The life and times of the Institute of Laryngology and Otology.
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Academies and Institutes↗
Biomedical subjects
H J Shaw
Publications and source records attributed to H J Shaw.
A view of partial laryngectomy in the treatment of laryngeal cancer.
Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of telecobalt irradiation. Material is presented from two treatment centres to indicate trends in surgical treatment and the complications experienced. Results will be given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. The results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave more cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery in two centres for laryngeal cancer in the United Kingdom.
Combined Modality Therapy↗
Advanced laryngeal cancer: a management perspective.
A retrospective study of 197 T3 and T4 squamous cell carcinomas of the larynx presenting between 1969 and 1978 has been undertaken. These patients have in the main been treated by primary radiotherapy with back-up salvage surgery. The aim of the study was to examine survival, and to try to identify reasons for failure of control. Various prognostic factors have been analysed and are discussed. Overall 5-year survival was 53 per cent but patients with nodal disease responded poorly. Subglottic tumours have a better survival than usually reported. Failure to pick up recurrence was the main problem, and in particular a persistently fixed cord carried a very poor prognosis if laryngectomy was delayed.
Aged↗
Relationships between luteinizing hormone, follicle-stimulating hormone and prolactin secretion and ovarian follicular development in the weaned sow.
Folliculogenesis was studied by assessing development of the largest 10 follicles obtained from 10 sows 48 h after weaning and by analyzing changes in plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL) for 24 h before weaning until 48 h after weaning. Follicular diameter, follicular fluid volume, and concentrations of estradiol and testosterone and granulosa cell numbers were determined in all follicles, and 125I-hCG binding to theca and granulosa and maximal aromatase activity in vitro was determined in five follicles/sow. Overall, a significant rise in LH, but not in FSH, occurred at weaning, although in individual sows an increase in LH was not necessarily related to subsequent estrogenic activity of follicles. In 9/10 sows, PRL fell precipitously after weaning. In lactation, LH was negatively, and after weaning, positively, correlated with FSH and PRL. Marked variability in follicular development existed within and between sows. Overall, most follicular characteristics were positively correlated to follicular diameter; however, in larger follicles the number of granulosa cells was variable and unrelated to estrogenic activity, which--together with theca and granulosa binding of hCG--increased abruptly at particular stages of follicular development. Differences in maturation of similarly sized follicles from different sows were related to estrogenic activity of the dominant follicles but not to consistent differences in LH, FSH or PRL secretion. Both the dynamics and the control of folliculogenesis in the sow, therefore, appear to be complex.
Animals↗
The use of free tissue transfer in reconstruction following head and neck tumour resection.
Experience in the use of free vascularised tissue flaps in reconstruction following major head and neck resections for malignant disease has been described. The benefits of the use of free flaps are improved function and cosmesis with more rapid rehabilitation and reduced in-patient stay in a group of patients, many of whom had a limited life expectancy. The disadvantages of this technique are the need for special equipment and for medical and nursing staff trained and experienced in this type of work.
Adult↗
Uncommon malignant tumours of the larynx. A 35 year review.
Sixty-five primary malignant laryngeal tumours, other than simple squamous cell carcinomas, treated at the Royal Marsden Hospital between 1949 and 1984 are presented. Of the 11 histological types pseudosarcomas (24 cases), verrucous carcinomas (9 cases) and lymphoreticular tumours (9 cases) predominated. Determinate three-year follow-up data were available in 50 cases. Sixteen patients (32 per cent) died of their neoplasms but survival was strongly related to histology. Only one death occurred among 24 determinate cases of pseudosarcoma and verrucous carcinoma. Radiotherapy was effective treatment for these two tumour types and for reticuloendothelial tumours. However, combined therapy yielded poor results with the other histological types.
Combined Modality Therapy↗
Malignant tumours of the tongue in young adults. Experience of a secondary referral centre.
Twenty-three cases of malignant tongue tumours in patients aged 15 to 30 are reported. Treatment and prognosis in the 18 for which follow-up information is available are discussed. The disease appears to be very similar to that in older subjects except for a greater incidence of neck node metastases. Close follow-up after primary treatment is essential since there is a high possibility of recurrent disease but which may respond well to salvage surgery if identified early. A greater awareness of the occurrence of tongue cancer in young adults is also necessary.
