Ali Amar

Análise comparativa entre avaliação fonoaudiológica perceptivo-auditiva, análise acústica e laringoscopias indiretas para avaliação vocal em população com queixa vocal

Com a evolucao e o desenvolvimento tecnologico, houve mudancas nos metodos de avaliacao da voz, tanto na pratica medica como fonoaudiologica. OBJETIVO: Relacionar os resultados da avaliacao perceptivo-auditiva vocal, analise acustica e avaliacoes medicas no diagnostico de alteracoes vocais e/ou laringeas em individuos com queixa vocal. FORMA DE ESTUDO: Clinico prospectivo. MATERIAL E METODO: Foram avaliados 29 individuos que participaram de uma acao de protecao de saude. Os sujeitos foram submetidos a avaliacao fonoaudiologica peceptivo-auditiva (AFPA), analise acustica (AA), laringoscopia indireta (LI) e telelaringoscopia (TL). RESULTADOS: Foram estabelecidas as relacoes entre os metodos de avaliacao medica e fonoaudiologica, verificando possiveis significâncias estatisticas a partir da aplicacao do Teste Exato de Fischer. Houve significância estatistica na relacao entre AFPA e LI, AFPA e TL, LI e TL. CONCLUSAO: Esta pesquisa realizada numa acao de protecao de saude vocal mostrou concordância entre a avaliacao fonoaudiologica perceptivo-auditiva e as avaliacoes medicas, bem como os exames medicos entre si no diagnostico de alteracoes vocais e/ou laringeas.

Qualidade de vida e prognóstico nos carcinomas epidermóides de cabeça e pescoço

Aim: a quality life questionnaire (QLQ) assessment and its relationship with prognostic of patients with head and neck cancer. Study design: prospective clinical. Material and method: a study of 31 patients with squamous cell carcinoma of upper aerodigestive tract submitted to therapy in Head and Neck Surgery and Otorhinolaryngology Department of Heliopolis Hospital, Hosphel between August,1999 and November, 2000. For evaluation of quality of life it was used the questionnaire QLQ-C30 and the module QLQ-H&N35, both supplied by EORTC, accomplished previously to the treatment. The differences of scores among patients with controlled disease and those with recurrence in the first 12 months after treatment was evaluated. Results: a significant difference was observed in scores between assimptomatic patients and those with recurrence, when related to the fadiga, problems of eating in public and global quality of life (p £ 0,05). The scores in this group were similar to those observed in other populations. Conclusion: the pre-treatment quality of life can be a prognostic indicator for patients with head and neck cancer.

Evolution of patients with squamous cell carcinoma of upper aerodigestive tract

CONTEXT Local and regional recurrences are frequent in patients with squamous cell carcinoma of the upper aerodigestive tract and early diagnosis is important for salvage treatment. OBJECTIVE To identify the period of highest risk for the development of recurrences after surgical treatment of squamous cell carcinoma of the upper aerodigestive tract, in spite of radical therapy, in order to plan the follow-up for these patients. TYPE OF STUDY Cross-sectional, descriptive. SETTING Department of Head and Neck Surgery/Otorhinolaryngology, Heliópolis Hospital (Hosphel), São Paulo, Brazil. PARTICIPANTS A review was made of the hospital records of 889 patients with squamous cell carcinoma of the upper aerodigestive tract surgically treated between October 1977 and December 1996: 364 had oral cavity tumors, 107 had tumors of the oropharynx, 152 of the hypopharynx and 266, larynx tumors. The disease was stage I in 14 patients, stage II in 117, stage III in 352, stage IV in 397 and 9 patients were not staged. MAIN MEASUREMENTS The interval between treatment and recurrence of disease was evaluated. The results were expressed as medians, quartiles (25% to 75%) and percentiles (10% to 90%). The annual incidence of recurrences and second tumors was calculated. RESULTS Seventy-four percent of the recurrences were diagnosed within 18 months post-treatment. The local and regional recurrences and distant metastases showed medians of 270, 210 and 435 postoperative days respectively. The incidence of a second primary tumor varied from 2 to 3.1% a year. CONCLUSION The majority of recurrences occurred within 18 months after the initial surgical treatment. The incidence of a second tumor remained stable after the first post-treatment year.

