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PubMed1999

Neck rejuvenation by combining Jessner/TCA peel, dermasanding, and CO2 laser resurfacing.

BACKGROUND: One of the greatest challenges facing facial cosmetic surgeons today is the simultaneous rejuvenation of the neck and face. Laser resurfacing of the face using the carbon dioxide (CO2) laser or the erbium:yttrium-aluminum-garnet (Er:YAG) laser has enjoyed widespread popularity, but the neck and chest are often avoided. It would be quite helpful to rejuvenate the neck at the same time the face is being resurfaced. This would diminish lines of demarcation and help reduce the signs of aging of the neck. There would be a better match between the new skin of the neck and face. OBJECTIVE: To develop a safe and effective method to rejuvenate the neck. METHOD: A step-by-step skin care program was instituted. The patients preconditioned their face and neck skin with vitamin A/glycolic skin conditioning lotions for 6-8 weeks prior to surgery. Following this the chest and neck area was treated with the Jessner-trichloroacetic acid (TCA) peel. Then the middle section of the neck was sanded with 150 grit sandscreen. Finally, the central area was resurfaced with the UltraPulse CO2 laser using reduced power settings. Usually two passes was adequate to shrink the skin of this central section of the neck. A petrolatum-based ointment was applied during the initial 7-day postoperative period. After reepithelialization a sunscreen-moisturizer was used during the day and hydrocortisone moisturizer was applied at night. RESULTS: The neck skin was able to tolerate this step-by-step skin rejuvenation. The blending from the décolleté area to the hairline produced a rejuvenation without a line of demarcation. There were no examples of scarring in the 12 cases that were evaluated for 6 months. Two cases developed persistent erythema that responded to silicone gel sheeting. Although no patients complained of hypopigmentation, a decrease in pigment was found using special UV photography. CONCLUSION: It is possible with this gradient, step-by-step method to produce a rejuvenation of the neck. An improved texture of the neck developed without visible scarring.

Chemexfoliation↗
PubMed2003

Role of neck ultrasonography in the follow-up of children operated on for thyroid papillary cancer.

The aim of this study was to evaluate the role of neck ultrasonography compared to (131)I whole-body scan (WBS) and circulating thyroglobulin (Tg) measurement after thyroid hormone withdrawal in the follow-up of children with thyroid papillary cancer, who had previously undergone total thyroidectomy for the diagnosis of neck lymph node metastases (LNM). Forty-five children were examined. Neck ultrasonography and diagnostic WBS were conclusive about the presence or absence of LNM in 35 patients. Diagnostic WBS revealed the presence of LNM in 6 cases not detected by neck ultrasonography; neck ultrasonography was positive in 3 cases that were negative at diagnostic WBS but confirmed by post-(131)I therapy WBS. One patient with suspicious neck lymphnodes at neck ultrasonography not confirmed by WBS was considered as a false-positive result of neck ultrasonography. Neck ultrasonography and thyroglobulin (Tg) were conclusive about the presence or absence of LNM in 29 patients. Tg was elevated in 10 subjects with negative neck ultrasonography (7 had also lung and/or mediastinic LNM). Tg was undetectable in 5 patients in whom the presence of LNM was confirmed by neck ultrasonography and WBS. In conclusion, our study in children demonstrates that neck ultrasonography can detect LNM that are not suspected by palpation, diagnostic WBS, or serum Tg determination. Furthermore, neck ultrasonography can pinpoint the anatomic site of the LNM.

Adolescent↗
PubMed2003

Therapeutic selective neck dissection: a 25-year review.

