Anatomy of the anterior jugular veins: anatomical study of 30 cadavers

Introduction: Human anatomy is essential for both clinical and surgical practice. Although the anterior jugular veins (AJVs) are of great importance in many surgeries, there are few studies addressing the anatomic variations of these vessels. This study highlights the venous drainage of the head and neck and the importance of anatomical variations in the AJVs. Objective: To observe and describe the anatomy of the jugular veins and evaluate whether there are patterns influenced by anthropometric factors or comorbidities. Methods: Neck dissections were performed on 30 cadavers. The anatomical characteristics of the AJVs were described considering diameter, midline distance, anastomosis, and presence of the jugular venous arch. Results: Cadavers of 14 women and 16 men were dissected. Ninety percent (90%) of the jugular veins had a rectilinear path and 37% presented anastomosis: H-shaped (63.7%),N-shaped (27.3% ), and Y-shaped (9%). In relation to the number of veins, 20% of the cadavers had only one AJV, 63.3% had two, 10% had three, and 6.7% presented a total of four. Mean distance between jugular veins was 12 mm, and most veins (60%) had a diameter <5 mm. There was no statistically significant correlation between anatomical variations and anthropometric factors. Conclusion: AJVs were always present in the dissected cadavers, and the configuration most commonly found was two veins, each <5 mm in diameter. They were less than 10 mm away from the cervical midline and, when they presented anastomosis, it was H-shaped in most cases.

Morphometry and Frequency of the Pyramidalis Muscle in Adult Humans: A Pyramidalis Muscles Anatomical Analysis

OBJECTIVES: To verify the pyramidalis muscle's frequency (bilaterality, unilaterality, or absence) and morphometry (length of the medial border and width of its origin/base) in a sample of the Brazilian population and the anthropometric influence. METHODS: Dissection of 30 cadavers, up to 24h post-mortem. RESULTS: The pyramidalis muscle was present bilaterally and unilaterally in 83.33% and 3.33% of the cadavers, respectively, and absent in 13.33%. The muscles on the right and left sides were symmetrical in length but not in width; the pyramidalis muscles of men were longer, while those of the women were wider. We also found that there was greater variation in the dimensions (length and width) of the men's muscles. Finally, in this sample of the Brazilian population, the pyramidalis muscle's unilaterality was more prevalent than in other populations, and its complete absence was less prevalent. CONCLUSIONS: There were no cases of muscle duplication in one or both sides, as described in some studies. Despite all of its morphometric variation, the pyramidalis muscle maintained its triangular shape with longitudinal fibers in every case. Furthermore, no statistically significant correlation was noted between the muscles' dimensions and person's age, height, weight, or gender.

Significant differe nces in demographic, clinical, and pathological features in relation to smoking and alcohol consumption among 1,633 head and neck cancer patients

OBJECTIVE: As a lifestyle-related disease, social and cultural disparities may influence the features of squamous cell carcinoma of the head and neck in different geographic regions. We describe demographic, clinical, and pathological aspects of squamous cell carcinoma of the head and neck according to the smoking and alcohol consumption habits of patients in a Brazilian cohort. METHODS: We prospectively analyzed the smoking and alcohol consumption habits of 1,633 patients enrolled in five São Paulo hospitals that participated in the Brazilian Head and Neck Genome Project - Gencapo. RESULTS: The patients who smoked and drank were younger, and those who smoked were leaner than the other patients, regardless of alcohol consumption. The non-smokers/non-drinkers were typically elderly white females who had more differentiated oral cavity cancers and fewer first-degree relatives who smoked. The patients who drank presented significantly more frequent nodal metastasis, and those who smoked presented less-differentiated tumors. CONCLUSIONS: The patients with squamous cell carcinoma of the head and neck demonstrated demographic, clinical, and pathological features that were markedly different according to their smoking and drinking habits. A subset of elderly females who had oral cavity cancer and had never smoked or consumed alcohol was notable. Alcohol consumption seemed to be related to nodal metastasis, whereas smoking correlated with the degree of differentiation. .

