Background Laryngeal early glottic tumors can benefit from different treatment modalities, including transoral laser microsurgery, open partial horizontal laryngectomy (OPHL), and radiotherapy. However, the treatment of early glottic tumors with the involvement of the anterior commissure remains controversial. The studies about the role of anterior commissure involvement in oncologic outcomes in patients with early glottic cancer treated with supracricoid laryngectomy (SCL) are very few. For this reason, we conducted a retrospective study to evaluate local recurrence-free survival and specific survival in patients with and without involvement of the anterior commissure who underwent SCL with cricohyoidoepiglottopexy. Methods This retrospective study has been carried out on patients with T1b–T2 glottic squamous cell carcinoma submitted to SCL with cricohyoidoepiglottopexy. The patients’ demographic and clinical data were collected, and the histological findings of the surgical specimens were reviewed to identify patients who had involvement of the anterior commissure. Results A total of 72 patients were included in the study; two of them were female and 70 were male. The mean age at diagnosis was 61.5±8.0 SD years. In 26 of the 72 (36.2%) patients, anterior commissure was not pathologically involved (group A), while in 46 (63.8%) patients, it was involved (group B). The 5-year local recurrence-free survival rate was 96.1% and 93.48% in groups A and B, respectively, P=0.09. The 5-year disease-specific survival rate was 92.31% and 95.65% in groups A and B, respectively, P=0.057. Conclusion SCL with cricohyoidoepiglottopexy seems to be an adequate treatment modality, even for T1b–T2 glottic tumors with anterior commissure involvement.

BACKGROUND The soluble fraction of the CD44 protein (solCD44) may constitute a valuable biological marker of Cancer Stem Cells (CSCs), useful for screening/early detection of laryngeal cancer, and for the prognosis. In previous papers, in fact, we have studied the expression of salivary solCD44 in patients with laryngeal tumors, supporting its use for early diagnosis of laryngeal carcinoma with high sensitivity and specificity, also with prognostic role, useful for clinical outcome. OBJECTIVE The purpose of present study was to verify the levels of solCD44 isoform v6, sCD44var (v6), in saliva samples of patients with laryngeal carcinoma in our tumoral biobank, to evaluate possible correlations with clinical-anamnestic and prognostic data. METHODS Study design was retrospective. Salivary samples of 66 patients with laryngeal cancer recruited from January 2012 to December 2013 were selected from our tumoral biobank. For each salivary sample was performed the determination of solCD44 and its isoform v6, sCD44var (v6), by ELISA. Qualitative and quantitative results of the test were correlated with clinical and medical history data. For statistical analysis we used the software MedCalc (versione 12.2.1.0). RESULTS Concentrations of salivary sCD44var v6 were significantly higher according to the size of the primary tumor (T) (p= 0.001), the tumor site glottic or supraglottic-transglottic (p= 0.005) and according to the metastatic lymph node involvement (p= 0005). Furthermore, tumors in advanced disease (stage III-IV) showed values of salivary sCD44var v6 higher than the tumors in early stage, with a statistically significant difference (p= 0.005). CONCLUSIONS The determination of the levels of salivary solCD44 v6 may represent a promising prognostic test in laryngeal carcinomas.

Recent studies have suggested a possible correlation between obesity and adenovirus 36 (Adv36) infection in humans. As information on adenoviral DNA presence in human adipose tissue are limited, we evaluated the presence of Adv36 DNA in adipose tissue of 21 adult overweight or obese patients. Total DNA was extracted from adipose tissue biopsies. Virus detection was performed using PCR protocols with primers against specific Adv36 fiber protein and the viral oncogenic E4orf1 protein nucleotide sequences. Sequences were aligned with the NCBI database and phylogenetic analyses were carried out with MEGA6 software. Adv36 DNA was found in four samples (19%). This study indicates that some individuals carry Adv36 in the visceral adipose tissue. Further studies are needed to determine the specific effect of Adv36 infection on adipocytes, the prevalence of Adv36 infection and its relationship with obesity in the perspective of developing a vaccine that could potentially prevent or mitigate infection.

