Laryngectomy: a quality of life assessment.

Cosmetic disfigurement and loss of voice following a total laryngectomy can cause major psychosocial problems. Fifty patients who had undergone a total laryngectomy and completed more than six months following surgery, were randomly selected during a routine follow-up, and asked to answer a questionnaire, to asses their degree of disability and extent of rehabilitation. The questionnaire have five main components viz. general information, functional evaluation, vocal rehabilitation, social assessment and economic sequelae. Results revealed that these patients suffered from a significant decrease in social acceptance (70%), social activity (82%), sexual activity (62%), ability to communicate vocally (58%), and severe financial repercussions (78%). A large number of patients (40%) were dissatisfied with the present level of rehabilitation offered. Inspite of these problems the majority (80%) were willing to accept a total laryngectomy as treatment of their cancer. This emphasizes the need for greater interaction between the treating surgeon, speech therapist, occupational therapist, and psychotherapist to rehabilitate these patients adequately.

Morbidity & mortality following craniofacial resections.

A seven year experience with twenty patients undergoing the craniofacial approach for excision of tumours of the paranasal sinus and orbit is presented. Results indicate a low postoperative morbidity and mortality with excellent cosmesis. Good palliation is achieved in the presence of extensive disease, while large tumours which would have been considered inaccessible can be resected. Its advantage recommend it as the treatment of choice for tumours of the orbit and paranasal sinuses.

Serum leucine amino peptidase levels as a marker in testicular tumours.

Serum levels of leucine aminopeptidase (LAP) were studied in 60 patients with testicular tumours and 26 normal individuals, and were found to be significantly elevated in patients with seminomas, nonseminomas and benign tumours of the testis. After treatment the LAP levels decreased in patients with seminomas, nonseminomas and mixed cell carcinomas indicating response to therapy. The quantitative method used for estimation of LAP, which is simple, quick, accurate and cost-effective, could be used more effectively as a tumour marker in testicular malignancies.

Gastric transposition & deltopectoral flap for peristomal recurrence following total laryngectomy--a case report.

Stomal recurrence following laryngectomy presents a difficult problem with an incidence of 8.3-15%. Wide excision of the recurrence with mediastinal dissection, although the operation of choice,m is technically demanding and has a high morbidity and mortality. We recommend a technically easier procedure for reconstruction after palliative excision and present a case to illustrate it.

Primary tracheo oesophageal puncture our initial experience.

Our initial experience of 9 primary tracheo oesophageal punctures with Blom Singer prosthesis is reported. Patient selection was based on motivation, intelligence and socioeconomic status. Excellent speech resulted in 7 out of 9 patients (77%), with 2 failures (23%). There were no major complications. The results are encouraging, but a larger study is required to determine the role of this procedure in our conditions.

Hyperamylasaemia & related enzyme factors in renal failure associated with benign & malignant conditions.

Total serum amylase activity, its isoenzymes and pancreatic to salivary amylase (P/S) ratio were studied in 40 normal subjects and 47 patients with renal failure, 32 with benign and 15 with malignant conditions. Amylase to creatinine clearance (Cam/Ccr) was studied in 17 normals and 14 patients with renal failure, 10 benign and 4 with malignant diseases. Total amylase activity, and pancreatic and salivary fractions were found to be increased by about 3.4 times the normal in both benign and malignant conditions producing renal failure though the P/S ratio was within the normal range. However, the increase in the urea and creatinine levels in patients could not be related to the increase in serum total amylase. Besides the Cam/Ccr ratio was elevated in patients with both benign and malignant conditions producing renal insufficiency whereas the Cam and Ccr were individually found to be decreased. Why patients with chronic renal failure in both conditions without clinical evidence of pancreatitis should have elevated Cam/Ccr ratio is not clear.

Study of total serum amylase, its salivary and pancreatic fraction and the pancreatic to salivary amylase ratio in testicular tumours.

Serum levels of total amylase, its pancreatic fraction (P), salivary fraction (S), and the ratio of pancreatic to salivary fraction (P/S) were determined in 52 cases of histologically proved testicular germ cell tumours and 33 healthy controls. Total serum amylase remained unchanged, but the salivary fraction had a lower mean value. P/S ratio and the pancreatic fraction were significantly elevated in both seminomatous and non- seminomatous tumours. The ratio was more frequently raised in non-seminomatous (100%) as compared to seminomatous (66.67%) tumors. Following treatment there was no appreciable fall in P/S ratio in non-seminomatous tumors whereas in seminomas there was a slight increase in the ratio. The pancreatic fraction showed a transient fall in seminomatous but not in non-seminomatous tumors following treatment. The pancreatic fraction of amylase and the P/S ratio may help in the diagnosis of testicular germ cell tumor but does not appear to be of use in assessment of prognosis or monitoring the course of the disease during treatment.

Serum lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase and ratio of alpha-hydroxybutyrate dehydrogenase to lactate dehydrogenase in testicular tumours.

Serum levels of Lactate Dehydrogenase (LDH), alpha-Hydroxybutyrate Dehydrogenase (HBDH) and the relative ratio of alpha-Hydroxybutyrate Dehydrogenase to Lactate Dehydrogenase (HBDH/LDH) were determined in 51 cases of histologically proved testicular germ cell tumors and 40 healthy controls. Serum LDH and HBDH levels were found to be raised in both seminomatous and non-seminomatous germ cell tumors. The ratio of HBDH/LDH was found to be statistically significant in seminomas and insignificant in non-seminomatous germ cell tumors. Furthermore, the levels of LDH and HBDH showed a fall, following treatment indicating response to therapy. Serum LDH and HBDH could both be used as tumor markers in the diagnosis of testicular germ cell tumors as well as prognostic indicators in monitoring therapy, HBDH, being more specific in monitoring therapy as compared to serum LDH.