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Simultaneous carcinomas of the esophagus and upper aerodigestive tract.

A review of 150 consecutive head and neck cancer patients over a 22-month period revealed a multiple primary cancer rate of 19%, 9% in the head and neck region. Nine patients (6%) had simultaneous esophageal and head and neck cancers. Complete systematic esophagoscopic examinations, in addition to barium swallow radiographic studies, are recommended for all patients with head and neck cancers.

Complications of CO2 laser surgery of the aerodigestive tract: experience of 4416 cases.

The CO2 laser was first Introduced for surgery of the aerodigestive tract in 1971. Since that time, great advances in application have been made in both the adult and pediatric population. Recent reports of isolated complications have appeared in the literature. However, a realistic complication rate in a large series of patients has yet to be reported. This report relates the combined experience of the authors in a total of 4416 cases during the 11–year period from 1971 to 1982. There were nine instances of complications, representing a complication rate of 0.2%. These complications provided a unique learning experience for the authors, and led to the establishment of certain basic principles that should be followed in all laser operations. This survey indicates that the CO2 laser is a safe, extremely useful surgical modality in the aerodigestive tract.

Anesthesia for carbon dioxide laser microsurgery on the larynx and trachea.

General anesthesia for laser microsurgery of the larynx and trachea included nitrous oxide (N?O), oxygen (02), halothane or enfiurane, and succinylcholine in children, and thiopental, N,O, 02, fentanyl, and succinylcholine in adults. During 392 procedures on 140 patients over a 28-month period, no side effects related to the procedure were seen nor were there any injuries to patients or personnel.

Pretreatment airway management in obstructing carcinoma of the larynx.

Partial endoscopic excision of obstructing laryngeal carcinoma with the CO2 laser is an alternative to emergency tracheotomy or emergency laryngectomy whenever the airway control can be initially ensured by endotracheal intubation. The practical advantages of this approach are elimination of the septic complications of tracheotomy, the opportunity for planned preoperative chemotherapy or radiation therapy, and better nutritional and psychologic preparation of the patient for surgery.

Diagnostic Value of Fine Needle Aspiration Biopsy in Neoplasms of the Head and Neck

In this paper, the cytologic findings of 90 aspirates obtained by the fine needle aspiration technique from head and neck masses are compared with the histology of the permanent section. The overall concurrence rate between cytologic and histologic findings for benign and malignant tumors is 80%. There is a 6.6% false negative rate. There are no false positive results. Fine needle aspiration biopsy is found to be safe, complication free, and most helpful in treatment planning.

The morphology of human papillomas of the upper respiratory tract

Recurrent squamous papillomas of the upper respiratory tract were examined by light microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Surface of the cells is irregular and is covered by numerous stout microvilli. These are shorter and broader than those of cells of the uninvolved mucosa. The villi often seem umbilicated at the apex; the remainder of them, however, are rounded. The epithelium participating in the formation of papillomas shows some maturation of the cells but this does not progress normally. The predominating area is the thickened spinous layer representing the bulk of the lesion. The basal layer shows mildly increased activity but the basement membrane is intact. The cells often are very closely packed but in some areas, more particularly in the deep layer, they are loosely arranged. The intercellular space contains a moderately electron‐dense finely fibrillar material. No abnormal mitoses are found. The neighboring uninvolved epithelium often shows increased growth activity and some inflammation. The laryngeal papillomas probably represent an overgrowth of epithelium which may develop following hindered desquamation caused and/or heralded by a chronic inflammatory condition probably of viral origin and may be preceded by epithelial metaplasia and hyperplasia.

Argon laser and soft tissue interaction.