Background: The majority of emerging diseases are zoonoses and surveillance programs of animals for zoonotic pathogens are a global challenge. Notably, previous studies of individuals occupationally exposed to animals have suggested an increased risk of cancer, especially hematopoietic malignancies, which may be related to their exposure to a variety of infectious agents, showed an elevated risk of lung cancer for poultry exposure in subjects ever had direct contact with chicken blood. Cancer risk associated with specific types of farm animals or specific etiologic agents have not been clearly described. It is hypothesized that chronic infection by several infectious agents are associated with human cancer risk and co-morbidities. The aim of the present study was to organize a cohort study with the long range goal to analyse the association between infectious agents and bio-molecular markers in a fraction, randomly selected, of both human and animal samples derived from a cohort of farmers. Methods & Materials: Subjects included in the cohort are 12,600 workers from 4311 farms located in Catania and Ragusa area. The total number of 7,754,704 animals raised in the farms comprises poultry, cattle, sheep and hogs. Peripheral blood samples from both workers and animals were collected during the health survey program, according to the current rule. For the risk evaluation (odds ratio), all workers, with a history of chronic diseases or positive for infectious agents were considered as "cases", the remaining subjects were considered as "controls". Results: Preliminary data on the analyses of biomarkers, such as interleukin-6, interferon-alpha, beta, osteopontin and matrix metalloproteinase-9, performed by standard procedures in a group of human samples, reveals higher levels of these markers in subjects with a history of pulmonary and liver chronic diseases compared with other workers. Intriguingly, the history of such infections may be associated with work exposure. Conclusion: The identification of bio-markers and zoonoses could contribute to translational research by supporting clinicians for the development of tailored therapies. Furthermore, early detection of infectious agents could be of great relevance to public health in terms of: a) reduction of infection diseases and infection-related diseases; b) reduction of costs associated to patients' monitoring.

Background: The aim of this study was to evaluate the effectiveness of selective neck dissection (SND) in patients with laryngeal cancer and clinically positive cervical nodes. Subjects and Methods: A retrospective review of the clinical records of 58 consecutive untreated patients affected by laryngeal carcinoma and submitted to surgical treatment was performed. Results: Twenty-six (44.8%) patients received monolateral neck dissection and 32 (55.2%) bilateral neck dissection. A total of 90 hemineck dissections were performed. Histopathological examination revealed that 25 of the 58 patients had negative nodes (pN0) and 33 had positive nodes (pN+). Extracapsular spread was found in 12 of the 33 pN+ patients. Twenty-eight of the 58 (48.2%) patients were submitted to adjuvant radiotherapy. Six of the 58 patients submitted to neck dissection had neck recurrence (rate of 10.3%). The only independent prognostic factor for neck recurrence was extracapsular spread. For the 58 patients, the 5-year overall survival was 50% and the disease-specific survival 68.9%. The 5-year disease-specific survival was 76% for pN0 patients and 63.6% for pN+ patients. Conclusions: SND can represent a therapeutic procedure because it has shown oncological results comparable to those of comprehensive neck dissection, especially when SND is combined with adjuvant radiotherapy.

INTRODUCTION:Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery. MATERIALS andMETHODS:This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report.RESULTS:CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report.CONCLUSION:Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2 laser.

BACKGROUND:The purpose of this study was to verify CD44sol levels in the saliva of patients during follow-up after surgery for laryngeal cancer, to compare them with those registered at the time of diagnosis (pre-intervention) in the same patients, and to assess the reliability of the test as a prognostic indicator.METHODS:This prospective study was performed on 21 patients having laryngeal cancer who underwent surgery at the Division of Otolaryngology, University of Catanzaro; twelve adults with head and neck benign disease were recruited to form a control group. For each patient, the clinical–anamnestic data were collected and entered into a database. The sampling of undiluted saliva was performed the day before surgery and during the follow-up, every 3 months. Salivary CD44sol levels were determined using the ELISA method.RESULTS:Mean salivary CD44sol levels in the patients group before surgery (pre-intervention) were significantly higher than those in the control group (70.75 ± 33.8 vs. 12.4 ± 8.7 ng/ml). At follow-up performed 3 months after surgery, 18 of 21 (85.71%) patients had a reduction in salivary CD44sol levels, with a mean value of 50.1 ng/ml; the difference between these and pre-intervention CD44sol levels was statistically significant (P < 0.04). Mean CD44sol levels of 31.1 ng/ml at 6 months post-intervention have been determined in 19 of 21 enrolled patients; none of the 19 patients have actual signs of recurrence.CONCLUSIONS:These data seem to show that the determination of salivary CD44sol levels can represent a promising prognostic test in laryngeal carcinomas.

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.

