Can Carpobrotus edulis, heal incisional and excisional wounds on the skin?

OBJECTIVES

This study aimed to investigate the wound healing activity of liposomal Carpobrotus edulis powder extract (CEPE) formulation on incisional and excisional wounds in rat.

BACKGROUND

In the event of any damage, the damaged tissue undergoes a process of regenerating itself, which is called wound healing.

METHODS

Centella asiatica extract (CAE) was used as the reference molecule in the study. The wound healing process was tested by using the excisional and incisional wound model. On the 12th day of the study, maximum stress, stress, % of elongation values were evaluated in the incisional wound. Also; histological parameters and macroscopic photographic analyses were evaluated in the excisional wound.

RESULTS

In the photo evaluations, the improvement was more prominent in both CAE and CEPE groups than in the control group. Histological evaluation showed that CEPE group had significant wound healing activity compared to the control and CAE groups. Axial tensile-elongation experiments in incisional wound tissue show that there was no significant difference between CAE and CEPE groups.

CONCLUSION

Liposomal formulations of C.edulis extract were found to have positive effects on the healing process, both on excisional and incisional wound tissues (Tab. 2, Fig. 3, Ref. 30).

Endonasal endoscopic nasopharyngectomy for the treatment of nasopharyngeal papillary adenocarcinoma: Report of a rare case

We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. We also suggest endonasal endoscopic resection in case of papillary adenocarcinoma.

Anticonvulsant activity of resveratrol-loaded liposomes in vivo

Resveratrol (3,5,4'-stilbenetriol), a natural polyphenol produced by various plants, has attracted attention over the past decade because of its multiple beneficial properties, including anti-inflammatory, anti-oxidant and chemopreventive, yet, there is limited information about its antiepileptic effects. Moreover, its poor solubility in water and low bioavailability are the challenging issues. In the present study, we aimed to investigate effects of free resveratrol and resveratrol delivered in amphipathic liposomal delivery system, which has a high blood-brain barrier crossing potential, on penicillin-induced epileptic seizure model. For this purpose, adult male Sprague-Dawley rats were divided into four groups as saline (Control), liposome (LIP), free resveratrol (RES) and resveratrol+liposome (RES+LIP). Penicillin-induced epileptic activity was recorded for 120 min by electrocorticography. Glutathione S-transferase (GST), Glutathione (GSH), Superoxide dismutase (SOD) and Malondialdehyde (MDA) assays were performed in brain tissues collected. Our results showed that RES+LIP was the most effective anticonvulsant treatment on penicillin-induced epileptic seizures when compared to control, as RES+LIP immediately decreased the number of spikes per minute. GST and SOD activity, as well as the GSH levels, were significantly increased in the RES+LIP group as compared with the control group. Also, the MDA levels were significantly higher in the RES+LIP compared to RES and control groups. In conclusion, RES+LIP treatment was more effective on the decrease in spike frequency and spike amplitudes than other treatments. Our results suggest that the RES+LIP is more effective than RES on penicillin-induced epileptiform activity.

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy

OBJECTIVE

The effect of arytenoid resection was investigated in patients who had undergone supracricoid partial laryngectomy (SCPL) by comparing functional and oncologic results between patients with both arytenoids preserved with those with one arytenoid resected.

METHODS

Patients were divided into 2 groups: (1) both arytenoids preserved SCPL (BASCL) cases and (2) one arytenoid preserved SCPL (OASCL). The functional outcomes of the 2 groups were compared in terms of nasogastric tube removal time, decannulation time, incidence of aspiration pneumonia, and Performance Status Scale Scores for Head and Neck Cancer Patients for the late postoperative period. Additionally, the oncologic outcomes of both groups were compared using the 5-year local control rate, overall survival, disease-specific survival, and larynx preservation rate.

RESULTS

Of the 68 patients who were enrolled in the study, 20 of them were in the OASCL group and 48 in BASCL group. There was no statistically significant difference in the early and late functional outcomes, and the oncologic outcomes were also similar.

