True Cord Research Articles

HYPERTROPHIC CHANGES IN THE INTERARYTENOID SPACE.

AN EXTENSIVE study of the literature yields convincing evidence of a need for revision in the description and nomenclature of certain lesions of the larynx, from the viewpoint of both anatomic location and histologic change. It is the purpose of this paper to review 32 cases of laryngeal pathology evidencing tissue changes in the interarytenoid space in an effort to approach the problems of this area. The laryngologist speaks commonly of the anterior and commissures.Webster's New World Dictionarystates under the definition of commissure: In anatomy, a band of fibers joining symmetrical parts, as of the right and left sides of the brain and spinal cord. One might justify this reference to the wide interarytenoid space as the All too frequently, however, the vocal processes of the arytenoids or extremities of the true cords are mistakenly considered a part of the posterior commissure. Originally

LARYNGEAL CANCER: PRIMARY TREATMENT WITH COBALT 60 IN A GENERAL HOSPITAL.

THE THERAPIST, when confronted with cancer of the larynx, should have an intimate knowledge of the normal laryngeal structures and a competency in indirect mirror examination of them. The value of soft-tissue films (5, 6), laryngeal tomography (5, 6, 9), and contrast examination (13) has been firmly established. If possible, these studies should be performed as part of the work-up, particularly if the disease involves other than the true cord. The authors' classification of anatomical levels of the larynx and laryngopharynx shown in Figure 1 is based mainly on Baclesse's and Lederman's (10) subdivisions. The modified classification of levels in this figure differs from Lederman's in that here the epiglottis is regarded as a separate supraglottic structure, whereas Lederman considers the infrahyoid part of the epiglottis a supraglottic structure and the suprahyoid epiglottis as part of the laryngopharynx. In our experience, such a subdivision of the epiglottis is not helpful and has no particular meaning t...

Acute epiglottitis in children.

Acute respiratory obstruction represents one of the most urgent and dramatic emergencies in the practice of medicine. In children, acute upper respiratory infection is a frequent etiologic agent in this condition. In the early part of this century, acute laryngeal obstruction from acute infectious “croup” was thought to be caused predominantly by laryngeal diphtheria. Later, other non diphtheritic infections causing acute edema of the glottic and subglottic regions were recognized and placed in the category of acute laryngotracheobronchitis (3). Recently, another entity has been gaining recognition in which acute inflammation and edema are localized to the supraglottic, arytenoid, and epiglottic regions, with resultant acute laryngeal obstruction. This has been termed acute supraglottitis, or acute epiglottitis, and, though it is receiving more attention in the literature of late, its radiological manifestations have been virtually ignored and on occasion have been said to be nonexistent (3). Acute epiglottitis usually runs a rapid course and without adequate treatment often terminates fatally, making early diagnosis and treatment of the greatest importance. Mortality rates in the literature are varied, ranging from 8 per cent (8) up to as high as 26 deaths in 29 cases reported by Jones and Camps (3). The disease can be recognized easily radiographically, and virtually all deaths are preventable. It has been emphasized that these children should be handled carefully. All unnecessary examinations and manipulations, particularly indirect and direct laryngoscopy, should be done only when the operator is prepared to do a tracheotomy (2). The purpose of this paper is to emphasize the ease and speed with which a radiologic diagnosis can be established, thus avoiding the steps which may precipitate even further edema and the need for a tracheostomy. Clinical Manifestations Acute epiglottitis is characteristically a disease of pre-school children, the average age ranging from two to five years. Briefly, the disease is of abrupt and unexpected onset, sometimes following one to three days of malaise and, occasionally, low-grade fever. The course is rapid and fulminating, with sore throat, high fever, prostration, varying degrees of cyanosis, and severe inspiratory obstruction usually manifest within four to five hours following the onset of symptoms. There is marked redness and swelling of the epiglottis, which may be eight to ten times its normal size (5), protruding posteriorly and inferiorly above the glottis, reducing its aperture and causing a typical inspiratory obstruction. In 50 per cent of cases, the epiglottis alone is involved, and in the remaining cases, there is similar but less marked involvement of the aryepiglottic folds and arytenoids. Of the latter cases, the false cords are edematous in 50 per cent. The pharynx, true cords, and subglottic areas are not involved (6).

Fluoroscopic and spot-film examination of the larynx.

