Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy.

BACKGROUND: Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed. METHODS: Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates. RESULTS: Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger). CONCLUSIONS: COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.

Inhaled Foreign Body Impaction: A Review of Literature in Malaysian Children.

Foreign body aspiration in children is a problem that can lead to several complications, including death. In this retrospective publication review from 1970 to 2015, there were altogether 42 Malaysian children below the age of 15 y reported with foreign body (FB) ingestion. There were 31 boys and 11 girls between 2 and 177 mo of age. The incidence of FB ingestion in children varied with dietary practices. Peanut was the most common food-related substance inhaled followed by watermelon seed and coconut kernel. The most common non-food related substances were metal objects (toys, springs, hair clips) and plastic objects (ballpoint tips, pencil caps and whistles). Successful removal of FB by bronchoscopy is achieved in the vast majority of cases except for a case of impacted whistle inhalation and a neglected laryngeal FB which required a tracheostomy. One child required thoracotomy for the removal of a peanut in the right bronchus. The incidence of food-related substance inhalation was more common than non-food related substance (30:7). From this review, the key messages are two: first, prevention can be achieved by educating parents not to allow access to small objects or dangerous foods to children below 3 y age; Second, emergency first aid home measures, in the combination form of back blows in the head down position and chest or abdominal thrusts, should be early performed according to the pediatric age group and can be quite effective.

High-dose versus low-dose cisplatin in advanced head and neck squamous carcinoma: a randomized study.

From November 1981 to February 1983, 64 patients with advanced head and neck squamous carcinoma were randomly treated with either high-dose (120 mg/m2) or low-dose (60 mg/m2) cisplatin. Of the 62 eligible patients, 59 were evaluable: the response rate observed in patients receiving high-dose and low-dose cisplatin was 16.1% and 17.8%, respectively. Survival was superimposable in the two treatment arms. No evidence of dose dependency of cisplatin activity in advanced head and neck squamous carcinoma was noted in this randomized trial.

Hemipharyngectomy and hemilaryngectomy for pyriform sinus cancer: reconstruction with remaining larynx and hypopharynx and with tracheostomy.

When resection of the posterior hypopharyngeal wall is undertaken for treatment of pyriform sinus carcinoma, a very narrow mucosal strip may be left for reconstruction. A surgical technique for carcinoma which has invaded the whole lateral hypopharyngeal wall is described. It consists of resecting half the larynx and half the hypopharynx and reconstructing the food canal using the mucosa of the unaffected half of the larynx and the remnant hypopharynx. A series of 34 patients treated by this technique is presented. No hypopharyngeal stenosis was observed. Local recurrences developed in 9 cases and distant metastases in 6. A specific disease mortality rate of 44% was encountered. At present, 15 patients are disease-free after a median follow-up of 48 months.

Superficial extending carcinoma of the larynx.

Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole-organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathological spectrum of so-called early laryngeal cancer are emphasized.

Blood transfusion and other prognostic variables in the survival of patients with cancer of the head and neck.

The clinical records of 207 patients with squamous cell carcinoma of the head and neck, diagnosed and surgically treated at the Otolaryngology Division of Pordenone General Hospital and Aviano Cancer Centre, northeast of Italy, from January 1982 to December 1987, were retrospectively reviewed to gather information on blood transfusions and other characteristics potentially related to survival. The group of patients (mean age = 59 years) included 85 cases (41%) of laryngeal cancer, 80 cases (39%) of oropharyngeal and hypopharyngeal cancer, and 34 cases (16%) of cancer of the oral cavity. Fifty-five patients (27%) did not receive any blood transfusion while 152 patients were transfused with different amounts of blood. At the univariate analysis, nodal involvement, clinical stage, type of therapy, status of surgical margins, and metastatic spread beyond the nodal capsule appeared to be significantly linked to prognosis. After adjustment for other prognostic variables, transfused patients showed a twofold higher hazard ratio as compared to nontransfused patients, but such an unfavorable predictive value should be evaluated in the context of the other prognostic correlates of cancer of the head and neck.

Nasopharyngeal lymphatic tissue in patients infected with human immunodeficiency virus. A prospective clinicopathologic study.

