Lymph node metastases in adenoid cystic carcinoma

The clinical characteristics of 76 patients with adenoid cystic carcinoma seen during a 22-year period are described. Lymph node metastases at presentation or later occurred almost exclusively in men, and the five-year rate of "node-free" survival was 62 per cent for men and 95 per cent for women. Node metastases were more common in poorly differentiated tumors, but site and stage of the primary disease did not affect the metastatic rate. Surgery scarcely improved the rate of survival of patients with nodal metastases. The authors were unable to confirm previous observations that embolic nodal metastases at a distance from the primary tumor do not occur.     

Pumping and clearance function of the eustachian tube

The purpose of this study was to clarify the relationship between mucociliary and muscular clearance in the eustachian tube. Displacement of various viscosities and volumes of a colored fluid through the tube was observed endoscopically in cats. To test ciliary clearance, the fluid was placed in either the tympanum or the mastoid bulla. The interval between the instillation and beginning of discharge of the fluid from the pharyngeal orifice of tube was measured. Clearance time was prolonged with fluids having high viscosities, and the clearance time from the tympanum was shorter than that from the mastoid bulla. To test muscular clearance, the tensor veli palatini muscle was stimulated electrically to simulate swallowing, and the number of contractions necessary for massive discharge of the fluid was counted. Massive discharge occurred only with low viscosity fluid placed in the tympanum, whereas small amounts of highly viscous fluid were cleared by linear discharge. The authors concluded that when the volume of middle ear effusion was small, the fluid was cleared by mucociliary clearance. When the volume of fluid was large, the low viscosity fluid was cleared by muscular clearance only, while highly viscous fluid was cleared both by ciliary and muscular clearance.     

Development of an evidence-based decision pathway for vestibular schwannoma treatment options

Objective

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS).

A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases

Purpose

Video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM.

The effect of amphetamine on head and eye movements following vestibular stimulation in squirrel monkeys

The effect of a single dose intra-muscular injection of amphetamine sulfate on head and eye movements evoked by vestibular stimulation was investigated in squirrel monkeys. Doses injected were 0.5, 0.4, 0.3, 0.2 mg/kg, and control no injections. Amphetamine did not change the gain of vestibular evoked head and eye movements, but prolonged time constant (in function of dose) showing greater effect in eye movements. More than 0.3 mg/kg was found to be a proper dose for this species to maintain an appropriate constant alertness level for vestibular studies.     

Tympanic membrane changes resulting from different methods of transmyringeal middle ear ventilation

This experimental study was designed to evaluate the morphologic changes of the tympanic membrane in the rat after different methods of transmyringeal ventilation. Artificial ventilation was obtained in two principal ways, either by making tympanic membrane perforations with delayed healing or by inserting a tympanostomy tube. Perforations occupying the upper rear quadrant of the tympanic membrane were made by diathermy or by a carbon dioxide laser with healing times of 12 to 15 days and 18 to 21 days, respectively. Compared with the healing times of perforations made by lancet (9 to 11 days), the healing pattern was considerably delayed. The structural changes of the healed tympanic membrane were minimal, but the connective tissue remained thickened for several months. Repeated insertion of tympanostomy tubes caused a remarkable thickening (30-fold) of the tubulated quadrants. The thickened tympanic membranes were characterized by a hyperplastic, dense connective tissue containing sclerotic plaques. Similar changes, though less pronounced, were also seen after reiterated myringotomies without tube insertion.     

Further observations of vestibular ototoxicity in the chick: Effects of streptomycin on the ampullary sensory epithelium

Starting eight days after hatching, chicks received daily subcutaneous injections of streptomycin sulfate, either 400 mg/kg for 30 days or 1,200 mg/kg for 15 days. Randomly selected chicks from each group were killed at intervals during the injection period, and the ampullae were examined for signs of vestibulotoxicity. Ampullary cell types differed in sensitivity to streptomycin. First, dark cell processes withered. Second, vacuoles formed in the apices of the light cells of the planum semilunatum. Third, nerve terminals swelled, and their organelles and ground substance clumped together, creating cleared areas. Last, hair cells and supporting cells became slightly vacuolated. However, these cells showed less overt damage than the other cell types. The onset of damage was earlier and the damage more severe with the 1,200-mg than with the 400-mg dosage. There was no evidence of hair cell loss during the experiment.     

