Measures of health-related quality of life and functional status in survivors of oral cavity cancer who have had defects reconstructed with radial forearm free flaps.

The aim of this study was to evaluate (by postal questionnaire) quality of life and function in patients who have had resections of oral cancer and reconstruction by radial forearm flaps. Between October 1987 and December 2002, 258 patients had reconstructions by radial forearm flaps after resection of tumours in the oral cavity. Of these, 139 surviving patients were identified from the database and were sent questionnaires comprising five sections: Functional Assessment of Cancer Therapy-General (FACT-G) and -Head and Neck (FACT-HN); University of Washington Quality of Life Scale (UWQoL); Performance Status Scale for Head and Neck Cancer (PSS-HN); and the final section addressed dental rehabilitation and morbidity at the donor site. Sixty-three questionnaires (45%) were returned. In 17 (27%), parts of the questionnaire were incomplete. The median UWQoL score was 623/900, FACT-G was 92/108, FACT-HN was 31/48, and PSS-HN showed that eating in public, understandability of speech and normality of diet were 75/100, 75/100 and 50/100, respectively. The effect of stage and site on quality of life and function did not reach statistical significance. The effect of radiotherapy on speech (p=0.036) and diet (p=0.007) was significant. Patients who worried about their cancer returning had a lower UWQoL score (p=0.016). Ninety percent regarded their arm as disfigured, but 81% felt comfortable wearing short-sleeved shirts. Sensation and function of the hand were reported as normal in 87 and 92%, respectively. We conclude that patients who have had oral cancer have a persistent reduction in quality of life and function long after completion of treatment. The effects can be assessed by postal questionnaire, but the low rate of return (45%) and difficulties with completion reduce the quality of the data. Quality of life and function are essential components of improvements in outcome.

Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity.

BACKGROUND: The aim of this study was to report the applications, complications, and limitations of the radial forearm flap when used for reconstruction after excision of cancers in the mouth. PATIENTS AND METHODS: We reviewed records in our database from October 1987 to December 2002; a total of 505 patients had surgical defects of the head and neck reconstructed with a radial forearm flap: 258 patients had oral cancers, of whom 173 were men and 85 women, median age was 70 years. Five patients had two reconstructions (total 263), of which 247 were fasciocutaneous and 16 osseofasciocutaneous flaps. Mucosal squamous carcinoma accounted for 97% of the primary cancers. RESULTS: There were nine failures of the flap (3.4%) and four episodes of partial necrosis. Four patients (2%) died within 30 days of operation. Orocutaneous fistulas appeared in nine patients (3.4%), 10 patients had wound infections, and nine had haematomas. The nine failed flaps were replaced by a second free flap in one patient, a pectoralis major flap in three, a buccinator myomucosal flap in one, a skin graft in one, and the remaining three defects healed by secondary intention. There was one failure and one partial failure among the 16 osseofasciocutaneous flaps.

Management of the neck in patients with T1 and T2 cancer in the mouth.

UNLABELLED: Our aim in this retrospective study was to evaluate the extent of control of metastatic disease in the neck and the survival of patients with T1 and T2 oral cancer. METHODS: All 171 patients with T1 and T2 squamous cell carcinoma (SCC) in the mouth were identified from our computerised database. All had had primary tumours resected and 21 patients with palpable neck nodes had therapeutic neck dissections. Among 150 patients with no palpable nodes, 75 had elective neck dissections, and 75 were observed. The decision to do an elective neck dissection was based on clinical criteria and was not randomised. RESULTS: Cervical nodes contained metastases in 17 of 21 patients who had therapeutic, and 27 of 75 who had elective, neck dissections. Neck metastases developed subsequently in 15 of 75 patients in the observed group, and 9 of these were salvaged by therapeutic neck dissection. The 5-year disease free survival was 19/21 after therapeutic dissection, 72/75 after elective dissection, and 69/75 in the observed group. Patients with cervical nodal metastases had significantly reduced 5-year survival compared with those without (63% and 91%, P = 0.003).

Management and outcome of cervical lymph node metastases of unknown primary sites: a retrospective study.

Analysis of the case records of 114 patients with cervical lymph node metastases from unknown primary sites showed that management should be adapted according to the site of nodal disease and the histopathology. Poorly differentiated carcinoma was best treated with radiotherapy, squamous cell carcinoma with radiotherapy and excision, and non-papillary adenocarcinoma by radical thyroidectomy and neck dissection. The 5-year survival for each regimen alone, was 15/40 (38%), 7/13 (54%) and 5/8 (63%), respectively. For metastatic masses in the supraclavicular region, chemotherapy was the preferred treatment. The overall survival for the 107 patients who completed the follow up was 36%.

