Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy.

SUMMARY: The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy.

Stapler suture of the pharynx after total laryngectomy.

The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.

PP008. Lipotoxicity and preeclampsia: A probable correlation (preliminary results).

INTRODUCTION: The impact of preeclampsia (PE) of pregnancy is seen as a global concern. Despite their importance, PE does not have well-established causes. Several studies point to obesity as a predisposing factor for PE [1]. In a systematic review Duckitt and Harrington showed that in women with BMI⩾30 the relative risk of developing PE is equal to 2.1 [2]. Bianco et al. demonstrated that the chance of patients with BMI⩾35 developing PE is more than 4 times [3]. Furthermore, it is believed that the intracellular accumulation of triglycerides cause mitochondrial dysfunction, more electron transport and generation of ROS (Reactive Oxygen Species) [4], causing a harmful effect on the endothelium. OBJECTIVES: To compare the incidence of potential lipotoxicity markers among normal pregnant women and with pre-eclampsia. METHODS: A case-control study, including pregnant women from October 2011 to January 2012 at Hospital Guilherme Álvaro in Santos/Brazil. The study group consisted of 27 mothers with pre-eclampsia, according to the criteria of NHBPEP (2000) and the control group consisted of 27 mothers with normal pregnancy, who gave birth vaginally, at term without hypertension. The exclusion criteria were diagnosis of collagen diseases, smoking, diabetes, twin pregnancy and fetal malformations. Blood samples were collected immediately after delivery and the results were analyzed in conjunction with maternal data, according to the following variables: age, body mass index (BMI), serum cholesterol total and fractions, glucose, triglyceride and creative protein. Analysis of SF data was performed by calculating the odds ratio adopting an hypothesis rejection level of 0.05. RESULTS: The PE group had BMI>30 (or), serum triglycerides>150 (or) and LDL cholesterol>100 (or) more frequently than normal mothers, and as regards statistical significance comparing the age of the women, glucose level, HDS cholesterol, there was no significant difference between the groups. CONCLUSION: In pregnancy, lipotoxicity reduces the ability of trophoblastic invasion, causing maternal systemic endothelial and placental dysfunction causing alterations in metabolic functions. All such changes maintain a close relationship with the pathophysiology of PE. Monitoring pregestational period of obese patients or those with lipid disorders is part of the medical arsenal against PE by monitoring and advising on the best time to conceive.

PP044. Profile of pregnant women with pre-eclampsia treated in priority area.

INTRODUCTION: The maternity mortality rate in the Santos lowlands region, priority region of São Paulo/Brazil, is higher when compared to regions in the state of São Paulo. The hypertensive disorders are implicated in approximately 20% of death. Severe preeclampsia (PE) is recognized as the frequent diagnosis associated with maternal and fetal ominous outcomes. The recognition of potential risk support antenatal intervention which could anticipate the installation of catastrophic results. Identifying the epidemiological profile of women who may present with this evolution can guide public health policies and actions of the professionals involved in caring for these women avoiding preformed concepts and contributing to the recognition of local reality situation. OBJECTIVES: Identify the epidemiological profile of women affected by severe PE. METHODS: A descriptive study involving 46 pregnant women admitted to specialized hospital for high-risk pregnancy with the diagnosis of severe PE according to the criteria of NHBPEP (2000), as: blood pressure ⩾160/110mmHg, proteinuria 2.0g/24h or +2 dipstick, serum creatinine >1.2mg/dl (new onset), platelets <100,000/mm(3), microangiopathic hemolysis (increased lactate dehydrogenase), elevated alanine aminotransferase or aspartate aminotransferase, persistent headaches or other cerebral or visual disturbance, persistent epigastric pain or eclampsia in the period from January/2008 to November/2010. RESULTS: The average age of the pregnant women was 25.5years (±6.5), 11 women were multiparous and nulliparous and 35 (76.1%), the average gestational age at admission was 34 4/7, developing to eclampsia and/or HELLP syndrome were 07 women (15.2%), admission often occurred before the installation of labor in (93.5%) had a previous diagnosis of chronic hypertension (30.4%) and in all cases magnesium sulfate administration with an average length of 32h (±16.6h). CONCLUSION: The occurrence of severe PE was more common in nulliparous women at the age of 25years, admitted in prematurity and not in preterm labor. The outcome of seizure and/or HELLP has a considerable impact. The association of chronic hypertension with severe PE is more than 1/4 of the cases. These data are equivalent to other areas of Brazil and may contribute to emphasize the practice of prenatal acting that can recognize and pre-comment possible adverse developments and attitudes aimed at intercepting the process.