[In vitro trials with single and co-cultures of osteoblasts and endothelial cells : evaluation of new biomaterials for bone reconstruction and regeneration]. / Bewertung von neuartigen Biomaterialien zum Zweck der Knochenrekonstruktion und -regeneration : In-vitro-Versuche mit Mono- und Kokulturen von Osteoblasten und Endothelzellen.

Many different types of bone substitute biomaterials are being developed for different applications in the body. The current dogma is that if osteoblasts and endothelial cells grow and exhibit normal cell functions on these materials in vitro as single cultures or in co-cultures, then the biomaterials are suitable for implantation for bone reconstruction and regeneration. Generally, only in vivo animal studies will prove whether this is the case. However, in vitro studies offer a good pre-screening and selection basis to evaluate the biocompatibility of novel biomaterials prior to animal studies. Multicell type co-culture systems hold a great promise for the future.

Nasal cheek flap in ethmoidal and skull base tumour surgery: results and complications.

Surgery is the treatment of choice for the management of malignant nasal/ethmoidal tumours, followed, in most cases, by external radiotherapy. Two main procedures are adopted to resect these tumours depending upon stage and extension: ethmoidectomy and medial maxillectomy, via a transfacial approach, or craniofacial resection with a combined transcranial and transfacial approach. The nasal cheek flap technique allows complete nasal swing thus obtaining a wide access to both the nasal fossae and the ethmoidal labyrinth. Furthermore, this approach can also be used in the management of small intracranial tumours extended through the skull base to the nasal cavity, paranasal sinuses, upper and middle clivus. We have used the nasal cheek flap since 1992 with good aesthetic and functional results. Aim of the present study was to analyse personal experience, focusing on complications, aesthetic results and self-evaluation expressed by the patients.

Angiogenesis: prognostic significance in laryngeal cancer.

The aim of this study was to evaluate the role of angiogenesis in the progression of laryngeal squamous cell carcinoma (LSCC). We correlated disease-free survival with microvessel count (MC) in the hot spot areas of 97 randomly selected caucasian males with LSCC followed for 60 to 90 months after surgery with or without radiotherapy. The results obtained indicate that: a) MC higher than 130 microvessels/mm2 is a cut-off value that distinguished patients who relapsed during the follow up period; b) multivariated analysis indicates that MC (p < 0.00001) is an independent predictor of disease free-survival; c) multivariated analysis selectively done on cases with relapse demonstrates that MC correlates with the presence of metastasis (or/and M) with local relapse (T). We suggest that MC is useful in the assessment of prognosis in LSCC and probably will permit selection of patients that could benefit from anti-angiogenic therapy associated with chemotherapy and/or radiotherapy.

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.

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. STUDY DESIGN: Follow-up of a total of eight patients who had surgery using ileocolic free graft. METHODS: The surgical technique is described. Five patients underwent pharyngolaryngectomy/cervical esophagectomy, and three patients had total laryngectomy with subtotal pharyngectomy. Patients were monitored to assess complications and recovery of satisfactory swallowing and speech. RESULTS: The technique, thanks to the use of material from the colon, proved to be extremely useful for the reconstruction of the digestive tract. At the same time, ileal anastomosis with the tracheal stump enabled aerodigestive crossing restoration, protected by the ileocecal valve. All patients recovered good swallowing capacity and phoniatric expression, which were obtained by digital occlusion of the tracheostomy, forcing the expiratory air through the ileum and ileocecal valve. Manometric tests also showed that after a while there was a gradual synchronization of swallowing between the transplanted colic segment and the residual esophagus. CONCLUSIONS: The technique described in the present study may be regarded, also in the light of possible further applications, as a new and interesting option for the reconstruction of the aerodigestive tract.

Relationships between cervical node histological patterns and rosette test scores: possible prognostic value in laryngeal cancer.

In previous research the authors have remarked that some hystological patterns--macrophagic hyperplasia and thymus-dependent areas hyperplasia--when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value. In this study the possible relationship between the results of E and EAC-rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found. Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.

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. STUDY DESIGN: A double-blind randomized multicenter trial of 102 patients with allergic rhinitis who were treated with specific LNIT for 8 consecutive months. METHODS: After identifying allergens with the skin prick test and sensitization threshold dose with the specific nasal provocation test, 102 patients were selected, of whom 55 were allergic to mites and 47 were allergic to Graminaceae or Parietaria pollen. The specific treatments were self-administered using an insufflator in two phases (phase 1: increasing doses; phase: 2, maintenance dose). Patients were evaluated before and after 32 weeks of treatment by subjective analysis of their self-reported symptoms and by objective analysis of nasal provocation test, nasal resistance by anterior rhinomanometry, and mucociliary clearance time. RESULTS: Clinical efficacy of LNIT for allergy to mites and pollens was confirmed by the differences in the symptoms score between the active group and the placebo group. The nasal provocation test results confirmed that this difference was statistically significant. The rhinomanometric analysis gave positive results for the treated group mainly in LNIT for mites. No differences in mucociliary clearance time were found. CONCLUSIONS: Specific LNIT is effective for allergic rhinitis and appears to offer considerable advantages over other hyposensitization methods. It can be done at home, patient compliance is good, and the treatment is safe.