A prospective clinicopathologic study of the nasopharyngeal lymphatic tissue, using a standardized approach, was carried out in 66 patients infected with human immunodeficiency virus (HIV) in Aviano, Italy. Two hundred eighteen patients without HIV infection served as a control group. A significantly higher percentage of nasopharyngeal lymphatic tissue hypertrophy was observed in HIV-infected patients compared with the control group, both clinically and pathologically. The finding of a higher incidence of nasopharyngeal lymphatic tissue hypertrophy during some stages of the disease, when cervical lymph nodes are enlarged, suggests that the extranodal nasopharyngeal district behaves in the same way as the lymph nodes. Nasopharyngeal lymphatic tissue hypertrophy should be placed at the forefront of the hitherto known head and neck manifestations of HIV infection. An ear, nose, and throat examination is mandatory for all patients with known or suspected HIV infection.

T staging of the laryngohypopharyngeal carcinoma. A 7-year multidisciplinary experience.

Sixty-six whole-organ sectioned, nonirradiated, laryngopharyngectomy specimens that were removed because of cancer during a 7-year period were uniformly examined to determine the accuracy of perioperative T staging by high-resolution computed tomography (CT) and clinical evaluation (indirect-direct laryngoscopy) by comparing this preoperative staging with the postsurgical pathologic staging. The accuracy of the clinical vs CT staging for laryngeal carcinomas was 58.8% vs 70.6%, whereas the accuracy of the staging by combination of the two modalities was 88.2%. Combined staging modalities showed the same accuracy for laryngeal and hypopharyngeal carcinomas (88.2%), whereas clinical staging accuracy for hypopharyngeal carcinomas was lower (52.9%) and CT accuracy was higher (82.4%) than that observed for laryngeal carcinomas. In the majority of the cases that were staged inaccurately, the error was one of under-estimation: in particular, tumors confined to the mucosa and early infiltration of laryngeal fat spaces were not detected by CT.

A method for routine approach to laryngeal and hypopharyngeal surgical specimens by whole organ sections in the horizontal plane.

A procedure of pathological analysis of laryngopharyngeal specimens by whole organ sections in the horizontal plane was developed and evaluated. The use of a fast decalcifying and fixative solution allowed both an easier sectioning of the whole organ and thin (5-6 microns) histological whole organ sections of laryngo pharyngectomy specimens. The complete procedure required 5 to 10 days for each case. A preliminary examination of 39 surgical laryngopharyngectomy specimens with laryngeal or hypopharyngeal carcinomas showed that most of the normal structures were histologically identifiable on whole organ horizontal histological sections. The data of the local neoplastic spread related to the main sites of origin were in accordance with the results obtained by other studies using whole organ sections in the coronal or vertical planes. In conclusion, with this procedure it is possible to obtain, in a reasonably short time, thin histological horizontal whole organ sections allowing an adequate and complete assessment of the microscopic characteristics of the tumor and of the tridimensional relationships of the neoplasm with the host organ; moreover, by this procedure pathological data may be compared with preoperative CT or MR scans in patients with laryngeal and hypopharyngeal carcinomas.

Cardiac arrhythmia: possible complication from treatment with cisplatin.

Cardiotoxicity is rarely observed during cisplatin chemotherapy. A possible synergistic toxic effect of cisplatin with etoposide on cardiac electrical activity is discussed. A case of a 60-year-old woman with squamous cell lung carcinoma who developed paroxysmal supraventricular tachycardia during cisplatin chemotherapy is reported. The potential cardiotoxicity should be considered when cisplatin is combined with other cardiotoxic agents or used in patients with cardiac disease.

Pathologic assessment of computerized tomography accuracy for the evaluation of the laryngeal cartilaginous framework in laryngopharyngeal carcinomas.

Sixty-six whole-organ sectioned laryngopharyngectomy specimens removed for cancer during a seven-year period were uniformly examined to determine the accuracy of preoperative high resolution computerized tomography (CT) for detection of cartilaginous involvement. Our results indicate that CT has a high overall specificity (88.2%) but a low sensitivity (47.1%); we observed a high false-negative rate (26.5%) and a fairly low false-positive rate (5.9%). Massive cartilage destruction was easily assessed by CT, whereas both small macroscopic and microscopic neoplastic foci of cartilaginous invasion were missed on CT scans. Moreover, false-positive cases were mainly due to proximity of the tumor to the cartilage. Clinical implications of these results are discussed.

Chemotherapy of advanced head and neck squamous carcinoma with cisplatin, fluorouracil and bleomycin administered in an outpatient schedule.

