The value of CT scans in improving laryngoscopy in patients with laryngeal cancer.

This retrospective study assessed the value of computed tomography (CT) scan with contrast in improving the staging accuracy of indirect and direct laryngoscopy. We compared the preoperative staging obtained by the two latter procedures with postoperative histopathological findings in 187 patients operated on for laryngeal cancer. Of these cancers, 98 were supraglottic, 82 glottic and 7 subglottic in origin. The staging accuracy of laryngoscopy was 51.3% and CT was 70.1%. When the two procedures were combined, the staging accuracy was 80.2%. The accuracy of the CT increased from glottic to supraglottic to subglottic tumors, although the accuracy of laryngoscopy decreased in the same direction. Laryngoscopy alone tended to understage larger tumors (pT3 and pT4), whereas CT underestimated the smaller ones (pT1 and pT2). Our data suggest that in order to plan the best treatment both laryngoscopy and CT should be used in making the diagnosis.

The pectoralis major myocutaneous flap in head and neck reconstructive surgery: 16 years of experience.

Wide defects resulting after resection of malignant tumors of the head and neck need an adeguate closure. In the last 16 years, 85 pectoralis major myocutaneous island flap procedures were carried out for the immediate reconstruction of surgical defects following extirpation of malignant tumors at various sites of the upper aerodigestive tract. The final functional and cosmetic results were satisfactory. Partial necrosis was observed in four cases. We did not have any cases of total flap necrosis. Post-operative fistulas were encountered in 14 cases (surgical closure was not necessary). The application and complications of the pectoralis major myocutaneous flap placed at cervical level are reviewed. The aspects of postoperative swallowing function of such surgery are discussed. Reconstruction with the pectoralis major myocutaneous flap is a safe and versatile procedure, yielding good clinical and functional results in patients with advanced head and neck tumors.

[Panendoscopy in the research of multiple malignant synchronous occult tumors in patients with cancer of the upper aero-digestive tract]. / La panendoscopia nella ricerca dei tumori maligni multipli sincroni occulti in pazienti portatori di cancro delle vie aero-digestive superiori.

The Authors consider the result obtained in the diagnosis of malignancies simultaneous neoplasia in patients with a tumour of the head and neck. The study was conducted on 337 patients on 750 observed in the last seven years with a squamous-cell carcinoma at different stages of keratinization, who underwent an ORL examination, bronchoscopy and esophagogastroduodenoscopy, sometimes with intravital staining. Bronchoscopy was conducted on 297 patients, esophagogastruoduodenoscopy on 300. Altogether 260 were subject to both techniques and 77 to only one procedure. Endoscopy released a second tumour in 4 cases on 297 (1.34%) of the bronchus and in 5 cases on 300 (1.66%) of the esophagus. The percentage amounts to 3.46% in 260 patients subject to both examinations. Our study released a malignancies cells (18 cases on 216); this number was not confirmed by istological examination on bronchial biopsy. Our collaborators consider this result as pollution derived from cells coming from clear tumour in expansion. Our study, obtained from a substantial number of cases, justify the use of panendoscopy screening in conjunction with routine studies; although this procedure is aggressive, it is acceptable, because these second tumours have been discovered in early and asintomatic stage and were not found in the radiological examination.

[The glosso-crico-arytenoid unit as a phonatory organ in sub-total reconstructive laryngectomy using the Labayle technic]. / L'unità glosso-crico-aritenoidea quale organo fonatorio nella laringectomia sub-totale ricostruttiva secondo Labayle.

The present study was carried out in order to assess characteristics of vicarious voice in patients undergoing Labayle's reconstructive sub-total laryngectomy. This type of surgery, which permits air passage for both respiration and phonation, makes it possible to preserve pneumophonic coordination. During phonation the expiratory air column is used and sound is generated as it passes through a vibrating structure having a sphincteric function. In the opinion of the authors this structure is not only made up of the cricoid orifice, against which the base of the tongue presses like an operculum, but also of the mobile residual arytenoid and, at times, of the lateral walls of the pharynx. Thus a single dynamic unit is formed involving several structures and their synergism guarantees the neoglottic occlusion required for a speaking voice. In the present study, glottography gave no significant results. In phonation a rapid vibration of the neoglottid mucosa is obtained thus producing a phonetically valid acoustic phenomenon. However, this does not result in an electroglottographic recording of adduction. On the other hand, interesting data were recorded when comparing the morpho-functional aspects of the neoglottis with characteristics of the vibrating voice, as recorded by spectrography. Spectrographic tracings are markedly better in cases of valid occlusion of the glosso-pharyngeal-arytenoid unit and this may be achieved regardless of the mobility of the remaining arytenoid. It is thus clear that several patients with a fixed arytenoid, but having valid sphincteric action of the other structures (i.e. base of the tongue or pharynx), had excellent speech quality and intelligibility. Therefore, Labayle's surgery, which reconstructs a pharyngo-tracheal continuity and consequently restores natural breathing, makes speech continuity possible. Such subjects have mixed vocal output (periodic components together with noise) although, on the whole, the voice produced has the fundamental requirements for intelligibility (i.e. intensity, pitch, harmonic structure, emission time) and may thus be considered valid for interpersonal verbal communication.

