Efficacy of photobiomodulation in the treatment of oral mucositis in patients undergoing antineoplastic therapy: systematic review and meta-analysis.

PURPOSE: To evaluate the effectiveness of photobiomodulation in the treatment of oral mucositis. METHODS: Systematic review and meta-analysis encompassing in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, and CINAHL and in http://clinicaltrials.gov . Eligibility criteria were randomized, non-randomized, and observational studies that used photobiomodulation for the treatment of oral mucositis. The endpoints were reduction in the severity of oral mucositis, duration of lesions, and pain reduction. For data analysis, the Review Manager 5.4 program was used. RESULTS: A total of 316 studies were identified, 297 in the electronic databases and 19 in http://clinicaltrials.gov . After removing duplicates, 260 studies were selected for title and abstract reading, of which 223 were excluded. A total of 37 studies were chosen for full reading, of which 6 were included in the review, totaling 299 patients. The treatment used was photobiomodulation. The patients were divided into two groups: the laser group used only photobiomodulation or associated with other therapies, and the control group did not use photobiomodulation. For the endpoint reduction in the severity of oral mucositis (OM), the chance of reduction of the OM was greater in the laser group as compared to the control group. For the endpoints duration of OM lesions and pain reduction, it was not possible to carry out a meta-analysis due to the high heterogeneity between studies. In the interpretation of the meta-analysis, the reduction in the severity of oral mucositis was greater in the group that received photobiomodulation. CONCLUSION: Photobiomodulation was effective in the treatment of oral mucositis.

Efficacy of Injectable Laryngoplasty With Hyaluronic Acid and/or Calcium Hydroxyapatite in the Treatment of Glottic Incompetence. Systematic Review and Meta-analysis.

BACKGROUND: Injectable laryngoplasty with hydroxyapatite and hyaluronic acid is frequently used for the treatment of glottic incompetence. The effectiveness of these substances is controversial due to the heterogeneity of studies. OBJECTIVES: To evaluate the effectiveness of the treatment for glottic incompetence using hydroxyapatite and hyaluronic acid. STUDY DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, published and unpublished trials, Web of Science. ELIGIBILITY CRITERIA: Studies that evaluated vocal fold function before and after 4-6 weeks and 6 months of hydroxyapatite and hyaluronic acid injection in adults with glottic incompetence. EXCLUSION CRITERIA: studies with outcome, follow-up time or type of intervention outside the predetermined pattern or systematic review and meta-analysis. SYNTHESIS OF METHODS: Primary outcome - Maximum Phonation Time. Secondary outcomes - Voice Handicap Index (VHI)-30, Parameters G and B of GRBAS Scale. Outcomes were analyzed for mean differences with the corresponding 95% CI. RESULTS: Six hundred forty-four studies identified, 12 included (5 CaHA; 6 HA; 1 HA and CaHA). After 4-6 weeks the mean difference were: MPT (+5.86), IDV (-39.32), G (-1.14), and B (-1.46). After 6 months: MPT (+5.97), IDV (-30.13), G (-1.33), and B (-1.33). LIMITATIONS: Studies comparing injectable drugs are small, as well as the number of patients in each one, making the isolated comparison of substances difficult. CONCLUSIONS AND IMPLICATIONS: There is an evidence that the injectable substances HA and CaHA are effective in the treatment of glottic incompetence, however, it is important that more studies are carried out comparing the two substances.

Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

PURPOSE: To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH). METHODS: Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment. RESULTS: Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF. CONCLUSIONS: RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.

Success of endoscopic dacryocystorhinostomy with or without stents: systematic review and meta-analysis.

