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Background and Objectives: Postoperative morbidity after open partial laryngeal surgery (OPLS) may be serious, leading to a prolonged length of hospital stay and increasing costs. We sought to define the predictive factors of complications and to develop nomograms for patients eligible for OPLS based on clinical and surgical data., Methods: We critically reviewed 535 patients with laryngeal carcinoma who underwent OPLS at our Institution from 1982 to 2007. We have identified patients affected by postoperative local, airway, dysphagia, bleeding, surgical site infection, dehiscence of pexy, emphysema, and laryngocutaneous fistula complications. We have analyzed them according to age, smoking, alcohol, tumor site, clinical T and N classification, type of OPLS and neck dissection, previous treatments. Prognostic factors were considered in a multivariate logistic regression model with backward stepwise elimination and selected to construct and design nomograms for overall and specific complications. The performance was assessed using the c-index, receiver operating characteristic, and calibration curves., Results: Age, clinical T classification, type of OPLS, and alcohol were related to overall (35%) and airway complications. Nomograms were built for overall, dysphagia, and airway complications., Conclusions: We have developed nomograms that can identify high-risk patients undergoing OPLS and that can help to prevent severe complications and to tailor surgical planning., (© 2018 Wiley Periodicals, Inc.)

Smoking is an important risk factor in the development of head and neck cancer. However, little is known about its effects on postoperative complications in head and neck cancer surgery. We performed a retrospective analysis on 535 consecutive laryngeal cancer patients submitted to open partial laryngectomy at the Otolaryngology-Head and Neck Surgery Department of Florence University to evaluate a possible correlation between smoking and surgical complications. Patients were grouped in non smokers and smokers and evaluated for airway, swallowing, local and fistula complications by multivariate analysis: 507 (95%) patients were smokers, 69% presented supraglottic, 30% glottic and 1% transglottic cancer. The most common operation was supraglottic horizontal laryngectomy in 58%, followed by supracricoid partial laryngectomy in 27% and frontolateral hemilaryngectomy in 15% of cases. The incidence of overall complications was 30%, airway complications representing the most frequent (14%), followed by swallowing (7%), local (6%) and fistula complications (3%). Smokers developed more local complications (p = 0.05, univariate, p = 0.04, multivariate analysis) and pharyngocutaneous fistula (p = 0.01, univariate, p = 0.03, multivariate analysis).

Reconstructive surgery of the head and neck region has undergone tremendous advancement over the past three decades, and the success rate of free tissue transfers has risen to greater than 95%. It must always be considered that not all patients are ideal candidates for free flap reconstruction, and also that not every defect strictly requires a free flap transfer to achieve good functional results. At our institution, free flap reconstruction is first choice, although we use pedicled alternative flaps for most weak patients suffering from severe comorbidities, and for pretreated patients presenting a second primary or a recurrent cancer. From July 2006 to May 2010, 54 consecutive patients underwent soft tissue reconstruction of oral cavity and oropharyngeal defects. We divided the cohort in three groups: Group 1 (G1): 16 patients in good general conditions that received free radial forearm flap reconstruction; Group 2 (G2): 18 high-risk patients that received a reconstruction with infrahyoid flap; Group 3 (G3): 20 patients that received temporal flap (10 cases) or pectoral flap (10 cases) reconstruction. We must highlight that pedicled alternative flaps were used in elderly, unfavourable and weak patients, where usually the medical costs tend to rise rather than decrease. We compared the healthcare costs of the three groups, calculating real costs in each group from review of medical records and operating room registers, and calculating the corresponding DRG system reimbursement. For real costs, we found a statistically significant difference among groups: in G1 the average total cost per patient was € 22,924, in G2 it was € 18,037 and in G3 was € 19,872 (p = 0.043). The amount of the refund, based on the DRG system, was € 7,650 per patient, independently of the type of surgery. Our analysis shows that the use of alternative non-microvascular techniques, in high-risk patients, is functionally and oncologically sound, and can even produce a cost savings. In particular, the infrahyoid flap (G2) ensures excellent functional results, accompanied by the best economic savings in the worst group of patients. Our data reflect a large disconnection between the DRG system and actual treatment costs.

