This paper reports on 16 cases of primary malignant melanoma of the external ear and the patients were followed up for two to 116 months. Fourteen patients had surgical excision with wide margins as initial treatment, whilst two had an amputation performed. Eleven patients had no recurrences, two died of other diseases, and four died of malignant melanoma. The five patients who developed recurrences received further surgery and two also radiotherapy.

Seven of the cases were histologically of the nodular type, six were superficial spreading, two were in situ melanoma, and one was a lentigo maligna. The thickness ranged from 0.15 to 11.5 mm. Classification according to Clark et al. (1969) revaled that as many as nine cases were Clark level IV or more. Immunostaining with PCNA yielded strong positivity in all cases, however, statistical analysis did not reveal any differences that could be correlated to the prognosis. Estimation of the vascularization at the base of the tumours by means of immunostaining with CD31 did not reveal any significant differences either.

We concluded that in our material the thickness of the tumour is of greater prognostic value than the estimation of proliferation by PCNA and vascularization by CD31. The value of PCNA and CD31 as possible prognostic parameters needs to be evaluated in a larger series. It is emphasized that malignant melanoma of the external ear is a highly malignant tumour, and that four of our 16 patients died of their disease, three of them within a year after diagnosis. Malignant melanoma of the external ear is readily inspected and thereby an early diagnosis should be possible.

From April, 1986 to June 1989 49 Patients (29 male, 20 female) aged 20 to 70 years old whod developed carcinomea of naospharynx (included 15 with relapses) were trated with neoadjuvant regional chemothrapy, followed by radiotherapy, or crysurgery and radiotherapy.

Thirty-three of the patients had squamous cell carcinoma with poor differentiated, four with well differentiated squamous cell carcinoma were included. Tumours were treated with three moalities: (I) Induction regional chemotherapy with temporal aftery catheterization as well as superselective intra-arterial chemotherapy of the femoral artery (chemotherapeutic agents: pingyangmycinum (P), Cisplatin (D), Vomcromstine (V), Methotrexate (M) and P.D.M. programmes); (2)Liquid cryosurgery in 25 cases; (3) Radiotherapy was carried out for two weeks after crysosurgery after chemotherapy.

The date showed CR (complete response—all tumour gone) and PR (partial response—more than 50 percent reduction) in 40 cases (81.6 per cent) and NR (no response—less than 50 per cent or no response) in nine cases (18.3 per cent) following regional chemotherapy. All of the patients were followed up for more than one year, and 48 of them survived (97.9 per cent). Thirty-five cases were followed up over two years and 28 of them survived (80 per cent). Twenty cases were followed up over three years, and 12 of them survived (60 per cent).

The effect of regional chemotherapy and crysurgery in combined treatment for carcinoma of the nasopharynx is discussed in this paper.

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.

A prospective, randomized, double-blind study to assess the effect of steroids on post-tonsillectomy pain was performed on 82 adults. The premedication, anaesthesia, surgical technique and post-operative analgesia were standardized. Pain was assessed on a visual analog scale. Steroids were found to have no appreciable effect on the amount of post-operative pain.

This paper describes a case of reconstructive laryngectomy in a patient with epidermoid carcinoma of the glottis. Reconstruction of the skeletal laryngeal architecture was carried out by implanting homologous cartilages, whilst the glottis was reconstructed with sternohyoid muscle. Laryngeal function was restored within 30 days of the operation.

The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam®. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Extended subtotal petrosectomy as a treatment for persistent cerebrospinal fluid (CSF) otorhinorrhoea is presented. Four patients were successfully operated on by this technique, all previously having undergone suboccipital removal of vestibular schwannoma: other interventions used had failed to seal the fistulae. The internal auditory canal was the usual pathway for CSF leakage as well as retrosigmoid, retrolabyrinthine, retro- or perifacial cells. Total exenteration of middle ear and mastoid cell tracts, skeletonization of sigmoid sinus, jugular bulb and facial nerve, drilling out of semicircular canals, vestibule, and cochlea, and skeletonization of the internal auditory canal, followed by obliteration, are the main steps of this approach.

In the period 1978–1986, 2907 cases of ear, sinonasal and throat (ENT) cancers were registered in the computer data base of the West Midlands Cancer Registry, Birmingham. These cases have been examined by site and subsite in this article. Squamous cell carcinomas continue to dominate ENT cancer with notable male predominance. Histology, male/female ratios and time trend analysis are reported for this group of cancers.

The standard recommended treatment for lateral sinus thrombosis is intravenous antibiotics. For those that fail, some authors recommend anticoagulant therapy, others internal jugular vein ligation. Despite these recommendations, there is still a significant mortality in all reported large series and the main reason this is that the cause of the failure has not been found or investigated.

Over a six-year-period, from January 1985 to December 1990,36 patients were admitted with lateral sinus thrombosis. The initial treatment consisted of intravenous antibiotics and surgery. The surgery included cortical mastoidectomy for non-cholesteatomatous ears and modified radical mastoidectomy for cholesteatomatous ears and drainage of the intracranial collection of pus in patients with subdural empyema and brain abscess.

There were nine failures (25 per cent) with this treatment regimen. Blood cultures and pus swab of the ears were taken from these patients. The blood cultures were positive in four patients and the organisms isolated included (3-haemolytic Streptococcus sp. in two, Proteus mirabilis and Streptococcuspneumoniae in one each). From the ear swab mixed cultures were found in eight and a single organism in one.

Gram-negative organisms were isolated in nine (100 per cent), Proteus mirabilis in eight (89 per cent) and Enterobacter sp. in two. Both these organisms were resistant to ampicillin and penicillin but were sensitive to amikacin.