[Reconstructive sub-total laryngectomy according to Labayle. Clinical experience on 21 cases]. / Laringectomia sub-totale ricostruttiva secondo Labayle. Esperienza clinica su 21 casi.

In this paper the authors report the functional and oncological results regarding 21 patients suffering from laryngeal carcinoma, who underwent surgery at the University of Parma's ORL Clinic - between 1975 and 1984 - for sub-total reconstructive laryngectomy using the Labayle method. This process provides for not just the radical removal of the laryngeal tumor, but also for restoring basic functions such as respiration, phonation and swallowing. To this end, during the destructive phase, the cricoid cartilage (partially or wholly) and one or both of the arytenoids are retained. The application of this method is situated somewhere between the classic total laryngectomy and the conservative supraglottic, at times finding itself in natural opposition to the expanded supraglottic the lateral-front, the hemilaryngectomy, the crico-ioidopesia and the Serafini-type total laryngectomy. Since it doesn't concern a total laryngectomy in the strict sense of the word, the operation presents general counterindications that are relative - and which exist for that matter in all laryngeal surgery, functional or reconstructive - and local counterindications that are absolute. In addition to the, elective indications are dictated critically. The surgical act, illustrated in detail, consists in a period of approach or preparation, a period of destruction and a period of reconstruction. The results obtained from the series of cases followed are wholly satisfactory from both the functional and oncological point of view: the parameters evaluated - respiration, phonation and swallowing - were totally restored in the majority of cases. Swallowing in just two patients was insufficient, as was respiration in one. Concerning the oncological results, if we exclude 4 cases of the 21 considered which do not have a follow-up of more than three years, there have been no clinical signs of a recurrence of the tumoral disease in the remaining 17, of which 15 have been under observation for more than 5 years. The survival rate, up to the first months of 1985, is 70.5%.

[Laryngeal plasmacytoma. Observations on a clinical case]. / Plasmocitoma laringeo. Osservazioni di un caso clinico.

Extramedullary solitary plasmocytoma (E.S.P.) is an undoubtedly rare neoplasm for the head and neck areas and even more for the larynx. The Authors take a case observed by them as a starting point for remarking its symptomatology and unforeseable development as well as various and unsteady histopathology. Afterwards they dwell upon the differential diagnosis with the multiple myeloma and the plasmacell granuloma. Such diagnosis is mainly suggested by the histopathological investigation with the support of clinical, blood and radiologic tests. The preferential treatment and the need of a long-term and careful follow-up are the suggested.

[Laryngocele. Possibilities and limitations of surgical treatment under direct microlaryngoscopy]. / Laringocele. Possibilità e limiti del trattamento chirurgico in microlaringoscopia diretta.

Three cases of laryngocele are reported, which were managed by surgery under direct microlaryngoscopy with excellent clinical and functional results, both at short and long term. According to the classification of Y. Lacomme, two patients had an internal or vestibular laryngocele, which was of the low type in one of them and of the middle type in the other. In the first case the pouch and the false vocal fold lying over it were completely removed under direct microlaryngoscopy. In the second case the laringeal cavity was marsupialized after extensive resection of the false fold and part of the lateral wall of the vestibule. Over a short period of time both patients were symptom-free and eventually recovered completely. In the third case tha laryngocele was of a classic mixed type. The patient, who risked suffocation, was elderly (77 years of age) and extremely debilitated. A few days earlier he had had an emergency tracheotomy for severe respiratory failure. Surgery under direct microlaryngoscopy consisted in removing the false fold and the internal laryngocele. About one and ahalf months later, the tracheostomy opening had closed and the latero-cervical pouch had been gradually reduced. The latter was drained abundantly into the laryngeal lumen and remained as an external laryngocele. When the patient is in good enough condition, the laryngocele will be completely removed by means of the most suitable among the common external-approach surgical techniques.

[Use of the Montgomery prosthesis in the treatment and prevention of anterior commissural synechiae secondary to bilateral cordectomy]. / L'impiego della protesi di Montgomery nel trattamento e nella prevenzione delle sinechie commessurali anteriori secondarie cordectomia bilaterale.

The authors report the results obtained with the use of the Montgomery silicone prosthesis for the prevention or treatment of thick and sometimes partially stenosing synechiae of the anterior commissure following bilateral cordectomy by median thyrotomy. The umbrella-shaped prosthesis consists of two silicone sheets which are perpendicular to each other. The vertical sheet is of variable length and, once placed in position, it separates at the anterior commissure the two portions of larynx operated on, so that they may be adequately reepithelized. This procedure was used in three patients undergoing internal subperichondral cordectomy by median thyrotomy, due to a malignancy in both vocal folds which, however, was not extended to the anterior commissure. In two patients the prosthesis was fitted in during the main surgical procedure to prevent an excess of scar tissue; in the third patient, by contrast, it was used to treat a thick, partially stenosing synechia in the commissure secondary to cordectomy, which had already been unsuccessfully managed under direct microlaryngoscopy. In the three patients the prostheses were left in place for 2 and a half, 3, and 3 and a half months, respectively, with no major irritation or inflammation inside the larynx. No supportive tracheotomy had to be performed, and only in one case was the prosthesis secured externally by percutaneous stitching. On indirect laryngoscopy several months after the prosthesis was removed, two patients showed a perfectly healed larynx; in the third patient a very small amount of scar tissue in excess was still present, but it did not affect his respiratory function.

