RESUMO
Abstract Background: Tropical grasses, such as elephant grass, have high moisture content during its ideal phenological state for silage. High moisture content hinders proper preservation and reduces the nutritive value of silage due to secondary fermentation and production of effluents. Adding feed materials with high dry matter content, such as murumuru (Astrocaryum murumuru) meal, is a potential alternative to improve silage yield. Objective: To determine the effects of including murumuru meal (0, 7, 14, 21, and 28%) on the fermentative characteristics, microbiological activity, aerobic stability, and chemical composition of elephant grass silages. Methods: A completely randomized design with five treatments and five replicates was used. Elephant grass was collected at 60 d of age, minced, and homogenized with murumuru meal. The mass was placed in experimental 15-L silos. The silos were collected and analyzed 45 d later. Results: Effluent production decreased (p<0.05) as the proportions of murumuru meal in silage increased. A quadratic effect (p<0.05) was observed on dry matter recovery. An increase (p<0.05) was observed in dry matter content, a decrease (p<0.05) in the neutral detergent fiber content, and an increase (p<0.05) in the non-fibrous carbohydrate content with the inclusion of murumuru meal. Conclusions: Addition of murumuru meal improves chemical composition and does not affect the fermentative characteristics of elephant grass silage, while it reduces effluent losses. Nevertheless, the inclusion of murumuru meal in the elephant grass silage decreased the time of aerobic stability.
Resumen Antecedentes: los pastos tropicales, tales como el pasto elefante, tienen alto contenido de humedad cuando están en su estado fenológico ideal para ensilar. Esto dificulta su adecuada preservación en el silo, reduciendo el valor nutritivo del ensilaje debido a fermentaciones secundarias y generación de efluentes. Una posible solución sería incluir materiales con alto contenido de materia seca, tales como la torta de murumuru (Astrocaryum murumuru). Objetivo: determinar el efecto de la inclusión de torta de murumuru (0; 7; 14; 21 y 28%) sobre las características fermentativas, microbiológicas, estabilidad aeróbica y composición química de los ensilajes de pasto elefante. Métodos: se utilizó un diseño completamente al azar, con cinco tratamientos y cinco repeticiones. El pasto elefante fue colectado a los 60 días de edad, luego picado y homogeneizado con la torta de murumuru. La masa fue colocada en silos experimentales con capacidad de 15 L. Luego de 45 días de ensilado, los silos fueron abiertos y las muestras fueron colectadas para su posterior análisis. Resultados: hubo reducción (p<0,05) en la producción de efluentes a medida que se incrementó la proporción de torta de murumuru en el ensilado. Se observó un efecto cuadrático (p<0,05) en la recuperación de materia seca. Hubo aumento (p<0,05) en los contenidos de materia seca con la adición de torta de murumuru. Se observó disminución (p<0,05) en el contenido de fibra detergente neutra y aumento (p<0,05) de carbohidratos no fibrosos. Conclusión: La adición de torta de murumuru mejora la composición química, reduce las perdidas por efluentes y no afecta las características fermentativas de ensilado de pasto elefante. Sin embargo, la inclusión de la torta de murumuru en el ensilado de pasto elefante disminuye el tiempo en estabilidad aeróbica.
Resumo Antecedentes: capins tropicais, como por exemplo o capim-elefante apresentam alto teor de umidade quando possuem produtividade compatível e estão no estádio fenológico adequado para ensilagem. Isso dificulta a adequada preservação no silo, ocasionando a redução do valor nutritivo da silagem devido a fermentações secundárias e a produção de efluentes. Uma possível solução seria o uso de aditivos com alto teor de matéria seca, como bolo de murumuru (Astrocaryum murumuru). Objetivo: determinar o efeito da inclusão da torta de murumuru (0; 7; 14; 21 e 28%) na ensilagem de capim-elefante sobre as características fermentativas, microbiológicas, estabilidade aeróbia e a composição química das silagens. Métodos: utilizou- se um delineamento inteiramente casualizado, com cinco tratamentos e cinco repetições. O capim-elefante foi colhido aos 60 dias de idade, o mesmo foi picado e homogeneizado à torta de murumuru. A massa foi ensilada em silos experimentais com capacidade de 15 L. Após 45 dias de ensilagem, os silos foram abertos e amostras foram coletadas para posteriores análises laboratoriais. Resultados: houve redução (p<0,05) na produção de efluentes à medida que se elevaram as proporções da torta de murumuru na ensilagem. Observou-se efeito quadrático (p<0,05) na recuperação de matéria seca. Houve aumento (p<0,05) nos teores de matéria seca com a adição da torta murumuru. Observou-se diminuição (p<0,05) nos teores de fibra em detergente neutro e aumento (p<0,05) nos teores de carboidratos não fibrosos. Conclusão: torta de murumuru como aditivo melhora a composição química, reduz perdas principalmente por efluente e não afeta as características fermentativas de silagens de capim- elefante. Entretanto, a inclusão da torta de murumuru na ensilagem de capim-elefante diminui o tempo em estabilidade aeróbia.
