Platelet-rich fibrin (PRF): an autologous packing material for middle ear microsurgery.

OBJECTIVES: To assess the use of PRF prepared using an optimised protocol in middle ear surgery as a substitute for conventional packing products of animal origin such as collagen derived from porcine skin. METHODOLOGY: A retrospective study of 108 patients in whom optimised PRF was used exclusively to pack the external auditory canal or middle ear. The effectiveness or harmlessness of the PRF was evaluated by assessing a range of parameters. A morphological comparison was also made of PRF produced using the Choukroun procedure and our procedure. RESULTS: The success rate of the repair of the tympanic membrane one year after the surgery was 45/48 patients. In 5 of 63 patients in whom a retro-auricular approach and wall-up technique were used, granuloma was observed along the incision in the ear canal. Granuloma was not seen in any of the 23 patients undergoing a procedure with an endaural approach. CONCLUSION: The use of a material prepared from patients themselves and not of animal origin has numerous advantages in terms of biocompatibility and safety, without any adverse effect on the success rate for general middle ear procedures. The protocol is simple and does not prolong the time spent by the patient in the operating theatre. The Choukroun technique should be modified to prevent excessive failure rates in PRF processing.

Prognostic factors and assessment of staging systems for head and neck soft tissue sarcomas in adults.

OBJECTIVES: The primary objectives of this study were to analyse the outcome of patients diagnosed with head and neck soft tissue sarcomas (HNSTS) and to identify relevant prognostic factors. As well as this, we compared the prognostic value of two staging systems proposed by the American Joint Committee on Cancer (AJCC) and the Memorial Sloan-Kettering Cancer Center (MSKCC). METHODS: From 07/1988 to 01/2008, the charts of 42 adult patients were retrospectively reviewed. Potential prognostic factors were analysed according to overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS). RESULTS: At 5 years, OS was 57%, DFS 47% and DSS 72%. On univariate analysis, statistically significant prognostic factors were for OS, distant or lymph node metastasis at diagnosis (p=0.032), for DFS, margins after surgery (p=0.007), for DSS, regional or distant metastasis at diagnosis (p=0.002), initial AJCC and MSKCC stage (p=0.018 and p=0.048) and margins after surgery (p=0.042). On multivariate analysis, margins remained statistically significant for DFS (p=0.039) when there was a trend with the initial AJCC stage (p=0.054) for OS. The AJCC staging system was of more prognostic value than the MSKCC staging system. CONCLUSIONS: Achieving clear margins after surgery is vital for improved local control and the best chance of survival. Adjuvant chemotherapy and radiotherapy were not shown to provide additional benefit. To better identify prognostic factors, it seems essential to set up national and international databases allowing multicenter registration for those patients.

Comparison between new and old generation RetroX auditory implants.

OBJECTIVE: To compare post aural soft tissues tolerance of the old and new titanium RetroX (Auric GmbH, Rheine, Germany) tube, and to compare the hearing improvements between the old (DSP-pro) and the new (Concertino) hearing aid units of the RetroX. METHODOLOGY: Retrospective case review of 46 patients with high-frequency sensorineural hearing loss, fitted with DSP-pro or Concertino, and who received 51 implantations (with the old or new generation titanium tube) in a tertiary referral center at a university hospital. The RetroX consists of an electronic unit situated in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the external auditory meatus. Implanting requires minor surgery (10 minutes under local anaesthesia). Three months after their implantation, patients were asked to fill out a questionnaire to evaluate acoustic feedback annoyance and to undergo 3 audiometric tests: pure-tone audiometry in silence, speech audiometry in silence, and speech audiometry in noise. RESULTS: The new tube is more reliable (12 explantations from patients who received 26 older tubes compared with 1 explantation in 25 who received new tubes) even if the size must be adjusted more often (2/26 for the old model and 5/25 for the new one). Concertino allows a higher amplification before feedback appears, which improves hearing gain. CONCLUSIONS: The new RetroX is better tolerated than the older one, and improves hearing ability.

Endonasal endoscopic resection of an ethmoidal solitary fibrous tumor.

Solitary fibrous tumor (SFT) is an uncommon spindle cell tumor that typically arises at the level of the pleura in adults. However, SFT has also been reported in various extrapleural sites including orbit, meninges, liver, lung, salivary glands, retroperitoneum, mediastinum. In the head and neck region, SFT has been documented in the external auditory canal, larynx, thyroid, sublingual gland, tongue, parapharyngeal space and the infratemporal fossa. The nose and the paranasal sinuses are a rare site for SFT with only 14 publications in the world literature. We present an additional case of a SFT arising at the level of the right ethmoid sinus successfully removed in one piece endoscopically and review the corresponding literature.

A preperitoneal approach in the prosthetic repair of inguinal hernia.

A series of one hundred consecutive patients who underwent prosthetic repair of inguinal hernia through a preperitoneal approach is reported. In 49% the hernia was recurrent. A large prosthetic sheet (Dacron or Teflon) is placed between the peritoneal sac and the wall, to cover the inguinal, femoral and hypogastric regions as well as the abdominal incision. It is not fixed but kept in place by abdominal pressure. The spermatic cord passes through a slit in the sheet that is closed afterwards. There were no recurrences and only one infection. The follow-up, however, is still short (60% of the patients (81 hernias) over one year, 37% (49 hernias) over two years).

Wound infections in general surgery. A two-year prospective study in a private hospital.

The major and minor infection rate in 1,219 surgical wounds in which infection was a possible hazard was 4.2%. For the clean group the infection rate was 1%, for the clean-contaminated 6%, for the contaminated 15% and for the dirty class 19%. The mortality was 0.8% but there were no deaths due to infection or septicaemia. The results are classified according to the kind of surgery. They reflect a two-year prospective study in a conventional operating room without special air handling systems, in a private hospital. The series is characterized by a low antibiotic use (32% of the patients), the complete absence of anastomotic leaks and a systematic change of gloves, drapes and instruments before abdominal wound closure.

Primary closure of the perineal wound after abdomino-perineal amputation for adenocarcinoma.

This is a prospective study of primary closure of the perineum in 35 successive cases of abdomino-perineal amputation of the rectum for adenocarcinoma (January 1972 - December 1978). All operations are performed by the same surgeon in a one-team approach. In 33 patients the perineum is closed, and 32 patients are available for evaluation. In 66% of them the wound heals per primam. Very extensive and exenterative procedures do not lower the chances for success. In women the results are better than in men. They are even better after posterior vaginal wall resection and posterior exeneration (no failures). Early postoperative failures are usually due to bleeding; the late ones are caused by infection. The procedure is complicated by one death (81 years), one ureteral fistula (47 years) and one late perineal hernia which may be imputed to the method. Primary closure of the perineum appears to be a very feasible (33/35), usefull and rather safe procedure from which the patient has a lot to win and quite nothing to loose.