Schweizerische medizinische Wochenschrift. Supplementum最新文献

Partial inferior turbinectomy with security (PITS) was performed in 224 patients. In 206 cases (92%) surgery was bilateral and 76 patients (34%) had no other associated intervention. The follow-up period ranged in the whole group from 12 to 64 months (mean 31 months). In the group of 76 patients the follow-up period ranged from 12 to 55 months (mean 28 months). The nasal obstruction was significantly reduced in 204 cases (91% of all patients operated on). The group of 76 cases including 9 children underwent isolated bilateral turbinectomy with 90% successful results. The principal interest of this publication is a detailed description of this new personal technique for a safe, rapid, non-haemorrhagic and inexpensive method which can be easily performed even in children and also in one-day surgery.

Introduction: Early stage oral cavity carcinoma is curable in most cases. This study follows the course of early stage squamous cell carcinoma of the oral cavity after radical surgical resection, in order to assess the necessity of further treatment modalities.

Material and methods: In a prospective multicentric study, 110 patients with T1-T2 and N0-N1 (without capsular invasion) squamous cell carcinoma of the oral cavity were enrolled. All patients were treated exclusively by surgical resection with histopathologically proven negative margins.

Results: Among 96 patients (14 excluded because of positive margins), followed-up for 3 years, 18 presented a local or regional recurrence. In 12 of these 18 loco-regional control was reestablished by second treatment. Overall, the 4-year disease-specific survival probability was 94%. Patients treated initially by selective neck dissection had significantly lower recurrence rates than those without neck surgery.

Conclusion: Early (T1-2, N0-1) squamous cell carcinoma of the oral cavity is adequately treated by surgery alone. The surgical procedure should include margin-free resection of the primary combined with selective neck dissection. Systematic postoperative radiotherapy does not appear necessary. Neck dissection is advocated in N0 patients as well.

The concept of multiple squamous cell carcinoma in the region of the upper aerodigestive tract was first described over 100 years ago by Billroth. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumours and refine the role of panendoscopy in diagnosing them. The charts of 358 patients presenting for initial treatment of primary squamous cell carcinoma of the upper aerodigestive tract between January 1990 and December 1995 were reviewed. The incidence of second primary tumours was 16.2%, 6.4% being synchronous and 9.8% metachronous. In only 3.1% of all patients was a synchronous tumour clinically silent and only revealed by panendoscopy. Synchronous tumours were most likely to be located in the oral cavity, pharynx or larynx (61%), whereas metachronous second primary tumours were most likely to be located in the lung (57%). Though the incidence of synchronous second primary tumours revealed by routine panendoscopy is low (3%), we still recommend this investigation because it is often necessary for exact assessment of the first primary tumour. Further, it is ideal for training in the use of rigid endoscopy. In our opinion panendoscopy involves minimal time, cost and morbidity.

A retrospective analysis was conducted of all thyroid operations performed at the ENT department in St. Gallen, Switzerland, between 1995 and 1997. The complications and technique of this surgery are outlined. In 79 patients 111 thyroid lobe resections were performed. No injury occurred to the superior laryngeal nerve. One recurrent laryngeal nerve injury and one permanent hypocalcaemia were observed. No revision operations were required for haematoma or infection. The different steps in the operative procedure, such as skin incision, handling of the strap muscles and identification of the parathyroid gland and superior laryngeal nerve, as well as the monitoring of the recurrent laryngeal nerve, are discussed.

Various aspects of stapes surgery have been improved since its introduction in 1958 by Shea. However, fixation of the prosthesis on the long process of the incus remains difficult. Furthermore, the functional result of crimping cannot be predicted. Necrosis of the lenticular process still occurs. A new stapes prosthesis has been developed with the Kurz Co. The use of titanium allowed an innovative design: titanium has a shape memory, and a clip was constructed which uses this memory for fixation on the incus. Two new instruments were also developed to facilitate application of the prosthesis: a prosthesis inserter and a prosthesis crimper. The clip does not strangulate the incus; it is attached only to the superior and inferior surface of the incus, which are the crucial locations for mechanical transmission of the piston-like movements of the ossicular chain. Avoidance of circumferential attachment should reduce the risk of incus necrosis. Once the clip is pushed onto the incus no further crimping is necessary. The piston is of pure gold, as in this company's gold piston which has been in use for many years. In future the prosthesis may be all-titanium.

Introduction: We studied the histories of 121 patients with hypopharyngeal carcinoma treated at our clinic from 1990-1998. From 1990-1993 all patients with curable hypopharyngeal carcinoma were treated by surgery. Radiotherapy was used for those in whom surgery was impossible or who refused laryngectomy. In 1994 we changed our therapy and only patients in whom the voice could be preserved were treated surgically. All others received radiotherapy as primary treatment. The goal of this study was to ascertain whether and how this shift in therapy was influenced by T and N stage.

Methods: From 1990-1993, 57 patients with hypopharyngeal carcinoma were registered at our clinic. Surgery was performed in 32, 16 received radiotherapy and 9 only palliative treatment. During this time there was no difference in diseased specific survival between the radiotherapy and surgical groups. Therapy was therefore changed in 1994 to preserve voice function. From 1994-1998, 64 patients were diagnosed. Only 10 were treated surgically. 40 received radiotherapy and 14 no curative therapy. Age, N and T stage were comparable in both groups. To show differences we performed Kaplan Meier survival rates for both groups and for the N and T stage of patients undergoing surgery or radiotherapy respectively.

Results: 3-year survival was 68% in patients treated from 1990-1993 and 38% from 1994-1998. The difference was statistically significant (p-value 0.02). Survival for nodal stages 0 and 1 was much better in patients undergoing surgery than those receiving radiotherapy. Multivariant analysis was highly significant. T-category showed no tendency for either treatment modality.

Discussion: After a switch in the treatment of hypopharyngeal carcinoma in 1994 there was a significant change in survival. For patients with nodal stage 0 and 1 surgery brought much better survival. We conclude that surgery should be the primary treatment for all patients in these small nodal stages, even if total laryngectomy is necessary.