ABSTRACT
OBJECTIVE: We report a case of a remaining hemi-thyroid following laryngectomy, which was misinterpreted as a pseudoaneurysm. METHODS: Case report and comment on this understandable error which is easily avoidable. RESULTS: A 59-year-old man had undergone salvage laryngectomy for recurrent squamous cell carcinoma of the larynx, which had previously been treated with radiotherapy. Three months after his laryngectomy, he presented with a sore neck and subcutaneous collections. Computed tomography revealed a unilateral mass with high signal contrast uptake anterior to the left common carotid artery, which was thought initially to be a carotid pseudoaneurysm. Further investigation, including ultrasonography and a review by the senior head and neck radiologist, demonstrated that this mass was actually the remnant hemi-thyroid preserved at laryngectomy (which is often misshapen compared with a normal hemi-thyroid). The collections were found to be recurrent tumour, and unnecessary further interventions were avoided. CONCLUSION: Ultrasonography easily distinguishes between a thyroid remnant and a pseudoaneurysm. Furthermore, the opinion of an experienced head and neck radiologist may be vital when interpreting complex post-surgical head and neck radiology.
Subject(s)
Aneurysm, False/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Laryngectomy , Neoplasm Recurrence, Local/diagnosis , Thyroid Gland/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Carotid Artery, Internal/diagnostic imaging , Diagnosis, Differential , Exudates and Transudates , False Positive Reactions , Humans , Laryngeal Neoplasms/diagnostic imaging , Laryngeal Neoplasms/pathology , Male , Middle Aged , Neck/pathology , Neck Dissection , Neck Pain , Postoperative Care , Radiography , Salvage Therapy , Thyroidectomy , UltrasonographySubject(s)
Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Cerebrospinal Fluid Rhinorrhea/therapy , Intracranial Hypertension/diagnosis , Adult , Anti-Bacterial Agents/administration & dosage , Cerebrospinal Fluid Rhinorrhea/physiopathology , Death, Sudden , Disease Progression , Humans , Intracranial Hypertension/etiology , Intracranial Hypertension/therapy , Male , Mannitol/therapeutic use , Prednisone/therapeutic use , Severity of Illness Index , Tomography, X-Ray Computed/methodsSubject(s)
Electrodes , Tracheostomy/instrumentation , Electrocardiography/instrumentation , Humans , SpeechABSTRACT
The aim of this study was to determine the regional control rate with concurrent chemoradiotherapy (CRT) based on pretreatment nodal size in mucosal head and neck squamous cell carcinoma (HNSCC) in patients who achieved a complete response (CR) at the primary site by 12 weeks post-treatment. Between December 1997 and November 2003, 117 patients with node-positive HNSCC were treated with concurrent CRT, with 108 (92%) achieving a CR at the primary site by 12 weeks. There were 93 males (86%), median age 55 (37-79) years and the most common primary site was the oropharynx (65%). Patients were divided into three subgroups:
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Drug Therapy/statistics & numerical data , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/therapy , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/prevention & control , Practice Guidelines as Topic , Radiotherapy/statistics & numerical data , Risk Assessment/methods , Adult , Aged , Aged, 80 and over , Australia/epidemiology , Carcinoma, Squamous Cell/mortality , Female , Head and Neck Neoplasms/mortality , Humans , Male , Middle Aged , Prognosis , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: The neuropeptide secretoneurin, with potential relevance to leukocyte trafficking, is present in nerves of the nasal mucosa in allergic rhinitis and may be released in response to allergen and histamine exposure. There is no information on the occurrence and mechanisms of release of secretoneurin in healthy human airways. METHODS: The presence of secretoneurin in nasal biopsies and its release in response to nasal capsaicin and histamine challenges were examined. Symptoms and lavage fluid levels of fucose were recorded as markers of effects in part produced by neural activity. Bronchial histamine challenges followed by sputum induction and analysis of secretoneurin were also carried out. RESULTS: Nerves displaying secretoneurin immunoreactivity abounded in the nasal mucosa. Nasal capsaicin challenge produced local pain (P <0.05) and increased the levels of fucose (P <0.05), but failed to affect the levels of secretoneurin. Nasal histamine challenge produced symptoms (P <0.05) and increased the mucosal output of secretoneurin (P <0.05) and fucose (P <0.05). Bronchial histamine challenge increased the sputum levels of secretoneurin (P <0.05). CONCLUSIONS: We conclude that secretoneurin is present in healthy human airways and that histamine evokes its release in both nasal and bronchial mucosae. The present observations support the possibility that secretoneurin is involved in histamine-dependent responses of the human airway mucosa.
