Short telomere length in peripheral blood leukocytes in head and neck cancer: Findings in a Brazilian cohort.

BACKGROUND: Telomeres are specialized DNA structures that are critical to maintain cell homeostasis and to avoid genomic instability. Epidemiological studies have examined the association between leukocyte telomere length (LTL) and risk of cancers, but the findings remain conflicting. METHODS: Mean LTL was measured by quantitative PCR in 97 patients with head and neck cancer (HNC) and 262 healthy controls. The association between LTL and patients' clinical status, such as smoke, alcoholism, and overall survival, were also evaluated. RESULTS: The age-adjusted LTL was significantly shorter in patients with HNC in comparison to healthy controls (P = .0003). Patients with shortest LTL had an increased risk to develop HNC (P < 0.0001). No significant correlation was observed between LTL and patients' clinical features and personal habits. CONCLUSIONS: Our data support the hypothesis that LTL is a risk factor for HNC. The use of LTL as a biomarker can help physicians to identify high-risk individuals for HNC.

Expression of cancer/testis antigens MAGE-A, MAGE-C1, GAGE and CTAG1B in benign and malignant thyroid diseases.

Despite considerable advances in the understanding of thyroid gland biology, correctly diagnosing thyroid nodules and treating high-grade thyroid carcinoma remains challenging. Cancer/testis (CT) antigens have emerged as potential diagnostic tools as well as targets of potential cancer vaccinations. In the present study, a total of 117 patients who underwent surgical therapy for thyroid disease were available for analysis. The expression levels of melanoma-associated antigen (MAGE) A, MAGE-C1/CT7, cancer/testis antigen 1B (CTAG1B) and G antigen (GAGE) were analyzed by immunohistochemistry. None of the CT antigens were expressed in the normal thyroid or goiter. In papillary and follicular carcinoma, MAGE-A was present in 8.1% of cases, GAGE in 10.8% and CT/7MAGE-C1 and CTAG1B in 2.7% each. In medullary carcinoma, CT antigen expression was as follows: MAGE-A in 42.9% of patients; MAGE-C1/CT7 in 46.5%; GAGE in 92.9%; and CTAG1B in 3.6%. A statistically significant association was observed between the expression of G MAGE-C1/CT7 and patient gender as well as patient clinical stage (P=0.029 and 0.031, respectively). In poorly differentiated and anaplastic carcinoma cases, CT antigen expression was as follows: MAGE-A in 61.8% of cases; MAGE-C1 in 57.1%; GAGE in 66.7%; and CTAG1B in 14.4%. There was a statistically significant association between expression of GAGE and gender (P=0.043). However, there was no association between CT antigen expression and patient survival in any of the tumor entities analyzed. The current study identified a distinct expression pattern of CT antigens in malignant thyroid tumors indicating that CT antigens have the potential to outperform existing thyroid cancer biomarkers. The prevalence of CT antigens in high-grade carcinomas suggests that they serve an important biological role within malignant tumors.

Gene expression analysis of laryngeal squamous cell carcinoma.

Laryngeal squamous cell carcinoma (LSCC) is one of the most common malignancies of the head and neck tumors Zhang et al., 2013 [1]). Previous studies have associated its occurrence with social activities, such as tobacco and alcohol consumption (Hashibe et al., 2007a [2]; Hashibe et al., 2007b [3]; Shangina et al., 2006 [4]). Here, we performed a genome-wide gene expression profiling in thirty-one patients positively diagnosed for LSCC, in order to investigate new targets involved in tumorigenesis.

Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity / Infiltrado peritumoral no prognóstico do carcinoma epidermoide de cavidade oral

INTRODUCTION: Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.OBJECTIVES: To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.METHODS: The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.RESULTS: This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).CONCLUSION: Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.

