Search

The worldwide need to replace 3He for the neutron detection has triggered R&D on new technologies and methods. A promising one is based on commercial solid state silicon detectors coupled with thin neutron converter layers containing 6Li. After proving the feasibility of this technique, we characterized the behavior of such a detector with different converter layer thicknesses. In this paper we also disentangle other contributions to the overall spectrum shape observed with this kind of detector, proving that its detection efficiency can be made reasonably high and that the gamma/neutron discrimination capability is comparable to the one of 3He tubes., Submitted to Nuclear Instruments and Methods in Physics Research, section A

Introduction Sleep is an important element of health that can impact daytime performance in brain injury rehabilitation. Actigraphy in a pediatric inpatient setting can pose challenges when there are increased amounts of time spent in a hospital bed. A rest-activity ratio (Duclos et al., 2013) has demonstrated utility in adult brain injury populations, showing sensitivity to improved regulation of the sleep-wake cycle as individuals recover during their hospitalization. The present study sought to examine the utility of this ratio in differentiating children with and without acquired brain injury (ABI). Methods Sixteen individuals, ages 8-16 (M=12.6, SD=2.4) admitted to an inpatient pediatric rehabilitation hospital wore an actigraph over a 7-day period. Eight inpatients were being treated for ABI whereas another 8 inpatients treated for other, non-neurological conditions served as a control. Raw activity counts across the 24-hour period were analyzed to derive a rest-activity ratio. Results Those with ABI had lower average ratios (0.73) compared with patients without ABI (0.84), F(1,14)=4.3, p=0.058. Individuals with ratios of 0.85 or higher were rated by their physical therapists as being more alert during therapy using a 5-point Likert scale, F(1,14)=4.1, p=0.061. While these results were marginally significant, this pilot sample was small, and the effect sizes were large (eta squared = 0.234 and 0.229 respectively). Conclusion The rest-activity ratio successfully distinguished those with ABI from a non-ABI sample. This preliminary evidence in a pediatric sample suggests that this ratio, shown to be sensitive to the effects of brain injury on sleep-wake regulation, may be a useful metric in the inpatient pediatric rehabilitation setting when sleep diaries may be difficult to obtain and patients may be spending more time in bed while awake. Future studies with larger sample sizes are needed to explore the correlates of this ratio with other aspects of rehabilitation after pediatric brain injury. Support This study was funded in part through a generous grant from the Church & Dwight Employee Giving Fund

The Silicon Photomultiplier (SiPM) has become a solid playground for many applications requiring compact and well performing photon detectors. In particular, this is true when the detection of few photons with good time resolution is required. In this paper, we show how the SiPM features can be exploited to set up a compact neutron detector. By coupling two SiPMs to an inorganic scintillator strip, one can discriminate between gamma-rays and neutrons and, at the same time, determine the impact position with millimeter accuracy.

A cheap and efficient diagnostic system for beam monitoring has been recently developed at INFN-LNS in Catania. It consists of a high sensitivity CCD camera detecting the light produced by an ion beam hitting the surface of a scintillating screen and a frame grabber for image acquisition. A scintillating screen, developed at INFN-LNS and consisting of a 2 μm BaF2 layer evaporated on an aluminium plate, has been tested by using (20)Ne and (40)Ar beams in the keV energy range. The CAESAR ECR ion source has been used for investigating the influence of the frequency and magnetic field tuning effects, the impact of the microwave injected power, and of the focusing solenoids along the low energy beam transport on the beam shape and current. These tests will allow to better understand the interplay between the plasma and beam dynamics and, moreover, to improve the transport efficiency along the low energy beam line and the matching with the superconducting cyclotron, particularly relevant in view of the expected upgrade of the machine.

We show the results of some test beams performed on a new monolithic strip silicon detector telescope developed in collaboration with the INFN and ST-microelectronics. Using an appropriate design, the induction on the ΔE stages, generated by the charge released in the E stage, was used to obtain the position of the detected particle. The position measurement, together with the low threshold for particle charge identification, allows the new detector to be used for a large variety of applications due to its sensitivity of only a few microns measured in both directions.

