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At least 199 records · Page 11Linked to original sources
PubMed1995

An increase of neuropeptide Y but not nitric oxide synthase-immunoreactive nerves in the bladder neck from male patients with bladder neck dyssynergia.

PURPOSE: To determine the distribution of neuropeptides in male patients with bladder neck dyssynergia and benign prostatic hyperplasia. MATERIALS AND METHODS: Bladder neck tissue, obtained from male patients with bladder neck dyssynergia (BND) and control patients with benign prostatic hyperplasia (BPH), was studied immunohistochemically for protein gene product 9.5 (a general neuronal marker), vasoactive intestinal polypeptide, neuropeptide Y, calcitonin gene-related peptide, substance P, growth associated protein 43 and nitric oxide synthase. RESULTS: In the bladder neck from control patients, the greatest density of nerves contained protein gene product 9.5, followed in decreasing order by neuropeptide Y; vasoactive intestinal polypeptide; calcitonin gene-related peptide; nitric oxide synthase; substance P and serotonin. The neuropeptides were found in the smooth muscle and were also associated with blood vessels. In patients with BND there was a statistically significant increase (P < 0.05) in the density of protein gene product 9.5- and neuropeptide Y-immunoreactive nerves in the smooth muscle and the base of the mucosa but not in blood vessels in the bladder neck, while the density of the other neuropeptides studied, nitric oxide synthase and serotonin did not significantly change from that of control tissue. Growth associated protein 43-immunoreactive nerves were absent from the bladder neck from both groups of patients. CONCLUSION: It is suggested that the increase in density of protein gene product 9.5- and neuropeptide Y-immunoreactive nerves, part of the sympathetic contractile system of the bladder neck, may exacerbate bladder outlet obstruction and thus play a role in the pathogenesis of BND.

Adult↗
PubMed2004

Shoulder and neck morbidity in quality of life after surgery for head and neck cancer.

BACKGROUND: Quality of life has become a major issue in determining the outcome of treatment in head and neck surgery with curative intent. The aim of our study was to determine which factors in the postoperative care, especially shoulder and neck morbidity, are related to quality of life and how these outcomes compared between patients who had undergone surgery and a control group. METHODS: We analyzed physical symptoms, psychological symptoms, and social and functional well-being at least 1 year after surgery and evaluated the differences in quality of life between patients who had undergone head and neck surgery and a control group. RESULTS: Depression scores contributed significantly to all domains of quality of life. Reduced shoulder abduction, shoulder pain, and neck pain are related to several domains of quality of life. The patient group scored significantly worse for social functioning and limitations from physical problems but scored significantly better for bodily pain and health changes. CONCLUSION: Depression and shoulder and neck morbidity are important factors in quality of life for patients who have undergone surgery for head and neck cancer.

Case-Control Studies↗
PubMed2002

A proposal for redefining the boundaries of level V in the neck: is dissection of the apex of level V necessary in mucosal squamous cell carcinoma of the head and neck?

In 1991, the Committee for Head and Neck Surgery and Oncology of the American Academy of Otolaryngology-Head and Neck Surgery proposed to define the anatomic boundaries between the lymph node levels in the neck, as initially described by the Memorial Sloan-Kettering Cancer Center (New York, NY). Recently, radiological parameters have been outlined to identify boundaries between various neck levels. The lymphatics of the posterior triangle of the neck are gathered in level V, recently subdivided into 2 subgroups: level Va and level Vb. The superior boundary of level Va is defined by the apex of the convergence of the sternocleidomastoid muscle and trapezius muscle. Based on anatomic evidence and surgical experience, we advocate the subdivision of level Va into 2 sections: the apex of level Va or level Vas (superior) and level Vai (inferior), demarcated by the lower two thirds of the spinal accessory nerve. Dissection of level Vas is not necessary in most head and neck cancers but should be considered only in selected skin cancer of the posterior cephalic area (retroauricular region, occipital scalp).

Carcinoma, Squamous Cell↗
PubMed2000

Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy.

