Actinic comedonal plaque of the eyelid

A variety of actinic lesions occur on the eyelids and facial skin. Actinic comedonal plaque is an unusual entity that falls into this category. We successfully treated such a lesion with cryotherapy.

Coat's disease: clinical, angiographic, histopathological findings and clinical management

Twenty-four consecutive patients with Coats's disease are reported. In 9 cases the blind eye was enucleated because of total exudative detachment of the retina or because of untreatable secondary glaucoma. No treatment had been given. Fifteen patients between 22 months and 52 years of age were managed by argon laser or xenon photocoagulation and/or cryocoagulation. The number of treatment sessions varied from 1 to 9 per patient and totalled 49 sessions. Fluorescein angiography was performed in all cases. In most eyes the arterial system seemed to be more damaged than the venous side. Many arterioles ended in macroaneurysm-like dilatations surrounded by avascular areas or complete vascular closure in more advanced cases. In 11 out of 14 eyes the vision improved after treatment or remained unchanged. The follow-up varied from 1 to 8 years. Persistent and aggressive long-term treatment of Coats's disease is recommended because the prognosis without treatment is poor.

Surgical therapy for ventricular tachyarrhythmias

Recurrent sustained ventricular tachyarrhythmias unresponsive to medical therapy are associated with a one year mortality of 70 to 85 per cent. Patients who are susceptible to these re-entrant arrhythmias usually have a history of previous myocardial infarction or chronic myocardial ischemic disease. More specifically, these patients demonstrate both anatomic and electrophysiologic derangements. Experimental work suggests that regions of non-uniform damage render the ventricle most susceptible to ventricular tachyarrhythmias, and even relatively large areas of homogeneous myocardial ischemic damage may not display the same susceptibility to these arrhythmias. Surgical techniques are being devised to treat patients with ventricular tachyarrhythmias refractory to medical management. These have provided control of arrhythmias in patients whose disease was previously resistant to all medical treatment. The evolving surgical therapies presently employed share either of two physiopathologic consequences which render them successful: the homogeneous ablation of previous heterogeneous myocardial ischemic damage or the delimiting of an arrhythmogenic focus by excluding conduction to surrounding myocardium. Finally, antitachycardia and defibrillating devices have also been developed to facilitate the management of patients not controlled satisfactorily with either conventional or investigative drugs. The surgeon will need to be familiar with these devices as well.

Multidisciplinary treatment of maxillary sinus carcinoma

The history of treatment of maxillary sinus carcinoma is divided into four characteristic periods, with the corresponding 5-year cumulative survival rates of: 20% of 282 patients for 1957 to 1966; 25% of 191 patients for 1967 to 1971; 39% of 166 patients for 1972 to 1975; and 54% of 134 patients for 1976 to 1979. The best treatment at present consists of 60Co gamma ray (5000 rad/25 fractions/5 weeks), continuous intra-arterial 5-FU infusion (2000 mg during the radiotherapy), tumor reduction mainly by weekly cryosurgery, and immunotherapy with cell wall skeleton of Nocardia rubra in appropriate combination. Early antrostomy and final curettage are mandatory. Maxillectomy should be resorted to when recurrence is histologically confirmed. Multidisciplinary treatment of maxillary sinus carcinoma based on this conception has successfully increased the survival rates and reduced the need for maxillectomy.

Cryosurgical treatment of cervical intraepithelial neoplasia (CIN III) in 102 patients

Results of cryosurgical treatment in 102 patients with a histologically confirmed diagnosis of severe dysplasia or carcinoma in situ of the uterine cervix (CIN III) are presented. The colposcopic evaluation performed in all patients required full visualization of the squamocolumnar junction. In 95 of the 102 patients no significant cytological abnormalities were found during the follow-up period, which amounts to a success rate of 93%. In seven patients (7%) treatment was considered to have failed because cervical smears persistently suggested CIN II or III. In five of them this was in all probability due to a residual lesion, since the abnormal smears occurred within 12 weeks after cryosurgery. It is concluded that in selected cases cryosurgery is a safe alternative for conisation in the treatment of CIN III. However, thorough colposcopic expertise is essential for adequate preoperative screening, as is careful selection of patients, and the latter may result in the withholding of cryosurgical therapy from 30% of patients with CIN III.

