Cervical paragangliomas: diagnosis, management and complications.

Sixteen patients were diagnosed as suffering from cervical paragangliomas. Eleven patients (68.75 per cent) had twelve carotid paragangliomas (CPs), and five patients (31.25 per cent) had six vagal paragangliomas (VP). One CP (8.33 per cent) originated from paraganglia around the common carotid artery (CCA). Three cases of multiple paragangliomas are presented (18.75 per cent). In 80 per cent (4/5) of VP patients there was widening of the carotid bifurcation similar to that seen with CP. This widening occurred whenever the VP was large enough to grown in between the external carotid artery and internal carotid artery (ECA and ICA). Large VPs may displace the vessels either anterolaterally or anteromedially. Knowledge of the direction of the carotid displacement is essential to avoid intra-operative vascular injuries. Colour flow doppler ultrasound (CFD-US) was found to be a good non-invasive method for diagnosis of vascular neck swellings. It enabled the diagnosis of CP with 100 per cent accuracy, but it was not sufficient for diagnosis of high VP. A transcervical approach, cutting the digastric muscle and the styloid process with the attached ligaments and muscles, was sufficient for excision of most VP. However, midline mandibulotomy might be necessary with high VP. Vascular injuries occurred in 12.5 per cent (2/16) of patients. Superior laryngeal nerve and hypoglossal nerve paralysis occurred, respectively, in (2/11) and (1/11) of patients with CP. Vagal paralysis occurred in all patients with VP. Cerebrovascular accident and post-operative death occurred in one patient (6.26 per cent).

Lateral saccular cysts of the larynx. Aetiology, diagnosis and management.

Lateral saccular cysts have been diagnosed in 17 patients. Definitive diagnosis was made by computed tomography (CT) that showed a fluid-filled cystic swelling of the saccule with no air fluid level in all patients. Fifty-three per cent of cysts were bulging through the thyrohyoid membrane. They were hugely enlarged in 18 per cent, moderately enlarged in 24 per cent, and slightly enlarged in 12 per cent of patients. One patient (six per cent) showed bilateral cysts. Lateral saccular cysts were primary in origin in 82 per cent of patients and secondary to prolonged intubation, hemilaryngectomy, and laryngoscleroma in 18 per cent of patients. Surgical excision via a lateral cervical approach was performed in eight patients, whereas endoscopic CO2 laser vestibulectomy was performed in nine patients. Endoscopic vestibulectomy with CO2 laser proved to be an efficient and safe procedure for excision of small and medium-sized cysts with a diameter equal to or less than 3 cm in the greatest dimension. The external approach appears more efficient than laser vestibulectomy in excision of huge cysts, as 22 per cent of patients undergoing laser surgery showed a recurrence.

Pitfalls in the surgical management of cancer of the larynx and hypopharynx.

This article is based on findings in 180 patients with cancer of the larynx and hypopharynx. Positive margins were found in 12.2% (22/180) of all tumors, 12.5% (8/64) of supraglottic tumors, 16% (4/25) of transglottic tumors, 5.3% (2/38) of glottic tumors, 11.1% (2/18) of pyriform fossa tumors, 50% (3/6) of posterior pharyngeal wall tumors, and 10.6% (3/29) of postcricoid tumors. The relationship between the inadequate surgical margins of the specimens, tumor spread, preoperative CT findings, and surgical procedures performed have been correlated.

Uterine response to PGE2 with IUDs: a possible mechanism of action and side effect.

PIP: 10 healthy nonpregnant women aged 20 to 35 years with at least 2 children and normal regular menstrual cycles participated in this study which was conducted to determine the effects of IUDs on uterine activity and to study uterine response to PGE2 (prostaglandin E2) before and after IUD insertion. The women were recruited on days 2 to 3 of the cycle. Uterine activity was recorded in 3 sessions (proliferative phase; midcycle; secretory phase) during the control cycle. Spontaneous contractility patterns were recorded in all cases followed by local PGE2 administration in 7 cases. A plain Lippes Loop size C was inserted in the next cycle and uterine contractility recorded during the same phases and on same days following same experimental design as control cycle. The results show that Lippes loop size C causes an increase in spontaneous contractility of the nonpregnant uterus, depending on phase of the cycle studied. Changes were minimal in the proliferative phase (3 out 7 cases) and more common in the other phases (all cases in luteal and menstrual phases). Excessive or irregular bleeding and cramps may be traced to the general tendency towards hypermotility due to the presence of IUDs. The contraceptive action of IUDs may be partly attributed to the uterine hyperactivity observed in the early or mid-luteal phase after IUD insertion. Increased uterine sensitivity to local instillation of PGE2 at the proliferative and luteal phases was observed following IUD insertion. Post-insertional changes in basal motility was also attributed in part to the increased or altered uterine reactivity to PGs as a result of IUD insertion.^ieng