A. Sartoris

Pectoralis major myocutaneous flap: analysis of complications in difficult patients

Abstract The purpose of this study was to assess and discuss the effects of old age and systemic diseases on complications related to the use of a pectoralis major myocutaneous flap (PMMF) for reconstruction in head and neck surgery. Eighty-four consecutive patients, operated on between January 1992 and December 1998, were included in the study. Of these patients, 47 were in relatively good condition, while 37were old and frail or affected by systemic diseases. Patients were monitored for complications during a follow-up of 2 years. All patients included in the study had very advanced squamous cell carcinomas (T3-T4) and reconstruction with PMMF was performed after a commando procedure, a total laryngectomy with partial pharyngectomy, or a composite resection. Necrosis of skin island was the most frequently encountered complication, but no surgical intervention was needed. Overall, complications occurred more frequently in patients with underlying pathologies, the risk ratio adjusted for age and sex being 2.94, but 95% confidence intervals were 0.99–8.65 and all complications were minor. In summary, we recommend the use of PMMF for immediate repair in difficult patients who have large oro-pharyngo-laryngeal excisions and radical neck dissections and who suffer concomitantly with various medical problems known to increase complication rates. PMMF proved to be suitable to give these patients good chances of a quick recovery with satisfactory aesthetic and functional results.

A multicenter trial of specific local nasal immunotherapy

Objective: To assess the efficacy and safety of specific local nasal immunotherapy (LNIT) in powder form in patients with allergic rhinitis, using subjective and objective parameters.

New Options for Aerodigestive Tract Replacement After Extended Pharyngolaryngectomy

Objectives Assess the results of a new type of reconstruction of the aerodigestive tract after extended pharyngolaryngectomy.

Is Pressure Dressing Necessary after Ear Surgery

Compressive bandages carry intrinsic risks and complications. The purpose of this study was to assess whether compressive head bandages are necessary after ear surgery to prevent complications such as hematoma or wound infection. A prospective, randomized, controlled study was conducted from August 1, 1993, to June 1, 1999. We randomly assigned 420 consecutive middle ear or mastoid operations to either a pressure bandage group or to a no—pressure bandage group. A careful follow-up was planned, and complications were recorded. In the pressure bandage group, 3 patients had bruising over the pinna and 70 patients had minor skin erythema when the dressing was removed. No patient had bruising or erythema in the no—pressure bandage group. No patient had hematoma, wound infection, or any other wound complication in either group. As a result of this study, we have decided to abandon the use of compression bandages after uncomplicated ear surgery.

Twenty years of experience with Marullo's supraglottic laryngectomy.

Abstract We present a follow-up study of 142 patients on whom we performed supraglottic laryngectomy (SL) with an anterior subperichondral approach using Marullo’s technique, which was described in 1975. Between January 1976 and December 1992, 142 patients (age range, 35–73 years) with squamous cell carcinoma of the supraglottic larynx were treated with SL or extended SL (ESL) and ipsilateral or bilateral neck dissections with or without postoperative radiotherapy. All cases were staged according to the 1997 UICC TNM classification. Survival was defined by the Kaplan-Meyer method and showed an overall survival of 77% and a local control rate of 78%. Regarding functional rehabilitation, the mean nasogastric tube-removal time was 16 days (range, 10–39 days) for SL and 23 days (range, 11–¶102 days) for ESL. Voice quality was very satisfactory after SL, while the voice was often harsh or breathy after ESL with postoperative radiotherapy. The overall oncologic and functional results obtained with Marullo’s SL were very similar to those obtained with the classic Alonso’s operation and demonstrated that this technique makes it possible to reach “en bloc” supraglottic sites and the hyothyroepiglottic space. We consider the operation to be safe and simple to perform, provided the sub-perichondral plane is correctly identified. This approach allows the surgeon easily to reach the correct transverse level above the anterior commissure of the vocal cords. Inferiorly, the resection cuts through the floor of the ventricle and is considered to be the safe oncologic plane for pure supraglottic lesions. This technique has also been used successfully in extended resections to treat tumors involving the base of the tongue, pyriform sinus and one arytenoid.

Natural killer-mediated cytotoxicity in patients with laryngeal carcinoma

Natural killer (NK)-mediated cytotoxicity against the K562 cell line was evaluated in normal subjects and in patients with laryngeal cancer. Results showed reduced lymphocyte cytotoxicity in patients with neoplastic disease and further reduction in NK activity following postoperative radiation therapy. The authors discuss the possibility of using this test in the immunological monitoring of patients with laryngeal carcinoma.

