Showing papers by "Hal G. Bingham published in 1983"

Multiple simultaneous tumors in patients with head and neck cancer

Abstract: A prospective panendoscopic study (bronchoscopy, laryngoscopy, esophagoscopy) was carried out in 81 consecutively seen, untreated patients newly diagnosed as having a mucosal neoplasm in the upper aerodigestive tract, to determine how many had a synchronous second primary lesion of the aerodigestive tract. Fourteen patients (17%) proved to have multiple primary lesions (14 second-primary and two third-primary lesions). Three lesions were hypopharyngeal, six esophageal, three pulmonary, two laryngeal, and two oropharyngeal. Two of the additional lesions were found during routine head and neck examination, nine lesions would have been found with a single routine symptom- or roentgenogram-directed endoscopic examination; five, because of their location or small size, would not have been found without panendoscopy, even after chest roentgenography, indirect laryngoscopy, and barium esophagography had been done. The most productive endoscopic examinations for detecting second primary lesions were esophagoscopy and laryngoscopy, the former detecting six lesions, the latter five lesions. The yield of chest roentgenograms was low (1/79). No complications resulted from this prospective panendoscopic protocol study. THese findings should reinforce the belief that head and neck cancer is a panmucosal disease of the aerodigestive tract, that silent second synchronous primary lesions are not uncommon, and that every effort should be made to find all primary sites before treatment of the index tumor is begun.

Lymphedema after groin dissection

Abstract: Groin dissection was performed in 67 patients, of whom 40 had superficial groin dissection and 27 had ilioinguinal dissection. The incidence of overall lymphedema of a mild to moderate degree was 21 percent. Lymphedema was observed more frequently (26 percent) in patients with primary lesions in the leg when compared with those with lower trunk lesions (6 percent, p less than 0.001), and in those who did not follow a prophylactic regime of leg elevation and use of a fitted elastic stocking (45.8 percent) when compared with those who adhered to the regime (7 percent, p less than 0.004). Sex, age, wound problems, histologic status of lymph nodes, and the duration of follow-up did not significantly affect the occurrence of lymphedema.

Preperitoneal abdominal wound repair: Incidence of dehiscence

Abstract: Preperitoneal abdominal wound repair in 100 consecutive patients who required midline laparotomy resulted in one case of wound dehiscence. The risk of dehiscence did not increase with the use of vertical midline abdominal incisions repaired without inclusion of the peritoneum. Avoidance of suture penetration of the peritoneum may result in a reduction in postoperative adhesions and intestinal obstruction without increasing the risk of wound dehiscence.

Epitrochlear node involvement in melanoma of the upper extremity

Abstract: Between 1955 and 1979, 240 patients with melanoma of the upper extremity were admitted to the National Institutes of Health (NIH). Thirty nine of these patients (16%) had primary lesions of the forearm, hand, or digit. Twenty-two patients underwent axillary dissection during their treatment. Ten patients were subjected to both axillary and epitrochlear lymph node dissection. Nine of these ten patients had lymph node metastases; two in the axillary nodes only, two in the epitrochlear nodes only, and five in both nodal groups. Epitrochlear node involvement occurred in 18% of patients with forearm or hand lesions, and only when the primary melanoma was within 5 cm of the elbow or in the ulnar distribution, the classically described drainage area of the epitrochlear nodes. The prognosis of the patients in this study was related to the depth of their primary lesions and the presence or absence of axillary node involvement. However, since approximately 18% of patients with melanomas of the hand, forearm and elbow area have a high probability of recurrence in the epitrochlear nodes, close attention to this area and early dissection of clinically suspicious nodes can favorably affect locoregional control in this group of melanoma patients.

Penetrating neck wounds

Abstract: Over a 15 year period 120 patients with neck injuries that penetrated the platysma were studied. Appropriate treatment was initiated in the emergency room. Sixty-one patients underwent exploration and 59 were observed. Two of the observed patients later required delayed operation. In 9.2 percent of the patients, two or more injuries were present within the neck, whereas in 30 percent the neck injury was only one of many bodily injuries. Length of hospital stay for the operative group of patients was 9 days and for the nonoperative group 5 days. There was one death. The complication rates in the operative and nonoperative groups were 2.5 and 1.7 percent, respectively. The major structures injured were within the venous system. The neck injuries were classified according to three zones defined by Saletta and Jones and their co-workers [4,5]. The majority were Zone II injuries. Our morbidity and mortality rates are slightly lower than those reported in most series. This review supports the concept that therapy for penetrating injuries to the neck should be individualized.