RESUMEN
OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.
Asunto(s)
Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Complicaciones Posoperatorias/etiología , Calidad de Vida , Adulto , Anciano , Cartílago Cricoides/patología , Cartílago Cricoides/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
Simultaneous platelet and fibrinogen survival and turnover were studied using selenomethionine (75Se) in early and late groups of schistosomal hepatic fibrosis (SHF) and in a control group. In the control group, the mean platelet survival was 11.66 +/- 1.59 days and mean platelet turnover was 20,230 +/- 5090 platelets/microliter/day. Mean fibrinogen survival was 7.3 +/- 0.60 days and fibrinogen turnover was 0.35 +/- 0.04 mg/ml/day. In the early schistosomal group, platelet survival was shortened with an increased turnover rate and normal platelet count. The presence of a structurally abnormal fibrinogen molecule in the early group may have resulted in its shortened survival, that was compensated by the liver through increasing the turnover rate. In the late group, platelet survival was shortened with no significant increase of fibrinogen turnover, while fibrinogen concentration remained normal, suggesting the presence of extrahepatic sites of fibrinogen synthesis.