Jacob Shvero

Papillary carcinoma of the thyroid

Between 1954 and 1993 503 patients with papillary carcinoma of the thyroid were treated at the Department of Otolaryngology-Head and Neck Surgery of the Beilinson Medical Center. Two thirds of these patients were women. The median follow-up period was 10.3 years. In more than 30% of cases the tumor was discovered because of the presence of an enlarged lymph node and/or invasion to adjacent structures. Total or near-total thyroidectomy was performed in 381 patients. The 48 patients in whom it was necessary to perform a reoperation had a significantly higher complication rate. Multicentricity was found in 65% of those cases in which both thyroid lobes were available for histologic examination. Nineteen patients were found to have a tail cell variant, 223 had a pure papillary variant, and 261 a follicular variant. The mortality rate was 6.2% 15 years after initial therapy. A number of factors-age, size of tumor, presence of distant metastases, tall cell variant, and type of surgery-were found to be significant predictors of survival. After almost 40 years of experience in treating more than 500 cases of papillary cancer, we have come to the conclusion that the surgical approach should be aggressive.

Objective and subjective nasal airflow

PURPOSEnThis study was designed to assess whether a correlation exists between the rhinomanometric measurement of nasal resistance, nasal airflow, and the subjective sensation of airflow.nnnMATERIALS AND METHODSnSixteen patients with recurrent maxillary sinusitis were examined before and after uncinectomy during functional endoscopic sinus surgery. Subjective nasal sensation of airflow was assessed by means of a visual scale before and after uncinectomy. Rhinomanometry was performed three times for every patient: before anesthesia, and before and after uncinectomy. The subjective nasal sensation of airflow was compared with the nasal airflow and resistance to flow as measured by rhinomanometry.nnnRESULTSnRhinomanometric measurements were almost the same before and after uncinectomy, with no significant difference, whereas patients reported a significant improvement in nasal airflow.nnnCONCLUSIONnRhinomanometric measurements of nasal airflow and resistance often have no correlation to the patientss sensation of airflow. However, because it is the patients ultimate concern to breathe more comfortably, the rhinomanometer has little clinical value.

Anaplastic thyroid carcinoma. A clinical, histologic, and immunohistochemical study.

Twenty‐six cases of anaplastic thyroid tumor were investigated and reclassified using immunoperoxidase techniques. Sections of the neoplasms were stained immunohistologically for the following thyroid associated antigens: (1) thyroglobulin, which shows a positive reaction with follicular cells of the thyroid; (2) calcitonin, which is positive in medullary carcinoma of the thyroid; and (3) leucocyte common antigen (LC), which identifies lymphomata and Factor VIII‐related antigen for hemangioendothelioma. Using these methods, five cases were reclassified. Three cases were identified as lymphomata, one case was reclassified as medullary carcinoma of the thyroid, and one case was identified as hemangioendothelioma. Eleven cases were confirmed to be anaplastic carcinoma of the thyroid and ten cases were negative for all the antigens tested. There was a significant difference in the survival of the groups of patients mentioned above. Prognostic data support the suggestion that immunohistochemical methods should be used for the precise classification of anaplastic thyroid carcinoma. In this way, tumors such as malignant lymphoma and medullary carcinoma, which resemble anaplastic carcinoma histologically but have a better prognosis, can be identified. This is important for planning surgical procedures and chosing chemotherapy and/or radiotherapy.

Isolated sphenoid sinus changes--history, CT and endoscopic finding.

This study reviews the records of 21 patients with isolated sphenoid sinus disease who were treated by rigid endoscopic sphenoidotomy at the Nose and Sinus Unit, Department of Otolaryngology of Beilinson Medical Center, Israel. Diagnosis was made on the basis of history, rigid nasal endoscopy and computed tomography (CT) scan. The most frequent symptom was headache; no instances of pathognomonic headache were found. Sphenoidotomy was performed through the area of the natural ostium. The pathological finding was infection in 11 patients, cyst in four patients, polyps in three patients, mucocoele in two, and inverted papilloma in one patient. Surgical results were very good. Endoscopic sphenoidotomy proved to be safe, with minimal blood loss, reduced operating time, decreased morbidity, and short post-operative hospitalization.

