Schweizerische medizinische Wochenschrift. Supplementum最新文献

Radiotherapy and surgery for laryngeal cancer achieve comparable results in patient survival. Therefore, the expected quality of life is increasingly influencing the choice of treatment. The aim of this study was to compare the quality of life of patients after surgery or radiotherapy for laryngeal carcinoma. To evaluate quality of life, we used the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC Head and Neck module (EORTC QLQ-H&N35). 65 patients who were treated with either radiotherapy or surgery for laryngeal cancer between January 1990 and December 1995, and who were alive and free of tumour in January 1999, were included in this study. In the first group with small tumours (T1/T2), 40 patients were treated by CO2-laser surgery and 16 by primary radiotherapy. In the second group with more advanced tumours (T3/T4), 5 patients underwent total laryngectomy and 4 primary radiotherapy. In the first group there was good global quality of life with no significant difference between the two treatment modalities. Surgically treated patients scored significantly better than the irradiated patients in questions about swallowing of solid food, xerostomia and dental problems. No other significant differences were found: hoarseness in particular was rated equally after both treatments. In the second group there was also good global quality of life with no significant difference between the two treatment modalities. The laryngectomized patients scored equally on questions about voice function, talking on the phone and social behaviour. As far as quality of life is concerned we can recommend both treatment modalities for patients with laryngeal cancer of all stages.

From 1992 to 1998, 105 patients of the Department of Otorhinolaryngology, Head and Neck Surgery in Berne underwent laryngectomy with primary implantation of a Provox prosthesis. These patients were followed up in an open prospective study and evaluated by the HRS scale, based on speaking ability and quality as well as on prosthesis care. 46 patients (44%) attained successful rehabilitation of the voice, defined as 12-15 points according to the HRS scale. Age, tumour stage and postoperative irradiation did not influence the results. Compared to the patient group with less than 12 HRS points, frequent replacements or short in situ lifetime of the prosthesis improve the results of rehabilitation. Patient compliance is an important factor in achieving success with the Provox prosthesis.

Spontaneous recovery of hearing following sudden deafness is evaluated. Between 1983 and 1997, 59 patients presenting with sudden hearing loss deliberately declined treatment. Recovery is similar for low and high frequency hearing losses, 40% of cases recovering hearing with an interaural threshold difference below 20 dB. These results are similar to those of several studies using different treatments. Therefore, sudden deafness need not be treated at all costs.

Introduction: Necrotising fasciitis is still a severe disease whose outcome is occasionally fatal.

Methods: Between August 1994 and August 1998, 6 patients with necrotising fasciitis, 5 in the neck area and one in the facial area, were treated. The source of the infection was odontogenic in 3 cases, pharyngeal in 2 and an insect sting in the left upper eyelid in one case.

Results: Following evaluation by CT scan, immediate surgical exploration with debridement and drainage was performed. Revision proved necessary in most cases. One patient suffered severe complications. Median stay in the intensive care unit was 7 days and in hospital 20 days.

Discussion: Deep and extensive neck infections require investigation by CT scan. All affected areas must be explored and drained immediately, including thoracotomy if mediastinitis is present. Apart from appropriate antibiotic therapy, the further course of the disease should be carefully monitored to detect further spread of the infection as well as complications.