Gastric adenocarcinoma and periodontal disease: A systematic review and meta-analysis.

BACKGROUND: The oral cavity is a link between of external environment with gastrointestinal tract. Studies are controversial on the presence of Periodontal Disease (PD) and its association with Gastric Adenocarcinoma (GAC). METHODS: The authors performed a systematic review and meta-analysis to verify the association between PD and GAC. Six electronic databases were evaluated between 1961 and 2022. Titles and abstracts were reviewed independently according to the eligibility criteria, assessing full texts of selected studies. The quality of the included research was verified using the Newcastle-Ottawa Scale for case-control and cohort studies. Statistical analyses were performed based on fixed and/or random effects models to calculate the summarized Relative Risk (RR) and its 95 % Confidence Interval (95 % CI). RESULTS: There were 639 studies, of which nine articles were included (3 case-controls and 6 cohorts). Overall, the authors identified 1,253 cases of GAC 2,501 controls in case-control studies, and 1,631 patients with GAC enrolled in cohort studies. Patients presenting PD increased the risk of developing GAC by 17 % (RR=1.17; 95 % CI 1.03‒1.32), which remained regardless of the diagnostic method for PD, i.e., clinical examination (RR = 1.19; 95 % CI 1.14‒1.24) and self-report (RR = 1.34; 95 % CI 1.06‒1.69). Moreover, Asian patients (RR=1.17; 95 % CI 1.00‒1.36) with PD had a higher risk of having GAC than American and European patients (RR = 1.18; 95 % CI 0.84‒1.66). CONCLUSIONS: The presence of PD the risk of GAC suggesting that its infectious-inflammatory process of PD may be related to GAC development. Further investigations on the oral-gastric microbiota and its role in the carcinogenesis of gastric cancer should be carried out, and the screening of patients with potential risk for GAC should be considered in the clinical practice of dentists.

Epidemiological, Clinical, and Genomic Profile in Head and Neck Cancer Patients and Their Families.

Inherited cancer predisposition genes are described as risk factors in head and neck cancer (HNC) families. To explore the clinical and epidemiological data and their association with a family history of cancer, we recruited 74 patients and 164 relatives affected by cancer. The germline copy number alterations were evaluated in 18 patients using array comparative genomic hybridization. Two or more first-degree relatives with HNC, tobacco-associated tumor sites (lung, esophagus, and pancreas), or other related tumors (breast, colon, kidney, bladder, cervix, stomach carcinomas, and melanoma) were reported in 74 families. Ten index patients had no exposure to any known risk factors. Family members presented tumors of 19 topographies (30 head and neck, 26 breast, 21 colon). In first-degree relatives, siblings were frequently affected by cancer (n = 58, 13 had HNC). Breast cancer (n = 21), HNC (n = 19), and uterine carcinoma (n = 15) were commonly found in first-degree relatives and HNC in second-degree relatives (n = 11). Nineteen germline genomic imbalances were detected in 13 patients; three presented gains of WRD genes. The number of HNC patients, the degree of kinship, and the tumor types detected in each relative support the role of heredity in these families. Germline alterations may potentially contribute to cancer development.

Second salvage surgery for re-recurrent oral cavity and oropharynx carcinoma.

BACKGROUND: Salvage surgery is considered the best treatment approach for patients with recurrent oral carcinoma. Unfortunately, 50% to 60% of the patients who undergo salvage surgery will develop further locoregional recurrence, and they are not usually considered for further treatment. Our aim in this study was to report our experience with a second salvage surgery for selected patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). METHODS: Forty-one patients underwent a second salvage surgical procedure, with curative intention for re-recurrent oral cancer. The surgical treatment used was wide local resection in 34 cases, neck dissection in 9 cases, and isolated neck dissection in 7 cases. RESULTS: Cancer-specific survival (CSS) rate in 3 years was at 20%. Patients with re-recurrence in <6 months presented 3-year CSS null, whereas patients with re-recurrence after 6 months presented 3-year CSS of 32.3% (p = .007). CONCLUSION: Second salvage surgery can be considered a potentially curative therapeutic approach for a selected group of patients with re-recurrent oral SCC. The disease-free interval was the main clinical factor associated with the prognosis.