CONCLUSION

In addition to the proven oncologic safety, arytenoid resection does not increase the functional morbidity of the SCPL.

Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients

OBJECTIVE

Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique.

METHODS

A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded.

RESULTS

This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series.

CONCLUSIONS

The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.

Xanthogranulomatous sialadenitis clinically mimicking a malignancy: case report and review of the literature

BACKGROUND

Xanthogranulomatous tissue reaction is a well-documented process that is most common in kidney. There are other uncommon sites being documented as case reports in the literature. We would like to describe the clinicopathologic findings in a case of xanthogranulomatous sialadenitis that involved the parotid gland, which was clinically thought to be a tumoral mass, and compare it with the 4 previously reported cases.

CASE REPORT

A 52-year-old man presented with a left parotid mass. Fine needle aspiration biopsy was consistent with Warthin's tumor. The mass lesion was excised.

DISCUSSION

The lesion measured 2.5 × 1.5 × 1.5 cm. Microscopic examination revealed sheets of foamy macrophages centrally admixed with neutrophils, eosinophils, lymphocytes, plasma cells and scattered giant cells indicating a xanthogranulomatous reaction. As a conclusion xanthogranulomatous tissue reaction can mimic neoplasms.

Induction chemotherapy with docetaxel and cisplatin is highly effective for locally advanced nasopharyngeal carcinoma

Radiotherapy (RT) with concomitant chemotherapy (CT) has improved the therapeutic outcome of patients with locally advanced nasopharyngeal carcinoma (LANC). However, the importance of induction CT before definitive therapy is still undefined. Patients (n=59) who had LANC were included in this retrospective study. They received induction CT consisting of cisplatin and docetaxel followed by definitive RT with cisplatin. The median age was 49 years (18-68). All patients were of stages II (15%), III (63%) and IV (22%). Fifty eight patients could receive 3 cycles of CT. Except one patient, there was no grade 3 or 4 toxicity during induction CT. Chemoradiotherapy could be given to 49 patients (83%). Twelve percent of patients had complete response after induction CT and this number had increased to 95% after the completion of the therapy. Objective responses (complete and partial) were 100% after the completion of the therapy. Median follow up time was 29 months. Nine patients had relapse (2 had local only, 4 distant, 3 local and distant). Three patients who had both local and distant relapse died during follow-up. Three year overall and progression free survival rates were 94.9% and 84.7%, respectively. Induction CT with docetaxel and cisplatin is a feasible and tolerable treatment for patients with LANC.

Vitamin D levels in children with recurrent tonsillitis

AIM

Although recurrent tonsillitis can be the consequence of defects in immune system, the exact etiology of recurrent tonsillitis is not clear. In this study, our aim was to determine the serum vitamin D levels and vitamin D receptor polymorphism among children undergone tonsillectomy due to the recurrent tonsillitis.

METHODS

A 106 children undergone tonsillectomy due to recurrent tonsillitis and a 127 healthy children aging between 2 and 12 years were enrolled in this study, to determine serum 25-hydroxyvitamin D level and vitamin D receptor gene polymorphisms (Apa1, Taq 1, fok1). Serum vitamin D level was measured with ELISA (nmol/L) and receptor gene polymorphism was determined by PCR. Vitamin D serum level below 80nmol/L was accepted as insufficient.

RESULTS

The average serum vitamin D level was 176±79nmol/L in recurrent tonsillitis group and 193±56nmol/L in control group. There was no significant difference between the groups (p=0.13). In recurrent tonsillitis group, 18% (n=15) of children had their serum vitamin D levels below 80nmol/L. The vitamin D receptor gene polymorphism (APA1, TAQ 1, FOK 1) in each group was compared (AA, Aa, aa, TT, Tt, tt, FF, Ff, ff). There was no significant difference between the two groups. The vitamin D serum levels and receptor sub-genotypes are also compared, and there was no significant difference between the groups.

