Η αναδιοργάνωση του κυτταροσκελετού ακτίνης έχει κρίσιμο ρόλο στη διήθηση και τη μετάσταση των καρκινικών κυττάρων. Οι πρωτεΐνες κοφιλίνη και N-WASP συνδέονται με την ακτίνη και ρυθμίζουν τη δυναμική του κυτταροσκελετού, ενώ η πρωτεΐνη β-παρβίνη εντοπίζεται στις εστιακές συνδέσεις και διαμεσολαβεί τη σηματοδότηση διαμέσου των ιντεγκρινών με επίσης σημαντική επίδραση στον κυτταροσκελετό ακτίνης. Μεταβολή της έκφρασης των παραπάνω πρωτεϊνών έχει παρατηρηθεί σε διάφορα νεοπλάσματα στον άνθρωπο. Η παρούσα μελέτη επιχειρεί να προσδιορίσει το ρόλο τους στον καρκίνο του λάρυγγα. Για αυτό το λόγο μελετήθηκε με ανοσοϊστοχημεία η έκφραση των πρωτεϊνών κοφιλίνη, N-WASP β-παρβίνη σε 72 ιστικά δείγματα ασθενών με πλακώδες καρκίνωμα του λάρυγγα και αξιολογήθηκε η συσχέτιση της έκφρασης τους με κλινικές και παθολογοανατομικές παραμέτρους καθώς και με την επιβίωση. Θετική ανοσοϊστοχημικη έκφραση των πρωτεϊνών κοφιλίνη, N-WASP β-παρβίνη παρατηρήθηκε στο 86,1%, 93,1% και 94,4% των περιπτώσεων καρκινώματος του λάρυγγα αντίστοιχα, σε αντίθεση με τον παρακείμενο φυσιολογικό ιστό όπου η έκφραση ήταν ασθενής ή απούσα. Η κυταροπλασματική έκφραση της κοφιλίνης έδειξε τάση συσχέτισης με τα προχωρημένα στάδια της νόσου (p=0,063), ενώ η πυρηνική της έκφραση συσχετίστηκε σε στατιστικά σημαντικό βαθμό (p=0,031) με την προχωρημένη ηλικία (>65 ετών) των ασθενών. Η κυτταροπλασματική έκφραση του N-WASP ήταν μεγαλύτερη στα γλωττιδικά καρκινώματα (p=0,068) και συσχετίστηκε σε στατιστικά σημαντικό βαθμό με τα καλά διαφοροποιημένα καρκινώματα (p=0,031). Η κυτταροπλασματική έκφραση της β-παρβίνης συσχετίστηκε σε στατιστικά σημαντικό βαθμό (p=0,038) με τα προχωρημένα στάδια της νόσου. Παρόλο που οι ασθενείς με υψηλότερη έκφραση του N-WASP εμφάνιζαν καλύτερες επιβιώσεις, δεν επιβεβαιώθηκαν στατιστικά σημαντικές συσχετίσεις της έκφρασης των 3 υπό μελέτη πρωτεϊνών με την επιβίωση. Η αυξημένη έκφραση των πρωτεϊνών κοφιλίνη, N-WASP και β-παρβίνη στον καρκίνο του λάρυγγα μπορεί να υποδεικνύει την πιθανή συμμετοχή τους στην παθογένεση της νόσου. Ενώ η υψηλή έκφραση της κοφιλίνης και της β-παρβίνης φάνηκε να ευνοεί την προαγωγή/εξέλιξη του καρκίνου, τα αυξημένα επίπεδα της πρωτεΐνης N-WASP συσχετιστήκαν με ευνοϊκούς προγνωστικούς παράγοντες. / Actin cytoskeleton dynamics are critically implicated in cancer invasion and metastasis. Actin binding proteins cofilin and N-WASP regulate actin filament turnover and the focal adhesion protein β-parvin mediates integrin signaling to actin cytoskeleton. Altered expression of these proteins has been implicated in human malignancies. This study addresses their role in human laryngeal cancer. Protein expression of cofilin, N-WASP and β-parvin were investigated by immunohistochemistry in 72 FFPE samples of human laryngeal squamous cell carcinoma. Correlations with clinicopathological data and survival were evaluated. Positive immunostaining of cofilin, N-WASP and β-parvin were observed in 86.1%, 93,1% and 94,4% cases respectively, in contrast to the weak or absent staining at the non neoplastic adjacent mucosa. Cytoplasmic cofilin immunoreactivity tended to correlate with advanced disease stage (p=0.063), while its nuclear immunoreactivity correlated significantly with advanced (>65 years) patient age (p=0,031). N-WASP immunoreactivity was higher in glottic laryngeal carcinomas (p=0.068) and significantly correlated with low grade tumors (p=0.031). Expression of β-parvin also correlated significantly with advanced disease stage (p= 0.038). Although patients with high N-WASP expression showed higher survival rates no statistical significant correlation between cofilin, N-WASP or β-parvin immunoreactivity and survival was found. Overexpression of cofilin, N-WASP and β-parvin may be implicated in human laryngeal carcinogenesis. While high expression of cofilin and β-parvin seems to favor tumor progression increased levels of N-WASP associated with favorable prognostic factors.