OBJECTIVES/HYPOTHESIS: The aim of the study was to show the efficacy of selective neck dissection in combination with postoperative radiation therapy in controlling squamous cell carcinoma metastatic to the cervical lymph nodes. The study compared the incidence of recurrences and overall disease-free survival between comparable cohorts undergoing a selective neck dissection and classic radical or modified neck dissection. STUDY DESIGN: Retrospective, 25-year review was made of data from a tertiary care academic facility comprising both private patients and veterans. METHODS: Inclusion criteria studied patients with untreated head and neck cancer who had squamous carcinoma metastatic to cervical lymph nodes on histological examination and were treated with a selective (n = 61), modified (n = 54), or radical neck dissection (n = 61). The three groups were compared with respect to regional control and overall cancer-free survival. All patients remained cancer free at the primary site, received postoperative radiation therapy, and had a minimum follow-up of 2 years. The median follow-up was 4.3 years. RESULTS: Control of recurrent carcinoma in the neck, as well as the incidence of overall cancer-free survival, was comparable in the three cohorts with no significant statistical difference. Eight of 176 sides of the necks (4.5%) showed evidence of recurrence (2 of 61 [3.3%] in the selective neck dissection group and 6 of 115 [5.2%] in the radical and modified neck dissection group. Disease-free 2-year survival was 80% in the selective neck dissection group and 64% in the radical and modified neck dissection group. CONCLUSION: Selective neck dissection, when used in combination with postoperative radiation therapy, is an efficacious way to manage metastatic squamous cell carcinoma to the neck.

Carcinoma, Squamous Cell↗
PubMed1998

The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults.

STUDY DESIGN: Population-based, cross-sectional mailed survey. OBJECTIVE: To determine the lifetime, period, and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias. SUMMARY OF BACKGROUND DATA: In Europe, the lifetime and point prevalence of neck pain is almost as high as the prevalence of low back pain. Similarly, chronic neck pain is highly prevalent and a common source of disability in the working-age population. However, no studies specifically have documented the prevalence of neck pain and its related disability in North America. METHODS: The Saskatchewan Health and Back Pain Survey was mailed to 2184 randomly selected Saskatchewan adults aged 20-69 years. Fifty-five percent of the study population participated. The presence of nonresponse bias was investigated through logistic regression and wave analysis. The Chronic Pain Questionnaire was used to classify the severity of chronic neck pain. RESULTS: The age-standardized lifetime prevalence of neck pain is 66.7% (95% confidence interval, 63.8-69.5), and the point prevalence is 22.2% (95% confidence interval, 19.7-24.7). The age-standardized 6-month prevalence of low-intensity and low-disability neck pain is 39.7% (95% confidence interval, 36.7-42.7), whereas it is 10.1% (95% confidence interval, 8.2-11.9) for high-intensity and low-disability neck pain and 4.6% (95% confidence interval, 3.3-5.8) for significantly disabling neck pain. The prevalence of low-intensity and low-disability neck pain decreases with age. More women experience high-disability neck pain than men. Wave analysis suggests that the point prevalence and 6-month prevalence of high-intensity and low-disability neck pain are overestimated in this survey. CONCLUSION: This cross-sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6% (95% confidence interval, 3.3-5.8) of the adult population.

Adult↗
PubMed1999

Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity.

STUDY DESIGN: The development and testing of a new comprehensive measure of neck pain and disability, the Neck Pain and Disability Scale. OBJECTIVES: To provide an initial evaluation of the Neck Pain and Disability Scale's reliability and validity. SUMMARY OF BACKGROUND DATA: Although several measures exist for generalized pain and disability, none is specific for neck pain. More specific measurements should improve assessment of treatments and clinical research aimed at cervical pain syndromes. METHODS: The Neck Pain and Disability Scale was designed using the Million Visual Analogue Scale as a template and consists of 20 items that assess neck pain. In this study, 100 patients with neck pain, 52 patients with lower back and leg pain, and 27 pain-free volunteers were rated by the Neck Pain and Disability Scale. In addition, a subset of the 47 patients with neck pain were rated by several other established psychometric instruments. RESULTS: An item analysis showed a high degree of internal consistency among the 20 items on the Neck Pain and Disability Scale (r = 0.93), and face validity was established by comparing patients who had neck pain as well as lower back and leg pain with a pain-free group. The Neck Pain and Disability Scale scores correlated with the Oswestry Disability Questionnaire, the Pain Disability Index, and psychological measures of depression and neuroticism. CONCLUSIONS: The results suggest a highly reliable instrument for evaluating neck pain with at least four underlying dimensions. Further work to address the predictive validity of this new tool are under way.

