Prognosis and Outcomes in Early Stage Glottic Carcinoma Involving the Anterior Commissure Treated with Laser CO2 Surgery: A Retrospective Observational Analysis

The anterior commissure (AC) is the area where the vocal cords attach to the thyroid cartilage through Broyles' ligament. Many authors argue that involvement of the anterior commissure in early stage glottic carcinoma (I, II) constitutes a risk factor for local recurrence. The objective of this study is to evaluate whether anterior commissure involvement in early stage glottis cancer is an independent risk factor for recurrence and mortality. The study included all those patients diagnosed with glottis carcinoma in stages I and II of the AJCC treated by transoral laser surgery at the Hospital San Pedro (Logroño, Spain) between 2005 and 2015. Patients were divided into two groups according to the presence (AC1) or absence (AC0) of involvement of the commissure. Of 29 patients treated, 44.8% were AC1. Patients with anterior commissure involvement had more local recurrence (p = 0.2701); higher mortality rate (p = 0.2256); lower disease-free survival (p = 0.0881) and a lower overall survival (p = 0.0331). The 5-year survival rate was 24.5% lower in patients with invasion of the anterior commissure. The involvement of the anterior commissure is an independent risk factor that should be considered in the prognosis of laryngeal cancer.

New TNM staging in lung cancer (8th edition) and future perspectives

BACKGROUND

Carrying out a correct anatomical classification of lung cancer is crucial to take clinical and therapeutic decisions in each patient.

AIM

TNM staging classification provides an accurate anatomical description about the extension of the disease; however, the anatomical burden of the disease is just one aspect that changes the prognosis.

RELEVANCE FOR PATIENTS

TNM staging classification is a tool that predicts survival, but we must consider that TNM is just one of the factors that concern the prognosis. The impact of a factor over the prognosis is complex due to: It depends on the specific environment, the treatment strategy, among others, and our level of certainty makes difficult to include all the factors just in a group of stages. In some groups, there are difficulties to get large series due to the low frequency of cases and the small number of events (metastasis, locoregional recurrence). It does not allow to obtain evidence in a short period of time. On the other hand, in the next years, new markers will be incorporated in the coming years, which are going to be included in the new TNM classification. It could help to improve the classification giving more information about prognosis and risk of recurrence. All these aspects are being used by the International Association for the Study of Lung Cancer (IASLC) to develop a new prognosis model. This continues the evolution of TNM system, allows us to overcome the difficulties, and build a flexible framework enough to continue improving the individual prognosis of the patients.

A phylogenetic framework of the legume genus Aeschynomene for comparative genetic analysis of the Nod-dependent and Nod-independent symbioses

BACKGROUND

Among semi-aquatic species of the legume genus Aeschynomene, some have the property of being nodulated by photosynthetic Bradyrhizobium lacking the nodABC genes necessary for the synthesis of Nod factors. Knowledge of the specificities underlying this Nod-independent symbiosis has been gained from the model legume Aeschynomene evenia but our understanding remains limited due to the lack of comparative genetics with related taxa using a Nod factor-dependent process. To fill this gap, we combined different approaches to perform a thorough comparative analysis in the genus Aeschynomene.

RESULTS

This study significantly broadened previous taxon sampling, including in allied genera, in order to construct a comprehensive phylogeny. In the phylogenetic tree, five main lineages were delineated, including a novel lineage, the Nod-independent clade and another one containing a polytomy that comprised several Aeschynomene groups and all the allied genera. This phylogeny was matched with data on chromosome number, genome size and low-copy nuclear gene sequences to reveal the diploid species and a polytomy containing mostly polyploid taxa. For these taxa, a single allopolyploid origin was inferred and the putative parental lineages were identified. Finally, nodulation tests with different Bradyrhizobium strains revealed new nodulation behaviours and the diploid species outside of the Nod-independent clade were compared for their experimental tractability and genetic diversity.

