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2.
Braz. j. otorhinolaryngol. (Impr.) ; 88(supl.4): S152-S162, Nov.-Dec. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1420873

ABSTRACT

Abstract Objective: To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region. Methods: Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS). Results: The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283. Conclusion: Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region. Level of evidence: II b - Retrospective Cohort Study - Oxford Centre for Evidence-Based Medicine (OCEBM).

3.
Braz. j. otorhinolaryngol. (Impr.) ; 88(6): 982-989, Nov.-Dec. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1420780

ABSTRACT

Abstract Objective: Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications. Methods: This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited. Results: All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients' physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions. Conclusions: Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.


Resumo Objetivo: Bócios e nódulos benignos detectados na tireoide são lesões em crescimento e a pandemia de Covid-19 impactou negativamente seu tratamento cirúrgico. A seleção adequada de pacientes para o tratamento vai melhorar o estado geral de saúde. Esta revisão de artigos se concentrará no impacto da pandemia de Covid-19 no tratamento de condições benignas da glândula tireoide e suas implicações. Método: Esta revisão evidenciou a situação do sistema de saúde em países em desenvolvimento e os problemas para tratar doenças cirúrgicas benignas da tireoide. Aspectos da epidemiologia, incidência, apresentação clínica e tratamento cirúrgico do bócio, impacto econômico e no estado de saúde foram relatados. Resultados: Todos os tratamentos cirúrgicos de bócio e outras condições benignas foram adiados, forçados a se redirecionar e a remarcar todas as cirurgias benignas, situação agravada pela má gestão pública e fechamento de leitos hospitalares. Essas condições têm causado deterioração do estado de saúde física (doença da tireoide descompensada) e mental dos pacientes, aumentam as incapacidades para o trabalho e sobrecarregando a sociedade e o custo social e de saúde. A situação geral pode ser catastrófica em países emergentes, onde esse aumento dos gastos sociais relacionados à doença sob tratamento cirúrgico pode aumentar o risco de empobrecimento nacional à medida que aumenta o custo do tratamento. A Sociedade Brasileira de Cirurgia de Cabeça e Pescoço forneceu algumas recomendações e novas sugestões foram feitas para tratar com segurança essas condições cirúrgicas de alto risco potencial. Conclusão: As cirurgias para bócio e condições benignas da tireoide podem ser feitas durante a pandemia de Covid-19, se forem seguidos rigorosos protocolos de segurança para o paciente e equipe médica, o que reduz o impacto negativo na economia e na saúde do paciente.

6.
Arch. Head Neck Surg ; 48(1): e00072019, Jan-Mar.2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1382323

ABSTRACT

Introduction: Surgical management of thyroid disease in children presents several peculiarities and has increasingly developed in recent years, but historically few studies conducted with this population have been published. Objective: Analysis of the surgical approach and postoperative outcomes of 59 pediatric patients submitted to thyroidectomy between 2003 and 2019. Methods: An outpatient postoperative follow-up of 59 patients aged 3-18 years submitted to thyroidectomy for different causes was performed, and immediate and late postoperative outcomes were analyzed. The operations were performed at a University Hospital as well as at Private Tertiary Hospitals. Results: The following postoperative outcomes were observed: three tracheostomies, 22 patients with transient hypoparathyroidism, eight patients with definitive hypoparathyroidism, and three patients with vocal fold paralysis. Conclusion: Thyroidectomy in children is a procedure with a higher complication rate and needs to be performed by a team of high-volume surgeons. This study focuses on the adverse events, so that those interested in the subject are aware of them.

