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Abstract Introduction: Partial glossectomy and reconstruction strategy for malignant tongue tumors influences speech and swallowing. Objective: The aim of this retrospective study was to evaluate long-term functional outcomes after partial glossectomy for pT2 mobile tongue carcinomas with a maximum dimension between 2 and 3 cm. Different reconstruction strategies (with or without pedicled flap) were compared. Methods: Twenty-two patients with at least 12 months followup were included. Clinician-based and self-reported instruments were used to analyze tongue motility, speech intelligibility and articulation, swallowing, and quality of life. Results: Patients with a higher tongue motility had better articulation and lower dysphagia. Avoiding pedicled flap reconstruction seemed to guarantee lower impairment of speech and swallowing. Worse functional outcomes induced a lower quality of life. Conclusion: Partial glossectomy results in tongue motility impairment and consequently alterations of oral functions. Since the type of reconstruction impacts long-term outcomes, it should be adequately planned before surgery.
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INTRODUCTION: Partial glossectomy and reconstruction strategy for malignant tongue tumors influences speech and swallowing. OBJECTIVE: The aim of this retrospective study was to evaluate long-term functional outcomes after partial glossectomy for pT2 mobile tongue carcinomas with a maximum dimension between 2 and 3cm. Different reconstruction strategies (with or without pedicled flap) were compared. METHODS: Twenty-two patients with at least 12 months followup were included. Clinician-based and self-reported instruments were used to analyze tongue motility, speech intelligibility and articulation, swallowing, and quality of life. RESULTS: Patients with a higher tongue motility had better articulation and lower dysphagia. Avoiding pedicled flap reconstruction seemed to guarantee lower impairment of speech and swallowing. Worse functional outcomes induced a lower quality of life. CONCLUSION: Partial glossectomy results in tongue motility impairment and consequently alterations of oral functions. Since the type of reconstruction impacts long-term outcomes, it should be adequately planned before surgery.
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Carcinoma de Células Escamosas , Procedimentos de Cirurgia Plástica , Neoplasias da Língua , Humanos , Estudos Retrospectivos , Qualidade de Vida , Neoplasias da Língua/cirurgia , Língua/cirurgia , Língua/patologia , Deglutição , Carcinoma de Células Escamosas/cirurgia , Inteligibilidade da FalaRESUMO
Abstract Introduction Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. Objectives The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. Methods Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. Results Margin status is related to recurrence rate in both groups (p < 0.05) without significant differences between open and laser cordectomy (p > 0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p > 0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p < 0.05). Conclusions Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.
Resumo Introdução Cordectomia por laringofissura e cirurgia transoral a laser têm sido propostas para o tratamento do câncer glótico inicial. Objetivos O objetivo desse estudo retrospectivo foi avaliar o valor prognóstico do estado da margem em 162 casos consecutivos de carcinoma glótico inicial (Tis-T1) tratado com cirurgia endoscópica a laser de CO2 (Grupo A) ou cordectomia por laringofissura (Grupo B) e comparar resultados oncológicos e funcionais. Método Foram analisados fatores prognósticos clínicos, taxa de recorrência local de acordo com o estado da margem, sobrevida global e sobrevida livre de doença. Resultados O estado de margem está relacionado à taxa de recorrência em ambos os grupos (p < 0,05) sem diferenças significativas entre cordectomia aberta e cirurgia a laser (p > 0,05). A sobrevida global de cinco anos e a sobrevida livre de doença foram, respectivamente, 90,48% e 85,71% no Grupo A; 88,14% e 86,44% no Grupo B (p > 0,05). Menor taxa de traqueostomia, recuperação mais rápida da função de deglutição e menor tempo de internação foram observados no Grupo A (p < 0,05). Conclusões O estado da margem tem papel prognóstico no câncer glótico T1a-T1b. A cirurgia a laser transoral mostrou resultados oncológicos semelhantes aos da cordectomia aberta, com melhores resultados funcionais.
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INTRODUCTION: Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. OBJECTIVES: The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. METHODS: Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. RESULTS: Margin status is related to recurrence rate in both groups (p<0.05) without significant differences between open and laser cordectomy (p>0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p>0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p<0.05). CONCLUSIONS: Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.
