Giant neck liposarcoma with pathological clavicular fracture.

Liposarcomas generally originate in the extremities or retroperitoneum, they are very unusual in the head and neck region, and extremely rare in the thorax. The mainstay of treatment for liposarcomas is surgical excision. We report a very unusual case, not reported before to our knowledge, of a well-differentiated liposarcoma arising from the supraclavicular fossa that produces a pathological clavicular fracture. The patient underwent complete resection of the lesion, without damage of the cervical nerves. Eight months after the surgery the patient is free of recurrence. We demonstrate that giant liposarcomas can be resected completely without morbidity.

[Factors predicting Voice Handicap Index]. / Indice de Incapacidad Vocal: factores predictivos.

OBJECTIVE: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. MATERIAL AND METHODS: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. RESULTS: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. CONCLUSIONS: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia.

Índice de Incapacidad Vocal: factores predictivos / Factors predicting óbice handicap index

Objetivo: Evaluar los factores que pueden influir en la percepción de la disfonía por parte del paciente, cuantificada mediante el Índice de Incapacidad Vocal (VHI). Material y método: Se realiza un estudio prospectivo de 81 registros vocales de pacientes diagnosticados de una patología benigna de las cuerdas vocales. Las variables analizadas para calcular la predicción sobre el VHI son: tiempo máximo de fonación, análisis del espectrograma, jitter, shimmer, HNR, NNE, Fo y el análisis perceptual de la disfonía (GRABS). Resultados: Los parámetros predictivos de la puntuación total del VHI fueron la relación armónico ruido (HNR), la frecuencia fundamental (F0) y los parámetros B y S del sistema GRABS. Conclusiones: La puntuación del VHI se correlaciona con la percepción de la voz aérea y sus atributos acústicos, como la relación señal-ruido. En otros estudios, la percepción de la disfonía por parte del paciente es independiente de muchos factores que se valoran de forma rutinaria en la evaluación de los trastornos de la voz. Parece razonable asumir que el grado de insuficiencia glótica causada por lesiones vocales benignas se relacione con una baja relación señal-ruido y con la voz aérea como su característica perceptual. La subescala física parece ser un elemento independiente

Objective: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. Material and methods: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. Results: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. Conclusions: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia

[Quantitative spectral evaluation of vocal hypofunction]. / Evaluación espectral cuantitativa de la hipofunción vocal.

The purpose of this study was to explore the interaction between voice asthenicity and the acoustic prediction of vocal hypofunction. One hundred and seven phonatory samples of Reinke's edema were categorized by listeners using GRBAS scale. Seven frequency and time domain parameters were used to predict perceptual severity of asthenicity. Logistic regresion analysis showed that a useful measure for the prediction of asthenicity was the loss of harmonic components in the middle and upper portion of the spectrum. A spectral classification of vocal hypofunction is proposed.

[Perceptual evaluation of dysphonia: correlation with acoustic parameters and reliability]. / Evaluación perceptual de la disfonía: correlación con los parámetros acústicos y fiabilidad.

The perceptual GRBAS scale for analysis of voice quality is quite important clinically in voices that cannot be effectively analyzed with a voicing parameter method like vocalizations with strong subharmonics and modulations and in chaotic or random voices. In the present study, two experiments were performed: Firstly, GRBAS/acoustical correlations were investigated in 107 pathological voices. Secondly, the GRBAS interrater and intrarater agreement. The severity of dysphonia was assesed better by breath related parameters and low fundamental frequencies. The presence of subharmonics in the power spectrum had not a significant relationship with the degree of roughness. A (asthenic) and S (strain) scales. The results of this study show that GRBAS test-retest reliability and intrerrater agreement is high.

