Etiological factors of laryngeal cancer.

In order to evaluate the etiological factors, all 318 cases of laryngeal cancer diagnosed during the period of 1962-91 in the Tampere University Hospital area with a population of 400,000 were reviewed. Among males the annual age-adjusted incidence decreased significantly from 7.1 to 2.3 per 100,000. No significant difference in the occurrence was found between urban and rural areas. In males the relative risk (RR) was significantly higher in the lower socio-economic groups. In both sexes smokers had significantly higher risk compared to non-smokers. For male smokers RR was 15.5 (95% CI 10.0-25.4) and for female smokers 12.4 (95% CI 3.9-39.5). Changes in smoking habits seem to be the most important factor contributing to the decreasing incidence of laryngeal cancer in Finland, but other factors like changes in dietary and sauna habits may also have some significance.

Changing trends in the incidence of laryngeal cancer.

The incidence of laryngeal cancer during the period 1962-1991 in the Tampere University Hospital area, with a population of 400000, was evaluated. There were 302 (95%) male and 16 (5%) female patients. The mean annual age-adjusted incidence rate was 4.4 per 100000 inhabitants for males and 0.2 for females. The incidence among males decreased significantly from 6.7 to 2.6 over the study period, the most prominent decline being in the age group 40-49 years. No distinct trend was detected in females. The frequency of the disease increased along with age in both sexes. One of the prominent phenomenons was a distinct increase of the glottic to supraglottic incidence ratio from 0.5:1 to 1.9:1 in males.

Endoscopic versus Caldwell-Luc approach in chronic maxillary sinusitis: comparison of symptoms at one-year follow-up.

The aim of this prospective randomized study was to compare functional endoscopic sinus surgery (FESS) with the standard Caldwell-Luc (C-L) procedure in relieving the symptoms of chronic maxillary sinusitis. One hundred and fifty consecutive adult patients were operated after the failure of treatment with antimicrobials and repeated antral irrigations: 143 patients were available for the follow-up examination, at a median of 12 months after the operation. The patients' global evaluation showed marked improvement in 50.7% of the C-L group and in 76.7% of the FESS group. Overall subjective symptoms deteriorated in 5.5% of C-L operated patients, but not at all in the FESS group. Patients' compliance, asked post-operatively, was 80.2% in C-L patients and 93.0% in FESS patients.

Clarithromycin vs. amoxicillin suspensions in the treatment of pediatric patients with acute otitis media.

Clarithromycin is a new macrolide antibiotic that is active in vitro against a variety of organisms that are responsible for acute otitis media in children. The parent compound is metabolized to microbiologically active 14-hydroxy clarithromycin, which is especially active against Haemophilus influenzae. The safety and efficacy of clarithromycin and amoxicillin suspensions were compared in the treatment of acute otitis media in children 1 to 12 years of age inclusive. This was a Phase III, single blind (investigator-blind), randomized, multicenter clinical trial. Clarithromycin oral suspension was given in a dose of 7.5 mg/kg (maximum, 500 mg) twice daily, and amoxicillin suspension in a dose of 20 mg/kg (maximum, 750 mg) was given twice daily for 7 to 10 days in a 1:1 ratio. Clinical evaluations were performed pretreatment, within 48 hours posttreatment and 10 to 14 days posttreatment. Myringotomy was performed in every child to obtain a microbiologic sample pretreatment and at subsequent visits as clinically indicated. A total of 79 children were enrolled, 39 in the clarithromycin and 40 in the amoxicillin treatment group. Thirty-two children were excluded from the efficacy analysis for various reasons. Clinical success (cure and improvement) rates at 0 to 4 days posttreatment were 93% for clarithromycin and 90% for amoxicillin (P > 0.999). Altogether 17 children (10 receiving clarithromycin, 7 receiving amoxicillin) experienced some adverse event, with gastrointestinal disorders being the most common complaint. No clinically significant differences in laboratory tests were found between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of primary tracheal carcinoma in Finland in 1967-1985.

The treatment results of all the 95 primary tracheal carcinomas recorded by the Finnish Cancer Registry in 1967-1985 are evaluated. Six of the 95 patients were treated by surgery, 60 received radiotherapy and 29 were left untreated or received only palliative endoscopic or cytostatic therapy. The prognosis of the disease was poor. Among the 44 squamous cell carcinoma patients treated by radiotherapy, the median survival time after the diagnosis was 8 months (range 1-81 months). Complete response to radiotherapy was a favourable prognostic sign; after complete response the survival rates at 1, 2 and 5 years were 45%, 18% and 9% respectively. Patients with adenocystic carcinoma had the best prognosis.

Diagnosis of tracheal carcinoma at chest radiography.

All of the 95 primary tracheal carcinomas registered in Finland during 1967 to 1985 were reviewed. Chest radiographs of 44 patients were available. A tracheal tumor was detected in 8 cases (18%) in the primary examination and according to the review all the detected tumors were larger than 15 mm. However, when the same radiographs were reexamined by a senior radiologist, the tumor was identified in the correct site in 66%. This percentage parallels the results of high kV tracheal radiography (69%) performed on 32 patients. Tumors involving anterior or posterior wall and tumors near the bifurcation were the most difficult to detect.

Diagnostic value of plain radiographs in chronic maxillary sinusitis: a comparison between radiological and endoscopic findings in 75 patients.

