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[EN]Introduction and objective: The number of patients with micropapillary thyroid carcinoma (mPTC) is increasing. Clinical practice guidelines have endorsed both active surveillance and surgery as treatment options for mPTC. In this review we aim to describe the current options for the management of mPTC. Synthesis: The evidence accumulated in various studies has allowed us to know the natural history and biological behavior of these tumors. Through extensive experience, it has been shown that the vast majority of these tumors often does not present a significant variation in size, or have very slow growth rates, and even some have decreased in size. Most mPTC are low-risk tumors that will not generate morbidity or mortality despite being untreated. In recent years, clinical practice has evolved towards a less aggressive treatment of these mCPT to avoid morbidity derived from active treatment by surgery and/or radioiodine and/or hormonal suppression. Patients with high-risk tumors should be managed following papillary carcinoma protocols. However, active surveillance (AV) of patients with low-risk tumors has shown excellent oncologic outcomes without increasing morbidity and mortality. When surgical treatment is indicated, lobectomy is a valid option for unifocal mPTC Initial selection criteria for the suitability of being managed by VA should take into account many aspects, including tumor and patient characteristics. If there is a high risk of progression, they should undergo immediate surgery instead of VA. Conclusions: VA has emerged as a new therapeutic alternative for these low-risk tumors, with excellent oncological results and lower complication rates. However, despite the encouraging results of the VA, its implementation in practice depends on many aspects among which are the characteristics of the tumor, the clinical characteristics of the patient and psychosocial factors. [ES]Introducción y objetivo: El número de pacientes con microcarcinoma papilar de la tiroides (mPTC) cada vez es más elevado. Las guías de práctica clínica han respaldado tanto la vigilancia activa como la cirugía como opciones de tratamiento para el (mCPT). En esta revisión nos planteamos como objetivo describir las opciones actuales de manejo del mCPT. Síntesis: La evidencia acumulada en los estudios realizados ha permitido conocer la historia natural y el comportamiento biológico de estos tumores. Mediante las extensas experiencias, se ha evidenciado que la gran mayoría de estos tumores muchas veces no presentan una variación significativa de su tamaño, o presentan tasas de crecimiento muy lentas, e incluso algunos presentan disminución de éste. La mayoría de mCPT son tumores de bajo riesgo clínico que no generarán morbilidad o mortalidad a pesar de no ser tratados. En los últimos años, la práctica clínica ha evolucionado hacia un tratamiento menos agresivo de estos mCPT para evitar la morbilidad derivada del tratamiento activo mediante cirugía y/o radioyodo y/o supresión hormonal. Los pacientes con tumores de alto riesgo deben ser manejados siguiendo los protocolos de los carcinomas papilares. Sin embargo, la vigilancia activa (VA) de pacientes con tumores de bajo riesgo ha mostrado excelentes resultados oncológicos sin aumentar la morbilidad y la mortalidad. Cuando se indica un tratamiento quirúrgico, la lobectomía es una opción válida para estos tumores. Los criterios de selección inicial para la idoneidad de ser manejados mediante VA deben tener en cuenta muchos aspectos, incluidas las características de los tumores y pacientes. En caso de alto riesgo de progresión deben ser sometidos a una cirugía inmediata en lugar de VA. Conclusiones: La VA ha surgido como una nueva alternativa terapéutica para estos tumores de bajo riesgo, con excelentes resultados oncológicos y menores tasas de complicaciones. No obstante, a pesar de los alentadores resultados de la VA, su implementación en la práctica depende de muchos aspectos entre los cuales se encuentran las características del tumor, las características clínicas del paciente y factores psicosociales.

