I. study on long term effects of chemical gases (Mustard Gas)
In this study we looked at the long term effects of mustard gas on Paranasal sinuses. This gas will stimulate the tissues by causing systemic toxicity and it is not rare to see mucosal changes after exposure to this gas.
This research studied 210 chemical victims of the war who were referred to Ghaem medical centers. These patients were mostly had injured between years 1985-1988 and were referred to us around 1991-1992.
The patients were visited and treated by specialists at their acute phase, but due to long term respiratory and air way problems it seemed necessary to study these long term consequences in the following years.
This study was limited to clinical findings due to effect of the gas on Paranasal sinuses. The major signs and symptoms and their frequency are shown the following table.
|
Nasal discharge |
51% |
|
Nasal obstruction |
59% |
|
Sinus type headache |
66% |
|
Posterior nasal discharge |
63% |
|
Nasal septal deviation |
13% |
|
Nasal mucosal atrophy |
33% |
|
Nasal mucosal hypertrophy |
35% |
|
Nasal polyps |
2% |
|
Frequent sneezing |
44% |
|
Mucoid nasal discharge |
19% |
|
Epistaxis and nasal itching |
36% |
|
Paranasal sinuses oversensitivity and intra nasal ulcer |
13% |
In radiographic study of these patients the following findings were common:
- Complete radio-opacity of maxillary sinus, one or both sides.
- Partial radio-opacity of maxillary sinus or thickening of the wall, one or both sides.
- Septal deviation.
85% of the final diagnosis was acute or chronic sinusitis. Considering these findings and frequent referral by the patients, it is necessary to set up regular follow-up visits for them in order to examine and perhaps perform pathologic studies on the mucosa.
I. The frequency of Thyroid Gland Involvement in Laryngeal Carcinoma
Presented in: The 7th International Congress of Iranian Society of Otolaryngology and Neck Surgery, Tehran,
E. Razmpa, MD.
Invasion of laryngeal carcinoma to thyroid gland has only been reported in a low fraction of the pathology results of total laryngectomy. However, it is routine to remove the ipsi-lateral lobe of the thyroid gland (to the side of laryngeal tumor) during total laryngectomy, whereas by means of pre-operative investigation and considering certain factors we can avoid an unnecessary thyroidectomy, shorten the operating time and prevent some adverse consequences. In most cases thyroid involvement present itself before or during the operation as a palpable mass.
In most of the cases of thyroid gland involvement (65%) with laryngeal origin the tumor invades thyroid gland directly rather than metastasis. Laryngeal carcinoma invades thyroid gland much less frequently than thyroid cartilage; however the tumor can invade the thyroid parenchyma as well.
Cases of laryngeal carcinoma with thyroid invasion have poor prognosis and would not survive, in most of the cases, more than 3 years.
There are not many researches done over the frequency of thyroid gland involvement in laryngeal carcinoma; a few which are done in other countries have reported a rate of 3-20%. There has been no research done in Iran, therefore we performed a study on this matter, using the pathology results in patients' files, who had undergone total laryngectomy in Amir Aalam and Imam Khomeiny Hospitals in recent years. We found out that the rate of thyroid involvement was very low and factors like the site of the tumor in larynx, type of the tumor and its stage are very important in its invasive behavior to thyroid gland. Therefore we could use these factors in order to make a decision regarding thyroidectomy at the time of total laryngectomy.
By: E. Razmpa, MD., Z. Zarnegar, MD.
