Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma.

AIM: To estimate the sensitivity and specificity of computed tomography used for the detection of extranodal spread of metastatic head and neck squamous cell carcinoma, by experienced head and neck radiologists. MATERIALS AND METHODS: Participants had undergone a neck dissection for head and neck squamous cell carcinoma, together with computed tomography scanning prior to surgery (accessible for reporting). Computed tomography images were independently examined by two experienced head and neck radiologists. Nodal involvement by squamous cell carcinoma and the presence or absence of extranodal spread were recorded. Results were compared to the histological specimen. The sensitivity, specificity and positive predictive value of using computed tomography for the detection of nodal involvement and presence or absence of extranodal spread were estimated, and 95 per cent confidence intervals were calculated. RESULTS AND ANALYSIS: The study analysed 149 neck dissections. When using computed tomography to detect the extranodal spread of head and neck squamous cell carcinoma, radiologists A and B had sensitivities of 66 and 80 per cent, specificities of 91 and 90 per cent, and positive predictive values of 85 and 87 per cent, respectively. DISCUSSION: The sensitivity and specificity of radiological detection of extranodal spread from head and neck squamous cell carcinoma is not well reported in the literature. Accuracy of reporting improves in the hands of experienced head and neck radiologists. This finding has clinical implications for surgical planning and adjuvant therapy requirements.

"Gearing to a time table"; the evolution of earlier surgical eschar excision in massive burns by British burns surgeons at the battles of Cassino, 1944: an example of real-time audit.

The effectiveness of burns care delivery is difficult to measure within a realistic workload and resource framework. In addition, workers must develop new tools for this purpose. We describe a historical example from World War II describing the evolution of burns excision in the context of thorough outcome assessment, during the allied advance from North Africa up the Italian peninsular, including the battles of Cassino 1942-1945. Patrick Clarkson and Rex Lawrie working as plastic surgeons in a small forward Maxillofacial Unit were able to fully assess the management and outcome of 800 burnt servicemen. 192 burns were full thickness and required grafting. Prospective data revealed that those burns which were surgically excised and grafted between 12 and 18 days recovered more quickly than those managed by conservative dressings until the eschar had sloughed off followed by grafting. Burns managed by excision and grafting in less than 5 weeks following burning (n=86) healed 8.6 days faster than those grafted later (n=106). This difference was increased for massive burns of over 1000 cm(2), with those grafted in less than 5 weeks (n=17) healing 13 days faster than the delayed group (n=27). Their transparent and simple method of prospective audit is described.

Catel-Manzke syndrome: a case report of a female with severely malformed hands and feet. An extension of the phenotype or a new syndrome?

An unusual case of a female infant with Catel-Manzke syndrome is presented. Additional features not previously reported include three accessory ossicles at the bases or associated with the proximal phalanx of the index, middle, ring and little fingers bilaterally. There are also numerous bony abnormalities in both feet. Previous cases have shown no more than 2 accessory ossicles in the hand and these usually involve the index alone. The foot abnormalities are more extensive than any previously seen in this syndrome. This is only the 8th female case out of a total of 27 reported cases.

Malignant change after 18 months in a lower limb ulcer: acute Marjolin's revisited.

Lower limb ulcers present a common clinical problem and are at risk of malignant change. A Marjolin's ulcer has traditionally been regarded as malignant change in a long standing ulcer and/or scar tissue. We report a case of Marjolin's degeneration that developed in an ulcer only 18 months following the initial injury. Such a short latent period has not been reported for over 70 years. This report highlights the possibility of early Marjolin's change and we propose a ranked diagnostic screen to aid in early identification of possible malignant change, based on the current published evidence.

Bronchogenic metastasis involving the frontal sinus and masquerading as a Pott's puffy tumour: a diagnostic pitfall.

A case is reported of metastatic bronchogenic carcinoma involving the frontal sinus and masquerading as a Pott's puffy tumour. A pathological fracture and persistent lung radiographic changes prompted fine needle aspiration of the mass, which showed a poorly differentiated adenocarcinoma.

Subungual melanoma in situ: two independent streaks in one nail bed.

We report an unusual case of two nail-bed streaks under one nail, revealing melanoma in situ affecting the nail bed and plate, but not the nail fold. This unusual mode of presentation together with the absence of any nail-fold involvement has not been reported previously. We highlight the need for early histological assessment of nail-bed lesions and discuss subungual melanoma.