Subtotal laryngectomy.

A subtotal laryngectomy may meet the requirements of adequate tumor resection in many patients who normally would undergo total laryngectomy. The uninvolved column of innervated endolarynx sacrificed at total laryngectomy to separate the airway and the food way can be preserved to valve a speaking shunt. Such a shunt remains patent and sphincteric without the use of a prosthesis an offers consistent advantages over "post-total" laryngectomy reconstructions.

Extended hemilaryngectomy for T3 glottic carcinoma with preservation of speech and swallowing.

Total laryngectomy is often applied in the treatment of invasive squamous cell carcinomas that fix one side of the larynx. The major drawback, of course, is loss of the voice. In many instances, however, preservation of the uninvolved portion of the larynx is compatible with adequate tumor margins, and the preserved laryngeal remnant, although it cannot be reconstituted to allow breathing, can readily be used for voice.

Follow-up on maxillary artery ligation for epistaxis.

Forty-six transantral maxillary artery ligation cases were compared with 30 controls with regard to the outcome of their treatment of epistaxis. The success rate and the complication rate were higher in the ligated patients. Maxillary artery ligation for severe idiopathic epistaxis is a valid procedure only if injury to the infraorbital nerve is avoided.

Laser therapy of rheumatoid arthritis.

Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec. One hand was lased at the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints, whereas the other hand was sham lased.

Alaryngeal speech and development of an internal tracheopharyngeal fistula.

Excellent speech can be produced by diverting expired pulmonary air to the pharynx through a tracheopharyngeal fistula. This study contributes basic information regarding the selection and fate of autogenous skin-lined tubes created for this purpose in a standardized fashion in pigs. Our specific objectives were to determine (1) the best cutaneous autograft for constructing a 6- to 7-cm skin-lined tube, (2) the airflow resistance of surviving skin-lined tubes, and (3) the effect of salivary contamination of the survival of tube grafts.

Early recognition of cutaneous melanoma.

Criteria for the early recognition of malignant melanoma include appreciation of variegation in color and irregularity of lesion border and pigment pattern. Application of these criteria should result in the diagnosis of cutaneous melanoma in its premetastatic surgically curable phase.

The significance of augmented radiocolloid uptake by the spleen in patients with malignant melanoma.

Increase in splenic uptake of Tc-99m sulfur colloid was noted in 47 of 147 (32%) patients with cutaneous malignant melanoma early in the coure of disease. Patients with disseminated disease and/or clinical or laboratory evidence of hapatic dysfunction were excluded from study. Recurrence rate of 2 yr was higher for those patients with splenic scans demonstrating augmented uptake compared with patients having normal scans, 36% against 16% (p less than 0.

The transseptal approach to lesions of the pituitary and parasellar regions.

In a series of 505 consecutive procedures, the transseptal-transsphenoidal pituitary operation has proved safe and effective. The overall mortality in this series is 1.39%.

Successful management of bilateral carotid-cavernous fistulae with a trans-sphenoidal approach.

A patient with traumatic bilateral carotid-cavernous fistulae was successfully treated by an entirely extracranial approach. The larger fistula on the left was exposed via a transethmoidal, trans-sphenoidal route and was directly opened and packed while the cavernous carotid artery was stented open by an intraluminal balloon catheter. The balloon catheter provided temporary hemostasis and was removed after the fistula had been packed.

Transvesical Harris-Hryntschak prostatectomy with primary bladder closure and local vasoconstriction.

The simple, rapid and satisfactory method of the transvesical Harris-Hryntschak open prostatectomy is described. When this technique is used bleeding is reduced to an average of 85 ml. and visibility is improved by the local injection of a synthetic vasoconstrictor, ornithine-8 vasopressin, before enucleation.

Benign cervical cystic teratoma.

Teratomas of the neck are rare in adults. Nine adult patients have been previously reported on in the world literature; six had malignant and three had benign lesions. Most of the lesions were seen as a mass in the neck, but teratoma is rarely considered in the differential diagnosis of neck lesions.

Chondrosarcoma of the nasal cavity, paranasal sinuses, and nasopharynx.

Thirteen patients, six men and seven women, were seen at the Mayo Clinic with chondrosarcomas of the nasal cavity, paranasal sinuses, or nasopharynx in a 25-year period. Nasal obstruction, discharge, and bleeding were the major symptoms and a nasal mass was the most common sign. The typical chondrosarcoma is low in grade but malignant and it arises in the nasal cavity as a large, pale, glistening mass.

Gross and microscopical blood supply of the trachea.

Twenty-one human tracheal specimens were perfused and dissected, 10 with conventional techniques and 11 with clearing and microdissection techniques. The lateral pedicles of the trachea and esophagus induct vessels from the inferior thyroid, subclavian, supreme intercostal, internal thoracic, innominate, and superior and middle bronchial arteries. These vessels are interconnected along the lateral surface of the trachea by an important longitudinal vascular anstomosis.