Pitfalls in the surgical management of cancer larynx and hypopharynx

One hundred and eighty patients presented with cancer of the larynx and hypopharynx form the basis of this report. Positive margins were found in 12.2% [22/180] of all cases, 12.5% [8/64] of supraglottic tumors, 16% [4/26] of tronsglottic tumors, 5.3% [2/38] of glottic tumors, 11.1% [2/18] of pyriform fossa tumor, 50% [3/6] of posterior pharyngeal wall tumors, and 10.6% [3/29] of postcricoid tumors. The relationship between the inadequate surgical margins of the specimens, tumor spread, the preoperative computerized tomography [CT] findings, and the surgical procedure performed have been correlated

Saccular disorders in cancer larynx

Abnormal saccular dilatations like laryngoceles, laryngomucoceles, large dilated saccules, and saccular cysts have been reported to occur secondary to laryngeal tumors. These disorders occurred in 11.5% [15/130] of our cases of cancer larynx. Laryngoceles, large saccules, and saccular cysts were found in 3.1%, 4.6%, and 3.8% of cases respectively. CT proved to be very accurate more than endoscopy in detection of symptomatic or asymptomatic saccular disorders associated with cancer larynx. However both endoscopy and CT are recommended in cases presented with laryngoceles or saccular cysts to rule out any underlying malignancy

Endoscopy and computed tomography [CT] in lower respiratory tract scleroma

Out of fifty two patients with scleroma, twenty patients with laryngotracheal scleroma [38.5%] were examined by CT and endoscopy. Tracheal involvement was found in 65% [13/20] of cases, whereas bronchial affection was found in 15% [3/20] of cases with laryngeal scleroma and in 23.1% [3/31] of cases with tracheal scleroma. Two patients were presented with supraglottic scleroma. The first one showed supraglotric granulomata, and the second one showed bilateral lateral saccular cysts. Culture of the cyst contents showed klebsiella rhinoscleromatis. Endoscopy was very efficient in diagnosis, staging, and management of these patients. Although diagnosis could not be made on the basis of CT only, CT was useful in determining the extent of the disease as well as the response to therapy

Hyoid Bone Syndrome [H.B.S.] and Styloid Process Syndrome [St P.S.] clinical presentation, diagnosis, and management

Both St.P.S. and H.B.S. involve pain in the anterolateral part of the upper neck radiating to the ear. In this study, fourteen patients were presented with St.P.S. and 74 patients were presented with H.B.S. The key for diagnosis of these syndromes was the palpating finger for a tender tip of the hyoid bone in H.B.S. or an elongated styloid process in St.P.S. Radiology had a confirmatory role in diagnosis of St.P.S, and a limited role in diagnosis of H.B.S. Both syndromes occurred in recurrent acute or chronic persistent forms. Conservative management was the treatment of choice in H.B.S., whereas surgery was the treatment of choice in St P.S. Clinical presentation, pathogenesis, and management plans of both syndromes were discussed

outcome of pyogenic brain abscess since the advent of C.T. scanning

Twenty-four patients with intraparenchymal brain abscesses were treated at the University Hospital during the last 2 years [1989-1990]. Since computerized tomographic [CT] brain scanning became a routine diagnostic procedure. In 18 cases, the source of infection was within or near the cranial cavity. The right cerebral hemisphere was affected more than the left. All the patients had received broad spectrum antibiotics before doing operation. Two patients were treated by aspiration alone with good results. Twenty cases were treated by excision of the encapsulated abscess. The use of serial CT scans permits postponement of surgery until the abscess wall is completely formed, which facilitates the total removal. The mortality rate was only 12.8%

role of postoperative irradiation in intracranial menlngloma

Ninety five patients with intracranial meningioims were included in this study. Total surgical removal was done in 51 patients and partial removal was done in 44 oases. Postoperative radiotherapy was applied in 63 oases depending on the extent of surgery and/or histologioal findings. Objective complete response was achieved in 67/95 of the cases. The 5 year actuarial survival rate was 93.8% in -cases with limited disease treated by complete removal alone, 89.5% in malignant types treated by complete removal and postoperative radiotherapy and 87.5% in patients whose tumours were incompletely removed and treated by radiotherapy