Biological markers and prognosis in recurrent oral cancer after salvage surgery.

OBJECTIVE: To analyze the prognostic effect of epidermal growth factor receptor (EGFR), matrix metalloproteinases 2 and 9, and vascular endothelial growth factor expression in patients with locally recurrent oral carcinoma after salvage surgery. DESIGN: Retrospective cohort study. Settings Tertiary center cancer hospital. PATIENTS: The charts of 111 patients with local recurrence of oral carcinomas were retrospectively analyzed. The previous treatment consisted of surgery in 33 patients (30.0%), radiotherapy with or without chemotherapy in 46 patients (41.0%), and surgery with adjuvant radiotherapy in 32 patients (29.0%). The expression of EGFR, matrix metalloproteinases 2 and 9, and vascular endothelial growth factor was analyzed with a tissue microarray immunohistochemical technique. MAIN OUTCOME MEASURES: Overall survival and cancer-specific survival (CSS). RESULTS: The recurrences were diagnosed in less than 1 year in 69 patients (62.2%) and in more than 1 year in 42 patients (37.8%). The prognosis was worse in the group with the disease-free interval of less than 1 year (P = .01). Patients with more advanced disease (clinical stage of recurrence, III/IV) had worse rates of CSS (P = .04). Cases that were positive for EGFR had a 3-year CSS of 27.2%, while EGFR-negative cases had a 3-year CSS of 64.3% (P = .001). The expression of matrix metalloproteinases 2 (P = .83) and 9 (P = .15) and vascular endothelial growth factor (P = .86) was not significant in this group. In multivariate analysis, only the disease-free interval and the overexpression of EGFR were associated with a higher risk of cancer death. CONCLUSIONS: Local recurrence in oral carcinomas carries a poor prognosis. A disease-free interval of more than 1 year and a EGFR-negative expression are the main prognostic factors related to better CSS in patients treated with salvage surgery.

Preservation of the internal jugular vein in the radical treatment of node-positive neck--is it safe?

BACKGROUND: The aim of this study was to evaluate risk factors of neck recurrence in patients with pN+ necks submitted to a modified or a classic radical neck dissection and the safety of preserving the internal jugular vein in the treatment of a subgroup of these patients. METHODS: The medical records of 311 untreated patients with squamous cell carcinoma of the oral cavity (106 cases), oropharynx (95 cases), larynx (49 cases), and hypopharynx (61 cases) were reviewed. Their clinical stages (CS) were CS II in 1%, CS III in 19.9%, CS IVA in 76.2%, and CS IVB in 19.6% of the cases. All patients were pN+. RESULTS: Ipsilateral neck recurrence occurred in 18 cases (5.8%), 14 cases (4.5%) where the internal jugular vein was resected, and 4 cases (1.3%) where the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .852), T stage (P = .369), N stage (P = .963), adjuvant radiotherapy (P = .701), number of positive lymph nodes (P = .886), jugular vein preservation (P = .240), and extracapsular spread (P = .670). There was significant correlation between neck recurrence and the lymph node size (.040). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase in the risk of neck recurrence.

Internal jugular vein preservation in neck dissection for pN1-N2c oral and oropharyngeal carcinoma.

PURPOSE: The aim of this study is to evaluate risk factors of neck recurrence in patients with pN1-N2 neck stage, submitted to a modified radical neck dissection with preservation of the internal jugular vein. MATERIALS AND METHODS: We reviewed the medical records of 72 patients with squamous cell carcinoma of the oral cavity (43 cases) and oropharynx (29 cases). The clinical stage of the neck was N1 in 23 cases and N2a-c in 49. RESULTS: Neck recurrences occurred in 6 cases at the side in which the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .391), T stage (P = .999), N stage (P = .203), adjuvant radiotherapy (P = .999), number of positive lymph nodes (P = .180), lymph nodes size (P = .429), and extracapsular spread (P = .400). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase on the risk of neck recurrence.