CONCLUSION

There is no difference between the serum vitamin D level and receptor gene polymorphism among children with recurrent tonsillitis and healthy children. But vitamin D insufficiency is more prevalent in children with recurrent tonsillitis group (18%).

The use of the latissimus dorsi myocutaneous flap in the reconstruction of complex head and neck defects

OBJECTIVES

To compare and contrast the use of the latissimus dorsi myocutaneous flap in complex head and neck defects requiring major reconstructive surgery with respect to the other reconstruction techniques, and to emphasize the importance of this flap as an life and surgeon-saving reconstruction modality.

PATIENTS AND METHODS

In this study, 20 cases (17 males, 3 females; mean age 58.5 years; range 48 to 72 years) of major head and neck operations reconstructed with a latissimus dorsi myocutaneous flap in Istanbul University, Istanbul Medical Faculty, Ear, Nose and Throat Clinic between October 2004 and November 2006 were retrospectively examined. The latissimus dorsi myocutaneous flap was preferred as a primary reconstructive modality in eight of the cases and a secondary reconstructive modality in the remaining 12 cases. The reasons for choosing the latissimus dorsi myocutaneous flap as the reconstructive modality were examined in this study and compared with other reconstruction techniques.

RESULTS

Partial flap necrosis was observed in four of the 20 cases. In two of these unsuccessful cases, minor intervention was sufficient to achieve functionally satisfactory results. However, one case with partial flap necrosis was lost due to the uncontrollable primary disease. In the one remaining case who had undergone cranioplasty, partial necrosis of the flap developed after the completion of radiotherapy in the 4th postoperative month. No total flap necrosis was encountered in any of the cases.

CONCLUSION

The latissimus dorsi myocutaneous flap is a reconstructive modality with a high success rate and should be considered among reconstruction alternatives.

Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease?

Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samter's Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

Significance of the counteracting oxidative and antioxidative systems in the pathogenesis of laryngeal carcinoma

OBJECTIVE

To evaluate the parameters of oxidative and antioxidative systems in laryngeal carcinoma for their effects on pathogenesis.

METHODS

Blood and plasma samples from 30 patients with laryngeal carcinoma were compared with 15 smokers who were otherwise healthy. The tumour tissue samples of the 30 patients were compared with the adjacent non-tumour-bearing mucosal tissue in which carcinoma was ruled out histologically. Although malondialdehyde was used as the main indicator of oxidative stress, superoxide dismutase, glutathione, and catalase activities were accepted as indicators of the antioxidative defense mechanism.

RESULTS

Malondialdehyde was significantly higher in the plasma and blood of patients when compared with those of the control group. Glutathione, superoxide dismutase, and catalase activity levels were measured in blood, and these parameters were significantly higher in the control group (p < .001). All results were found to be statistically significant (p < .001). The malondialdehyde level was also found to be significantly higher (p < .01) in the tumour tissue sample. Among the parameters of the tissue antioxidative defense mechanism, superoxide dismutase levels were determined to be significantly higher (p < .001) in the tumour when compared with the levels in adjacent healthy tissue. However, there was no statistically significant difference between the glutathione and catalase activities of the tumour and non-tumour-bearing tissues (p > .05).

CONCLUSION

Although the parameters of the oxidative system appear to increase, the antioxidative variants seem to be reduced in laryngeal carcinoma, with one exception: superoxide dismutase has been found in higher amounts in tumour tissue. These results may reflect the effect of oxidative stress in the pathogenesis of laryngeal carcinoma.

Allergic vs nonallergic rhinitis: which is more predisposing to chronic rhinosinusitis?

BACKGROUND

The impact of allergy on chronic rhinosinusitis (CRS) is controversial.

OBJECTIVE

To evaluate whether a history of CRS is more prevalent in patients with allergic rhinitis than in those with nonallergic persistent rhinitis.

