Postoperative Cardiac Complications in Patients Undergoing Laryngectomies

Introduction: The European Society of Cardiology provides guidelines for preoperative cardiac risk assessment in patients undergoing laryngectomies. Cardiovascular risk factors: chronic congestive heart failure, ischemic heart disease, severe arrhythmias, have important prognostic significance for major surgical interventions and must be carefully evaluated preoperatively.The Aim of the study is to determine the most common postoperative cardiac complications in patients undergoing laryngectomies.Materials and Methods: A clinical prospective cohort study including 120 patients undergoing total laryngectomy, in the Department of Otorhinolaryngology at the University Hospital „Queen Giovanna“ – ISUL, Sofia, 2014-2017.Results and discussion: The most common postoperative cardiac complications in patients undergoing laryngectomies are arterial hypertension, angina pectoris, and tachycardia.Conclusion: There are many cardiac risk factors in patients undergoing laryngectomies that can lead to postoperative complications, respectively prolong the hospital stay and increase medical expenses

Changes in gene expression of EGFR and LAD1 in patients with metastatic squamous cell laryngeal carcinoma

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Endoscopic orbital decompression in a patient with a metastasis in the orbit

Endoscopic orbital decompression is an evolving operative technique for managing intraorbital pressure, exophthalmos and reduced visual acuity. We present a clinical case of a palliative orbital decompression in a patient with metastasis in the right orbit from anaplastic carcinoma of unknown origin. Full ethmoidectomy was performed, resection of lamina papyracea and periorbital incisions followed. After surgery patient reported of considerable reduction of pain and exophthalmos but no improvement of visual acuity was registered.Patient carried on his treatment with chemotherapy

Intraoperative and postoperative complications during microlaryngeal surgery

Theoretical basis: Patients presenting for microlaryngeal surgery may have a variety of comorbidities contributing to their voice symptoms and affecting anesthetic management.Results: Many patients presenting for laryngeal surgery have a long history of heavy smoking and drinking. Many patients who present for laryngeal surgery are elderly and have cardiovascular disease. The rate of difficult endotracheal intubation may reach almost 16% among patients presenting for ear, nose, or throat cancer surgery, which is on average six times higher than among the general surgical patient population. Loss of the airway on induction, requiring emergent cricothyrotomy or tracheostomy, can be sudden, especially in patients with critical airway obstruction. Prospective trials identify the incidence of dental trauma after suspension laryngoscopy at 0% to 6.5%, depending on the operator’s experience, methodology of the study, dental injury criteria, preexisting dentition status of the patient, and suspension technique used. Minor surgical complications, such as sore throat, mucosal injury (e.g., cuts, edema, hematoma), and cranial nerve dysfunction (e.g., lingual, glossopharyngeal, hypoglossal), are most commonly observed. The risk of postoperative airway compromise is significantly greater among the patients who underwent diagnostic laryngoscopy than those in the general surgical population.Conclusion: Patients presenting for microlaryngeal surgery may have a variety of intraoperative and postoperative complications

Infiltrazione macrofagica e densità capillare nel carcinoma della laringe. Studio su 52 casi

L’angiogenesi è uno dei sei principali meccanismi alla base del cancro, ed è stato studiato approfonditamente negli ultimi 20 anni. L’obiettivo del presente studio è stato quello di determinare sia la densità capillare sia l’infiltrato macrofagico nei campioni di carcinoma laringeo e di determinarne la correlazione con gli aspetti clinici e patologici. Sia la densità capillare (CD34) sia l’infiltrato macrofagico (CD68) sono stati determinati con metodiche immunoistochimiche mediante microarray. Il nostro campione ha mostrato una densità capillare media di 14,27 ± 12,92 vasi su campo ingrandito a 200×, e l’infiltrato macrofagico medio è stato di 5,19 ± 4,32. La densità capillare si è dimostrata superiore nei pazienti metastatici. Inoltre uno studio di regressione lineare ha mostrato che l’entità dell’infiltrato macrofagico poteva predire la densità capillare del campione di carcinoma laringeo preso in esame. Non abbiamo invece individuato una correlazione fra ambo i fattori studiati e l’incidenza delle recidive o gli altri fattori clinici presi in esame. Il nostro studio aggiunge dati ad un problema che per quanto studiato a fondo negli ultimi 20 anni resta nella sostanza controverso