Spinal accessory nerve neuropathy following neck dissection

UNLABELLED The most common complication of neck dissection is shoulder dysfunction due to manipulation of spinal accessory nerve, resulting in trapezius muscle atrophy mainly in procedures involving the posterior neck triangle. AIM This study used electromyography to evaluate the injury to the spinal accessory nerve following neck dissection. MATERIALS AND METHODS Prospective case series of 51 patients submitted to 60 neck dissections followed by physical therapy evaluation of shoulder dysfunction. Nerve integrity was evaluated before and after the surgery by means of surface EMG registering the electric activity of the trapezius muscle during voluntary contraction. The patients were grouped according to the type of neck dissection, presence of shoulder pain, impairment during abduction movement and hypotrophy/atrophy of the trapezius muscle. RESULTS Action potential had median values of 54.3 microV before surgery and 11.6 microV after it (p<0.001). There was a mean decrease of 70% comparing to preoperative values. The median was 12.5 microV after dissection including level IIb, and 8.9 microV after dissection including levels IIb and V (p<0.002). CONCLUSION Surface EMG is a sensitive and painless method for spinal accessory nerve dysfunction evaluation. The results suggest the usefulness of the trapezius muscle electromyography to confirm diagnosis and early physical therapy intervention in neuropathies of the spinal accessory nerve.

Indication of elective contralateral neck dissection in squamous cell carcinoma of the hypopharynx

Lymph node metastases (LNM) are common in hypophariyngeal carcinomas; the neck dissection is an important therapeutic approach. AIM: to analyze the incidence...

Correlação entre a evolução clínica e a freqüência de micronúcleos em células de pacientes portadores de carcinomas orais e da orofaringe

BACKGROUND: To verify the correlation between the micronucleus frequency and the presence of local recurrences or second primary lesion in patients with carcinoma of the oral cavity. METHODS: We studied the frequency of micronucleus of the oral mucosa in 27 untreated patients with carcinoma of the oral cavity and oropharynx. The patients were monthly followed after initial treatment, in an attempt to identify local recurrences or second primary lesions. RESULTS: Of the 24 patients evaluated during the whole time, 5 cases (20,8%) were alive and free of disease, and 19 cases died, 18 (75%) owing to cancer and 1 to perfurative peptic ulcer. In relation to micronucleus frequency, no difference was observed among the patients with local recurrence of the disease (N=14) and the patients who died of other causes or were alive and free of disease (N=10) (p = 0.83). There was higher micronucleus frequency in the stages T3 and T4 (p = 0.01). CONCLUSION: In the present study was not possible to find a clinical correlation between the frequency of micronucleus of the oral mucosal and the risk of development of local recurrence or second primary tumor in patients with upper aerodigestive tract carcinoma.

Microvascular density in carcinoma of the tongue

BACKGROUND. Assessment of microvascular density in squamous cell carcinoma of the oral tongue (primary lesion and metastasis). METHODS. Immunohistochemical analysis by anti CD-34 of neoangiogenesis density and its relation with clinical and histological data concerning the prognosis. After optic microscopy amplification, the relation between microvascular density, clinico-histological data and prognosis, was established. RESULTS. The microvascular density presented 15.4 vessels/field (5.5 to 25.3) in primary tumors and 16.4 vessels/field (12 to 32.2) in lymph node metastases. It was observed an inverse relation between microvascular density in primary lesions and their lymph node metastasis (r= -0.68 and p=0,04). CONCLUSIONS. No evidence was detected between microvascular density, histological features and prognosis. There is an inverse relation between microvascular density in primary tumor and in lymphonode metastasis, suggesting a regional or systemic control of angiogenesis in squamous cell carcinoma of the oral tongue.

