A densidade do linfonodo metastático como fator prognóstico no carcinoma espinocelular da língua e soalho bucal

Objective

Materials and Methods

Results

Conclusion

Spinal accessory nerve neuropathy following neck dissection

Aim

Materials and methods

Results

Conclusion

Retardo diagnóstico e terapêutico em pacientes com câncer da laringe em hospital público de referência

Aim

Study design

Materials and Methods

Result

Conclusion

Genomics and proteomics approaches to the study of cancer-stroma interactions

Background

The development and progression of cancer depend on its genetic characteristics as well as on the interactions with its microenvironment. Understanding these interactions may contribute to diagnostic and prognostic evaluations and to the development of new cancer therapies. Aiming to investigate potential mechanisms by which the tumor microenvironment might contribute to a cancer phenotype, we evaluated soluble paracrine factors produced by stromal and neoplastic cells which may influence proliferation and gene and protein expression.

Methods

The study was carried out on the epithelial cancer cell line (Hep-2) and fibroblasts isolated from a primary oral cancer. We combined a conditioned-medium technique with subtraction hybridization approach, quantitative PCR and proteomics, in order to evaluate gene and protein expression influenced by soluble paracrine factors produced by stromal and neoplastic cells.

Results

We observed that conditioned medium from fibroblast cultures (FCM) inhibited proliferation and induced apoptosis in Hep-2 cells. In neoplastic cells, 41 genes and 5 proteins exhibited changes in expression levels in response to FCM and, in fibroblasts, 17 genes and 2 proteins showed down-regulation in response to conditioned medium from Hep-2 cells (HCM). Nine genes were selected and the expression results of 6 down-regulated genes (ARID4A, CALR, GNB2L1, RNF10, SQSTM1, USP9X) were validated by real time PCR.

Conclusions

A significant and common denominator in the results was the potential induction of signaling changes associated with immune or inflammatory response in the absence of a specific protein.

Avaliação da sobrevida livre de doença em pacientes com carcinoma epidermoide de laringe submetidos à tratamento radioterápico exclusivo ou associado à quimioterapia

In early stage (I and II) laryngeal squamous cell carcinoma, both surgery and radiotherapy results in significant local and regional control. In advanced tumors (III and IV), radiotherapy alone has local-regional control rates of 32-43%.

Aim

To assess disease-free survival in SCC laryngeal carcinoma patients submitted to radiotherapy alone and/or associated with chemotherapy.

Materials and Methods

Retrospective study involving 84 cases of laryngeal SCC treated with radiotherapy or chemotherapy together with radiotherapy. Fifty-three cases were treated with intension to cure and 31 because of impossibility to resect the disease. As to clinical stage (CS), 12 were CS I, 15 II, 21 III and 5 IV. In the second group, 11 cases were EC III and 20 IV.

Results

Mean age was 60 years, 84.5% were men. Fifty-eight (69.1%) cases had complete response and 26 (30.9%) had persistent or residual disease. Five-year disease-free survival was of 42.5%; 62.5% of the patients with organ preservation indication and 9.75 in the group of irressecable disease.

Conclusion

disease-free survival of those patients submitted to radiotherapy because of laryngeal SCC was of 62.5%

Assessment of CD4 T-lymphocyte reactivity by the Cylex ImmuKnow assay in patients following allogeneic hematopoietic SCT

After allogeneic hematopoietic SCT (alloHSCT), immunosuppressed patients are susceptible to opportunistic infections, and uncontrolled function of the graft can result in GVHD. Accurate immune monitoring may help early detection and treatment of these severe complications. Between October 2005 and November 2007, a total of 170 blood samples were collected from 40 patients after alloHSCT in the Hadassah Hebrew University Medical Center and from 13 healthy controls. We utilized the Cylex ImmuKnow assay for CD4 ATP levels to compare known clinically immunocompromised vs immunocompetent patients after alloHSCT. We also compared the reconstitution of WBC count to the ImmuKnow results and clinical status. The patients' clinical course correlated with the stratification of immune response established by the ImmuKnow assay for solid organ transplantation (immunocompetent vs immunocompromised), and this often differed from their WBC count. On the basis of our observations, we conclude that the ImmuKnow assay is a simple and fast immune-monitoring technique for patients undergoing alloHSCT, with potential to predict clinical course and facilitate prompt management of post-HSCT complications. The assay should be evaluated prospectively in clinical trials.

Quantitative monitoring of multi-donor chimerism: a systematic, validated framework for routine analysis

Despite therapeutic advantages, double-donor (DD) HSCTs present technical problems for molecular chimerism (CHM) monitoring. These DD chimeras contain three matched DNAs, so that the genomes of donor(s) and recipient often share the same alleles. In the STR assay, shared recipient/donor alleles are common and have identical physico-chemical properties. As a consequence of the latter, they co-migrate in the same band ('shared peak'), which prevents measuring each allele separately. Without individual allelic measurements, the direct calculation of the chimeric recipient/donor DNA ratio is precluded. This is the first study to document and systematically examine these problems. Its goal was to provide a validated framework for accurate, routine monitoring based on a stepwise analytic paradigm for approximating percent CHM (%CHM) from shared STR-alleles. Analysis of STR-DNA from DD loci showed that at least four of six alleles were typically shared. Despite such extensive allelic sharing, we show how simple arithmetic procedures can be applied for standardized calculation of %CHM based on peak measurements. Criteria for selecting loci suitable for such analysis are provided. Validation of the computational results required analyzing 18 'informative' loci with pre-established reference values for %CHM. In all cases, the results for %CHM, calculated from peak measurements, were +/-5% of the reference value. The conclusions of the study are as follows: (1) Multi-donor chimeras, with shared alleles, can be accurately and simply analyzed within the usual limits of STR measurement error; (2) by examining these various facets of DD CHM analysis, this novel study has provided a basis for standardized, routine quantitative monitoring using the STR/VNTR assay.