Background The clinical evolution of laryngeal squamous cell carcinoma (SCC) is undetectable with the current staging criteria. To more completely understand the biology of laryngeal SCC, we assessed the expression of the proteins B-cellspecific Moloney murine leukemia virus integration site 1 (BMI1) and p16. Methods We assessed immunohistochemically the expression of BMI1 and p16 in 25 laryngeal SCCs at different stages. Results High BMI1 expression was detected in 11.7% of glottic tumors and in 50% of supraglottic tumors. No significant differences were observed in the patients' clinical data after they were stratified by the tumor expression of p16. The expression of nuclear BMI1 in the absence of p16 immunoreactivity correlated significantly with the pN status of the primary tumors. Conclusion Nuclear BMI1 expression in the absence of p16 expression seems to characterize a subset of patients with a high risk of developing lymph node metastasis. (c) 2012 Wiley Periodicals, Inc. Head Neck 35: 847-851, 2013

Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumour. Aggressive surgical treatment has thus been traditionally recommended because of the risk of transformation in squamous carcinoma. CT and MRI are used to evaluate bone destruction and soft-tissue extension before surgery but may be ineffective to differentiate an inverted papilloma from squamous cell carcinoma. In recent years, F-18 Fluorodeoxyglucose positron emission tomography ((18)FDG-PET) is widely used as diffuse imaging procedure for diagnosis and followup of malignancy affecting the head and neck district. To evaluate the utility of (18)FDG-PET/CT in the diagnosis of patients with suspicious lesions for IP, twelve patients with suspicious sinonasal inverted papilloma were selected for this study. (18)FDG-PET/CT imaging was performed, and standard uptake value (SUV) was calculated for each patient. SUVmax was considered as the maximum value measured in the visualized lesions. Seven of the twelve cases exhibited uptake of (18)FFDG with an SUVmax ranging from 1 to 8.1. Histopathologic diagnosis after surgery confirmed the diagnosis of IP in five cases; all these cases had an SUVmax > 3. The five cases, which exhibited absence of (18)FDG uptake, had a histological diagnosis of absence of IP.

BACKGROUND:The main cause of treatment failure and death in laryngeal squamous cell carcinoma is metastasis to the regional lymph nodes. The current clinical staging criteria fail to differentiate patients with occult metastasis from patients without metastasis. Identifying molecular markers of the disease might improve our understanding of the molecular mechanisms underlying the pathogenesis and development of laryngeal carcinoma and may help improve clinical staging and treatment.METHODS:Sixty-four previously untreated patients who underwent surgical excision of laryngeal squamous cell carcinoma with neck dissection were included in this study. The expression of B cell-specific Moloney murine leukemia virus integration site 1 (BMI-1) was examined immunohistochemically on formalin-fixed paraffin-embedded primary tissue specimens.RESULTS:Nuclear expression of BMI-1 (nBMI-1) was detected in 32 of the 64 tumors (50%), cytoplasmic expression of BMI-1 (cBMI-1) was detected in 22 (34.4%), and 10 tumors (15.6%) showed no BMI-1 immunoreactivity. High nBMI-1 expression levels (≥ 10) were detected in 28 of the 32 (87.5%) nBMI-1-positive patients. Multivariate analysis including age at diagnosis, grade, tumor location, TNM status, and nBMI-1 expression showed that a high nBMI-1 expression level was an independent prognostic factor for lymph node metastasis.CONCLUSION:The expression of BMI-1 in patients with laryngeal carcinoma seems to correlate with lymph node metastasis.

Background and objective: Supracricoid partial laryngectomy (SCL) was introduced as an organ preservation procedure for treating selected early laryngeal cancer. However, the recovery of the voice after SCL may result in different degrees of dysphonia. To improve the functional recovery and quality of the voice, we realized a modified supracricoid laryngectomy (MSCL) using sternohyoid muscles for neoglottic reconstruction in selected patients affected by T1b-T2 laryngeal cancer. In this study, we evaluate the quality of life (QoL) in patients treated by SCL and MSCL.Methods: The quality of life (QoL) evaluation was undertaken using the Italian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.Results: The overall QoL, assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, was better in patients treated with MSCL than in those treated with SCL. The better QoL correlates with the highest response scores to the questions on the relative global functioning scales in patients treated with MSCL.Conclusion: The new surgical technique has improved the QoL of patients with early laryngeal cancer, with improved communication ability achieved. Reconstruction of neocords in MSCL improves speech function in comparison to SCL, and patients experience less discomfort and achieve an almost normal communication performance.

