Pre-operative CT cephalometry and functional outcomes after open partial horizontal laryngectomy

Objectives

To identify pre-operative radiological parameters that are able to predict the functional outcomes of open partial horizontal laryngectomy (OPHL).

Methods

The present retrospective study concerned a cohort of 96 patients with laryngeal squamous cell carcinoma who underwent pre-operative radiological staging with contrast-enhanced computerised tomography of the neck, and subsequent supracricoid or supratracheal laryngectomy. Univariate and multivariate analyses were run to assess the prognostic value of the main demographic and surgical variables, and the pre-operative cephalometric values, respectively, in terms of predicting patients' functional outcomes.

Results

Multivariate analysis showed that a larger anteroposterior cross-sectional dimension of the aero-digestive tract in the mid-retroglossal area, and a greater distance between the genial tubercle and the hyoid bone in the mid-sagittal plane correlated significantly with better functional outcomes in terms of decannulation rate at discharge.

Conclusions

Our findings show that larger pre-operative upper aero-digestive tract diameters and volumes coincide with better post-operative functional outcomes after OPHL.

Cardiovascular risk and obesity

BACKGROUND

This is an overview of the mechanisms of obesity and its relation to cardiovascular risks, describing the available treatment options to manage this condition.

MAIN BODY

The pathogenesis of obesity includes the balance between calories consumed and energy expenditure followed by the maintenance of body weight. Diet, physical activity, environmental, behavioral and physiological factors are part of the complex process of weight loss, since there are several hormones and peptides involved in regulation of appetite, eating behavior and energy expenditure. The cardiovascular complications associated to obesity are also driven by processes involving hormones and peptides and which include inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin angiotensin or the sympathetic nervous systems. Pharmacological treatments are often needed to insure weight loss and weight maintenance as adjuncts to diet and physical activity in people with obesity and overweight patients.

CONCLUSION

To accomplish satisfactory goals, patients and physicians seek for weight loss, weight maintenance and improvement of the risk factors associated to this condition, especially cardiovascular risk.

Multicentric Glioblastoma Multiforme Mimicking Optic Neuritis

A 49-year-old previously healthy woman presented with acute painless visual loss in the right eye, a right relative afferent pupillary defect, and a normal fundus examination. She was diagnosed with retrobulbar "optic neuritis" and given a course of intravenous steroids. Despite treatment, however, she continued to lose vision and serial visual field testing confirmed a junctional scotoma in the fellow eye. Cranial magnetic resonance imaging (MRI) showed a mass at the junction between the right optic nerve and the anterior aspect of the chiasm and a right frontal lesion that proved to be multicentric glioblastoma multiforme. Clinicians should be aware of the possibility of aggressive neoplasm in the differential diagnosis of retrobulbar optic neuritis.

Effects of two diet techniques and delivery mode on weight loss, metabolic profile and food intake of obese adolescents: a fixed diet plan and a calorie-counting diet

The aim of this study is to compare the weight loss of obese adolescents on two different low-calorie diets: fixed diet plan and calorie-counting diet. This is a randomized clinical study with 66 obese adolescents (body mass index Z score (ZBMI)>+3, 13.7±0.7 years, 60.6% male) with anthropometric, food intake, physical activity, laboratory, body composition and stage of pubertal development data evaluated. There was a reduction in the ZBMI in both groups (P<0.0001), without significant difference between them (P=0.87). There was a significant reduction in insulin, and homeostasis model assessment insulin resistance (HOMA-IR), with no difference between groups. A reduction in total energy intake of the groups was found, with an increase in the proportion of protein and reduction in carbohydrates. In this cohort of severely obese adolescents, fixed diet plan and calorie-counting diet led to a similar reduction of ZBMI, metabolic markers and total energy intake.

Obesity and obstructive sleep apnea-hypopnea syndrome

Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. Obesity affects upper airway anatomy because of fat deposition and metabolic activity of adipose tissue. Obstructive sleep apnea-hypopnea syndrome and metabolic syndrome have several characteristics such as visceral obesity, hypertension and insulin resistance. Inflammatory cytokines might be related to the pathogenesis of sleep apnea and metabolic syndrome. Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.

[Frequency of utilization and reasons for exclusion from thrombolytic therapy in patients with acute myocardial infarction in Salvador-Bahia]

PURPOSE

To determine the rate of utilization and reasons for exclusion from thrombolytic therapy in acute myocardial infarction (AMI) in the setting of Intensive Care Unit (ICU) Salvador-BA.

METHODS

Retrospective cohort study recording patients admitted with suspected AMI in six ICU in Salvador-BA between January/93 and December/94 were reviewed.

RESULTS

Three hundred and eighty-eight of confirmed cases of AMI were analysed, 165 (42.0%) were admitted at public hospitals and 225 (58.0%) at private hospitals. Thrombolytic therapy was indicated in 143 (36.8%) patients. The thrombolysis was more frequently performed in men (PR = 1.96 IC 95% 1.39-2.77), in patients less than 60 years of age (PR = 4.46 CI 95% 2.17-9.19) and in those with Killip class I (PR = 2.62 CI 95% 1.60-4.31). The major reasons for excluding from thrombolytic therapy were late arrival, old age and lack of ST elevation. Thirty three percent of patients were excluded for more than one reasons. Multivariate analysis showed that female gender was associated with a reduced indication for thrombolytic therapy, independent of the clinical findings on admission.

CONCLUSION

The frequency of the use and reasons for excluding patients from thrombolytic therapy in AMI in Salvador-BA were similar to those of other clinical studies. The recent recommendations of the Thrombolysis Brazilian Consensus will enhance the utilization of this therapy, as it expands its utilization to elderly patients and to those who arrive late to the hospital.