willingness to dissect dogs. Some students

  19. An unusual case of uterine cotyledonoid dissecting leiomyoma with adenomyosis.

    Science.gov (United States)

    Shimizu, Ai; Tanaka, Hoshihito; Iwasaki, Sari; Wakui, Yukio; Ikeda, Hitoshi; Suzuki, Akira

    2016-08-04

    Cotyledonoid dissecting leiomyoma is a rare variant of uterine smooth muscle tumor with an unusual growth pattern that shows intramural dissection within uterine myometrium and often a placenta-like appearance in its extrauterine components. We present a unique case of cotyledonoid dissecting leiomyoma with adenomyosis. A 40-year-old Japanese female presented with prolonged menorrhagia and severe anemia. She had a pelvic mass followed-up for 6 years with a diagnosis of leiomyoma. However, increase in tumor size and cystic changes with hemorrhage were found by magnetic resonance imaging, and total abdominal hysterectomy with bilateral salpingectomy was performed. Macroscopically, the placenta-like exophytic mass protruding from the posterior uterine wall was composed of multiple nodules containing numerous hemorrhagic cysts. The mass showed continuity as a white multinodular dissecting mass infiltrating the posterolateral myometrium. Microscopically, both extra-and intrauterine portions of the mass were composed of nodules that contained swirled neoplastic smooth muscle cells with marked hyalinized degeneration, as observed in cotyledonoid dissecting leiomyomas of conventional type. In addition, numerous non-neoplastic glands of endometrial type surrounded by abundant endometrium-like stromal cells and non-neoplastic smooth muscle cells were found in the tumor, suggesting that it involved a part of concomitant adenomyosis originating from the nontumoral myometrium. Thus far, over 30 cases of cotyledonoid dissecting leiomyoma have been reported, none of which have described the presence of adenomyosis within the tumor. The present case suggested that cotyledonoid dissecting leiomyoma might have a unique clinical presentation involving concomitant uterine adenomyosis. It is critical for pathologists, gynecologists, and radiologists to be cognizant of cotyledonoid dissecting leiomyoma variants for timely and appropriate diagnosis and treatment.

  20. Aortic dissection presenting with secondary pulmonary hypertension caused by compression of the pulmonary artery by dissecting hematoma: a case report

    International Nuclear Information System (INIS)

    Kim, Dong Hun; Ryu, Sang Wan; Choi, Yong Sun; Ahn, Byoung Hee

    2004-01-01

    The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension

  1. Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients

    Science.gov (United States)

    2014-01-01

    Background Conventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. This article investigates the prevalence of the main complications of ALND: lymphedema, range-of-motion restriction, and arm paresthesia and pain. Methods This cross-sectional study included 200 women with invasive breast cancer who underwent breast-conserving surgery (82.5%, n = 165) or mastectomy (17.5%, n = 35) with ALND from 2007 to 2011. Arm perimetry was used to assess lymphedema, defined as a difference >2 cm in the upper arm circumference between the nonsurgical and surgical arms. Range-of-motion restriction was assessed by evaluating the degree of arm abduction. Paresthesia was measured in the inner and proximal arm regions. Arm pain was assessed by directly questioning the patients and defined as either present or absent. Results The average (±SD) time between ALND and morbidity evaluation was 35 ± 18 months (range, 7-60 months). The average dissected lymph node number per patient was 14 ± 4 (range, 6-30 lymph nodes). Only 3.5% (n = 7) of the patients presented with lymphedema. Single-incision approaches to breast tumor and ALND (P = 0.04) and the presence of a postoperative seroma (P = 0.02) were associated with lymphedema in univariate analysis. Paresthesia was the most frequent side effect observed (53% of patients, n = 106). This complication was associated with increased age (P < 0.0001) and a larger dissected lymph node number (P = 0.01) in univariate and multivariate analysis. Additionally, 24% (n = 48) of patients had noticeable limited arm abduction. Among the patients, 27.5% (n = 55) experienced sporadic arm pain corresponding to the surgically treated armpit. In multivariate analysis, the pain risk was 1.9-fold higher in patients who underwent ALND corresponding to their dominant arm (95% CI, 1.0-3.7, P = 0

  2. Why sauropods had long necks; and why giraffes have short necks

    Science.gov (United States)

    Wedel, Mathew J.