BACKGROUND:Supracricoid laryngectomy is an organ preservation surgical technique for early-stage glottic tumors. Modified supracricoid laryngectomy using sternohyoid muscles for neoglottis reconstruction is a new surgical technique. This report evaluates oncological and functional outcomes of this new technique and its feasibility in elderly patients.METHODS:Clinical records from 21 consecutive patients affected by glottic cancer and treated by modified SCL between 2004 and 2009 were retrospectively reviewed. Postoperative parameters and quality of voice after modified SCL were retrospectively reviewed. Actuarial overall survival, disease-specific survival rates, and recurrence-free survival rates were assessed. The functional and oncological outcomes of patients over 65 years were compared with those of patients younger than 65 years of age.RESULTS:There were no postoperative complications and all of the patients had complete swallowing rehabilitation. Twenty of the 21 patients had decannulation. Two patients received total laryngectomy for locoregional relapse. Overall survival and disease-specific survival rates were 100%. Recurrence-free survival rates were 90.1% and 90% in patients younger and older than 65 years of age, respectively. The larynx preservation index was lower in patients who were older than 65 years of age. The postoperative courses with regard to functional outcome and voice quality in elderly patients were similar to those of patients younger than 65 years of age.CONCLUSION:Modified SCL is a new open organ preservation surgical technique that is oncologically safe. The positive functional and oncological outcomes of this surgical procedure allow it to be performed in elderly patients.

CONTEXT:Factors involved in the biology of normal and cancer stem/precursor cells from the thyroid are unknown. Thyroid cancer cells are responsive to insulin and IGF-I and IGF-II and often overexpress the insulin receptor (IR) and the IGF-I receptor (IGF-IR).OBJECTIVE:We investigated the role of IR isoforms (IR-A and IR-B), IGF-IR, and their ligands in thyroid follicular cell precursors both normal and malignant.DESIGN:We established cultures of follicular cell precursors as thyrospheres from three papillary thyroid cancers and the corresponding nonaffected tissues. The expression of IR, IGF-IR, and their ligands was evaluated by quantitative RT-PCR and, in one case, also by Western blot. The effects of insulin and IGFs on thyrosphere growth and self-renewal were evaluated.RESULTS:Thyrospheres were characterized by the expression of stem cell markers and low/absent thyroid specific markers. Thyrospheres from normal tissue, but not from cancer tissue, could be induced to differentiate. Both IR isoforms, IGF-IR, IGF-I and IGF-II, were expressed at high levels in thyrospheres and markedly decreased in differentiating cells. IR-A was the predominant isoform in thyrospheres, especially from cancer, while IR-B was predominant in differentiating cells. Cancer thyrosphere growth was stimulated by insulin and IGFs.CONCLUSIONS:Our data suggest that IR isoforms and IGF-IR play a role in the biology of follicular thyroid precursors. Cell differentiation is associated with marked changes in the expression of these receptors and cognate ligands. These data may provide insight for future differentiation therapies in thyroid cancer.

Our previous study demonstrated that Melaleuca alternifolia (tea tree) oil (TTO) had an interesting antiviral activity against Influenza A in MDCK cells. In fact, when we tested TTO and some of its components, we found that TTO had an inhibitory effect on influenza virus replication at doses below the cytotoxic dose; terpinen-4-ol, terpinolene, and alfa-terpineol were the main active components.The aim of this study was to investigate the mechanism of action of TTO and its active components against Influenza A/PR/8 virus subtype H1N1 in MDCK cells.None of the test compounds showed virucidal activity nor any protective action for the MDCK cells. Thus, the effect of TTO and its active components on different steps of the replicative cycle of influenza virus was studied by adding the test compounds at various times after infection. These experiments revealed that viral replication was significantly inhibited if TTO was added within 2 h of infection, indicating an interference with an early step of the viral replicative cycle of influenza virus.The influence of the compound on the virus adsorption step, studied by the infective center assay, indicated that TTO did not interfere with cellular attachment of the virus.TTO did not inhibit influenza virus neuraminidase activity, as shown by the experiment measuring the amount of 4-methylumbelliferone, cleaved by the influenza virus neuraminidase from the fluorogenic substrate 2'-O-(4-methylumbelliferyl)-N-acetylneuraminic acid.The effect of TTO on acidification of cellular lysosomes was studied by vital staining with acridine orange using bafilomycin A1 as positive control. The treatment of cells with 0.01% (v/v) of TTO at 37 degrees C for 4 h before staining inhibited the acridine orange accumulation in acid cytoplasmic vesicles, indicating that TTO could inhibit viral uncoating by an interference with acidification of intralysosomal compartment. (C) 2010 Elsevier B.V. All rights reserved.

