Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers(SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire.Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the first cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10.CONCLUSION: The VHI is a reliable self assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Voice outcomes after laser cordectomies: subjective evaluation using the voice handicap index

INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers (SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire. Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the rst cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10. CONCLUSION: The VHI is a reliable self-assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes

Natural products and ring-closing metathesis: synthesis of sterically congested olefins.

Covering: 2002 to August 2017.This review highlights recent RCM reactions towards the synthesis of sterically congested natural products. It offers an insight into various synthetic targets and approaches and provides information on the evolution of catalysts as powerful tools enabling the use of increasingly challenging diene precursors.

Recent advances in the synthesis of natural multifunctionalized decalins.

This review highlights recent innovative synthetic strategies developed for the stereoselective construction of natural complex decalin systems. It offers an insight into various synthetic targets and approaches and provides information for developments within the area of natural products as well as synthetic methodology.

Les goitres plongeants : particularites cliniques; radiologiques et therapeutiques

Introduction: Les goitres plongeants; devenus rares de nos jours; posent des problemes diagnostiques et chirurgicaux particuliers. Leur prise en charge est facilitee par l'apport de la tomodensitometrie permettant de planifier l'attitude therapeutique.Le but de ce travail est de preciser les modalites d'exploration et de prise en charge chirurgicale des goitres plongeants. Materiels et methodes : Nous rapportons une etude retrospective portant sur42 cas de goitre plongeant colliges sur une periode de 11 ans entre 2001 et 2011. Resultats : L'age moyen de nos patients etait de 56;9 ans (36-86 ans). Le sex-ratio etait de 0;13. La tumefaction basi-cervicale etait le motif de consultation le plus frequent; rapportee dans 74 des cas associee a des signes de compression oesotracheale dans 45 des cas.Une paralysie recurrentielle unilaterale a ete objectivee dans 3 cas.Une radiographie de thorax a montre un elargissement mediastinal dans 23 des cas avec deviation tracheale chez 63 des malades. Une TDM cervico-thoracique pratiquee dans 85 des cas a confirme le diagnostic. Le traitement chirurgical etait mene par voie cervicale exclusive chez tous les patients. Une paralysie recurentielle a ete observee dans 3 cas. Aucune hypoparathyroidie definitive n'a ete rapportee avec un reculmoyen de 24mois. Conclusion : Les goitres plongeants devenus rares du fait de la prise en charge plus precoce des nodules thyroidiens. Ils posent actuellement moins de difficultes therapeutiques. L'indication chirurgicale est toujours formelle devant le risque vital qu'ils posent

Cutaneous metastasis of lung carcinoma: a retrospective study of 12 cases.

BACKGROUND: The skin is a rare site of metastasis of the internal malignancies. On the contrary, lung cancer is a common primary malignancy of skin metastasis. The latter is either synchronous with the primary lung tumour or can reveal it. OBJECTIVE: To analyse the clinical findings and the outcome of cutaneous metastasis in patients with primary lung cancer. METHODS: Retrospective study including 12 cases of cutaneous metastasis of lung cancer diagnosed in our institution during 6years. RESULTS: Our patients included three women and nine men with a median age of 59.83years. The cutaneous metastases were unique in seven cases. They revealed the primary tumour in two cases, were discovered synchronously with the primary tumour in six cases and after the primary tumour in four cases. They appeared in patients presenting multiple metastases in 10 cases. Clinical appearance consisted on a firm nodule, sometimes ulcerated with a diameter ranging from 0.5 to 5.5cm. The tumour was sited in the thorax, the back, the abdomen; or the upper or lower limbs. Pathological examination of bronchial biopsy revealed an adenocarcinoma in eight cases, a squamous cell carcinoma in two cases and a small cell carcinoma in two cases. In spite of lung cancer therapies, the patients with metastasis to other organs with a median follow-up time of 4months died. CONCLUSION: Cutaneous metastases of lung cancer are of poor prognosis. They are most of the time associated with an advanced neoplastic process with metastasis to other organs. Median survival after skin involvement does not exceed months.