Amikacin was then added to the treatment regimen and a dramatic response with a fall in the temperature, and improvement in the patients' general condition was noted within 24 hours, in all patients. There was not a single death, despite the fact that 42 per cent of the patients had other associated intracranial complications. The conclusion is that the treatment of choice for patients refractory to the conventional antibiotic therapy and surgery is amikacin therapy and not internal jugular vein ligation, or anticoagulant therapy.

The use of phlebotomy for a full blood count (FBC) and group and serum storage (G&S) prior to tonsillectomy with or without adenoidectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists within the South West Thames region. This was compared with ‘countrywide’ practice assessed by means of questions to attenders at an otolaryngology course.

A postal response rate of 86 per cent was obtained with 67 per cent within the region requesting a FBC prior to tonsillectomy and 50 per cent to adenoidectomy alone. This was much greater than for the ‘countrywide’ group with 24 per cent and 6 per cent respectively. Requests for pre-operative G&S were 17 per cent and 6 per cent respectively.

This large difference in practice suggests that in the clinically healthy patient with no specific indications, pre-operative haematological investigations may be non-contributary, which has important financial implications. The maintenance of post-operative intravenous access is considered to be much safer, less traumatic and cheaper.

Chlamydia trachomatis is a common sexually transmitted pathogen. We describe six cases of tonsillitis associated with sexually transmitted C. trachomatis infection. The organism was isolated from tonsillar crypts in all patients, and from uro-genital swabs in five of the six patients. In three partners of the patients, C. trachomatis infection of the uro-genital organ was assessed. They all had a history of orogenital sexual intercourse prior to the illness.

Cordyceps ophioglossoides is one of the Japanese old ’Kanpoh‘ drugs used for metrorrhagia as a decoction. We found that CO-N, a galactosaminoglycan from Cordyceps ophioglossoides, reacted with sera from patients with some collagen diseases. By using CO-N, we made a new serological activity index (CO—N reac tion). In the present study, we investigated CO-N reaction on patients with Wegener's granulomatosis (WG). The aggregation titres of CO-N (CO-N numbers) displayed a possible correlation with their clinical activity. CO-N reaction might also serve an important role in supporting the diagnosis of active WG and in helping to assess the degree of disease activity. The purpose of this report is to introduce this new serological activity index for Wegener's granulomatosis.

Adenotonsillectomies are performed increasingly as day cases in North America and Canada. This paper analyses reports where such tonsillectomies were performed. It is possible to successfully select a group with lower risk of complications. Haemorrhage occurs either early in the post-operative period or later than 24 hours after operation. With good organization tonsillectomies can be safely performed as day cases.

Tularemia can present as an oto-rhino-laryngological disease. The clinical and radiological (CT) manifestations, diagnosis and treatment are discussed based on a case report where a patient with tonsillitis and enlarged cervical lymph nodes was admitted to the department of oto-rhino-laryngology of a hospital in Northern Norway. Francisella tularensis was isolated from the blood and there was a high titre of agglutinating serum antibodies to F. tularensis. The patient's contaminated drinking water well is the suspect source of infection.

This study compares the relative thermal damage caused by a surgical CO2 laser and the Erbium: YAG laser when used to incise the human vocal fold in vitro. Results show that charring is completely eliminated when using the Erbium: YAG laser. The depth of coagulative necrosis adjacent to an incision is reduced from 510 ±m(µ 75) using the CO2 laser to 23 ±m(µ 12) using the Ebrium: YAG laser and at the base is reduced from 125 ±m (µ 45) using the CO2 laser to 12 ±m (µ 8 ) using the Erbium: YAG laser. The potential advantages regarding post-operative healing after laryngeal surgery are discussed.

Carcinoma in Situ (CIS) of the glottis is an uncommon and poorly understood condition with few, large, long- term studies. Twelve cases are presented which were treated with radiotherapy. At three-year follow-up all the patients are disease free and in 83 per cent the mucosa has returned to normal. The alternative methods of treatment are discussed.

Seventy-four patients with Stage T3 NO MO squamous carcinoma of the glottis were treated initially by either surgery or radiotherapy between 1980 and 1985. The treatment adopted was determined by consultant preference. The long-term survival in both groups was approximately the same. Of 38 patients treated initially by radiotherapy, 25 had local recurrence. Fifteen of these underwent salvage surgery and 10 died of disease. Thirteen patients (33 per cent) retained their larynx. One of the major advantages of treating patients with stage T3 NO MO carcinoma of larynx by radiotherapy initially is that approximately one-third will retain their larynx. Local recurrences can usually be treated readily by salvage surgery.

Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate giving rise to clicking objective tinnitus. The intrusive nature of the tinnitus prompts patients to seek medical advice but to date no single treatment modality has been shown to be consistently effective. We present three cases in whom various management regimes were unsuccessful and in whom botulinum toxin injection to the palatal muscles was undertaken. All three cases were rendered free of their tinnitus with complete abolition of the myoclonus. The questions of optimum dosage as well as frequency of injection will be answered as greater numbers are treated by this method.

In order to elucidate the causal mechanism of trismus in head and neck cancer, 21 patients manifesting trismus out of 212 patients with malignant tumours in the head and neck (treated in Tokyo University Branch Hospital from 1983 to 1991) were reviewed. Nine patients developed trismus either by infiltration of the muscles of mastication or by reflex spasm. Trismus was considered to have developed as a result of irradiation in five cases and of surgical intervention in seven cases. In some cases of oropharyngeal cancer, CT revealed no evidence of tumour invasion into the infratemporal fossa when trismus occurred, suggesting that trismus was caused either by the reflex spasm of muscles or by microinvasion too small to be seen in CT films. Maxillary sinus tumours were often without tnsmus even when they extended posteriorly to the infratemporal fossa.

Over the eight-year period to May 1991,256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngooesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4–41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.