PURPOSE: To evaluate the effect of stents on the success of endoscopic dacryocystorhinostomy (DCR-EN) for treating primary acquired nasolacrimal duct obstruction (NLDO). METHOD: A systematic review of randomized clinical trials of DCR-EN for NLDO comparing outcomes of surgeries performed with and without the use of bicanalicular stents and the complications associated with each procedure. Two authors independently searched six databases (Scopus, PubMed, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science) up to May 2019. Statistical analysis and meta-analysis were performed using RevMan 5.3 software provided by the Cochrane Collaboration. RESULTS: Twelve studies involving 997 surgeries were included in this systematic review. The meta-analysis using a fixed-effects model showed a 94% success rate with stents versus 90.6% without stent. Although stent use favors greater success of DCR-EN, the confidence interval (CI) was wide and very close to nullity line (1.01), decreasing the strength of the recommendation for stent (odds ratio: 1.62, 95% CI: 1.01-2.59, I 2 = 0%). Meta-analysis of the adverse effects was not possible. A descriptive analysis was performed of the general complications related to the stents. CONCLUSIONS: There is evidence that the use of bicanalicular stents slightly improves the success rate of DCR-EN, but the quality of evidence is low. Future prospective, randomized trials enrolling larger sample sizes may provide stronger evidence to determine whether the stent use influences the success of primary acquired DCR-EN.

Telomere-associated genes and telomeric lncRNAs are biomarker candidates in lung squamous cell carcinoma (LUSC).

In the past decade, research efforts were made to identify molecular biomarkers useful as therapeutic targets in Non-Small Cell Lung Cancer (NSCLC), the most frequent type of lung carcinoma. NSCLC presents different histological subtypes being the most prevalent LUSC (Lung Squamous Cell Cancer) and LUAD (Lung Adenocarcinoma), and only a subset of LUAD patients' present tumors expressing known targetable genetic alterations. Telomeres and its components, including telomerase, the enzyme that replenishes telomeres, have been considered potential cancer biomarkers due to their crucial role in cell proliferation and genome stability. Our study aims to quantify expression changes affecting telomere-associated genes and ncRNAs associated with telomere regulation and maintenance in NSCLC. We first assessed the transcriptome (RNA-Seq) data of NSCLC patients from The Cancer Genome Atlas (TCGA) and then we tested the expression of telomere-associated genes and telomeric ncRNAs (TERC, telomerase RNA component, and TERRA, telomere repeat-containing RNA) in Brazilian NCSLC patient samples by quantitative RT-PCR, using matched normal adjacent tissue samples as the control. We also estimated the mean size of terminal restriction fragments (TRF) of some Brazilian NSCLC patients using telomeric Southern blot. The TCGA analysis identified alterations in the expression profile of TERT and telomere damage repair genes, mainly in the LUSC subtype. The study of Brazilian NSCLC samples by RT-qPCR showed that LUSC and LUAD express high amounts of TERT and that although the mean TRF size of tumor samples was shorter compared to normal cells, telomeres in NSCLC are probably maintained by telomerase. Also, the expression analysis of Brazilian NSCLC samples identified statistically significant alterations in the expression of genes involved with telomere damage repair, as well as in TERC and TERRA, mainly in the LUSC subtype. We, therefore, concluded that telomere maintenance genes are significantly deregulated in NSCLC, representing potential biomarkers in the LUSC subtype.

Clinical usefulness of prethymectomy plasmapheresis in patients with myasthenia gravis: a systematic review and meta-analysis.

OBJECTIVES: Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis. METHODS: MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis. RESULTS: The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08-1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11-4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07-1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93-43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02-0.65; I2 = 63%). CONCLUSIONS: Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.

Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease.

OBJECTIVE: To analyse the diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤1.0 determination. PATIENTS AND METHODS: BE images were analyzed retrospectively by 2 examiners and the results were compared with the histopathology of rectal biopsies. RESULTS: TZ identification and RSI ≤1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the 2 examiners than RSI ≤1.0. However, interexaminer agreement was higher for RSI ≤1.0 than for TZ identification. The combination of TZ identification and RSI ≤1.0 increased the sensitivity (83.3%-92.3%) and the negative predictive value (90.4%-92.3%). CONCLUSION: Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease.

Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study / Mitomicina C no tratamento endoscópico de estenose traqueal: estudo prospectivo de coorte

ABSTRACT Objective: To evaluate the efficacy of mitomycin C (MMC) in the endoscopic treatment of tracheal stenosis. Methods: Patients with laryngotracheal, tracheal, or tracheobronchial stenosis were treated with dilation and topical MMC. The inclusion criteria were as follows: being ineligible for surgery (for medical reasons) at the time of evaluation; membranous stenosis responding well to dilation; and postoperative stenosis at the anastomosis site. Etiology of stenosis and indication for treatment with MMC, as well as site, length, and percentage of stenosis, together with presence of tracheostomy and duration of follow-up, were analyzed. The outcomes evaluated were symptom-free interval ≥ 12 months, number of dilations with topical application of MMC, and complications. Results: Twenty-two patients (15 men and 7 women) were treated between 2003 and 2010. Stenosis was due to endotracheal intubation in 15 patients and surgery in 8. Pure tracheal stenosis was encountered in 13 patients, subglottic stenosis was encountered in 4, tracheobronchial stenosis was encountered in 3, and complex stenosis was encountered in 2. The length of stenosis ranged from 0.5 cm to 2.5 cm, and the percentage of stenosis ranged from 40% to 100%. Nine patients had undergone tracheostomy and had a Montgomery T-tube in situ. Treatment was successful in 14 patients, who remained free of symptoms for at least 12 months. The number of topical applications of MMC ranged from 1 to 5, and complications included fungal infection, keloid scarring, granuloma, and mediastinal emphysema. Conclusions: MMC appears to be effective in the endoscopic treatment of tracheal stenosis.

RESUMO Objetivo: Avaliar a eficácia da mitomicina C (MMC) no tratamento endoscópico de estenose traqueal. Métodos: Pacientes com estenose laringotraqueal, traqueal ou traqueobrônquica foram tratados por meio de dilatação e MMC tópica. Foram empregados os seguintes critérios de inclusão: pacientes inaptos para cirurgia (por motivos médicos) no momento da avaliação; estenose membranosa com boa resposta a dilatação e estenose pós-operatória no local da anastomose. Foram analisadas as seguintes variáveis: etiologia da estenose; indicação de tratamento com MMC; local e extensão da estenose, bem como a porcentagem de estenose; presença de traqueostomia e tempo de seguimento. Os desfechos avaliados foram 12 meses ou mais sem sintomas, número de dilatações com aplicação de MMC tópica e complicações. Resultados: Vinte e dois pacientes (15 homens e 7 mulheres) foram tratados entre 2003 e 2010. As causas da estenose foram intubação endotraqueal em 15 pacientes e cirurgia em 8. A estenose traqueal pura foi observada em 13 pacientes, a subglótica, em 4, a traqueobrônquica, em 3 e a complexa, em 2. A extensão da estenose variou de 0,5 a 2,5 cm, e a porcentagem de estenose variou de 40 a 100%. Nove pacientes haviam sido submetidos a traqueostomia e apresentavam tubo T de Montgomery in situ. O tratamento teve êxito em 14 pacientes, que permaneceram sem sintomas durante pelo menos 12 meses. O número de aplicações de MMC tópica variou de 1 a 5, e as complicações foram infecção fúngica, queloide, granuloma e enfisema mediastinal. Conclusões: A MMC é aparentemente eficaz no tratamento endoscópico de estenose traqueal.

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis / Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis

Abstract Introduction: Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment. Objective: To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation. Methods: Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used. Results: Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery ± associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I 2 = 90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid. Conclusion: There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.