7.
J. bras. nefrol ; 40(4): 319-325, Out.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-984583

ABSTRACT

ABSTRACT Introduction: Surgical treatment of hyperparathyroidism related to chronic kidney disease is a challenging procedure even for experienced parathyroid surgeons. Over the years, adjuvant techniques have been developed to assist the medical team to improve surgical outcomes. However, medical staff in poor countries have less access to these techniques and the effectiveness of surgery in this context is unclear. Objective: verify the effectiveness of surgery for treatment of hyperparathyroidism related to chronic kidney disease without adjuvant techniques. Methods: Over a 5-years period, patients with hyperparathyroidism that had clinical therapeutic failure were evaluated for surgical treatment. Total parathyroidectomy with autograft or subtotal resection were the selected procedures. Surgeries were performed in a tertiary hospital in Brazil without the assistance of some of the adjuvant techniques that are usually applied, such as frozen section, nerve monitoring, and gamma probe. Intraoperative PTH and localization pre-operative exams were applied, but with huge restrictions. Results: A total of 518 patients with hyperparathyroidism (128 secondary and 390 tertiary) were surgically treated. Total parathyroidectomy were performed in 81.5%, subtotal in 12.4%, and 61% of patients had a surgical failure. Of all failures, only 1.4% needed a second surgery totaling 98.6% of successful initial surgical treatment. Neck hematoma and unilateral focal fold paralysis occurred in 1.9% and 1.5%, respectively. Conclusion: parathyroidectomy is a safe and reproducible surgical procedure even in the absence of adjuvant techniques.


RESUMO Introdução: O tratamento cirúrgico do hiperparatireoidismo relacionado à doença renal crônica é um procedimento desafiador mesmo para cirurgiões de paratireoide experientes. Ao longo dos anos, técnicas adjuvantes foram desenvolvidas para ajudar a equipe clínica a aprimorar os desfechos cirúrgicos. Contudo, as equipes clínicas de países mais pobres têm menor acesso a tais técnicas, o que faz com que a eficácia da cirurgia nesses contextos não seja tão evidente. Objetivo: Verificar a eficácia da cirurgia para tratamento do hiperparatireoidismo relacionado à doença renal crônica, sem técnicas adjuvantes. Métodos: Ao longo de período de cinco anos, pacientes com hiperparatireoidismo cujo tratamento clínico não resultou em melhora foram avaliados para resolução cirúrgica. Os procedimentos selecionados foram paratireoidectomia total com enxerto autólogo ou ressecção subtotal. As cirurgias foram realizadas em um hospital terciário no Brasil sem o auxílio de algumas das técnicas adjuvantes geralmente aplicadas, como exame de congelação, monitorização neurofisiológica e sonda gama. Exames intraoperatórios de PTH e pré-operatório de localização foram realizados, mas com grandes restrições. Resultados: Um total de 518 pacientes com hiperparatireoidismo (128 secundários e 390 terciários) foram tratados cirurgicamente. Paratireoidectomia total foi realizada em 81,5% e subtotal em 12,4% dos casos; 61% dos pacientes apresentaram falha cirúrgica. De todas as falhas, apenas 1,4% necessitaram de uma segunda cirurgia, totalizando 98,6% de sucesso no tratamento cirúrgico inicial. Hematoma cervical e paralisia unilateral de prega vocal ocorreram em 1,9% e 1,5% dos pacientes, respectivamente. Conclusão: A paratireoidectomia é um procedimento cirúrgico seguro e reprodutível, mesmo na ausência de técnicas adjuvantes.


Subject(s)
Humans , Male , Female , Middle Aged , Parathyroidectomy/statistics & numerical data , Hyperparathyroidism, Secondary/surgery , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Retrospective Studies , Treatment Outcome , Hyperparathyroidism, Secondary/etiology
8.
Rev. Col. Bras. Cir ; 44(4): 374-382, jul.-ago. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-896590

ABSTRACT

RESUMO Objetivo: estudar a condroradionecrose de laringe por complicação de radio-quimioterapia para tratamento do câncer de laringe e propor um fluxograma de tratamento com a utilização de câmara hiperbárica. Métodos: estudo retrospectivo de pacientes portadores de carcinoma de laringe admitidos em dois hospitais terciários num período de cinco anos. Resultados: de 131 pacientes portadores de câncer de laringe, 28 foram submetidos à radio e quimioterapia exclusiva e destes, três evoluíram com condroradionecrose. O tratamento destes pacientes foi realizado com câmara hiperbárica e com desbridamento cirúrgico, conforme proposição do fluxograma. Todos os pacientes tiveram a laringe preservada. Conclusão: a incidência de condroradionecrose de laringe por complicação de radioterapia e quimioterapia em nossa casuística foi de 10,7% e o tratamento com oxigenoterapia hiperbárica, com base no nosso fluxograma, foi efetivo no controle desta complicação.


