Bilateral radical neck dissection.
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A series of 113 patients operated on in the period 1980-1989 for a neck recurrence from a head and neck cancer was studied. All patients had no other evidence of disease. The male/female ratio was 93/20, and the median age was 58 years (range 28-87). Previous treatment consisted of surgery (SG) +/- radiotherapy (RT) in 81 patients (SG group) and only RT in 32 (RT group): 59 cases presented a relapse in the treated neck and 54 in the contralateral side. All but one contralateral recurrences were in the SG group. Ten patients were lost to follow-up. The observed 5-year survival rate of the whole series was 29.2% (95% confidence interval, 0%-38%). Considering patients with ipsilateral recurrences, the 5-year disease-free survival rate was 38.7% (95% c.i., 28.7%-48.7%) and 27% (95% c.i., 18%-36%) for the SG and the RT group, respectively. The 5-year disease-free survival rate after SG for contralateral recurrences was 38.8% (95% c.i., 23.8%-53.8%). Dimension and mobility of the neck nodes were the only demonstrable prognostic factors.
The clinical management of an unusual case of postoperative ARDS is reported. A few hours following neck surgery and septic insult, the patient developed unexpected ARDS. Aetiologic and supportive treatment were successfully instituted and after 72 hours of intensive therapy, the patient's clinical status improved. The very short time lapse between the septic insult and appearance of ARDS is emphasized. A brief literature review on aetiology, diagnosis and therapy of sepsis, as well as some pertinent aspects concerning the pathogenesis of ARDS and its linkage to sepsis are presented.
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