No description available.

This study examines the production and perception of laryngeal constriction in the early vocalizations of Bai and English infants. The first part of the study documents the development of laryngeal voice quality features in the non-syllabic and syllabic utterances of Bai and English infants. The second part of the study focuses on the perception of laryngeal constriction in infant vocalizations by adult Bai and English listeners. The study is grounded in Esling’s (2005) model of the vocal tract, which characterizes the laryngeal vocal tract as a separate articulator, distinct from the oral vocal tract. The study of Bai and English infants’ production identifies universal and language-specific patterns in infants’ development of laryngeal constriction. In the first months of life, most sounds produced by Bai and English infants are constricted. As the year progresses, all infants explore degrees of constriction in dynamic utterances that feature alternations between constricted and unconstricted laryngeal voice quality settings. As well, throughout the year, infants produce an increasing proportion of unconstricted vocalizations. By the end of the first year, when infants have developed increasing control of the laryngeal and oral vocal tracts, they produce syllabic utterances that begin to reflect the use of laryngeal voice quality features in their ambient language. English syllabic utterances are mostly unconstricted, mirroring the prevalence of unconstricted settings in the target language. By contrast, Bai syllabic utterances are mostly constricted or dynamic, reflecting the use of laryngeal voice quality in Bai, a register tone language that employs laryngeal voice quality features distinctively at the syllabic level. The second part of the study highlights universal and language-particular patterns in Bai and English adults’ perception of laryngeal voice quality in infants’ utterances. In evaluating the importance of a range of infant sounds in learning the target language (Bai or English), adults from both language groups assign lower ratings to infant utterances that occur earlier in development, such as constricted non-syllabic utterances, and higher ratings to sounds that occur later, such as syllabic utterances with rapidly articulated syllables. Bai and English adults’ perceptions also reflect some language-specific patterns that correspond to language-particular characteristics identified in infants’ use of laryngeal voice quality in syllabic and non-syllabic utterances. These correspondences suggest that adults are attuned to laryngeal voice quality in infants, and that, in turn, infants become attuned to the use of laryngeal voice quality features in their ambient language early in development. The production study demonstrates the fruitfulness of Esling’s (2005) model of the vocal tract in revealing previously undocumented patterns in the development of laryngeal constriction in the first year of life and in highlighting the importance of emergent laryngeal control as a stimulator of phonetic development. The perception study shows that adults whose native languages differ markedly in their use of laryngeal constriction can systematically evaluate laryngeal voice quality features in the full range of non-distress vocalizations produced by infants in the first year of life.