ABSTRACT Objective: to study larynx chondroradionecrosis related to radiotherapy and chemotherapy treatment and provide a treatment flowchart. Methods: retrospective study with clinical data analysis of all larynx cancer patients admitted in a two tertiary hospital in a five years period. Results: from 131 patients treated for larynx cancer, 28 underwent chemoradiotherapy with curative intent and three of them presented chondroradionecrosis. They were treated with hiperbaric oxigen therapy and surgical debridment following our flowchart, preserving the larynx in all. Conclusions: the incidence of chondroradionecrosis as a complication of chemoradiotherapy in our series was 10,7% and the treatment with hiperbaric oxigen therapy, based in our flowchart, was effective to control this complication.


Subject(s)
Humans , Male , Aged , Radiation Injuries/etiology , Radiation Injuries/pathology , Laryngeal Neoplasms/radiotherapy , Laryngeal Cartilages/radiation effects , Laryngeal Cartilages/pathology , Radiotherapy/adverse effects , Retrospective Studies , Middle Aged , Necrosis
9.
Rev. Col. Bras. Cir ; 44(4): 403-412, jul.-ago. 2017. graf
Article in Portuguese | LILACS | ID: biblio-896599

ABSTRACT

RESUMO As neoplasias das glândulas salivares são relativamente raras, compreendendo cerca de 1% das neoplasias de todo corpo, com incidência de 1/100.000 habitantes por ano. As neoplasias benignas predominam sobre as malignas. O prognóstico depende muito do tipo histológico, grau de diferenciação, localização, infiltração de tecidos vizinhos e da presença de metástases regionais ou a distância. O principal tratamento ainda é a cirurgia, com os seus desafios e dificuldades, devido aos ramos do nervo facial nas glândulas salivares maiores, seguido de radioterapia e em casos selecionados quimioterapia adjuvante. O objetivo desta revisão é fornecer ao leitor uma abordagem histórica sobre o tratamento das doenças das glândulas salivares, com especial atenção às doenças da glândula parótida assim como peculiaridades associadas aqueles que as estudaram ao longo da história.


ABSTRACT Salivary gland neoplasms are a relatively uncommon disease, with nearly one case per 100.000 adults estimated per year and an overall incidence of 1% of all neoplasms. The benign neoplasms are majority and the prognosis depends on the histologic type, grade, localization, soft tissue infiltration, regional and distant metastasis. The main treatment is surgery with caution to facial nerve in the major salivary glands, followed by radiotherapy and chemotherapy in selected cases. The objective of this review is to provide the lector an historic approach about salivary gland diseases treatment, with special attention to the parotid neoplasms and its peculiarities associated to those who studied these glands in their history course.


Subject(s)
Humans , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , Salivary Gland Neoplasms/surgery , Salivary Gland Neoplasms/history , Oral Surgical Procedures/history , History, Ancient , History, Medieval
10.
Acta cir. bras ; 31(2): 92-102, Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-775568

ABSTRACT

PURPOSE The parotidectomy technique still has an elevated paresis and paralysis index, lowering patient life's quality. The correct identification of the facial nerve can prevent nerve damage. Fluorescent dye identifies nerves in experimental studies but only few articles focused its use on facial nerve study in parotidectomies. We aimed to stain the rat facial nerve with fluorescent dye to facilitate visualization and dissection in order to prevent injuries. METHODS Forty adult male Wistar rats were submitted to facial injection of saline solution (Gsf-control group, 10) or fluorescent dye solution (Gdye group, 30) followed by parotidectomy preserving the facial nerve, measuring the time for localization and facility of localization (LocTime and LFN). Nerve function was assessed using the Vibrissae Movements (PMV) and Eyelid Closure Motion (PFP) scores. RESULTS Nerve localization was faster in Gdye group, with 83% Easy LFN rate. The Gdye group presented with low nerve injury degree and better PMV and PFP scores, with high sensitivity and accuracy. CONCLUSIONS This experimental method of facial nerve fluorescence was effective for intraoperative nerve visualization, identification and preservation. The technique may be used in future facial nerve studies, translated to humans, contributing to the optimization of parotid surgery in the near future.


