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.

Pulmonary Infectious Diseases Questions and Answers

The microscopic world of bacteria, viruses, and other microorganisms that invade our systems causing lung disease, pneumonia, and a variety of attacks on the respiratory system keeps the pulmonary specialist busy. Various therapies and drugs now being used and those still being studied give hope to people who suffer persistent and severe viral infections and diseases of the lungs.

Dr. S.N White discusses the viral agents that make us all vulnerable to a variety of infections.

Q. Is pneumonia an irresistible illness? 

A. Pneumonia is an irritation of the lung and all the time is brought about by disease, yet it might be the consequence of different operators, for example, drugs. Most pneumonias are brought about by irresistible operators. The term pneumonia, be that as it may, just alludes to aggravation of the lung; it doesn't disclose to you the reason. In many examples, however, it's a particular contamination. 

Q. Is it a viral contamination? 

A. For the most part, it's a bacterial disease, less generally an infection. It could be a contagious or parasitic contamination, and in certain occurrences pneumonias can happen from tranquilize treatment. 

Q. For what reason do drugs have that impact? 

A. Here and there medications may prompt an unfavorably susceptible response in the lungs that outcomes in pneumonia. What's more, there are different occasions in which a pneumonia happens with chemotherapy. The reason isn't clear, however they're identified with the utilization of medications. 

Q. Older individuals appear to have a high frequency of pneumonia. Why would that be? 

A. To a great extent, in more established patients, that is on the grounds that they have basic heart and lung malady and are progressively inclined to suction, which is to have particles from the throat go through the trachea into the aviation routes instead of down into the throat. These particles are not cleared appropriately due to the languid instruments for hacking, and they are bound to contain microbes, which would then be able to cause pneumonia. That generally happens in a setting with somebody who has coronary illness and clog of the lungs. That is the most regular setting of a more established individual incapable to hack, as a rule when lying in bed. 

Q. Are the pneumonias of little youngsters and the pneumonias of more seasoned individuals a similar kind or of a similar character? 

A. The pneumonia of youngsters is bound to be obtained from a viral disease or from life forms that are like or in the middle of infections and microbes called mycoplasma. Typically, more seasoned individuals get bacterial pneumonias, for example, that from the Pneumococcus, a typical respiratory bacterium. 

Q. Is pneumonia an inescapable hazard factor for a more seasoned individual who is encountering an activity? 

A. Those are two separate inquiries. In the event that one is worked on, regularly it prompts a lot of bed rest, lying on one's back; frequently stomach methodology are done and the stomach doesn't move appropriately. This makes an inclination for the lungs to crumple. When they breakdown, in the event that they become defiled with microscopic organisms, at that point those microorganisms will in general develop and produce a pneumonia. With a more established individual, the issue again is that they will in general be fundamentally in bed, not to clear their lungs, and to suction. This causes particles from the pharynx containing microbes to go down through the trachea into the lungs a procedure alluded to as yearning. 

Q. Is there a relationship among pneumonic and irresistible sicknesses, or are these different things? 

A. Pneumonic is a claim to fame dependent on the organ known as the lungs. Irresistible maladies allude to the reason, to the irresistible operators that can taint any organ in the body. It is a forte wherein the doctor is equipped to a causation, though the strength of pneumonic infection is in managing all illnesses of the lung from any reason.

Q. We've been speaking of the lungs and pulmonary problems. What about the arteries? Are the bedridden equally susceptible to pulmonary embolism, and exactly what is that? 
A. Pulmonary embolism means that an artery is obstructed. Most of the time, this is by a blood clot from another part of the body. There is an estimated 90 percent of pulmonary emboli that are thought to arise in the veins of the legs or pelvis. Now they can develop in conditions where there is poor blood flow and limited movement or action, such as the elderly confined to bed, and also with persons who have a disorder of the normal blood clotting ability. This can sometimes occur with women who are taking birth control pills. The clots that reach the lungs are usually small and do not cause problems. If the pulmonary embolism is of some magnitude, it can cause death. This takes place very infrequently.

