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PubMed2002

[Strategy of neck dissection in parotid cancer].

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.

Adolescent↗
PubMed2005

[Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck].

OBJECTIVE: This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice. METHODS: Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed. RESULTS: Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control. CONCLUSIONS: Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.

Adult↗
PubMed2005

Reliability of a measurement of neck flexor muscle endurance.

BACKGROUND AND PURPOSE: Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both with and without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. SUBJECTS: Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. METHODS: Two raters used an isometric neck retraction test to assess neck flexor muscle endurance for all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. RESULTS: For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82-.91), and interrater reliability was moderate to good (ICC[2,1]=.67-.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate (ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (mean=38.95 seconds, SD=26.4) and the group with neck pain (mean=24.1 seconds, SD=12.8) were significantly different. DISCUSSION AND CONCLUSION: Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.

Adult↗
PubMed2006

Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Among patients with cutaneous squamous cell carcinoma (SCC) of the head and neck, recent studies have shown that those with involvement of the parotid gland also have a high incidence of neck node involvement. Treatment of the neck by either surgery or radiotherapy is therefore recommended among patients with parotid SCC, even if clinical examination is negative. The aim of this study was first to analyze patterns of metastatic spread in the parotid and cervical lymph nodes and then to correlate the pattern of involved nodes with the primary cutaneous site in order to guide the appropriate extent of surgery, should neck dissection be used to treat the neck in patients with parotid SCC. METHODS: A cohort of 209 patients with cutaneous SCC of the head and neck and clinically evident regional metastatic disease was reviewed retrospectively from 3 Australian institutions. The distribution of involved nodes was obtained from pathology reports; the anatomic sites of primary cutaneous cancers were then correlated with these findings. RESULTS: Among 209 patients, 171 (82%) had clinical parotid involvement. Of these, 28 had clinical neck disease, whereas 143 had parotid disease alone. Thirty-eight (18%) patients had neck disease only. A total of 199 patients were treated surgically, whereas 10 received radiotherapy alone. Surgery included 172 parotidectomies and 151 neck dissections (93 of which were elective). Primary sites were cheek (21.7%), pinna (20.4%), temple (15.8%), forehead (15.8%), postauricular region (5.9%), neck (5.3%), anterior scalp (5.3%), posterior scalp (3.3%), periorbital (3.3%), nose (2.6%), and chin (0.6%). Among pathologically positive necks, level II was most frequently involved (79%). Level IV (13%) and level V (17%) were only involved in extensive lymph node disease, the exception being for isolated level V metastases from the posterior scalp. CONCLUSIONS: Primary sites were mainly localized to the lateral aspect of the head. Among patients with cutaneous SCC involving the parotid and neck, level II was the most commonly involved neck level. The distribution of involved nodes suggests that in a patient with parotid involvement and a clinically negative neck with an anterolateral primary, a supraomohyoid neck dissection, always including the external jugular lymph node(s) would be appropriate. In the case of a posterior primary, level V should be dissected as well. In patients with parotid SCC and a clinically positive neck, a comprehensive neck dissection is recommended.

Adult↗
PubMed2004

Predicting persistent neck pain: a 1-year follow-up of a population cohort.