Incidência e fatores de risco para hemorragia intracraniana em recém-nascidos / Incidence and risk factors of intracranial hemorrhage in newborns

Hemorragia intraventricular (HIV) é uma importante causa de mortalidade e morbidade em recém-nascidos de muito baixo peso. Consequências desastrosas podem ocorrer principalmente se o diagnóstico for tardio. Vários fatores de risco associados a HIV tais como, baixo peso ao nascimento e prematuridade, foram identificados. Por outro lado a sobrevivência de recém-nascidos de muito baixo peso tem crescido significativamente nas últimas décadas.

Intraventricular hemorrhage (ICV) is an outstanding cause of mortality and morbidity of very low weight newborns. Disastrous consequences may mostly occur if the diagnosis is made in a late stage. Several risk factors associated with ICV, such as low weight at birth and prematurity, have been identified. On the other hand, the survival of extremely low-weight newborns has increased significantly in the last decades.

Postoperative complications of thyroidectomy for differentiated thyroid carcinoma.

OBJECTIVE: This study evaluates the incidence and risk factors of complications in patients submitted to thyroidectomy for differentiated thyroid carcinoma in a cancer hospital with residency training. STUDY DESIGN: A retrospective chart and complications review of 316 consecutive patients who underwent thyroidectomy for differentiated thyroid carcinoma. RESULTS: Of the 316 patients, the main postoperative complications were transient hypocalcemia in 87 (27.5%), permanent hypocalcemia in 16 (5.1%), transient vocal cord palsy in 4 (1.2%), and permanent vocal cord palsy in 2 (0.6%). Neck dissection and paratracheal lymph node dissection when associated with total thyroidectomy were significantly related to transitory and permanent hypocalcemia. CONCLUSION: Thyroid surgery can be performed safely in a hospital with medical residency training program under direct supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant complication. Neck and paratracheal lymph node dissections were the most significant predictors of hypocalcemia in patients submitted to total thyroidectomy.

Results of the treatment of locally invasive thyroid carcinoma.

BACKGROUND: Well-differentiated thyroid carcinoma usually has an excellent prognosis. However, when extrathyroidal invasion occurs, it is associated with significant morbidity and mortality. This report presents the experience of a single institution in the treatment of patients with locally invasive, well-differentiated thyroid carcinoma. PATIENTS AND METHODS: Forty-six patients with locally invasive well-differentiated thyroid carcinoma were diagnosed. Histopathologic types included: 28 papillary carcinoma and 18 follicular. RESULTS: Patients with exclusive invasion of the muscle or recurrent laryngeal nerve usually had complete tumor resection. Patients with tracheal, laryngeal, or esophageal invasion usually underwent shave resection. The factors that adversely affected survival were: age >45 years, preoperative diagnosis of extrathyroidal extension, and incomplete resection (p <.05). CONCLUSIONS: There were similar survival results after complete or shave resection and poor survival when the resection was incomplete. Tumors with minimal invasion can be treated by shave resection with acceptable survival and low morbidity.

Avaliaçäo nutricional da gestante e suas repercussöes sobre o peso do recém-nascido / Assessment of maternal nutritional profile on her offspring's birth weight

O objetivo desta pesquisa foi avaliar o estado nutricional das gestantes e suas repercussões sobre o peso do recém-nascido. Este estudo foi realizado na Maternidade Cândida Vargas, João Pessoa, Paraíba, Brasil, no período de 01/11/1997 a 31/08/1998, com uma amostra de 390 gestantes e 142 recém-nascidos. A avaliação nutricional das gestantes foi realizada nos três trimestres gestacionais; no último trimestre obteve-se um total de 306 gestantes, sendo 42,5 por cento de baixo peso, 26,1 por cento de peso normal e 31,4 por cento com sobrepeso. Totalizando 73,9 por cento de gestantes malnutridas por déficit ou excesso de peso. A incidência de PIG foi de 10,42 por cento e de recém-nascidos com peso insuficiente de 19,44 por cento. O incremento médio de peso das gestantes foi inferior ao recomendado pela OMS (1987), (400g/semanal). A incidência de gestantes fumantes foi de 11,8 por cento e não fumantes foi de 88,2 por cento. Em relação ao grupo de gestantes com doenças e o grupo de gestantes sem doenças não houve diferença significante em relação ao peso de nascimento dos recém-nascidos. A incidência de gestantes com Hg menor ou igual a 10g/dl foi de 4,35 por cento e nas gestantes com Hg: 10,1-11g/dl foi de 10,43 por cento. Conclui-se que a incidência de gestantes desnutridas e recém-nascidos de baixo peso e peso insuficiente ao nascer é alta na população estudada