Adult↗
PubMed1997

QT interval changes following neck dissection. A stratified prospective study.

Studies from Europe have suggested that neck dissection, especially right radical neck dissection, causes a dangerous prolongation of the QT interval. Sudden cardiac arrest due to QT prolongation has been reported following right radical neck dissection. We investigated the prevalence of QT interval prolongation following neck dissection. Electrocardiogram tracings from 45 patients who underwent different combinations of neck dissection were studied. Preoperative and postoperative tracings were interpreted by a cardiologist blinded to the patient identification of each tracing. There were 28 unilateral neck dissection patients and 17 bilateral neck dissection patients eligible for analysis. There were 7 patients in the classic right radical neck dissection group, and only 3 of these had no neck dissection on the left. Comparisons of preoperative versus postoperative corrected QT interval for all subjects did not indicate a significant change. Stratification by neck dissection type (radical, modified or selective, and carotid artery resection) or by side dissected (left, right, or both) also showed no significant differences. No malignant arrhythmias were encountered. Thus, in contrast to the European experience, our findings show no significant predictable change in the QT interval after any of the combinations of neck dissection. Head and neck surgeons should be aware of the possibility of postoperative QT interval prolongation following neck dissection, although in the absence of other risk factors it appears to be a rare occurrence.

Analysis of Variance↗
PubMed2005

Gender differences in head-neck segment dynamic stabilization during head acceleration.

PURPOSE: Recent epidemiological research has revealed that gender differences exist in concussion incidence but no study has investigated why females may be at greater risk of concussion. Our purpose was to determine whether gender differences existed in head-neck segment kinematic and neuromuscular control variables responses to an external force application with and without neck muscle preactivation. METHODS: Forty (20 females and 20 males) physically active volunteers participated in the study. The independent variables were gender, force application (known vs unknown), and force direction (forced flexion vs forced extension). The dependent variables were kinematic and EMG variables, head-neck segment stiffness, and head-neck segment flexor and extensor isometric strength. Statistical analyses consisted of multiple multivariate and univariate analyses of variance, follow-up univariate analyses of variance, and t-tests (P < or = 0.05). RESULTS: Gender differences existed in head-neck segment dynamic stabilization during head angular acceleration. Females exhibited significantly greater head-neck segment peak angular acceleration (50%) and displacement (39%) than males despite initiating muscle activity significantly earlier (SCM only) and using a greater percentage of their maximum head-neck segment muscle activity (79% peak activity and 117% muscle activity area). The head-neck segment angular acceleration differences may be because females exhibited significantly less isometric strength (49%), neck girth (30%), and head mass (43%), resulting in lower levels of head-neck segment stiffness (29%). CONCLUSION: For our subject demographic, the results revealed gender differences in head-neck segment dynamic stabilization during head acceleration in response to an external force application. Females exhibited significantly greater head-neck segment peak angular acceleration and displacement than males despite initiating muscle activity earlier (SCM only) and using a greater percentage of their maximum head-neck segment muscle activity.

Acceleration↗
PubMed2002

Biomechanical analysis of head-neck force in hybrid III dummy during inverted vertical drops.