RESUMO
OBJECTIVE: This study was undertaken to assess the excess cost of hospitalization accrued to patients who develop postoperative wound infection following neck dissection in which the wound was not exposed to secretions from the upper aerodigestive tract. DESIGN: A retrospective cohort of patients who underwent "clean" neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), post-operative wound infection (yes or no), and duration and cost of hospitalization were assessed. SETTING: All surgeries were performed in a university medical center. PATIENTS: All patients underwent neck dissection in which the procedure was clean, ie, there was no exposure to secretions from the upper aerodigestive tract. MAIN OUTCOME MEASURES: Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duration and cost of hospitalization. RESULTS: Wound infection developed in 10 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant difference may have been missed (false-negative) as a result of the small number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36,000 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount. CONCLUSION: The decision to withhold antibiotic prophylaxis should not be made in an effort to reduce hospital costs.
Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Cabeça/cirurgia , Pescoço/cirurgia , Pré-Medicação/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/economia , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/prevenção & controle , Cefalosporinas/economia , Cefalosporinas/uso terapêutico , Clindamicina/economia , Clindamicina/uso terapêutico , Estudos de Coortes , Custos e Análise de Custo , Fístula Cutânea/economia , Fístula Cutânea/etiologia , Fístula Cutânea/prevenção & controle , Dissecação , Custos de Medicamentos , Feminino , Custos Hospitalares , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
This study was undertaken to determine the feasibility of using perioperative topical antibiotics in contaminated head and neck surgery and to standardize the culture methodology (both qualitative and quantitative) which could serve as bacteriologic endpoints for evaluation. Following preliminary studies to establish oral cavity indicator organisms and the impact of a single antibiotic mouthwash dose on oral microflora, 10 consecutive patients undergoing contaminated head and neck surgery were recruited into a clinical trial where clindamycin mouthwash and intraoperative irrigation containing clindamycin were used instead of traditional parenteral antibiotics. The bacteriologic efficacy of topical clindamycin was assessed by comparing the presence of four indicator microorganisms (two aerobic and two anaerobic) cultured from two oral cavity culture sites before and after antibiotic prophylaxis. The patients included in the study underwent total laryngectomy plus neck dissection(s) for laryngeal or hypopharyngeal carcinoma from 1991 to 1992 at a large university hospital specializing in head and neck cancer surgery. The main outcome measures used were the development of a postoperative wound infection and quantitative and qualitative bacteriology of the intraoperative neck wound and postoperative oral cavity. Two aerobic and two anaerobic organisms proved useful as a practical indicator for bacteriologic efficacy. Preoperative mouthwash resulted in a 99% reduction of both aerobic and anaerobic bacteria in intraoperatively cultured neck sites. Irrigation during surgery with the clindamycin solution further reduced the bacterial neck counts by an additional 90%. There was a consistent overgrowth of Hemophilus species on postoperative oral cavity cultures. No patient developed a postoperative wound infection. A topical prophylactic antibiotic alone was efficacious and safe for patients undergoing major contaminated head and neck surgery. Culture methods for assessment of bacteriologic efficacy were reproducible and cost-effective. This pilot study furnishes the ethical and scientific basis for large-scale prospective trials comparing topical versus parenteral antimicrobial agents.
