Adenoid cystic carcinoma of the supraglottic larynx: report of a case and review of the literature

Although adenoid cystic carcinoma is the most common malignant tumor of the minor salivary glands, it seldom occurs in the larynx. Less than 0.25 per cent of all laryngeal carcinomas are adenoid cystic, and only 15 such cases of supraglottic origin are recorded in the literature. In only four cases the details of treatment and outcome are described. We report another case and review the literature in order to define the entity of adenoid cystic carcinoma of the supraglottic larynx. This case reveals the aggressive nature of the disease, which is often associated with the solid variant histology and also demonstrates the most rapid course of any cases described in the literature. Other histologic variants of adenoid cystic carcinoma of the supraglottic larynx follow a more prolonged course that can extend many years even with persistent local disease. However, development of distant metastases may eventually occur. Therefore, 5-year statistics are not adequate, and 10 or 20 years' follow-up is required to evaluate the curability of this disorder. Evaluation, treatment, and clinical course of adenoid cystic carcinoma of the supraglottic larynx are discussed.     

A prospective randomized study of doxycycline as a prophylactic antibiotic in patients undergoing radical hysterectomy

A prospective randomized study was undertaken to evaluate doxycycline as a prophylactic antibiotic in patients undergoing radical abdominal hysterectomy and pelvic lymphadenectomy. Although 69 patients were initially randomized, 64 patients (34 study, 30 control) are the basis of this report: 5 patients were omitted because large pelvic lymph nodes positive for tumor were found at laparotomy and radical hysterectomy was abandoned. The two study groups were similar in both preoperative and operative risk factors. There was a statistically significant reduction in the 7- and 14- day febrile index in the doxycycline group. The rate of cuff and/or pelvic cellulitis was 2.3 times higher in the control group. Thus, single-dose doxycycline as a prophylactic antibiotic reduced both febrile morbidity and the rate of serious infections in the radical hysterectomy patient.     

Contingent reinforcement for reduced breath carbon monoxide levels: Target-specific effects on cigarette smoking

This study determined the effects on smoking behavior of providing contingent reinforcement for nonsmoking versus reduced smoking afternoon breath carbon monoxide (CO) target levels. Twenty-eight hired chronic smoker volunteers were randomly assigned to one of three experimental conditions during a 10-day intervention: (a) 8 ppm target CO, $5 per day incentive (n = 11); (b) 16 ppm target CO, $4 per day incentive (n = 8); or (c) 8 ppm target CO, no incentive (n = 9). Both payment groups showed significantly lower CO levels and greater amounts of daytime smoking reduction than the no-pay group. A specific effect of CO target was also seen; 45% of subjects in the 8 ppm group compared with 0% of subjects in the 16 ppm target and no-pay groups produced average afternoon CO levels of 8.5 ppm or lower during the intervention. Average levels of CO and smoking reduction did not differ for the two paid groups, however, because some subjects in the 8 ppm group failed to reduce CO sufficiently to contact the reinforcer. Contingent reinforcement based on expired air CO levels can exercise powerful and precise (target-specific) control over smoking behavior, but there may be individual differences in ability to meet reinforcement contingencies if difficult targets are introduced abruptly.     

Measurement of urinary epinephrine in screening for pheochromocytoma in multiple endocrine neoplasia type II

A sensitive screening test for the pheochromocytoma component of multiple endocrine neoplasia type II (MEN-II), comparable to the calcitonin radioimmunoassay for medullary carcinoma of the thyroid (MCT), has been lacking. A large family with MEN-II was screened for pheochromocytoma measuring 24 hour urinary catecholamines as norepinephrine and epinephrine fractions. Pheochromocytomas have been confirmed at surgery in six family members and at autopsy in one. All seven have had associated MCT. In an additional six family members, MCT only has been detected. In five of the six patients treated surgically, the urinary epinephrine fraction was either the dominant or sole abnormality, and an epinephrine level above 20 μ/24 hours, by itself, was diagnostic of a pheochromocytoma. An increased urinary epinephrine fraction appears to be a characteristic feature of the pheochromocytoma of MEN-II, and measurement of this fraction is a sensitive and reliable screening test in afflicted families.