The hybrid III dummy has been used extensively for crash testing. The comparison between the cadaver and dummy data provides the biofidelic nature of dummy head-neck system to predict cervical spine injury as a function of applied force. The existing dummy data are limited to a lower drop height up to 0.5 m. The present study quantified the head-neck biomechanical response of the dummy up to a drop height of 1.20 m. At 0.15 m, the head force was 5740 N and 5695 N at the upper neck and 4231 N at the lower neck. At 0.6 m, the head force was 13,000 N and 12,000 N at the upper neck and 8900 N at the lower neck. At 1.2 m, the calculated head force was 19,500 N and 18,600 N at the upper neck and 13,500 N at the lower neck. The present results closely match with data of previous studies. The data indicated that the hybrid III system transmits about 70 to 75% of the applied force from the head or upper neck to the lower neck area. In contrast, the cadaver studies showed for drops from 0.9 to 1.5 m, about 20 to 30% of the applied force was transmitted from the head to the lower neck. The comparison demonstrates the capability of the Hybrid III dummy head-neck force response to realistically predict injury and also the need for comparing the dummy's response to the human head neck force data for injury.

Accidental Falls↗
PubMed2006

[Diagnosis and treatment of the femoral shaft fractures combined with ipsilateral occult femoral neck fractures].

OBJECTIVE: To improve the ability of recognizing, diagnosing and treatment for the femoral shaft fractures combined with ipsilateral occult femoral neck fractures, and reduce the rate of loss-diagnosis. METHODS: By retrospective study of 50 patients who sustained ipsilateral femoral shaft and neck fractures from March 1998 to October 2003, 9 cases were femoral shaft fractures combined ipsilateral femoral neck fractures. The neck fractures were diagnosed separately before, during and after operation. Among the 9 cases, 5 cases treated with reconstructive intramedullary nail to fix both shaft and neck fractures; 3 cases were treated with retrograted intramedullary nail to fix shaft fractures and with canulated screws to fix neck fractures; another one was sustained two operations, after the fixation of shaft by intramedullary nail, the neck fracture was found, the neck fracture was fixed with canulated screws anterior and posterior of the nail. RESULTS: Nine cases were followed up for average 20 months. All femoral shaft fractures were united during 6 months; and all neck fractures were united during 3 months. CONCLUSIONS: Femoral shaft fractures combined with ipsilateral occult femoral neck fractures have a high rate of loss-diagnosis during the early stage after injure, the orthopaedic surgeons should consider the femoral neck fracture by analyzing the mechanism of high energy injury patient with femoral shaft fracture. The occult femoral neck fractures can be diagnosed by CT scan before operation. During and after the operation of fixing the femoral shaft fractures, the femoral neck should be observed intensively to identify the exist of fractures.

Adult↗
PubMed1988

On neck muscle activity and load reduction in sitting postures. An electromyographic and biomechanical study with applications in ergonomics and rehabilitation.

In this study of the biomechanics and muscular function of the cervical spine, skilled women workers simulated standardized electromechanical assembly work in eight sitting postures. Normalized electromyography was used to quantify activity in neck-and-shoulder muscles. With the whole spine flexed, muscle activity in the cervical erector spinae, trapezius and thoracic erector spinae muscles was higher than when the whole spine was straight and vertical. The posture with the trunk slightly inclined backward and neck vertical gave the lowest activity levels. Flexed neck compared to vertical neck gave higher activity in the cervical erector spinae. Work with abducted arm gave high neck muscle activity. Work postures can thus be optimized to diminish neck muscle load. Two ergonomic acids were studied during the work cycle. Elbow support reduced the activity in the trapezius and thoracic erector spinae/rhomboids muscles in the posture with the whole spine flexed and in the posture with the whole spine vertical. Arm suspension gave mainly similar reduction in these postures, and also a reduction in the cervical erector spinae. In the position with the trunk slightly inclined backward, arm suspension gave a reduction in the trapezius. These findings indicate that arm support or arm suspension can be used to reduce neck muscle load. Three methodological studies related to neck muscle load and normalization were included. 1) Examination of the effect of different isometric maximum test contractions on neck muscles showed that all contractions activated all muscles studied, including those on the contralateral side, to some extent and at various levels. The highest frequency of attained maximum levels was: for neck extension, in cervical erector spinae; for cervical spinae lateral flexion, in splenius and levator scapulae; for arm abduction, in trapezius, and, for shoulder elevation and scapular retraction/elevation, in thoracic erector spinae/rhomboids. Proximal resistance gave higher activity than distal. 2) The relationship between EMG activity and muscular moment was studied in women during submaximal and maximum isometric neck extension. The relationship found was non-linear, with greater increase in activity at high moments in the posterior neck muscles studied. The slightly flexed cervical spine position induced a higher level of activity in erector spinae cervicalis than did the neutral position for a given relative muscular moment. 3) Muscular activity was related to cervical spine position during maximum isometric neck extension. Peak activity in the cervical erector spinae was found in the slightly flexed lower-cervical spine position.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Microvascular reconstruction after previous neck dissection.