Assuntos
Clindamicina/administração & dosagem , Laringectomia , Pré-Medicação , Administração Tópica , Idoso , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Carcinoma de Células Escamosas/cirurgia , Feminino , Haemophilus/isolamento & purificação , Humanos , Injeções Intravenosas , Cuidados Intraoperatórios , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Boca/microbiologia , Antissépticos Bucais , Neoplasias Hipofisárias/cirurgiaRESUMO
An ideal tumor marker should be sensitive in tumor-bearing patients while having adequate specificity so that controls do not demonstrate the marker. To date, a single circulating marker has not been identified for squamous cell carcinoma of the head and neck. This study evaluates a panel including squamous cell carcinoma radioimmunoassay, lipid-associated sialic acid, carcinoembryonic antigen, and CA-125. In this population of patients with cancer, serum samples from 101 patients and 88 controls were evaluated. The squamous cell carcinoma radioimmunoassay was the most sensitive marker identified (47.5%), while carcinoembryonic antigen level was elevated in 40.6%, lipid-associated sialic acid level in only 16.8%, and CA-125 level in 7.9%. False-positive results were found with all markers, including squamous cell carcinoma radioimmunoassay (18.2%), carcinoembryonic antigen (18.2%), lipid-associated sialic acid (10.2%), and CA-125 (15.9%). Various combinations of markers did not significantly improve either specificity or sensitivity. Available tumor markers are inadequate for diagnostic purposes in patients with squamous cell carcinoma of the head and neck.
Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células Escamosas/sangue , Neoplasias de Cabeça e Pescoço/sangue , Ácido N-Acetilneuramínico , Serpinas , Antígenos de Neoplasias/sangue , Antígenos Glicosídicos Associados a Tumores/sangue , Antígeno Carcinoembrionário/sangue , Carcinoma de Células Escamosas/diagnóstico , Reações Falso-Positivas , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Lipídeos/sangue , Radioimunoensaio , Sensibilidade e Especificidade , Ácidos Siálicos/sangueRESUMO
The leading cause of postoperative morbidity in patients undergoing major head and neck surgical procedures is postoperative infection. This prospective randomized multi-institutional clinical trial was designed to compare the effectiveness of clindamycin phosphate and high-dose cefazolin sodium therapy in preventing postoperative wound sepsis in patients undergoing contaminated head and neck surgical procedures in which flap reconstruction was required. Either clindamycin phosphate (900 mg) or cefazolin sodium (2 g) therapy was instituted intravenously prior to surgery and continued every 8 hours, for a total of 24 hours. The patients received postoperative follow-up, and the wounds were graded according to the worst condition observed. One hundred cases were evaluated. Fifty-one patients received clindamycin and 49 patients received high doses of cefazolin; wound infection developed in 10 patients (19.6%) and 11 patients (21.6%), respectively. This difference was not statistically significant. The average duration of surgery was approximately 8 hours for both the infected and the noninfected groups of patients. High-dose cefazolin and clindamycin have similar efficacy when administered prophylactically under these circumstances. Reconstruction with free vascularized tissue may aid in reducing postoperative wound infection.
Assuntos
Cefazolina/uso terapêutico , Clindamicina/uso terapêutico , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/prevenção & controle , Cefazolina/administração & dosagem , Método Duplo-Cego , Humanos , Estudos ProspectivosRESUMO
Definitive treatment is surgical removal of the cyst and any tract, with care taken to preserve vital structures. TDCs and BCCs are congenital cervical lesions that are encountered in adults. Experiences at the Eye and Ear Hospital of Pittsburgh are reviewed. Forty-five patients with TDCs and 59 patients with BCCs were treated between 1983 and 1988. Clinical findings are discussed and principles for diagnosis are detailed.