Evaluación espectral cuantitativa de la hipofunción vocal / Quantitative spectral evaluation of vocal hypofunction

El propósito del presente estudio es el de explorar la interacción entre la astenia vocal y la predicción acústica de la hipofunción vocal. Ciento siete muestras de voz de edema de Reinke fueron clasificadas usando el sistema GRBAS. Se utilizaron siete parámetros acústicos para predecir la severidad perceptual de astenia. Las pruebas de regresión logística mostraron que la pérdida de componentes armónicos en las porciones medias y altas del espectro son útiles para la predicción de la astenia vocal. Se propone una clasificación espectrográfica de la hipofunción vocal (AU)

The purpose of this study was to explore the interaction between voice asthenicity and the acoustic prediction of vocal hypofunction. One hundred and seven phonatory samples of Reinke's edema were categorized by listeners using GRBAS scale. Seven frequency and time domain parameters were used to predict perceptual severity of asthenicity. Logistic regresion analysis showed that a useful measure for the prediction of asthenicity was the loss of harmonic components in the middle and upper portion of the spectrum. A spectral classification of vocal hypofunction is proposed (AU)

Evaluación perceptual de la disfonía: correlación con los parámetros acústicos y fiabilidad / Perceptual evaluation of dysphonia: correlation with acoustic parameters and reliability

El análisis de la calidad vocal mediante la escala perceptual GRBAS tiene importancia clínica para las voces que no pueden ser estudiadas mediante la determinación de sus parámetros acústicos tales como las vocalizaciones con fuertes subarmónicos y modulaciones y las voces caóticas o aperiódicas. En el presente estudio se realizaron dos experimentos: Primero, se investigó la correlación entre los parámetros acústicos y la escala GRBAS en 107 voces patológicas. Segundo, la coincidencia intra e interobservador del GRBAS. La severidad de la disfonía se correlacionó con parámetros relacionados con la voz aérea y con frecuencias fundamentales bajas. La presencia de subarmónicos en el espectrograma no mostró una relación significativa con el grado de aspereza. La fiabilidad intra e interobservador del sistema GRBAS es alta (AU)

The perceptual GRBAS scale for analysis of voice quality is quite important clinically in voices that cannot be effectively analyzed with a voicing parameter method like vocalizations with strong subharmonics and modulations and in chaotic or random voices. In the present study, two experiments were performed: Firstly, GRBAS/acoustical correlations were investigated in 107 pathological voices. Secondly, the GRBAS interrater and intrarater agreement. The severity of dysphonia was assesed better by breath related parameters and low fundamental frequencies. The presence of subharmonics in the power spectrum had not a significant relationship with the degree of roughness. A (asthenic) and S (strain) scales. The results of this study show that GRBAS test-retest reliability and intrerrater agreement is high (AU)

[Laser cordectomy: oncologic outcome and functional results]. / Cordectomías láser: resultados oncológicos y funcionales.

OBJECTIVE: Early glottic carcinoma can be effectively treated with radiation or endoscopic laser surgery. We evaluated our experience treating early glottic cancer with laser CO2 surgery. MATERIAL AND METHODS: 64 patients with Tis, T1 and T2 carcinoma, who underwent endoscopic CO2 laser excision between January 1999 and July 2002, were retrospectively analyzed. We performed an objective and subjective evaluation of speech, and evaluation of physical, emotional and functional well being. The mean follow-up was thirty months. RESULTS: No patient died of this laryngeal neoplasm. Local control was achieved in 96% (62/64). Two patients with recurrence required total laryngectomy as savage treatment. Cause-specific survival was 100%, and overall survival was 98% (63/64). Voice quality was affected by laser surgery but impact on the quality of life was minor. CONCLUSIONS: Laser cordectomy for treatment of early glottic cancer is a valid alternative to radiation, with good outcome for voice and minimum impact on quality of life.

