Discrepancy between clinical and pathological neck staging in oral cavity carcinomas / Discrepancia entre el estadiaje clínico y patológico cervical en los carcinomas de cavidad oral

Introduction: The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%. Objective: The aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases. Methods: Outcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated. Results: For pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p = 0.009). Conclusion: Clinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma (AU)

Introducción: La presencia de metástasis ganglionares cervicales en los pacientes con carcinoma de la cavidad oral reduce la supervivencia hasta en un 50%. Objetivos: Los objetivos de este estudio son evaluar la exactitud del estadiaje N clínico frente al estadiaje N patológico y su impacto en la supervivencia, de cara a identificar los factores predictivos asociados a la presencia de metástasis ocultas cervicales. Métodos: Se han evaluado retrospectivamente los resultados de 105 pacientes con carcinoma epidermoide de la cavidad oral tras tratamiento quirúrgico del tumor primario y vaciamiento cervical. Resultados: En los pacientes pN0 y pN+ la supervivencia global a los 5 años fue del 53 y del 27%, respectivamente, y la supervivencia específica libre de enfermedad fue del 66% para los pN0 y del 33% para los pN+. En los pacientes estadiados clínicamente como negativos se verificó un subestadiaje en el 62% de los casos. La supervivencia específica libre de enfermedad en función de la discrepancia del estadiaje tuvo un impacto estadísticamente significativo en la supervivencia (p = 0,009). Conclusión: El estadiaje clínico suele subestimar la presencia de enfermedad ganglionar. La disección cervical debe realizarse en los carcinomas de cavidad oral aunque se trate de uno cN0 (AU)

Discrepancy between clinical and pathological neck staging in oral cavity carcinomas.

INTRODUCTION: The presence of cervical lymph node metastases in patients with oral cavity squamous cell carcinoma reduces survival by up to 50%. OBJECTIVE: The aims of this study are to assess the accuracy of clinical N staging versus pathological N staging and its impact on survival in order to identify predictive factors associated with the presence of occult neck metastases. METHODS: Outcomes of 105 patients with oral cavity squamous cell carcinoma who underwent surgical treatment of the primary tumor and neck were retrospectively evaluated. RESULTS: For pN0 and pN+ patients 5-year overall survival was respectively 53% and 27%; disease specific survival was 66% for pN0 and 33% for pN+. Patients with clinical negative lymph nodes were pathologically upstaged in 62% of cases. Disease specific survival according to staging discrepancy had statistically significant impact on survival (p=0.009). CONCLUSION: Clinical staging usually underestimates the presence of nodal disease. Neck dissection should be performed in cN0 oral cavity squamous cell carcinoma.

Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success / Osiculoplastia en otitis media crónica: resultados quirúrgicos y factores pronósticos de éxito quirúrgico

Background and objectives: The goal of ossiculoplasty is to improve hearing. Successful ossiculoplasty depends on several factors. This retrospective study was carried out to analyze hearing results of ossiculoplasty in ears with chronic otitis media (COM) and evaluate clinical outcomes and factors predictive of hearing improvement. Subjects and methods: We reviewed the results of 153 patients with COM (with cholesteatoma (COMC) and without cholesteatoma (COMWC)) who underwent ossiculoplasty between January of 2002 to December of 2011. Several potential prognostic factors were evaluated: cholesteatoma present vs absent; type of surgical procedure, state of the middle ear mucosa, state of the ossicular chain, type of prosthesis. Results: We analyzed 153 ossiculoplasties: 96 patients presented COMWC and 57 patients presented COMC. The ossiculoplasties were performed using autologous ossicles for the most part. All ossiculoplasties were carried out in one-stage surgery. In 38% of cases ossiculoplasty was combined with mastoidectomy; in the remaining 62% of cases, ossiculoplasty was performed without mastoidectomy. Ossiculoplasty was successfully achieved in 113 patients (74%). The presence of the stapes superstructure and normal mucosa were significant predictive factors of surgical success. Conclusion: The majority of the ossiculoplasties improved hearing status satisfactorily. Multivariate analysis should be performed to investigate prognostic factors of favorable short-term hearing outcomes after ossiculoplasty. Better knowledge of these predictive factors may contribute to the surgeon's judgment and the information given to patients (AU)

