[Lymphatic and vascular invasion in laryngeal and pyriform sinus carcinomas]

BACKGROUND

To investigate prognostic significance of the lymphatic and vascular invasion in patients with squamous cell carcinoma of the larynx and pyriform sinus.

MATERIAL AND METHODS

Patients with squamous cell carcinoma of the larynx and pyriform sinus who underwent laryngectomies between 2002 and 2006 in the ENT Clinic of Cluj-Napoca were investigated for lymphatic and vascular invasion and their effect on disease-free survival and recurrence rates.

RESULTS

The present study included 396 patients. The mean disease-free survival of patients with or without lymphatic invasion was statistically significant (p=0.000000). The mean disease-free survival of patients with or without vascular invasion was statistically significant (p=0.000021). In multivariant analysis, the lymphatic invasion was significantly correlated only with surgical resection borders (p=0.0004), while vascular invasion was significantly correlated with surgical resection borders (p=0.0000), nodes diameter (p=0.0075) and postoperative radiotherapy and/or chemotherapy (p=0.0002).

CONCLUSION

Lymphatic and vascular invasion have a significant prognostic value and influence the disease-free survival, regional and distant metastasis rates significantly.

Surgical management of Gerhardt syndrome

Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

Prevalence of the c.35delG and p.W24X mutations in the GJB2 gene in patients with nonsyndromic hearing loss from North-West Romania

OBJECTIVE

In Central and South-Eastern European countries, the most frequent mutation types responsible for congenital nonsyndromic sensorineural hearing loss (NSHL) are c.35delG and p.W24X (15-55.8% and 2.5-4.3%, respectively). The aim of the study was to determine for the first time in Romania the prevalence of c.35delG and p.W24X mutations in patients with NSHL.

MATERIAL

75 unrelated children with NSHL from Transylvania (North-West Romania).

METHODS

a. Audiological examination (otoscopy, tympanogram, acoustic otoemission and tonal audiogram or auditory evoked potentials); b. detection of the c.35delG (semi-nested-PCR, RFLP and ARMS-PCR analysis) and p.W24X (ARMS-PCR analysis) mutations.

RESULTS

Audiological examination allowed the diagnosis of hearing loss of various degrees: moderate in 8 patients (10.7%), severe in 14 cases (18.7%), profound in 53 patients (70.6%). The number of reported mutation cases as against the number of alleles indicates a 33.3% frequency rate for c.35delG mutation and respectively 5.3% for p.W24X mutation. All 22 patients with 35delG/c.35delG genotype (19 patients), c.35delG/p.W24X genotype (2 patients) or p.W24X/p.W24X genotype (1 patient) presented profound/severe hearing loss.

CONCLUSION

Our study confirms that the frequency rate of the two mutations analyzed in patients with NSHL from North-West Romania is comparable to that seen in other Central and South-Eastern European countries. The homozygote or compound heterozygote states represent a major risk factor for profound or severe deafness. Audiological screening in newborns and genetic testing in confirmed congenital hypoacusis cases are compulsory for early therapeutic intervention (hearing prosthesis or cochlear implant) and genetic counselling.

[Cortisone treatment in prevention of pharyngocutaneous fistula after total laryngectomy]

PURPOSE

To identify a method of prophylaxis in pharyngocutaneous fistula (PCF) after radical surgery for cancer of larynx and pyriform fossa.

MATERIALS AND METHODS

A prospective longitudinal study on patients who were operated for cancer of larynx and pyriform fossa, in year 2007 in ENT Department of Clinic Emergency County Hospital Cluj-Napoca, with total laryngectomy and partial hypo-pharyngectomy. These patients were distributed in two lots: case (who received postoperative treatment with hemisuccinate of hydrocortisone or dexamethasone) and witness (they didn't received cortisone or other treatment except the standard therapy). We followed the detection of PCF at these 2 lots of patients and the time of resumption for naturally feeding and hospitalization. We performed the bi-variant analysis (Spearman).

