The timing of intravenous immunoglobulin therapy in Stevens-Johnson syndrome and toxic epidermal necrolysis.
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Adolescent↗
Biomedical subjects
L K Lam
Publications and source records attributed to L K Lam.
The use of pulsed dye laser for the prevention and treatment of hypertrophic scars in chinese persons.
BACKGROUND: Pulse dye laser has been used with variable degrees of success in the treatment of hypertrophic scars, and although earlier reports suggested a significant degree of improvement, more recent studies have raised concern about its effectiveness. Furthermore, most previous studies examined its use in patients with light skin types, and the use of pulse dye laser in dark-skinned patients for the treatment of hypertrophic scars is not well established. OBJECTIVE: The objective was to assess the role of pulsed dye laser therapy in the treatment and prevention of hypertrophic scars in Chinese persons. METHODS: Twenty-nine patients (35 scars) who had scars for less than 6 months were recruited into the prevention group, and 27 patients (36 scars) who had scars for more than 6 months were recruited into the treatment arm of the study. Each received pulse dye laser treatment (585 nm, 1.5-msec pulse duration, 5-mm spot size, 7-8 J/cm(2)) for three to six treatments at 8-week intervals. Half of the scar was treated with the laser and the other half was used as a control. All patients were assessed for subjective improvement with the use of a structured questionnaire and objectively with ultrasonography for thickness and a cutometer for viscoelasticity. Scars were marked on every patient and mapped with a translucent paper at the first appointment to ensure the consistency of location. At the end of the study, 15 patients from the prevention group (15 scars) and 23 patients from the treatment group (34 scars) agreed to return for spectrophotometer assessment. RESULTS: Fifty-four percent of patients in the prevention group and 66% of patients in the treatment group considered their scars to be better or much better. For both groups of patients, there was significant improvement in term of pruritics after laser treatment. For objective assessment, although scar thickness reduced significantly compared to baseline in the treatment group, such change was not significant when changes in the control side were taken into consideration. There was insignificant change in viscoelasticity. Spectrophometer assessment indicated a significant degree of lightening in the treatment group. CONCLUSION: Our study indicated that although there was significant symptomatic improvement, there was an insignificant degree of objective improvement in terms of scar thickness and viscoelasticity in the prevention group compared to the control group. Our findings are in line with several previous controlled studies and contradict the results of several others. Such differences can be due to differences in assessment methodology, laser settings, skin type, and scar location. Suprapurpuric pulsed dye laser should not be considered as the standard of practice for the treatment and prevention of hypertrophic surgical scars especially in the chest in Asians patients.
Adolescent↗
Microvascular free tissue reconstruction following extirpation of head and neck tumour: experience towards an optimal outcome.
Familiarity with four types of free tissues transfers allows appropriate reconstruction of most defects in the head and neck region functionally and aesthetically. These include jejunal graft, radial forearm, rectus abdominus myocutaneous and fibula osteocutaneous flaps. Free colonic and gastric patches were used occasionally. We report our experience of 215 free tissue transfers for reconstruction of defects in the head and neck region after tumour extirpation. The overall success rate was 94 per cent. The commonest cause of failure was related to arterial inflow (70 per cent). Three patients died in hospital, but their mortality was not related to the tissue transfers. Complications due to free tissue transfer at both the donor and recipient sites were few and manageable. The co-operation between the two surgical teams, together with the timely application of suitable salvage procedures, contribute to an optimal outcome.
Adolescent↗
Nevus of Ota: a new classification based on the response to laser treatment.
BACKGROUND AND OBJECTIVE: For 60 years, Tanino's classification has been used to classify the extent of nevus of Ota. However, such classification not only fails to address variants such as phacomatosis pigmentovascularis but also cannot be used to predict the therapeutic outcome. Our objective is to retrospectively study our series of laser-treated patients with the aim of re-classifying nevus of Ota, so that such important issues can be taken into account. STUDY DESIGN/MATERIALS AND METHODS: One hundred nineteen patients that had received Q-switched laser treatment were recruited into the study. They were recalled for interview and examination for evidence of coexisting birthmarks and extracutaneous involvement. Two observers assessed the pre- and posttreatment clinical photographs for evidence of periorbital under-response (panda's sign), defined as the degree of periorbital laser clearing significantly less than clearing in the other area. RESULTS: A total of 47.8% of the patients with periorbital pigmentation were considered by the observers to have significant periorbital under-response (panda's sign). Additionally, 10.1% had other birthmarks, and extracutaneous involvement was seen in 31.4% of the patients. CONCLUSION: Periorbital under-response is commonly seen in patients with periorbital pigmentation. Taking this and other factors into consideration, we have proposed a new classification for nevus of Ota that allows for the prediction of the clinical outcome of laser treatment.