STUDY DESIGN: A population cohort study to determine the 1-year persistence of neck pain. OBJECTIVES: The aim of this study was to determine the persistence of neck pain over a 12-month period among the general adult population and to explore socio-demographic, health-related, occupational, physical, and lifestyle factors that might be linked to such persistence. SUMMARY OF BACKGROUND DATA: Musculoskeletal clinicians report that neck patients frequently return to consult for recurring episodes of pain. However, the persistent nature of neck pain has been less researched than other common chronic pain syndromes. METHODS: First, to identify a cohort of current neck pain sufferers, a baseline cross-sectional survey was conducted in a general population of 7,669 adults, 18 to 75 years of age, registered with two primary care practices in South Manchester, UK. The second phase was a follow-up survey, 12 months later, to determine the 1-year persistence of neck pain among those who had reported neck pain at baseline. Persistence of neck pain was compared across groups of responders stratified by potential prognostic factors measured at baseline. "Persistent" neck pain was defined according to shading within the region of the neck on a blank body mannequin. The term "persistent" neck pain could therefore reflect chronic, recurrent, or continuous pain. RESULTS: There were 1,359 neck pain responders in the baseline survey, and these subjects formed the study population for the prospective study. At follow-up, 786 (58%) subjects responded, of whom 48% reported having neck pain lasting for more than 1 day, during the previous month. Significant baseline characteristics, which independently predicted persistent neck pain, were age (odds ratio [OR] = 3.4), being off work at the time of the baseline survey (OR = 1.6), comorbid low back pain (OR = 1.6), and cycling as a regular activity (OR = 2.4). CONCLUSION: Among the general population, neck pain persists at 12 months in around half of those who report neck pain at the start of the period. An increased risk of persistent neck pain was associated with age 45 to 59 years and low back pain, and also with cycling. The link with psychological distress and the absence of a link with occupational factors compares with other previous findings for common musculoskeletal syndromes in the community.

Adolescent↗
PubMed2006

The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device.

OBJECTIVE: Endovascular repair of abdominal aortic aneurysm (AAA) is complicated by the potential for stent graft migration over time. Factors including the type of fixation, initial proximal fixation length, and dilation and elongation of the infrarenal aortic neck may contribute to device migration. We sought to determine when device migration is a real phenomenon with actual device movement that compromises aneurysm exclusion. METHODS: Computed tomographic (CT) scans and computer reconstructions of all patients undergoing endovascular AAA repair with a passive fixation device at our institution from June 1996 to October 2004 were retrospectively reviewed. The distance from the distal renal artery to the proximal end of the stent graft at the time of initial deployment was determined for each patient. Migration was defined as a distance increase greater than 5 mm in the follow-up period; proximal fixation length, aortic neck enlargement and elongation, and neck angle were then measured. Data were further analyzed with respect to AAA growth, development of endoleak, AAA rupture, and the need for reintervention. RESULTS: A total of 308 patients with endovascular AAA repairs using a passive fixation device had complete postoperative imaging data sets; 48 patients (15.6%) with stent graft migration of 5 mm or more were identified, and 25 (8.1%) of these had a migration of 10 mm or more. Seventeen (35.4%) of 48 migration patients had a total loss of the proximal seal zone (loss patients); their average migration distance was 17.7 +/- 12.0 mm, with a mean neck shortening of 13.6 +/- 14.2 mm, and the average proximal fixation length loss was 14.0 +/- 7.6 mm. Those 31 patients with an intact proximal seal zone (nonloss patients) showed an average migration of 9.4 +/- 3.7 mm, with a mean neck lengthening of 9.6 +/- 8.4 mm and an average proximal fixation length change of 0.7 +/- 8.0 mm. Univariate analysis demonstrated significant differences between the loss and nonloss patients in follow-up duration (65.9 +/- 20.4 months vs 45.9 +/- 26.4 months; P = .01), neck dilatation at the distal renal artery (4.6 +/- 4.5 mm vs 1.8 +/- 1.9 mm; P = .026), stent graft migration distance (17.7 +/- 12.0 mm vs 9.4 +/- 3.7 mm; P = .001), change in aortic neck length (-13.6 +/- 14.2 mm vs 9.6 +/- 8.4 mm; P < .0001), change in proximal fixation length (-14.0 +/- 7.6 mm vs 0.7 +/- 8.0 mm; P < .0001), change in AAA size (1.8 +/- 7.1 mm vs -3.6 +/- 9.7 mm; P = .033), and use of a stiff body stent graft (47.1% vs 19.4%; P = .043). However, only change in aortic neck length was statistically significant on multivariate analysis (odds ratio, 0.75; 95% confidence interval, 0.591-0.961; P = .022). There were no differences between the loss and nonloss patients in time to migration discovery, initial AAA size, initial aortic neck diameter or length, initial device oversizing, initial neck angle, neck angle increase, type II endoleak, or AAA rupture. Eight of the 17 loss patients have been treated with proximal aortic cuffs; the remainder have refused reintervention, died of unrelated causes, or elected to have open repair. CONCLUSIONS: Postoperative elongation of the infrarenal aortic neck may create the radiographic perception of migration without necessarily causing a loss of proximal stent graft fixation. Patients with a total loss of the proximal seal zone actually have infrarenal aortic neck shortening, with a degree of neck dilatation beyond initial device oversizing that may compromise proximal fixation length. Conversely, those with an intact proximal seal zone demonstrate aortic neck elongation equivalent to migration, with no loss of proximal fixation length; these patients have a benign natural history without intervention. Thus, aortic neck dilatation beyond oversizing, aortic neck shortening, and loss of proximal fixation length are more clinically relevant predictors of proximal stent graft failure than simple migration distance.

