John E. Woods

Experience with 1,360 primary parotid tumors.

Experience with 1,360 primary parotid tumors seen at the Mayo Clinic during two fifteen year periods, 1940 through 1954 and 1955 through 1969, is reviewed. A comparison of histopathologic classification, type of treatment indicated, recurrence rates, and survival in the two periods reveals considerably greater understanding of all factors in the later fifteen year period. The relatively high mortality still encountered among patients with high grade malignant tumors of the parotid glands indicate the nature of the challenge still to be met. Based on the data in this study, it is our opinion that superficial or total conservative parotidectomy is best employed primarily for benign tumors and that the shift to more radical operative procedures should continue in the management of malignant tumors, especially those that are less well differentiated. For experienced surgeons, exceptions might be the small superficially located tumors or the tumors in the lower pole of the gland such as Warthins tumors. Local excision with removal of a margin of parotid parenchyma might be justifiable in such cases.

Regional lymph node management and outcome in 100 patients with head and neck melanoma

One hundred patients with invasive melanoma of the head and neck were treated by one surgeon from 1970 to 1978. Lymph node dissections were performed in 77 patients for palpable adenopathy, local recurrence, or tumor thickness greater than 0.75 mm when measured by micrometry. No patient whose lesion was less than 1.0 mm thick had a local recurrence or died as a result of melanoma. Patients who underwent elective lymph node dissection with findings of up to two positive nodes had a 53 to 56 percent 5 year survival rate, while those with three or more nodes had a poor prognosis (15 percent 5 year survival rate). The patterns of recurrence showed that relapse after nodal dissection usually presented with systemic metastases. The data support a therapeutic scheme based on 2 to 5 cm wide excision alone for lesions less than 0.75 mm in thickness and elective nodal dissection for specific indications.

Parotoidectomy: points of technique for brief and safe operation.

Abstract Parotidectomy is, in the experience of some surgeons, a very long and cumbersome procedure. If followed in detail, the technique that has been presented makes it possible to perform the procedure safely and in a relatively short period of time.

Plasma cell lymphoma after renal transplantation

Abstract An unusual type of malignant lesion, a plasma cell lymphoma, developed in a patient who had had a renal transplant. In this case there were two possible predisposing factors to the development of malignancy: (1) the use of immunosuppressive agents, and (2) the presence of viral infection. The presence of antigenic stimulation may have been an additional factor.

Factors influencing quality of renal function in dog kidneys implanted after twenty-four hour preservation

Abstract Data from this study indicate that ischemia, rapid nephrectomy with harvesting of the kidney in the non-diuretic phase, and failure to hydrate either the donor or the recipient are deleterious to renal function and survival in the continuously perfused kidney reimplanted after twenty-four hours of preservation. The suggested mechanism of injury is vasoconstriction.

Radiation therapy for malignant melanoma of the head and neck

Thirty-one patients with melanoma of the head and neck received split-course radiation therapy (5,000 to 6,000 rads/30 fractions) for loco-regional disease. There was no difference in survival in patients with gross tumors versus patients with no clinical evidence of disease at the start of radiation therapy. The prognosis was notably worse in patients with recurrence in the irradiated field.

The challenge of large facial hamartomas and other benign conditions of the head and neck

Large facial hamartomas (including large hemangiomas or arteriovenous malformations, lymphangiomas, and neurofibromas) may constitute a formidable therapeutic challenge, as may other large and deforming nonmalignant conditions of the head and neck. This report deals with 10 such cases selected from the authors’ experience to illustrate the varied and flexible approaches required. These included five instances of either a large hemangioma or arteriovenous malformation; invasive lymphangioma of the face in two children; and unusually advanced fibrous dysplasia, a highly vascular plexiform neuroma, and an extensive desmoid tumor of the neck. The degree of success in treatment varied considerably from patient to patient, although some improvement was achieved in all.

The value of lactic dehydrogenase as a predictor of early allograft survival.

Levels of serum lactic dehydrogenase (LDH) were determined in renal transplant recipients to assess their value as consistent predictors of acute allograft rejection. Although serum LDH levels of more than 250 U/l were in most cases associated with irreversible graft rejection, they were unreliable as a predictor or as an early indication of allograft rejection. Their chief value appears to be as an aid in determining when to discontinue high dose immunosuppression in an attempt to save an allograft that is most probably doomed to ultimate failure.

Experience with elective surgery in renal allograft recipients

Abstract Twenty-one of 180 patients who had received renal allografts during a nine and a half year period underwent twenty-four elective procedures twenty-four hours to five years after transplantation. All survived operation, but two patients died within the postoperative period of conditions that existed before surgery. Two additional patients died of unrelated causes three and ten months after surgery. The remaining seventeen patients are alive and well and have satisfactory to excellent renal function, with the exception of one patient who is on maintenance hemodialysis after transplant nephrectomy for oxalosis. Data indicate that elective surgery can be undertaken with reasonable risk in renal allograft recipients.

Surgical technic in en bloc bilateral cadaveric nephrectomy for transplantation.

En bloc bilateral cadaveric nephrectomy for transplantation has some advantages over excision of each kidney separately. There is also an advantage of single cannula perfusion through the aorta for two kidneys, especially when multiple renal arteries are present. The anatomic vascular variants are important, as are the incision and the approach to the suprarenal aorta and the lumbar venous drainage of the kidney.