Elective lymph node dissection in stage I cutaneous malignant melanoma of the head and neck. A report from the Swedish Melanoma Study Group.

The effect of elective lymph node dissection in patients with cutaneous malignant melanoma of the head and neck was investigated in a retrospective study. Of 517 patients in clinical stage I, 84 underwent elective dissection of the ipsilateral neck lymph nodes. In six of these patients, lymph node metastases were demonstrated at histopathological examination. There was a slight reduction in the incidence of recurrent disease in the regional lymph nodes in the group of patients who had undergone elective lymph node dissection, but this difference was not statistically significant. No significant differences were seen between the two groups regarding overall survival of disease-related survival.

Cutaneous malignant melanoma of the head and neck. Analysis of treatment results and prognostic factors in 581 patients: a report from the Swedish Melanoma Study Group.

BACKGROUND: Results of surgical treatment of cutaneous malignant melanoma (CMM) have been highly variable, probably because of patient selection. Therefore, a study of representative patients with this disease was performed. METHODS: In a defined area of Sweden, 581 patients were analyzed. Clinical records and histopathologic findings were reviewed. The minimum follow-up time was 7 years. Prognostic factors were evaluated by the Cox proportional hazards model. RESULTS: Evaluation of sex distribution, age, and anatomic site of the primary tumor showed that the patients were representative of all Swedish patients with CMM of the head and neck. The mean patient age at diagnosis was 64 years for both sexes. Fifty-three percent of the patients were women. Female patients had more tumors of the face than did male patients, whereas male patients were overrepresented among patients with tumors of the auricle-external ear canal and scalp-neck area. Localization to the face was observed in 68%, which is an overrepresentation of three to four times when skin surface is taken into consideration. Twenty-four percent of the patients had lentigo maligna melanoma. Only 33% of the patients had superficial spreading melanoma. In univariate analyses, sex, anatomic site of the primary tumor, histogenetic type, Clark level of invasion, and tumor thickness had prognostic power. In a multivariate analysis, tumor thickness, anatomic site of the primary tumor, and sex of the patient were independent prognostic factors. CONCLUSIONS: In representative patients with CMM of the head and neck, tumor thickness, anatomic site of the primary tumor, and sex of the patients were independent prognostic factors.

Salivary duct carcinoma--a clinicopathologic study of 12 cases.

Salivary duct carcinoma (SDC), a recently defined malignant tumor usually of major salivary glands, has probably been included in the group of adenocarcinomas, NOS. As yet, only a few descriptions of its clinical behavior have appeared. We have found 12 cases of SDC treated at our institution since 1970 and have reviewed their presentation and course. Despite total parotidectomy in most cases and radiotherapy in all, most patients have succumbed to their tumors, six with distant metastases. SDC appears to be a highly malignant tumor requiring aggressive combined therapy for locoregional control. The high incidence of systemic spread indicates a need for effective chemotherapy on an adjuvant basis.

[Histologic scoring system for various cancers of the external ear]. / Histologisches Punktesystem bei verschiedenen Karzinomen des äusseren Ohres.

A histological scoring system was created to determine the aggressiveness of basal cell carcinomas of the head and neck and to determine which squamous cell carcinomas of the external ear will develop metastases. Basal cell carcinomas of the external ear were the most aggressive. The parameters depth of growth and mode of invasion were the most valuable in predicting metastases.

[Dilatation of esophageal strictures using a balloon catheter]. / Dilatation der Oesophagusstrikturen mit einem Ballonkatheter.

The technique of balloon catheter dilatation of benign esophageal strictures is presented. A general anesthetic is unnecessary which is an advantage in older patients. Moreover, the encouraging results and the absence of complications support the opinion that balloon catheter dilatation is an excellent alternative in the treatment of esophageal strictures.

Neural beta-adrenergic dilatation of the facial vein in man. Possible mechanism in emotional blushing.