Angioplasty↗
PubMed1999

Extent of lymphadenectomy achieved by various modifications of neck dissection: a pathologic analysis.

OBJECTIVES: Quantify the extent of lymphadenectomy achieved by the various modifications of neck dissection based on microscopic pathologic analysis. STUDY DESIGN: Retrospective review of neck specimens of patients who underwent neck dissection for head and neck malignancies at our institution over a 5-year period. METHODS: Charts and pathology report findings on patients who underwent neck dissection were reviewed. Patients who received preoperative chemotherapy or radiation therapy to the neck were excluded. The number of lymph nodes documented by pathologic microscopic examination for each specimen was recorded. RESULTS: There were 164 neck specimens on 135 patients (29 patient had simultaneous bilateral neck dissection). Those were divided into four groups based on the nonlymphatic structures preserved. There were 58 radical neck dissections (radical neck dissections) (group 1), 50 modified radical neck dissections sparing the eleventh cranial nerve (group 2), 15 modified radical neck dissections sparing the eleventh cranial nerve and internal jugular vein (group 3), and 33 modified radical neck dissections sparing the eleventh cranial nerve, internal jugular vein, and sternocleidomastoid muscle (group 4). The remaining 8 had other modifications of radical neck dissection. The mean number of lymph nodes found per specimen was 34 in group 1, 27 in group 2, 31 in group 3, and 22 in group 4. We performed one-way between-group analysis of variance (ANOVA). Pair-wise comparisons of means were carried out subsequent to ANOVA utilizing the Fisher Exact Test. Group 4 was significantly different from all other groups. Additionally, group 2 significantly differed from group 1. CONCLUSIONS: The extent of lymphadenectomy achieved by neck dissection decreases as the number of nonlymphatic structures preserved in the neck increases. The impact of this finding on the pathologic staging or prognosis needs further analysis.

Accessory Nerve↗
PubMed1999

Treatment of the clinically negative neck in oral squamous cell carcinoma.

OBJECTIVE: To define the most effect treatment plan of patients with oral cavity squamous cell carcinoma with clinically negative (NO) neck staging. STUDY DESIGN: Retrospective review of 54 patients with NO neck staging who underwent resection of an oral cavity primary tumor with or without elective neck dissection between January 1982 and December 1992 and with a minimum follow-up of 3 years. METHODS: The records of 54 patients with previously untreated oral cavity squamous cell carcinoma and NO neck staging were retrospectively reviewed to determine the impact of elective neck dissection on patient outcomes including regional recurrence and overall survival. RESULTS: All patients underwent surgical resection of their oral cavity tumors, with 33 patients undergoing "watchful waiting" observation for the development of neck disease while 21 patients had elective neck dissections. The most controversial group of patients were those with intermediate-sized (T2 and T3) primary tumors. Eighteen of these patients underwent elective neck dissection, with two patients developing recurrent neck disease and an ultimate prognosis of 72%. Twelve patients had observation of their necks, with five of these patients subsequently requiring neck dissection. An additional seven patients did not undergo neck dissection, and this group had four survivors free of disease. The prognosis was 42% in patients not having elective neck dissections. CONCLUSIONS: T1 tumors do well with neck treatment other than careful observation. The data suggest that patients with T2 and T3 oral squamous cell carcinoma should undergo surgical resection of their primary tumor site and elective neck dissection. Patients with T4 oral cavity lesions should routinely undergo neck dissection.

