Rapid percutaneous tracheostomy.

We describe a new method of performing percutaneous tracheostomy rapidly and safely using a specialized instrument kit. The technique permits the safe insertion of a full-sized 7.0 (ID) or 7.5 mm (ID) cuffed cannula into the trachea within 1-2 min, through the membranous second intercartilagenous space. Animal studies have demonstrated a superior healing process compared to that seen after conventional tracheostomy techniques.

Bilateral chylothorax complicating radical neck dissection: report of a case with no concurrent external chylous leakage.

Bilateral chylothorax as a complication of radical neck dissection is extremely rare. Six cases are reported in the English literature. All of these patients' cases were associated with a concurrent external chylous fistula, as evidenced by the appearance of a milky fluid confirmed to be chyle by chemical determination. Chyle had also been noted to leak during the operation. This presentation illustrates an additional case of bilateral chylothorax occurring after radical neck dissection, and the first case, to our knowledge, with no concurrent external lymph leakage. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed. Chylothorax has two major complications--respiratory and metabolic. A short summary of the modern concepts of treatment is presented.

Pure squamous cell carcinoma and mixed adenosquamous cell carcinoma of the thyroid gland.

Four cases of pure squamous cell carcinoma and two cases of mixed squamous cell and glandular carcinoma are reported. Obviously, there is a possibility that squamous cell carcinoma of the thyroid gland develops from the existing squamous cells or as a result of metaplasia of follicular cells. Metastases and direct extension of squamous cell carcinoma in the thyroid gland are much more frequent and must be excluded before the diagnosis can be established. Although the gross and microscopic pathology of these lesions presents no unusual features, follicles lined by metaplastic squamous cells offer strong presumptive evidence of a primary thyroid neoplasm. These tumors are comparatively radioresistant and biologically highly malignant. The treatment of choice is radical surgical resection, and these neoplasms must be treated more aggressively in the initial stage.

Carcinoma of the prostate metastatic to the maxillary antrum.

Metastatic carcinoma of the maxillary antrum is an extreme rarity. Until 1980, less than 100 cases with distant primaries metastatic to the entire sinonasal tract had been reported. In a review of these cases, we found no mention of primary prostate cancer metastatic to the antrum. The purpose of this paper is to document the first case of this entity.

Clear cell carcinoma of the thyroid gland.

Clear cell carcinoma is a rare variant of thyroid cancer, histologically related to the well-differentiated thyroid malignancies. The purpose of this paper is to discuss data collected from the English literature and to present three additional cases. In two of the three cases presented, thyroglobulin levels were extremely high after thyroid ablation. Both cases presented metastasis to lung and bone with significant I131 uptake. It seems that, when compared to the well-differentiated carcinomas of the thyroid gland, clear cell carcinoma has a more aggressive clinical course. Initial radical surgery is the treatment of choice for this kind of neoplasm and I131 should always be considered for the treatment of its metastasis.

Inverting papilloma of the nose and paranasal sinuses.

A series of 30 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. The inverted papilloma is a rare tumor with an overall incidence varying from 0.5% to 4% of all primary nasal tumors. The incidence of inverted papilloma is much more common in the fifth to seventh decades. An association between inverted papilloma and carcinoma is well established. In the large series of patients, the incidence of malignancy associated with inverted papilloma ranges from 1% to 13%, and in our series 10%. Treatment of inverted papilloma is always surgical. The incidence of recurrence is directly related to the method of surgical treatment. Among our 20 patients who were treated by limited surgery, there was recurrence in 14 cases (70%). By contrast, medial maxillectomy and ethmoidectomy via lateral rhinotomy reduced the recurrence rate dramatically. In our opinion this approach is the surgery of choice in the treatment of inverted papilloma.

Chondroma of the tongue. Report of two cases.

Lingual chondromas are very rare tumors. It can be assumed that chondromas of the tongue develop from heterotopic embryonal cartilage. Chondromas are usually seen on the lateral borders of the tongue. Because chondrosarcomas can appear in this location, wide excision of the lesions should be performed. The CO2 laser facilitates the excision, providing a dry surgical field. Two cases of lingual chondroma are presented and their probable cause discussed.