Prognostic factors in the treatment of squamous cell carcinoma of the larynx: partial surgery x radical surgery

The present study aimed at assessing the other sites as the carcinoma spreads, as well as therapeutic results, in larynx preservation and patient survival. Study type: It is a Longitudinal Historical Cohort Study, a retrospective clinical study.

Materials and Methods

A hundred and sixty (160) patients treated at 'Escola Paulista de Medicina' ('Paulista' Medical School) - São Paulo Hospital, from January 1988 to December 2004 were examined as for the spreading of their larynx carcinoma. Those patients whose evaluations were at least two years old after treatment were the only ones accepted. The parametric tests used were: Test X2, Fisher's test, and Kaplan-Meier's curve.

Results

The posterior commissure and the infraglottis were significant in terms of the laryngectomy: glottal tumors AC: (p=0.03) AP: (p=0.0001); AC: (p=0.0007) AP: (p<0.0001), respectively. The infraglottis was significant in G+SG tumors in AP: (p=0.04) and in death rate AP: (p=0.03).

Conclusion

total laryngectomy is the treatment of choice in the presence of total involvement of the posterior commissure and the infraglottis. The latter may compromise survival, according to local invasion, even in the presence of free surgical margins.

Prevalence of cytomegalovirus infection among patients undergoing hemodialysis

CMV diseases predominantly occur as an opportunistic infection in patients with severe immunosuppression, such as cancer and renal failure patients, and rarely occur in immunocompetent patients. This study aimed to investigate the prevalence of CMV infection in patients undergoing hemodialysis and to compare the results of different serological tests for CMV infection. Data were collected from 100 patients with renal failure and undergoing hemodialysis in the hemodialysis center of health insurance hospital in Tanta City, Gharbia Governorate, Egypt during the period from January 2007 to January 2008. The data collected from the study patients included sociodemographic characteristics, history of blood transfusion and duration of hemodialysis. CMV/IgG, CMV/IgM and CMV/Ampilcor (PCR) tests were done for each studied patients. Cross-tabulation and Fisher exacts and McNamar's tests as well as concordance agreement tests were used. The mean age of the study patients was 42.0 +/- 8.1 and most of them (60%) were males with the mean duration of dialysis was 1.8 +/- 1.1 years. The seroprevalance of CMV antibodies among these acute patients was 98% using CMV/IgG, 11% using CMV/IgM and 30% by using CMV/Ampilcor (PCR). Comparing these findings showed highly statistically significant difference (P = 0.001). Sensitivity and specificity of CMV/IgG and IgM were varied compared to CMV/Ampilcor test. The IgM was less sensitive (30%) but highly specific (97%), so PCR is the gold standard test with concordance estimated to be 28%. For this test, sensitivity and agreement is increased with decreasing years of dialysis to become 40% and 43%, respectively. On the other hand, however, CMV/IgG appeared to be highly sensitive (93%) and not specific at all (0%), and the agreement with PCR is very low (3%). In summary, the choice of diagnostic IgM and IgG tests depends upon the duration of hemodialysis that might primarily determine the duration of infection, although the use of PCR testing appeared to be more convenient.

Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth

The therapeutic paradigm for neck metastasis of squamous cell carcinoma (SCC) in the lower level of the mouth has changed due to survival. Aim: A comparative study between radical (RND) versus selective neck dissection (SND). Material and Method: An analysis of mouth SCC in the lower level of the mouth in 460 files from the Head & Neck and ORL Department of the Heliopolis Hospital, from 1978 to 2002. In the RND the metastathic rate in levels IV and V was assessed; in the SND the presence and site of recurrence was identified. The chi square test with the Yates correction was the chosen statistical method. Results: In the RND the metastatic rates were 5.8% (level IV) and 4.6% (level V) for cNO cases, and 9.9% (level IV) and 5.9%(level V) for cN+ cases; for level I only the rates were 11,0% for cNO cases and 5.5% for cN+ cases. In the SND the number of recurrences was 4 (4.1%) in 97 neck dissections (pNO) and 2 (10%) in 20 neck dissections (pN+). There was no advantage in using radiation compared to non-irradiated cases (5.6% and 5.7%). Conclusion: The SND may be used for SCC of the lower level of the mouth.