While body-section radiography (1, 2, 4, 6, 9), positive-contrast technics 8, 11), and cineradiography (1) provide excellent visualization of the laryngeal apparatus, these procedures require special equipment and preparation and are often complicated and time-consuming. In many cases a preliminary screening examination with fluoroscopic spot-filming will eliminate the need for a more extensive study. Although inspection of the larynx is recommended as part of a complete duoroscopic examination of the chest in standard radiological texts and treatises on the subject (5, 10, 12), scant attention has been paid to the advantages of spot-film recording of the appearance of the larynx, particularly in the postero-anterior projection (3, 7, 13), as an aid in diagnosis. The size, shape, and spatial arrangement of the valleculae, epiglottis, laryngeal vestibule, pyriform recesses, true and false vocal cords, and laryngeal ventricles can usually be determined with accuracy on spot-films of the larynx, and the movements of the true cords and shape of the subglottic space can be visualized in considerable detail (Figs. 1, 2, 3, 4, and 8). Vocal cord paralysis can be diagnosed with ease (Figs. 5 and 6), and encroachment of tumors upon the air-filled laryngeal passages can be defined with little difficulty (Fig. 7). Technic The examination is ordinarily carried out with the patient erect and facing the examiner. The chin is elevated to uncover the laryngeal structures, and fluoroscopy is performed. The patient is instructed to phonate on command and to sustain phonation for several seconds. This preliminary rehearsal prior to actual filming adds to the ease of performance and quality of the examination. When the examiner is satisfied that the patient understands and is able to do what is expected of him, four exposures are made on two 8 × 10-inch films, with conventional spot-filming apparatus: posteroanterior exposures during quiet respiration and while phonating a high-pitched “E,” and lateral exposures under the same circumstances; 80 to 90 kvp and about 15 mas are usually adequate technical factors. Phototimed spot filming often adds to the quality of the films. Advantages The examination may be performed in a few minutes without discomfort to the patient and without the need for preparation. It has the advantage of providing views of the larynx in two projections and two states of physiologic activity on only two films. It permits the examiner to form an opinion about laryngeal mobility at the time of fluoroscopy, and it allows him to control respiration and phonation completely during filming. While fluoroscopic spot-films of the larynx are often inferior to other more elaborate examinations in respect to minor morphologic detail of the false cords, vestibule, and pyriform recesses, they usually afford excellent visualization of the true cords and subglottic space.

Larynx examination by spot-films.

In the Radiology Department of the University of California Hospitals, San Francisco, as in many other radiologic departments, the extent of malignant laryngeal tumors has been determined by routine tomograms. Tomography is time-consuming, requires special apparatus, and, unless meticulously done, is not always conclusive. By comparison, spot-films of the larynx during fluoroscopy give adequate information quickly without requiring special equipment or preparation of the patient. This method of laryngeal examination, not previously stressed in the literature, is therefore presented. Method: The patient faces the fluoroscopic screen, with head so placed that the chin and occiput are not superimposed upon the larynx. The films are exposed during quiet breathing (glottis open) and during phonation of the letter “E” (glottis closed) for comparison with tomograms during the same maneuvers and to demonstrate cord motion (Fig. 2). A fixed 4 × 5-inch diaphragm is used in addition to the fluoroscopic shutters to limit the roentgen beam to the area of interest. Four exposures are. possible on a single 8 × 10-inch film. No grid is used, since the grid lines interfere with definition of detail. Phototimed spot-films are taken at 110 kv and at 90 to 200 ma. These settings give exposures in approximately 0.1 second, so that motion and loss of definition are minimized. Density is increased or decreased, according to preference, by altering the phototimer sensitivity. The conventional fluoroscopic unit and one using an image intensifier are equally satisfactory in positioning the patient for the spot-films. Results: The radiographic anatomy of the normal larynx is shown in Figures 1 and 2. The roentgenograms were obtained with a standard spot-film device and illustrate the results achieved with the simplest equipment, most commonly available. The outline of the cords and evidence of their mobility are discernible in Figure 2. The vocal cords and the supraglottic area are usually successfully examined by mirror. The subglottic space, however, not seen by mirror examination, is clearly outlined on spot-films as well as on tomograms. The ability of this method to demonstrate abnormal laryngeal anatomy is illustrated by the following examples. Figure 3 shows elevation of the right vocal cord with phonation, which was observed clinically. This larynx had been irradiated for carcinoma of the right cord. Figure 4 compares spot-films and tomograms, demonstrating obliteration of the right laryngeal ventricle. Direct laryngoscopy showed both cords moving well and no subglottic extension of true cord carcinoma. Although the tomogram verifies these observations, the same conclusions arc possible with the spot-films. Figure 5 shows swollen true and false cords bilaterally. Limited motion on the left, observed clinically, is demonstrated. Squamous-cell carcinoma of the posterior larynx could be seen in the specimen removed one week later (Fig. 6).