Introducción y objetivos: El objetivo de osiculoplastia es mejorar la audición y sus resultados funcionales dependen de varios factores. Se ha realizado un estudio retrospectivo para analizar los resultados funcionales de la osiculoplastia en enfermos con otitis media crónica (OMC) y evaluar los resultados clínicos y los factores pronósticos que influyen en la recuperación auditiva. Sujetos y métodos: Revisión de los resultados de 153 pacientes con el diagnóstico de OMC (con colesteatoma [COMC] y sin colesteatoma [COMSC]) sometidos a osiculoplastia entre enero de 2002 y diciembre del 2011. Los factores pronósticos evaluados fueron: la presencia o no de colesteatoma, el tipo de técnica quirúrgica, el estado de la mucosa del oído medio, el estado de la cadena osicular y el tipo de prótesis. Resultados: Se han analizado 153 osiculoplastias: 96 pacientes presentaron COMSC y 57 pacientes presentaron COMC. En la mayoría de las osiculoplastias se utilizó material autólogo. Todas las osiculoplastias se realizaron en un único tiempo quirúrgico. En el 38% de los casos de las osiculoplastias se añadió la mastoidectomía; en el 62% restante de los casos la osiculoplastia se realizó sin mastoidectomía. Se ha lograda una mejoría de la audición en 113 pacientes (74%). La presencia de la supraestructura del estribo y de una mucosa normal fueron los factores pronósticos estadísticamente significativos en el suceso quirúrgico. Conclusión: La mayoría de las osiculoplastias mejoró la audición de forma satisfactoria. El análisis multivariado permite evaluar cuáles los factores pronósticos de mejoría auditiva a corto plazo tras la realización de la osiculoplastia. Un mejor conocimiento de estos factores contribuye para la decisión del cirujano y la información a los pacientes (AU)

Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success.

BACKGROUND AND OBJECTIVES: The goal of ossiculoplasty is to improve hearing. Successful ossiculoplasty depends on several factors. This retrospective study was carried out to analyze hearing results of ossiculoplasty in ears with chronic otitis media (COM) and evaluate clinical outcomes and factors predictive of hearing improvement. SUBJECTS AND METHODS: We reviewed the results of 153 patients with COM (with cholesteatoma (COMC) and without cholesteatoma (COMWC)) who underwent ossiculoplasty between January of 2002 to December of 2011. Several potential prognostic factors were evaluated: cholesteatoma present vs absent; type of surgical procedure, state of the middle ear mucosa, state of the ossicular chain, type of prosthesis. RESULTS: We analyzed 153 ossiculoplasties: 96 patients presented COMWC and 57 patients presented COMC. The ossiculoplasties were performed using autologous ossicles for the most part. All ossiculoplasties were carried out in one-stage surgery. In 38% of cases ossiculoplasty was combined with mastoidectomy; in the remaining 62% of cases, ossiculoplasty was performed without mastoidectomy. Ossiculoplasty was successfully achieved in 113 patients (74%). The presence of the stapes superstructure and normal mucosa were significant predictive factors of surgical success. CONCLUSION: The majority of the ossiculoplasties improved hearing status satisfactorily. Multivariate analysis should be performed to investigate prognostic factors of favorable short-term hearing outcomes after ossiculoplasty. Better knowledge of these predictive factors may contribute to the surgeon's judgment and the information given to patients.

Abnormal Congenital Location of Stapes' Superstructure: Clinical and Embryological Implications.

