Mucosal changes in the upper gastrointestinal tract in Sri Lankan patients with squamous carcinoma of the oesophagus.

BACKGROUNDS: Squamous carcinoma of the oesophagus, is a common tumour in Sri Lanka. A thickened and pale appearance of the oral, hypopharyngeal and oesophageal mucosa, has been observed during endoscopy. The aim of this study was to document the histological changes of the mucosa thus affected in 93 patients with squamous carcinoma of the oesophagus. METHOD: 93 patients with oesophageal carcinoma had mucosal biopsies done from the left cheek, hypopharynx and 2.5 cm. and 5 cm above the tumour, during endoscopy for biopsy of the tumour. Paraffin sections of the biopsy stained with Haematoxylin and Eosin were examined. 25 specimens of oesophageal tissue, and tissue from the mucosa and hypopharyngeal mucosa obtained at coroners' autopsies from a comparable group served as controls (15 males, 10 females). RESULTS: The tumours were squamous carcinoma of varying grades of differentiation. The mucosal biopsies showed, acanthosis, basal cell hyperplasia, intra epithelial neoplasia (IEN) grades I-III, chronic oesophagitis, koilocytosis and papillomatosis. The mucosa of the control group only showed koilocytosis and papillomatosis in two cases. CONCLUSION: Pathological changes such as acanthosis, basal cell hyperplasia, intra epithelial neoplasia, chronic oesophagitis koilocytosis and papillomatosis occur in the oral hypopharyngeal and other areas of the oesophageal squamous mucosa, in association with squamous carcinoma of the oesophagus.

Middle ear surgery under local anaesthesia and sedation.

BACKGROUND: Middle ear surgical procedures such as myringoplasty, stapedectomy and tympanolasty are traditionally performed under general anaesthesia, with induced hypotension. METHODS: We performed middle ear surgery in 73 patients, without induced hypotension, under local anaesthesia with sedation, and assessed feasibility, safety and acceptability. RESULTS: The operating conditions achieved were good and the complications were minor. None required conversion to general anaesthesia. CONCLUSION: Middle ear surgery under local anaesthesia and sedation is safe and feasible. Prospective trials are needed to fully assess the advantages of this technique over general anaesthesia.

Surgical treatment of otosclerosis, a Sri Lankan experience.

OBJECTIVE: To assess the success of surgical treatment of otosclerosis by stapedectomy and replacement with prostheses and to compare the results with other series. DESIGN: 115 operations done in 109 patients at one of the ENT units of the General Hospital Kandy. RESULTS AND CONCLUSIONS: After post-operative periods varying from 1 to 6 years the patients were tested by audiometry. The treatment was successful in 86 (74.4%), partially successful in 21 (18.2%) and unsuccessful in 8 (6.9%). These results compare well with other published series.

Treatment of bilateral abductor palsy of the vocal cords by lateralisation of one cord.

Two patients with bilateral abductor vocal cord palsy were treated by lateralisation of one cord (1), with two modifications. These modifications have not been documented before. The second modification makes the operation more suitable for developing countries as an operating microscope is not necessary. The surgical procedure is described.

Parotid fistulae treated by tympanic neurectomy.

OBJECTIVE: To study the feasibility of tympanic neurectomy in the treatment of parotid fistulae. DESIGN: Five patients with parotid fistulae were treated by tympanic neurectomy at the ENT Department, General Hospital, Kandy. RESULTS: Four were completely and one was partially cured.

Necrotising adenometaplasia (sialometaplasia) of the nasopharynx.

Necrotising sialometaplasia of the nasopharynx with nasal extension in a 43 year old man, with no preceding history of trauma, is reported. Some unusual histological features are described.