Cord-Forming Property, Lethality and Pathogenicity of Mycobacteria

CONCLUSIONS The pathogenicity of 245 strains of Mycobacteria was tested by means of guinea pig inoculations; in another laboratory the same cultures were tested for their cord-forming ability in the liquid medium. Both methods, the guinea pig inoculation and the cord-forming ability, recognized 192 lethal and 40 saprophytic strains with equal efficiency. The two above mentioned groups of Mycobacteria represented 94.3 per cent of the strains tested. The remaining material consisted of eight N strains showing rudiment of cord formation. These strains were not lethal to guinea pigs but caused considerable morbid lesions in them. The origin of these strains from the lethal ones was presumed. Five isoniazid-resistant R strains formed true cords; they were classified as lethal. Two of these strains were lethal to guinea pigs; when injected intravenously, the other three were lethal to mice.

Polyp evertors: new instruments for examining the subglottic area of the larynx and the lower surface of the vocal cords.

The techniques of examining the larynx from the glottis upward have been long established and are reasonably adequate. One can see the pyriform sinus, true and false cords, the laryngeal ventricle, the superior surface of the vocal cords and their medial edges, as well as the anterior Polyp evertors commissure by various instruments now in common use. However, despite the fact that pathology occurs on the lower surface of the vocal cords and the subglottic area, there has been, to date, no adequate technique or instrumentarium to examine these areas with the same degree of visibility and confidence that characterizes examination of the regions of the superior reaches of the larynx. Some degree of accessibility to view has been accomplished by manipulating the various types of anterior commissure laryngoscopes through the cords, but the degree of accuracy with this has been such that it has been sometimes with luck that

Cancer of the Larynx

THE PURPOSE OF this report is to discuss the indications and limitations of radiotherapy in cancer of the larynx and to analyze the extent to which these and other results call for a revision of opinion on the present treatment of this disease. This paper is based upon a study of 107 consecutive, microseopicaUY'prO'ved"cancersof:the larynx treated by radiation in the Chicago Tumor Institute from the time it opened in April 1938 through December 1942,2 with a minimum observation period of five years. The controversy regarding the best treatment for laryngeal cancer revolves about two questions: 1. Is radiotherapy or surgery preferable for early true cord lesions suitable for laryngofissure? 2. Is radiotherapy or surgery preferable for operable laryngeal cancer suitable for laryngectomy? The main difficulty in attempting to answer these questions is due to the following circumstances: (a) Curability of early lesions of the vocal cord by laryngofissure is between 80 and 85 per cent and the curability of more advanced but operable cancer of the larynx by laryngectomy has increased to about 60 per cent. Surgeons understandably hesitate to substitute a newer method for an older and more established procedure until adequate evidence is available. (b) Whereas surgical technic for laryngeal cancer has become more or less standardized, the development of the principles and technic of irradiation is in mid-progress. As the technic improves, the curability increases, a fact that has not received adequate attention in the literature quoting comparative results of the two methods. (c) One obvious difficulty is that, generally speaking, the radiotherapist occupies himself largely with the treatment of cancer discarded by the surgeon and thus has only a limited opportunity to treat early and hence favorable cases. A study of the literature elicits the significant fact that, with isolated exceptions, the largest cancer clinics throughout the world treat only 8 or 10 operable cancers of the larynx each year. Since many cases are treated surgically, it becomes clear that the accumulation of enough operable cases treated by radiotherapy is a long and difficult task; yet only in this way will it ever be possible to settle the question of the relative merits of surgery and irradiation in laryngeal cancer. In spite of these difficulties, there has accumulated during the last twenty-five years sufficient experience to permit certain conclusions and to indicate the trend toward further progress. The first successful results of radiotherapy in laryngeal cancer were reported in 1922 by Regaud, Coutard, and Hautant before the International Congress of Otology in Paris (1). The report dealt with six advanced inoperable carcinomas treated with roentgen rays. The first large series was reported in 1932 by Coutard (2), who obtained 27 per cent five-year cures in 142 patients treated in the Curie Institute of Paris. In 1941, Ahlborn (3) reported 76 carcinomas of the larynx treated in the Radiumhemmet in Stockholm between 1930 and 1939.