From May 1983 to September 1984, 48 consecutive patients with locally advanced, recurrent and/or metastatic head and neck squamous carcinoma were treated with cisplatin 60 mg/m2 i.v. on day 1, fluorouracil 10 mg/kg i.v. push from day 1 to day 4 and bleomycin 10 mg/m2 i.v. from day 1 to day 4, every 3 weeks. In the 44 evaluable patients complete remission was observed in 4, partial remission in 9, stable disease in 19, and progression in 12, for a 29.5% response rate. When the analysis was limited to the 21 patients with PS greater than 70 and no previous chemotherapy or radiotherapy, the response rate was 48%. Toxicity was acceptable, and no treatment related deaths occurred. Overall median survival (all eligible patients) was 7 months. Although further studies with this combination in poor risk patients (previously treated or with PS less than 70) do not appear to be indicated, a more accurate assessment in good risk patients might be warranted.

Phase II trial of oral VP 16-213 (etoposide) in patients with advanced head and neck cancer.

We tested VP 16-213 in 16 patients with advanced head and neck cancer after conventional treatments. VP 16-213 was administered orally at the dosage of 100 mg/mq for 5 consecutive days every 3 weeks. No patient achieved an objective response. Toxicity was mild. VP 16-213 given at this dose and schedule revealed no activity in pretreated patients with head and neck cancer.

Benign parotid tumour enucleation--a reliable operation in selected cases.

The method of surgical treatment for benign tumours of the parotid gland had not yet been rationalized, but many authors recommend parotidectomy as the most appropriate procedure. A series of 289 operations for parotid swelling is reported; the majority of mixed and Warthin's tumours underwent enucleation without either complications or recurrence. The rationale of parotidectomy versus enucleation is discussed but in fast growing, deeply infiltrating and recurrent tumours, parotidectomy appears to be the best choice. In the other group of more commonly occurring tumours, enucleation represents a reliable time saving option.

Head and neck manifestations during HIV infection.

The ENT manifestations of HIV infection are well known and the findings in AIDS patients have been described, nevertheless there are no reports of the frequency of head and neck involvement during the various stages of the disease. From 1987 to 1991, 210 HIV positive patients had ENT evaluation without symptoms-related selection. The majority of them were men and intravenous drug users. The frequency of enlarged neck nodes, neck mass, nasopharyngeal lymphatic tissue hypertrophy, extranodal localization of non-Hodgkin's lymphomas, Kaposi's sarcoma, oral hairy leukoplakia, candidiasis and other less common findings is reported, in relation to the stage of the disease. Overall 84 per cent of the observed patients had head and neck manifestations. An ENT evaluation in every HIV infected patient is suggested.

Carcinoma of the nasal vestibule: report of 12 cases.

Carcinoma of the nasal vestibule has an individual clinical character; in this retrospective analysis the data of 12 consecutive patients are reported. Small lesions were treated by surgical resection and larger tumours by intra-arterial chemotherapy (IAC) followed by external beam radiotherapy. One patient had a recurrence which was successfully treated surgically; six had previous or subsequent malignancies. The results of the most recent series reported in the literature are reviewed and the rationale of the IAC approach is discussed. The reported treatment policy seems effective in achieving the highest cure rate with the best functional results.

Head and neck cancer and ageing: a retrospective study in 438 patients.

To evaluate whether age over 70 years represents a prognostic factor in head and neck cancer, we reviewed all cases observed between 1981 and 1984. Four hundred and thirty-eight (438) patients were considered in relation to three age groups (less than or equal to 59, 60-69, and greater than or equal to 70 years, defined as non-elderly, mid-elderly and elderly respectively). The main parameters analyzed included histological diagnosis (no difference emerged among the three age groups); anatomical site (hypopharyngeal carcinoma was most frequent in non-elderly patients); TNM stage (an higher incidence of early stages was seen in the elderly); performance status (better in the non-elderly); previous illnesses (life-style related diseases were more frequent in the non-elderly); contraindications to surgery (more frequent in the elderly); surgical treatment ('en bloc' resections were more often employed in the non-elderly); post-operative complications and local control (no difference between the three groups); multiple primary malignancies (head and neck, oesophagus and lung were more frequent in non-elderly patients) and survival (no difference). Although age affects several features of head and neck cancer patients, it does not appear from the present study to be an independent prognostic factor for local control and survival. With regard to survival, stage appeared to be the most important prognostic factor.

Patients compliance in an early detection program for upper aero-digestive tract tumours in north-eastern Italy.

