Recent experience with reconstructive surgery following major glossectomy.

In an attempt to monitor the impact of new reconstructive procedures and shifting interest away from routine preoperative radiotherapy, we have reviewed the 81 patients undergoing major glossectomy and reconstruction (MGR) at the Royal Marsden Hospital, London and Surrey, England, between 1975 and 1987. While there were four marginal and 13 major reconstructive failures, 11 of the latter were successfully managed with an alternative flap, thus providing a prompt and effective palliation for most of these patients. An evolution in our choice of reconstructive procedures as well as a recent trend toward using MGR as a primary therapeutic modality were noted. Data relating to speech following reconstruction and diet rehabilitation were encouraging, particularly with the use of the latissimus dorsi flap. Survival following MGR, however, was dismal due to early local and regional recurrence.

Right hepatic lobectomy for primary and metastatic tumour: experience in a community teaching hospital.

The first eight patients who required either a total or extended hepatic lobectomy for malignant tumour at a community teaching hospital are reviewed. Two patients had primary liver tumours and six had metastatic adenocarcinomas, five from colorectal and one from an unknown primary tumour. There were no deaths perioperatively, morbidity was minimal and survival was encouraging. Three patients died of disseminated disease 9, 16 and 18 months respectively after hepatic resection. However, five patients were free of disease 19, 27, 52, 63 and 80 months after operation. The authors' initial experience compares favourably with that of others and demonstrates that major hepatic resection can be done safely and can offer prolonged survival of good quality to a selected group of patients, even when the tumour load is large.

Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and II Breast Cancer.

There is a general consensus that earlier detection of breast cancer should result in improved survival. Current breast imaging relies primarily on mammography. Despite better equipement and regulation, variability in interpretation and tissue density still affect accuracy. A number of adjuvant imaging techniques are currently being used, including doppler ultrasound and gadolinium-enhanced MRI, which can detect cancer-induced neovascularity. In order to assess the potential contribution of currently available high-resolution digital infrared technology capable of recognizing minute regional vascular flow related temperature variation, we retrospecitively reviewed the relative ability of our preoperative clinical exam, mammography, and infrared imaging to detect 100 new cases of ductal carcinoma in situ, stage I and II breast cancer. While the false-negative rate of infrared imaging was 17%, at least one abnormal infrared sign was detected in the remaining 83 cases, including 10 of the 15 patients, a slightly younger cohort, who had nonspecific mammograms. The 85% sensitivity rate of mammography alone thus increased to 95% when combining both imaging modalities. Access to infrared information was also pertinent when confronted with the relatively frequent contributory but equivocal clinical exam (34%) and mammography (19%). The average size of those tumors undetected by mammography or infrared imaging was 1.66 cm and 1.28 cm, respectively, while the false-positive rate of infrared imaging in a concurrent series of 100 successive benign open breast biopsies was 19%. Our initial experience would suggest that, when done concomitantly with clinical exam and mammography, high-resolution digital infrared imaging can provide additional safe, practical, and objective information. Further evaluation, preferably in controlled prospective multicenter trials, would provide valuable data.