Adolescent↗
An in vivo study comparing the efficacy and complications of diode laser and long-pulsed Nd:YAG laser in hair removal in Chinese patients.
BACKGROUND: Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients. OBJECTIVE: To compare the efficacy and complications of 800 nm diode and long-pulsed 1064 nm Nd:YAG lasers in laser-assisted hair removal in Chinese patients. METHODS: Fifteen women had hair removal treatments (13 axillae and 2 legs) with diode laser on one side and Nd:YAG laser on the other. They were followed up for 36 weeks. Subjective assessments included the degree of immediate pain and the degree of hair regrowth. Clinical photographs were taken for evaluation by two independent observers to assess complications and the degree of hair regrowth. RESULTS: Long-pulsed Nd:YAG laser was found to be significantly associated with a greater degree of immediate pain after laser surgery (P =.0001, independent sample t-test) and also had a longer laser time (P =.0001, independent sample t-test). Besides transit adverse effects such as erythema and perifollicular edema, only one patient developed hypopigmentation at week 6 which resolved by week 36. Although regrowth rates were low at week 6 (subjective rates were 23% and 19% for Nd:YAG and diode laser, respectively), most patients had significant regrowth at week 36 (subjective regrowth rate 91% for both long-pulsed Nd:YAG and diode lasers). CONCLUSION: Diode 800 nm and Nd:YAG 1064 nm lasers are safe in laser-assisted hair removal in Chinese patients, and besides immediate pain, there was no other significant adverse effect. Most patients experienced regrowth 36 weeks after a single treatment. Further study is necessary to determine the long-term clinical efficacy and complications of laser-assisted hair removal with these systems in dark-skinned patients.
Adult↗
A retrospective study on the efficacy and complications of Q-switched alexandrite laser in the treatment of acquired bilateral nevus of Ota-like macules.
BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori's macules, is a common Asian condition that is characterized by bluish hyperpigmentation in the bilateral malar regions. Unlike nevus of Ota, ABNOM is an acquired condition that often develops after 20 years of age and involves both sides of the face, but there is no mucosal involvement. Recently Q-switched (QS) 1064 nm Nd:YAG lasers have been effective in clearing this condition. The effectiveness of QS alexandrite lasers has not yet been studied. OBJECTIVE: To retrospectively assess the efficacy and complications of QS alexandrite lasers in the treatment of ABNOM. METHODS: Thirty-two Chinese women with ABNOM ranging in age from 28 to 66 years were involved in the study. All underwent QS alexandrite laser treatment (755 nm, spot size 3 mm, 8 J/cm(2)). Topical hydroquinone and tretinoin cream were given to those with hyperpigmentation after the laser surgery. Clinical photographs were taken before and after laser surgery and assessed by two independent observers. The degree of clearing was scored and complications, including hypopigmentation, hyperpigmentation, scarring, and erythema, were assessed. RESULTS: The mean number of treatment sessions was 7 (range 2-11) and the mean treatment interval was 33 days. Both observers identified more than 80% of the patients as having more than a 50% degree of clearing, and complete clearance was seen in more than 28% of patients. Although most patients had postlaser hyperpigmentation and were on depigmentary regimes, the hyperpigmentation was seen in only 12.5% of the patients during photographic evaluation. Hypopigmentation was seen in 50% of patients and erythema in 41%. CONCLUSION: QS alexandrite appears to be effective in the treatment of ABNOM. Postoperative pigmentary changes were frequent and the use of topical depigmentary agents was necessary to achieve a satisfactory result. Transient hypopigmentation risk was high, affecting up to 50% of the patients. Further study is warranted to compare the efficacy and complications of different laser systems in the treatment of this condition.
Adult↗
Relationship between the size of neopharynx after laryngectomy and long-term swallowing function: an assessment by scintigraphy.