Adult↗
PubMed1980

Responses of Purkinje cells of cerebellar vermis to sinusoidal rotation of neck.

1. The response of Purkinje (P) cells located in the vermal cortex of the cerebellar anterior lobe to sinusoidal rotation of the neck was investigated in precollicular decerebrate cats. The head of the animal was fixed in a sterotaxic frame while the spinous process of the second cervical vertebra was held by a clamp rigidly fixed to the tilting table. It was then possible to elicit a selective neck input by rotating the neck and the body simultaneously along the longitudinal axis of the animal while maintaining the head in horizontal position. 2. Among the 95 P-cells tested for neck stimulation, 35 units showed a mossy fiber (MF) or a climbing fiber (CF) response to sinusoidal rotation of the axis vertebra at the frequency of 0.026 Hz and at the peak amplitude of displacement of 5--10 degrees. The response consisted in a periodic modulation of the discharge frequency during sinusoidal rotation of the neck. Most of these units were excited during side-down rotation of the neck, but were inhibited during side-up rotation. 3. The threshold amplitude of neck rotation responsible for the MF-induced responses varied in different units from 1 to 3 degrees at the frequency of 0.026 Hz. The sensitivity of the units, expressed in percentage change of the average firing rate per degree of displacement, either did not change or very slightly decreased as a result of increasing amplitude of stimulation from 1--3 degrees to 10--15 degrees at the frequency of 0.026 Hz or by increasing frequency of neck rotation from 0.015 to 0.15 Hz at the amplitude of neck displacement of 5--10 degrees. 4. Changes in amplitude or frequency of stimulation at the parameters reported above did not greatly modify the phase of the unit responses relative to the side-down position of the neck. These findings indicate that the MF and CF responses of P-cells to sinusoidal rotation of the neck depended on changes in neck position and not on changes in velocity of neck rotation. 5. The observation that the majority of responding P-cells located in the vermal cortex of the cerebellar anterior lobe increased their firing rate during side-down rotation of the neck is discussed in relation to the results of stimulation and lesion experiments, indicating that postural changes can be elicited either during asymmetric stimulation of neck receptors or by unilateral interruption of the neck afferents.

Afferent Pathways↗
PubMed2004

Parameters influencing AIS 1 neck injury outcome in frontal impacts.

In order to gain more knowledge of the neck injury scenario in frontal impacts, a statistical study of parameters influencing incidences of AIS 1 neck injuries was performed. The data set consisted of 616 occupants in Volvo cars. Information regarding the crash, the safety systems, occupant characteristics (including prior neck problems), behavior and sitting posture at the time of impact, and neck symptoms (including duration) was collected and analyzed. Occupant characteristics (mainly gender, weight, and age), kinematics (head impacts) and behavior at the time of impact were identified as the most prominent parameter areas with regard to AIS 1 neck injury outcome. Specifically, women had a significantly higher AIS 1 neck injury rate as compared to men, occupants under the age of 50 had a significantly higher AIS 1 neck injury rate as compared to those above 50 and occupants weighing less than 65 kg have a significantly higher AIS 1 neck injury rate than heavier occupants. Drivers stating that they impacted their head against a frontal interior structure had a significantly higher AIS 1 neck injury rate than those without head impact. Also, occupants who stated they had tensed their neck muscles at the time of impact, had a significantly higher AIS 1 neck injury rate as compared to occupants who did not. Occupant activities, such as tightly gripping the steering wheel or straightening their arms showed a significantly increased AIS 1 neck injury rate, indicating that occupant behavior at time of impact could be influential with respect to AIS 1 neck injury outcome. Also, occupants reporting prior neck problems had a higher rate of persistent symptoms (>1 year) but no difference with respect to passing symptoms (<3 months) as compared to those without prior neck problems. Additionally, there was no distinct pattern for the duration of neck symptoms.