Objective. To compare quality of voice in patients treated by supracricoid laryngectomy and patients treated by modified supracricoid laryngectomy using the sternohyoid muscle for neoglottis reconstruction.Study Design. Case series.Setting. Teaching hospital.Subjects and Methods. This study was performed between 2004 and 2008 on 28 consecutive patients affected by T1b-T2 laryngeal carcinoma. Eleven patients were treated by supracricoid laryngectomy, and 17 patients were treated by modified supracricoid laryngectomy. For each patient, postoperative parameters such as decannulation time, nasogastric feeding tube, and length of hospitalization were noted. Vocal function, Voice Handicap Index scores, and perceptual voice analysis scores on intelligibility, noise, fluency, and voice scale were evaluated.Results. The postoperative course of the patients treated by modified supracricoid laryngectomy was similar to patients treated by supracricoid laryngectomy. No delay in the length of hospitalization was detected in patients undergoing surgery with the new technique. A significant difference was detected in the nasogastric tube removal time and decannulation time. The data from intelligibility, noise, fluency, and voice scale analyses revealed a better quality of voice in patients treated by modified supracricoid partial laryngectomy with a significant difference in intelligibility, fluency, and voicing. The Voice Handicap Index mean value of physical, functional, and emotional subscales confirmed patients' perceptions of a minor voice handicap in patients treated by modified supracricoid laryngectomy, with a significant difference on the physical subscale.Conclusion. Modified supracricoid laryngectomy seems to be a good way to improve quality of voice and quality of life in patients with early laryngeal cancer.

The role of bacterial infections, mainly Chlamydophila pneumoniae, on atherosclerotic processes as well as the therapeutic utility of additional antibiotic treatment is still an open question. In this study we compared the serological profiles of 160 patients (80 with peripheral arterial disease (PAD), diagnosed with an ankle/brachial index (ABI) ≤ 0.9 and 80 with risk factors for cardiovascular disease - CVD) with those of 80 healthy subjects, serum levels of specific C. pneumoniae antibodies using the microimmunofluorescence test. Our results show that PAD patients had a higher frequency of C. pneumoniae infection than those with risk factors for cardiovascular disease. This frequency was lower if compared to the previous two groups in controls. 44 out of the 80 (55%) patients with PAD and 34 out of the 80 (42.58%) subjects with risk factors for cardiovascular disease were seropositive while only 24 of the 80 (30%) healthy subjects showed seropositivity to C. pneumoniae. Furthermore, higher anticorpal titers were also found in patients with peripheral arterial disease and in patients with cardiovascular risk factors if compared to healthy subjects. On the basis of these results, we confirm that C. pneumoniae infection is frequent in peripheral arterial disease patients and we believe that it could be considered as an additional risk factor involved in the pathogenesis of this disease.

Clinical OtolaryngologyVolume 35, Issue 3 p. 249-251 Possible role of 18FDG-PET/CT for the surveillance of sinonasal inverted papilloma E. Allegra, E. Allegra Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorN. Lombardo, N. Lombardo Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorG. Cascini, G. Cascini Radiology Unit, “Magna Graecia” University, Catanzaro, Italy E-mail: [email protected]Search for more papers by this authorA. La Boria, A. La Boria Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorA. Garozzo, A. Garozzo Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorO. Tamburrini, O. Tamburrini Radiology Unit, “Magna Graecia” University, Catanzaro, Italy E-mail: [email protected]Search for more papers by this author E. Allegra, E. Allegra Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorN. Lombardo, N. Lombardo Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorG. Cascini, G. Cascini Radiology Unit, “Magna Graecia” University, Catanzaro, Italy E-mail: [email protected]Search for more papers by this authorA. La Boria, A. La Boria Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorA. Garozzo, A. Garozzo Otolaryngology Head and Neck Surgery, “Magna Graecia” UniversitySearch for more papers by this authorO. Tamburrini, O. Tamburrini Radiology Unit, “Magna Graecia” University, Catanzaro, Italy E-mail: [email protected]Search for more papers by this author First published: 23 June 2010 https://doi.org/10.1111/j.1749-4486.2010.02131.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume35, Issue3June 2010Pages 249-251 RelatedInformation