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The target tissue of photodynamic therapy (PDT) of tumours by haematoporphyrin derivative (HPD) in vivo is controversial. A direct attack on the malignant cell itself, an indirect effect via the vascular system supplying the tumour, or a combination of both factors, have been suggested. We investigated this question in squamous cell carcinoma in experimental animals. Histology showed massive interstitial bleeding in carcinomas induced in the mucosa of the cheek pouch of hamsters or in the skin of mice, indicating a vascular response to PDT. However, it was also possible to induce similar changes in the neighbourhood of newly formed vessels at the margin of an inflammatory reaction induced in the cheek pouch of the hamster in the absence of tumour cells. We implanted cells from human squamous cell carcinomas into athymic nude mice and found that carcinoma cells removed immediately after PDT remained viable, whereas tumour cells left in situ died. Thus, the point of action of PDT and HPD in vivo is not the tumour cell itself, but the vascular stroma of the tumour or its immediate vicinity.

We describe the Erlangen microconducting spectrometer (EMPHO I), a device that measures the oxygen saturation and relative haemogloblin content in the capillaries. These factors determine the oxygen supply and survival of cutaneous flaps. The EMPHO I was used for intraoperative measurements in pectoralis major myocutaneous flaps and showed reproducible results, so that it is valid for intraoperative monitoring in plastic surgery.

Animal experiments were carried out on 12 dogs. Dogs are specially qualified because the choledochus and the pancreatic duct seperately fall into the duodenum. Laboratory tests demonstrated the influence of the choledocholigature on the exocrine function of the pancreas. These findings refer to the unity of the biliary tract and the pancreas. The histologic inquiries of pancreas did not showed any pathologic alterations because the survival time was too short likely.

The authors report on the use of angiography in the application of pectoralis myocutaneous flaps in head and neck surgery on the basis of 18 cases. They state that angiographic information is very useful in planning the transplantation and for the security and viability of the flap.

The principles of reconstructive operations successfully performed with the pectoralis major or myocutaneous flap in the oral cavity, pharynx and trachea are reviewed. The author's modification is demonstrated on one case of each group.

The modified pectoralis major myocutaneous paddle flap has been used in 75 cases since 1982 for the closure of major defects of the oral cavity, oro- and hypopharynx and neck. Although almost all of the patients had a stage IV tumour, we had good aesthetic and functional results. There was no total flap necrosis. Three cases of partial necrosis underwent spontaneous healing. The details of the operative techniques are compared with other reconstructive methods, and the advantage of the pectoralis major flap is discussed.

The data on 356 laryngectomies during a 12-year period were analysed retrospectively. The operations were divided into three groups: group I, laryngectomy alone; group II, laryngectomy and secondary neck dissection; group III, one-stage laryngectomy and radical neck dissection. Most patients had advanced disease (stage III and IV: 54.5% and 23.9%, respectively). Supraglottic and glotto-supraglottic tumours were commonest (39.6% and 36.8%, respectively). The results of palpation, fine-needle biopsy and histology of the lymph nodes are compared. The mean survival time for the three groups was 53.4, 42.7 and 29.8 months, respectively, and the 5-year survival rates were 61.9%, 32.0% and 30.8%, respectively.