Subject(s)
Animals , Male , Parotid Gland/surgery , Carbocyanines/administration & dosage , Facial Nerve/surgery , Fluorescent Dyes/administration & dosage , Time Factors , Observer Variation , Sensitivity and Specificity , Rats, Wistar , Models, Animal , Dissection/methods , Microinjections/instrumentation , Microscopy, Polarization
12.
Rev. bras. cir. cabeça pescoço (Online) ; 43(3): 120-122, jul.-set. 2014.
Article in Portuguese | LILACS-Express | LILACS | ID: lil-733538

ABSTRACT

Introdução: A tireoidectomia é considerada um procedimento complementar para o tratamento de carcinomas epidermoides avançados de laringe e hipofaringe. Entretanto poucos dados apontam o real acometimento glandular e suas indicações para extirpação. Objetivos: Avaliar o real acometimento da glândula tireoide em pacientes que foram submetidos a laringectomias total ou faringolaringectomias com tireoidectomia por carcinoma epidermoide e comparar os resultados com a literatura mais recente. Casuística e Método: Avaliação retrospectiva dos últimos 20 (vinte) pacientes submetidos ao tratamento proposto no serviço de cirurgia de cabeça e pescoço da Universidade Federal de São Paulo / Escola Paulista de Medicina. Os dados epidemiológicos foram obtidos da revisão do prontuário médico. A avaliação final foi baseada no resultado do exame anatomopatológico definitivo. Resultados: A idade média encontrada foi de 61,7 anos, com uma prevalência de 85% do gênero masculino. Dezenove dos vinte pacientes eram tabagistas. Todos se encontravam em estádios avançados da doença, 19(dezenove) em estádio IVA e 01(um) em III. A glândula tireoide apresentou acometimento pelo tumor em 05(cinco) casos. Conclusão: Nos pacientes submetidos a tireoidectomia complementar por carcinoma epidermoide avançado de laringe em nosso serviço encontramos 25% de comprometimento neoplásico da glândula tireoide, dado compatível com trabalhos recentes publicados por outros autores.


Introduction: Thyroidectomy is considered an additional procedure for the treatment of advanced squamous cell carcinomas of the larynx and hypopharynx . However few data indicate the actual glandular involvement and its indications for removal. Objectives: Assess the actual involvement of the thyroid gland in patients who underwent total laryngectomy with thyroidectomy for squamous cell carcinoma and compare the results with the recent literature. Materials and Methods: Retrospective evaluation of the last twenty (20) patients undergoing the proposed i treatmentn the service of the head and neck surgery at the Federal University of São Paulo / Escola Paulista de Medicina. Epidemiological data were obtained from review of medical records. The final evaluation was based on the outcome of the final pathology exam. Results: Mean age was 61.7 years, with a prevalence of 85% male gender. Nineteen of twenty patients were smokers. All were in advanced stages of disease, 19 (nineteen) in stage IVA and 01 in III. The thyroid gland showed involvement by tumor in five (05) cases. Conclusion: In patients undergoing thyroidectomy supplemented by advanced laryngeal squamous cell carcinoma in our hospital we found 25% of neoplastic involvement of the thyroid gland, as consistent with recent work published by other authors.

