Factors associated with the quality of life of subjects with facial disfigurement due to surgical treatment of head and neck cancer

Background

Facial disfigurement has been considered one of the most challenging consequences of the surgical treatment for head and neck cancer patients, mainly due to the importance of the facial region for the personal identity, body self-image and interpersonal interactions, which might affect negatively the quality of life. The aim of this study was to assess factors associated with the quality of life of subjects with facial disfigurement due to surgical treatment.

Material and Methods

Clinical data were retrieved from 103 patient’s medical records and quality of life data were collected using the Functional Assessment of Cancer Therapy (FACT-H&N) questionnaire. Moreover, the degree of facial disfigurement was classified by means of a specific ordinal scale.

Results

Data from the FACT-H&N questionnaire showed that the domain directly related to head and neck symptoms was considered the most impacted, while emotional domain was the least affected. Lower quality of life was associated with sequels in the neck and/or lower third of the face (β=-0.39; p=0.001), a higher level of disfigurement (β=-0.29; p=0.016) and female gender (β=-0.20; p=0.038).

Conclusions

Disfigurement due to surgical treatment was significantly associated with the functional dimension of the patients, especially in extensive sequels in the cervical and lower regions of the face.

Key words:Quality of life, Head and neck cancer, Patient-reported outcomes.

Overall Survival in Advanced Breast Cancer: Relevance of Progesterone Receptor Expression and DNA Ploidy in Fine-Needle Aspirates of 392 Patients

Fine-needle aspiration cytology (FNAC) is essential for making a diagnosis in advanced breast cancer. The determination of hormone receptors in the material obtained is useful for predicting patient response to endocrine therapy, but the prognostic value of hormone receptor expression as well as the clinical utility of DNA flow cytometry are controversial. The aim of this prospective study with long-term follow-up (median: 81 months) was to evaluate these biomarkers in relation to overall survival in a series of 392 patients with advanced breast cancer (stage IIB, n=106; IIIA, n=66; IIIB, n=174; and IV, n=46) using FNAC. Estrogen and progesterone receptor expression was found in 65.1% and 46.1% of the tumors, respectively. Hormone receptors were not found to be associated with clinical staging. DNA aneuploidy was present in 70.9% of the cases and the median S-phase fraction (SPF) was 9.4%. There was a significant correlation of aneuploidy and high SPF with lack of hormone receptors. In univariate analysis, advanced disease stage, absence of hormone receptors, DNA aneuploidy and high SPF showed a statistically significant correlation with poor clinical outcome. In multivariate analysis, disease stage, progesterone receptors and DNA ploidy retained independent prognostic significance in relation to overall survival. These data indicate that progesterone receptor expression and DNA ploidy are independent prognostic factors in advanced breast cancer.

Comparison of a test battery for assessing the toxicity of a bleached-kraft pulp mill effluent before and after secondary treatment implementation

Pulp and paper mill effluents may cause harmful effects to the aquatic environment due to the combined influence of physical factors, toxic compounds, and nutrient enrichment. In the present study, the effectiveness of secondary treatment in reducing the toxicity of an elemental chlorine-free bleached-kraft pulp mill effluent was evaluated. To characterize the toxicity of the effluent, before and after the implementation of secondary treatment, a battery of tests with organisms bearing different functions at the ecosystem level was used, namely Vibrio fischeri (5-min luminescence), Pseudokirchneriella subcapitata (72-h growth), Lemna minor (7-day growth), Daphnia magna (21-day reproduction and 24-h postexposure feeding), Chironomus riparius (9-day growth), and Danio rerio (28-day growth). For the effluent sample collected before the implementation of secondary treatment, P. subcapitata was the most sensitive organism followed by V. fischeri and D. magna, and no toxic effects were observed toward the other organisms. For the effluent sample collected after the implementation of secondary treatment, the effluent caused no toxic effects on any of the tested species. The present results demonstrated not only that secondary treatment efficaciously reduced effluent toxicity toward the selected test organisms but also the usefulness of a battery of tests to characterize the toxicity of pulp mill effluents.