Análise clínica e molecular de pacientes não tabagistas e não etilistas com carcinoma epidermóide de cabeça e pescoço / Clinical and molecular analysis of non smoking and non drinking patients with head and neck squamous cell carcinoma

O carcinoma epidermóide de cabeça e pescoço (CECP) é um problema de saúde relevante no mundo, por sua prevalência e agressividade. Os papéis do tabaco e do álcool estão bem definidos na sua etiologia, mas uma minoria crescente dos pacientes acometidos pela doença não é tabagista ou etilista. A infecção pelo papilomavirus humano (HPV) parece ser responsável por parte desses casos. Sugere-se que o CECP que acomete pacientes não tabagistas e não etilistas (NTNE) tenha processos carcinogênicos e evolução clínica distintos daqueles de pacientes tabagistas e etilistas (TE). Os objetivos desse estudo foram verificar se os aspectos demográficos, clínicos e histopatológicos de pacientes com CECP são diferentes conforme os hábitos tabágico e etílico; verificar se os CECPs de pacientes NTNE e TE diferem em relação à positividade para HPV; e comparar a sobrevida específica pela doença e a expressão de marcadores biológicos em amostras tumorais e de mucosa normal do trato aerodigestório de pacientes NTNE e de pacientes TE. Para tanto, realizamos estudo transversal de pacientes com carcinomas epidermóides de cavidade oral (exceto lábio), orofaringe, laringe e hipofaringe, prospectivamente incluídos em um banco de tumores de CECP de 2001 a 2009, pelo grupo de pesquisa multi-institucional GENCAPO. Seus dados demográficos, clínicos e patológicos foram analisados conforme os hábitos de tabagismo e etilismo. Através de análise de pareamento, pacientes NTNE e TE foram comparados em relação à sobrevida, à positividade para o HPV no tumor por reação em cadeia da polimerase (PCR) e aos marcadores imunohistoquímicos p53, FHIT, Ki-67, VEGF, EGFR e p16 tanto em amostras tumorais como de epitélio não tumoral. Dos 1633 pacientes selecionados, 80 eram NTNE (4,9%), 1374 TE (84,1%), 140 tabagistas atuais ou no passado mas não etilistas (TNE:8,6%) e 39 apenas etilistas atuais ou no passado, mas não tabagistas (NTE:2,4%). O grupo de pacientes NTNE constituiu-se principalmente por mulheres...

Head and neck squamous cell carcinoma (HNSCC) is a major health problem worldwide, due to its prevalence and aggressiveness. The role of tobacco and alcohol in its etiology is well established; however, a growing minority of patients with HNSCC neither smokes nor consumes alcohol. Human Papillomavirus (HPV) infection seems to be responsible for some of these cases. It is suggested that HNSCC affecting non smoking and non drinking (NSND) patients has different carcinogenesis and outcomes than those in smoking and drinking (SD) subjects. The objectives of this study were to test if demographic, clinical and pathological aspects of patients with HNSCC vary according to smoking and drinking habits; to test if HNSCC in NSND and SD patients differ in terms of HPV positivity; and to compare NSND and SD patients with HNSCC according to survival and biomarkers in tumor and mucosal samples of the aerodigestive tract. We conducted a cross-sectional study of patients with oral cavity (lips excluded), oropharynx, larynx and hypopharynx tumors prospectively included in a multi-institutional HNSCC tumor bank - GENCAPO, from January 2001 to February 2009. Demographic, clinical and pathological data were analyzed in regards of smoking and drinking habits. Using matched-pair analysis, we compared NSND and SD patients in relation to disease-free survival, HPV positivity through polymerase chain reaction (PCR) and Immunohistochemical staining of p53, FHIT, Ki-67, VEGF, EGFR and p16 biomarkers in tumor and mucosal samples. From 1633 patients, 80 were NSND (4.9%), 1374 SD (84.1%), 140 current or past smokers, but non drinkers (SND:8.6%) and 39 current or past drinkers, but non smokers (NSD:2.4%). NSND patients were most frequently women, remarkably elderly, with oral cavity cancers more commonly than the other groups (p<0.001).Comparing to the other groups, SD patients were younger (p<0.001); SND patients were more frequently affected by larynx tumors (p<0.001) and NSND...