Ring preparations of the superficial buccal segment of the human facial vein, taken from extirpated tissue in 12 patients during neck surgery, were studied in vitro. The vein developed a maintained intrinsic myogenic tone in response to passive stretch and was supplied with alpha- as well as beta-adrenoceptors, both of which could be influenced by transmural nerve stimulation (TNS) and noradrenaline. These unusual characteristics for a vein are basically similar to the ones described for the rabbit facial vein by Pegram, Bevan & Bevan (1976). In man there seemed to be an inter-individual difference with regard to the abundance of 'innervated' alpha- and beta-adrenoceptors. Facial vein specimens from some subjects thus responded with prompt and pronounced net dilatation to TNS with maximum at 4 Hz and those from others with net constriction with maximum at 16 Hz. The latter showed a reversal into neural beta-adrenergic dilatation after alpha-adrenergic blockade. The human external jugular vein was devoid of intrinsic tone and beta-adrenoceptors. It is tentatively proposed that a beta-adrenergic neuro-effector mechanism in superficial ramifications of the facial vein in man might be involved in the emotional blushing reaction.

Sleep apnea syndrome caused by acromegalia and the treatment with a reduction plasty of the tongue. Case report.

Obstructive sleep apnea syndrome was every likely caused by an enlarged tongue in a 60-year-old man with acromegalia. The diagnosis was confirmed by polygraphic sleep recordings and by roentgenologic examination. The patient was treated with a tongue-reduction plasty which gave him good subjective relief and better sleep. A whole night polygraphic sleep recording showed a couple of hours of normal sleep without apneas or arousals. The last part of the night was, however, still disturbed by several apneas with concomitant arousals.

Sleep apnea syndrome--an alternative treatment to tracheostomy.

Two patients with obstructive sleep apnea syndrome had polygraphic recordings demonstrated upper airway obstruction and sleep with extremely short sleep latency, severely disturbed nightsleep resulting in sleep deprivation, and excessive daytime sleepiness. Radiological investigation showed the upper airway obstruction to be caused by the tongue falling back occluding the pharynx. Nasopharyngeal intubation relieved the symptoms. The patients were trained to perform this treatment themselves every night, demonstrating that this treatment is an attractive alternative to the conventional tracheotomy.

Guidelines for prophylactic radical lymph node dissection in cases of carcinoma of the external ear.

All cases of squamous-cell carcinoma of the external ear that were treated at the ENT Clinic, University Hospital, Lund, Sweden, between 1970 and 1977 were analyzed retrospectively to determine parameters for predicting the development of metastases. These cases included 62 males and 3 females, with a mean age of 77 years. The frequency of metastases for these patients was 16.4%. The carcinomas were graded according to four parameters: depth of growth, mode of invasion, cellular differentiation, and cellular plasmolymphocytic response. We concluded that depth of growth and mode of invasion were the most useful of these parameters and that prophylactic lymph node dissection should be performed in cases of tumors larger than 4 cm in diameter, of tumors infiltrating the cartilage, and of smaller tumors with maximum scores for depth of growth and mode of invasion.

Vertigo and dizziness of functional origin.

In patients consulting otologists for vertigo a functional source can be expected in 50% of the patients and more frequently among young females than among older male subjects. Functional vertigo is frequently perceived as a turning sensation inside the head, functional dizziness frequently as a rocking sensation of the whole body, while patients with vertigo of somatic origin frequently seem to complain of a spinning sensation outside the head. The duration pattern of functional vertigo is frequently of a fluctuating or continuous type, while in the nonfunctional subjects it is of 2-5 hr. duration. In patients with vertigo of functional origin eye-closure tends to release rather than inhibit nystagmus.

Facial fractures. A review of 368 cases.

The medical records of 368 patients, hospitalized for facial fractures, were analyzed according to sex, age, etiology, etc. To get the long-term results, the patients were given a questionnaire which was answered by 271 patients (73.6%). In the total material there is an overrepresentation for younger males and the main reasons for the fractures are traffic accidents (34.8%) and fights (27.1%). The most common fracture is the zygomaticomaxillary one (202 cases), followed by the fractures of the mandible (121 cases). The results 1 week postoperatively were good from a clinical point of view. The results from the X-ray examination with its exact demands were poorer. This discrepancy is discussed. The questionnaire covers a postoperative period of 6--99 months. Altogether, 40.1% of the patients operated on and 57.1% of those not operated on were satisfied and considered themselves as good as before the lesion. The results improve in the course of time, especially the functional ones. The reactivation of the function in the infraorbital nerve seems to be a more drawn-out process than previously supposed.