RESUMO
Parkinson's disease (PD) is the second most common neurodegenerative disorder; however, there is no treatment able to prevent the loss of dopaminergic neurons or its consequences. Trophic factors such as NGF and BDNF has positive effects on different disorders of the brain, including neurodegeneration. Additionally, studies have suggested the use of venom peptides as a therapeutic strategy for neurological disorders. Therefore, in the present study, we investigated the neuroprotective activity of a peptide isolated from Bothrops atrox venom and its trophic ability by using a cellular model of dopaminergic neurotoxicity induced by 1-methyl-4-phenylpyridinium (MPP(+)) in PC12 cells. We showed that it decreased the activities of the apoptotic proteases caspase-9 (mitochondrial) and caspase-3 (executor) and increased cell viability and proliferation in this model. Additionally, it increased neuritogenesis in non-treated PC12 cells (neuronal model) as well as in PC12 cells treated with the dopaminergic neurotoxin. The amino acid sequence of the peptide was identified as Glutamic acid-Valine-Tryptophan (Glu-Val-Trp). These findings suggest that this tripeptide has the potential to protect against the dopaminergic neurons loss and that trophic stimulation of neuroplasticity might be involved in its mechanism of neuroprotection.
Assuntos
Bothrops/metabolismo , Fármacos Neuroprotetores/farmacologia , Doença de Parkinson/tratamento farmacológico , Peptídeos/farmacologia , Peçonhas/farmacologia , 1-Metil-4-fenilpiridínio/farmacologia , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Caspase 9/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Dopamina/metabolismo , Neurônios Dopaminérgicos/efeitos dos fármacos , Neurônios Dopaminérgicos/metabolismo , Ácido Glutâmico/farmacologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Modelos Biológicos , Células PC12 , Doença de Parkinson/metabolismo , Ratos , Triptofano/farmacologia , Valina/farmacologiaRESUMO
Caffeic acid phenethyl ester (CAPE) is a botanical compound abundant in honeybees' propolis. It has anti-inflammatory, antiviral, antioxidant, immunomodulatory and antitumor properties. Its beneficial effects against neurodegenerative diseases, including Parkinson's disease, have also been suggested and some mechanisms have been proposed. Mitochondrial damage and oxidative stress are critical events in neurodegeneration. Release of cytochrome c from mitochondria to cytosol and the downstream activation of caspase-3 have been suggested as targets of the protective mechanism of CAPE. Most of the studies addressing the protective effect of CAPE have been performed in cell culture. This is the first study to demonstrate the protective effect of CAPE against the dopaminergic neuronal loss induced by 6-hydroxydopamine (6-OHDA) in rats. It also demonstrates, for the first time, the inhibitory effect of CAPE on mitochondrial permeability transition (MPT), a mediator of neuronal death that triggers cytochrome c release and caspase-3 activation. Scavenging of reactive oxygen species (ROS) and metal chelation was demonstrated in the brain-affected areas of the rats treated with 6-OHDA and CAPE. Additionally, we demonstrated that CAPE does not affect brain mitochondrial function. Based on these findings and on its ability to cross the blood-brain barrier, CAPE is a promising compound to treat Parkinson's and other neurodegenerative diseases.
Assuntos
Ácidos Cafeicos/farmacologia , Neurônios Dopaminérgicos/efeitos dos fármacos , Proteínas de Transporte da Membrana Mitocondrial/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Transtornos Parkinsonianos/prevenção & controle , Álcool Feniletílico/análogos & derivados , Adrenérgicos , Animais , Antioxidantes/farmacologia , Morte Celular/efeitos dos fármacos , Modelos Animais de Doenças , Sequestradores de Radicais Livres/farmacologia , Poro de Transição de Permeabilidade Mitocondrial , Oxidopamina , Transtornos Parkinsonianos/induzido quimicamente , Álcool Feniletílico/farmacologia , Ratos , Ratos WistarRESUMO
Cisplatin is a highly effective chemotherapeutic agent which causes severe nephrotoxicity. Studies have suggested that reactive oxygen species, mainly generated in mitochondria, play a central role in cisplatin-induced renal damage. A wide range of antioxidants have been evaluated as possible protective agents against cisplatin-induced nephrotoxicity; however a safe and efficacious compound has not yet been found. The present study is the first to evaluate the protective potential of carvedilol, a beta-blocker with strong antioxidant properties, against the mitochondrial oxidative stress and apoptosis in kidney of rats treated with cisplatin. The following cisplatin-induced toxic effects were prevented by carvedilol: increased plasmatic levels of creatinine and blood urea nitrogen (BUN); lipid peroxidation, oxidation of cardiolipin; oxidation of protein sulfhydryls; depletion of the non-enzymatic antioxidant defense and increased activity of caspase-3. Carvedilol per se did not present any effect on renal mitochondria. It was concluded that carvedilol prevents mitochondrial dysfunction and renal cell death through the protection against the oxidative stress and redox state unbalance induced by cisplatin. The association of carvedilol to cisplatin chemotherapy was suggested as a possible strategy to minimize the nephrotoxicity induced by this antitumor agent.