BACKGROUND: Microvascular reconstruction of defects in the head and neck is more challenging in patients who have undergone a previous neck dissection, owing to prior resection of potential cervical recipient blood vessels used for free flap perfusion. OBJECTIVE: To evaluate the reliability and safety of free flap reconstruction in patients with previous neck dissection. PATIENTS AND METHODS: Sixty free flaps were performed in 59 patients with a medical history of neck dissection for head and neck cancer. This included patients undergoing salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction of cancer surgery-related defects. Flap selection included 25 radial forearm flaps, 20 fibula flaps, 7 rectus abdominis flaps, 7 subscapular system flaps, and 1 iliac crest flap. RESULTS: Recipient vessels were used in the field of previous neck dissection in approximately half the patients with previous selective neck dissection, while contralateral recipient vessels were always used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary in any cases. One arterial anastomosis that was created under excessive tension required urgent reoperation and revision, but there were no cases of free flap failure. CONCLUSIONS: Free flap reconstruction of the head and neck is highly successful in patients with a history of neck dissection, despite a relative paucity of potential cervical recipient blood vessels. Heavy reliance on free flaps with long vascular pedicles obviated the need to perform vein grafts in the present series, probably contributing to the absence of free flap failure. Previous neck dissection should not be considered a contraindication to microvascular reconstruction of the head and neck.

Adult↗
PubMed1995

Accuracy of intraoperative staging of the NO neck in squamous cell carcinoma.

Management of the neck in squamous cell carcinoma of the upper aerodigestive tract continues to be a topic of great debate. One major problem is that incorrect clinical staging is expected in approximately 20% of necks. This is true of both clinical stage NO and N+ necks, even when imaging studies are used. This prospective study of 108 necks in 79 patients examined the role of intraoperative palpation and inspection in improving the surgeon's ability to predict nodal stage. Of 62 patients with NO necks clinically on both sides, 26 were staged N+ by intraoperative node examination. Nineteen of the 26 were histologically negative (73% false-positive). Of the 36 patients staged intraoperatively as NO, 10 were histologically positive (28% false-negative). Of 108 necks judged clinically to be NO, 25 (23%) had occult metastases and 11 (10%) had extracapsular spread. Forty-one of 108 clinical NO necks were believed to have positive nodes at the time of neck dissection. Of these 41 necks, 30 (73%) were found to be histologically NO (false-positive). Of the 67 clinical NO necks that were also believed to be NO intraoperatively, occult metastases were found in 14 (21% false-negative). Therefore, intraoperative staging did not significantly improve the false-negative rate. Frozen-section biopsy obtained in the operating room was reliable in 24 (92.3%) of 26 patients. Although frozen-section biopsy was not performed in all patients, these data suggest that upstaging the neck without frozen-section biopsy is much less reliable. This study supports the use of frozen-section biopsy before converting the selective dissection to a radical or modified neck dissection in most instances.

Biopsy↗
PubMed1995

Floor of mouth carcinoma. The management of the clinically negative neck.