Q. What are the symptoms of pulmonary embolism? 
A. Common symptoms are coughs with resultant bloody sputum (hemoptysis), rapid heartbeat, breathlessness, and pleuritic chest pain. These symptoms have to be skillfully interpreted in order to be accurate in determining true embolism.

Q. Is there a difference between mucus and cough sputum? 
A. No. There is a difference between saliva and mucus. Mucus is thicker than saliva. Sputum is of great importance in the diagnosis of many pulmonary diseases, and when it is cultured and examined under a microscope, it is possible to detect the presence of any infecting microorganisms.

Q. There are constant reminders and persuasive messages for people to stop smoking. In that connection, a report was published that said just giving up smoking, ignoring diet and exercise, would elevate the mortality factor by a large percentage. What is your view on this? 
A. Smoking certainly is an important cause of lung cancer. There are 50,000 or more cases of lung cancer a year. In addition, smoking seems to play an important role in coronary heart disease and probably plays an important role in gastrointestinal problems such as peptic ulcers. It's a habit that influences a number or organ systems. And I think it's very true that the cessation of smoking is probably the single most important health measure a person can take.

Q. Is singing in any way a good health promoter or lung protector? Does it benefit us in any way other than for musical expression? 
A. I'm not aware of any study that establishes it as a protective effect. There's a normal mechanism by which we sigh intermittently to open up our lungs to prevent collapse. In fact, patients who are on ventilators in a hospital setting are programmed to have deeper breath intake periodically to prevent collapse of the lungs. Under ordinary circumstances, we do it naturally. I don't know of any evidence that singing per se improves on the sighing that we do normally as far as expanding lungs.

Q. How would you identify something called kuru, "the dance of death/' and what would the modern reference be? I understand that it's a virus that lurks in the body for years and then erupts as a kind of degenerative disease somewhere along the continuum of life. 
A. Kuru is a viral illness that was studied extensively by a physician who ultimately won the Nobel Prize, Dr. Michael Smith. Fundamentally, it was discovered that in a cannibal civilization in the Pacific, the disease was transferred through the tribal pattern in which the brains of the deceased were eaten by other tribe members. That allowed a virus to be transferred from the infected brain. It's not that the virus waits in the body; it takes five to ten years for the disease to become manifest. The virus in that circumstance doesn't cause an inflammation; it causes degeneration. It's a very unusual response to a viral disease. Instead of the ordinary inflammation, as we see in pneumonia, where a lot of other cells come in, in this instance the virus is able to infect the brain cells and cause them to degenerate by making them lose their normal covering so that the cells die.

Q. The immune system is not able to ward off the attack? 
A. There doesn't seem to be an immune response, so in some way the body doesn't recognize the virus as foreign, as it would recognize a foreign bacterium or other kind of virus. There are several viruses within this group that are caHed persistent viruses. It's from those examples, including kuru, that we speculate that other chronic diseases may be caused by similar viral agents, although none has been identified among the common chronic diseases such as asthma, bronchitis, and emphysema.

Q. Is that the same way we get lesser diseases? In other words, when we get the flu, a cold, or any number of minor infections, do we get it through a kuru type of virus that lurks in our system? 
A. No, we just acquire the virus from another host. In our society, it would be other human beings. We transfer the virus. Most of the respiratory viruses would be transferred by droplets in the air from one person to another.

Q. I read that kuru at some point was transmitted in epidemic proportions. Is this so? 
A. No. There are some suggestions that you can transfer these viral agents in corneal transplants, but not kuru because kuru requires cannibalism to transfer. However, there are other long acting, viral induced diseases that can be transferred by passage of nervous tissue. One example of that was a rare case of what seemed to be virus transmission by using the cornea of the eye, which represents nervous tissue that is projected outside the skull. But that's very rare. At the present time, the diseases related to persistent virus infections are very small in number. Again, there is the theoretical possibility that such viruses could be causally involved in chronic diseases that are unexplained at the present time.

