Arthur G. James

Needle aspiration biopsy of major salivary gland tumors: Its value

Three hundred forty‐one needle aspiration biopsies (NAB) of major salivary gland tumors were performed over a 32‐year period. Eighty percent of tumors were benign, and 20% were malignant. Preoperative NAB findings were compared with pathologic diagnosis of the surgically resected specimen in all cases. Forty‐six of 63 aspirates from malignant tumors were correctly diagnosed by NAB, establishing a sensitivity at 73%. Two hundred forty‐nine of 265 aspirates from benign tumors were correctly diagnosed by NAB, establishing a specificity at 94%. Overall accuracy was 90%. Diagnostic error or difficulty in clinically localizing the tumor to the salivary gland was encountered in 64 patients with parotid tumors and 12 patients with submandibular tumors. NAB correctly localized over 85% of these tumors to the salivary gland, thus enabling both immediate and correct decision‐making concerning subsequent management to be undertaken.

Surgical management of papillary and follicular carcinoma of the thyroid.

The clinical outcome in 155 patients with papillary or follicular carcinoma of the thyroid gland operated on over a 25-year period demonstrated no difference in survival rates or incidence of recurrent tumor between those treated by total thyroidectomy and those undergoing less than total thyroidectomy. However, the complication rate was statistically significantly higher in those undergoing total thyroidectomy. Partial thyroidectomy with lobectomy on the side of the tumor, resection of the thyroid isthmus, and simple excision of enlarged cervical lymph nodes, if present, appears to be equally effective and safer.

Clinical and pathologic correlations in disease metastatic to the thyroid gland

Findings in our series of patients and a review of the literature seem to suggest that metastatic cancer to the thyroid is much more common that is clinically evident. The clinical presentation of an asymptomatic mass, normal thyroid functions, and a cold nodule on thyroid scan can occur months to years after treatment of a primary cancer and thus often produces a clinical dilemma. Workup should include ruling out other metastatic cancer and fine-needle aspiration of the thyroid mass. If isolated metastatic cancer to the thyroid is found, surgical resection should be performed, usually by lobectomy and isthmusectomy. Unfortunately, the prognosis is poor, but surgery often prolongs the disease-free interval and occasionally will be curative.

A method for intraoperative identification of the recurrent laryngeal nerve

Thyroid and parathyroid surgery is associated with a 1 to 6 percent incidence of injury to the recurrent laryngeal nerve. Electrical stimulation of the recurrent laryngeal nerve produces vocal cord motion that can be monitored by means of a double-cuffed endotracheal tube. Twelve patients underwent prospective evaluation with this monitoring system, and in all 12, the recurrent laryngeal nerve was accurately identified and localized. The nerve could be stimulated from a mean distance of 1.7 cm by a mean amperage of 1.3 mA. Postoperative indirect laryngoscopy demonstrated normal vocal cord function in all patients.

The use of cautery in “bloodless” radical mastectomy

Several different forms of operative procedures for carcinoma of the breast have been advocated, but radical mastectomy remains the one most often recommended. Blood loss during this procedure is frequently high, often necessitating transfusion. Unfortunately, complications of the latter have been significant and justifiably have continued to receive attention in literature. In this study, blood loss and wound healing, with and without the use of electrocautery, in radical mastectomy were evaluated from both clinical and laboratory studies. Fifty patients who underwent radical mastectomy were studied for blood loss, transfusions received, and wound healing. Technique was identical except that one half of the patients had thin skin flap elevation via electrocautery rather than by sharp dissection. The average blood replacement was 160 ml per patient when cautery was used vs. 960 ml per patient when cautery was not used. The postoperative hemoglobin and hematocrit values were statistically similar for both groups. Wound healing was not affected. In addition, a laboratory study, utilizing skin incisions in dogs using scalpel and cautery, was performed. No appreciable difference in healing was noted either on gross or microscopic inspection. The use of electrocautery, therefore, for skin flap elevation during radical mastectomy is recommended.