Assuntos
Carbazóis/farmacologia , Cisplatino/toxicidade , Nefropatias/induzido quimicamente , Nefropatias/metabolismo , Mitocôndrias/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Propanolaminas/farmacologia , Animais , Antineoplásicos/toxicidade , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Nitrogênio da Ureia Sanguínea , Carvedilol , Creatinina/sangue , Interações Medicamentosas , Humanos , Malondialdeído/metabolismo , Mitocôndrias/metabolismo , Oxirredução , Ratos , Ratos Wistar , Estatísticas não ParamétricasRESUMO
The neurodegenerative diseases are important causes of morbidity and mortality in Western countries. Common mechanisms of toxicity involving mitochondrial damage have been suggested; however, a definitive treatment has not yet been found. Therefore, there has been great interest in the development of mitochondria-targeted protective compounds for the treatment of neuropathies. Animal toxins represent a promising source of new molecules with neuroprotective activity and potential to originate new drugs. We present here the effects of a low-molecular-mass peptides fraction (Ba-V) from Bothrops atrox snake venom, on rat brain mitochondrial function. Ba-V did not induce the mitochondrial swelling and moreover, was as effective as cyclosporin A (CsA) to inhibit the calcium/phosphate-induced swelling, which indicates its potential to prevent the mitochondrial permeability transition (MPT). The membrane electrochemical potential, the oxygen consumption during states-3 and -4 respirations as well as the respiratory control ratio (RCR) were not affected by Ba-V. Additionally, Ba-V did not induce reactive oxygen species (ROS) generation. Interestingly, Ba-V did not protect against the generation of ROS induced by t-BOH, which suggests a protection mechanism other than ROS scavenging. Given the important role of the mitochondrial damage and, more specifically, of MPT, in the development of neuropathies, Ba-V might be useful in the future strategies for the treatment of these diseases.
Assuntos
Bothrops , Venenos de Crotalídeos/química , Dilatação Mitocondrial/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Peptídeos/uso terapêutico , Proteínas de Répteis/uso terapêutico , Animais , Encéfalo , Brasil , Avaliação Pré-Clínica de Medicamentos , Peróxido de Hidrogênio/metabolismo , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Peso Molecular , Doenças Neurodegenerativas/tratamento farmacológico , Fármacos Neuroprotetores/efeitos adversos , Fármacos Neuroprotetores/química , Fármacos Neuroprotetores/isolamento & purificação , Fosforilação Oxidativa/efeitos dos fármacos , Peptídeos/efeitos adversos , Peptídeos/química , Peptídeos/isolamento & purificação , Permeabilidade/efeitos dos fármacos , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Proteínas de Répteis/efeitos adversos , Proteínas de Répteis/química , Proteínas de Répteis/isolamento & purificaçãoRESUMO
The clinical use of cisplatin is highly limited by its nephrotoxicity, which has been associated with mitochondrial dysfunction. We investigated the protective effect of carvedilol, an antihypertensive with strong antioxidant properties, against the nephrotoxicity induced by cisplatin in rats. Carvedilol was able to counteract the renal damage by preventing the mitochondrial dysfunction induced by cisplatin. The mitochondrial eletrochemical potential, calcium uptake, respiration and the phosphorylative capacity were preserved by the co-administration of carvedilol. The mechanism of protection probably does not involve alterations in the cellular and sub-cellular distribution of cisplatin. The study suggests that carvedilol is a potential drug for the adjuvant nephroprotective therapy during cisplatin chemotherapy.
