Clinical significance of granulation tissue after transoral laser microsurgery for glottic cancer.

BACKGROUND: Granulation tissue after transoral laser microsurgery can make it difficult to distinguish between normal healing and tumour recurrence. MATERIALS AND METHODS: We carried out a retrospective analysis of 316 consecutive glottic carcinomas (Tis-T3). Presence of granulation tissue at one and six months was correlated with demographic and clinical data, tumour and surgical characteristics, and tumour relapse. RESULTS: Granulation tissue appeared in 53.8 per cent of patients at month 1, resolving spontaneously in 41.8 per cent. Revision surgery was performed in 60.1 per cent and was effective in 41.1 per cent. At month 6, 14.9 per cent of patients presented with granulation tissue. In 74.5 per cent the tissue was surgically removed and was positive for malignancy in 62.9 per cent. Tumour relapse presented in 29.4 per cent with granulation tissue at month 1 and in 61.7 per cent at month 6 (p = 0.000). Granulation tissue at month 1 correlated with thyroid cartilage exposure and continued smoking. At month 6, granulation tissue correlated with thyroid cartilage exposure, the affected surgical margins and diabetes. CONCLUSION: Granulation tissue after transoral laser microsurgery is frequent. When it persists at six months, revision surgery is formally recommended.

Utilidad del laringoscopio de suspensión de Kleinsasser para facilitar la intubación orotraqueal en tumores supraglóticos de laringe / No disponible

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[Complications of transoral laser surgery for malignant tumors of the larynx and hypopharynx]. / Komplikationen in der transoralen Laserchirurgie maligner Tumoren des Larynx und Hypopharynx.

BACKGROUND: Transoral dioxide laser resection of early tumors (Tis, T1, T2) in the aerodigestive tract seems to be an established method of treatment. Recently, large tumors (T3 and T4) have been treated by this surgical method too, and therefore it seems reasonable to assess the complication rates. MATERIAL AND METHODS: All consecutive patients operated on primarily, with curative intention by means of carbon dioxide laser from February 1998 to February 2008 were prospectively registered in a SPSS-databank. Besides all data on the tumors and the surgery all types of complications were collected prospectively and updated weekly. Depending on their treatment, complications were divided into "minor" or "major". All patients with a minimum follow-up of 36 months were considered. The one-sample Kolmogorov-Smirnov test was used to study the distribution of the variables. Correlation between the variables was calculated with the Spearman test. The Mann-Whitney-U test was used to compare groups. All calculations were performed in a SPSS Windows 14.0 version;, the significant value for p was established at <. 05. RESULTS: Six-hundred and eighty patients fulfilled the selection criteria. Postoperative bleeding and aspiration pneumonia were among the most frequent complications, the rate of "major" complications being 5.6%. Large tumors (T3, T4) and tumors of the supraglottis and the pyriform sinus had a statistically significant higher probability (p<0.001) to suffer a postoperative complication. CONCLUSIONS: After carbon dioxide laser surgery of malignant tumors of the upper aerodigestive tract postoperative complications may happen. Large tumors and those located in the supraglottis and the pyriform sinus have a statistically higher probability to develop a complication.

Hyoid and laryngeal chondrosarcomas have different clinicopathologic features.

Hyoid chondrosarcomas (CSs) are uncommon cervical tumours with different features compared to laryngeal CSs. Herein we report a hyoid CS in a 36-year-old male and review the literature. Only eight cases of hyoid CS have been reported to date. We have found important differences between hyoid and laryngeal CSs in terms of the age at presentation, gender, clinical symptoms, time before diagnosis, histologic findings and tumour size.

An aesthetic deformity: Madelung's disease.

Madelung's disease, also known as benign symmetric lipomatosis, multiple symmetrical lipomatosis or Lanois-Bensaude syndrome, consists of growth of fatty masses predominantly on the face, neck, shoulders, upper thorax and arms. These painless and symmetrical fatty deposits can cause important aesthetic changes in these patients. Middle-aged males are more commonly affected, with an increased prevalence in the Mediterranean area. Currently, the incidence in Italy is 1 in 25,000 males. The aetiology of Madelung's disease remains unknown, although approximately = 60% of affected patients are clinically overweight and there is an intimate association with chronic alcohol abuse. We report an unusual case of Madelung's disease in a 52-year-old male. The fatty deposits were completely resected by means of surgical lipectomy. The patient remains well and disease-free after 12 months of postoperative follow-up.