BACKGROUND: To evaluate the outcome after surgery and radiotherapy for extensive nodal disease in patients with primary head and neck cancer. METHODS: Between 1973 and 1995, 77 from a total of 1398 patients had histopathologic evidence of positive margins in 85 neck dissection specimens for squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. Postoperative radiotherapy with a curative dose was given to 50 necks. Ipsilateral neck recurrence was defined as the relevant event, and cumulative survival distributions were estimated by the Kaplan-Meier method. Differences between groups were analyzed with the log rank test. RESULTS: Disease-free survival was 24.9% at 2 years, and disease-specific survival was 33.6% at 2 years. After restriction of the 50 patients who received postoperative curative radiotherapy, the time to neck recurrence was stratified according to irradiation dosage, with 62.5 Gy as the cutoff point. A statistically significant difference was found for patients treated with 62.5 Gy or more, with a regional control rate of 75.6% at 2 years (p <.036). CONCLUSIONS: The overall outcome after neck dissection with positive surgical margins is poor. Considerable improvement is achieved by postoperative radiotherapy treatment with dosages of 62.5 Gy or more.

Adult↗
PubMed2004

Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer.

PURPOSE: The purpose of this study was to evaluate the role of neck lymph node (ND) in the combined dissection modality therapy for locoregionally advanced head and neck. METHODS: We identified patients with N2-N3 head and neck cancers who were enrolled in three consecutive multicenter phase II studies of concurrent chemoradiotherapy utilizing 5-fluorouracil and hydroxyurea on an alternate-week schedule with radiotherapy twice daily plus either cisplatin (C-FHX) or paclitaxel (T-FHX). Patients with unknown primary tumors, nasopharyngeal or paranasal sinus primaries, nonsquamous histology, progression or death during therapy, or incomplete therapy were excluded. RESULTS: A total of 131 patients were analyzed. Seventy-nine percent had N2 stage. ND was performed in 92 patients (70%), either prior to enrollment (n = 31) or after chemoradiotherapy (n = 61). With a median follow-up of 4.6 years, the 5-year locoregional and neck progression-free survival (PFS) rates were higher in patients with ND versus patients without ND: 88% versus 74% (p =.02) and 99% versus 82% (p =.0007). respectively; there was also a trend toward improved overall survival (OS) with ND, but PFS and distant PFS were comparable. In the subset of patients with N3 disease, ND was associated not only with better locoregional control but also with improved distant PFS. However, in patients with clinical complete response (n = 92), no significant differences in PFS (68% vs 75% at 5 years, p =.53) or any other survival parameters with or without ND were observed. CONCLUSIONS: ND improves neck control and is required for patients with clinically residual disease or N3 neck cancer but has no significant impact on the outcome of patients with N2 stage disease who are rendered clinically disease-free with intensive concurrent chemoradiotherapy.

Adolescent↗
PubMed2006

Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all?

In the absence of large-scale randomized trials evaluating dissection versus observation of the involved neck after neoadjuvant chemoradiotherapy, there is a need to collect data that will either support or ultimately refute a role for planned posttreatment neck dissection. A significant percentage of patients with extensive (N2 or N3) neck disease who demonstrate a complete response to chemoradiation therapy may harbor residual occult metastases, and identification of this subset of patients remains a clinical challenge. Because surgical salvage rates are greatly diminished when occult nodal disease becomes clinically manifest, planned posttreatment neck dissection is advocated but may not be necessary in all patients. The role of positron emission tomography chemoradiotherapy (PET-CT) in this scenario remains unproven but holds promise in being able to identify which patients may be harboring residual disease in the neck after chemoradiotherapy. The implementation of as yet unidentified molecular tumor markers in combination with PET-CT may ultimately prove to be effective in identifying patients who will best benefit from posttherapy neck dissection. Correlation of imaging results and pathologic node status will be important in determining the accuracy and, therefore, the value of this imaging modality for predicting the presence or absence of residual disease.

Carcinoma, Squamous Cell↗
PubMed2006

Elective lateral neck dissection for laryngeal cancer in the clinically negative neck.

BACKGROUND: Despite the introduction of modern imaging techniques, it is still difficult to detect microscopic disease in neck nodes. The purpose of this study is to evaluate the efficacy of the lateral neck dissection (LND) for elective treatment of the clinically node negative neck (cN0) in laryngeal squamous cell carcinoma (SCC). METHODS: The clinical records of 110 cN0 patients with laryngeal SCC treated in this hospital from January 1997 to December 2002 were reviewed retrospectively. RESULTS: One hundred ten patients received 145 elective LND. Occult metastasis was detected in 22 (20.0%) of this group of patients. The distribution of the 37 positive nodes was as follows: Level II 56.8%; Level III 37.8%; Level IV 5.4%. The 3-year neck recurrence rate estimated by the Kaplan-Meier approach for all cN0 patients (n = 110) was 5.4% [95% CI: 0.0%; 12.5%]. No significant difference in 3-year lymph node recurrence was found between node negative and node positive groups, between supraglottis and glottis groups, or between surgery alone and combined therapy groups. CONCLUSION: The lateral neck dissection is effective in elective treatment of the neck in patients with laryngeal carcinoma.