Cordectomías láser: resultados oncológicos y funcionales / Laser cordectomies: outcomes and functional results

Objetivo: El carcinoma glótico en estadios iniciales puede tratarse eficazmente con radioterapia o con cirugía endoscópica láser. Evaluamos nuestra experiencia en el tratamiento del carcinoma glótico en estadios iniciales con cirugía láser CO2. Material y método: Estudio retrospectivo de 64 pacientes con tumores Tis, T1 y T2 glóticos a quienes se les realizó una resección endoscópica láser CO2 entre enero de 1999 y julio de 2002. Se realizó una valoración objetiva y subjetiva de la voz y una valoración del bienestar físico, emocional y funcional. El seguimiento medio fue de 30 meses. Resultados: Ningún paciente murió a consecuencia de su carcinoma de laringe. El control local fue del 98 por ciento (62/64). A los dos pacientes con recidiva local se rescató con una laringectomía total. La supervivencia causa-específica fue del 100 por ciento y la supervivencia global del 98 por ciento (63/64). La calidad de la voz se afectó tras la cirugía, pero el impacto que tiene en la calidad de vida es pequeño. Conclusiones: La cordectomía láser para tratar el carcinoma glótico en estadios iniciales es una alternativa válida a la radioterapia, con buen pronóstico y un pequeño impacto en la calidad de vida (AU)

OBJECTIVE: Early glottic carcinoma can be effectively treated with radiation or endoscopic laser surgery. We evaluated our experience treating early glottic cancer with laser CO2 surgery. MATERIAL AND METHODS: 64 patients with Tis, T1 and T2 carcinoma, who underwent endoscopic CO2 laser excision between January 1999 and July 2002, were retrospectively analyzed. We performed an objective and subjective evaluation of speech, and evaluation of physical, emotional and functional well being. The mean follow-up was thirty months. RESULTS: No patient died of this laryngeal neoplasm. Local control was achieved in 96% (62/64). Two patients with recurrence required total laryngectomy as savage treatment. Cause-specific survival was 100%, and overall survival was 98% (63/64). Voice quality was affected by laser surgery but impact on the quality of life was minor. CONCLUSIONS: Laser cordectomy for treatment of early glottic cancer is a valid alternative to radiation, with good outcome for voice and minimum impact on quality of life (AU)

[Inactivation of p53 and amplification of cyclin D1 in squamous cell carcinomas of the head and neck]. / Inactivación de P53 y amplificación de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello.

P53 and CCND1 (cyclin D1) genes play a critical role in the cell cycle regulation. Abnormalities of these genes are frequent in different types of cancers, including those of the head and neck. The aim of this work is to investigate whether P53 inactivation (determined by loss of heterozygosity analysis) is related to CCND1 gene amplification (determined by differential PCR analysis), and if these alterations are correlated with clinical outcome in a series of 56 patients with squamous cell carcinoma of the head and neck. Loss of heterozygosity of the P53 gene was found in 39 cases (70%) and CCND1 amplification in 17 cases (30%). Both abnormalities together were found in 11 cases (20%), without a significant association between them (P = 0.83). No relationship was found between P53 inactivation, the clinico-pathological parameters analyzed and the clinical outcome. CCND1 amplification was associated with advanced T-stages (P = 0.02), nodal metastases (P = 0.01) and a decreased survival (P = 0.002). The combination of both abnormalities shows a pattern that seems to be additive, since it was associated with an increase in tumor recurrences and a decrease in survival that was higher than for either of them individually. In conclusion, P53 and CCND1 abnormalities are frequent in squamous cell carcinomas of the head and neck. The combined analysis of these abnormalities seems to be more informative than either of them individually and may have a prognostic value in these carcinomas.