Q. Is there some way we can be diagnosed well in advance to track down a hiding virus? 
A. The persistent viruses are rare. There are no known persistent viruses in the respiratory tract. The major persistent viruses that we deal with are the herpes group. This group of viruses stays in the nervous system all one's life. The herpes simplex virus, which one can get around the mouth and is called fever blisters, is now recognized as a common problem in the genital region. The herpes virus, once one acquires it, resides in the nervous tissue and intermittently come out, infects the skin or mucous membranes, and causes the clinical blisters. There are other virus infections that stay within the body, but by and large they don't cause clinical disease chemically. The herpes viruses are the most important ones that we recognize as staying within the body for long periods causing intermittent symptoms.

Q. The virus is a live organism running around? 
A. It is an incomplete organism because it cannot survive by itself. It can only survive when it takes control of the cells of the body and leads them to proliferate the virus. In other words, the virus has to instruct the cell to make more of the virus. The virus cannot duplicate itself independent of a cell.

Q. What components make up a virus? 
A. The virus is made up of chemical components, but the only way it can manufacture itself is to go into a cell and instruct the cell to make more of the virus. Then the new virus breaks out of the cell.

Q. Can we program it not to do that by counterinstructions? 
A. Yes, there are actual therapies that can do that interferon, for example. Interferon is a substance produced by the body which helps to terminate viral infections and is now being used to treat viral infections. Most viruses spread by getting into another cell and instructing that cell to make viruses. Interferon is a body mechanism for accomplishing that termination, and clinical studies are in process to try to use these chemicals therapeutically. The major problem with their use is limited supply. It's produced in very small amounts in the natural setting.

Q. Studies are also being conducted whereby individuals arc able to trigger the release of interferon by mental processes. Is that promising? 
A. I think that is a reasonable possibility. The placebo response is one by which a person responds to a blind treatment because of his or her desire to respond and the physician's reinforcement of that. That may be caused by the release in the brain of morphinelike products that are normally present. This release can relieve pain that the person might otherwise experience if he or she were not undergoing the placebo response.

Q. Are the viruses made up of DNA or RNA? 
A. Viruses are made up of either DNA or RNA. The herpes viruses are DNA viruses. There are others, and the viruses that cause respiratory infections and influenza are the RNA viruses. These are nucleic acids. What these viruses do is penetrate into a cell and then instruct the cell to make more of the DNA or RNA from which the virus is packaged.

Q. Do tumors and cancers form form this type of cellular activity or growth? 
A. There are animal models in which viruses can induce tumors. There is very little evidence that most human tumors are caused by specific viruses. At least that's still unclear. What is clear is that viruses can induce tumor experimentally.

Q. I was 43 when I had my first child, and now she is six. I was given a tuberculosis test, and after a week it had swollen to about the size of a 50 cent piece. The doctor said it was a normal thing for my age. Is that a fact? 
A. The tuberculin skin test reflects a normal response to having had an infection with the tuberculosis bacterium. Most patients who've had tuberculosis recover on their own and have a residual positive skin test. In itself, in the absence of any clinical disease, it would just reflect the earlier tuberculosis infection.

Q. I've never had tuberculosis. He just referred to my age. What does it mean? A. It means that you probably did have tuberculosis, but it was not an infection that led to clinical symptoms. It probably left a small scar on your lung, which may or may not be visible on chest X rays at the present time. It's of no concern. and Sunday, and we are the only ones in the living room, but is there any way that we can do this so my children will not be affected by the smoking? 
A. I think the best way to approach it would be to ask your husband to smoke less or in a more controlled fashion. If that's not possible, you could get an air cleaner that would help reduce the smoke particles in the air.

Q. I have a grandmother who has bronchitis, and my small daughter visits her and they drink tea and eat together. Is it possible that my daughter could catch anything from her? 
A. In most patients, chronic bronchitis that an older person might have would not contain transmissible agents that are likely to cause a disease in someone else.

