RESUMEN
OBJECTIVES: Supracentimetric cervical lymph node metastasis is classically a poor prognostic factor for locoregional recurrence and survival in head and neck cancer. Causality, however, is more controversial for infracentimetric cervical lymph node metastases. The objective of this study was to evaluate the incidence and prognostic value of infracentimetric lymph node metastasis. MATERIALS AND METHODS: Two hundred and forty-three neck dissections from 150 head and neck cancer patients were analyzed. A single pathologist exhaustively inventoried the number and size of all adenopathies in the surgical specimen. RESULTS: Cervical lymph node metastases were infracentimetric in 38% of cases, with 72% extracapsular spread (versus 91% for supracentimetric adenopathies; P<0.01). Infracentimetric metastases were more often associated with other cervical lymph node metastases (mean 5.3 versus 3.9; P=0.14). Fifty three percent of specimens showed only supracentimetric metastases (versus 13% infracentimetric metastases; P<0.01). Disease-specific and failure-free survival were lower in case of infracentimetric metastasis, associated with supracentimetric metastasis or not, than in case of macrometastasis only. CONCLUSION: Infracentimetric cervical lymph node metastasis is a factor of poor prognosis, and may represent a different, more aggressive lymphatic process. We suggest complete neck dissection by the surgeon and meticulous analysis by the pathologist, the results of which guide complementary therapy. Close surveillance of recurrence is also recommended.
Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Neoplasias de Cabeza y Cuello/mortalidad , Ganglios Linfáticos/patología , Metástasis Linfática , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Francia/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Disección del Cuello , PronósticoAsunto(s)
Esófago , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/terapia , Cateterismo , Esofagoscopía , HumanosRESUMEN
Communication and information technology are developing very rapidly at present. At the same time, the number of older drivers is increasing. When designing systems for elderly drivers, it has been shown that: (1) simplifying a task reduces performance differences between old and young; and (2) the optimization of onboard systems (better legibility and intelligibility of the information, simplified dialogue) in relation to the abilities of elderly drivers benefits the rest of the user population. Elderly people do not automatically reject new information and assistance technologies especially when the systems are user friendly. However, the ergonomics of these new technologies must be studied, with particular attention to the specific needs of the elderly, in order not to marginalize them