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PubMed1996

Elective neck irradiation versus observation of the clinically negative neck of patients with oral cancer.

PURPOSES: A retrospective study was conducted to determine the efficacy of elective neck irradiation (ENI) versus observation of patients with oral tumors of varying T stages and clinically negative necks, and to statistically evaluate outcome in the two groups with regard to the subsequent development of neck disease. PATIENTS AND METHODS: Seventy-three patients were treated with surgery of their primary site; 31 received ENI, and 42 of the necks were observed. Of the ENI patients, 3.2% developed neck disease compared with 31% of those observed. When the two groups were evaluated by the T stage of the primary tumor, the results for ENI versus observation were as follows: T1 (0% vs 31%), T2 (5.9% vs 26.7%), T3 + 4 (0% vs 31%), respectively (P < .0000, adjusted odds ratio = 13.73, 95% confidence interval). The difference between the two groups was highly statistically significant. One hundred fourteen patients were treated with only radiation therapy alone at the primary site. In this group, 88 received ENI, and 16 necks were observed. Eight percent of the ENI group developed neck disease, compared with 3.8% of the observational group. Further evaluation by T stage of ENI versus observation showed T1 (3% vs 0%); T2 (9.3% vs 7.7%); T3 + 4 (5.6% vs 0%), respectively. The difference between these groups was not found to be statistically significant. RESULTS: The 5-year disease-free survival rate for the surgical group was 90% for patients who received ENI and 40% for those observed. This difference was statistically significant (P = .0007). No statistical difference was found in 5-year disease-free survival for the radiation group between ENI and observation. CONCLUSIONS: When comparing the above data for ENI versus observation, the survival advantages of elective neck irradiation in patients whose primary tumor was treated surgically is striking for all T stages. These results make the decision to observe the neck in such patients difficult to justify. Lack of statistical difference between ENI and observation in the radiation cohort likely reflects selection bias. If radiation therapy is being used to treat the primary disease, only low-risk sites or histologically favorable tumors would not, on a routine basis, have the neck fields treated as well.

Adult↗
PubMed2006

Deep neck infection as the main initial presentation of primary head and neck cancer.

OBJECTIVES: Primary head and neck cancer and deep neck infection are not uncommon, but deep neck infection as the initial presentation of primary head and neck cancer is rare and these patients risk potential misdiagnosis. MATERIALS AND METHODS: The records of 301 patients with deep neck infection and 3,337 patients with primary head and neck cancers from 1990 to 2002 were retrospectively reviewed. Patients with primary head and neck cancers who had deep neck infection as their initial presentation were enrolled. RESULTS: Seven patients were identified (six men and one woman). The median age was 64 years. All patients presented with painful, erythematous neck swelling and all image studies showed abscess formation. Four abscesses received needle aspiration and three received surgical drainage, which yielded malignant cells in four specimens. The primary origins of malignancies were the nasopharynx (two patients), oropharynx (two patients), hypopharynx (one patient), parotid gland (one patient) and maxillary sinus (one patient). All patients had stage IV disease. Only three patients could receive curative therapy and only one patient was disease-free after three years. CONCLUSION: We suggest that detailed history-taking, complete examination of the ENT field and pathological study of the infected tissue must be performed for patients with deep neck infection to enable early detection and prompt treatment of any underlying malignancy.

Abscess↗
PubMed2004

Neck discomfort of wheelchair users: effect of neck position.

PURPOSE: To test the hypothesis that wheelchair users experience more discomfort when holding their necks in extended and/or rotated positions than when in their self-selected most comfortable positions (MCPs). METHODS: We studied 20 wheelchair users, first determining their MCPs with the eyes closed. Then, subjects assumed and maintained (for 5 min each) four neck positions in random order: level (L) and elevated (E), both straight ahead of the subject (S) and with the neck rotated (R). We measured neck extension angles (from digital photographs) and neck discomfort (using visual analogue scales [VAS], in %). RESULTS: The mean neck-extension angles were MCP - 2.6 degrees, LS 9.5 degrees, LR 8.1 degrees, ES 23.9 degrees and ER 25.4 degrees (ANOVA p < 0.0001). The mean VAS neck discomfort scores were LS 5.7%, LR 17.4%, ES 24.0% and ER 34.1% (ANOVA p < 0.0001). CONCLUSIONS: Sustained extension and rotation of the neck, alone or in combination, increase the neck discomfort of wheelchair users. The MCP for most wheelchair users is straight ahead with the neck slightly flexed, about 11 degrees and 27 degrees more flexed, respectively, than when looking at an average-height sitting or standing person. These findings have implications for wheelchair design, the behaviour of clinicians and wheelchair users, and the built environment.

