Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases

One hundred ninety-six patients treated for oral cancer between 1992 and 1999 self-scored their speech, chewing, and swallowing using a new self-questionnaire (Functional Intraoral Glasgow Scale) developed at Canniesburn Hospital, Glasgow, to assess the functional efficiency of patients treated for intraoral cancer. The patients were distributed into 12 homogeneous groups, according to the site and size of surgical resection, carefully mapped out on standard diagrams of the oral cavity. The functional outcome for chewing and swallowing was correlated to the site and size of resected tissue, to the reconstruction modality, and to radiotherapy and compared with the speech quality. The general trend is very similar for both chewing and swallowing; the smaller the resections, the better the functional outcome. Chewing was mostly affected by resections of the floor of the mouth, whereas swallowing was mostly affected by demolition of the base of the tongue and of the retromolar trigone. Speech showed a better postoperative recovery than chewing and swallowing. The reconstruction modality did not influence the eventual outcome for either function. Radiotherapy in combination with surgery is a negative functional prognostic factor. A correlation between site and size of excision and functional outcome is presented using color multiple-view diagrams for immediate appreciation to identify positive and negative prognostic factors.     

Our local experience with the surgical treatment of ampullary cancer

Background

The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999.

Methods

Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery.

Results

When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%.

Conclusion

In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates.

     

Objective assessment of treatment response in hirsutism

A simple photographic technique was used to assess the objective response of hirsute women to treatment with cyproterone acetate (CA). The skin in front of the left ear was shaved and photographs taken immediately and after 1 week, and hair growth per week estimated by averaging the length of 20 hairs in the magnified photographs. The precision, repeatability and patient acceptance of the method were found to be satisfactory. Basal hair growth rates were 2.28 +/- 0.4 mm/week (mean +/- SD, n = 34) and showed a significant correlation with hirsutism scores derived from a standard physician-rated scale. During therapy with CA the mean (+/- SD) improvement in hair growth rate was 19 +/- 13%, whereas physician-rated hirsutism scores improved by 33 +/- 20%. The reduction in hair growth rate showed no significant correlation with improvement assessed using subjective rating by either physician or patient. The greater improvement in physician-rated scores compared with hair growth rate assessment suggests that hair shaft width, colour and other factors may be as important as hair length when assessing treatment response.     

Our experience with surgical treatment of primary cancer of the gallbladder

Witkin 1980-1988, 42 patients (4 males and 38 females) were operated for the gall-bladder cancer; it makes 2.9% of the patients who underwent cholecystectomies. Average age of female patients was 65 and males--71 years. No typical complaints were revealed making possible an early diagnosing of the gall-bladder cancer. The far advanced stages of this cancer were found in 41 cases. In i case no macroscopic features of the cancer were found. Cancer was diagnosed by means of histopathological examination. One patient (woman) survived more than 3 years after operation; 3 women survived more than 1 year. Average survival is 4 months.     

Conservative and surgical treatment of pericarditis--our experience

Methods and results of both conservative and invasive therapy of pericarditis were analysed in the group of 30 patients. An emphasis was on successful treatment of mild (idiopathic) pericarditis and efficiency of the early started, combined pharmacotherapy (tuberculostatics + corticosteroids) of pericarditis of tuberculous etiology. A stress is on marked immediate efficacy of surgery in case of cardiac tamponade, independent on its etiology, with simultaneous recommendation of ultrasound-guided pericardial sac paracentesis. Survival rate in patients with malignant pericarditis is relatively low.     

Ultrasound-assisted lipoplasty treatment for axillary bromidrosis: clinical experience of 375 cases