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Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgery method used to help obese patients to lose weight. However, even if LAGB is able to produce a durable and relevant weight loss, it is less effective in improving body image: as demonstrated by a recent study, obese patients with a body image disorder in the pre-operative stage continue to show this even 13 months after the operation. In this presentation we will discuss the possible role of virtual reality (VR) in addressing this problem within an integrated cognitive behavioral approach. To test this approach, a case series of three LAGB patient who experienced body dissatisfaction even after a >30/40% excess body weight loss, is presented and discussed. At the end of the 6-week protocol the patients experienced a 15%-20% further reduction of their weight. This reduction was also matched by a general improvement of the psychological state. Both the weight loss and the level of well-being were further improved after a three-month follow-up.
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Cirurgia Bariátrica/métodos , Transtornos Dismórficos Corporais/psicologia , Simulação por Computador , Obesidade Mórbida/cirurgia , Redução de Peso , Adulto , Feminino , Humanos , Laparoscopia/métodos , Masculino , Obesidade Mórbida/psicologiaRESUMO
Many studies have shown the ability of media--television, movies, and virtual reality (VR) experiences--to elicit emotions. Nevertheless, it is still unclear how the different factors involved--user related and medium related--play a role in producing an emotional response during a VR experience. We investigate this issue, analyzing the role played by the cultural and technological backgrounds of the users in the emotional responses to VR. Specifically, we use the "core affect" model of emotions developed by Russell (2003) to explore how these factors influence the way in which participants experience virtual worlds. Our sample includes 20 Mexican participants: 8 living in El Tepeyac, a small rural and isolated Mexican village characterized by a very primitive culture, and 12 high civilized inhabitants of Mexico City. The "Green Valley," a noninteractive, relaxing immersive environment showing a mountain landscape around a calm lake, was used to induce relaxation in the two groups during an ambulatory surgical operation. To investigate the effects of VR on the relaxation process, we measured participants' physiological (heart rate) and emotional (VAS-A) responses before, during, and after the operation. The results show that VR significantly modified the core affect (reduced arousal) in all participants but that the final emotional response produced by this change was influenced by the attribution process: the civilized inhabitants of Mexico City, who were able to attribute the reduced arousal to the VR experience, reported a significant reduction in the self-reported level of anxiety, while people from El Tepeyac showed a reduction in their physiological reactions but not in their perceived anxiety.
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Ansiedade/psicologia , Comparação Transcultural , Emoções , Terapia de Relaxamento/métodos , Relaxamento/psicologia , Adulto , Idoso , Simulação por Computador , Meio Ambiente , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Inquéritos e Questionários , Terapia Assistida por Computador/métodos , Interface Usuário-ComputadorRESUMO
Los sistemas de realidad virtual (RV) son instrumentos tecnológicos que pueden ofrecer muchas ventajas potenciales a la investigación y a la intervención dentro del ámbito de la psicología clínica. La relevancia metodológico-experimental de la RV reside en su capacidad de crear rigurosos contextos experimentales multisensoriales, interactivos y ecológicamente representativos, de modo tal de activar los mismos procesos psicológicos y las mismas acciones que los individuos realizan en la vida cotidiana. Las aplicaciones realizadas, y la multiplicidad de las que se hayan en curso, testimonian la eficacia y la eficiencia de la RV para el tratamiento de una amplia gama de problemas y déficits psicológicos, entre los cuales se encuentran: la terapia de los trastornos fóbicos, la cura paliativa para pacientes oncológicos, el entrenamiento para niños autistas, el diagnóstico y la terapia de las distorsiones de la imagen corporal en los trastornos alimentarios...(AU)
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Humanos , Psicologia Clínica/instrumentação , Interface Usuário-ComputadorRESUMO
Los sistemas de realidad virtual (RV) son instrumentos tecnológicos que pueden ofrecer muchas ventajas potenciales a la investigación y a la intervención dentro del ámbito de la psicología clínica. La relevancia metodológico-experimental de la RV reside en su capacidad de crear rigurosos contextos experimentales multisensoriales, interactivos y ecológicamente representativos, de modo tal de activar los mismos procesos psicológicos y las mismas acciones que los individuos realizan en la vida cotidiana. Las aplicaciones realizadas, y la multiplicidad de las que se hayan en curso, testimonian la eficacia y la eficiencia de la RV para el tratamiento de una amplia gama de problemas y déficits psicológicos, entre los cuales se encuentran: la terapia de los trastornos fóbicos, la cura paliativa para pacientes oncológicos, el entrenamiento para niños autistas, el diagnóstico y la terapia de las distorsiones de la imagen corporal en los trastornos alimentarios...