13.
Braz. j. otorhinolaryngol. (Impr.) ; 80(4): 318-324, Jul-Aug/2014. tab, graf
Article in English | LILACS | ID: lil-721407

ABSTRACT

INTRODUCTION: Several methods have been proposed to improve operative success in renal hyperparathyroidism. OBJECTIVE: To evaluate stereomicroscopy in parathyroid tissue selection for total parathyroidectomy with autotransplantation in secondary (SHPT)/tertiary (THPT) hyperparathyroidism. METHODS: 118 renal patients underwent surgery from April of 2000 to October 2009. They were divided into two groups: G1, 66 patients operated from April of 2000 to May of 2005, with tissue selection based on macroscopic observation; G2, 52 patients operated from March of 2008 to October 2009 with stereomicroscopy for tissue selection searching for the presence of adipose cells. All surgeries were performed by the same surgeon. Patients presented SHPT (dialysis treatment) or THPT (renal-grafted). Follow-up was 12-36 months. Intra-operative parathyroid hormone (PTH) was measured in 100/118 (84.7%) patients. RESULTS: Data are presented as means. G1 included 66 patients (38 SHPT, 24 females/14 males; 40.0 years of age; 28 THPT, 14 females/14 males; 44 years of age). G2 included 52 patients (29 SHPT, 11 females/18 males; 50.7 years of age; 23 THPT, 13 females/10 males, 44.4 years of age). SHPT patients from G2 presented preoperative serum calcium higher than those of SHPT patients in G1 (p < 0.05), suggesting a more severe disease. Definitive hypoparathyroidism was found in seven of 118 patients (5.9%). Graft-dependent recurrence occurred in four patients, two in each group. All occurred in dialysis patients. CONCLUSION: Stereomicroscopy in SHPT/THPT surgical treatment may be a useful tool to standardize parathyroid tissue selection. .


INTRODUÇÃO: Diversos métodos têm sido propostos com intuito de melhorar índices de sucesso cirúrgico no tratamento do hiperparatiroidismo associado à doença renal crônica (DRC). OBJETIVOS: Avaliar uso do estereomicroscópio na seleção de tecido paratiroideano na paratiroidectomia total com autoimplante em pacientes com DRC. MÉTODOS: 118 pacientes DRC operados entre 04/2000-10/2009 foram divididos em: G1-66 pacientes operados entre 04/2000-05/2005 cuja seleção de tecido foi realizada por método convencional (macroscopia); G2-52 pacientes operados entre 03/2008-10/2009, cuja seleção de tecido foi realizada com uso da estereomicroscopia: Leica-Stereomicroscope (amplificação: 10×-80×). Pacientes foram ainda categorizados em hiperparatiroidismo secundário (HPS) ou terciário (HPT) (HPS-diálise/HPT-transplantados renais). Seguimento pós-operatório: 12-36 meses. PTH intraoperatório medido 100/118 pacientes (84.7%). Todos pacientes foram operados pelo mesmo cirurgião. RESULTADOS: Dados em média. G1, 66 pacientes (38 HPS, 24f/14m; 40 anos; 28 HPT, 14f/14m; 44 anos). G2, 52 pacientes (29 HPS, 11f/18m; 50,7 anos; 23 HPT, 13f/10m; 44,4 anos). Pacientes dialíticos do G2 apresentaram cálcio pré-operatório maior que G1 (p < 0,05), sugerindo doença mais severa. Hipoparatiroidismo definitivo: 7/118 (5,9%) pacientes: G1, 4/66 (6%); G2, 3/52 (5,7%). Recorrência do hiperparatiroidismo no autoimplante: 4 pacientes, 2 em cada grupo. Todas foram em pacientes em diálise. CONCLUSÃO: Estereomicroscopia no tratamento do hiperparatiroidismo associado à DRC é útil na padronização da técnica de seleção de tecido para o autoimplante. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Autografts , Hyperparathyroidism, Secondary/surgery , Kidney Failure, Chronic/complications , Hyperparathyroidism, Secondary/etiology , Prospective Studies , Parathyroidectomy/methods , Treatment Outcome
14.
Rev. bras. cir. cabeça pescoço (Online) ; 43(2): 77-82, abr.-jun. 2014. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: lil-733529