Background Surgical resection or radiotherapy (RT) are standard approaches for early-staged hypopharyngeal squamous cell carcinoma (HPSCC). Transoral laser microsurgery (TOLMS) seems to provide good oncological and functional results with few local complications. The aim of our study was to analyze the outcomes of TOLMS, with or without neck dissection or RT, in the treatment of HPSCC in a tertiary referral center. Methods A retrospective study was conducted in patients with early T-category (T1–T2) HPSCC treated by TOLMS. Results A total of 34 patients were included in the study. The series includes 17 (50%) T1 and 17 (50%) T2 classified tumors. The 5-year overall survival and disease-specific survival rates were 51% and 66%, respectively, with a 5-year local control rate of 92%. All patients reassumed oral diet and none of them had a tracheostomy at the end of the follow-up. Conclusions TOLMS offers an effective treatment option in terms of oncologic control and function preservation in locally circumscribed HPSCC.

Introduction and objectives dysfunction of the E-cadherin/catenin complex is directly related to carcinogenesis and metastases development. The aim of this paper is to investigate the prognostic significance of E-cadherin and β-catenin expression in surgically treated laryngeal and hypopharyngeal squamous cell carcinomas. Material and methods Tumour tissue samples were obtained from 133 consecutive patients with squamous cell carcinomas of the head and neck: 68 of the larynx and 65 hypopharyngeal carcinomas, who underwent surgical treatment in our hospital between 2000 and 2005. E-cadherin and β-catenin expression was analysed by immunohistochemistry, quantifying the percentage of stained cells and the intensity of staining. Results E-cadherin and β-catenin expression was evaluable in 59 laryngeal carcinomas and in 58 cases of hypopharyngeal carcinomas. In the laryngeal tumours, a significant association was found between the low expression of membrane β-catenin with T4 tumours and tumour recurrence. In the hypopharynx there was a significant association between positive expression of nuclear β-catenin and poor histological differentiation (P = .02). In the multivariate analysis, only the presence of lymph node metastases was an independent predictive factor of decreased disease-specific survival in laryngeal squamous cell carcinomas. Conclusions The expression of E-cadherin and β-catenin does not show prognostic significance in laryngeal and hypopharyngeal squamous cell carcinomas over the TNM classification.

Resumen Introduccion y objetivos La disfuncion del complejo E-cadherina/catenina esta relacionada directamente con la carcinogenesis y el desarrollo de metastasis. El objetivo de este trabajo es investigar el significado pronostico de la expresion de E-cadherina y β-catenina en carcinomas de celulas escamosas de laringe e hipofaringe tratados quirurgicamente. Material y metodos Se obtuvieron muestras de tejido tumoral de 133 pacientes consecutivos con carcinomas escamosos de cabeza y cuello (68 de laringe y 65 carcinomas de hipofaringe), que fueron sometidos a tratamiento quirurgico en nuestro hospital entre 2000 y 2005. La expresion de E-cadherina y β-catenina se analizo mediante inmunohistoquimica, cuantificando el porcentaje de celulas tenidas y la intensidad de la tincion. Resultados La expresion de E-cadherina y β-catenina fue evaluable en 59 muestras de carcinomas de laringe y en 58 de hipofaringe. En tumores de laringe se observo una asociacion significativa entre la baja expresion de β-catenina de membrana y tumores avanzados T4 y la recidiva tumoral. A nivel de hipofaringe se encontro una asociacion significativa de la expresion positiva de β-catenina nuclear con pobre diferenciacion histologica (p = 0,02). En el analisis multivariante solo la presencia de metastasis ganglionares era factor predictor independiente de disminucion de la supervivencia especifica para enfermedad en carcinoma de celulas escamosas de laringe. Conclusiones La expresion de E-cadherina y β-catenina no parece tener utilidad pronostica superior al TNM en los carcinomas epidermoides de laringe e hipofaringe.