The interaction of the argon laser with the mucous membrane of the upper aerodigestive tract was studied. The advantages of the argon laser are a small spot that can be varied in size and intensity, selective vascular absorption, the capability of being incorporated into a flexible delivery system, and a coincident aiming beam. The acute soft tissue effects are characterized by subepithelial extension, with a variable delayed reaction between the application of the laser and a detectable break in the epithelium. Postoperative edema persisted, with an increase in the lateral spread of the lesion over 3 days and an acute inflammatory reaction extending over 7 days. By 21 days the lesions were reepithelialized and healed, but their width was 30% greater than the original defect. The unpredictable interaction with soft tissue, the postoperative edema, and the quality of wound healing are disadvantages. The argon laser appears to have limited clinical potential as a surgical tool for the air and food passages.

Continuous vindesine infusion in advanced head and neck cancer.

SIXTEEN PATIENTS WITH ADVANCED squamous cell carcinoma of the head and neck were treated with a 48-hour I.V. vindesine infusion. The dosage was 3 mg/m2/48 hours every 2 weeks. Toxicity consisted of leukopenia, paresthesias, and phlebitis. Major objective responses were seen in four patients (one CR, three PR), with a median duration of 4 months.

Induction bleomycin infusion in head and neck cancer.

TWENTY-ONE MALE PATIENTS WITH previously untreated advanced squamous cell carcinoma of the head and neck were treated with an induction regimen of bleomycin 15 mg/m2 I.V. bolus followed by a continuous 24-hour I.V. infusion at a dose of 15 mg/ m2/day for 7 days. One week following induction therapy, patients were reevaluated for response and then received definitive therapy with surgery and/or radiation therapy. The chemotherapy yielded a major response rate of 33% (one CR, six PR). Toxic manifestations of this regimen were mild, consisting of fever, alopecia, rash, and mucositis. There was no pulmonary toxicity detected. The response rate obtained with bleomycin infusion is inferior to the combination of cis-platinum with a bleomycin infusion as induction therapy in previously untreated patients with squamous cell carcinoma of the head and neck.

Conservation surgery for laryngeal pseudosarcoma.

1 . Miller D, Goodman M, Weber A; Primary liposarcoma of the larynx: Trans Am Acad Ophthalmol Otolaryngol 80444-447, 1975. 2 . Velek JP: Liposarcoma of the larynx: Trans Am Acad Ophthalmol Otolaryngol 82:569-570, 1976. 3 . Krausen AS, Gall AM, Garza R, et al: Liposarcoma of the larynx: A multicentric or a metastatic malignancy. Laryngoscope 87:1116-1124, 1977. 4 . Ferlito A: Primary pleomorphic liposarcoma of the larynx. J Otolaryngol 7: 161-166, 1978. 5. Gorenstein A, Nee1 HB, Weiland LH, Devine KD: Sarcomas of the larynx. Arch Otolaryngol 106:8-12, 1980. 6. Batsakis JG: Tumors of the head and neck, clinical and pathological considerations, ed 2. Baltimore, 1979, Williams & Wilkins. 7. Pack GT, Pierson JC: Liposarcoma; a study of 105 cases. Surgery 36:687-712, 1954. 8 . Batsakis JG, Fox JE: Supporting tissue neoplasms of the larynx. Surg Gynecol Obstet 131:989-997, 1970. 9. Tobey DN, Wheelis RF, Yarington CT Jr: Electron microscopy in the diagnosis of liposarcoma and fibrosarcoma of the larynx. Ann Otol Rhino1 Laryngol 88:867-871, 1979. 10. Spittle FM, Newton KA, Mackenzie D H Liposarcoma: A review of 60 cases. Br J Cancer 24:696-704, 1970. 1 1 . Stout A P Liposarcoma: The malignant tumor of lipoblasts. Ann Surg 119536-107, 1944. 12. Enzinger FM, Winslow DG: Liposarcoma. A study of 103 cases. Virchows Arch [Path Anat] 335367-388, 1962. 13. James DH Jr, Johnson WW, Wrenn EL Jr: Effective chemotherapy of an abdominal liposarcoma: J Pediatr 68:311-313, 1966. 14. Enterline HT, Culberson JD, Rochlin DB, Brady LW: Liposarcoma: A clinical and pathological study of 53 cases: Cancer 13~932-950, 1960.