Adult↗
PubMed2000

Selective neck dissection and sentinel node biopsy in head and neck squamous cell carcinomas.

The Sentinel Node concept is now well established for HNSCC and gives us a strong basis to treat patients with N0 neck where the rate of occult node metastasis is high. At the present time, the most accurate method for staging N0 neck is pathologic examination of the neck content. In this way, sentinel node dissection (SND) and sentinel node biopsy (SNB) are complementary surgical procedures. SNB has limited indications in HNSCC because of the inaccessibility of most of the primary sites to local injection of Tc99m colloid. However it seems to be an encouraging approach for small tumors of the oral cavity. In other primary sites, except for small glottic tumors, patients must undergo an SND. Supraomohyoid neck dissection which removes levels I, II and III, is performed in oral cavity tumors. Lateral neck dissection which removes levels II, III and IV, is used by many authors for laryngeal, oropharyngeal and hypopharyngeal tumors. In our experience, SND could be limited to levels II and III for laryngeal and oropharyngeal tumors without more neck failures. SND is a reliable procedure, we report only 1.5% of skip nodal metastases in 464 patients who had this staging procedure.

Carcinoma, Squamous Cell↗
PubMed1996

Effect of neck posture on patterns of activation of feline neck muscles during horizontal rotation.

The electromyographic (EMG) patterns of neck muscles were recorded during whole-body horizontal rotation in head-free, alert cats and head-restrained, decerebrate cats. In some trials the cervical column of the animal was oriented vertically, whereas in others it was oriented more horizontally. In alert cats making head movements that compensated for the motion of the platform, neck muscles with modulated patterns of activity could be divided into a subset whose individual EMG patterns changed significantly when the neck posture was altered (including longissimus capitis, obliquus capitis superior and scalenus anterior) and a subset whose individual EMG patterns were invariant regardless of neck posture (including obliquus capitis inferior, levator scapulae and complexus). In head-restrained, decerebrate cats, electromyograms from all implanted muscles were modulated similarly in phase with the platform position. Changing the orientation of the neck had little effect upon these EMG patterns evoked by the horizontal vestibulocollic reflex. One decerebrate cat with strong extensor tone was tested further under head-free conditions. There was very little compensatory head movement, but individual neck muscles displayed patterns of activity that were more similar to those observed in alert, head-free animals.

Adaptation, Physiological↗
PubMed2005

Surgical technique--unwrapping the neck node levels around a sternocleidomastoid muscle bar: a systematic way of performing (modified) radical neck dissection.

AIM: Description of a systematic approach to the neck for removal of lymph node bearing tissues in levels I-V. METHOD: A (modified) radical neck dissection is divided in three steps: (1) Dissection of levels I-IV, (2) dissection of level V and (3) transection of SCM bar and finalisation of the dissection. The sternocleidomastoid muscle (SCM) is used as a "bar", around which the different neck levels can be systematically unwrapped, warranting permanent cranio-caudal tension of the neck specimen, while anatomical relations remain intact. RESULTS: In a group of 115 (modified) radical en bloc neck dissections with or without post-operative radiotherapy 10% regional recurrences, 2% post-operative chylous fistulas and < 5% post-operative wound infections occurred. The overall 5 years survival was 45% (95% confidence interval: 36-54%). CONCLUSION: A systematic unwrapping of lymph node levels around the sternocleidomastoid bar provides a reliable systematic method for performing (modified) radical neck dissections without a negative influence on clinical outcome.

Head and Neck Neoplasms↗
PubMed2004

Can post-RT neck dissection be omitted for patients with head-and-neck cancer who have a negative PET scan after definitive radiation therapy?