Bromidrosis is a condition of abnormal offensive body odor caused mostly by apocrine gland secretion from the axilla. Although no morbid sequelae are known, the odor can be disturbing enough to cause social impairment and psychological distress. Medical care is available but is temporary and yields limited clinical benefit. Surgical treatment may provide a more definite remedy through reduction of the apocrine gland. However, there are risks for complication following surgical treatment such as subdermal excision, subcutaneous shaving, en bloc excision, and liposuction. The search for a less invasive but still effective procedure has led the authors to use ultrasound-assisted liposuction, which has reduced the risk of complication and recurrence. The purpose of this article was to evaluate the long-term outcome of ultrasound-assisted liposuction for the treatment of bromidrosis. From August 1998 to September 2002, 375 consecutive patients underwent ultrasound-assisted liposuction for bromidrosis of the axilla. The average age of the patients was 25.7 years (range, 15 to 55 years) and the average follow-up period was 18.8 months (range, 7 to 56 months). Subjective complaints of recurrences were noted in 22 patients (5.9 percent) and secondary ultrasound-assisted liposuction was performed, resulting in no further complaints. Complications other than recurrences were mild skin sloughing (3.2 percent), hematoma (1.3 percent), subcutaneous band (0.3 percent), and hypesthesia of the hand (0.3 percent), all of which healed spontaneously. Through a questionnaire that was answered by 264 patients, a subjective satisfaction rate was measured. Among the completed questionnaires, 91.7 percent reported satisfactory reduction of odor. Ultrasound-assisted liposuction to treat bromidrosis of the axilla provides advantages such as rapid recovery, less restriction of movement, unnoticeable scars, and a low rate of recurrence. The long-term outcome supports the benefits of this procedure. The authors recommend the use of ultrasound-assisted liposuction as first-line treatment for bromidrosis of the axilla.     

27例外科治疗脊柱结核病例的长期随访与分析

目的:通过长期随访27例外科治疗脊柱结核病例,探讨外科方法对于脊柱结核的治疗效果。方法:回顾性分析本单位近10年来收治的采用病灶清除植骨内固定术治疗的27例脊柱结核病例,通过分析平均44个月的随访结果,评价外科手术和药物干预的治疗效果。结果:本组所有患者早期随访结果显示:伤口一期愈合,内固定稳定,脊髓压迫症状缓解或消失。长期随访结果显示:能够贯彻全程化疗方案的病例,植骨完全融合,脊髓症状无反复,结核病灶无复发;未能完成化疗方案的4例患者在切口部位出现窦道,并在植骨床周围形成死骨,感染复发。4例复发患者经全身使用抗结核药物和二次手术翻修,在完成12月术后化疗后治愈。结论:对于脊柱结核必需坚持外科手术与术后全程化疗并重的的治疗方法。     

Restoration of fertility after treatment for cancer

The late effects of chemotherapy and radiation treatment on fertility are an important issue for long-term survivors of cancer who may not have started or completed a family at the time of diagnosis. Attempts at protecting reproductive function using hormonal manipulation have proved largely unsuccessful and other strategies have to be considered. For men, semen cryopreservation allows subsequent artificial insemination of a female partner or ivf but cryopreserved semen is a finite resource, does not allow natural conception and is not an option for prepubertal boys. In an effort to overcome this, research is in progress to investigate whether testicular cells harvested and cryopreserved before the start of chemotherapy can be reintroduced to the testis after treatment and resume normal spermatogenesis. This has been achieved in a mouse model and the results of experimental protocols in men are awaited with interest. For women, harvested mature oocytes are only poorly tolerant of the freezing process although immediate in vitro fertilization and cryopreservation of embryos can be successful. An experimental technique of great interest is the harvesting and cryopreservation of ovarian cortex before the start of sterilizing treatment. In ewes, the reimplantation of autologous ovarian cortical tissue into surgically castrated animals has resulted in resumption of oestrus, conceptions after normal matings and the birth of live offspring. Recently, ovarian function has been re-established using a similar technique in a patient following treatment for Hodgkin's lymphoma, but so far pregnancy has not been reported.     

62例有机磷农药中毒救治临床体会

目的:急性有机磷中毒是农村基层医院常见急症之一,它发病急、进展快,如不及时抢救或救治不当,患者可迅速死亡.本研究目的为总结我院近年来有机磷中毒患者救治体会,为基层医院救治农药中毒患者提供更多救治参考.方法:回顾性分析我院2008年6月-2010年3月收治的62例口服有机磷农药中毒患者,分析病例的发病情况和救治方法,并评价不同中毒剂量和不同救治时间患者的预后.结果:62例患者中,中、重度中毒45例,其中救治成功56例,4例因中毒时间较长,毒量大抢救无效死亡.结论:仔细观察患者症状,详细询问中毒途径及量,合理应用解毒药,维持呼吸功能,防止反跳,重视救治后的护理.     