Objetivos: Descrever a incidência de lesões laríngeas agudas após extubação em unidade de terapia intensiva pediátrica (UTIP), e avaliar os seus fatores de risco e sua relação com a presença de estridor pós-extubação. Delineamento: Coorte Prospectiva. Métodos: Foram elegíveis todas as crianças de zero a cinco anos incompletos internadas na UTIP do Hospital de Clínicas de Porto Alegre que necessitaram de intubação endotraqueal por mais de 24 horas. Foram excluídas aquelas com história de intubação, patologia laríngea prévia, presença de traqueostomia atual ou no passado, presença de malformações craniofaciais e consideradas terminais pela equipe assistente. As crianças incluídas foram acompanhadas diariamente e, após a extubação, foram submetidas à fibronasolaringoscopia (FNL). Resultados: Foram acompanhadas 202 pacientes entre novembro de 2005 e dezembro de 2012. Na FNL após a extubação, 88 pacientes (43,6%) apresentaram lesões laríngeas agudas moderadas ou graves. Após análise multivariada dos fatores de risco, verificamos que tais lesões estão associadas com a presença de balonete no tubo endotraqueal (TET), risco relativo de 1,42 (IC 95%: 1,02-1,97; P=0,039). Dos pacientes com lesões moderadas a graves, 21 (23.9%) tiveram estridor por mais de 72 horas (P<0,001). Houve associação estatisticamente significativa entre a persistência de estridor após 72horas e a presença de balonete no TET (P=0,036). Conclusões: Este estudo encontrou uma alta frequência de lesões laríngeas agudas após a extubação, que foram associadas com o uso de TET com balonete. Além disso, o estridor persistente após 72 horas da extubação foi mais frequente em pacientes que apresentaram lesões laríngeas e naqueles que usaram TET com balonete. / Objectives: To describe acute laryngeal injuries after extubation in a pediatric intensive care unit (PICU) and to assess risk factors and their association with post-extubation stridor. Design: Prospective cohort. Methods: Children aged zero to five years admitted to the PICU of Hospital de Clínicas de Porto Alegre who required endotracheal intubation for more than 24 hours were eligible for study. Patients with previous intubation, history of laryngeal disease, current or past tracheostomy, presence of craniofacial malformations and those considered terminal by the staff were excluded from the study. Children were monitored daily and underwent flexible fiber-optic laryngoscopy (FFL) after extubation. Results: We followed 202 children between November 2005 and December 2012. In the FFL after extubation, 88 children (43,6%) had moderate to severe laryngeal lesions. After multivariate analysis of potential risk factors, it was found acute lesions were associated with the presence of cuffed endotracheal tube (ETT), relative risk of 1,42 (CI 95%: 1,02-1,97; P=0,039). Among patients with moderate to severe laryngeal lesions, 21 (23,9%) had stridor for more than 72 hours (P<0,001). There was a statistically significant association between persistent stridor after 72 hours and the presence of the cuffed ETT (P=0,036). Conclusions: This study found high frequency of acute laryngeal injuries after extubation, which were associated with cuffed ETT. Moreover, persistent stridor after 72 hours of extubation was more frequent in patients with laryngeal lesions and in those who used cuffed ETT.