For measuring fusion excitation functions, the activation technique with a stack of targets offers the considerable advantage that several reaction energies may be simultaneously measured by using one beam energy. However, its main drawback is the degradation of the beam quality as it passes through the stack due to statistical nature of energy loss processes and any non-uniformity of the stacked targets. If not taken properly into account, this degradation can lead to a wrong determination of the fusion excitation function. In this contribution some results of the investigation of this problem are reported.

The possibilities presented by the improved portable PIXE system are discussed. Examples are given of applications in the cultural heritage field, and in particular in the characterization of pigments and silver patina on ancient Roman coins. The limitations of the system are also discussed.

For low energy reaction studies involving radioactive ion beams, the experimental reaction yields are generally small due to the low intensity of the beams. For this reason, the stacked target technique has been often used to measure excitation functions. This technique offers considerable advantages since the reaction cross-section at several energies can be simultaneously measured. In a further effort to increase yields, thick targets are also employed. The main disadvantage of the method is the degradation of the beam quality as it passes through the stack due to the statistical nature of energy loss processes and any nonuniformity of the stacked targets. This degradation can lead to ambiguities of associating effective beam energies to reaction product yields for the targets within the stack and, as a consequence, to an error in the determination of the excitation function for the reaction under study. A thorough investigation of these ambiguities is reported, and a best practice procedure of analyzing data obtained using the stacked target technique with radioactive ion beams is recommended. Using this procedure a re-evaluation is reported of some previously published sub-barrier fusion data in order to demonstrate the possibility of misinterpretations of derived excitation functions. In addition, this best practice procedure has been used to evaluate, from a new data set, the sub-barrier fusion excitation function for the reaction Li-6+ Sn-120.

A new version of the portable polonium source, named L-PIXE (large-particle induced X -ray emission), to be used for the non-destructive analysis in the Cultural Heritage field, was realised in the framework of a collaboration between the Italian LNS-INFN (Laboratori Nazionali del Sud-Istituto Nazionale di Fisica Nucleare) and IBAM-CNR (Istituto per i Beni Archeologici e Monumentali-Consiglio Nazionale delle Ricerche). The new source presents a compact geometry and it was designed to operate with large area SDD (silicon drift detector) detectors. In particular, the L-PIXE source was coupled to a 50 mm² SDD detector and tested by measuring geochemical reference materials. Results evidenced a gain factor, in terms of counting statistics in the measured X -ray spectra, equal to 11–12 with respect to the previous versions of the source. A preliminary evaluation of the MDL (minimum detection limit) of the new experimental set-up evidenced the possibility of using the new L-PIXE source for identifying the presence of minor and, in some cases, trace elements composing samples under investigation.

A new portable XRF spectrometer which allows control of the energy and the intensity stability of the emitted x-ray beam has been designed and built. The control is obtained by measuring the x-ray fluorescence generated by a double Ag/Ba thin target when crossed by the x-ray beam during a measurement. The silver and barium fluorescence K lines are detected by an ancillary Si-PIN detector and analysed by software developed at the LNS/INFN laboratories. The new portable spectrometer, the beam stability control method, the evaluation of the system and some quantitative applications of interest in the cultural heritage field are presented and discussed. Copyright © 2004 John Wiley & Sons, Ltd.

Because of its high radiation hardness, diamond can be used better than other materials in the intense radiation field characterizing the interior region of a particle beam in an accelerator. In effect, the measurements reported here were carried out by placing diamond detectors under continuous irradiation in the 26-MeV proton beam of the 15-MV TANDEM accelerator of Southern National Laboratory (LNS) of INFN in Catania. The diamond detectors were built in the Rome Tor Vergata Laboratory. Diamond films were deposited by microwave plasma enhanced chemical vapor deposition on silicon substrates. A four-pixel beam monitor prototype was then realized by depositing four titanium gold contacts on the diamond surface. The signal was found to be stable and reproducible. The collected charge in DC mode was more than 20 000 electrons/protons for a diamond thickness of 65 μm, thus exhibiting a gain of approximately 10 4 with respect to the Faraday cup. For the measured samples, both response and release times of approximately 1 s were observed in the above experimental conditions. An analysis of the relative sensitivity between pixels was also performed. No differences of the detector current and Faraday cup current ratio were observed for different pixels, indicating the homogeneity of the beam monitor response.

