Patterns of Guillain-Barre syndrome in children: results from a Mexican population.

BACKGROUND: Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City. METHODS: We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed. RESULTS: Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases. CONCLUSIONS: This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.

[Predictive biochemical indicators of a postlaryngectomy pharyngocutaneous fistula: a clinical study]. / Indicadores bioquímicos predictivos de fístula faringocutánea postlaringuectomía: un estudio clínico.

UNLABELLED: The aim of this clinical study was to determinate biochemical predictor indicators of postlaryngectomy pharyngocutaneous fistula. PATIENTS AND METHODS: We have studied 100 patients with T2- 4 a laryngeal and piryform sinus carcinoma who underwent a laryngectomy. All patients were ASA 2-3. We studied serum albumin, protein serum level, cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05). RESULTS: 19% of the patients developed a postlaryngectomy pharyngocutaneous fistula, with a long-stay of 25 days vs. 10 days of stay in patients without postlaryngectomy pharyngocutaneous fistula. 7 postlaryngectomy pharyngocutaneous fistula needed surgical repair. Low serum albumin (< 3.5 g/dL) and a low level of serum proteins (< 6.5 g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous fistula (p < 0.05). CONCLUSIONS: Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of postlaryngeal pharyngocutaneous fistula.

Indicadores bioquímicos predictivos de fístula faringocutánea postlaringuectomía: un estudio clínico / Predictive biochemical indicators of a postlaryngectomy pharyngocutaneous fistula: a clinical study

Introducción: El objetivo de este trabajo será identificar posibles indicadores bioquímicos predictores de la aparición de fístula faringocutánea tras laringuectomía y revisar el tratamiento quirúrgico de este problema. Material y métodos: Se seleccionaron 100 pacientes con carcinoma epidermoide T2-4 de laringe y seno piriforme clasificados como ASA 2-4 tratados mediante cirugía. Las variables estudiadas fueron la albúmina plasmática, las proteínas totales, el colesterol sérico y el número total de linfocitos. Se realizó estudio estadístico mediante Chi-cuadrado. Resultados: El 19% de los pacientes laringuectomizados presentaron fístula faringocutánea en el postoperatorio, con una estancia media hospitalaria de 25 días frente a 10 días en postoperatorio sin fístula postlaringuectomía. Fue necesario tratamiento quirúrgico del faringostoma en 7 de los 19 pacientes, que se realizó a los 25 días de la laringuectomía de media. Se identificó como marcadores bioquímcos predictivos de faringostoma proteínas totales <6,5 g/dL y albúmina plasmática <3,5g/dL (p < 0,05). El 45% de los enfermos presentaban un colesterol sérico <180. Conclusiones: Nuestros resultados sugieren qué identificación prequirúrgica hipoproteinemia e hipoalbuminemia se asocian a alto riesgo de aparición de fístula faringocutánea tras laringuectomía (AU)

The aim of this clinical study was to determinate biochemical predictor indicators of postlaryngectomy pharyngocutaneous fistula. Patients and methods: We have studied 100 patients with T2- 4 a laryngeal and piryform sinus carcinoma who underwent a laryngectomy. All patients were ASA 2-3. We studied serum albumin, protein serum level, cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05). Results: 19% of the patients developed a postlaryngectomy pharyngocutaneous fistula, with a long-stay of 25 days vs. 10 days of stay in patients without postlaryngectomy pharyngocutaneous fistula. 7 postlaryngectomy pharyngocutaneous fistula needed surgical repair. Low serum albumin (< 3.5 g/dL) and a low level of serum proteins (< 6.5 g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous fistula (p < 0.05). Conclusions: Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of postlaryngeal pharyngocutaneous fistula

[Efficacy of postoperative radiation therapy for squamous cell carcinoma of the head and neck: results of a prospective randomised clinical trial]. / Eficacia de la radioterapia postoperatoria en los carcinomas epidermoides de cabeza y cuello: resultados de un ensayo prospectivo aleatorizado.

INTRODUCTION: A prospective randomised clinical trial was designed to assess the usefulness of postoperative radiotherapy (RT) in terms of loco-regional control and survival in patients with surgically treated advanced (stages III to IV) head and neck squamous cell carcinoma with negative margins and without extracapsular extension in positive neck nodes. MATERIALS AND METHODS: Between 1994 and 1995, 51 patients were included in the study and 42 were considered evaluables (from which 21 received postoperative RT). A minimum follow-up of 3 years was required. RESULTS: The loco-regional recurrence rates were identical in irradiated and non-irradiated patients (15/21 cases--70%--in each group), as was the 5-year disease-specific survival (35% for both groups). The only parameter that was associated with a reduced disease-specific survival was the presence of regional lymph node metastases. CONCLUSION: Our results suggest that postoperative RT does not increase loco-regional control or survival in patients with completely resected advanced head and neck squamous cell carcinoma.

Eficacia de la radioterapia postoperatoria en los carcinomas epidermoides de cabeza y cuello: resultados de un ensayo prospectivo aleatorizado / Efficacy of postoperative radiation therapy for squamous cell carcinoma of the head and neck: results of a prospective randomised clinical trial

Introducción: Diseñamos un estudio prospectivo aleatorizado con el fin de determinar la utilidad de la radioterapia (RT) postoperatoria, en términos de control loco-regional y de supervivencia, en el tratamiento de los pacientes con carcinoma epidermoide localmente avanzado (estadios III y IV) con bordes quirúrgicos libres y sin extensión extracapsular en los ganglios cervicales positivos. Material y métodos: Entre 1994 y 1995, 51 pacientes fueron incluidos en el estudio, de los cuales 42 fueron considerados evaluables (de los cuales 21 recibieron RT postoperatoria). Se requirió un seguimiento mínimo de 3 años para ser incluidos en el estudio. Resultados: La tasas de recidiva loco-regional fueron idénticas en el grupo de pacientes radiados y no radiados (15/21 casos -70 por ciento- en cada grupo), al igual que la supervivencia específica para la enfermedad a los 5 años (35 por ciento para ambos grupos). El único parámetro asociado significativamente con una menor supervivencia fue la presencia de metástasis ganglionares. Conclusión: Nuestros resultados sugieren que la RT postoperatoria no aumenta el control loco-regional ni la supervivencia en los pacientes con carcinoma epidermoide de cabeza y cuello en estadios avanzados cuando ha sido totalmente resecado (AU)

INTRODUCTION:A prospective randomised clinical trial was designed to assess the usefulness of postoperative radiotherapy (RT) in terms of loco-regional control and survival in patients with surgically treated advanced (stages III to IV) head and neck squamous cell carcinoma with negative margins and without extracapsular extension in positive neck nodes. MATERIALS AND METHODS: Between 1994 and 1995, 51 patients were included in the study and 42 were considered evaluables (from which 21 received postoperative RT). A minimum follow-up of 3 years was required. RESULTS: The loco-regional recurrence rates were identical in irradiated and non-irradiated patients (15/21 cases--70%--in each group), as was the 5-year disease-specific survival (35% for both groups). The only parameter that was associated with a reduced disease-specific survival was the presence of regional lymph node metastases. CONCLUSION: Our results suggest that postoperative RT does not increase loco-regional control or survival in patients with completely resected advanced head and neck squamous cell carcinoma (AU)