Adolescent↗
Reconstruction of the mandible with autogenous bone following treatment for squamous carcinoma.
In a series of 24 patients treated for squamous carcinoma of the oral cavity and oropharynx, 26 mandibular reconstructions using 27 grafts or flaps were performed. Reconstruction was immediate in 23 cases and delayed in three. There were five 'simple' bone grafts, 10 pedicled compound myocutaneous flaps, and 12 vascularized free compound flaps. Operative mortality was 12% and complication rate 65%, but 70% of the grafts survived till death or follow-up of the patients. Three 'simple' bone grafts failed and were removed. Three of five compound pectoralis major flaps failed along with one of five pedicled compound latissimus dorsi flaps. Only one vascularized free compound flap was lost. The major cause of graft failure was intra-oral suture line dehiscence exposing the bone to saliva. Under these circumstances, bone graft necrosis occurred when blood supply to the bone was poor--viz. 'simple' grafts and compound pectoralis major flaps. The vascularized free compound flaps were most reliable but the need for jaw preservation where possible and better patient selection are recognized.
Adult↗
Palliation in head and neck cancer: discussion paper.
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Head and Neck Neoplasms↗
Prognostic implications of perineural spread in squamous carcinomas of the head and neck.
The occurrence and prognostic implications of perineural spread were examined in 239 patients with mucosal squamous carcinomas of the head and neck. Perineural spread was demonstrated in resections from 64 patients (27%), the majority having primary tumors at one of three sites: buccal cavity, larynx, and pharynx. Perineural spread near nodal metastases was uncommon. There was no evidence that perineural involvement was more commonly associated with large tumors or less differentiated ones. No association was established between perineural spread and coexistent lymph node deposits in the surgical resections. Perineural spread was, however, shown to be a statistically significant prognostic factor for an increased incidence of subsequent locoregional recurrence and for decreased survival.
Adult↗
Transcapsular spread of metastatic squamous cell carcinoma from cervical lymph nodes.
The incidence, extent, and selected clinicopathologic correlations of transcapsular spread from metastatic tumor in the cervical lymph nodes have been investigated in 210 specimens obtained by radical neck dissection from 203 patients with squamous cell carcinomas of the head and neck. Transcapsular spread was detected in 137 of 159 (86 percent) positive specimens, and classified as macroscopic in 74 (54 percent) and microscopic in 63 (46 percent). Macroscopic transcapsular spread was seen most frequently in association with large nodal masses more than 3 cm in diameter (48 of 70 specimens, 69 percent), but also occurred in some specimens with smaller lymph nodes less than 3 cm in diameter (26 of 67 specimens, 39 percent). Anatomic structures most commonly invaded in areas of neck dissection with macroscopic spread from nodal metastases were skeletal muscle (39 dissections) and the adventitial coat of the internal jugular vein (27 dissections). Macroscopic transcapsular infiltration was associated with a high incidence (44 percent) of recurrent tumor in the ipsilateral neck, particularly within 12 months of surgery. Microscopic transcapsular growth was associated with a lower incidence (25 percent) of recurrent tumor in the ipsilateral neck but the difference did not reach statistical significance. Similar recurrence figures (32 percent) were found in the minority of patients whose nodal disease was intracapsular at the time of neck dissection. More precise definition of the morphologic extent of transcapsular spread could be important in clarifying its clinicopathologic correlations.
Adult↗
The place of partial laryngectomy in the treatment of laryngeal cancer--a view from the U.K.
Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of Telecobalt irradiation. Material is presented from two treatment centres to indicate trends in surgical treatment and the complications experienced. Results will be given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. The results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave more cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery in two centres for laryngeal cancer in the United Kingdom.
Adult↗
Pseudotumoral mycobacterial infection in the head and neck: a clinical study.
