耳鼻と臨床

Fifty-five cases of malignant neoplasm of the head and neck were treated with the intra-arterial infusion of anti-cancer drugs. Clinico-pathological studies of these cases have justified the following conclusions.
1) The retrograde insertion of a catheter from the superficial temporal artery is the best approach for neoplasm of the head and neck. The tip of the catheter should be placed at the entrance of the artery which supply the tumorbearing area. The direct catheterization in the local artery is unfavorable because of frequent failures in holding the catheter in place and various complications.
2) Exact placement of the catheter can be confirmed by angiography, an injection of Patent Blue solution gives confirmation that the drug can be distributed in the tumor-bearing area by staining the mucosa and/or skin. These two procedures should be done before the actual infusion of the drug.
3) The intra-arterial infusion of anti-cancer drugs is much more effective when associated with irradiation than when used alone.
4) Among: various drugs, 5 - Fluorouracil is the most effective at this moment. Histological and clinical investigations revealed that 4, 000 mg of 5- Fluorouracil combined with 3, 500 rads 60Co irradiation was comparable to 60Co irradiation of 5, 000 to 6, 000 rads alone.
5) The present technique can be effectively applied to tumors of the regions supplied by any branches of the external carotid artery distal to the superior thyroid artery. Especially, for cancer of the maxilla, the intra-arterial infusion of 5-Fluorouracil combined with irradiation is extremely effective being superior to any other treatments.

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Tracheal fenestration is more profitable than tracheotomy in patients who need tracheostoma open for a long period. After tracheal fenestration has been done, the patient does not need to have a tracheal canula in the tracheostoma, and principally, he can phonate without closing the tracheostoma with the finger.
The purposes of the present investigation comprise 1) to determine the technique best in a phonic aspect, and 2) to establish a simpler procedure than the Rockey's original one, which is rather complicated and accompanied by large scar formation on the neck. Phonic function was studied in five cases who had received tracheal fenestration. Subglottic pressure was registered with excised canine larynges coupled to a simulated bronchial tree system. The results are summarized as follows:
1. When the excised larynges were blown, the subglottic pressure varied rapidly corresponding to the vocal cord vibration. The variation of the pressure was greatest in size immediately below the vocal cords, becoming less as the distance from the glottis became greater in the trachea. No oscillation of the pressure was found below the carina.
2. The size of the oscillation of the subglottic pressure was proportional to the intensity of phonation. This suggests that the air below the glottis is compressed during phonation. The change in size of pressure oscillation on the basis of the intensity of phonation was not remarkable 5 cm or more below the glottis.
3. The results mentioned above indicate that the phonic function after tracheal fenestration should be better when the tracheostoma has been made lower on the neck. Practically, fenestration should be performed 5 cm below the glottis, or at the third and fourth tracheal rings.
4. In order to obtain a phonation time more than 3 sec or a phonation time with the tracheostoma open more than 50 % of the phonation time with the fenster closed, the tracheostoma should be less than 5 mm in diameter.
5. A simpler procedure of the surgery followed by a favorable phonic function was established on the basis of the experimental results described above. It adopts a semicircular skin incision about 3 cm in diameter instead of the complicated incision in the Rockey's method.

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