ABSTRACT

Introdução: As neoplasias de glândulas salivares correspondem a cerca de 3% a 10% dos tumores em cabeça e pescoço, com incidência anual de 1/100.000 casos. A idade média é de 45 anos, no gênero feminino. Nas neoplasias benignas, a incidência anual é de 4,7%, mais da metade em glândulas salivares maiores e tipo mais comum o Adenoma Pleomórfico. As neoplasias malignas tem incidência anual de 0,9%, gênero masculino e Carcinoma Mucoepidermóide em glândulas parótidas. Objetivo: Determinar as características demográficas, clínicas e histológicas dos pacientes tratados por neoplasias de glândulas salivares na UNIFESP retrospectivamente no período de 10 anos. Material e Métodos: Análise retrospectiva dos prontuários de pacientes tratados por neoplasias de glândulas salivares no Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Universidade Federal de São Paulo-UNIFESP, no período de 10 anos (2002 a 2012). Para análise descritiva utilizou-se o Microsoft Excel 2011 e teste t-student com significância p<0,05. Resultados: As mulheres compreenderam 55%, maioria entre as neoplasias malignas (60%) e benignas (85%), idade média de 52 anos. Sintoma inicial de dor: 62,5% das malignas e 18,9% das benignas. Tempo médio de apresentação de 4,6 anos para as malignas e 2,7 anos para as benignas, diagnóstico com a punção em 89,4%. Ambas neoplasias acometeram a glândula parótida (81,9%). O Carcinoma Mucoepidermóide e o Adenoma Pleomórfico foram os mais comuns. Complicações ocorreram em 23,4%: paralisia facial periférica (13,8%) e hematomas (6,4%). Conclusões: Os dados epidemiológicos, a sensibilidade, especificidade e acurácia da punção concordam com a literatura. Maior incidência de neoplasias em parótida, mais comum o Carcinoma mucoepidermóide. A Parotidectomia com preservação do facial, com ou sem esvaziamento cervical foi a cirurgia mais comum realizada e maior incidência de metástases cervicais ocultas.


Introduction: The salivary gland neoplasms are about 3% to 10% of all head and neck tumors, with annual incidence of 1/100.000 habitants. The medium age of presentation is 45 years in the female. In the benign neoplasms, the annual incidence is 4,7%, more than half in the major salivary glands and the pleomorfic adenoma is the commonest subtype. The malignant neoplasms has 0,9% of annual incidence, being more common in the male and the Mucoepidermoid subtype in the parotid gland. Objective: To determine retrospectively the clinical, demographic and histopathological characteristics of a consecutive series of surgical treated patients due salivary gland neoplams in the UNIFESP in a ten years period. Material and Methods: Retrospective analisys from clinical data of treated patients due salivary gland neoplasms in the Otorhinolaryngology Head and Neck Surgery Department at Sao Paulo Federal University in a ten years period (2002-2012). The Microsoft excel was used to descriptive analisys with t-student with p<0,05 significance. Results: The female patients were 55% of all, even in the malignant neoplasms (60%) or in the benign ones (85%). The medium age was 52 years and the initial symptom was pain in 62,5% of the malignant and in the 18,9% in the benign neoplasms. The main time of duration of symptoms was 4,6 and 2,7 years for the malignant and benign neoplasms respectively. In 89,4% of patients the diagnosis was made by the aspirative biopsy. The parotid gland was majority in both malignant and benign histology (81,9%), the Mucoepidermoid carcinoma and the pleomorfic adenoma were the commonest histology. Complications occurred in 23,4% of the patients, divided in periferic facial paralysis (13,8%) and hematoma (6,4%). Conclusion: The epidemiological data, the sensivity, especificity and accuracy of aspirative biopsy agree with the current literature. The parotid was the principal gland with disease and the mucoepidermoid carcinoma the main malignant neoplasm. Parotidectomy with preservation of the facial nerve, followed by neck dissection was the commonest surgery and we found a higher incidence of occult lymph node metastasis.