Avaliação nutricional de pacientes com carcinoma espinocelular de cabeça e pescoço / Nutritional evaluation of the patients with head and neck squamous cell carcinoma

Introdução: pacientes com carcinoma espinocelular de cabeça epescoço (CECP) frequentemente têm quadro de desnutriçãoassociado à doença, seja pelo acometimento direto do tratodigestivo alto, seja pela modalidade terapêutica empregada.Objetivo: avaliar o estado nutricional de pacientes com CECP emdiferentes fases do tratamento. Métodos: estudo transversal com155 pacientes assim divididos: 103 com CECP (29 pré-tratamento,47 pós-tratamento sem doença e 27 pós-tratamento com recidivatumoral) e 52 controles sem CECP. Foram coletados dados clínicose epidemiológicos, realizada avaliação nutricional a partir de dadosantropométricos (peso, altura e índice de massa corpórea – IMC),de composição corpórea por meio de bioimpedância (porcentagemde massa magra) e laboratoriais (albumina e contagem total delinfócitos – CTL). Resultados: a estatura e a massa magra emhomens e mulheres não foram diferentes entre os grupos. Asmédias do IMC, albumina e CTL foram normais, porém, menoresnos pacientes com recidiva da doença. Os casos pré-tratamentoapresentaram média do IMC menor que a dos controles, contudo,as médias de albumina sérica e CLT foram semelhantes entre eles.O grupo de pacientes pós-tratamento com doença recidivadaapresentou médias dos três critérios menores do que aquelas dogrupo sem doença. Nos casos tratados sem doença, pacientessubmetidos à cirurgia exclusiva apresentaram maiores índices deIMC e CTL que aqueles que receberam tratamentos combinados.Conclusão: pacientes com CECP apresentaram média de IMCmenor do que controles. Os casos com doença recidivada tiverampior estado nutricional que aqueles que se encontravam semdoença após o tratamento.

Introduction: Patients with head and neck squamous cellcarcinoma (HNSCC) usually present nutritional disorders,secondary to the upper aerodigestive tract involvement or due tothe treatment sequels. Objective: To assess the nutritional status ofpatients with HNSCC in different phases of the disease treatment.Methods: Cross-sectional study with 155 patients divided in 4groups: 103 patients with HNSCC (29 before treatment, 47 posttreatment with no recurrence and 27 post treatment with recurrentdisease) and 52 controls without HNSCC. Clinical and epidemiologicaldata were collected and a nutrition assessment wasperformed from anthropometric parameters (weight, height andBody Mass Index – BMI), electric bioimpedance (thin masspercentage) and biochemical parameters (albumin and totallymphocyte count – TLC). Results: Height and thin masspercentage were similar between the groups. The means of BMI,albumin and TLC were normal; however, they were lower in posttreatment patients with recurrent disease. The patients beforetreatment had BMI average lower then control patients but albuminand TLC were similar between them. The post treatment groupwithout recurrent disease had averages of the three parametershigher than those of the patients with recurrent disease group. Inthe post treatment group without recurrent disease, the patientswho underwent surgical treatment exclusively had BMI and TLChigher than those who received adjuvant therapy. Conclusion:Patients with HNSCC had lower BMI average then control patients.Cases with recurrent disease had worst nutritional status thenpatients treated without disease.

Câncer de faringe tratado com tonsilectomia radical transoral por cirurgia robótica / Transoral robotic radical tonsillectomy for pharynx squamous cell carcinoma

Com a Cirurgia Robótica Transoral (TORS), padronizada por Weinstein, houve um acréscimo de facilidades para as cirurgias transorais em áreas de difícil acesso, onde havia necessidade de acessos combinados. Relata-se o caso de um doente com carcinoma espinocelular de orofaringe, T1N2bM0, submetido a TORS, onde se ressecou totalmente o tumor com margens, sem mandibulotomia. Não houve falhas do sistema, complicações ou acidentes. Foi realizada traqueostomia de proteção, retirada no dia da alta, no quarto pós-operatório, com alimentação oral. A TORS ofereceu excelente acesso para a ressecção da amígdala, mesmo em seu coto mais caudal, ao nível da epiglote.

