Laringectomía parcial supracricoidea de rescate por recurrencia de carcinoma laríngeo tratado inicialmente con hemilaringectomía parcial vertical: informe de caso / Supracricoid partial laryngectomy as salvage for recurrent carcinoma of the larynx initially treated by vertical partial hemilaryngectomy: case report

OBJECTIVE: We undertook this study to report the possibility of salvage of vertical partial hemilaryngectomy with imbrication laryngoplasty (PVHLIL) to supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) in a patient with recurrent glottic carcinoma. CLINICAL CASE: A 68-year-old patient with recurrent glottic squamous cell carcinoma (T1aN0) was treated with imbricated partial laryngectomy. Transoperative histopathological report demonstrated vocal cord free surgical margins anterior at 1 cm and 0.4 cm posterior. The patient was evaluated trimonthly and at 16-month follow-up presented with tumor activity on the posterior third of the left false vocal cord, close to the arytenoids, which still conserved mobility. Biopsy was performed and confirmed recurrence of squamous cell carcinoma. SCPL with CHEP was performed with a satisfactory postoperative evolution with tracheotomy decannulation at day 7. Physiological phonation and retirement of nasogastric tube were accomplished at day 15, as well as reinitiation of oral feeding. Histopathological report showed a moderately differentiated squamous cell carcinoma. Functional evaluation with PVHLIL is a clear voice alteration; however, patients do not require permanent tracheostomy, and a close to normal biopsicosocial integration after SCPL + CHEP is possible. CONCLUSIONS: PVHLIL is an excellent treatment option for selected glottic tumors staged T1 or T2. Close follow-up must be given to allow the possibility of organ conservation either with radiotherapy or surgery. When recurrence occurs, SCPL + CHEP must be considered according to the established criteria for this procedure. Total laryngectomy must be considered as the last option, with the only purpose being a normal quality of life.

Reconstrucción con doble colgajo libre del piso anterior de la boca: informe de tres casos / Reconstruction of the floor of the mouth with double free flap: report of three cases

BACKGROUND: We undertook this study to describe three cases of reconstruction of the floor of the mouth with two simultaneous free flaps. METHODS: Three patients with cancer of the anterior floor of the mouth were subjected to segmental resection of the mandible and resection of the floor of the mouth with subsequent reconstruction using two simultaneous osseous and fasciocutaneous free flaps. RESULTS: All patients had a satisfactory evolution. Two patients underwent adjuvant radiotherapy, one due to the initial clinical stage and the other due to positive surgical margins. The third patient had neoadjuvant postoperative radiotherapy and concomitant chemoradiotherapy. CONCLUSIONS: If a tumor involves osseous structures of the anterior floor of the mouth, it is best to perform surgery with wide margins with segmental resection of the mandible. Surgical technique is the decision of the surgeon: how many and which types of flaps will be used for reconstruction of the anterior floor of mouth. When there is necrosis of a free flap in the head and neck region, attempt with another free flap is recommended.

Efeito de drogas inibidoras de TNF-a em células mononucleares do sangue periférico de pacientes infectados pelo HTLV-I / Effect of drugs inhibiting TNF-a in peripheral blood mononuclear cells of patients infected by HTLV-I

O Retovírus HTLV-I é o agente etiológico da Mielopatia Associada ao HTLV-I/Paraparesia Espástica Tropical (HAM/TSP), Leucemia de Células T do Adulto (ATL) e outras doenças sistêmicas mediadas pela resposta imune. A infecção pelo HTLV-I induz uma elevada proliferação espontânea das células T do perfil de citocinas com predominância das pró-inflamatórias. Nos indivíduos com HAM/TSP o TNF-a encontra-se elevado e envolvido na lesão tecidual. O surgimento de drogas inibidoras da síntese de TNF-a traz a possibilidade de uma terapêutica, buscando reduzir a inflamação e lesão tecidual. O objetivo deste estudo foi avaliar o poder inibidor destas drogas na produção de TNF-a em PBMC de indivíduos infectados com HTLV-I. PBMC de 37 indivíduos foram avaliados: assintomáticos (n=11), subclínicos (n=7) e com mielopatia (n=19). Foram utilizadas quatro drogas inibidoras da síntese de TNF-a: Pentoxifilina, Forskolin, Rolipram e Talidomida, as quais agem em diferentes etapas da síntese desta citocina. As concentrações espontâneas de TNF-a e IFN-y e com as drogas inibidoras foram avaliados nos sobrenadantes das culturas de PBMC através da técnica de ELISA e os resultados comparados entre os grupos usando o teste Mann-Whitney. A produção espontânea de TNF-a foi mais elevada no grupo com HAM/TSP quando comparado ao assintomático e a diferença estatisticamente significante (p = 0.001). A produção espontânea de IFN-y também foi mais alta no grupo com HAM/TSP quando comparados aos assintomáticos e a diferença estatisticamente significante (p = 0.017). Para avaliação das drogas inibidoras de TNF-a, utilizamos PBMC de indivíduos com de TNF-a e IFN-y espontâneos maiores que 5 pg/ml e os resultados comparados pelo teste estatístico Wilcoxon signed ranks. Pentoxifilina foi utilizada nas doses de 50 e 200 μM. A inibição da produção de TNF-a com 50 μM foi de 71 ± 26% (p = 0.003) e de IFN-y com 50 μM foi de 46 ± 24% (p = 0.001). Forskolin foi utilizado nas doses...