A new high-throughput method to make a quality control on tattoo inks.

Nowadays, practice of tattooing is very common worldwide and, along with this increasing trend, there is also an increased risk of adverse reactions to tattoo pigments that are well known and described in literature. Previous studies have reported that cutaneous and allergic reactions to a particular pigment can manifest in several ways (allergic contact dermatitis and photo-allergic dermatitis). In this paper, a new high-throughput method is presented, in order to achieve a new system for the quality control on tattoo inks based on chromatographic-spectroscopic approach. The samples, twenty-one tattoo inks and three permanent makeup, comprised the following colors: black inks, yellow, blue, green, white, pink and various shades of red (pigment that gives many allergic responses) were analyzed through the combination of chromatographic and spectroscopic techniques, the HPTLC-Raman. In particular, Raman technique has been chosen because of its high sensitivity towards the inorganic and organic pigments, main constituents of tattoo inks. Moreover, the advantage of this hyphenated technique is to overcome the problem of analysing the complex mixture of tattoo inks, allowing to obtain a Raman spectrum of each single component, isolated by chromatographic separation. This approach aims at developing a powerful instrument to establish the nature of tattoo inks and substances that could be cause adverse reactions in tattooed patients.

Plastic tracheostomal-widening procedure: the "petal" technique.

Severe tracheostomal stenosis after total laryngectomy may require the permanent use of a tracheostomy tube which undoubtedly represents a personal and social handicap (cosmetic impairment, accumulation of sputum, noisy breathing, cough stimulation, tube management). In patients with voice prostheses, this is a major obstacle to phonation and device maintenance. Stenosis is so pronounced, in some cases, as to cause dyspnoea. The main causes of stenosis are perichondritis of the upper tracheal rings or, more frequently, a defect in the tracheostoma preparation. All such cases require surgical revision of the tracheostomal diameter, for which numerous procedures have been described in the literature. The "petal" technique, adopted by the Otorhinolaryngology O.U. in Vittorio Veneto, for four years, has been used in 59 patients. The technique is described and results of retrospective study, to assess outcome, are outlined. In 40 cases, outcome was immediately satisfactory, while recurrence of stenosis was observed in 19 patients, 9 of whom preferred to accept tube dependence while 10 were reoperated, with permanent successful results in 6 cases. In our opinion, since this is an easy surgical procedure to perform and, in the majority of cases, is carried out under local anaesthesia with good patient compliance, absence of complications and good long-term results, this should be considered the method of choice for surgical widening of permanent tracheostomas.

[Endoscopic laser surgery in laryngeal stenoses]. / La laser chirurgia endoscopica nelle stenosi laringee.

The use of CO2 laser beam is quite common in the treatment of laryngeal stenosis, but it also has precise limits. In general, endoscopic laser surgery has possibilities of success only in stenosis resulting from non-circumferential soft tissue involvement the depth of which is less than one centimeter; in more complex forms of stenosis, with cartilagoneous involvement, endoscopic laser treatment is rarely successful. Laser surgery efficacy varies in this condition: results are better in treatment of post-traumatic and post-surgical stenosis, while the outcome is definitely worse in stenosis resulting from radiotherapy and ingestion of corrosive agents. Laser surgery efficacy varies according to the site of lesion: the results are generally good in the supraglottis, variable at the level of the glottis and very poor in the subglottis.

Induction intra-arterial cisplatin and bleomycin in head and neck cancer.

Fifty-two consecutive patients, affected by large T2 (greater than 3 cm), T3, T4, N0, or N1 previously untreated squamous cell carcinoma of the head and neck, entered this phase I-II study. Treatment consisted of a continuous 8-day infusion on the following daily schedule: cisplatin 25 mg and bleomycin 15 mg administered for 4 and 20 hours, respectively. Technical-related toxicities were 1 case each of coagulation and displacement of the catheter and 1 case of reversible monoparesis of the contralateral arm. Drug-related relevant toxicities accounted for 4 cass of grade 3 or 4 leukopenia and 2 cases of peripheral palsy of the 7th and 12th cranial nerve, respectively. Forty-five of 50 evaluable patients obtained an objective response. In particular, 13 patients obtained a complete response, 22 a partial response greater than or equal to 75%, and 10 a partial response greater than or equal to 50%. Furthermore, 5 of 31 patients showed a complete pathologic disappearance of the tumor, whereas in 12 of 31 only a microscopic residue was found.