Assuntos
Antineoplásicos/toxicidade , Antioxidantes/farmacologia , Carbazóis/farmacologia , Cisplatino/toxicidade , Nefropatias/prevenção & controle , Mitocôndrias/efeitos dos fármacos , Propanolaminas/farmacologia , Animais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/farmacologia , Antineoplásicos/administração & dosagem , Antioxidantes/administração & dosagem , Cálcio/metabolismo , Carbazóis/administração & dosagem , Carvedilol , Cisplatino/administração & dosagem , Rim/efeitos dos fármacos , Rim/metabolismo , Rim/ultraestrutura , Nefropatias/induzido quimicamente , Nefropatias/metabolismo , Masculino , Potenciais da Membrana/efeitos dos fármacos , Mitocôndrias/metabolismo , Consumo de Oxigênio/efeitos dos fármacos , Propanolaminas/administração & dosagem , Ratos , Ratos WistarRESUMO
This study investigated the antioxidant effects of pecan nut (Carya illinoensis) shell aqueous extract (AE) on toxicity induced by cyclophosphamide (CP) in the heart, kidney, liver, bladder, plasma and erythrocytes of rats. Rats were treated with water or pecan shell AE (5%) ad libitum, replacing drinking water for 37 days up to the end of the experiment. On day 30, half of each group received a single administration of vehicle or CP 200 mg/kg-ip. After 7 days, the organs were removed. Rats treated with CP showed an increase in lipid peroxidation (LP) and decrease in reduced glutathione (GSH) levels in all structures. Catalase (CAT) activity was increased in the heart and decreased in liver and kidney. Besides, CP treatment decreased plasmatic vitamin C (VIT C) levels and induced bladder macroscopical and microscopical damages. In contrast, co-treatment with pecan shell AE prevented the LP development and the GSH depletion in all structures, except in the heart and plasma, respectively. CAT activity in the heart and liver as well as the plasmatic VIT C levels remained unchanged. Finally, AE prevented CP-induced bladder injury. These findings revealed the protective role of pecan shell AE in CP-induced multiple organ toxicity.
Assuntos
Carya , Ciclofosfamida/toxicidade , Extratos Vegetais/uso terapêutico , Animais , Ácido Ascórbico/sangue , Catalase/metabolismo , Glutationa/análise , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Fitoterapia , Ratos , Ratos WistarRESUMO
The use of the classic aromatic antiepileptic drugs (AAEDs) has recently been expanded to a broad spectrum of psychiatric and neurological disorders. However, the clinical use of these drugs is limited by several adverse effects, mainly idiosyncratic hepatotoxicity. AAED-induced hepatotoxicity has been attributed to a defective detoxification by the epoxide hydrolase and accumulation of arene oxides. The underlying mechanism has been proposed as immune-mediated, but direct toxicity has also been suggested. In general, idiosyncratic drug-induced hepatotoxicity may be mediated, at least in part, by oxidative stress. On the other hand, the oxidative stress induced by the AAED metabolites has not been demonstrated yet. Therefore, in the present study we have evaluated the induction of oxidative stress by three classical AAEDs: carbamazepine, phenytoin and phenobarbital as well as by their metabolites. The toxic effects of the metabolites were evaluated by incubating the drug with rat liver microsomes. The AAED-induced oxidative stress was demonstrated by the increased malondialdehyde levels, oxidation of cardiolipin; oxidation of sulfhydryl proteins and alteration of the cellular redox status. Results suggest that the hepatotoxicity associated with AAED might be mediated by the oxidative stress induced by the drugs metabolites.
Assuntos
Anticonvulsivantes/toxicidade , Fígado/efeitos dos fármacos , Microssomos Hepáticos/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Animais , Anticonvulsivantes/metabolismo , Carbamazepina/metabolismo , Carbamazepina/toxicidade , Cardiolipinas/efeitos dos fármacos , Cardiolipinas/metabolismo , Masculino , Malondialdeído/metabolismo , Microssomos Hepáticos/metabolismo , Mitocôndrias Hepáticas/efeitos dos fármacos , Oxirredução/efeitos dos fármacos , Fenobarbital/metabolismo , Fenobarbital/toxicidade , Fenitoína/metabolismo , Fenitoína/toxicidade , Ratos , Ratos Wistar , Compostos de Sulfidrila/metabolismo , Testes de ToxicidadeRESUMO
Idiosyncratic hepatotoxicity is a well-known complication associated with aromatic antiepileptic drugs (AAED), and it has been suggested to occur due to the accumulation of toxic arene oxide metabolites. Although there is clear evidence of the participation of an immune process, a direct toxic effect involving mitochondria dysfunction is also possible. The effects of AAED on mitochondrial function have not been studied yet. Therefore, we investigated, in vitro, the cytotoxic mechanism of carbamazepine (CB), phenytoin (PT) and phenobarbital (PB), unaltered and bioactivated, in the hepatic mitochondrial function. The murine hepatic microsomal system was used to produce the anticonvulsant metabolites. All the bioactivated drugs (CB-B, PB-B, PT-B) affected mitochondrial function causing decrease in state three respiration, RCR, ATP synthesis and membrane potential, increase in state four respiration as well as impairment of Ca2+ uptake/release and inhibition of calcium-induced swelling. As an unaltered drug, only PB, was able to affect mitochondrial respiration (except state four respiration) ATP synthesis and membrane potential; however, Ca2+ uptake/release as well as swelling induction were not affected. The potential to induce mitochondrial dysfunction was PT-B>PB-B>CB-B>PB. Results suggest the involvement of mitochondrial toxicity in the pathogenesis of AAED-induced hepatotoxicity.