A semiconductor detector coupled with a neutron converter is a good candidate for neutron detection, especially for its compactness and reliability if compared with other devices, such as 3He tubes, even though its intrinsic efficiency is rather lower. In this paper we show a neutron detector design consisting of a 3 cm × 3 cm silicon pad detector coupled with one or two external 6LiF layers, enriched in 6Li at 95%, placed in contact with the Si active surfaces. This prototype, first characterized and tested at INFN Laboratori Nazionali del Sud and then at JRC Ispra, was successfully shown to detect thermal neutrons with the expected efficiency and an outstanding gamma rejection capability.

During a period of 23 years, 57 patients who had an initial neck node biopsy elsewhere, with the diagnosis of metastatic squamous cell carcinoma established, underwent curative resection by our department after the site of head and neck primary was found. Ten patients free of disease died of other causes, leaving 47 patients who were eligible for at least 3 years of follow-up. Nineteen patients are aliye after 3 or more years. The incidence of recurrence in the neck was 57% (27/47). The 3-year survival in this group of Stage III was 40% (19/47) and 5-year survival was 34% (16/47). Compared with historical data, it appears from the present study that a previous biopsy of a neck node did not adversely affect the incidence either of neck recurrence or survival when appropriate surgery is performed.

Operations for intraoral carcinoma do produce deformities and loss of function. Historically, surgeons have constantly tried to correct or improve these deficiencies. The tendency on the part of the surgeon is to replace each bit of tissue removed, hoping that if the site appears normal the patient will be normal. The appearance of the patient has as a rule been given more attention than the functional result. Dysfunction is related to the alteration of certain anatomic and physiologic conditions identified as: (1) inability to obliterate the anterior oral cavity, (2) defects in the palate, (3) inability to close off the oropharyngeal space, and (4) disturbance of normal channels to bypass the larynx. Lateral mandibulectomy and radical neck dissection performed for cancer of the retromolar area, lower gum, lateral tongue, or floor of the mouth will in most instances result in very acceptable cosmetic and functional results. These patients look well, speak well, eat and swallow well, and can assume their usual role in society. Further surgical attempts to improve any deficiencies are discouraged. Patients sometimes ask about bone grafting or devices to replace the resected mandible and our recommendations are very emphatic on the negative side.

Multiple malignancies occurred in 7.5 per cent of 1,919 patients with head and neck cancer. In 64 per cent of patients the two cancers were diagnosed within twenty-four months of each other. Multiple malignancies occurred most frequently in patients with head and neck skin cancer. The most commonly encountered additional malignancy was another cancer of the head and neck. The three year survival of patients after treatment of a second primary malignancy was 21 per cent and the five year survival 9 per cent.

1. 1. Results of radical surgery for intraoral cancer relating survival to tumor size are presented. 2. 2. Tumor size appears to be a more realistic way of reporting results. 3. 3. A clinical method for accurately measuring tumors of the head and neck is needed.

Over 90% of malignant tumors of the head and neck are squamous cell cancers. These originate in the epithelium of the upper respiratory and alimentary tracts. Some thirty or more primary sites are recognized. Though there are specific therapeutic problems relative to each of these sites, there are general principles which apply to many. I have attempted to present a general outline of therapy for squamous cell carcinoma of the head and neck. It is hoped that this will help the physician who is not intimately involved with the details of therapy to understand why some patients with malignancy are treated one way while others are directed along other avenues of therapy.

Four different techniques of parathyroid gland reimplantation into muscle were studied in 38 dogs following total parathyroidectomy. The types of autotransplants were whole gland, minced glandular tissue, thin slices 0.3 mm or less, and thick slices 0.4 mm to 0.5 mm. The animals were followed for four months. Parathyroid function was evaluated by serum calcium and phosphorus determinations. Graft sites were extirpated two months after re-implantation and studied histologically. The thin slice technique was found to be most successful of the four techniques studied.