Female↗
PubMed2005

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients.

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.

Adult↗
PubMed2005

Micrometastasis and recurrent neck node in supraomohyoid neck dissection field.

OBJECTIVES: Supraomohyoid neck dissection (SOHND) is one of the treatment for clinically negative neck disease in carcinoma of the oral cavity when primary is treated with surgery. Neck tumor recurrence in these patients who were treated by SOHND with and without post-operative radiotherapy was evaluated. MATERIAL AND METHOD: Forty-four patients with squamous cell carcinoma of the oral cavity aged between 33-78 years was studied Every case had clinically negative neck and was treated with SOHND. RESULTS: There were 53 supraomohyoid neck dissections. The overall recurrence rate was 11.3% (6/53). The duration of recurrence ranged from six to nine months and was seen in five of pathologically negative neck and one in pathologically positive neck. Five of six of the recurrence cases were in the field of SOHND without post-operative radiotherapy. Histopathological review with immunohistochemistry study of all recurrent cases that was previously reported as negative by H&E stain showed no micrometastasis. The 5-yr survival of neck node metastasis was 64% versus 82% of these with no lymph node metastasis which showed no statistically significant difference. CONCLUSION: The SOHND was useful for treating clinical negative neck of oral cancer with high percentage of occult lymph node. The pathological report influenced the adjuvant treatment. Micrometastasis and other indicators for this pathologically negative neck is still await further study to improve survival of this particular group of patients.

Adult↗
PubMed2000

Endoscopic neck dissection in an animal model: comparison of nodal yield with open-neck dissection.

OBJECTIVE: To evaluate the possibility, complications, and efficacy of endoscopic neck dissection (END) in a porcine model. DESIGN: Experimental self-controlled study. SUBJECTS: Minipigs. INTERVENTION: Endoscopic neck dissection was performed using general anesthesia with techniques adapted from laparoscopic surgery. The tissue specimens removed were divided according to porcine equivalents of human neck groups. After the completion of END, open-neck dissection was performed using standard surgical techniques, and the remaining tissue within each neck group was retrieved. A pathologist evaluated each specimen without knowing its exact origin in terms of neck group or side and the type of surgical technique used. For each specimen, the number of retrieved lymph nodes and their anatomical integrity were analyzed. RESULTS: Ten neck dissections were performed in 8 minipigs without any major complications. The number of retrieved lymph nodes by END was 18.4 +/- 7.4 (mean +/- SD). Completed open-neck dissection retrieved an additional 3.3 +/- 1.8 lymph nodes. The efficacy rate of END was 88% +/- 10% (+/ -SD). The majority of retrieved lymph nodes were intact, with less than 5% of nodes exhibiting crushing artifacts. CONCLUSIONS: Endoscopic neck dissection in a porcine model seems to be free of major complications and able to retrieve the majority of neck lymph nodes. A larger number of animals and their survival need to be studied before human studies can begin.

Animals↗
PubMed2002

Results of selective neck dissection in management of the node-positive neck.

BACKGROUND: Although increasingly accepted in treatment of the N0 neck, use of selective neck dissection in patients with node-positive squamous cell carcinoma of the head and neck remains controversial. OBJECTIVE: To determine the oncologic efficacy of selective node dissection in patients with node-positive squamous carcinoma of the head and neck. SETTING: Three tertiary care academic/Veterans Affairs medical centers. METHODS: Ten-year retrospective medical chart review of 106 previously untreated clinically and pathologically node-positive patients undergoing 129 selective neck dissections and followed for a minimum of 2 years or until patient death. RESULTS: Regional metastasis was clinically staged as N1 in 58 patients (54.7%), N2a in 5 (4.7%), N2b in 28 (26.4%), N2c in 14 (13.2%), and N3 in 1 (0.9%). Extracapsular extension of tumor was present in 36 patients (34.0%), and postoperative radiation therapy was administered to 76 patients (71.7%). Overall, 9 patients experienced disease recurrence in the neck. Six of these recurrences were in the side of the neck that had undergone selective neck dissection, for a regional control rate of 94.3%. CONCLUSIONS: These results support the use of selective neck dissection in carefully selected patients with clinically node-positive squamous cell carcinoma of the head and neck region. Regional control rates comparable to those achieved with comprehensive operations can be achieved in appropriately selected patients.

