One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20–30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in non-responders (54 per cent) p<0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p<0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p<0.01). Survival data are available for a mean follow-up time of 48 months (range 12–78 months). Chemotherapy responders have a longermedian survival than non-responders, 33 versus 20 months (p<0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p<0.001). Actuarial analyses indicate that at five years 46 percent of patients in complete remission are alive, compared with only 9 per cent with residual disease. Since chemotherapy responders are significantly more likely to achieve a complete remission than non-responders (p<0.05), objective response to this schedule of chemotherapy is a good prognostic sign.

Three patients treated with bromocriptine for chronic hepatic encephalopathy showed audiometric evidence of bilateral sensori-neural hearing-loss. Audiometrically, the hearing improved in all three patients when the bromocriptine dosage was reduced, thus suggesting that this drug may produce a reversible ototoxicity.

Twenty-four patients underwent crico-thyroidotomy at Guy's Hospital between 1977 and 1981. Of these, 13 died during admission or shortly after discharge as a result of their primary disease and three were unsuitable for further examination. The eight remaining patients were examined to assess the effect of crico-thyroideotomy on the laryngeal function of voice production. Assessment was made both subjectively and objectively by laryngography. Objective findings were correlated with structural changes seen by indirect laryngoscopy. Six of the eight patients examined had both subjective and objective disturbance of voice production. We report our experience with the surgical procedure of cricothyroidotomy which, in addition to a high incidence of vocal disturbance, includes one case of subglottic stenosis secondary to granulation tissue.

What I have to say follows on very naturally from what Dr. Johnson has just said. I ought to explain that in the United Kingdom we work in somewhat different situations from yours in the United States, from the administrative point of view, but most particularly from the financial funding point of view. Under the National Health Service we are not paid per item of service; we get a lump sum on which we have to run our departments. If we see two patients or if we see a million patients it makes no difference. In many ways, if we see few patients we can give them a better service than if we see many. I realise that this is a concept which is perhaps new to those of you in the United States, that your income in fact comes from numbers of patients.

A postal survey of 100 members of the Association of Head and Neck Oncologists of Great Britain was conducted in the first 6 months of 1983. The sample consisted principally of Otolaryngologists (50 per cent), Radiotherapists (14 per cent), Medical Oncologists (10 per cent), Oral Surgeons (10 per cent) and Plastic Surgeons (10 per cent). More than 80 per cent of those who completed the questionnaire used chemotherapy for Head and Neck cancer (72 per cent used it for palliation, and 64 per cent as part of combined modality therapy). There was great variation in the chemotherapeutic regimens used by the various responders. Furthermore, most responders used more than one regimen. Methotrexate was the agent most frequently used. No specific regimen, either single-agent or multiple-agent, enjoyed universal acceptance, although the combination of Vincristine, Bleomycin and Methotrexate was popular. Chemotherapy was thought by most responders to have a useful but as yet undefined place in the management of Head and Neck cancer. This survey underlines the need for prospective, controlled, clinical trials into the efficacy of cytotoxic chemotherapy for Head and Neck cancer.

Immunohistochemical staining for keratin proteins may be useful as a diagnostic parameter in head and neck neoplasms. Our study evaluates the keratin antibody staining properties of normal tissues as well as neoplastic and non-neoplastic head and neck lesions from surgical procedures performed on 100 patients. The results indicate that the anti-keratin antibody technique can be helpful in several areas of head and neck pathology.

Plasma cell neoplasms have been classified as multiple myeloma, solitary plasmacytoma and extramedullary plasmacytoma. They are usually considered as osteolytic lesions of bone except for the rare occurrence of osteosclerotic lesions. This paper describes the first reported osteosclerotic plasmacytoma of the maxillary bone and orbital floor. The difficulties in establishing a diagnosis and the relationship to other plasma cell neoplasms are discussed.

Osteosclerotic plasmacytomas are a rare variant of plasma cell tumors which usually produce osteolytic lesions rather than bony sclerosis. Sixty-eight patients with the osteosclerotic variant have appeared in the world literature, with an overall incidence of about 1 per cent in a large series of plasma cell neoplasms (Dreidger and Pruzanski, 1979). There have been only six previous cases of solitary osteosclerotic plasmacytomas reported (Morley and Schweiger, 1964; Roberts et al., 1974; Rodriguez et al. 1976; Rushton, 1965; Schneinker, 1938; Brigham Medical Review, 1961) involving spine, sternum, or rib. None have previously been reported in the head and neck area.

Plasma cell tumors have been classified into multiple myeloma, solitary plasmacytomas of bone, and extramedullary plasmacytomas. Multiple myeloma is a disseminated plasma cell malignancy characterized by the production of homogeneous immunoglobulins (whole or fragments) which appear in the serum and urine. Plasma cell tumors can also occur as solitary plasmacytomas, usually in bone, but also in soft tissue. With time, most solitary plasmacytomas develop disseminated disease with all the characteristics of multiple myeloma (Wiltshaw, 1976). Extramedullary plasmacytomas arise in soft tissue rather than bone, and primarily occur in the head and neck region. Clinically, they remain localized and less frequently develop into disseminated myeloma.

The concept of the critical band was first described in 1937 when Fletcher and Manson (1937) reported the results of an experiment conducted at the Bell Telephone Laboratories in which they used a random noise that had been shown to produce uniform masking throughout the frequency spectrum as the masking stimulus. From the results of this initial experiment, Fletcher (1940) was able to make two important assumptions concerning the masking of pure tones by thermal noise. The first assumption states that only the energy in a narrow band around the test frequency is instrumental in the masking of that pure tone and the energy outside this small band is superfluous. This small band of noise, Fletcher referred to as the ‘critical band’. Secondly, he assumed that at its masked threshold the energy of the tone and overall energy in the critical band were exactly equivalent. Using these assumptions, Fletcher computed critical bandwidths for several different frequencies. He found the critical band to be approximately 63 Hz for a 1000 Hz tone, to remain relatively constant for the lower frequencies, and to increase rather rapidly for high frequencies, reaching a width of about 500 Hz for a tone of 8000 Hz.