The Expression of Hypoxia-Related Biomarkers: A Significance of HIF-1α C1772T Polymorphism as Predictor of Laryngeal Carcinoma Relapse.

INTRODUCTION: The association between the expression of HIF-1α in the laryngeal carcinoma and the prognosis of disease is quite well documented, but the significance of HIF-1α C1772T polymorphism and its relation to disease phenotype have to be clarified. The aim of this study was to investigate the influence of C1772T polymorphism on the clinical-pathological characteristics and disease-free survival after initial surgical treatment of patients with laryngeal carcinoma. MATERIALS AND METHODS: The prospective cohort study included 65 patients with laryngeal carcinoma. Two representative tumor tissue specimens were taken in each patient during surgery; 1 specimen was used to asses HIF-1α C1772T polymorphism and the other 1 to determine the immunohistochemical expression of HIF-1α, VEGF, as well as CD 34 proteins. The comparison of polymorphism frequency between study and control population was conducted by collecting a 5 mL of peripheral venous blood samples in each subject. RESULTS: Clinicopathological characteristics of laryngeal carcinoma didn't affect the expression of hypoxia-related biomarkers, such as HIF-1α, VEGF or MVD. The statistically significant association between HIF-1α and VEGF expression was found (P = .034), but not between HIF-1α expression and MVD value (P = .696). The expression of HIF-1α was significantly higher among CT heterozygotes (P = .029). We found a significantly more recurrence among CT heterozygotes compared with patients with CC homozygous alleles (57.10% and 24.30%, respectively; P = .007). Patients with C1772T polymorphic variants had significantly worse disease-free survival compared with patients without polymorphism (Log-rank test, P = .007). CONCLUSION: HIF-1α C1772T polymorphism was significantly associated with worse disease-free survival which nominates it as a predictor of laryngeal carcinoma relapse. The preoperative assessment of hypoxia-related biomarkers should be used in everyday practice in order to determine the treatment modalities for laryngeal carcinoma.

Transcultural Adaptation and Validation of the Voice Handicap Index-10 into the Serbian Language.

BACKGROUND: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and ease of use by patients. OBJECTIVES: The aim of this paper was to evaluate the internal consistency, reliability, and clinical validity of the Serbian version of the VHI-10. METHOD: In this cross-sectional study, we translated the original English version of the VHI-10 into Serbian, after which it was back-translated into English. The Serbian version of the VHI-10 was completed by 161 patients with voice disorders, divided into 4 groups according disease etiology (structural, neurological, functional, and inflammatory) and 73 healthy control subjects. RESULTS: The VHI-10 internal consistency was 0.88. Spearman's rank correlation coefficient for VHI-10 test-retest reliability was ρ = 0.991 (p< 0.001). Patients with voice disorders had higher median total VHI-10 scores compared with controls (p< 0.001). The patients' Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale scores were significantly correlated with the VHI-10 test scores (ρ = 0,682, p < 0.001) and VHI-10 retest scores (ρ = 0.716, p < 0.001). CONCLUSION: The Serbian version of the VHI-10 had good validity and reliability and can be used by Serbian patients with voice disorders.

Laser transoral microsurgery in treatment of early laryngeal carcinoma.

PURPOSE: Laser transoral laryngeal microsurgery has become widely accepted treatment method because of its organ and function preservation and shorter period of hospitalization. The aim of this study was to examine the overall, disease-specific and disease-free survival in patients with early laryngeal carcinoma treated with laser depending on age, gender, common risk factors (tobacco and alcohol use), histopathological tumor grade, anterior commissure involvement, performed tracheotomy, positive surgical margins, T stage, type of endoscopic cordectomy, postoperative radiotherapy and laryngeal preservation. METHODS: Retrospective study included 234 patients with squamocellular carcinoma of the larynx treated with laser transoral laryngeal microsurgery. 5-year overall, disease-specific and disease-free survival and the prognostic impact of mentioned factors were evaluated using Kaplan-Meier and Cox proportional hazard analyses. RESULTS: 5-year OS and DSS was 92.5% and 95.3%, respectively. OS was significantly lower for older patients and in patients with histologically poorly differentiated tumors, 3 and 5 years postoperatively (Log rank test; p = 0.031). DSS was significantly lower in patients with anterior commissure involvement, positive surgical margins and patients who underwent postoperative RT. DFS was significantly lower in patients with anterior commissure involvement, patients with T1b tumor stage and patients who underwent cordectomies type Vb and VI (Log rank, p < 0.05). Laryngeal preservation significantly influenced 5-year OS, DSS and DFS (Log rank, p ≤ 0.001). Multivariate Cox regression analysis showed that age, histological tumor grade and laryngeal preservation were significant negative prognostic factors for 5-year DSS and DFS. CONCLUSION: Transoral laryngeal microsurgery delivers excellent oncological results, even in selected patients with higher stages of early laryngeal cancer and anterior commissure involvement.