Adjuvant therapy after radical surgery of cervical cancer: Zagreb experience

The results of the analysis of the treatment of 72 patients with carcinoma of the uterine cervix are presented. Seventy-two patients with Stage IB1 carcinoma of the cervix underwent a radical hysterectomy and pelvic lymphadenectomy. The low-risk group includes the patients without unfavourable prognostic factors that were treated by surgery alone. The high-risk group included women with pelvic node metastases, clinical tumour size greater than 3.0 cm, depth of stromal invasion greater than 1/3 of the cervical wall, Grade 3 tumours and the presence of lympho-vascular space involvement. High-risk patients received whole pelvic radiotherapy between two and four weeks following surgery. Thirty-four patients (47.2%) were in the low-risk group and thirty-eight patients (52.8%) were in the high-risk group. Locoregional recurrences were diagnosed in three cases (8.8%) in the surgery group and in four patients (10.5 %) assigned to postoperative radiotherapy. The incidence of distant metastases was 2.9% in the group treated by surgery alone and 5.3% in the group treated by surgery and radiotherapy. Overall survival at five years was 91.2% in the low-risk group and 89.5% in the high-risk group of patients. Five-year overall survival, locoregional and distant metastases were similar in the low-risk and high-risk groups of patients, which emphasizes the value of whole pelvic radiation in patients with one or more unfavourable prognostic factors after radical surgery in Stage IB1 cervical cancer     

A hybrid life cycle assessment of water treatment chemicals: an Australian experience

Purpose

Life cycle assessment (LCA) of chemicals is usually developed using a process-based approach. In this paper, we develop a tiered hybrid LCA of water treatment chemicals combining the specificity of process data with the holistic nature of input–output analysis (IOA). We compare these results with process and input–output models for the most commonly used chemicals in the Australian water industry to identify the direct and indirect environmental impacts associated with the manufacturing of these materials.

Methods

We have improved a previous Australian hybrid LCA model by updating the environmental indicators and expanding the number of included industry sectors of the economy. We also present an alternative way to estimate the expenditure vectors to the service sectors of the economy when financial data are not available. Process-based, input–output and hybrid results were calculated for caustic soda, sodium hypochlorite, ferric chloride, aluminium sulphate, fluorosilicic acid, calcium oxide and chlorine gas. The functional unit is the same for each chemical: the production of 1 tonne in the year 2008.

Results and discussion

We have provided results for seven impact categories: global warming potential; primary energy; water use; marine, freshwater and terrestrial ecotoxicity potentials and human toxicity potential. Results are compared with previous IOA and hybrid studies. A sensitivity analysis of the results to assumed wholesale prices is included. We also present insights regarding how hybrid modelling helps to overcome the limitations of using IO- or process-based modelling individually.

Conclusions and recommendations

The advantages of using hybrid modelling have been demonstrated for water treatment chemicals by expanding the boundaries of process-based modelling and also by reducing the sensitivity of IOA to fluctuations in prices of raw materials used for the production of these industrial commodities. The development of robust hybrid life cycle inventory databases is paramount if hybrid modelling is to become a standard practice in attributional LCA.     

Clinical experience with gene therapy for the treatment of prostate cancer

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients.     

食管穿孔外科治疗22例临床分析

目的:探讨食管穿孔的诊断、临床特征与外科治疗方法.方法:回顾分析1999年-2009年我院收治的食管穿孔22例.结果:本组病例4例保守治疗,2例行颈部脓肿切开引流,8例行单纯食管穿孔修补术,3例行纵隔及胸腔脓肿清除术并引流,1例行食管下段切除、胃代食管弓上吻合术,2例行食管修补并肺叶切除,2例行空肠双管造瘘加纵隔胸腔引流,2例因经济原因放弃治疗出院.治愈19例,治愈率86.3%,死亡1例,死亡率4.5%.结论:早期诊断和及时采取正确的处理措施是提高本病治愈率,降低死亡率的关键.