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A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy. more...

Summary: The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy., (Copyright © 2018 Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.) more...

The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae. more...

Objective: To verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy., Methods: This was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included., Results: The results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT]=7), vomiting (NNT=7), and need for smaller doses of rescue antiemetics (NNT=6)., Conclusion: The preoperative infusion of 8 mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.) more...

Objective: To elucidate the benefits of using probiotics in the prevention of necrotizing enterocolitis (NEC) and its complications in preterm newborns., Method: This was a systematic review of randomized controlled trials, which included studies retrieved from three databases (MEDLINE, Embase, and LILACS), using a combination of the terms (necrotizing enterocolitis) AND (probiotics)., Results: 11 randomized trials were included, totaling 2,887 patients, 1,431 in the probiotic group and 1,456 in the control group. There was a reduction in the incidence of NEC (NNT=25), overall death (NNT=34), and neonatal sepsis (NNT=34) in the probiotic group compared to the control group. Patients that received probiotic supplementation had lower food reintroduction time (p<0.001) and hospitalization time (p<0.001) when compared to those not receiving probiotics. There was no difference in mortality caused by NEC., Conclusion: In premature newborns, the use of probiotics is effective as a prophylaxis for NEC and its complications., (Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.) more...

Unlabelled: Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy., Objectives: To establish the incidence of this complication and to analyze the predisposing factors., Method: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment., Results: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure., Conclusion: Advanced primary tumor staging is correlated with higher incidences of PCF. more...

Objective: To evaluate the efficacy of the association of corticosteroids and the standard treatment of bacterial meningitis in pediatric patients., Methods: A systematic review of the literature was conducted through the MEDLINE database. Only randomized controlled trials comparing dexamethasone with placebo in the treatment of pediatric patients with bacterial meningitis were included., Results: Eight articles met the inclusion criteria and were selected for analysis. There were no difference in mortality (p = 0.86), and incidence of neurological (p = 0.41) and auditory (p = 0.48) sequelae between the groups., Conclusion: There are no benefits in associating corticosteroids with the standard treatment of bacterial meningitis in pediatric patients. more...