METHODS

A total of 115 patients (78 females; mean age, 31.9 years; age range, 14-64 years) with persistent rhinitis were included in the study. A 7-point analog scale was used to report the severity of individual and global CRS symptoms and to determine the impact of rhinosinusitis symptoms on quality of life. The allergic status of the patients was evaluated using skin prick tests for common inhalant allergens, and asthma was evaluated by means of history, physical examination, and respiratory function tests. Rhinoscopy and paranasal sinus computed tomography were used to determine CRS.

RESULTS

Asthma and CRS were not significantly different in allergic and nonallergic patients. Nasal polyps were found equally in both groups (8 patients). However, mean Lund-Mackay staging scores, postnasal drainage, dental pain, and global CRS scores were significantly higher in patients with nonallergic rhinitis (P = .045, P = .001, P = .02, and P = .01, respectively). No significant correlations, except for dental pain (correlation coefficient, 0.250; P = .008), were found between Lund-Mackay scores and CRS symptoms. In rhinoscopy, the only conspicuous difference was nasal purulence in allergic patients (P = .002).

CONCLUSION

Allergic and nonallergic rhinitis may contribute similarly to the development of CRS.

[Reconstruction of the head and neck with free osteoseptocutaneous flap in elderly heavy smokers]

OBJECTIVES

We evaluated complications of free flap reconstruction following oncological head and neck surgery in elderly patients who smoked heavily.

PATIENTS AND METHODS

The study included eight patients (2 females, 6 males; mean age 68.5 years; range 65 to 74 years) over 65 years of age, who smoked heavily (at least 1 pack/day). All cases but one with mandibular ameloblastoma had intraoral squamous cell carcinoma. Two patients underwent reconstruction with free radial forearm osteoseptocutaneous flap following bilateral maxillary resection, and six patients with free fibular osteoseptocutaneous flap following mandibular resection. Postoperative complications, in particular those associated with the donor and recipient sites were evaluated.

RESULTS

No partial or total flap loss was observed. Wound healing problems were seen in three patients (37%), which were at the donor site in two patients, and at the recipient site in one patient. Psychogenic disorders were observed in two patients (25%). No other complications were encountered.

CONCLUSION

Aside from some recipient- and donor-site-related healing problems, heavy smoking and advanced age cannot be regarded as contraindications for free flap reconstruction.

Malignant peripheral nerve sheath tumor of the parotid gland

Malignant peripheral nerve sheath tumors originating from the parotid gland are extremely rare. A 76-year-old male patient underwent an incisional biopsy for an ulcerated mass in the anteroinferior aspect of the left auricle. The diagnosis was made as malignant mesenchymal tissue sarcoma, but the patient refused treatment. Upon progressive growth of the mass within two months, he underwent a partial parotid gland resection. After three months, he was referred to our clinic with an aggressively growing parotid mass. Total parotidectomy and radical neck dissection were performed. Histopathological diagnosis was malignant peripheral nerve sheath tumor. Following radiotherapy, he has been under follow-up for five years.

Oncological results of surgical treatment of malignant tumors of the nasal vestibule

OBJECTIVES

We evaluated functional results of surgical treatment for squamous cell carcinoma of the nasal vestibule.

PATIENTS AND METHODS

A retrospective review of 2,763 patients treated for head and neck cancers between 1991 and 2000 revealed 10 cases of nasal vestibule tumors, with an incidence of 0.36%. All the patients were males with a mean age of 64.8 years (range 58 to 72 years). Based on the classification system of the AJCC 1992 for skin cancers, and the UICC classification for neck metastasis, three patients had T2, three patients had T3, and four patients had T4 tumors. Lymph node metastasis was present in three patients. Nine patients were treated with surgery as the primary treatment. One patient underwent surgical salvage following radiotherapy failure. The mean follow-up period was 3.65 years (range 6 months to 12 years).

