Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics / Prevenção ao câncer do trato aerodigestivo superior através das estratégias de buscaativa e uso da propedêutica armada

Abstract Introduction Upper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. Objective To evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. Methods A cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. Results A total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. Conclusion The method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

Resumo Introdução O câncer do trato aerodigestivo superior configura-se entre os mais frequentes e apresenta-se com importância epidemiológica no mundo. A maior parte apresenta-se avançada ao diagnóstico, com forte impacto negativo na sobrevida e elevado custo ao erário. As campanhas feitas contra esses cânceres têm frequentemente falhado no Brasil. Objetivo Avaliar a efetividade do rastreamento para lesões cancerizáveis do trato aerodigestivo superior com estratégias de busca ativa e uso da propedêutica armada. Método Estudo transversal, prospectivo, descritivo, analítico e exploratório, uma vez que os seus objetivos se alicerçam na visualização das lesões cancerizáveis numa amostra composta por indivíduos com fatores de risco, de forma a aprofundar o conhecimento necessário para a sua detecção, visando à prevenção secundária do câncer da cavidade oral, orofaringe, laringe e hipofaringe. Resultado Foram visualizadas clinicamente 16,7% lesões cancerizáveis e 0,5% cânceres de localização no trato aerodigestivo superior. Conclusão O método mostrou-se efetivo na identificação de lesões cancerizáveis com intuito de prevenção secundária, mas igualmente importante contra o câncer do trato aerodigestivo superior, uma vez que neste presente estudo multiplicou-se a chance do encontro desse por 22,7; apresenta-se como opção para futuras campanhas contra a doença.

Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics.

INTRODUCTION: Upper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. OBJECTIVE: To evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. METHODS: A cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. RESULTS: A total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. CONCLUSION: The method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

The role of transoral robotic surgery in the management of oropharyngeal cancer.

PURPOSE OF REVIEW: The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC), in large part as a result of the human papillomavirus (HPV), has driven a movement for the change in the management strategies. Renewed interest in minimally invasive approaches of endoscopic head and neck surgery led to introduction of transoral surgery, including transoral robotic surgery (TORS). RECENT FINDINGS: Several recent studies, based on large multi-institutional studies and systematic reviews of the literature, have shown excellent oncologic and functional outcomes with TORS for OPSCC. Also, a growing amount of clinical evidence supports the use of TORS in the management of carcinoma of unknown primary site and in selected patients with recurrent OPSCC with acceptable oncologic and better functional outcomes in comparison with traditional surgical approaches. Comparative studies with other therapeutic modalities (conventional surgical and nonsurgical) showed that TORS can be used to treat OPSCC, reducing morbidity and treatment costs, while providing equivalent oncologic results. SUMMARY: Large and robust data available in the literature supports the role of TORS within the multidisciplinary treatment paradigm for the management of OPSCC. Information from ongoing randomized clinical trials comparing TORS with and without dose-reduced radiotherapy or with and without intensified adjuvant treatment for high-risk OPSCC patients is necessary to determine the role of de-escalation of therapy in the era of HPV and OPSCC.

Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function.

BACKGROUND: The aim of this study was to assess the quality of life of patients with oropharyngeal squamous cell carcinoma after transoral robotic surgery (TORS). METHODS: Short Form (SF)-8 and Performance Status Scale (PSS) questionnaires were completed prior to surgery, 6 and 12 months of follow-up. RESULTS: In all, 38 patients treated with TORS followed by adjuvant therapy as indicated were prospectively enrolled. For PSS Eating and Diet domains, significant decreases occurred at 6 months (p ≤ .001 and p ≤ .001, respectively) but not at 12 months. Significant declines in PSS Speech were seen at 6 and 12 months (p ≤ .001 and p ≤ .001). There were no significant declines in the SF-8 domains, except for Bodily Pain and Global Health (6 months). Significantly higher PSS Eating and Diet scores were seen at 6 months for TORS alone compared with TORS and chemoradiation. CONCLUSIONS: Combination TORS and adjuvant therapy caused a temporary decrease in several domains at 6 months, returning to baseline including swallowing function in all patients.