Resumen Introduccion y objetivos El tratamiento principal de los carcinomas diferenciados de tiroides es la cirugia seguida de radioyodo. El proposito de este estudio es exponer nuestra experiencia en el manejo de estos tumores. Material y metodo Se presenta un estudio retrospectivo de los 55 pacientes intervenidos quirurgicamente de un carcinoma diferenciado de tiroides en nuestro hospital entre los anos 2007 y 2011. Resultados La edad media al diagnostico fue de 49 anos, con un predominio femenino (78% de los casos). El 78% de los pacientes se encontraban en fases iniciales (estadios i y ii ). El diagnostico histopatologico definitivo fue de carcinoma papilar en el 84% y folicular en el 16% restante. A todos, salvo a 2 pacientes (4%), se les realizo una tiroidectomia total, acompanada de linfadenectomia en el 58% de los casos. Un 9% de los pacientes presento hipoparatiroidismo permanente y aunque un 18% sufrio paralisis recurrencial unilateral transitoria, un 40% de ellos se recupero completamente a los 6 meses. Se administro radioyodo en el postoperatorio al 89% de los pacientes. Se produjo un 40% de recidivas, la mayor parte de las cuales (29% de los pacientes) se localizaron a nivel cervical. La supervivencia a los 5 anos fue del 87%, siendo del 95% en el subtipo papilar y descendiendo al 56% en el folicular (p = 0,001). Discusion/conclusiones Los carcinomas diferenciados de tiroides son tumores con un pronostico excelente tras un tratamiento quirurgico adecuado previa valoracion preoperatoria exhaustiva y seguimiento postoperatorio estricto debido a las tasas significativas de recidiva.

Resumen Introduccion y objetivos La fiabilidad de las calificaciones perceptuales de la calidad global de la voz y sus dimensiones especificas es dificil de alcanzar, por cuanto estos juicios dependen de la subjetividad del examinador. De este modo, la busqueda de unas medidas clinicas que sean objetivas, validas y accesibles es una prioridad para incluirlas en los protocolos de evaluacion de la voz. El proposito del presente estudio fue: 1) determinar la exactitud diagnostica de un unico parametro acustico, la prominencia del pico cepstral suavizado (CPPS), para predecir la presencia y severidad de una disfonia en vocales sostenidas y habla conectada utilizando el programa Praat; 2) determinar la relacion entre las medidas del CPPS y las calificaciones perceptuales de la calidad vocal; y 3) describir los valores normativos del CPPS. Metodo Se obtuvo el valor del CPPS de muestras vocales sostenidas y de habla conectada de 72 sujetos hispanohablantes con trastornos vocales y de 52 sujetos hispanohablantes sanos utilizando el programa Praat. Se llevo a cabo un estudio estadistico completo utilizando el programa SPSS de IBM version 23. Resultados Se encontro una sensibilidad de un 70% y una especificidad de un 85%. La severidad estimada de la voz, tanto en vocal sostenida como en habla conectada, se correlaciono de forma importante con las calificaciones perceptuales de severidad global de la disfonia. Conclusiones Un parametro acustico unico, el CPPS calculado mediante el programa Praat, predice de forma importante el estatus de un trastorno vocal. Se considera la incorporacion del CPPS para complementar la valoracion clinica de la voz.

Introduction and objectives Perceptual rating of overall voice quality and other more specific perceptual dimensions is difficult, as such judgments depend on the listener's subjectivity. Thus, finding objective, valid, and accessible clinical measures to include in comprehensive voice evaluation protocols is a priority. The purposes of this study were to (1) determine the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from sustained vowels and connected speech samples using the software Praat; (2) to determine the relationship between measures of CPPS and perceptual ratings of vocal quality; and (3) describe the normative values of CPPS. Method Measures of CPPS were obtained from connected speech and sustained vowel recordings of 72 Spanish-speaking subjects with voice disorders and 52 nondysphonic Spanish-speaking subjects with no vocal disorders using freely downloadable Praat software. IBM SPSS Statistics software version 23 was used to complete the statistical analyses. Results Results revealed a 70% sensitivity rate, a specificity rate of 85%. Estimated severity for sustained vowels and connected speech were strongly correlated and significantly associated with listener ratings of dysphonia severity. Conclusions A single acoustic measure of CPPS was highly predictive of voice disorder status using Praat software. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols.

Objective The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolisation were compared. Material and method Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. Results Eleven patients (17%) underwent embolisation, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolisation was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolisation. One patient suffered a hemispheric stroke after embolisation. No post-surgical complications were observed. Conclusions Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient.