RESULTS

Three patients with metastatic neck disease and four patients with advanced tumors underwent radical neck dissection and selective supraomohyoid neck dissection, respectively. Seven patients underwent reconstruction with paramedian forehead flap (n=3), nasolabial flap (n=2), aural composite graft, or split thickness flap. Including the one with radiotherapy failure, two patients died within the first postoperative year due to local and neck recurrences. Another patient died in the postoperative third year due to metastatic squamous cell carcinoma of the lung. No cosmetic or functional complaints were observed in patients with early stage lesions. Two patients with advanced tumors had nasal ventilation problems and a secondary revision procedure was required in one.

CONCLUSION

Surgery is a successful therapeutic modality for carcinoma of the nasal vestibule, especially when applied in conjunction with proper reconstruction techniques and, when necessary, neck dissection procedures.

Cricohyoidoepiglottopexy vs Near-Total Laryngectomy With Epiglottic Reconstruction in the Treatment of Early Glottic Carcinoma

OBJECTIVE

To compare functional and oncological outcomes of cricohyoidoepiglottopexy (CHEP) and near-total laryngectomy with epiglottic reconstruction (NTLER) techniques in early glottic carcinoma.

DESIGN

Case series, clinical study.

SETTING

Two tertiary care referral centers.

PATIENTS

Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER.

MAIN OUTCOME MEASURES

Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability.

RESULTS

Fundamental frequency (P=.78), maximum phonation time (P=.44), and maximum phonation intensity (P=.94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score (P=.62), mean decannulation time (P=.25), time to nasogastric tube removal (P=.12), or clinical grades of late postoperative aspiration (P=.87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall (Kaplan-Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER (P=.76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively (P=.07).

CONCLUSIONS

Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.

Infestation of the human intestine by the millipede, Nopoiulus kochii

Specimens of the millipede, Nopoiulus kochii (Gervais) were seen in faeces and vomit of a 14-year-old boy residing in Oltu, Erzurum, Turkey. The patient complained of a burning sensation in his throat and stomach-ache. Physical examination revealed no pathological findings, and how the patient became infected was unknown. Anti-parasitic drugs (niclosamide, albendazole), which he had been taking intermittently for 2 years by the prescription of a physician, had not resolved the problem.

Incidence of cochlear involvement in hyperbilirubinemic deafness

Neonatal hyperbilirubinemia remains an important cause of childhood deafness, especially in developing countries. After neonatal hyperbilirubinemia, the auditory neural pathways, cochlea, or both may be affected. In this study, we aimed to determine the incidence of cochlear impairment and the appropriate means of hearing screening in hyperbilirubinemic neonates. A retrospective review of 1,032 pediatric patients with hearing loss revealed 67 cases (6.5%) of severe hyperbilirubinemia in the neonatal period. Thirty of these patients had neonatal hyperbilirubinemia as the single identifiable risk factor for hearing loss. In 26 of 30 cases (87%), otoacoustic emissions (OAEs) were absent, whereas in the remaining 4 cases (13%), robust emissions were detected despite an absent auditory brain stem response (ABR). Auditory screening of newborns with jaundice by OAEs possesses a significant risk of undiagnosed deafness. On the other hand, if the ABR is used as the single means of screening, auditory neuropathic conditions will probably be underlooked. Therefore, we recommend dual screening of hearing by ABR and OAEs in hyperbilirubinemic newborns.

