Educational workshops with graduates of the University of Cape Town Karl Storz Head and Neck Surgery Fellowship Program: a model for collaboration in outreach to developing countries.

The University of Cape Town Karl Storz Head and Neck Surgery Fellowship is the only head and neck surgery fellowship in Sub-Saharan Africa. This article briefly describes this fellowship and outlines the experience and ongoing collaborative efforts of members of the American Academy of otolaryngology-head and neck surgery with graduates of this program who are now building head and neck surgery programs in East Africa. This educational collaboration avoids many common pitfalls associated with short-term humanitarian outreach and represents a successful model for international collaborative educational efforts with head and neck surgeons in developing countries in Africa.

Establishing a head and neck unit in a developing country.

Head and neck cancers pose an especially serious problem in developing countries due to late presentation requiring complex surgical intervention. These countries are faced with many challenges, ranging from insufficient health care staff to problems with peri-operative requirements, diagnostic facilities, chemoradiation services and research funding.These challenges can be addressed through the training of head and neck surgeons and support personnel, the improvement of cancer awareness in local communities, and the establishment of dedicated head and neck institutes which focus on the special needs of head and neck cancer patients.All these changes can best be achieved through collaborative efforts with external partners. The Karl Storz Fellowship in Advanced Head and Neck Cancer, enabling training at the University of Cape Town, South Africa, has served as a springboard towards establishing head and neck services in developing sub-Saharan African countries.

Fine-Needle Aspiration Cytology in the Management of Thyroid Nodules: a Preliminary Retrospective Review of 53 Cases at King Faisal Hospital

This is a retrospective review of 50 thyroid nodules investigated by fine-needle aspiration cytology (FNAC). On clinical grounds alone; it is not easy to differentiate between benign and malignant lesions. The use of FNAC in the preliminary investigation of cases assisted in the clinical management of these nodules in ruling out malignancy and in helping to avoid unnecessary open biopsies and surgery. Its cost-effectiveness and rapidity of results and attendant relief of anxiety to the patient make it acceptable to both physician and patient. Materials and Methods: 53 thyroid nodules were evaluated clinically and sampled by FNA using 23G and 25G needles and 10 ml syringes. Ethanol fixed and air-dried methanol -fixed smears were prepared for Papanicolaou and Diff-Quik staining; respectively. Stained preparations were evaluated on the light microscope.Results: Cytodiagnoses included 24 nodular goitres; 19 colloid goitres; 5 cystic lesions; 1 hyperplastic lesion; 1 thyroidifis; and 1 fungal infection. Conclusions: FNAC was useful in ruling out malignancy and avoiding unnecessary surgery. Benign thyroid nodules were more frequent than thyroid carcinoma. Thyroid nodules were more frequent in female patients than male patients with a ratio of 6:1. Further studies are required to unravel any related aetiologic factors; if any

Early oral feeding following total laryngectomy.

OBJECTIVES: To determine whether, in a developing world context, early oral feeding after laryngectomy is safe, cost-effective and appropriate. STUDY DESIGN: A prospective study of early oral feeding after laryngectomy, compared with retrospective, historical delayed feeding controls. METHOD: Forty patients underwent total laryngectomy for advanced carcinoma of the larynx with or without hypopharyngeal involvement, not requiring tongue base resection or myocutaneous flaps, and were commenced on oral feeding on the second post-operative day. Thirty-nine laryngectomy patients previously managed in the same unit who had received conventional, delayed oral feeding served as controls. RESULTS: Pharyngocutaneous fistulae developed in 20 per cent of the early feeding patients, compared with 15.4 per cent of the delayed oral feeding controls (p = 0.592). For patients who did not develop fistulae, hospitalisation was shorter in the early oral feeding group (p = 0.007). CONCLUSION: Early oral feeding for laryngectomy patients is recommended, both in developed and developing countries.