Outcome after radial forearm, gastro-omental, and jejunal free flaps in oral and oropharyngeal reconstruction.

We undertook a retrospective study of the outcome of radial forearm, gastro-omental, and jejunal free tissue transfer for oral and oropharyngeal reconstruction in 30 patients (10 in each group). No significant differences were found between the type of free flap and the clinical outcome. More long-term difficulties were experienced with swallowing than with speech. The selection of free flap did not correlate with speech function (P=0.44), swallowing (P=0.68), or management of saliva (P=0.59). No significant difference was found between the patients' outcome and the site of resection of the tumour. There were more complications after gastro-omental flaps and this may influence the choice of reconstruction.

Expression of nitric oxide synthase-2 in cutaneous squamous cell carcinoma of the head and neck.

Nitric oxide (NO) has a pivotal role in angiogenesis. The expression of NO synthase (NOS2) is down-regulated in basal cell skin cancer but we know of no studies that have investigated its expression in the more aggressive squamous cell skin carcinoma. This immunohistochemical study assessed NOS2 expression in 37 cases of head and neck squamous cell skin carcinoma. NOS2 expression was located in cells of the basal cell layer of epidermis, but was significantly increased in tumour epithelium. No correlations were found between NOS2 expression and tumour size or degree of tumour differentiation. The raised NO concentrations in these tumours may provide one explanation for their more aggressive behaviour than that of the slower-growing basal cell carcinoma.

Sign of the changing times: CPT 1999.

Although CPT 1999 contains fewer changes than in past years, coders should take some time to learn them by: familiarizing themselves with the new symbols + and [symbol: see text] reviewing Appendix A for a complete list of modifiers as well as modifiers used in the ambulatory surgery center hospital outpatient setting; reviewing Appendix E for a complete list of add-on codes; reviewing Appendix F for a list of modifier-51-exempt codes; consulting the excludes note found above code 69,990 to identify procedures exempt from the use of the new operating microscope code; examining the specific codes used to identify bronchoscopic procedures; reviewing the parenthetical notes found after code 15,001, directing the coder to also assign the appropriate code for lesion excision; reviewing the changes associated with the coding of destruction of lesions understanding the changes in immunization code assignment; consulting payers for specific reimbursement guidelines.

Uranium-series dating of sediments from searles lake: differences between continental and marine climate records.

One of the major unresolved questions in Pleistocene paleoclimatology has been whether continental climatic transitions are consistent with the glacial delta(18)O marine record. Searles Lake in California, now a dry salt pan, is underlain by sediment layers deposited in a succession of lakes whose levels and salinities have fluctuated in response to changes in climate over the last 3 x 10(6) years. Uraniumseries dates on the salt beds range from 35 x 10(3) to 231x 10(3) years. This range of dates allows identification of lake-sediment horizons that are time correlatives of the boundaries of marine isotope stages from the recent 3/4 boundary back to the 8/9 boundary. The 5/6 boundary coincided with a deepening of the lake, but the analogous 1/2 boundary coincided with desiccation. The 3/4, 4/5, 6/7, 7/8, and 8/9 boundaries correspond in age to horizons that record little or no change in sedimentation or climate. These hydrologic results demonstrate that the continental paleoclimate record at this mid-latitude site does not mimic the marine record.

Chlorine-36 dating of saline sediments: preliminary results from searles lake, california.

Measurements have been made of the ratios of chlorine-36 to chlorine in five halite samples from Searles Lake sediments, previously dated by carbon-14, thorium-230, and magnetostratigraphic techniques. The ages calculated from the chlorine ratios are generally concordant with those from the other methods, implying the constancy of the chlorine input ratio over the last million years.

Deuterium content of snow as an index to winter climate in the sierra nevada area.

The winter of 1968-69 produced two to three times the amount of precipitation in the Sierra Nevada area, California and Nevada, as the winter of 1969-70. The deuterium content in snow cores collected at the end of each winter at the same sites, which represents the total snowfall of each interval, shows a depletion in 1968-69 of approximately 20 per mil. The higher snowfall in 1968-69 and the depletion of deuterium can be explained by an uncommonly strong westward flow of cold air over and down the western slopes of the Sierras, which interacted with an eastward flow of moist Pacific air that overrode and mixed with the cold air; this resulted in precipitation that occurred in greater than normal amounts and at a lower than normal temperature. Pluvial periods of the Pleistocene may have had the same shift in air-mass trajectory as the wet 1968-69 year. Snow cores collected in the norrmal 1970-71 winter have deuterium concentrations that resemble those of the normal 1969-70 winter. Small and nonsystematic differences in samples from these two normal winters are due to variations in climatic character as well as to factors inherent in the sampling sites.