Inactivación de P53 y amplificación de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello / Inactivation of P53 and amplification of cyclin D1 in squamous cell carcinomas of the head and neck

Los genes P53 y CCND1 (ciclina D1) juegan un papel clave en el control del ciclo celular. Las anomalías de dichos genes son frecuentes en diversos tipos de cánceres, incluyendo los de cabeza y cuello. El objetivo de este estudio es investigar sí existe una relación entre la inactivación del gen P53 (determinada como pérdida de heterocigosidad) y la amplificación del gen CCND1 (determinada mediante PCR diferencial) y si dichas anomalías se correlacionan con el pronóstico en una serie de 56 carcinomas epidermoides de cabeza y cuello. Se halló pérdida de heterocigosidad del gen P53 en 39 casos (70 por ciento) y amplificación del gen CCND1 en 17 casos (30 por ciento). Ambas anomalías fueron encontradas conjuntamente en 11 casos (20 por ciento), no habiendo una relación significativa entre ellas (P=0,83).La inactivación de P53 no se asoció con ninguno de los parámetros clínicopatológicos analizados, ni con la evolución de los pacientes. La amplificación del CCND1 se relacionó con estadios T avanzados (P=0,02), con la presencia de metástasis ganglionares (P=0,01) y con una menor supervivencia (P=0,002). La combinación de ambas anomalías genéticas parece tener un patrón aditivo, pues se asoció con una mayor incidencia de recidivas tumorales y con una peor supervivencia que los casos con una sola de las alteraciones. En conclusión, las anomalías de los genes P53 y CCND1 son frecuentes en los carcinomas epidermoides de cabeza y cuello. Cuando se consideran conjuntamente son más informativas que cada una de ellas individualmente y podrían tener valor pronóstico en estos carcinomas. (AU)

P53 and CCND1 (cyclin D1) genes play a critical role in the cell cycle regulation. Abnormalities of these genes are frequent in different types of cancers, including those of the head and neck. The aim of this work is to investigate whether P53 inactivation (determined by loss of heterozygosity analysis) is related to CCND1 gene amplification (determined by differential PCR analysis), and if these alterations are correlated with clinical outcome in a series of 56 patients with squamous cell carcinoma of the head and neck. Loss of heterozygosity of the P53 gene was found in 39 cases (70%) and CCND1 amplification in 17 cases (30%). Both abnormalities together were found in 11 cases (20%), without a significant association between them (P = 0.83). No relationship was found between P53 inactivation, the clinico-pathological parameters analyzed and the clinical outcome. CCND1 amplification was associated with advanced T-stages (P = 0.02), nodal metastases (P = 0.01) and a decreased survival (P = 0.002). The combination of both abnormalities shows a pattern that seems to be additive, since it was associated with an increase in tumor recurrences and a decrease in survival that was higher than for either of them individually. In conclusion, P53 and CCND1 abnormalities are frequent in squamous cell carcinomas of the head and neck. The combined analysis of these abnormalities seems to be more informative than either of them individually and may have a prognostic value in these carcinomas (AU)

[Preoperative evaluation in thyroplasty: the laryngeal lateral compression]. / Valoración preoperatoria de la tiroplastia: el test de compresión lateral de la laringe.

Thyroplasty type I has provided significant improvement to the treatment of patients with glottal incompetence. It is essential that patients be preoperatively evaluated using objective criteria. Laryngeal manual compression test are manipulations of the thyroid and cricoid cartilages that result in modifications of the position of the vocal folds. The most valuable laryngeal manual compression test for patients with glottal insufficiency is the lateral compression test. When this test results in a preoperative improvement in voice suggest that surgery will be successful. In this paper we present the objective evaluation of the effects of lateral compression test upon glottic incompetence by means of narrow band power spectrum analysis.

Valoración preoperatoria de la tiroplastia: el test de compresión lateral de la laringe / Preoperative assessment of tryroplasty: the lateral compression test of the larinx

La tiroplastia tipo I ha supuesto una importante mejora en el tratamiento de los pacientes con una incompetencia glótica. La valoración preoperatoria de estos pacientes mediante criterios objetivos es primordial. Los test de compresión manual de la laringe consisten en la manipulación de los cartílagos tiroides y cricoides, produciendo cambios en la posición de las cuerdas vocales. El test más valorado en la incompetencia laríngea es el test de compresión alar. Si se percibe una mejoría de la voz en el preoperatorio al realizar este test sugiere que la cirugía tendrá éxito. En este trabajo se presenta la evaluación objetiva del test de compresión alar sobre la glotis incompetente usando la espectrografía de banda estrecha (AU)