Management of carotid artery invasion in advanced malignancies of head and neck comparison of techniques

The objective of this study was to retrospectively investigate a single institution's experience with carotid artery resection performed as part of an oncological procedure and to determine acute and convalescent complication and survival rates. We performed a record review of 28 patients with head and neck malignancy invading the carotid artery. Immediate carotid artery resection and ligation on an emergent basis was performed on 12 patients (group 1), elective resection and ligation was performed on 8 patients (group 2), and elective resection and revascularization was performed on 8 patients (group 3). In group 1, although 1 patient survived for 1 year and 1 patient survived for 2 years, 1 patient died of severe neurologic deficit, 2 patients experienced neurologic deficit with good recovery, and 1 patient was moderately disabled. In group 2, 2 patients survived without disease for 5 years, and 2 patients experienced neurologic deficit, 1 with good recovery and the other with complete recovery. In group 3, only 1 patient survived for 5 years, and within this group, 1 patient died of severe neurologic deficit, 1 patient had neurologic deficit with moderate recovery, and 1 patient had neurologic deficit with complete recovery. No significant difference in mortality and morbidity rate was observed between the "resection and ligation" group and the "resection and revascularization" group (p = .52, chi(2) = 0.79). We conclude that the surgical treatment of patients with an invaded carotid artery, including carotid resection, provides a small but real chance of 5-year survival. The methods of carotid resection and repair should be guided by clinical presentation and by preoperative and intraoperative investigations.

Metastasis to infraclavicular lymph nodes in head and neck cancer: a report of three cases

Metastasis predominantly occurs via the lymphatic system in head and neck tumors. The disturbance of the lymphatic system in the cervical region resulting from neck dissection or radiotherapy may result in unusual patterns of metastasis in patients with recurrent tumors. This is more frequent when the recurrent tumor invades the myocutaneous flap used for the primary reconstruction. We encountered three patients (2 men, 1 woman) with infraclavicular lymph node metastasis. All were previously treated by surgery, postoperative radiation therapy, and reconstruction with the use of the pectoralis major myocutaneous flap.

The functional and oncologic effectiveness of near-total laryngectomy

PURPOSE

To investigate the oncologic efficiency of near-total laryngectomy for advanced laryngeal and neighboring organ cancers and to evaluate the functional results.

MATERIALS AND METHODS

A retrospective review of 135 cases of near-total laryngectomy carried out in a tertiary university hospital between 1989 and 2000 was undertaken. The original operation was carried out in 3 groups: classic "near-total laryngectomy" for endolaryngeal lesions; "near-total laryngectomy and partial pharyngectomy" for lesions originating from the pyriform sinus or lesions with extension to the pharynx or tongue base but reconstructed primarily; and "near-total laryngopharyngectomy" for lesions requiring pedicled flap reconstruction after resection. Oncologic success was evaluated according to the location and extent of the tumor and the particular operation. Functional outcome was evaluated according to phonation and its quality as well as to the severity of aspiration.

RESULTS

Of the 135 cases, 121 were men, and 14 were women (age range, 33-80 years; mean, 56.2 years). Mean phonation time was 35.2 days, and mean onset of oral intake was 18.5 days. Of the 135 cases of the series, 124 were evaluated for survival. Thirteen of 26 (50.0%) cases of T2, 34 of 53 (64.2%) cases of T3, and 33 of 45 (73.3%) cases of T4 carcinomas survived by the end of the evaluation period. Likewise, 46 of 77 (59.7%) cases of N0, 16 of 19 (84.2%) cases of N1, and 18 of 27 (66.7%) cases of N2 survived the same period; however, none with N3 metastatic neck disease survived. The probability of survival with regard to the T and N stages of the disease did not reveal a statistically significant result (P =.15 and.49, respectively).

CONCLUSIONS

According to these results, near-total laryngectomy is a valid alternative for extended laryngeal and neighboring organ cancers with an acceptable morbidity and a high success rate for voice preservation. Near-total laryngectomy should be offered as a surgical treatment alternative for these patients.

