Cuff induced tracheal injury in dogs following prolonged intubation.

As the newer high volume low pressure endotracheal tube cuffs have replaced the high pressure cuffs commonly used in the past, there has been a marked decline in the incidence of severe complication due to cuff injury. Studies have shown, however, that the respiratory epithelium of the trachea at the cuff site undergoes squamous metaplasia following prolonged intubation with low pressure cuffs. An experimental model utilizing the canine trachea has been developed to study cuff induced squamous metaplasia and the present study was undertaken to determine the effect of the induced squamous metaplasia on tracheal mucous velocity as well as to determine whether the induced epithelial changes are reversible following removal of the cuffed tube.

Bone and liver scans in patients with head and neck carcinoma.

The initial evaluation of patients with malignant tumors of the head and neck must include an attempt to determine the presence or absence of distant metastases so that the patient's tumor can be accurately staged and appropriate treatment planned. To determine the value of routine bone and liver scans in detecting distant metastases, the records of 169 patients with head and neck carcinoma, on whom such scans were performed, were reviewed retrospectively. No true positive liver scans were found and the incidence of true positive bone scans was only 2%. It is felt, therefore, that routine scanning is not a worthwhile procedure and we recommend that liver and bone scans be reserved for those patients with advanced primary tumors, with regional node metastases or with clinical or laboratory evidence of liver or bone involvement.

Rhinitis medicamentosa.

The diagnosis of rhinitis medicamentosa was made in 130 patients seen over a 10 year period from July 1967 to June 1977. There was an incidence of 1% in our otolaryngological practice. Patients had been taking the causal medication for an average of 21.4 months. There were 73 males and 57 females with the peak incidence in young and middle-age adults. The primary offending medications were decongestant nasal sprays in 85 patients, decongestant drops in 33, and a combination of these drugs in 12 patients. The major reasons for self-medication were 1. deviated nasal septum in 40 patients, 2. an acute upper respiratory infection in 33, 3. allergy in 18, 4. miscellaneous causes in 24 and 5. unknown in 15 patients. The initial management in addition to avoidance of the medication consisted of systemic antibiotics, decongestants, antihistamines, and sedatives depending on the severity of the rhinitis and the presence of secondary infection. Later treatment consisted of correction of the deviated septums, allergic management, and supportive care. Eight patients were considered to have complications of the disease by development of chronic ethmoiditis and nasal polyposis. The pharmacologic properties of the causal agents are thoroughly reviewed as they relate to the pathogenesis of this disease. It is felt that the ready commercial availability and limited clinical value of the topical nasal sprays and drops represents a certain risk to all patients using them.

Adenoid cystic carcinoma of the submaxillary gland.

A review of submaxillary gland neoplasms over a 21 year period revealed 15 malignancies and 7 benign tumors. All of the malignancies occurred in females, and 11 of these were adenoid cystic carcinoma. Two of the 11 were found to have infiltrating ductal carcinoma of the breast (1 pre and 1 postdiagnosis of the submaxillary carcinoma) and 3 had benign breast disease. While previous reports have suggested an association of parotid gland neoplasia and breast cancer, this is the first known report of an association between adenoid cystic carcinoma of the submaxillary gland and cancer of the breast. The discussion of adenoid cystic carcinoma of the submaxillary gland emphasizes the increased frequency of this disease in females, its association with breast disease, and also experimental submaxillary gland neoplasia.

Experimental induction of squamous metaplasia in the dog trachea with cuffed endotracheal tubes.

Clinical reports cite the development of squamous metaplasia in tracheas following tracheostomy, laryngectomy, and cuffed intubation. The purpose of this study was (1) to develop an experimental model using the dog trachea and study the effects of prolonged cuffed intubation and (2) to determine whether squamous metaplasia is produced by prolonged contact of the endotracheal cuff with the tracheal mucosa. Modifications of widely used high-volume, low-pressure 8-mm endotracheal tubes were made with the distal portion of the tube, its cuff, and the inflating catheter attached. This model formed an implantable cuffed tube approximately 8 cm in length. The dogs remained intubated for 14 days, at which time they were killed; seven animals were available for histologic study. Varying degrees of squamous metaplasia were produced in all animals.

Radioisotope measurement of the velocity of tracheal mucus.

A radioisotope scanning technique for measuring the velocity of tracheal mucus has been developed utilizing a canine model. A solution of stannous phytate labeled with 99mTc is introduced percutaneously into the lower trachea and the upward movement of the leading edge of the radioactivity is followed by repeat scanning at 2-minute intervals using a modified rectilinear scanner, thus allowing calculation of the velocity of the mucus. It is believed that this technique may be of value in studying the effect of experimentally induced tracheal injuries on mucus velocity. Possible applications of the technique for the study of the velocity of mucus in the human trachea are discussed.

Vocal cord fixation in laryngeal carcinoma.

The 1962 TNM classification (T, tumor and extent; N, regional lymph node metastasis, M, distant metastasis) did not emphasize vocal cord fixation in staging. In the revision of 1972, lesions with partial fixation were classified T2, stage II, and those causing fixation were T3, stage III. The therapeutic results in 39 patients with fixed cords revealed a determinante five-year survival of 41% and an absolute of 23%. These statistics support the validity of the 1972 classification. Careful evaluation of vocal cord mobility prior to selection of therapy is stressed.

Recurrence patterns by treatment modality of carcinomas of the floor of the mouth and oral tongue.

Recurrence patterns were examined by stage of disease and treatment modality in 139 patients with 141 squamous cell carcinomas of the floor of the mouth and oral tongue, reflecting an 11-year experience at two hospitals. Treatment categories included surgery, irradiation, and combined treatment. Patients who were without evidence of disease at two years, or at the time of death, were considered cured. Cures were achieved in 87 per cent of patients with Stage I disease, 83 per cent with Stage II, 40 per cent with Stage III, and 34 per cent with Stage IV. Similar results were achieved by irradiation alone and by surgery alone in controlling early lesions. Combined treatment offered the best chance of cure for patients with advanced disease. Failure was most often associated with persistence at the primary site. No patient with advanced disease was salvaged after local treatment failure. One of 51 patients who received prophylactic treatment of the neck in the absence of clinical evidence of metastases had a regional treatment failure, while seven of 26 such patients who did not receive prophylactic treatment developed regional metastases. The ten-year adjusted survival rate, as calculated by the actuarial method, was 53 +/- 4.7 per cent. Forty-two multiple primary lesions were found in the 139 patients.