Bilateral chylothorax following right radical neck dissection.

Chylothorax is a relatively common complication in non cardiac thoracic surgery or chest injury. However, the accumulation of cycle in pleural space bilaterally following neck dissection is extremely rare, with less than 10 cases documented in literatures. We report a case of bilateral chylothorax following total laryngectomy and right radical neck dissection who was successfully treated conservatively. The anatomy, diagnosis and management of chylothorax following neck dissection are discussed.

Ability of clinical nodal staging to predict histologic nodal status in breast cancer patients.

Axillary lymph node metastasis is the most important prognostic factor for breast cancer. Pathologic examination of axillary lymph node dissection specimens is the gold standard for determining if the tumour has metastasized. Clinical nodal staging may help the physician to plan for management and to decide what advice to give the breast cancer patients. We studied the metastasis predictive ability of clinical lymph node staging, and tried to identify subgroups that were more reliable for clinical staging. Patients and Methods: We did a cross-sectional study by collecting the data of patients who had their breast cancers treated at Siriraj Hospital from 1983 to 1993. The lymph node status from preoperative physical examination was compared to the pathologic result of axillary lymph node dissections. Results: Of 1,355 breast cancer patients, 4 patients were stage 0, 224 were stage I, 891 were stage II, 161 were stage III, and 40 patients were stage IV (with 35 missing). Mean diameter of the cancer was 3.6 cm. The average age at diagnosis was 48.5 years. Fifty one percent (697 patients) had at least one palpable node from preoperative physical examination, and 50% of cases (678 patients) had pathologic axillary lymph node positive for metastasis. When compared to pathologic examination, the accuracy of clinical lymph node staging was 70.6%, with 70% sensitivity and 71% specificity. The accuracy was increased in patients with small (T1) or large primary tumor (T3,4) subgroups. Conclusion: Physical examination of axillary lymph node could be used as a guide for predicting metastasis of breast cancer, but with 25-30% of uncertainty.

The surgical correction of the bony ankylosis of the temporomandibular joint.

Bony ankylosis of the temporomandibular joint (TMJ) is an uncommon problem. Since 1997 only seven patients have been treated by the Department of Surgery, three with unilateral involvement and four with bilateral involvement. The associated deformity of the mandible is dependent on the age at the onset of disease or injury. Surgical correction is the only way of treatment, with the main objective being to resume joint movement and jaw function as well as to prevent relapse and, hopefully, restore appearance and occlusion. Surgical procedure included condylectomy with or without coronoidectomy, degloving of the masticator muscles, temporalis muscle flap interposition, costochondral grafting and granioplasty. Postoperative wound infection was found in three patients, one died of gentamicin-induced renal failure six weeks postoperatively. In the long-term follow-up, one patient developed recurrence that was successfully treated repeated surgery.

Carotid body tumor resection and hypotensive anaesthesia during 1985-1991.

We retrospectively analysed the administration of anaesthesia for carotid body tumor resection in Siriraj Hospital during 1985-1991. The tumors were excised from seven patients under general hypotensive anaesthesia. Such slow-growing large tumors frequently encircle the internal and external carotid arteries, which increases the risk of massive blood loss and damage to major cranial nerves. Thus, carotid arteriography for diagnosis and demonstration of collateral circulation and cardiovascular monitoring during resection was indispensable. All tumors were completive death. Following surgery, one patient developed transient weakness of the upper extremity which lasted one week. Cranial nerve palsy (CN IX, X) occurred in one patient who recovered in three months.

Platysma myocutaneous flap for hypopharyngeal reconstruction.

Ten male patients with hypopharyngeal and/or laryngeal cancer underwent hypopharyngeal reconstruction after tumor ablation, using platysma myocutaneous flaps. Their age ranged from 41-82 years, (mean age of 62.7 years). All were examined by barium swallowing before and 2 weeks after operation in order to compare the size and function of hypopharynx. The immediate postoperative period was uneventful and satisfactory except one patient (10%) who suffered from the separation of suture lines on the flap leading to the development of saliva fistula and neck infection. The surgical technique, minor complications and long-term postoperative results were fully described in the report.

Mitoxantrone as single agent in the treatment of advanced breast cancer: Clinical study at Siriraj Hospital.

During August 1986 – August 1988, a total of 35 patients with advanced breast cancer were treated with Mitoxantrone (Novantrone), 14 mg/M3 intravenously every 3 weeks. Of these, 27 patients with total 78 lesions could be evaluated for response and 30 patients for toxicity. The mean follow-up period was 18 months (2-24 months). The median time to achieve response was 9 weeks after treatment. Eleven patients (41%) achieved an objection tumor response (CR+PR) including four (7%) complete response. In another way of evaluation, a total of 78 evaluable lesions were assessed of which 29 (37%) achieved response (CR+PR), including 10 (13%) complete response. The duration of response varied from minimum 2 months to more than 19 months (median=5 months). The median time to treatment failure was 5.9 months. Myelosuppression was the dose-limiting toxicity and was observed with moderate to severe degree in 19 patients (63%). The most frequent non-haematological toxicities were mild grade of nausea and vomiting occurred in 137 cycles from the total number of 195 evaluable cycles (70%). No cardiotoxicity was noted in this study after the maximum cumulative dose of Mitoxantrone 157.5 mg. This agent is well tolerated and offers comparable efficacy with less tolerable toxicity than other effective agents currently used as single agent in the treatment of advanced breast cancer.