The diagnosis 'acute' mastoiditis is not an unambiguous entity. It contains both 'classical' and 'latent' mastoiditis. 'Classical' mastoiditis was often seen before the antibiotic era, had serious complications and was cured by mastoidectomy. After the introduction of antibiotics, the number of cases of 'classical' mastoiditis decreased and was replaced by a more prolonged condition called 'latent' mastoiditis. Lately in Oslo, we have seen an increase in numbers of 'classical' mastoiditis and at the same time a decrease in the incidence of 'latent' mastoiditis. A four year study of patients with 'classical' mastoiditis is described.
Data from population-based cancer registries provide information on the causes and outcome of cancer and form a basis for important decision making in connection with the prevention of cancer and the planning of health services. This makes it of the utmost importance to assess the data at all stages of collection to ensure the highest possible quality. The present study focuses on the quality of the Cancer Registry of Norway's data on head and neck cancer for the period 1953-1991. When the study was started, 16,104 cases of head and neck malignancies had been registered. All histological codes were reviewed. The pathologists' reports were reevaluated for 369 cases selected according to set criteria: 133 cases received a new histological code without being excluded from the data material: 112 cases were excluded. The distribution of histological diagnoses for each location is presented. A reevaluation of 300 cases selected at random from the corrected series indicates discrepancies between the pathologist's classification and the Registry's coding in less than 2% (1.4%) of all cases. The percentage that lacked histological verification fell from 5.7% in the first decade to 2.1% during the last 9-year period. Completeness of the Cancer Registry's data base was checked against hospital-based registries and this investigation showed that virtually all new cases are reported. We conclude that the data on head and neck cancer for the studied time period meet standards that justify their use as a basis for epidemiological as well as clinical studies.
Mucosal malignant melanomas in the head and neck are most frequently located in the nose and sinuses. The tumours are rare, the clinical course unpredictable and the prognosis poor. 13 patients were presented with malignant melanoma in nose and sinuses in the ENT department, Ullevål Hospital, in the course of 30 years. Average age at presentation was 72 years; there were eight women and five men. Ten patients were primarily operated, and two of these received postoperative irradiation. Three patients received only palliative treatment. Four patients are alive, observation time respectively ten, seven and approximately two years (two patients). Several of the dead patients had long observation periods before death and several had operations for recurrences. The longest observed survival was 19 years. All tumours had histological characteristics indicating aggressive growth. The material is too small and sampled over too long a period for conclusions to be drawn with regard to the effect of different treatment modalities.
A cohort of 433 Oslo patients with head and neck (H/N) carcinomas was analysed for prognostic factors of survival. Mean observation time was 635 days, the distribution of men and women was 2:1 and the mean age was 64.5 years. Tumour localisations were: oral cavity 32.1%, oro/hypopharynx 19.3%, larynx 22.6% and others 25.2%. Stage distribution was: stage I: 21.0%, stage II: 22.6%, stage III: 18.7% and stage IV: 37.4%. Pragmatic strategy showed independent prognostic factors of survival to be gender, age, tumour localisation and stage. A model of predicting 3 year survival was generated. An explanatory approach showed that female patients had a 38% lower risk of mortality compared to male patients after controlling for age, stage and tumour localisation. Comparing observed to expected mortality of the age and gender matched Norwegian population, showed excess risk of death among male compared to female patients when also adjusted for demographic confounders.
Survival of patients with carcinoma in head or neck is positively associated with the stage of the disease at diagnosis. A dynamic cohort of 433 patients from Oslo with head and neck carcinoma included 162 (37.4%) patients staged 4. For these patients, the prognosis was extremely serious, 5-year survival was 22.3%. In 120 of these, the primary tumour was staged 4. It was found that the presence of an advanced primary tumour (T4) in the oral cavity, oro- or hypopharynx gave the worst prognosis. Compared with NO patients, Neck metastasis, irrespective of T-stage, increased the odds ratio for mortality to the double in N1 patients, by a factor of three in N2 patients and by a factor of nearly eight in N3 patients. Owing to the serious prognosis and reduced quality of life after surgery, this is not the treatment of choice for stage 4 disease, especially when the primary tumour is advanced and localized in the oral cavity or oro/hypopharynx, or if neck metastases are present. Irrespective of treatment (surgery or irradiation) the patient's outcome (quality of life) must be evaluated against the chance of survival. 34 (8%) patients of the cohort did not receive any active treatment.