Resumen Introduccion y objetivos El objetivo fue determinar los resultados del tratamiento de las epistaxis graves y/o refractarias que requirieron ingreso hospitalario. Ademas se compararon los resultados del tratamiento mediante ligadura arterial o embolizacion. Material y metodo Se incluyeron de forma prospectiva 63 pacientes con epistaxis grave y/o refractaria que requirieron ingreso hospitalario entre agosto de 2014 y diciembre de 2016. Resultados En 11 pacientes (17%) se realizo embolizacion, 5 (8%) fueron intervenidos mediante endoscopia y en los 47 restantes (75%) se realizo tratamiento conservador. La edad media de los pacientes en los que las medidas conservadoras fueron suficientes fue de 72 anos, mientras que la edad de aquellos tratados con embolizacion fue de 71 anos y de los que fueron intervenidos quirurgicamente fue de 53 anos. En los pacientes sometidos a tratamiento conservador o a cirugia la estancia media fue de 6 dias, frente a 9 dias en aquellos en los que se realizo embolizacion. Un paciente sufrio un ictus hemisferico tras la embolizacion. No se observaron complicaciones posquirurgicas. Conclusiones La mayoria de los pacientes con epistaxis graves y/o refractarias se resuelven mediante taponamiento convencional. El tratamiento mediante ligadura arterial esta asociado a una disminucion de la estancia hospitalaria, sin observarse complicaciones graves. Es aconsejable disponer de todas las opciones terapeuticas posibles para lo cual la presencia de radiologos intervencionistas y cirujanos experimentados es fundamental para evitar complicaciones y decidir el tratamiento a realizar de forma individual en cada paciente.

Introduction Contralateral sensorineural hearing loss (CSNHL) after vestibular schwannoma (VS) is a severe complication, especially in those cases in which hearing preservation in the operated side was not possible. There are several theories that attempt to explain this issue, but there is no established guideline of treatment. Material and methods We report 4 patients treated in our institution who developed a severe CSNHL after surgery. Results Of the 185 cases of VS treated with surgery, 4 patients (2.2%) developed a CSNHL after VS surgery. After medical treatment, partial recovery of hearing occurred in one patient the other 3 patients presented a well-established severe SNHL. Conclusions Established treatment guidelines do not exist, but the use of high doses of corticosteroids has been recommended and cochlear implant in cases with no recovery and complete hearing loss may be useful.

Tonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications. Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered. The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control.A prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis.The patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding.Male patients had a higher incidence of bleeding than women. The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding.

Background: We performed a comparative analysis between an organ-preservation protocol and surgery followed by radiotherapy in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx, Methods: 60 previously untreated patients who were treated with induction chemotherapy followed by chemoradiotherapy in responders were compared with a control group of 60 patients treated with up-front surgery. Both groups were statistically comparable, according to the subsite, TNM (tumor-node-metastasis) stage, age, and sex, Results: Mean age was 58 years and 92% were male. No significant statistical difference was observed for overall survival (OS) (HR 0.75, 95% CI 0.48–1,18, P = 0.22) and disease-specific survival (DSS) (HR 0.98, 95% CI 0.52–1.83, P = 0.96). Also, there was no significant difference for recurrence-free survival (HR 0.931, 95% CI 0.57–1.71, P = 0.81), metastases-free survival (HR 2.23, 95% CI 0.67–7.41, P = 0.19), and the appearance of second primary tumors (HR 1.22, 95% CI 0.51–2.88, P = 0.64), Conclusions: The results of the organ-preservation approach did not appear inferior to those of surgery plus (chemo)radiotherapy for patients with T3/T4a larynx and T2–T4a hypopharynx cancer with respect to OS and DSS, locoregional control and metastases-free survival.