INTRODUÇÃO: Pacientes com carcinoma epidermoide de cavidade oral mostram déficits em sua imunidade celular, que contribuem para o crescimento neoplásico. Assim, a atividade inflamatória, como resposta imunológica ao tumor, pode servir como fator prognóstico.OBJETIVOS: Avaliar a correlação entre o processo inflamatório peritumoral com as características clínicas dos pacientes, com a sobrevida e com o tempo livre de doença.MÉTODO: A amostra deste estudo foi composta por uma coorte retrospectiva de base hospitalar com pacientes submetidos à cirurgia para remoção de carcinoma epidermoide de cavidade oral. O infiltrado inflamatório presente nas lâminas foi avaliado semi quantitativamente, sendo dividido em processo inflamatório: menor e maior.RESULTADOS: Analisaram-se 57 amostras tumorais, com infiltrado de linfócitos, plasmócitos e histiócitos. O teste log-rank não mostrou significância para as curvas de sobrevida e de recidiva dos processos "inflamatório menor" e "inflamatório maior", p = 0,14 e p = 0,24, respectivamente. Observou-se associação direta da idade com o processo inflamatório (p = 0,04), e relação indireta entre o grau de diferenciação tumoral e o processo inflamatório (p = 0,01).CONCLUSÃO: O processo inflamatório peritumoral, embora relacionado com a diferenciação histológica, não pode ser considerado fator prognóstico de carcinoma epidermoide de cavidade oral, pois não se relaciona com sobrevida e tempo livre da doença.

Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity.

INTRODUCTION: Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor. OBJECTIVES: To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval. METHODS: The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes. RESULTS: This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p=0.14 and p=0.24, respectively. A direct association between age and inflammation (p=0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p=0.01). CONCLUSION: Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.

Assessment of MLL methyltransferase gene expression in larynx carcinoma.

Larynx cancer is the second most common type of cancer among all head and neck cancers. Deregulation of epigenetic effectors, including altered expression of histone methyltransferases from the MLL (mixed lineage leukemia) family, have been reported in many cancer types, yet little is known concerning their involvement in larynx cancer. Our objective was to determine the expression profile of MLL genes in larynx carcinoma and normal adjacent tissues and correlate this profile to tumor characteristics. We analyzed the expression profile of 5 MLL genes in 13 cases of larynx carcinoma and their adjacent non-tumor tissues using quantitative real-time PCR. MLL3 was significantly downregulated in tumor samples compared to their normal counterparts, and all MLL genes showed decreased expression in advanced tumors compared to tumors in the initial stage. Altered expression in a single MLL gene was associated with a similar alteration in the other MLL genes, revealing a strong correlation of expression in each individual patient. In conclusion, MLL genes may have similar transcriptional control, and decreased expression of these genes may contribute to larynx cancer progression.

Expression of calcium binding protein S100 A7 (psoriasin) in laryngeal carcinoma.

UNLABELLED: Many studies have reported increased expression of S100 A7 (psoriasin) in neoplastic lesions. Among them are studies on breast carcinoma, bladder squamous cell carcinoma, skin tumors and oral cavity squamous cell carcinoma. The expression of S100 A7 has not been described for laryngeal cancer. OBJECTIVE: This study aims to identify the expression of the calcium-binding protein S100 A7 and its correlation with squamous cell carcinomas of the larynx. MATERIAL AND METHODS: Specimens from 63 patients were submitted to immunohistochemistry testing with antibody S100 A7. Results were classified and compared. RESULTS: The group with highly differentiated tumors had the highest treatment failure scores. Moderately differentiated tumors had higher treatment failure scores than poorly differentiated tumors. Higher scores were predominantly seen on stages I and II in moderately differentiated tumors, whereas score distribution was more homogeneous in advanced stage disease (III and IV). Regarding failure in treatment, the group scoring zero (3/4 complications: 75%) differed significantly from the remaining groups (13/59: 22%). CONCLUSIONS: S100 A7 marker was expressed in 93.7% of laryngeal cancer cases, with higher positive correlation rates in more differentiated tumors and significantly lower rates of treatment failure. Scores had no impact on survival rates.