    2013-01-01

    The necks of the sauropod dinosaurs reached 15 m in length: six times longer than that of the world record giraffe and five times longer than those of all other terrestrial animals. Several anatomical features enabled this extreme elongation, including: absolutely large body size and quadrupedal stance providing a stable platform for a long neck; a small, light head that did not orally process food; cervical vertebrae that were both numerous and individually elongate; an efficient air-sac-based respiratory system; and distinctive cervical architecture. Relevant features of sauropod cervical vertebrae include: pneumatic chambers that enabled the bone to be positioned in a mechanically efficient way within the envelope; and muscular attachments of varying importance to the neural spines, epipophyses and cervical ribs. Other long-necked tetrapods lacked important features of sauropods, preventing the evolution of longer necks: for example, giraffes have relatively small torsos and large, heavy heads, share the usual mammalian constraint of only seven cervical vertebrae, and lack an air-sac system and pneumatic bones. Among non-sauropods, their saurischian relatives the theropod dinosaurs seem to have been best placed to evolve long necks, and indeed their necks probably surpassed those of giraffes. But 150 million years of evolution did not suffice for them to exceed a relatively modest 2.5 m. PMID:23638372

  3. Why sauropods had long necks; and why giraffes have short necks

    Directory of Open Access Journals (Sweden)

    Michael P. Taylor

    2013-02-01

    Full Text Available The necks of the sauropod dinosaurs reached 15 m in length: six times longer than that of the world record giraffe and five times longer than those of all other terrestrial animals. Several anatomical features enabled this extreme elongation, including: absolutely large body size and quadrupedal stance providing a stable platform for a long neck; a small, light head that did not orally process food; cervical vertebrae that were both numerous and individually elongate; an efficient air-sac-based respiratory system; and distinctive cervical architecture. Relevant features of sauropod cervical vertebrae include: pneumatic chambers that enabled the bone to be positioned in a mechanically efficient way within the envelope; and muscular attachments of varying importance to the neural spines, epipophyses and cervical ribs. Other long-necked tetrapods lacked important features of sauropods, preventing the evolution of longer necks: for example, giraffes have relatively small torsos and large, heavy heads, share the usual mammalian constraint of only seven cervical vertebrae, and lack an air-sac system and pneumatic bones. Among non-sauropods, their saurischian relatives the theropod dinosaurs seem to have been best placed to evolve long necks, and indeed their necks probably surpassed those of giraffes. But 150 million years of evolution did not suffice for them to exceed a relatively modest 2.5 m.

  4. Dose-response relationship for elective neck irradiation of head and neck cancer - facts and controversies

    International Nuclear Information System (INIS)

    Suwinski, R.; Maciejewski, B.; Withers, H.R.

    1998-01-01

    The aim of this study is to assign dose-response relationship for subclinical neck metastases of squamous cell head and neck cancer based on extensive survey of 24 data sets collected from the literature. Neck relapse rates (NRR) without and after elective (ENI) or preoperative irradiation were estimated for each site and stage of primary tumor and the reduction in neck relapse rate was calculated. An average NRR without ENI was 22% (12-35% ) and only 2.5% (0-1 0%) after the ENI with total dose of 46- 50 Gy which gives high reduction rate in the risk of neck recurrences being on the average 89% and 42% (0-46%) after preoperative irradiation using 22-30 Gy. Dose response curve for elective and preoperative irradiation have shown that 50 Gy in 2 Gy fraction reduces the incidence of neck relapses in the NO patients by more than 90% and only by less than 50% after total doses lower than 30 Gy. No correlation between the risk of neck metastases without ENI and the reduction in neck relapses after ENI was found. (authors)

  5. MR imaging of the entry, the abdominal communicating orifice, and the retrograde dissection in aortic dissections

    International Nuclear Information System (INIS)

    Yoshida, Y.; Mukohara, N.; Nakamura, K.; Sugimura, K.; Kono, M.