The Transoral Robotic Surgery (TORS), standardized by Weinstein, provides facilities to transoral surgeries in difficult access areas, where a combined access would be indicated.We describe the case of a patient with a T1N2bM0 squamous cell carcinoma of the oropharynx, treated through TORS, transorally ressected without a mandibulotomy access. The surgery was conducted without any systems' failure, accidents or complications. We performed a tracheotomy, deccanullated at the forth postoperative day, at the time of the patient discharge, receiving oral feeding. The TORS offered an excellent access for radical tonsilectomy, including the transition to the hypopharynx, at the level of the epiglottis.

Análise crítica do tratamento atual para o carcinoma espinocelular precoce de língua oral e soalho com invasão perineural / Critical assessment of the current treatment for initial squamous cell carcinoma of tongue and floor of mouth with perineural invasion

Introdução: O espaço perineural é reconhecido como rota de propagação do carcinoma espinocelular (CEC) e, quando acometido, tem sido relacionado com pior prognóstico, maior recorrência e menor tempo de sobrevivência. Contudo, seu papel nos tumores precoces de cavidade oral ainda não está totalmente esclarecido. Objetivos: comparar a sobrevivência global e livre de doença entre pacientes com carcinoma espinocelular precoce de língua oral e soalho de boca com e sem invasão perineural; comparar a ocorrência de fatores clínicos e anátomo-patológicos entre os grupos; e descrever os casos de óbito para análise crítica da realização do tratamento radioterápico adjuvante. Métodos: Foi realizado estudo retrospectivo longitudinal de caso-controle, de 42 pacientes operados por CEC precoce (T1/T2 N0) de língua oral e soalho de boca, divididos em dois grupos: com invasão perineural (n=16) e sem invasão (n=26). Variáveis clínicas, anátomo-patológicas e de seguimento, incluindo realização de tratamento adjuvante foram comparadas. Resultados: No grupo com invasão perineural houve maior freqüência de homens (p=0,008), óbito relacionado (p=0,015), quantidade de cigarro consumida (p=0,042) e menor freqüência de não etilistas. As médias do maior diâmetro (p=0,046) e da espessura (p=0,002) do CEC primário foram maiores nesse grupo. Conclusões: Houve menor sobrevivência global no grupo de doentes com CEC precoce de língua oral e soalho com invasão perineural (p=0,019), apesar da maior freqüência de radioterapia adjuvante. Todos os óbitos relacionados ocorreram no grupo com invasão perineural, por recidiva local, sendo que, em dois casos, nenhuma outra característica de mau prognóstico foi observada. À análise multivariada, a presença de invasão perineural foi indicada como fator associado ao óbito correlacionado, de maneira não significante (p=0,275). Os resultados favorecem a indicação de tratamento radioterápico adjuvante.

Introduction: perineural space is known as a pathway for spreading of the squamous cell carcinoma (SCC). Its invasion has been associated with worse prognosis, greater rates of recurrence and lower survival rates. However, its impact on the initial oral cavity tumors is not well established. Objectives: to compare global survival and disease free survival between patients with initial SCC of tongue and floor of mouth, with and without perineural invasion; to compare clinical and pathological features between the two groups; and to describe the cases of death for a critical analysis of the use of adjuvant radiotherapy. Methods: retrospective longitudinal case-control study of 42 patients surgically treated for initial SCC (T1/T2 N0 ? UICC-2002) of oral tongue and floor of mouth. The patients were divided into two groups: with (n=16) and without (n=26) perineural invasion. Clinical and pathological features, as well as the follow-up and treatment information were compared. Results: the group with perineural invasion presented a higher frequency of male patients (p=0.008) and of tobacco use (p=0.042) and lower frequency of non users of alcohol. The mean of greater tumor diameter (p=0.046) and thickness (p=0,002) were higher in this group. Those patients also had higher disease specific death (p=0.015) and a lower survival (p=0.019), regardless of a higher frequency of adjuvant treatment with radiotherapy. All disease specific deaths occurred in this group and, in two of these cases, no other known features of worse prognosis were observed. At the multivariate analysis, the perineural invasion was related to disease-specific death in a non significant manner (p=0.275). Conclusion: These results point out the perineural invasion as a feature of worse prognosis, even in initial tumors and despite more aggressive treatment.