O presente trabalho de doutorado tem por objetivo a criação de uma nova família de filtros digitais específica para o processo de classificação de dados, particularmente aplicada ao pré-diagnóstico de patologias na laringe. Antes de explicar a criação dessa nova família de filtros, foi apresentada uma breve revisão bibliográfica sobre o funcionamento do aparelho fonador humano, sobre o processo de diagnóstico de patologias e sobre a transformada discreta Wavelet, que serviu de base para a construção dos filtros propostos. Em seguida, é descrita a tecnologia proposta para a criação da nova família de filtros, que é baseada na construção da Transformada Wavelet de Daubechies, além disso, apresenta-se uma breve comparação com outras técnicas já descritas na literatura para a mesma finalidade. Posteriormente, são apresentados os resultados obtidos com base na técnica proposta, verificando-se uma taxa de acerto na classificação de vozes normais de 100% e uma taxa de acerto de 95,52% para vozes patológicas. / The main purpose of this thesis is the development of a new family of digital filters used for data classification, particularly applied to the pre-diagnosis of pathologies in the larynx. A brief bibliographical review, that concentrates on the functioning of the human vocal tract, on the process of disease diagnosis, and on the discrete wavelet transform, which formed the basis for the construction of the proposed filters, is presented. The technology used to develop these new families of filters, that is based on the Daubechies Wavelet Transform, is also described, moreover, a comparison with other techniques described in the specialized literature for the same purpose is also presented. The investigation shows the results obtained with the proposed technique, in which the accuracy of 100% in normal voice classifications and of 95,52% in pathological voice classifications, was obtained.

Trata-se de uma investigação de desenvolvimento metodológico cujo objetivo foi construir e validar um instrumento para medir a satisfação da comunicação do paciente após a laringectomia total e avaliar a qualidade de vida deste, através do instrumento validado por Sawada (2002). A metodologia utilizada baseou-se em procedimentos teóricos, empíricos e analíticos propostos por Pasquali (1998) para a elaboração de instrumentos psicométricos e da comunicação (Berlo, 1979). O instrumento foi submetido à análise da adequação semântica e conceitual dos itens, por três peritos, seguido do pré-teste. Os procedimentos empíricos compreenderam a aplicação do mesmo a uma amostra de 52 laringectomizados, entre julho de 2002 a janeiro de 2003, realizadas no GARPO–Laringectomizado, Ribeirão Preto-SP. Os analíticos compreenderam a análise da validade do construto (análise fatorial com extração de 15 fatores) e da confiabilidade (Alpha de Cronbach total de 0,97 e nos domínios, variando de 0,95 a 0,96). Este estudo resultou na criação de um instrumento composto por 94 itens e dois domínios, com índices de confiabilidade altamente satisfatórios. Os resultados revelam a importância do método de vocalização atualmente utilizado e avaliado pelo próprio indivíduo. Para os laringectomizados que utilizam a voz de bochecho, os gestos/mímica labial e escrita, como forma de comunicação alaringeal, a boa qualidade de vida não é sinônimo de boa satisfação da comunicação atual. Entretanto os que utilizam a prótese traqueoesofágica forneceram dados que mostram que a boa qualidade de vida é sinônimo de boa satisfação da comunicação atual. Contudo, os estudos sobre mensuração da satisfação da comunicação do paciente após a laringectomia total ainda são incipientes em nosso meio e esta investigação pode ser entendida como um ponto de partida para outras dessa natureza. / This methodological development study aimed to construct and validate a scale to measure satisfaction levels with patients’ communication after total laryngectomy and to evaluate their quality of life, through the scale validated by Sawada (2002). The applied methodology was based on theoretical, empirical and analytical procedures proposed by Pasquali (1998) for elaborating psychometric and communication scales (Berlo, 1979). The scale was submitted to an analysis of the items’ semantic and conceptual adequacy, carried out by 3 experts, followed by a pretest. Empirical procedures covered the application of this scale to a sample of 52 laryngectomized patients, from July 2002 to January 2003, realized at the GARPO–Laryngectomized patients, Ribeirão Preto-SP, Brazil. Analytical procedures included construct validity analysis (factorial analysis with extraction of 15 factors) and reliability analysis (total Cronbach’s Alpha 0,97 and varying from 0,95 to 0,96 in the dominions). This study resulted in the creation of a scale that consists of 94 items and 2 dominions, with highly satisfactory reliability rates. Results disclose the importance of the vocalization method that is currently used and evaluated by the proper individual. The laryngectomized patients who use voice the mouth, gestures/lip mimics and writing as a form of alaryngeal communication do not consider good quality of life as synonymous with high satisfaction with current communication. Patients who use tracheo-esophageal prosthesis, on the other hand, supplied data indicating that good quality of life is synonymous with high satisfaction with current communication. However, studies measuring satisfaction with patients’ communication after total laryngectomy are still in an initial stage in our area. This research can be considered a starting point for other studies of this kind.

