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Biomedical subjects

A P Yuen

Publications and source records attributed to A P Yuen.

33 records · Page 2Linked to original sources
PubMed1997

Results of surgical salvage of locoregional recurrence of carcinoma of the tongue after radiotherapy failure.

The aim of this study was to evaluate the efficacy of surgical salvage of local and nodal recurrence of carcinoma of the oral tongue after radiotherapy failure. Of the 47 patients in this retrospective review (between 1980 and 1992), there were 25 with local recurrence alone, 11 with locoregional recurrence, and 11 with nodal recurrence alone. There was no operative mortality, and 17% of patients had one or more surgical complications, including wound infection, flap necrosis, anastomotic leakage, and chest infection. Twenty-nine (62%) patients developed recurrences in the head and neck region after the salvage operation, and 9 of them had second surgical salvage operations. At the last follow-up, 53% of patients had died of carcinoma of the tongue and the overall 5-year actuarial survival rate was 43%. The 5-year actuarial survival rates were 39% for local recurrence alone, 27% for locoregional recurrence, and 68% for nodal recurrence alone. Surgical salvage had satisfactory results for patients with oral tongue carcinoma after radiotherapy failure. Close follow-up and early surgical intervention are essential for patients primarily treated with radiotherapy.

Adult↗
PubMed1996

Critical appraisal of watchful waiting policy in the management of N0 neck of advanced laryngeal carcinoma.

OBJECTIVE: To analyze the problem of nodal recurrence of N0 neck advanced laryngeal carcinoma. DESIGN: Retrospective analysis. SETTING: Hospital referral center. PATIENTS: One hundred thirty-three patients with cancer stages T3-T4, N0, M0 who had total laryngectomy between January 1981 and December 1990. MAIN OUTCOME MEASURE: Nodal recurrence. RESULTS: Of the 11 patients who had elective radical neck dissections, there was no nodal recurrence. Of the other 122 patients who had no elective neck dissection, 19 patients (16%) developed nodal recurrence and all nodal recurrence was at levels II, III, and IV. Twelve patients (63%) underwent salvage radical neck dissection for nodal recurrence and they had a 38% adjusted 5-year actuarial survival rate. Of these 122 patients who had no elective neck dissection for the N0 neck, 12 patients (10%) eventually died of nodal recurrence. CONCLUSIONS: The watchful waiting policy is a satisfactory management option of N0 neck of advanced laryngeal carcinoma.

Adult↗
PubMed1996

Risk factors of tracheostomal recurrence after laryngectomy for laryngeal carcinoma.

BACKGROUND: Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. METHODS: This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322 laryngeal squamous cell carcinomas. The factors included in the analysis were sex, age, tumor stage, sites of tumor involvement, preoperative airway obstruction, preoperative tracheostomy, extent of surgical resection, radiotherapy, and pathological resection margin. RESULTS: Seventeen (5%) patients developed tracheostomal recurrence. Univariate analysis showed that preoperative airway obstruction, subglottic involvement, and postcricoid extension were significant factors associated with tracheostomal recurrence. Multivariate analysis using logistic regression method showed that both subglottic and postcricoid involvement were independent predisposing factors for tracheostomal recurrence. The tracheostomal recurrence rates were 2% in patients without the risk factor and 10% in patients with the presence of one or both risk factors. CONCLUSIONS: Subglottic and postcricoid involvement were independent risk factors for tracheostomal recurrence.

Adult↗
PubMed1996

Comprehensive analysis of nodal recurrence of advanced laryngeal carcinoma following surgery.

The problems of nodal recurrence after surgical treatment of T3-4 laryngeal carcinoma were analysed. There were 133 N0 and 66 N+ patients. The 5-year actuarial nodal recurrence rate of N0 patients was 18% and N+ patients was 31%. Nodal recurrence was the commonest site of recurrence. The sites of nodal recurrence of N0 patients were at the level II, III, and IV nodes. Both ipsilateral and contralateral nodal recurrences were common. Of those patients who developed nodal recurrence, 63% patients were feasible for surgical salvage. Surgical salvage with radical neck dissection was the preferred treatment for nodal recurrence with 38% 5-year survival rate. The 'watchful waiting policy' in the management of N0 neck is an acceptable option with eventual nodal failure rate of 10% after surgical salvage. Close follow-up of patients is mandatory for the early detection of surgically salvageable nodal recurrence.

Adult↗
PubMed1996

Cancer of the larynx in Hong Kong: a clinico-pathological study.

