Canadian journal of otolaryngology最新文献

Four patients with severe thermal burns showed Gentamicin cochlear toxicity. The hearing loss ranged from moderate to severe and was progressive in the three patients that were followed. These side effects were seen even with only topical application of Gentamicin to large surface burns of the body. All patients had an associated loss of bestibular function. None of the patients during treatment with Gentamicin was in renal failure. These finding are discussed in the light of current knowledge of Gentamicin toxicity, blood levels, and absorption from surface burns of the body.

The anterior commissure may be a line or an area with the same vertical extension as the vocal cords anteriorly. If it is an area it may laterally be bounded by the "maculae flavae". The subglottic region includes the under surface of the vocal cords corresponding to the mucosa covering the conus elasticus and the mucosa inferiorly to the lower border of the cricoid cartilage. Serial sectioning has proved that the weak spot of the laryngeal framework is the anterior midline as far as early tumor invasion of cartilage and extension of tumor outside the larynx through the cricothyroid membrane is concerned. Despite many unfavorable anatomico-pathological points at this site, radiotherapy gives at least as good results as those reported with conservative (voice conservation) surgery. Primary subglottic carcinomas are rare. In a series of 110 serially sectioned laryngectomy specimens only four were classified as subglottic. These tumors possess specific characteristics: an extensive circumferential growth, cartilage invasion, and spread outside the larynx through the cricothyroid membrane, to trachea or to the hypopharynx. Twenty-four tumors were classified as glottic-subglottic. Three of these invaded the thyroid cartilage and seven spread outside the larynx through the cricothyroid membrane. Vocal cord fixation occurred in all four subglottic and in six of the glottic-subglottic tumors. The thyroarytenoid muscle was most freqeuntly invaded. Thyroid gland invasion did not occur in any of the subglottic tumors. A metastatic focus of tumor was observed in one lobe of the thyroid in the glottic-subglottic group. Two neck dissections were performed in the subglottic group and one of these contained a metastatic carcinoma. Eleven neck dissections were performed in the glottic-subglottic group and three contained metastatic tumor.

The changes seen by light and electron microscopy in the differentiation of squamous carcinoma are described. The grading of the differentiation of squamous carcinomas by overall impression and by quantitative methods are discussed. Reasons are given for retaining the former in the assessment of prognosis. Other differentiating phenomena, particularly retention of basement membrane in the formation of rounded rather than jagged growing edges, are discussed. The differentiating effect of radiation on squamous carcinomas is discussed as a means of assessing the efficacy of the radiation. A similar differentiating effect of bleomycin, a cytotoxic drug, on human squamous carcinoma is described. Using electron microscopical criteria belomycin also increases differentiation of a transplanted, experimental, poorly differentiated squamous carcinoma and human laryngeal carcinoma cells in tissue culture. The significance and possible practical utilization of this phenomenon are discussed.

Nine patients with primary adenocarcinoma of the larynx representing 0.1 per cent of 888 patients with primary laryngeal malignancy treated between 1955 and 1971 are reported. Following surgical therapy, four patients are alive without disease and five patients are dead due to their disease. Survival time was not related to histopathologic type, stage of disease, or mode of therapy. We cautiously advocate the use of the most conservative surgery feasible as the primary treatment of this poorly understood and highly fatal disease.

The incidence of vallecular cysts is low. They deserve full awareness of their existence because clinically they may produce upper airway obstruction. The case of a 20 month old infant in whom the large vallecular cyst was incidentally found on a routine examination is presented with a review of the literature.

Twenty-one cases of laryngeal tuberculosis were found while surveying 1,383 patients with pulmonary tuberculosis, giving an incidence of 1.5 per cent. All had abnormal chest films and tubercle bacilli in their sputum. Symptoms were variable. Patients with pain were relieved within seven days of triple therapy. All but one patient's laryngeal appearance was normal after two months' therapy.

Of the 6,067 malignant laryngeal tumors treated at the Ear, Nose and Throat Clinical Hospitals in Yugoslavia, a total of 20 were sarcoma. Eighteen of these patients were men. The most frequent forms were chondrosarcoma and fusocellular sarcoma - four cases of each. A survival rate of more than five years was seen in only four patients (one fibrosarcoma, two lymphosarcomas, and one chondrosarcoma).