Abbreviated Injury Scale↗
PubMedDate not supplied

Radiotherapy for the clinically negative neck in supraglottic laryngeal cancer.

PURPOSE: The supraglottic larynx has rich lymphatic drainage, resulting in a high incidence of occult cervical metastases, and the optimal treatment of the clinically uninvolved neck in supraglottic laryngeal cancer remains controversial. Selected retrospective series report a greater than 20% regional failure after treatment by radiotherapy alone, and some investigators recommend routine prophylactic neck dissection. We report on our series of patients who received radiotherapy as sole treatment to the clinically negative neck, either to the bilateral neck for N0 disease or to the contralateral neck for ipsilateral lymphatic involvement. PATIENTS AND METHODS: Between 1971 and 1998, 150 patients with supraglottic laryngeal cancer received radiotherapy alone to the clinically negative neck. Fifty-two patients had ipsilateral lymph node metastases (N1 = 16, N2a = 12, N2b = 20, N3 = 4), and 98 patients had no clinical nodal involvement. The primary site (T1/T2 = 74, T3/T4 = 76) was treated with radiotherapy (N = 91) or laryngectomy plus radiotherapy (N = 59). Neck dissection was performed on the involved neck in 36/52 node-positive patients for either multiple involved nodes (N = 20) or size > 3 cm (N = 16). Radiotherapy was delivered in standard fractionation and field arrangement. The median dose to the clinically negative neck was 5000 cGy (range: 4860-6000 cGy). RESULTS: With a median follow-up of 48 months, the clinically negative neck was the first site of failure in 3.3% of patients. The contralateral neck remained disease free in all patients. Five failures occurred in the N0 neck, and the median time to recurrence was 12 months (range: 5-30 months). Salvage therapy was neck dissection for the N0 neck failures. The 5-year locoregional control, disease-specific survival, and overall survival were 69%, 74%, and 61%, respectively. DISCUSSION: Our data support the use of radiotherapy as a prophylactic treatment for the clinically negative neck. Tumor control in the clinically uninvolved cervical lymphatics is comparable to that in surgical series, suggesting that routine neck dissection may not be necessary. Prospective trials are necessary to further define the role of radiotherapy in this patient population.

Adult↗
PubMed1984

Treatment of the clinically negative neck in floor of the mouth carcinoma.

A retrospective study of 61 consecutive patients with floor of mouth carcinoma and a clinically negative neck was done to determine the value of elective treatment to the neck. Subsequent histologically proven nodal disease was analyzed according to initial treatment modality (23 surgical, 38 irradiation), stage (29--T1,27--T2,5--T3), hemi-neck at risk (midline lesions placed both hemi-necks at risk), and primary control for a minimum of 2 years (50 patients, 78 hemi-necks at risk). Neck failures were classified by T stage, extent of neck treatment (upper neck or complete) and by primary control at the time of manifest neck metastasis. Of the hemi-necks at risk with the primary controlled, 10% (17% of patients) developed nodal disease without complete neck treatment; 86% (6/7) of these patients were salvaged. The occult positive node incidence, conservatively calculated by elimination of all patients treated with elective partial or total neck irradiation, was 10% for patients with T1 and T2 lesions (7% for hemi-necks at risk). Based on the clinical course of patients with primary control, only 1 patient (2%) might have benefited from initial complete elective neck treatment. These results suggest that elective neck treatment in early (T1 and T2, N0) floor of mouth carcinoma is of doubtful value. Supraomohyoid , rather than suprahyoid dissection, is recommended if surgical treatment of the neck is undertaken.

Adult↗
PubMedDate not supplied

[Results of treatment of deep neck abscesses and phlegmons].