Metástase linfática cervical no carcinoma espinocelular de vias aerodigestivas superiores: análise crítica de fatores preditivos, pelo modelo de regressão logística / Lymph node metastasis from squamous cell carcinoma of the upper aerodigestive tract: individual risk prediction by logistic regression model

Introdução: a dissecção cervical no carcinoma espinocelular (CEC) de vias aerodigestivas superiores (VADS) é preconizada com base no risco epidemiológico de metástase linfática. A indicação do esvaziamento eletivo, porém, ainda é controversa. Determinar o risco individual de metástase auxilia na escolha do tratamento mais adequado. Objetivo: verificar a possibilidade de calcular o risco individual de metástase segundo os resultados da comparação de características clínicas e anátomo-patológicas entre os doentes com e sem metástase linfática cervical do CEC de VADS. Pacientes e Método: estudo retrospectivo longitudinal de caso-controle de 209 operados no período de agosto de 2002 a janeiro de 2007, distribuídos em dois grupos: 128 casos com e 81 sem metástase (estes seguidos por mais de 12 meses). Variáveis passíveis de serem preditivas do risco de metástase linfática foram comparadas entre os grupos e analisadas pelo modelo de regressão logística. Resultados: No grupo com metástase, o CEC apresentou maior freqüência de invasão sangüínea, linfática, perineural, margem comprometida e infiltrado inflamatório escasso. Maior diâmetro e grau de diferenciação foram variáveis independentes preditivas do risco (razão de chances) de desenvolver metástase linfática respectivamente de: 4,8 vezes para o CEC moderadamente diferenciado; e 1,5 vezes para cada centímetro de aumento no diâmetro do carcinoma primário. Maior espessura e invasão sangüínea foram co-variáveis dependentes. O cálculo do risco individual revelou que tanto para o CEC T1/T2 de língua oral e soalho, bem diferenciado e com espessura a partir de 1cm, assim como para o CEC de laringe (não glótico) com diâmetro acima de 1,3cm, o risco de metástase foi maior de 20%, para esta casuística. Conclusão: O grau de diferenciação e o maior diâmetro do CEC de VADS foram variáveis independentes preditivas da ocorrência de metástase linfática cervical. O risco individual de metástase pôde ser calculado em função dessas características, segundo o modelo logístico.

Introduction: the elective neck dissection is indicated for head and neck squamous cell carcinoma (SCC) with metastasis risk higher than 20% in epidemiological investigations, but it remains controversial in some situations. To determine the individual risk to develop node metastasis would allow the surgeons to offer a more adequate treatment case by case. Objective: to verify if it is possible to obtain an individual risk prediction model based on clinical and pathological features presented by patients with SCC of the upper aerodigestive tract. Patients and methods: retrospective longitudinal case-control study of 209 patients treated from August 2002 to January 2007, divided into two groups: 128 cases with and 81 without node metastasis followed up more than 12 months. The clinical and pathological characteristics of the primary tumor were compared between the groups and analyzed by the logistic regression model. Results: Diameter and histological grade were independent predictive variables of node metastasis risk (odds ratio = 4.8 for moderately, compared to well differentiated carcinoma; 1.5 per centimeter of primary carcinoma diameter). Thickness and vascular invasion were covariates related to them. The logistic prediction model revealed that the risk of node metastasis was higher than 20% for T1/T2 well differentiated SCC of the oral tongue and floor of mouth with thickness larger than 1.0cm. Laryngeal SCC (except glottic) with diameter smaller than 1.3cm presented less than 20% of risk. Conclusion: histological grade and diameter of the upper aerodigestive tract SCC were independent predictive variables of the neck node metastasis. The individual risk could be calculated in function of these factors by the logistic regression model.