15.
Braz. j. otorhinolaryngol. (Impr.) ; 79(4): 494-499, jul.-ago. 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-681895

ABSTRACT

Avaliamos medida de PTH intraoperatório (IO-PTH) no intuito de melhorar índices de sucesso no tratamento cirúrgico do hiperparatiroidismo associado à doença renal. MÉTODO: Oitenta e seis pacientes realizaram paratiroidectomia total com autoimplante em musculatura pré-esternal entre abril de 2000 e outubro de 2009 com 26,5 meses de seguimento em média, prospectivo. Foram divididos em dois grupos: hiperparatiroidismo secundário (HPS) - pacientes em diálise e hiperparatiroidismo terciário (HPT) - transplantados renais. Medido IO-PTH (Elecsys-PTH-Immunoassay/Roche) na indução anestésica (IOPTH-0') e 20 minutos (IOPTH-20') após a retirada das paratireoides. RESULTADOS: 80,2% (69/86) do total de pacientes apresentaram queda de 80% ou mais do IOPTH-20' e todos se curaram. Em 11/86 (12,7%) pacientes, foi observada queda entre 70-79%, sendo que dois (18,1%) deles evoluíram com falha cirúrgica. 6/86 (6,9%) pacientes apresentaram redução de IOPTH-20' menor do que 70%: dois foram curados; três apresentaram paratireoide supranumerária/ectópica que foi localizada e removida; um paciente evoluiu com persistência da doença após término da cirurgia com a retirada de quatro paratireoides. CONCLUSÃO: Queda do IOPTH-20' de 80% ou mais foi preditor de cura em todos os pacientes renais durante o período avaliado. Redução menor que 70% sugere paratireoide hiperfuncionante não reconhecida/supranumerária, sendo preditor de falha cirúrgica em 66.6%. A queda marginal de 70%-79% delega ao cirurgião experiente a decisão de continuar ou não o procedimento cirúrgico.


In order to improve success rates in surgery of renal hyperparathyroidism, we evaluated intraoperative PTH (IOPTH) measurement utility. METHOD: 86 patients underwent total parathyroidectomy with intramuscular presternal autotransplantation from 04/2000 to 10/2009 and were followed for 26.5 months on average (prospective cohort). Patients were divided in secondary (SHPT) and tertiary hyperparathyroidism (THPT). SHPT group was composed by patients under dialysis treatment, THPT group included renal grafted ones. IOPTH (Elecsys-PTH-Immunoassay/Roche) was measured at anesthesia induction (IOPTH-0') and 20 minutes (IOPTH-20') after parathyroidectomy. RESULTS: 80.2% (69/86) presented with 80% decrease or more in the IOPTH-20' and all were cured. In 11/86 patients (12.7%), a lower IOPTH-20' drop (70-79%) was observed, and 2 of them (18.1%) failed to cure. 6/86 (6.9%) patients presented IO-PTH-20' decrease of less than 70%: two were cured, in three a supernumerary/ectopic parathyroid was found and removed, and in one of these six patients, surgery was finished after 4-gland excision and the patient failure to cure. CONCLUSION: IOPTH-20' decrease of 80% or more compared to IOPTH-0' predicts cure in all renal patients throughout follow-up. A decay of less than 70% points to missed or hyperfunctioning supernumerary gland and is predictive of surgical failure in 66.6%. A marginal IOPTH drop of 70-79% leaves the decision whether or not surgery should be continued up to the experienced surgeon.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Hyperparathyroidism, Secondary/blood , Parathyroid Hormone/blood , Biomarkers/blood , Cohort Studies , Hyperparathyroidism, Secondary/etiology , Hyperparathyroidism, Secondary/surgery , Kidney Transplantation , Monitoring, Intraoperative , Prospective Studies , Parathyroid Glands/transplantation , Parathyroidectomy/methods , Recurrence , Renal Dialysis , Treatment Outcome , Transplantation, Autologous/methods
16.
Article in Portuguese | LILACS-Express | LILACS | ID: lil-671035

