Laryngeal papillomas: the epidemiology in a Danish subpopulation 1965–1984

The incidence rate of laryngeal papillomas in a Danish subpopulation (approximately 2.8 million inhabitants) was 3.84 × 10^-6 per year in the period 1968–1984. For juvenile papillomas the incidence rate was 3.62 × 10^-6, compared with 3.94 × 10^-6 for laryngeal papillomas of adult onset. When comparing different time periods a significantly low incidence was found in the time 1965–1968, while the incidence remained constant in 1969–1984. The low incidence rate in the early period may be real, but selectional bias may have played a part. It is in general anticipated that maternal genital HPV-infections may serve as an HPV-reservoir, and that juvenile laryngeal papilloma is a result of HPV transmission from the mother to the child during birth. In the period in question cervical HPV-infections have been recorded with increasing frequency in younger women, indicating that the prevalence is rising. However, this is not reflected in the incidence of laryngeal papillomas.     

Liver transplantation in tyrosinaemia type 1: the dilemma of timing the operation

Four children with tyrosinaemia type 1 received liver transplants. The metabolic disorder was corrected and all four had normal liver function on an unrestricted diet. Two children, transplanted at age five and seven years, proved to have occult hepatocellular carcinoma and both subsequently developed pulmonary metastases. One child was well 32 months after removal of a single pulmonary metastasis but the other child died with multiple metastases. The two younger children, transplanted at age 19 and 21 months, were well 28 and 44 months after operation, one after a second liver transplant. Our experience confirms the high risk of hepatocellular carcinoma in this disease and the potential value of early liver transplantation.     

The role of endoscopy in evaluating patients with head and neck cancer. A multi-institutional prospective study

In a prospective multi-institutional study of 384 patients undergoing endoscopy, an 8.9% incidence of second primary neoplasms was discovered simultaneously in the lung (3.3%), esophagus (1.8%), and other head and neck sites (3.6%). The endoscopy was the only source of detection of these tumors in 58% of cases. A trend indicates that flexible fiberoptic bronchoscopy was more effective than rigid bronchoscopy in discovering lung tumors (7.5% vs 2.3%). Nevertheless, the chest roentgenogram remains an important tool in the diagnosis of second primary lesions in the lung. Panendoscopy is safe, takes little time, and can add invaluable information concerning therapy in patients with head and neck cancers.     

Intrapulmonary shunting in the biliary atresia/polysplenia syndrome: reversal after liver transplantation

One hundred and seventy three children, including 93 with biliary atresia, received liver grafts at Addenbrooke's Hospital between 1983 and 1993. Of these, only seven developed cyanosis due to intrapulmonary shunting as a complication of their liver disease, and all seven of these had the biliary atresia/polysplenia syndrome. Intrapulmonary shunting was confirmed by a radioisotope scan in four children. Only one child with the syndrome did not have cyanosis when undergoing transplantation. Seven of the eight children are alive 6-54 months after transplantation, with normal pulmonary and hepatic function. Cyanosis recurred in one child who developed chronic rejection with liver failure. In conclusion: (a) there is a strong association between the biliary atresia/polysplenia syndrome and cyanosis due to intrapulmonary shunting; (b) intrapulmonary shunting is fully reversible after successful liver transplantation; and (c) cyanosis, once present, is progressive, and these children should be considered for liver transplantation as soon as it occurs.     

Neurological crisis in hereditary tyrosinaemia and complete reversal after liver transplantation

A 19 month old Indian girl with tyrosinaemia developed a severe generalised neuropathy involving both phrenic nerves. Treatment with haemarginate failed to improve her condition. After liver transplantation the raised concentrations of the neurotoxin delta amino-laevulinic acid returned to normal and gradual but complete neurological recovery occurred over a period of 13 months.     

Parotid gland swelling

The salivary glands are seldom noticed by the physician when they are functioning properly, but they cause vexing problems in diagnosis and management during times of their disordered function. One reason for this is that numerous salivary diseases have similar onsets and patterns of symptomatology. Another reason is that the clinical expression of these diseases is often similar, including pain, diffuse swelling, and altered salivary discharge. This paper enumerates useful points of differentiation which may be elicited from the history and physical examination to distinguish among parotid diseases. If management is to be successful, it must be based on (1) identification of the etiology of the pathologic process, and (2) the institution of therapeutic measures designed to eliminate the etiology of the disease, and restore, as closely as possible, the normal physiology of the gland.     

Deflation of metrizamide-filled balloon used to occlude a carotid-cavernous fistula. Case report

A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.