Tumour-node-metastasis staging of human papillomavirus negative upper aerodigestive tract cancers: a critical appraisal.

OBJECTIVE: The tumour-node-metastasis staging system has a dynamic structure that is continuously being updated as scientific data develops. This review discusses some suggested revisions on tumour-node-metastasis staging of human papillomavirus negative upper aerodigestive tract cancers. METHODS: The seventh edition of The American Joint Committee on Cancer Staging Manual was reviewed and important issues that could be considered for revision were identified and discussed. RESULTS: According to our assessment of the oncological outcomes of previous studies, the following factors should be considered for revision: anterior commissure involvement and subglottic extension in laryngeal cancers; underlying bone involvement in hard palate and upper alveolar ridge cancers; tumour thickness in oral cancers; and extracapsular spread and carotid artery involvement in neck metastases. CONCLUSION: Sufficient data on the prognostic importance of these issues have been reported. Suggested revisions in line with current knowledge on the clinical behaviour of upper aerodigestive tract cancers would improve the relevancy of staging.

An individualised treatment algorithm for tumour stage 1 glottic squamous cell carcinoma.

OBJECTIVE: To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma. METHOD: A retrospective outcome analysis study was performed using data from a tertiary referral centre. RESULTS: Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent. CONCLUSION: Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes.

Comparison of effects of anaesthesia with desflurane and enflurane on liver function.

INTRODUCTION: Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aimed to compare the effects of desflurane and enflurane on liver function. METHODS: 40 patients, who were in the ASA I-III risk groups and were planned to undergo head and neck surgery of at least three hours' duration, were randomly divided into two groups: the desflurane (Group D) and enflurane groups (Group E). Venous blood samples (5 ml) of the patients were obtained before anaesthesia induction, in the postoperative first hour and on the first and seventh days. The samples were centrifuged and then stored at -80 degrees Celsius until the determination of glutathione S-transferase (GST) levels. For maintenance of anaesthesia in Group D, desflurane (6 percent) was used, while in Group E, enflurane (1.2 percent) was used. RESULTS: GST levels were significantly higher in Group E in the postoperative first hour (p-value is 0.002), and on the first day (p-value is 0.025) and seventh day (p-value is 0.035), although there were no differences preoperatively (p-value is more than 0.05). When postoperative levels were compared with preoperative levels, the postoperative GST levels of Group E were significantly higher (first hour [p-value is 0.008], first day [p-value is 0.010], seventh day [p-value is 0.038]). CONCLUSION: Subclinical hepatic injury after anaesthesia continues to be an issue of interest, particularly with the development of new, more sensitive methods of measuring GST levels. The increase in GST concentration after anaesthesia is thought to be a result of reduced hepatic blood flow. This study has shown that desflurane has fewer effects than enflurane on liver function tests in lengthy operations of up to 330 minutes.

Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study.

OBJECTIVE: To investigate the impact of nasal irrigation with isotonic or hypertonic sodium chloride solution on mucociliary clearance time in patients with allergic rhinitis, acute sinusitis and chronic sinusitis. PATIENTS AND METHODS: Mucociliary clearance time was measured using the saccharine clearance test on 132 adults before and after 10 days' application of intranasal isotonic or hypertonic saline. Patient numbers were as follows: controls, 45; allergic rhinitis, 21; acute sinusitis, 24; and chronic sinusitis, 42. The results before and after irrigation were compared using the Wilcoxon t-test. RESULTS: Before application of saline solutions, mucociliary clearance times in the three patient treatment groups were found to be significantly delayed, compared with the control group. Irrigation with hypertonic saline restored impaired mucociliary clearance in chronic sinusitis patients (p < 0.05), while isotonic saline improved mucociliary clearance times significantly in allergic rhinitis and acute sinusitis patients (p < 0.05). CONCLUSION: Nasal irrigation with isotonic or hypertonic saline can improve mucociliary clearance time in various nasal pathologies. However, these solutions should be selectively prescribed rather than used based on anecdotal evidence. Further studies should be conducted to develop a protocol for standardised use of saline solution irrigation in various nasal pathologies.

Relationship between tumour-node-metastasis stage of laryngeal squamous cell carcinoma and duration of symptoms.

OBJECTIVE: To evaluate the relationship between disease stage and duration of symptoms for squamous cell carcinoma of the larynx. METHOD: We evaluated retrospectively data from 102 laryngeal squamous cell carcinoma patients seen in the otorhinolaryngology department of the Gazi University School of Medicine between December 1996 and June 2004. Inclusion criteria were a histologic diagnosis of laryngeal squamous cell carcinoma, no previous medical, surgical or radiological treatment for carcinoma, and the absence of any other primary tumours or distant metastatic disease. RESULTS: There was no relationship between duration of symptoms and stage of the disease, both for glottic and supraglottic tumours. When glottic and supraglottic tumours were compared, no significant difference in symptom duration could be found. CONCLUSION: There is no correlation between symptom duration and the stage of the disease for squamous cell carcinoma of the larynx. Therefore, symptom duration does not reflect the stage of the tumour.