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BACKGROUND: To investigate prognostic significance of the lymphatic and vascular invasion in patients with squamous cell carcinoma of the larynx and pyriform sinus. MATERIAL AND METHODS: Patients with squamous cell carcinoma of the larynx and pyriform sinus who underwent laryngectomies between 2002 and 2006 in the ENT Clinic of Cluj-Napoca were investigated for lymphatic and vascular invasion and their effect on disease-free survival and recurrence rates. RESULTS: The present study included 396 patients. The mean disease-free survival of patients with or without lymphatic invasion was statistically significant (p=0.000000). The mean disease-free survival of patients with or without vascular invasion was statistically significant (p=0.000021). In multivariant analysis, the lymphatic invasion was significantly correlated only with surgical resection borders (p=0.0004), while vascular invasion was significantly correlated with surgical resection borders (p=0.0000), nodes diameter (p=0.0075) and postoperative radiotherapy and/or chemotherapy (p=0.0002). CONCLUSION: Lymphatic and vascular invasion have a significant prognostic value and influence the disease-free survival, regional and distant metastasis rates significantly.

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Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

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OBJECTIVE: In Central and South-Eastern European countries, the most frequent mutation types responsible for congenital nonsyndromic sensorineural hearing loss (NSHL) are c.35delG and p.W24X (15-55.8% and 2.5-4.3%, respectively). The aim of the study was to determine for the first time in Romania the prevalence of c.35delG and p.W24X mutations in patients with NSHL. MATERIAL: 75 unrelated children with NSHL from Transylvania (North-West Romania). METHODS: a. Audiological examination (otoscopy, tympanogram, acoustic otoemission and tonal audiogram or auditory evoked potentials); b. detection of the c.35delG (semi-nested-PCR, RFLP and ARMS-PCR analysis) and p.W24X (ARMS-PCR analysis) mutations. RESULTS: Audiological examination allowed the diagnosis of hearing loss of various degrees: moderate in 8 patients (10.7%), severe in 14 cases (18.7%), profound in 53 patients (70.6%). The number of reported mutation cases as against the number of alleles indicates a 33.3% frequency rate for c.35delG mutation and respectively 5.3% for p.W24X mutation. All 22 patients with 35delG/c.35delG genotype (19 patients), c.35delG/p.W24X genotype (2 patients) or p.W24X/p.W24X genotype (1 patient) presented profound/severe hearing loss. CONCLUSION: Our study confirms that the frequency rate of the two mutations analyzed in patients with NSHL from North-West Romania is comparable to that seen in other Central and South-Eastern European countries. The homozygote or compound heterozygote states represent a major risk factor for profound or severe deafness. Audiological screening in newborns and genetic testing in confirmed congenital hypoacusis cases are compulsory for early therapeutic intervention (hearing prosthesis or cochlear implant) and genetic counselling.

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PURPOSE: To identify a method of prophylaxis in pharyngocutaneous fistula (PCF) after radical surgery for cancer of larynx and pyriform fossa. MATERIALS AND METHODS: A prospective longitudinal study on patients who were operated for cancer of larynx and pyriform fossa, in year 2007 in ENT Department of Clinic Emergency County Hospital Cluj-Napoca, with total laryngectomy and partial hypo-pharyngectomy. These patients were distributed in two lots: case (who received postoperative treatment with hemisuccinate of hydrocortisone or dexamethasone) and witness (they didn't received cortisone or other treatment except the standard therapy). We followed the detection of PCF at these 2 lots of patients and the time of resumption for naturally feeding and hospitalization. We performed the bi-variant analysis (Spearman). RESULTS: 23 patient were accomplished the inclusion and exclusion criteria. 4 of those patients developed postoperative pharyngo-cutaneous fistula, only one in the case lot. Statistically, cortisone administrated postoperative brought benefits: PCF was developed in a significant reduced proportion (p=0.02) and the resumption of naturally feeding was made in a significant shorter time (p=0.003) and hospitalization time was significantly reduced (p=0.001). CONCLUSION: Cortisone administration after total laryngectomy and partial hypo-pharyngectomy seems to be a prophylactic method for pharyngocutaneous fistula.

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MLPA (Multiplex Ligation-dependent Probe Amplification) is a recently introduced method, based on PCR principle, useful for the detection of different genetic abnormalities (aneuploidies, gene deletions/duplications, subtelomeric rearrangements, methylation status etc). The technique is simple, reliable and cheap. We present this method to discuss its importance for a modern genetic service and to underline its multiple advantages.

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OBJECTIVE: To assess the prognostic factors of recurrence in a cohort of patients operated on for polyposis by means of endonasal endoscopic surgery. METHODS: Prospective study of 227 patients operated on for polyposis in a single institution between 1993 and 2001. The mean follow-up period was 24 months (range 12 months to 60 months). Nine parameters were analysed to study their association with polyp recurrence: age, gender, smoking history, presence of asthma, allergy, non-steroidal anti-inflammatory drugs (NSAID) intolerance, recurrent sinusitis, previous nasal surgery, and polyp extension. Analysis of recurrences was accomplished using the Kaplan-Meier survival curves and differences were analysed using the log-rank test. The Cox proportional hazards model was used to estimate the effect of individual risk factors on polyp recurrence. A probability value of p < 0.05 was the level of significance selected. RESULTS: During the study period, recurrences developed in 55 patients, giving a rate of 24%. In the univariate analysis, NSAID intolerance, asthma, revision surgery and polyp extension were associated with recidivism. The other mentioned factors did not attain statistical significance. However, the multivariate analysis demonstrated that only NSAID intolerance and asthma are independent predictive factors for recurrence. CONCLUSIONS: Patients presenting NSAID intolerance or asthma are at risk for the development of recurrences after endonasal surgery for nasal polyposis.

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OBJECTIVE: The aim of this study was to discuss the presenting signs and symptoms important for the early diagnosis and to review the medical and surgical management of patients presenting with intracranial complications of sinusitis. METHODS: Retrospective review of the medical records of all patients admitted with intracranial infections between 1990 and 1999 at the Department of Otolaryngology, Department of Neurosurgery and Department of Infectious Diseases, University of Cluj, Romania. RESULTS: Sixteen patients had 23 intracranial complications of sinusitis. These were meningitis (6 cases), frontal lobe abscess (6 cases), epidural abscess (5 cases), subdural abscess (4 cases), and cavernous sinus thrombophlebitis (2 cases). In almost all patients, early symptoms included headache and fever. Clinical diagnosis was confirmed by imaging. Management of these infections included intravenous broad-spectrum antibiotics, appropriate neurosurgical and sinus drainage. Among these patients, there was one death and 4 patients developed significant neurologic sequelae. Poor prognosis was associated with the presence of subdural abscess and a prolonged time interval between the onset of symptoms and the beginning of treatment. CONCLUSION: Early diagnosis of intracranial complication of sinusitis can reduce morbidity and mortality associated with these complications.

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After a short survey of the data of vertebrobasilar anatomy and physiology, the authors present their conclusions drawn from the study of 110 patients with vertebrobasilar circulatory insufficiency accompanied by severe vestibular disturbances. The paper reports on the clinic disturbances present in the patients studied, with emphasis on the importance of the interdisciplinary consultation and of the repeated otologic examination for application of an adequate therapeutics.

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The paper reports on three cases of phlebectasia of the internal jugular vein, two in adults and one in a child, admitted and operated in the Cluj-Napoca Clinic of O.R.L. The surgical technique had to be adapted to each case separately, according to the extension of phlebectasia, the patient's age, and other related diseases.

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