Prognostic significance of thyroid gland involvement in laryngeal carcinoma.

We reviewed 173 laryngeal specimens that included thyroid tissue received from patients undergoing laryngectomy between 1966 and 1980 for evidence of thyroid gland invasion. Twenty-three (14%) of the larynges demonstrated thyroid involvement. In 15 specimens, involvement of the thyroid gland was by direct extension, and in eight the thyroid was involved metastatically.

Evaluation of chicken kidney and chicken embryo kidney cultures for the large-scale growth of attenuated influenza virus master strain A/Ann/Arbor/6/60-ca.

Primary chicken kidney (CK) and chicken embryo kidney (CEK) cells were evaluated as possible substrates for growth of the cold-adapted attenuated influenza vaccine master strain A/Ann Arbor/6/60 (A/AA/6/60-ca). Yields of 10(6)-10(7) TCID50 per ml of culture fluid were obtained in either cell type. Yields from the human diploid strain MRC-5 were approximately 100-fold less.

Primary subglottic carcinoma masquerading clinically as T1 glottic carcinoma--a report of nine cases.

In a clinical and pathological study of patients who had failed radiotherapy for T1 glottic carcinoma, nine patients were encountered who presented with hoarseness, and were considered clinically to have glottic carcinoma at an early stage. Whole organ sections of the laryngectomy specimens showed them to be tumors arising in the subglottic region with involvement of the vocal cord as a late manifestation of their disease. The clinical and pathological features of these nine patients and their tumors are discussed with emphasis on how the diagnosis may be made prior to embarking upon therapy.

Responses to one or two doses of a deoxycholate subunit influenza vaccine in a primed population.

A trial with a trivalent influenza subunit vaccine prepared with sodium deoxycholate was carried out in 88 volunteers between May and November 1981. Each haemagglutinin antigen was present at 7 micrograms per dose. Fourfold or greater haemagglutination inhibition antibody (HI) responses to the H1N1 virus A/Brazil/11/78 occurred in 70% of volunteers following a single dose.

Histopathological study of radionecrosis in laryngeal carcinoma.

With modern radiotherapy techniques, clinical radionecrosis is uncommon following eradication of primary squamous cell carcinoma from the larynx. Histologic sections from 265 specimens, prepared by the technique of whole organ subserial step-sectioning were studied to determine the incidence and location of chondronecrosis and/or osteomyelitis in both irradiated and non-irradiated cases. Chondronecrosis occurred in only 1 of 41 early (pT1 - pT2) tumors but in 143 advanced tumors (pT - pT4) treated with radical radiotherapy and containing residual carcinoma, 27% had evidence of significant necrosis, compared with 24% of those not irradiated.

Second primary respiratory tract malignant neoplasms in supraglottic carcinoma.

In this study, a second respiratory tract malignant neoplasm developed in 20 of 163 cases of supraglottic carcinoma either at the time of diagnosis or after diagnosis. Using an actuarial method of calculation, 19% of the survivors will experience a second respiratory tract malignant neoplasm within five years after the diagnosis of supraglottic carcinoma. This is three times the incidence in patients who survive glottic carcinoma and 14 times the incidence in the normal population.

Unique features of head and neck malignancies which relate to their management.

The unique features of head and neck malignancies which relate to their management have resulted in the development of a surgical specialty group for which training criteria have been established. Head and neck tumors are uniquely sensitivity to radiotherapy which provides the surgeon with an alternate method of therapy. They are easily visible and palpable so that the results of therapy can be readily assessed and appropriate treatment protocols developed.

Management of T3 glottic cancer.

We reviewed 144 cases of T3NOMO glottic cancer. One hundred twelve patients were treated by radical radiotherapy with surgery for salvage (RRSS), and 28 patients were treated by combined preoperative irradiation and laryngectomy. Two patients underwent palliative irradiation, and two patients had surgery alone.

Second primary respiratory tract malignancies in glottic carcinoma.

Of 740 cases of glottic cancer, a second respiratory tract tumor developed in 48. Only 14 cases would have been expected in a sample of the same age and sex distribution drawn from the general population of Ontario. Of 25 patients with second tumors in the lung, 23 are dead.

Primary carcinoma involving the temporal bone: analysis of twenty-five cases.

Twenty-five patients with primary carcinoma involving the temporal bone were reviewed. Pain and discharge were the most common complaints. A history of previous otitis media was found in 64% of the patients.

Radiotherapy of early glottic cancer.

Patients (383) with stage Tis, Tla and Tlb NoMo glottic cancer are reviewed. Radiotherapy cured 93% of Tis patients and 86% of Tla and Tlb cases. Of all recurrences, 63% were cured.

Fibromatosis presenting as vocal cord palsy.

For many years, pathologists have sought to create some order in the classification of non-metastasizing fibrous tissue disorders ranging from the benign keloid at one end of the scale to the "non-metastasizing fibrosarcoma" at the other. It is now generally accepted that these fibrous anomalies are members of the same family and the entire range from the most benign to the most bizarre is encompassed by the term "fibromatosis". Unfortunately, some of these lesions behave in a most aggressive manner and there appears to be little correlation between the histological appearance of the tumor and its clinical aggression.

Longterm effects of heavy irradiation to the neck.

The longterm effects of heavy irradiation to the neck are now well known. The literature contains reports of major skin contractures, hypothyroidism, laryngeal and tracheal stenosis, major vessel stenosis, and hypoplastic development of cervical vertebrae, but very rarely are all these complications seen in a single patient. Two patients have undergone extensive treatment at the Toronto General Hospital during the past decade for complications of neck irradiation in childhood and their stories should serve as yet another reminder that irradiation, although a major ally in oncological therapy when carefully applied, can be a tool of great destruction when used in excess.

Microvascular surgery.

In situations where existing techniques of reconstruction are inadequate or involve multiple stages, free-flap transfer offers major advantages for the head and neck surgeon. Wider application of free-flap surgery has been inhibited by problems of flap design and graft take. Thrombosis at the microanastomic site, particularly at the venous site, is still a cause of failure.

Laryngotracheal trauma: observations on its pathogenesis and its prevention following prolonged orotracheal intubation in the adult.

The authors have clinically examined the larynges of 117 patients who were successfully extubated in a Respiratory Care Unit, and have examined the larynges at autopsy from an additional 68 patients who failed to survive in the same Respiratory Care Unit. Based on these observations, our understanding of the pathogenesis of laryngotracheal trauma has allowed us to modify our clinical management in order to minimize such damage. Influence of this study on the management of patients is described.

Leiomyosarcoma of the cervical trachea. Report of a case with reconstruction using a latissimus dorsi island flap.

A case of leiomyosarcoma of the cervical trachea is described, detailing clinical presentation, pathologic diagnosis and surgical management. The rarity of this tumor in this location accounted for difficulties in clinical diagnosis and pathologic classification. Surgical treatment involved resection of two thirds of the circumference of the infracricoid trachea, with partial resection of the cricoid cartilage and thyroid gland.

Conservation surgery in laryngeal cancer and its role following failed radiotherapy. A histopathological and clinical study of 32 cases.

The partial laryngectomy specimens from 32 patients with laryngeal carcinoma were histologically examined by the technique of whole organ sectioning. Twenty-three of these patients had previous irradiation therapy. We identify local criteria for performing conservation laryngeal surgery based on clinical and histopathological studies.