Transurethral Resection in Treatment of True and Pseudo Cord Bladder

Transurethral Resection in Treatment of True and Pseudo Cord Bladder

The Classification of Laryngeal Cancer from a Radiotherapeutic Viewpoint

For over sixty years it has been customary to classify laryngeal cancer into two main groups: (1) Intrinsic—where cancer arises within the cavity of the larynx (true cords, false cords and ventricle, subglottic space). (2) Extrinsic—where cancer arises from the aperture and pharyngeal surface of the larynx (epiglottis, aryoepiglottic folds, arytenoids, pyriform fossæ, post cricoid region). Considering the difficulties of classification in medicine where cases rarely lend themselves to stereotyped grouping, the persistence and wide adoption of this particular one provide clear evidence of its value. Nevertheless, although this classification is of great use to the surgeon, it does not follow that it is of equal value to the radiotherapist. This is well shown by the confusion in the use of the terms “intrinsic” and “extrinsic” existing in radiotherapeutic literature, where some authors tend to consider all forms together and fail to distinguish between “intrinsic” and “extrinsic” disease, whilst others who make this distinction fail to attach to each group the significance and special consideration that it merits. From the radiotherapist's view-point this surgical classification is unsatisfactory, because included under the heading “laryngeal cancer” are various separate and distinct types of neoplasms between which the only common bond is anatomical proximity to the boundaries of the larynx.

HISTOPLASMOSIS OF THE LARYNX

REPORT OF CASE A teamster, aged 41, became hoarse in May 1941. The hoarseness increased and at the end of four months severe cough, stridor and dyspnea were present on exertion, followed later by dysphagia, pain deep in the ears and generalized weakness. There was a loss in weight of 20 pounds (9.1 Kg.) during this period. When first seen at Barnes Hospital in January 1942 (seven and a half months after the onset of the illness), the patient appeared poorly nourished; he was unable to speak above a whisper and was in mild distress, due to inspiratory stridor. The epiglottis was thick, nodular and pale. It was tilted in a position preventing indirect examination of the larynx and encroached on the airway. Direct examination showed the whole interior of the larynx to be white and nodular. The false and true cords were involved to such an extent as to

An Experimental Study of Bladder Disturbances Analogous to Those of Tabes Dorsalis

No AccessJournal of Urology1 Nov 1935An Experimental Study of Bladder Disturbances Analogous to Those of Tabes Dorsalis1 John E. Dees and Orthello R. Langworthy John E. DeesJohn E. Dees More articles by this author and Orthello R. LangworthyOrthello R. Langworthy More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)72290-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1935 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byShoemaker W and Long D (2018) Experimental Studies on the Reconstruction of the Neurogenic Bladder: A Preliminary ReportJournal of Urology, VOL. 76, NO. 2, (150-161), Online publication date: 1-Aug-1956.Ney C and Duff J (2018) Cysto-Urethrography: its Role in Diagnosis of neurogenic BladderJournal of Urology, VOL. 63, NO. 4, (640-652), Online publication date: 1-Apr-1950.Mcdonald D (2018) Advances in Urology Made Possible By Animal experimentationJournal of Urology, VOL. 63, NO. 4, (764-766), Online publication date: 1-Apr-1950.Emmett J, Daut R and Sprague R (2018) Transurethral Resection for Neurogenic Vesical Dys-Function in Cases of Diabetic NeuropathyJournal of Urology, VOL. 61, NO. 2, (244-257), Online publication date: 1-Feb-1949.Lich R and Grant O (2018) Vesical Abnormalities Incident to Diabetes MellitusJournal of Urology, VOL. 59, NO. 5, (863-871), Online publication date: 1-May-1948.Lewis L (2018) Treatment of Bladder Dysfunction after Neurologic TraumaJournal of Urology, VOL. 54, NO. 3, (284-295), Online publication date: 1-Sep-1945.Emmett J (2018) Transurethral Resection in Treatment of True and Pseudo Cord BladderJournal of Urology, VOL. 53, NO. 4, (545-564), Online publication date: 1-Apr-1945.Simons I (2018) Further Neurologic Studies by Means of the Microcys-tometer and the Sphincterometer: X. Studies in Bladder FunctionJournal of Urology, VOL. 48, NO. 3, (331-342), Online publication date: 1-Sep-1942.Herbst W (2018) Treatment of neurogenic Diseases of the BladderJournal of Urology, VOL. 40, NO. 6, (789-796), Online publication date: 1-Dec-1938.Simons I (2018) Neurologic Studies by Means of the Microcystometer and the Sphincterometer: Studies in Bladder Function. VII (Preliminary Report)Journal of Urology, VOL. 39, NO. 6, (791-812), Online publication date: 1-Jun-1938.Langworthy O and Dees J (2018) A Study of Bladder Disturbances in Spina BifidaJournal of Urology, VOL. 35, NO. 2, (213-226), Online publication date: 1-Feb-1936. Volume 34Issue 5November 1935Page: 359-371 Advertisement Copyright & Permissions© 1935 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John E. Dees More articles by this author Orthello R. Langworthy More articles by this author Expand All Advertisement PDF downloadLoading ...