    1986-01-01

    MR imaging (1.5 T) was performed on 41 patients with aortic dissection. Entries were clearly visualized on the MR images as partial defects of the intimal flap in 18 of 21 patients (85.7%). In eight of ten patients, the locations of abdominal communicating orifices corresponded to the lowest signal intensities of the false lumina. Retrograde disections were diagnosed in all six patients from gradual increases in signal intensities of the false lumina toward the heart. MR imaging was very useful in diagnosing entries of the thoracic aorta, abdominal communicating orifices between true and false lumina, and retrograde dissections

  6. Neck x-ray

    Science.gov (United States)

    X-ray - neck; Cervical spine x-ray; Lateral neck x-ray ... There is low radiation exposure. X-rays are monitored so that the lowest amount of radiation is used to produce the image. Pregnant women and ...

  7. Manipulating radicals: Using cobalt to steer radical reactions

    OpenAIRE

    Chirilă, A.

    2017-01-01

    This thesis describes research aimed at understanding and exploiting metallo-radical reactivity and explores reactions mediated by square planar, low-spin cobalt(II) complexes. A primary goal was to uncover novel reactivity of discrete cobalt(III)-bound carbene radicals generated upon reaction of the cobalt(II) catalysts with carbene precursors. Another important goal was to replace cobalt(II)-porphyrin catalysts with cheaper and easier to prepare metallo-radical analogues. Therefore the cata...

  8. Advances in Robotic-Assisted Radical Prostatectomy over Time

    Directory of Open Access Journals (Sweden)

    Emma F. P. Jacobs

    2013-01-01

    Full Text Available Since the introduction of robot-assisted radical prostatectomy (RALP, robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

  9. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

    Science.gov (United States)

    Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

    2014-01-01

    The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

  10. Free radical inactivation of trypsin

    International Nuclear Information System (INIS)

    Cudina, Ivana; Jovanovic, S.V.

    1988-01-01

    Reactivities of free radical oxidants, radical OH, Br2-anion radical and Cl 3 COO radical and a reductant, CO2-anion radical, with trypsin and reactive protein components were determined by pulse radiolysis of aqueous solutions at pH 7, 20 0 C. Highly reactive free radicals, radical OH, Br2-anion radical and CO2-anion radical, react with trypsin at diffusion controlled rates. Moderately reactive trichloroperoxy radical, k(Cl 3 COO radical + trypsin) preferentially oxidizes histidine residues. The efficiency of inactivation of trypsin by free radicals is inversely proportional to their reactivity. The yields of inactivation of trypsin by radical OH, Br2-anion radical and CO2-anion radical are low, G(inactivation) = 0.6-0.8, which corresponds to ∼ 10% of the initially produced radicals. In contrast, Cl 3 COO radical inactivates trypsin with ∼ 50% efficiency, i.e. G(inactivation) = 3.2. (author)

  11. IV DSA in the diagnosis and follow-up of dissection of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickx, P.; Luska, G.; Laas, J.; Haverich, A.

    1986-05-01

    Intravenous DSA was performed in 53 patients with suspected dissection of the thoracic aorta and in 13 patients following surgery for aortic dissection. In 36 patients, the suspected diagnosis could be excluded definitely and, in 14 cases out of 17, a dissection was correctly diagnosed. All 11 type B dissections were correctly diagnosed. Of six type A dissections, only three were adequately demonstrated by IV DSA. In type B dissections, IV DSA is reliable, but in type A dissection with massive aortic insufficiency or pericardial tamponade the findings are not reliable. In all 13 patients who had surgery for dissection, IV DSA proved suitable for showing the anastomosis and progress of the disease.