INTRODUCTION: Neck, as a structure very closely connected with oral cavity and pharynx, with great number of lymph nodes, (about 2, 3 of all are in the neck), is sometimes a localization of purulent inflammatory process but its incidence is not so high as the incidence of inflammations of surrounding organs and tissue. Deep neck abscesses are localized under the upper fascial layer. They have a serious clinical picture which could be further complicated if inflammation spreads on vessels or neck organs. If the processes spread toward the mediastinum because of the communication space between medial and deep fascial layer with mediastinum, it could be mediastinal inflammation with high mortality. The aim of this study is evaluation of results of treatment in patients with deep neck abscesses and phlegmons treated at Clinic in a ten year period (1988-1997). MATERIAL AND METHODS: This study comprised 21 patients who were treated at the ENT Clinic in Novi Sad during 1988-1997. The group consisted of 5 female and 16 male patients from one to 65 years of age. Sixteen (76.2%) patients were treated with antibiotics in general practice, and 5 were admitted without previous therapy, 8 patients were afebrile, with temperatures between 37-38 degrees C and 5 with fever and high temperature. In 17 patients 5 days passed from onset of symptoms to admittance at the Clinic, and 4 patients had enlarged neck lymph nodes a few months. Unknown primary site of infections were in 13 (61.9%) patients, that means abscesses developed as colliquation of inflammatory changed lymph node. In the rest of 8 patients abscesses developed as: oropharyngeal inflammation (4 patients), foreign body perforation of esophagus, chronic otitis media, neck injury, malignant lymphoma. Lateral side of the neck was the most frequent site of neck abscesses and phlegmon in 16 (76%) patients. Red skin over the abscesses didn't appear in 4 patients. In 2 patients neck emphysema developed: anaerobic inflammation in one patient and esophageal perforation in the second. In a patient with SE over the 50 per hour the length of the abscess was over 7 cm, and in those with SE over 100 per hour, the whole neck inflammed. All patients underwent surgical therapy between 24 to 48 h after admission with incision or excision of the abscesses. Pus was collected for culture during the incision or excision of the abscesses and phlegmon. Bacteria were discovered in specimens taken during the incision in 4 (19%) of patients. Different aerobic and anaerobic bacteria were isolated: Enterococcus, Peptostreptococcus sp, Streptococcus viridans, Clostridium species. Surgery was the basic therapy of neck phlegmons and abscesses. In all patients incision was sutured in the second stage. Only one patient got paralysis of n. accesorius. One patient died with gas gangrene of the neck. DISCUSSION AND CONCLUSION: Deep neck abscesses and phlegmons are relatively rare inflammations in spite of high incidence of surrounding tissue inflammations. The most frequent causes are inflammatory changes of lymph nodes. Treatment has to be urgent, because of vital neck structures and communications between deep neck space and mediastinum. We consider that surgery is the basic principle of therapy although we have not had experience with needle aspiration. Antimicrobial agents must be given only parenterally.

Abscess↗
PubMed2005

[Radiotherapy on neck for nasopharyngeal carcinoma patients with negative cervical lymph node].

BACKGROUND & OBJECTIVE: Nasopharyngeal carcinoma (NPC) patients with negative cervical lymph node (N0-NPC) account for 20% -30% of all NPC patients. Prophylactic irradiation to the upper neck is a criterion of treatment for these patients. But some authors suggest to prophylactically irradiate the the whole neck. This study was to analyze and compare long-term outcomes of the N0-NPC patients treated by prophylactic irradiation to the upper neck and to the whole neck, and explore radiotherapy on neck for N0-NPC patients. METHODS: A total of 178 N0-NPC patients, proved by pathology, were treated in our hospital from Jul. 1998 to Dec. 1999. Of the 178 patients, 88 received prophylactic irradiation to the upper neck (upper neck group), 90 received prophylactic irradiation to the whole neck (whole neck group). Kaplan-Meier method and log-rank test were used to analyze and compare survival rate of the 2 groups. Cox model was used to study prognostic factors of N0-NPC. RESULTS: The 1-, 3-, and 5-year overall survival rates were 98.9%, 90.9%, and 80.7% in upper neck group, and 97.8%, 80.0%, and 71.1% in whole neck group (P = 0.224). The 1-, 3-, and 5-year disease-free survival rates were 93.2%, 80.7%, and 77.3% in upper neck group, and 85.6%, 68.9%, and 64.4% in whole neck group (P = 0.163). The incidence of cervical lymph nodes recurrence was 1.14% in upper neck group, and 1.09% in whole neck group (P> 0.05). Multivariate analysis showed that gender, T stage, and short-term outcome were independent prognostic factors of N0-NPC. CONCLUSION: Prophylactic irradiation to upper neck is recommended for N0-NPC patients.