Diagnostic and therapeutic delay in patients with larynx cancer at a reference public hospital

O carcinoma epidermoide da laringe, apesar dos sintomas precoces, ainda e frequentemente diagnosticado em estadio avancado. Apesar da demora ate chegar ao atendimento especializado, o tempo despendido no diagnostico e a espera para o tratamento definitivo tambem sao importantes para o resultado final. OBJETIVO: Avaliar o intervalo de tempo entre a primeira consulta no especialista e o tratamento nos pacientes com carcinoma epidermoide da laringe. FORMA DE ESTUDO: Coorte historica longitudinal. MATERIAL E METODO: Estudo de 272 pacientes com carcinoma epidermoide da laringe atendidos consecutivamente entre janeiro de 1996 e dezembro de 2004. Avaliadas as caracteristicas clinicas e epidemiologicas, assim como sua relacao com o tempo despendido entre a consulta inicial e o tratamento. RESULTADO: O intervalo de tempo entre a primeira consulta e o inicio do tratamento apresentou mediana de 49 dias e media de 57 dias. Nao houve diferenca em relacao ao estadiamento, faixa etaria, sexo, naturalidade ou escolaridade. CONCLUSAO: O tempo entre o atendimento inicial com especialista e o inicio do tratamento apresentou mediana de 49 dias, similar ao relatado em outros estudos.UNLABELLED Laryngeal squamous cell carcinoma is very often diagnosed at advanced stages. The time interval between the specialist consultation and the start of treatment may contribute to better outcomes. AIM the interval assessment between the first specialist evaluation and the treatment of patients with laryngeal squamous cell carcinoma. STUDY DESIGN longitudinal historical cohort. MATERIALS AND METHODS 272 consecutive patients with laryngeal squamous cell carcinoma seen between January, 1996 and December of 2004. Clinical and epidemiological data were evaluated, as well as their association with the time interval between the first specialist visit and the start of treatment. RESULT the median time between first evaluation and treatment was 49 days. There was no relationship with gender, age, birth place, disease stage or education. CONCLUSION the treatment median delay was 49 days, similar to what has been reported in other studies.

Reatividade linfonodal com metástase cervical de tumor primário oculto: estudo de 24 pacientes

OBJETIVO: Avaliar a reatividade linfonodal em pacientes com metastase cervical de tumor primario oculto. METODO: Foram avaliados retrospectivamente 24 pacientes submetidos a esvaziamento cervical entre 1983 e 1995 devido a metastase de tumor primario oculto. Os cortes histologicos dos 601 linfonodos resultantes foram corados pela hematoxilina-eosina e avaliados a microscopia optica. A reatividade linfonodal considerou a presenca de hiperplasia paracortical, hiperplasia de centro germinativo e hiperplasia sinusal. Foram avaliadas a relacao da reatividade linfonodal, ruptura capsular, necrose e desmoplasia com a recidiva da doenca. A analise estatistica foi feita com Teste de Fisher com erro inferior a 5%. RESULTADOS: Setenta e sete por cento (77%) dos linfonodos se mostraram reativos. Cinquenta e cinco por cento (55%) dos pacientes com hiperplasia paracortical ou mista e dezesseis por cento (16%) dos pacientes com hiperplasia de centro germinativo ou linfonodos nao reativos estavam assintomaticos por ocasiao do ultimo retorno ambulatorial (p=0,11). A presenca de necrose tumoral mostrou associacao significativa com a presenca de desmoplasia (p=0,02). CONCLUSOES: A reatividade linfonodal e frequente na maioria das metastases cervicais em tumor primario oculto e a necrose tumoral esta diretamente ligada a presenca de desmoplasia.

Valor da PET/CT na abordagem do câncer de cabeça e pescoço*

OBJECTIVE: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. MATERIALS AND METHODS: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. RESULTS: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. CONCLUSION: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method.