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Survival of patients with metastatic pulmonary squamous cell carcinoma from upper aerodigestive tract primaries
Otolaryngology Head and Neck Surgery Volume 117 Number 2
controlled tracheostomies are unnecessary and not cost-effective. Our study will prospectively evaluate the effectiveness of the clinical examination in detecting postoperative pneumothorax in leu of routine chest radiographs. Methods: All patients undergoing tracheostomy with our service were entered prospectively into our study. To date, 64 patients have been entered. Because physical examinations and chest radiographs are usually routine, no deviation from standard procedure was needed. Every instance of pneumothorax was analyzed for its correlation with the physical examination. Data was tabulated according to age, sex, diagnosis, urgency, complications, and anesthesia technique. Blinded radiologists also interpreted the study in the usual fashion, quantifying the degree of pneumothorax. Results: Of the 64 patients, 57 patients received postoperative chest radiographs. All patients had postoperative cardiopulmonary examination documentation. Of the six patients that had postoperative shortness of breath or desaturation, one patient (1.7%) suffered a tension pneumothorax postoperatively, which was detected during the postoperative examination and confirmed by a chest radiograph. The other five patients were found to have pulmonary edema confirmed by clinical examination and radiography. Conclusions: Routine, postoperative chest radiographs in uncomplicated tracheostomies are not necessary given a thorough postoperative clinical examination. Cost analysis reveals a savings of approximately $6000 if our proposed criteria were used.
25 Digital Imaging in Otolaryngology HAYES H. WANAMAKER, MD, Syracuse, N.Y.
Objective: Recent advances in personal computer (PC)based digital imaging have made acquisition, processing, and application of medically related images and graphics straightforward, portable, and inexpensive. A review of currently available hardware and software for digital imaging was undertaken to demonstrate applicability for the otolaryngologist. Methods: Widely available off-the-shelf portable devices for high-resolution image capture from video camera and VCR input combined with a laptop PC were used for realtime acquisition of intraoperative images during microsurgery and endoscopy. Similar techniques were used for capture of diagnostic images as well. Inexpensive services for conversion of 35 mm slides and negatives to digital media (photocompact disk-photo CD-and floppy disk) were also utilized. Results: High quality intraoperative and diagnostic images were easily, consistently, and inexpensively obtained. Unlike output from videoprinters, these digital images could be stored, edited, and reprinted as needed. High quality conversion of existing 35 mm slide images was obtained from commercial service bureaus.
Scientific Posters
P 169
Conclusions: Advances in PC hardware and software have made acquisition of digital images readily available to the otolaryngologist with minimal cost and technical expertise. The images can be incorporated into databases, presentation programs, and image libraries for use in patient education, documentation, presentation, and publishing (examples will be illustrated). 26 Survival of Patients With Metastatic Pulmonary Squamous Cell Carcinoma From Upper Aerodigestive Tract Primaries ROY S. LEWIS, MD, and EDUARDO M. DIAZ, Jr., MD, Houston, Tex,
Objective: To analyze the results of management of patients with pulmonary metastases of squamous cell carcinoma of the upper aerodigestive tract (UADT). Design: A case series review of the charts of 301 patients treated over a 10-year period from 1981 through 1990. Factors evaluated included site and stage of primary, diseasefree interval, treatment of primary and metastases, and survival. Setting: The University of Texas-M. D. Anderson Cancer Center, Houston. Patients: Between January 1, 1981, and December 31, 1990, 4154 patients were registered in our department with a primary diagnosis of squamous cell carcinoma of the UADT. Of these patients, 301 developed pulmonary metastases. The charts of these patients were then reviewed fo~ treatment and outcome. Outcome measures: Factors studied were control ot locoregional disease, disease-free interval, extent of metastatic disease, and survival. Results: Of the 301 patients with pulmonary metastases, 23 patients underwent surgery with or without adjuvant therapy for management of the pulmonary disease. Of these, 18 had a solitary pulmonary nodule, while the remaining five had more than one lesion. Two-year survival for these 18 patients was 39% with a mean survival of 107 weeks. Conclusions: While pulmonary metastasis of squamous cell carcinoma of the upper aerodigestive tract has a very poor prognosis, it is apparent that patients with a single nodule have improved survival compared to those with more than one metastasis, and that surgical resection of that metastasis provides reasonable survival. 27 Ethmoid/Sphenoid Sinus Fibrous Dysplasia: Surgical Management STEVEN GABEL, MD, JAMES STANKIEWICZ, MD, and JAMES CHOW, MD, Maywood, III.
