Schweizerische medizinische Wochenschrift. Supplementum最新文献

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.

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: Hypothyroidism is a well described complication of head and neck cancer treatment, but routine testing of thyroid function is generally not done. The combination of surgery and radiotherapy seems to increase the risk of thyroid hypofunction.

Methods: Thyroid function was measured in 82 patients treated for head and neck cancer (different types of surgical resection combined with pre- or postoperative radiotherapy). The treatment was undertaken 1 to 220 months before measurement of THS and T4.

Results: 43 out of the 82 patients (52%) had abnormal thyroid tests. Hormonal replacement was necessary in 20/43 cases (24%). More than 85% of patients treated by total laryngectomy or pharyngo-laryngectomy, associated with hemithyroidectomy or not, had hypothyroidism and replacement therapy was necessary in more than half of these patients. For the other types of surgery the incidence of hypothyroidism was 32% with 10% of patients needing substitution.

Discussion: A high percentage of patients treated by surgery and radiotherapy develop hypothyroidism. In our experience, routine thyroid function testing is necessary in this group.

In 548 stapes operations performed in Berne during the period 1994-1998, an anomaly of the course of the facial nerve was observed in 37 cases. 29 exhibited partial prolapse of the nerve over the oval window, with or without dehiscence of the bony canal, while 5 showed total prolapse of the nerve over the oval window. In one case the nerve was duplicated round the oval window and in a further instance the facial nerve was situated over the promontory and also over the oval window. In one other case the nerve was spread widely over the oval window. Concomitant anomalies of the stapes were frequently observed. The following surgical techniques were employed: in the case of partial prolapse of the nerve, a small piston was placed in the lower part of or in the oval window, which was widened towards the promontory. In cases of total prolapse of the facial nerve the prosthesis was drilled straight into the promontory. Where the nerve was duplicated the prosthesis was placed in the footplate between the nerve branches, and where the nerve ran over the promontory and over the oval window the prosthesis was placed above the oval window. In the case where the nerve was spread widely over the oval window, no prosthesis was inserted. 78% of patients had a residual air-bone gap of 20 dB or less; in only three cases did hearing fail to improve. One patient with Crouzon disease involving a complex anomaly had a hearing impairment of 22 dB. There was no deafness, facial paralysis or vertigo with nystagmus.