Assuntos
Anticonvulsivantes/toxicidade , Carbamazepina/toxicidade , Mitocôndrias Hepáticas/efeitos dos fármacos , Fenobarbital/toxicidade , Fenitoína/toxicidade , Trifosfato de Adenosina/biossíntese , Animais , Anticonvulsivantes/metabolismo , Cálcio/metabolismo , Sinalização do Cálcio/efeitos dos fármacos , Carbamazepina/metabolismo , Relação Dose-Resposta a Droga , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Microssomos Hepáticos/efeitos dos fármacos , Microssomos Hepáticos/metabolismo , Mitocôndrias Hepáticas/metabolismo , Dilatação Mitocondrial/efeitos dos fármacos , Consumo de Oxigênio/efeitos dos fármacos , Fenobarbital/metabolismo , Fenitoína/metabolismo , Ratos , Ratos WistarRESUMO
Cisplatin is a potent and widely used chemotherapeutic agent. Nephrotoxicity induced by this drug has been well documented. However, very little information is available on cisplatin-induced hepatotoxicity and its underlying mechanism remains unclear. High doses of cisplatin have been known to produce hepatotoxicity. Additionally, elevated expression of CYP 2E1 has been associated with enhanced cisplatin-induced hepatotoxicity. Several studies suggest that cisplatin toxicity occurs by the increased generation of reactive oxygen species (ROS) in mitochondria. Therefore, the present study examined, in vivo, the cisplatin-induced effects on hepatic mitochondrial structure and function as well as the occurrence of hepatocellular death by apoptosis. Adult male Wistar rats (200-220 g) were divided into two groups (n=8) treated as follows: (1) control group (saline solution, 1 ml 100 g(-1) body weight, i.p.) and (2) cisplatin group (10 mg kg(-1) body weight, i.p.). The animals were killed 72 h after the treatment. Hepatotoxicity was evidenced in the cisplatin group by the increased serum levels of alanine (ALT) and aspartate (AST) aminotransferases. The mechanism of cisplatin-induced hepatotoxicity was found to involve membrane rigidification; decreased GSH/GSSG ratio, ATP, GSH and NADPH levels; lipid peroxidation; oxidative damage of cardiolipin and protein sulfhydryl groups. Moreover, cell death by apoptosis was also demonstrated and the findings strongly suggest the participation of the mitochondrial signaling pathway in this process. Therefore, the results show the key role of mitochondria in the hepatotoxicity induced by cisplatin and delineate several mitochondrial processes that could be targeted in future cytoprotective therapy approaches.