Congenital middle ear malformations are rare. Most part of them are usually associated with other malformations, such as aural atresia, microtia, and dysmorphic craniofacial features. A clinical case of a 24-year-old male with a right-sided conductive hearing loss since his childhood, without craniofacial malformation, is presented. He was proposed for exploratory tympanotomy under the suspicious diagnosis of otosclerosis. The surgery revealed an abnormal location of stapes' superstructure, which was attached to the promontory and had an isolated and mobile osseous footplate in the oval window. A stapes prosthesis was inserted and resulted in closure of the air-bone gap by 25 dB. A review of the literature was also performed using MEDLINE. Two theories diverge on the embryologic origin of the stapes. Our findings seem to be in favour of the theory that defines two different embryologic origins to the stapes.

A compreensão de textos em condições de compartilhamento da atenção / Understanding texts under sharing attention situations

Este estudo propõe investigar a compreensão de textos em condições de compartilhamento da atenção. Participaram 75 alunos do Ensino Médio distribuídos em compreendedores bons e menos proficientes. Foi utilizado um questionário para coleta das variáveis sociodemográficas, um texto e seu respectivo questionário e um segundo texto que era visualizado no computador com seu questionário. A primeira etapa consistiu na aplicação do questionário do participante e do primeiro texto com seu questionário. Ao final desta etapa, foram classificados os participantes como bons e compreendedores menos proficientes. A segunda etapa consistiu em responder ao segundo texto e seu questionário em três condições diferentes: em silêncio; exposto ao som musical e ouvindo a narração de um jogo de futebol. Os resultados mostram que o grupo dos bons compreendedores apresenta melhor desempenho sob as três condições e que tanto bons quanto compreendedores menos proficientes têm melhor desempenho em condição de silêncio.(AU)

This study proposes to investigate the understanding of texts under sharing attention situations. 75 students from high school were divided in two groups: the high-quality proficient in text understanding and the less one . We used a questionnaire to collect socio-demographic variables, a text and its questionnaire and a supplementary text that was displayed on the computer with its questionnaire. The first step was to apply the questionnaire for the participant and the first text with his questionnaire. At the end of this phase, participants were classified as good and less proficient. The second step was to answer the second questionnaire and its text under three different conditions: in silence, exposed to a musical sound and listening to a football game narration. The results have shown that high-quality proficient in text understanding presents better performance under the three conditions and that high-quality proficient in text understanding and less one have better perform under silence situation.(AU)

A compreensão de textos em condições de compartilhamento da atenção / Understanding texts under sharing attention situations

Este estudo propõe investigar a compreensão de textos em condições de compartilhamento da atenção. Participaram 75 alunos do Ensino Médio distribuídos em compreendedores bons e menos proficientes. Foi utilizado um questionário para coleta das variáveis sociodemográficas, um texto e seu respectivo questionário e um segundo texto que era visualizado no computador com seu questionário. A primeira etapa consistiu na aplicação do questionário do participante e do primeiro texto com seu questionário. Ao final desta etapa, foram classificados os participantes como bons e compreendedores menos proficientes. A segunda etapa consistiu em responder ao segundo texto e seu questionário em três condições diferentes: em silêncio; exposto ao som musical e ouvindo a narração de um jogo de futebol. Os resultados mostram que o grupo dos bons compreendedores apresenta melhor desempenho sob as três condições e que tanto bons quanto compreendedores menos proficientes têm melhor desempenho em condição de silêncio.

This study proposes to investigate the understanding of texts under sharing attention situations. 75 students from high school were divided in two groups: the high-quality proficient in text understanding and the less one . We used a questionnaire to collect socio-demographic variables, a text and its questionnaire and a supplementary text that was displayed on the computer with its questionnaire. The first step was to apply the questionnaire for the participant and the first text with his questionnaire. At the end of this phase, participants were classified as good and less proficient. The second step was to answer the second questionnaire and its text under three different conditions: in silence, exposed to a musical sound and listening to a football game narration. The results have shown that high-quality proficient in text understanding presents better performance under the three conditions and that high-quality proficient in text understanding and less one have better perform under silence situation.