N S Victor | PubMed Health

PubMed1996

Merkel cell cancer: is prophylactic lymph node dissection indicated?

Our objective was to determine prognostic factors and the role of prophylactic lymph node dissection in Merkel cell cancer. A retrospective chart review of 15 patients from Loma Linda University Medical Center, Loma Linda, and Kaiser Permanente, Fontana, was used. The most important predictor of survival was presence of lymph node metastasis (P = 0.03). Lymph node metastasis was the first sign of recurrence in 60 per cent of patients and preceded distant metastasis. Age at presentation, tumor size, and location had no influence on survival. Gross presurgical determination of tumor extent was misleading. Microscopically positive margins necessitated reexcision in 60 per cent of patients. Local recurrence occurred in 27 per cent of patients. Recurrence at lymph node basins was lower in patients with elective lymph node dissection (0%) compared with therapeutic node dissection (57%)(P < 0.05). Incidence of micrometastases in patients undergoing prophylactic lymph node dissection was 100 per cent. No difference in survival was seen between prophylactic and therapeutic node dissection. Because Merkel cell cancer spreads in a "cascade" fashion, elective node dissection may provide a chance for a cure. Elective node dissection provides better locoregional control compared with therapeutic node dissection and helps to determine prognosis.

Aged↗

PubMed1993

Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury.

UNLABELLED: Setting priorities in the management of patients with suspected injuries to both the head and the abdomen is difficult and depends on the likelihood of different injuries. Eight hundred trauma patients were retrospectively reviewed to determine the likelihood of a surgically correctable cerebral injury. All 800 patients, at the time of initial evaluation, were thought to have potentially correctable injuries to both the head and the abdomen. Of these, 52 had a head injury requiring craniotomy; 40 required a therapeutic celiotomy. Only three patients required both craniotomy and therapeutic celiotomy. There were more cases of delay in therapeutic celiotomy because of negative results of computed tomographic (CT) scanning of the head (13 cases) than there were delays in craniotomy because of nontherapeutic celiotomy (four cases). Need for craniotomy, based on emergency department evaluation, was indicated by the presence of lateralizing neurologic signs. Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy. CONCLUSIONS: Patients with surgically correctable injuries of both the head and the abdomen are rare. In stable patients with altered mental status and potential injuries to both the head and the abdomen, the abdomen is best evaluated first by diagnostic paracentesis. If paracentesis does not return gross blood, CT scanning of the head should be done.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