Cervical carcinoma, primary undetermined, is a clinical entity which occasionally confronts the head and neck surgeon. Most regard the neck mass as a metastatic rather than as a primary lesion. In the present series, 82 per cent of the neck tumors were histologically anaplastic carcinoma. Reticulum cell sarcoma and anaplastic carcinoma of the breast, pancreas and lung should be considered in the differential diagnosis. Eighty per cent of the neck masses were clinically inoperable by radical neck dissection. The primary was subsequently located in 45 per cent of patients. Half of these primaries were located in the head and neck, and the most frequent site was the nasopharynx. The other half were located below the level of the clavicles, but in each instance the presenting mass was in the supraclavicular area or lower spinal accessory area. All patients were treated with radiation. The four year survival of the entire group was 39 per cent. The four year survival clinically free of disease was 30 per cent. Since the eight year period included in this report, the Head and Neck A Service has embarked on a surgical approach in selected patients with this entity. Surgery is indicated if the neck mass is (1) clinically operable (not fixed to skin or deep structures), (2) located in the cervical area, and (3) histologically Grade I or Grade II. Contraindications to surgery are as follows: (1) a large, fixed mass, (2) a. supraclavicular mass, (3) a mass located over the mastoid area, and (4) anaplastic carcinoma. Adherence to these surgical criteria excludes approximately 80 per cent of patients, and these are treated with radiation.

A brief review of the salient literature is presented in regard to extramedullary plasmacytoma. The relevant clinical features, pathology, and methods of treatment are discussed. The eight cases seen by the authors are reviewed and their followup progress noted. The authors discuss a few interesting facets of extramedullary plasmacytoma.

Summary o 1. A modified neck operation for carcinoma of the thyroid gland is described in which the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve are preserved. 2. Histologic studies and clinical follow-up data suggest that the operation is as effective as standard radical neck dissection. 3. The operation has the advantage of reducing cosmetic disfigurement and preserving function.

In recent years, the indication for tracheotomy has been recognized more frequently. Severe accident cases, chest injuries, postoperative neurosurgical cases, and head and neck cases often require tracheotomy, not only to prevent immediate asphyxiation but also to promote a smoother post-traumatic or postoperative convalescence. The successful outcome of many of these cases is partially dependent on a systematic and efficient system of tracheotomy care. Experience has proved that this is often lacking on some surgical floors. Many of the patients admitted to the Head and Neck Service of the Roswell Park Memorial Institute require tracheotomy. It is the purpose of this paper to describe a simple and adequate method of tracheotomy care now in use on this Service. The method of care must take into consideration the alterations in physiology of the patient. First, the freshly tracheotomized patient is unable to cough efficiently and rid the tracheobronchial tree of secretions.

1. 1. When 106 patients with carcinoma of the oral cavity, pharynx or larynx were interviewed concerning their use of alcoholic beverages and tobacco, 92 per cent reported that they drank significant amounts of alcohol daily. A history of heavy consumption of alcohol was given by 62 per cent of the patients, and 85 per cent smoked the equivalent of one or more packs of cigarettes a day. 2. 2. Of the 106 patients interviewed, eightynine were men and seventeen were women, a ratio of 5.2:1. The median age of diagnosis for the entire series was sixty-two years. 3. 3. Of all of the patients with oral carcinoma in this study, a second primary malignant lesion developed in 7.5 per cent. 4. 4. Additional supporting evidence is presented that the habitual use of tobacco and alcohol plays an important role in the cause of oral carcinoma. The etiologic mechanism is not understood, but possible related factors are discussed.

From January 1957 to December 1971, 141 patients were treated for hypopharyngeal carcinoma. Twenty-one patients who died within three years of treatment with unrelated cause are excluded, leaving 120 patients for the present study with a minimum of five years follow-up. Nine patients were classified stage I, eight stage II, eighty-four stage III, and nineteen stage IV. Eighty-one patients were treated primarily by radical surgery with (27) or without (54) deltopectoral flap reconstruction. Twenty of these eighty-one patients (24 per cent) survived for five years. Four patients had microscopic tumor at margin of resection and received a full course of radiation therapy in the immediate postoperative period. Two of four (50 per cent) survived for five years. Fiftyseven other patients developed recurrences; of these, forty patients could be treated with radiation therapy. Eight of forty patients (20 per cent) with postoperative local recurrences and treated with radiation therapy survived five years. The overall total five year survival by surgery, surgery and immediate postoperative radiation therapy for microscopic residual disease, and surgery and radiation therapy for postsurgical local recurrence is 37.3 per cent (30/81). Eleven patients were seen here with radiation therapy failures elsewhere that were treated with surgery. Five year survival in this group is 27.27 per cent (3/11). Twenty-eight patients were treated here with radiation therapy alone. These patients were in very poor general condition or had far advanced disease (fixed neck masses). Only one of twenty-eight (3.5 per cent) was alive after five years. Total five year survivorship was 34 of 120 (28.3 per cent). Seven patients had stage I, five stage II, twenty-one stage III, and one stage IV disease. From this study it appears that radiation therapy for local postoperative recurrence and in the immediate postoperative period for microscopic residual disease is worthwhile and can significantly increase the five year salvage rate.

