Radiation therapy has proved to be a valuable modality in the management of patients with nasopharyngeal tumors. Routine follow-up of patients in the tumor clinic of the University of Illinois Eye and Ear Infirmary appeared to indicate an increasing incidence of otologic pathology. For this reason, a retrospective study focusing on the otologic findings in patients whose radiation therapy for nasopharyngeal tumors included the external auditory canal, middle ear space, or eustachian tube was performed. The results of this study are discussed in relationship to total radiation dosage, time of survival after therapy, and pretreatment otologic status. The complications covered a spectrum from intermittent serous otitis media to osteoradionecrosis of the external auditory canal. Possible contributing factors are discussed, and preventive measures are suggested.
Differentiated thyroid carcinoma was studied with regard to mode of presentation, initial findings, treatment and survival. The classic signs, symptoms, physical and scan findings were found to be present in approximately 70% of the patients. Thirty percent of the patients had either unusual presentations or findings. Prognosis was found to be dependent on age of presentation more than any other factor. The effects of neck metastasis, extracapsular invasion and recurrent laryngeal nerve involvement on long-term survival are studied in detail. patients with prior exposure to radiation were found to have more extensive disease and require more extensive surgery but ultimately had the same prognosis for 15-year cure. Treatment for distant metastatic disease by surgery, radioactive iodine and external radiation all resulted in long-term survival in certain cases.
A retrospective study was done of 602 patients with primary squamous cell carcinoma of the upper aerodigestive tract and a clinically negative neck (No) seen at the University of Illinois Hospital between 1960-1975. There was no uniform policy as to the treatment of No neck during this period; therefore in many of the patients, cervical lymph nodes were treated with elective neck dissection and others were followed until they became positive clinically. It was this difference which formed the basis for this study. All the patients were treated surgically; the patients were placed into two groups depending on whether they had radical neck dissection at the same time as resection of the primary. Group 1 consisted of 149 patients and had surgery for the primary only. The 253 patients of group 2 had surgery for the primary and also had a neck dissection. Both groups were analyzed for recurrences in the cervical region. In group 1, 12.9% of the patients developed either ipsilateral or contralateral metastases. Of the group 2 patients, 22% developed palpable nodal disease. The evolution of palpable nodal disease was analyzed by primary site, T-stage, and according to whether the tumor at the primary was controlled. Only 3% of the patients developed lymph nodes when the primary was controlled. The pathology reports of the neck specimens were studied to determine the relationship between a) positive node histology and b) number of nodes positive to the recurrence rate in the neck. Our results showed a 23% failure rate for the histologically positive group and a 21% failure rate for the negative group. The number of positive nodes did not seem to affect the recurrence rate.
Two cases of gastric heterotopias in the head and neck are described. Also, a brief review of previous case reports is presented as well as a discussion of the etiologic possibilities.
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