Expressão da proteína ligadora de cálcio S100 A7 (psoriasina) no carcinoma laríngeo / Expression of calcium binding protein S100 A7 (psoriasin) in laryngeal carcinoma

Muitos estudos relatam o aumento da expressão de S100 A7 (psoriasina) em lesões neoplásicas. Destacam-se trabalhos em carcinoma da mama, espinocelular da bexiga, pele e cavidade oral. Não foi demonstrada expressão da S100 A7 em câncer de laringe. OBJETIVO: Identificar a expressão da proteína ligadora de cálcio S100 A7 e sua correlação com carcinomas espinocelular da laringe. MATERIAL E MÉTODOS: Amostras de tecido neoplásico de 63 pacientes foram submetidos à imunohis toquímica com o anticorpo S110 A7. Os resultados foram classificados e comparados. RESULTADOS: O grupo bem diferenciado teve a maior pontuação de falha no tratamento. O grupo moderadamente diferenciado apresentou escores mais elevados do que o grupo pouco diferenciado. Pontuações mais altas predominaram nos estágios I e II no grupo moderadamente diferenciado, enquanto a distribuição do escore foi mais homogênea em estados avançados (III e IV). Em relação às falhas no tratamento, o grupo pontuação zero (04/03 complicações: 75%) diferiu significativamente da pontuação restante (13/59: 22%). CONCLUSÕES: A S100 A7 foi expressa em 93,7% dos casos de câncer de laringe, com maior positividade nos tumores mais diferenciados e taxa significativamente menor de falha no tratamento. A pontuação obtida não teve impacto sobre a sobrevivência.

Many studies have reported increased expression of S100 A7 (psoriasin) in neoplastic lesions. Among them are studies on breast carcinoma, bladder squamous cell carcinoma, skin tumors and oral cavity squamous cell carcinoma. The expression of S100 A7 has not been described for laryngeal cancer. OBJECTIVE: This study aims to identify the expression of the calcium-binding protein S100 A7 and its correlation with squamous cell carcinomas of the larynx. MATERIAL AND METHODS: Specimens from 63 patients were submitted to immunohistochemistry testing with antibody S100 A7. Results were classified and compared. RESULTS: The group with highly differentiated tumors had the highest treatment failure scores. Moderately differentiated tumors had higher treatment failure scores than poorly differentiated tumors. Higher scores were predominantly seen on stages I and II in moderately differentiated tumors, whereas score distribution was more homogeneous in advanced stage disease (III and IV). Regarding failure in treatment, the group scoring zero (3/4 complications: 75%) differed significantly from the remaining groups (13/59: 22%). CONCLUSIONS: S100 A7 marker was expressed in 93.7% of laryngeal cancer cases, with higher positive correlation rates in more differentiated tumors and significantly lower rates of treatment failure. Scores had no impact on survival rates.

Expression of cancer-testis antigens MAGE-A4 and MAGE-C1 in oral squamous cell carcinoma.

BACKGROUND: Tumor markers are genes or their products expressed exclusively or preferentially in tumor cells and cancer-testis antigens (CTAs) form a group of genes with a typical expression pattern expressed in a variety of malignant neoplasms. CTAs are considered potential targets for cancer vaccines. It is possible that the CTA MAGE-A4 (melanoma antigen) and MAGE-C1 are expressed in carcinoma of the oral cavity and are related with survival. METHODS: This study involved immunohistochemical analysis of 23 patients with oral squamous cell carcinoma (SCC) and was carried out using antibodies for MAGE-A4 and MAGE-C1. Fisher's exact test and log-rank test were used to evaluate the results. RESULTS: The expression of the MAGE-A4 and MAGE-C1 were 56.5% and 47.8% without statistical difference in studied variables and survival. CONCLUSION: The expression of at least 1 CTA was present in 78.3% of the patients, however, without correlation with clinicopathologic variables and survival.

Traqueostomia / Tracheostomy

Traqueostomia consiste na abertura da parede anterior da traqueia comunicando-a com o meio externo.Está indicada em situações onde existe obstrução da via aérea alta, acúmulo de secreção traqueal,debilidade da musculatura respiratória e intubação traqueal prolongada. Ou seja, a indicação ocorre em situações em que a dificuldade respiratória não possa ser revertida em curto espaço de tempo.

