Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection.

BACKGROUND: Sentinel node biopsy (SNB) has been proposed for staging of N0 neck in oral/oropharyngeal carcinomas. It is claimed that SNB may be superior to selective neck dissection (SND) with respect to quality of life (QOL) and postoperative morbidity. METHODS: Twenty-four patients after SNB and 25 patients after SND (levels I-III) were enrolled. QOL and psychosocial variables were assessed by the health-related EORTC QLQ-C30 questionnaire, the disease-specific EORTC QLQ-H&N35 module, the Hospital Anxiety and Depression Scale, and a fear of progression questionnaire. The functional status was evaluated by scores for cervical scar, extent of lymphedema (Miller score), sensory function, function of facial and hypoglossal nerve, cervical spine, and shoulder (Constant score). RESULTS: Health-related QOL measurement revealed no differences between the 2 groups. Disease-specific QOL scores showed fewer swallowing problems in SNB patients (p = .043). SNB patients felt less fear of progression, experienced significantly less impairment from cervical scars, and had less sensory dysfunction and better shoulder function. CONCLUSION: Functional outcome after SNB is significantly better than after SND; however, this is not reflected in the scores of QOL questionnaires.

Remodeling of the cardiac extracellular matrix differs between volume- and pressure-overloaded ventricles and is specific for each heart valve lesion.

BACKGROUND AND AIM OF THE STUDY: Different patterns of fibroblast-mediated remodeling of the extracellular matrix (ECM) might be expected between patients with pressure- and volume-induced left ventricular hypertrophy. METHODS: Patients with chronic pressure-overload due to aortic stenosis (AS, n = 19) and chronic volume-overload due to either aortic regurgitation (AR, n = 9) or mitral regurgitation (MR, n = 10) were examined. The amount of interstitial collagen was quantified by using circular-polarization-microscopy in picrosirius red-stained biopsies. Biopsies from 10 patients with mild cardiomyopathy served as controls. In a subgroup, collagen type-I (Coll-I) and collagen type-III (Coll-III) gene expression was evaluated by quantitative RT-PCR. After immunohistological staining, procollagen-I/procollagen-III ratio and density of fibroblasts (FB) per vision-field were analyzed. RESULTS: The amount of interstitial cardiac fibrosis (ICF) was significantly higher in AS (5.7 +/- 4.1 g/m2), AR (8.8 +/- 4.9 g/m2) or MR (4.7 +/- 2.8 g/m2) than in controls (2.3 +/- 1.5 g/m2) (p = 0.003). The amount of thick collagen fibers was higher in AR than in AS, where-by density of fibroblasts did not differ. In volume-overloaded ventricles, the Coll-I/Coll-III ratio was shifted towards Coll-I, and in pressure-overloaded ventricles towards Coll-III. The severity of ECM remodeling was positively correlated with wall stress and impaired diastolic function, but not with systolic function or clinical symptoms. CONCLUSION: Remodeling of the ECM is specific for left ventricular volume and pressure overload, and may serve as an early indicator for inadequate adaptation.