Development and sensitivity of a 12-h laboratory test with Daphnia magna Straus based on avoidance of pulp mill effluents

Studies on avoidance of contaminants by aquatic organisms verified that such behavior may have crucial ecological implications. Yet, avoidance tests have not been considered in ecological risk assessments. This study aimed at developing a short-term test with Daphnia magna Straus based on avoidance of pulp mill effluents and at comparing its sensitivity to the standard 21 d D. magna reproduction test. The avoidance effective dilution values (12 h EDil20 and EDil50) were as sensitive as the 21 d EDil20 and EDil50 values for reproduction. Therefore, this easily standardizable short-term test can be recommended as a valuable complementary tool in ecological risk assessments.

Ecotoxicological evaluation of cork-boiling wastewaters

Toxicity tests with Vibrio fischeri, Daphnia magna, and Lemna minor were used to evaluate acute and chronic toxicity of cork-boiling wastewaters and correlation analysis was performed with physicochemical parameters. Acute toxicity values (EC(50)) ranged from 2.3% to 24.2% in the Microtox test and from 4.4% to 29.5% in the Daphnia test. According to these values, 78% of the samples were classified as acutely toxic to the most sensitive species (V. fischeri). Significant correlation was obtained between EC(50) and chemical oxygen demand, biochemical oxygen demand after 5 days, total organic carbon, tannin and lignin and total solids. No significant correlation was found between the two acute tests. The D. magna chronic test showed significant differences between all tested concentrations and the control, with an EC(50) of 0.32%. An EC(50) value of 26.0% was calculated for L. minor. For the analysis of cork-boiling wastewater toxicity and routine biomonitoring, the use of the Microtox test is suggested, to afford greater environmental protection.

Searching for RET/PTC rearrangements and BRAF V599E mutation in thyroid aspirates might contribute to establish a preoperative diagnosis of papillary thyroid carcinoma

OBJECTIVE

Searching for multiple molecular markers in thyroid aspirates appears to be a promising approach for establishing a preoperative diagnosis of papillary thyroid carcinoma (PTC).

METHODS

Based on this hypothesis, a total of 63 samples from 55 patients, were collected at random. RNA was extracted from the residue cells inside the needle used for fine needle aspiration cytology (FNAC) and thereafter molecular analysis was carried out both for RETrearrangements (type 1, 2, 3) and BRAF codon 599 mutation molecule. Results were compared with the cytological and histopathological diagnoses in 24 patients submitted to surgery.

RESULTS

58% PTCs presented a genetic alteration either RET/PTC rearrangement, BRAF V599E mutation or both: three cases of PTCs (25%) presented a RET/PTC rearrangement; three cases of PTCs (25%) presented a BRAF V599E mutation and in one case (8%) both alterations were identified.

CONCLUSIONS

The present results suggest that searching for multiple molecular markers in thyroid aspirates may enhance the accuracy of FNAC and refine preoperative diagnosis of PTC.

Assessing HER-2 status in fresh frozen and archival cytological samples obtained by fine needle aspiration cytology

Determination of HER-2 status is an essential prerequisite in considering a patient's eligibility for anti-HER-2 therapy; few studies have focused on its evaluation on cytological material. We present a new method of assessing HER-2 status on cytological samples, by fluorescence in situ hybridization (FISH) with an automated detection system, using fresh frozen (FF) and May-Grunwald-Giemsa (MGG) stained smears, and we evaluate the reliability of HER-2 determination on fine needle aspiration cytology (FNAC). The pre-treatment protocol for FF smears is easier and faster than for MGG stained slides. However, with the described procedure, FISH is also feasible on archival MGG stained slides. We conclude that with this method, cytological samples obtained by FNAC, either FF or MGG, are a reliable option for assessing HER-2 status.

Ecotoxicological monitoring of remediation in a coke oven soil

Assessment of contaminated sites is usually based on chemical analyses of hazardous compounds in soil. This is enough either to assess the environmental hazard of contaminated soil nor to evaluate the efficiency of applied remediation techniques. Information on the bioavailability of complex mixtures of xenobiotics and degradation products cannot be provided by chemical analytical data, but results from bioassays can integrate the effects of pollutants in mixtures. In the preservation of human health and environmental quality, it is important to evaluate ecotoxicological effects of contaminated industrial soils to complement the techniques of analytical chemistry. The monitoring of a coke oven soil and the evaluation of the landfarming treatment technique, conducted on-site in a pilot scale installation, was done by a battery of ecotoxicological tests: acute, chronic, and genotoxicity tests. Contaminated soil samples revealed toxic effects for different species mainly due to high concentrations of polycyclic aromatic hydrocarbons (PAHs). After landfarming treatment, soil samples presented significant reduction in toxicity, confirming the effectiveness of the landfarming process pointed out by a significant reduction in low molecular weight PAH concentrations. Comparative analysis of the different ecotoxicological tests allowed the establishment and validation of a more suitable procedure for the monitoring of PAH contaminated soils.