OBJECTIVES: Examine the management of the clinically negative neck and evaluate the role of elective neck dissection in patients with squamous carcinoma of the floor of the mouth. DESIGN: Retrospective analysis of a cohort of patients with squamous carcinoma of the floor of the mouth and N0 stage disease of the neck who were treated between 1973 and 1992. The mean follow-up was 6 years. PATIENTS: The cohort consisted of 129 patients. Excluded from analysis were patients without evidence of disease but less than 3 years of follow-up and those with uncertain resection margins. INTERVENTION: Resection of the floor of the mouth lesion with or without marginal mandibulectomy. Elective lymphadenectomy was performed in 26 (23%) of the 129 patients. OUTCOME MEASURE: Estimates were obtained of survival according to mode of therapy, classification of treatment modality, determinate cure, locoregional failure, salvage, and occult disease by clinical stage. RESULTS: Occult disease was detected in 23% of the patients who underwent elective neck dissection. Recurrence in the neck occurred in 36% of 103 patients who received follow-up but did not undergo elective neck dissection. The determinate survival at 3 years was 100% for patients with occult disease who underwent elective neck dissection. Overall, 96% of the patients who were treated with elective neck dissection were cured; 85% of the patients who received no initial treatment of the neck were cured; and 59% of the patients with failure in the neck were salvaged. CONCLUSIONS: A more aggressive approach to the neck with N0 disease may be warranted. Selective neck dissection allows early removal of occult metastases with acceptable morbidity. In elective dissection for clinically and histologically negative necks, the high rate of survival may result from the removal of metastatic carcinoma that was missed in the histopathologic sampling process.

Adult↗
PubMed2003

Endoluminal repair of abdominal aortic aneurysm prevents enlargement of the proximal neck: a 9-year life-table and 5-year longitudinal study.

OBJECTIVE: Endoluminal repair of abdominal aortic aneurysm (AAA) is predicated on stability of the proximal neck of the aneurysm. Reports on morphologic changes in the proximal neck after endoluminal repair of AAA have thus far been limited in duration to 3 years or less. The aim of this study was to document changes in diameter of the proximal neck of AAA in a group of patients who had undergone endoluminal repair between 5 and 9 years previously. METHODS: Between May 1992 and December 1996, 61 patients with AAA were treated with endoluminal repair by the senior author. The following patients were excluded from the study group: those requiring primary conversion to open repair at the original operation (n = 8), those with false aneurysm (n = 1), and those with dissection in the proximal neck (n = 1). Fifty-one patients (48 men and three women) with a mean age of 71 years remained in the study group. The endoprostheses used were modified Parodi (n = 4), Endovascular Technologies (n = 14), White-Yu (n = 10), Stentor/Vanguard (n = 21), and Bard 1996 prototype (n = 2). Morphologic changes in the proximal aortic neck were studied with contrast computed tomographic scan with the methodology recommended by the Ad Hoc Committee for Standardized Reporting Practices for Endovascular AAA Repair (revised version). The maximum transverse diameter of the proximal neck was measured 1 cm below the most inferior renal artery. A Kaplan-Meier analysis was performed showing the proportion of patients at risk with a demonstrated enlargement of the neck at each interval of time compared with the predischarge computed tomographic scan. A longitudinal study of morphologic changes in the proximal aortic neck was also undertaken in 28 patients with successful endoluminal repair who survived 5 years. RESULTS: The Kaplan-Meier curve showed a probability of no dilatation of the proximal neck of 0.943 at 7 years after endoluminal AAA repair. Of 28 patients with 5 years of follow-up after discharge, only two had increases in the diameter of the proximal neck greater than 2 mm. The endograft in both patients had undergone migration before any proximal neck dilation. A paired t test showed that the overall average increase of 0.4 mm (standard error, 0.3 mm) in these 28 patients was not statistically significant (P =.23). CONCLUSION: A high probability (0.943 at 7 years) exists of no enlargement of the proximal neck of AAA after endoluminal repair. We hypothesize that endografts positioned correctly immediately below the renal arteries protect the proximal neck from dilatation in a manner that does not occur after open repair of AAA.

Aged↗
PubMed1995

Quantitation of intracranial aneurysm neck size from diagnostic angiograms based on a biomathematical model.

