Melatonin and cancer.

Melatonin plays an important role in cancer (tumor growth and metastasis) through different pathways and may have therapeutic significance.

Enzymatic aspects in ENT cancer-Matrix metalloproteinases.

The study of ENT cancer allows the implementation of molecular biology methods in diagnosis, predicting the evolution of the disease and suggesting a certain treatment. MMPs are proteolytic enzymes, zinc dependent endopeptidases, secreted by tissues and proinflammatory cells that play a role in the clearance of cell surface receptors. They are expressed as zymogens (inactive forms). Proteolytic enzymes cleave zymogens generating active forms. They are involved in cell proliferation, adhesion, differentiation, migration, angiogenesis, apoptosis and host defense.

Sonotubometry, a useful tool for the evaluation of the Eustachian tube ventilatory function.

From the three Eustachian tube (ET) functions: middle ear protection, secretion clearance and middle ear ventilation, the ventilatory function is unanimously considered the most important one, because proper hearing is established only when tympanic membrane compliance is normal. This requires equilibrium between the middle ear and ambient gas pressure, which makes the normal functioning of active ET opening of critical importance. There are several methods and tests that can assess such a complex and variable mechanism. Sonotubometry is one such method; despite the fact that it has been continuously improved in the last 20 years, it is not yet systematically used to evaluate the ET ventilatory function, because its measurement pattern, context mapping (patient, clinic data, medication, treatment), validation, reproducibility and value for clinic practice, have not yet been fully consolidated and integrated in a knowledge-based, service-oriented system, that can provide decision support or even diagnostic. The paper reviews the role of tubal sonometry as a non-invasive, physiologic and easy to use method in assessing the ventilatory function and investigates the validity and reproducibility of a measuring pattern and test in a group of children. The paper describes the test pattern used, and the computer-based platform based on: (1) Digital Signal Processing (DSP) for sound acquisition and low-level processing; (2) Artificial Intelligence techniques to extract significant sound features from sonotubograms and learn a manifold context database. Results are reported from test series carried out in healthy children; a similar study between tests is included in the final Discussions section.

Case reports - common and external carotid artery resection in head and neck cancer patients.

Most head and neck cancer patients are first referred to an E.N.T. specialist thus the need for that surgeon to be the leader of the multidisciplinary team. Oncological surgical interventions need to ensure clear resection margins; this means that whatever anatomic structures are involved in the tumor spread, need to be resected. The carotid artery is a vascular vessel system that provides blood supply for the head and neck region, the most important structure being the brain and its organs. The ligation or the resection of the common carotid artery leads to an abrupt decrease of blood flow towards the brain, which can cause single sided paralysis, decreased cognitive functions, shock and even death. Common or internal carotid arteries ligatures or resections can be performed in patients with malignant tumors of the head and neck. This is a synopsis of 2 successful cases of patients who underwent common and external carotid artery resection.

Anatomo-surgical correlations in larynx cancer.

OBJECTIVE: Cancer remains a crucial problem of contemporary medicine and the principle is perfectly true regarding the laryngeal cancer. Laryngologists are constantly searching for laryngeal cancer to provide functional and oncological surgical techniques. Conservative surgery in laryngeal cancer tries to keep enough laryngeal lumen and maintain the main laryngeal functions: breath, phonation, swallowing, by using open surgical techniques. METHODS: 412 patients with larynx neoplasms were operated by open surgical techniques between 1.01.2006 and 31.12. 2008 in the ENT Clinic of "Coltea" Clinical Hospital. We selected 21 cases divided into three groups, each with 7 patients, to whom we have changed the type of surgery based on anatomical data. Careful preoperative selection is of outmost importance for the clinical outcome of the patients. Postoperative follow up was between 3 and 5 years. RESULTS: All the patients are alive, decannulated; they feed orally and are fully socially integrated. CONCLUSIONS: In the light of anatomical structures analysis, indications of partial laryngeal surgery may be extended from where it is now, to accepting only total laryngectomy.

Morphology and morphopathology of hypopharyngo-esophageal cancer.

Cervical esophageal cancer and hypopharyngeal cancer represent a major diagnostic issue in early stages, considering the fact that the implication of both cervical esophageal and hypopharyngeal cancers shows a poor prognostic from the very beginning. Positive diagnosis can only be made after histopathological analysis and immunohistochemical analysis in addition. The bioptic material is sampled by rigid endoscopy this being the only viable method of assessing data on the tumor prior to the surgery. As much as 95% of tumors located at this site are epidermoid carcinomas with different staging and characteristics, other types of tumors being adenocarcinomas, lymphomas, etc. Several risk factors influence the biology of this site thus inflicting both cellular and molecular modifications that are the origin of cancer development.

