[Near-total laryngectomy: multicenter experience]. / Laringuectomía casi-total: experiencia multicéntrica1.

Near-total laryngectomy (NTL) produces good functional and oncological results that are reproducible in different institutions. It is an alternative to total laryngectomy in patients with laryngeal or hypopharyngeal tumors who meet selected criteria. This study analyzed 245 patients treated with NTL in three different institutions. Functional and oncological results were remarkably consistent between the institutions. Local control in previously untreated patients was 98%. A useful voice was obtained in 80% of patients and voice quality was better than that obtained with tracheoesophageal puncture and a voice prosthesis. NTL was not recommended for salvage surgery after radiation failure because recurrences occur in up to 20% of patients.

Laringuectomía casi-total: experiencia multicéntrica / Near-total Laryngectomy: multicenter experience

La utilidad de una determinada técnica viene definida por los resultados obtenidos así como por la capacidad de que esos resultados puedan ser repetidos por diferentes equipos. La laringuectomía casi total (LCT) es una técnica útil para el tratamiento de cáncer de laringe e hipofaringe que cumpla unos determinados requisitos. Este estudio, 245 pacientes, agrupa la experiencia acumulada con la utilización de la LCT en tres centros diferentes. Los resultados funcionales y oncológicos obtenidos en cada una de ellas son superponibles, con un control local del 98 por ciento en pacientes previamente no tratados. El 80 por ciento de los pacientes obtienen una voz útil, cuya calidad es superior a la obtenida mediante punción traqueoesofágica y prótesis fonatoria. La LCT no debe ser utilizada como técnica de rescate para el tratamiento de recidivas postradioterapia ya que el índice de recidiva local ronda el 20 por ciento (AU)

Near-total laryngectomy (NTL) produces good functional and oncological results that are reproducible in different institutions. It is an alternative to total laryngectomy in patients with laryngeal or hypopharyngeal tumors who meet selected criteria. This study analyzed 245 patients treated with NTL in three different institutions. Functional and oncological results were remarkably consistent between the institutions. Local control in previously untreated patients was 98%. A useful voice was obtained in 80% of patients and voice quality was better than that obtained with tracheoesophageal puncture and a voice prosthesis. NTL was not recommended for salvage surgery after radiation failure because recurrences occur in up to 20% of patients (AU)

Adjustment for regression dilution in epidemiological regression analyses.

PURPOSE: The term "regression dilution" describes the dilution/attenuation in a regression coefficient that occurs when a single measured value of a covariate is used instead of the usual or average value over a period of time. This paper reviews the current knowledge concerning a simple method of adjusting for regression dilution in single and multiple covariate situations and illustrates the adjustment procedure. METHODS: Formulation of the regression dilution problem as a measurement error problem allows existing measurement error theory to be applied to developing methods of adjustment for regression dilution. This theory leads to a precise method of adjustment for linear regression and approximate methods for logistic and Cox proportional hazards regression. The method involves obtaining the naive estimates of coefficients by assuming that covariates are not measured with error, and then adjusting these coefficients using reliability estimates for the covariates. Methods for estimating the reliability of covariates from the reliability and main study data and a method for the calculation of standard errors and confidence intervals for adjusted coefficients are described. RESULTS: An illustration involving logistic regression analysis of risk factors for death from cardiovascular disease based on cohort and reliability data from the Busselton Health Study shows that the different methods for estimating the adjustment factors give very similar adjusted estimates of coefficients, that univariate adjustment procedures may lead to inappropriate adjustments in multiple covariate situations, whether or not other covariates have intra-individual variation, and when the reliability study is moderate to large, the precision of the estimates of reliability coefficients has little impact on the standard errors of adjusted regression coefficients. CONCLUSIONS: The simple method of adjusting regression coefficients for "regression dilution" that arises out of measurement error theory is applicable to many epidemiological settings and is easily implemented. The choice of method to estimate the reliability coefficient has little impact on the results. The practice of applying univariate adjustments in multiple covariate situations is not recommended.

An open-label, dose-ranging trial of AL 721 in patients with persistent generalized lymphadenopathy and AIDS-related complex.

AL 721, a lipid mixture with reported in vitro activity against human immunodeficiency virus (HIV) via cell membrane or virion cholesterol depletion, was evaluated in a multicenter, open-label, dose-ranging trial. Forty men with persistent generalized lymphadenopathy or AIDS-related complex were treated with doses of 20, 30, 40, or 50 g orally twice daily for 8 weeks, and monitored for toxicity, disease progression, and with immunologic, virologic, and serum lipid profiles. The compound was found to be well tolerated over the broad range of doses examined; adverse reactions were confined to the gastrointestinal tract, of mild to moderate severity, and self-limited in duration. Modest weight gains observed on treatment were reversed within 4 weeks following cessation of therapy. While disease progression was not observed in this short-term study, we could find no indication of an immunorestorative or antiviral effect of AL 721, as determined by T-lymphocyte subset quantitation or HIV culture. All three patients who were HIV p24 antigenemic at entry retained positive antigen levels throughout treatment. As a consequence of therapy, however, significant increases in serum lipids were observed, including elevations in both triglyceride and total cholesterol levels. In conclusion, our experience on the largest group of HIV-infected patients treated with the highest doses of AL 721 provides no support for the use of this compound as an antiretroviral agent.

Hypomelanosis of Ito. Report of a case and review of the literature.

A 5-month-old boy with hypomelanosis of Ito was studied. Lesions presented as bizarre, hypopigmented whorls and streaks. Histologic studies showed that the hypopigmented areas contained normal melanocytes with decreased content of intracellular melanin. A review of the literature revealed the disease to be a discrete entity of hypopigmentation associated with a high percentage of central nervous system abnormalities, particularly seizure disorders and mental retardation.