Adult↗
PubMed1989

Treatment of the clinically negative neck in advanced cancer of the head and neck.

The proper management of the clinically negative neck in primary squamous cell carcinomas of the head and neck remains controversial. Although many clinicians believe that elective neck dissection or neck irradiation are equally effective for controlling subclinical disease, previous studies have not directly addressed this question. The charts of 195 patients with advanced primary squamous carcinoma, yet with clinically negative necks, were reviewed. There were no significant differences in the rates of neck cancer recurrence among the elective neck irradiation, dissection, and combined treatment groups. Elective neck irradiation and neck dissection in patients with clinically negative nodes seemed equivalent in their ability to control neck disease. The decision as to which form of therapy is preferable must therefore be based on other criteria.

Carcinoma, Squamous Cell↗
PubMed2001

The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck.

BACKGROUND: Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck. METHODS: Patients undergoing elective neck dissections for head and neck squamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive SLNs; visualization of blue stained lymphatics identified blue SLNs. A neck dissection completed the surgical procedure, and the pathology of the SLN was compared with that of the remaining neck dissection. RESULTS: Sentinel lymph node biopsy was performed on 40 cases with clinically N0 necks. Twenty were pathologically clear of tumor and 20 contained subclinical metastases. SLNs were found in 17 necks with pathologic disease and contained metastases in 16. The sentinel lymph node was the only lymph node containing tumor in 12 of 16. CONCLUSIONS: The SLN, in head and neck carcinomas accessible to injection without anesthesia, is an accurate reflector of the status of the regional lymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in identifying the clinically N0 patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph node dissection should be considered.

Adult↗
PubMedDate not supplied

Failure in the neck following multimodality treatment for advanced head and neck cancer.

Failure in the neck is an important cause of morbidity and mortality in head and neck cancer. Patients who underwent therapeutic or elective radical neck dissection at Memorial Sloan-Kettering Cancer Center between 1960 and 1966 developed recurrence of cancer in the dissected neck in 36.5% of the cases when metastatic carcinoma was present in the cervical lymph nodes at one level, and in 71.3% when metastases were present at multiple levels. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with the combination of surgery and elective postoperative radiation therapy. Of these, 106 patients underwent radical neck dissection and 94 were proven to have metastatic carcinoma in the neck. Eleven patients developed recurrences in the neck. Recurrence developed in 16% of 19 patients with metastases at one level, and in 13% of 75 patients with metastases at multiple levels. For 53 patients, radiation therapy was started within 6 weeks after neck dissection and only 2% of them developed recurrence in the neck; for 41 patients, radiation therapy started later than 6 weeks and 29% of them developed recurrence (P less than 0.01). Comparison of these data with our historical control group suggests a decrease in the number of failures in the neck when a multimodality treatment is used. It appears, however, that irradiation must be started within 6 weeks after surgery for the best results.

Carcinoma, Squamous Cell↗
PubMed2000

Selective neck dissection in the management of the clinically node-negative neck.

OBJECTIVE: To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node-negative neck. STUDY DESIGN: Case histories were evaluated retrospectively. METHODS: The results of 300 neck dissections performed on 210 patients were studied. RESULTS: The primary sites were oral cavity (91), oropharynx (30), hypopharynx (16), and larynx (73). Seventy-one necks (23%) were node positive on pathological examination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had extracapsular spread. The median follow-up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological examination (3%) when compared with patients with positive nodes without extracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with extracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pNO) necks in the patients who did not have irradiation. CONCLUSION: SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.

Adolescent↗
PubMed2002

The node-negative neck: accuracy of clinical intraoperative lymph node assessment for metastatic disease in head and neck cancer.