Avaliação epidemiológica da gestação em adolescentes de João Pessoa-Paraíba-Brasil / Epidemiologic assessment of the gestantion in adolescents sample of João Pessoa-Paraíba-Brazil

O presente estudo teve como objetivo avaliar epidemiologicamente as gestantes adolescentes e seus respectivos recém-nascidos, atendidos nos Serviços de Obstetrícia e Neonatologia do Hospital Universitário Lauro Wanderley da UFPB, em João Pessoa-Paraíba-Brasil. Os dados foram coletados durante o período de agosto de 1998 a abril de 1999, a partir de entrevistas realizadas com as mães, no puerpério imediato, bem como, através do seguimento dos RNs, até a alta hospitalar. Observou-se que a gravidez cursou com morbidade significativa (69,2 por cento), destacando-se a DHEG, a anemia e a ITU. O pré-natal foi realizado por 96,7 por cento das entrevistas e 68,3 por cento delas eram primigrávidas. A incidência global de prematuridade foi da ordem de 16,4 por cento, atingindo a cifra de 28,5 por cento entre os RNs do grupo de mães da faixa etária entre 14 a 15 anos. Diante do exposto faz-se necessária a implantação de ambulatórios especializados para o atendimento e aconselhamento do adolescente

Peso e comprimento de recém-nascidos normais e de portadores de Hb AS / Weight and lengh of low income newborns and in sickle cell trait newborns (Hb AS)

A distribuição do peso e do comprimento de 1006 recém-nascidos vivos, de parturientes de classe sócio-econômica de baixa renda e residentes na região metropolitana de João Pessoa, Paraíba, foi comparado com os valores encontrados de peso e comprimento de recém-nascidos portadores de Hemoglobinopatias Estruturais. Os valores médios de peso (3.189g) e de comprimento (48,36cm) foram concordantes com os achados de NÓBREGA (1989) para a mesma população. Os recém-nascidos heterozigotos Hb AS tiveram peso e comprimento abaixo dos limites do Intervalo de Confiança para o peso médio e para o comprimento médio. Este fato reforça a hipótese de que apesar de os portadores do traço falcêmico apresentarem sinais e sintomas brandos da doença, fazem parte do grupo nosológico da Anemia Falciforme

Aspectos tomográficos da síndrome de West / CT scan findings on West's syndrome

No presente trabalho os autores relatam os achados tomográficos (TCC) de 34 crianças afetadas pela SW. Em 12 crianças (35,29 por cento) a TCC foi considerada normal; onze (32,35 por cento) apresentaram atrofia cerebral difusa; seis (17,64 por cento) mostraram sinais de atrofia cortical difusa; duas (5,88 por cento) apresentaram calcificações parenquimatosas cerebrais; numa criança (2,94 por cento) foi observada imagem de dilatação ventricular com formação cística intraventricular à direita; numa lactente (2,94 por cento) a TCC evidenciou agenesia do corpo caloso e cisto porencefálico à esquerda e, finalmente, noutra (2,94 por cento) o exame detectou apenas assimetria craniana. Os autores chamam a atenção para a importância do exame tomográfico do crânio como subsídio para o diagnóstico etiológico da SW