Cryosurgical treatment of early cervical intraepithelial neoplasia

Two hundred forty patients, ages 12 to 54 years, with biopsy-confirmed early cervical intraepithelial neoplasia (CIN I) treated by cryosurgery were reviewed. CIN I has been viewed historically as having high rates of remission or stabilization. The initial cure rate was 89%, with a 97% cure rate after retreatment of failures. All failures were confirmed histologically. The initial cure rates are no better than those for higher grades of CIN. Thus, CIN I should be viewed with the same seriousness as CIN II or CIN III.

Bilateral retinoblastoma: the prognosis for vision

In the treatment of retinoblastoma careful case selection is essential. Each eye is assessed individually; the worse affected eye is no longer routinely enucleated in bilateral cases. One hundred and sixteen patients were reviewed to assess the overall visual prognosis. 50% achieved a final acuity of 6/12 or better in one eye at the age of 8 years, and 2 patients had acuities of 6/12 or better in both eyes. Various methods of treatment are discussed.

His bundle interruption for reentry tachycardia in Wolff-Parkinson-White syndrome

This report relates the experience with 16 patients with Wolff-Parkinson-White syndrome in whom His bundle interruption was performed for reentry atrioventricular (AV) tachycardia caused by a circuit composed of the His and Kent bundles. A review of the surgical anatomy of the area encompassing the AV node and the His bundle is included. The reasons for selection of His bundle interruption in the 16 patients were as follows: (1) it is safer in the poor-risk patient; (2) the His bundle was adjacent to the Kent bundle and could not be avoided; or (3) the His bundle was divided after attempted interruption of the Kent bundle failed. The methods used for interruption, either alone or in combination, included suture ligation, electrocautery, incision, and cryothermia. This study showed that in order to interrupt the His bundle with minimum physiological impairment, ablation should be done at the AV node--His bundle junction. This can be achieved in most patients with carefully applied cryothermia. If cryothermic ablation fails, then an incision must be made that separates the inferior aspect of the atrial septum from the right fibrous trigone. His bundle interruption at the AV node--His bundle junction was accomplished in 13 of the 16 patients.

[Head and neck cancers--significance of salvage operation]

The crude and determinate 5 year survivals out of 264 cases were 28.4% and 34.6% respectively. There were 136 cases in which the recurrence located at the primary site only. Whereas surgery performed on 81 cases resulted in the determinal survival rate of 58.0%, radiation therapy for 42 cases could attained only 19.5% survival. Cryotherapy were performed on 4 localized recurrent lesions and all but one which died of other cause are living well for more than 5 years. In 58 cases, the recurrence appeared only in neck nodes. Determinate 5 year survival rate of 64.7% could be obtained out of 40 cases treated by radical neck dissection. Only 7.1% of cases treated otherwise survived more than 5 years. Results of treatment were poor in the 39 cases in which both the primary and neck nodes were involved by recurrences. Only one case survived more than 5 years which had undergone composite operation. Introduction of composite operation simultaneously combined with reconstruction extended the indication of radical therapy. Seventy-eight cases which would have been the candidate for palliative treatment underwent this type of surgery, and 41.0% of them survived more than 5 years. It is noteworthy that radical treatment is still reserved for many recurrent cases of head and neck carcinoma. And salvage operation, if indicated, promises the best results among various methods of treatment.

A comparison of complications of laser and cold knife conization

A comparison was made of intraoperative and postoperative complications of laser conization and cold knife conization. Of 428 women hospitalized for cold knife conization, 23.6% had one or more complications; 14.3% had postoperative hemorrhages, 6.8% had infections, and 4.7% suffered from stenosis. Two hundred sixteen women were hospitalized for laser conization; 5.1% of them suffered complications. Postoperative hemorrhages occurred in 2.8% and infections in 2.3%. No case of stenosis occurred. Laser conization as an outpatient procedure was undertaken in 240 women; 4.2% had complications. Postoperative hemorrhages occurred in only 2.5%, infections in 1.3%, and stenosis in 0.8%. Laser conization has the same complication rate as laser vaporization and can be safely performed on an outpatient basis, thereby reducing hospital costs.