Thyroid carcinoma in children and adolescents.

Carcinoma of the thyroid gland, although fairly common in young adults, is uncommon in the first two decades of life. Because therapy is controversial, it is important to study a relatively large group of patients treated in a single department. This report records the findings and responses to treatment in 40 cases of thyroid gland carcinoma in children and adolescents treated from 1953 to 1982.

Detection of specific IgA antibodies to varicella zoster virus in serum of patients with Ramsay Hunt syndrome.

Varicella zoster virus (VZV)-specific IgG and IgA antibody titers were determined in serial serum samples of 23 patients with Ramsay Hunt syndrome by the immunoperoxidase assay. Varicella zoster virus-specific IgG antibodies were found in the first serum samples of all the patients. In 80% of 20 patients in whom a serum sample was available within 5 days after the onset of the disease. VZV-specific IgA antibodies were detected. The second serum sample was VZV-specific IgA-positive in all of the patients. While all the healthy age- and sex-matched control subjects had VZV-specific IgG antibodies, VZV-specific IgA antibodies were detected in a low titer (dilution = 2) in only three of the subjects. By using VZV-specific IgA antibody titers greater than or equal to 2 and greater than or equal to 4 by the immunoperoxidase assay as a "cutoff" for younger and older patients with Ramsay Hunt syndrome, respectively, an early diagnosis of the disease can be obtained in 89% of the younger and in 64% of the older patients by a single serum sample.

Thyroid cancer in patients 70 years of age or older. Retrospective study of 50 patients.

This report presents our experience with 50 thyroid cancer patients 70 years of age or older, out of 606 patients of all ages. Comparing this series to those describing thyroid cancer patients of all ages, we found that thyroid carcinoma in the 70+ age group presents at a more advanced clinical stage, behaves more aggressively, and has a higher death rate. These findings are attributed mainly to the higher incidence of undifferentiated carcinoma and the more aggressive course of the differentiated types of carcinoma in the older age group. If suspected thyroid nodules are managed by initial radical treatment, carcinoma can be diagnosed earlier and patients will survive longer.

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.

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.

Primary Schwannoma of the thyroid gland.

A primary Schwannoma of the thyroid gland caused severe dyspnea due to tracheal compression and deviation. The thyroid gland is a very rare site of origin for this tumor, and to the best of our knowledge this report represents the first documented case of a Schwannoma with such symptomatology.

Hashimoto's thyroiditis and carcinoma of the thyroid gland.

Seven cases of Hashimoto's disease (HT) occurring in association with carcinoma of the thyroid gland are presented. The diagnosis of HT was not reached before surgery in any of the cases; it was an incidental histopathological finding. There was no case of pure papillary cancer: two specimens showed mixed papillary and follicular cancers, four revealed follicular carcinomas (one of them with anaplastic areas) and one medullary neoplasm. Other authors, however, have reported that pure papillary carcinoma occurred with significantly greater frequency in thyroids also displaying Hashimoto's disease. Total thyroidectomy was performed in all seven patients and one patient with anaplastic follicular cancer also received external irradiation. TSH suppressive therapy was given postoperatively. All these patients are alive with no evidence of further disease after seven to 17 years of follow-up study, whereas the mortality in our total series of thyroid cancers, even in patients with low-grade malignancy, was about 9%. Thus the prognosis of patients with carcinoma of the thyroid gland with coexisting Hashimoto's disease is better than that of patients with carcinoma of the thyroid gland alone. Hashimoto's thyroiditis does not seem to be a premalignant lesion. There was no evidence suggesting that thyroid carcinoma originated in the proliferating epithelium of Hashimoto's thyroiditis. It would appear that thyroid carcinoma stimulates the development of HT in some patients and that the presence of the autoimmune inflammatory reaction and the circulating antibodies retard growth and dissemination of carcinoma of the thyroid gland.

Ossified segments of the stylohyoid ligament. A case of radiological misdiagnosis.

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

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.

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.

Giant cementoblastoma simulating a peridental infection.

A case of giant cementoblastoma of the maxilla in a young female is reported. An unusual painful swelling of the gingivolabial area led to an initial misdiagnosis of a peridental infection and consequently to inappropriate treatment.

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 patient's 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.