Objective: Symptomatic fibrous dysplasia is a rare lesion in the paranasal sinus. However, when presented with patients complaining of severe pain or visual change, surgical
controlled tracheostomies are unnecessary and not cost-effective. Our study will prospectively evaluate the effectiveness of the clinical examination in detecting postoperative pneumothorax in leu of routine chest radiographs. Methods: All patients undergoing tracheostomy with our service were entered prospectively into our study. To date, 64 patients have been entered. Because physical examinations and chest radiographs are usually routine, no deviation from standard procedure was needed. Every instance of pneumothorax was analyzed for its correlation with the physical examination. Data was tabulated according to age, sex, diagnosis, urgency, complications, and anesthesia technique. Blinded radiologists also interpreted the study in the usual fashion, quantifying the degree of pneumothorax. Results: Of the 64 patients, 57 patients received postoperative chest radiographs. All patients had postoperative cardiopulmonary examination documentation. Of the six patients that had postoperative shortness of breath or desaturation, one patient (1.7%) suffered a tension pneumothorax postoperatively, which was detected during the postoperative examination and confirmed by a chest radiograph. The other five patients were found to have pulmonary edema confirmed by clinical examination and radiography. Conclusions: Routine, postoperative chest radiographs in uncomplicated tracheostomies are not necessary given a thorough postoperative clinical examination. Cost analysis reveals a savings of approximately $6000 if our proposed criteria were used.
25 Digital Imaging in Otolaryngology HAYES H. WANAMAKER, MD, Syracuse, N.Y.
Objective: Recent advances in personal computer (PC)based digital imaging have made acquisition, processing, and application of medically related images and graphics straightforward, portable, and inexpensive. A review of currently available hardware and software for digital imaging was undertaken to demonstrate applicability for the otolaryngologist. Methods: Widely available off-the-shelf portable devices for high-resolution image capture from video camera and VCR input combined with a laptop PC were used for realtime acquisition of intraoperative images during microsurgery and endoscopy. Similar techniques were used for capture of diagnostic images as well. Inexpensive services for conversion of 35 mm slides and negatives to digital media (photocompact disk-photo CD-and floppy disk) were also utilized. Results: High quality intraoperative and diagnostic images were easily, consistently, and inexpensively obtained. Unlike output from videoprinters, these digital images could be stored, edited, and reprinted as needed. High quality conversion of existing 35 mm slide images was obtained from commercial service bureaus.
Scientific Posters
P 169
Conclusions: Advances in PC hardware and software have made acquisition of digital images readily available to the otolaryngologist with minimal cost and technical expertise. The images can be incorporated into databases, presentation programs, and image libraries for use in patient education, documentation, presentation, and publishing (examples will be illustrated). 26 Survival of Patients With Metastatic Pulmonary Squamous Cell Carcinoma From Upper Aerodigestive Tract Primaries ROY S. LEWIS, MD, and EDUARDO M. DIAZ, Jr., MD, Houston, Tex,
Objective: To analyze the results of management of patients with pulmonary metastases of squamous cell carcinoma of the upper aerodigestive tract (UADT). Design: A case series review of the charts of 301 patients treated over a 10-year period from 1981 through 1990. Factors evaluated included site and stage of primary, diseasefree interval, treatment of primary and metastases, and survival. Setting: The University of Texas-M. D. Anderson Cancer Center, Houston. Patients: Between January 1, 1981, and December 31, 1990, 4154 patients were registered in our department with a primary diagnosis of squamous cell carcinoma of the UADT. Of these patients, 301 developed pulmonary metastases. The charts of these patients were then reviewed fo~ treatment and outcome. Outcome measures: Factors studied were control ot locoregional disease, disease-free interval, extent of metastatic disease, and survival. Results: Of the 301 patients with pulmonary metastases, 23 patients underwent surgery with or without adjuvant therapy for management of the pulmonary disease. Of these, 18 had a solitary pulmonary nodule, while the remaining five had more than one lesion. Two-year survival for these 18 patients was 39% with a mean survival of 107 weeks. Conclusions: While pulmonary metastasis of squamous cell carcinoma of the upper aerodigestive tract has a very poor prognosis, it is apparent that patients with a single nodule have improved survival compared to those with more than one metastasis, and that surgical resection of that metastasis provides reasonable survival. 27 Ethmoid/Sphenoid Sinus Fibrous Dysplasia: Surgical Management STEVEN GABEL, MD, JAMES STANKIEWICZ, MD, and JAMES CHOW, MD, Maywood, III.
Objective: Symptomatic fibrous dysplasia is a rare lesion in the paranasal sinus. However, when presented with patients complaining of severe pain or visual change, surgical