Allogeneic stem cell transplantation from matched related and unrelated donors in thalassemia major patients using a reduced toxicity fludarabine-based regimen

The only radical cure for thalassemia major patients today is the replacement of the defective hematopoietic system by allogeneic stem cell transplantation (allo-SCT). The major obstacles for the application of allo-SCT even from matched family members have been the transplant-related morbidity and mortality and graft failure that is usually associated with the recurrence of the thalassemia hematopoiesis. The outcome of allo-SCT from HLA-identical family donors is largely dependent on the age of the recipient as well as on pretransplant parameters reflecting the degree of organ damage from iron overload. In this study we report our experience of allo-SCT from matched related and unrelated donors, using a reduced toxicity conditioning consisting of fludarabine, busulfan or more recently busulfex and antithymocyte globulin, in a cohort of 20 patients with thalassemia major. The regimen-related toxicity was minimal, while the incidence of acute grade II-IV and chronic GVHD was 25 and 25%, respectively. With a median follow-up period of 39 months (range: 5-112 months) the overall survival was 100%, while thalassemia-free survival was 80%. Although the results of our study look promising, larger cohorts of patients and prospective clinical trials are required to confirm the benefits of our approach as a possible better alternative to the existing protocols.

Lymph node reactivity and microvessel density in neck metastases of unknown primary squamous cell carcinoma

BACKGROUND

Neoangiogenesis and the immune response are important mechanisms in metastasis development.

AIM

to evaluate lymph node reactivity and microvessel density in neck metastasis of occult primary squamous cell carcinoma considering their histological and clinical variables.

STUDY DESIGN

retrospesctive case-series.

METHOD

19 patients with neck metastasis of occult primary squamous cell carcinoma who underwent neck dissection between 1983 and 2000 were selected. The lymph nodes were reevaluated on the type of reactivity in both the cortical and paracortical areas, and the metastasis were assessed as to grade, desmoplasia, necrosis and microvessel density (CD34). The relationship between histological and clinical variables was evaluated.

RESULTS

the median microvessel density was 91 vessels/mm2, varying from 28 to 145. Paracortical hyperplasia was more common in patients below 55 years of age (90%x44%, p=0.05), but there was no relationship between reactivity patterns and microvessel density with prognosis. The disease-free survival was 52% in 3 years, being similar in both groups, with higher or lower microvessel densities.

CONCLUSION

microvessel density in neck metastasis of occult primary squamous cell carcinoma had a great individual variability. It wasnt possible to establish the relationship between microvessel density and the clinical or histological variables studied.

Neck dissection in squamous cell carcinoma of the tongue

Aim

The purpose of this study was to assess the prognosis of patients with tonsillar squamous cell carcinoma with different stages of lymph node involvement and to determine the best elective neck dissection for those cases.

Study design

Case series.

Material and Method

51 patients with tonsillar tumors were treated between 1992 and 2001. The incidence of different tumor-node-metastasis stages was evaluated according to primary tumor extension.

Results

cN0 patients had metastases in stages I and II only. Among pN+ subjects with stage I metastases, 6/7 had primary tumor extending to oral cavity.

Conclusion

Supraomohyoid neck dissection (stages I, II and III) is the elective treatment of choice when tonsillar primary tumor extends to oral cavity. When primary tumors are limited to the oropharynx, selective neck dissection of stages II and III proved to be more adequate.

Esvaziamento cervical seletivo no tratamento do carcinoma epidermóide do andar inferior da boca

OBJETIVO: O esvaziamento cervical seletivo, removendo apenas os linfonodos com maior probabilidade de metástases, pode ser adequado para o tratamento do pescoço nos carcinomas epidermóides do andar inferior da boca. O objetivo deste estudo é avaliar os níveis linfonodais acometidos por metástases em uma série de pacientes tratados em uma única instituição. MÉTODO: Foram avaliados os registros de 416 pacientes com câncer de lábio, língua oral, soalho de boca, gengiva inferior, região jugal e trígono retromolar, submetidos à 519 esvaziamentos cervicais entre 1977 e 2001, quanto ao níveis linfonodais acometidos por metástases. RESULTADOS: O nível I estava acometido em 107/519 (20%) esvaziamentos, o nível II em 147/519 (28%), o nível III em 75/519 (14%), o nível IV em 32/419 (7%) e o nível V em 22/419 (5%). A taxa de falso-negativos e de falso-positivos foi de 36% e 30%, respectivamente. Os pacientes com metástases nos níveis I e/ou II, III, IV ou V tiveram uma média 2,2; 4,8; 6,5 e 7,5 linfonodos comprometidos, respectivamente (p < 0.0001). As metástases no nível IIb foram diagnosticadas em 21 (5%) pacientes, sendo que 11 (52%) deles tinham metástases no nível V (p < 0,0001). CONCLUSÃO: O esvaziamento cervical dos níveis I a IV remove quase todos os linfonodos com risco de metástases no carcinoma epidermóide do andar inferior da boca. O esvaziamento seletivo com esta extensão é adequado para o tratamento eletivo do pescoço (N0), onde ocorrem aproximadamente 30% de casos falso-negativos, e também pode ser suficiente no esvaziamento terapêutico (N+). Quando ocorrem metástases no nível IIb, aumenta significativamente o risco de metástases no nível V.