CONCLUSIONS

The extended knowledge of the genetics and biology of the different lineages sheds new light of the evolutionary history of the genus Aeschynomene and they provide a solid framework to exploit efficiently the diversity encountered in Aeschynomene legumes. Notably, our backbone tree contains all the species that are diploid and it clarifies the genetic relationships between the Nod-independent clade and the Nod-dependent lineages. This study enabled the identification of A. americana and A. patula as the most suitable species to undertake a comparative genetic study of the Nod-independent and Nod-dependent symbioses.

Activity profile in multiple sclerosis: an integrative approach. A preliminary report

In order to define an activity profile in patients with multiple sclerosis (MS), T-cell subpopulations and proliferative responses to myelin basic protein (MBP) associated with anti-MBP antibodies, nitrotyrosine levels in serum and cerebrospinal fluid (CSF), and serum CD40L (sCD154) were simultaneously assessed in 29 consecutive and untreated MS patients. When compared to controls, patients in secondary progressive stable (SP/I), or in full remission (RR/I) stages, individuals with secondary progressive active disease (SPIA) or in acute relapse (RR/A) showed a significant decrease of CD4/CD45RA+ T cells associated with an increase of absolute numbers of CD4/45R0+ T cells (p < 0.001). In addition, in vitro-specific T-cell proliferative responses against MBP (SP/A, RR/A, SP/I: p < 0.001 versus controls) in association with augmented sCD154 serum levels (SP/A, RR/A, versus controls p < 0.001) and a significant increase of both CSF and serum levels of anti-MBP antibodies and nitrotyrosine levels (p < 0.001) were also found. Thus, the simultaneous evaluation of antibody and cell-mediated immunopathological parameters, along with the effector mediators of inflammation such as the nitric oxide products, offers a new integrative approach to characterize markers of clinical activity in MS patients, which may be used at the moment of the initial diagnosis and during an apparent recurrences of the disease to monitor therapeutic protocols and to determine whether immune-based nerve destruction mechanisms are still operating in patients with few clinical findings.

[Extramedullary plasmocytoma. Report of 5 cases]

The extramedullary plasmacytoma account for 1-2% of the total number of plasma-cell growths. 80 percent are originated on head and neck, beginning on submucous layer of the upper airways. Male are more frequent affected at sixth-seventh decade. Roentgentherapy chemotherapy is only worldwide accepted in cases of scattered disease, but when the cases are localizated the method is under assessment. Long tern follow up of patients is recommended, because there are cases which after many years of calm can evolve into a multiple myeloma. We report 5 cases: 3 women and 2 men, diagnosed as extramedullary plasmocytoma. In one of them, considered as nasal plasmacytoma, three years later was discovered an other plasmacytoma on a tibial epiphysis. The whole group was surgically treated with complementary röntgentherapy 4 of them. Afterwards no one showed multiple myeloma.

[Extracranial schwannomas. Report of seven cases]

Seven cases of extracranial schwannomas in head and neck area are presented. The anatomical structures involved were: tongue, oral mucosa, nasal cavity, IX and XI cranial nerves. It rarely appears (7 cases in 19 years). The clinic is anodyne and its diagnosis is anatomopathological. It is treated by enucleation and relapse is infrequent.

[Surgical pathology of submandibular gland. Experience in La Rioja community]

The AA. had work through medical histories of 44 patients operated for inflammatory and tumoral pathology of submandibular gland. Between inflammatory diseases they emphasize sialolithiasis (45%), acute submaxillaritis (18%) and Kuttner's tumor (11%). Pleomorphic adenoma accounted for the 50% of tumors. Diagnosis was based on each peculiar history sheet, on imaging procedures (simple X-ray plate, echography, sialography, TC) and extemporaneous biopsy. In all cases a complete exeresis of the gland was performed. In malignoma cases the procedure was completed with a prophylactic neck dissection. Incidence of lasting paralysis of the ramus marginalis mandibulae accounted for 6.8%.

