This is a retrospective analysis of 60 patients with previously untreated metatypical basal cell (3 patients) or squamous cell (57 patients) carcinoma of the skin, metastatic to the parotid area. All patients had a minimum 2-year follow-up, and 43% had a minimum 5-year follow-up. Treatment was surgery alone (8 patients), irradiation alone (16 patients), or planned combined surgery and irradiation (36 patients). The ultimate rates of control of disease in the parotid area were surgery alone, 5 of 8 (63%); irradiation alone, 6 of 13 (46%); planned combined surgery and irradiation, 32 of 36 (89%). In the combined-treated group, all 4 recurrences were in patients who had positive surgical margins and gross involvement of the facial nerve. In patients with negative surgical margins, without involvement of the facial nerve, who had combined treatment, the control rate was 100%. Of the surgery-alone group, only 1 patient ultimately had the disease controlled and retained a functioning facial nerve.

Adult↗

PubMedDate not supplied

The identification of high risk asthmatic children using the emergency department asthma visit count.

A subset of asthma patients accounts for a disproportionate amount of health care resources through repeat visits. A retrospective analysis of emergency department (ED) billing and admission databases was performed to assess the value of the asthma visit count as an indicator of future health care utilization. The asthma visit count was found to have a direct and linear relationship with both future ED visits and future inpatient admission for asthma. Children with 2 visits in 1997 had a substantial (26.9%) risk of returning in the 1998 study period, and a 6.6% risk of admission. Children who visited the ED 3 or more times in 1997 for asthma had a risk of repeat visit of more than 52%, and more than 12% of this highest risk group were admitted to the hospital at least once during the 1998 study period. Once an annual asthma visit count of 3 or more is achieved, there can be little controversy with the "high utilizer" label. The substantial increase in the visit and admission risk warrants consideration of the asthma visit count as an easily obtainable, objective marker to identify high-risk children for both study and clinical purposes. Further research is needed.

Asthma↗