Recurrent head and neck cancer: the results of treatment

A study of 144 patients with cancer of the head and neck showed that 67 (46 per cent) developed recurrent cancer. Radical second treatment, almost exclusively by surgery, secured an 11 out of 67 or 16 per cent crude 5-year survival rate for recurrent head and neck cancer. Further analysis showed that the prospects of successful second treatment were negligible or nil with certain identifiable tumours or tumour sites. When these identifiable cases are excluded the survival rate for head and neck cancer became 11 out of 45 or 24 per cent. Age and general condition rendered some patients unfit for radical surgery. In this series 30 patients were treated by radical surgery with a patients cured: patients surgically treated ratio of 11 out of 30 or 36 per cent.

Echocardiographic features of endocardial cushion defects

The echocardiographic features of endocardial cushion defects were defined in 28 patients. Two basic characteristics, common to both complete and incomplete forms of endocardial cushion defects, were found. First, the mitral valve excursion was not seen best in the usual location as defined by intraventricular landmarks. Secondly, the mitral valve echoes in cases where there are dense attachments of the mitral leaflet to the crest of the interventricular septum may be traced to the rightward and anterior border of the left ventricular outflow tract. This is the echocardiographic representation of the characteristic "goose-neck" deformity seen angiographically.

Two additional paterns were recognized in patients with complete atrioventricular (A-V) canal. In Pattern I, a large, single, A-V valve was found occupying a central location between the two ventricles. During diastole, the superior segment moved anteriorly into the right ventricle and the inferior segment posteriorly into the left ventricle. In Pattern II, a large single A-V valve moved from the left ventricle in systole into the right ventricle in diastole. This pattern was specific to patients with common A-V valve leaflets.

Anterior approach to recurrent chordomas of the clivus. Technical note

✓ A modified transpalatal transclival approach was used for removal of two recurrent tumors of the clivus. New features of the exposure include placing the mucosal incision immediately behind the line of the upper teeth, removal of the posterior third of the hard palate, increased mobilization of the soft palate, and removing the posterior ends of the inferior turbinals.