[Cordectomy. Review of cases treated in our department between 1984 and 1991]

Survey of the 49 glottic tumors, state T1, treated by the AA. at their Department between the years 1984 and 1991. Subperichondral cordectomy through the midsaggital plane and laryngotracheal dissection of middle area was the followed procedure. Description of outcomes and bibliographical review.

[Congenital cervical deformities]

The paper deals with the survey of 66 congenital neck malformations (27 thyroglossal cysts and 32 branchial plus 7 lymphatic anomalies) surgically treated in the last 5 years term. Thyroglossal cysts presented in children and young people, in the middle line, and 92.6% of them were infrahyoid. Recidivation appeared in 7.4% of all cases, always in connection with previous infections. Branchial malformations presented on the neck's side of middle age persons were related to the 2nd. cleft (97%). Lymphatic anomalies presented in children under 3 years, in these instances the dissection sheaths were not spared and the neighboring structures altered.

[Surgical pathology of parotid gland tumors]

The records of 27 patients operated for parotid tumors were reviewed retrospectively. Pleomorphic adenoma was the most frequent tumor (37.1%) and required subtotal parotidectomy in all cases. Twenty percent presented permanent facial paralysis of the marginal mandibular branch. No recurrence has been observed in five years of follow-up. Warthin's tumor, found in 11.1% of patients, was removed by either superficial or subtotal parotidectomy. Parotidean cysts were observed in 7.4% and were excised by superficial parotidectomy. The malignant tumors included squamous cell carcinoma (22.2%), adenoid cystic carcinoma (14.8%), melanoma (3.7%), and renal-cell metastasis (3.7%). All were treated by total parotidectomy with conservation of the facial nerve in 67%. Twenty-five percent had postoperative facial paralysis and 33% developed Frey's syndrome. Thirty-three percent died in the next 5 years from locoregional metastases.

[Kukuchi disease]

Kikuchi's necrotizing lymphadenitis is rare in Spain. The main clinical signs are cervical lymph node enlargement, fever, accelerated erythrocyte sedimentation rate and/or leukopenia. The diagnosis is histological and the course generally is benign and self-limited. Two cases diagnosed in our hospital are reported.

[Mandibular actinomycosis]

We report a case of mandibular actinomycosis secondary to dental surgery in a 19-year-old male. The major features of this clinical entity are described. Loss of the integrity of the oral mucosa was the determinant factor in our case. Systematic realization of panoramic radiographs of the jaw is proposed as a means of excluding lower maxillary involvement secondary to Actinomyces infection.

[Monomorphic adenoma of basal cells in a minor salivary gland]

Tumors of the minor salivary glands represent 15% of all salivary gland tumors. Monomorphic adenoma is an uncommon histological type that usually is located in the parotid gland, minor salivary glands of the upper lip and less frequently, palate. The clinical and histological features of a case of palatal monomorphic adenoma that was diagnosed and treated in our hospital are described.

[The evolution of otitis media with effusion treated by transtympanic drainage]

One hundred sixty children with effusive otitis media who did not improve with medical treatment were reviewed. The evolution and complications observed in 294 ears treated by myringotomy and ventilation tubes (grommets) over a three-year period were analyzed. Otorrhea occurred during grommet placement in 11.6%. The disease remitted in 84%. Recurrences occurred in 15.3%: 4.8% had different degrees of tympanic atelectasia and 0.7% had perforation. Three per cent of the children were reoperated for bilateral recurrence of otitis. Younger children and those whose had delayed surgery had a worse outcome. Insertion of ear grommets improved hearing.

