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BACKGROUND: Information is scarce regarding the impact of treatment on Health-Related Quality of Life (HRQL) of patients with Head and Neck (H&N) cancers. We assessed the effect of treatment on HRQL and its association with prognosis in H&N cancer. PATIENTS AND METHODS: Patients with H&N cancer in whom HRQL was assessed before and after treatment. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35 instruments were used. Association of changes in patients' HRQL after treatment with Loco-Regional Recurrence (LRR) and Overall Survival (OS) was investigated. RESULTS: One hundred sixty patients were included; scales of the baseline assessment of HRQL were moderately associated with LRR and OS, but the impact of treatment on most HRQL scales was strongly associated with OS. By multivariate analysis, baseline assessment of Global Health, Physical, HN Teeth, HN Dry mouth, and HN Cough scales, and impact of treatment on the Physical and Pain scales comprised independent variables associated with LRR. Male gender, positive lymph nodes, baseline assessment of Role, HN Pain, HN Cough, and impact of treatment on Emotion, Pain, Financial, HN Swallowing, HN Social contact, and the interaction of HN Pain-change in Pain scales were associated with OS. Both multivariate models were adjusted by the neoplasm's site of origin. CONCLUSION: Aside from well-known clinical-pathologic prognostic factors in H&N cancers, HRQL assessment, both prior to and after treatment, provides significant prognostic information and should be measured. Design of therapeutic clinical trials in patients with H&N cancers should consider these novel prognostic factors.

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BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx. Our aim is to analyze prognostic factors, report results obtained with radiation therapy and propose a staging system. MATERIALS AND METHODS: Retrospective study of patients with JNA. Clinical, radiological and therapeutic data were assessed for recurrence- and disease free survival-associated prognostic factors. Bivariate and multivariate analyses were performed. RESULTS: Fifty-four males were analyzed. Invasion to anterior infratemporal fossae (ITF) +/or to pterygomaxillary fossae, to posterior infratemporal fossae, or intracranial extension were associated with recurrences in 2 of 15, in 8 of 18, and in 8 of 12 cases, respectively. Tumors < or > or =6 cm were associated with zero and with 18 recurrences, respectively (P = 0.006). A staging system is constructed considering extension patterns and size. Multivariate analyses conferred significance (P = 0.002) to a model including this staging system and surgical margins. CONCLUSION: Our system stratifies recurrence risk and disease-free survival efficiently. Since radiotherapy at young age has potential to induce malignancies, it should be used with caution. It could be considered as primary treatment in stage IV cases with major invasion to cavernous sinus or orbital apex. Therapy design may be improved.

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BACKGROUND: Nasopharyngeal angiofibroma (NA) is a vascular tumor of the nasopharynx of young males which presents rarely. Our aim was to analyse outcome and prognostic factors of a case series of NA. MATERIALS AND METHODS: We conducted a retrospective study of patients with diagnosis of NA treated at a single institution from 1981 to 2003. We evaluated clinical, radiological and therapeutic data for recurrence- and disease-free survival-associated prognostic factors. Bi- and multivariate analyses were performed. RESULTS: Fifty-four males with NA constitute our study group. Age varied from 12 to 35 years (mean, 18.5 years; standard deviation [SD], 4.9). There were 18 recurrences; localization in nasopharynx, nasal fossae or maxillary antrum was not associated with recurrences. Invasion to pterygomaxillary fossae, to infratemporal fossae or to skull base and/or intracranial extension were associated with recurrences in two of 14, in five of 12, and in 11 of 18 cases, respectively. Tumors < or >or=6 cm were associated with zero and with 18 recurrences, respectively (p<0.01). Multivariate analyses conferred statistical significance (p<0.01) to a model including patterns of extension, tumor size in pterygomaxillary or anterior infratemporal fossa invasion, and surgical margins. CONCLUSION: Recurrence factors for NA are defined and consequently treatment design is suggested. Endoscopic approaches could be considered in patients with minor lateral extensions, while wide surgical approaches are indicated in invasive cases. Radiotherapy could be applied alone or combined with surgery for extensive intracranial involvement.

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AIMS: The aim of the present study is to define prognostic factors, particularly the impact of treatment on paranasal sinus and nasal cavity malignancies. MATERIAL AND METHODS: Retrospective study of patients with maxillary antrum and nasal fossae malignancies. A maxillectomy classification as performed to treat malignancies in our institution is described. Multivariate analysis of prognostic factors was done using the Cox's model. RESULTS: One hundred and nine patients were evaluated. Squamous cell carcinoma was found in 62 cases and in 95 patients the epicentre of the tumour was located in the maxillary antrum. Ten patients were treated with surgery only, 39 patients with surgery and adjuvant radiation therapy, 37 cases received only radiotherapy, and 18 received radiotherapy followed by surgery; in five cases a combination of chemo-radiotherapy was used. Multivariate analysis identified T classification, orbit invasion, N classification, site of origin of tumour in nasal fossae, and no surgical resection as independent prognostic factors (p=0.0001). CONCLUSION: T4 tumours with orbit invasion present bad prognosis as compared to other T4 tumours. Surgical resection should be included in the treatment strategy. Because of the high frequency of lymph-node metastasis, neck treatment should be considered in T4 tumours.