OBJECTIVES: To study the relationship between the size of neopharynx after total laryngectomy and long-term swallowing function by means of scintigraphy. STUDY DESIGN: The width of pharyngeal remnant was measured during surgery in 11 patients. Their swallowing function was assessed by scintigraphy 8 to 10 years after surgery. METHODS: The width of pharyngeal remnant at its narrowest point in both relaxed and stretched state was measured during surgery. Postoperative scintigraphy data on swallowing were obtained and computed along 3 lines, (1) transit time through neopharynx, (2) percentage of bolus transferred, and (3) swallowing efficiency. The relationship between the 2 sets of data was analyzed by linear regression analysis. RESULTS: (1) No statistically significant relationship was found between the size of neopharynx and swallowing function. (2) All patients are clinically asymptomatic. CONCLUSIONS: The swallowing function is not affected by the size of the neopharynx in 11 patients with pharyngeal remnant width ranging from 3 to 8 cm (stretched).
Aged↗
Carotid stenosis after radiotherapy for nasopharyngeal carcinoma.
OBJECTIVE: To determine the prevalence and risk factors for radiation-induced carotid stenosis in patients with malignant neoplasms of the head and neck. DESIGN: Prospective cross-sectional screening of extracranial carotid stenosis by color-flow duplex ultrasonography with an analysis of demographic and comorbid risk factors. SETTING: Tertiary oncology and vascular referral center. PATIENTS: The study included 96 consecutive patients (75 men and 21 women; mean age, 53.6 years) who had undergone cervical radiotherapy (RT) for nasopharyngeal carcinoma more than 12 months ago. The mean post-RT interval was 79.9 months. Fourteen patients had cerebrovascular symptoms. A group of 96 healthy individuals were used as controls. MAIN OUTCOME MEASURES: Internal carotid stenosis and common carotid artery stenosis were classified by duplex ultrasonography into moderate (30%-69%), severe (70%-99%), and totally occlusive. RESULTS: Internal carotid artery stenosis of 70% or more was detected in 14 arteries in 12 patients (6 occlusions). Common carotid artery stenosis of 70% or more was found in 11 arteries in 9 patients (4 occlusions). Overall, 15 patients (16%) had critical stenosis in their common or internal carotid arteries, and another 20 (21%) had stenosis in the moderate range. Critical carotid stenosis was not present in any of the control subjects. Severe post-RT carotid stenosis was associated with age (P = .003), smoking (P = .004), heart disease (P<.001), no prior oncological surgery (P<.001), cerebrovascular symptoms (P<.001), and interval from RT (P<.001). Smoking, interval from RT, cerebrovascular symptoms, and no head and neck surgery were significant independent predictors for severe carotid stenosis on multivariate logistic regression analysis. CONCLUSIONS: Patients who undergo irradiation of the head and neck for more than 5 years have a higher risk of developing significant carotid stenosis (relative risk, 15), and routine duplex ultrasound screening is recommended.
Carotid Artery, Common↗
Thoracoscopic esophageal mobilization for pharyngolaryngoesophagectomy.
BACKGROUND: Pharyngolaryngoesophagectomy (PLE) for hypopharyngeal cancers and tumors of the cervical esophagus is a procedure of significant morbidity and mortality. Conventional esophageal mobilization is performed with the transhiatal dissection technique. Thoracoscopic esophageal mobilization is tested as an alternative to determine whether surgical outcome can be improved. METHODS: From 1994 to 1998, thoracoscopic mobilization was carried out in 30 consecutive patients who underwent PLE (PLE-TS). This was compared to a historical cohort of 30 patients who had PLE with transhiatal mobilization (PLE-TH). RESULTS: In PLE-TS, thoracoscopic esophageal mobilization was successful in 28 patients (93%). Median blood loss was 700 mL (range, 164 to 3,000 mL) compared to 1,000 mL (range, 400 to 2,200 mL) in group PLE-TH, p = 0.21. Thoracoscopy time was 90 minutes (range, 60 to 180 minutes). Total operating time were 392 minutes (range, 180 to 570 minutes) and 300 minutes (range, 150 to 550 minutes) in PLE-TS and PLE-TH, respectively (p = 0.03). Major pulmonary complications occurred in 7 (23%) and 8 (27%) patients in PLE-TS and PLE-TH, respectively (p = 0.77). Cardiac complications occurred in 7 (23%) and 5 (17%) patients in PLE-TS and PLE-TH, respectively (p = 0.52). Thirty-day mortality rates were 3.3% and 10% (p = 0.6) and hospital mortality rates were 13% and 17%, (p = 1.0). CONCLUSIONS: Thoracoscopy was safe and feasible. Morbidity and mortality after PLE was not significantly reduced. The theoretical advantage offered by thoracoscopy may be offset by the lengthened time of one-lung anesthesia.
