RESUMEN

Conventional cytology cannot discriminate between benign and malignant follicular neoplasms. Our study evaluated the diagnostic role of computer-assisted image analysis in the presurgical assessment of thyroid follicular neoplasms. Fifty-eight patients (14 males, 44 females, age range, 45-75 years) who underwent surgery for cytologic diagnosis of thyroid follicular neoplasm were studied. All patients were first evaluated on clinical grounds and assigned a high/low suspicion of malignancy on the basis of gender, age, and nodule size. Cell image analysis was subsequently performed using a Cytometrica BYK Gulden microscope image processor on Feulgen-stained thyroid cytologic smears. A different population of 50 benign and 50 malignant, histologically evaluated nodules was studied in order to establish image analysis criteria suggestive of thyroid malignancy. Ploidy histogram, proliferation index (PI), nuclear area coefficient of variation (NACV), and anisocariosis ratio (AR) were studied. Thyroid cancer was diagnosed in 16 of 58 follicular neoplasms. Only 7 of these lesions were clinically suspicious (43.7%), whereas 14 of 16 (87.5%) malignant tumors were identified by image analysis. Positive and negative predictive values of image analysis versus clinical evaluation were 46.6% versus 30.4% and 92.8% versus 74.3%, respectively. The distribution of ploidy pattern was different in benign versus malignant follicular neoplasms (chi2 8.25, p = 0.016), malignant lesions showing an increased frequency of heteroclonal aneuploid DNA content (37.5% vs. 7.1%). Increased PI (mean +/- standard deviation (SD) = 11.3 +/- 5.7 vs. 7.1 +/- 6.1; p < 0.01) and NACV (mean +/- SD = 25.28 +/- 1.89 vs. 20.14 0.91; p < 0.01) levels were also observed in malignant follicular neoplasms. In conclusion, computer-assisted image analysis may profitably support clinical evaluation in the assessment of thyroid follicular neoplasms.

Asunto(s)

RESUMEN

The identification of metastatic neck lymph nodes in patients awaiting surgery for differentiated thyroid tumor permits their excision during thyroidectomy. In order to detect thyroid cancer lymphatic metastasis before surgery, we measured thyroglobulin (Tg) in the needle wash-out of fine-needle aspiration biopsy (FNAB). Ultrasound-guided FNAB on enlarged neck nodes was performed in 23 patients awaiting surgery for differentiated thyroid tumor (n = 33 lymph nodes), 47 patients previously thyroidectomized for thyroid tumor (n = 89 lymph nodes), and 60 patients without thyroid disease (n = 94 lymph nodes). Immediately after aspiration biopsy, the needle was rinsed with 1 mL of normal saline solution and Tg levels were measured on the needle wash-out (FNAB-Tg). FNAB-Tg levels were markedly elevated in metastatic lymph nodes both in patients awaiting thyroidectomy (metastatic vs. negative lymph nodes, mean +/- SEM, 16,593 +/- 7,050 ng/mL vs. 4.91 +/- 1.61 ng/mL; p < 0.001) and in thyroidectomized patients (11,541 +/- 7,283 ng/mL vs. 0.45 +/- 0.07 ng/mL; p < 0.001). FNAB-Tg sensitivity, evaluated through histological examination in 69 lymph nodes, was 84.0%. The combination of cytology plus FNAB-Tg increased FNAB sensitivity from 76% to 92.0%. In conclusion, FNAB-Tg measurement is a useful technique for early diagnosis of lymph node metastasis originating from differentiated thyroid cancer.

Asunto(s)

RESUMEN

Systematic use of preoperative antibiotic prophylaxis (PAP) and nasal packing (NP) in septoplasty-both directly and indirectly affecting the cost of surgery (length of hospitalization)-appear based on controversial scientific data and, at times, even on unjustified clinical "habits". A controlled study was thus performed on 100 adults undergoing exclusive nasal septoplasty to determine whether these techniques are actually useful. The subjects were randomly divided into four groups: TN-PAP-(29 subjects), TN-PAP+ (25 subjects), TN+ PAP- (21 subjects) and TN+ PAP+ (25 subjects). Surgery was always performed by the same surgeon and was concluded with continuous suture of the mucoperichondrial layers. Only one patient (TN-PAP-) presented complications of infection (vestibulitis). Three patients in the TN- group required nasal packing a few hours after surgery because of moderate bleeding. As of three months after surgery no other complications had arisen. Postoperative pain, evaluated on an analogicalvisual scale, was higher during the 12 hours after surgery. Analysis of variance showed that the only pain-related factor was nasal packing while PAP and the interaction between TN and PAP did not prove significant. The above results suggest that PAP and TN should not be systematically used, thus reducing the hospitalization period for septoplasty to the day of surgery (Day surgery).

