Evaluation of health-related quality of life with EORTC QLQ-C30 and QLQ-H&N35 in Romanian laryngeal cancer patients.

The aims of this study were to evaluate the health-related quality of life (HRQL) according to: type of surgery, adjuvant oncological treatment and postoperative complications. We performed a retrospective case-control study between October 2013 and November 2014 at the Ear Nose and Throat Clinic of Cluj-Napoca. We included patients diagnosed with laryngeal or hypopharyngeal cancer treated with total or partial laryngectomy, and a sample of healthy volunteers recruited from the hospital stuff. We used the European Organisation for Research and Treatment of Cancer (EOTRC) core questionnaires (the QLQ-C30 version 3) and the head and neck cancer module (the QLQ-H&N35). We included in the study 80 patients diagnosed and surgically treated for laryngeal/hypopharyngeal squamous cell carcinoma and 20 healthy volunteers. Median age of the patients was 59.90 years. The most common location was the larynx, in 72 (90 %) of cases and the hypopharynx in 8 (10 %) cases. Sixty-six (82, 50 %) underwent total laryngectomy and 14 (17, 50 %) a partial laryngectomy. Forty-eight patients had received external radiation therapy, with adjuvant chemotherapy in 25 patients. Postoperative complication rates were 14 (17, 50 %) cases. We found a low score in total laryngectomy group regarding functional scales: role (28.03), emotional (37.75) and social (37.88) and a high score on insomnia (35.86) and financial difficulties (45.45). Partial laryngectomy group had a high score on functional scales: role (47.62), emotional (51.19) and social (52.38). These two QOL instruments were effective for Romanian patients. The QLQ-H&N35 questionnaire discriminating better the problems between groups compared with QLQ-C30.

Mastoid obliteration with concha cartilage graft and temporal muscle fascia.

AIM: The aim of our study was to describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and to review its efficacy in producing a dry, low-maintenance, small mastoid cavity. MATERIAL AND METHOD: A retrospective clinical study of 56 consecutive patients undergoing procedures for active chronic otitis media with cholesteatoma has been carried out. All surgical interventions involved partial mastoid obliteration and restoration of the middle ear space by use of cartilage reconstruction of the tympanic membrane. Ossicular reconstruction was achieved with either a partial or total ossicular replacement prosthesis. RESULTS: A completely dry cavity was achieved in 49 of 56 patients (approx. 88%, 95% confidence interval 77-95%). An overall statistically significant improvement in hearing (p < 0.05) was obtained, with the mean pure-tone average air-bone gap decreasing from 33.4 ± 8.2 dB (average ± SD) to 18.3 ± 9.7 dB. There were no residual or recurrent cholesteatomas. CONCLUSION: Cartilage reconstruction of the tympanic membrane proved to be a useful adjunct in the surgical management of the chronically draining cavity.

The role of contrast enhanced ultrasound in the assessment of superficial lymph nodes.

Evaluation of superficial lymphadenopathy is important for patients with pathologies like head and neck cancers or breast cancer, as it helps the assessment of patient prognosis and the selection of treatment method. Cervical lymph nodes are also common sites of involvement in lymphoma. Lymphomatous nodes are usually difficult to differentiate from metastatic nodes in clinical examinations. As the treatment for lymphoma and metastases is different, accurate differential diagnosis between the two conditions is important. Ultrasound is a useful imaging modality in evaluation of superficial lymphadenopathy because of its high sensitivity and specificity, especially when combined histopathology. With the use of power Doppler sonography, the vasculature of the lymph nodes can also be evaluated, which provides additional information in the sonographic examination of superficial lymph nodes. But there are still nodes that cannot be examined by Doppler or their vasculature cannot be visualized. So, in the last decade, contrast-enhanced ultrasound was more and more discussed as a non-invasive method for a more accurate differential diagnosis of cervical lymphadenopathy.

[Lymphatic and vascular invasion in laryngeal and pyriform sinus carcinomas]. / Die lymphatische und vaskuläre Ausbreitung von Larynx- und Sinus piriformis Plattenepithelkarzinomen.

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.

Protective effect of L-N-acetylcysteine against gentamycin ototoxicity in the organ cultures of the rat cochlea.

UNLABELLED: The AIM of this study was to test if L-N-acetylcysteine (L-NAC) can protect hair cells against gentamycin-induced damage in vitro. Mammalian auditory cells are unable to regenerate when affected by several toxic agents. Aminoglycosides are large-scale antibiotics, extremely useful for the treatment of several Gram-negative bacterial infections, but their use is limited by the extremely severe side effects like ototoxicity and nephrotoxicity. MATERIALS AND METHODS: 1-4-day-old rat cochlea explants were exposed to different doses of gentamycin. Half of the cochleas were pretreated for 24 hours with different doses of L-NAC. The explants were fixed and stained with phalloidin, and the intact hair cells were counted. RESULTS: GM treatment resulted in the loss of sensorial cells in the organ of Corti explants in a dose-dependent manner. All doses of L-NAC offered significant protection (p<0.001) when added in culture 24 hours prior to GM. There was no significant difference between the level of protection offered by the different doses of L-NAC, both in the outer and inner hair cells. CONCLUSIONS: Our results demonstrate that L-NAC can protect cochlear cells against gentamycin toxicity.

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.

[Scleromyxedema with laryngeal changes. Beneficial results of the treatment with mucopolysaccharidases]. / Scléromyxoedème avec modifications laryngées. Résultats bénéfiques du traitement par mucopolysaccharidases.

We observed a case of scleromyxoedema with specific cutaneous lesions in a 62-year-old man. These lesions were associated with modifications of the central nervous system, latent thyroid failure, cardiovascular changes and myopathy, usual manifestations of this disease, but without paraproteinaemia. Unusual laryngeal manifestations were a dysphonia with chronic pseudomyxomatosis of the larynx. Urinary mucopolysaccharide excretion was increased. It is important to underscore the favourable response to Thiomucase when more toxic drugs had become ineffective.