Thalidomide plus dexamethasone as a maintenance therapy after autologous hematopoietic stem cell transplantation improves progression-free survival in multiple myeloma.

Despite the good response of stem cell transplant (SCT) in the treatment of multiple myeloma (MM), most patients relapse or do not achieve complete remission, suggesting that additional treatment is needed. We assessed the impact of thalidomide in maintenance after SCT in untreated patients with MM. A hundred and eight patients (<70 years old) were randomized to receive maintenance with dexamethasone (arm A; n = 52) or dexamethasone with thalidomide (arm B; n = 56; 200 mg daily) for 12 months or until disease progression. After a median follow-up of 27 months, an intention to treat analysis showed a 2-year progression-free survival (PFS) of 30% in arm A (95% CI 22-38) and 64% in arm B (95% CI 57-71; P = 0.002), with median PFS of 19 months and 36 months, respectively. In patients who did not achieve at least a very good partial response, the PFS at 2 years was significantly higher when in use of thalidomide (19 vs. 59%; P = 0.002). Overall survival at 2 years was not significantly improved (70 vs. 85% in arm A and arm B, respectively; P = 0.27). The addition of thalidomide to dexamethasone as maintenance improved the PFS mainly in patients who did not respond to treatment after SCT.

Use of laser phototherapy on a delayed wound healing of oral mucosa previously submitted to radiotherapy: case report.

Radiotherapy produces both acute and delayed effects on mucosal tissues, disturbing their healing. This report shows a successful treatment with laser phototherapy (LPT) on a delayed wound healing in oral mucosa previously submitted to radiotherapy with a follow up of 3 years. A 47-year-old patient treated 6 months earlier for tongue squamous cell carcinoma by surgery and radiotherapy presented with a mass in the operated area. Biopsy showed chronic inflammatory infiltrate around a residual polyglactin suture. After 2 months there was a painful mucosal dehiscence on the biopsy site. LPT was performed using a semiconductor laser with 660-nm wavelength (InGaAlP) and spot size of 0·04 cm(2) . The parameters applied were 40 mW, 4 Jcm(2) /point, 0·16 J/point, 2·4 J/session. The irradiation was performed punctually, through contact mode in 15 points (4 seconds/point), on top of and around the lesion, during ten sessions. The wound healed completely after ten sessions. This treatment proved to be conservative and effective, inducing healing of a chronic wound in a tissue previously submitted to radiotherapy.

Anatomic landmarks for localization of the spinal accessory nerve.

This anatomical study examines the anatomic topography and landmarks for localization of the spinal accessory nerve (SAN) during surgical dissections in 40 fresh human cadavers (2 females and 38 males; ages from 22 to 89 years with a mean of 60 years). In the submandibular region, the SAN was found anteriorly to the transverse process of the atlas in 77.5% of the dissections. When the SAN crossed the posterior belly of the digastric muscle, the mean distance from the point of crossing to the tendon of the muscle was 1.75 +/- 0.54 cm. Distally, the SAN crossed between the two heads of the SCM muscle in 45% of the dissections and deep to the muscle in 55%. The SAN exited the posterior border of the sternocleidomastoid muscle in a point superior to the nerve point with a mean distance between these two anatomic parameters of 0.97 +/- 0.46 cm. The mean overall extracranial length of the SAN was 12.02 +/- 2.32 cm, whereas the mean length of the SAN in the posterior triangle was 5.27 +/- 1.52 cm. There were 2-10 lymph nodes in the SAN chain. In conclusion, the nerve point is one of the most reliable anatomic landmarks for localization of the SAN in surgical neck dissections. Although other anatomic parameters including the transverse process of the atlas and the digastric muscle can also be used to localize the SAN, the surgeon should be aware of the possibility of anatomic variations of those parameters. Similar to previous investigations, our results suggest that the number of lymph nodes of the SAN chain greatly varies.

Pseudotumor inflamatório do linfonodo X linfoma na linfadenopatia cervical: caso clínico e revisäo da literatura / Inflammatory pseudotumor of the lymphoma X lymph nodes in the cervical limphadenopathy: clinical case and review of the literature

O pseudotumor inflamatório de linfonodo (PIL), lesäo inflamatória expansiva crônica nao neoplásicade linfonodo, foi descrito por Perrone e cols1, em 1988, através de comparaçöes com achados histopatológicos encontrados em pseudotumor inflamatório de pulmäo e outros órgäos. Histologicamente o PIL caracteriza-se por lesöes vasculares e infiltraçäo celular reativo polimorfo, e clinicamente (massa cervical, febre e perda ponderal) possui comportamento incerto, por vezes simulando neoplasia maligna. Por essas características o PIL possui como principal diagnóstico diferencial o linfoma. Discutimos esta questäo através da revisäo de literatura e relato de um caso, onde houve dificuldades no diagnóstico.

Analise retrospectiva de 100 parotidectomias / Parotidectomy: retrospective analysis of 100 cases

Sao analisados diferentes aspectos de 100 pacientes submetidos a parotidectomias, consecutivas, no periodo de janeiro de 1981 a janeiro de 1989. Os resultados sao comparados e discutidos,com base na literatura consultada, sobre tumores de parotida e parotidectomias. Foram realizadas 72 parotidectomias superficiasis e 18 parotidectomias totais, com achado de 69% de neoplasias benignas, 17% de neoplasias malignas, 4% de sialoadenite cronica e 10% de tumores nao parotideos. A incidencia de tumores do lobo profundo da glandula foi de 17%. Observamos, no pos-operatorio, deficit motor-temporario no territorio do nervo facial em 34% dos pacientes. A recidiva, com acompanhamento de cinco anos em media, foi de 3%. Nosso estudo apresenta certas peculiaridades, mas e, em geral, similar aos encontrados na literatura, quando comparadas as estatisticas