Quantification of Trapezius Muscle Innervation During Neck Dissections: Cervical Plexus Versus the Spinal Accessory Nerve.

OBJECTIVES: Despite increasing use of selective, nerve-sparing surgical techniques during neck dissections, the reported rate of postoperative paralysis of the trapezius muscle is still high. The aim of the study is to measure and compare motor inflow to the trapezius muscle, in order to better understand the peripheral neuroanatomy. METHODS: Intraoperative nerve monitoring (electroneurography) in patients undergoing routine neck dissection (n=18). The innervation of the 3 functional parts of the trapezius muscle was mapped and quantified through compound muscle action potentials. RESULTS: In 18/18 (100%) of the patients, the spinal accessory nerve (SAN) innervated all parts of the trapezius muscle. In 7/18 (39%) of the patients, an active motor branch from the cervical plexus was detected, equally distributed to all functional parts of the trapezius muscle, at levels comparable to the SAN. CONCLUSIONS: Compared to the SAN, branches from cervical plexus provide a significant amount of neural input to all parts of the trapezius muscle. Intraoperative nerve monitoring can be used in routine neck dissections to detect these branches, which may be important following surgical injury to the SAN.

Management of the neck in node-positive tonsillar cancer.

CONCLUSION: Neck dissection (ND) may not be warranted for those patients with complete response in the neck. Human papillomavirus (HPV)-positive or -negative tumour does not affect this recommendation. OBJECTIVES: Treatment of tonsillar cancer varies considerably worldwide, although non-surgical treatment, e.g. radiotherapy (RT), possibly combined with chemotherapy (CRT), is gradually coming to be regarded as the first line of therapy. However, the optimal treatment of nodal disease remains controversial, and the fundamental question is if and when to perform ND. METHODS: We performed a retrospective analysis of all patients with tonsillar cancer treated in the Stockholm area between 2000 and 2006. An analysis of node-positive tumours was done and the neck specimen was investigated for the presence of viable tumour cells after RT. A sub-analysis of HPV status was also carried out. RESULTS: Following complete response after RT, 2% of patients showed viable cells in the neck specimen, compared with 60% in patients who did not show complete response. HPV-positive tumours had the same proportion of viable tumour cells in the neck specimen as HPV-negative tumours.

Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample.

BACKGROUND: Studies investigating the importance of social network, empowerment and experiences of stigma on subjective quality of life among persons with mental illness are rare. AIM: This study aimed to investigate beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and the relationship of these factors to subjective quality of life among subjects with mental illness. METHODS: A cross-sectional study assessing beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and subjective quality of life was performed on 150 subjects with mental illness. RESULTS: The factors most prominently related to subjective quality of life were overall empowerment and overall social network. For a subgroup of subjects suffering from psychotic disorders there was a significant negative relationship between subjective quality of life and rejection experiences. This group also reported more frequent rejection experiences. CONCLUSION: The findings indicate that persons with mental illness are a heterogeneous group with regard to the influence of social network, stigma and empowerment on subjective quality of life. The negative impact of actual rejection experiences might express that, in order to increase subjective quality of life, stigma must be addressed as a separate and important factor in its own right.

Experiences of stigma among people with severe mental illness. Reliability, acceptability and construct validity of the Swedish versions of two stigma scales measuring devaluation/discrimination and rejection experiences.

Stigma has been identified as one of the most important obstacles for a successful integration of people with mental illness into the society. Research about stigma has shown negative attitudes among the public towards people with mental illness. Studies so far have, however, put little emphasis on how these negative attitudes are perceived by the mentally ill persons. The aim of the present study was to investigate acceptability and internal consistency of the Swedish versions of two stigma scales, the Devaluation and Discrimination scale and the Rejection experiences scale. Forty individuals were subject to an interview, which also comprised assessments of needs for care, quality of life, therapeutic relationship and empowerment. The results showed that both the Devaluation and Discrimination scale and the Rejection experiences scale had a good internal consistency and acceptability. Stigma in terms of perceived devaluation and discrimination was found to be most markedly associated with empowerment and rejection experiences was found to be most associated with the number of previous psychiatric admissions. It is concluded that the Swedish versions of the Devaluation and Discrimination scale and the Rejection experiences scale may well be used in further studies of stigma among people with mental illness.

Sociodemographic and clinical factors related to devaluation/discrimination and rejection experiences among users of mental health services.

BACKGROUND: A major goal in mental health research and policy is to identify ways to reduce stigma among persons with mental illness. AIMS: The aims of the present study were to (1) investigate the prevalence of rejection and devaluation/discrimination in a cross-sectional sample of 200 individuals with experiences of mental illness and (2) investigate the relationship between sociodemographic and clinical, client characteristics and perceived devaluation/discrimination and experiences of rejection. METHODS: A total of 200 subjects in current contact with mental health services or with earlier experiences of this were interviewed regarding beliefs about devaluation/discrimination and rejection experiences. RESULTS: The results showed that subjects with a higher degree of global functioning perceived less devaluation/discrimination. With regard to rejections experiences associations were found between rejection experiences and global functioning, number of admissions to inpatient psychiatric care and current contact with social services. CONCLUSION: Further research should investigate the causal relationship between stigma experiences and psychosocial functioning. To understand what consequences perceived devaluation/discrimination has for the afflicted, a psychological and social approach in the research must be taken into consideration.

Human papillomavirus is more common in base of tongue than in mobile tongue cancer and is a favorable prognostic factor in base of tongue cancer patients.

The frequency of human papilloma virus (HPV) and its influence on clinical outcome was analyzed retrospectively in pre-treatment paraffin embedded biopsies from 110 patients with tongue cancer. The presence of HPV DNA was examined in 85 mobile tongue tumors and 25 base of tongue tumors by a polymerase chain reaction (PCR) with 2 general primer pairs, GP5+/6+ and CPI/IIG. When HPV-DNA was found, HPV-type specific primers and direct sequencing were used for HPV sub-type verification. Twelve of 110 (10.9%) samples were HPV-positive; 9 for HPV-16, 1 for HPV-33, 1 for HPV-35 and 1 could not be analyzed because of shortage of DNA. HPV was significantly more common in base of tongue tumors (10/25, 40.0%) compared to tumors of the mobile tongue (2/85, 2.3%). The influence of HPV on clinical outcome in mobile tongue cancer could not be studied, due to that HPV was present in too few cases. Of the 19 patients with base of tongue cancer that were included in the survival analysis, however, 7 patients with HPV-positive base of tongue cancer had a significantly favorable 5-year survival rate compared to the 12 HPV-negative patients. In conclusion, HPV is significantly more common in base of tongue cancer than in mobile tongue cancer, and has a positive impact on disease-specific survival in patients with base of tongue cancer.