From January 1958 through December 1983, 56 modified radical neck dissections were performed on 47 patients with metastases to the cervical nodes from differentiated carcinomas of the thyroid. In nine patients, a second modified radical neck dissection was performed either simultaneously or at a later date. Lymph node clearance was performed on all but one surgical specimen. The number of nodes in each specimen ranged from 10 to 96, and the number of involved nodes ranged from 1 to 20. Thirty-eight of the 56 neck specimens contained four or more positive nodes. Seventeen patients were followed for 10 to 26 years, 18 patients for 5 to 9 years, and 5 patients for less than 5 years. Seven other patients died, three from other causes and four from lung metastases. There were no recurrences in the neck sides that would have been cleared if standard radical neck dissection had been performed. This reappraisal with long-term follow-up supports our initial impression that a modified radical neck dissection sparing the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, or any combination thereof is an effective procedure for differentiated cancer of the thyroid, with preservation of good shoulder function and improvement in the cosmetic appearance of the neck.

1. 1. Squamous cell carcinoma of the pyriform sinus is a rare tumor. 2. 2. Eighty per cent or more of patients with this lesion have metastases in the cervical nodes at the time of treatment. 3. 3. Radiation administered to the patients treated between 1940 and 1954 controlled the lesion in 3 per cent of patients. 4. 4. The introduction of radical surgery during a later period (1954 to 1961) increased the absolute five year survival rate to 10 per cent. 5. 5. The resectability rate of lesions in patients treated between 1954 and 1961 was 50 per cent. 6. 6. The five year survival among the surgically treated patients was 20 per cent. 7. 7. Earlier diagnosis and an improved rate of resectability would theoretically improve the absolute survival figures.

In an investigative study sixty patients with single and multiple areas of leukoplakia were treated by cryotherapy. The acceptability of this modality by patients was excellent. Recurrence developed in twelve patients during a follow-up period which ranged from two and a half to four and a half years. In four patients squamous cell carcinomas developed which were relatively small primary lesions in or adjacent to the area of the treated leukoplakia. Although the incidence of malignancy of 6.6 per cent is well within the reported range of malignant change in intraoral leukoplakia, this finding considerably diminishes our initial enthusiasm regarding this modality as routine treatment for leukoplakia and certainly emphasizes the need for further study before it can be completely acceptable as a routine form of treatment.

We have outlined the clinical manifestations of “localized” malignant lesions of the intraoral cavity, their clinical behavior after intraoral excision, and their control rate employing intraoral excision as primary therapy. We must keep in mind that these small “localized” cancers are potential “killers” and the five year mortality from disease in our series was 25 per cent. This mortality may decrease with (1) more careful selection when patients are included in the “localized” lesion group and (2) earlier use of composite procedures in questionable cases.

Serum antibody titers to Epstein-Barr virus were significantly elevated in a group of twenty-three patients with nasopharyngeal carcinoma as compared with eighty-six patients with cancer of other sites in the head and neck and 222 age-matched controls. Our findings in this group of patients support the suggestion of an association between the Epstein-Barr virus and nasopharyngeal carcinoma.

One hundred and five deltopectoral flaps were raised in 100 patients. Fifty-four were delayed prior to use and 51 flaps were used immediately without delay. Delay was used whenever there was a high probability of impaired healing or a modification of a portion of the flap was necessary. In patients with delayed flaps there was major loss in 16.6 per cent and minor loss in 9.2 per cent. In immediate reconstruction of the flap, major loss occurred in 15.7 per cent and minor loss in 17.6 per cent. The most frequent major flap losses occurred during attempts to reconstruct the palate. Placement of the flap into a previously radiated tissue bed, diabetes, and wound infections were the major contributing factors to major flap loss in both groups of patients.