Assuntos
Região Branquial/anormalidades , Otorrinolaringopatias/diagnóstico , Cisto Tireoglosso/diagnóstico , Adolescente , Adulto , Região Branquial/patologia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/congênito , Otorrinolaringopatias/epidemiologia , Recidiva , Estudos Retrospectivos , Cisto Tireoglosso/congênito , Cisto Tireoglosso/epidemiologiaRESUMO
This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Bucais/patologia , Neoplasias da Língua/patologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/secundário , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Soalho Bucal , Neoplasias Bucais/mortalidade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Células Neoplásicas Circulantes , Prognóstico , Estudos Retrospectivos , Neoplasias da Língua/mortalidadeRESUMO
A retrospective study was undertaken to assess the outcome of 54 patients who have elected to undergo vertical hemilaryngectomy for T1, NO squamous cell carcinoma of the glottic larynx. Fifty-one (94%) of 54 patients were cured with surgery alone. The voice was preserved in 52 (96%) of 54 patients. In the subgroup of patients who had received no prior radiation therapy, voice preservation was achieved in 98% of patients and ultimate control of disease with cure was achieved in 95%. These data substantiate the contention that vertical hemilaryngectomy offers better cure rates than external beam radiation therapy alone. Our data support the efficacy of hemilaryngectomy in T1, NO glottic carcinoma. These data question the traditional belief that surgery effects its success at the expense of voice preservation, whereas external beam radiation therapy does not.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Prega Vocal , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Qualidade da VozRESUMO
Gastric pull-up or free jejunal interposition was used for reconstruction after total laryngopharyngectomy in 31 patients. Complications and functional outcomes of the two methods are compared. Primary swallowing was achieved in 86% of patients after gastric pull-up and in 82% of patients after jejunal interposition. Patients who underwent jejunal interposition were able to swallow sooner and had a shorter hospital stay than patients who underwent gastric pull-up. Esophageal tumor recurrence after jejunal interposition was not observed. Hepatic failure occurred in two gastric pull-up patients, leading to perioperative death in one. Flap necrosis occurred in two jejunal interposition patients and one gastric pull-up patient. Two additional fistulas occurred in jejunal interposition patients as a result of microvascular complications. Stricture developed in four jejunal interposition patients, requiring revision surgery in two. Minor complications were more common in the gastric pull-up group. Long-term speech and swallowing function are compared. Our current choice of jejunal interposition or gastric pull-up for reconstruction after total laryngopharyngectomy primarily depends on the location of the tumor.
Assuntos
Hipofaringe/cirurgia , Idoso , Deglutição , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Jejuno/transplante , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Métodos , Pessoa de Meia-Idade , Neoplasias Faríngeas/cirurgia , Faringectomia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fala , Estômago/cirurgiaRESUMO
Wound infection was studied prospectively in 23 (6.5%) of 354 patients who participated in a series of antibiotic trials during major contaminated head and neck surgical procedures. Polymicrobial infection was identified in 22 (96%) of 23 cases. The most commonly encountered organisms were aerobic bacteria (91%), anaerobes (74%), and fungi (48%). All fungal infections resolved without systemic antifungal therapy. It was, therefore, concluded that the presence of fungus represented colonization. The primary treatment of an infected wound is surgical drainage accompanied by broad-spectrum antibiotic therapy to prevent sepsis. The value of postoperative wound cultures is unclear. The majority of patients who developed wound infection had a variety of organisms that appeared to be unrelated to the prophylactic antibiotic used, as well as to the particular surgery performed.
Assuntos
Antibacterianos/uso terapêutico , Neoplasias de Cabeça e Pescoço/cirurgia , Pré-Medicação , Infecção da Ferida Cirúrgica/microbiologia , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Candida/isolamento & purificação , Humanos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
Reconstruction of the laryngopharynx and cervical esophagus presents difficult problems. We embarked on a program using free jejunal transfer for such reconstruction. Thirty-two patients have been evaluated, with a mean follow-up of 16.7 months. Thirty-four transfers were undertaken--14 as primary repair and 20 after the failure of alternate methods. Twenty-six patients were able to achieve oral feeding. There was one immediate and one delayed failure of the graft. Twelve fistulas developed, seven of which healed spontaneously in less than 2 weeks. Four patients experienced complications related to the microvascular anastomosis which required repair. Six patients had significant dysphagia; four of these had side-to-end distal anastomosis. This technique had been abandoned and improvement resulted. We conclude that free jejunal transfer is an expeditious, safe, and reliable method of reconstruction for patients who require total laryngopharyngectomy.