Importance of anterior commissure in recurrence of early glottic cancer after laser endoscopic resection.

OBJECTIVE: To analyze the impact of anterior commissure involvement on rates of local control, recurrence, and laryngeal preservation in patients with early glottic cancer (T1a-T2 lesions, staged according to the TNM staging system) treated with laser microsurgical resection. DESIGN: Retrospective review. SETTING: A tertiary university referral center. PATIENTS: Forty-eight patients with early glottic (T1-T2a) cancer. INTERVENTION: Laser endoscopic resection of glottic cancer. MAIN OUTCOME MEASURES: Evaluation of local control and larynx preservation rates. RESULTS: Among 48 patients presenting with early glottic cancer, the anterior commissure was involved in 24 cases. The local control rate was 79% (19 cases), and the larynx preservation rate was 96% (23 cases). In the 24 cases without anterior commissure involvement, the local control rate was 96% (23 cases) and the corresponding larynx preservation rate was 100% (24 cases). The rate of local recurrence with anterior commissure involvement was 21% (5 cases) and was 4% (1 case) when this site was not compromised by the tumor. This difference was not statistically significant (P = .08). When the anterior commissure was compromised by a lesion, more surgical margins taken from the patient after the completion of surgery (additional margins) were compromised by squamous cell carcinoma (SCC) on permanent section (33% [8 cases]) compared with 0% from patients with anterior commissure involvement (P = .003), despite the fact that these margins were negative for disease on frozen section. Cases with additional margins compromised by SCC on permanent section (P = .004) and T1 lesions (P = .009) had a higher rate of recurrence. CONCLUSIONS: This study shows the tendency toward greater additional margins compromised by SCC and a higher rate of tumor recurrence in lesions with anterior commissure involvement after laser microsurgery for early glottic carcinoma. Higher recurrence rates were observed in cases with compromised additional margins and in T1 cases.

Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings.

CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

Can cochlear implants decrease tinnitus?

Suppression of tinnitus by electrical stimulation via a cochlear implant has been studied in recent years. Some individuals who undergo cochlear implant surgery report total or partial relief of the symptoms even in the contralateral ear. The mechanisms involved in this suppression are not clear. The results obtained in our study demonstrated an improvement of 71% in 29 implant cases, confirming data found in the literature. Our aim was to study tinnitus in individuals before surgery and after cochlear implant activation and to observe improvement in the perception of tinnitus, comparing these results with data in the literature. We conducted a retrospective study of 29 postlingual adults who had profound sensorineural hearing loss and underwent cochlear implant surgery at the cochlear implant sector of the Otorhinolaryngology, Head and Neck Surgery Department, University of Campinas, São Paulo, Brazil, between May 2003 and June 2005. The device employed in this procedure was the Nucleus 24K multichannel device (Cochlear Ltd, Lane Cove, Australia). After the internal component was activated, patients completed a questionnaire. Before surgery, 21 of the 29 patients (72%) who later underwent cochlear implant surgery presented with tinnitus, which was bilateral in 14 cases (67%). After the cochlear implant was activated, seven patients (33%) presented with total suppression, and eight patients (39%) reported partial relief. In the 14 cases with bilateral symptoms, tinnitus was totally suppressed or decreased in both ears in 12 cases (86%). Individuals who underwent multichannel cochlear implant surgery presented with reduced tinnitus even in the contralateral ear.

Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings

CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. DESIGN AND SETTING: An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. METHODS: Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. RESULTS: Flare-ups occurred in 85.3 percent of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. CONCLUSIONS: Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

CONTEXTO E OBJETIVO: O lúpus eritematoso sistêmico é uma doença crônica que acomete preferencialmente mulheres em idade reprodutiva. A associação entre lúpus e gravidez é problemática e os resultados maternos e perinatais são piores que na população geral. O objetivo foi determinar os resultados de 76 gestações de 67 mulheres lúpicas segundo a atividade da doença. TIPO DE ESTUDO E LOCAL: Estudo clínico descritivo avaliando a evolução de gestantes lúpicas seguidas no Ambulatório de Pré-Natal Especializado do Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), no período de 1995 a 2002. MÉTODOS: Os dados foram coletados a partir de uma ficha pré-codificada. As mulheres foram divididas em dois grupos segundo atividade do lúpus eritematoso sistêmico (LES) na gestação, conforme o índice de atividade de doença lúpica SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). A presença ou não de atividade de doença e de envolvimento renal foram consideradas variáveis independentes e os demais resultados as variáveis dependentes. RESULTADOS: A doença em atividade durante a gestação ocorreu em 85,3 por cento dos casos, sendo o acometimento renal o mais importante, relacionando-se a um maior número de mulheres que tiveram pré-eclâmpsia e pior evolução perinatal. Restrição do crescimento intra-uterino foi mais freqüente nas mulheres com doença ativa. O peso da placenta também foi significativamente menor nas mulheres com envolvimento renal. CONCLUSÕES: A atividade da doença e o envolvimento renal do LES na gestação associam-se com o aumento de complicações maternas e perinatais.