Squamous cell carcinoma of the external auditory canal and middle ear results of treatment with subtotal temporal bone resection and postoperative radiotherapy

Surgical treatment of carcinoma of the ear canal had evolved over the last half century. Several approaches are practiced. Primary radiotherapy is practiced in only a few centres. The small number of patients seen each year in a given centre, the lack of proper staging and the variability of treatment schedules used, make comparisons difficult. Twenty one cases of histologically proven squamous cell carcinoma of the ear canal seen over a period of 20 years were treated with subtotal temporal bone resection and postoperative external beam radiotherapy. Tumors were staged preoperatively according to the classification suggested by Stell. There were 9 T1, 7 T2 and 2 T3 tumors. Three patients had cervical lymph node metastases at presentation. The overall 5 year disease free survival was 42%. Quality of life as regards speech, swallowing, body image and social contacts was preserved

Heart rate variability in patients with atrial fibrillation is related to vagal tone

Background Analysis of heart rate variability (HRV) has thus far not been applied in patients with atrial fibrillation, probably because of the presumed absence of any form of patterning of the ventricular rhythm, particularly vagally mediated respiratory arrhythmia. However, such patterning is theoretically conceivable given the function of the atrioventricular node in atrial fibrillation and its susceptibility to autonomic influences. Methods and Results Sixteen patients (mean age, 56 +/- 4 years) with long-term atrial fibrillation on fixed doses of digoxin or verapamil were studied; 12 healthy men in sinus rhythm were used as control subjects. HRV (standard deviation of RR intervals [SD], coefficient of variance [CV], the root-mean-square of successive difference [RMSSD], and low-frequency [LF] and high-frequency power [HF]) was analyzed during 500 RR intervals at baseline, after administration of propranolol (0.2 mg/kg IV), and after subsequent administration of methylatropine (0.02 mg/kg IV). HRV at baseline and changes in HRV after methylatropine were then related to vagal tone (vagal cardiac control), quantified as the decrease in mean RR after methylatropine. Baseline HRV was higher in the atrial fibrillation group than in the control group; after propranolol, HRV increased in both groups; after methylatropine, HRV neared zero in the control group, whereas it returned to baseline values in the atrial fibrillation group. SD, RMSSD, LF, and HF at baseline were significantly (P <.05) correlated with vagal tone in the control group but also in the atrial fibrillation group (correlation coefficients of .60, .61, .57, and .64, respectively). Even stronger correlations were observed between changes in these parameters after methylatropine and vagal tone, particularly in the atrial fibrillation group (correlation coefficients of .89, .87, .72, and .90, respectively). Conclusions This study shows that HRV in patients with atrial fibrillation is related to vagal tone