Factors minimizing mortality and morbidity rates in head and neck surgery. Hayes Martin lecture.
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DNA measurements were performed on formalin-fixed, paraffin-embedded squamous cell carcinomas, using the method of Hedley et al. Ultrasonication was sometimes necessary after enzymatic disintegration to dispose of residual cytoplasm. The isolated nuclei were stained with Hoechst 33258. DNA measurements were performed using a rapid system for static fluorometry (FLUORA-programme). The method proved to be highly accurate. The mean CV of the stem cell peaks from different tumours was 5.3. There was no difference between material less or more than 5 years old (mean CVs 5.2 and 5.5 respectively). RNase treatment had no effect and was therefore not considered necessary. The proliferative activity was calculated by computer assuming a rectilinear distribution of S-phase cells. Because routinely paraffin-embedded material can be used, DNA analysis can be performed on tumour material where the clinical outcome is known, in order to evaluate certain DNA variables.
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Primary malignant melanoma of the oral cavity is uncommon. Four cases are presented. The average age is in the sixth decade. Early diagnosis is difficult and prognosis is generally poor. Efforts toward earlier detection and treatment are recommended.
To primarily repair a series of radial forearm flap donor defects, a total of 10 bilobed flaps based on the fasciocutaneous perforator of the ulnar artery were designed at the Chang Gung Memorial Hospital in Kaohsiung in the period from January of 2002 to January of 2003. All patients were male, with ages ranging from 36 to 67 years. The forearm donor defects ranged in size from 5 x 6 cm to 8 x 8 cm, with the average defect being 47 cm. One to three sizable perforators from the ulnar artery were consistently observed in the distal forearm and were most frequently located 8 cm proximal to the pisiform, which could be used as a pivot point for the bilobed flap. The bilobed flap consisted of two lobes, one large lobe and one small lobe. With elevation and rotation of the bilobed flap, the large lobe of the flap was used to repair the radial forearm donor defect and the small lobe was used to close the resultant defect from the large lobe. All bilobed flaps survived completely, without major complications, and no skin grafting was necessary. Compared with conventional methods for reconstruction of radial forearm donor defects, such as split-thickness skin grafting, the major advantage of this technique is its ability to reconstruct the donor defect with adjacent tissue in a one-stage operation. Forearm donor-site morbidity can be minimized with earlier hand motion, and better cosmetic results can be obtained. Furthermore, because a skin graft is not used, no additional donor area is necessary. However, this flap is suitable for closure of only small or medium-size donor defects. A lengthy postoperative scar is its major disadvantage.
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In a series of 50 consecutive cases with oral or oropharyngeal malignancies, aryl hydrocarbon hydroxylase (AHH) inducibility and smoking habits were studied. 82% of the patients were smokers. The AHH levels were divided into high, intermediate and low groups and were correlated to a healthy control material also divided into the groups mentioned. A significant overrepresentation of patients with a high AHH level (p less than 0.0005) as well as an underrepresentation of low AHH levels (p less than 0.01) was found. Smokers with a high AHH level run a sixfold risk of developing cancer in this area and develop it earlier in life than people with low or intermediate AHH levels. Recurrences or secondary malignancies in the upper digestive tract or airways were substantially higher in the high AHH level group as compared to the other. A high AHH inducibility level thus is of both pathogenetic as well as prognostic importance in oral and/or oropharyngeal cancer.
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