Elevação de hormônio tireoestimulante (TSH) após as lobectomias: incidência e fatores associados / Thyroid-stimulating Hormone (TSH) rising following hemithyroidectomy: incidence and adjuvant factors

OBJETIVO: Determinar a freqüência de elevação da dosagem sérica do hormônio tireoestimulante (TSH) em pacientes submetidos à lobectomia da tireóide, em um período de até 12 semanas após a operação, buscando fatores associados à sua ocorrência. MÉTODO: Foram analisados retrospectivamente 88 pacientes submetidos à lobectomia da tireóide no Serviço de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da FMUSP, no período de setembro de 2002 a setembro de 2004. Realizaram-se dosagens de hormônios tireoideanos a partir de quatro semanas após a cirurgia. Excluíram-se os pacientes com dosagens hormonais pré-operatórias alteradas, os casos que necessitaram de totalização da tireoidectomia e também aqueles em que houve perda do seguimento pós-operatório. Foram analisados os dados quanto à idade e ao sexo dos pacientes, quanto à presença de tireoidite no estudo histopatológico da tireóide e quanto ao tempo de aparecimento do hipotireoidismo. A análise estatística dos dados obtidos foi realizada através do teste qui-quadrado de Pearson. RESULTADOS: Dos 88 pacientes, 71 (80,7 por cento) eram mulheres. A idade média foi de 41,7 anos. Observou-se elevação do TSH em 20 (22,73 por cento) dos 88 pacientes estudados. Não foi observada diferença estatisticamente significante na incidência de elevação do TSH, quando analisados quanto ao sexo, à idade ou à presença de tireoidite. CONCLUSÃO: A elevação do TSH é freqüente após lobectomias da tireóide e ocorre, muitas vezes, precocemente após a cirurgia. Não se encontraram, neste estudo, fatores que pudessem predizer sua ocorrência a curto prazo.

BACKGROUND: To determine the frequency of serum elevations of thyrotropin in patients submitted to lobectomy within a period of up to 12 weeks after surgery, in the search for factors associated with its occurrence. METHODS: Eighty-eight patients submitted to thyroid lobectomy from September 2002 to September 2004 in the Department of Head and Neck Surgery - University of São Paulo Medical School were retrospectively analyzed. Thyroid hormone determinations were performed from 4 weeks on after the surgery. Cases of patients with altered preoperative hormone determination, need for total thyroidectomy, and loss of postoperative follow-up were excluded. Data regarding age and gender of patients, presence of thyroiditis on histopathologic analysis of the thyroid and time of emergence of hypothyroidism were studied. Statistical analysis was performed using Pearson's chi-square test. RESULTS: Of the 88 patients, 71 (80.7 percent) were women. The mean age was of 41.7 years. Elevation of thyrotropin was observed in 20 (22.73 percent) of the 88 studied patients. No statistically significant difference was observed regarding its incidence in relation to gender, age or the presence of thyroiditis. CONCLUSION: Elevation of thyrotropin is frequent after thyroid lobectomy and it may occur early after surgery. In this study, no factor that could predict its occurrence in the short term were found.

Análise crítica dos exames iniciais de seguimento pós-tireoidectomia total por carcinoma bem diferenciado / Analysis of the initial follow-up exams after total thyroidectomy for well-differentiated, low risk thyroid cancer

Introdução: a incidência do câncer de tireóide tem aumentado nos últimos anos devido ao aumento do diagnóstico precoce. Considerando a tireoidectomia total como parte do tratamento, o seguimento [e realizado inicialmene com a pesquisa de corpo inteiro (PCI), dosagem sérica tireoglobulina (Tg) estimulada pelo hormônio tireo-estimulante (TSH) e sem estímulo. Objetivo: análise da importância relativa dos três exames na detecção de doença e indicação de terapia complementar conforme conduta do serviço. Pacientes e Método: estudados retrospectivamente os dados (gênero, idade, tipo histológico, tamanho do tumor, PCI e Tg com e sem estímulo de TSH) referentes aos pacientes operados por carcinoma bem diferenciado de tireóide entre 1999 e 2004, excluindo tipos histológicos mais agressivos, tumores > 4cm, extensão extratireoidiana e dosagem positiva para anticorpos anti-Tg. Os pacientes foram analisados em dois grupos (tumores com menos de 1cm e entre 1 e 4cm), sendo calculada sensibilidade dos exames em relação ao padrão-ouro (PCI associado a Tg estimulada). Resultados: dos 85 pacientes, 81 eram mulheres e 4 eram homens, com idade m[edia 44 anos. A sensibilidade da PCI e da Tg sem estímulo foi de 26,9%, enquanto a da Tg estimulada foi de 92,2%. Entre os tumores < 1cm, a sensibilidade da PCI foi de 16,6%, a da Tg sem estímulo foi de 33,3% e da Tg com estímulo de TSH foi de 100%. Discussão: O carcinoma bem diferenciado de tireóide tem excelente prognóstico para o grupo de baixo risco. A tireoglobulina estimulada foi o exame mais sensível em todos os grupos, com sensibilidade de 100% nos tumores menores que 1cm. A interpretação dos exames de seguimento deve ser individualizada e a indicação de ablação de restos tireóideos não deve ser aplicada em todos os pacientes