In this study, we assessed the effectiveness of a live, attenuated Salmonella enterica serovar Typhi (S. Typhi) vaccine strain as a cancer immunotherapy in a mouse model of metastatic T-cell lymphoma. EL4 tumor-bearing C57BL/6J mice immunized with S. Typhi strain CVD 915, by injection into the tumor and the draining lymph node areas, displayed a significant decrease in tumor growth, a reduction in the mitotic index (MI) of tumors, a delayed development of palpable lymph node metastases and most importantly improved survival, compared to untreated mice. Besides, complete tumor regression was achieved in a small number of bacteria-treated mice. A successful therapeutic response associated with a significant reduction of tumor mass was evident as early as 5 days after treatment. The administration of Salmonella to tumor-bearing mice promoted early cellular infiltration (mainly neutrophils) within the tumor, and was accompanied by a decreased intratumoral interleukin 10 production as well as by leukocyte expansion in tumor draining lymph nodes. A tumor-specific memory immune response was induced in most of cured animals, as evidenced by the lack of tumor growth after a rechallenge with the same tumor. EL4 cells cultured with live Salmonella failed to proliferate and underwent apoptosis in a dose-dependent, time-dependent, and contact-dependent manner. To our knowledge, these results demonstrate for the first time the efficacy of a S. Typhi vaccine strain as an oncolytic and immunotherapeutic agent against a highly malignant tumor and support the use of S. Typhi-based vaccine strains in cancer therapy.

Background: Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review., Methods: The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value., Results: The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied., Conclusions: The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

Background: In current practice, surgeons frequently deal with elderly patients who have severe medical comorbidities., Methods: We present our series of 18 consecutive patients with severe general comorbidities that received infrahyoid flap reconstruction. The results were compared with those of 16 consecutive patients in good general medical state receiving free radial forearm flap reconstruction during the same study period. We also describe an original method for tongue base reconstruction using the infrahyoid flap., Results: No total flap necrosis was experienced; successful separation between oral cavity/oropharyngeal contents and neck spaces was obtained in all patients with a low rate of general complications. No significant differences were found with regard to verbal intelligibility and diet scores between groups., Conclusions: Infrahyoid flap in high-risk cases represents a valid alternative to free radial forearm flap. We introduced a novel technical innovation for tongue base reconstruction using the infrahyoid flap with very encouraging results., (Copyright © 2011 Wiley Periodicals, Inc.)

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

Aim of the work was to describe a new physical therapeutic approach for benign paroxysmal positional vertigo determined by canalolithiasis of the lateral semicircular canal. A review is made of the literature, and personal experience is reported. A total of 55 cases were observed, 40 geotropic forms, 15 apogeotropic forms. Liberatory manoeuvres were carried out observing the nystagmus during videonystagmoscopic examination, thus attempting to solve the problem in the first treatment session. Monitoring the patient under videonystagmoscopic examination, progression of the otolithic mass towards the non-ampullary segment is documented by the appearance of a nystagmus directed towards the healthy side (and, therefore, inhibitory, due to ampullofugal deflection of the ampullary cupula) during the individual steps of the rehabilitation treatment. Of the 40 geotropic forms, 30 were successfully treated with the Vannucchi-Asprella technique, and the other 10 with the Vannucchi-Asprella manoeuvre followed by a Lempert barbecue rotation. Of the 15 apogeotropic forms, 6 were solved with the Vannucchi-Asprella manoeuvre, 2 with the Vannucchi-Asprella technique followed by Lempert, 6 with the inverted Gufoni technique, followed by Lempert, 1 transformed into geotropic with inverted Gufoni plus Lempert and then resolved by means of a Vannucchi-Asprella manoeuvre. In all cases, therapeutic success was achieved in the first session. Treatment of benign paroxysmal positional vertigo of the lateral semicircular canal does not allow every case to be fully solved at the first attempt with any technique proposed up to now, in particular, for the apogeotropic forms. Being aware of the different techniques, choosing that most appropriate for the patient's "physical" needs, and, above all, verifying under videonystagmoscopic examination the progression in an ampullofugal direction of the otolithic mass during treatment enable excellent therapeutic results to be obtained in the treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, by modifying the rehabilitation strategy while it is being carried out. Videonystagmoscopic examination monitoring of the nystagmus during treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, is taking the place of the rigid schematism of the manoeuvres proposed, so far, allowing the treatment programme to be adapted to the individual case, thus enabling a solution to be reached in the first rehabilitation session by means of tailored therapy.