Zagalo C

Lip cancer: A 5-year review in a tertiary referral centre

INTRODUCTION Lip cancer is second only to skin cancer in terms of frequency in the head and neck region. Surgery is the treatment of choice for most of these cancers. Although there are several strategies to reconstruct lip tumours after tumour ablation, scarce attention has been paid to the impact of the specific reconstructive modality on recurrence and survival. PATIENTS AND METHODS A retrospective review of 228 patients treated for lip cancer in the Head and Neck Surgery Department of the Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal, from 1993 to 2000 with at least 2 years of follow-up was conducted. All the cases were evaluated for demographic features, tumour characteristics, lip reconstructive surgery used and recurrence and survival. RESULTS There were 184 male and 44 female patients (4:1 ratio), with an average age of 67.6±13.3 years. Most tumours were squamous cell carcinomas (94.7%), and were located in the lower lip (99.5%). Squamous cell carcinomas were well differentiated in 70.8% of cases. Tumour size and neck staging were strongly correlated (Pearsons coefficient of 0.805; p<0.001). Microscopical signs of neuroinvasion or lymphatic invasion were associated an increased risk of death due to cancer (chi-square=18.5; df=3; p=0.016). The different strategies used for lip reconstruction after tumour ablation did not differ significantly in the probability of later recurrence or death. CONCLUSIONS Our data seem to lend support to the classical view that the most significant aspect of lip cancer surgery is tumour ablation, and that this is not affected by the subsequent reconstructive strategy. Hence, this seems to indicate that experienced surgeons are rightly not willing to compromise complete excision of the tumour for the sake of an easier or better reconstruction.

Mandible reconstruction: History, state of the art and persistent problems

Background: Mandibular reconstruction has been experiencing an amazing evolution. Several different approaches are used to reconstruct this bone and therefore have a fundamental role in the recovery of oral functions. Objectives: This review aims to highlight the persistent problems associated with the approaches identified, whether bone grafts or prosthetic devices are used. A brief summary of the historical evolution of the surgical procedures is presented, as well as an insight into possible future pathways. Study design: A literature review was conducted from September to December 2012 using the PubMed database. The keyword used was “mandible reconstruction.” Articles published in the last three years were included as well as the relevant references from those articles and the “historical articles” were referred. This research resulted in a monograph that this article aims to summarize. Results: Titanium plates, bone grafts, pediculate flaps, free osteomyocutaneous flaps, rapid prototyping, and tissue engineering strategies are some of the identified possibilities. The classical approaches present considerable associated morbidity donor-site-related problems. Conclusion: Research that results in the development of new prosthetics devices is needed. A new prosthetic approach could minimize the identified problems and offer the patients more predictable, affordable, and comfortable solutions. Clinical relevance This review, while affirming the evolution and the good results found with the actual approaches, emphasizes the negative aspects that still subsist. Thus, it shows that mandible reconstruction is not a closed issue. On the contrary, it remains as a research field where new findings could have a direct positive impact on patients’ life quality. The identification of the persistent problems reveals the characteristics to be considered in a new prosthetic device. This could overcome the current difficulties and result in more comfortable solutions. Medical teams have the responsibility to keep patients informed about the predictable problems related with each elected approach, even understanding that a perfect reconstruction is a secondary goal when compared with maintenance of life.

Tracheal transplantation: cytological changes studied by scanning and transmission electron microscopy in the rabbit.

Objectives Our goal was to offer a comprehensive cytological study of the changes in the trachea after experimental transplantation of the organ.

Estenosis traqueal yatrógena por intubación endotraqueal: Estudio de 20 casos clínicos

Resumen Realizamos un estudio retrospectivo de veinte casos de estenosis traqueal pura por intubacion endotraqueal, diagnosticados y tratados en nuestro centro entre 1995 y 1999. De los veinte pacientes estudiados 17 eran hombres (85%) y tres (15%) eran mujeres, con edades comprendidas entre 9 y 68 anos (32,8 ± 14,9 anos). La extension del segmento estenosado vario entre los 2 y 5 cm (3,3 ± 1,2 cm). Todos estos casos fueron tratados quirurgicamente por via externa para reseccion del segmento estenosado y posterior anastomosis traqueo- traqueal. Los resultados clinicos evaluados entre el tercer y sexto mes postoperatorio fueron: 16 casos (80%) con buen resultado, dos casos (10%) con resultado satisfactorio y dos resultados insatisfactorios (10%), verificando que la existencia de una estenosis, para un nivel de confianza del 5%, esta relacionada con el tiempo de intubacion y la edad del paciente (R=0,478, p= 0,033).