Preoperative radiologic and intraoperative endoscopic findings of maxillary and ethmoid sinuses were compared in 75 adult patients, in whom 135 chronically inflamed maxillary sinuses were operated using functional endoscopic sinus surgery (FESS). At sinoscopy, secretion was found in 91% (41/45) of the radiologically opacified antra and in 47% (31/65) of the antra with moderate or marked mucosal swelling in plain radiographs. Antral fluid level in radiographs was a relatively rare (23%) finding and showed secretion as reliably as opacification. Radiographic detection of secretion in maxillary sinuses with mucosal thickening is difficult. There was a fair correlation in both antral and ethmoidal mucosal changes with the mucosal findings in antroscopy and endoscopic ethmoid surgery.

Cefetamet pivoxil in pediatric otitis media.

Cefetamet, an oral 3rd-generation cephalosporin, was investigated in 40 children with acute otitis media in a comparative randomized trial. The efficacy of 20 mg/kg cefetamet syrup in 20 patients was compared with that of 20 mg/kg cefaclor in another 20, both drugs being given orally twice daily for 7 days. Tympanocentesis was performed for every child before the initiation of antimicrobial treatment. After 7 days treatment with cefetamet pivoxil, clinical cure was obtained in 12 patients, 3 were failures and 5 could not be assessed. In the cefaclor group, 10 patients were cured, 1 improved and 9 were failures. No severe adverse events were observed with either drug.

Occurrence of tracheal carcinoma in Finland.

During the period 1967-1985, 95 primary tracheal carcinomas occurred in Finland. The mean annual incidence rate was one per one million inhabitants, the male:female ratio being 7:3. There was a significant increase of the disease by increasing age with the exception of 70-79 years. The most common location was the lower third of the trachea. Over two-thirds of the tumours were squamous carcinomas. Smoking seems to be an important risk factor at least in males.

Mequitazine and dexchlorpheniramine in perennial rhinitis. A double-blind cross-over placebo-controlled study.

The therapeutic effect and adverse reactions of two antihistamines, mequitazine and dexchlorpheniramine were double-blindly compared both to placebo, to each other and to the pre-treatment status in 29 adult patients suffering from perennial rhinitis. Dexchlorpheniramine relieved the rhinitis symptoms significantly (p less than 0.01) better compared to placebo while mequitazine did not differ from placebo. 20 out of 29 patients chose dexchlorpheniramine as their favourite drug. Dexchlorpheniramine reduced all the separate symptoms studied (obstruction, rhinorrhoea, sneezing) significantly, mequitazine relieving merely rhinorrhoea. In anterior rhinoscopy mucosal congestion was reduced both by dexhlorpheniramine (p less than 0.01) and by mequitazine (p less than 0.05) but secretion or lividity showed no difference between the active drugs and placebo. The occurrence of side-effects was not significantly different between the drugs. In controlling perennial rhinitis symptoms mequitazine was markedly inferior to dexchlorpheniramine and only slightly better than placebo.

Serum levels and urinary excretion of mequitazine after a single oral dose.

Pharmacokinetics of mequitazine, a recently introduced peripheral H1-histamine receptor antagonist of phenothiazine type, was followed up to 72 h after the single oral dose of 5 mg of the drug to eight fasted healthy volunteers. Each subject was treated thrice with a dosing interval of 15 days or more. Thus all the results were triplicated. Serum mequitazine was measured by mass fragmentography using a gas-liquid chromatograph/mass spectrometer set in the electron impact mode. Urine phenothiazines were determined fluorometrically before and after cleaving phenothiazines from their glucuronide conjugates. Peak concentration of mequitazine in serum was 3.19 +/- 1.70 (s.d.) ng.ml-1, time to peak concentration 5.67 +/- 1.68 h, elimination half-life 45 +/- 26 h, and elimination rate constant 0.018 +/- 0.007 h-1. Only 10.9 +/- 3.3% of the dose appeared in urine in unconjugated plus the glucuronidated form during the first 72 h. About 46% of the urinary phenothiazines were glucuronide conjugates. The results suggested that after the oral administration only low mequitazine concentrations appeared in serum, most of the drug seemed to be deactivated by the extrarenal route, and the kinetic properties of the drug resembled those of several phenothiazines used for psychiatric therapy.

Middle ear fluid bacteriology of acute otitis media in neonates and very young infants.

The middle ear fluid (MEF) bacteriology of 107 attacks of acute otitis media (AOM) in 101 infants less than 3 months old was analyzed. A total of 108 bacteria were isolated from 85 attacks. Major AOM-pathogens, S. pneumoniae (19%), H. influenzae (9%) or B. catarrhalis (7%) were cultured in approximately one-third of all the attacks. S. aureus (17%) and coagulase-negative staphylococci (22%) without the above pathogens were commonly found, whereas gram-negative enteric bacteria were culturable from only 5 attacks. Only 8% of the MEFs were polymicrobial. More than half of all the bacterial strains produced beta-lactamase. The bacteriology of those younger than one month was not different from that of the others. The same was true with attacks of out-patients and in-patients, except for a larger proportion of beta-lactamase producing strains in in-patients. Nasal-nasopharyngeal and MEF samples showed the same bacteriology in only 20% of cases. Two-thirds of AOM attacks were present in infants with perinatal or other concomitant morbidity, but their bacteriology was not different from those without other morbidity. In addition to the examination of ears in infants presenting with any illness before the age of 3 months, the study stresses the importance of bacteriological analysis of MEF in all cases of AOM at this age.