Isabel Vilaseca

Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study

BACKGROUNDnWe postulated that idiopathic rapid-eye-movement (REM) sleep behaviour disorder (IRBD) represents the prodromal phase of a Lewy body disorder and that, with sufficient follow-up, most cases would eventually be diagnosed with a clinical defined Lewy body disorder, such as Parkinsons disease (PD) or dementia with Lewy bodies (DLB).nnnMETHODSnPatients from an IRBD cohort recruited between 1991 and 2003, and previously assessed in 2005, were followed up during an additional period of 7 years. In this original cohort, we sought to identify the nature and frequency of emerging defined neurodegenerative syndromes diagnosed by standard clinical criteria. We estimated rates of survival free from defined neurodegenerative disease by means of the Kaplan-Meier method. We further characterised individuals who remained diagnosed as having only IRBD, through dopamine transporter (DAT) imaging, transcranial sonography (TCS), and olfactory testing. We did a neuropathological assessment in three patients who died during follow-up and who had the antemortem diagnosis of PD or DLB.nnnFINDINGSnOf the 44 participants from the original cohort, 36 (82%) had developed a defined neurodegenerative syndrome by the 2012 assessment (16 patients were diagnosed with PD, 14 with DLB, one with multiple system atrophy, and five with mild cognitive impairment). The rates of neurological-disease-free survival from time of IRBD diagnosis were 65·2% (95% CI 50·9 to 79·5) at 5 years, 26·6% (12·7 to 40·5) at 10 years, and 7·5% (-1·9 to 16·9) at 14 years. Of the four remaining neurological-disease-free individuals who underwent neuroimaging and olfactory tests, all four had decreased striatal DAT uptake, one had substantia nigra hyperechogenicity on TCS, and two had impaired olfaction. In three patients, the antemortem diagnoses of PD and DLB were confirmed by neuropathological examination showing widespread Lewy bodies in the brain, and α-synuclein aggregates in the peripheral autonomic nervous system in one case. In these three patients, neuronal loss and Lewy pathology (α-synuclein-containing Lewy bodies and Lewy neurites) were found in the brainstem nuclei that regulate REM sleep atonia.nnnINTERPRETATIONnMost IRBD individuals from our cohort developed a Lewy body disorder with time. Patients who remained disease-free at follow-up showed markers of increased short-term risk for developing PD and DLB in IRBD, such as decreased striatal DAT binding. Our findings indicate that in most patients diagnosed with IRBD this parasomnia represents the prodromal phase of a Lewy body disorder. IRBD is a candidate for the study of early events and progression of this prodromal phase, and to test disease-modifying strategies to slow or stop the neurodegenerative process.nnnFUNDINGnNone.

Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors.

The objective of this study was to evaluate the outcomes of transoral laser microsurgery (TLM) in T3 laryngeal carcinomas and to identify prognostic factors for survival and laryngeal preservation.

Long-term quality of life after total laryngectomy†

There is a perception that a total laryngectomy has a devastating effect on patients and their families, but only a few studies have addressed long‐term quality of life (QOL) after laryngectomy.

VOICE QUALITY AFTER CO2 LASER CORDECTOMY—WHAT CAN WE REALLY EXPECT?

Endoscopic management of laryngeal carcinoma has gained popularity among laryngologists based on the good oncologic and functional results. We evaluated the voice quality after laser cordectomy for early glottic cancer in a variety of vocal situations and its relation with the extension of resection and the age.

CO2 laser surgery: A larynx preservation alternative for selected hypopharyngeal carcinomas

Transoral CO2 laser surgery (TLS) has demonstrated good oncologic results and low morbidity in the treatment of selected laryngeal carcinomas, but experience in hypopharyngeal carcinomas (HC) is limited. The aim of this study was to evaluate the usefulness of TLS in the treatment of selected HC.

PET-CT vs contrast-enhanced CT : What is the role for each after chemoradiation for advanced oropharyngeal cancer?

The aim of our study was to assess the utility of positron emission tomography (PET) and 2 fluoro‐2‐deoxy‐D‐glucose coupled with neck CT compared with contrast‐enhanced CT in predicting persistent cancer either at the primary site or cervical lymphatics in patients with oropharyngeal cancer treated with concurrent chemoradiation

OUTCOME OF TRANSORAL LASER MICROSURGERY FOR T2-T3 TUMORS GROWING IN THE LARYNGEAL ANTERIOR COMMISSURE

To evaluate the outcomes of transoral laser microsurgery (TLM) in the treatment of T2 to T3 laryngeal carcinomas growing in the laryngeal anterior commissure.

Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1-T4 pharyngo-laryngeal cancers.

Histological affected or close margin is an adverse factor in conventional surgery of larynx-hypopharynx cancer. Our objective was to analyze the relevance of the margins in transoral laser microsurgery (TLM). A retrospective study of 357 consecutive patients with cancer of the larynx and hypopharynx (T1–T4) treated with TLM. Three possible margins were considered: tumor free, affected, and uncertain. An affected margin showed marked tumor infiltration. An uncertain margin was defined when the sample was insufficient, when it showed carbonization impeding accurate evaluation, or when tumor cells were less than 2xa0mm. Margins were free in 254 (71.1%) patients, affected in 64 (17.9%) and uncertain in 39 (10.9%). One hundred and three patients (28.9%) presented tumor relapse. The margins were associated with tumor relapse (Pxa0<xa00.001), but were not significantly related to the tumor site (Pxa0=xa00.307), the pT classification (Pxa0=xa00.183), or the difficulty of surgical exposure (Pxa0=xa00.427). Distant metastases were found in 4.7% of the patients with free margins, in 7.7% of those with uncertain margins, and in 14.1% with affected margins. These differences were statistically significant (Pxa0=xa00.028). Tumor involvement of the surgical margin was associated with higher rates of local relapse, distant metastasis and the necessity of salvage surgery, together with a lower specific actuarial survival rate.

Quality of life after transoral laser microresection of laryngeal cancer: A longitudinal study

In the treatment of early to moderate laryngeal carcinoma, both, transoral laser surgery and radiation‐based protocols have demonstrated good survival and preservation rates. In this scenario, quality of life (QOL) may become an important tool for treatment planning. We aimed to evaluate QOL changes after transoral laser microsurgery (TLM). Prospective longitudinal study. Ninety‐three consecutive disease‐free patients were evaluated using UW‐QOL v4 and SF‐12, before and 12 months after treatment. Changes over time were assessed according to age, gender, location, tumor size, and adjuvant treatment.

The learning curve in transoral laser microsurgery for malignant tumors of the larynx and hypopharynx: parameters for a levelled surgical approach

The goal of the study was to identify parameters helpful to define a learning curve for laser microsurgery (TLM). 587 patients with malignant tumors of larynx and hypopharynx treated with TLM were divided into groups depending on the number of interventions their surgeons had performed. Outcome measures were obtained for the number of revision surgeries and complications, rates for tumor-free margins, tumor relapse and disease-specific survival rates for early and advanced tumors, serving to evaluate their potential influence on the learning curve. Surgery of early tumors was not influenced by the grade of experience. For locally advanced tumors the learning curve was statistically related to the number of surgeries needed per patient (pxa0=xa00.018). The number of overall complications (pxa0=xa00.000) and the disease-specific survival rate (pxa0=xa00.019) was significantly lower in the “expert” group. The percentage of postoperative bleedings was similar between all groups. Tumor-free margins and tumor relapse were not influenced by experience. In TLM, a learning curve could be observed for locally advanced tumors.