Jack Sidi

Percutaneous tracheostomy: a new method

A rapid method of definitive low tracheostomy utilizing an original instrument kit and percutaneous approach is described. Through a horizontal, shallow (1.5-cm) skin incision in the neck, a 12-ga needle is introduced into the tracheal lumen. A flexible metal guidewire is gently introduced through the needle, which is then removed. A specially designed percutaneous tracheostomy tool slides over the guidewire into the trachea; by squeezing its handles, the intercartilaginous space is enlarged, securing the placement of a cuffed tracheal cannula. After extensive and successful investigation in both cadaver and animal trials, the procedure was carried out in 80 patients who had a variety of underlying diseases, without serious complications. Of these 80 patients, 33 required airway control after neurosurgical interventions or after severe head trauma, 23 had percutaneous tracheostomy performed before radical excision for head and neck cancer, and the remaining 24 suffered from severe cardiorespiratory problems. Twenty-nine procedures were performed in the operating theater, and 51 procedures were carried out at the patients bedside in the ICU, ED, or in the ward. There was no infection at the stoma site, and late healing was remarkable. It should be strongly emphasized that in the majority of our patients the procedure was carried out safely at the bedside. This resolved the logistic problem of moving very sick ICU patients (who are sometimes on high PEEP levels) to the OR. Although our experience is totally restricted to elective situations, we do postulate that it could be as effective in a variety of urgent situations.

Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy

Hurthle cell carcinoma is a rare thyroid cancer histologically related to the well‐differentiated malignancies of the thyroid gland. This report presents the evaluation of 30 years experience in treating 17 patients (out of 549 thyroid cancer patients) with Hurthle cell carcinoma. All 17 patients were treated surgically. Six patients (35.3%) died of their thyroid disease. Survival rates for 10 and 15 years were 63.7% and 25%, respectively. These rates are above those of high‐grade malignancies and below those of low‐grade malignancies of the thyroid gland. Nonsurgical treatment, including radioactive iodine therapy, is disappointing; thus, initial radical surgery is recommended as the treatment of choice. Cancer 57:1613–1617, 1986.

Laryngeal carcinoma in patients 40 years of age and younger.

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1NOMO) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1NOMO) and seven patients (35%) had laryngeal carcinoma in Stage II (T2NOMO) and III (T3NOMO). Patients with T1NOMO received only radiotherapy. Three patients with T2NOMO underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3NOMO received pre‐operative and postoperative radiotherapy in addition to total laryngectomy. The 5‐year survival rate for T1NOMO and T2NOMO was 100% and for T3NOMO 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.

Congenital pleomorphic adenoma of the nasopharynx (report of a case).

A case of congenital salivary gland tumour occurring in the nasopharynx is reported. Congenital neoplasms of the head and neck (of any histological type) and congenital tumours of the nasopharynx are discussed and the literature is reviewed.

Acute myelogenous leukemia presenting as facial nerve palsy. A case report

A case is presented of a 5.5-year-old girl admitted with acute mastoiditis and facial nerve palsy. The final diagnosis of leukemic infiltration of the mastoid bone, middle ear and VIIth cranial nerve was made only after surgery and histological examination. Similar cases described in the English literature are reviewed and treatment is discussed. Chemotherapy or combined chemo- and radiotherapy are the treatment of choice in known leukemic patients without symptoms of superimposed infection of the ear or the mastoid process. Surgical management is restricted to cases in which tissue for histological diagnosis is required or drainage of acute infection is needed.

Anaplastic thyroid carcinoma metastatic to the tonsil

We describe a 65-year-old woman who presented with a left tonsillar tumour. Biopsy revealed metastatic anaplastic cell carcinoma of the thyroid. Metastatic tumours are rare in the tonsils. This case, to the best of our knowledge, is the first in which the thyroid was the primary site.

Heterotopic salivary tissue and branchial sinuses.

Heterotopic salivary tissue and branchial sinuses occur not infrequently (Goodman et al., 1981; Stingle and Priebe, 1974), caused probably by heteroplasia within remnants of the second cleft (Stingle, 1974). Bilateral lesions which presented clinically as branchial cleft sinuses have been removed from a patients neck; both of them proved to be branchial cleft sinuses with elements of salivary tissue. The paper describes salivary tissue and branchial sinuses along the anterior border of the sternocleidomastoid muscle on both sides of the neck and bilateral preauricular fistulae occurring in a boy and probably in his sister.

Epidemiological aspects of idiopathic peripheral facial palsy

Four hundred and twenty seven idiopathic peripheral facial palsy (IPFP) patients admitted to the Otolaryngology Department of the Soroka Medical Center in southern Israel between 1978 and 1982 were characterized and analyzed by age, sex and season of illness. An average annual incidence rate of 33.6 patients per 100,000 inhabitans was calculated which is considered to be the highest incidence reported so far, and may be explained by the very high coverage of the ≪Sick Fund≫ insurance in the region and by the warm arid climate that prevails in the area. Knowledge of the demographic characteristics of the patients and the population in the catchment area, allowed the calculation of age-specific incidence rates and it was found that this rate increases with age, reaching a peak of 68.2/100;00 in the older age group (>65 years of age). Peak morbidity in young patients (<30 years of age) occurs in the winter while elderly patients lack seasonal variability.

Ossified segments of the stylohyoid ligament A case of radiological misdiagnosis

An ossified segment of the stylohyoid ligament was misdiagnosed as a foreign body.

Haemangioma of the zygoma presenting as a tumour in the maxillary sinus

A case of haemangioma of the zygomatic bone is presented. The presenting symptoms and signs of this case, unlike those of the other five cases described in the English literature, were of an antral tumour. The treatment comprised surgical removal through a Caldwell-Luc approach. Clinical and histopathological considerations are discussed.