Resumo: Introdução: Granulomas laríngeos pós-intubação são lesões laríngeas benignas, porém recorrentes. Não há um consenso na literatura em relação ao seu tratamento. Objetivo: Descrever a eficácia de diferentes modalidades de tratamento para granulomas laríngeos primários ou recorrentes resultantes da intubação endotraqueal. Método: Estudo-revisão sistemática e metanálise proporcional. Critérios de elegibilidade: estudos experimentais ou observacionais com pelo menos cinco indivíduos. Desfechos estudados: resolução do granuloma, recorrência e tempo de resolução. Bases de dados usadas: Pubmed, Embase, Lilacs e Cochrane. Foi usado o software Stats Direct 3.0.121. Resultados: Foram selecionados seis estudos, com 85 pacientes. Os tratamentos registrados foram: terapia antirrefluxo, terapia da voz, medicamentos anti-inflamatórios, esteroides, antibióticos, sulfato de zinco e cirurgia. Receberam tratamento primário 85 pacientes de seis estudos: cirurgia ± associações (41 pacientes), chance de resolução de 75% (IC 95% 0,3% a 100%, I2 = 90%) e risco absoluto de recorrência de 25% (IC 95%: 0,2% a 71%); tratamento clínico (44 pacientes), chance de resolução de 86% (IC 95%: 67% a 97%) e risco absoluto de recorrência de 14% (IC 95%: 3% a 33%). Não houve diferença significante entre os grupos. Três estudos, que abrangeram 19 pacientes, analisaram o tratamento secundário (falha ou recorrência após o tratamento primário); três indivíduos apresentaram nova recorrência. O tempo necessário para resolver as lesões variou de imediato, logo após a cirurgia, até 23 meses, com tratamento com esteroides inalados. Conclusão: Não há evidências de alta qualidade que provem a eficácia de qualquer tratamento para granulomas laríngeos resultantes da intubação endotraqueal.

Hyperhidrosis: prevalence and impact on quality of life.

OBJECTIVE: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. METHODS: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. RESULTS: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. CONCLUSIONS: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

Hyperhidrosis: prevalence and impact on quality of life / Hiperidrose: prevalência e impacto na qualidade de vida

ABSTRACT Objective: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. Methods: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. Results: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. Conclusions: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

RESUMO Objetivo: Estabelecer a prevalência de hiperidrose primária no município de Botucatu (SP) e avaliar como o transtorno afeta a qualidade de vida dos seus portadores. Métodos: Foi realizado um levantamento populacional para identificar os casos de hiperidrose em moradores da região urbana da cidade, selecionados por amostragem sistemática de conglomerados. O número amostral de 4.033 participantes foi calculado usando os mapas censitários do município. Dez entrevistadores aplicaram um questionário que avaliou a presença de transpiração excessiva e convidaram os sujeitos que referiram hiperidrose para uma entrevista com um médico para a confirmação do diagnóstico. Resultados: Foram pesquisados 1.351 domicílios, com 4.133 moradores. Desses, 85 queixaram-se de sudorese excessiva (prevalência = 2,07%), sendo 51 (60%) do gênero feminino. Dos 85 indivíduos, 51 (60%) concordaram receber avaliação médica para confirmar o diagnóstico, e apenas 23 (45%) apresentaram hiperidrose primária (prevalência = 0,93%). Dos 23 indivíduos diagnosticados com hiperidrose primária, 11 (48%) referiram qualidade de vida ruim ou muito ruim. Conclusões: Embora as queixas de transpiração excessiva tenham sido superiores a 2%, a prevalência real de hiperidrose primária em nossa amostra foi de 0,93% e o distúrbio afetava a qualidade de vida em quase 50% dos indivíduos.

Outcome of Percutaneous Radiofrequency Thoracic Sympathectomy for Palmar Hyperhidrosis.