T-wave alternans in LQTS: repolarization-rate dynamics from digital 12-lead Holter data

T-wave alternans (TWA) is a harbinger of ventricular vulnerability and an important prognostic indicator for torsade de pointes and likely sudden death in patients with LQTS. We analyzed the occurrence of TWA in 18 patients with LQTS (7 males, 11 females, ages ranging from 6 months to 32 years--median 8.4 years). Analysis was performed with software to investigate dynamics of cycle length mediated repolarization changes. Digital Holter ECG analysis revealed macroscopic, true TWA in 3 of 18 patients. TWA showed a variable morphological expression. One patient had continuous changes of T wave polarity, but not on a periodic beat-to-beat basis. Onsets of macroscopic TWA were preceded by long/short cycle length sequences and tachycardic rates above 130 to 140 bpm. Impact of ventricular premature beats on TWA onset was insignificant. Two of the identified patients with TWA had sudden cardiac death during follow-up (one refused PM therapy). At present, TWA cannot be detected automatically from Holter ECGs and therefore may be missed, despite the potential danger for the individuals. The observation that predominantly high beat rates and not beat rate changes, per se, triggered episodes of TWA renders difficult general therapeutic recommendations for the identified patients at risk.

Does the addition of hyperbaric oxygen therapy to the conventional treatment modalities influence the outcome of sudden deafness?

OBJECTIVE

To investigate the therapeutic effects of the addition of hyperbaric oxygen (HBO) therapy to the conventional therapies in sudden deafness (SD) and to investigate the influence of patient age on the effectiveness of HBO therapy.

STUDY DESIGN AND SETTING

We undertook a retrospective review of 50 cases of SD treated at a tertiary university hospital. Twenty-five patients (group 1) were treated with betahistine hydrochloride, prednisone, and daily stellate ganglion block. A second group (group 2) of 25 patients received the same basic treatment with the addition of HBO therapy.

RESULTS

The mean hearing gain was 20.0 dB in group 1 and 37.9 dB in group 2 (P < 0.05). In group 2 patients, the mean gains were 51.4 and 23.3 dB for those younger and older than 50 years (P < 0.05) and 48.9 and 14.5 dB for those younger and older than 60 years (P < 0.001), respectively. In patients older than 60 years, the mean gains were 14.5 and 14.4 dB in group 2 and group 1, respectively (P > 0.05).

CONCLUSIONS

The addition of HBO therapy to the conventional treatment significantly improves the outcome of SD, especially in patients younger than 50 years. Additional HBO therapy provides limited benefit in patients older than 50 years and no benefit in patients older than 60 years.

An indolent course of multiple myeloma mimicking a solitary thyroid cartilage plasmacytoma

Multiple myeloma, solitary plasmacytoma, and extramedullary plasmacytoma constitute a continuum of a disease spectrum, which is called plasma cell neoplasms. These three entities can not be differentiated from each other on a histological basis and, for this reason, clinical evaluation is important in their differential diagnoses. Differential diagnosis guides the proper planning of treatment and helps in estimation of survival. Multiple myeloma located within the larynx is very rare. Because of its rarity, any established diagnostic and treatment criteria do not exist. In this report, a case of laryngeal multiple myeloma is presented for its extraordinary presentation and also for educational purposes.

Near-total laryngectomy for laryngeal carcinomas with subglottic extension

OBJECTIVE

To investigate whether Pearson classic near-total laryngectomy is a sensible surgical treatment modality for laryngeal carcinomas with subglottic extension.

DESIGN

Retrospective analysis of patients treated by near-total laryngectomy in a university hospital that is an academic tertiary health care center.

PARTICIPANTS AND INTERVENTION

Medical and computer records of 135 patients who were treated by near-total laryngectomy for laryngeal and hypopharyngeal carcinomas between April 1, 1989, and June 30, 2000, were searched thoroughly, and the final outcomes were confirmed by telephone contact.

MAIN OUTCOME MEASURES

Survival rates of the patients with laryngeal carcinomas with subglottic extension treated by near-total laryngectomy were compared with those of the patients with malignancies of other laryngeal regions given the same treatment.

