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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the use of antibiotic prophylaxis has significantly reduced the frequency of postoperative wound infections, they continue to be a critical issue in head and neck cancer surgery. A study was made of possible risk factors for the development of these infections. A prospective study was made of 159 patients with pharyngo-laryngeal squamous-cell carcinoma who underwent open-pharynx surgery in order to analyze the factors associated with wound infections. Postoperative wound infection was defined as purulent drainage or mucocutaneous fistula formation, or both, in the first 10 days after surgery. Potential risk factors examined were age, medical illnesses, prior surgery and radiotherapy, TNM stage, type of operative procedure, method of reconstruction, and operative time. The overall wound infection rate was 23%. Although the incidence of wound infection was higher in patients who received preoperative radiotherapy, in patients with advanced stage disease, and in those who required flap reconstruction, the only preoperative factor that significantly increased the rate of wound infection was the concurrence of medical illnesses (chronic obstructive pulmonary disease and diabetes mellitus; p = 0.018). In conclusion, the presence of prior medical diseases was the main risk factor in the development of postoperative wound infections.
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PMID:[Risk factors in surgical wound infection in oncological surgery of the head and neck]. 964 62

There has been significant concern that the dental curriculum and system of clinical education, in particular, is not designed to take advantage of the explosion in knowledge in biomedical science and its application to the health of the public. Although there are some examples of innovations in dental education on a global scale that have the capacity to increase the assimilation of basic and clinical knowledge, most of the dental education models are mired in the traditional '2 + 2' approach to education. This can be seen in North America and the European '2 + 3' model or the stomatological '4 + 2' approach. In each of these systems, the basic and behavioural science courses continue to be perceived as hurdles over which students must leap in order to reach the clinical programmes where there is little opportunity to use basic science information to advance patient care and treatment. Examples of issues that are not well represented include: innovations in imaging; diagnosis; bio-materials; science-based approaches to clinical practice; novel approaches to therapeutics; interactions between the oral, dental and craniofacial complex and systemic health and disorders; the role of oral infections and systemic disease; the increasing appreciation of chronic diseases and disorders such as osteoporosis and diabetes that affect oral tissues; the promise of bioengineering, tissue engineering and biomimetics; the potential use of saliva as a diagnostic tool; the understanding of oral complications of cancer treatment; the treatments of HIV/AIDS diseases and hepatitis; the use of dental and dental hygiene staff on health-care teams to deal with issues such as birth defects, orofacial trauma, head and neck cancer, chronic pain management and so on. There seems to be an excessive emphasis on restorative dentistry and, to a lesser extent, on the more biological approaches to diagnosis, prevention and therapeutics. This continued lack of integration of basic and clinical sciences in the curriculum continues to foster a dental workforce that is highly technically competent to provide specific clinical services but poorly equipped to evaluate and implement new biological approaches to diagnosis, therapeutics and intervention. Unfortunately, after many attempts by organized dental symposia aimed at the integration of basic and clinical sciences, there has been little discernible curricular change. It appears that there is an opportunity through this global congress to identify the best practices in the various global curricula that could change this paradigm in dental education and lead us toward the education of a more scientifically orientated practitioner-one who can take advantage of innovations in new and emerging technologies in their application to patient care. It is the challenge of this section to try to ascertain the best method or methods by which dental education promotes research to the dental student and what research represents in terms of critical thinking and evidence-based approaches to dental education and clinical practice.
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PMID:1.4 Research and the dental student. 1239 Feb 58

The association between cisplatin treatment and diabetes mellitus was analyzed retrospectively in 219 patients with locally advanced squamous cell head and neck cancer treated in two consecutive trials with cisplatin-based induction chemotherapy. It was found that 11 patients (5%) developed diabetes mellitus during the treatment period, two cases presenting as hyperosmolar coma. The literature contains only sporadic descriptions of cases of hyperosmolar coma related to cisplatin chemotherapy. The present study was initiated owing to a case of hyperosmolar coma observed by us. We suggest that glycemia levels in patients receiving chemotherapy with a cisplatin-based regimen should be monitored regularly.
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PMID:Diabetes mellitus following cisplatin treatment. 1266 35