The impact of upper thoracic percutaneous sympathectomy with radiofrequency on the quality of life (QOL) of patients with palmar hyperhidrosis was evaluated. Thirty-six patients with palmar hyperhidrosis were selected for a prospective observational study. Treatment consisted of percutaneous radiofrequency thoracic sympathectomy of T3 and T4 ganglions in all cases. QOL questionnaires were applied preoperatively, on the 1st postoperative (PO) day, and on the 30th, 90th, 180th, and 360th PO days. Furthermore, compensatory hyperhidrosis (HDSSc) scale measures were used simultaneously, in order to evaluate the rate and frequency of this side effect. The QOL questionnaire evaluation showed preoperative values of 83.94 ±â€¯4.74 (meaning poor quality of life), decreasing to 24.61 ±â€¯2.86 on the 1st PO day, 25.14 ±â€¯3.12 on the 30th PO day, 31.28 ±â€¯4.42 on the 90th PO day, 32.97 ±â€¯4.54 on the 180th PO day, and 33.94 ±â€¯4.6 on the 360th PO day (all postoperative results with values below 35 were considered optimal). Compensatory hyperhidrosis (HDSSc) scale values were 1.14 ±â€¯0.35 on the 1st PO day, 1.42 ±â€¯0.55 on the 30th PO day, 1.83 ±â€¯0.85 on the 90th PO day, 1.92 ±â€¯0.91 on the 180th PO day, and 1.92 ±â€¯0.91 on the 360th PO day (meaning that hyperhidrosis was mainly unnoticed). Patients' subjective satisfaction was considered very good and the majority of patients would recommend the treatment procedure. Percutaneous radiofrequency thoracic sympathectomy had a positive impact on the quality of life of patients with palmar hyperhidrosis, compared to the surgical treatment, with a low rate and intensity of HDSSc and without other complications.

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis.

INTRODUCTION: Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment. OBJECTIVE: To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation. METHODS: Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used. RESULTS: Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery±associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I2=90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid. CONCLUSION: There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.

Strategies to optimize MEDLINE and EMBASE search strategies for anesthesiology systematic reviews. An experimental study

ABSTRACT BACKGROUND: A high-quality electronic search is essential for ensuring accuracy and comprehensiveness among the records retrieved when conducting systematic reviews. Therefore, we aimed to identify the most efficient method for searching in both MEDLINE (through PubMed) and EMBASE, covering search terms with variant spellings, direct and indirect orders, and associations with MeSH and EMTREE terms (or lack thereof). DESIGN AND SETTING: Experimental study. UNESP, Brazil. METHODS: We selected and analyzed 37 search strategies that had specifically been developed for the field of anesthesiology. These search strategies were adapted in order to cover all potentially relevant search terms, with regard to variant spellings and direct and indirect orders, in the most efficient manner. RESULTS: When the strategies included variant spellings and direct and indirect orders, these adapted versions of the search strategies selected retrieved the same number of search results in MEDLINE (mean of 61.3%) and a higher number in EMBASE (mean of 63.9%) in the sample analyzed. The numbers of results retrieved through the searches analyzed here were not identical with and without associated use of MeSH and EMTREE terms. However, association of these terms from both controlled vocabularies retrieved a larger number of records than did the use of either one of them. CONCLUSIONS: In view of these results, we recommend that the search terms used should include both preferred and non-preferred terms (i.e. variant spellings and direct/indirect order of the same term) and associated MeSH and EMTREE terms, in order to develop highly-sensitive search strategies for systematic reviews.

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis.

PURPOSE: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. METHODS: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. RESULTS: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). CONCLUSIONS: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.

Strategies to optimize MEDLINE and EMBASE search strategies for anesthesiology systematic reviews. An experimental study.

BACKGROUND: A high-quality electronic search is essential for ensuring accuracy and comprehensiveness among the records retrieved when conducting systematic reviews. Therefore, we aimed to identify the most efficient method for searching in both MEDLINE (through PubMed) and EMBASE, covering search terms with variant spellings, direct and indirect orders, and associations with MeSH and EMTREE terms (or lack thereof). DESIGN AND SETTING: Experimental study. UNESP, Brazil. METHODS: We selected and analyzed 37 search strategies that had specifically been developed for the field of anesthesiology. These search strategies were adapted in order to cover all potentially relevant search terms, with regard to variant spellings and direct and indirect orders, in the most efficient manner. RESULTS: When the strategies included variant spellings and direct and indirect orders, these adapted versions of the search strategies selected retrieved the same number of search results in MEDLINE (mean of 61.3%) and a higher number in EMBASE (mean of 63.9%) in the sample analyzed. The numbers of results retrieved through the searches analyzed here were not identical with and without associated use of MeSH and EMTREE terms. However, association of these terms from both controlled vocabularies retrieved a larger number of records than did the use of either one of them. CONCLUSIONS: In view of these results, we recommend that the search terms used should include both preferred and non-preferred terms (i.e. variant spellings and direct/indirect order of the same term) and associated MeSH and EMTREE terms, in order to develop highly-sensitive search strategies for systematic reviews.