Visualizing flow vortices inside a single levitated drop

The internal flow dynamics in single liquid drops, kept in place through levitation by a counterflowing continuous fluid phase in a suitably designed glass cell, is investigated by PFG NMR techniques. The positional stability of the drops was confirmed from series of one-dimensional profiles and was found to be below the spatial resolution of the experiment. Velocity distribution functions (propagators) along all three coordinates were obtained and demonstrated the long-time stability of the internal dynamics in terms of the velocity magnitudes occurring in the systems. Finally, velocity imaging was applied to visualize the internal vortex patterns in the drops either as projections onto different planes or within thin slices of selected orientations. Two different fluid systems were investigated in order to cover the principal cases of rigid and mobile interfaces. Different fast velocity imaging techniques were employed for monitoring the vastly differing velocity ranges of both cases, and the high sensitivity of the internal three-dimensional motion to the cell geometry is demonstrated.

Sobrevida após recidiva intratável do carcinoma epidermóide de cabeça e pescoço

OBJETIVO: Avaliar a sobrevida em pacientes com câncer de cabeça e pescoço recidivado e sem possibilidade de tratamento curativo. MÉTODO: Foram revisados os prontuários dos pacientes com carcinoma epidermóide de boca, orofaringe, hipofaringe e laringe tratados cirurgicamente (tumor primário e esvaziamento cervical) entre 1978 e 2001, e selecionados 140 com recidiva da doença acompanhados até o óbito pelo câncer. Após 1999, 30 pacientes receberam cuidados paliativos de uma equipe multidisciplinar. Foi avaliado o intervalo de tempo entre a recidiva não resgatável e o óbito, considerando o sítio primário, estadiamento inicial, sobrevida livre de doença e cuidados paliativos. Os resultados foram expressos em medianas e médias, com os respectivos quartis e percentis. RESULTADOS: A sobrevida livre de doença apresentou média de 30 semanas. A sobrevida média após a recidiva foi de 17 semanas (Q25-75% = 8 a 34 semanas). Dezessete pacientes (12%) sobreviveram por mais de 12 meses após a recidiva. O sítio primário, estadiamento inicial, local da recidiva, sobrevida livre de doença e os cuidados paliativos não influenciaram a sobrevida após a recidiva. CONCLUSÃO: A sobrevida após uma recidiva não resgatável é similar ao relatado para os pacientes não tratados. Os cuidados paliativos não aumentaram a sobrevida destes pacientes.

Myotonic dystrophy: does it affect ovarian follicular status and responsiveness to controlled ovarian stimulation?

BACKGROUND

Myotonic dystrophy (MD) is characterized by myotonia, multisystemic lesions and hypogonadism. In women, the relationship between MD and infertility remains controversial. This study investigated the ovarian status and response to controlled ovarian stimulation (COS) in MD women entering our preimplantation genetic diagnosis programme.

METHODS

We elected to compare MD patients with X-linked disorders (XLD) carriers, given that XLD have not been shown to affect ovarian status. On the one hand, we analysed all the cycles performed and, on the other hand, we conducted a subanalysis based on only first cycles.

RESULTS

MD and XLD groups were similar with regard to women's ages, day 3 parameters, number of oocytes retrieved, embryos obtained and prevalence of top quality embryos. The day of HCG was significantly delayed and the prevalence of poor quality embryos was higher in the MD group. The subanalysis on first cycles only also showed significantly fewer mature follicles on the day of HCG in MD population. Implantation and pregnancy rates were similar in both groups; however, no pregnancy occurred at the first cycle in MD (0 out of 4), whereas 77% of pregnancies (10/13) occurred at the first attempt in XLD carriers.

CONCLUSIONS

These results indicate that the responsiveness to COS was moderately hindered in MD women as compared to controls. Reassuring data about implantation and pregnancy rates support the feasibility of PGD in selected mildly affected MD women.

[The use of implants in ptosis, hypertrophic and breast deformities]

Breast precise analysis, due to a partial or global diformity, total or minor tuberous breast allows an interesting appreciation of the skin and gland importance in breast modifications. This same analysis enables us to consider the ptosis and hypertrophies under a different angle. Thus, the relative proportions in between the various segments, their evolution in the time and especially the glandular distribution mode, sometimes leads to a different technical approach. To ensure a better glandular distribution, an important factor of the breast stability, the use of a mastopexy, which everyone knows the limits, appears under a new light and, more often than one thought, the use of a breast implant ensures homogeneity of consistency and a more long term result. Concerning the various skin modifications, their specific analysis permit to establish the type of incision used for a better-adapted scar result. The approach we suggest, (detailed analytic study of the breast, glandular distribution, relative proportion of the different breast levels and a more frequent use of an implant) which in any case should not be systematic, can obviously in certain situation optimize the quality of the result (long term projection and a better stability of the mammary shape).

Internal fluid dynamics in levitated drops by fast magnetic resonance velocimetry

Fluid motion inside a levitated drop is determined by the interface properties. Momentum transfer through a highly mobile interface results in stationary vortex patterns inside the drop that dramatically enhance mass transfer between both phases, while immobile interfaces suppress internal dynamics. The presence of small amounts of surface-active substances can result in a partial reduction of interface mobility, the so-called rigid cap. The time dependence of internal flow patterns is presented by means of NMR velocity images of levitated drops, and is compared to fast measurements of the velocity distribution along the three orthogonal coordinates.