Very rapid adaptation in the guinea pig auditory nerve

Guinea pig auditory ganglion cell responses to 100-ms duration tone bursts were recorded over a range of stimulus intensities. The responses, recorded in the form of peristimulus/poststimulus time histograms, were analysed by reduction into two phases. The first phase was a rapid exponential adaptation from an initial onset response; the second was a more gradual reduction in the firing rate which, over the 100 ms duration of the stimulus, appeared to be a linear function of time. The first, rapid, phase was nonlinear in its response to changes in stimulus intensity, exhibiting a change in amplitude and having a time constant which decreased with increasing intensity. Individual units were consistent in the magnitude and time course of this phase. The second phase was also nonlinear with intensity, and was far more variable from unit to unit. With the recording parameters employed it was not possible to determine whether the effect of intensity on the second phase was an effect on the magnitude or time course, or both. Stimulus termination responses were also analysed, and typically were of one of two forms. If, at any particular stimulus intensity, the unit under study showed little sign of the slower adaptation then the termination response was a simple depression of activity (perhaps to zero) which recovered with an exponential time constant of about 25 ms, independent of intensity. If, however, the peristimulus responses showed a significant amount of the slow adaptation then the termination responses also exhibited a second, slower, phase of recovery. This was modelled over the recording epoch as a linear function of time. The magnitude of the slow offset response also increased with intensity faster than did the average firing rate.     

Experimentelle Untersuchungen über die Anlage einer kontralateralen Carotisanastomose

Summary The contribution is presenting a procedure for reconstruction of cerebral blood flow after resection of the A. carotis communis and the A. carotis externa in animal experiments. The preparation in human corps will demonstrate the possibilities on anatomical points.The surgical intervention is based on the fact that we can tie up the A. carotis externa on both sides without disadvantage. On the healthy side, without formation of metastasis, we prepare the A. carotis externa from the bifurcation up to the region of the Mm. pterygoidei. There we will tie up the vessel. The vessel can be transplanted to the contralateral side via a retropharyngeal tunnel. On this side we dissect the big vessels of the neck. There the suture will be applied to the transplanted A. carotis externa and to the stump of the A. carotis interna by end-to-end or end-to-side anastomosis. The results are documentated by angiographies and local pressure measurements during the operation.

     

Metastatic squamous cell carcinoma in the neck invading the facial canal--a case report

The results of histopathologic examination of the temporal bone of a 71-year-old woman with squamous cell carcinoma of the tonsil and ipsilateral facial palsy are presented. The right temporal bone was directly involved by metastatic spread of the primary lesion to the right upper cervical lymph nodes. Tumor cells had invaded the canal of the facial nerve, the chorda tympani nerve, and the stapedius muscle, as well as the air cells in the mastoid region. However, although tumor cells had infiltrated the facial canal to a considerable distance from the metastatic tumor mass, the facial nerve had not been infiltrated. Slight degeneration of the facial nerve, however, was observed and appeared to have been caused by compression by the tumor.     

Treatment of locally advanced parotid malignancies with parotidectomy and temporal bone resection

Purpose

In this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies.

Risk stratification for outpatient parathyroidectomy and predictors of postoperative complications

Introduction

The mainstay of treatment for primary hyperparathyroidism is surgery. Hypocalcemia after parathyroidectomy is common and poses a significant challenge, leading to increased patient morbidity and health care costs. While several groups have found predictor factors for hypocalcemia, none have created a risk stratification model. Here, we recognize important factors and optimal cut-off values that can allow risk stratification of patients.

Prevention of otitis media in children by pneumococcal vaccination

A total of 3,340 infants, 95 per cent of them 7 to 9 months old, were randomly vaccinated in a double-blind fashion with either the 14-valent pneumococcal (Pn) polysaccharide vaccine or a saline placebo in three urban areas in Finland. The second dose of the vaccine was given 5 months later. Age and sex distribution, recruitment of infants, and their otitis-related treatment and follow-up were similar in the study areas. Side effects after vaccination were mild and fewer than among older children. Antibody responses to vaccine polysaccharides varied from type to type, but were generally poor, especially to types most prevalent in otitis media. After the first dose of vaccine, the occurrence of otitis visits among the Pn-vaccinated, as compared with controls, showed inter-area differences, but ranged from not more than a 30 per cent reduction at its best to an increase in some areas and in some clinical categories. The respective figures for children with acute otitis media were similar between the vaccination groups and the study areas. The effect of the vaccine on acute otitis media caused by specific Pn types/groups represented in the vaccine was variable but generally poor. Group 6 attacks especially seemed to behave problematically. The second dose of the vaccine did not give additional benefit serologically or clinically. The efficacy of currently available pneumococcal vaccine against otitis media seemed poor in infants.     

