Long-surviving case of adenosquamous carcinoma of the larynx: case report and review of literature.

A singularly long-surviving (15 years) disease-free case of a stage II adenosquamous carcinoma of the larynx is described. A review of the literature reveals that prognosis of this aggressive malignant neoplasm is poor (mean 2-3 years free of disease) on account of local recurrences, early cervical lymph node metastasis and distant dissemination. This long survival rate emphasises the importance of early radical surgical treatment and the choice of total laryngectomy with neck dissection in stage II laryngeal neoplasm.

[Selective parathyroidectomy with unilateral cervical exploration for primary hyperparathyroidism]. / La paratiroidectomia selettiva con esplorazione cervicale unilaterale nel trattamento chirurgico dell'iperparatiroidismo primitivo.

Primary hyperparathyroidism (pHPT), is caused in over 90% of the cases by a single parathyroid adenoma. Preoperative diagnostic imaging techniques, in particular dual phase scintigraphy with SestaMIBI/TC99 and high frequency probe ecography, are able to pinpoint it 90% of the time. These are the two cornerstones of modern pHPT surgery, which has witnessed the passage from cervical exploration of all the most common parathyroid glandular sites to a more carefully targeted, restricted approach in the side of the neck where the adenoma is suspected to be. This is how selective parathyroidectomy with unilateral cervical exploration and, recently, mini-invasive parathyroidectomy, came into being. Between 1996 and 2001, in the Otolaryngology Department of S. Maria della Misericordia Hospital in Udine, 39 patients affected by pHPT, half of whom (49%) were asymptomatic, underwent selective parathyroidectomy with unilateral cervical exploration. The object of this paper was to evaluate the efficacy of this surgical technique by comparing the pre- and post-operative calcaemia and parathormone levels. The normalization of these parameters, and particularly of the latter, was considered indicative of successful treatment. All the postoperative calcaemia levels were normal, while elevated parathormone levels persisted in only 2 cases (5%). Our statistics showed a 95% efficacy for selective parathyroidectomy, a result that is comparable to the percentages described in the literature. There were, furthermore, no significant peri- or postoperative complications in any of the cases. These observations, together with the brief operating times required for the procedure (20-25 minutes on average) and the low cost of the material employed, enable us to conclude that selective parathyroidectomy with unilateral cervical exploration continues to hold its own as a valid option in the present scenario of surgical pHPT treatment, also in consideration of the fact that it does not present the rigid inclusion criteria characteristics of mini-invasive techniques.

Treatment of hyperacusis in Williams syndrome with bilateral conductive hearing loss.

Williams syndrome (WS) is a rather rare congenital disorder characterised by a series of cardiovascular, maxillo-facial and skeletal abnormalities. It sometimes displays otorhinolaryngological symptoms because of the relatively high incidence of secretory otitis media and hyperacusis, which may be present in up to 95% of patients. The present paper describes a case of WS associated with bilateral conductive hearing loss which was not related to secretory otitis media. Hyperacusis was, moreover, present in spite of the conductive deafness. Surgical or prosthetic treatment of hearing loss was delayed because of hyperacusis. Treatment of the hyperacusis by acoustic training, instead, yielded excellent, long-lasting remission of the symptoms.

[Unusual radiological findings in combined laryngeal mucocele]. / Aspetti radiologici peculiari in un caso di mucocele laringeo misto.

In laryngeal mucocele, Morgagni's ventricle fills with mucous resulting from proliferation of the innner glandular epithelium and simultaneous closure of the ventricular opening. In making a diagnosis, the physician must first rule out any underlying neoplasm in Morgagni's ventricle which would give rise to a secondary mucocele. The present work reports a clinical case which came under observation because of cough, dysphonia and swelling of the left ventricular band with normal motility of the true vocal cords. CT of the neck, performed with contrast medium and axial scanning, showed a solid neoformation starting from the left laryngeal ventricle; densitometry proved moderately non homogeneous and showed radiological signs of hypervascularization. On the basis of these data the patient underwent direct bioptic laryngoscopy. During the beginning of the endoscopic maneuver, the pressure exerted by the stiff laryngoscope forced out dense, sticky mucous-like material and caused the laryngeal ventricle to collapse. Subsequently, multiple bioptic samples were taken from the walls and floor of the ventricle. The histological and microbiological examination confirmed the diagnosis of laryngeal mucocele. Six months later the laryngoscopic picture was nearly normal. In the years since computerized tomography came into clinical practice, diagnosis of this pathology has become easier and quicker Computerized tomography provides radiological indication of benignness which is certainly valid for laryngocele, a tumefaction containing air and which is therefore clearly differentiated from the radiodensity of the surrounding tissues. Vice versa, the homogeneous mucous content of the laryngeal mucocele can be altered by bacterial proliferation and may not show up on the CT as a uniformly hypodense area. Phlogosis due to the presence of colonies of bacteria can lead to greater blood flow in the ventricular site, thus making it impossible to distinguish the hyperdense boundary surrounding the hypodense mass. This, in turn, creates a blurry, ambiguous area of hyperdensity typical of increased vascularization. The rarity of the lesion, the relative likelihood of a simultaneous neoplasm and the ambiguousness of the clinical diagnostic elements available justify the use of preliminary bioptic microlaryngoscopy before surgically treating laryngeal mucocele.

[Videofluoroscopic study of deglutition in patients with multiple sclerosis]. / Studio videofluoroscopico della deglutizione nei pazienti affetti da sclerosi multipla.

Multiple sclerosis is a neurological disease that affects the I/II motor neurons of the CNS and its symptoms include oropharyngeal dysphagia. The onset and course of this dysphagia significantly conditions the progression of the disease. The present study evaluates the incidence on deglutition and type of alterations in a sampling of 10 multiple sclerosis patients of which 4 showed clinical signs of dysphagia. The results, obtained by combining quantitative (clinical severity) and qualitative (functional alterations) parameters showed that 9 of the 10 patients (90%) presented radiological abnormalities in the progression of the bolus. The conclusion drawn is that the high prevalence of dysphagia in multiple sclerosis, even if not always manifest clinically, justifies drawing up a standard protocol for radiological evaluation and clinical follow-up in order to screen those patients at greater risk of pulmonary complications and delay them as long as possible.