A review of vascular anastomosis with mechanical aids and nonsuture techniques.

Devices and techniques for nonsuture vascular anastomosis and for suture anastomosis with minimum blood flow interruption are reviewed from their beginnings in the late 19th century through the development of microvascular surgery in the 20th century. The various devices that have been invented fall into 3 basic categories: butt, flanged, and lapped joints. Although the development of microsurgical instruments and the improvement of suture materials have diminished the use of such mechanical aids in recent years, it is hoped that this historical overview will be of interest to investigators involved in the surgery of vessels of various calibers.

Finding the missing information in cancer statistics.

The current cancer literature is imprecise and confusing. This hampers the ability to draw meaningful conclusions regarding diagnosis and treatment. It is suggested that all future reporting of statistics contain the following features: (1) discussion of case selection criteria; (2) use of TNM system for case classification; (3) listing of minimal treatment details; (4) explanation for length of follow-up used; (5) standardized terms for evaluation (relating these to individual TNM classification); and (6) listing of all failures by standardized terms. It is proposed that editors of journals and organizers of meetings reject all papers that do not meet these criteria.

The biomechanics of facial bone fracture.

Selected facial bone locations were impacted to simulate clinical trauma conditions. Locations selected included the nose, zygoma, mandible, maxilla, and frontal bone. The experiment clearly delineate tolerance bands for the facial bones for both sexes. These data should permit the improved design of injury producing structures.

The dilemma of the second surgeon.

The dilemma of the second surgeon is created when a patient is seen who has received advice and/or treatment by a colleague in the same specialty. The problem is compounded when conflicting opinions as to diagnosis, treatment, and results occur. This is discussed in the context of providing optimal care, maintaining effective communication, and avoiding the obvious pitfalls.

The case for elective prophylactic neck dissection.

The possibility of improving the cure rate of cancer of the head and neck by radical neck dissection of the clinically negative neck (elective neck dissection) continues to pose a therapeutic dilemma. This paper seeks to review the available information, analyze relevant aspects of the issue and attempt to draw conclusions which will be helpful both to physicians and their patients. The discussion is confined to squamous carcinoma of the larynx, pharynx, and oral cavity.

Mandibular trauma: secondary problems in reconstruction.

Cosmetic and functional restoration of the fractured mandible in the great majority of cases is the sine qua non of therapeutic success. Not only must an acceptable low complication rate be obtained, but when present, their complex nature must be understood from the onset. Successful treatment of complications is a multifaceted problem requiring planned, interdisciplinary, often times staged reconstruction. The radiologist and dental prosthodontist make valuable contributions towards the surgeon's ultimate rehabilitation of the patient. A three year experience of 111 mandibular fractures treated on the UCSD Otolaryngology Service is characterized. Sixteen complications nine of which were seen after initial treatment elsewhere provide the focus of this report. Special emphasis is given to the pre-treatment planning and surgical techniques necessary to correct malunion and nonunion. Particular advantages achieved by the use of osteogenic autogenous marrow, cellulose acetate filters and Vitallium (chrome cobalt) trays are detailed.

Laryngeal papillomatosis: immunologic and viral basis for therapy.

The distressing nature of laryngeal papillomatosis and lack of clinical progress in its treatment are reviewed. Presently accepted and investigative methods of therapy are reviewed with special attention being given to immune therapy. Support for the concept of a viral etiology is discussed and other etiologic agents considered. Known and possibly significant roles of wart virus antibodies are discussed and the importance of complex interplay between maternal and fetal immune systems explored as a possible explanation for some puzzling aspects of laryngeal papillomatosis. Finally, a proposed experimental design is outlined, the purpose of which is to provide a useful animal model to investigate immune changes in laryngeal papillomatosis, as well as effects of surgical or medical therapy.

Surgical management of the thyroid nodule: patient selection based on the results of fine-needle aspiration cytology.

To determine whether the routine use of fine-needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA. Twenty-nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant. Two of the 17 patients who had a negative FNA but underwent thyroidectomy based on other factors were found to have thyroid cancer. Only 8 (33.3%) of the 24 surgical specimens of patients who did not have an FNA were found to be malignant. FNA had a sensitivity of 93.5% and a specificity of 75.0%. The results indicate that the routine use of FNA for patients with thyroid nodules reduces the incidence of unnecessary surgery. Furthermore, FNA alone is sufficient to identify most patients at risk and is, therefore, cost-effective. However, the presence of other findings suspicious of malignancy should preclude clinical decision making based on FNA alone.

The biomechanics of maxillofacial trauma.

Current advances in vehicle design include nonlacerative windshields and energy-absorbing instrument panels and interior structures. In order to prevent more severe injuries, it may be necessary to accept minor soft tissue trauma and nasal fractures, but it should be possible to prevent almost all other facial trauma at reasonable impact speeds.