Intruduction: the incidence of thyroid cancer has been rising in the last years due to the improvement of early diagnosis. Considering the total thyroidectomy as part of the treatment, the follow-up can be performed with total body scan and thyroglobulin measurement, with and without TSH stimulation. Objective: to analyze the relative importance of each exam in detecting disease and the indication of complementary therapy as routine. Patients and methods: retrospective review of patients' charts, which underwent total thyroidectomy as part of the treatment for well-differentiated thyroid cancer, including gender, age, histologic subtype, size of tumor, total body scan, thyroglobulin with and without TSH stimulus. The patients with aggressive histologic subtypes, tumors > 4cm, extra-thyroid extension, and anti-thyroglobulin antibodies were excluded. The patients were analyzed in two groups- tumors < 1cm and between 1 and 4cm. The sensibility of each exam was calculated in relation to gold-standard total body scan associated with thyroglobulin. Results: 85 patients were studied, being 81 women and 4 men, with median age of 44 years-old. The sensibility of Tg without stimulus and total body scan were 26.9% and the sensibility of stimulated Tg was 92.2%. The sensibility of total body scan, Tg without stimulus and Tg with TSH stimulus was, respectively, 16.6%, 33.3% and 100%. Discussion: the well-differentiated thyroid cancer has excellent prognosis in the low-risk group. Stimulated thyroglobulin was the most sensitive exam in all groups, with a sensibility of 100% in the group with tumors < 1cm. Follow-up exams interpretation must be individualized and the ablation must not be applied for all patients

Hipocalcemia e hipoparatireoidismo clínico após tireoidectomia total / Hypocalcemia and clinical hypoparathyroidism after total thyroidectomy

OBJETIVO: O hipoparatireoidismo que se sucede à tireoidectomia total é uma complicação relativamente freqüente, porém, em geral, assintomática. O presente estudo foi realizado a fim de correlacionar níveis séricos pós operatórios de cálcio com sinais e sintomas de hipocalcemia. MÉTODO: Cinqüenta e sete pacientes submetidos à tireoidectomia total foram estudados retrospectivamente na Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A dosagem sérica de cálcio, total ou ionizado,foi correlacionado com a presença, ou não, de sinais e sintomas de hipocalcemia, no pós-operatório imediato e tardio. RESULTADOS: A hipocalcemia precoce ocorreu em 37 por cento dos casos e em 18 por cento na fase tardia. Após seis meses da cirurgia, 50 por cento dos pacientes sintomáticos não eram hipocalcêmicos e do total de hipocalcêmicos 57 por cento eram assintomáticos. CONCLUSÕES: A avaliação clínica exclusiva pós-operatória não se mostrou confiável para o diagnóstico de hipocalcemia. A dosagem de cálcio deve ser feita como rotina após tireoidectomias totais.

BACKGROUND: Hypoparathyroidism after total thyroidectomy is a common complication although the majority of cases are asymptomatic. The present study was prompted in order to correlate postoperative serum calcium levels and clinical signs and symptoms of hypocalcemia. METHODS: Fifty-seven patients operated on for total thyroidectomy were retrospectively studied at Hospital das Clínicas of São Paulo University. Serum calcium levels were measured 48 hours and six months after surgery and were correlated with signs or symptoms of hypocalcemia. RESULTS: Transient hypocalcemia occurred in 37 percent and permanent hypocalcemia in 18 percent. After six months, 50 percent of symptomatic patients were not hypocalcemic and 57 percent of hypocalcemic patients were asymptomatic. CONCLUSION: The diagnosis of hypocalcemia after total thyroidectomy based solely on clinical evaluation is not reliable; therefore, serum calcium levels should be monitored routinely after total thyroidectomies.