ABSTRACT
INTRODUCTION: Two new methods of reconstructing the proximal oesophagus after resection of cancer in the larynx, hypopharynx, or proximal oesophagus are examined. MATERIAL AND METHOD: Between 1991 and 1996, 12 patients were operated on after initial irradiation. The reconstructions were done by a microsurgical technique, with eight jejunum transplants and four tubulated radial forearm flaps. The records were reviewed retrospectively. RESULTS: The patients were hospitalised for about a month and were able to swallow soft food three weeks after the operation. Most patients achieved pain palliation and a good swallowing function for a period of three to more than 24 months, until relapse. All patients except two died between five and 21 months after the operation. DISCUSSION AND CONCLUSION: Both techniques give an acceptable swallowing function until relapse. The size of the defect indicates the choice of flap. They are also suitable in such situations as complex fistula formation, congenital atresia, and the after-effects of corrosion.
Subject(s)
Esophageal Neoplasms/surgery , Esophagoscopy/methods , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Aged , Esophageal Neoplasms/radiotherapy , Esophagectomy , Female , Humans , Hypopharyngeal Neoplasms/radiotherapy , Jejunum/transplantation , Laryngeal Neoplasms/radiotherapy , Laryngectomy , Male , Middle Aged , Pharyngectomy , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Radial Artery/transplantation , Retrospective Studies , Skin TransplantationSubject(s)
Lymph Node Excision , Lymph Nodes/diagnostic imaging , Melanoma/surgery , Skin Neoplasms/surgery , Axilla , Guidelines as Topic , Humans , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis/diagnostic imaging , Lymphatic Metastasis/pathology , Melanoma/pathology , Radionuclide Imaging , Skin Neoplasms/pathologyABSTRACT
New trial have shown that immediate regional lymph node dissection offers increased survival in patients with regional lymph node metastases only. Introduction of isotope technique to identify the first node, the sentinel node (SN), receiving lymph from a tumour area has made it possible to avoid node dissection in SN metastasis negative patients. The feasibility of the technique is illustrated by to examples.
Subject(s)
Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Melanoma/pathology , Skin Neoplasms/pathology , Adult , Humans , Inguinal Canal , Lymph Node Excision , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Male , Melanoma/diagnostic imaging , Melanoma/surgery , Middle Aged , Radionuclide Imaging , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgeryABSTRACT
Seals and other Pinnipedia my carry a range of infectious agents which could be of clinical interest. A paramyxovirus infection caused epizootic seal death around danish coasts in 1988, but as the population is now recovering more contacts between seal and man must be envisaged. Bites and other forms of direct and indirect contact and carry a risk of development of seal (or blubber) finger. This entity encompasses oedema of the affect finger, swelling of the interphalangeal joint adjacent to the lesion, and no suppuration. The condition is extremely painful and may lead to residual dysfunction or amputation. There is circumstantial evidence that the condition is caused by mycoplasma, and Canadian researchers have identified three species, one of which has been directly linked to blubber finger. At the first medical contact after seal bites and other seal-inflicted lesions thorough cleansing with water and soap is recommended. Systemic therapy with tetracycline is recommended, but both fluorquinolones and macrolides may be efficacious.
