CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR.

CFR for malignant paranasal sinus tumors is a safe surgical treatment with an overall mortality of 4.5% and complication rate of 33%. The status of surgical margins, histologic findings of the primary tumor, and intracranial extent are independent predictors of outcome.

BACKGROUND:In this study by the International Collaborative Group, the authors examined a large cohort of patients accumulated from multiple institutions that had experience in craniofacial surgery with the objective of reporting outcomes and complications for craniofacial resection (CFR) in the elderly. METHODS: One hundred seventy patients aged 70 years were included in the study. The median age was 75 years (range, 70-98 years). One hundred four patients (61%) had received previous single-modality or combined treatment, which included surgery in 79 patients (46%), radiation in 47 patients (28%), and chemotherapy in 13 patients (8%). The most common histology was squamous cell carcinoma (67 patients; 39%). The margins of resection were close or microscopically positive in 56 patients (33%). Sixty-eight patients received adjuvant radiotherapy (40%), and 3 patients received chemotherapy (2%). Complications were classified into overall, local, central nervous system (CNS), systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by using the Kaplan-Meier method. Outcomes were compared with patients aged <70 years. Statistical analyses for outcomes were performed in relation to patient characteristics, tumor characteristics (including histology and extent of disease), surgical resection margins, previous radiation, and previous chemotherapy to determine predictive factors. RESULTS: Postoperative mortality occurred in 16 patients (9%), and postoperative complications occurred in 72 patients (42%). Local wound complications occurred in 40 patients (24%), CNS complications occurred in 24 patients (14%), systemic complications occurred in 19 patients (11%), and orbital complications occurred in 4 patients (2%). Postoperative mortality and complications were significantly more frequent in elderly patients compared with patients aged <70 years (postoperative mortality: 9% vs 3%; P ¼.04; complications: 42% vs 32%; P ¼.0009). The 5-year OS, DSS, and RFS rates were significantly poorer than those for patients aged <70 years (OS: 42% vs 56%; P < .0001; DSS: 53% vs 61%; P ¼.04; RFS: 46% vs 54%; P ¼.03). Surgical margin status and primary tumor histology were independent predictors of OS, DSS, and RFS in multivariate analysis. CONCLUSIONS: CFR for malignant skull base tumors in elderly patients (aged 70 years) was associated with increased mortality, complications, and poorer outcomes compared with patients aged <70 years.

Objective: To report postoperative mortality, complications, and outcomes in a subset of patients with the histologic diagnosis of malignant melanoma extracted from an existing database of a large cohort of patients accumulated from multiple institutions. Design: Retrospective outcome analysis. Setting: Seventeen international tertiary referral centers performing craniofacial surgery for malignant skull base tumors. Patients: A total of 53 patients were identified from a database of 1307 patients who had craniofacial resection for malignant tumors at 17 institutions. The median age was 63 years. Of the 53 patients, 25 (47%) had had prior single modality or combined treatment, which included surgery in 22 (42%), radiation in 11 (21%), and chemotherapy in 2 (4%). The margins of resection were close or microscopically positive in 7 (13%). Adjuvant radiotherapy was given in 22 (42%), chemotherapy in 3 (6%), and vaccine or interferon therapy in 2 (4%). Complications were classified into overall, local, central nervous system, systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined using the Kaplan-Meier method. Predictors of outcome were identified by multivariate analysis.

Preoperative differential diagnosis of a swelling in the neck is mandatory for a good therapeutic planning. Indiscriminate biopsy as first approach is to be disregarded, since it can compromise the result of a radical neck dissection in cases where a metastasis of epidermoid cancer is histologically recognized. A cervical biopsy is not to be performed until a complete HNT examination (including the thyroid and major salivary glands) has excluded the presence of a primary tumor in these regions. Since every localization of the head and neck malignancies shows rather fixed patterns in its lymphatic spreading, a correlation between site of T and particular localizations of N within the neck can be found. The knowledge of the probabilities that an adenopathy in a given region of the neck correlates with a primary tumor located in a given site of the body could strongly aid the physician in detecting the latter, following a rational statistically based approach. This study was performed applying Bayes theorem for probability calculus to the maps of distribution of metastases of tumors of different site in 3,700 patients who were taken into National Cancer Institute of Milan during 7 consecutive years. The results are gathered in tables and text-figures showing the great significance of some correlations, who become more evident when the adenopathies are multiple, but who usefully direct the physician also when the adenopathy is only one.

No abstract

No abstract

As possibilidades de intervenção no campo da saúde são múltiplas e marcaram a história da humanidade. Nos últimos séculos, o trato da saúde foi atribuído à medicina, que, valendo-se de dispositivos institucionais, jurídicos e científicos, tornou-se preponderante. Um dos pilares dessa profissão está constituído nos processos de medicalização. O presente estudo, de cunho teórico, objetivou problematizar a hegemonia da noção de medicalização baseada no arcabouço médico-científico ocidental. A partir da argumentação foucaultiana acerca das tentativas de padronização dos sujeitos a partir das noções de saúde e de doença pretendida pela medicina ocidental, pontua-se a necessidade de levar em conta as proposições que evocam terapêuticas plurais voltadas para compreender os processos de saúde e adoecimento em outras perspectivas. Elaborado entre duas fronteiras teóricas, o estudo analisa, primeiramente, a constituição histórica da medicina e sua legitimação como saber hegemônico. Na sequência, busca-se matizar as possibilidades de intervenção na área de saúde, dando visibilidade ao que a Antropologia denomina de medicalização do simbólico, que engloba os saberes advindos do cotidiano relacional e afetivo de diferentes culturas. Ao final da trajetória, fomentam-se análises acerca das tentativas de apagamento de modos de existência plurais empreendidas a partir da medicalização hegemônica, discorrendo sobre a relevância de multiplicar perspectivas de intervenção na saúde para superar essa exclusividade, tomando em consideração também os saberes advindos de fontes sociais e culturais.