A 62-year-old Caucasian man presented with a slow-growing 3 by 3 cm. mass in the left preauricular region. The pathologist's report on the surgical specimen favored a diagnosis of acinic cell carcinoma but recommended evaluation of the patient for possible metastatic renal cell carcinoma. A subsequent intravenous pyelogram and arteriogram revealed the presence of a mass in the right kidney. The lesion proved to be a renal cell carcinoma which was microscopically indistinguishable from the parotid tumor.

In clinical practice, small or localized thyroid cancer is often missed at the time of surgery and is diagnosed only later after the pathologist has been able to study multiple sections. Our data suggest that patients with early or localized thyroid cancer can be controlled with less than total thyroidectomy. If the nodule is completely excised without fracture (preferably lobectomy) or not cut into, if there is no evidence of metastatic disease either by palpation or frozen section, and if gross examination of the surgical specimen and frozen sections is negative for carcinoma, it is our policy to place these individuals on a regimen of observation only. Additional surgery is performed only if clinical evidence of recurrent cancer develops. Long-term follow-up of forty-four patients supports this treatment policy. Of these, seven had clinical recurrences: three benign; four (9 per cent) malignant. (The 2 patients with metastatic periglandular lymph nodes in the surgical specimen would not meet our present criteria.) We have in our files several additional patients who seem to support the same conclusions but will be reported on only after longer follow-up.

The surgical oncologist is sometimes confronted with a patient who was surgically treated for cancer of the thyroid gland and now has recurrent disease. In most instances, additional surgical treatment is indicated. The magnitude of surgery is primarily determined by the amount of tissue removed at the original operation. Surgery for recurrent disease may include completion of total thyroidectomy with dissection of lymphatic tissues in the thyroid compartment or/and neck dissection, preferably modified. Several clinical situations are outlined and discussed.

A therapeutic approach to thyroid cancer has been outlined. An effort was made to identify some areas of therapy which are controversial. Long-term follow-up of patients suggests that our approach is justified. It is recognized that there are still many unanswered questions and some of these may be concerned with immunological factors involved.

Sequential radiofluoride photoscans were used to follow experimental bone autografts in the tibia of dogs. They were more sensitive than roentgenograms and were found to correlate quite well with the histologic progress of the grafts in incorporation and remodeling.

Animal experiments demonstrated that full thickness flaps of esophagus and pharynx can be rotated to reconstruct surgical defects of the cervical esophagus. Because of the blood supply of the esophagus success can be expected only when the flaps are kept relatively short. The procedure has been carried out successfully in two human subjects.

1. 1. Forty-eight operative dental procedures, which in most instances included multiple extractions, were performed on thirty-two patients previously treated with cancericidal doses of radiotherapy. 2. 2. In no patient did osteoradionecrosis of the mandible develop.

1.1. Cancer cells were found in washings from sixteen of 279 radical operative wounds for head and neck cancer. In five washings, atypical cells were seen. No false positive or suspicious cells were found in washings from fifty-one benign head and neck lesions. 2.2. Our recurrence rate in 178 operative sites with negative washings and a follow-up of one year or more has been 25 per cent. 3.3. In fifty-eight cases selected at random with negative washings, 0.5 per cent Clorpactin XCB has been used as a wound irrigant. In forty-seven cases which have been followed up one year or more, the local recurrence rate has been 25.5 per cent. 4.4. Local recurrence has been found in eight of the ten patients who have had positive washings and have been followed up for one year or longer. 5.5. In one of two patients who had positive wound washings and received 0.5 per cent Clorpactin XCB irrigation has developed local recurrence during a follow-up of one year or longer.