Resumen Introduccion y objetivos La quimiorradioterapia es el tratamiento de eleccion del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirurgico o la reirradiacion son el tratamiento de eleccion, segun la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugia de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaringeos mediante abordajes abiertos vs. endoscopicos. Metodos Veinte pacientes con recidivas locales de carcinomas nasofaringeos fueron intervenidos quirurgicamente: 12 pacientes fueron intervenidos mediante cirugia abierta y 8 mediante un abordaje endoscopico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscopica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3. Resultados En 3 de los pacientes (25%) intervenidos mediante cirugia abierta (un rT4, un rT3 y un rT2) no se logro una reseccion macroscopica completa). En el grupo endoscopico la reseccion fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicacion grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicacion grave). La supervivencia a los 3 y 5 anos fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscopico, respectivamente. Conclusiones Los abordajes endoscopicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncologico favorable.

Resumen Introduccion y objetivos La laringectomia total (LT), mas eventual radioterapia, ha demostrado ser un tratamiento eficaz en los casos de cancer de hipofaringe localmente avanzado. El objetivo de este trabajo es analizar los resultados oncologicos de este procedimiento en pacientes con cancer de hipofaringe T3 y T4. Metodos Se incluyeron 59 pacientes (33 pacientes con estadio T3 y 26 con estadio T4a) con carcinoma epidermoide primario de hipofaringe tratados mediante LT entre los anos 1998 y 2012. Resultados La edad media fue de 61 anos, con predominio de varones (96,6%). Todos los pacientes excepto uno eran fumadores y el 96% consumia alcohol. Se realizo vaciamiento cervical funcional unilateral en 12 pacientes, radical unilateral en 11 pacientes, funcional bilateral en 20 pacientes y funcional mas radical en 14. El 66% de los pacientes recibieron radioterapia postoperatoria. Un 81% de los pacientes presentaba metastasis ganglionares y de estos un 56% presentaba invasion extracapsular. Un 29% de los pacientes presentaron recidiva locorregional, un 17% desarrollaron metastasis a distancia y un 25% un segundo tumor primario. La supervivencia especifica fue del 46% a los 5 anos. Conclusiones La LT ampliada a faringe (con eventual radioterapia complementaria) ofrece buenos resultados oncologicos en terminos de control locorregional de la enfermedad y supervivencia en el cancer de hipofaringe localmente avanzado, de modo que los protocolos de preservacion de organo deben alcanzar resultados oncologicos similares a los demostrados por la LT.

Introduction and objectives Total laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4. Methods We studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012. Results Mean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. Sixty-six percentage of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. Twenty-nine percentage of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%. Conclusions TL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL.

Dysfunction of the E-cadherin/catenin complex is directly related to carcinogenesis and metastases development. The aim of this paper is to investigate the prognostic significance of E-cadherin and β-catenin expression in surgically treated laryngeal and hypopharyngeal squamous cell carcinomas.Tumour tissue samples were obtained from 133 consecutive patients with squamous cell carcinomas of the head and neck: 68 of the larynx and 65 hypopharyngeal carcinomas, who underwent surgical treatment in our hospital between 2000 and 2005. E-cadherin and β-catenin expression was analysed by immunohistochemistry, quantifying the percentage of stained cells and the intensity of staining.E-cadherin and β-catenin expression was evaluable in 59 laryngeal carcinomas and in 58 cases of hypopharyngeal carcinomas. In the laryngeal tumours, a significant association was found between the low expression of membrane β-catenin with T4 tumours and tumour recurrence. In the hypopharynx there was a significant association between positive expression of nuclear β-catenin and poor histological differentiation (P=.02). In the multivariate analysis, only the presence of lymph node metastases was an independent predictive factor of decreased disease-specific survival in laryngeal squamous cell carcinomas.The expression of E-cadherin and β-catenin does not show prognostic significance in laryngeal and hypopharyngeal squamous cell carcinomas over the TNM classification.