Introduction: Despite the great technological evolution in medicine, given its anatomical location, the larynx still presents a great challenge to those who need to see it adequately for either diagnostic or therapeutic purposes. This difficulty increases when anatomical factors of some individuals are present. Objectives: To identify the existence of predictive factors of laryngeal exposure difficulty and to evaluate the association of these factors in conjunction with this difficulty of exposure. Method: A retrospective cross-sectional study was carried out based on a sample of 30 clinical and surgical records of individuals with laryngeal lesions treated surgically at the Otorhinolaryngology Service of a Philanthropic Hospital of the State of Sergipe in the years 2014 and 2015. We collected the registry of their measurements of cervical circumference, oral opening, thyroid distance, presence of micrognathia and laryngeal anterioration, modified Malampatti Index and the surgical technique used, if conventional (with straight tweezers and microscope) or variant (with angled tweezers and endoscopes), the latter used as a last resort for satisfactory laryngeal exposure during surgery. The data were statistically analyzed by means of simple and percentage frequencies when categorical variable, or mean and standard deviation when continuous variable. Fisher Exact test was used to evaluate the existing associations, and these were graphically represented by multiple correspondence analysis. The mean differences were tested by the Mann-Whitney test. Relative risks were adjusted to their respective confidence intervals through univariate Cox Regression and the software used was the R Core Team 2017. Results: The presence of micrognathia (P = 0,005) and predisposition were identified as predictive factors of difficult laryngeal exposure of the larynx (P = 0,005), both with a 9-fold greater risk of difficult laryngeal exposure, the cervical circumference above 40 cm (p = 0,041), with a 5-fold increased risk of difficult laryngeal exposure and the Mallampati III index IV (p = 0,009) with 10 times greater risk of laryngeal exposure. Conclusion: The Micrognathia, laryngeal anterioration, cervical circumference above 40 centimeters and modified Mallampati index III and IV, were identified as predictive factors of difficult laryngeal exposure with statistical significance. The association of these four predictive factors has a sensitivity of 100% and a specificity of 85% to predict difficulty in laryngeal exposure. / Introdução: Apesar da grande evolução tecnológica na medicina, dada a sua localização anatômica, a laringe ainda representa um grande desafio àqueles que necessitam vê-la adequadamente quer seja para fins diagnósticos ou terapêuticos. Esta dificuldade aumenta quando fatores anatômicos de alguns indivíduos se fazem presentes. Objetivos: Identificar a existência de fatores preditivos de dificuldade de exposição da laríngea e avaliar a associação destes fatores conjugados com esta dificuldade de exposição. Método: Foi realizado um estudo transversal baseado em uma amostra coletada de 30 prontuários clínico-cirúrgicos de indivíduos portadores de lesões laríngeas, tratados cirurgicamente no Serviço de Otorrinolaringologia de um Hospital Filantrópico do Estado de Sergipe nos anos de 2014 e 2015. Foi coletado o registro das suas medidas de circunferência cervical, abertura oral, distância tireomentual, presença ou não de micrognatia e de anteriorização da laringe, Índice de Mallampati modificado e a técnica cirúrgica utilizada. Se convencional (com pinças retas e microscópio) ou variante (com pinças anguladas e endoscópios), esta última utilizada como último recurso para uma exposição laríngea satisfatória durante a cirurgia. Os dados foram estatisticamente analisados por meio de frequências simples e percentuais quando variável categórica, ou média e desvio padrão quando variável contínua. Para avaliar as associações existentes foi utilizado o teste Exato de Fisher, sendo estas representadas graficamente pela análise de correspondência