Changes in bone Pb accumulation: Cause and effect of altered bone turnover

This paper assesses the magnitude of Pb uptake in cortical and trabecular bones in healthy animals and animals with altered balance in bone turnover, and the impact of exposure to Pb on serum markers of bone formation and resorption. The results reported herein provide physiological evidence that Pb distributes differently in central compartments in Pb metabolism, such as cortical and trabecular bones, in healthy animals and animals with altered balance in bone turnover, and that exposure to Pb does have an impact on bone resorption resulting in OC-dependent osteopenia. These findings show that Pb may play a role in the etiology of osteoporosis and that its concentration in bones varies as a result of altered bone turnover characteristic of this disease, a long standing question in the field. In addition, data collected in this study are consistent with previous observations of increased half-life of Pb in bone at higher exposures. This evidence is relevant for the necessary revision of current physiologically based kinetic models for Pb in humans.

Systematic Review and Meta-analysis of Unconventional Perfusion Flaps in Clinical Practice

Background: Although unconventional perfusion flaps have been in clinical use since 1975, many surgeons are still deterred from using them, because of some reports of high necrosis rates. Methods: The authors performed a systematic review and meta-analysis of all articles written in English, French, German, Spanish, and Portuguese on the clinical use of unconventional perfusion flaps and indexed to PubMed from 1975 until July 15, 2015. Results: A total of 134 studies and 1445 patients were analyzed. The estimated survival rate of unconventional perfusion flaps was 89.5 percent (95 percent CI, 87.3 to 91.3 percent; p < 0.001). Ninety-two percent of unconventional perfusion flaps (95 percent CI, 89.9 to 93.7 percent; p < 0.001) presented complete or nearly complete survival. Most defects mandating unconventional perfusion flap reconstruction were caused by trauma (63.6 percent), especially of the hand and fingers (75.1 percent). The main complication of all types of flaps was a variable degree of necrosis (7.5 percent of all unconventional perfusion flaps presented marginal necrosis; 9.2 percent and 5.5 percent had significant and complete necrosis, respectively). There was a positive correlation between the rate of postoperative infection and the need for a new flap (Pearson coefficient, 0.405; p = 0.001). Flaps used to reconstruct the upper limb showed better survival than those transferred to the head and neck or to the lower limb (p < 0.001). Conclusion: Unconventional perfusion flaps show high survival rates and should probably be used more liberally, particularly in the realm of upper limb reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Prevention of ventilator-associated pneumonia

Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways.

THYROIS PARAGANGLIOMA: CASE REPORT

Los paragangliomas de la glandula tiroides son tumores poco frecuentes. Se presenta un caso clinico de una mujer de 32 anos de edad, con una masa en el lobulo derecho de la glandula tiroides, sin otros sintomas. El diagnostico inicial, al que se llego por citopuncion, fue de carcinoma medular de tiroides. La opcion terapeutica fue de hemitiroidectomia. Los estudios anatomopatologicos de la pieza operatoria y la histoquimica fueron compatibles con un paraganglioma. Se pone de manifiesto las dificultades del diagnostico y la importancia de la

Radix nasi Transposition Flap for Medial Canthus and Nasal Sidewall Defects

and when they involve dif-ferent cosmetic units, they constitute a challengefor skin surgeons. An example of this is nasal side-wall and medial canthus area. Direct repair is pos-sible for small defects, but for larger defects, localflaps or grafts are often required. In this anatomicarea, the goals of reconstruction should be toobtain functional and aesthetic results, maintainingthe normal concavity of the canthus with minimaldistortion of the surrounding tissues. To obtaincontinuity of color and texture and reproductionof a natural appearance, reconstruction with a flapis frequently the first choice.The classic banner-type transposition flap

Structure of the rat tracheal mucosa after chronic intermittent hypoxia or chronic hyperbaric oxygen therapy

OBJECTIVE This paper is aimed at identifying putative morphological changes induced in the rats tracheal mucosa by chronic hyperbaric oxygen (HBO) treatment or chronic intermittent hypoxia (CIH). STUDY DESIGN Tracheal samples were obtained from three groups of 11, 12 and 13 adult Wistar rats. The first group was submitted to 20 sessions of 100 min-long HBO treatment; the second group was submitted to eucapnic CIH for 35 days; and the third group was not submitted to any CIH or HBO therapy. METHODS Four proximal tracheal rings were collected after sacrifice and neck dissection of the animals. The samples were processed for both light microscopy and morphometric analysis. Inflammatory leukocyte infiltration was evaluated by a semiquantitative method. Unpaired t test and Bernoulli distribution were applied to evaluate statistical differences in the data collected from the three groups. RESULTS Both CIH and HBO promote an increase in the thickness of the epithelium and of the basement membrane of the rat tracheal mucosa, as well as an increment in the number of infiltrating leukocytes, when compared with results seen in the untreated group. In the HBO group there was a significant lack of seromucous glands, as opposed to the results obtained in the CIH group. CONCLUSIONS Chronic HBO and CIH exposure causes only minor changes in the architecture of the tracheal mucosa of the rat. The respiratory tract of the rat showed a mild inflammatory response when subject to variations of pressure and oxygen content. Apparently these effects do not constitute a critical issue on prescribing HBO treatments and in the management of sleep apnea patients.