Asunto(s)

RESUMEN

AIMS AND BACKGROUND: The aim of the study was to assess the activity and the toxicity of cisplatin (DDP) and fluorouracil (FU) administered by continuous infusion as neoadjuvant chemotherapy for patients with stage II-IV, M0 squamous cell carcinoma of the head and neck. METHODS: Thirty previously untreated patients were submitted to chemotherapy with DDP (20 mg/m2) and FU (1000 mg/m2), both in continuous infusion for 5 days, repeated every 21 days, for a maximum of 5 cycles. Following completion of chemotherapy, the patients underwent radiotherapy; in some patients surgery was performed immediately after chemotherapy. All patients were monitored for response, time to failure, survival, treatment-related events and toxicity. RESULTS: All patients were evaluated for response; after chemotherapy the complete response rate was 27% and the partial response rate 33%. Twenty-four patients underwent radiotherapy: the overall response rate was 83% (complete response 79%). After a median follow-up of 34 months, the median survival time was 22 months with a median time to failure of 15 months. Acute vascular accidents were the main and unexpected adverse events, with 2 deaths for pulmonary embolism and 1 for stroke. The response rate to the regimen does not seem to be better than that obtained with the standard combination of cisplatin bolus and fluorouracil continuous infusion. The disadvantage of the regimen is that it causes more discomfort for the patient in that it requires hospitalization. CONCLUSIONS: For this reason, we believe that there are no elements for recommending the schedule as neoadjuvant treatment of patients with squamous cell carcinoma of the head and neck or as an experimental arm in a randomized trial.

Asunto(s)

RESUMEN

In two ear, nose and throat (ENT) divisions, 74 patients affected by acute sinusitis of bacterial origin were selected and, after randomization in two balanced groups following an open parallel group design, assigned to treatment with brodimorprim and roxithromycin. At the beginning, after 3 days, 7 days and at the end of treatment the following symptoms were evaluated, using a four-step score: intensity of facial pain, headache, nasal stiffness, hyposmia, nasal secretion. The mean treatment period was 8.7 days. Tolerability was evaluated through registration and analysis of side effects and laboratory blood tests. The comparison between groups showed a better activity of brodimoprim on facial pain, headache, nasal stiffness and nasal secretion. The presence of resistant bacterial strains was greater in the group treated with roxithromycin (30.8%) when compared with the brodimoprim group (12.5%). Side effects were reported in 5 patients treated with brodimoprim and in 3 patients in the control group. Lab tests did not show serious variations.

Asunto(s)

RESUMEN

770 patients affected by squamous cell carcinoma of the vocal cords, classified as T1a (U.I.C.C. TNM - P978) were studied retrospectively by the Head and Neck Oncology Cooperative Group. Several such studies have demonstrated the substantial equality of results, in terms of survival, obtained by the two common therapeutic approaches (radiotherapy and cordectomy). On the other hand, from a functional point of view, radiotherapy undoubtedly offers the best outcome. Site of origin has never been considered a possible prognostic factor for such cordal neoplasms; such factors could possibly make the choice between treatments significant. Therefore, the present study evaluated tumors, separating them by the anterior, middle and posterior third of the vocal cord and taking into consideration local check-up as a function of therapy. Local check-up, in terms of Relapse Free Survival (R.F.S.) was 83% at 10 years and no significant difference was observed between the different treatment modalities. Moreover, the site of origin did not appear relevant to prognosis. More accurate and prospective studies should be encouraged so as to assess the value of such data.

Asunto(s)

Asunto(s)

RESUMEN

Our experience with the so-called "neoglottis" (according to Staffieri) after total laryngectomy is presented. The technique, described in detail, aims at giving the patient good speech by creating a tracheoesophageal fistula through which air passes. In the period from 1973-1979, 63 patients underwent the procedure. The functional results were satisfactory in 68% of the cases. The patient's voice is much more agreeable than the esophageal voice and sounds louder and less monotonous than a laryngophone voice. The spectrographic analyses confirm its resemblance to natural voice. An occasional passage of liquids into the trachea may occur, but is not prejudicial to either speech or swallowing. Some dysfunctional problems may arise early or late after the operation: they are continuous aspiration during swallowing and lack of phonatory function. In most cases, these problems are due to incorrect surgical technique; the possibilities and procedures of correction are described. In conclusion, we maintain that the "neoglottis" which may be applied to nearly all cases of total laryngectomy, represents a worthwhile "phonatory" innovation in the field of mutilating surgery of laryngeal cancer.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)