Surgical resection of oral cancer: en-bloc versus discontinuous approach

Objectives: In the past literature agreed on treating oral carcinomas, using an \u201cen-bloc\u201d resection (EBR) but recently minimally invasive transoral surgery has spread as the preferable treatment for selected cases. This latter technique, which is performed with a discontinuous resection (DR), allows for a satisfactory postoperative quality of life (QoL) maintaining good survival rates. Materials and methods: In this study, we analyzed data about 147 surgically treated patients with oral cancer involving tongue and floor of the mouth. The sample was divided according to the surgical approach: EBR and DR group which were compared in terms of recurrence, overall survival, disease-free survival, and QoL. Results: In the DR group, survival analysis showed better results in term of survival, locoregional control, and postoperative anxiety, while the other QoL scores were similar in the two groups. Conclusion: The more invasive approach does not correlate to a better outcome. In selected cases, DR is an oncologically safe technique; EBR is still a valid option to treat advanced oral cancers

Acesso venoso central de longa duração: experiência com 79 cateteres em 66 pacientes

Procedures such as bone marrow transplantation, chemotherapy, total parenteral nutrition and hemodialysis increasingly require long-term central venous access (LTCVA). According to the indication, fully implantable catheters (with a reservoir) or partially catheters (Broviac- Hickman) are used. In the present study, we evaluated 79 catheres consecutively implanted into 66 patient treated at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, from January 1993 to June 1997. The following parameters were evaluated: indication of venous access, type of catheter implanted, technique used, early and late complications, and duration of the implant. Thirty four of the 66 patients (51,5%) were men. Mean patient age was 28.2 years. There was a predominance of catheter implantation for chemotherapy in 55 (69.5%) patients and for bone marrow transplantation in 12 (15.2%). Twenty eight catheters with a reservoir (35.5%) and 51 partially implantable catheters (64.5%) were implanted. As to the technique used, 71,4% of the catheters were implanted by percutaneous puncture and the remaining ones by open venous dissection and catheterization. Two types of complications related to the technique occured, 9 infections and 8 late occlusions. The mean duration of catheter was 371 days for the Broviac-Hickman catheters and 395 days for the totally implantable catheters. No death occured due to the implants. The rates of early and late complications observed in the present series are similar to those reported in the literature.Procedimentos, como o transplante de medula óssea, a quimioterapia, a nutrição parenteral total e a hemodiálise, exigem a necessidade cada vez maior do acesso venoso central de longa duração (AVCLD). Utilizam-se, de acordo com a indicação, cateteres totalmente implantáveis (com reservatório) e parcialmente implantáveis (Broviac-Hickman ). Foram avaliados setenta e nove (79) cateteres implantados, consecutivamente, em sessenta e seis (66) pacientes, tratados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP, no período de janeiro de 1993 a junho de 1997. Avaliaram-se os seguintes parâmetros: indicação do acesso venoso, tipo de cateter implantado, técnica utilizada, complicações precoces e tardias e duração do implante. Dos sessenta e seis (66) pacientes, trinta e quatro (34) (51,5%) eram homens. A idade média foi de 28,2 anos. Houve predomínio de indicação de implante de cateter para realizar-se a quimioterapia em cinquenta e cinco (55) (69,5%) pacientes e transplante de medula óssea em doze (12) (15,2%). Foram implantados vinte e oito (28) (35,5%) cateteres com reservatório e cinqüenta e um (51) (64,5%) parcialmente implantáveis. Quanto à técnica utilizada, 71,4% foram implantados por punção percutânea e os demais por dissecção e cateterização venosa, a céu aberto. Ocorreram duas complicações relacionadas à técnica, nove (9) infecções e oito (8) oclusões tardias. A duração média da implantação dos cateteres foi trezentos e setenta e um (371) dias para os cateteres Broviac- Hickman e trezentos e noventa e cinco (395) para o totalmente implantável. Não houve óbito associado aos implantes. Os índices de complicações precoces e tardias, observadas nesta casuística, assemelham- se aos dados encontrados na literatura

