Laryngotracheal stenosis treated with multiple surgeries: experience, results and prognostic factors in 70 patients.

Laryngotracheal stenosis is a complex condition that usually requires multiple procedures to restore physiological respiration. The aim of this study was to evaluate the percentage of decannulation compared to different or multiple surgical treatments. We retrospectively reviewed the charts of 70 patients treated between 1990 and 2005 for laryngotracheal stenosis of various aetiology: iatrogenic stenosis (n = 55), post-traumatic stenosis (n = 11) or other causes (autoimmune disease, n = 3; diphtheria, n = 1). In order to maintain laryngotracheal patency, a Montgomery Safe-T tube was used in all patients as a single dilation treatment or associated with endoscopic and/or open-neck surgery. Fifty-four of the 70 patients (77.1%) were eventually decannulated; 39 of these (72.2%) underwent 3 or fewer surgical procedures, showing a significant difference compared to patients who underwent more than 3 surgeries (p = 0.00002). A total of 257 surgeries were performed. Only seven of 54 patients (13%) were decannulated after more than 5 surgical procedures. Patients over 60 years of age and with a higher grade of stenosis showed a significantly lower success rate (p = 0.0017 and p = 0.007, respectively). There was no significant correlation between the rate of decannulation and gender, aetiology, site of stenosis or surgery. Patients undergoing dilation for laryngotracheal stenosis usually require multiple procedures. The T tube plays an important role in the treatment of this pathology. However, if the tracheostomy is not removed within 3 surgical interventions, the odds of decannulating the patient decrease significantly, and additional surgeries may be of questionable therapeutic benefit.

Lipoma of the larynx: a case report.

Lipoma is a benign tumour of mesenchymal origin with a very rare occurrence in the upper aero-digestive tract. To date, approximately 100 cases have been described in the literature. This lesion has a slow growth and, therefore, can present with various symptoms due to the mass effect with obstruction and compression on neighbouring structures, including dysphagia for liquid and solid food, dyspnoea and hoarseness. For a precise pre-operative diagnosis, indirect or direct laryngoscopy (flexible fibre-optic laryngoscopy) can be employed or, if necessary, also imaging techniques such as computed tomography scan and magnetic resonance imaging scan. These offer more useful information for better treatment planning. Surgery is the treatment of choice and includes endoscopic techniques and an external surgical approach (cervicotomy). It is very important to completely remove these benign neoplasms in order to avoid local recurrence. The present report referring to a case of laryngeal lipoma removed through an external surgical approach, aims to demonstrate that the choice of an external surgical approach is required for complete surgical removal of a large lipoma in order to prevent any possible recurrence. Furthermore, it is useful to keep in mind the possibility of recurrence of lipomas after long free intervals; therefore, it is mandatory to observe these patients at long-term follow-up.

[Determination of the diagnostic value of erythrocyte discrimination indices (Mentzer and Srivastava) and of glycerol lysis time (GLT 50) in microcytosis]. / Contributo alla precisazione del valore diagnostico di alcuni indici discriminanti eritrocitari (Mentzer e Srivastava) e del tempo di lisi al glicerolo (GLT50) nelle microcitosi.

Many authors proposed erythrocytes discriminating functions to differentiate most common microcythemic hypochromic anemias (beta-thalassemia and iron deficiency). This study considers two of these discriminating functions: 1. Mentzer's index; 2. Srivastava's index; and also test GLT50 proposed by Authors with the same aim. The purpose is to quantify the percent of false positive and false negative results of such tests. As standard the test of measurement HbA2 and HbF was used to classify thalassemic patients. The results prove that the Mentzer test is the best while, not highly specific (20% false positive), but we did not find any false negatives in our study. Srivastava's method for the presence of false negatives (7% of thalassemic patients) is less reliable, and even less so the GLT50 test (30% of thalassemic patients).