Canadian journal of otolaryngology最新文献

This paper reviews the state of the art knowledge of laryngeal physiology and evaluates the parameters necessary for voice production following laryngeal surgery for cancer. Data from normal voice production as well as esophageal speech production are used to generate some relationships that must exist in order to produce sound. Included are the relationships between esophageal pressure, subglottal pressure and intraoral pressure, the mechanical constraints of a pseudolarynx, muscle activity during normal and esophageal speech and the role of the tongue, lips, and palate in esophageal speech. Consideration is given to early and current reed-fistula and air bypass surgical procedures. Alternatives to current experimental and commonly used rehabilitation procedures will also be considered. The limiting factors for use of such devices and some requirements for their operation will be considered. Consideration will also be given to the manner in which various kinds of speech can be compared for acceptability and intelligibility.

Possible objectives to be served by a multiple source cancer data acquistion program and some limitations associated therewith are presented. Alternative approaches to on-going cancer data collection from multiple sources are briefly considered. Basic requirements of a cancer record keeping and end-results reporting system, and standard defintions, procedures, and rules relating thereto are indicated. Points which may be useful in reaching a decision on an on-going international collaborative data collection arrangement are noted.

Bleomycin has been shown to have a significant effect on squamous cell carcinomas, particularly on highly differentiated types. Applying combined bleomycin and x-rays simultaneously in an intermittent schedule, a synergistic effect was obtained. It was possible to lower the dosage of each and still achieve remarkable therapeutic responses. At the same time the side effects were reduced. The total dosages have been bleomycin 180 mg and x-rays 4.200 r skin dose, tumor dose approximately 2.500 r. Eighty-two laryngeal cases received such treatment. Altogether a complete regression was achieved in 62 per cent. Glottic tumors showed complete regression in 85 per cent. In six out of 10 inoperable cases, the tumor became surgically accessible by laryngectomy. In successfully treated patients characteristic histological changes were found, consisting in unusually large amounts of fully keratinized cells.

The system of tumor grading of Jakobsson et al was applied in a study of the malignancy grade of biopsy tissue compared with the grade of the corresponding tissue obtained at definitive surgery. The results suggest that at biopsy tumors are rated lower grade than they exhibit in the final tumor tissue. Some observations are made on the application of this system of point rating multiple features to determine histologic grade.

Two hundred and thirty patients with glottic carcinomas of the larynx treated at the Radiumhemmet from 1956 to 1966 by radiotherapy and followed for at least five years were investigated. Histologic grading of malignancy was made in each case by the registration of eight morphologic criteria, four representing the tumor cell population itself (structure, differentiation, nuclear polymorphism, and mitoses) and four representing the tumor host relationship (mode of invasion, stage of invasion, vascular invasion, and cellular response). There parameters were graded on the bases of a one to four point system according to arbitrary units. Multivariate analysis of the material revealed that the most important factors in the prediction of the five year result were found to be the nuclear polymorphism, mode of invasion, and total malignancy point value. The histologic grading of malignancy in this series was found to be better in the prediction of the five year result, recurrence or not, than the TNM classification.

A microlaryngoscopic photographic technique is described similar to that technique advocated by Kleinsasser. This technique is an uncomplicated routine method, which can be adopted by anyone using the Zeiss surgical microscope. With a relaxed, intubated patient, alignment of the optical axis of the microscope with the central axis of the laryngoscope, and with careful focusing, using the over-changed (9.5 A, 7.6 V) 6 V 50 W bulb, shutter at 22, magnification of 16 or 25, and with 1/4 second exposure time, and the Kodak Ektachrome HS film (125 ASA), the result should be satisfactory.

Dr. J. G. Stewart of the Christie Hospital and Holt Radium Institute in Manchester gave an anecdotal account of two methods which were previously used to radiate laryngeal carcinomata and neck nodes. Both techniques have been superseded by newer irradiation techniques, but in view of their considerable success and historical interest, they are included here. The first paper concerns the radium collar which was used for the treatment of late cases of laryngeal carcinoma, and in particular for cases with neck nodes. The second is a brief account of the Finzi Harmer radium needle implant technique, which was at one time widely used.