The clinical aspects of mycobacterial infection of the head and neck are considered as presenting in patients at a cancer hospital over the last 15 years. Some difficulties in diagnosis with respect to the evolution of tuberculosis in this region are discussed. A total of 32 patients with evidence of infection were identified. Twenty-six of these with cervical lymphadenopathy are considered as a group; their clinical features and diagnosis are summarized and a note made of the recent change in the macroscopic quality of the nodes removed. Six cases are given particular attention: two with laryngeal tuberculosis, two with nasal or adenoidal infection and two with atypical mycobacterial infection diagnosed on clinical grounds.
Adolescent↗
Palliation in head and neck cancer.
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Analgesics↗
Relationships between LH, FSH and prolactin secretion and reproductive activity in the weaned sow.
Blood samples were collected from primiparous sows via indwelling jugular cannulae at 15-min intervals for 12 h before and for 24 h (2 sows) or 48 h (10 sows) after weaning and then every 4 h until behavioural oestrus. Weaning to oestrus intervals ranged from 3 to 10 days and 2 sows showed no signs of oestrus and had not ovulated by Days 11 and 16 after weaning. Prolactin concentrations in plasma decreased significantly (P less than 0.001) and reached basal levels 1-2 h after weaning in all sows whilst plasma progesterone concentrations remained basal until approximately 30 h after the preovulatory LH surge in sows that ovulated. Elevated concentrations of prolactin or progesterone during the post-weaning period were, therefore, not responsible for delayed restoration of cyclicity. Overall, mean LH concentrations rose significantly (P less than 0.001) from 0.22 +/- 0.02 during the 12-h period before weaning to 0.38 +/- 0.03 ng/ml during the 12-h post-weaning period. After weaning, pulsatile and basal LH secretions were markedly increased for sows that showed an early return to oestrus (less than or equal to 4 days) compared with sows showing a longer weaning to oestrus interval but a correlation did not exist between either of these LH characteristics and the time taken to resume cyclicity. Mean LH concentrations before weaning were, however, inversely related (r = -0.649; P less than 0.05) to the weaning to oestrus interval. Overall, mean FSH concentrations rose significantly (P less than 0.001) from 151.1 +/- 6.2 (s.e.m.) ng/ml in the 12-h period immediately before weaning to 187.7 +/- 9.7 ng/ml in the subsequent 12-h period but there was no correlation between FSH concentrations, before or after weaning, and the interval from weaning to oestrus. However, a significant correlation was apparent between ovulation rate and peak concentrations of the rise in FSH after weaning (r = 0.746; P less than 0.05) and overall mean FSH values (r = 0.645; P less than 0.05). It is concluded that both LH and FSH concentrations in peripheral blood rose in response to removal of the suckling stimulus at weanling. The increase in LH pulse frequency associated with weaning was not directly related to the weaning to oestrus interval although a specific pattern of LH secretion was observed in sows showing an early return to oestrus (less than or equal to 4 days).(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Radical neck dissection for squamous cell carcinoma of the head and neck: early and long-term results of treatment.
An account is given of the use of radical neck dissection in a consecutive series of 147 patients treated during the years 1967-76 in the Head and Neck Unit of the Royal Marsden Hospital. The majority had received previous treatment principally by irradiation to full dosage, some by previous surgery, and a minority by induction cytotoxic chemotherapy. The 5-year determinate survival results for surgical salvage are 28.03%, and 20.5% at 10 years. Prevention of recurrent cancer in the neck was achieved in 70% of all those who later succumbed to their disease.
Adult↗
Calcitonin and carcino-embryonic antigen in the follow-up of patients with medullary carcinoma of the thyroid.
Nineteen patients who have had medullary carcinomas of the thyroid have been followed up at the Royal Marsden Hospital. All had nodal involvement. Postoperative unprovoked serum calcitonin assays have been performed. Four patients had incomplete excisions of their tumours and these had the highest postoperative levels. Two died within 3 years, one has stable disease 8 years later and one remains well 13 years later. Four patients had postoperative calcitonin assays of over 100 ng/ml but had no clinical evidence of remaining disease. Only one has died (7 years later), the others remaining well 10, 10 and 3 years later. Four patients died of their disease and all had assays of over 200 ng/ml, before death. Slightly raised postoperative assays were found in all the other patients, but these have not significantly altered. These patients had good prognoses. Three patients also had regular carcino-embryonic antigen (CEA) assays and the value of this is discussed.
Aged↗