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: the LIF production in lymphocytes derived from the peripheral blood and cervical nodes of patients with laryngeal carcinoma by using an autologous pattern (i.e., for each patient, the specific LIF production was challenged by means of an autologous cell extract derived from his own tumor); the influence of histologically confirmed cervical node metastases on LIF production. Our results indicate that: There is a significant decrease in LIF production in patients with histologically proven cervical node metastases as compared to patients with no metastatic foci. The decrease of LIF production is related to the presence of mononuclear adherent cells. When the latter are removed, there is a significant reversal of specific LIF suppression. The possible meaning of the data is discussed.

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.

Nasal secretory IgA circadian rhythm: a single-dose suppression test.

The existence of a clear circadian rhythm in the local secretion of nasal IgA is well-known phenomenon which is confirmed in the present research. Since the temporal pattern of secretory IgA (SIgA) strictly parallels the ACTH-cortisol cycle, a dependence was hypothesized in previous research, but the suppression of adrenal rhythm by means of massive doses of exogenous corticosteroids showed no influence on the SIgA cycle. In the present research a more sophisticated method of corticoid-incretion suppression was used; the single-dose suppression test with dexamethasone, which influences only the impulsive phase of the rhythm. In this case too, however, no influence was demonstrated on nasal SIgA secretion.

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.

Hemodiafiltration without replacement fluid. An experimental study.

Paired filtration dialysis (PFD) is the only hemodiafiltration (HDF) technique in which the ultrafiltrate is continuously available but not mixed with the dialysate. As is the case during all convective or predominantly convective techniques, use of a replacement fluid is necessary in an amount equal to the difference between the ultrafiltrate and the desired patient weight loss. This replacement fluid must have an adequate electrolytic composition (Na+, Ca++, and buffer), and must be sterile and pyrogen free. Using an uncoated adsorbent charcoal cartridge (130 g), the ultrafiltrate obtained in PFD was regenerated, eliminating both the small (except for urea, glucose, and phosphates) and medium-to-large solutes but not the electrolytes and bicarbonate. This verified the ultrafiltrate's possible use as replacement fluid. This technique experimentally studied during 24 standard PFD sessions, with a total mean ultrafiltrate of 9,950 +/- 860 ml, allowed a replacement solution to be obtained with the following mean +/- SD composition: pH 7.467 +/- 0.122, HCO3- 27.0 +/- 2.12 mmol/L, Na+ 137.4 +/- 2.6 mmol/L, K+ 4.1 +/- 0.83 mmol/L, Ca++ 1.12 +/- 0.19 mmol/L, urea 68.3 +/- 16.2 mg/dl, creatinine 0.08 +/- 0.02 mg/dl, uric acid 0.05 mg/dl, phosphates 2.77 +/- 0.71 mg/dl, beta-2 microglobulin 0.5 +/- 0.4 mg/L, and atrial natriuretic peptide 4.41 +/- 5.6 pg/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Specific LIF production in laryngeal cancer patients: evidence of suppressor activity exerted by adherent cells.

The specific tumor-induced LIF production in 30 laryngeal cancer patients has been investigated before and after the removal of adherent cells to evaluate the existence of a suppressor activity. LIF production, after challenging lymphocytes with 3 M KCI autologous tumor extracts, was significant in 16 patients and showed a further significant increase after removal of adherent cells. A conversion to significance when the adherent cells were removed was shown in 6 patients, with no previous significant LIF production. These data suggest the existence of a suppressor activity exerted by adherent cells on LIF production in laryngeal cancer patients.

Use of the ultrafiltrate obtained in two-chamber (PFD) hemodiafiltration as replacement fluid. Experimental ex vivo and in vitro study.

PFD (Paired Filtration Dialysis) is the only hemodiafiltration (HDF) technique in which the ultrafiltrate (UF) is continuously available not mixed with the dialysate. As with all convective or prevailingly convective techniques, a replacement fluid is necessary in an amount equal to the difference between the UF and the desired weight loss. This replacement fluid (R) must have an adequate electrolytic balance (Na+, Ca++, and buffer), and must be sterile and pyrogen-free. Using an uncoated adsorbent charcoal cartridge, we "regenerated" the UF obtained in PFD, eliminating the small (except for urea, which was later eliminated by diffusion in the dialyzing section of the PFD system) and the medium-to-large molecules (vit B12 and myoglobin in vitro and beta-2-microglobulin (B2m) and (hANP) in vivo), but not the electrolytes and the endogenous bicarbonate, so as to verify its possible use as R. This technique, experimentally performed in 12 patients under HDF treatment with standard PFD, with a total mean UF of 9650 +/- 875 ml and the use of 130 g of uncoated charcoal, produced a solution with the following composition: Na+ 135.4 +/- 2.4 mmol/l, K+ 3.4 +/- 1.23 mmol/l, Ca++ 1.18 +/- 0.14 mmol/l, HCO3- 26.7 +/- 2.3 mmol/l, phosphates 2.88 +/- 0.81 mg/dl, urea 63 +/- 14 mg/dl, creatinine 0.08 +/- 0.02 mg/dl, uric acid 0.05 +/- 0.0 mg/dl, beta-2 microglobulin 0.5 +/- 0.5 mg/l, and hANP 4.15 +/- 5 pg/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospects and limitations of systematic monitoring in patients with laryngeal cancer.