Stroke represents a major cause of disability among middle-aged and elderly people. Carotid artery stenosis is an important risk factor for stroke and is prevalent in elderly men with hypertension, diabetes mellitus, and those who smoke or have atherosclerotic disease, or both. Patients who undergo neck dissection for head and neck cancer may have some or all of the above characteristics and may experience surgical manipulation of the carotid arteries. This combination of medical and surgical factors may predispose such patients to perioperative stroke. A critical review of the literature was completed to determine the incidence of stroke perioperatively in patients undergoing a neck dissection for head and neck cancer. We found 2 studies that quoted the risk of stroke to be between 3.2% and 4.8%. The implications of these results are significant because they suggest a need for preoperative screening (with Doppler ultrasonography) or intervention (with carotid endarterectomy), or both. However, the quality of these 2 studies is such that future research is first needed to define the rate of stroke in head and neck surgery.
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PMID:Perioperative stroke occurring in patients who undergo neck dissection for head and neck cancer: unanswered questions. 1457 3

Most of the head and neck tumors are squamous cell carcinomas (SCCs), which are relatively sensitive to chemotherapeutic agents. Cis-platinum (CDDP), 5-fluorouracil and taxanes are widely used worldwide for SCCs, and CDDP is the most common agent. Renal toxicity is a well-known adverse effect of CDDP, and adequate pre and post-hydration or combined administration of neutralizing agents is performed during CDDP injection. Before the CDDP administration, we have to evaluate renal function of the patients using creatinine clearance rate (Ccr). In Japan, CDDP at the dose of 60-70 mg/m(2)/day is administered in cases with over 65 ml/min/1.73 m(2) of Ccr, whereas in cases under 60 ml/min/1.73 m(2), we use other drugs, e.g., carboplatin, to prevent the renal dysfunction followed by chemotherapy. In other countries, the dose of CDDP is 70-100 mg/m(2)/day, and the discrepancy is based on the poor renal function of Japanese. We calculated Ccrs of 107 head and neck cancer patients since January, 2004 to August, 2005, and evaluated renal function before any treatment. Ccr was decreased in proportion to aging. At the age of fifties, 43.5% of the patients indicated lower Ccr than 65 ml/min/1.73 m(2): sixties, 45.7%; seventies, 50.0%; and eighties, 85.7%. In the United States, the average glomerular filtration rate of over 70 year-old healthy people is estimated as 75 ml/min/ 1.73 m(2), and it is considered sufficient kidney function for the administration of CDDP at the dose of 70-100 mg/ m(2)/day. The incident rate of end-stage renal disease is 1.3 times higher in the United States than in Japan. The incident rate of diabetes, which is the main cause of renal dysfunction, is almost the same in both countries. Though the reason is unclear, it is the fact that the renal function of Japanese decreases quickly in accordance with aging.
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PMID:[Change of creatinine clearance rate in accordance with aging in Japanese patients with head and neck cancer]. 1661 54

Formation of carotid artery pseudoaneurysm is uncommon after intensive treatment for head and neck cancer. We encountered a case of postoperative formation of pseudoaneurysm at the left carotid bifurcation in a diabetic man. The risk factors for carotid artery pseudoaneurysm in the patient included diabetes mellitus, previous radiotherapy to the neck, neck dissection, and postoperative Staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula. We successfully obliterated this pseudoaneurysm using a Smart stent and detachable coils without neurological deficits. The possibility of vascular injury after treatment for head and neck cancer must be considered, especially in patients with risk factors for it due to previous treatment.
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PMID:Carotid artery pseudoaneurysm as a rare sequela of surgery for laryngeal cancer. 1669 10

Our aim was to assess the influence of age, co-morbidity factors and tumour characteristics on dysphagia severity in the diagnosis of head and neck cancer. Modified barium swallow (MBS) examinations were performed in patients at diagnosis of head and neck cancer. Dysphagia was graded on a scale of 1 to 7 of increasing severity. Between 2000 and 2006, 236 patients with dysphagia underwent MBS at diagnosis of their head and neck cancer. 82 patients were scored as Grade 1, 88 as Grade 2, 29 as Grade 3, 15 as Grade 4, 9 as Grade 5, 5 as Grade 6, and 8 as Grade 7. Grade 3-7 dysphagia occurred in 20% and 31% of patients with T1-T2 and T3-T4 tumours, respectively (p = 0.004). Corresponding values for N0-N1 and N2-N3 tumours were 20% and 39%, respectively (p = 0.002). The percentage of patients with Grade 3-7 dysphagia was 5%, 29%, 33% and 52% for oral cavity, laryngeal, oropharyngeal and hypopharyngeal tumours, respectively, (p = 0.002). Age and co-morbidity factors (e.g. diabetes, hypertension, coronary artery disease, peripheral vascular diseases and arthritis) did not appear to have an impact on swallowing in this limited retrospective study. Patients with locally advanced stages (T3-T4, N2-N3) are at risk of severe dysphagia. Patients with oral cavity tumours appear to be less at risk of dysphagia than those with tumours in different anatomic locations. The role of age and co-morbidity factors should be investigated in future prospective studies.
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PMID:Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. 1850 71