CHICAGO LARYNGOLOGICAL AND OTOLOGICAL SOCIETY: Nov. 5, 1934

MULTIPLE CARCINOMA (PATHOLOGIC SPECIMEN). FRANCIS L. LEDERER. Mr. R. H., aged 55, married, stated that about one year ago he became hoarse, and that this condition became progressively worse. He was first seen in my clinic at the Illinois Research and Educational Hospital early in March 1934. The past history was essentially negative. Examination of the larynx revealed a marked infiltration of the left true and false cords and of the left arytenoid and aryepiglottic fold, with ulceration of these areas. Biopsy revealed a noncornifying squamous cell carcinoma. The Wassermann and Kahn reactions were 4 +. Treatment consisted of roentgenotherapy by the Coutard method. A 10 cm. square field was used, with 200 roentgens (r) alternately to the right and left sides daily for a total of 3,800 r to each side and a total of 7,600 r to the larynx. The treatment was begun on June 5 and ended

THE PHYSIOLOGY OF THE "FALSE" VOCAL CORDS AND THE ANATOMY OF THE THYRO-ARYTENOID MUSCLE AND OF THE THYRO-EPIGLOTTIC LIGAMENT

The function of the ventricular bands or, as they are frequently termed, the vocal cords, has stirred but little interest in laryngology; and though the true vocal cords have been more or less thoroughly studied, little mention of the ventricular bands has been made in the literature. About two years ago, I published in the footnote of an article 1 a preliminary report of a study on the function of the false cords. This paper is an elaboration of that report. The ventricular band is generally regarded as a relatively inert structure, which has little to do with phonation, and which is composed of folds of mucous membrane covering the true cords and forming the roof of the sinus Morgagnii and its appendix. As a matter of fact, its construction is considerably more interesting. A cross-section of the ventricular bands reveals a fold of mucosa rich in glands,

ADHESIVE SPINAL ARACHNOIDITIS SIMULATING SPINAL CORD TUMOR

There is a group of cases with the clinical picture and course of spinal cord tumor in which, at operation, no neoplasm of the spinal cord or other pathologic change except adhesions of the arachnoid to the spinal pia and to the dura is to be found. These adhesions vary from rather fine discrete bands to adherent processes completely surrounding the spinal cord and producing complete obstruction of the subarachnoid spaces. In both varieties of adhesions marked disturbances in spinal cord function have been found, and the evolution of the clinical signs has been identical, in most respects, with that of true spinal cord tumors. Cases of spinal arachnoid adhesions were little recognized in this clinic before the routine use of the finer cerebrospinal fluid manometric tests, which are now used in all suspected spinal cord neoplasms. It is significant that in the past three years I have encountered ten

A NOTE ON THE USE OF THUJA OCCIDENTALIS IN REMOVAL OF PAPILLOMA OF THE LARYNX.

Several cases of papilloma of the larynx have come under my observation, occurring in the practice of Dr. Moreau R. Brown, which were treated by removal of parts with forceps and the subsequent application of thuja. The following case is one in which good results were obtained by this treatment. Mrs. W., an elderly woman, had been hoarse for about two years, had slight dyspnea, and at times noticed some little noise located in the larynx during respiration. She tried change of climate several times but found little relief. Upon examination with the laryngeal mirror, a papilloma about the size of the end of a finger was seen springing, with a broad base, from the false vocal cord of the right side, and extending beyond the true cord to the median line. The growth was of an unusually hard consistency. A portion of it was removed by the laryngeal forceps