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BACKGROUND: Resection of malignant neoplasms invading the anterior cranial base is performed with craniofacial resection (CFR) with acceptable results in complication rates and oncologic outcomes. However, still there are series with major morbidity in up to 40% of patients, and mortality of 5%. A retrospective study was performed to evaluate the results in terms of morbidity, mortality, function and aesthetics using a median fronto orbital flap (MFOF). METHODS: The MFOF was used in 28 consecutive patients who presented to the Head and Neck Service from 1992 to 1999, in the Instituto Nacional de Cancerología, Mexico City, and was combined with a superior rhinotomy for en bloc resection of the ethmoid complex in the last 12 cases. 89% of patients had malignant neoplasms. RESULTS: 1 death occurred in this series (3%) and the global morbidity was 35%. Aesthetics and function were good to excellent. Percentages of tumor-free survival for malignant lesions was 76% and 41% at 2 and 5 years follow up, respectively. CONCLUSION: CFR is a safe approach for treatment of neoplasms of the anterior skull base. MFOF mobilization decreases complication rates and gives superb exposure for en bloc resection of tumors invading the ethmoidomaxillary complex specially when combined with a superior rhinotomy. A positive impact on quality of life was obtained.

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To evaluate morbidity, quality of life, and oncological outcomes of patients with advanced breast cancer, recurrence, or sequelae secondary to radiotherapy, the authors present their experience with 21 patients at the Instituto Nacional de Cancerología in Mexico City, who underwent resection of the lesion and reconstruction using thoracoepigastric fasciocutaneous, rectus abdominis, or latissimus dorsi musculocutaneous flaps. Complications included partial flap necrosis and bronchopleural fistulae in 2 of 7 patients with whole-thickness chest wall resection. The remaining patients progressed nicely, with a short recovery period. The patients and the surgical team evaluated results in terms of aesthetics and function using questionnaires. The results were from fair to good according to Sneeuw's scale. Pedicled musculocutaneous and fasciocutaneous flaps are an excellent reconstructive option in patients with advanced, recurrent breast cancer and in those with radionecrotic complications, which sometimes require resection of the whole-thickness chest wall.

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Fine-needle aspiration biopsy (FNAB) of thyroid nodules is an operator-interpreter-dependent procedure whose diagnostic accuracy has deficiencies, especially concerning indeterminate and negative results. There are reports in the literature of up to a 15% definitive diagnosis of carcinoma in the first category of cytology and an 11% false-negative rate in the second category. With these facts in mind, a prospective study was done at the Instituto Nacional de Cancerología, Mexico City, to determine whether one or several clinicoradiologic factors were associated with a final pathologic diagnosis of carcinoma, thereby increasing the diagnostic accuracy of thyroid FNAB. In total, 200 cases were reviewed, and 159 patients underwent surgery. Our study group comprises these 159 patients. The only clinical factor associated with false-negative results was size > or = 4 cm, with no statistical significance for the other factors analyzed. A comparison was done between clinical factors of patients who had indeterminate results in the aspirate and those of patients who had a definitive diagnosis by permanent section of the thyroid carcinoma, where an association was found between malignancy and tumor size > or = 4 cm, irregular borders, fixed lesions, and heterogeneity on ultrasound. We conclude that in the presence of a negative cytology result, with tumor size > or = 4 cm, close follow-up is indicated, and a new thyroid FNAB should be performed in 6 months. If the nodule persists or grows, a surgical procedure should be considered. In the case of an indeterminate cytology result and in the absence of those factors associated more frequently with a pathologic result of carcinoma, a conservative approach could be indicated with clinical follow-up and repeat thyroid FNAB in 6 months to 1 year.

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The authors compared different vascularized bone grafts in 15 patients with different oncological diagnoses that were treated with hemimandibulectomy in 9 patients, total mandibulectomy in 1 patient, resection of the mandible involving the anterior arch and the symphysis in 3 patients, 1 patient who underwent a segmental mandibular resection, and 1 patient in whom the entire hemimandible was reconstructed because of mandibular hypoplasia diagnosed during the resection of a parotid neoplasm. The flaps used included fibular free flaps in 11 patients, iliac crest in 3 patients, and a radial forearm osteocutaneous flap in 1 patient. Two patients had major complications and 1 patient experienced recurrence of the primary tumor. The fibular free flap was the preferred method in this series due to the size of the defect, which in most patients did not require extensive soft-tissue reconstruction, and due to the nature of the bone defect involving the symphysis and condyle in 9 patients. The different vascularized bone grafts provided adequate osseous and soft tissue for oromandibular reconstruction.