The sequence analysis of Epstein-Barr virus EBNA1 gene: could viral screening markers for nasopharyngeal carcinoma be identified?

Epstein-Barr virus (EBV) has been identified as a group 1 carcinogenic agent, particularly for nasopharyngeal carcinoma (NPC). The sequence diversity of EBV nuclear antigen 1 (EBNA1) reflects region-restricted polymorphisms, which may be associated with the development of certain malignancies. The aims of the present study were to evaluate EBV EBNA1 gene polymorphisms circulating in NPC, infectious mononucleosis, and isolates from patients with transplanted organs to determine if EBNA1 sequence specificities are useful as viral biomarkers for NPC. Forty biopsies of undifferentiated carcinoma of nasopharyngeal type (UCNT), 31 plasma samples from patients with mononucleosis syndrome, and 16 plasma samples from patients after renal transplantation were tested in this study. The EBNA1 gene was amplified by nested PCR. Further investigation included sequencing, phylogenetic, and statistical evaluations. Eighty-seven sequences were identified as one of the four EBNA1 subtypes, P-Ala, P-Thr, V-Val, and V-Ala, with further classification into ten subvariants. Of these, P-Thr-sv-1 and P-Thr-sv-3 have never been identified in Europe, while V-Val-sv-1 was newly discovered. Statistical analysis revealed significant differences in the distribution of EBNA1 P-Thr subvariants between the three groups of patients, with noticeable clustering of P-Thr-sv-5 in NPC isolates (p < 0.001). EBV EBNA1 showed no sequence specificity in primary infection. This research revealed a newly discovered EBNA1 subvariant. Importantly, EBNA1 P-Thr-sv-5 showed carcinoma-specific EBNA1 variability. Thus, identification of this subvariant should be considered as a viral screening marker for NPC or UCNT.

Quantification of biofilm formation on silicone intranasal splints: An in vitro study.

OBJECTIVES: Biofilms are associated with persistent infections and resistant to conventional therapeutic strategies. The aim of this study was to investigate the quantity of biofilm produced on silicone intranasal splints. METHODS: Quantity of biofilm formation on silicone splints (SS) was tested on 15 strains of Staphylococcus aureus and Moraxella catarrhalis, respectively. Antimicrobial susceptibility testing was performed in accordance with European Committee on Antimicrobial Susceptibility Testing recommendations. RESULTS: All tested strains formed different amounts of biofilm on SS: 66.7% S. aureus and 93.3% M. catarrhalis were weak biofilm producers and 33.3% S. aureus and 6.7% M. catarrhalis were moderate biofilm producers. S. aureus formed significantly higher quantity of biofilm compared with M. catarrhalis (p < 0.05). Multidrug resistant S. aureus produced significantly higher amount of biofilm compared with non-multidrug resistant strains (p < 0.05). CONCLUSION: Quantity of biofilm on SS is highly dependent on bacterial species and their resistance patterns. Future studies are needed to ascertain another therapeutic option for prophylaxis prior to SS placement.

Characterization of the Variability of Epstein-Barr Virus Genes in Nasopharyngeal Biopsies: Potential Predictors for Carcinoma Progression.

