This intensive treatment regimen for head and neck cancer is feasible and effective in a multi-institutional setting.

The nasogastric tube can produce sudden, life-threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo-documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pharyngodynia, hoarseness, or evolving stridor present in the postoperative period.

Experimental evidence suggests that tumor growth beyond the earliest stages is dependent on angiogenesis, or neovascularization, and that angiogenesis may also promote metastasis. Recent clinical studies demonstrate that angiogenesis is a prognostic marker in breast, lung, and prostate cancer. To investigate whether tumor angiogenesis also correlates with metastasis and survival in early head and neck carcinoma, we quantified the microvascularity of 106 primary carcinomas prior to treatment and correlated the counts with eventual outcome after 3 to 15 years of follow-up. Microvessels were stained immunocytochemically for von Willebrand factor and then counted by light microscopy. Microvessels were counted per 200x and 400x fields, and their density was graded from 1 to 4, in the area of most intense neovascularization. We found that neither microvessel counts nor density grades correlated with metastatic disease, local recurrence, or survival in early head and neck carcinoma. These results are in contradistinction to those recently reported for other tumor sites.

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Five percent of all head injuries affect some portion of the visual system, and the most common locus of injury is the canalicular segment of the optic nerve. The classic surgical approach to this area is via the transfrontal craniotomy, although the Japanese have utilized an external ethmoidal technique to provide limited extracranial access to the optic canal. Harvey Cushing utilized the transsphenoidal hypophysectomy principally for pituitary tumors causing visual deficits. This paper presents a variation of the transsphenoidal hypophysectomy technique which will allow exposure of the optic nerve from the orbital apex to the optic chiasm through the use of microsurgical instrumentation. A detailed step-wise description of the surgical methodology is presented, along with drawings to define the approach fully. Four case reports and representative pre and postoperative radiographs illustrate the actual approach in the clinical setting.

Intraoperative PTH assay has added a new dimension to primary and revision parathyroid surgery. It is cost-effective and accurate and may reduce the morbidity of surgical intervention in revision procedures.