[Cervical metastasis of squamous cell carcinoma of unknown origin: experience at Hospital de Sant Pau, Barcelona, Spain]. / Metástasis cervical de carcinoma escamoso sin primario conocido: experiencia en el HSCSP.

Between 1984 and 1992, 18 cases of cervical metastasis of squamous cell or anaplastic carcinoma (1% of all head and neck tumors) were seen at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). Fifteen patients underwent radical surgery: 1 N1, 4 N2A and 10N3, N1 and N2A patients underwent surgery followed by radiotherapy. The 10 N3 patients began with neoadjuvant chemotherapy (cisplatin and 5-fluorouracil), then 8 had radical neck dissection and 2 had palliative radiotherapy. The primary tumor was found in 11%. The 5-year survival rate was 40% in N1+2A and 11% in N3. Chemotherapy did not improve survival in advanced disease, but it facilitated neck dissection and selection of the group with the prognosis.

[Laryngocele: clinical and therapeutic study of 60 cases]. / Laringoceles: estudio clínico y terapéutico de 60 casos.

Sixty patients with laryngocele were diagnosed in the last seven years: 25 of them without previous laryngeal pathology (group A) and the rest 35 with laryngeal or pharyngeal cancer (group B). The laryngocele was unilateral in the majority of the 25 patients of group A (68%). The internal laryngoceles were the most common type (63%). The initial symptom was hoarseness in 56% of these patients and 20% developed, in their evolution, an acute respiratory distress. The diagnosis was clinical in 16 patients and radiological in the rest. Endoscopically marsupialization with laser-CO2 was performed to remove internal laryngoceles. The mixed and external laryngoceles were completely removed via an external cervical approach without the need to perform any thyrotomy. The diagnosis was radiological by CT in the 35 patients of the group B. In 30 of them the CT was performed to evaluate the local extension of the laryngeal or pharyngeal cancer before its treatment. Supraglottic carcinoma was the most common laryngeal tumor (50%). The anatomic relationship between laryngocele and laryngeal cancer was ipsilateral to each other only in 50% of the patients. In the other 5 patients, no laryngocele was found in the radiological study previous to the treatment of the laryngeal or pharyngeal cancer. The diagnosis was made after chemotherapy and/or radiotherapy treatment.

[Carcinoma of superior aerodigestive pathways in the Otolaryngological Services of the Santa Creu and Sant Pau Hospital in Barcelona]. / Carcinomas de las vías aerodigestivas superiores en el Servicio de ORL del Hospital de la Santa Creu i Sant Pau de Barcelona.

We have studied 1,353 patients with squamous cell carcinoma of the head and neck diagnosed between June 1984 and December 1991, at the Service of Otolaryngology of the Hospital de la Santa Creu i Sant Pau of Barcelona. We have analysed tumor location, age, sex, tobacco and alcohol consumption, tumor staging, and the incidence of nodal involvement as they relate to the extension of the primary tumor. We have found the features accepted for the south of Europe such as a high male predominance, and a very high incidence of advanced stages at the moment of diagnosis for all the regions except for the glottis. The glottis has been the only region--in the present study--where we have achieved an early diagnosis in a high proportion of cases.

[Synchronous carcinomas of the upper aerodigestive tract: a diagnostic and therapeutic problem]. / Carcinomas sincrónicos de vías aerodigestivas superiores: un problema diagnóstico y terapéutico.

Patients with epithelial cancer of the upper aerodigestive tract are at increased risk of a new epithelial cancer developing in the same upper aerodigestive tract, in the oesophagus, or in the lung. We studied the cases seen at our Hospital in the last seven years. The clinical characteristics, the diagnosis and the treatment of 38 patients with synchronic epithelial cancer of the upper aerodigestive tract, oesophagus and lung, were reviewed.

Primary tracheoesophageal puncture vs esophageal speech.

We studied the cost-efficiency profile of tracheoesophageal puncture with prosthesis insertion in alaryngeal patients who were given the opportunity of choosing between esophageal and prosthetic voice. A primary tracheoesophageal puncture was made in 28 patients who were undergoing total laryngectomy. Five of the patients were excluded from the study because of failure to phonate correctly with their prostheses. The remainder were given esophageal speech instruction while they were using tracheoesophageal speech, and were permanently allowed to shift between both techniques of alaryngeal voice. Seventy percent of the patients (16/23) left the prosthetic voice to use only esophageal speech, even though they agreed that prosthetic voice was superior to esophageal voice. The remaining 30% (7/23) continued to use tracheoesophageal speech almost exclusively. In the authors' opinion, primary tracheoesophageal punctures significantly provide both psychological and practical help, as they supply an immediate and clear postoperative voice, and one of every three patients will use them for daily oral communication. Nevertheless, esophageal speech is still the method of voice restoration preferred in our region by those of our patients who managed to learn it.

[Vocal rehabilitation of the laryngectomized patient using tracheo-esophageal puncture and phonatory prosthesis]. / Rehabilitación vocal del laringectomizado mediante punción traqueoesofágica y prótesis fonatoria.

We present the results of 25 tracheo-esophageal punctures (20 primary and 5 secondary) followed by insertion of a voice prosthesis, as a method of voice restoration after total laryngectomy. This method is compared with the other three commonly used (tracheo-esophageal fistuloplasty, esophageal voice, and electrolarynx), and a personal variation (Burgués) of the primary tracho-esophageal puncture technique is presented.

[Cancer of the hypopharynx: clinical and epidemiological data on 41 cases]. / Cáncer de hipofaringe: datos clínicos y epidemiológicos de 41 casos.

The clinical and epidemiological data of 41 hypopharyngeal neoplasms diagnosed at the Department of Otolaryngology, Hospital de "La Santa Cruz y San Pablo", Barcelona, are analysed according to eleven computerized parameters. Our results are compared with those appeared in the literature. Though the are close similarities with regard to incidence, sex, tobacco and alcohol consumption, presentation, and histology, our patients are younger and in a better condition than it is generally accepted.