Tracheostomy consists in creating an opening in the anterior aspect of the cervical trachea, communicatingthe tracheal lumen with external environment. It is recommended in cases of upper airway obstruction,prolonged orotracheal intubation, respiratory muscles weakness and mandatory secretion removal.In general, tracheostomy is performed in situations of respiratory distress that cannot be resolved in a short time.

Expression of MAGE-A4 and MAGE-C1 tumor-associated antigen in benign and malignant thyroid diseases.

BACKGROUND: A subset of thyroid tumors characterized by a follicular growth pattern can represent a serious diagnosis. Immunohistochemistry and molecular pathology for genetic profiling have been used in an attempt to resolve some of these issues. METHODS: Tumor tissue samples of thyroid were obtained from 70 patients who underwent surgical therapy. They were divided into 4 groups: 20 adenomatous goiters, 10 follicular adenomas, 24 papillary carcinomas, and 16 follicular carcinomas. Immunohistochemical analysis was carried out using antibodies for MAGE-A4 (melanoma antigen-encoding gene A4) and MAGE-C1 (melanoma antigen-encoding gene C1). RESULTS: Standard histologic analysis and immunohistochemistry analysis of MAGE-A4 and MAGE-C1 expression were performed in all patients. The antigens examined were not expressed in any of the tissues. CONCLUSIONS: The malignant degeneration of normal tissues is a multifactorial process, varying considerably both among tumor types and among individual patients. The present study showed that there was no immunolabeling of the MAGE-A4 and MAGE-C1 antigens.

Electrophysiologic activity of the vestibular fold.

OBJECTIVES: To assess the vestibular fold muscle after cordectomy and laryngeal reconstruction, the pattern of motor unit recruitment during sound emission, and the morphologic characteristics of motor unit action potentials. DESIGN: Prospective analysis. SETTING: Tertiary academic hospital. PATIENTS: We evaluated 11 men (mean age, 65.7 years; age range, 53-82 years) who underwent laryngofissure, cordectomy, and laryngeal reconstruction with a vestibular fold flap. INTERVENTIONS: Laryngeal electromyography with the insertion of a needle electrode for the assessment of the electrophysiologic activity of thyroartenoid muscle fibers and of the cricothyroid muscle on the operated on and nonoperated on sides. The thyroarytenoid muscle was evaluated by introducing a needle electrode through the thyroid cartilage and the cricothyroid membrane. MAIN OUTCOME MEASURES: Activities of needle insertion, spontaneous muscle activity during rest, and pattern of motor unit recruitment. RESULTS: Seven patients (64%) had vestibular fold muscle fiber, all of whom showed motor unit recruitment in response to sound emission. No neurogenic muscle injuries were observed except in 1 patient with evidence of chronic injury. CONCLUSION: After cordectomy and laryngeal reconstruction, thyroarytenoid muscle fibers are present in the vestibular fold, with motor unit recruitment during sound emission.

Do foreign bodies migrate through the body towards the heart?

UNLABELLED: Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: 'FB walk to the heart'. AIM: Describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: Three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: The study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

A importância da suspeita clínica da síndrome de Hamman na sala de urgência / Importance of the suspicion of Hamman's syndrome in the emergency room

A síndrome de Hamman (pneumomediastino espontâneo) pode,com frequência, estar associada ao acometimento cervical. Oenfisema cervical espontâneo, observado nesses pacientes, édefinido como a dissecção aérea dos tecidos profundos e/ousuperficiais do pescoço sem a determinação de uma causaaparente. Além do trauma, o enfisema subcutâneo pode advir deoutras situações relacionadas à elevação da pressão intratorácica,assim como pode estar associada ao consumo de drogas inaladas.Apresentamos um caso raro de enfisema espontâneo acometendoo pescoço e o mediastino, de importante valor semiológico e queexige do médico assistente auto grau de conhecimento esuspeição.

