Surgery remember@: an innovation to reduce surgical cancellations.

The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

Metaheuristics in the decentralization of SAMU bases using simulation in northeastern Brazil.

BACKGROUND AND OBJECTIVE: The growth of the urban population exerts considerable pressure on municipalities' public managers to focus their attention on providing emergency medical care that meets the growing demand for emergency pre-hospital medical care. Currently, there are a significant number of traffic accidents and other serious occurrences, such as heart attacks, drownings, epidemics, fires and disasters (floods, landslides, earthquakes) that demand a prompt and seamless response from pre-hospital medical care. As a result of such scenario, the present article endeavours to apply a dual-coverage mathematical model (DSM-Double Standard Model) to define the optimal location of the Emergency Medical Service (SAMU) decentralized dispatch bases in Natal/RN and conduct a simulation study to evaluate the displacement of ambulances between such bases. METHODS: The methodological course that was followed by this research constitutes of 12 steps. The location of decentralized bases for sending emergency ambulances was established using the DSM model and the simulation model was performed using the FlexSim© software version 2018 evaluating base coverage in relation to the total number of calls by demand points for different scenarios. RESULTS: The results obtained throughout the research demonstrated the feasibility of redefining the decentralized bases of SAMU/Natal ambulances as a strategy to reduce response time and guarantee compliance with performance parameters established by international organizations (the World Health Organization, for instance, establishes the time of 8 minutes for emergency medical service calls response). The simulation study showed a significant reduction in response time, by up to 60% in some cases. CONCLUSION: The proposition of new locations for the decentralized dispatch bases of the SAMU/Natal can provide an overall significant reduction on the ambulance response time, so as to contribute to expedite the initiation of treatment of patients, if necessary, sent to hospitals.

Surgery remember@: an innovation to reduce surgical cancellations / Surgery remember@: uma inovação para reduzir os cancelamentos cirúrgicos

ABSTRACT The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

RESUMO O uso de telefones celulares aumentou dramaticamente em todo o mundo. Essa revolução na comunicação entre os indivíduos tem impacto no cuidado ao paciente, apoiando sua autogestão e promovendo a responsabilidade compartilhada com os serviços de saúde. Tendo em vista que a melhoria da comunicação facilita o cumprimento dos procedimentos programados e reduz os cancelamentos cirúrgicos, o presente trabalho tem como objetivo desenvolver uma ferramenta de comunicação denominada Surgery Remember@ para mitigar as suspensões cirúrgicas por absenteísmo do paciente. O presente artigo é um estudo da produção tecnológica dividido em quatro capítulos: revisão de literatura; análise do perfil administrativo do hospital; desenvolvimento de software; e mapeamento de processos para implementação de software. Tendo em conta que nos últimos três anos o problema do absenteísmo foi a principal causa de cancelamentos cirúrgicos institucionais o desenvolvimento do Surgery Remember@ se apresenta como esforço para reduzir os cancelamentos de cirurgias, melhorando a eficiência e reduzindo custos. Sabe-se que o envio de mensagens três dias antes do procedimento cirúrgico possibilita a reposição de pacientes em caso de cancelamentos, otimizando os recursos humanos e materiais da sala cirúrgica. A confirmação da consulta pré-anestésica também é positiva, pois permite verificar a melhora da assistência perioperatória. Assim, além de viável e de fácil implementação, o software desenvolvido permite agregar outros recursos de acordo com a necessidade do usuário, mostrando-se uma ferramenta para redução de cancelamentos cirúrgicos.

Ergonomics and telework: A systematic review.

BACKGROUND: Telework has been widely studied by public and private organizations; however, in ergonomics, studies that focused on this topic are still sporadic. OBJECTIVE: Thus, this article endeavours to systematize the qualified scientific research related to ergonomics and teleworking to determine the main benefits and disadvantages and to identify the main issues addressed by authors. METHODS: A thorough research was conducted in the Scopus/Embase and Web of Science databases for this review. The following descriptors were used for the cataloguing of articles: "teleworking", "telecommuting", "telecommuters", "home office", "ergonomics" and "human factors". 36 studies were selected. RESULTS: The study highlights four relevant questions in the scientific literature: a) where is the discussion of these themes consolidated; b) what are the main descriptors related to the discussion; c) which journals and conferences establish a scientific debate on the topic; and d) what are its main advantages and disadvantages. CONCLUSIONS: Results suggest that telecommuting can be a valuable tool for balancing professional and family life, which helps to improve the well-being of workers; however, several factors can influence the overall remote working experience which leads to the need for companies to adopt unique strategies reflecting their unique situation.

Multi-criteria analysis in the health area: selection of the most appropriate triage system for the emergency care units in natal.