Ausência de mutações no proto-oncogene RET relacionadas com carcinoma medular de tireoide em pacientes com doença de Hirschsprung / Absence of RET proto-oncogene mutations related with medullary thyroid carcinoma in patients with Hirschsprung disease

Objetivo: O objetivo desse estudo é avaliar, em pacientes com Doença de Hirschsprung, a incidência e o tipo de mutações no proto-oncogene RET encontradas. Método: Foram estudados 15 pacientes com diagnóstico de Doença de Hirschsprung. As características fenotípicas foram obtidas através de entrevista com os pacientes e familiares e através de revisão de prontuário. As características genotípicas foram obtidas como se segue: dos leucócitos do sangue periférico foi extraído o DNA genômico. Amplificamos os exons 10, 13 e 16 através da Reação de Polimerase em Cadeia (PCR). O produto PCR foi purificado e submetido à sequenciamento direto, e os resultados do sequenciamento foram analisados utilizando sequências previamente depositadas no GeneBank. Resultados: Os pacientes apresentaram a distribuição por sexo de 13 do sexo masculino (86,7%) e 2 do sexo feminino (13,3%).A idade atual variou de 2 a 16 anos, com a média de 7 anos. Nenhum dos pacientes apresentou características fenotípicas de Neoplasia Endócrina Múltipla tipo 2A, 2B ou Carcinoma Medular de Tireoide Familiar, ou havia antecedente familiar positivo para essas doenças. Quanto às características genotípicas: o produto do sequenciamento genético, não apresentou alterações nos exons 10 e 16 em nenhum paciente, mas foi encontrado um polimorfismo em heterozigose no exon 13 no códon 769 em 4 pacientes. Conclusões: não foram encontradas mutações no proto-oncogene RET concomitantes à Neoplasia Endócrina Múltipla tipo 2A, 2B ou Carcinoma Medular de Tireoide Familiar, nos pacientes com Doença de Hirschsprung estudados, sendo encontrado polimorfismo no códon 769 em 4 pacientes.

Objective: To assess the frequency of mutations of the RET proto-oncogene in patients with Hirschsprung´s Disease and its association with Multiple Endocrine Neoplasia type 2. Method: 15 patients with Hirschsprung´s Disease were evaluated, regarding the phenotypic and genotypic characteristics. The phenotypic characteristics were obtained by interview and patients´ charts evaluation. Genotypic characteristics evaluation: genomic DNA was extracted from peripheral blood lymphocytes. Primers specific for exons 10, 13 e 16 of the RET gene were designed and used to generate Polimerase Chain Reaction products, which were purified and directly sequenced. The 3 exons were sequenced in both directions - sense and antisense - and the results analyzed using the sequences deposited on GeneBank. Results: Thirteen (86.7%) patients were male and 2 (13.3%) female. The age mean age was 7 years old, ranging from 2 to 16 years old. No patient presented phenotypic characteristics of Multiple Endocrine Neoplasia type 2, or familial history. Regarding the genotypic characteristics, no patient presented mutations on exons 10 or 16, but 4 patients presented a heterozigotic polymorphism on exon 13, codon 769. Conclusion: there was no concomitant mutation on the RET proto-oncogene, of Multiple Endocrine Neoplasia type 2 and Hirschsprung´s Disease in the patients studied.

Auditory processing in patients with temporal lobe epilepsy.

UNLABELLED: Temporal epilepsy, one of the most common presentation of this pathology, causes excessive electrical discharges in the area where we have the final station of the auditory pathway. Both the anatomical and functional integrity of the auditory pathway structures are essential for the correct processing of auditory stimuli. AIM: to check the Auditory Processing in patients with temporal lobe epilepsy regarding the auditory mechanisms of discrimination from sequential sounds and tone patterns, discrimination of the sound source direction and selective attention to verbal and nonverbal sounds. METHOD: eight individuals with temporal lobe epilepsy were assessed, after excluding those with non-confirmed diagnosis or with the focus of discharges not limited to this lobe. The evaluation was carried out through special auditory tests: Sound Localization Test, Duration Pattern Test, Digits Dichotic Test and Non-Verbal Dichotic Test. Their performances were compared to the performances of individuals without neurological diseases (case-control study). RESULTS: similar performances were observed between patients with temporal lobe epilepsy and the control group regarding the auditory mechanism of sound source direction discrimination. Comparing the other auditory mechanisms assessed, the patients with temporal lobe epilepsy presented worse results. CONCLUSION: individuals with temporal lobe epilepsy had more deficits in auditory processing than those without cortical damage.

Vocal assessment in patients submited to CO2 laser cordectomy.

