Comparison of thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in an animal model

OBJECTIVE: To evaluate and compare the use of autogenous thyroid cartilage with that of auricular and costal cartilage in laryngotracheoplasty (LTP). DESIGN: A blinded comparison of LTP techniques using anterior thyroid, auricular, or costal cartilage as graft material in a rabbit model. Histological and anatomical analyses were performed on the laryngeal specimens 1, 4, and 6 weeks after surgery. The following factors were analyzed in each specimen: graft viability, cartilage proliferation, perichondrial viability, degree of necrosis, inflammatory response, and degree of epithelialization. SUBJECTS: Fifty-seven New Zealand adult male rabbits, aged 6 months, were divided into 3 study groups (19 animals in each group) initially and equally into the 3 time periods. RESULTS: No episodes of respiratory compromise occurred in any of the animals in the 3 study groups. Gross inspection of the laryngotracheal complex in the thyroid cartilage group revealed no evidence of laryngeal structural compromise. There was no statistical difference between the 3 types of cartilage used for reconstruction for the variables of graft or perichondrial viability, degree of necrosis, or inflammatory response at 1, 4, or 6 weeks. Cartilage proliferation in the thyroid cartilage group was decreased compared with that in the other 2 groups at 1 week. The amount of proliferation increased in this group and was equal to the amount present in the other 2 groups 4 and 6 weeks after surgery. Complete epithelialization of the graft material was present in all 3 groups at 4 and 6 weeks after reconstruction. CONCLUSIONS: The use of autogenous thyroid cartilage for LTP compares favorably with that of other methods of reconstruction that use either auricular or costal cartilage in the rabbit model. This technique is a viable alternative for single-stage LTP and has the added advantage of using a single incision.     

Pediatric rhabdomyosarcoma of the head and neck: is there a place for surgical management?

OBJECTIVE: To review and evaluate the place of surgical treatment in the management of rhabdomyosarcoma of the head and neck in children. DESIGN: Retrospective analysis of patient charts from January 1, 1972, to December 31, 1998. SETTING: Tertiary pediatric referral center. PATIENTS: Twenty-nine consecutive children with nonorbital head and neck rhabdomyosarcoma. INTERVENTIONS: Surgery, chemotherapy, and radiotherapy. MAIN OUTCOME MEASURES: Disease-free survival and long-term morbidity from treatment. RESULTS: Twenty patients had parameningeal and 9 had nonparameningeal head and neck tumors. All were treated with chemotherapy. For 18 patients, diagnostic biopsies were performed and they received radiotherapy. Eleven patients underwent surgery as definitive therapy. Using the Intergroup Rhabdomyosarcoma Study (IRS) staging system, 5 of these 11 patients had complete resection of tumor (IRS group I) and avoided radiotherapy. The other 6 patients required radiation because of compromised, regional, or incomplete resection of tumor. One had undergone regional resection with nodal involvement, and 2 had compromised resections with microscopic residual disease (IRS group II). Three had incomplete resections with gross residual tumor (IRS group III). Only 1 patient who underwent surgery ultimately died from recurrence at 2.7 years after an incomplete resection. The other 10 patients were relapse free at a median follow-up of 3.7 years (range 0.8-21.0 years). Long-term surgical morbidity was seen in 36% (4/11) of the patients and included facial nerve paralysis, trismus, and cosmetic deformity. CONCLUSIONS: Children with localized disease of the head and neck are able to undergo complete surgical resection, with low long-term surgical morbidity. By undergoing complete surgical resection, these children are able to avoid radiotherapy and its long-term complications, with no compromise in survival.     

Malignant tumours of the small intestine: a case of jejunal adenocarcinoma

The Authors analyse the main problems concerning malignant tumours of the small intestine. They report a case of jejunal adenocarcinoma recently observed. They emphasise the importance of surgery, both diagnostic and therapeutic, even in advanced stages, for the treatment of this neoplasm.     

Pattern electroretinogram optimized for glaucoma screening (PERGLA) and retinal nerve fiber thickness in suspected glaucoma and ocular hypertension

The purpose of this study is to evaluate pattern electroretinogram optimized for glaucoma screening (PERGLA) and retinal nerve fiber layer (RNFL) at spectral optical coherence tomography (OCT) in eyes with suspected glaucoma (GS) and in eyes with ocular hypertension (OHT). This is a cross-sectional, observational study. Twenty-four patients with GS (BCVA 20/20, normal visual field, intraocular pressure, IOP, less than 21 mmHg, and glaucomatous optic neuropathy, GON) and 14 patients with OHT (BCVA 20/20, intraocular pressure 25 mmHg, absence of glaucomatous optic neuropathy and normal visual field) were considered in this study. GON was intended as vertical cup-disk ratio of 0.5 or more; asymmetry of greater than 0.2, disk notching, disk splinter hemorrhages. PERGLA amplitude and phase were measured, while thickness of the RNFL was obtained with spectral OCT. A control group of 50 age-matched healthy patients was added. In the GS group, 16 eyes (66.7%) showed normal average RNFL analysis and normal PERGLA, 3 eyes (12.5%) showed abnormal average RNFL analysis and abnormal PERGLA, 5 eyes (20.8%) presented with normal average RNFL analysis and abnormal PERGLA. In the OHT group, 11 eyes (78.6%) showed an average normal RNFL and normal PERGLA, while 3 eyes (21.4%) presented with an average normal RNFL and abnormal PERGLA. PERGLA is a non-invasive, fast, and fully automatic version of the pattern ERG. In eyes with OHT and in eyes with GS, PERGLA abnormalities in presence of a normal RNFL could suggest an early functional damage of viable retinal ganglion cells.     

Amyotrophic lateral sclerosis: thyrotropin-releasing hormone and histidyl proline diketopiperazine in the spinal cord and cerebrospinal fluid

In spinal cords from seven amyotrophic lateral sclerosis (ALS) patients and four controls, we found no difference in thyrotropin-releasing hormone (TRH) concentration relative to protein content, but there was a reduction per tissue wet weight in ALS. Immunohistochemical localization of TRH in ALS cord was unaltered. Histidyl proline diketopiperazine (HisPro-DKP), a possible metabolite of TRH, was significantly elevated per protein content in ALS. CSF levels of TRH and HisPro-DKP were unchanged. These findings suggest that TRH neurons are not primarily affected in ALS, but TRH and tissue protein are lost together as the disease progresses.