[Duplex sonography of the carotid artery following neck dissection. Initial experiences in tumor after care].
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Postoperative blindness due to ischemic optic neuropathy is a rare and dramatic complication. A review of the literature from 1960 until nowadays reveal several physiopathological mechanisms of the blindness. Through the description of their clinic case of a fourty seven years old man showing definitive postoperative blindness after sustaining surgery for epidermoid carcinoma of the mouth floor, the authors suggest as etiology the conjunction of the following factors: brain venous high pressure, head and neck oedema, hypotension and the vascular state of the patient. Special perioperative care taking in account the risk factors is needed to prevent this complication.
OBJECTIVE: Our study was designed to find out the rate and the characteristics of micrometastasis in cervical lymph nodes using immunohistochemical staining. STUDY DESIGN AND SETTING: From 69 patients, 1710 lymph nodes negative for metastasis on hematoxylin-eosin stain, were examined. Immunohistochemical stain was performed using pan-cytokeratin AE1/AE3 antibody. RESULTS: In 13 cases, occult lymph node metastasis was detected by immunohistochemical method. On retrospective review of the hematoxylin-eosin stain by the pathologist, lymph node metastasis was detected in 4 of 13 patients. CONCLUSIONS: Because the immunohistochemical method enhanced the detection rate of occult micrometastasis in cervical lymph nodes of head and neck squamous cell carcinoma patients, it may be recommended for routine diagnostic use in patient with negative for a lymph node metastasis on routine hematoxylin-eosin stain.
With the proliferation of operations designed to treat cervical metastatic nodal disease, it has become ever apparent for the need to more clearly and precisely communicate the location of the metastatic cervical nodes and the specific surgery performed. To this end, this paper reviews the variety of operations and the resultant confusing terminology that has emerged over the past five decades. It is suggested that a simplified technology be used that specifically describes the nodal levels dissected, the relevant nonlymphatic structures removed, and those structures that are preserved. It is also suggested that the new imaging-based nodal classification be used to standardize the definition of the nodal levels. It is hoped that this approach will eliminate many of the often confusing and nondescriptive terms and there by facilitate better inter-physician and inter-institutional communication.
Occult thyroid cancer is an occasional incidental finding during surgery for other indications and is usually considered of minor clinical significance; however, the appropriate approach for incidentally found metastatic thyroid cancer is less clear especially when it occurs in the context of another malignancy that has more aggressive potential. Among 2,855 patients treated for squamous cancer of the tongue at The University of Texas M. D. Anderson Cancer Center, eight patients had coexisting differentiated thyroid cancer metastatic to cervical lymph nodes which was found incidentally during regional lymph node dissection. The eight patients included three women and five men with a median age of 47 years (range, 32-62 years); tumors were of the papillary variety in four patients and follicular in the other four. In one patient, no gross or microscopic primary tumor could be identified after thyroidectomy; in another patient, no gross tumor was evident, but whole organ section revealed an area of fibrosis consistent with a primary lesion. Two patients had primary lesions less than 1 cm in maximal diameter. In four patients who had no surgery, physical exam and radiologic evaluation failed to show any intrathyroidal lesions. Clinically relevant thyroid cancer did not develop in any of those patients during the duration of documented follow-up (1-15 years). Three patients died of progressive tongue cancer, one patient of unrelated pulmonary disease, and four patients remain alive without evidence of disease for 1 to 15 years of available follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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