OBJECTIVES/HYPOTHESIS: Often, the type of neck dissection performed in patients with head and neck malignancy is finally determined by intraoperative assessment of clinically suspect lymph nodes by frozen section. This prospective study aimed to assess the accuracy of clinical intraoperative lymph node assessment and therefore to examine validity of the underlying assumption that the surgeon can consistently identify nodes that contain metastatic tumor. We also aimed to assess whether gross morphological characteristics of the lymph nodes examined could be correlated with nodal status and therefore used to predict those nodes containing metastatic disease. STUDY DESIGN: A prospective study assessing the accuracy of clinical intraoperative lymph node assessment in the node-negative neck. METHODS: Forty-six neck dissections from 34 patients with head and neck cancer were prospectively examined intraoperatively by a single surgeon. All obvious nodes were clinically assessed, morphologically described, and subsequently correlated with pathological findings. RESULTS: Sixty palpable nodes were identified in 32 neck dissections. They were clinically categorized as malignant or suspect (22) or benign (38). Pathological examination revealed a false-positive rate of 30% and a false-negative rate of 44%. The sensitivity of intraoperative lymph node assessment was 56%, and the specificity was 70%. Apart from "infiltration," morphological characteristics could not be correlated with nodal status. In the 14 neck dissections with no obviously palpable lymph nodes, 4 (29%) were positive for metastatic disease. CONCLUSIONS: In the node-negative neck, intraoperative assessment does not seem to improve the accuracy of staging. The only parameter of benefit and correlating with metastatic disease is clinical evidence of infiltration. The assumption that frozen section is a good determinate for selection of type of neck dissection is questionable. If selective neck dissection is not found to be therapeutic, its use leads to over-reliance on other therapeutic treatment such as postoperative radiotherapy, depriving the patient of a potential useful treatment modality in cases of locoregional recurrence.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

[Selective neck dissection in the treatment of pN1/2 lymph node metastases in the neck].

INTRODUCTION: As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. MATERIAL AND METHOD: This retrospective study included 595 surgically treated patients in the period 1990-1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck, without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiatitherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. RESULTS: Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were pathohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. DISCUSSION: This study includes comparison of our results with results of literature data. CONCLUSION: Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.

Adult↗
PubMed1992

[Neck lymph node dissection in squamous cell carcinoma originating in the head-and-neck area; the significance for the prognosis].

Neck dissection has a therapeutical as well as a prognostic relevance with respect to regional recurrence and distant metastases. Between January 1973 and July 1986 576 neck dissections in 511 patients (396 men, 115 women, among whom 486 with squamous cell carcinoma of the head and neck, and 14 with neck metastases of an unknown primary tumour) were performed at the department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam. Patients with tumour at the margins were excluded. Recurrence-free curves were calculated according to Kaplan-Meier and the log rank test was used to test the differences. All patients underwent a comprehensive neck dissection and were irradiated postoperatively when three or more tumour-positive nodes or extranodal spread were reported by the pathologist. Endpoint for analysis was occurrence of an ipsilateral neck recurrence or of a distant metastasis. Figures were corrected for a simultaneous recurrence at a higher level. A total of 29 neck recurrences (7.2%; n = 523) and 26 distant metastases (10.7%; n = 281) were demonstrated in the 5-year follow-up period. The number of positive nodes was of prognostic significance for both events (p = 0.039 and p = 0.0027). Extranodal spread was shown only to increase the incidence of distant metastases (p = 0.017), whereas its prognostic value with regard to recurrence in the neck was nullified by the strict institution of postoperative radiotherapy. It is recommended to give radiotherapy to patients with two positive nodes and possibly to every patient with a histopathologically positive neck.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Scapular neck fracture--the influence of permanent malalignment of the glenoid neck on clinical outcome.

A scapular neck fracture is considered unstable if it is associated with an ipsilateral clavicular fracture or an acromioclavicular (AC) joint dislocation. Currently, it is recommended that stabilization of a disrupted shoulder girdle must be achieved through open reduction and internal fixation of the clavicular fracture or by reduction of the AC joint, without addressing the scapular neck. However, if the displaced glenoid neck is not simultaneously reduced, malalignment of the glenoid neck may persist. The purpose of this retrospective study was to analyze the effect of associated shoulder girdle injury on glenoid displacement and the influence of glenoid malalignment on clinical outcome. Nineteen patients with scapular neck fractures were reviewed clinically and radiologically at a mean of 8 years (range 2-21 years) after injury. None of them has developed nonunion of the scapular neck, and only one showed radiological signs of mild degenerative joint disease. The glenopolar angle (GPA), which assesses the rotational malalignment of the glenoid about an anteroposterior axis perpendicular to the scapular plane on plain X-rays was measured less than 20 degrees in six patients. Three of them had sustained an associated clavicular fracture or AC joint dislocation. The other 3 patients had permanent severe malalignment of the glenoid neck in the absence of an associated shoulder girdle injury. Five patients with GPA less than 20 degrees complained of moderate or severe pain, whereas of the 13 patients with mild or no glenoid rotational displacement or medial displacement alone, 11 patients had no or mild pain, and only 2 had moderate or severe pain (P = 0.0095). Five patients presented with reduced activities of daily living, 4 of them had severe glenoid rotational displacement (P = 0.0173). Loss of motion was found in only 2 patients, and both had a severely displaced glenoid neck (P = 0.088). In conclusion, severe displacement of the glenoid neck may occur with or without associated fracture of the clavicle or dislocation of the AC joint and can be identified as a GPA less than 20 degrees. Scapular neck fractures with such malalignment have a less favorable long-term outcome compared with otherwise comparable cases with absence of glenoid malalignment as measured with the glenopolar angle.