Landfarming in a PAH-contaminated soil

The present work describes a coke oven soil treatability study by land-farming, conducted on-site in a field scale facility covering 100 m2. The soil contamination was mainly due to high concentrations of polynuclear aromatic hydrocarbons (PAHs) up to 1,140 mg/Kg dry weight (sigma EPA). Along the treatment process the soil was characterised at the chemical, microbiological and ecotoxicological levels. After 3 months a reduction of 63% in total PAHs concentration was observed, being detected a more pronounced reduction for PAHs with 2, 3 and 4 rings (79%). Concomitantly, a change in the composition of the microbial population was observed with a significant increase in the PAHs degrading and total heterotrophic colonies. Concerning the ecotoxicity and genotoxicity data no effect was detected in the treated soil samples eluates.

Medullary thyroid carcinoma: an accurate pre-operative diagnosis by reverse transcription-PCR

OBJECTIVE

To study the expression of calcitonin (CT) and thyroglobulin mRNA in samples of leftover cells in needles used for fine-needle aspiration biopsy either from thyroid tumours or cervical lymph nodes.

PATIENTS AND METHODS

Specimens were analysed using reverse transcription-polymerase chain reaction; 12 samples from 11 patients were included and molecular diagnosis was compared with cytological or histological diagnosis and serum CT measurements.

RESULTS

Transcripts of the CT gene were detected in all six patients with medullary thyroid carcinoma (MTC) but in none of the other patients.

CONCLUSIONS

Present data reinforce this technique as a reliable and alternative tool to establish the pre-operative diagnosis of MTC, especially when cytological examination is not conclusive or when cytological information is not in agreement with clinical data. Furthermore, it may be clinically useful to identify those conditions in which increased serum CT in the presence of a thyroid nodule is not due to MTC.

Coordinated changes of adenylate energy charge and ATP/ADP: use in ecotoxicological studies

The coordinated variations of the adenylate energy charge and ATP/ADP ratio were modeled and a function that depends on the numerical value of the adenylate kinase-catalyzed reaction has been derived. The model allows sensitive detection of the effects of xenobiotics on adenylate kinase and its cellular environment and offers a robust estimation of the direct or indirect effects of pollutants on the adenylate kinase system: data obtained in laboratory studies on shrimp exposed to cadmium and in field studies on oysters either exposed to polychloro-biphenyl compounds or located in a heavily polluted area indicate that xenobiotics affect the adenylate kinase reaction directly or by changing its cellular environment. These results demonstrate that application of the model to the treatment of ecotoxicological data allows detection of energetic changes that would have been missed by simple analysis of the usual energetic parameters, and should overcome problems encountered in using energetic parameters during assessment of pollution monitoring.

Bartter's syndrome and pregnancy

Bartter's syndrome is a rare renal tubular disorder and few cases are reported associated with pregnancy. We describe a case of long standing disease with a good obstetric outcome in which the main concern was to maintain normal potassium serum levels.

Metaplastic carcinomas of the breast--fine needle aspiration (FNA) cytology findings

Metaplastic carcinomas of the breast are defined by mesenchymal and/or squamous cell components associated with ductal carcinoma and may raise diagnostic problems in FNA cytology. We reviewed FNA smears of a series of nine cases; seven were compared with histological sections and two with cell-block sections. The cytological pattern was diagnostic of carcinoma in six cases; in two cases a diagnosis of sarcoma/phyllodes tumour was considered, as cells were predominantly spindle-shaped. One case had a pleomorphic adenoma type pattern. The cytological findings suggesting a diagnosis of metaplastic carcinoma include a liquid aspirate, a proteinaceous or chondromyxoid background and a poorly differentiated tumour with multinucleated giant cells, neoplastic or histiocytic. A definite diagnosis requires the presence of both carcinomatous and metaplastic (squamous/mesenchymal) components.