Estudo retrospectivo dos carcinomas epidermóides das vias aerodigestivas superiores com metástases bilaterais

OBJETIVO: Estudo retrospectivo das características dos carcinomas epidermóides das vias aerodigestivas superiores relacionadas ao desenvolvimento de metástases cervicais bilaterais. MÉTODO: Foram revisados os prontuários de 150 pacientes com carcinoma epidermóide de boca, orofaringe, laringe e hipofaringe submetidos a esvaziamento cervical bilateral entre janeiro de 1979 e dezembro de 1996, dos quais foram selecionados 73 pacientes que apresentavam metástases bilaterais confirmadas no exame histológico. Foram considerados o estadiamento e a localização dos tumores, confrontando os achados com os estudos sobre drenagem linfática e distribuição das metástases cervicais neste tipo de tumor. RESULTADOS: Quatorze pacientes apresentaram tumor primário nos estádios T1 e T2, 57 nos estádios T3 e T4 e dois não foram estadiados (Tx). Nos cinco pacientes T1 ou T2 de laringe com metástases bilaterais, a lesão estava localizada na epiglote. CONCLUSÕES: Nos pacientes com lesões unilaterais que apresentaram disseminação bilateral, todos apresentavam lesões palpáveis unilaterais.

Recidivas locais após tratamento cirúrgico do carcinoma epidermóide de cabeça e pescoço em estágio avançado

OBJETIVO: Avaliar os resultados do tratamento de resgate das recidivas locais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos a tratamento cirúrgico. MÉTODO: Foram revisados os prontuários de 943 pacientes submetidos à ressecção do tumor primário e esvaziamento cervical entre 1977 e 1996, e selecionados 107 pacientes com recidiva no sítio primário. Foram avaliados os resultados do tratamento de resgate, bem como os motivos para a não realização do mesmo. RESULTADOS: A principal queixa no diagnóstico da recidiva foi dor. O tratamento de resgate foi realizado em 45% dos pacientes e o principal motivo para a não realização do mesmo foi a extensão da recidiva. Foram resgatados 54% dos pacientes com recidiva no estádio rT1T2 em comparação com 31% dos pacientes rT3T4 (p = 0,04). Apenas quatro (8%) dos pacientes resgatados estavam assintomáticos por período superior a 12 meses após o re-tratamento, todos resgatados com cirurgia. O intervalo de tempo entre o tratamento inicial e a recidiva apresentou mediana de oito meses e as novas recidivas ocorreram na mediana de cinco meses. CONCLUSÃO: As recidivas locais após tratamento cirúrgico extenso apresentam prognóstico reservado.

Análise comparativa entre avaliação fonoaudiológica perceptivo-auditiva, análise acústica e laringoscopias indiretas para avaliação vocal em população com queixa vocal

Com a evolução e o desenvolvimento tecnológico, houve mudanças nos métodos de avaliação da voz, tanto na prática médica como fonoaudiológica. OBJETIVO: Relacionar os resultados da avaliação perceptivo-auditiva vocal, análise acústica e avaliações médicas no diagnóstico de alterações vocais e/ou laríngeas em indivíduos com queixa vocal. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foram avaliados 29 indivíduos que participaram de uma ação de proteção de saúde. Os sujeitos foram submetidos à avaliação fonoaudiológica peceptivo-auditiva (AFPA), análise acústica (AA), laringoscopia indireta (LI) e telelaringoscopia (TL). RESULTADOS: Foram estabelecidas as relações entre os métodos de avaliação médica e fonoaudiológica, verificando possíveis significâncias estatísticas a partir da aplicação do Teste Exato de Fischer. Houve significância estatística na relação entre AFPA e LI, AFPA e TL, LI e TL. CONCLUSÃO: Esta pesquisa realizada numa ação de proteção de saúde vocal mostrou concordância entre a avaliação fonoaudiológica perceptivo-auditiva e as avaliações médicas, bem como os exames médicos entre si no diagnóstico de alterações vocais e/ou laríngeas.

Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint

As a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice.

Aim

To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint.

Study design

Clinical prospective.

Material and Method

29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL).

Results

Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL.

Conclusion

This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams.

Esvaziamento cervical no tratamento do carcinoma epidermóide de lábio

O carcinoma epidermóide de lábio geralmente é diagnosticado em fase inicial e as metástases linfonodais são pouco freqüentes. OBJETIVO: Avaliar a incidência e a localização das metástases linfonodais no carcinoma epidermóide de lábio. FORMA DE ESTUDO: Estudo retrospectivo, série de casos. CASUÍSTICA E MÉTODO: Revisão de prontuários de 78 pacientes com carcinoma epidermóide de lábio, sem tratamento prévio, atendidos no período de 1990 a 2001. Foi avaliada a relação do tamanho do tumor primário, grau de diferenciação e comprometimento da comissura labial com a presença de metástases linfonodais, bem como a localização das metástases. RESULTADOS: As metástases linfonodais foram observadas em 7% dos tumores até 3 cm e em 41% nos tumores maiores do que 3 cm (p=0,002). Dez pacientes apresentavam metástases, sendo que todos estes tinham metástases no nível I e apenas 2 tinham metástases em outros níveis. Os pacientes submetidos ao esvaziamento eletivo apresentavam metástases apenas no nível I. CONCLUSÃO: As metástases são infreqüentes nos tumores menores do que 3 cm. Quando presentes, as metástases habitualmente acometem o nível I, portanto o esvaziamento suprahioideo pode ser indicado no tratamento eletivo do pescoço.

