Distant metastasis in malignancies of the head and neck

It is a well known fact that disease in head and neck cancer remains confined above the clavicle in a majority of cases for a considerable length of time. The causes of death in head and neck cancer patients are known to be due to lymph node metastasis, fungation, asphyxia, cachexia, invasion of major vessels and infection. Distant metastasis occurs late in the disease. However, many reports have appeared in the literature which indicate a high incidence of distant metastasis in head and neck malignancies. Merino et al. (1977), in a clinical study, have indicated an incidence of 10.9 per cent. Studies based on autopsy findings, however, quote a much higher figure (30 per cent, Papac, 1984; 57 per cent, Gowen and Dessuto Nagy, 1963). Dennington and Caster (1980) reported that at least seven per cent of patients with head and neck cancer have distant metastasis when first seen. The present study was designed to find out the incidence of distant metastasis in our head and neck cancer patients.     

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).     

Livedo reticularis associated with the use of a midline catheter

We report a case of livedo reticularis as an unusual complication of a midline catheter in a patient being treated for pyelonephritis with intravenous antibiotics. The rash resolved completely after catheter removal. The constellation of symptoms suggested an aberrant autonomic response as the cause of the illness.     

Surgical considerations in malignant neoplasia of nose and paranasal sinuses

Most recurrences of cancers of the nose and paranasal sinuses are attributed to inadequate local control of disease. Since such tumours are usually advanced a standard maxillectomy procedure is inadequate Nevertheless batter local control is obtainable by modifying palatal zygomatic or superior bone cuts (cranifacial resection) or including an appropriate part of the septum in the specimen. This paper describes 78 such cases undergoing surgicad ablation. Uses of CT and modifications of standard surgical techniques adapted for various tumour extensions are described.     

Allergic fungal sinusitis: expanding the clinicopathologic spectrum.

OBJECTIVE: We sought to determine whether histologic tissue invasion occurs in allergic fungal sinusitis (AFS) and, if so, to identify clinical indicators for the same.Study design and setting We conducted a retrospective case record review of all 28 AFS cases identified by histology over a 32-month period at a tertiary care referral center. All histologic specimens were reevaluated for features of invasive pathology, and case records were correlated for clinical, radiologic, or laboratory parameters associated with such invasion. RESULTS: In addition to the universal finding of the characteristic allergic mucin with fungal elements on histopathologic examination of the sinus luminal contents, 6 cases (21%) had additional evidence of mucosal invasion as indicated by granulomatous inflammation and branching septate fungal hyphae in the submucosal tissues. Such coexistent invasion was associated with advanced disease as indicated by a higher incidence of orbital involvement on clinical evaluation (P = 0.024), and extrasinus spread (intraorbital or intracranial spread) on the computed tomography evaluation (P = 0.003). The single death that occurred on follow-up was in a patient with coexistent invasion. CONCLUSION: Advanced AFS may be complicated by histologic evidence of tissue invasion. SIGNIFICANCE: The noninvasive and invasive forms of fungal sinusitis are not necessarily discrete and may coexist in the same patient. Clinical features of orbital involvement or computed tomography manifestations of extrasinus spread should alert the clinician to the possibility of invasion.     

Intratemporal facial nerve grafting

The paper deals with observations made on ten patients who had undergone intratemporal facial nerve grafting for traumatic facial palsy (following mastoid surgery). Good recovery of facial movements (including emotional and associations) was noticed in nine patients after the continuity of the severed facial nerve had been restored by grafting.     

Syntheses and biological activities of some new 4(3H)-quinazolinones

Substituted 2-phenylbenzoxazinones or 2-methylacetanthranils were condensed with substituted 4-aminodiphenyl ethers to furnish the quinazolinones 3. Most of the compounds were screened for their inhibitory effects on mono-amine oxidase and acetylcholinesterase of rat brain homogenate. All compounds were also evaluated for their antimicrobial activity.     

Ossiculoplasty

This paper deals with our observations in 140 patients who had deficiency of the ossicular chain due to various causes. The reconstructive procedures along with the results of surgery are described.