Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation. denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.

[Diagnosis and therapy of laryngeal diseases in the history of medicine. I: The pre-laryngoscopic era]. / Die Diagnostik und Therapie der Kehlkopfkrankheiten in der Geschichte der Medizin. Teil I: Die vorlaryngoskopische Ara.

BACKGROUND: ANATOMY, PHYSIOLOGY AND PATHOLOGY: Hippocrates and Aristotle did not yet have a clear idea of the anatomy and physiology of the larynx. 500 years later Galenos carried out subtle studies on animals and elaborated a fairly precise description of the different cartilages, muscles and nerves of the larynx; he was the first to demonstrate the superior and the recurrent nerves of the larynx. He performed numerous experiments on animals with temporary or permanent interruption of the nervous function and thus developed a correct opinion of the vocal physiology. However, he did not draw clinical conclusions from his knowledge. In the 16th century the macroscopic anatomy of the larynx was elaborated further bei Andreas Vesalius, Fabricius ab Aquapendente et al.; Jacob Henle in 1838 described the different epithelia in the larynx, based on microscopic studies. The pathology was inaugurated by Giovanni-Battista Morgagni in 1761, including the pathology of the larynx. Francis Home in Edinburgh (1765) and Pierre-Fidèle Bretonneau in Tours (1826) made the first studies on croup and diphtheria and coined these names. Fr. Hermann Albers in Bonn in 1829 published the first monography on diseases of the larynx, incorporating more than 80 relevant case reports from the literature and numerous observations of his own. The first system of the pathology of the larynx was put up by von Rokitansky in Vienna. DIAGNOSIS AND THERAPY OF DISEASES OF THE LARYNX: Before the invention of laryngoscopy the physicians could deduce the underlying disease only from the clinical symptoms like hoarseness, dyspnoea, dysphagia. The conservative therapy followed the theory of humours and included bloodletting, leeches, purgatives and emetics; the surgical procedures were blind caustery with silver nitrate and ablation of polyps guided by palpation and scarification with a knife in cases of oedema; in desperate dyspnoea endonasal intubation was attempted (Desault 1789-1803) or a tracheotomy performed. Concluding the chapters a typical patient history of 1813 with a case of purulent laryngitis where most of these measures were applied but could not avert but rather provoked the death of the patient. This historical development is described with numerous anecdotic details.

[Robert R. Macintosh and Spain: a productive relationship]. / Robert R. Macintosh y España: una relación fecunda.

Through his visit to Spain in 1946, Robert R. Macintosh exercised considerable influence on the introduction and development of modern anesthesia in this country. This paper reviews the technical advances Mackintosh introduced and considers how his visit was one of the most important factors in unleashing the development of the profession here. Also reviewed are the other visits Mackintosh made in the course of his career. Those trips were less important, with the exception of a 1937 visit that inspired the design of the Oxford vaporizer, a technical concept based on simplicity, safety and the anesthesiologist's experience.

Indirect laryngoscopy.

Indirect laryngoscopy is one of the procedural methods used for achieving a histopathologic diagnosis of cancer of the larynx. A chronologic historical summary of the development of mirror laryngoscopy is presented. The details of the procedure employed for obtaining a biopsy with the aid of topical anesthesia is discussed.