[Factitious lithiasis: Case report from Western Algeria]

A 19-year-old woman with recurrent lithiasis was admitted to the urology department for renal colic. Although radiologic examinations and laboratory tests were negative, the patient regularly brought into consultations small "stones", resembling gravel, that she said had been spontaneously expelled. These 42 samples were the object of a preliminary morphological analysis under a binocular magnifier to detect their particulate components. A non-metabolic origin was suspected from the organoleptic characteristics of their surfaces and sections. In view of the diversity of the materials of these apparently false calculi, methods of precise physical analysis were necessary to ascertain their exact origin and thereby confirm the diagnosis of factitious lithiasis. The use of two methods of physical analysis, infrared spectrophotometry and x-ray diffraction, enabled us to determine their exact chemical and mineralogical composition. The samples claimed to be of urinary origin actually consisted of exogenous products of various compositions. Some samples were made of pure calcite, others of mixed calcite and silicates. Moreover several samples of the patient's first morning urine showed no correlation between the nature of the crystalluria and the composition of these stones. These tests made it possible to direct the clinician towards useful complementary investigations. This strange case represents 0.1% of the urinary calculi analysed in Western Algeria.

Significado prognóstico do linfonodo metastático N3 em carcinomas epidermóides de cabeça e pescoço

OBJETIVO: Avaliar os resultados do tratamento da doença metastática em estádio avançado (N3) e sua relação com o prognóstico do carcinoma espinocelular de cabeça e pescoço. MÉTODO: Foram revisados as informações de prontuários de 241 pacientes, com carcinoma espinocelular de boca, orofaringe, laringe e hipofaringe com metástases cervicais maiores que 6 cm (N3) submetidos à cirurgia e/ou radioterapia, no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo, de 1988 a 1998. Nos pacientes submetidos à cirurgia foi avaliada a radicalidade cirúrgica, macroscopicamente completa ou não, e naqueles tratados pela radioterapia, foi analisada a resposta do sítio primário e do pescoço imediatamente ao término do tratamento. A sobrevida livre de doença foi estimada pelo método de Kapplan Meier no grupo submetido à cirurgia. RESULTADOS: A irressecabilidade da lesão primária e metastática no pescoço justificou a indicação da radioterapia na dose média de 65 Gy, em 69 pacientes ocorrendo resposta completa no sítio primário em 24(36%), no pescoço em 12 (18%), e em ambos os sítios em 11 casos (16%). No grupo sumetido à cirurgia seguido de radioterapia, a dose média foi de 56 Gy. Dos 25 pacientes com ressecção macroscópica radical do pescoço, cinco (20%) recidivaram, e dos cinco com ressecção incompleta e radioterapia, dois tiveram sobrevida de sete a 12 meses após o tratamento, quando foram perdidos de seguimento. A sobrevida livre de doença em dois anos neste grupo foi de 58%. CONCLUSÕES: Para pacientes com linfonodo metastático N3, o esvaziamento cervical seguido de radioterapia foi eficiente no controle regional da doença enquanto que nos inoperáveis, a radioterapia é um tratamento paliativo.

Conduta conservadora no carcinoma papilífero da glândula tireóide

OBJETIVO: Avaliar os resultados do tratamento do carcinoma papilífero limitado a um lobo da glândula tireóide, através de tireoidectomia parcial com seguimento superior a cinco anos. MÉTODO: Estudo retrospectivo de 105 prontuários de pacientes portadores de carcinoma diferenciado da glândula tireóidea operados no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo de 1977 a 1997 e selecionados 31 casos que apresentavam nódulos limitados a um lobo da glândula com seguimento superior a cinco anos e submetidos à lobectomia total mais istmectomia. RESULTADOS: Observamos somente um caso (3%) de disfonia transitória com paresia de prega vocal unilateral que regrediu espontaneamente. Não houve casos de hipoparatireoidismo transitório ou definitivo. O seguimento médio foi de 12,6 anos, sendo todos com seguimento superior a cinco anos; 10 casos (32%) com seguimento entre 10 e 15 anos e 10 casos (32%) com seguimento além de 15 anos. Não foram observados casos com recorrência loco-regional ou metástase à distância, estando todos eles assintomáticos e sem doença. CONCLUSÃO: Nesta série, a tireoidectomia parcial para carcinoma papilífero limitado a um lobo, mostrou-se eficaz.

Significado prognóstico da deiscência e infecção da ferida operatória no carcinoma epidermóide das vias aerodigestivas superiores

OBJETIVO: Avaliar o efeito da infecção e da deiscência da ferida operatória sobre o controle local do carcinoma epidermóide das vias aerodigestivas superiores, identificando fatores associados à ocorrência destas complicações. MÉTODO: Estudo retrospectivo de 239 pacientes com carcinoma epidermóide de boca, orofaringe e hipofaringe tratados cirurgicamente no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis entre 1990 e 1996, onde foram avaliados o hemograma e o proteinograma pré-operatório em relação ao risco de desenvolvimento de deiscência e infecção da ferida operatória e comparadas as taxas de recidiva local entre os pacientes com e sem deiscência/infecção da ferida operatória. RESULTADOS: A doença em estádio avançado (estádio IV) e a relação albumina/globulina inferior a 1,2 foram mais freqüentes entre os pacientes que desenvolveram deiscência/infecção (DI) da ferida operatória. A taxa de recidiva local foi de 49% nos pacientes que apresentaram DI e 42% naqueles sem DI. CONCLUSÃO: os pacientes com doença em estádio avançado e aqueles com relação albumina/globulina inferior a 1,2 apresentam maior risco de deiscência/infecção da ferida operatória. A presença de deiscência/infecção não apresentou relação com as taxas de recidiva local.