PURPOSE: A prospective, single institution study was conducted to evaluate the role of positron emission tomography with fluoro-deoxyglucose (FDG) before and after definitive radiation therapy for patients with head-and-neck cancer. Correlation with CT or MRI imaging and pathologic findings at the time of planned neck dissection was made. METHODS AND MATERIALS: Twelve patients with AJCC Stages III-IV cancer of the head and neck received CT or MRI and PET imaging before treatment with definitive radiation therapy. One month after completion of treatment, repeat CT or MRI and PET imaging was obtained. All images were reviewed independently by radiologists who were blind to the results of the other modality. Patients then underwent planned neck dissection. Pathologic correlation with posttreatment scans allowed calculation of the sensitivity, specificity, negative predictive value, and the positive predictive value for both CT/MRI and PET. RESULTS: Comparison of CT/MRI to PET obtained before definitive RT revealed both primary tumor and nodal disease were detected by both modalities in all cases where primary tumor was known. After RT, comparison of CT/MRI imaging to findings of neck dissection revealed a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 50%. Comparison of PET imaging with pathologic findings demonstrated sensitivity of 45%, specificity of 100%, positive predictive value of 100%, and a negative predictive value of 14%. CONCLUSIONS: In this small series of patients, the presence of a positive PET 1 month after RT accurately indicated the presence of residual disease in all cases; however, a negative PET indicated absence of disease in only 14%. Further investigation is warranted before FDG-PET should be used to determine whether post-RT neck dissection should be omitted.

Carcinoma, Squamous Cell↗
PubMed2000

[Neck abscess as primary manifestation of head and neck carcinoma: implications for diagnostic management].

BACKGROUND: Neck abscesses and deep neck infections are common diseases in the field of otorhinolaryngology. However, malignant lymph node metastases presenting as abscesses are uncommon and have rarely been described up to now. PATIENTS: A retrospective review between March 1997 and August 1999 was conducted of 40 patients with deep neck abscesses. RESULTS: In five patients (12.5%) the histological diagnostics revealed a malignancy. From these, in 3 cases the cervical abscess was the primary clinical symptom of an oropharyngeal as well as a hypopharyngeal carcinoma. With further 2 patients, the neck-abscess was located as first clinical sign of a metachronous lymph node metastases after oropharyngeal carcinoma. Aerobic bacteria were recovered in 18 patients, anaerobes alone in 3 and mixed aerobic and anaerobic bacteria in 6 patients. Bartonella henselae was recovered in 7, Mycobacterium tuberculosis in 3 and Actinomyces israelii in 1 patient. CONCLUSIONS: A biopsy of the abscess wall is recommended in establishing the diagnosis. The indication for a simultaneous panendoscopy--especially in patients with typical risk for malignancies--to exclude a primary tumor in the aerodigestive tract should be regarded generously. Neck abscesses should be considered in the differential diagnosis of head and neck carcinoma.

Abscess↗
PubMed2001

Treatment of neck laxity with a Gore-Tex cervical sling for patients with heavy neck tissues.

Treatment of neck laxity is a challenging problem for facial plastic surgeons. Many factors may contribute to this problem, including relaxation of the SMAS- platysma complex, excess submental adipose tissue, loss of skin elasticity, and anatomic factors such as hyoid position. Patients with heavy tissues in the neck area are more likely to have disappointing or short-lived results from neck rejuvenation surgery. Placement of an expanded-polytetrafluoroethylene (Gore-Tex) cervical sling provides additional support to the soft tissues of the neck, improving both initial and long-term cervical contours. This method is used in our practice for most patients with heavy neck tissues undergoing lower facial rejuvenation procedures. The cervical sling is well tolerated and provides the additional benefit of easy adjustability should the soft tissues of the neck further relax.

Humans↗
PubMed2005

Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety.

OBJECTIVE: The smooth pursuit neck torsion test is thought to be a measure of neck afferent influence on eye movement control and is useful in assessing subjects with whiplash, especially those complaining of dizziness. Nevertheless, it is not known whether impairments identified relate only to abnormal cervical afferentation or are influenced by levels of anxiety or neck pain. DESIGN: A prospective, 3-group, observational design. SUBJECTS: One hundred subjects with persistent whiplash (50 complaining of dizziness, 50 not complaining of dizziness) and 50 healthy controls. METHODS: The smooth pursuit neck torsion test was performed and analysed taking into account subjects' reported levels of pain, anxiety and dizziness. RESULTS: The results confirm that there are significant (p<0.01) differences in the smooth pursuit neck torsion test between subjects with persistent whiplash both with dizziness (mean 0.11) and without dizziness (mean 0.07) compared with healthy control subjects (mean 0.01). The results suggest that the test is not influenced by a patients' level of anxiety, but may be influenced by both nocioceptive and proprioceptive factors. CONCLUSION: The results provide further evidence of the usefulness of the smooth pursuit neck torsion test to identify eye movement disturbances in patients with whiplash, which are likely to be due to disturbed cervical afferentation.

Adult↗
PubMed2005

Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort.

