Objectives/Hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.Study Design: Delphi method-based survey series. Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up.Results: The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics ( 22), and Prior Workup Characteristics (18).Conclusion: This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes.
Problem: Sjögren's syndrome (SS) is a chronic autoimmune disease, characterized by a progressive lymphocytic and plasma cell infiltration of the exocrine glands, particularly of the salivary and lacrimal glands. The progression of the disease leads to the decrease of the glandular function and consequently to the development of xerostomia and keratoconjunctivitis sicca. SS may occur alone (primary) or in association with another autoimmune disease (secondary) such as rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and scleroderma.Methods: The goal of this study was to assess the clinical and histopathological characteristics of the oral component of SS in patients assisted at the Stomatology Division of the Otorhinolaryngology and Head and Neck Surgery Department of Universidade Federal de São Paulo, Brazil. Twenty-four adult female patients were enrolled in the study and classified according to the European Criteria for Sjögren's Syndrome. All patients were submitted to a detailed oral evaluation, and the oral signs and symptoms were correlated to the focal sialadenitis present in the labial salivary gland biopsy.Results: The patients were predominantly of white ethnicity (79.1%) in their sixth decade of life. Xerostomia was the most relevant oral symptom, present in 79.1% of patients. We found a positive correlation between the enlargement of the major salivary gland and the decrease or thickening of saliva during the oral examination and a higher number of lymphoplasmocitary foci / 4 mm 2 Ͼ4 mm 2 .Conclusion: Although the oral symptoms, chronic and/or recurrent salivary gland enlargement, and oral mucosa dryness are strongly suggestive of SS, they cannot be considered the only oral criteria for the diagnosis of this syndrome. Lymphoplasmocitary infiltration of the minor salivary gland was found even in patients without oral symptoms, corroborating the importance of the minor salivary gland biopsy as part of the SS diagnosis.Significance: This study provides a better understanding of the oral characteristics of Sjögren's Syndrome, and the importance of proper criteria use for its clinical diagnosis.
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