Evaluation of lung function in patients submitted to total laryngectomy / Avaliação da função pulmonar em pacientes submetidos à laringectomia total

Abstract Introduction: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. Objective: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. Methods: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. Results: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. Conclusion: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.

Resumo Introdução: A condição pós-laringectomia é caracterizada por várias alterações na função pulmonar. Uma estimativa confiável da função pulmonar pode ser muito útil em pacientes laringectomizados para prevenir complicações após as intervenções cirúrgicas e avaliar os resultados do tratamento. Objetivo: Caracterizar a presença de distúrbios funcionais respiratórios e o padrão funcional de pacientes laringectomizados através do uso de um dispositivo extratraqueal. Método: Estudo transversal que incluiu 50 pacientes submetidos à laringectomia total pelo menos seis meses antes desta investigação, como tratamento de escolha para o câncer de laringe. Resultados: Dos participantes, 56% apresentavam padrão respiratório alterado, assim distribuídos: 14 com padrão obstrutivo sem aprisionamento aéreo, 11 com padrão obstrutivo e aprisionamento aéreo e apenas três com padrão restritivo. Em média, verificou-se que a difusão encontrava-se diminuída (74,3%) e a resistência das vias aéreas aumentada (121,7%) em relação aos resultados esperados em brasileiros. Conclusão: A maioria dos pacientes submetidos à laringectomia total apresenta função pulmonar alterada, do tipo obstrutiva, quase sempre associada a história de tabagismo.

Proliferative verrucous leukoplakia: diagnosis, management and current advances / Leucoplasia verrucosa proliferativa: diagnóstico, conduta e avanços atuais

Abstract Introduction: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Objective: To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. Methods: A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. Results: There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. Conclusion: More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.

Resumo Introdução: Leucoplasia verrucosa proliferativa (LVP) é uma lesão multifocal e progressiva da mucosa oral, com etiologia desconhecida e comumente resistente a todas as tentativas terapêuticas, com recorrências frequentes. É caracterizada por uma alta taxa de transformação em carcinoma de células escamosas e carcinoma verrucoso da cavidade oral. Objetivo: Analisar os estudos sobre LVP e elaborar uma atualização resumida. Método: Foi realizada uma pesquisa na base de dados Pubmed que identificou estudos (pesquisas laboratoriais, séries de casos e revisões de literatura) que avaliaram pacientes com LVP. Resultados e discussão: Não há estudos suficientes sobre LVP na literatura. Os poucos estudos encontrados não apresentam consenso quanto aos critérios de etiologia e diagnóstico. Embora várias estratégias de tratamento tenham sido propostas, a maioria ainda apresenta alta taxa de recorrência. Conclusão: Mais pesquisas sobre LVP são necessárias para entender e tratar essa doença.

Distribución de los genotipos del virus del papiloma humano en mujeres de Bogotá con anomalías en la citología cervicouterina / Genotype distribution of Human Papillomavirus in women from Bogotá with abnormal cervical smear

Objetivos: Determinar la distribución de los genotipos de VPH en mujeres de Bogotá con citología cervicouterina anormal. Métodos: Se colectaron muestras cervicales de 191 mujeres con ASCUS, 236 con lesiones intraepiteliales escamosas de bajo grado (LIEBG) y 116 de alto grado (LIEAG). La tipificación de VPH se realizó usando PCR con iniciadores consenso GP5+/GP6+ y reverse line blot. Resultados: La prevalencia de VPH fue 76,1%. Se observaron infecciones únicas en el 41,4% de las participantes, y coinfecciones en el 34,6%. La frecuencia de VPH según diagnóstico fue: 60,2%, 84,7% y 84,5% en ASCUS, LIEBG y LIEAG. Los VPH-16 y 58 fueron los tipos más frecuentes en los tres grupos, con frecuencias para VPH-16 de 20,4%, 33,9% y 38,8%, y para VPH-58 de 7,3%, 13,6%, 18,1% para ASCUS, LIEBG y LIEAG. En ASCUS y LSIL el tercer tipo en frecuencia fue VPH-56 (6,8% y 11,0%), mientras que en LIEAG fue VPH-18 (10,3%). Las infecciones con tipos virales probablemente oncogénicos y con tipos de bajo riesgo fueron mucho menos frecuentes y en general se presentaron como coinfecciones con tipos de alto riesgo. Conclusiones: Las infecciones con tipos de VPH de alto riesgo fueron las más frecuentes en todas las lesiones estudiadas, el VPH-58 ocupo el segundo lugar en frecuencia, como ha sido reportado en México y en general en Suramérica. El cambio hacia nuevas vacunas profilácticas que incluyan más tipos virales como el VPH-58 puede tener un mayor impacto en la disminución de la incidencia de lesiones preneoplásicas en nuestra región.

Objective: To determine the distribution of HPV genotypes in women from Bogotá with abnormal cervical smear. Methods: Cervical samples were collected from 191 women with ASCUS, 236 with low-grade (LSIL) and 116 with high-grade squamous intraepithelial lesions (HSIL). HPV typing was performed using consensus PCR primers GP5+/GP6 + and reverse line blot. Results: The prevalence of HPV was 76.1%. Unique infections were observed in 41.4% of the participants and co-infections in 34.6%. The frequency of HPV according to diagnosis was: 60.2%, 84.7% and 84.5% in ASCUS, LSIL and HSIL respectively. HPV16 and 58 were the more frequent types in the three groups, HPV16 frequencies were 20.4%, 33.9% and 38.8%, and HPV58 frequencies were 7.3%, 13.6%, and 18,1% for ASCUS, LSIL and HSIL respectively. The third type in frequency in ASCUS and LSIL was HPV56 (6.8% and 11.0%), while in HSIL was HPV18 (10.3%). Infections with probably oncogenic types or with low risk types were much less frequent and generally were observed as co-infections with high-risk types. Conclusions: Infections with high risk HPV types were the most frequent in all studied lesions, VPH-58 ranked second in frequency as has been reported in Mexico and in general in South America. The change to new prophylactic vaccines including more viral types as HPV58 could have a higher impact in reducing the incidence of pre-neoplastic lesions in our region.