Organ preservation with chemoradiation in advanced laryngeal cancer: The problem of generalizing results from randomized controlled trials

Item does not contain fulltextBACKGROUND: The primary goal of treatment in advanced laryngeal cancer is to achieve optimal oncologic outcomes while preserving function and quality of life. Combination of chemotherapy and radiation has been popularized as an alternative to surgery for patients facing total laryngectomy. However, survival analyses from large, population-based databases have not duplicated results reported from randomized trials. METHODS: A comprehensive literature review was undertaken to try to better understand the reasons why results differ among randomized trials and population cohort studies. RESULTS: A variety of reasons are discussed, including differences in patient staging, selection bias, complexity bias, inconsistent terminology, patient compliance and treatment expertise. CONCLUSIONS: Personalized treatment considering all factors is critical for optimal outcomes. In general, evidence supports total laryngectomy for patients with T4 cancers. Definitive chemoradiotherapy strategies are acceptable alternatives for T3 cancers, provided that all resources for the administration of the treatment, follow-up and surgical salvage are available

Surgical margins in head and neck cancer: A contemporary review

Adequate resection margins are critical to the treatment decisions and prognosis of patients with head and neck squamous cell carcinoma (HNSCC). However, there are numerous controversies regarding reporting and interpretation of the status of resection margins. Fundamental issues relating to the basic definition of margin adequacy, uniform reporting standards for margins, optimal method of specimen dissection, and the role of intraoperative frozen section evaluation, all require further clarification and standardization. Future horizons for margin surveillance offer the possible use of novel methods such as "molecular margins" and contact microscopic endoscopy, However, the limitations of these approaches need to be understood. The goal of this review was to evaluate these issues to define a more rational, standardized approach for achieving resection margin adequacy for patients with HNSCC undergoing curative resection. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2013

Management of the facial nerve in parotid cancer: preservation or resection and reconstruction

Contains fulltext : 200241.pdf (publisher's version ) (Closed access)PURPOSE: Management of the facial nerve is instrumental in the surgical treatment of parotid cancer. METHODS: A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality. RESULTS: In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face. CONCLUSIONS: The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery

Humic substances isolated from residues of sugar cane industry as root growth promoter Substâncias húmicas isoladas de resíduos da indústria da cana-de-açúcar como promotoras de crescimento radicular

Plant growth promoting substances are widely used in modern agriculture. Several products in the market are humic substances isolated from different sources. The filter cake, a residue of sugar production, is a rich and renewable source of organic matter and these characteristics place the filter cake as a possible source of plant growth promoting substances. Humic acids (HA) from filter cake were characterized, and their effects as root growth promoters were evaluated. Chemical features of the HA were evaluated through elemental composition, acidic functional groups, E4/E6 ratio and infrared spectroscopy analyzes. The biological activity of the HA was assessed using root architecture parameters and the P-type H+-ATPase activity. The lateral root development was directly related to the stimulation of plasma membrane ATPase activity. The ability of HA to promote root development indicate that HA from filter cake can be used as environmental plant growth stimulators.<br>Substâncias promotoras do crescimento vegetal são amplamente utilizadas na agricultura moderna. Existem vários produtos no mercado, muitos dos quais são substâncias húmicas isoladas de diferentes fontes. A torta de filtro, um resíduo da produção do açúcar, é uma fonte rica e renovável de matéria orgânica e essas características a tornam uma possível fonte de substâncias promotoras do crescimento vegetal. Ácidos húmicos (AH) da torta de filtro foram caracterizados, e foi avaliado seu efeito como promotor de crescimento radicular. As características químicas dos AH foram avaliadas por meio da composição elementar, grupos funcionais ácidos, relação E4/E6 e espectroscopia de infravermelho. A atividade biológica dos AH foi acessada avaliando-se a arquitetura radicular e a atividade da H+-ATPase de membrana plasmática. O desenvolvimento de raízes laterais foi diretamente relacionado ao estímulo da atividade da H+-ATPase. A habilidade dos AH em promover o desenvolvimento radicular indica que AH extraídos da torta de filtro podem ser utilizados como estimuladores do crescimento de plantas