[Treatment of laryngeal adenoid cystic carcinoma]. / Sul trattamento del carcinoma adenoido-cistico laringeo.

Laryngeal localization (nearly always hypoglottic) of adenoid cystic carcinoma is quite rare (0.6% of all malignant laryngeal tumors). In most cases the local development of the neoplasm is slow, of an infiltrating and highly invasive nature (affecting the cartilage, thyroid gland, esophagus). On the other hand in some cases, particularly in the laryngeal-tracheal localization, the tumors take on an exophytic, sessile, polypoid aspect. Although the evolution is quite slow prognosis is poor due to the latent spreading of distant metastasis (average survival is 8 years). Prognosis is further worsened by delay in diagnosis due to the poor, aspecific initial symptoms. C.A.T. and N.M.R. have made a marked contribution to improved diagnostic definition, especially in terms of tumor extension, which is of great importance in therapeutic staging. Given the poor results obtained with radiotherapy and chemotherapy the only possible treatment is surgery which, in most cases, must be quite radical. Only in those forms which are still localized (with endoluminal exophytic development) is it possible to perform conservative surgery. Two paradigmatic cases are reported here indicating two different tumor extensions: in the first case total laryngectomy was performed and extended to the thyroid gland and the upper portion of the trachea; in the second, a partial glottic-subglottic laryngectomy was performed with functional restoration of laryngeal function. Conservative surgery is only possible if the hypoglottic neoformation is limited to the larynx, if it is mainly exophytic in nature and if histological examination reveals a low degree of malignancy (a high degree of cell differentiation). Since this type of carcinoma tends to give rise to latent distant metastases prognosis is, in all cases, poor no matter what surgical technique is employed for the primary tumor. Therefore it is imperative that a conservative laryngectomy be performed in all cases where it proves oncologically possible and particular attention should be paid to the quality of the patient's post-surgery life.

[Three-quarter laryngectomy. Our experience: indications, surgical technique, results]. / La laringectomia tre-quarti. Nostra esperienza: indicazioni, tecnica chirurgica, risultati.

Three-quarter laryngectomy is regarded as a supraglottic laryngectomy which has been extended on one side to the glottic plane. Indications are those for supraglottic laryngectomy at the vestibular level and of cordectomy extended to the arytenoid at the glottic level (undamaged lower paraglottic space, preserved motility). Surgical technique includes total removal of the laryngeal vestibule together with the hyoid bone, pre-epiglottic space and one supracricoid hemilarynx (vocal cord, arytenoid, medial wall of the entrance of the pyriform fossa) through an internal, subperichondrial approach. Reconstruction of a new cord on the hemilaryngectomy side is through a triangular strip of the exterior thyroid perichondrium. From 1975 to 1989 44 patients underwent a three-quarter laryngectomy in the authors' department. Functional results were positive in all cases. The oncological results were as follows: 6 recurrences (3 local, 2 locoregional lymph node recurrences and 1 distant metastasis) and 4 primary secondary tumors. 9 patients expired (6 of T, 2 of secondary tumor, 1 of other causes). The actuarial 5-year survival rate for the tumor was 79%.

[The prevention of liver disease in the hemophilic child]. / La prevenzione dell'epatopatia nel bambino emofilico.

The modern replacement therapy of inherited bleeding disorders has proved to be a major advance in the management of haemophilic children. However, the haemophiliacs, early treated with commercial clotting factor concentrates obtained from large amounts of plasma, are exposed to blood borne viruses responsible for post-transfusion hepatitis (PTH) and for their possible harmful long-term sequelae. Infact high prevalence of infection with hepatitis B virus, non-A, non-B agents, delta agent has been documented among haemophilic children. In this study we analyze the measures of surveillance at present available in order to reduce the risk of PTH in young haemophilic patients. Among these measures of prevention we point out the magnitude of administrating hepatitis B vaccine to susceptible children and of using antihaemophilic factor heat-treated to reduce infectivity in those children who have never been treated and without signs of active viral infections.