Squamous cell carcinoma implantation in gastrostomy orifice. Case report / Implantação de carcinoma espinocelular em orifício de gastrostomia. Relato de caso

ABSTRACT Percutaneous endoscopic gastrostomy is used to provide enteral nutritional support for patients with obstructive oropharyngeal or esophageal neoplasms. The placement of the catheter is considered safe, with few complications. Despite this, a specific complication that is considered rare, has been increasingly described in the literature, i.e., metastasis of head and neck cancer in the gastrostomy stoma. In this report, we described a case of metastasis of squamous cell carcinoma of the larynx in the gastrostomy site, and discussed the possible etiologies and alternatives, seeking to reduce the incidence of this complication.

RESUMO A gastrostomia endoscópica percutânea é utilizada para oferecer suporte nutricional enteral para pacientes com neoplasias obstrutivas de orofaringe ou esôfago. A colocação da sonda é considerada segura, com poucas complicações. Apesar disso, uma complicação em particular, considerada rara, está sendo cada vez mais descrita na literatura: a metástase de neoplasia de cabeça e pescoço para o estoma da gastrostomia. Neste relato, descrevemos um caso de metástase de carcinoma espinocelular de laringe para o sítio da gastrostomia, e discutimos as possíveis etiologias e alternativas, buscando diminuir a incidência desta complicação.

Predictive factors of long-term stay in the icu after cardiac surgery: logistic casus score, serum bilirubin dosage and extracorporeal circulation time

Abstract Objective: To test the capacity of the Logistic CASUS Score on the second postoperative day, the total serum bilirubin dosage on the second postoperative day and the extracorporeal circulation time, as possible predictive factors of long-term stay in Intensive Care Unit after cardiac surgery. Methods: Eight-two patients submitted to cardiac surgery with extracorporeal circulation were selected. The Logistic CASUS Score on the second postoperative day was calculated and bilirubin dosage on the second postoperative day was measured. The extracorporeal circulation time was also registered. Patients were divided into two groups: Group A, those who were discharged up to the second day of postoperative care; Group B, those who were discharged after the second day of postoperative care. Results: In this study, 40 cases were listed in Group A and 42 cases in Group B. The mean extracorporeal circulation time was 83.9±29.4 min in Group A and 95.8±29.31 min in Group B. Extracorporeal circulation time was not significant in this study (P=0.0735). The level of P significance of bilirubin dosage on the second postoperative day was 0.0003 and an area under the ROC curve of 0.708 with a cut-off point at 0.51 mg/dl was registered. The level of P significance of Logistic CASUS Score on the second postoperative day was 0.0001 and an area under the ROC curve of 0.723 with a cut-off point at 0.40% was registered. Conclusion: The Logistic CASUS Score on the second postoperative day has shown to be better than the bilirubin dosage on the second postoperative day as a predictive tool for calculating the length of stay in intensive care unit during the postoperative care period of patients. Notwithstanding, extracorporeal circulation time has failed to prove itself as an efficient tool to predict an extended length of stay in intensive care unit.