Evolution of patients with squamous cell carcinoma of upper aerodigestive tract

CONTEXT

Local and regional recurrences are frequent in patients with squamous cell carcinoma of the upper aerodigestive tract and early diagnosis is important for salvage treatment.

OBJECTIVE

To identify the period of highest risk for the development of recurrences after surgical treatment of squamous cell carcinoma of the upper aerodigestive tract, in spite of radical therapy, in order to plan the follow-up for these patients.

TYPE OF STUDY

Cross-sectional, descriptive.

SETTING

Department of Head and Neck Surgery/Otorhinolaryngology, Heliópolis Hospital (Hosphel), São Paulo, Brazil.

PARTICIPANTS

A review was made of the hospital records of 889 patients with squamous cell carcinoma of the upper aerodigestive tract surgically treated between October 1977 and December 1996: 364 had oral cavity tumors, 107 had tumors of the oropharynx, 152 of the hypopharynx and 266, larynx tumors. The disease was stage I in 14 patients, stage II in 117, stage III in 352, stage IV in 397 and 9 patients were not staged.

MAIN MEASUREMENTS

The interval between treatment and recurrence of disease was evaluated. The results were expressed as medians, quartiles (25% to 75%) and percentiles (10% to 90%). The annual incidence of recurrences and second tumors was calculated.

RESULTS

Seventy-four percent of the recurrences were diagnosed within 18 months post-treatment. The local and regional recurrences and distant metastases showed medians of 270, 210 and 435 postoperative days respectively. The incidence of a second primary tumor varied from 2 to 3.1% a year.

CONCLUSION

The majority of recurrences occurred within 18 months after the initial surgical treatment. The incidence of a second tumor remained stable after the first post-treatment year.

Recidivas regionais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos à esvaziamento cervical

OBJETIVO: Avaliar a localização das recidivas regionais em pacientes com carcinoma epidermóide de vias aerodigestivas superiores tratados com esvaziamento cervical, bem como os resultados do tratamento de resgate. MÉTODO: Foram avaliados os prontuários de 943 pacientes submetidos a esvaziamento cervical, dos quais foram selecionados 95 com diagnóstico de recidiva regional isolada como primeira manifestação de recorrência da doença. Foi avaliada a localização da recidiva (lado e nível linfático) e o controle da doença após o tratamento de resgate. RESULTADOS: As recidivas ipsilaterais ocorreram no nível II em 57% dos pacientes. O tratamento de resgate foi realizado em 51% das recidivas ipsilaterais e em 75% das recidivas contralaterais. O controle da doença 12 meses após o resgate foi de 31%, sendo 25% nas recidivas ipsilaterais e 37% nas contralaterais. CONCLUSÕES: As recidivas cervicais ocorrem predominantemente no nível II. As recidivas no nível I são freqüentes apenas nos tumores de boca e as recidivas no nível V são raras. A recidiva cervical tem prognóstico reservado mesmo entre os pacientes submetidos à retratamento com intenção curativa.

Allergy development after bone marrow transplantation from a non-atopic donor

BACKGROUND

Transfer of allergy from atopic bone marrow donors to recipients is known to occur. Development of allergy in a non-atopic patient transplanted from a non-atopic donor is an unfamiliar phenomenon in clinical practice.

OBJECTIVES

To clarify the course of events causing a bone marrow recipient to acquire an allergic disease in such non-conducive circumstances.

METHODS

Full medical history, prick and intradermal skin tests, and serum IgE levels were obtained from both donor and recipient patients. DNA and red blood cell phenotype analyses were used to detect the degree of chimerism.

RESULTS

Only the recipient patient showed positive specific IgE antibodies and skin tests to house dust mite. The recipient patient displayed 100% donor chimera, based on all engraftment markers sought.

CONCLUSION

Full engraftment after allogeneic bone marrow transplantation may be associated with modulation of T and B cell function, which in turn could cause the onset of allergic disease after bone marrow transplantation.

[Relationship between the outcome and the frequency of micronuclei in cells of patients with oral and oropharyngeal carcinoma]

BACKGROUND

To verify the correlation between the micronucleus frequency and the presence of local recurrences or second primary lesion in patients with carcinoma of the oral cavity.

METHODS

We studied the frequency of micronucleus of the oral mucosa in 27 untreated patients with carcinoma of the oral cavity and oropharynx. The patients were monthly followed after initial treatment, in an attempt to identify local recurrences or second primary lesions.

RESULTS

Of the 24 patients evaluated during the whole time, 5 cases (20,8%) were alive and free of disease, and 19 cases died, 18 (75%) owing to cancer and 1 to perfurative peptic ulcer. In relation to micronucleus frequency, no difference was observed among the patients with local recurrence of the disease (N=14) and the patients who died of other causes or were alive and free of disease (N=10) (p = 0.83). There was higher micronucleus frequency in the stages T3 and T4 (p = 0.01).

