The posterolateral neck dissection. Technique and results.

OBJECTIVE: To evaluate the effectiveness of the posterolateral neck dissection in providing regional control of metastatic disease to the posterior triangle from head and neck primary tumors as part of a multidisciplinary treatment approach. DESIGN: A case series review of 55 patients treated over a 10-year period form 1982 through 1991 with a minimum of 3 years of follow-up. Factors evaluated included site and histologic type of primary tumors, extent of surgery performed, other therapies provided, pathologic findings, and clinical outcome. SETTING: The University of Texas M.D. Anderson Cancer Center, Houston. PATIENTS: Forty-six male and nine female patients were studied. Three of them had bilateral dissections, for a total of 58 operations. Thirty-five were diagnosed as having melanoma; 10, squamous cell carcinoma, and 10, various other histologic types. INTERVENTION: All patients underwent a posterolateral neck dissection, either alone or as part of a multidisciplinary treatment plan. OUTCOME MEASURES: Factors reviewed were recurrence, either at the primary site or at a regional site, development of distant metastases, and surgical morbidity. RESULTS: Our review showed that, overall, disease was controlled at the site of the primary tumor in 89% of patients (94% of patients with melanoma) and that regional disease was controlled in 93% of patients (89% of patients with melanoma). Surgical morbidity was minimal. CONCLUSION: The "functional" posterolateral neck dissection as practiced at the University of Texas M.D. Anderson Cancer Center is effective surgical therapy that provides control of regional metastatic disease to the posterior neck from head and neck primary tumors.

External laryngocele: an unusual cause of respiratory distress in a newborn.

Congenital laryngoceles are rare causes of respiratory distress in the newborn. We report a case of airway compromise in a two day old newborn boy secondary to a solitary giant external laryngocele. No internal component or other laryngeal pathology was found. The patient had a progressively enlarging neck mass and increasing stridor culminating in respiratory arrest. Tracheotomy was avoided and the lesion was excised in its entirety. Airway management, the role of CT scanning, and surgical excision of laryngoceles are discussed.

Surface areas of naturally occurring lipid classes and the quantitative microdetermination of lipids.

The surface area (A) of a lipid was directly proportional to the amount of lipid in a surface film (A = k micro moles) measured at constant surface pressure, temperature, and subphase composition. A surface area of 2300 cm(2)/ micro mole was obtained for cholesterol isolated from human adrenal and aorta and for cholesterol from hydrolysates of cholesteryl esters isolated from the same tissues. Unsaturated methyl esters that contained from one to four cis double bonds had the same surface area, 39.4 A(2)/molecule. As a consequence, naturally occurring triglyceride mixtures which had similar saturated-unsaturated fatty acid ratios had the same surface area, 6090 cm(2)/ micro mole. Naturally occurring phospholipid mixtures had the same surface area, 4590 cm(2)/ micro mole, and it appeared that the composition of these mixtures was regulated to control the physical properties of the mixtures. Surface area was much more sensitive than colorimetric procedures for the estimation of cholesterol and triglycerides. The surface area/molecule was a criterion of purity and an expanded surface area/molecule was an indication of autoxidation. Thus, surface area measurements were valuable for both the microdetermination and the characterization of lipid classes.