Adult↗
Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma.
BACKGROUND: The study aims at evaluation of the efficacy of elective neck dissection as a staging and therapeutic procedure for N0 neck of early carcinoma of the oral tongue by whole organ serial sectioning. METHODS: There were 50 stage I and II patients. The neck dissection specimens were whole organ sectioned in 3-mm intervals for the evaluation of nodal metastasis. RESULTS: There were 18 (36%) patients with subclinical nodal metastasis. The total number of metastatic nodes were 31 (1%) among all 2,826 nodes being examined. The metastatic foci had a median size of 3 mm and occupied a median of 6% of the cross sectional area of the involved nodes. The ipsilateral level II nodes were the commonest (26%) site of metastasis. Metastatic nodes were present in 34% patients who had negative preoperative radiological assessment and in 20% patients who had negative intraoperative frozen section sampling of neck nodes. Patients with subclinical nodal metastasis had a high incidence of regional recurrence (62%) and low survival (27%) when postoperative radiotherapy was not given after elective neck dissection. CONCLUSIONS: Ipsilateral level I,II,III neck dissection is an adequate diagnostic procedure for staging of the N0 neck of early oral tongue carcinoma. Its diagnostic role cannot be replaced by the available pre-operative radiological screening and intra-operative frozen section sampling. However, elective selective neck dissection is an effective but not adequate therapeutic procedure, and post-operative adjuvant radiotherapy and chemotherapy have to be considered for all pathologically positive necks.
Adolescent↗
Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies.
BACKGROUND: Carotid stenosis is a recognized complication of external irradiation to the head and neck for malignancy. This study aim to investigate the pattern and prevalence of radiation induced carotid disease, and to identify risk factors associated with significant stenosis. METHODS: In a comparative cross-sectional study, carotid arteries color flow duplex scan was performed on 240 patients who had received external irradiation to the head and neck area, with a mean interval of 72 months from radiotherapy. They consisted of 181 men and 59 women, with a mean age of 59 years. Fifteen patients had a history of cerebrovascular symptoms. RESULTS: Internal carotid artery (ICA) stenosis of 70% or greater was detected in 29 arteries in 24 patients. Common carotid artery (CCA) disease of > or =70% was present in 13 arteries in 12 patients. Overall 28 patients had significant ICA/ CCA disease (11.7%). Patients with nasopharyngeal and laryngeal carcinoma had more cerebrovascular symptoms, and more frequent CCA stenosis. Significant ICA/CCA stenosis was associated with age, smoking, coronary heart disease, stroke, no head and neck surgery, time interval from radiotherapy, and the site of primary tumor. On logistic regression analysis age (>60 years), cerebrovascular symptoms, interval from irradiation (>5 years), and nasopharynx and larynx cancer were found to be independent significant (P<0.05) predictors of 70% or greater ICA/CCA stenosis. CONCLUSIONS: Patients who had received radiotherapy to the head and neck have a high risk of developing significant carotid stenosis. Routine duplex ultrasound screening in these patients is indicated.
Carotid Artery, Internal↗
Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis.
BACKGROUND: Pharyngolaryngo-esophagectomy and pharyngogastric anastomosis (PLO & PGA) is one of the surgical options in the management of tumors arising from the hypopharynx and cervical esophagus. Indications of the operation and the outcome are changing over the years. To examine these, the experience of this operation in one Institute (the Head and Neck Division of the Department of Surgery, The University of Hong Kong at Queen Mary Hospital, Hong Kong) over the last 30 years was reviewed. METHODS: From 1966 to 1995, a total of 317 patients underwent PLO & PGA. The clinical results of 69 patients operated on between 1986 and 1995 were analyzed and compared with those of the two groups of patients reported previously from the same Institute to establish the current status of PLO & PGA. RESULTS: The demographic data of three groups of patients were similar. In previous years, 53% of the primary tumors were advanced laryngeal carcinomas extending to the hypopharynx, whereas the other 47% originated from hypopharyngeal and cervical esophageal regions. In recent years, all patients belonged to the latter group. CONCLUSIONS: The hospital mortality has decreased from 31% to 9%, and the incidence of morbidity such as anastomotic leakage and bleeding has also been reduced, from 20% to 10%. This may be related to the introduction of transthoracic endoscopic mobilization of the esophagus and patient selection. The overall minor morbidity has, however, remained at about 49%, and the 5-year actuarial survival rate has improved, from 18% in the 1970s to 24.5% at present.
