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Biomedical subjects

S J Stöckli

Publications and source records attributed to S J Stöckli.

6 recordsLinked to original sources
PubMed2000

[Zenker's diverticulum].

The first case of posterior pharyngooesophageal diverticulum was published in 1764 by Ludlow. Zenker's name has been attributed to the diverticulum since his description of a series of patients in 1878. The aetiology and pathogenesis of Zenker's diverticulum are not well understood. Research has mainly focused on the role of the upper oesophageal sphincter, but numerous manometric studies have produced controversial results. Also, the influence of gastrooesophageal reflux on the upper oesophageal sphincter and the development of a diverticulum is unclear. Patients with a Zenker's diverticulum typically present with a long history of slowly progressive dysphagia for solid consistencies and regurgitation of undigested food. Weight loss and nocturnal attacks of coughing may bother the patient. The diagnosis of a diverticulum needs to be confirmed by radiologic examination. The only definite therapy is surgery. The classical extramucosal cricopharyngeal myotomy by transcervical approach, with or without removal of the diverticular sac, is increasingly giving way to transmucosal myotomy through a transoral endoscopic approach. Compared to the transcervical approach the endoscopic technique avoids the risk of injuring the recurrent laryngeal nerve, substantially lowers the number of pharyngeal fistulas and, in large series, showed an equivalent outcome as far as relief of symptoms is concerned. In the light of the literature and our own experience diverticulooesophagostomy with the Endo-GIA stapler by a transoral endoscopic approach has become the therapy of choice at the ENT-Department of the University Hospital of Zurich, Switzerland. In an operating time of only 10-15 minutes the stapler cuts the wall between the diverticular sac and the oesophagus, and in the same manoeuvre closes the mucosal wound edges with tiny staples. Oral feeding is possible from the first postoperative day. With the technique described this elderly population of patients obtains rapid and safe relief of symptoms.

Disease Progression↗
PubMed2000

[Value of panendoscopy in assessment of mouth cavity, pharyngeal and laryngeal cancers].

The concept of multiple squamous cell carcinoma in the region of the upper aerodigestive tract was first described over 100 years ago by Billroth. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumours and refine the role of panendoscopy in diagnosing them. The charts of 358 patients presenting for initial treatment of primary squamous cell carcinoma of the upper aerodigestive tract between January 1990 and December 1995 were reviewed. The incidence of second primary tumours was 16.2%, 6.4% being synchronous and 9.8% metachronous. In only 3.1% of all patients was a synchronous tumour clinically silent and only revealed by panendoscopy. Synchronous tumours were most likely to be located in the oral cavity, pharynx or larynx (61%), whereas metachronous second primary tumours were most likely to be located in the lung (57%). Though the incidence of synchronous second primary tumours revealed by routine panendoscopy is low (3%), we still recommend this investigation because it is often necessary for exact assessment of the first primary tumour. Further, it is ideal for training in the use of rigid endoscopy. In our opinion panendoscopy involves minimal time, cost and morbidity.

Carcinoma, Squamous Cell↗
PubMed2000

[Salvage surgery in laryngeal and hypopharyngeal carcinoma].

INTRODUCTION: The aim of this study was to analyse survival and complications in patients undergoing surgery for squamous cell carcinoma of the larynx and hypopharynx as a salvage procedure for recurrent tumours after radiotherapy. METHODS: Between January 1990 and December 1998, 166 patients with previously untreated squamous cell carcinoma of the larynx and hypopharynx were primarily treated by radiotherapy. Local failure occurred in 77 patients (46%). 57 (34%) underwent salvage surgery. RESULTS: 5-year survival for the 42 patients with carcinoma of the larynx was 60% and for the 15 patients with carcinoma of the hypopharynx 20%. The overall rate of postsurgical complications was 33% in patients with laryngeal and 47% in patients with hypopharyngeal cancer. DISCUSSION: There are few data in the literature regarding the clinical outcome in patients whose tumours are not controlled by initial radiotherapy. Our results indicate that only in carefully selected cases is salvage surgery successful in treating radiation failure in hypopharyngeal cancer. In patients with carcinoma of the larynx salvage surgery is successful and the rate of postoperative complications acceptable.

Adult↗
PubMed2000

[Quality of life after treatment of laryngeal carcinoma: surgery versus radiotherapy].

Radiotherapy and surgery for laryngeal cancer achieve comparable results in patient survival. Therefore, the expected quality of life is increasingly influencing the choice of treatment. The aim of this study was to compare the quality of life of patients after surgery or radiotherapy for laryngeal carcinoma. To evaluate quality of life, we used the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC Head and Neck module (EORTC QLQ-H&N35). 65 patients who were treated with either radiotherapy or surgery for laryngeal cancer between January 1990 and December 1995, and who were alive and free of tumour in January 1999, were included in this study. In the first group with small tumours (T1/T2), 40 patients were treated by CO2-laser surgery and 16 by primary radiotherapy. In the second group with more advanced tumours (T3/T4), 5 patients underwent total laryngectomy and 4 primary radiotherapy. In the first group there was good global quality of life with no significant difference between the two treatment modalities. Surgically treated patients scored significantly better than the irradiated patients in questions about swallowing of solid food, xerostomia and dental problems. No other significant differences were found: hoarseness in particular was rated equally after both treatments. In the second group there was also good global quality of life with no significant difference between the two treatment modalities. The laryngectomized patients scored equally on questions about voice function, talking on the phone and social behaviour. As far as quality of life is concerned we can recommend both treatment modalities for patients with laryngeal cancer of all stages.

Adult↗