Accurate measurement of the aneurysm neck size from diagnostic angiograms is crucial in the consideration and implementation of interventional embolotherapeutic procedures. Due to inherent problems in angiography, aneurysm morphology and location, and obstruction by overlying structures, accurate measurement of the aneurysm neck size is difficult. We are proposing a method for the angiographic measurement of aneurysm neck size based on a biomathematical model of an aneurysm. A biomathematical model of an intracranial saccular aneurysm was developed based on Laplace's law for a spherical elastic object, given by: Stress = Pressure x Radius/2 x Wall thickness. In addition, another biomechanical parameter used to describe an elastic sphere is the strain: Strain = delta R/Ri = (R-Ri)/Ri where R is the current aneurysm radius and Ri is the initial radius prior to aneurysm development. The stress and strain of an elastic structure are used to describe the elastic modulus, E: E = stress/strain = [PR/2h]/[(R-Ri)/Ri] = [PRRi]/[2hR-2hri]. It is assumed at this point that no additional tissue growth occurs through the developmental course of the aneurysm. The expression for E is now solved for Ri which, in essence, represents the radius of the aneurysm neck: Ri = [2hER]/[PR + 2hE]. Thus, the diameter of the neck, Dn, is given by Dn = 2 + i = 2 ([2hER]/[PR + 2hE]). During diagnostic angiography, the radius, R, and pressure, P, are easily obtained during the examination procedure. However, it is not possible to angiographically determine the elastic modulus, E, and the wall thickness, h. In this case, the following average values are used: E = 1.0 MPa and h = 50 microns. From the diagnostic angiograms and hospital records of 23 patients, the aneurysm neck size was determined using the biomathematical model and compared to the results obtained from the correlative relationship between the measured and accepted ratios of neck size to diameter of parent artery. The neck diameter as measured from the accepted ratios of neck size to parent artery diameter for the 23 patients ranged from 1.5 mm to 8.7 mm. The angiographically measured neck sizes were in excellent agreement with those obtained from the biomathematical model, particularly for the wide-necked aneurysms, as evidenced by the fact that all but two chi 2 values were < 1.0. We have described a simple yet accurate method for obtaining aneurysm neck size measurements from diagnostic angiograms using a biomathematical model. The model requires knowledge of only the aneurysm radius and blood pressure and becomes particularly important in characterizing wide-necked aneurysms.

Adult↗
PubMed1998

Dynamic displacement changes of the bladder neck with the patient supine and standing.

PURPOSE: With the patient standing and supine we determine the differences in dynamic changes of the bladder neck and directions of dynamic bladder neck displacement. MATERIALS AND METHODS: To evaluate the dynamic movement of the bladder neck we recruited into the study 78 consecutive women 27 to 69 years old with various urogynecological complaints. The anatomical changes of the bladder neck from rest to maximal straining and from rest to holding were evaluated and compared with the patients supine and standing. RESULTS: Except for bladder neck rotational angle with the patient standing, all parameters were significantly different from corresponding measurements with the patient supine. Mean rotational angle of rest to maximal straining plus or minus standard deviation was 39.4 +/- 18.9 degrees when standing versus 39.8 +/- 23.4 degrees when supine (p > 0.05). The distances between the bladder neck and symphysis pubis at rest, and during maximal straining and holding the bladder neck in the supine position were significantly longer than those in the standing position. The direction of bladder neck displacement from rest to maximal straining was more caudad and ventral when standing. The bladder neck moved cephalad and ventral when the patient was standing, and cephalad and dorsal with the patient supine and holding the bladder neck. CONCLUSIONS: The anatomical locations and dynamic displacements of the bladder neck at rest, and during maximal straining and holding were significantly different in the supine and standing positions. While evaluating the dynamic motion of the bladder neck to determine bladder neck mobility, patient position must be considered and specified in accordance with diagnostic standards.