Q. Of the three diseases mentioned asthma, bronchitis, and emphysema which is the most harmful? 
A. Pulmonary emphysema is the most incapacitating. Although the cause is really not known for emphysema, the condition results from destruction of the lung tissue. In this disease, the air sacs (alveoli) of the lungs become overdistended or inflated with trapped air. There is an association of bronchitis and emphysema with cigarette smoking, air pollution, and dust particles.

Lung Infection; Lung Abscess, Aspiration Syndromes, Systemic fungi



Q. What are the symptoms of emphysema? 
A. Shortness of breath is the primary symptom and then coughing, excess production of sputum, and wheezing.

Q. What is silicosis? 
A. It is caused by the silica that are in crystalline form tiny enough to stay in the bronchial tree. It is inhaled and is one of many dust diseases of the lungs.

Q. I always thought that viruses were produced by the body itself that they don't come from outside. Am I wrong? 
A. Well, they do come from the outside, but they require the cells of the body to be manufactured. If someone has influenza, when that person sneezes or coughs he or she will release a number of water droplets.Those droplets will contain the viral organism. The virus has been growing in the cells of the other human being, is in the droplet and when you inhale, that virus will then infect your cells and grow in you. When you cough, you will transmit the same droplets. Viruses are dependent on cells to grow. They're not produced by the body; they have to be acquired first, but they instruct the human body to make more of them. Some bacteria may survive in soil as well as in some water systems and then be dispersed. Because of that, they may cause infections even in hospitalized patients. It is true that a defective human host may be more likely to develop a clinical infection and become ill than an otherwise normal host. You have an interaction with an agent from the outside. At some point in time it has come from the outside, and the subsequent consideration involves the individual and the body, cells, and organs.

Q. Where does the first virus come from? 
A. We have to go back and try to understand the evolutionary development of multicellular organisms. For 1 billion years, we've gone from the evoluton of a single organism like a bacterium to a more complicated multicellular organism. Human beings developed last, not first. Bacteria, viruses, fungi, and the parasites are simpler organisms that were developed earlier. We came later; they were there first. We come along and allow them to proliferate. We provide, as do other animals, an interaction that allows them to survive. Without us, some viruses couldn't survive since they have lost the ability to infect other hosts in an extraordinary process of adaptation.

Q. My window is not very well sealed, and the wind blows pigeon droppings through from time to time. Is there any harm that can come from these droppings? 
A. Pigeon droppings are a concern because these tend to become a very good culture medium for a fungus called Cryptococcus. There is a real concern about being exposed to these droppings on any regular basis. There are two kinds of air filters that can help. One is electrostatic. This removes particles after they have been electrically charged. The problem with the electrostatic filters is that they give off ozone when they become dirty, and ozone itself is an irritant. Ozone is a form of oxygen that is irritating to the respiratory tract, and a person with heart or lung disease could react with clinical symptoms. The second kind of filter is called hepa filter. These are high efficiency mechanical air cleaners. They don't give off ozone. They are extremely efficient in removing very small particles. Their use is encouraged for cleaning air. In a single room, you would use a large unit. You have to realize, though, that for a single room unit to be effective, the doors and windows have to be closed and the unit must be a suitable size for the room.

Q. I read in an article that multiple sclerosis can come from a virus that could possibly be transmitted by a dog. Is that true, and does saturation with vitamin C act as a general antiviral factor? 
A. There have been suggestions that multiple sclerosis is caused by viral agents, but the evidence is not conclusive. It's been mainly based on blood tests that showed antibodies to viruses rather than the actual demonstration of viruses. At the present time, the cause of multiple sclerosis is really unknown. Large doses of vitamin C do have effects on the white cells of the body. In fact, vitamin C appears to be useful in treating some uncommon disorders of the white blood cells. The question of the use of vitamin C in an otherwise normal person to reduce the incidence of common colds is still open. There are studies that appear to support its clinical usefulness. At the present time, the side effects from vitamin C are small, so its use in moderate amounts is not going to be harmful to those patients who feel it may help. But I don't think the scientific evidence at the present time clearly shows a clinical effect.

