Sixteenth Daniel C. Baker, Jr, memorial lecture. Surgical management of supraglottic cancer and its lymph node metastases in a conservative perspective.

Supraglottic laryngectomy combined with functional elective or curative neck dissection is a priceless contribution toward treatment of supraglottic cancer and its lymph node metastases. The history and background of this conservative approach is reviewed. Results related to staging are presented.

Medical treatment of senile cataract: clinical investigation of bendazac-lysine using objective and subjective methods.

A modified Zeiss slit lamp coupled with a digital image-processing system was used to evaluate objectively changes in lens transparency over 1 year at 4-month intervals in 150 eyes of 92 patients affected by early senile cataract. A total of 59 patients were treated daily with 1.5 g bendazac-lysine, and 33 patients constituted the control group.

Extended supraglottic laryngectomy. Review of 84 cases.

Extended supraglottic laryngectomy is a surgical procedure by which the boundaries of standard supraglottic laryngectomy are extended to include the base of the tongue and/or pyriform sinus and/or one of the arytenoids, according to the extent of epilaryngeal or extralaryngeal invasion by vestibular cancer. We report the results of 84 extended supraglottic laryngectomies performed by our group from 1970 to 1980. Besides the highly favorable 5-year cure rate (75%), full functional rehabilitation followed in all but three patients, who were therefore submitted to secondary total laryngectomy.

Modifications of the slit lamp for digital image processing of the anterior segment of the eye.

The Zeiss slit lamp has been modified in order to extend its use to measurements of lens transparency. Two major modifications have been introduced: (1) a support for a high-sensitivity TV camera that is connected to an image processing system; (2) two potentiometers for recording electrical signals proportional to the rotation angle of the slit-supporting arm with respect to the visual axis and the slit tilting angle. As a result, the slit lamp output consists of three signals; one TV signal for the images and two analog signals for measurement of the angles.

Device for eliminating corneal light reflections during recording of lateral images with a slit lamp.

Corneal reflections produce defects in photographic sections of the lens taken with a slit-lamp biomicroscope for computerized densitometric analysis of cataract opacity. A simple and workable, adjustable antireflection device was built that can be easily adapted to photographic slit lamps, a common instrument in ophthalmology equipment. The slit lamp is a versatile tool for photographing structures in the anterior segment of the eye, particularly the lens.

Occult metastases in cancer of the larynx and their relationship to clinical and histological aspects of the primary tumor: a four-year multicentric research.

The authors have tried to verify whether some clinical or pathological features of laryngeal cancer may favor the occurrence of occult metastases in the lymph nodes of the neck in N0 cases. The purpose of the investigation was to define the possible existence of tumors, where elective neck dissection, in the absence of palpable nodes, could be done without, thus contributing to settlement of a long debated problem. Different parameters, both clinical and pathological, have been considered.

Functional neck dissection: an evaluation and review of 843 cases.

After briefly reviewing the principles, indications, and merits of functional neck dissection, the results of 1200 neck dissections performed on 843 patients in the period 1961-1979 are presented. They compare very favorably with those reported for classic (radical) neck dissection by other leading authors; however, a retrospective analysis of data derived from material of different origin is hardly possible and has a disputable value. Therefore, we decided to compare our data on functional neck dissections (FND) with those of classic neck dissections (CND) performed by the same surgical team at the same clinic in the period 1948-1960.

Supraglottic laryngectomy: 30 years of experience.

A review of 467 cases of supraglottic laryngectomy operated during the last 30 years is presented. Cases have been subdivided into groups according to stage and TNM classification. By far the most numerous in this series were T2 cases.

Functional neck dissection. A description of operative technique.

The operative technique involved in functional neck dissection is described to clarify its stepwise execution. Recent interest in functional preservation demands therapeutic techniques that are oncologically reliable but not multilating. The functional neck dissection seems to be a reasonable alternative to radical radiotherapy and a preferred alternative to traditional neck dissection in the control of regional metastasis when disease in the neck is either occult of still confined to mobile lymph nodes.

Masking level difference: another tool for the evaluation of peripheral and cortical defects.

Masking level difference (MLD) due to binaural unmasking was measured for speech signals (5-word meaningful sentences) masked by broad-band noise. Tests were carried out in a group of patients with unilateral cerebral lesions of vascular origin and apparently normal pure-tone audiograms (CNS patients), in a control group (normally hearing young adults) and in 5 other groups of patients (conductive symmetrical hearing loss, conductive asymmetrical hearing loss, bilateral presbyacusis, unilateral sudden deafness, Menière's disease). Testing pattern implied three or more S/N ratios in the listening conditions, of SmNm, Sdelta tNo and SmNu (noise correlated), and the speech signal intensity was 70 dB SPL re 20 muPa for the control group, whilst for the pathological cases, speech level intensities were established by means of alternate binaural loudness balance and simultaneous balancing median-plane localization procedures to assess subjective suprathreshold sound image localization at the midline.

Conservative neck dissection.

The areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses.

Supraglottic cancer.

Supraglottic cancer, because of the embryological development of the larynx, and of the arrangement of its lymphatic network, tends to remain limited within the vestibule of the larynx and the pre-epiglottic space also in its advanced stages of evolution. The cancer spread may superiorly involve the epilarynx, the vallecula, the base of the tongue, and the pyriform fossa; however, inferiorly, the invasion of the glottis is quite exceptional (1 percent of cases); therefore, supraglottic laryngectomy is the operation of choice. The lower the location of cancer in the vestibule, the safer the indication.

Limitations of supraglottic laryngectomy and conservative neck dissection.

Limitations of supraglottic laryngectomy may arise from either the primary location, or secondary spread of the tumor in the vestibule. When a growth reaches the epilarynx a modified supraglottic laryngectomy or a more radical operation must be envisaged. Other limitations include poor bronchopulmonary condition, age of the patient, and previous radiotherapy.