Hydrogen sulfide content in pregnant women with preeclampsia in late gestation and their newborns.

We examined 70 women who were 22-40 weeks pregnant and their newborns. Of these, 15 women with moderate PE made up group 1, 22 women with severe PE-group 2, and 55 women with uncomplicated pregnancy without hypertensive disorders - the control group. Blood was collected from women when they were admitted to the clinic, and blood was taken from newborns for 3-5 days of life. The concentration of hydrogen sulfide was determined by the method of K. Qu et al [17]. There was a decrease in the level of hydrogen sulfide in the blood serum of women whose pregnancy was complicated by severe preeclampsia. In newborns born to mothers with preeclampsia, an increase in the concentration of hydrogen sulfide was detected in the blood, which is probably a compensatory reaction aimed at restoring vascular homeostasis during early postnatal adaptation.

Evaluation of oxidative stress and antioxidant activity in women with moderate and severe preeclampsia in the third trimester of pregnancy and their newborns.

We examined 66 women who were 22-40 weeks pregnant and their newborns. Of these, 15 women with moderate PE were in group 1, 22 women with severe PE were in group 2, and 55 women with uncomplicated pregnancy without hypertensive disorders were in the control group. Blood was taken from women when they were admitted to the clinic, and newborns ' blood was taken for 3-5 days of life. Free radical oxidation and antioxidant activity were evaluated by induced chemiluminescence. It was found that in patients with severe and moderate preeclampsia, the development of oxidative stress is accompanied by a weakening of antioxidant activity. In newborns born to mothers with preeclampsia, oxidative stress is accompanied by a compensatory increase in antioxidant activity.

[Changes in the indicators of thromboelastography and platelet function in pregnant women with various forms of hypertensive disorders in the third trimester of pregnancy.]

The aim of this research is the study of haemostasis of pregnant women suffering from various forms of hypertensive disorders in their III trimester of pregnancy. 165 women at 26-41 weeks of pregnancy were examined: 22 women had moderate preeclampsia, 31 had severe preeclampsia, 45 women suffered from chronic hypertension, 20 women have developed preeclampsia on the background of chronic hypertension and 47 women had no hypertensive disorders (control group). The hemostasis system has been assessed using the results of the following investigations: thromboelastography, induced platelet aggregation with ADP and adrenaline at a dosage of 1.25 and 2.5 µg/ml respectively and collagen at a dosage of 20 mg/ml, platelet ATP secretion and the average concentration of platelet components. Thromboelastography has been performed using TEG® 5000 thromboelastograph (Haemoscope Corporation, USA). The study of platelet aggregation and platelet ATP secretion has been performed at automatic aggregometer CHRONO-LOG® Model 700 (USA). The mean platelet component concentration has been measured using SIEMENS ADVIA 2120i automated hematology analyzer (Siemens Healthcare Diagnostics Inc., USA). Thromboelastogram analysis showed a decrease in the plasma hemostasis activity in all groups of women with hypertensive disorders. The functional activity of platelets of women with moderate preeclampsia and chronic arterial hypertension did not change in comparison with to the control group. The disorder of dense platelet granules degranulation and decrease in their aggregation ability have been detected in a cohort with severe preeclampsia. The decrease in adrenaline induced platelet aggregation has been noted in the group of women suffering from preeclampsia on the background of chronic arterial hypertension. Thromboelastography analysis (R, K, angle α, TMA, Cl, LY30) may be useful for the differential diagnosis of severe preeclampsia and chronic arterial hypertension. The results of the study led to the conclusion that it is advisable to use low doses of ADP and adrenaline as inducers of platelet aggregation, considering their granulocyticity and the ability to secrete ATP.

Supracricoid partial laryngectomy: an alternative to total laryngectomy for locally advanced laryngeal cancers.

OBJECTIVES: The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges. STUDY DESIGN: We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004. RESULTS: Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival. CONCLUSION: Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

Histological changes in the cervical lymph nodes after radiotherapy.

Radiotherapy to the neck is frequently employed in the treatment of malignancies, sometimes alone and sometimes before or after surgery or with or without chemotherapy. We checked the histopathological changes in the neck after radiotherapy, dividing the changes into two groups. One with short-term changes between six months to one year, and the second group with long-term changes after more than six years. We compared these two groups with a control group without radiotherapy. The changes in the long-term group were more pronounced than in the short-term group, with more stromal fibrosis, vascular changes, and specially lymph nodes smaller than one centimeter. Thus, bigger lymph nodes (more then one centimeter) are more radiosensitive and become smaller after six years.

Neck-dissection surgical specimens treated by lymph node revealing solution.

