A non-looping afterloading technique for base of tongue implants: results in the first 20 patients

The results of treatment in the first 20 patients treated by a non-looping afterloading technique for base of tongue implant are described. Ten patients had carcinoma recurrent in the base of tongue after previous treatment and they were treated by implant alone. The other 10 patients had previously untreated carcinoma of the base of tongue and they were treated with a combination of interstitial implant, external radiation therapy and surgery. The minimum follow-up is 1 year and maximum 5 years. No local or regional failures have occurred in the previously untreated patients. No local failures have occurred in the previously treated patients who had lesions up to 4 cm in diameter, but three out of four patients with recurrent lesions larger than 4 cm have failed locally. Two patients developed necrosis related to the implant; the factors responsible for this are discussed.

Attempts to manipulate specific responses to induce resistance to Schistosoma mansoni in Kenyan baboons (Papio anubis)

Attempts were made to manipulate specific responses of baboons to protect them from infection with Schistosoma mansoni. In Experiment 1, eosinophilia was induced in naive baboons with Trichinella spiralis larvae given intravenously before intraperitoneal injection of globulin fractions from S. mansoni-infected baboon sera and subsequent percutaneous exposure to S. mansoni cercariae. In Experiment 2, baboons with 8- or 32-week-old primary S. mansoni infections received T. spiralis i.v. before an S. mansoni challenge. In experiments 3 to 5 respectively, naive baboons received intramuscularly before challenge: formalin-fixed S. mansoni schistosomula, with Bordetella pertussis as an adjuvant; a preparation of S. mansoni adult worm teguments; and a preparation of IgE-immune complexes obtained from S. mansoni-infected rat sera, with Freunds Complete Adjuvant. Minor, but statistically insignificant, protection was obtained in Experiments 2 (32-week infections) and 3, but was far less than that given by intact, irradiated living vaccines. There are signs on the horizon of non-living vaccines protecting rodents against S. mansoni infection and it would be prudent, as with drugs, to test these in primates before proceeding to man. The results of our experiments, though essentially negative, should help the design of any future vaccine trials in primates.

An anterior surgical approach to the upper thoracic vertebrae

Of the various anterior surgical approaches to the spine, exposure of the upper two thoracic vertebrae remains the most challenging. An operative approach to this region is described. The major features include resection of a portion of the clavicle and the manubrium sterni. Following resection of the tumor and involved vertebra, anterior fusion is performed using the clavicle as a strut graft. Immediate stabilization may also be achieved with methyl methacrylate replacement of the vertebral bodies. The operation is well tolerated, and requires minimal postoperative immobilization. The clinical presentation, radiological features, and results of treatment in a series of seven patients operated on during a 2-year period are presented.

A transsternal approach to the upper thoracic vertebrae

An anterior surgical approach to the upper thoracic vertebrae has been described. A T-shaped skin incision is used, with the horizontal limb 1 cm above the clavicle, and the vertical limb extending in the midline over the body of the sternum. A portion of the manubrium sterni, as well as the medial third of the clavicle, is resected; the avacular tissue plane between the carotid sheath laterally and the trachea and esophagus medially is developed to reach the prevertebral space. After surgery, immediate fusion is performed using the clavicle and manubrium. This procedure is well tolerated, and was associated with minimal morbidity and no mortality in a series of seven patients.

Stability of nitroglycerin solutions in polyolefin and glass containers

The stability of nitroglycerin in concentrations of 200 and 400 micrograms/ml in eight common intravenous solutions was studied. Two containers of each solution at each concentration, one glass and one polyolefin, were stored under each of the following conditions: intense light (1400-2000 foot-candles) and ambient room temperature (18-27 degrees C), normal light and ambient room temperature, dark and 40 degrees C, and dark and 5 degrees C. All samples were tested at 0 and 24 hours. Room temperature and refrigerated samples were also tested at 48 hours, 7 days, and 1 month. Testing included measurement for optical density at 400 and 600 nm, pH, and nitroglycerin content as determined by HPLC. The admixtures remained clear and colorless, and no appreciable changes in pH were observed. HPLC assays showed no significant changes in nitroglycerin concentrations. There were no differences in the stability of the admixtures stored in the glass and polyolefin containers. Nitroglycerin is compatible with each of the common intravenous solutions tested under the storage conditions and in the containers used for this study.