RESULTS

Of the 135 patients in the study, 74 were available for determination of 5-year survival. The rate was 65.8% (27/41) for transglottic tumors, 53.8% (7/13) for supraglottic tumors, and 20.0% (4/20) for tumors with subglottic extension. Only 3 of 16 patients with laryngeal carcinomas with supraglottic or transglottic localization died of local recurrence; the rest of the deaths were from regional recurrence or distant metastasis. However, 6 of 13 patients with subglottic extension died of local recurrence, 5 of peristomal recurrence, and only 2 of distant metastasis.

CONCLUSIONS

Success was directly related to adherence to precise indications in cancer surgery. While near-total laryngectomy is an effective and reliable treatment modality in laryngeal cancer surgery, its effectiveness in laryngeal cancers with subglottic extension is debatable. These subglottic lesions should be treated by total laryngectomy, which is a more radical surgery.

The site of the hearing loss in Refsum's disease

Refsum's disease is a disorder of lipid metabolism with pigmentary retinopathy, demyelinating neuropathy, ataxia, and hearing loss. Previous histological studies have located the site of hearing impairment in the inner ear, but it has never been confirmed audiologicaly in the literature. In this reported case of Refsum's disease, despite hearing loss and absence of response in ABR, robust otoacoustic emissions were measured. Together with these and other audiological findings, we conclude that our case might be the first reported case of Refsum's disease with auditory neuropathy. The site of the hearing abnormality in Refsum's disease may be 'post-outer hair cells' in some cases as in the current case. Because of their limited benefits and risk of noise-induced damage to outer hair cells, the use of hearing aids before otoacoustic emission measurements should be considered cautiously in Refsum's disease.

Malignant triton tumour of the parapharyngeal space

We report the clinical course in a 25-year-old male patient of neurofibromatosis with malignant triton tumour (MTT). Triton tumour is a peripheral nerve sheath tumour with rhabdomyoblastic differentiation. This is relatively rare tumour of head and neck region and only 26 cases have been reported to date. The present case is the first reported MTT of parapharyngeal space, one of the most aggressive course among all head and neck MTTs, resulting in the death of the patient within three months following surgical resection. The aggressive nature of this tumour necessitates adjuvant therapeutic measures in addition to radical surgery in order to obtain better survival rates.

Temporal bone imaging findings in Waardenburg's syndrome

OBJECTIVE

(a) To report computed tomography findings of eight new cases with Waardenburg's syndrome (WS) type I and review reported temporal bone radiographic and histopathological findings in WS with hearing loss; (b) To determine the frequency of inner ear pathologies that may contraindicate cochlear implantation.

METHODS

A review of 1166 pediatric patients with sensorineural hearing loss revealed 12 cases (1%) with WS, whose family screenings disclosed additional 12 subjects with the same disorder. Among these 24 cases, eight had WS type I and were subjected to computed tomography scanning of temporal bone. Imaging findings of 28 cases reported previously in English literature were evaluated together with our eight patients.

RESULTS

Malformation of the inner ear was found in none of the nine WS type I cases evaluated here, while the frequency of internal acoustic canal malformation was 11%. Regardless of the subtypes of the syndrome, 6 of 36 cases (17%) had radiological abnormality of the inner ear. Malformation and/or absence of the semicircular canals were the most common congenital abnormality of the inner ear. Hypoplasia of the cochlea was present in 3 of 36 cases (8%).

CONCLUSIONS

Abnormality of bony labyrinth in WS with congenital deafness is not a frequent finding, particularly in WS type I. Therefore, the otologist and audiologist must keep in mind that most of these cases are suitable for cochlear implantation regarding inner ear anatomy.

Sudden total bilateral deafness due to asymptomatic mumps infection

Mumps is the most common cause of unilateral acquired sensorineural hearing loss in children. Although it usually affects the salivary glands. the inner ear may be involved. Deafness is usually unilateral, sudden in onset, profound and permanent. Bilateral total sensorineural hearing loss had been rarely reported in English literature. We present a case of total deafness due to asymptomatic mumps infection.