Q. Some researchers claim that cancer is a virus. Is it possible, if it is a very slow acting virus, that it is in the real sense of the word contagious?
 A. There's some evidence that some cancers are contagious clinically. You have to judge contagion separately from causation. Since we don't know the cause, we have to look at the clincal transfer of cancer from one person to another. And there are some epidemics with some of the cancers that certainly suggest a community transfer of some kind. It's not clear that it's an infectious agent. It could be some other factor in common, such as exposure to a chemical. At the present time, we don't regard most cancers as transmissible from one human to another, but that view may change. It doesn't look like it's transferable at the time when the person has the cancer. If the transfer does occur, it would have to be an extremely slow process.

Q. What is your view of an anticancer drug called ARA-A that was used in Canada? Twenty four patients had been treated for dangerous viral infections with this drug, and all survived and almost fully recovered. Is that drug going to be used widely in the United States? 
A. I think it's important to realize that there have been very few drugs available for the treatment of viral infections. In fact, for most of the common respiratory virus infections, there is no specific treatment. That's why organized medicine, by and large, has discouraged the broad use of antibiotics. ARA-A (adine arabinoside) was a chemotherapy drug used for cancer that was shown to be effective against certain viruses. The principle use of ARA-A is against the herpes virus simplex, which is an important cause of infection in an abnormal host. It's also useful in newborns who develop herpes acquired from the mothers' genital tract as they pass through the birth canal. So it's also used in neonatal infections. It's only available in two forms: intravenously for a serious disease and in an ointment or drops for local therapy for herpes. Its major uses at the present time are intravenously for serious disease and as drops for herpes simplex infections in the eye. A more potent drug, Acyclovir, has been made available for intravenous and local use, but it has been waiting to be approved for local therapy.

Q. Do you agree with Dr. Michael Bar of the University of Alabama? He says Acyclovir may prove to be effective against a whole range of DNA viruses. 
A. Yes. There's a good chance that it also will be effective against viruses similar to herpes simplex, which are DNA viruses that infect cells.

Q. Is the ointment named LSO-1 effective for genital herpes? 
A. This is an experimental vdccine developed by a British medical researcher for genital herpes, and it utilizes lithium succinate, an ointment form of a drug for depression called lithium carbonate. It is not approved by the Food and Drug Administration for use in the United States.

Q. I had a bad cough and was unable to breathe. The doctor gave me a dose of cortisone. Why did that help me to feel better? 
A. Cortisone, like drugs, is effective for treating asthma or asthmatic bronchitis. The way it accomplishes that is still a matter of uncertainty. But we know clinically that this group of drugs has an effect usually about three hours after one has a dose, intravenously or orally, and that the peak effect occurs in six or eight hours depending on which cortisone preparation is used. These hormones are used clinically a great deal, but we try to avoid abusing them, because cortisone, like drugs, affects a variety of tissues in the body. We consider it a serious form of therapy. We utilize it either for acute situations or in patients on a chronic basis when it's required, usually when other forms of therapy are not adequate.

Q. My niece had a very serious case of herpes for the last ten days on her face, her mouth, inside her nose, and all of this with a high fever. Would vitamins or ARA-A help? 
A. Ordinarily ARA-A would not be used for that kind of herpes, but it would be used for more serious herpetic infections. Intravenous ARA-A is a drug with important side effects, so it is not to be used for a disease that would otherwise improve and get better.

Q. People have a habit of spitting on the streets. Can serious diseases be picked up by a passerby? 
A. Sputum or secretions from a person who has an infection could represent a danger. The recipient has to inhale droplets, but this usually requires close contact and exposure to secretions with large numbers of infectious organisms.

Q. Do animals suffer from viruses? 
A. That is a complex biological question. I think, as an overall generalization, that the symbiotic living together of organisms in nature is the common pattern.

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