Reconstruction of the pharynx and cervical esophagus using ileocolic free autograft

BACKGROUND Advanced stage hypopharyngeal cancer is commonly treated by surgery and radiotherapy. This report presents a technique using ileocolic free autograft as a single-stage procedure for voice and swallowing rehabilitation after pharyngolaryngoesophagectomy. METHODS Digestive tract restoration is obtained by using the cecum and ascending colon, while the last ileal loop, protected by the ileocecal valve for food and liquid inhalation, is anastomized to the cervical trachea. After abdominal harvesting, the ileocolic complex is transected, transposed, and then revascularized in the cervical field. RESULTS Six patients underwent this operation successfully with recovery of swallowing function and vocal performance within a short period of time, varying from 18 to 38 days. CONCLUSION On the basis of achieved results, the ileocolic free autograft can be considered a good option for pharyngoesophageal reconstruction, offering as it does an immediate restoration of swallowing and voice function.

Production of leukocyte migration inhibition factor by lymphocytes of larynx cancer patients stimulated by laryngeal carcinoma solubilized membrane antigens.

The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91 % of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73 % of the cases and from normal donors in 90 % of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65 % of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6 % of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65 % test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.

Basal serum interferon‐gamma production in hay fever patients

Basal serum interferon-gamma production in hay fever patients SIR, Atopy is characterized by elevated serum IgE levels and it has been suggested that this may result from an imbalance in T-lymphocyte populations influencing B-cell production of this immunoglobulin [1,2]. No such imbalance has been identified in the numbers of Theiper (OKT4) and Tsuppressor (OKT8) lymphocytes in association with atopic asthma [3], but it is possible that the mechanisms of increased IgE production in atopic subjects may be associated with T-cell subsets not defined by the 0KT4 and OKT8 monoclonal antibodies. We considered that the investigation of lymphokine production might provide a better insight into the functional aspects of the allergic response. In-vitro studies with lymphocytes from hay fever patients have shown that they can produce at least two lymphokines, macrophage inhibitory factor and mitogenis factor, following stimulation with specific antigen [4]. There is evidence to suggest that interferon may be involved in allergic and autoimmune disease [5,6], and this lymphokine has also been associated with increased expression of IgE receptors on basophils [7] and a monocyte cell line [8]. We postulated that abnormal lymphokine production may be linked with altered homeostasis of T-cell activity in hay fever patients. ,We have compared basal serum interferon-gamma (IFN-y) levels in a group of twenty-five hay fever patients with those in twenty-five normal controls. The patients, fifteen males and ten females, were between the ages of 18 years and 25 years and had not previously received pharmacotherapy for their hay fever. All had positive skinprick tests to grass pollen, but not to other common allergens, and an eosinophilia between 5% and 8%. The normal controls, thirteen males and twelve females, were age matched, and all were skin-prick test negative to common allergens and had an eosinophii count of less than 4%. Erythrocyte sedimentation rate and total leucocyte counts were normal in all subjects, and there was no evidence of pyrexia. Blood was collected in December and January, well outside the pollen season, and all samples were taken at the same time of day (08-00 h). Interferon-gamma levels were measured using a commercial radioimmunoassay kit (Centocor MRX IFN-y, RIA test, Malvern, PA, U.S.A.), and all tests were performed in quadruplicate. In the hay fever group, basal IFN-y levels ranged from 3-5 to 7-0 IU/ml (mean 4-9+1-21 IU/ml), compared with 0-5 to 1-5 IU/ml (mean 0-9 + 0-35 IU/ml) in the control group. This five-fold higher level of IFN-y in the hay fever group suggests that Theiper activity may be increased in these atopic patients and that basal T-cell hyperactivity in the immune system may be a feature of the pathogenesis of the disease. This conclusion is supported by other evidence of increased Theiper activity in atopic patients [9,10]. We suggest that this observation justifies further investigation of the

Specific lymphokine responses in cervical nodes of patients with laryngeal cancer

The role of lymphokines in modulating the immune response in patients suffering from neoplastic disease is still controversial. Recent studies indicate that in patients with head and neck cancer, a decrease in LIF (leukocyte migration inhibiting factor) production is usually present in advanced disease. In this study, the authors investigate: