1,721,375 research outputs found
Reconstructive subtotal laryngectomy in the treatment of laryngeal cancer
No full textSurgical techniques of sub-total reconstructive laryngectomies can often prevent the serious impairment of total laryngectomy without having to relinquish oncological radicality. The aim of the present work has been to report on the experience in this field accrued in the ENT Department of the University of Modena from 1987 to 1992. During this period 54 subtotal laryngectomies were performed. Of these, 13 were crico-hyoido-epiglotto-pexies (C.H.E.P.) and the remaining 41 were crico-hyoido-pexies (C.H.P.). The criteria suggested in the literature was adopted for tumor evaluation, surgical indications and contraindications. All the patients had a follow-up of at least 2 years and 31 of them have had at least 5 years of follow-up. There were 9 deaths: 3 due to intervening illnesses, 2 from second primary tumors and 4 from tumor and/or node recurrences. The overall survival was 83.3% at 2 years and 77.6% at 5 years. Determinate survival (ruling out those who had died because of intervening illnesses) were 88.2% and 80%, respectively. There were 11 neoplastic repetitions of which 2 were of the primary tumor, 2 of the primary tumor plus cervical metastases, and 7 of cervical metastases alone. Recovery surgery was performed in 9 patients, 5 of whom are still alive and disease free. Functional recovery (respiration, deglutition) took place slightly earlier in C.H.E.P. than in C.H.P. but in both cases this could be shortened, particularly by introducing a rehabilitative protocol during the immediate post-operative period. In no case did it prove necessary to perform a total laryngectomy to avoid "ab ingestis" problems and only one patient has a permanent tracheostomy
Comparative study of famotidine vs ranitidine in critically ill patients in mechanical ventilation
No full textStress ulcers are frequent in critically ill patients. Gastric mucosa protection with antacids, H2 blockers or sucralphate decrease the incidence of stress ulcers and upper gastrointestinal bleeding but may have adverse effects. The present study compares the efficacy of continuous infusions of famotidine on gastric pH control and bleeding prevention in critically ill patients receiving mechanical ventilation. Fifty six patients (aged 55 +/- 22 years, 26 male) were randomly assigned to receive famotidine 40 mg/day (n = 27) or ranitidine 150 mg/day (n = 29) during 5 days. Gastric pH was measured every 6 hours and when it was below 5, aluminum hydroxide (30 ml every 2 hours) was administered to obtain values over 5. Patients receiving famotidine had higher mean gastric pH (6.3 +/- 0.2 and 93% of measurements over 5 vs 5.8 +/- 0.6 and 83% of measurements over 5 (p < 0.05), and required lower amounts of aluminum hydroxide (1.880 vs 2.770 ml). No patient had evidence of gastrointestinal bleeding and one had a mild psychomotor agitation. No other adverse reactions were observed. It is concluded that famotidine was more effective than ranitidine on gastric pH control in mechanically ventilated critically ill patients
Logopedic rehabilitation of laryngeal granulomas
No full textPosterior laryngeal granuloma is an infrequent pathology of multidisciplinary interest. Actually, its real prevalence is difficult to quantify because in some cases it is asymptomatic and in other instances it may either be reabsorbed or eliminated spontaneously. It is located at the vocal apophysis of the arytenoid or, less frequently, above it or on the laryngeal side of the arytenoid. The many etiologic factors (laryngeal intubation, gastro-esophageal refluxes, blunt trauma of the larynx, vocal dysfunction), sometimes concomitant and with the possible addition of enhancing circumstances (upper aerodigestive tract inflammation, naso-gastric tube, smoking and alcohol abuse), converge to a single pathogenetic mechanism: an ulceration of the mucosa and the pericondrium, sometimes complicated by an infection, which does not heal but instead produces a typical granulation tissue with capillaries oriented radially from the center of the lesion. Post intubation granulomas, extremely rare in children, are more frequent in females. It appears that there is no correlation with duration of intubation in that granulomas, can also occur after short general anesthesia. Idiopathic or contact granulomas are more frequent in the males. They are the result of vocal laryngeal hyperfunction, habitual throat clearing or cough-like throat clearing. Gastro-esophageal reflux of gastric juice, coughing or throat clearing may injure the mucosa. A blunt trauma of the larynx may cause a granuloma if the cartilage of the vocal process is exposed. Symptoms, when present, are dysphonia, tiredness during or after voicing, bolus, laryngeal unilateral pain, sensation of something in the throat which is mobile during breathing and swallowing, traces of blood in the expectoration. Therapeutic options are surgical, medical or logopedic. Surgery, although followed by frequent recurrences, is mandatory when the granuloma causes dispnea or if a pathologic essay is needed. Medical treatment aims at solving gastroesophageal reflux and/or inflammations of the district. Logopedic rehabilitation is the most successful therapy. Since January 1992 the Authors have been adopting the rehabilitation protocol planned by the French phoniatrician Brigitte Arnoux-Sindt for post-intubation granulomas, which, moreover, is utilyzed for all type of granulomas, including those arising during the early postoperative period after cordectomy. This protocol is analytically presented and discussed. In the cases of contact granulomas, and when there is concomitant vocal dysfunction, logopedic treatment is prolonged after granuloma dissapearance with some sessions aiming at restoring correct vocal behaviour. In all the ten patients rehabilitated up to now, granulomas disappeared after a mean of 16.3 sessions held twice a week. After several months of follow-up we had no recurrences. This clinical experience, while limited in number, seems to confirm the good results already reported in French Literature
Human herpesvirus 8 and interstitial pneumonitis in an HIV-negative patient
No full textNo abstract availabl
The new lymphotropic herpesviruses (HHV-6, HHV-7, HHV-8) and hepatitis C virus (HCV) in human lymphoproliferative diseases: An overview
Full text linkConsiderable evidence has been accumulating in favor of a possible involvement of viral agents in the pathogenesis of human lymphomas. The most recent proposal for a lymphoma classification, the Revised European-American Classification, emphasized for the first time the pathogenetic importance of two viruses, namely Epstein-Barr virus (EBV) and human T lymphotropic virus I (HTLV-I) in the development of certain lymphoid neoplasias. However, in the last ten years new viral agents possibly related to lymphoproliferative activity have been discovered: three herpesviruses [human herpesvirus-6 (HHV-6), -7 (HHV-7) and -8 (HHV-8)] and a flavivirus, HCV. HHV-6 was isolated from the peripheral blood of patients with lymphomas and a possible role for this beta-herpesvirus in Hodgkin's disease and in angioimmunoblastic lymphadenopathy (AILD) has emerged from serological and molecular studies. HHV-7, a beta-herpesvirus genetically close to HHV-6, has not yet been found in a human disease but it utilizes CD4 as a receptor on the lymphocyte surface. Only partial HHV-8 genomic sequences have been identified so far, suggesting a genetic homology with members of the gamma-herpesvirus family, including EBV. HHV-8 sequences have been identified for the first time in all forms of Kaposi's sarcoma as well as in a variety of lymphoid disorders, including body-cavity-based non Hodgkin's lymphomas, Castleman's disease, AILD and a type of HIV-negative reactive lymphadenopathy with peculiar histologic features. Finally, after its identification as the major cause of post-transfusion and sporadic non-A, non-B hepatitis, HCV has revealed a lymphotropism both in vitro and in vivo. A strong association between HCV infection and a benign lymphoproliferative disease, essential mixed cryoglobulinemia type II, has clearly emerged both from serological and molecular studies. A possible role for this viral infection in B-cell non Hodgkin's lymphomas not associated with cryoglobulinemia has also been proposed recently. The present work offers an overview of the huge amount of experimental and clinical observations supporting the possible involvement of these new lymphotropic viruses in human lymphoproliferative diseases
MALT Lymphomas: Epidemiology and Infectious Agents
No full textIn 1983 Isaacson and Wright observed that low grade lymphomas arising from the stomach, thyroid, salivary glands and lung exhibit histological features that reproduce the architecture of mucosa associated lymphoid tissue (MALT) rather than that of similar lymph node tumor. The tumor cells are located in the marginal zone surrounding the mantle, and like the B cells of the marginal zone of Peyer\'s patches and tonsils, invade the overlying epithelium, forming the so-called “lymphoepithelial lesion“; like normal MALT, these lymphomas have reactive lymphoid follicles. MALT lymphomas have been defined as extranodal marginal zone B-cell lymphomas of MALT type both in the REAL classification and in the last WHO Classification. These tumors present an indolent natural course, since they tend to remain localized for long periods and show a good response to the therapy. They usually arise from organs where MALT is physiologically absent and is acquired following a persistent antigenic stimulation by an infectious agent or by an autoimmune process
Human Cytomegalovirus, Human Herpesvirus 8 and Other Herpesviruses (Part III, Section 2, Chapter 75)
No full textWritten by a young, innovative author group, this exciting new book gives you the clinically relevant aspects of hematology in an innovative, unique format. The book is structured to comprehensively cover the complete scope of hematology, but allows fast access to key information you need in everyday practice. A section on consultative hematology includes chapters on special populations (pregnancy, pediatrics, geriatrics), infections of marrow and blood, and hematologic problems of medical practice and surgery. You'll also find a section on tools for the hematologist, covering clinical aspects of transfusion, transplantation, and the latest innovative laboratory procedures
Early palliative and supportive care in hematology wards.
No full textEarly palliative and supportive care in hematology ward
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