[Determination of alpha fetoproteins in patients infected with virus B and C. Preliminary report]

The presence of detectable levels of aFP was investigated through RIA in 78 serum samples classified as follows: 32 samples from healthy volunteers (group A), 15 anti-HCV positive sera, 19 samples from HBV Chronic carriers (Group B), and 12 sera from a group of anti-core positive individuals, (Group C). Increased aFP levels, upper to the calculated maximal limit (Above 2.6 ng/ml) were detected in 2 individuals from Group A, in 2 HCV positive sera and in 6 HBV chronic carriers. None of the Group C demonstrated increased aFP value. Two B positive sera with augmented aFP activity showed significantly elevated values of this protein 13 and 20 fold upper than maximal limit. In Venezuela, aFP levels the HBV chronic carriers do not appear to be comparable to the reported values in HBV hyper-endemic countries. The need to analyze aFP values in normal groups is emphasised.

[Hepatitis C in Venezuela. Preliminary report]

Five hundred serum samples from volunteers blood donors were investigated in order to determine the presence of anti-HCV antibodies by an enzyme-linked immunoassay recently developed worldwide. Prevalence of true-positive samples was 1.2% (6/500), 2 fold higher than the reported prevalence in most of the industrialized countries. From these 6 sera, one (16.6%) showed simultaneous reactivity for HBV anticore antibody. Three sera (25%) from 12 patients with diagnosis of Non-A Non-B hepatitis were reactive for anti-HCV antibodies while in a group of 32 sera with negative HAV and HBV screening, 4 (12.5%) showed anti-HCV antibodies. Two samples out of 16 sera persistently positive for anticore demonstrated the presence of anti-HCV antibodies. The anti-HCV antibodies were undetectable in two cases of autoimmune chronic hepatitis. Our results indicate that in Venezuela, HCV represents a significant problem of public health coexisting in certain cases with HBV infection.

[Evaluation of a molecular hybridization trial for the detection of circulating DNA of hepatitis B virus. Immunoclinical correlation]

Immunoclinical correlation of the HBV circulating DNA was performed. The DNA was detected by means of a hybridization technique set-up in fluid phase using a complementary DNA probe labelled with 125I (Abbott-Genostics). The correlation was carried-out in 12 serum including 8 from known HBV carriers with or without liver disease. Only the positive HBeAg serum shown circulating viral DNA in ranges between 60 to 2800 pcg/ml. The assay shows to be easy to perform, however the expensive cost plus the use of a short-life isotope makes difficult in routine use, which still is under research. The immunopathogenic significance of the findings is discussed.

[Chronic diarrhea as a clinical expression of common variable hypogammaglobulinemia: apropos of 3 cases]

Sixty per cent of the patients with immuno-compromise of the humoral compartment may show chronic diarrhoea, specially seen in the common variable hypogammaglobulinemia (CVH). We presented 3 cases of late-onset CVH who referred chronic diarrhoea as the main symptom. The immunodiagnosis revealed undetectable or subnormal immunoglobulins levels (G, M, A), preserved total haemolytic complement and a negative autoimmune screening. The cell compartment analysis showed increased number of suppressor T lymphocytes (CD8) plus hyporesponsiveness of the total peripheral lymphocytes to polyclonal mitogens such PHA. The clinical approach of the CVH patients should be performed by a multispecialized team including the clinical immunologist and the gastrointestinal and infectious diseases specialists.

[Acute meningococcal infection (author's transl)]

Authors report 49 patients bacteriologicallyly diagnosed of acute meningococcal infection collected during a 12 months period out of a series of 76 cases diagnosed on clinical grounds. "N. meningitidis" was found in 18 blood and 43 CSF cultures. 31 cases were of the B-group, one was A-group and 17 were not typed. All of them were sulphamide resistant. Hyperthermia with vomiting, cephalea, arthralgia and seizures were the initial symptoms. All patients showed pettechiae, purpura and/or ecchymoses. Endotoxic shock was diagnosed in 26,5% of the cases. In them systolic blood pressures were under p-5. Overall mortality was 14%, and that of endotoxic patients 53%. Therapeutic routines and chemoprophylaxis are reviewed.