[Althesin in cryoextraction of the lens]. / L'althesin nella crioestrazione del cristallino.

The bulbar hypotonizing activity of Althesin in eye surgery has been assessed. The anaesthetic was then utilized in the induction and maintenance of narcosis in cryoextraction operations on the crystalline lens. In the 50 narcoses examined, a mean decrease in ocular tone of 30% was noted with respect to basal value five minutes after induction; tone then reduced further, reaching a mean decrease of 43% with respect to base value, prior to opening of the anterior chamber.

[Peripheral (end-organ) vertigo) (author's transl)]. / Le vertigine periferiche.

The physical examination and symptoms (vertigo, nystagmus and muscular asymmetry) of patients with typical vertigo are reviewed after a brief description of anatomic and physiologic features of the vestibular system. According to the daily clinical practice, the etiology, pathogenesis and differential diagnosis of peripheral vestibular syndromes are discussed. A review of the therapeutic approach to peripheral vertigo is presented.

[Békésy audiometry at suprathreshold level in sensorineural bearing losses (author's transl)]. / Audiometria automatica sopraliminare nelle ipoacusie neurosensorali.

In order to study the suprathreshold hearing phenomena for a differential diagnosis of sensorineural hearing losses Békésy Audiometry has been used at two different levels: a) Békésy threshold level; b) Békésy comfortable level. Are considered: the tracing's amplitude; the continuous decay; the gap between the two different threshold levels. Results has demonstrated that Békésy comfortable level give substantial contribution as decay test and as indirect recruitment test.

[Forward and backward Békésy audiometry in neurosensorial hearing loss (author's transl)]. / Rilievi sui tracciati anterogradi e retrogradi in autiometria automatica in pazienti affetti da ipoacusia di tipo neurosensoriale.

Békésy audiometry was utilized to show that an abnormal separation of forward and reverse frequency tracing is to be referred to an abnormal fatigability in neurosensorial hearing loss (presbycusis and noise-induced hearing loss). The ascending and descending threshold with continuous tone was compared to fixed frequency per-stimulatory threshold that has been determinated using interrupted and continuous tone. During the study has been evaluated the gap between the continuous and interrupted tone and the excursion amplitude in interrupted and continuous tone. The results are than an abnormal separation between forward and reverse frequency tracings is connected to an abnormal fatigability. Thus, according to other authors, forward-backward Békésy audiometry can be used to show a retrocochlear pathology in the considered hearing loss.

En bloc cortical resection in the treatment of paramandibular carcinomas.

The authors describe a method which, according to the site of the lesion, permits the removal of a segment of the internal or external mandibular cortex en bloc with the primary tumour and with the satellite lymph nodes. This method, which retains the continuity and height of the mandible, offers the advantage of a greater radicality and at the same time avoids those impairments of the endoral morphology which are an obstacle to a subsequent prosthetic rehabilitation. Its advantages are compared with other surgical techniques proposed for the treatment of paramandibular cancer.

[Fistulae and congenital cysts of dorsum of the nose. Report of a case (author's transl)]. / Fistole e cisti congenite del dorso del naso. Contributo clinico. Caso personale.

The Authors, after a brief review of the literature concerning the congenital fistulae and cysts of the nasal dorsum with special regard to the etiology, pathology, diagnosis and therapy, report a personal case of such fistulae in a 15 year old male. They stress importanct, for an accurate diagnosis, of radiography and fistulography and reccomend, radical surgery.

[Chromium exposure biological indices and clinical findings in chromium plating industry (author's transl)]. / Indici biologici de esposizione al cromo e rilievi clinici nell'industria di cromatura galvanica.

According to the investigations carried out on workers of two chromium plating plants, the authors believe that chromium urinary excretion allows to determine the degree of its acute absorption. Moreover, the renal clearance of diffusible chromium allows the evaluation of chromium body burden and is related to the duration as well as to the severity of exposure. This interpretation is supported by the relation between the exposure biological indexes and the clinical and instrumental investigations which make possible the evaluation of lesions caused by chromium exposure, mostly concerning the respiratory system.

[Trigeminal herpes zoster]. / "Herpes zoster trigeminale".

The authors, after a brief discussion about etiopathogenesis, istopathological changes and principal symptomatologic and therapeutic elements of Herpes Zoster, present three personal observations of Herpes Zoster facialis, two affecting only the third branch of the trigeminus nerve and one only its second branch. Finally they discuss, basing on clinical peculiarities, a possible diagnostic localization of the disease.