Thyroplasty type I has provided significant improvement to the treatment of patients with glottal incompetence. It is essential that patients be preoperatively evaluated using objective criteria. Laryngeal manual compression test are manipulations of the thyroid and cricoid cartilages that result in modifications of the position of the vocal folds. The most valuable laryngeal manual compression test for patients with glottal insufficiency is the lateral compression test. When this test results in a preoperative improvement in voice suggest that surgery will be successful. In this paper we present the objective evaluation of the effects of lateral compression test upon glottic incompetence by means of narrow band power spectrum analysis (AU)

[Use of narrow-band spectrogram in voice surgery]. / Aplicación del espectrograma de banda estrecha en fonocirugía.

Subjective voice qualities are difficult to transform into permanent objective visual patterns. Voice spectrography is not a new method of voice analysis. However, in spite of many contributions to the literature, few otolaryngologists have used this interesting method as a clinical tool for evaluating the voice before and after surgical voice procedures. We used the Yanagihara method for classifying degrees of hoarseness, witch is based on the appearance of noise components and loss of harmonic components as the major acoustic factors related to hoarseness. This classification is clinically useful because the severity of hoarseness can be numerically expressed. Changes in the harmonic components were analyzed by voice spectrographic analysis.

[Spectrographic study of voice disorders: subharmonics]. / Estudio espectrográfico de la disfonía: subarmónicos.

The presence of subharmonics in abnormal adult voices (polyps, polypoid degeneration, plicae ventricularis) was investigated. Subharmonics are low-frequency modulations located between two consecutive harmonics in the spectrum. Spectrum analysis was performed on 115 abnormal voices, of which 36 (31%) had subharmonics. Thirteen of the 36 voices with subharmonics had normal jitter and shimmer, so the rough voice was characterized acoustically not only by jitter and shimmer but by the presence of subharmonics in the spectrum. Subharmonics may correspond to a qualitative change in the behavior of the vibratory system.

Aplicación del espectrograma de banda estrecha de fonocirugía / Use of narrow-band spectrogram in voice surgery

Las cualidades subjetivas de la voz son difíciles de transformar en patrones visuales objetivos. La espectrografía no es un método novedoso de análisis de la voz, pero a pesar de numerosos trabajos presentes en la literatura, pocos otorrinolaringólogos utilizan este interesante método como una herramienta clínica para la evaluación de la voz antes y después de realizar intervenciones fonoquirúrgicas. Nosotros hacemos uso de la clasificación según el método de Yanagihara en grados de severidad de la disfonía que se basa en la aparición de componentes de ruido y la pérdida de componentes armónicos en el espectro de una voz disfónica. Esta clasificación es clínicamente útil dado que el grado de severidad de la disfonía se puede expresar de forma numérica. En este trabajo se analizan los cambios en los componentes armónicos y la suma de componentes de ruido en las disfonías basándonos en el análisis espectrográfico de la voz (AU)

Subjective voice qualities are difficult to transform into permanent objective visual patterns. Voice spectrography is not a new method of voice analysis. However, in spite of many contributions to the literature, few otolaryngologists have used this interesting method as a clinical tool for evaluating the voice before and after surgical voice procedures. We used the Yanagihara method for classifying degrees of hoarseness, witch is based on the appearance of noise components and loss of harmonic components as the major acoustic factors related to hoarseness. This classification is clinically useful because the severity of hoarseness can be numerically expressed. Changes in the harmonic components were analyzed by voice spectrographic analysis (AU)

Estudio espectrográfico de la disfonía: subarmónicos / Spectrographic study of voíce disorders: subharmonics