The detection of metastatic lymph nodes in cancer patients is essential for determining the cancer stage, and thus, the therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. We described a "Lymph Node Revealing Solution" (LNRS) that helps to detect tiny lymph nodes in neck dissection specimens. Twenty-one consecutive specimens of neck-dissection were investigated. The entire surgical specimen, fixed at first in formalin, was searched for lymph nodes by the traditional method. These were excised and sent for processing. The remaining tissue was immersed for 24 hours in LNRS. The lymph nodes stood out as white chalky nodules on the background of the yellow fat. They were then excised, and examined. A total of 227 lymph nodes were detected by the traditional method; 38 (17%) were positive for metastasis. Using the LNRS method, an additional 72 nodes were identified, among them 8 (11%) were positive for metastases and 2 cases were upstaged. LNRS is an inexpensive and easy method of detecting tiny lymph nodes; it enhances significantly the yield of normal and metastatic nodes of neck-dissection specimens and helps to establish a more accurate staging.

A new rapid technique for the fixation of thyroid gland surgical specimens.

One of the main diagnostic problems in thyroid pathology is to distinguish between follicular adenoma and follicular carcinoma. Thorough sampling of the nodule's capsule is recommended in order to identify capsular invasion. However, during the hardening of the tissue, by the usual fixatives the capsule shrinks and rolls downwards and sometimes the capsule separates from the remaining tissue. The present work evaluates the use of "Lymph Node Revealing Solution" (LNRS) for the rapid fixation (2h) of different thyroid lesions as compared to that of formalin. Fifty-one unselected consecutive cases of thyroid nodules, which included various benign and malignant lesions, were examined. Each specimen was cut in two equal parts; one was fixed in LNRS, the other in formalin. Fixation in LNRS for 2 hours gave adequate results in sectioning and staining of the tissue, and excellent immunostains. Its advantage over formalin is the conservation of the natural relationship between the capsule and the rest of the tissue, on the same plane, as well as the short time required for the final diagnosis.

[The parapharyngeal space: tumors and surgical approaches].

The potential parapharyngeal space contains the great vessels of the neck, cranial nerves IX-XII, the sympathetic chain and lymph nodes. Surgical access is difficult and the infrequency of tumors in it make surgery of this part of the head and neck a challenge, 8 women and 2 men (mean age 54.7, range 31-70 years) with tumors of the parapharyngeal space operated on during the past 6 years are presented. The most common surgical approach was the cervical submandibular, used in 6 of our patients with relative ease and minimal complications. Tumors of deep lobe parotid origin should be operated through a transparotid approach. Large benign or malignant tumors have a better prognosis when the transcervical transmandibular approach is used, providing wider access.

Ultrastructural study of peripheral nerve injury induced by monopolar and bipolar diathermy.

The effect of unipolar and bipolar electrocoagulation on human and albino rat peripheral nerves was examined by transmission electron microscopy. The greater auricular nerve obtained from operated patients and the femoral nerve of an albino rat were chosen for this study. The nerves were divided into three groups: controls, segments of nerves spot-coagulated with unipolar instruments, and segments of nerves spot-coagulated with bipolar instruments. Significant cell injury, expressed by marked damage of the Schwann cells, was induced by unipolar coagulation in both myelinated and unmyelinated nerves, in humans as well as in the albino rat. However, in bipolar-treated nerves, the Schwann cell architecture remained well preserved in both types of nerves. The results are in favor of bipolar electrocoagulation when applied in areas rich in neurovascular supplies.

[Head and neck sarcoma].

We reviewed patients with primary soft tissue and bone sarcomas treated in our department. Malignant tumors arising in somatic, connective, soft tissues, especially those of the head and neck, are uncommon and few reports have been published. Between 1980 and 1995 15 patients with head and neck sarcoma were seen. The major sites involved included: paranasal sinuses and orbits (2 patients), neck (4) and 1 each in the forehead, temporal region, mandible, parapharyngeal space, tongue, hypopharynx, larynx, cervico-mediastinal region and nasal cavity. Follow-up ranged from 1-16 years. The youngest patient was a 12-year-old male. Rhabdomyosarcoma, one of the most common mesenchymal tumors found in the head and neck, especially in children, was excluded from our study because of its different clinical behavior and its chemosensitivity, unlike other sarcomas. Most of our patients were treated with wide-field resection; 12 received postoperative radiation, and 3 combined surgery and chemotherapy. Wide excision with negative margins is considered an important, positive, prognostic factor, as the extent and adequacy of excision largely determines survival and the incidence of local recurrence. All our patients underwent initial, wide, local excision of the lesion. Our observations strongly suggest that wide resection is the most effective means of therapy for sarcoma of the head and neck. Radical neck dissection was not only performed for manifest regional neck metastases, but was also used for completing the enlarged, wide-excisions of liposarcomas. The worst survival was in patients with osteosarcoma, angiosarcoma and fibrosarcoma, with an absolute 5-year survival of 60% (9/15).

Internal jugular vein patency after functional neck dissection: venous duplex imaging.