Pharyngoesophageal junction neoplasia--therapeutic management.

Not only the anatomy but the treatment and the prognosis of these tumors are intermediate between hypopharyngeal and esophageal tumors. After a portion of the esophagus is removed or complete esophagectomy, a conduit must be established. The authors reviewed the experience of Prof. Cristian Popescu in total pharyngo-laryngectomy and his technique of pharyngoesophageal reconstruction with synthetic esophageal prosthesis. We have some 21 patients who underwent an esophageal reconstruction with Montgomery esophageal tube. This is a very important new, modem, interdisciplinary approach bewteen the head and neck surgeon and the general/thoracic surgeon to treat the pharyngo-laryngo-esofageal neoplasia with one stage reconstruction. The follow up for these patients shows that this reconstruction method is a good, reliable choice with low costs and considerable advantages for the quality of life. Surgery for these patients should be considered primarily palliative and the optimal reconstruction should preserve the quality of life for the duration of survival.

Functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

Radical neck dissection is a concept that was presented in 1906 by GW Crile and suffered constant improvement ever since. The surgical oncology procedure included the resection of the internal jugular vein, the sternocleidomastoid muscle, and the submandibular gland and the spinal accessory nerve. Deformities and impairment in the functionality of different regions of the neck and scapular regions have great implications on the quality of life of the patients who undergo such a procedure. Modifications to the radical neck dissection were made in the attempt to maintain the efficacy of the surgical oncology therapy. The authors try to assess the functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

Endoprosthetic reconstructive surgery with medical grade long term implantable silicone in facial asymmetry.

The authors present their experience over a period of 13 years (1998-2011) regarding a cohort of 54 patients. In an extensive loss of tissues resulted from congenital malformations (maxillary and mandibular malformations, micro stoma), collagenosis (scleroderma, Romberg Syndrome), traffic and work accidents, post surgical (cancer and facial nerve paralyze), when usual surgical procedures fail to establish the normal look of the patient medical grade long-term implantable silicone endoprosthetic reconstruction (rehabilitation) intervenes. Using a specific technique and materials like long-term implantable silicone grade, the resulted endoprostheses replace and create the aesthetic and a normal anatomy of the specified region, very well tolerated, elastic and non-allergic and with a perfect acceptation from the body all the life.

Reconstructive surgery of the nasal pyramid.

The authors present their personal experience regarding the reconstruction of the nasal pyramid on 150 cases, encompassing both children and adults during the period 2000-2011. Reconstruction of the nasal pyramid, regardless of age, was performed in cases of dysmorphias due to congenital malformations, accidents and surgical treatments with great loss of substance (benign or malignant tumors). There were used the classical methods of reconstruction meaning rhino correction and rhinoplasty. However we mainly focused on the use of heterografts (implantable silicone implants - endoprostheses), or on the reconstruction of the nasal pyramid entirely with elastomeric silicone (epitheses), fixed with adhesive, implants and titanium magnets. Silicone, as a synthetic material, is very well tolerated by the body, having been demonstrated that it is a good oxygen carrier. Moreover, both nasal silicone and titanium implants are well tolerated as well and, in addition, they have good aesthetic, functional and psychological results. Patients regain an almost normal appearance, having good family and social integration and improved quality life.

The epidemiology of hypopharynx and cervical esophagus cancer.

At the beginning of the 21st century the hypopharynx and the cervical esophagus cancer represents a major issue for all countries of the world. The epidemiology of the hypopharynx and cervical esophagus cancer deals with the spread of the disease in the human population with regard to sex, age, profession, time and space, as well as risk factors that contribute to these phenomena. The main goal is to investigate the causes and the factors involved in the development of the tumors at the pharyngoesophageal junction, knowledge that contributes to the latest therapeutic assessment through interdisciplinary collaboration (E.N.T. surgeon, general surgeon, radiation oncologist, chemotherapist, and nutritionist). The epidemiology of the hypopharynx and cervical esophagus cancer includes three major areas of interest: descriptive (the study of the spread in mass population), analytical (the study of causal risk factors on the disease) and experimental (that verifies by experiments on animals the prior identified hypothesis).