Several authors have cited liver cirrhosis as a risk factor for surgery but no study performed statistical correlation between flap outcome and severity of liver cirrhosis in patients with head and neck cancer. We performed a retrospective analysis of 3108 patients who underwent free tissue transfer after head and neck cancer ablation between January 2000 and December 2008. Liver cirrhosis was identified in 62 patients. Forty-two patients (67.7%) were classified as having Child's class A cirrhosis, seventeen (27.4%) as having class B, and three (4.9%) as having class C cirrhosis. The overall complete flap survival rate was 90.3% (56/62). The flap-related complications of patients with Child's class A, B, and C were 38.1% (16/42), 47.1% (8/17), and 100% (3/3), respectively and showed no significant difference between these three groups (p=0.2758). The rate of postoperative neck hematoma was 14.5%; the risk of postoperative neck hematoma was significantly higher in patients with more advanced liver cirrhosis (p=0.0003). The recipient-site complications of patients with Child's class A cirrhosis, Child's class B, and Child's class C cirrhosis were 35.7%, 41.1%, and 66.6%, respectively, with no significant difference among the three groups. The statistical analysis demonstrated that diabetes mellitus is significantly associated with a negative prognosis for free flap reconstruction (p=0.0364). The flap survival rate and patency of microvascular anastomosis have no association with liver cirrhosis. To achieve a superior surgical outcome, preoperative optimization and a multidisciplinary team responsible for the evaluation and treatment of head and neck cancer patients with cirrhosis are necessary.
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PMID:The impacts of liver cirrhosis on head and neck cancer patients undergoing microsurgical free tissue transfer: an evaluation of flap outcome and flap-related complications. 1972 21

The goal of this study was to evaluate the relationship between postoperative fistula formation and perioperative risk factors after radial forearm free flap (RFFF) reconstruction for head and neck cancer. A total of 180 patients underwent RFFF reconstruction after head and neck ablative surgery from October 1993 to July 2009. Age, gender, systemic disease, smoking status, tumor stage, preoperative radiotherapy, reconstruction site, concurrent neck dissection, flap shape and size, and partial or complete flap necrosis were recorded as potential prognostic variables. Twenty-one (11.7%) of the 180 patients developed a fistula. Significant correlations were found between fistula formation and diabetes mellitus (p=0.015) and preoperative radiotherapy (p=0.029). Reconstruction of the hypopharynx influenced fistula formation with borderline significance (p=0.057). The multivariate analysis showed a significant association between fistula formation and diabetes mellitus (odds ratio=5.4 [95% CI, 1.0-27.6]) and preoperative radiotherapy (odds ratio=5.9 [95% CI, 1.1-32.6]). Spontaneous fistula closure occurred in 10 patients, but surgical closure with a local flap or pectoralis major myocutaneous flap was necessary in the other 11 patients. Diabetes mellitus and preoperative radiotherapy were found to be risk factors for fistula formation in patients that underwent RFFF reconstruction for head and neck cancer.
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PMID:Factors predicting fistula following radial forearm free flap reconstruction for head and neck cancer. 2072 37

Free tissue transfer has become a popular technique for soft tissue defect reconstruction in head and neck cancer ablation. Although high success rates and good reliability of free flaps are proven, microvascular thrombosis is still the most critical issue for microsurgeons. Pharmacological antithrombotic agents are widely used but their efficacy is still debated. In this study, we analyzed whether prostaglandin-E1 (PGE1) and dextran-40 can improve the outcomes compared to no antithrombotic therapy at all. We retrospectively reviewed 1,351 free flaps performed for head and neck reconstruction after cancer ablation. Three groups defined were 232 flaps received PGE1, 283 flaps received dextran-40, and 836 received no antithrombotic therapy. The demographics of these three groups indicated no statistical differences. The results showed that flap survival revealed no significant difference among PGE1, dextran-40, and control group (P = 0.734). There was a tendency to hematomas in PGE1 group (P = 0.056) when compared with other two groups. Dextran-40 significantly increased flap failure rate in high-risk patients with diabetes mellitus (P = 0.006) or hypertension (P = 0.003), when compared with PGE1 and control group. These results revealed antithrombotic therapy with PGE1 and dextran-40 do not determine a significant improvement in flap survival.
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PMID:The outcome of prostaglandin-E1 and dextran-40 compared to no antithrombotic therapy in head and neck free tissue transfer: analysis of 1,351 cases in a single center. 2243 38


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