In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post-laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis. To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of T3N0M0 glottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage-matched cases treated with laryngectomy alone. Analysis shows the 'emergency tracheotomy' group to have a very poor prognosis with a higher incidence of recurrence at the stoma, and also in the regional lymph nodes. These findings suggest that paratracheal lymph node metastasis is an important mechanism in the development of stomal recurrence and thus has considerable implications for the prevention of such a recurrence following laryngectomy in the patient presenting with malignant airway obstruction.

No abstract

In a review of 1000 consecutive neonates of all races, nasal septal deformity was identified in 29, an incident of 2.9%; significantly fewer cases were found in negroid babies (0.1>P > 0.05). Ten cases (35%) underwent manipulation of the deviated septum. Six-monthly review revealed that symptoms associated with the septal deformity are rare. In 7 (44%) of the 16 cases not manipulated, the septum straightened spontaneously during the first few months of life. The appearance of the deviation is not of a dislocation of the caudal edge of the cartilage but a smooth concavity. In vitro compression of the neonatal nasal cavity reproduced this C-shaped deformity, but only temporarily. Histological serial sections of 6 postmortem nasal cavities showed that the high laminae of the vomer prevent any caudal dislocation of the septal cartilage.

SummaryCongenital or acquired forms of the long Q±T syndrome may result in ventricular tachycardia known as torsade de pointes. Many drugs including volatile anaesthetics modify the Q±T interval. Sevoflurane is known to prolong of the rate-corrected Q±T interval (Q±Tc). The objective of this study was to determine whether the sevoflurane-associated Q±Tc prolongation is rapidly reversible when propofol is substituted for sevoflurane. Thirty-two female patients were allocated to two groups. All patients received sevoflurane induction and anaesthesia for 15 min. In one group, sevoflurane was then discontinued and anaesthesia maintained on propofol for another 15 min. The second group received sevoflurane anaesthesia for 30 min. Measurements were taken before, and 15, 20, 25 and 30 min after induction. Q±Tc prolongation was significantly reduced 5, 10 and 15 min after propofol had been substituted for sevoflurane. We conclude that the sevoflurane-associated Q± Tc prolongation is fully reversible within 15 min when propofol is substituted for sevoflurane. Long Q±T syndromes represent ECG-abnormalities that may result in recurrent syncopal attacks and sudden death due to ventricular tachyarrhythmia known as torsade de pointes [1]. These abnormalities may be caused by mutated genes encoding for myocardial sodium and potassium ion channels (congenital long Q±T syndrome, CLQTS), metabolic or electrolyte abnormalities, or by drugs (acquired long Q±T syndrome, ALQTS). The CLQTS is based on a malfunction of ion channels at the myocardial cell membrane, resulting in an inadequate outflow of potassium or excessive inflow of sodium [2]. Prolongation of myocardial repolarisation delays the inactivation of calcium channels resulting in late calcium inflow, which in turn contributes to the formation of early after-depolarisations (EADs) [2]. EADs may reach threshold amplitude and trigger ventricular arrhythmia [2, 3]. Many factors contribute to the development of ALQTS. Hypokalaemia [4], age and sex [5], obesity [6], and many drugs have been shown to be associated with a prolonged Q±T interval [2]. Among the drugs currently used in anaesthesia, volatile anaesthetics are known to alter the Q±T interval. Prolongation of the Q±T interval by isoflurane [7, 8] and sevoflurane [9] and shortening of the Q±T interval by halothane has been already described [7, 8]. It has also been reported that induction of anaesthesia using propofol tends to shorten the Q±Tc interval in patients with an already prolonged Q±Tc interval [10]. Prolongation of Q±Tc by sevoflurane in such patients is alarming and may force the anaesthetist to consider an alternative anaesthetic.The aim of this study was to determine whether intraoperative sevoflurane-associated Q±Tc prolongation can rapidly be reversed when propofol is substituted for sevoflurane. MethodsAfter approval of the institutional ethics committee and after obtaining written informed consent, 32 otherwise Only women were selected, as women are per se prone to a prolonged Q±T interval [11]. Patien...

Little is known about patient compliance with topical aural antibiotic regimens. The compliance of 50 patients with unilateral otitis externa attending an otolaryngology clinic was studied by comparing the weight of dispensed topical ear preparations before and after completion of a 7-day-course of treatment. A standard was obtained from controlled administration of the preparation under laboratory conditions and the performance of different delivery systems evaluated. Thirty-seven patients re-attended for review with their medication. A total of 34 of 50 patients entering the study (70%) satisfied conventional criteria for compliance. However, over-use of preparations was common and stricter criteria are proposed and applied. Compliance was significantly increased when someone other than the patient administered the preparation.