Varicella infection is one of the most common and contagious infection in children and could course with severe complications. We report the case of a 4-year-old patient derived to our hospital for suspicion of suppurative complication in the context of a varicella infection. A computerized tomographic scanning was performed, showing a large retropharyngeal abscess with mediastinitis. Complications of varicella are up to 2% of patients, but this is the first report of a retropharyngeal and mediastinal abscess in this context. In the face of clinical suspicion, early intervention is important through imaging, intravenous antibiotics and surgical drainage in necessary cases.

Objective To determine the effectiveness and outcomes of SND in the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) with clinically positive neck (cN+) at diagnosis. Material and methods We retrospectively reviewed 159 patients with SCCHN with cN+ at diagnosis, who underwent a SND with curative intent at a tertiary care academic teaching hospital in Spain. We registered patient and tumor characteristics, date and site of recurrences, together with the outcomes. Survival rates were calculated by the Kaplan-Meier method. The minimum follow-up was 18 months or till death. Results A total of 28 neck recurrences were found in the whole series but only 10 neck recurrences occurred in absence of local recurrence. The regional control in the neck in absence of local recurrence was observed in 94% of patients. The neck recurrence rates did not correlated with the pN classification (P = 0.49), the administration of postoperative radiotherapy (P = 0.49) or extranodal extension (P = 0.43). The 5-year regional recurrence-free survival rate was 80% and 92% if only isolated neck recurrences are considered. Conclusions SND offers an effective and oncologically safe surgical procedure in selected patients with clinically positive metastatic nodes in the neck. Our findings suggest that in cN1 and cN2 tumors, SND could replace the modified radical neck dissection without compromising oncologic efficacy.

Introduction and objectives Radioiodine is the principal treatment for differentiated thyroid carcinomas. The aim of this study is to present our experience in the management of these tumours. Material and method We present a retrospective study of 55 patients operated for differentiated thyroid carcinoma in our hospital between 2007 and 2011. Results The mean age at time of diagnosis was 49 years, and females predominated (78% of cases). Seventy eight percent of the patients were in the initial stages (stages I and II). The definitive histopathological diagnosis was papillary carcinoma in 84% and follicular carcinoma in the remaining 16%. All of the patients, with the exception of 2 (4%), underwent total thyroidectomy, with lymphadenectomy in 58% of cases. Nine percent of the patients had permanent hypoparathyroidism and although 18% suffered transitory unilateral paralysis, 40% of these female patients had completely recovered after 6 months. Eighty-nine percent of the patients were given radioiodine postoperatively. There was a recurrence rate of 40% most of which was at cervical level (29% of the patients). Survival at 5 years was 87%, 95% of the papillary subtype, falling to 56% of the follicular subtype (P=.001). Discussion/conclusions The prognosis for differentiated thyroid carcinomas is excellent after appropriate surgical treatment, thorough preoperative assessment, and strict postoperative follow-up due to the significant recurrence rates.

Introduction and Objectives Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. Methods Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1, three as rT2, two as rT3, and six as rT4 in the group of open approaches; in the endoscopic series, two patients were rT1, five rT2 and one rT3. Results In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (five minor complications, five moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (seven had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. Conclusions Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.

Background The purpose of this work was to investigate the prognostic significance of E-cadherin and β-catenin expression in surgically treated human papillomavirus (HPV)-negative patients with oropharyngeal squamous cell carcinoma (SCC). Methods Consecutive patients with oropharyngeal SCC who underwent surgical treatment between 1990 and 2009 were retrospectively collected. Immunohistochemical analysis of E-cadherin and β-catenin expression was performed on tissue microarrays. Results E-cadherin and β-catenin expression was evaluable in 232 cases. Low membranous E-cadherin, low membranous β-catenin expression, and nuclear β-catenin expression were associated with a poorer disease-specific and overall survival, although the differences were only significant for β-catenin membranous expression (P = .024 and P = .016, respectively). In multivariate analysis, nodal metastasis and low membranous β-catenin expression were significant independent predictors of reduced disease-specific and overall survival. Conclusion Low membranous β-catenin expression is a significant independent predictor of both reduced disease-specific and overall survival in patients with HPV-negative oropharyngeal SCC.