ABSTRACT
Abstract Introduction: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. Objective: To describe our clinical experience with tumor debulking as an alternative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. Methods: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. Results: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. Conclusion: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer.
Resumo Introdução: A obstrução das vias aéreas superiores com estridor, secundária a neoplasias, é tradicionalmente tratada com traqueotomia. No entanto, este procedimento comum pode potencialmente ter um impacto sobre o desfecho a longo prazo, com a implantação do tumor na ferida cirúrgica da traqueotomia, o que leva à recorrência peristomal após laringectomia, com o risco de recorrência do estoma. Objetivo: Descrever nossa experiência clínica com a redução do volume tumoral como tratamento alternativo à traqueotomia em pacientes com câncer avançado de laringe em um centro de referência terciário. Método: Foi realizada uma revisão retrospectiva de prontuários de 87 indivíduos com câncer avançado de laringe (T3/T4) com obstrução das vias aéreas em nosso banco de dados institucional. Registros médicos incluindo dados demográficos, anotações diárias durante a hospitalização e anotações operacionais foram utilizados como dados clínicos dos pacientes. A estratégia para manter a patência das vias aéreas foi a traqueotomia (emergência ou em pacientes acordados) e redução do volume tumoral (por laser ou coblation). Tumores endofíticos e exofíticos da laringe também foram anotados. Resultados: Uma traqueotomia foi realizada como tratamento inicial em 41/87 (47,1%) pacientes (11 foram de emergência, 30 foram eletivas) para manter a patência das vias aéreas. A redução do volume tumoral foi realizada em 28 lesões exofíticas e 18 endofíticas por laser ou coblation (17 e 29 pacientes, respectivamente). A traqueotomia foi realizada em 5 pacientes (4 endofíticos, 1 exofítico) que não podiam tolerar a cirurgia de redução de volume devido à aspiração, edema e dispneia. Três deles que necessitaram de uma traqueotomia subsequente estavam no grupo de laser e dois no grupo coblation. A taxa de sucesso da redução tumoral foi de 82,35% (14/17) para o laser e 93,1% (27/29) para coblation. Conclusão: A redução do volume tumoral é um método seguro e eficaz para evitar a traqueotomia com paciente acordado, nos casos de obstrução das vias aéreas devido ao câncer de laringe avançado.
Subject(s)
Humans , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/complications , Airway Obstruction/surgery , Airway Obstruction/etiology , Tracheotomy , Tracheostomy , Retrospective Studies , Cytoreduction Surgical Procedures , Neoplasm Recurrence, LocalABSTRACT
Abstract Lasia spinosa (L.) Thwaites is a widely used ethnomedicinal plant in Bangladesh. In this study, we investigated phenolic contents, volatile compounds and fatty acids, and essential oil components of extracts prepared from aerial parts of the plant. The main volatile compounds were methyl ester of oleic acid, palmitic acid and stearic acid as determined by GC/MS. Phenolic contents of the extracts were determined qualitatively and quantitatively by HPLC/TOF-MS. Six phenolic compounds (syringic acid, morin, gentistic acid, 4-hydroxybenzoic acid, cinnamic acid, and apigenin) were found in the extracts. GC/MS analysis of steam distilled essential oil showed camphor, α-pinene and δ-3-carene as the main constituents. In DPPH radical scavenging assay, the highest free radical scavenging activity was observed for the methanol extract with an IC50 value of 0.48 ± 0.04 mg/mL, whereas, in metal chelating activity on ferrous ions (Fe2+) assay, the highest chelating activity was observed for hexane extract (IC50 = 0.55 ± 0.08 mg/mL). The extracts and essential oil were tested against five severe human pathogenic bacteria using disc diffusion assay and subsequent MIC values were also determined. All the extracts (except methanol extract) and the essential oil were found to possess potential antimicrobial activity with corresponding inhibition zone and minimum inhibitory concentration (MIC) ranging from 9-23 mm and 62.5-500 µg/mL. This study has been explored the plant Lasia spinosa can be seen as a potential source of biologically active compounds.
Subject(s)
Chelating Agents/analysis , Free Radical Scavengers , Phenolic Compounds/analysis , Volatile Organic Compounds/analysis , Fatty Acids/analysisABSTRACT
Aim: A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD). Materials and Methods: Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test. Results: The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001). Conclusions: The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.