Adult↗
PubMed2000

The role of cervical lymphadenectomy after aggressive concomitant chemoradiotherapy: the feasibility of selective neck dissection.

OBJECTIVES: To evaluate the necessity, technical feasibility, and complication rate of neck dissection performed on patients with head and neck cancer after 5 cycles of concomitant chemoradiotherapy (CRT) and to justify a selective neck dissection (SND) approach and define the optimal timing of post-CRT neck dissection. DESIGN AND SETTING: Retrospective analysis in an academic university medical center. PATIENTS: Sixty-nine eligible patients with advanced (stage III and IV) head and neck cancer who have undergone 1 of 4 CRT protocols. Patients ranged in age from 36 to 75 years, and surgical procedures were performed over a 4-year period. Follow-up ranged from 6 to 64 months. INTERVENTION: Neck dissection (most commonly unilateral SND) performed within 5 to 17 weeks after CRT completion. MAIN OUTCOME MEASURES: Complication rate and incidence of positive pathology (viable cancer) in pathologic neck dissection specimens. RESULTS: Seven (10%) of 69 patients developed wound healing complications, 4 (6%) of whom required surgical intervention for ultimate closure. There were no wound infections. Other complications occurred in 11 (16%) of 69 patients and included need for tracheotomy, nerve transection and paresis, and permanent hypocalcemia. Twenty-four (35%) of 69 patients revealed microscopic residual disease. Ten (50%) of 20 patients with N3 neck disease had positive pathology, whereas 14 (36%) of 39 patients with N2 disease had viable carcinoma in the dissection specimen (P =.09 by chi(2) analysis). There was no significant relation between radiologic complete response or partial response and residual microscopic cancer. In 1 patient, disease recurred in the neck after dissection. Mean follow-up time was 30.3 months. CONCLUSIONS: (1) Neck dissection for patients with N2 or greater neck disease after CRT is necessary to eradicate residual disease. (2) The complication rate of SND after CRT with hyperfractionated radiotherapy is low. (3) SNDs are technically feasible when performed within the "window" between the acute and chronic CRT injury (4-12 weeks). (4) SNDs, rather than more radical procedures, appear to be therapeutically appropriate in this group of patients because of the low incidence of disease recurrence in the neck.

Adult↗
PubMed2005

Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation.

OBJECTIVE: To determine the efficacy of selective and superselective neck dissection for patients with bulky or residual nodal metastasis treated with concomitant intra-arterial cisplatin and radiotherapy. DESIGN: Prospective study. SETTING: University of Tennessee, Memphis. PATIENTS: A total of 240 patients with stage III or IV head and neck squamous cell carcinoma. INTERVENTIONS: Treatment with cisplatin, 150 mg/m2 intra-arterially, and sodium thiosulfate, 9 g/m2 intravenously, weekly for 4 weeks; and radiotherapy, 2 Gy per fraction per day, 5 times weekly, for a total of 68 to 74 Gy over 6 to 7 weeks. MAIN OUTCOME MEASURES: Regional control, distant metastases, and overall survival for patients undergoing radical or modified radical neck dissection (n = 12), selective neck dissection (n = 65), and superselective neck dissection (levels II-III only) (n = 7). RESULTS: Among the total group of 240 patients, 106 neck dissections were performed on 84 patients who had bulky nodal disease. With a median follow-up of 58 months (range, 12-96 months), regional failure occurred in 11 (4.6%) of 240 patients: 2 (17%) of the 12 who had modified radical neck dissection, 3 (5%) of the 65 who had selective neck dissection, none of the 7 patients who had superselective neck dissection, and 6 (4%) of the 156 who had no neck dissection. The rates of overall survival and distant metastases were not significantly different among the 3 neck dissection subsets. CONCLUSION: Selective and superselective neck dissection, which spare function and minimize morbidity, are viable therapeutic alternatives for patients with residual disease confined to 1 level after intra-arterial chemoradiation treatment, and possibly for other chemoradiation protocols.

Adult↗