What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

How is a bone marrow aspiration done?

What is maintenance therapy?

It is an effort to keep the patient in remission, prevent the reappearance ofleukemic cells, and maintain a normal bone marrow and blood picture.

How is a bone marrow aspiration done?

The bone marrow test may be done on the breastbone or hipbone. The breastbone test is done with the patient lying on his or her back. The patient usually lies on the stomach when it is done on the hipbone. The area is numbed and a tiny opening is made in the skin. The doctor will use a special two part needle made up of a hollow tube with another solid tube fitted into it. When this has been inserted into the bone marrow, the solid tube is removed and an empty suction tube is attached to the opening ofthe needle. The doctor will pull some of the marrow out by pulling back on the plunger. You are likely to feel pressure, but it will hurt for just a few seconds. If the first attempt is not successful, the doctor will repeat the process. Sometimes it is difficult to obtain a bone marrow specimen and the doctor will try again. Sometimes when aspiration will not give adequate information, a bone marrow biopsy may be needed.

What is involved in a bone marrow biopsy?

A similar type of needle is used as for the bone marrow aspiration. The hollow needle is pressed farther into the bone so that it can pick up a piece of whole marrow and take it out so that a biopsy can be performed. Bone marrow biopsies are usually taken from the hipbone.

How long does it take to do a bone marrow test?

The whole procedure only takes 5 or 10 minutes, and complications are rare. You will be able to feel the needle, but the pain is minimal.

What is a bone marrow trephine?

This is a less commonly used procedure than the bone marrow aspiration or biopsy and involves taking a tiny piece of whole bone for examination. A larger needle than that used for an ordinary bone marrow test is usually used for this purpose.

When the doctor does my bone marrow test, he refers to spicules. What does that mean?

Spicules are bits of bone marrow with fat in them, which give a representative sample of marrow cells. Without spicules, it is impossible to make an accurate diagnosis of the bone marrow cells.

Does leukemia change the bones?

No. It does not change the shape or strength of the bones, but it does interfere with the work of the bone marrow. The red blood cells, along with the platelets and certain of the white blood cells, are formed primarily in the bone marrow and are then released into the bloodstream as they become mature.

The doctor talks about "blast" or "leukemic" cells. What does he mean?

Blasts or leukemic cells are immature white blood cells.

What complications are most common in leukemia patients?

Anemia (low red cell count), thrombocytopenia (low platelet count), and infections are complications of the illness. You may have none, any, or all of these in your course of treatment but it is important to be aware of them and report them to your doctor as soon as they occur. Your doctor will also be checking for bone pain, kidney problems, gonadal involvement, and central nervous system involvement.

Is it unusual for leukemia patients to stop passing urine?

If you have trouble passing urine, be sure to let your doctor know. When cells are dividing often or when the treatments are causing them to die in large numbers, it is more difficult for your body to dispose of wastes. The doctor will usually ask you to drink lots of fluid and to take pills if you have this problem.

What is plateletpheresis?

This is a process which makes it possible to get large numbers of platelets for transfusion by use of a continuous flow centrifuge which removes platelets from the whole blood and returns red blood cells to the donor in a single operation. This technique permits donors to give platelets as often as twice in a single week for periods up to 3 months. Formerly, the limit was once in 6 to 8 weeks. Since transfusions of blood platelets are often effective in preventing or stopping hemorrhage, this advance is an important one for leukemia patients. Plateletpheresis enables a single adult donor to provide the major portion of the platelets required by a patient with leukemia.

Bone Marrow Biopsy & Aspiration


Can this method be used for other types of blood cells?

Granulocytes can also be obtained by using a continuousflow centrifuge. Leukopheresis is the donation of white blood cells through the same process.

How is leukopheresis used in leukemia patients?

Leukopheresis is a procedure in which the blood is withdrawn from the patient, about a pint at a time, and run through a sterile centrifuge. The centrifuge separates the blood into its component parts and can allow for the removal of a large percentage of life threatening white blood cells. The process can be done at the patient's bedside, takes a few hours, and can be repeated daily until the blood cell level falls to a point where the patient is out of immediate danger.

What is the role of transfusions in treating leukemia?

Often different types of blood transfusions are used during treatment (particularly with patients who have AML) to help prevent infections and hemorrhaging. White blood cells, red blood cells, and platelets can all be transfused. It has been found, for example, that patients who are given transfusions of leukocytes and platelets early in their treatment may have fewer infections and less hemorrhaging. Since patients can become resistant to platelets from persons of different platelet types, platelets can be closely matched, if necessary, to the patient's own platelets through the same tissue typing methods that are used in kidney and heart transplants.


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