Growth of pulmonary metastases of B16 melanoma in mast cell-free mice☆☆☆

The relationship of mast cells to tumor growth has been debated but not elucidated. The existence of a mast cell-free animal, the W/Wv mouse, provides a model in which tumor metastasis can be studied with special reference to host tissues and their mast cell content rather than to the adhesiveness of the tumor cell itself. Both hind footpads of 30 W/Wv mice and 30 control mice (+/+) were injected with 2 X 10(5) cells of B16-F10 melanoma cells. The left paw received 1000 rads orthovoltage radiation 12 hr before tumor inoculation. Growth of tumors in both paws was recorded. Ten animals from each group were killed on Day 31 after tumor inoculation, and the remaining animals were kept until they died. Autopsy was performed in all animals, and patterns of metastasis were recorded. Results showed that (1) preinoculation radiation significantly slowed tumor growth in the left paw (P = 0.0009), and (2) lung metastases were present in 4 of 10 W/Wv mice, but in none of 10 +/+ mice killed after 31 days (P = 0.05). Overall, 17 of 25 W/Wv mice and 8 of 26 +/+ mice had lung metastases (P = 0.008).

The significance of the internal mammary lymph nodes in medially located breast cancer

The efficacy of adjuvant radiotherapy for medial breast cancers in Stage I or II disease was studied with a retrospective clinical analysis. All cases of breast cancer free of axillary node metastases at the time of standard or modified radical mastectomy were included. These were grouped by location and size of the primary tumor. There were 76 medial lesions, including those in the 6:00 or 12:00 axis. Seventeen of these had received postoperative radiation. Lateral tumors included 59. The size was based on the largest linear dimension and grouped ⩽2 cm or > 2 cm. At the time of initial recurrence, all areas of metastases were determined. The data suggests that: (1) medial breast cancers have a greater rate of recurrence than lateral ones; (2) adjuvant radiation for medial lesions decreases that recurrence rate to the range of lateral tumors; (3) large lesions may have a greater chance for local recurrence as well as medial lesions of all sizes; and (4) the potential problems with local recurrence may be diminished with adequate radiotherapy as an adjunctive measure. When recurrence does occur, prior radiotherapy seems to delay the appearance of that recurrence.

Improved birth weight for black infants: Outcomes of a healthy start program

OBJECTIVES We determined whether participation in Healthy Babies Healthy Start (HBHS), a maternal health program emphasizing racial equity and delivering services through case management home visitation, was associated with improved birth outcomes for Black women relative to White women. METHODS We used a matched-comparison posttest-only design in which we selected the comparison group using propensity score matching. Study data were generated through secondary analysis of Michigan state- and Kalamazoo County-level birth certificate records for 2008 to 2010. We completed statistical analyses, stratified by race, using a repeated-measures generalized linear model. RESULTS Despite their smoking rate being double that of their matched counterparts, Black HBHS participants delivered higher birth-weight infants than did Black nonparticipants (P = .05). White HBHS participants had significantly more prenatal care than did White nonparticipants, but they had similar birth outcomes (P = .7 for birth weight; P = .55 for gestation). CONCLUSIONS HBHS participation is associated with increased birth weights among Black women but not among White women, suggesting differential program gains for Black women.

Cancer of the scalp

Abstract A discussion of the treatment of cancer of the scalp is presented. Three cases illustrating varying degrees of involvement are presented along with the treatment carried out in each case.

Relationship of tumor grade, stage and host response in a group of breast neoplasms

Two hundred thirty‐nine breast carcinomas were reviewed, and the interrelationship of stage, grade, host response (sinus histiocytosis), bilaterality, and survival was studied. A peculiar pleomorphic grade with infrequent axillary involvement but considerable bilateral involvement was noted. The stage of the disease was the single most important factor; 54% of those operated on for cure (radical mastectomy) survived 5 or more years.