AIM: To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD: 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Processamento auditivo em indivíduos com epilepsia de lobo temporal / Auditory processing in patients with temporal lobe epilepsy

A epilepsia do lobo temporal ocasiona descargas elétricas excessivas onde a via auditiva tem sua estação final. É uma das formas mais comuns e de mais difícil controle da doença. O correto processamento dos estímulos auditivos necessita da integridade anatômica e funcional de todas as estruturas envolvidas na via auditiva. OBJETIVO: Verificar o Processamento Auditivo de pacientes portadores de epilepsia do lobo temporal quanto aos mecanismos de discriminação de sons em seqüência e de padrões tonais, discriminação da direção da fonte sonora e atenção seletiva para sons verbais e não-verbais. MÉTODO: Foram avaliados oito indivíduos com epilepsia do lobo temporal confirmada e com foco restrito a essa região, através dos testes auditivos especiais: Teste de Localização Sonora, Teste de Padrão de Duração, Teste Dicótico de Dígitos e Teste Dicótico Não-Verbal. O seu desempenho foi comparado ao de indivíduos sem alteração neurológica (estudo caso-controle). RESULTADO: Os sujeitos com epilepsia do lobo temporal apresentaram desempenho semelhante aos do grupo controle quanto ao mecanismo de discriminação da direção da fonte sonora e desempenho inferior quanto aos demais mecanismos avaliados. CONCLUSÃO: Indivíduos com epilepsia do lobo temporal apresentaram maior prejuízo no processamento auditivo que os sem danos corticais, de idades semelhantes.

Temporal epilepsy, one of the most common presentation of this pathology, causes excessive electrical discharges in the area where we have the final station of the auditory pathway. Both the anatomical and functional integrity of the auditory pathway structures are essential for the correct processing of auditory stimuli. AIM: to check the Auditory Processing in patients with temporal lobe epilepsy regarding the auditory mechanisms of discrimination from sequential sounds and tone patterns, discrimination of the sound source direction and selective attention to verbal and nonverbal sounds. METHOD: eight individuals with temporal lobe epilepsy were assessed, after excluding those with non-confirmed diagnosis or with the focus of discharges not limited to this lobe. The evaluation was carried out through special auditory tests: Sound Localization Test, Duration Pattern Test, Digits Dichotic Test and Non-Verbal Dichotic Test. Their performances were compared to the performances of individuals without neurological diseases (case-control study). RESULTS: similar performances were observed between patients with temporal lobe epilepsy and the control group regarding the auditory mechanism of sound source direction discrimination. Comparing the other auditory mechanisms assessed, the patients with temporal lobe epilepsy presented worse results. CONCLUSION: individuals with temporal lobe epilepsy had more deficits in auditory processing than those without cortical damage.

Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2 / Vocal assessment in patients submited to CO2 laser cordectomy

OBJETIVO: Avaliar a voz de pacientes portadores de carcinomas iniciais glóticos submetidos à cordectomia com laser de CO2. MÉTODO: Foram avaliados 15 pacientes com diagnóstico de carcinoma espinocelular Tis e T1 glóticos. A avaliação foi feita por meio da análise perceptivo auditiva da voz, pela análise acústica computadorizada e videolaringoestroboscópica. Os pacientes responderam a um questionário de avaliação geral da voz e um protocolo de qualidade de vida relacionado à voz (QVV). Os resultados foram comparados aos de um grupo controle de indivíduos com laringes normais. RESULTADOS: A análise perceptivo-auditiva da voz revelou que a maioria dos pacientes submetidos à cordectomia apresentou algum grau de disfonia, à custa de rouquidão e soprosidade. Considerando os parâmetros acústicos analisados e os valores do grupo controle, observou-se a tendência de um pequeno incremento da freqüência fundamental, mas sem diferença estatisticamente significante; os valores de jitter, shimmer e da proporção harmônico-ruído apresentaram-se significantemente alterados. Os aspectos analisados na videolaringoestroboscopia mostraram-se melhores nas cordectomias menos extensas. Os escores do QVV sugerem que os pacientes tiveram um discreto impacto na qualidade de vida relacionada à voz. CONCLUSÕES: Apesar da presença de alterações na qualidade vocal dos pacientes submetidos à cordectomia com laser de CO2, os resultados funcionais tendem a ser bem aceitos pelos pacientes, com discreta repercussão na qualidade de vida.

AIM: To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD: 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo- stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Head and neck hemangiopericytoma in a child: case report.