[Psammomatoid ossifying fibroma. Apropos a case]. / Fibroma osificante psamomatoide. A propósito de un caso.

A 41-year-old woman had a left palatal tumor diagnosed as psammomatoid ossifying fibroma. This tumor is a rare subtype of benign fibro-osseous craniofacial lesion that occurs mainly in women, younger age groups, and the sinonasal tract. It has distinctive histomorphological features. The tumor is slow-growing but tends to be locally aggressive and to destroy adjacent anatomic structures. Surgical excision with broad margins is the treatment of choice.

Follow-up study in head and neck cancer: cure rate according to tumor location and stage.

The purpose of this clinical study was to analyze a long-term follow-up of all the patients with head and neck cancer in our institution. Between 1973 and 1993, 1,355 consecutive cases of head and neck cancerwere diagnosed, treated and followed up regularly. All were subjected to a multidisciplinary approach, and followed up until death or for 10 years with no event of disease. The local relapse rate was 20% and the node-regional relapse rate 15%. Distant metastases were observed in 6% of the patients mainly arising from the nasopharynx (23%) followed by the hypopharynx (11%). The main organ involved was the lung (50%). Median follow-up of the group was 10 years (range 4 months to 15 years). Cancer cure was observed after 5 years in glottic and supraglottic laryngeal carcinoma, oral and nasopharyngeal cancer and after 2.5 years in patients with cancer of the oropharynx and hypopharynx. The highest cure rate was 80% in the glottis, followed by 70% in the supraglottic area, 45% in the mouth, 30% in the nasopharynx, 25% in the oropharynx, and 20% in the hypopharynx. A second primary tumor was observed in 7% of the patients and a third primary in 0.6% of the patients. Only in 7 patients, the second or third primary was seen after 5 years of follow-up. Curability should be observed after 5 years from definitive therapy of glottic, supraglottic, oral and nasopharyngeal and earlier in oropharyngeal and hypopharyngeal cancer. Further follow-up should be discontinued. Second and third neoplasias are the main problems after 5 years of follow-up but their incidence is low.

Calcium supplementation and ototoxicity in patients receiving cisplatin.

We have studied the effect on ototoxicity of maintaining serum calcium concentration by calcium gluconate infusion in cancer patients receiving high-dose cisplatin in a randomized study in two groups: 11 patients received calcium gluconate, 4 mg kg-1 i.v. infusion during cisplatin therapy; 11 other patients without any calcium supplementation served as controls. All of them received the first course of chemotherapy, based on cisplatin, 120 mg m2 with a hydration schedule. An audiogram was performed in each patient just before cisplatin and repeated after 1 day and 3 weeks. Mean total calcium concentration in control patients before and after chemotherapy was 2.2 +/- 0.14 (95% confidence interval 1.9-2.5) and 2.0 +/- 0.13 (95% CI 1.7-2.24) mmol 1(-1) respectively (P = 0.0004) and for ionized calcium 1.22 +/- 0.52 (95% CI 0.21-2.23) and 1.11 +/- 0.07 (95% CI 0.97-1.25) mmol 1(-1) respectively (P = 0.0005). Serum magnesium levels were maintained or increased by magnesium supplementation. Although there was no change in serum total or ionized calcium, or serum magnesium in the calcium infusion group, no differences in hearing loss between the groups were observed. High-dose cisplatin chemotherapy for cancer patients induces an acute decrease of serum total calcium and serum ionized calcium and audiometric changes. Maintenance of calcium serum levels by calcium gluconate infusion did not protect against ototoxicity in those patients.

Neoadjuvant and adjuvant chemotherapy in the multidisciplinary treatment of oral cancer stage III or IV.