CONCLUSION

In the present study was not possible to find a clinical correlation between the frequency of micronucleus of the oral mucosal and the risk of development of local recurrence or second primary tumor in patients with upper aerodigestive tract carcinoma.

Crescimento tumoral versus estadiamento no carcinoma epidermóide de língua e soalho da boca

OBJETIVO: Este estudo tem por objetivo avaliar a relação entre o tamanho do tumor, duração da sintomatologia e a evolução de pacientes com carcinoma epidermóide de língua e soalho bucal. MÉTODO: foram avaliados retrospectivamente 226 pacientes submetidos à ressecção de tumor primário de língua e/ou soalho da boca em combinação com esvaziamento cervical. Foi estimado o crescimento mensal do diâmetro tumoral médio (raiz quadrada da superfície/número de meses de evolução) e relacionado com a presença de metástases e recidiva local. A sobrevida livre de doença foi avaliada em relação ao tamanho do tumor e à duração dos sintomas. RESULTADOS: 16% dos tumores T1 e T2 e 11% dos tumores T3 e T4 apresentaram tempo de sintomatologia igual ou inferior a um mês. A mediana de crescimento do diâmetro tumoral foi de 0,81cm/mês. Não houve diferença no crescimento tumoral entre os pacientes pN+ ou pN0; 30 pacientes desenvolveram recidiva local, sendo 15 com crescimento tumoral menor do que 0,82cm/mês e 15 no grupo com crescimento ³ 0,82cm/mês. CONCLUSÕES: A taxa de crescimento tumoral não se relacionou com o intervalo livre de doença nos pacientes que apresentaram recidiva local. Os pacientes com tumores menos extensos e menor duração dos sintomas apresentaram maior sobrevida livre de doença. O tempo de sintomatologia e a estimativa de crescimento tumoral não apresentam valor prognóstico nos carcinomas epidermóides de língua e soalho oral.

[Microvascular density in carcinoma of the tongue]

BACKGROUND

Assessment of microvascular density in squamous cell carcinoma of the oral tongue (primary lesion and metastasis).

METHODS

Immunohistochemical analysis by anti CD-34 of neoangiogenesis density and its relation with clinical and histological data concerning the prognosis. After optic microscopy amplification, the relation between microvascular density, clinico-histological data and prognosis, was established.

RESULTS

The microvascular density presented 15.4 vessels/field (5.5 to 25.3) in primary tumors and 16.4 vessels/field (12 to 32.2) in lymph node metastases. It was observed an inverse relation between microvascular density in primary lesions and their lymph node metastasis (r= -0.68 and p=0,04).

CONCLUSIONS

No evidence was detected between microvascular density, histological features and prognosis. There is an inverse relation between microvascular density in primary tumor and in lymphonode metastasis, suggesting a regional or systemic control of angiogenesis in squamous cell carcinoma of the oral tongue.

Valor prognóstico da espessura tumoral no carcinoma epidermóide de boca e orofaringe

OBJETIVO: Avaliar o significado prognóstico da espessura tumoral no carcinoma epidermóide de boca e orofaringe. MÉTODO: Foram avaliados retrospectivamente 112 pacientes atendidos entre janeiro de 1990 e dezembro de 1994, dos quais foram selecionados 84 casos com amostras teciduais disponíveis. A medida da espessura foi realizada à microscopia óptica com ocular milimetrada, considerando a maior medida perpendicular à superfície. RESULTADOS: A incidência de metástases ocultas foi de 7% nos tumores menos espessos do que 3mm e 50% naqueles com espessura igual ou superior a 5mm. As margens cirúrgicas estiveram comprometidas com maior freqüência nos pacientes com espessura tumoral maior ou igual a 5mm, mas a espessura não identificou os pacientes com maior risco de recidiva local. CONCLUSÃO: A espessura tumoral auxilia a identificar os pacientes com carcinoma epidermóide de boca e orofaringe com maior risco de metastatização oculta.

Qualidade de vida e prognóstico nos carcinomas epidermóides de cabeça e pescoço

Objetivo: avaliar um questionário para mensuração da qualidade de vida e sua relação com o prognóstico em pacientes com câncer de cabeça e pescoço. Forma de estudo: prospectivo clínico. Material e Método: estudo de 31 pacientes com carcinoma epidermóide de vias aerodigestivas superiores atendidos no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo, no período de agosto de 1999 a novembro de 2000. Na avaliação da qualidade de vida empregou-se o questionário QLQ-C30 e o módulo QLQ-H&N35, ambos fornecidos pela EORTC, sendo realizada previamente ao tratamento. Foi avaliada a diferença de pontuação entre os pacientes que apresentavam doença controlada e aqueles com recidiva nos primeiros 12 meses após o tratamento. Resultados: foi observada uma diferença significativa na pontuação entre os pacientes assintomáticos e aqueles com recidiva da doença nas escalas relacionadas à fadiga, dificuldade de comer em público e qualidade de vida global (p <= 0,05). A pontuação obtida neste grupo de pacientes foi semelhante à observada em outras populações. Conclusão: a qualidade de vida prévia ao tratamento pode constituir um indicador prognóstico para os pacientes com câncer de cabeça e pescoço.