Laryngeal cancer is a relatively common cancer in Hong Kong when compared with other cities over the world. The purpose of this study is to characterize and identify the clinico-pathological features of patients with laryngeal cancer being resected or autopsied in our hospital for the years 1973 to 1992. The peak age at presentation of 451 patients (408 males, 43 females) with primary laryngeal cancer resected was 62 years old and 1.6% of patients were under 40. The incidence increased with age in both sexes. The patients were noted to be ageing steadily in the 20-year study period. Most patients (30%) had tumours involving both the supra-glottis and glottis. Histological examination revealed that the cancers comprised squamous cell carcinomas (98.3%), spindle cell carcinoma (0.7%), adenoid cystic carcinoma (0.2%), mucoepidermoid carcinoma (0.2%), atypical carcinoid (0.2%) and chondrosarcoma (0.4%). Most cases of squamous cell carcinoma were moderately differentiated (67.3%). Poorly differentiated squamous cell carcinomas were more often noted in females. Forty-six laryngeal cancers were noted in the study period giving an autopsy incidence of laryngeal cancers of 0.46%. Distant metastases were found in 50% of these autopsied cases. The metastatic lesions were found in the lung (43%), liver (18%), diaphragm/pleura (18%), kidney (9%), bone (7%), heart (5%), spleen (2%), nostril (2%) and small intestine (2%). The results indicate that there are different histological subtypes of laryngeal cancer in Hong Kong Chinese and they share similar epidemiological characteristics with those reported in other studies.

Adult↗
PubMed1995

Results of surgical salvage for radiation failures of laryngeal carcinoma.

The results of surgical salvage of radiation failures of laryngeal carcinoma were reviewed. There were 167 stage T3 and T4 patients. The operative mortality was 7%. The complication rates were 8% wound infection, 13% chest complication, and 25% anastomotic leakage. After the first salvage operation, pharyngeal recurrence developed in 28 (18%) patients. Seven (25%) patients were feasible for second salvage operation, and none of them had further local recurrence. There were 9 (5%) tracheostomal recurrences. Of the 126 N0 patients, 23 (18%) had nodal recurrence, and only 5 of the nodal recurrences were feasible for salvage by radical neck dissection. All 41 node-positive patients underwent radical neck dissection, and 9 (23%) had nodal recurrence. Of the 126 node-negative patients, 19 (15%) had distant metastasis. Of the 41 node-positive patients, 18 (44%) had distant metastasis. The node-positive patients had a significantly high distant failure rate despite locoregional control of tumor. The adjusted 5-year survival rate of T3-4N0M0 was 45%, and that of T3-4N + M0 was 22%.

Adult↗
PubMed1995

Analysis of recurrence after surgical treatment of advanced laryngeal carcinoma.

The pattern of recurrences after surgical treatment of 276 patients with stage T3 and T4 laryngeal carcinoma was reviewed. Nodal recurrence was the commonest site and occurred mainly in patients with supraglottic and transglottic carcinoma. Distant metastasis was the second commonest site of recurrence, and the most distant metastases developed without locoregional recurrence. Local recurrence alone was uncommon in patients treated with primary surgery.

Adult↗
PubMed1995

Thyroidectomy during laryngectomy for advanced laryngeal carcinoma--whole organ section study with long-term functional evaluation.

Whole organ step-serial section of laryngectomy specimens was carried out in 16 patients with a T3 and T4 laryngeal carcinoma to study the involvement of the thyroid gland. Three patients (19%) were found to have tumour invasion into the thyroid gland, and two patients (16%) were found to have tumour on the thyroid capsule. Of the 12 patients who had tumour involving the subglottic region, five patients were found to have involvement of the thyroid gland. Of the remaining four patients without subglottic tumour extension, none had tumour involvement of the thyroid gland. Of the five patients who had long-term survival of 10 years, two patients had subclinical hypothyroidism and one patient had clinical hypothyroidism. We recommend routine hemithyroidectomy when the subglottic region is involved by tumour. The whole thyroid gland should be preserved when the laryngeal tumour is confined to the supraglottic and glottic regions without clinical evidence of thyroid gland involvement.

Aged↗
PubMed1995

Bacteriology of chronic suppurative otitis media: ofloxacin susceptibility.

Fifty-four patients with active chronic suppurative otitis media (CSOM) were prospectively studied for the bacteriology and their in vitro antibiotic susceptibility to ofloxacin. Thirty-nine patients (72%) had positive cultures. The commonest organism was Pseudomonas sp., which was found in 18 (33%) patients. The second commonest organism was Staphylococcus aureus, which was found in 15 (28%) patients. Bacteroides sp. was found only in 3 (6%) patients, and all were in association with the aerobes. Of all 42 aerobes found, 35 (83%) were susceptible to ofloxacin. The in vitro susceptibility results indicate that ofloxacin can be an effective antibiotic in the treatment of active CSOM.

Adolescent↗
PubMed1995

Clinics in diagnostic imaging.