We present a retrospective study performed to determine jugular patency after functional neck dissection (FND). Twenty-six patients, 16 females and 10 males, ranging in age from 16 to 78 were examined. These patients underwent either unilateral FND or bilateral FND for cervical lymph node metastases. Cervical duplex and pulsed Doppler imaging were chosen to determine internal jugular vein (IJV) patency. The examination was performed after a minimum postoperative period of 2 months and a maximum one of 22 years. Thirty-one IJVs were examined. All but 4 IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in FND was found to be high (27 of 31 or 87%). These results favor the use of FND for IJV preservation, particularly in bilateral neck dissection.

Anatomic study of the otic ganglion in humans.

The presentation in the literature of the anatomy of the human otic ganglion (OG) has not varied much over the past three quarters of a century. Precise, similar descriptions of its size, color, shape, and relation with neighboring structures are portrayed in numerous textbooks and articles. We have carried out a study of the OG in 30 infratemporal fossae of 15 cadavers. Otic ganglia resembling the classic description were found in less than 60% of the cases. In 13%, some thickening could be seen adjacent to the mandibular nerve and in 27%, no definite structure could be observed. Except for a fleeting mention of this occurrence in a textbook from 1927, substantiated by personal communication with an authority in the field, we could find no record of the possible absence of this structure in the available literature. We describe our findings and stress the apparent anatomic variability of the OG. The pertinent literature is reviewed.

Use of a linear stapler in excision of Zenker's diverticulum.

Zenker's diverticulum is an outpouching of the hypopharyngeal wall through a triangular area of weakness in the inferior pharyngeal constrictor muscle. The current treatment of choice is a one-stage diverticulectomy, with or without a cricopharyngeal myotomy. Closure of the esophagus after diverticulectomy by conventional suturing techniques may be somewhat difficult and time consuming. In the past 2 decades, use of stapling devices has been suggested in four reports, the largest being a series of four patients. We have used the Proximate disposable linear stapler in seven cases of Zenker's diverticulectomy with excellent results. Operation time was shortened, patient recovery hastened, and no complications were seen. We recommend the use of the stapling device in excision of Zenker's diverticulum.

Acoustic trauma-induced Meniere's syndrome.

Eight male patients suffering from Menière's syndrome are presented. All patients sustained sudden or prolonged exposure to severe noise levels and suffer from acoustic trauma. The incidence of Menière's syndrome in our group of patients is significantly higher than in series reported in the normal population. Our presentation supports the implication of acoustic trauma as a possible cause of Menière's syndrome.

Teratoma of the mastoid region in a newborn.

Teratomas are congenital tumours arising from pluripotent cells and usually consisting of tissue arising from all 3 embryonic germ layers. Teratomas are quite uncommon in head and neck sites and to date only 150 such cases have been reported. A rare case of teratoma of the mastoid region in a newborn is reported. The method of diagnosis and treatment are discussed and the literature is reviewed.

Use of human amniotic membrane in otolaryngologic practice.

Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster epithelialization. We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu-Osler-Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis. Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis. Use of amnion in eardrum perforations was unsuccessful and was discontinued. Properties of human amniotic membrane are listed and its application in the otolaryngologic practice is reviewed.

Surgical management of epistaxis in hereditary hemorrhagic telangiectasia.

The most common manifestation of hereditary hemorrhagic telangiectasia (HH) is recurrent epistaxis. Numerous treatments have been used over the years, none proving entirely satisfactory. We have applied a new surgical treatment in seven selected cases of HHT with severe, life-threatening epistaxis. It consists of a near-total excision of the diseased nasal mucosa and its replacement by different skin flaps or a myocutaneous flap. This procedure has been performed since 1981. We stress the reliability and versatility of using the forehead myocutaneous island flap. Our original technique is described, follow-up of the patients is reported, and the criteria for selection of treatment are discussed.

Laryngeal carcinoma in childhood. Report of a case and review of the literature.

A rare case of an 81/2 year old boy with a stage III well differentiated squamous cell carcinoma of the larynx, which responded to chemotherapy and irradiation, is reported. It is the 56th case in children up to 15 years of age and 20th case in children 10 years old or younger reported since 1868. Carcinoma of the larynx in children has similar clinicopathological features to those of adult laryngeal carcinoma, but markedly differs as concerning sex incidence ratio. The main differential diagnosis is juvenile papillomatosis and the principal risk factor is previous cervical irradiation. Delayed diagnosis is frequent since clinical manifestations might be attributed to the normal laryngeal maturation process or to a common respiratory infection. Treatment is problematic, for special effort must be made to preserve laryngeal anatomy and function and to avoid complications. Prognosis of childhood laryngeal cancer is unclear since the reported survival rates are not tumor stage related.

New clinical applications of the stapedial reflex.

Stapedial reflex data were obtained from 11 myasthenic, 18 hyperthyroid and six hypothyroid patients. Data were studied with respect to reflex threshold, amplitude and decay. Elevated threshold, decreased amplitude, and high and low frequency reflex decay were observed in myasthenic and hyperthyroid patients. Hypothyroidism merely increases stapedial reflex amplitude but causes no significant threshold or decay changes.