Dislocation of the carpometacarpal joint of the thumb. A report of four cases

In four cases of complete carpometacarpal dislocation of the thumb, closed reduction, although easily performed, usually had unstable results. Open reduction and internal fixation with Kirschner wires were used in two cases. The third case was stable after open reduction. The fourth patient was treated by closed reduction and percutaneous Kirschner wire fixation. The joints were immobilized in spica casts for six weeks. At follow-up examinations, two patients had asymptomatic dorsal subluxation. At two years' follow-up examinations, two of the four patients had dorsal subluxations. Open reduction and internal fixation alone were not adequate for this type of injury. The dorsal capsule and ligament should be explored during surgery and reconstructed by free tendon grafts.

Choosing a wheelchair cushion

A preliminary survey of twelve cushions on the standard 8L chair suggests that sheepskin and ministry cushions compare favourably with commercial cushions in respect to pressure and displacement characteristics. Ripple and water cushions were best.

Giant ossifying fibroma of the nasal cavity with intracranial extension

A 12-year-old white male presented with an ossifying fibroma of the maxillary sinus. The tumour recurred following incomplete excision through a maxillary approach. Computerized tomography revealed an extensive tumour involving the paranasal sinuses, which extended intracranially through the cribriform plate. The tumour was successfully excised through a combined craniofacial approach. This approach should be used whenever there is radiological involvement of the base of the skull from paranasal sinus tumours. Accurate radiological delineation of the extent of the tumour is only possible by computerized tomography in the axial and coronal planes.

Edwardsiella tarda osteomyelitis in a patient with SC hemoglobinopathy

Edwardsiella tarda is a recently identified gram-negative organism of the family Enterobacteriaceae. Reports of human infections with E tarda have been infrequent. We review 14 cases of systemic edwardsiellosis reported in the literature and report a case of E tarda osteomyelitis in a patient with sickle cell-hemoglobin C disease. In our case the remains of a snake may have been the source of the organism. Systemic edwardsiellosis is rare, and it may present as meningitis, endocarditis, bacteremia, liver abscess, or osteomyelitis. In 12 of 15 cases reported, systemic E tarda infection occurred in patients suffering from additional debilitating illnesses.

Elective postoperative radiation therapy in stages III and IV epidermoid carcinoma of the head and neck

One hundred five patients with advanced (American Joint Committee stages III and IV) but resectable epidermoid carcinoma of the head and neck were treated with radical surgery and elective postoperative radiation therapy. Follow-up periods range from 16 to 66 months. Nineteen patients (18 percent) have had recurrence in the head and neck area. This is better than our past experience with surgical treatment alone in advanced head and neck cancer, in which 50 to 75 percent of patients had local recurrence within the 1st 18 months. When radiation therapy was started no later than 6 weeks after surgery, only 3 of 54 patients (5.5 percent) had local recurrence, but when there was a longer delay 16 of 51 patients (31.5 percent) had recurrence. These results suggest that elective postoperative radiation therapy improves local control in patients with advanced head and neck cancer, but that it should be delivered soon after surgery for maximum effectiveness.

Craniofacial resection following chemotherapy

A patient with intracranial extension of an ethmoidal carcinoma is reported. Since the tumor progressed in size despite conventional radiation and chemotherapy, the patient was treated with Cis-dichlorodiamine platinum). Significant regression in the intracranial component was noted, thus allowing complete excision of the tumor through a craniofacial approach. Preoperative chemotherapy with this agent may have a role in the management of patients with paranasal sinus carcinoma if intracranial extension is present.

cis-Dichlorodiammineplatinum(II)-based chemotherapy as initial treatment of advanced head and neck cancer

During the past 2--3 years, a total of 73 patients with advanced head and neck cancer (mostly stage IV) were treated with cis-dichlorodiammineplatinum(II) (cis-platinum) as initial therapy, either alone or in combination with other agents. After chemotherapy, the patients received surgery and/or radiation therapy in standard fashion. Major degrees of tumor regression were seen in 40%--71% of the patients. cis-Platinum and bleomycin given by infusion gave the highest response rate (71%). The addition of high-dose methotrexate to cis-platinum plus bleomycin produced an unacceptable level of toxicity. Similarly, a four-drug regimen in which low-dose methotrexate and vinblastine were added to cis-platinum and bleomycin resulted in increased toxicity without additional therapeutic effect. Initial chemotherapy does not compromise subsequent surgery or increase either the immediate complications of surgery or the acute toxicity of radiation therapy. It seems unlikely that initial chemotherapy has altered the grim prognosis of an advanced, inoperable presentation. The effect of initial chemotherapy on advanced, operable disease will have to be assessed by suitable controlled trials.