múltipla. As diferenças de média foram testadas pelo teste de Mann-Whitney. Foram ajustados riscos relativos com seus respectivos intervalos de confiança através de Regressão de Cox univariada e o software utilizado foi o R Core Team 2017. Resultados: Micrognatia (p=0,005) e anteriorização da laringe (p=0,005) apresentaram risco relativo 09 vezes maior de exposição laríngea difícil. A medida de circunferência cervical acima de 40 cm (p=0,041), apresentou risco relativo 05 vezes maior de exposição laríngea difícil e o índice de Mallampati III e IV (p=0,009) apresentou risco relativo 10 vezes maior de dificuldade de exposição laríngea. Conclusão: Foram identificados como fatores preditivos de dificuldade de exposição laríngea e com significância estatística a micrognatia, a anteriorização da laringe, a medida da circunferência cervical acima de 40 centímetros e os Índices de Mallampati modificado III e IV. A associação desses quatro fatores preditivos possui uma sensibilidade de 100% e uma especificidade de 85% para prever dificuldade de exposição laríngea. / Aracaju

Introdução: A comissura anterior constitui-se em área de infiltração do câncer glótico, mesmo em estádio precoce. Objetivo: Avaliar o acometimento por tumor da cartilagem da comissura anterior em espécimes de laringectomia frontolateral. Métodos: Foram incluídos 48 pacientes submetidos à laringectomia frontolateral por carcinoma espinocelular T1b/T2. Aspectos epidemiológicos, clínicos e análise morfológica histopatológica foram avaliados. Resultados: Quarenta e dois pacientes (87,5%) tinham lesões T1b e seis (12,5%), T2. Trinta e quatro casos (70,8%) apresentaram tecido sadio entre o tumor e a cartilagem tireoidea, 10 casos (20,8%) tinham tumor contíguo à cartilagem e, em quatro casos (8,3%), houve invasão da cartilagem. Não houve maior risco de desfecho adverso nos grupos com infiltração ou tumor adjacente à cartilagem. Grau de diferenciação, índice mitótico, irregularidade nuclear, presença de nucléolo e necrose tumoral não tiveram relação com invasão da cartilagem. Conclusão: A infiltração da cartilagem tireoidea ocorreu em 8,3% dos tumores e não mudou o desfecho em pacientes submetidos à laringectomia fronto-lateral. As características morfológicas não apresentaram significado estatístico / Introduction: The anterior commissure is an area of glottic cancer infiltration, even in early stages. Objective: To evaluate the involvement of cartilage by the tumor of the anterior commissure in surgical specimens of frontolateral laryngectomy. Methods: 48 patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. Results: 42 patients (87,5%) had T1b lesions and 6 (12,5%) had T2. Thirty-four cases (70,8%) showed healthy tissue between the tumor and thyroid cartilage, 10 cases (20,8%) had a tumor contiguous with cartilage; and in 4 cases (8,3%) there was cartilage invasion. There was no major risk of adverse closure in the groups with the infiltration or tumor adjacent to cartilage. Grade of cellular differentiation, mitotic index, nuclear irregularity, the presence of nucleolus and tumoral necrosis were not related to cartilage invasion. Conclusion: the infiltration of thyroid cartilage occurred in 8,3% of tumors and did not change the outcome in patients submitted to partial frontolateral laryngectomy. The morphological characteristics did not show any statistical significance

Introdução: O câncer de laringe é a segunda neoplasia maligna mais comum no segmento cervicofacial. As caderinas epiteliais (E-caderinas) em conjunto com cateninas formam o complexo E-caderina-catenina que atuam na adesão célula-célula. A perda dessa molécula pode levar à redução ou até mesmo ausência de expressão de E-caderina na membrana celular, acúmulo citoplasmático de beta-catenina e sua translocação para o núcleo, contribuindo para eventos carcinogênicos. Objetivo: Avaliar a expressão de E-caderina e beta-catenina em pacientes com tumor laríngeo precoce ou avançado e na presença ou ausência de metástase cervical. Métodos: Realizou-se estudo retrospectivo de 52 pacientes portadores de carcinoma