Adult↗
PubMed2004

Bladder neck invasion is an independent predictor of prostate-specific antigen recurrence.

BACKGROUND: The 1997 TNM staging system for prostatic carcinoma and the 2002 revision thereof classified prostatic carcinoma with bladder neck involvement classified as pT4 disease. This classification is based on the belief that tumors that invade surrounding structures are more aggressive and warrant higher staging than tumors that do not invade surrounding structures. Recent reports in the literature suggested that microscopic involvement of the bladder neck does not carry independent prognostic significance. Therefore, resection specimens with bladder neck involvement should not be classified as pT4. The current study prospectively examined the prognostic significance of bladder neck involvement by prostatic carcinoma. METHODS: The authors analyzed the totally embedded and whole-mounted radical prostatectomy specimens from 364 consecutive patients. The mean patient age was 66 years (range, 41-77 years). The bladder neck, which had been coned from the specimen, was cut in a perpendicular fashion. Involvement of the bladder neck was defined as the presence of neoplastic cells within the smooth muscle bundles of the coned bladder neck. The data were prospectively collected. Bladder neck involvement was analyzed in relation to age, preoperative prostate-specific antigen (PSA) level, prostate weight, Gleason score, final pathologic classification, tumor volume, surgical margin status, the presence of high-grade prostate intraepithelial neoplasm, multifocality, seminal vesicle invasion, extraprostatic extension, perineural invasion, and PSA recurrence. RESULTS: Bladder neck involvement was found in 22 (6%) of 364 patients. Univariate results indicated that bladder neck involvement versus no bladder neck involvement was significantly associated with preoperative PSA (P < 0.001), higher pathologic classification (P < 0.001), larger tumor volume (P < 0.001), extraprostatic extension (P < 0.001), positive surgical margins (P < 0.001), and PSA recurrence (P = 0.003). In a multivariate logistic regression model controlling for pathologic classification, Gleason score, and surgical margin status, bladder neck involvement was an independent predictor of PSA recurrence (P = 0.04). The adjusted odds ratio for bladder neck involvement was 3.3 (95% confidence interval, 1.04-10.03). CONCLUSIONS: In the current study, bladder neck involvement was an independent predictor of early PSA recurrence. The data demonstrated the importance of continued assessment of bladder neck invasion and supported the placement of tumors with bladder neck involvement in a stage that recognizes the prognostic implications of such involvement.

Adult↗
PubMed2005

Neck dissections: radical to conservative.

BACKGROUND: Neck dissection is an important surgical procedure for the management of metastatic nodal disease in the neck. The gold standard of neck nodal management has been the radical neck dissection. Any modification in the neck dissection is always compared with this standard. Over the last few decades, in order to alleviate the morbidity of radical neck dissection, several modifications and conservative procedures have been advocated. These procedures retain certain lymphatic or non-lymphatic structures and have been shown not to compromise oncological safety. METHODS: A literature search of the Medline was carried out for all articles on neck dissections. The articles were systematically reviewed to analyze and trace the evolution of neck dissection. These were then categorized to address the nomenclature, management of node positive and node negative neck including those who had received chemoradiation. RESULTS: The present article discusses the neck nodal nomenclature, the radical neck dissection, its modifications and migration to more conservative procedures and possible advances in the near future. CONCLUSION: Radical neck dissection is now replaced with modified radical neck dissections in most situations. Attempts are being made to replace modified radical neck dissections with selective neck dissections for early node positivity. Sentinel node biopsy is being studied to address the issue of node negative neck. More conservative surgeries are likely to replace the 'radical' surgeries of bygone era. This process is facilitated by earlier detection of the disease and better understanding of cancer biology.

