Canadian journal of otolaryngology最新文献

An attempt has been made in this paper to suggest the role of ultra high speed motion photography in laryngeal research and to sketch the more important technical requirements of the equipment and procedures for its use. The latter included comments about a camera and its auxilliary equipment, illumination, recording, synchronizaiton of the patient whose larynx is to be photographed.

India is a developling country with its necessary priorities. Therefore the limited resources which are available cannot be spared for basic cancer research. The population is close to 600 million -- 80 per cent living in villages and receiving hardly any medical aid. This has provided extensive clinical material which can be beneficially utilized for research. The following plan is suggested under the existing circumstances: 1. Motivation of specialists towards head and neck problems. 2. Creation of regional specialists in cancer hospitals. 3. Advanced cases as objects for research. 4. A universal law regarding compulsory postmortem. 5. In a developing country like India with limited resources highly academic investigations should have low priority. 6. Refresher courses for general practitioners to educate them regarding early clinical manifestations of laryngeal cancer. 7. Training of postgraduates. A postgraduate should be first trained in one's own country, particularly in a developing country like India. He can then go for further experience to other international centres. 8. Communication by way of publication. The clinicians from developing countries should have easy opportunity to get their works published in English journals.

An air bypass voice prosthesis and the refinement of a surgical technique has been developed. It involves a one-stage, low retrograde cervical esophagostomy that is functionally and cosmetically feasible since it permits hidden use of the device and eliminates fistula tract stenosis; and the problem of aspiration is eliminated. Most importantly, it provides a natural speech mechanism without any training period. Patients can regain immediate speech following installation of a voice prosthesis with a minimum of maintenance required. Ultimately, they have demonstrated greater self-reliance and developed a high degree of self-esteem which has enabled them to resume a normal way of life.

Carcinoembryonic antigen (CEA) levels in plasma were determined serially during radiotherapy in 10 patients with glottic carcinoma of the larynx. There were moderate high levels initially in three patients, all of clinical stage T1. Elevation during irradiation was noted in seven patients at a tumor dose of around 4000 rad. At this does the tumors were no longer visible and it is possible that the raised CEA represents circulating breakdown products from them. As raised levels were not seen in all patients, it is less likely that irradiation of laryngeal tissue by itself raises CEA plasma levels. After treatment, CEA normalized to the initial levels.

An acceptable roentgenologic evaluation of the laryngeal status can only be made at present with the use of contrast medium. Further, a high potential technique should be used, combined, if possible, with a p.a. projection. Lesions of 1-2 mm size should be detectable with this technique. Xeroradiography is not at present superior to conventional roentgenography and involves an increased radiation hazard.

A retrospective study has been made of the role of intermediate (4500-5000 rads in five weeks) pre-operative radiotherapy in the treatment of advanced carcinoma of the larynx. The results of treatment in 72 cases treated at the University of Virginia have been analyzed with particular attention to local recurrences and complications. The local recurrence rate is comparable to that achieved with higher doses of pre-operative irradiation and the complication rate and the pre-operative level of radiation dose employed. Deaths from causes other than local recurrence indicate that a considerable number of patients die from a second primary or distant metastases even though the local disease has been controlled.