Flow cytometric DNA hypertetraploidy is associated with unfavourable prognostic features in breast cancer

AIM

Breast tumours with a DNA content higher than 4N (hypertetraploidy) are not well characterised. The aim of this study was to evaluate the clinical and biological characteristics of 51 hypertetraploid breast carcinomas selected from a series of 860 consecutive cases analysed by flow cytometry.

METHODS

The clinicopathological characteristics of the hypertetraploid group were compared with those of a control group of 138 non-hypertetraploid breast carcinomas. Breast tumours from patients submitted to surgery as primary therapeutic approach (15 hypertetraploid and the 138 non-hypertetraploid) were TNM staged and classified according to the histological type and grade. The remaining 36 patients had advanced neoplastic disease at presentation and were classified by cytological criteria only. DNA flow cytometric analysis was performed on fresh-frozen samples stained with propidium iodide. Hormone receptors were analysed by immunocytochemistry.

RESULTS

The incidence of hypertetraploid breast tumours was 5.9% (51 of 860). All the patients were women and the mean age at diagnosis was 65 years. There was a family history of breast cancer in 21.6% of cases. In the group of operated patients, 33.3% had pT3 tumours and 53.3% had axillary lymph node metastases. All but one tumour were invasive ductal carcinomas; the remaining was an invasive papillary carcinoma. Ten (66.7%) tumours were classified as poorly differentiated carcinomas. Oestrogen and progesterone receptors were negative in 33 (64.7%) and 38 (74.5%) tumours, respectively. At last follow up, 35 (72.9%) patients were alive, while 13 (27.1%) died of disease within three years of diagnosis. Statistical comparison of the clinicopathological features of hypertetraploid v non-hypertetraploid breast carcinomas yielded a significant difference in tumour size (p < 0.001), histological grade (p < 0.001), hormone receptor status (p < 0.001), and overall survival (p < 0.001) between the two groups.

CONCLUSION

Flow cytometric DNA hypertetraploidy is related to clinicopathological features of breast cancer usually associated with unfavourable prognosis.

[Intrauterine and perinatal management of complete atrioventricular block in the fetus]

PURPOSE

To report the experience of one of the most severe fetal rhythm disturbances, the complete atrioventricular block.

METHODS

Descriptive study of 14 fetuses diagnosed and monitored at the Fetal Cardiology Unit, from January, 1991 to August, 1995.

RESULTS

Fourteen cases of complete AV block were identified during the study period, with post-conceptional age between 22 and 38 weeks at the moment of diagnosis. Twelve cases were referred to the Fetal Cardiology Unit because of low heart rate during obstetric examination. Eight fetuses showed complete AV block without evidence of structural heart disease; maternal collagen tissue disease was diagnosed in three of these cases. Four neonates were discharged from the hospital, two of them with a permanent pacemaker, one with complete AV block but no pacemaker and the fourth with sinus rhythm. The remaining seven neonates presented with severe heart failure leading to death despite treatment.

CONCLUSION

Complete AV block is a rare fetal condition, but carries a high morbidity and mortality. A several treatment techniques have been suggested to improve monitoring and survival of these patients, particularly in utero.

Schinzel-Giedion syndrome. A patient with hypothyroidism and diabetes insipidus

The Schinzel-Giedion is an autosomal recessive syndrome characterized by midface retraction, hypertrichosis, multiple skeletal anomalies, cardiac and renal malformations and mental retardation. We describe a female child with this syndrome and a clinical status complicated by hypernatremic dehydration, hypothyroidism and diabetes insipidus at the age of 10 months.

[Human alfa-2b in rabbit's eyes]

The toxicity of human interferon alpha 2b in rabbit's vitreous and conjonctiva is studied through electroretinography, echography, angiography and histological examination. Interferon was injected in increasing doses 150,000 UI, 500,000 UI and 1,000,000 UI. The results from examinations in the rabbits are presented and the conclusion is drawn, that good tolerance is achieved, even at higher doses.

[Interstitial hypertrophic neuritis. Study of 3 cases]

Three cases of hypertrophic interstitial neuropathy with severe decrease of motor nerve conduction velocity are reported; on sural nerve biopsy was found the typical onion bulb formation, with connective tissue proliferation. The pathogenesis of the onion bulb formation and the correlation with the decreased motor nerve conduction are discussed. The authors concluded that only one of the cases could be named Dejerin-Sottas disease, since the others probably are Charcot-Marie-Tooth disease cases.