BACKGROUND: Multiobjective decision-making processes present a high degree of complexity in their solution, and tools such as multicriteria decision analysis appear as a way to facilitate the decision-makers' solution and ensure that the decision is made cohesively and efficiently. In the public health sector, decisions are even more delicate because they work not only with the direct influence of human needs, but also with limited financial resources. An important point for the emergency care units is the triage system, which consists of a pre-evaluation of the patients, classifying them according to the degree of life risk. Through triage, the patient can be attended more quickly and efficiently, streamlining the whole process. Thus, the present research endeavored to determine the most appropriate triage protocol for emergency healthcare units in Natal-RN city in Brazil and may help others less advanced countries to determine the most appropriate triage protocol for emergency healthcare. METHODS: In this study, we used the multicriteria analysis method known as FITradeoff. In addition, interviews and structured questionnaires applied with nurses, specialists and directors. RESULTS: Based on the questionnaires and preferences presented by the decision-makers, the Spanish Triage System was the most suitable protocol for the emergency care units, which presented with high ease of use and implementation. CONCLUSIONS: This study reached its main objective, which was to determine the most appropriate triage protocol. In addition, it was observed the possibility of new research, such as the development of a specific protocol for this emergency care units and the creation of an application software for this new protocol.

Response time in the emergency services. Systematic review

Abstract The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Response time in the emergency services. Systematic review.

The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer / Prevalência das alterações em tomografias computadorizadas de tórax em pacientes com câncer de cabeça e pescoço

Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Objetivo: avaliar a prevalência de alterações encontradas na tomografia computadorizada (TC) de tórax em pacientes com carcinoma epidermóide de cabeça e pescoço. Métodos: Foram analisadas retrospectivamente 209 TC de tórax de pacientes com carcinoma epidermoide de cabeça e pescoço. As alterações tomográficas foram estratificadas como: inflamatórias/infecciosas, parenquimatosas, nodulares incaracterísticas e nodulares metastáticas/tumorais Resultados: foram diagnosticadas alterações em 66,6 % dos exames. Destes, 25,3% representaram enfisema pulmonar; 18,8% micronódulos incaracterísticos; 12,9% metástases; 11,9% de linfonodomegalias torácicas; e, em 6,6%, foram detectadas tuberculose pulmonar ativa ou sequela, pneumonia ou sinais inflamatórios/infecciosos e espessamento ou derrame pleural. Conclusão: a prevalência de exames com alteração e o considerável índice de metástases detectadas, indicam que a TC de tórax deve ser solicitada para complementação diagnóstica e/ou estadiamento nos casos de câncer de cabeça e pescoço.

Extracranial neurogenic tumors of the head and neck, / Tumores neurogênicos extracranianos na cabeça e pescoço

ABSTRACT INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Resumo INTRODUÇÃO: Tumores dos nervos periféricos tipicamente derivam das células de Schwann da bainha dos nervos periféricos. Por serem incomuns, devem ser lembrados no diagnóstico diferencial pré-operatório. OBJETIVO: Relatar a experiência de serviço de referencia terciária. MÉTODO: De 1977 a 2013, 42 pacientes com tumores neurogênicos periféricos da cabeça e pescoço foram operados e analisados retrospectivamente. A confirmação diagnóstica pré-operatória deu-se por biópsia ou método de imagem. RESULTADOS: A média da idade foi de 41,7 anos, sendo 15 indivíduos (36%) do gênero masculino. O tamanho médio foi de 5,5 cm e 26 (61%) localizavam-se na face lateral do pescoço. A maior parte (39,9%) apresentou-se como tumor palpável assintomático. A maioria (39,9%) foi ressecadapor acesso cervical. A maioria originou-se de nervos cranianos. CONCLUSÕES: Tumores neurogênicos extracranianos apresentam-se com tamanho médio de 5,5 cm, na face lateral do pescoço, costumam originar-se de nervos cranianos e ser ressecados por via cervical.

Extracranial neurogenic tumors of the head and neck.

INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer.

OBJECTIVE: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. METHODS: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic/tumoral. RESULTS: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. CONCLUSION: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Análise do PET-CT no estadiamento do câncer epidermoide de cabeça e pescoço / Analysis of PET-CT in the staging of head and neck cancer

Introdução: O carcinoma epidermoide na cabeça e pescoçotem uma recidiva loco-regional em 40% dos casos em dois anos,tornando necessário o seguimento convencional e por meio deexames de imagens, somando-se a técnica do 18F-FDG-PET.Objetivo: Demonstrar os primeiros dois anos de indicações eresultados da PET-CT em uma instituição pública. Método: Estudoretrospectivo de 50 exames de julho de 2009 a junho de 2012,realizados consecutivamente em 49 pacientes com carcinomaepidermoide das vias aerodigestivas superiores de estádiosclínicos I (4,1%), II (10,2%), III (32,7%) e IV (53%). Resultados:Em 12 casos, o exame foi realizado durante o estadiamento inicial.Em quatro casos, a PET foi realizado por tumor primário oculto naapresentação inicial. A PET-CT foi realizada pós-tratamento em31 casos, sendo que houve mudança de estádio clínico em 12desses pacientes após a realização da PET-CT. Foram realizadosdois exames em pacientes sob cuidados paliativos com sobrevidasuperior à esperada, sendo um diagnosticado sem doença e outrocom segunda lesão. Conclusão: O diagnóstico e estadiamento docâncer na cabeça e pescoço fazem-se por meio de exame diretocom biópsia e exame histológico. Exames de imagem metabólicose anatômicos - PET-CT - auxiliam, especialmente, no diagnósticodas recidivas loco-regionais.