Epstein-Barr virus (EBV) infection is a significant factor in the pathogenesis of nasopharyngeal carcinoma, especially in the undifferentiated carcinoma of nasopharyngeal type (UCNT, World Health Organization type III), which is the dominant histopathological type in high-risk areas. The major EBV oncogene is latent membrane protein 1 (LMP1). LMP1 gene shows variability with different tumorigenic and immunogenic potentials. EBV nuclear antigen 1 (EBNA1) regulates progression of EBV-related tumors; however, the influence of EBNA1 sequence variability on tumor pathogenesis is controversial. The aims of this study were to characterize polymorphisms of EBV genes in non-endemic nasopharyngeal carcinoma biopsies and to investigate potential sequence patterns that correlate with the clinical presentation of nasopharyngeal carcinoma. In total, 116 tumor biopsies of undifferentiated carcinoma of nasopharyngeal type (UCNT), collected from 2008 to 2014, were evaluated in this study. The genes EBNA2, LMP1, and EBNA1 were amplified using nested-PCR. EBNA2 genotyping was performed by visualization of PCR products using gel electrophoresis. Investigation of LMP1 and EBNA1 included sequence, phylogenetic, and statistical analyses. The presence of EBV DNA was significantly distributed between TNM stages. LMP1 variability showed six variants, with the detection of the first China1 and North Carolina variants in European nasopharyngeal carcinoma biopsies. Newly discovered variants Srb1 and Srb2 were UCNT-specific LMP1 polymorphisms. The B95-8 and North Carolina variants are possible predictors for favorable TNM stages. In contrast, deletions in LMP1 are possible risk factors for the most disfavorable TNM stage, independent of EBNA2 or EBNA1 variability. A newly discovered EBNA1 subvariant, P-thr-sv-5, could be a potential diagnostic marker, as it represented a UCNT-specific EBNA1 subvariant. A particular combination of EBNA2, LMP1, and EBNA1 polymorphisms, type 1/Med/P-thr was identified as a possible risk factor for TNM stage IVB or progression to the N3 stage.

Laryngeal Granuloma - Benefit in Treatment with Zinc Supplementation?

Laryngeal granulomas present as contact and postintubation ulcers and granulomas. Essentially, a contact granuloma is a pseudotumor of the lateral wall of the posterior glottis. The most common etiological factor is voice abuse, with predisponing factors such as reflux disease. Postintubation ulcers and granulomas, although of different etiology, according to all the other traits belong to this clinical entity. The therapy of choice is conservative treatment. Surgical laser excision is indicated for resistant cases and those whose size is causing respiratory distress. Treatment of laryngeal granulomas with zinc supplementation is reported in the literature as one of the forms of conservative treatment, and we wanted to consider it in this review. Zinc is an essential mineral that plays a vital role in many biochemical reactions and is considered very important for wound healing.

Clinical outcomes and quality of life in patients with nasal polyposis after functional endoscopic sinus surgery.

The majority of studies have shown that the use of functional endoscopic sinus surgery (FESS) leads to symptomatic improvement in 73-98.4 % of patients with chronic rhinosinusitis and nasal polyposis (NP). The aim of the study is to evaluate clinical outcomes and quality of life (QoL) in patients with NP after FESS. The prospective study included 85 consecutive adult patients (≥18 years) with NP who were operated on using FESS after failure of the medicamentous treatment and in certain cases of surgical treatment. QoL was assessed by Short Form-36 Health Survey (SF-36) questionnaire, and the symptom intensity was presented using visual analogue scale (VAS). The objective finding was presented as endoscopic and computerized tomography (CT) score. The intensity of each symptom, the values of symptom scores (major, minor and total), the values of dimension scales and summary scales of the QoL, as well as the values of endoscopic score through three periods of time (pre-surgery, 6 and 12 months after the surgery) were analyzed. Following the FESS, mean intensity values of all individual symptoms and symptom scores were significantly lower and the values of all dimension scales and summary scales of QoL were significantly higher (p < 0.05). There was no statistically significant difference in symptom intensity and QoL after 6 and 12 months of surgical treatment (p > 0.05). Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but the mean score value after 12 months of operation was significantly higher in relation to that after 6 months of surgery (p < 0.05). Nevertheless, the recurrence of NP was observed in 28 patients (32.9 %) in the follow-up period. In conclusion, FESS in NP patients results in significant improvement of symptom intensity, QoL and endoscopic score. While the intensity of symptoms and QoL showed a tendency to maintain between 6 and 12 months after surgery, endoscopic score showed a tendency of exacerbation in the same period.

Oncological and functional outcome after surgical treatment of early glottic carcinoma without anterior commissure involvement.

INTRODUCTION: Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years. MATERIAL AND METHODS: Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II-IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment. RESULTS: There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy. CONCLUSION: Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal.

MRI in evaluation of neoplastic invasion into preepiglottic and paraglottic space.