ABSTRACT

O hemangiopericitoma é um tumor raro em cabeça e pescoço, comlocalização mais frequente na cavidade nasossinusal. Em 1942,quando Stout e Murray aplicaram o termo ?hemangiopericitoma?para essa neoplasia, verificaram que não havia característicasmacroscópicas que permitissem seu reconhecimento ediagnóstico. O tratamento de escolha em qualquer localização éa ressecção cirúrgica ampla, com margens oncológicas. A via deacesso transmento-transglosso é uma boa opção para tumoreslocalizados em parede posterior de orofaringe. O objetivo denosso estudo é relatar um caso de um hemangiopericitomalocalizado em valécula em um paciente jovem do sexo masculino,dada a raridade deste tipo de tumor nessa topografia, bem comodescrever o acesso cirúrgico utilizado.

17.
Arq. bras. endocrinol. metab ; 57(1): 79-86, fev. 2013. ilus, tab
Article in English | LILACS | ID: lil-665766

ABSTRACT

We hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma removal.


O presente artigo descreve o relato de dois pacientes com carcinoma de paratiroide que apresentavam valores intensamente elevados de cálcio sérico e de PTH, associado a doença óssea e presença de nódulo cervical palpável ao diagnóstico. Ambos foram submetidos à paratiroidectomia, sendo que um evoluiu com metástases pulmonares. Hipocalcemia importante foi observada após a paratiroidectomia em um paciente e somente após remoção cirúrgica das metástases pulmonares em outro. Ambos necessitaram de reposição endovenosa de cálcio, revelando, assim, o estado de fome óssea (FO). A presença da FO usualmente reflete rápida mineralização óssea após correção do hiperparatiroidismo; assim, quanto mais severa a doença óssea previa à cirurgia, maior será a FO observada no pós-operatório desses pacientes. Embora inicialmente considerada um evento indesejável, a FO representa a bem-sucedida remoção cirúrgica do tecido paratiroideano hipersecretor. Fome óssea deve ser esperada no pós-operatório do tratamento cirúrgico bem-sucedido do carcinoma de paratiroide.


Subject(s)
Adult , Aged , Female , Humans , Hypocalcemia/etiology , Parathyroid Neoplasms/surgery , Parathyroidectomy/adverse effects , Calcium/administration & dosage , Carcinoma/secondary , Carcinoma/surgery , Lung Neoplasms/secondary , Postoperative Period , Parathyroid Neoplasms/pathology , Syndrome
19.
Arq. bras. endocrinol. metab ; 56(3): 168-172, Apr. 2012. ilus
Article in English | LILACS | ID: lil-626267

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.


OBJETIVO: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. SUJEITOS E MÉTODOS: Foram estudados quarenta pacientes submetidos à tireodiectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. RESULTADOS: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. CONCLUSÃO: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia total.


Subject(s)
Female , Humans , Middle Aged , Calcium/blood , Hypocalcemia/etiology , Parathyroid Hormone/blood , Thyroidectomy/adverse effects , Biomarkers/blood , Calcium/administration & dosage , Hypocalcemia/diagnosis , Hypocalcemia/therapy , Parathyroid Glands , Predictive Value of Tests , Preoperative Care , Prospective Studies , Risk , Vitamin D/administration & dosage , Vitamins/administration & dosage
20.
Article in Portuguese | LILACS-Express | LILACS | ID: lil-639243

ABSTRACT

Nódulos tireoideanos são afecções muito frequentes napopulação adulta. A pesquisa diagnóstica de nódulos tireoideanosinclui, além de exames laboratoriais, exame ultrassonográfico eexame citopatológico representado pela Punção Aspirativa porAgulha Fina (PAAF). O exame citopatológico representa peçachave na indicação cirúrgica diante da suspeita de malignidade.Apesar da acurácia do método diagnóstico, existe uma parcelaconsiderável de achados incidentais de malignidade no examehistopatológico final das tireoidectomias. Foram estudados 171pacientes submetidos à tireoidectomia, sendo que 63 pacientestiveram diagnóstico de malignidade confirmado no examehistopatológico e desses, 25 (39,68%) foram achados incidentais.

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