CONTEXT: Hemangiopericytoma is a relatively rare tumor, first described in 1942, with approximately 300 cases described in the literature to date. In most cases, it affects the trunk and lower extremities. The head and neck incidence is less than 20%, mostly in adults. We describe a case of malignant head and neck hemangiopericytoma in a child. TYPE OF STUDY: Case report. CASE REPORT: A twelve-year-old male patient noted the presence of a firm painless right-side retroauricular lymph node of 1 cm in diameter, which at first remained unchanged for six months, but subsequently enlarged progressively. He denied having had previous trauma at that site. In November 2000, he presented nasal obstruction and voluminous epistaxis that required hospitalization and blood transfusion. During dental treatment one month later, a cranial x-ray revealed bone alterations. A subsequent computed tomography scan showed an extensive lesion of soft tissue density that had invaded the maxillary fossa, eroding the skull base and middle and nasal fossa. The child was then referred to our service, where biopsy was performed, giving a diagnosis of hemangiopericytoma. Shortly afterwards, magnetic resonance imaging revealed that this lesion had undergone significant growth, while maintaining the same invasion pattern. The patient was submitted to conservative surgery in April 2001, with only partial resection of the tumor because of its extent. Histopathological examination of the specimen confirmed the presence of malignant hemangiopericytoma. Following the surgery, the patient presented fast regrowth of the lesion, with partial response to chemotherapy and radiotherapy.

Head and neck hemangiopericytoma in a child: case report

CONTEXTO: O hemangiopericitoma é uma neoplasia relativamente, descrita pela primeira vez em 1942, e com aproximadamente 300 casos descritos até hoje na literatura. Na maioria dos pacientes, acomete o tronco e membros inferiores, sendo a incidência em cabeça e pescoço menor que 20%, e principalmente em adultos. Relatamos um caso de hemangiopericitoma de cabeça e pescoço em criança. TIPO DE ESTUDO: Relato de caso. RELATO DO CASO: Paciente do sexo masculino, 12 anos, que, em dezembro de 1999, notou nódulo retroauricular à direita, endurecido, indolor e de 1 cm de diâmetro, que evoluiu estável por seis meses e com posterior crescimento progressivo. Negava história de trauma. Em novembro de 2000, apresentou obstrução nasal e epistaxe volumosa, necessitando de internação e transfusão sangüínea. Um mês depois, durante tratamento dentário, uma radiografia craniana evidenciou alterações ósseas. Tomografia computadorizada subseqüente mostrou lesão extensa característica de partes moles, invadindo fossa maxilares, destruindo base do crânio, fossa média e fossas nasais. A criança foi encaminhada ao nosso serviço, onde biópsia foi realizada, com diagnóstico de hemangiopericitoma. Logo após exame de ressonância nuclear magnética evidenciou a mesma lesão com aumento importante, mas invadindo as mesmas estruturas. Submetido à cirurgia conservadora em abril de 2001 com ressecção parcial do tumor devido à sua extensão. O exame histopatológico revelou hemangiopericitoma maligno. Após a cirurgia, o paciente apresentou rápido crescimento da massa tumoral e resposta parcial a quimioterapia e radioterapia.

Disacusia neurossensorial imunomediada / Immunomediated sensorineural hearing loss

A disacusia neurossensorial imunomediada (DNSI) é caracterizada geralmente por uma disacusia neurossensorial bilateral, progressiva e assimétrica, acompanhada ou näo por outros sintomas da orelha interna. Três pacientes com DNSI cujo quadro clínico e audiométrico eram sugestivos de doença auto-imune, e apresentaram resposta positiva à terapia imunossupressora ou pesquisa positiva de anticorpo anti hsp-70 68kD, foram estudados com relaçäo às características clínicas, testes diagnósticos, alternativas terapêuticas e evoluçäo da doença. Dois pacientes apresentaram quadro de disacusia neurossensorial rapidamente progressiva, associado a quadro vestibular, e outro, quadro de surdez súbita unilateral. Nenhum paciente apresentou positividade às provas reumatológicas, e apenas um paciente apresentou aumento na velocidade de hemossedimentaçäo. Nenhum paciente obteve resposta adequada sustentada à corticoterapia, mas dois deles melhoraram com outras terapias imunossupressoras. O diagnóstico da DNSI é clínico e baseado na resposta positiva ao teste terapêutico com imunossupressores. A pesquisa de anticorpo anti-hsp70 de 68 kD pelo Western Blot é o único exame laboratorial específico para seu diagnóstico, possuindo sensibilidade de 42 por cento e especificidade de 90 por cento. Apenas 1 paciente apresentou positividade para este teste e näo respondeu à terapia imunossupressora. Os dois pacientes com teste negativo responderam satisfatoriamente ao tratamento. A baixa sensibilidade do Western Blot e seu alto custo dificultam sua difusa utilizaçäo em nosso meio. A introduçäo precoce do tratamento é de suma importância por auxiliar no diagnóstico e por proporcionar um melhor prognóstico auditivo