Predictors of local failure in early laryngeal cancer.

The aim of the study was to assess the impact of factors that could predict the probability of local failure in early laryngeal squamous cell carcinoma treated with curative radiotherapy. Sixty seven patients (12 women and 55 men) with laryngeal cancer stage I (47 patients) and stage II (20 patients) were treated from 1998 to 2003 with curative radiotherapy and retrospectively evaluated. Median follow-up was 36 months (3-80). Local relapse occurred in 10 patients (15%), regional lymphnodes relapse affected 2 patients. The median time between start of radiotherapy to recurrence was 13 months (3-48). Death due to cancer occurred in 4 patients (2 died from locoregional progression of the recurrence and 2 from distant metastases), whereas 7 patients died from non-cancer related causes. The 2-year overall survival rate was 90% and 5-year OS was 79%. The 2-year local control rate was 82% and 5-year local control was 79%. In the univariate analysis there was a statistically significant decrease in local control influenced by grading (p < 0.0001). High risk group of relapse encompassed patients with at least two negative factors: supraglottic tumor, women, radiotherapy prolongation by 3 or more days and high grade tumor and has 3 times worse local control than low risk group (p=0.0125). The highest risk of local recurrence was in the first three years after radiotherapy than later (p=0.0057). On multivariate analysis unfavourable prognostic factors for local control were gender (p=0.022), presence of 2 or more negative risk factors (p=0.018) and lengths of follow up (p=0.005). Radiation dose, stage, age, hemoglobin level and anterior commissure involvement were not significant factors for local control. Overall survival was affected both in the univariate and multivariate analysis by presence of local relapse (p < 0.005) and follow up duration (p < 0.02). Anemia had borderline significance for overall survival in univariate analysis (p=0.064), but in the multivariate analysis was significant unfavourable factor (p=0.008). Other studied factors (radiation dose, anterior commissure involvement and age) were not reaching level of statistical significant value for overall survival. Close follow up strategy is recommended for high risk group of patients with two or more risk factors especially in the first three years after radiation therapy.

[Malignant mucosal melanoma of the head and neck]. / Maligní melanom sliznic hlavy a krku.

Mucosal melanoma comparison to cutaneous melanoma of the head and neck are rare and do poorly. Approximately 0.5-2% of all melanomas occur from the mucous membranes of aerodigestive tract. Most common site of the tumor are the nasal cavity and paranasal sinuses but melanoma of the oral cavity are described too. Therapy usually consists of surgical resection with or without postoperative radiotherapy and immunochemotherapy eventually. The definite role of a kind of therapy in the treatment of mucosal melanoma is not remains to be defined as the small number of cases make prospective study challenging. This article reviews 19 patients with mucosal melanoma of the head and neck treated at the Department of ENT and Head and Neck Surgery Charles University of Prague since 1980 to 1999. Clinical data were obtained from the patient's charts. Analysis of the metastatic disease, type of therapy and follow-up was retrospectively reviewed. The site of the tumor was the lateral wall of the nasal cavity (five cases), nasal septum (four cases), maxilar cavity (two cases), and ethmoidal cavity, orbitoethmoidal complex, nasopharynx, saccus lacrimalis to ethmoidal sinuses diffused, tonsilla (one case each) and hypopharynx (two cases). Primary treatment was surgical resection in ten cases, in one case with radiation therapy, and in seven cases chemotherapy. In three cases were diagnostic surgery only and one patient was without therapy. Three patients received radical neck dissection more. Four patients were treated radiation therapy and three chemotherapy after surgery. In two cases were surgery after primary radiotherapy. For nine cases of recurrence of the disease were surgery (in five cases) and chemotherapy (in four cases). Overal and disease free interval was from 2 to 22 month, approximately 9.3 month and 3-year survival was 41.18%.

[Biodegradation of silicone in voice prosthesis]. / Biodegradace silikonu hlasových protéz.

The most important problem of the useful life of vocal prostheses is bacterial and especially mycotic colonization of their surface which impaired tightness of the closing valve of the prosthesis and caused subsequent leakage of fluids and food into the airways. The objective of the present study was to prevent colonization of the silicone surface and to prolong the service life of the prosthesis. The implanted prostheses were examined under microscope after varying intervals in vivo. The silicone of the implanted prosthesis was colonized by numerous microorganisms, in particular moulds. Seventeen bacterial and mycotic strains were identified. They behave to Candida, Acinetobacter, Micrococcus, Pseudomonas, Bacillus and Chryseomonas. The results confirmed the deep degradation of silicone rubber located in islets. Plant of bacterial tissue were inoculated on two types of silicone disks. Two types of silicone were tested (Silastic Q7-4550-50ShA and Q7-4765-65) after 4, 8 and 12-week exposure. Neither of these materials was attacked by mycotic agents in vitro. Only frame print was appreciable in five hundred times magnification. The second object of the study was to recognize the main degradation factor that means a kind of microorganism. The ability of microorganisms to assimilate oligo- and polyorganosiloxans was studied. Candida albicans does not seem like a typical microorganism assimilating silicon rubber. The results of our study proved Microccus as a typical vector which assimilates silicone.