The incidence of carcinoma of the nasopharynx is high among Indonesian natives. The data for this paper were compiled from the histological material in the Department of Pathology, Surabaja Medical School. The material included biopsy and surgical specimens from 160 patients with malignancy of the nasopharynx examined during the years 1952-1955. Some of this material was obtained from patients in hospitals in East Java, the eastern part of Indonesia, but most of it from the Central Hospital in Surabaja. Of the 107 Indonesian patients with malignancy of the nasopharynx, 75 were men and 32 were women, resulting in a ratio of 2:1. Teoh 1 stated that the incidence of nasopharyngeal carcinoma in men was at least twice as much as in women. The findings of Mekie 4 and Digby 3 showed an incidence of 3:1 and 2:1 respectively. Table 1 lists the relative frequency of malignant tumors affecting various organs

Postoperative wound drainage fluid from sixty patients who had undergone clinically curative resections for squamous cell carcinomas of the head and neck region was collected during a seventy-two hour postoperative period, processed and examined for the presence of tumor cells. Operative washings from each of the cases were also examined. Wound drainage fluids from nine patients (15 per cent) were found to contain tumor cells as late as forty-eight to seventy-two hours after surgery, even though wound irrigations at the time of surgery were negative. In a relatively short follow-up period in two of these patients, seeding under the skin flaps has developed. These observations indicate that seeding of the surgical wound may occur during the early postoperative period, and may be a contributory factor in local recurrence.

Eighty-five patients underwent total laryngectomy or total laryngectomy in continuity with a radical neck dissection during the five year period 1964 through 1968. Forty-eight patients (56.4%) were able to learn esophageal speech; six were rated as excellent, 25 as good, eight as fair, and nine as poor. Nineteen patients (22.4%) who either could not learn esophageal speech or had no desire to learn were able to communicate with the aid of an electronic speaking device. Of the 53 patients gainfully employed outside the home prior to surgery, only 22 were able to return to work. Forty of the 48 patients who learned esophageal speech were gainfully employed outside the home before surgery, but only 19 (47%) were able to return to work.

The period 1950 to 1962 has seen improved results for both radiation and surgery. Radiation will provide good survival results in patients with mobile cord lesions without involvement of the anterior commissure. Laryngectomy is the treatment of choice for anterior commissure involvement even when cord motion is normal. Surgery, however, is the treatment of choice for fixed cord, extrinsic endolaryngeal, and extrinsic exolaryngeal lesions. The absolute five year survival with no evidence of disease showed an improvement of 40, 40, and 30 per cent, respectively, over radiation in these categories.

Autogenous parathyroid tissue was reimplanted by a thin slice technic in five patients undergoing unilateral thyroid lobectomy and removal of two adjacent parathyroid glands as part of en bloc surgical resection for squamous cell carcinoma of the extrinsic larynx. An implant site was excised at varying periods of one to six months in different patients and all revealed histologically viable parathyroid tissue. This technic of implantation is advocated for reimplantation of parathyroid tissue present in the surgical specimen in cases of total thyroidectomy for cancer of the thyroid.

Previous studies have indicated that the interposition of a short reversed small bowel segment after massive small bowel resection in dogs will prolong transit time and maintain better nutritional status. 1-5 Using triolein 1131, Singleton et al 3 found that fat absorption rose temporarily after interposition of a nine- to ten-inch reversed segment of ileum, but was unable to explain why the animals became cachectic and died after a three- to four-month period, with a gradual decrease of absorption levels. Stahlgren et al 5 found that losses of water, fat, and nitrogen were decreased by the effects of a short antiperistaltic segment. Recently, Gibson et al 6 reported the successful use of a short reversed small bowel segment in an 80-year-old female patient who underwent resection of more than 90% of the intestine for occlusion of the superior mesenteric artery with gangrene of the bowel. The present study of fat

1. 1. Data have been presented indicating that the mandible may be preserved in a higher percentage of patients. 2. 2. Clinical application in a small number of patients has provided good results. 3. 3. Clinical criteria for the selection of patients have been outlined.

1. 1. Cancericidal doses of x-rays will produce tissue changes which interfere with normal healing of surgical wounds in the neck. 2. 2. Evaluation of tissue changes and judgment in selection of patients for surgery will lessen postoperative complications. 3. 3. The resulting complications, in most instances, can be satisfactorily handled. 4. 4. The most serious complication is wound slough and perforation of the carotid artery, which may result in death.

• A painless lateral neck mass in an otherwise healthy 58-year-old man is a frequent diagnostic problem. We have recently seen such a patient with a cervical neck mass whose preoperative evaluation findings were normal. Excisional biopsy revealed a lymph node exhibiting changes compatible with extramedullary hematopoiesis. This becomes an additional unusual cause of enlarged lateral neck nodes. (Arch Otolaryngol1982;108:523-524)