激光辅助悬雍垂腭成形术后语音的客观评价

为客观评价激光辅助悬雍垂腭成形术(LAUP)对语音有无影响,利用USSA计算机语图频谱分析系统,对15名LAUP手术患者,进行了手术前.后2～3周/a/、/i/、/e/、/u/、/(?)/汉语单元音五个共振峰模式、基频和舌根软腭辅音/g/、/k/、/h/三维语图强频区频率的比较.结果显示;各元音前三个共振峰频率及基频在手术前后的变化无统计学意义,术后三个辅音的强频区频率改变也不明显,说明LAUP手术对汉语单元音的音质无影响,也不影响辅音的发音,     

Novel use of unilateral galeopericranial flaps for closure of sino-orbital cutaneous fistulas

Sino-orbital cutaneous fistulas are a well-documented complication of orbital exenteration and sinonasal carcinoma resection. Challenges to successful closure of this common complication include complex anatomy, communication with sinonasal mucosa, persistent mucopurulent drainage, compromised wound healing due to previous irradiation, and wound infection. We describe a novel approach for closure of sino-orbital cutaneous fistulas in two patients using a galeopericranial flap. The galeopericranial flap is ideal due to its thin, pliable nature and predictable, abundant vascularity. Additionally, it obviates the need for a more cosmetically disfiguring closure. Although used successfully in a variety of skull base and ophthalmologic surgeries, the galeopericranial flap has not been previously described for closure of sino-orbital cutaneous fistulas. Both patients' defects have remained closed at follow-up with excellent cosmetic results.     

Norepinephrine in cochlear microcirculation of guinea pigs

The blood flow in the radiating arteriole through a small cochlear fenestra was recorded with motion pictures in anesthetized guinea pigs, before and after norepinephrine injection into the ipsilateral carotid artery. The flow velocity was determined by measuring the displacement of plasma space running through the radiating arteriole per second. Norepinephrine injection of 0.01 and 0.15 mg/kg increased both flow velocity and arterial blood pressure. The flow velocity increase related directly to the increase in arterial blood pressure. However, a larger norepinephrine dose (1.2 and 2.5 mg/kg) led to transient cessation in flow, which was independent of the blood pressure increase. Dilatation of vessel diameter was always observed with the rise in blood pressure, irrespective of norepinephrine doses. When blood flow in the radiating arteriole stopped after a large norepinephrine injection, the arteriole's vascular lumen was completely obstructed by the aggregated red blood cells. These results suggested that cochlear microcirculation is disturbed by microemboli formed by norepinephrine-induced platelet hyperaggregation.     

Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Treatment of ear and bone disease in the Phex mouse mutant with dietary supplementation

Hypothesis

Phosphorus and vitamin D (calcitriol) supplementation in the Phex mouse, a murine model for endolymphatic hydrops (ELH), will improve otic capsule mineralization and secondarily ameliorate the postnatal development of ELH and sensorineural hearing loss (SNHL).

Septilin and geriforte in allergic and vasomotor rhinitis

Our study comprised 50 patients of allergic and vasomotor rhinitis. Seventeen patients gave history of stress and strain hence they were given Geriforte in addition to Septilin. The results of therapy were judged on following criteria: i) Symptomatic improvement. ii) Appearance of nasal mucosa before and after the therapy. Thirty-nine patients (78%) were cured 100% as they had total relief from symptoms along with change of nasal mucosa from bluish to pink. Eight patients (16%) had about 75% improvement and 3 patients (6%) had only 50% improvement. These patients were advised to continue the therapy for a longer time (6-8 weeks). Of these, 4 patients showed further improvement. In our opinion, Septilin has proved very useful in cases of allergic and vasomotor rhinitis. The patients who have history of stress and strain may also need Geriforte in addition to Septilin.     

Stomal recurrence--etiologic factors and prevention

Out of a total of 340 laryngectomies performed in the Department of Otorhinolaryngology at Kobe University Hospital from 1969 to 1982, there were 20 stomal recurrences. In the preoperative tracheostomy group, 6 out of 52 patients (11.5%) developed stomal recurrence compared to 14 out of 288 (4.9%) in the operative tracheostomy group. Of these 20 stomal recurrences, 7 were supraglottic with 1 subglottic extension, 9 were glottic with 8 subglottic extensions, and 4 were primary subglottic cancers. The mean interval between the laryngectomy and stomal recurrence was 16 months and ranged from 20 days to 55 months after laryngectomy. We analyzed our series together with recent material which had been subjected to pretracheal and paratracheal lymphatic dissection. Reports from the literature were also used. Tumor cell inoculation in the tracheostomy wound and persistent pretracheal and paratracheal lymph node lesion are the two most likely major etiologic factors. The above evaluation leads us to propose the following preventive measures: 1) thorough irrigation of the wound following the removal of the larynx, 2) complete excision of the tracheostomy tract for preoperatively tracheostomized patients, 3) pretracheal and paratracheal lymphatic dissection for subglottic lesion, 4) in the above cases, laryngectomy should be followed by peristomal radiotherapy.