We performed a retrospective analysis on the effect of initial induction chemotherapy with two courses of cisplatin (each course 120 mg/m2 cisplatin on day 1, then 20 mg/m2 bleomycin (alone) per day for 5 days with 4 weeks between courses) in 75 consecutive patients with advanced cancer of the oral cavity or lip. Further local therapy consisted of surgery or radiation, depending on tumour location. In 18 resected patients adjuvant chemotherapy was added. This consisted of carboplatin, 400 mg/m2 on day 1 then ftorafur alone, 500 mg/m2/day for 30 consecutive days, repeated every month for 4 consecutive months. Among the patients treated in the neoadjuvant setting, complete response was observed in 10 out of 75 patients (13%), and partial response in a further 50 patients (67%) (partial plus complete rate 80%). Of all the patients, 43% in stage III and 26% in stage IV were long-term survivors. Improved survival was observed in surgical patients where adjuvant postoperative chemotherapy was added (P < 0.025). The main toxic effect was vomiting, observed in 71 patients. We noted a low rate of stomatitis (4%) and an important hearing loss (12%). Neoadjuvant and adjuvant cisplatin-based chemotherapy as part of a multidisciplinary approach have a high overall response rate and low toxicity, and should increase survival in cancer of the oral cavity or lip.

Carboplatin plus ftorafur as a palliative treatment in locally advanced cancer of the oral cavity and lip.

Forty consecutive patients with local advanced cancer of the oral cavity and lip, heavily pretreated, were palliated with two courses of carboplatin, 400 mg/m2 intravenously once a month plus ftorafur, 500 mg/m2 daily per os for 30 days. Previous treatment consisted of surgery (17 patients), radiation therapy (23 patients), and chemotherapy with cisplatin plus bleomycin (15 patients). The main sites of primary tumor were the tongue (12 patients), hard palate (6 patients), retromolar area (6 patients), tonsils (6 patients), perioral skin and lip (5 patients), and floor of the mouth (5 patients). Complete response was observed in 3 patients, and partial response in 7. Symptomatic improvement was observed in 56% of the cases. Median duration of response was 9 months. Median survival was 7 months. The main toxic effects were nausea (39 cases), vomiting (35 cases), and thrombocytopenia (4 cases). We conclude that carboplatin plus ftorafur has a role as palliative chemotherapy in cancer of the oral cavity and lip in heavily pretreated patients when local therapies are not suitable.

[The laryngeal involvement in Kaposi's sarcoma in the acquired immunodeficiency syndrome]. / Afectación laríngea por sarcoma de Kaposi en el síndrome de inmunodeficiencia adquirida.

Kaposi's sarcoma (KS) is a malignant vascular neoplasm characterized, in its classical form, by a slow evolutive course, beginning in the lower extremities. Lately have been reported more and more cases of this entity associated with the acquired immunodeficiency syndrome (AIDS), running much more aggressively. In ENT-pathology are not uncommon this kind of neoplasm in the oral cavity and oropharynx. However at larynx's level such descriptions till now had been sporadic. The AA. present a KS case sitting in the epiglottis of an AIDS patient. They emphasize the importance of a throughout ENT-examination of these patients and also remark the necessity of performing various and deep biopsies in order to gain a diagnosis that can be relied on. Finally, they review the updated management alternatives for this sort of pathology.

[Incidence of Borrelia burgdorferi infection in isolated facial paralysis. A prospective study]. / Incidencia de la infección por Borrelia burgdorferi en la parálisis facial aislada. Estudio prospectivo.

Between the causes of facial paralysis, similar to Bell's palsy, recently are included those due to some families of spirochaeta (Borrelia burgdorferi) transmitted through tick-bite. These bacteria, besides de facial palsy, may produce several degrees of lymphocytic meningitis and subsequently the paralysis of the face, sometimes clumsy or recurrent. The treatment being the antibiotic drugs, never the corticoids. In the paper are explained prospectively the incidence of this disease in the AA's environment.

[Cholesteatoma of the paranasal sinuses. Apropos of 2 cases]. / Cholestéatome des sinus de la face. A propos de deux cas.

Two cases of cholesteatoma of the facial sinuses are presented. One of them was located in the maxillary sinus and the other was originally located in the ethmoid cells and extended into the maxillary sinus. After reviewing the literature on this subject, the authors analyze the pathogenetic theories and the clinicoradiological expressions. These raise an obvious diagnostic difficulty: the diagnosis is virtually impossible to establish before surgery and a clinicopathological study are performed.