Short-term postoperative distress associated with open vs. transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis.

BACKGROUND: This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis. METHODS: A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level. RESULTS: Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence. CONCLUSIONS: The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.

The head problem. The organizational significance of segmentation in head development.

This review argues for the segmental basis of chordate head organization which, like somite-based segmental organization in the trunk, takes its origin from early mesodermal development. The review builds on, and brings up to date, Goodrich's well-known scheme of head organization. It surveys recent data in support of this scheme and shows how evidence and arguments supposedly in conflict with it can be accommodated. Many of the arguments revolve around matters of methodology; the limitations of older LM, SEM (on which the concept of "somitomeres" is based) and recent molecular evidence (which has sometimes been seen as allocating the central role in head organization to the CNS and the neural crest) are highlighted and shown to explain a number of claims contrary to Goodrich's. We provide (in Part 2) a new, comparative survey of the best available evidence most directly relevant to the Goodrich Bauplan, with a special emphasis on stem chordates. The postotic region has commonly been seen as segmentally organized: the critical issues concern the preotic region. There are many reasons why Goodrich's three preotic segments may become specialized during evolution and why the underlying initial segmental organization may be overridden in later stages during embryonic development; we refer to a number of these. We conclude that the preotic segmental Bauplan is remarkably conserved and most explicitly demonstrated among stem forms, but we also suggest that the concept of the prechordal plate requires careful reexamination. Central to our overall analysis is the importance of the epigenetic nature of embryogenesis; its implications are made clear. Finally we speculate on evolutionary implications for the origin of the head and its specialized features. The review is intended to serve as a resource giving access to references to a wealth of now neglected, older data on anamniote embryology.

Developmental relation between palatine tonsils and kidney.

The evolutionary changes of the immune process in the whole line of representatives of the organisms were followed. The immune organs responsible for processing the antigens evolved from the derivatives of coelomic lining over the gut folds to the immune organs developed in the gill region of the digestive tract. Among them the tonsils have to be considered as a very modern evolutionary immune organ. They develop also as the latest in ontogeny even though their primordium contributes very early to the IgA production. The results of the host-antigen reactions have to be eliminated by the excretory organs, which are in invertebrates represented by body poruses and various types of simple segmentally arranged nephridia which are in contact with the gills. These nephridia have evolved in lower vertebrates in pronephros, further in mesonephros and finally in kidneys with filtrating nephrons. In case of defective elimination, the more voluminous immunocomplexes can form the subendothelial or mesangial deposits.