An early detection program for tumours of the upper respiratory and digestive tract has been conducted from December, 1988 to May, 1989 in the Friuli Venezia-Giulia region, Northeastern Italy. This region shows very high mortality rates for cancers in these sites. Six hundred seventy-one high risk patients (i e habitual smokers and/or drinkers) were referred to Ear, Nose and Throat (ENT) specialists from 16 General Practitioners (GPs) for a free examination as part of the screening program. Four hundred thirty-six patients underwent the visit (65%) with fifty-five precancerous lesions and eight epithelial tumours detected among them. This program appears to have accomplished its aims of establishing a closer relationship between GPs and ENT specialists, discovering early cancerous and precancerous lesions, and targeting high risk patients with an educational message against smoking and heavy drinking.

[Free forearm skin flap with vascular microanastomosis in the reconstruction of the posterior pharyngeal wall]. / Lembo libero di cute antibrachiale con microanastomosi vascolari per la ricostruzione della parete faringea posteriore.

The posterior wall of the oropharynx and hypopharynx is a single anatomo-functional structure which is artificially divided into oro and hypo by an imaginary line at the valleculae floor level. From the oncological point of view this division serves merely for classification purposes. In fact, the tumors of the posterior wall of both the oro and hypopharynx have the same risk factors, the same lymphatic drain, the same clinical behaviour, the same means of treatment and, almost certainly, the same prognosis. One of the most important problems after posterior pharyngeal wall resection and larynx preservation, is reconstruction without interfering with laryngeal functions. Between April 1990 and April 1991 four patients with squamous cell carcinoma of the posterior pharyngeal wall underwent, surgery after a complete staging including CT and panendoscopy. All underwent bilateral neck dissection, resection of the tumor preserving the larynx and free forearm flap reconstruction. The anastomosis between the radial and superior thyroid arteries and between the venae comitantes and the branches of the internal or external jugular veins were performed under operating microscope with the microvascular technique. The overall average surgical time was 8 hours. No flap necrosis, fistulae or donor site morbidity were observed. Postoperative radiotherapy was initiated without delay. This approach was chosen because, in the authors' experience, in cases of advanced posterior pharyngeal wall cancer, the results of radiotherapy alone are quite disappointing. The feasibility of surgical resection with good, radical macroscopic margins, easily allows margins which are microscopically free of disease and this is an important prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

[The cervicofacial manifestations of Kaposi's sarcoma and of non-Hodgkin's lymphomas in HIV-infected patients]. / Manifestazioni cervicofacciali del sarcoma di Kaposi e dei linfomi non Hodgkin in pazienti con infezione da HIV.

Infection from human immunodeficiency virus (HIV) is well known for the particular host susceptibility to a variety of opportunistic infections and unusual malignant neoplasms. Although no tumor develops exclusively in concomitance with HIV infection, malignancies in these patients have different clinical behaviour, response to treatment and prognosis than the pattern observed in HIV negative hosts. Kaposi's sarcoma (EKS) and non-Hodgkin's lymphoma (NHL) are tumors per se diagnostic of AIDS in patients with HIV infection. From 1987 to 1991, 210 HIV positive patients underwent ENT examination without symptom-related selection: 128 were intravenous drug users, 50 homosexual males, 22 heterosexuals, 4 intravenous male homosexual drug users, 3 blood recipients and 3 subjects without known risk factors. Sixteen were allocated in group II, 37 in III, 9 in IV A, 2 in IV B, 31 in IV C1, 37 in IV C2, 48 in IV D and 30 in IV E. Fourteen had head and neck EKS localization. All were males, with a median age of 40 of which 11/14 were homosexuals. The concomitant involvement of skin and mucosa was the most common manifestation and the palate was the most frequently affected mucosal site. Twenty-four had NHL localized within the head and neck: 21 males and 4 females with a average age of 38, 10 intravenous drug users, 9 homosexual males, 3 heterosexuals, 1 blood recipient, 1 subject without known risk factors. Extranodal localization was the most frequent characteristic while the gums were the most commonly involved site. The main characteristics of head and neck manifestations of EKS and NHL are reported with references to literature. The majority of HIV infected patients with EKS or NHL have ENT localizations, perhaps because lymphatic tissue, a HIV target, is well represented in this area and contamination by infectious agents (such as Epstein-Barr virus and cytomegalovirus, probably involved in the pathogenesis of EKS and NHL) can easily occur in the head and neck. The otolaryngologist should be aware of the various, and sometimes misleading, characteristics of these diseases.