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Abstract Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.

Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study.

OBJECTIVE: To evaluate the efficacy of mitomycin C (MMC) in the endoscopic treatment of tracheal stenosis. METHODS: Patients with laryngotracheal, tracheal, or tracheobronchial stenosis were treated with dilation and topical MMC. The inclusion criteria were as follows: being ineligible for surgery (for medical reasons) at the time of evaluation; membranous stenosis responding well to dilation; and postoperative stenosis at the anastomosis site. Etiology of stenosis and indication for treatment with MMC, as well as site, length, and percentage of stenosis, together with presence of tracheostomy and duration of follow-up, were analyzed. The outcomes evaluated were symptom-free interval ≥ 12 months, number of dilations with topical application of MMC, and complications. RESULTS: Twenty-two patients (15 men and 7 women) were treated between 2003 and 2010. Stenosis was due to endotracheal intubation in 15 patients and surgery in 8. Pure tracheal stenosis was encountered in 13 patients, subglottic stenosis was encountered in 4, tracheobronchial stenosis was encountered in 3, and complex stenosis was encountered in 2. The length of stenosis ranged from 0.5 cm to 2.5 cm, and the percentage of stenosis ranged from 40% to 100%. Nine patients had undergone tracheostomy and had a Montgomery T-tube in situ. Treatment was successful in 14 patients, who remained free of symptoms for at least 12 months. The number of topical applications of MMC ranged from 1 to 5, and complications included fungal infection, keloid scarring, granuloma, and mediastinal emphysema. CONCLUSIONS: MMC appears to be effective in the endoscopic treatment of tracheal stenosis.

Endobronchial solitary fibrous tumor

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that appears primarily in the pleura and rarely in intrapulmonary or endobronchial topography. The authors report the case of a 47-year-old woman who presented obstructive respiratory symptoms for 4 years. The chest computed tomography and bronchoscopy showed an obstructive polypoid lesion located between the trachea and the left main bronchus associated with distal atelectasis of the left lung. A resection of the lesion was performed and, macroscopically, the mass was oval, encapsulated, and firm, measuring 2.3 × 1.7 × 1.5 cm. Histology revealed low-grade mesenchymal spindle cell neoplasm, with alternating cellularity, myxoid areas, and mature adipose tissue outbreaks, as well as blood vessels with irregular walls. The immunohistochemical study was positive for CD34, CD99, and BCL2. The diagnosis was SFT in an unusual topography. The patient's symptoms remitted after tumor excision, and no systemic problems were evident. SFTs primarily affect adults and often follow a benign course; however, their behavior is unpredictable. The presence of necrosis and mitotic activity may portend a poor prognosis. Endobronchial SFTs are rare but should be evaluated and monitored similar to SFTs at other sites, with a long-term follow-up

Myelolipoma of the posterior mediastinum in a patient with chronic dyserythropoietic anemia.

Myelolipoma (ML) is an uncommon benign mesenchymal neoplasia composed of mature adipose and hematopoietic tissues of uncertain etiology. Less than 3% of MLs occur in the mediastinal topography. The main differential diagnosis involves extramedullary hematopoiesis; therefore, pathological evaluation is essential for the definitive diagnosis. The authors report the case of a 50-year-old man diagnosed with congenital dyserythropoiesis and secondary hemosiderosis, who presented a posterior mediastinal tumor. The tumor was resected. It was macroscopically characterized by mature fat tissue with fibrous areas and soft consistency, which was yellowish at the cut surface. Histology revealed a well-defined nodule composed of adipocytes and hematopoietic tissue represented by erythroid, granulocytic, and megakaryocytic series, which was consistent with the diagnosis of ML located in the posterior mediastinum. There was no recurrence of the lesion during the 3-year follow-up. The aim of this report is to show the diagnosis of an unusual mediastinal lesion in the context of a chronic hematologic disease.