The significance of "positive" margins in surgically resected epidermoid carcinomas.

Sixty-two patients with epidermoid carcinomas of the head and neck (excluding glottic larynx and skin), in whom surgical-resection margins were classified as "positive", were studied to determine the incidence of local recurrence, the subsequent clinical course, and survival. The recurrence rate in this group was compared with that of patients who had "negative" margins. Four histologic findings are classified as positive margins: (1) margin closeness (tumor within 0.5 cm), (2) premalignant change in the margin, (3) in-situ cancer in the margin, and (4) invasive microscopic cancer at the margin. Patients with these variants showed a significant increase in local recurrence and in mortality when compared to those with negative margins. A review of the literature is presented, and recommendations are made for this clinical setting.

Primary tumors of the mandible. A study of 49 cases.

Forty-nine cases of primary tumors of the mandible have been reviewed. The anatomic location, pathologic features, sites of metastases, survival rates, and treatment methods were evaluated. Lesions studied included ameloblastoma, osteogenic sarcoma, reticulum cell sarcoma, fibrosarcoma, chondrosarcoma, myxosarcoma, epidermoid carcinoma, adenocarcinoma, and giant cell sarcoma. An in-depth discussion of primary osteogenic sarcoma of the mandible is presented. Because of upper cervical lymph node metastases in two cases of osteogenic sarcoma of the mandible, an upper neck dissection should be considered in the primary treatment. Also presented in this study are the first reported cases or primary myxosarcoma of the mandible and giant cell sarcoma of the mandible. Recent methods of treatment of ablative resection of the mandible followed by immediate or delayed repair are discussed. A revised technic for mandibular replacement which has met with success in six of seven cases is presented.

Pelvic fractures: an anatomic guide to severity of injury. Review of 100 cases.

A series of 100 cases of pelvic fracture secondary to violent trauma were reviewed and divided into two anatomic groups, those with pure anterior arch fractures (57 patients) and those with posterior fractures (43 patients). By this classification, mortality and associated injury are shown to be markedly increased in those patients with posterior fractures. A detailed study of the major complications has shown that a conservative approach to these injuries is probably the safest for the patient. Major blood loss is the rule rather than the exception and restoration of an adequate circulating volume by transfusion should precede operative attempts to control continuing retroperitoneal hemorrhage.

Infection of cardiac suture line after ventricular aneurysmectomy. Report of two cases.

Two cases of sepsis following ventricular aneurysmectomy are presented. In both, the source of sepsis was an infected caridac suture line in which Teflon felt strips were used to reinforce the closure. One patient had a pseudoaneurysm and a chronic empyema of the left side of the chest, and the second had a ventriculocutaneous fistula. Early operation with removal of the foreign body is warranted in this major complication of a ventricular aneurysmectomy.