[Voice prostheses mechanisms in total laryngectomy]. / Náhradní hlasové mechanismy po totální laryngektomii.

Loss of the voice after laryngectomy eliminates to a great extent patient's social life. Apart from other frequently used methods in laryngectomized patients, a number of tracheoesophageal vents called voice prostheses, has been developed in past decade. A survey of their most important features is given. A basic way of induction of these vents with technique of tracheoesophageal functions is described.

[Voice rehabilitation with the Provox system after total laryngectomy]. / Zkusenosti s rehabilitací hlasu po totální laryngektomii systémem Provox.

Total laryngectomy has a profound impact on the life of a patient. The loss of the larynx creates a major communication problem that can result in disruption of the patients normal pattern of social interaction. It is for this reason that adaptation to the loss of normal speech has been the focus of research on the rehabilitation of laryngectomized patients. Tracheoesophageal puncture and induction of the voice prosthesis have very well results in rehabilitation of the voice. The long terms clinical results obtained by experience with any of the complication are described. We use 4 types of voice prosthesis (Provox, Blom-Singer, Bivona Colorado and Czech prosthesis). We have very good experiences with system Provox. Our collection of the patients with Provox prostheses are 53 patients after total laryngectomy. All tracheoesophageal punctures were done in second time. Over 85% patients were able to produce satisfying voice. Speech quality was evaluated by Robe scale. 38.9% of them can speak fluently, which corresponds with a category F. Local inflammatory reaction occurred in 28.1% that resulted in extrusion or removal of voice prostheses in 14.2% patients. Use of voice prostheses in rehabilitation of laryngectomized patients occupies a significant place.

[Treatment of oropharyngeal and esophageal mycoses in immunodeficient patients with fluconazole (Diflucan, Pfizer)]. / Lécba orofaryngeální a jícnové mykózy u imunodeficitních nemocných Fluconazolem (Diflucan, Pfizer).

Thirteen patients with oropharyngeal and oesophageal mycosis were treated with a new triazole antimycotic, fluconazole. In the whole group in addition to the basic neoplastic disease as multifactorial predisposition to mycotic infection was revealed. After treatment a 100% clinical as well a laboratory effect was achieved. However, within one month a relapse developed in three of eight patients and reinfection in four of eight (renewal of laboratory evidence). The preparation was well tolerated by the patients, no laboratory signs of organ toxicity were revealed. In patients with cumulation of predisposing factors for mycotic infection the authors recommend long-term prophylactic protection with a small dose of fluconazole.

Effect of exercise on muscle fibre composition and enzyme activities of skeletal muscles in young rats.

Young Wistar rats underwent dynamic (D) or static (S) exercise from the 5th to 35th day after birth. Histochemical and biochemical analysis were performed in the extensor digitorum longus (EDL) and the soleus muscle (SOL). Lactate dehydrogenase (LDH) (regulating anaerobic metabolism) and citrate synthase (CS) and hydroxyacyl-CoA dehydrogenase (HAD) (both regulating aerobic metabolism) activities were determined spectrophotometrically. An increase of the fast oxidative-glycolytic (FOG) muscle fibres was found in the slow SOL muscle in both trained groups, i.e. by 10% in group D and by 7% in group S in comparison with the C group. The EDL muscle fibre distribution did not differ from those of control animals in respect to the slow oxidative (SO) fibre type. A higher percentage of FOG fibres by 19% was found in group D contrary to a decreased number of the fast glycolytic (FG) muscle fibres in this trained group. The greatest increase of CS (EDL 185%, SOL 176%) and HAD (EDL 83%, SOL 178%) activities were found in group D as compared with control group (C). Only small differences were observed in LDH activity. The values of characteristic enzyme activity ratios show that dynamic training resulted in an elevation of oxidative capacity of skeletal muscle, while the static load led preferentially along the glycolytic pathway. It may be concluded that an adaptive response to the training load during early postnatal development is different due to the type of exercise (dynamic or static) and/or the type of skeletal muscle (fast or slow).