VARIETIES OF angiographic changes in occlusive basilar disease are described and the final outcome correlated with the site of occlusion and the type of collateral flow. MethodsFrom 1969 to 1973, 20 patients with basilar artery occlusion were studied radiologically. The examinations consisted of right and/or left brachial arteriograms in 18 patients and biplane aortic arch arteriograms in two. In addition, angiography of the right carotid was performed in two patients and of the left carotid in four.Each of the arteriograms was reviewed by one of us to establish the site and extent of the basilar artery occlusion and the type of collateral flow.The chart of each patient was then reviewed for the data in table 1. Follow-up information was obtained on 19 patients with the cooperation of the family physician or the relatives.During the same period, three patients with bilateral vertebral artery occlusion were studied in a similar way. A summary of their clinical information is found in table 2 (and their angiographic findings in table 6). ResultsTen of the 20 patients with basilar artery occlusion were men and ten women. Their ages ranged from 43 to 78 years, with one in the 40-49 year range, eight in the 50-59, six in the 60-69, and five in the 70-79.Hypertension was present in 14 patients and arteriolonephrosclerosis was found in the one patient who had a postmortem examination but who was clinically normotensivea total of 15 hypertensives.Two patients had rheumatic heart disease; both of them were normotensive but one had arteriolonephrosclerosis. Two normotensive patients had diabetes mellitus.A history of vertebro-vasilar disease was not obtained in any patients, but three had suffered a stroke in the past, presumably owing to disease in the carotid system.Only two autopsies were made but one was incomplete and the results of the second unobtainable.

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In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging--as well as the accuracy of the staging by combination of the two modalities--was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

The larynx is separated into compartments bounded by connective tissue membranes and cartilages. The membranes and cartilages affect the localization and spread of cancer for a while, but invasion eventually occurs. Histological study of the cartilages in the earliest stages of invasion shows cancer cells growing between the collagen bundles where the connective tissue membranes attach to the cartilages. At these points, the collagen bundles pass obliquely through the perichondrium to anchor into the cartilage and bone like Sharpey's fibers. As the cancer cells multiply, they separate the collagen bundles, forming linear passageways through the perichondrum. This appears to be the mechanism for cartilage invasion. Thus the sites of attachment of the strongest membranes are also the most frequent sites of invasion, i.e., the anterior commissure tendon and the cricothyroid membrane.