RESULTS

23 patient were accomplished the inclusion and exclusion criteria. 4 of those patients developed postoperative pharyngo-cutaneous fistula, only one in the case lot. Statistically, cortisone administrated postoperative brought benefits: PCF was developed in a significant reduced proportion (p=0.02) and the resumption of naturally feeding was made in a significant shorter time (p=0.003) and hospitalization time was significantly reduced (p=0.001).

CONCLUSION

Cortisone administration after total laryngectomy and partial hypo-pharyngectomy seems to be a prophylactic method for pharyngocutaneous fistula.

[MLPA technique--principles and use in practice]

MLPA (Multiplex Ligation-dependent Probe Amplification) is a recently introduced method, based on PCR principle, useful for the detection of different genetic abnormalities (aneuploidies, gene deletions/duplications, subtelomeric rearrangements, methylation status etc). The technique is simple, reliable and cheap. We present this method to discuss its importance for a modern genetic service and to underline its multiple advantages.

Recurrence rates in endonasal surgery for polyposis

OBJECTIVE

To assess the prognostic factors of recurrence in a cohort of patients operated on for polyposis by means of endonasal endoscopic surgery.

METHODS

Prospective study of 227 patients operated on for polyposis in a single institution between 1993 and 2001. The mean follow-up period was 24 months (range 12 months to 60 months). Nine parameters were analysed to study their association with polyp recurrence: age, gender, smoking history, presence of asthma, allergy, non-steroidal anti-inflammatory drugs (NSAID) intolerance, recurrent sinusitis, previous nasal surgery, and polyp extension. Analysis of recurrences was accomplished using the Kaplan-Meier survival curves and differences were analysed using the log-rank test. The Cox proportional hazards model was used to estimate the effect of individual risk factors on polyp recurrence. A probability value of p < 0.05 was the level of significance selected.

RESULTS

During the study period, recurrences developed in 55 patients, giving a rate of 24%. In the univariate analysis, NSAID intolerance, asthma, revision surgery and polyp extension were associated with recidivism. The other mentioned factors did not attain statistical significance. However, the multivariate analysis demonstrated that only NSAID intolerance and asthma are independent predictive factors for recurrence.

CONCLUSIONS

Patients presenting NSAID intolerance or asthma are at risk for the development of recurrences after endonasal surgery for nasal polyposis.

Intracranial complications of sinusitis

OBJECTIVE

The aim of this study was to discuss the presenting signs and symptoms important for the early diagnosis and to review the medical and surgical management of patients presenting with intracranial complications of sinusitis.

METHODS

Retrospective review of the medical records of all patients admitted with intracranial infections between 1990 and 1999 at the Department of Otolaryngology, Department of Neurosurgery and Department of Infectious Diseases, University of Cluj, Romania.

RESULTS

Sixteen patients had 23 intracranial complications of sinusitis. These were meningitis (6 cases), frontal lobe abscess (6 cases), epidural abscess (5 cases), subdural abscess (4 cases), and cavernous sinus thrombophlebitis (2 cases). In almost all patients, early symptoms included headache and fever. Clinical diagnosis was confirmed by imaging. Management of these infections included intravenous broad-spectrum antibiotics, appropriate neurosurgical and sinus drainage. Among these patients, there was one death and 4 patients developed significant neurologic sequelae. Poor prognosis was associated with the presence of subdural abscess and a prolonged time interval between the onset of symptoms and the beginning of treatment.

CONCLUSION

Early diagnosis of intracranial complication of sinusitis can reduce morbidity and mortality associated with these complications.

[Vertebrobasilar circulatory insufficiency and vestibular disorders]

After a short survey of the data of vertebrobasilar anatomy and physiology, the authors present their conclusions drawn from the study of 110 patients with vertebrobasilar circulatory insufficiency accompanied by severe vestibular disturbances. The paper reports on the clinic disturbances present in the patients studied, with emphasis on the importance of the interdisciplinary consultation and of the repeated otologic examination for application of an adequate therapeutics.