A New Calibrated Bayesian Internal Goodness-of-Fit Method: Sampled Posterior p-Values as Simple and General p-Values That Allow Double Use of the Data

Background: Recent approaches mixing frequentist principles with Bayesian inference propose internal goodness-of-fit (GOF) p-values that might be valuable for critical analysis of Bayesian statistical models. However, GOF p-values developed to date only have known probability distributions under restrictive conditions. As a result, no known GOF p-value has a known probability distribution for any discrepancy function. Methodology/Principal Findings: We show mathematically that a new GOF p-value, called the sampled posterior p-value (SPP), asymptotically has a uniform probability distribution whatever the discrepancy function. In a moderate finite sample context, simulations also showed that the SPP appears stable to relatively uninformative misspecifications of the prior distribution. Conclusions/Significance: These reasons, together with its numerical simplicity, make the SPP a better canonical GOF p-value than existing GOF p-values

Medical liability in organ transplantation procedures.

In February 2000, a sentence of the Supreme Court of Justice ratified that being the transplantation surgery procedures close dependent, they have to be co-ordinate. Therefore, this kind of surgery presupposes a "multidisciplinary co-operation", where different specialists work at the same time or one after another. For this reason, in the sentence not only the doctor who committed the mistake was held responsible, but also other colleagues that have undervalued his action. Strarting from this sentence, Authors describe the procedure of transplantation in all phases (donor's and receiver's clinical condition, donor-receiver compatibility, surgical treatment, receiver short or long time post- surgical assistance) isolating the cases of receiver damage and analysing in which of these hypothesis of professional liability can be recognised

Medical liability in organ transplantation procedures.

In February 2000, a sentence of the Supreme Court of Justice ratified that being the transplantation surgery procedures close dependent, they have to be co-ordinate. Therefore, this kind of surgery presupposes a "multidisciplinary co-operation", where different specialists work at the same time or one after another. For this reason, in the sentence not only the doctor who committed the mistake was held responsible, but also other colleagues that have undervalued his action. Strarting from this sentence, Authors describe the procedure of transplantation in all phases (donor's and receiver's clinical condition, donor-receiver compatibility, surgical treatment, receiver short or long time post- surgical assistance) isolating the cases of receiver damage and analysing in which of these hypothesis of professional liability can be recognised

Malignant external otitis with facial nerve paralysis

Malignant external otitis (MOE) is a severe infection of the external auditory canal and the skull base that is often seen in elderly diabetic patients with a high mortality and morbidity rate. in >98% of cases, the causative pathogen is Pseudomonas aeruginosa. Here, we describe a case of MOE associated with facial nerve paralysis in a patient hospitalized. A 62-year-old man was referred to our department experiencing right otalgia, purulent otorrhea, ear loss, and a Grade III right facial nerve palsy according to the House-Brackmann scale. He was affected by uncompensated insulin-dependent type 2 diabetes. The patient had a history of noncholesteatomatous ipsilateral chronic otitis treated with tympanomastoid surgery 10 years before, without any sign of recurrence. After 10 days of specific antibiotic and corticosteroid therapy, symptoms were reduced and the paralysis of the superior branches of the facial nerve had improved, but the persisting swell of the ear canal did not allow a thorough evaluation of the tympanic membrane. Therefore, an explorative tympanotomy was performed, and few days after surgery, the marginalis branch paralysis of the facial nerve had improved according toelectroneurography (ENG) results, and the culture swab showed a polymicrobial flora

An alternative to skin graft for superficial surgical defect in oral cancer surgery

Introduction: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported. Objective: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors. Methods: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speech- and taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result. Results: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient's own mucosa. No adverse features were observed in the cohort. Conclusion: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient's own mucosa to be restored with a more physiological result

stadiazione dei tumori dell'orofaringe secondo linee guida NCCN

Oropharynx spinocarcinoma is a tumour of the upper aerodigestive tract; the last research has showed the relevance of the HPV type 16, 18,31 in the etiopathogenesis. Different clinical implications depend from these data