[Computerized tomography in the evaluation of the larynx after surgical treatment and irradiation]. / Valutazione mediante tomografia computerizzata della laringe dopo trattamento chirurgico e irradiazione.

INTRODUCTION: The follow-up of the patients submitted to surgery for laryngeal carcinoma requires both clinical and CT examinations, particularly in the cases at high risk of recurrence. Our series consisted of 72 laryngeal carcinoma patients operated on and regularly followed-up with CT to distinguish relapse from normal or abnormal postoperative changes. MATERIALS AND METHODS: Seventy-two laryngeal carcinoma patients were submitted to surgery: total laryngectomy was performed in 33 cases, supraglottic laryngectomy in 16 cases, Labayle subtotal laryngectomy in 18 cases and Mayer Piquet subtotal laryngectomy in 5 cases. The patients were followed-up postoperatively with CT and 94 examinations were performed in all; pathology was performed in all the cases with radiologic suspicion of recurrence (19 patients) and further clinical examinations were performed to exclude recurrence in the 14 cases where imaging findings were questionable. RESULTS AND DISCUSSION: Local recurrences were confirmed in 16 of 19 patients with positive CT findings. Radiologically, the recurrence appeared as an irregular thickening of the pharyngo-laryngeal wall with inhomogeneous density after i.v. contrast agent infusion. The patients submitted to total or supraglottic laryngectomy recurred most often at the cranial site of resection (5/6 cases), those submitted to Labayle surgery at the mucosa adjacent to the cricoarytenoid unit (3/3 cases) and those submitted to Mayer Piquet surgery in the supraglottic region. Two more patients submitted to emergency tracheotomy recurred at this level. Lymph node recurrences were found in 6 total laryngectomy patients. Misinterpretations were most frequently due to postirradiation changes (5 of 14 cases) or to atypical postoperative images (4/14 cases). Three more patients presented a secondary lesion misinterpreted as a relapse. CONCLUSIONS: Our results confirm the role of CT in the follow-up of the patients operated on for laryngeal carcinoma when CT findings are closely correlated with clinical and endoscopic results, permitting to correctly assess the extent of relapse and possible nodal spread.

[Assessment with magnetic resonance imaging of response to radiotherapy for tongue and mouth floor tumors]. / Valutazione mediante Risonanza Magnetica della risposta al trattamento radiante dei tumori della lingua e del pavimento orale.

To investigate the role of Magnetic Resonance Imaging (MRI) in assessing the effects of radiation therapy and in differentiating postirradiation scar tissue from residual tumor, we examined 22 patients with primary squamous cell carcinoma of the tongue and floor of the mouth treated with definitive radiation therapy; all patients were examined before and after treatment. Pretreatment MRI showed mass effect and obliteration of the fascial planes, with hyperintense signal on T2 and T1 post-Gd-DTPA injection sequences in all patients. Follow-up exams were performed 4 months after radiation therapy completion to wait for postirradiation phlogistic changes to become less apparent. The role of posttreatment exams was determined on the basis of clinical and bioptic follow-up. Radiation therapy yielded complete remission in 16/22 patients and partial remission in 6/22. MR follow-up showed, in complete remission patients, persistently obliterated fascial planes in 12/16 patients (75%) and a residual mass, hypointense on T2-weighted sequences and without enhancement in 9/16 patients (56%). In all partial remission patients, MRI showed some residual tissue hyperintense on T2-weighted sequences, with persistent enhancement. Persistent alterations in primary tumor sites, such as residual tissue and fascial plane obliteration, are frequent findings after irradiation. Hyperintense signal and enhancement can persist for months after radiation therapy as signs of postirradiation changes. To conclude, MRI performed 4 months after radiation therapy appears as a reliable tool to refer a residual mass to scar tissue when MR signal is hypointense on T2-weighted and enhanced sequences and to residual tumor when MR signal is hyperintense on T2-weighted and post-Gd-DTPA sequences.

Heroin induces changes in mother-infant monkey communication and subsequent disruption of their dyadic interaction.

Heroin was given in a single, low dose (0.2 mg/kg i.v.) to the mother monkey of mother-infant pairs, living in a stable community of 30 individuals (Macaca fascicularis; six pairs treated plus six controls, in experiments repeated twice). The drug did not induce alterations in the response of the mother to the infant's calling signals when they were placed in a new environment denoting a potentially dangerous situation. However, after being returned to the community cage, the treated mother rarely responded to the infant's calling (non-alarming, non-vocal) signals (P less than 0.02). This behaviour was followed by an increased latency of the infant-to-mother approach, by a diminution of the reciprocal ventroventral clasping as well as a diminution of the overall duration of clasping, and by an increase in nipple suckling (unusual for the age), as compared to saline-treated controls (P less than 0.05, P less than 0.02, P less than 0.025, and P less than 0.05, respectively). Analysis of behavioural sequences strongly confirmed this relationship among data (P less than 0.01 and P less than 0.025). Even short lasting, pharmacologically induced failure in the non-vocal communication of a mother monkey may in itself constitute a pathogenetic mechanism. This is an important cause of the disruption of her dyadic interaction with the infant which consequently upsets the infant's behaviour.