Sangramento intestinal em lactente / Severe intestinal bleeding in a infant

No presente trabalho o autor relata um caso de sangramento intestinal severo, acompanhado de hipoproteinemia significativa, em lactente com 10 meses de idade, decorrente de alergia às proteínas do leite de vaca e de cabra. São discutidos os aspectos clínicos, a fisiopatologia e o diagnóstico diferencial.Finalmente, o autor enfatiza a importância de considerar a possibilidade de alergia à proteína do leite de vaca, no diagnóstico diferencial de sangramento intestinal em lactente, salientando, igualmente, o risco de alergia cruzada com a proteína do leite de cabra e de sensibilizacão à proteina da soja

Toxicidade de plantas medicinais na terapêutica infantil / Toxicity of medicinal plants in infantile therapeutics

Apesar da reconhecida riqueza da nossa flora e da utilização de ervas tidas como medicinais por grande parcela da população, pouquíssimos são os dados científicos existente no Brasil sobre o uso terapêutico e possíveis efeitos tóxicos de plantas medicinais.Dessa maneira, o presente trabalho se propõe, com base em informações obtidas a partir de um questionário aplicado à população, e a partir do conhecimento pré-existente, obter subsídios para esclarecer e informar à população sobre o assunto.Foi, então, aplicado questionário em 180 mães atendidas no ambulatório de Pediatria do HULW-PB.Oservou-se que 96,7 por cento das genitoras utilizavam plantas medicinais; 94,7 por cento relatam ter obtido o possível efeito desejado; 50,7 por cento fizeram uso em associação a outras plantas e/ou medicamentos e 2,9 por cento referiram possíveis efeitos tóxicos. Os autores concluem que grande parcela da população faz uso de plantas medicinais indiscriminadamente, tendo sido relatado baixo índice de possíveis efeitos tóxicos

Aspectos clínicos da síndrome de West / West's syndrome: clinical features

Foram estudados os aspectos clínicos da Síndrome de West (SW) em 34 crianças afetadas, atendidas no Ambulatório de Pediatria do HULW (UFPB - Joäo Pessoa - Paraíba - Brasil). Vinte e três crianças foram avaliadas retrospectivamente e onze foram estudadas prospectivamente. A incidência da Sw em Joäo Pessoa - PB, estimada no período de 1986 a 1990, variou de 0,07 a 0,1 por mil nascidos vivos (média de 0,08/1000). A idade de aparecimento das primeiros espasmos variou de um a doze meses (média de 4,1 meses), sendo que os sinais e sintomas observados por ocasiäo do primeiro exame físico, foram, por ordem de freqüência: retardo neuropsicomotor, hipotonia, microcefalia, diplegia ou quadriplegia, outros tipos de convulsäo, acúmulo de secreçäo brônquica, autismo, hiper-reflexia, monoparesia, espasticidade, manchas cutâneas, estrabismo, amaurose e hipoacusia. Prognóstico mais favorável foi observado em crianças portadores de SW de origem criptogênica, cujo tratamento foi iniciado precocemente. Finalmente, os autores enfatizam a importância do diagnóstico correto e tratamento precoce

Estudo da maturaçäo sexual em escolares do sexo feminino no município de Joäo Pessoa - Paraiba / Sexual maturation in female students from Joäo Pessoa City, Paraiba, Brazil

Com o propósito de determinar as características do desenvolvimento pubertário em escolares do sexo feminino, foi realizado um estudo transversal em 1.066 estudantes, saudaveis, pertencentes as classes sócio-economicas baixa e média que foram averiguadas em 1993 na cidade de Joäo Pessoa, PB, Brasil. Os estágios de desenvolvimento de escolares de 5 a 15 anos foram avaliados através do Metodo de TANNER...

Apnéia neonatal: consideraçöes terapêuticas e etiopatogênicas / Neonatal apneia: therapeutic and etiopathology

No presente trabalho, os autores realizaram revisäo bibliográfica sobre apnéia neonatal. Aspectos atuais sobre conceito, patogenia e tratamento säo apresentados e discutidos. Pela freqüência e relevância do problema, os autores chamam a atençäo para a necessidade da monitoragem rotineira dos recém-nascidos de risco, com o objetivo de evitar o óbito ou prevenir seqüelas neurológicas futuras