BACKGROUND: The technique of free jejunal transfers has been widely used for pharyngoesophageal reconstruction. However, secondary infectious and fistulous complications may develop in extensive and preoperatively high-dose irradiated cases. METHODS: A generous jejunomesenteric composite graft was harvested and the mesenterium was effectively applied for head and neck reconstruction. RESULTS: The mesenteric flap connected with the revascularized jejunum was used as means for obliterating dead space in the head and neck region, as a cover for the cover for the cervical vessels, as a vascularized bolstering for the vascular and enteral anastomoses, or as a vascularized bed for skin grafting when the skin flaps are deficient. Only one small fistula occurred in 10 patients who underwent the mesenteric flap. CONCLUSIONS: This versatile technique is expected to reduce the incidence of postoperative complications in pharyngoesophageal reconstruction using free jejunal transfers.

Adult↗

PubMedDate not supplied

Extramedullary plasmacytoma of the sinonasal cavities: CT evaluation.

Computed tomography was performed in four patients with solitary extramedullary plasmacytoma of the nasal cavity and paranasal sinuses. Two tumors originated in the nasal cavity, one in the maxillary sinus, and one in the frontal sinus. Soft tissue mass(es) was seen in all patients. Bone destruction was apparent in only two patients. It seems possible to rule out carcinomas in such patients with no or subtle bony destruction. Computed tomography was also helpful for planning radiation therapy.

Adult↗

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Adjuvant chemotherapy with oral tegaful and uracil for maxillary sinus carcinoma.

We have applied tegaful and uracil (UFT) treatment as adjuvant chemotherapy to patients after the completion of primary therapy. UFT was given per os at a dose of 300 or 400 mg/day for more than 1 year. A retrospective study was conducted on 15 patients, assessed as the UFT-treated group, and 24 patients assessed as the UFT-nontreated group. The 5-year survival rate in patients treated or not treated with UFT was 76.6 and 22.6%, respectively. Among those who underwent surgery in combination with other therapy, the 5-year survival rate was 74.1% with UFT and 27.3% without UFT. In patients receiving chemotherapy plus radiotherapy alone, the 5-year survival rate was 80.0% with UFT and 19.2% without UFT. In 23 patients with proven effects of neoadjuvant chemotherapy comprising 18 PR cases and 5 CR cases, a comparison was made between 10 patients treated with UFT and 13 patients not treated with UFT. As a result, the 5-year survival was 76.2 and 17.9%, respectively. In the patients with T3 disease, who occupied the majority, the 5-year survival rate was 71.4 and 23.8%, respectively. Adjuvant chemotherapy with UFT tends to show a substantial significant difference particularly in patients who were successfully treated with radiotherapy plus chemotherapy as the primary treatment. UFT was clearly shown to have a statistically significant effect, despite a small population. The findings of the present investigation point to the value of conducting further study to ascertain the effect of UFT by a randomized trial in a larger population.

Adult↗

PubMedDate not supplied

Prognostic factors in stage I and II non-Hodgkin's lymphoma of Waldeyer's ring.

Sixty-nine stage I and II patients treated for non-Hodgkin's lymphoma of Waldeyer's ring were retrospectively analysed. Diffuse histiocytic lymphoma (Rappaport's classification) was the most common histology (67%). Staging without laparotomy revealed 31 patients in stage I and 38 in stage II. Sixty-five patients received radiation therapy against involved or extended fields. In 43 patients adjuvant chemotherapy with single or multiple agents was given and 4 patients received only chemotherapy. A relapse occurred in 34 (49%) patients. The 5-year relapse-free survival was 67 per cent and 36 per cent in stage I and stage II, respectively. Radiation doses of 50 Gy gave no recurrence within treated volumes. However, since relapse below the clavicles and especially below the diaphragm was common, the radiation doses did not seem important for reduction of the overall failure rate. In stage II, patients with a single neck node less than 5 cm in diameter seemed to have a better prognosis than patients with large or multiple neck nodes. In this non-randomized study adjuvant chemotherapy seemed to reduce the risk of relapse, especially in stage II patients.

Adolescent↗

PubMedDate not supplied

Treatment of non-Hodgkin lymphomas in the nasal cavities and paranasal sinuses. A failure analysis.

Twenty-five patients with sinonasal lymphoma were treated mainly with irradiation. All were non-Hodgkin lymphomas of diffuse type. Twenty patients had stage IA, 2 had stage IB, 1 stage IIA, 1 stage IIIA, and 1 stage IVA disease. Relapse developed in 16 (64%) of the 25 patients, with a failure rate of 64 per cent in the stage I patients (14/22). Most patients with failures had distant spread of the disease with or without local recurrence. Only one patient had local recurrence alone at the first relapse. Histologic classification according to the new working formulation seemed to be a reliable prognostic indicator for relapse: failure rates for low, intermediate, and high grade lymphomas were 0 per cent (0/2), 46 per cent (6/13), and 100 per cent (10/10), respectively. Computed tomography was valuable for planning of radiation therapy and for follow-up.

Adolescent↗

PubMedDate not supplied

[Feasibility of autologous graft of the larynx in dogs].

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Animals↗