Journal Article↗
PubMedDate not supplied

Adverse events at the aneurysmal neck identified at follow-up after endovascular abdominal aortic aneursym repair: how do they correlate?

The objective of this study was to assess the prevalence of and the correlation between dilatation of the infrarenal neck and proximal device migration after endovascular abdominal aortic aneurysm repair (EVAR). The analysis made use of the EUROSTAR registry. Between 1994 and 2004, 4,233 patients with an abdominal aortic aneurysm larger than 4 cm underwent EVAR. Only patients with available follow-up data regarding neck size and device position were included in this assessment. Chi-square and t-tests or Wilcoxon rank sum tests were used for comparison of discrete and continuous variables, respectively. Time-dependent variables were evaluated by log-rank tests. In addition, multivariate analysis was performed to determine anatomic and operative variables with an independent correlation with neck growth and device migration, respectively. In addition, the association with proximal endoleak was assessed. Neck dilatation and proximal migration were found in 1,342 (32%) and 192 (4.5%) of the 4,233 patients, respectively. One hundred twelve patients (2.5%) had neck dilatation and migration of the proximal device extremity. The correlation between proximal migration and neck dilatation was statistically significant (p < .0001). Other independent variables for migration were a wider neck and aneurysmal diameter, shorter necks, proximal endoleak, and absence of suprarenal fixation. Neck dilatation was predicted by narrow necks, use of devices with suprarenal fixation, and larger device diameters. Proximal endoleak occurred in 136 (3.2%) patients and was significantly associated with shorter, angulated necks and proximal migration. The present study documented that migration may be caused by neck dilatation. However, neck dilatation was not significantly promoted by proximal migration. Other factors, such as dimensions of the neck, the device fixation system, and perhaps progressive wall degeneration, are also likely to play a role in the pathogenesis of neck dilatation. To obtain good results from EVAR, accepted criteria of neck dimensions should be adhered to.

Adult↗
PubMed2005

Influence of neck-rail placement on free-stall preference, use, and cleanliness.

Three experiments examined how the presence of a neck rail at different heights and locations influenced dairy cattle behavior and stall cleanliness. Experiment 1 compared 4 levels of neck-rail height (102, 114, and 127 cm and no neck rail; presented at 160 or 180 cm from the curb) in a preference test. Cows (n = 10) showed no consistent preference based on neck-rail height, regardless of the horizontal position of the neck rail. When cows were restricted to each treatment in turn, however, time spent standing fully (with all 4 hooves) in the stall was least in the stall with the lowest neck rail (mean, 22 min/24 h) and was greatest in the stall with no neck rail (mean, 83 min/24 h). A second experiment examined the effect of a neck rail placed at 3 distances from the curb (140, 175, and 233 cm) when height was held constant (131 cm; n = 12). Time spent standing fully in the stall was least when the neck rail was close to the curb (140 cm; mean, 11 min/24 h) and was greatest when the neck rail was furthest from the curb (233 cm; mean, 86 min/24 h). When the neck rail was far from the curb, the cows were more likely to soil the stall by defecating while standing fully in the stall. Experiment 3 compared soiling of the stall by 14 cows with and without a neck rail at a height of 124.5 cm. When the neck rail was removed, cows were more than twice as likely to soil the stall by defecating while standing fully in the stall compared with when the neck rail was present (1.3 vs. 0.5 defecations/24 h). Thus, restrictive neck-rail placement prevents cows from standing in stall, but helps keep stalls clean. Access to more comfortable flooring surfaces outside the stall may help mitigate the negative effects of restrictive neck rails.

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