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The effect of free transplanted jejunum autografts, inserted after resection of extensive squamous cell carcinoma of the larynx and hypopharynx is evaluated in terms of survival and the development of local and regional recurrences. In a matched-pair analysis, 22 patients with jejunum transplants were compared with 44 patients with the same performance status, in whom after laryngopharyngectomy, the pharynx had been closed with local mucosa. The cumulative survival rate was calculated using the Kaplan-Meier method; the statistical comparison of the survival curves of the two groups was made with the Mantel-Haezel test. Patients of the study group had a statistically significant (p less than = 0.01) better survival rate than those of the control group, the 50% survival rate being 36 and 11 months, respectively. Local recurrences occurred in 9.1% of the patients in both the study group and in controls, and regional recurrences in 40.8 and 43.2%, respectively. This militates against the possibility that the surgery in patients in whom reconstruction with jejunum was possible might have been more radical. Further, it may be speculated that the statistically significant better survival rate is due to the jejunum itself, presumably to a tumourprotective effect of the lymphatic tissue of the transplant.

The role of sonography in evaluation of tumorous infiltrations of the wall of the cervical arteries is discussed upon 75 patients with histologically proved lymphnode metastasis. Direct signs for the infiltration--loss of the echogenic wall of the arteries and indirect signs--length and circumference of the tumor/vessel contact area are evaluated. In 9 patients the infiltrations were correctly diagnosed, 4 patients were false positive. The technic of the sonographic investigation and potential pitfalls are demonstrated. The role of other investigation modalities are discussed.

Endoscopy permits visualization of the endolaryngeal spread of laryngeal tumors, yet the depth of tumor infiltration often remains unclear. The authors used high-resolution sonography in 37 patients with advanced laryngeal cancer to assess the tumors and the cervical lymph nodes. Sonographic findings were compared to operative and histologic reports. Sonography demonstrated histologically confirmed infiltration into the thyroid (n = 8) and cricoid cartilages (n = 1), preepiglottic space (n = 12), base of the tongue (n = 4), hypopharynx (n = 8), subglottic space (n = 3), and thyroid gland (n = 2). Except for the retrolaryngeal portion of the tumor, sonography was valuable in assessing extralaryngeal spread of advanced cancers. It enabled detection of subclinical lymph node metastases in four patients. Furthermore, invasion of the wall of the carotid artery was found in two patients. For evaluating the endolaryngeal and hypopharyngeal portions of the tumor, endoscopy remains mandatory.

16 operatively and histologically proven branchiogenic cysts were evaluated sonographically and the contents of some of them were analysed by microscopy and chemistry. The echographic appearance of all cysts depended on the frequency of the scanheads and ranged from cystic (3.0 MHz) via semi-solid (5.0 MHz) to solid (7.5 MHz). This frequency-related sonographic pattern is caused by the high amount of cholesterin contained in these cysts and permits diagnosis of a branchiogenic cyst.