[Oral cancer surgery and oral cutaneous fistulas: risk factors]. / Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS: A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco / Oral cancer surgery and oral cutaneous fistulas: risk factors

OBJETIVO: Quantificar as fístulas após cirurgia de câncer da cavidade oral e identificar fatores de risco. MÉTODOS: Estudo retrospectivo, interessando pacientes submetidos à cirurgia. Seguimento pós-operatório mínimo de dois anos. Variáveis estudadas: sexo, comorbidades, tabagismo, etilismo, risco anestésico e pulmonar, estadiamento clínico, linfadenectomia cervical, tratamento radioterápico, acidentes cirúrgicos, infecção ou deiscência de ferida operatória, seroma ou hematoma de sítio cirúrgico, infecção respiratória no pós-operatório, tipo de cirurgia e reconstrução realizadas. RESULTADOS: Estudados 159 pacientes. Ocorreu fístula orocutânea em 30,3 por cento (48 pacientes). Pacientes T3 tiveram fístula em 16 por cento dos casos, T4 em 40,3 por cento e naqueles estádio T1 ou T2, 26,6 por cento e 1,8 por cento respectivamente (p=0,0138). Os casos N+ evoluíram com fístula em 22.9 por cento (N2c com 42,8 por cento, p=0,0136), os com radioterapia pré-operatória em 63,6 por cento (p=0,0346). Aqueles com infecção de sítio cirúrgico em 47,3 por cento (p=0,0146) e aqueles com deiscência de ferida operatória em 53,7 por cento (p=0,0030). O índice de fístula foi de 60 por cento nos retalhos regionais mucocutâneos, de 39,2 por cento nos miocutâneos e de 12,5 por cento com retalho microcirúrgico (p=0,0286). CONCLUSÃO: O índice de fístulas foi de 30,3 por cento. Foram estatisticamente significativos para ocorrência de fístulas: estádio T, linfadenectomia cervical bilateral, radioterapia pré ou pós-operatória, infecção e deiscência de ferida operatória, e o uso de retalhos para reconstrução.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS:A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3 percent): Patients stage T1 in 26,6 percent,T2 in 1,8 percent,T3 in 16 percent, and T4 in 40,3 percent (p=0,0138). The cases N+ developed fistulae in 22.9 percent, (N2c with 42,8 percent, (p=0,0136), those with preoperative radiotherapy in 63,6 percent (p=0,0346) Those with wound infection in 47,3 percent (p=0,0146), and those with wound deiscense in 53,7 percent (p=0,0030). The fistulae rate was of 60 percent in the regional mucocutaneous flaps reconstruction cases, 39,2 percent in the myocutaneous ones and 12,5 percent of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3 percent. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Accuracy, sensitivity and specificity of fine needle aspiration biopsy in salivary gland tumours: a retrospective study.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the course of a four year period. STUDY DESIGN: A retrospective study was carried out between 2001-2005 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosed during post-operative histopathology examination. RESULTS: A total of 106 cases of salivary gland tumours were considered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. The sensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in which FNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22), specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negative predictive value was 87.7% (50/57). CONCLUSIONS: Despite the high rate of inadequate samples obtained in the FNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity.

Sarcoma granulocítico de mama / Granulocytic sarcoma of breast

Sarcoma granulocítico é uma neoplasia maligna extramedular rara composta de mieloblastos e outros precursores granulocíticos que acomete pacientes leucêmicos. Manifesta-se menos comumente como precursor de leucemia e, nestes casos, o intervalo entre o tumor inicial e o aparecimento de sinais e sintomas de leucemia é de 6 meses em média. Raramente se apresenta como lesäo isolada sem manifestaçäo da leucemia. Relatos anteriores demonstram uma tendência ao tratamento quimioterápico sistêmico igual aquele preconizado para pacientes com leucemia mielóide aguda, mesmo quando ausente, acompanhado de radioterapia local. O presente estudo descreve uma paciente com diagnóstico de sarcoma granulocítico de mama em maio de 1987, com lesäo isolada, sem evidências de leucemia. Foi tratada com ressecçäo segmentar de mama e radioterapia, permanecendo assintomática sem recorrência neste período de 8 anos de acompanhamento.