Hamman's Syndrome (spontaneous pneumomediastinum) can beassociated to neck extension. Spontaneous cervical emphysema observedin those patients is defined as air spread on deep and/or superficial necktissues without an apparent cause. Beyond trauma, subcutaneousemphysema can happen in other related situation with rise of intrathoracicpressure, as well as can be associated to use of inhalated drugs. We presenta rare case of a cervical and mediastinal spontaneous emphysema, withimportant semiologic value and that it demands a high degree of themedical knowledge and suspicion.

Dynamics of parathyroid hormone secretion after total parathyroidectomy and autotransplantation.

BACKGROUND: Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests. METHODS: We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP. RESULTS: In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 +/- 65) pg/ml, 2.3 to 6.2 (3.3 +/- 1.1) mg/dl, and 77 to 504 (250 +/- 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium. CONCLUSIONS: Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.

Corpos estranhos caminham pelo corpo em direção ao coração? / Do foreign bodies migrate through the body towards the heart?

A fixação dos CE, principalmente os pontiagudos, favorece a migração pelo corpo, gerando a expressão popular: "os CEs caminham pelo corpo em direção ao coração". OBJETIVO: Descrever os mecanismos envolvidos na migração do CE e a forma de diagnosticá-los. METODOLOGIA: Numa população de 3.000 casos de corpos estranhos, em 40 anos, foram analisados quatro que tiveram deslocamento extraluminal. Foram tomados os dados clínicos, radiológicos, endoscópicos e ultrassonográficos coletadas no serviço de documentação médica. RESULTADOS: São apresentadas três histórias clínicas em que o CE era de espinha de peixe e uma de cartilagem de peixe. Em todos se analisou o deslocamento. Em dois a migração se iniciou no esôfago, um para a aorta e outro para a região cervical e nos dois outros, o deslocamento ocorreu a partir da faringe: um para a fáscia pré-vertebral e outro se exteriorizou na região submandibular. Discutem os mecanismos pelos quais ocorre a migração dos CEs pelo corpo e os riscos que tais deslocamentos promovem para o paciente e a forma de diagnosticá-los. CONCLUSÕES: Os CE podem caminhar pelo corpo, porém não para o coração. Em casos de histórias arrastadas de ingestão de CEs, o estudo por imagens se faz obrigatório, previamente ao exame endoscópico.

Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: "FB walk to the heart". AIM: describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

Secção laringotraqueal e laceração faringo-esofágica no trauma cervical fechado / Laryngotracheal rupture and pharyngoesophageal injury caused by blunt neck trauma

A separação laringotraqueal decorrente do trauma contuso é uma situação de extrema gravidade. Apresentamos os procedimentos necessários para o atendimento de um caso de trauma cervical fechado com secção laringotraqueal completa e laceração faringo-esofágica extensa. O sucesso no tratamento decorreu da realização de exame clínico acurado e diagnóstico preciso e da possibilidade de garantir uma via aérea que permitiu restabelecer a ventilação e da abordagem apropriada da lesão de maneira a ter reconstituído a arquitetura laringotraqueal. Salientamos, no entanto, que a rápida intervenção é fundamental, o que demanda uma equipe médica treinada e tecnicamente habituada às abordagens cirúrgicas do pescoço.

Laryngotracheal separation caused by a blunt trauma is a situation of extreme severity. We present the necessary procedures for the initial assistance of a patient with blunt cervical trauma that presented complete laryngotracheal section and a large pharyngoesophageal injury, with satisfactory functional recovery after the surgical reconstruction. The success in treatment depends on detailed clinical examination and diagnosis, possibility to guarantee an airway to keep the ventilation, and appropriate injury approach, reconstituting the integrity of the laryngotracheal architecture. The fast intervention is essential. It demands a prepared medical group, with qualified doctors in surgical approaches of the neck.

Effect of BCG stimulus on proinflammatory cytokine production in laryngeal cancer.

