Prognostic significance of the distribution of neck node metastasis from oral carcinoma

BACKGROUND

Carcinoma of the oral cavity presents a high risk for neck metastasis, which reduces the probability of regional control and survival.

OBJECTIVES

The main objective of this study is to analyze prognostic implications of the distribution of neck metastasis in 513 patients with squamous cell carcinoma of the oral cavity.

PATIENTS AND METHODS

All patients underwent surgery from 1970-1992. Tumor stages were I, 63; II, 120; III, 173; and IV, 157. Neck dissections were performed in 448 patients (115 bilateral).

RESULTS

By use of multivariate regression techniques the level of lymph node involvement was the most important prognostic factor (relative risks from 1.8 to 2.5). The following variables were also associated with prognosis: mobility of lymph nodes, sex, T stage, age, and tumor thickness.

CONCLUSIONS

The level of ipsilateral lymph node involvement was the most significant prognostic factor patients with in oral cancer who underwent surgical treatment. A significant decrease in survival also was seen with regard to the involvement of multiple contralateral lymph nodes. Our results support the indication of elective neck dissections in high-risk patients because among the cases that had metastases at follow-up, 50% were not candidates for salvage treatment.

A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms

A randomized blinded clinical trial was performed in 53 patients bitten by Bothrops sp. and Porthidium sp. in Antioquia and Chocó, Colombia, in order to compare the efficacy and safety of two antivenoms made of whole IgG obtained by either ammonium sulphate (monovalent anti-B. atrox) or caprylic acid (polyvalent) fractionation. Additionally, antivenoms were compared by electrophoretic and chromatographic analyses and anticomplementary activity in vitro. With a protocol of 2, 4 and 6 antivenom vials for the treatment of mild, moderate and severe envenomings, respectively, both antivenoms were equally efficient to neutralize the most relevant signs of envenoming and to clear serum venom levels in patients from the first hour and later on. Three patients with severe envenoming and initially treated with less than six vials on admission had persistent or recurrent venom antigenemia within 12-48 h. Monovalent antivenom fractionated by ammonium sulphate precipitation had higher amounts of protein aggregates and nonimmunoglobulin proteins than polyvalent antivenom fractionated by caprylic acid precipitation. Both antivenoms presented anticomplementary activity in vitro, being higher in the monovalent product. In agreement, monovalent antivenom induced a significantly higher incidence of early antivenom reactions (52%) than polyvalent antivenom (25%).

Surgical treatment of lung metastases of head and neck tumors

BACKGROUND

Head and neck tumors often spread to the lungs, with a variety of presentations. The ideal treatment for those patients is still controversial. Resection of lung metastases was shown to significantly influence overall survival of patients.

OBJECTIVE

To evaluate results of surgical resection of lung nodules in patients with head and neck primary tumors.

METHODS

A retrospective analysis was made of 53 patients with head and neck tumors and lung nodules (no other metastases detected in other organs) admitted to our department. They were separated into two groups: OPER (thoracotomy, n = 26), and NOTOPER (no thoracotomies, n = 27). Overall survival was compared (Kaplan-Meier, log-rank) between groups.

RESULTS

Overall median survival of all patients was 10 months, of OPER 20 months, and of NOTOPER 6 months (P <0.0001). Complete resection (n = 19) of lung metastases was associated with the greatest survival rate (median 23 months). Patients submitted to incomplete resection (n = 7) had a median survival of 16 months, compared with 7 months for patients who received only chemotherapy (n = 7) and 4 months for patients (n = 20) with no treatment (P <0.0001).

CONCLUSION

Resection of lung metastases offers a significant survival benefit for patients with head and neck primary tumors, when compared with the current chemotherapeutic regimens. It should be considered for all patients clinically fit and who present with no extrapulmonary disease.