STUDY OBJECTIVE: To assess the impact of mechanical exposure and work related psychosocial factors on shoulder and neck pain. DESIGN: A prospective cohort study. PARTICIPANTS: 4919 randomly chosen, vocationally active men and women ages 45-65 residing in a Swedish city. Neck and shoulder pain were determined by the standardised Nordic questionnaire. Mechanical exposure was assessed by an index based on 11 items designed and evaluated for shoulder and neck disorders. Work related psychosocial factors were measured by the Karasek and Theorell demand-control instrument. MAIN RESULTS: High mechanical exposure was associated with heightened risk for shoulder and neck pain among men and women during follow up. Age adjusted odds ratios (OR) were 2.17 (95% confidence intervals (CI): 1.65, 2.85) and 1.59 (95% CI: 1.22, 2.06), respectively. In women, job strain (high psychological job demands and low job decision latitude) correlated with heightened risk (OR = 1.73, 95% CI: 1.29, 2.31). These risk estimates remained statistically significant when controlled for high mechanical exposure regarding job strain (and vice versa), and for sociodemographic factors. Testing for effect modification between high mechanical exposure and job strain showed them acting synergistically only in women. CONCLUSION: Job related mechanical exposure in both sexes, and psychosocial factors in women, seem independently of each other to play a part for development of shoulder and neck pain in vocationally active people. The effect of psychosocial factors was more prominent in women, which could be the result of biological factors as well as gender issues. These results suggest that interventions aiming at reducing the occurrence of shoulder and neck pain should include both mechanical and psychosocial factors.

Aged↗
PubMed2005

Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer.

BACKGROUND: This study evaluates the utility of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients with a node-positive mucosal head and neck squamous cell carcinoma who achieved a complete response at the primary site but had a residual mass in the neck 8 weeks or more after definitive (chemo)radiotherapy. METHODS: Between October 1996 and July 2002, 39 eligible patients were identified. The reference PET scan was performed at a median of 12 weeks (range, 8-32 weeks) after treatment. RESULTS: PET showed no metabolic activity in the residual mass in 32 patients. Five of these patients had a neck dissection and were all pathologically negative. The remaining 27 patients were observed for a median of 34 months (range, 16-86 months), with only one locoregional failure. The negative predictive value of PET for viable disease in a residual anatomic abnormality was 97%. CONCLUSION: Patients who have achieved a complete response at the primary site but have a residual abnormality in the neck that is PET negative approximately 12 weeks after treatment do not require neck dissection and can be safely observed. Head Neck

Adult↗
PubMedDate not supplied

Elective neck irradiation in squamous-cell carcinoma of the head and neck.

One hundred fifty-nine patients with squamous-cell carcinoma of the oral cavity, oropharynx, nasopharynx, hypopharynx, and supraglottic larynx, and with clinically negative neck (Stage NO) were reviewed to determine the value of elective neck irradiation (ENI). The primary cancer was controlled in 125 patients; in these patients the neck failure rate was 1.9% with ENI and 18% without ENI. Recurrence in the neck in cases where the primary cancer was controlled was associated with an increased risk of death due to cancer. The primary cancer was not controlled in 34 patients; in these patients the neck failure rate was 25% with ENI and 67% without ENI. Ten of 11 patients in whom treatment failed both at the primary site and in the neck died of cancer despite attempts at surgical salvage. ENI may be associated with an increased risk of local failure in oral tongue lesions as a result of a decreased proportion of treatment given with interstitial therapy.

Carcinoma, Squamous Cell↗
PubMed2006

Efficacy of supraomohyoid neck dissection in patients with oral squamous cell carcinoma and negative neck.

BACKGROUND: Supraomohyoid neck dissection (SOHND) has been identified as an appropriate staging procedure to provide valuable pathologic information of the neck for patients with oral squamous cell carcinoma. However, the role of SOHND as a therapeutic procedure, compared with the oncologic results of radical neck dissection, remains controversial for lack of adequate data in current literature. METHODS: Patients with oral SCC who underwent elective SOHND and radical neck dissection (RND) between January 1, 1993, and December 31, 1999, were retrospectively reviewed. The 2 types of treatment were analyzed for incidence of neck recurrence and survival probabilities. RESULTS: No significant differences were found between patients treated with SOHND versus RND. Occult metastasis rate, regional disease-free survival, overall and disease-free survival, and distant metastasis-free survival rates were found to be comparable. CONCLUSIONS: SOHND compares favorably with RND for the staging and treatment of patients with oral squamous cell carcinoma and negative neck.

Adult↗