[Phlebectasia of the internal jugular vein treated by surgery]

The paper reports on three cases of phlebectasia of the internal jugular vein, two in adults and one in a child, admitted and operated in the Cluj-Napoca Clinic of O.R.L. The surgical technique had to be adapted to each case separately, according to the extension of phlebectasia, the patient's age, and other related diseases.

[Therapeutic implications derived from the pathogenesis of suppurated otitis media]

The author discusses the pathogenic mechanisms considered to occur in the course of suppurated otitis media. These mechanisms are explained on the basis of experimental research work and laboratory investigations, published in the medical literature. With reference to the pathogenic aspects described the author tries to justify certain therapeutical attitudes and to criticize others. The theoretical rationale is illustrated by cases in the author's own experience.

[Morphological (Macro-, micro-electronoptical) changes and cytoenzyme changes after ligation of the pulmonary artery, pulmonary veins and both in dogs]

In six dogs ligature of the main pulmonary artery was performed, and in five other ligature of the pulmonary veins was carried out, while in five other animals combined simultaneous ligatures were made. Extensive infarcization was noted, of the pulmonary tissue, with an evolution toward death, in all types of ligatures. Death occured earlier in ligatures of the pulmonary veins. All the interventions were performed on the left lung, under general anesthesia, orotracheal intubation and assisted respiration. Electron-optic investigation revealed mitochondrial alterations 30 minutes after ligature of the pulmonary veins and 2 hours after that of the pulmonary arteries. The lesions were extensive in time. In the infarction areas the activity of the energetic enzymes (SDH, NADH2, G6PD, LDM) appears to be reduced, and even completly abolished. This occurs earlier when pulmonary veins are closed. On the basis of clinical and surgical data already mentioned in the literature, as well as on that of the experimental studies performed, the authors consider that ligature of the pulmonary artery, either therapeutically or due to various necessities, an intervention that is recommended by some surgeons, is not a functional type of intervention, and can even have ill-fated results, especially if the pulmonary venous circulation is also involve in the pathological process.

Ultrastructural changes in cartilage after intra-articular administration of osmium tetroxide and the sodium salts of fish oil fatty acids (Varicocid)

A clinical and experimental study was carried out on knee joints of rabbits and in humans. In one knee joint of each rabbit 0.3 ml 1% osmic acid or 0.3 ml 5% Varicocid was injected, the remaining uninjected joints serving as controls. The animals were killed after 1 and 24 hours, 15, 45 and 90 days. Study with the electron microscope after osmic acid injection revealed necrosis of the chondrocytes in the superficial layer and upper middle zone. The articulations injected with Varicocid exhibited only slight lesions of the chondrocytes in the upper layer, consisting of dilated rough endoplasmatic reticulum, mitochondria lacking matrix and christae; the electron density of the layer seemed to be diminished. Biopsy of the non-weight-bearing cartilage of the lateral femoral condyle was performed in 4 patients with Rheumatoid Arthritis and arthritis of the knee in the onset stage. Two of these patients received one intra-articular injection of 10 ml 1% osmic acid, 5 ml 2% xylocaine and 50 mg hydrocortisone and the other 2 patients 6 ml 5% Varicocid. Biopsy of the cartilage in the areas adjacent to the site of the first biopsies 1 and 3 1/2 months after treatment with osmic acid and 2 and 3 1/2 months after treatment with Varicocid showed in the first two cases necrosis of the chondrocytes in the superficial layer and upper middle zone of the articular cartilage and depletion of the mucopolysaccharides in the ground substance, revealed by PAS and alcian blue staining. No lesion of the knee joint cartilage was observed in the other two cases. In view of the results obtained, chemical synovectomy with Varicocid can be considered as having received further support.