Assuntos
Antineoplásicos/toxicidade , Apoptose/efeitos dos fármacos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Cisplatino/toxicidade , Fígado/efeitos dos fármacos , Fluidez de Membrana/efeitos dos fármacos , Mitocôndrias Hepáticas/efeitos dos fármacos , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Cardiolipinas/metabolismo , Membrana Celular/efeitos dos fármacos , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Glutationa/metabolismo , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Injeções Intraperitoneais , Fígado/metabolismo , Masculino , Mitocôndrias Hepáticas/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacosRESUMO
Nephrotoxicity is the major dose-limiting factor of cisplatin chemotherapy. Reactive oxygen species generated in mitochondria are thought to be the main cause of cellular damage in such injury. The present study examined, in vivo, the protective potential of the hydroxyl radical scavenger dimethylthiourea (DMTU) against cisplatin-induced effects on renal mitochondrial bioenergetics, redox state and oxidative stress. Adult male Wistar rats (200 to 220 g) were divided into four groups of eight animals each. The control group was treated only with an intraperitoneal (i.p.) injection of saline solution (1 ml/100 g body weight). The second group was given only DMTU (500 mg/kg body weight, i.p, followed by 125 mg/Kg, i.p., twice a day until they were killed). The third group was given a single injection of cisplatin (10 mg/kg body weight, i.p.). The fourth group was given DMTU (500 mg/kg body weight, i.p.), just before the cisplatin injection (10 mg/kg body weight, i.p.), followed by injections of DMTU (125 mg/kg body weight, i.p.) twice a day until they were killed. Animals were killed 72 h after the treatment. Besides not presenting any direct effect on mitochondria, DMTU substantially inhibited cisplatin-induced mitochondrial injury and cellular death by apoptosis, suppressing the occurrence of acute renal failure. All the following cisplatin-induced effects were prevented by DMTU: (1) increased plasmatic levels of creatinine and blood urea nitrogen (BUN); (2) decreased ATP content, calcium uptake and electrochemical potential; (3) oxidation of lipids, including cardiolipin; and oxidation of proteins, including sulfhydryl, and aconitase enzyme, as well as accumulation of carbonyl proteins; (4) depletion of the antioxidant defense (NADPH and GSH) and (5) increased activity of the apoptosis executioner caspase-3. Our findings show the important role played by mitochondria and hydroxyl radicals in cisplatin-induced nephrotoxicity, as well as the effectiveness of DMTU in preventing the renal mitochondrial damage caused by cisplatin. These results strongly suggest that protection of mitochondria by hydroxyl radical scavengers may be an interesting approach to prevent the kidney tissue damage caused by cisplatin-chemotherapy.
Assuntos
Antineoplásicos/efeitos adversos , Cisplatino/efeitos adversos , Sequestradores de Radicais Livres/uso terapêutico , Nefropatias/induzido quimicamente , Tioureia/análogos & derivados , Animais , Apoptose/efeitos dos fármacos , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Metabolismo Energético/efeitos dos fármacos , Glutationa/metabolismo , Rim/efeitos dos fármacos , Rim/metabolismo , Nefropatias/metabolismo , Nefropatias/prevenção & controle , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Potenciais da Membrana/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , NADP/metabolismo , Oxirredução/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Tioureia/uso terapêuticoRESUMO
The clinical use of cisplatin (cis-diamminedichloroplatinum II) is highly limited by its nephrotoxicity. The precise mechanisms involved in cisplatin-induced mitochondrial dysfunction in kidney have not been completely clarified. Therefore, we investigated in vivo the effects of cisplatin on mitochondrial bioenergetics, redox state, and oxidative stress as well as the occurrence of cell death by apoptosis in cisplatin-treated rat kidney. Adult male Wistar rats weighing 200-220 g were divided into two groups. The control group (n = 8) was treated only with an intraperitoneal (i.p.) injection of saline solution (1 ml per 100 g body weight), and the cisplatin group (n = 8) was given a single injection of cisplatin (10 mg/kg body weight, i.p.). Animals were sacrificed 72 h after the treatment. The cisplatin group presented acute renal failure characterized by increased plasmatic creatinine and urea levels. Mitochondrial dysfunction was evidenced by the decline in membrane electrochemical potential and the substantial decrease in mitochondrial calcium uptake. The mitochondrial antioxidant defense system was depleted, as shown by decreased GSH and NADPH levels, GSH/GSSG ratio, and increased GSSG level. Moreover, cisplatin induced oxidative damage to mitochondrial lipids, including cardiolipin, and oxidation of mitochondrial proteins, as demonstrated by the significant decrease of sulfhydryl protein concentrations and increased levels of carbonylated proteins. Additionally, aconitase activity, which is essential for mitochondrial function, was also found to be lower in the cisplatin group. Renal cell death via apoptosis was evidenced by the increased caspase-3 activity. Results show the central role of mitochondria and the intensification of apoptosis in cisplatin-induced acute renal failure, highlighting a number of steps that might be targeted to minimize cisplatin-induced nephrotoxicity.