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To evaluate the impact of the practice of a preoperative tracheotomy and different prognostic factors reported in the literature in patients with transglottic carcinoma of the larynx, a retrospective study was performed in the Instituto Nacional de Cancerologia, Mexico City. In all, 90 cases with T3 transglottic squamous cell carcinoma requiring a total laryngectomy as primary treatment were studied. Prognostic factors such as the Karnofsky index, tumor differentiation, surgical margins and preoperative tracheotomy were analyzed by a Cox's proportional hazards model. The Kaplan-Meier method and log rank test were used to evaluate the disease-free intervals and survival curves. Thirty-two patients had preoperative tracheotomies, while 58 did not. Eighty percent of the patients in the non-preoperative tracheotomy group were alive after 5 years versus 20% of those with preoperative tracheotomies (P < 0.001). Although possibly controversial, our findings indicate that a pretreatment tracheotomy should be avoided in T3 transglottic obstructive lesions. In patients with these lesions and a subglottic extension < or = 3 cm we recommend an emergency total laryngectomy when possible to increase survival and decrease surgical morbidity.

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OBJECTIVE: A prospective study to evaluate the confidence level and predictive value of the fine needle aspiration biopsy was performed in the Oncology Service, "Hospital 20 de Noviembre, ISSSTE", Mexico City. MATERIAL AND METHODS: The cases with a palpable breast tumor, histologically confirmed who presented from 1992 to 1994 were included. One aspirate was done in each patient and these were reviewed by the same pathologist. We determined sensitivity, specificity and predictive value of the test. Age, border characteristics, size and mobility of the tumor were evaluated by Bayesian analysis. RESULTS: From 213 aspirates, 199 were elegible for diagnosis, 98 (46%) had a diagnosis of carcinoma, 13 were acellular and one suggestive. The acellular diagnoses were considered negative and suggestive positive, for analysis purposes. Mean age and tumor size were: 46.6 years (range 14-90) and 3.7 cm. (range 1-13) respectively. Sensitivity (0.932), specificity (0.973) and positive predictive value (96.9%) were estimated. We observed a high probability of true positive [P(D+/T+)] > 0.8 results in patients between 40 and 60 years of age, irregular borders, size > 2 cm and fixed lesions. CONCLUSIONS: The test has a high confidence level and in presence of two or more of the clinical factors mentioned, definitive decisions regarding treatment could be taken, without need of histologic confirmation.

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To analyze the prognostic value of clinical-radiologic staging, morbidity, mortality and results of treatment used in the Instituto Nacional de Cancerologia, Mexico, a retrospective study of angiofibroma was performed. Charts were reviewed from patients who attended the institute from 1977 to 1993. History and physical examination, rhinoscopy and fiber-optic nasopharyngolaryngoscopy were done in every patient. Radiologic evaluation was done with computed tomography, after which Chandler's staging system was used. Disease-free interval curves were estimated for patients who had presented with stage III or IV tumors. Thirty-one patients were treated with surgery and/or radiotherapy. Most of the patients had stage III (70.9%) or stage JV (25.8%) disease. Surgical procedures included lateral rhinotomies (15 cases), transpalatal dissections (11 cases), transantral degloving (3 cases), median rhinotomies (2 cases), infratemporal transzygomatic dissections (2 cases), frontotemporal craniotomy (1 case) and suprahyoid pharyngotomy (1 case). Radiotherapy (as 3000-5500 cGy) was administered to 16 patients: 7 patients with stage III persistent or recurrent tumor and 8 patients as initial treatment for stage IV disease. The disease-free interval of patients with stage III and IV disease was 80.3% and 19%, respectively, after 36 months of follow-up. Findings demonstrated that surgery was the treatment chosen in patients with stage II and III disease, with low morbidity and mortality, and good results in disease control. In contrast, radiotherapy was usually the treatment in stage IV disease, but had low effectiveness, indicating the need to carefully investigate the value of craniofacial approaches in these tumors.

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Cork is a natural material produced in the Mediterranean countries. Cork stoppers are used to seal wine bottles, Cork stopper quality classification is a practical pattern classification problem. The cork stoppers are grouped into eight classes according to the degree of defects on the cork surface. These defects appear in the form of random-shaped holes, cracks, and others. As a result, the classification cork stopper is not a simple object recognition problem. This is because the pattern features are not specifically defined to a particular shape or size. Thus, a complex classification form is involved, Furthermore, there is a need to build a standard quality control system in order to reduce the classification problems in the cork stopper industry. The solution requires factory automation meeting low time and reduced cost requirements. This paper describes a cork stopper quality classification system using morphological filtering and contour extraction and following (CEF) as the feature extraction method, and a fuzzy-neural network as a classifier. This approach will be used on a daily basis. A new adaptive image thresholding method using iterative and localized scheme is also proposed, A fully functioning prototype of the system has been built and successfully tested. The test results showed a 6.7% rejection ratio, It is compared with the 40% counterpart provided by traditional systems. The human experts in the cork stopper industry rated this proposed classification approach as excellent.

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A model of the uterus-placenta-fetus system was designed using an electronic device which proportions at its outputs the representative signals of the fetal heart rate (FHR) and uterine contractions (UC). The uterus subsystem provides a voltage variable in time similar to the pressure of the UC. The placenta subsystem is controlled by the difference between the UC and the maternal arterial pressure as well as by the time in which the blood flow to the fetus is reduced. The fetus subsystem provides a voltage representative of the FHR.

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