The authors report the first results concerning the systematic use of "immunological monitoring" in patients suffering from well-developed laryngeal cancer. The authors have also studied, in 50 cases in different stages of development, the activity of T-cells using the cutaneous tests (BCG, PPD, PHA and SK-SD), the E-rosette test and the PHA-induced lymphocytic blastization test (it is well known that the T-cells are responsible for a cytotoxic effect against neoplastic cells). The authors have also studied the activity of B-lymphocytes by means of the EA and EAC rosette test and of IgG, IgA, IgM and complement serum titles. They have observed a progressive depression of the T-cell activity after surgical intervention, whereas the B-cell activity in several cases tends to increase. The authors discuss these immunological results and the possibility that these findings may represent the basis for a complementary immunotherapy following the surgical treatment and/or radiotherapy or chemotherapy. Finally, the authors discuss the possibilities and the limitations of these immunological methods from the point of view of clinical application.

Enlarged approach to the anterior cervical spine.

In this report a new enlarged approach to the anterior cervical spine is presented. A 66-year-old female, having a large C3-C4-C5 chordoma, recurrent after surgery and following radiotherapy, underwent a surgical resection. The approach allows a wide retraction of the nasopharynx, oropharynx and larynx from the midline, only sacrificing the superior laryngeal nerve on one side. Its continuity can be re-established later by adopting the stent in tube technique. The approach we used presents all the risks of infection common in trans-oral approaches. For this reason, closure of the pharynx in two layers must be meticulous and watertight and reinforced by using a myofascial sternocleidomastoid flap, according to the tracheoesophageal fistula closure technique. A correct alignment of the tongue, the pre-plating of the mandible and the correct suture of the vermillion border guarantee excellent cosmetic and functional results.

[General aspects of secondary prevention and possible interventions applicable to squamous carcinoma of the upper respiratory-digestive tract]. / Aspetti generali di prevenzione secondaria e possibili interventi applicativi sul carcinoma squamoso delle vie aero-digestive superiori.

The authors report some aspects of secondary prevention, including screening programs. General standards for screening programs are first analyzed; standards including a) definition of the problem and its social importance; b) tumor natural history; c) diagnostic test characteristics; d) therapeutic possibilities; e) evaluation of results. The problem of selective screenings are then discussed as they attempt to reduce costs and maximize benefits.

[Complications of rhinoplasty]. / Complicanze della rinoplastica.

For an operation as technically demanding as rhinoplasty, surprisingly few studies have examined the results of this procedure. A retrospective study was, therefore, made of 5470 patients who had undergone rhinoplasty, performed by different surgeons, from 1970 to 1989. The patients were followed up for a minimum of one year. As for all forms of surgery, aspecific complications such as infections, hemorrhage and side-effects from anesthesia will occasionally occur but, fortunately, such cases are quite rare. The specific classification included both early and late complications. Post-rhinoplasty failures may be estimated at approximately 28% of all cases; this figure taking into account typical deformities, both minor and severe, as well as functional sequelae and patient dissatisfaction. Approximately 4% have required secondary procedures. Some causes for failure derive from patient characteristics; for example, the importance and complexity of initial deformity are, of course, partly responsible, particularly after trauma. The skin quality (i.e. thickness, or whether it is fatty or loose) also affects the results. Furthermore, uncontrollable factors inherent to healing (i.e. excessive scar contraction in the intranasal area, connective tissue hyperplasia, particularly at the tip, and periosteal proliferation either to the osteotomy site or over the nasal dorsum) can all lead to residual deformities. Nevertheless, most failures can be attributed the operator. The commonest mistakes are linked to cartilaginous dorsum and nasal tip (approx. 22%). There are several polymorphic deformities the main sites of which should be known well in order to prevent, or at least reduce, such risks.

[Vestibular rehabilitation of patients suffering of vertigo: literature review and personal experience]. / La rieducazione vestibolare del paziente vertiginoso: rassegna della letteratura ed esperienze personali.

The paper reports the results of a study on the effectiveness of vestibular rehabilitation therapy in patients suffering from vertigo, mostly in those cases in which spontaneous compensation is only slight or not achieved at all. The main aim or rehabilitation training is to foster functional compensation between the two vestibular hemisystems. Fifty patients were divided into two groups: those with labyrinthine vertigo, who underwent therapy which included vestibular habituation training (VHT); those with disequilibrium, who received balance coordination training. The results turned out successfully in 75% of those patients belonging to the first group, whereas patients in the second group showed relevant improvement of subjective symptoms related to imbalance, confirmed by the results of post-urographic assessment. Moreover, the severity of vertigo decreased by about 50% with regard to initial intensity after the first week of treatment and reduced considerably by the end of the second week.