epidermoide glótico ou supraglótico, tratados entre 1998 a 2011 e avaliados de acordo com o sítio de localização tumoral, grau de diferenciação histológica, estádio TNM, dados de sobrevida e confrontados com a expressão imunoistoquímica de E-caderina e beta-catenina. Resultados: Observou-se associação com significância estatística entre a queda da expressão de E-caderina com a localização supraglótica da lesão, a presença de metástase cervical, em tumores pouco diferenciados e em tumores localmente avançados quando em topografia glótica. Com relação à expressão de beta-catenina, também foi encontrada significância estatística ao relacionar a presença de metástase cervical e tumor de baixa diferenciação com a diminuição de expressão deste marcador. Quanto à análise de sobrevida, a baixa expressão de beta-catenina está relacionada a pior sobrevida global e a redução da expressão de ambos os marcadores a pior sobrevida livre de doença. Conclusão: A expressão anômala dos marcadores estudados levam a impacto prognóstico por poder propiciar tumores com maior agressividade local e presença de metástase cervical / Introduction: Larynx cancer is the second most common malignant neoplasm in the cervicofacial segment. Epithelial cadherins (E-cadherins) together with catenins form the E-cadherin-catenin complex that acts on cell-to-cell adhesion. The loss of this molecule may lead to the reduction or even absence of E-cadherin expression in the cell membrane, cytoplasmic accumulation of beta-catenin and its translocation to the nucleus, contributing to carcinogenic events. Objective: To evaluate the expression of E-cadherin and beta-catenin in patients with laryngeal tumor in different locoregional situations. Methods: A study retrospective of 52 patients with glottic or supraglottic squamous cell carcinoma treated between 1998 and 2011 was conducted, evaluated according to the tumor localization site, the degree of histological differentiation, TNM stage and survival analysis. These data were confronted with the immunohistochemical expression of E-cadherin and ?-catenin. Results: We observed statistically significant association between the fall of E-cadherin expression and the supraglottic localization of the lesion, the presence of cervical metastasis, poorly differentiated tumors and locally advanced tumors when in glottic topography. Related to the expression of beta-catenin, statistical significance was also found for the presence of cervical metastasis and tumor of low differentiation with the decreased expression of this marker. Regarding survival analysis, the low expression of beta-catenin is related to worse overall survival and the reduction of expression of both markers to worse disease-free survival. Conclusion: The anomalous expression of the markers studied leads to a prognostic impact in order to provide tumors with greater local aggressiveness and presence of cervical metastasis

A fisiopatologia do edema de Reinke ainda permanece desconhecida e poucos estudos abordam sobre as alterações das proteínas fibrosas, colágeno e elastina, na matriz extracelular da prega vocal com edema de Reinke. Por isso, este estudo foi idealizado para descrever a distribuição das fibras colágenas e do sistema de fibras elásticas do espaço de Reinke com edema de Reinke comparando com a prega vocal normal e com a severidade do edema. Foram obtidas 20 amostras de pregas vocais de indivíduos com edema de Reinke, sendo nove casos com edema de Reinke grau II e 11 casos grau III. Dezessete indivíduos eram do sexo feminino e três do sexo masculino, com idade variando de 47 a 62 anos (55 ± 4,4 anos). Quinze pacientes eram tabagistas e cinco ex-tabagistas, média e desvio padrão de 22 ± 10,7 maço/ano. O tempo de disfonia apresentou média e desvio padrão de 36 ± 16,6 meses. Dez pregas vocais normais de laringes humanas excisadas foram utilizadas como controles. Os métodos da Picrossírius-polarização e da Resorcina-fucsina de Weigert com oxidação prévia pelo oxone 10% foram empregados para visualização das fibras colágenas e do sistema de fibras