Este estudio investiga la presencia de subarmónicos en voces adultas patológicas (pólipos, edema de Reinke, disfonía ventricular). Los subarmónicos son trazados de baja frecuencia localizados entre dos armónicos consecutivos en el espectrograma. Se realizó un espectrograma en 115 voces patológicas, 36 de las cuales presentaron subarmónicos (31 por ciento). 13 de las 36 voces con subarmónicos presentaban valores normales de jitter y shimmer, por lo que la voz áspera se caracteriza acústicamente no sólo por las alteraciones deljittery shimmer sino tambiénpor la presencia de subarmónicos en el espectro. Los subarmónicos pueden corresponder a un cambio cualitativo en la conducta del sistema vibratorio (AU)

The presence of subharmonics in abnormal adult voices (polyps, polypoid degeneration, plicae ventricularis) was investigated. Subharmonics are low-frequency modulations located between two consecutive harmonics in the spectrum. Spectrum analysis was performed on 115 abnormal voices, of which 36 (31%) had subharmonics. Thirteen of the 36 voices with subharmonics had normal jitter and shimmer, so the rough voice was characterized acoustically not only by jitter and shimmer but by the presence of subharmonics in the spectrum. Subharmonics may correspond to a qualitative change in the behavior of the vibratory system (AU)

[Objective evaluation of vocal pathology in childhood]. / Evaluación objetiva de la patología vocal en la infancia.

Voice disorders in children are often described as existing on a continuum with anatomic or physiologic causes at one end and functional or psychogenic causes at the other. In this study we report the objective evaluation of the voice disorders on 48 school children. The evaluation was made by means of laryngostroboscopy, acoustic analysis of the voice and narrow-band spectrography. The stroboscopic examination was performed on more than a half of the patients, resulting in the change of diagnose in six cases. The severity of the hoarseness was classified in four groups according Yanagihara method. A multivariate analysis was carried out using jitter, shimmer and harmonic-to-noise ratio as variables. Only the harmonic-to-noise ratio predicts the severity of the spectrographic record. Classification of degrees of hoarseness is found to be clinically useful in two respects: the degree of hoarseness can be numerically expressed and the objective acoustic degree of hoarseness based on this method closely agrees with subjective perceived degree of hoarseness.

Using polymerase chain reaction to human papillomavirus in oral and pharyngolaryngeal carcinomas.

PURPOSE: Increasingly, evidence has shown that human papillomavirus (HPV) plays a role in the induction of certain carcinomas. The presence of HPV sequences in 56 previously untreated oral and pharyngolaryngeal carcinomas was examined by the polymerase chain reaction (PCR). MATERIALS AND METHODS: After DNA extraction, samples underwent 40 replication cycles with specific oligonucleotide primers corresponding to sequences from the E6 open-reading frame of HPV-6b, HPV-16, and HPV-18. To determine the E6 genomic integration, positive samples were processed with specific primers for the corresponding HPV L1 genes. Genomic HPV DNA clones into PBR 322 was used as positive control. RESULTS: HPV E6 DNA of the 6b and 16 types was detected in 14 patients (25%). The L1 gene was not present. CONCLUSION: Detected HPV E6 DNA might be integrated into the cell genome in the positive cases as indicated by the absence of the L1 gene-coding for the viral capside. Histological and survival rates, were unrelated to the presence of HPV.

[The expression of nuclear proliferation antigen in oropharyngeal carcinoma]. / Expresión del antígeno nuclear de proliferación nuclear (PCNA) en el carcinoma orofaríngeo.

Proliferating cell nuclear antigen (PCNA) is a nuclear protein synthesized in the late G1 and S phase of the cell cycle. Immunohistochemical detection of the protein is a useful marker of the proliferating cell fraction in tissue specimens. A series of 106 oropharyngeal carcinomas were evaluated using the streptavidin biotin immunoperoxidase method for detection of this protein. PCNA positivity ranged from 9 to 90.2% (mean: 54.86%; SD: 22.05). PCNA results did not correlate with clinical or histological parameters. Cox regression analysis confirmed the absence of statistical significance of the PCNA index in relation to overall survival.