Adult↗
PubMed1996

Comparison of bladder neck preservation to bladder neck resection in maintaining postrostatectomy urinary continence.

OBJECTIVES: This study compares the effectiveness of a bladder neck preservation procedure with that of bladder neck resection in maintaining postprostatectomy urinary continence. METHODS: Bladder neck preservation was attempted in 107 men and completed in 91; bladder neck resection was performed in 99 patients. Successful follow-up was performed in 90 and 98 patients, respectively, during a mean interval of 42 months. The two groups were compared for return of urinary continence at monthly intervals to 1 year, the incidence of positive surgical margins, and recurrence, using an unpaired t test and regression curves. RESULTS: Continence at 1 month was 11.2% for patients undergoing a bladder neck resection and 23.3% for those with preservation of the bladder neck. At 3 months, the continence rates were 44.3% and 62.4%, respectively; at 6 months, they were 70.1% and 82.4%, respectively; and at 1 year, they were 86.3% and 89.4%, respectively. There was no significant difference in time to continence at 1 year between the two groups; however, there was a significantly decreased time to continence seen in patients with preservation of the bladder neck. The incidence of positive margins and organ-confined disease was not significantly different between the two groups. Detectable serum prostate-specific antigen levels were seen in 17.3% of patients undergoing bladder neck resection and in 16.7% of those with bladder neck preservation. CONCLUSIONS: Preservation of the bladder neck is technically feasible; in selected patients, it is effective in eradicting disease without an increased recurrence rate. The procedure does not produce an improved rate of postprostatectomy incontinence, although it can be expected to shorten the interval of incontinence.

Adenocarcinoma↗
PubMed2000

Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter Project for Research in Osteoporosis.

The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck-shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60-90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60-90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck-shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck-shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.

Absorptiometry, Photon↗
PubMed1998

Radiotherapeutic management of bulky cervical lymphadenopathy in squamous cell carcinoma of the head and neck: is postradiotherapy neck dissection necessary?

Although traditional recommendations for the management of bulky cervical lymphadenopathy (AJCC categories N2-3) with definitive radiotherapy call for postradiotherapy neck dissection regardless of treatment response, recent data suggests that this policy can be modified on the basis of tumor regression rate. In a series of 130 patients with stage III-IV squamous cell carcinoma of the head and neck managed with a concomitant boost-accelerated hyperfractionated radiotherapy schedule, 81 cases had cervical lymphadenopathy at the time of referral. Patients were analyzed with respect to regional control outcomes for those having complete and incomplete clinical responses during the initial 3-month follow-up interval. The general management policy has been close observation of patients demonstrating complete clinical responses to radiation rather than postradiotherapy neck dissection. Failure patterns were examined in the 58 patients classified as complete responders. Failure occurred in the primary site in 16 (28%) of these patients, while isolated neck failure occurred in only 3 (5%). Neck recurrence rates for patients with maximum lymph node size < or = 3 cm vs. > 3 cm were not statistically different at 3-year follow-up (94% vs. 86%). Among the 23 incomplete clinical responders, 18 had incomplete neck responses. Five of these patients underwent salvage neck dissection; 4 remain clinically free of recurrence. The remaining 13 patients who either refused or were not eligible for salvage surgery ultimately succumbed with persistent loco-regional disease. The policy of observation after complete response to the radiotherapy schedule employed here was associated with a very low incidence of isolated neck failures and was safe and appropriate in patients who can be followed reliably. The prognosis for patients who failed to respond in the neck was poor except for those who underwent salvage surgery.

Carcinoma, Squamous Cell↗