BACKGROUND: Evaluate the production of TNF and IL-6 in the supernatant of peripheral blood mononuclear cell (PBMC) cultures of patients with supraglottic laryngeal cancer before and after surgical treatment. MATERIALS AND METHODS: Adherent cell cultures were stimulated with LPS and BCG. Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cytokine concentration was determined by ELISA in supernatants of mononuclear cell cultures. RESULTS: In non-stimulated cultures, lower TNF cytokine levels were detected during the late postoperative (LP) period compared to control (P = 0.02). LP TNF and IL-6 levels were high in cultures stimulated with LPS compared with the preoperative period (PREOP) (P = 0.007; P = 0.008, respectively). Stimulation with BCG led to increased levels of TNF and IL-6 during the LP period compared to control (P = 0.001; P = 0.04, respectively). CONCLUSION: BCG is able to modulate the immune response of patients with advanced supraglottic laryngeal cancer in vitro, increasing the secretion of TNF and IL-6 by macrophages during the postoperative period.

Tumor marrom gigante de mandíbula em regressão espontânea no hiperparatireoidismo secundário pós-paratireoidectomia

Introdução: O tumor marrom é uma lesão erosiva óssea causada por uma rápida atividade osteoclástica e fibrose peritrabecular. Esse tumor é conhecido por estar associado ao estado de hiperparatireoidismo, sendo considerado a alteração esquelética patognomômica que acompanha esta doença. Embora apresente uma evolução insidiosa, com tendência à involução após a paratireoidectomia, alguns pacientes podem ter uma apresentação atípica, com crescimento rápido e desfigurante. Este trablaho tem o objetivo de apresentar um tumor marrom de mandíbula de rápida evolução associado ao hiperparatireoidismo secundário, complicado pela presença de uma glândula paratireóide supranumerária não identificada. Relato de caso: JFT, 21 anos, sexo masculino, em hemodiálise há 2 anos, encaminhado ao Ambulatório de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, apresentando tumor marrom desfigurante na mandíbula há 2 meses. O paciente foi submetido a uma paratireoidectomia, sendo ressecadas quatro paratireóides aumentadas, identificadas em localização habitual por cintilografia e confirmadas por exame anatomopatológico. Foi realizado autotransplante de tecido paratireóideo no músculo braquiorradial direito. O paciente evoluiu com aumento da lesão mandibular, disfagia, hemorragia da mucosa oral e persistência dos níveis séricos elevaods de paratormônio. Uma nova cintilografia de paratireóide revelou uma área focal, não existente na primeira cintilografia, de radioconcentração persistente em topografia retroesternal...

Ameloblastoma de partes moles: relato de caso e revisão de literatura

Introdução: O ameloblastoma extra-ósseo ou de partes moles é um tumor odontogênico, raro e benigno, idêntico ao ameloblastoma intra-ósseo, mas se desenvolve nos tecidos moles e exibe habitualmente um comportamento clínico brando. O ameloblastoma comumente é intra-ósseo e a maioria das recidivas ocorre no local do tumor primário. O índice de recidiva destes tumores varia de acordo com o tratamento aplicado, com uma taxa de 65% a 75% quando se procede à enucleação ou curetagem do tumor e 5% a 15% quando se realizam ressecções radicais, mas raramente envolvem tecidos moles adjacentes. Em alguns casos de recidiva óssea, o ameblatoma pode também envolver tecidos moles. O ameloblastoma extra-ósseo tende a crescer no tecido mole sem envolvimento ósseo histologicamente comprovado, são geralmente assintomáticos e de crescimento muito lento, têm usualmente uma forma regular, sólida e endurecida com a superfície lisa. Relato do caso: Trata-se de uma de 48 anos, sexo feminino, operada há 20 anos de um ameloblastoma intra-ósseo e que apresenta atualmente recidiva apenas em partes moles. A paciente apresentava uma tumoração submandibular e parafaríngea à esquerda associada a disfagia e dispnéia leve por estreitamento e deslocamento contralateral da coluna aérea da oro e hipofaringe. Feito estudo de imagem com tomografia computadorizada e biópsia que confirmaram o diagnóstico. A paciente foi submetida a tratamento cirúrgico para exérese da tumoração por acesso cervical...