Assuntos
Injúria Renal Aguda/metabolismo , Apoptose , Metabolismo Energético , Rim/metabolismo , Mitocôndrias/metabolismo , Estresse Oxidativo , Aconitato Hidratase/metabolismo , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/enzimologia , Injúria Renal Aguda/patologia , Trifosfato de Adenosina/metabolismo , Animais , Antineoplásicos , Cálcio/metabolismo , Cardiolipinas/metabolismo , Caspase 3/metabolismo , Cisplatino , Modelos Animais de Doenças , Ativação Enzimática , Glutationa/metabolismo , Rim/enzimologia , Rim/patologia , Peroxidação de Lipídeos , Masculino , Potencial da Membrana Mitocondrial , Mitocôndrias/enzimologia , Mitocôndrias/patologia , Proteínas Mitocondriais/metabolismo , NADP/metabolismo , Oxirredução , Carbonilação Proteica , Ratos , Ratos Wistar , Compostos de Sulfidrila/metabolismoRESUMO
BACKGROUND: Oral tumor resections cause articulation deficiencies, depending on the site, extent of resection, type of reconstruction, and tongue stump mobility. OBJECTIVES: To evaluate the speech intelligibility of patients undergoing total, subtotal, or partial glossectomy, before and after speech therapy. PATIENTS AND METHODS: Twenty-seven patients (24 men and 3 women), aged 34 to 77 years (mean age, 56.5 years), underwent glossectomy. Tumor stages were T1 in 3 patients, T2 in 4, T3 in 8, T4 in 11, and TX in 1; node stages, N0 in 15 patients, N1 in 5, N2a-c in 6, and N3 in 1. No patient had metastases (M0). Patients were divided into 3 groups by extent of tongue resection, ie, total (group 1; n = 6), subtotal (group 2; n = 9), and partial (group 3; n = 12). Different phonological tasks were recorded and analyzed by 3 experienced judges, including sustained 7 oral vowels, vowel in a syllable, and the sequence vowel-consonant-vowel (VCV). The intelligibility of spontaneous speech (sequence story) was scored from 1 to 4 in consensus. All patients underwent a therapeutic program to activate articulatory adaptations, compensations, and maximization of the remaining structures for 3 to 6 months. The tasks were recorded after speech therapy. To compare mean changes, analyses of variance and Wilcoxon tests were used. RESULTS: Patients of groups 1 and 2 significantly improved their speech intelligibility (P<.05). Group 1 improved vowels, VCV, and spontaneous speech; group 2, syllable, VCV, and spontaneous speech. Group 3 demonstrated better intelligibility in the pretherapy phase, but the improvement after therapy was not significant. CONCLUSIONS: Speech therapy was effective in improving speech intelligibility of patients undergoing glossectomy, even after major resection. Different pretherapy ability between groups was seen, with improvement of speech intelligibility in groups 1 and 2. The improvement of speech intelligibility in group 3 was not statistically significant, possibly because of the small and heterogeneous sample.
Assuntos
Transtornos da Articulação/reabilitação , Carcinoma de Células Escamosas/cirurgia , Glossectomia/reabilitação , Complicações Pós-Operatórias/reabilitação , Inteligibilidade da Fala , Fonoterapia , Neoplasias da Língua/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fonética , Medida da Produção da Fala , Neoplasias da Língua/patologiaRESUMO
BACKGROUND: The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resection, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort. Furthermore, a glossectomy is frequently associated with voice and speech difficulties. OBJECTIVES: To characterize swallowing in patients who underwent a glossectomy and to define the limits and the compensatory movements using video fluoroscopic analysis. DESIGN AND SETTING: Video fluoroscopic evaluation of 15 patients who underwent glossectomies at the Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo, S*ao Paulo, Brazil. PATIENTS: We examined 15 patients: 5 who underwent a partial glossectomy, 2 who underwent a subtotal glossectomy, and 8 who underwent a total glossectomy with laryngeal preservation and reconstruction with myocutaneous flaps (9 pectoralis major flaps and 1 latissimus dorsi flap). The 15 patients were enrolled in a program that included voice, speech, and swallowing rehabilitation. RESULTS: All patients who underwent a partial glossectomy had difficulties with formation and anteroposterior propulsion of the bolus in the oral cavity and an increase in oral transit time, which was more evident with materials of thicker consistencies. All patients who underwent a total or subtotal glossectomy with laryngeal preservation had an increase in oral transit time and stasis of food in the oral cavity, the pharynx, and the superior esophageal sphincter. Of the 15 patients, 2 had moderate and asymptomatic aspiration. These 2 patients had swallowing compensations, such as increased buccal, mandibular, pharyngeal, and laryngeal activity and voluntary protection of the larynx during swallowing. CONCLUSIONS: This study demonstrates the effectiveness of swallowing in patients who were enrolled in voice, speech, and swallowing rehabilitation after undergoing a partial or total glossectomy. An increase in oral transit time was detected in all patients. Only 2 of the 10 patients who underwent a total glossectomy had persistent asymptomatic aspiration.