A 48-year-old Chinese woman presented with progressive right-sided sensorineural hearing loss. Computerised tomography showed asymmetrical widening of the right internal acoustic canal. Post-gadolinium magnetic resonance images demonstrated marked enhancement of an intracanalicular tumour. The diagnosis of acoustic neuroma was confirmed surgically. The approach to imaging of deafness, particularly of unilateral sensorineural hearing loss, is discussed. Magnetic resonance imaging is currently the definitive test for diagnosis of acoustic neuromas.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Prognosis of recurrent laryngeal carcinoma after laryngectomy.

BACKGROUND: Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy. METHODS: The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed. RESULTS: Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5-year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5-year actuarial survival rate was 2%. CONCLUSIONS: The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow-up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible.

Actuarial Analysis↗
PubMedDate not supplied

Comprehensive analysis of pharyngeal recurrence of laryngeal carcinoma after total laryngectomy.

PURPOSE: This study analyzes the incidence, risk factors, treatment results, and prognosis of local recurrence at the pharynx after total laryngectomy for laryngeal carcinoma. PATIENTS AND METHODS: The records of 292 patients who underwent total laryngectomy for the treatment of laryngeal carcinoma between January 1978 and December 1990 were reviewed. RESULTS: Of these 292 patients, there were 24 patients who developed local recurrence at the pharynx. The 5-year actuarial cumulative local recurrence rate was 10%. There were 17 cases of pharyngeal recurrence alone, five cases of pharyngeal and nodal recurrence, one case of pharyngeal and tracheostomal recurrence, and one case of pharyngeal and distant metastasis. Ten (42%) patients were salvaged surgically; the 5-year actuarial survival rate after surgical salvage was 53%. The other 14 patients were treated with palliative treatment, and all died of tumor, with the longest period of survival being 28 months. CONCLUSION: Surgical salvage of pharyngeal recurrence has acceptable results. Close monitoring of patients is important to have an early diagnosis of salvageable recurrence.

Adult↗
PubMedDate not supplied

Long-term results of voice rehabilitation after total laryngectomy using primary tracheoesophageal puncture in Chinese patients.

PURPOSE: Prosthetic voice restoration is an increasingly popular method of postlaryngectomy voice rehabilitation. Despite its success in non-tonal languages, the efficacy of tracheoesophageal speech in tonal languages was largely unknown. The aim of the present study was to evaluate the long-term results of voice rehabilitation using a Blom-Singer valve (BSV) in the tonal language of Cantonese. PATIENTS AND METHODS: The records of 159 patients who underwent total laryngectomy and primary tracheoesophageal puncture (TEP) between May 1985 and December 1994 were retrospectively reviewed. Tracheoesophageal speech was regarded as functional if effective communication could be made during face-to-face conversation and telephone conversation. Any TEP-related complications were noted. Perioperative factors that might contribute to nonfunctional speech were subjected to statistical analysis. RESULTS: Six hospital mortalities were excluded from speech analysis. Of the remaining 153 patients, the median follow-up was 25 months, ranging from 3 to 113 months. Seventy-three patients had closure of tracheosophageal fistulae (TEF), and the main causes were ineffective voice production, dislodgment, and tracheostomal stenosis. Only 15 of them acquired functional speech before closure. The other 80 patients used a BSV as the chief modality of voice rehabilitation, with functional results achieved in 64 patients. None of the perioperative factors were found to be statistically significant in relation to nonfunctional speech. CONCLUSION: Primary TEP is an established method of voice rehabilitation after total laryngectomy. In our series, 52% patients achieved functional tracheoesophageal speech using a BSV.

Esophagus↗
PubMedDate not supplied

Otorrhea after grommet insertion for middle ear effusion in patients with nasopharyngeal carcinoma.

PURPOSE: To document the incidence of complications after myringotomy and grommet insertion in patients with nasopharyngeal carcinoma. The focus is on the incidence of otorrhea and perforation. The possible risk factors for these conditions and treatment response were studied. MATERIALS AND METHODS: We reviewed the records on 206 ears of 163 patients who suffered from nasopharyngeal carcinoma and underwent myringotomy and grommet insertion in a 7-year period. The follow-up period ranged from 4 weeks to 78 months (median, 9 months). RESULTS: The overall incidence of otorrhea in these ears was 38%. Patients with nasopharyngeal carcinoma (NPC) had a significantly high incidence of postoperative discharge (chi2 test, P<.0001) compared with other patients who underwent myringotomy and grommet insertion. The mean interval between myringotomy and otorrhea was 19.8 weeks. Forty-seven per cent of the ears with a discharge developed otorrhea within 1 month. In 42%, the otorrhea responded to treatment and the ears became dry. After extrusion of the grommet, 29% of those ears with otorrhea ended with an eardrum perforation, and 24% of the ears showed recurrent effusion. CONCLUSIONS: For patients with NPC who underwent myringotomy, there was a significant risk of otorrhea (49%) and persistent perforation (29%), and these complications were difficult to manage. We conclude that myringotomy and grommet insertion should not be routinely offered to NPC patients with middle ear effusion.

Case-Control Studies↗