Subject(s)
Bronchi/metabolism , Capsaicin/administration & dosage , Histamine/administration & dosage , Nasal Mucosa/metabolism , Neuropeptides/metabolism , Respiratory Mucosa/metabolism , Administration, Topical , Adult , Bronchi/drug effects , Bronchial Provocation Tests , Capsaicin/pharmacology , Fucose/metabolism , Histamine/pharmacology , Humans , Nasal Mucosa/drug effects , Nasal Mucosa/innervation , Nasal Provocation Tests , Nervous System/metabolism , Reference Values , Respiratory Mucosa/drug effects , Secretogranin II , Tissue DistributionABSTRACT
Supracricoid laryngectomy is a new development in the treatment of laryngeal cancer in Australia. It allows the removal of both vocal cords, vestibular folds, and the entire thyroid cartilage including the paraglottic space without the loss of laryngeal function. This technique may offer a significant advance in the treatment of squamous cell carcinoma of the larynx. This paper reviews the surgical management of laryngeal cancer and discusses this new technique with modifications, indications for its use and the advantages of supracricoid laryngectomy. Case reports of seven patients operated on in our institution are included.
Subject(s)
Carcinoma, Squamous Cell/surgery , Cricoid Cartilage/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Carcinoma, Squamous Cell/physiopathology , Follow-Up Studies , Humans , Laryngeal Neoplasms/physiopathology , Length of Stay , Male , Middle Aged , Postoperative Care , Vestibule, Labyrinth/surgery , Vocal Cords/surgerySubject(s)
Tracheoesophageal Fistula/diagnosis , Aged , Bronchoscopy , Deglutition Disorders/etiology , Diverticulum, Esophageal/complications , Fatal Outcome , Humans , Male , Patient Care Team , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/etiology , Radiography, Thoracic , Sleep Apnea Syndromes/etiology , Tracheoesophageal Fistula/complications , Tracheoesophageal Fistula/pathologyABSTRACT
BACKGROUND: Reconstruction of tubular defects following pharyngolaryngectomy has required complicated surgery with high perioperative morbidity and mortality. Free jejunal interposition provides an excellent reconstruction with potential for lower immediate complications and better long-term results than other procedures. METHODS: A total of 201 consecutive free jejunal interpositions were performed following pharyngolaryngectomy between 1977 and 1993. Operative details, complications, and outcome were prospectively documented. RESULTS: Perioperative mortality was low (4.5%) and microvascular success rate high (97%), although a small number of late failures were recorded. Average time until swallowing postoperatively was 11 days, and 92% of patients could maintain full nutrition. Voice rehabilitation was mentioned, and increasingly good results are being obtained. Complication rates for the neck (17%) and the abdomen (2.5%) were also low. There were no problems with excess mucus production or reflux. Radiation effect on the jejunal conduit was not detrimental to long-term patency of the vascular anastomoses or to function as a conduit. CONCLUSIONS: Comparison with other published techniques permits the contention that a free jejunal interposition is the reconstruction of choice after pharyngolaryngectomy.
Subject(s)
Laryngeal Neoplasms/surgery , Laryngectomy , Pharyngeal Neoplasms/surgery , Pharyngectomy , Surgical Flaps , Graft Survival , Humans , Jejunum , Postoperative Complications , Prospective Studies , Surgical Flaps/methods , Survival Rate , Treatment OutcomeABSTRACT
This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned. The Price-Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5-fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price-Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50-60 Gy in 5-6 weeks. The lengthy treatment was generally well tolerated although there were two chemotherapy and two perioperative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognostic factors.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Radiotherapy/standards , Surgical Flaps/standards , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Cisplatin/administration & dosage , Combined Modality Therapy , Fluorouracil/administration & dosage , Follow-Up Studies , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Humans , Lymphatic Metastasis/pathology , Middle Aged , Neoplasm Staging , Prognosis , Queensland/epidemiology , Regression Analysis , Survival Rate , Treatment OutcomeSubject(s)
Ear Diseases/epidemiology , Native Hawaiian or Other Pacific Islander , Acoustic Impedance Tests , Adolescent , Audiometry , Australia , Child , Child, Preschool , Cross-Sectional Studies , Ear Diseases/physiopathology , Female , Hearing Disorders/epidemiology , Humans , Longitudinal Studies , Male , SeasonsABSTRACT
Fifty-two patients who underwent reconstruction of the pharynx and esophagus using the free jejunal graft were retrospectively reviewed. The complications were categorized into those associated with the resection, those associated with the harvesting of the graft, and those related to the reconstruction per se. In this series, the graft failure rate was 7.6% with an overall success rate of 90.3%. Graft necrosis was found to be the most serious complication occurring in four patients. Methods of detection of graft necrosis and management of these complications are discussed.
Subject(s)
Esophagus/surgery , Jejunum/transplantation , Pharynx/surgery , Adolescent , Adult , Aged , Deglutition Disorders/etiology , Female , Fistula/etiology , Humans , Male , Methods , Middle Aged , Necrosis/etiology , Pharyngeal Diseases/etiology , Postoperative Complications , Rupture, Spontaneous , Skin Diseases/etiology , Surgical Wound Infection/etiology , Vascular Diseases/etiologyABSTRACT
In most cases, the cause of an earache is obvious. If the cause is not apparent after careful inspection, a systematic approach to the associated causes and sites of referred pain is necessary. Glue ear is the most frequent cause of hearing loss in children. The diagnosis, investigation and management have been described. Recurrent earache from pressure change or from recurrent middle ear infection is an important clue to the presence of a glue ear.