  12. Reduction of xerostomia in head and neck cancer patients. A critical review of the literature

    International Nuclear Information System (INIS)

    Hanley, O.; Leech, M.

    2016-01-01

    Background: Radical radiotherapy given with or without concurrent chemotherapy is the main treatment modality in non-surgical patients for the management of squamous cell carcinoma in the head and neck. Xerostomia, which results from reduced salivary production is a debilitating side-effect of radiation therapy to these patients. Xerostomia may greatly impact on quality of life for head and neck cancer patients for up to 24 months post-radiation therapy. Such effects include difficulties in fundamental daily activities such as speech, mastication and swallowing. It is believed that modulated techniques provide better sparing to surrounding salivary glands. The aim of this critical review of the literature is to investigate what advantage intensity modulated radiotherapy (IMRT) can provide over 3 dimensional conformal radiation therapy (3DCRT) in reducing xerostomia in this subset of patients. Search methodology: An extensive literature search was undertaken to compare the incidence of grade 2 or worse xerostomia in HNSCC patients treated with IMRT or 3DCRT (±chemotherapy). Results: Studies reported a lower incidence of grade 2 or worse xerostomia with IMRT over patients treated with 3DCRT. The highest incidence of xerostomia was reported at 6 months following the completion of radiotherapy treatment. The incidence of xerostomia in patients declined with time, in both patients treated with IMRT and those of the 3DCRT cohort. The incidence of xerostomia was greater in the acute setting than in the late. Conclusion: An IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over conformal techniques. This will not compromise dose homogeneity or dose coverage. IMRT should remain the standard of care for head and neck patients. - Highlights: • IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over 3DCRT. • IMRT does not compromise the treatment's dose homogeneity or

  13. Intensity-Modulated Radiotherapy is Associated With Improved Global Quality of Life Among Long-term Survivors of Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Vazquez, Esther G.; Lau, Derick H.; Purdy, James A.

    2012-01-01

    Purpose: To compare the long-term quality of life among patients treated with and without intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Methods and Materials: University of Washington Quality of Life instrument scores were reviewed for 155 patients previously treated with radiation therapy for locally advanced head-and-neck cancer. All patients were disease free and had at least 2 years of follow-up. Eighty-four patients (54%) were treated with IMRT. The remaining 71 patients (46%) were treated with three-dimensional conformal radiotherapy (3D CRT) by use of initial opposed lateral fields matched to a low anterior neck field. Results: The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients at 1 and 2 years, respectively, compared with 55.4 and 57.0 for the 3D CRT patients, respectively (p < 0.001). At 1 year after the completion of radiation therapy, the proportion of patients who rated their global quality of life as “very good” or “outstanding” was 51% and 41% among patients treated by IMRT and 3DCRT, respectively (p = 0.11). At 2 years, the corresponding percentages increased to 73% and 49%, respectively (p < 0.001). On multivariate analysis accounting for sex, age, radiation intent (definitive vs. postoperative), radiation dose, T stage, primary site, use of concurrent chemotherapy, and neck dissection, the use of IMRT was the only variable independently associated with improved quality of life (p = 0.01). Conclusion: The early quality of life improvements associated with IMRT not only are maintained but apparently become more magnified over time. These data provide powerful evidence attesting to the long-term benefits of IMRT for head-and-neck cancer.

  14. Prevalance of neck pain in computer users

    International Nuclear Information System (INIS)

    Sabeen, F.; Bashir, M.S.; Hussain, S.I.

    2013-01-01

    Prolonged use of computers during daily work activities and recreation is often cited as a cause of neck pain. Neck pain and computer users are clearly connected due to extended periods of sitting in a certain position with no breaks to stretch the neck muscles. Pro-longed computer use with neck bent forward, will cause the anterior neck muscles to gradually get shorter and tighter, while the muscles in the back of neck will grow longer and weaker. These changes will lead to development of neck pain. Objectives: To find incidence of neck pain in computer users, ass