elásticas, respectivamente. Uma avaliação semiquantitativa foi utilizada para categorizar os resultados histológicos que foram correlacionados com a idade, consumo de cigarro, tempo de disfonia e com a severidade do edema. Evidenciou-se que o arranjo entrelaçado das fibras colágenas semelhante a uma cesta de vime observado em pregas vocais normais estava desestruturado no edema de Reinke. A desestruturação foi caracterizada por um afastamento das fibras, fragmentação, formando áreas esparsas e tomadas por um estroma mixóide de quantidade variável. Todos os casos de edema de Reinke mostraram uma maior preservação do arranjo das fibras colágenas próximo ao epitélio da prega comparada com as fibras da camada mais profunda do espaço de Reinke. O arranjo do sistema de fibras elásticas formado por fibras finas e onduladas paralelas à membrana basal do epitélio e uma rede de fibras mais finas, logo abaixo da membrana basal do epitélio observado em pregas vocais normais estava desestruturado no edema de Reinke. Na avaliação semiquantitativa observou-se que moderada e intensa desestruturação ocorreram em 90% dos casos com relação às fibras colágenas e em todos os casos para o sistema de fibras elásticas. Houve uma correlação estatisticamente significante entre a idade e o grau de desestruturação das fibras colágenas (r=0,47, p=0,037). Houve diferenças estatisticamente significantes entre os edemas grau II e III quanto à desestruturação das fibras colágenas (p=0,007) e quanto à idade (p=0,036). Observamos com este estudo que as alterações nas proteínas fibrosas presentes no edema de Reinke podem contribuir com a deformidade da prega vocal / The physiopathological mechanisms underlying Reinkes edema are still unknown and few studies addressed alterations in the fibrillar proteins, collagen and elastin, in extracellular matrix with Reinkes edema. This study was idealized to describe the distribution of collagen fibers and elastic system fibers in Reinkes space with Reinkes edema, comparing with normal vocal fold and with the severity of Reinkes edema. Twenty surgical vocal fold specimens were obtained from patients with Reinkes edema, nine cases presented grade II severity and 11 cases grade III. Seventeen subjects were females and three were males, ranging in age from 47 to 62 years (mean±SD 55 ± 4.4 years). Fifteen patients were smokers and five ex-smokers, mean±SD of 22 ± 10.7 pack-years. The duration of dysphonia ranged from 6 to 60 months (mean of 36 ± 16.6 months). Ten vocal folds from human larynges of nonsmokers cadavers were used as normal controls. The Picrosirius polarization method and the Weigerts resorcin-fuchsin stain after oxidation with 10% aqueous oxone were used for visualization of collagen fibers and the elastic system fibers, respectively. Findings were categorized semiquantitatively and correlated with age, cigarette smoking, duration of dysphonia and Reinkes edema severity. The intertwined network of collagen fibers resembling a wicker-basket found in normal vocal folds was disarranged in Reinkes edema. Disarrangement of collagen fibers was characterized by loosely arranged and fragmented fibers intermixed with varying amounts of myxoid stroma. All cases showed a better preservation of collagen fibers arrangement closer to the epithelium compared to fibers of the deeper of the Reinkes space. The elastic system fibers arrangement formed by a delicate network of thin and undulated fibers arranged in parallel to the epithelial basement membrane and a network of thinner fibers immediately below the basement membrane was disarranged. The semiquantitatively analysis showed that moderate and large areas of disarrangement of collagen fibers were found in 90% of cases and in all cases for elastic fibers. Age was significantly correlated with collagen fiber disarrangement (r=0.47, p=0.037). There was a statistical difference in collagen disarrangement (p = 0,007) and age (p=0,036) between grade II and grade III severity. In our study, the alterations in the fibrillar proteins observed in Reinkes edema may contribute to the vocal fold deformity