Prognostic significance of the distribution of neck node metastasis from oral carcinoma.

BACKGROUND: Carcinoma of the oral cavity presents a high risk for neck metastasis, which reduces the probability of regional control and survival. OBJECTIVES: The main objective of this study is to analyze prognostic implications of the distribution of neck metastasis in 513 patients with squamous cell carcinoma of the oral cavity. PATIENTS AND METHODS: All patients underwent surgery from 1970-1992. Tumor stages were I, 63; II, 120; III, 173; and IV, 157. Neck dissections were performed in 448 patients (115 bilateral). RESULTS: By use of multivariate regression techniques the level of lymph node involvement was the most important prognostic factor (relative risks from 1.8 to 2.5). The following variables were also associated with prognosis: mobility of lymph nodes, sex, T stage, age, and tumor thickness. CONCLUSIONS: The level of ipsilateral lymph node involvement was the most significant prognostic factor patients with in oral cancer who underwent surgical treatment. A significant decrease in survival also was seen with regard to the involvement of multiple contralateral lymph nodes. Our results support the indication of elective neck dissections in high-risk patients because among the cases that had metastases at follow-up, 50% were not candidates for salvage treatment.

Factors influencing contralateral lymph node metastasis from oral carcinoma.

BACKGROUND: An ipsilateral neck dissection is mandatory during initial treatment stages II-IV oral carcinomas. However, no consensus exists whether or not to perform an elective contralateral neck dissection. METHODS: Five hundred thirteen consecutive cases of squamous cell carcinoma (269 tongue, 135 floor of the mouth, 44 inferior gingiva, 65 retromolar trigone) were reviewed. Tumor stages were: 69 T1, 227 T2, 217 T3-T4, 263 N0, 250 N1-N3. A total of 563 neck dissections were performed in 448 patients. Univariate and multivariate analysis of risk factors were performed using logistic regression. RESULTS: Two hundred twenty-three patients (49.8%) had positive nodes in the specimen (182 ipsilateral, 36 bilateral, 5 contralateral). Contralateral neck recurrences occurred in 38 cases (33 not submitted to a contralateral neck dissection initially). Multivariate logistic regression analysis demonstrated that clinical stage (p = .0001), tumor crossing midline (p = .0011), and floor of the mouth involvement (p = .0236) were the most important predictors of contralateral metastasis. CONCLUSION: The contralateral side of the neck is a common and potentially preventable site of recurrence in tumors of the oral cavity. The multivariate model obtained discriminates patients with low and high risk (more than 20%) of contralateral metastasis. The application of this mathematical model can be useful for the indication of contralateral neck dissections, because not all tumors crossing midline are associated to a high risk (stages I and II tumors not involving the floor of the mouth) and not all tumors not crossing midline are at low risk (stages III and IV tumors involving the floor of the mouth).

[Ultrasonography as diagnostic method in abdominal trauma and wounds]. / La ultrasonografía como método diagnóstico en traumatismos y heridas abdominales.

Abdominal trauma is a public health problem. Early diagnosis of this lesion is directly related to the survival of these patients. Ultrasonography is a good method for the study of the traumatized patient. Abdominal ultrasonography was performed in 35 patients seen at the Central Military Hospital of Caracas during the years 1987-1988. Free liquid in the abdominal cavity and parenchymatous hematomas were the most frequent findings followed by retroperitoneal hematomas. Abdominal ultrasonography performed by trained and experienced personnel can be of great help in the management of patients with abdominal trauma. Correlation between ultrasonography, surgical findings and the clinical follow up was 100%. We recommended this method for the initial evaluation of these patients.