Stomal Recurrence Following Laryngectomy
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To the Editor.—The interesting article by Bonneau and Lehman in theArchives(101:408-412, 1975) has prompted me to write. These authors have listed several theories as to the cause of recurrence at the stoma following laryngectomy. I have seen other theories expressed by other writers, but, with one possible exception, I have seen no reference to what looks to me like an obvious reason for this to occur. Carcinomas of the lung exfoliate malignant cells, which are sought in the mucus for diagnostic purposes. Is it not to be expected that a laryngeal cancer also exfoliates malignant cells? Any malignant cells inhaled by the patient, especially when he is struggling with partial obstruction, and any cells that might reach the lower respiratory tract from manipulation of the lesion during removal or by the use of endotracheal tubes or tracheostomy tubes, on getting down into the tracheobronchial tree will beCite
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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OBJECTIVE To explore the indication and effect of primary repair of the defects for stomal recurrence after total laryngectomy. METHODS A total of 18 cases with stomal recurrence after total laryngectomy were performed operation.The defect of hypopharynx and cervical oesophagus was repaired with free forearm flap (n=5),free jejunual interposition(n=3),pectoralis major myocutaneous flap (n=1)and pharyngogastric anastomosis(n=2).The defect of skin was repaired with pectoralis major myocutaneous flap.RESULTS All pectoralis major myocutaneous flaps were viable. Pharyngeal fistula occurred in 4 cases,one of whom had been performed free jejunual interposition,2 had been performed free forearm flap,and one with fistula bleeding had been performed pharyngogastric anastomosis.All cases could swallow after operation. During follow-up for 6 to 74 months,swallow obstruction occurred in 3 cases.CONCLUSION The methods of repair for surgical defect of stomal recurrence after total laryngectomy should depend on the bound of stomal recurrence and therapeutic procedure of primary tumor.
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