Advancing the time of ovulation in the mare with a short-term implant releasing the GnRH analogue deslorelin

A small, biocompatible and short-term implant releasing 1.5 mg or 2.25 mg of the GnRH analogue deslorelin was evaluated in 140 Hanoverian (warm blooded) mares during the 1990 breeding season (Study I). Mares in oestrus and with a follicle 40 +/- 2 mm in diameter were assigned alternately to treatment (70) or remained as untreated controls. Implants were administered subcutaneously, and intervals to ovulation determined by rectal examination and ultrasound at 12-h intervals. Since results with both doses of deslorelin were similar, data were pooled. Deslorelin implantation resulted in ovulations in 65 of 70 mares within 48 h (93%), while only 5 of 70 control mares ovulated within the same time period (7%) (P < 0.01). Most induced ovulations (63%) occurred 36-48 h after implantation. In Study II, 4 groups of 12 Hanoverian mares each were treated with 3,000 or 5,000 iu hCG, or a 2.25 mg deslorelin implant, or received placebo. All treatments resulted in 100% ovulations within 48 h, versus 25% ovulations in controls (P < 0.01), and 63%, 75% and 86% of these ovulations occurred 36-48 h after treatment with 3,000 and 5,000 iu hCG and deslorelin respectively. Hormonal response to deslorelin in treated mares, sampled every 12 h, consisted of elevations of FSH and LH concentrations of > 200% and > 300% baseline values at 12 h (P < 0.001), of 67% and 79% at 24 h (P < 0.01) and of 35% and 49% at 48 h (P < 0.05), respectively. No local reactions at the implantation site were observed.

Review of patients with multiple injuries treated at University Hospital, Kuala Lumpur

This study has analyzed 260 patients with multiple injuries sustained in road accidents admitted to the University Hospital during the period July 1967 to July 1976, in relation to age, sex, and ethnic distribution. The types of injuries sustained have been discussed to highlight their effects on the community in a developing country. The extremities have been most frequently involved, while head injuries followed closely. The causative factors of multiple injury-producing accidents have been evaluated. The categories of victims most liable to multiple injuries have been discussed. The significance of understanding the mechanism of these accidents and the effect of such knowledge in minimizing diagnostic errors, thus enabling management and the urgent need for regional accident services in developing countries, have been stressed.

A review of patients with skeletal tuberculosis treated at the University Hospital, Kuala Lumpur

Two hundred and nineteen patients with skeletal tuberculosis have been reviewed analysing the site of the lesion and the treatment given. Operative management is advocated since the results of this approach are encouraging.

Prevalence of parasitemia and seroreactivity to Trypanosoma cruzi in a rural population of Northeast Brazil

Age-specific prevalence rates of parasitemia and seroreactivity to Trypanosoma cruzi were determined in a rural area endemic for Chagas' disease in Northeast Brazil. Parasitemia was detected by blood cultures and xenodiagnosis, and serum antibodies to the parasite were measured by the complement fixation (CF) and indirect immunofluorescence (IFA) tests. Of the 116 persons examined, 39 (33.7%) had antibodies and 23 (19.8%) had parasitemia. Ninety-six percent of parasitemic individuals were seropositive and 56% of seropositive individuals were parasitemic. The percentage of seropositive individuals with detectable parasitemia declined with age; all seropositive children in the 1- to 4-year age group and two-thirds of seropositive persons 5-19 years old had parasitemia while only one-third of seropositive adults above 19 years had parasitemia. CF and IFA tests were equally sensitive in detecting persons with parasitemia. Xenodiagnosis was more sensitive than culture for detecting parasitemia, but the two methods together were more sensitive than either method alone. Using the age-dependent relationship of parasitemia to seropositivity determined in this study, the prevalence rate of T. cruzi parasitemia was estimated in a much larger adjacent population in which seropositivity rates and the demographic structure were already known.

A comparative study of road traffic accidents in West Malaysia

The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period 1970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.

Total elbow replacement

This is a report of a total elbow low friction arthroplasty consisting of a vitallium humeral component and a high density polyethylene ulnar component equipped with a special snap-lock fit joint. The immediate results in 16 patients are most encouraging.

An epidemiologic study of osteogenic sarcoma in Malaysia. Incidence in urban as compared with rural environments and in each of three separate racial groups, 1969-1972

To explore the possibility that environmental and/or genetic factors may yield clues to the etiology of osteogenic sarcoma, an epidemiologic retrospective study of all cases of osteogenic sarcoma in a country with clear geographic and racial variables (Malaysia) was conducted covering a 4-year period. Sixty-eight cases were identified (+85% of the predicted total). The incidence (cases per 100,000 population per year) was 0.11 in Malay, 0.23 in the Chinese, and 0.23 in the Indian. The urban versus rural incidence in the Malay was 0.22 versus 0.09, and in the Chinese 0.31 versus 0.18. The Indian population was too small when dividied into urban and rural segments to be significant.

Case of cryptoccosis of spine

Images