OBJECTIVE: The purpose of this study was to evaluate whether magnetic resonance (MR) imaging can accurately predict invasion of the preepiglottic and paraglottic space in patients with laryngeal carcinoma. Identification of these fat filling spaces is important for surgical treatment and prognosis. MATERIALS AND METHODS: The study was based on the prospective analysis of MRI images in a series of 40 patients (90% males), overall average age 60.1 ± 7.3 years, (49-70 years), with histopathologically diagnosed laryngeal squamous cell carcinoma. Unenhanced T2w, T2w FS, T1w, and contrast-enhanced T1w FS scans were analyzed for the presence of preepiglottic and paraglottic neoplastic invasion and were compared to postoperative histopathologic analysis. RESULTS: In 28 patients (70%) the tumor was glottic and in 12 patients (30%) supraglottic. No statistical difference was found in the number of patients with positive MRI findings in comparison to postsurgical patohistology for infiltration of the preepiglottic space (23% vs 20%, respectively). Sensitivity for infiltration of preepiglottic space was 89% and specificity was 97%. However, infiltration of the paraglottic spaces was observed more frequently on MRI than on postsurgical patohistology analysis (60% vs 40%, respectively; p<0.05), with a sensitivity of 67% and a specificity 50%. According to MRI findings, 26 (65%) patients were classified as T3, 14 (35%) patients as T2 while according to histopathologic analysis of specimens after surgery, 19 patients were classified as T3 (48%) and 21 as T2 (52%). CONCLUSION: MRI has been shown to be a reliable method for assessment of preepiglottic space while the diagnostic accuracy in patients with infiltration of the paraglottic space is limited.

Stroboscopy in detection of laryngeal dysplasia effectiveness and limitations.

Vocal fold pathology changes the appearance and vibratory patterns observed during stroboscopic examination, but a strict correlation between the vibratory pattern and the dysplasia type does not exist. The aims of this study were to determine the role of stroboscopy in vocal fold dysplasia assessment and to determine whether stroboscopy is the deciding factor when performing laryngomicroscopy with biopsy in suspicious lesions. This prospective controlled study involved 112 patients with laryngeal dysplasia treated over a 2-year period at a tertiary medical center. Patient data and clinical, stroboscopy, laryngomicroscopy, and histopathologic reports were reviewed. During the stroboscopy, glottic occlusion, phase symmetry, periodicity, amplitude, mucosal wave, and nonvibratory segments were followed. Laryngomicroscopy with different types of endoscopic cordectomies (types I-III) was performed as a therapeutic measure, with a 12-month follow-up period. Nonvibrating segments were present in 15.1% of the patients with mild dysplasia and in 38.5% of the patients with moderate dysplasia. In 45.5% of the patients with severe dysplasia (carcinoma in situ), nonvibrating segments were absent. The amplitude of vocal fold vibrations in patients with mild dysplasia (P=0.03) was a significant factor indicative of recurrent disease, but none of the stroboscopic signs was significant for the disease progression. Severe dysplasia can be related to both nonvibrating and vibrating vocal fold segments. Stroboscopy cannot be used reliably for classifying laryngeal dysplasia and may indicate the need to perform laryngomicroscopy with biopsy in suspicious vocal fold lesions. The warning factors for recurrence and progression of dysplasia are treatment modality, abnormal amplitude of vibration, and nonvibrating segment.

Morphometric analysis of Ki-67 and p16 expression in laryngeal precursor lesions.

Laryngeal precursor lesions represent areas of altered epithelium with an increased likelihood for progression to squamous cell carcinoma. The exact molecular mechanisms of malignant transformation of laryngeal mucosa are not completely clear, but are certainly due to deregulation of cell proliferation. To assess the potential value of the p16 and Ki-67 as markers of malignant progression, we undertook a retrospective immunohistochemical and morphometric analysis on biopsy specimens from patients with precancerous lesions in the larynx. Morphometric analysis of samples stained with p16 antibody showed epithelial cell positivity in 29 (100 %) of samples with simple hyperplasia, 31 (100 %) samples with basal/parabasal cell hyperplasia, 23 (88 %) samples with atypical hyperplasia and 20 (95 %) samples with in situ carcinoma. There was a significant difference in percentage of p16-positive cells between samples with simple hyperplasia and samples with in situ carcinoma. Morphometric analysis of samples stained with Ki-67 antibody showed epithelial cell positivity in 27 (93 %) of samples with simple hyperplasia, 30 (97 %) samples with basal/parabasal cell hyperplasia, 26 (100 %) samples with atypical hyperplasia and 18 (86 %) samples with in situ carcinoma. There was a significant difference not only in the percentage of Ki-67-positive cells between samples with simple hyperplasia and samples with in situ carcinoma, but also between samples with simple and basal/parabasal cell hyperplasia. Laryngeal epithelial precursor lesions show significantly opposite patterns in p16 and Ki-67 immunopositivity. Simple hyperplasia on average shows 12 % of Ki-67-positive cells and 46 % of p16-positive cells. In situ carcinoma on average shows 23 % of Ki-67-positive cells and 36 % of p16-positive cells.