Lymphomas of the Head and Neck

Проследени са диагностицираните малигнени лимфоми в областта на главата и шията с ангажиране на УНГ-органите в Катедра УНГ-болести при МУ – София за периода 01.01.1996 – 31.12.2009 год. Те бяха категоризирани в три големи групи: І група – Генерализирани нодални лимфоми, обхванали и УНГ-органите, в която бяха включени: Неходжкинови лимфоми с висока степен на малигненост, Неходжкинови лимфоми с ниска степен на малигненост; ІІ група – Първично обхванали УНГ-органите Неходжкинови лимфоми, в която бяха включени ангиоцентричните НХЛ, MALT-лимфомите и екстраосалните (солитарни) плазмоцитоми; III група-Ходжкинови лимфоми. Поради това, че НХЛ с ниска степен на малигненост и тези с благоприятна прогноза се трансформират хистоморфологично в лимфоми с висока степен на малигненост в 28-44% от случаите, ранното им откриване с помощта на използваните в оториноларингологията диагностични средства (биопсия от епифаринкс, мезофаринкс, хипофаринкс, ларинкс, носни и околоносни кухини, слюнчени жлези и лимфни възли) позволява ранно започване и провеждане на лечение, с което вероятността за пълно излекуване или постигане на по-дълга ремисия е по-голяма.------------------------------------------------------A follow-up of all cases diagnosed as head and neck Lymphomas involving ENT organs admitted to the ENT Department at Medical University-Sofia for the period 01.01.1996-31.12.2009 was carried out. Cases are categorized in two major groups: Group I: Generalized Nodal Lymphomas engaging ORL-organs, including NHL with high and low-grade malignancy; Group II: NHL primarily affecting ORL-organs, including Angiocentric NHL, MALT-lymphomas and Extraossal (Solitary) Plasmocytomas; Group III: Hodgkin lymphoma. Since 28-44% of all low grade malignancy NHL and those with favorable prognosis transform histomorphologically into high grade malignancy lymphomas, the early diagnose of these tumors by means of ENT diagnostic methods (biopsy of the epipharynx, mesopharynx, larynx, nose and paranasal cavities, salivary glands and lymph nodes) allows an early start of treatment and therefore increases the chances of a full recovery or the achievement of a longer remission

Difficult Intubation in Patients with Carcinoma of the Larynx and Hypopharynx

Introduction: ASA defines difficult intubation as tracheal intubation which requires more than three attempts with direct laryngoscopy. In a major study including 3325 patients, three or more attempts for direct laryngoscopy were needed in 1,9%, and intubation failure was observed in 0,1%. The Aim of the study is to determine difficult intubation rates in patients with laryngeal and hypopharyngeal carcinoma.Materials and Methods: A prospective cohort study including 100 patients undergoing microlaryngeal surgery in the Department of Otorhinolaryngology at the University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2014-2017.Results and discussion: Difficult intubation is observed in 8 patients (8%). Impossible intubation is observed in 12 patients (12%). The study showed that the major factor leading to difficult endotracheal intubation in patients with carcinoma of the larynx and hypopharynx is the laryngeal obstruction caused by the malignant process.Conclusion: difficult and impossible intubation rates in patients undergoing laryngectomies are higher than in the common population due to the obstruction caused by the carcinoma

Risk Factors For Periopertive Complications In Patients Undergoing Laryngectomies

Introduction: The European Society of Cardiology provides guidelines for preoperative cardiac risk assessment in patients undergoing laryngectomies. Cardiovascular risk factors: chronic congestive heart failure, ischemic heart disease, severe arrhythmias, valvular diseases, have important prognostic significance for major surgical interventions and must be carefully evaluated preoperatively.The Aim of the study is to determine the most common risk factors leading to perioperative complications in patients undergoing laryngectomies.Materials and Methods: A retrospective cohort study including 1260 patients with laryngeal carcinoma, operated in the Department of Otorhinolaryngology at the University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2007-2011.Results and discussion: The most common risk factors leading to perioperative complications in patients undergoing laryngectomies are: smoking,alcohol abuse, cardiovascular risk factors: arterial hypertension, ischemic heart disease, atrial fibrillation, and respiratory risk factors: chronic obstructive pulmonary disease.Conclusion: There are many risk factors in patients undergoing laryngectomies that can lead to postoperative complications, respectively prolong the hospital stay and increase medical expenses

Malignant peripheral nerve sheath tumor arising in schwannoma - case report with rare laryngeal location

Laryngeal nerve sheath tumors are extremely rare. Most of the cases affect supraglottic and occasionally glottic space. Clinically they are presented with foreign body sensation, dysphagia, dysphonia and dyspnea. Due to their slow progression, the diagnosis and treatment (which is mainly surgical) are not uncommonly delayed for years. We present a clinical case of female patient with malignant transformation of laryngeal schwannoma, revealing the ten-year duration of medical history from the first examination to the final diagnosis

Hemodynamic Responses to Different Methods for Upper Airway Instrumentation in Patients Undergoing Laryngectomies

Introduction: Laryngectomy is a surgical procedure for patients with malignancies of the larynx or adjacent anatomical structures. Total laryngectomy is a procedure for complete surgical removal of the larynx. Every surgical intervention with preservation of the physiological speech and swallowing, without the need of permanent tracheostomy, is evaluated as organ preservation laryngeal surgery.The Aim of the study is to determine the hemodynamic responses to different methods of upper airway instrumentation during the tracheostomy, in patients undergoing laryngectomies.Materials and Methods: A clinical prospective cohort study including 60 patients undergoing frontolateral resection and 60 patients undergoing total laryngectomy, operated in the Department of Otorhinolaryngologyat the University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2012-2015. Patients were divided into three groups according to the used method for upper airway instrumentation during the tracheostomy.Results and discussion: Patients undergoing frontolateral resection and total laryngectomy have a characteristic hemodynamic response to the used method for upper airway instrumentation.Conclusion: Upper airway instrumentation during the tracheostomy is a hemodynamic stability defining factor in patients undergoing laryngectomies