Lasko et al., 1991;Latif et al., 1992;Cunningham et al., 1993;Adamson et al., 1994). A number of oncogenic and tumoursuppressor gene functions have been demonstrated in squamous cell carcinoma of the head and neck (SCCHN) (Field et al., 1989(Field et al., , 1991Field, 1992) To date only two global analyses of the whole genome have been undertaken with the view to determine the fractional allele loss (FAL) of specific tumours and thus provide information concerning the 'genetic burden' of the disease during its progression as measured by clinicopathological parameters and survival data. This type of analysis has been undertaken in colorectal (Vogelstein et al., 1989) and bladder cancers (Knowles et al., 1994), and provides an indication of interacting genetic mechanisms in the development of these diseases. In addition, the results of such detailed allelotypes may aid the interpretation of carcinogenesis and the development of molecular progression models for specific tumours.We have undertaken a very comprehensive allelotype of SCCHN using 145 microsatellite markers in order to identify common regions of allelic imbalance and to analyse the interactions of these regions by calculating the fractional allele loss (FAL) in these tumours.
Materias and methods
Specimens
Adenoid cystic carcinoma has a long natural history but frequently proves fatal. The present study describes 108 patients with an adenoid cystic carcinoma of the head and neck seen over a 30-year period. Analysis of the data utilized both univariate and multivariate methods. Forty per cent of patients had tumours arising from the oral cavity and half of these were in the hard palate; 29% occurred in the major salivary glands; 41% of tumours were locally advanced at presentation and 11% had lymph node metastases at this time. The histological pattern was solid in 25%, cribriform in 40% and tubular in 20%. In addition, 15% of patients had a polymorphous low-grade adenocarcinoma and these were analysed separately. Primary site recurrence was more common in the presence of locally advanced tumours at presentation (T3-4) (P = 0.0093). Only six patients had surgery with adjuvant radiotherapy. Six patients had no curative treatment, 21 had primary radiotherapy, 39 had local excision and 42 radical excision. The actuarial primary site recurrence rate was 100% at 30 years. The neck node recurrence rate was 23% at 15 years. Tumour specific survival was 40% at 20 years. Solid histology had a worse prognosis than other histological types (P = 0.0429) but those patients with polymorphous low-grade adenocarcinomas fared very well. Patients with tumours of the hard palate fared better than those patients with tumours at other sites (P = 0.0301). Early disease at the primary site (T1-2) was a good prognostic sign (P = 0.0013). Patients with neck node metastases at presentation tended to do badly (P = 0.009).
We demonstrated significant use of the internet amongst those attending paediatric general surgical services. Clinician sourced information remains important, however we should engage with patients to utilise this vast resource effectively.
While globus pharyngeus is a common disorder, accounting for 3% to 4% of new otolaryngology outpatient referrals, few long-term follow-up studies have been conducted on patients with this condition. The authors of this study followed 74 patients with a diagnosis of globus pharyngeus for an average of 7 years, 7 months (range: 7 years to 8 years, 10 months). During the follow-up period, 55% of patients were asymptomatic and 45% of patients had persistent symptoms. An in-depth analysis of features at clinical presentation failed to reveal any reliable prognostic indicators. A number of patients developed other conditions during the follow-up period, but no patient developed upper aerodigestive tract malignancy. This study represents the longest follow-up of globus patients to date and, to the authors' knowledge, is the first to address the issue of malignancy in globus.
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