Profile and speech-language rehabilitation of patients with laryngeal cancer. / Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe.

PURPOSE: to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. METHODS: cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. RESULTS: 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). CONCLUSION: Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

OBJETIVO: descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. MÉTODO: estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. RESULTADOS: prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). CONCLUSÃO: fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe / Profile and speech-language rehabilitation of patients with laryngeal cancer

RESUMO Objetivo descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. Método estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. Resultados prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). Conclusão fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

ABSTRACT Purpose to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. Methods cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. Results 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). Conclusion Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

Dor torácica e disfagia decorrentes de escleroterapia de varizes esofágicas: estudo de 14 casos / Chest pain and dysphagia due to sclerotherapy of esophageal varices: study of 14 cases

Introdução - A esclerose endoscópica (EE) de varizes esofágicas é largamente utilizada para prevenção do ressangramento varicoso, mas há relatos inconsistentes sobre dor torácica e disfagia relacionadas ao procedimento. Materiais e metodologia - Foram estudados prospectivamente 14 portadores de cirrose hepática,hipertensão portal e varizes do esôfago, que já haviam apresentado episódio(s) de sangramento. Todos foram submetidos a exame endoscópico, antes da EE, para aferir as varizes, e cerca de três meses depois da EE, para listar complicações do procedimento. Em cada cordão varicoso eram realizadas injeções intravasais de 2 a 5ml de oleato de etanolamina a 2,5%, a intervalos de 2cm, até a eliminação das varizes, respeitando olimite de 20 a 30ml/sessão e cerca de 15 dias de intervalo entre as sessões. A cada sessão de EE e depois do final do tratamento, questionava-se sobre presença de disfagia e dor retrosternal. Resultados - Foram necessárias de duas a quatro sessões de escleroterapia para a eliminação das varizes, no tempo médio de 1,6± 0,71 meses. Ao exame endoscópico efetuado 3,07 ± 0,17 meses depois do final da EE, as varizes estavam erradicadas em todos os pacientes e não foram constatadas complicações em oito casos. Quatro pacientes apresentavam úlceras esofágicas superficiais, de aspecto isquêmico, em fase final de cicatrização, enquanto outros dois também mostravam sinéquias, de fácil desfazimento. Durante o período de EE, foram freqüentes as queixas de disfagia e dor retrosternal de moderada intensidade, mas, depois de cerca de três meses do finalda EE, dez pacientes estavam assintomáticos, os outros mantendo sintomas leves e fugazes. Conclusões –Dor torácica e disfagia são queixas atribuíveis à escleroterapia de varizes esofágicas, manifestando-se principalmente entre as sessões do procedimento; aos três meses de seguimento, não são mais queixas relevantes.

Introduction - The endoscopic sclerosis (ES) of the esophageal varices is broadly employed to prevent new variceal bleedings, but there are inconsistent reports about chest pain and dysphagia related to the procedure. Materials and methodology – Fourteen cirrhotic patients with portal hypertension and at least one bleeding occurrence were prospectively studied. They were submitted to an endoscopic exam previous to ES to evaluate the varices and around three months after the procedure to list its complications. 2-5 mL intravasal injections of 2.5% ethanolamine sulfate were applied at each 2 cm cranially in each varix reaching 20-30 mL persession at about 15-day intervals. In each ES session and after the end of the treatment, all the patients were inquired focusing the presence or not of chest pain and dysphagia. Results – After 2-4 sessions, in anaverage time of 1.6± 0.71 months, the varices was eliminated. The endoscopic exam realized 3.07 ± 0.17months from the end of the program showed that the varices remained eradicated and no complications were observed in eight cases. Superficial ischemic ulcers were seen in six patients, accompanied of some thin fibrous adherences in two of them, easily ruptured with the endoscope. Moderate chest pain and dysphagia were frequently reported during the ES sessions, but ten patients were asymptomatic around three months from the end of the treatment, the others presenting only inconstant and slight symptoms. Conclusions –Chest pain and dysphagia can be reported mainly among the sessions of the programmed variceal sclerotherapy,but often are abolished three months later.

Analysis of human papillomavirus prevalence and TP53 polymorphism in head and neck squamous cell carcinomas.

Head and neck squamous cell carcinoma is a disease associated with tobacco and alcohol abuse. There is evidence that the oncogenic human papillomavirus (HPV) may also be a risk for upper aerodigestive tract cancers. High-risk HPVs encode two early proteins, E6 and E7, that can bind to p53 and pRb, respectively, and induce its degradation or inactivation. The TP53 gene has a single polymorphism at codon 72 of exon 4 that encodes either arginine (Arg) or proline (Pro). The purpose of this study was to evaluate the role of HPV infection and TP53 polymorphism in head and neck cancer. We analyzed 50 tumors, as well swabs of oral mucosa from 142 control individuals, with a polymerase chain reaction technique. The prevalence of HPV in controls was 10.6% and in cancer specimens 16%. The frequency distribution of genotypes in controls was 50% Arg/Arg, 43% Arg/Pro and 7% Pro/Pro; in tumors, it was 52% Arg/Arg, 32% Arg/Pro, and 16% Pro/Pro. Contrary to the results of some studies on cervical cancer, no association between any TP53 genotype or allele and the development of head and neck cancer was observed, regardless of HPV status, except for the Pro/Pro genotype, which is associated with the absence of HPV. The arginine allele appears to protect against head and neck cancers. Also, the data showed that HPV infection results in no increased risk of developing head and neck tumors.