Clinical outcome of early glottic carcinoma in Serbia.

OBJECTIVE: Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment. METHODS: Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO2 laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis. RESULTS: Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor. CONCLUSION: Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients' surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.

Influence of asthma on quality of life and clinical characteristics of patients with nasal polyposis.

Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in physical, emotional and social aspects of life of the affected patients. The study is aimed to investigate the influence of asthma on quality of life (QoL), intensity of symptoms, endoscopic and computerized tomography (CT) sinus findings in patients with NP. The cross-sectional study included 88 adult patients with NP out of whom 35 (39.8 %) were asthmatic while 53 (60.2 %) were non-asthmatic. QoL is assessed based on Short Form-36 Health Survey (SF-36) questionnaire, while symptom intensity was presented using visual analogue scale (VAS). The objective finding is presented as endoscopic and CT score. Comparison of individual symptom intensity, total score and major symptom score failed to evidence any statistically significant difference between the groups. Minor symptom score which include intensity of headache, fetor ex ore, fatigue/malaise, dental pain, cough, pressure/fullness in the ears and fever was higher in the group with asthma (p < 0.05). Comparison of scores according to SF-36 domains, as well as summary scores for physical and mental health did not reveal statistically significant difference between the observed groups. Mean value of the endoscopic score in the group with asthma was 8.57 ± 2.22, being 8.38 ± 1.93 in the group without asthma (p > 0.05). Mean value of the CT score in the groups with and without asthma was 20.37 ± 4.34 and 17.47 ± 4.75, respectively (p < 0.01). Asthma has no influence on QoL and endoscopic findings of patients with NP, however it influences minor symptom score and CT findings.

Voice quality after treatment of early glottic carcinoma.

OBJECTIVES: Increasing incidence of laryngeal carcinoma and advancement in diagnostics and therapy methods, have led to constant exploration in that field. Early glottic carcinoma can be treated successfully with several procedures: cordectomy through laryngofissure, laser cordectomy, and radiotherapy. Our objective was to assess the voice quality after these different modalities of treatment. STUDY DESIGN: Prospective controlled study with 69 patients, treated in a 1-year period for glottic Tis and T1a carcinoma at the tertiary medical centre. METHODS: Nineteen of our patients were treated endoscopically with CO(2) laser (types III-IV cordectomy according to recommended European Laryngological Society classification of endoscopic cordectomies). Thirty-five patients underwent cordectomy through laryngofissure, 15 patients had radiotherapy. Multidimensional computer analysis of voice and speech was conducted 1, 6, and 12 months after the treatment. Three programs included 14 parameters, which were observed. RESULTS: While comparing the parameters between the groups, there were significant differences in the values of fundamental frequency (Hz), jitter (%), normalized noise energy (dB), standard deviation of fundamental frequency (Hz), percent silent time (%), and sound-pressure level in the different follow-up periods (P<0.05). CONCLUSION: In the long run, patients treated with radiotherapy show better voice quality in comparison with other two groups.

[Impact of rhinosinusal polyposis on CT score in patients with chronic rhinosinustis].

BACKGROUND/AIM: Chronic sinusitis is a disease characterized with mucosal inflammation of nasal and paranasal sinuses for at least 12 weeks. In order to assess the extent and severity of inflammatory changes in paranasal sinuses CT score according to Lund-Mackay is the most commonly used. Recent studies show the possibility of existing different subtipes of chronic rhinosinusitis, pointing out the presence of nasal polyps and their influence on the severity of chronic rhinosinusitis. The aim of this research was to examine the influence of sinonasal polyposis on the extensity of inflammatory changes on computerized tomography (CT), evaluated by the Lund-Mackay CT score. METHODS: A prospective study compared the Lund-Mackay CT score values between the patients with chronic rhinosinusitis associated with nasal polyps and those without them. We determined mean values of the total CT score in both groups of the patients, as well as mean values of CT score for each group of sinuses and ostiomeatal complexes. RESULTS: The study included 90 patients, 47 males and 43 females, 45-year old on average, diagnosed with chronic rhinosinusitis on the basis of diagnostic algorithm. The group with uncomplicated chronic rhinosinusitis (without nasal polyps) consisted of 30 patients and the group with complicated chronic rhinosinusitis (with nasal polyps) of 60 patients. Observing these two groups of patients revealed statistically highly important intergroup difference in CT score for each group of sinuses and ostiomeatal complexes. The mean value of total CT score in the group with uncomplicated chronic rhinosinusitis was 4.37 while in the group with complicated chronic rhinosinusitis it was 16.05 (p < 0.01). CONCLUSION: Chronic rhinosinusitis complicated by sinonasal polyposis is characterized with more extensive inflammatory changes on CT and, consequently, with higher CT score for each group of sinuses and ostiomeatal complexes, as well as higher total CT score.