Adult↗
Mucosal changes of the free jejunal graft in response to radiotherapy.
BACKGROUND: Microvascular free jejunal transfer was employed for reconstruction of pharyngeal defect resulting from circumferential resection of the hypopharynx. Postoperative radiotherapy to the neck might affect the graft, but this information was lacking. The mucosal changes of the jejunum in response to radiation were identified in this prospective study. METHODS: Normal jejunal mucosa was obtained at operation, and endoscopic jejunal mucosal biopsies were taken during and at completion of radiotherapy. Endoscopic biopsies were repeated at 1, 3, 6, 12, and 24 months afterwards. All jejunal biopsies were subjected to histologic and scanning electron microscopic (SEM) examinations. Nine patients had a complete set of biopsy while 5 other patients who received no radiotherapy also went through a similar sequence of biopsies as controls. RESULTS: Histologic examination showed mucosal edema and extensive blunting of jejunal villi at the completion of radiotherapy. Increased fibrosis with focal loss of glands was noticed at 3 months after radiotherapy, and this remained throughout the 2-year period. SEM revealed patchy loss of microvilli at completion and at 1 month after radiotherapy, but this feature was not apparent in biopsies taken at 3 months onwards, showing that it was only a transient event. CONCLUSIONS: Transient responses and persistent changes of jejunal mucosa to radiotherapy were identified and characterized. The presence of these mucosal lesions was not associated with any clinically significant adverse effect in the graft up to 2 years postradiotherapy.
Aged↗
Clinicopathological analysis of local spread of carcinoma of the tongue.
BACKGROUND: The aims of the study are three-dimensional analysis of mode and distance of local spread of oral tongue carcinoma. METHODS: The glossectomy specimens were examined in the coronal plane in 3 mm thickness section. RESULTS: There were 50 glossectomy specimens. The maximum spread was 1.8 cm. Ninety-six percent of specimens had local spread within 1.2 cm. The distance of spread was not correlated with tumor size, including the diameter, depth, and volume. The incidence of local recurrence was 27% with positive histological margin. Perineural infiltration was the most important prognostic factor for local recurrence and survival. CONCLUSIONS: A minimum of 1.5-cm surgical resection margin is recommended. A smaller margin is not recommended as it has significant risk of local recurrence. A maximum of 2-cm surgical resection margin is recommended; larger margins will increase the surgical morbidity without a significant advantage of local control.
Adolescent↗
Wide margin resection and brachytherapy for post-irradiation breast cancer recurrence.
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Brachytherapy↗
An unusual complication of emergency tracheal intubation.
A 68-year-old woman presented with dyspnoea having undergone a short period of tracheal intubation during an episode of congestive cardiac failure 10 days earlier. On the fourth day of admission, she suddenly developed acute respiratory distress followed by a cardiac arrest and was found to have an enlarging neck mass. Following intubation and resuscitation, computerised tomography was carried out and surgical exploration revealed a retropharyngeal abscess and a pseudo-aneurysm of the common carotid artery resulting from pharyngeal rupture which most probably occurred as a complication of the original tracheal intubation.
Aged↗
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↗
Cervical lymph node metastatic patterns of squamous carcinomas in the upper aerodigestive tract.
The radical neck dissection specimens of 384 ethnically Chinese patients with different primary squamous carcinomas in the head and neck region were studied. Over 50 per cent of the specimens showed metastatic disease at one level in the neck. For oral cavity carcinoma, the levels of metastasis frequently involved were I, II and III while for carcinoma of the oropharynx, hypopharynx and larynx the levels were II, III and IV. Extracapsular spread was present in 112/384 of patients (29 per cent) and this increased with advancing N-stages. Based on these findings, different selective neck dissections could be used for patients harbouring different primary head and neck carcinomas with limited neck disease.
Carcinoma, Squamous Cell↗