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.

Well-differentiated thyroid carcinoma

PURPOSEnThis study presents our experience with 728 patients treated in our department for well-differentiated thyroid carcinoma between 1954-1994.nnnMATERIALS AND METHODSnThe retrospective evaluation of the prognostic implications of the clinical and pathological findings was performed. Age, sex, histological variants, tumor size, and locoregional and distant spread were evaluated as risk factors in relation to the prognosis.nnnRESULTSnDuring follow-up, which ranged from 1 to 31 years, 125 locoregional and/or distant metastases developed (17.2% of the patients), 87 of which occurred in the first 10 years after initial therapy. Thirty-two patients with papillary cancer and 20 with follicular cancer died of causes related to malignancy of the thyroid.nnnCONCLUSIONnThe experience gained in our department has led us to adopt an aggressive approach in the treatment of patients with well-differentiated carcinoma of the thyroid gland.

Stapedotomy technique and results: Ten years' experience and comparative study with stapedectomy

Fifty of the 810 patients who underwent stapedotomy for otosclerosis from 1969 through 1988 were randomly chosen for follow‐up of at least 5 years. Most of the patients (65%) had follow‐ups of 10 years after stapedotomy, but another 50 patients who underwent stapedectomy had follow‐ups of longer than 10 years.

Histopathological changes of the nasal mucosa induced by smoking

Changes in the histopathology of the respiratory epithelium in response to cigarette smoking have been studied in depth in the lungs, but data on the nasal lining are lacking. The aim of the present retrospective study was to investigate the histological changes that occur in the nasal mucosa of smokers compared with non-smokers. The study group included 47 patients who underwent partial resection of the inferior turbinates. Archival nasal tissue samples were collected and examined by light microscopy: the number of goblet cells was counted, and the degree of inflammation, congestion, and edema was graded as mild, moderate, or severe. Epithelial thickness was measured as well. Findings were compared between smokers (nu2009=u200921) and non-smokers (nu2009=u200926). On statistical analysis, significant differences were found between the smokers and non-smokers in mean number of goblet cells in the nasal epithelium, 43.43u2009±u200916.80 vs. 16.23u2009±u20095.65 respectively (pu2009<u20090.0001), mean edema grade, 2.43u2009±u20090.75 vs. 1.12u2009±u20090.33 respectively (pu2009<u20090.0001), and mean epithelial thickness, 111.9u2009±u200925.8 μm vs. 60.4u2009±u200918.4 μm respectively (pu2009<u20090.0001). The corresponding mean values of congestion were 2u2009±u20090.71 and 1.27u2009±u20090.67 (p < 0.001), and of inflammation, 1.81u2009±u20090.60 and 1.81u2009±u20090.85 (NS). In conclusion, the histopathological findings in the nasal mucosa of smokers resemble reported findings in the bronchial respiratory epithelium. The main differences from non-smokers are greater goblet cell hyperplasia and thicker epithelium.

Oral ofloxacin as treatment of malignant external otitis: A study of 17 cases

Seventeen patients with malignant external otitis were treated with oral ofloxacin. Their mean age was 69 years. Seven of the patients were diabetic.

Respiratory distress due to diffuse cervical hyperostosis.

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are common findings. Although these hypertrophic changes can be completely asymptomatic, it is known that dysphagia may occur occasionally in the presence of massive cervical hyperostosis. Laryngotracheal symptoms due to cervical hyperostosis are less frequent and may be managed initially as tumors of the esophagus, trachea, or thyroid gland. The management of two severe cases of dyspnea due to cervical ankylosing hyperostosis are discussed.