Prognostic relevance of CD105-assessed microvessel density in laryngeal carcinoma.

OBJECTIVE: To examine immunohistochemical expression of CD105 among patients with laryngeal cancer and investigate the prognostic significance of CD105-assessed microvessel density (MVD). STUDY DESIGN: Cross-sectional study. SETTING: University hospital. SUBJECTS AND METHODS: The study comprised 80 patients with laryngeal squamous cell carcinoma who underwent complete excision. Clinicopathological data were collected retrospectively. Immunohistochemical analysis was performed with CD105 (endoglin) antibody. Positive-stained microvessels for CD105 were counted on hot spots of tumors at x200 magnification. RESULTS: Average CD105-assessed MVD in considered laryngeal squamous cell carcinomas (SCCs) was 12.9 (SD 3.84). High expression of CD105 correlated significantly with advanced T (tumor) classification (P = 0.008), advanced TNM (tumor, node, metastasis) stage (P = 0.001), tumor recurrence (P = 0.001), and age > or =65 years (P = 0.026). The multivariate logistic regression showed that a high CD105+ MVD (odds ratio [OR] 4.27; P = 0.019) and advanced TNM stage (OR 3.72; P = 0.047) were independent markers of tumor recurrence. High MVD, advanced clinical stage, the presence of lymph node metastasis at the time of diagnosis, and age <66 years were associated with worse disease-free survival. Cox regression analysis revealed that expression of CD105 (P = 0.016) and advanced clinical stage (P = 0.05) were the independent factors for disease-free survival. CONCLUSION: The present results suggest that MVD evaluation with CD105 is a promising prognostic factor for the outcome of patients with laryngeal SCC. CD105-assessed MVD could help to identify patients with more aggressive disease and increased risk of developing malignancy recurrence after treatment.

Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society.

In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classification of different laryngeal endoscopic cordectomies. This is actually a common classification system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classification of the different laryngeal endoscopic supraglottic partial laryngectomies. This classification comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superficial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the pre-epiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1-T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; finally, Type IV, lateral supraglottic laryngectomy, suitable for tumors of the threefolds' region, which may include the ventricular fold (Type IVa) or the arytenoid (Type IVb), when involved. As in the cases of endoscopic cordectomies, these operations are similarly classified according to the surgical approach used and the degree of resection completed in order to facilitate their use in daily clinical practice.

The analysis of clinical characteristics of the chronic rhinosinusitis: complicated and uncomplicated form.

The objective of our study was to analyze the intensity of subjective symptoms and objective findings of endoscopy and CT scanning in chronic rhinosinusitis, in the groups with and without nasal polyps. To evaluate the intensity of subjective symptoms visual analogue scale (VAS) was used, while scores were obtained by adding grades. Endoscopic finding was given in scores recommended by Lanza and Kennedy and CT results were presented by Lund-Mackay scoring system. The study included 90 consecutive adult patients, 47 males (52%) and 43 females (48%), mean age 45 years. The group with chronic rhinosinusitis without nasal polyps (uncomplicated form) consisted of 30 patients, while the group with polyps (complicated form) included 60 patients. Comparing mean intensity values of all subjective symptoms between these two groups we found out that nasal obstruction, nasal secretion and hyposmia were significantly more manifested in the polyp group (P<0.01). Facial congestion was also more manifested in the polyp group (P<0.05). Mean score value of major symptoms was 35.55 in the polyp group, and 23.13 in the group without polyps (P<0.01). Mean value of total symptom scores was 48.68 in the polyp group, and 35.00 in the group without polyps (P<0.01). Endoscopic score was approximately 9.03 in the polyp group, and 2.43 in the group without polyps (P<0.01). CT score was 16.05 on an average in the polyp group, and 4.37 in the group without polyps (P<0.01). Chronic rhinosinusitis complicated by nasal polyposis is characterized by higher degree of nasal obstruction, nasal secretion, hyposmia and facial congestion, which results in higher score of major and total score of symptoms, respectively. This form is also characterized by worse objective findings, which is reflected in higher endoscopic and CT scores.