Conflitos de interesses na pesquisa médico-farmacológica / Conflicts of interest in the medical pharmacological research

A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinações, caminhando em direção ao respeito à dignidade da pessoa.

The clinical medical pharmacological research corresponds to the experimental application of specific drug in human beings. Such application aims to protect them from unacceptable adverse effects and its inefficiencywhen comparing with other possibilities, more efficient. Partnerships between the pharmaceutical industryand external researchers establish potential conflict of interest. Literature use for this work indicates that researches performed under the sponsorship of pharmaceutical industry have a high rate of favorable results,and the conflicts of interest represent gaps which may interfere the result. There are studies that compare theefficiency of different drugs, whereas others compare their costs. All results should be published, even whennegative. The present work concludes that the private sector must sponsor the science in order to improve human beings, especially to avoid diseases. However, it must keep its engagement in sponsoring the research withany influence on its methods, results and application, for a respectful understanding of the dignity of a person.

Valor da PET/CT na abordagem do câncer de cabeça e pescoço / Value of PET/CT in the approach to head and neck cancer

OBJETIVO: Avaliar a PET/CT na abordagem de pacientes com câncer de cabeça e pescoço. MATERIAIS E MÉTODOS: Estudo retrospectivo de 63 prontuários e exames de PET/CT de pacientes com câncer de cabeça e pescoço. RESULTADOS: Foram encontradas alterações em 76% dos exames. Destes, 7 (11%) foram considerados falso-positivos, com SUV < 5,0. A PET/CT mostrou-se negativa em 15 situações (24%). Dos 14 casos nos quais se utilizou o exame para estadiamento, em 3 (22%) houve aumento no estadiamento. CONCLUSÃO: A PET/CT mostra-se como exame de potencial valor na rotina de avaliação de pacientes com câncer de cabeça e pescoço, entretanto, necessitamos de maior número de casos para definirmos protocolo de uso.

OBJECTIVE: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. MATERIALS AND METHODS: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. RESULTS: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. CONCLUSION: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method.

Análise da concordância intra e inter-observadores na detecção das fraturas da face por meio da tomografia computadorizada / Intra and interobservers concordance analysis of face fractures detection through computed tomography

Introdução: A face está sujeita a agressões externas, encontrando-se em uma região propícia a ferimentos leves e graves, através de acidentes automobilísticos, esportivos, além de agressões, sendo a primeira zona de impacto do organismo a sofrer determinadas injúrias. A Traumatologia apresentou um importante desenvolvimento na área diagnóstica, com grandes avanços na tecnologia de obtenção de imagens para diagnóstico das fraturas faciais, como o desenvolvimento de novas técnicas de tomografia computadorizada como exame complementar no tratamento dos pacientes vítimas de traumas faciais. Objetivos: Avaliar a importância da tomografia computadorizada de face como meio diagnóstico dos traumatismos faciais através da análise de concordância intra e inter-observadores na detecção de fraturas da face por em pacientes vítimas de traumatismos faciais. Métodos: Para realização da análise de concordância foram utilizados 40 exames de tomografias computadorizadas de 40 pacientes vítimas de trauma facial atendidos entre os anos de 2000 e 2006. Os exames foram apresentados a dois observadores, em duas películas tomográficas para cada paciente observado, sendo uma contendo apenas cortes coronais e a outra com cortes axiais e foram interpretadas, com o objetivo de identificar a concordância intra e inter-observadores para a detecção das fraturas da face em dois intervalos diferentes (inicial e final ou A e B), com diferença de 30 dias do período inicial (A) para o período final(B). Para a análise da concordância intra e inter-observadores foi empregado o Índice Kappa (K) de Cohen (1960). Resultados: A eqüidade de valores encontrados nos dois intervalos de observação (A e B) reproduziu uma concordância considerada excelente para os observadores 1 e 2. Devido ao fato de que todos os valores serem exatamente iguais nos dois intervalos para o observador 1 e 2, mas diferentes entre eles, não se aplicou o índice Kappa para a análise intra-observadores 1 e 2. Na análise de...

Introduction: The face is subject to external aggressions since it is very liKely to minor as well as serious injuries. Such injuries can happen in a car accident or when practicing sports besides aggressions, because it is the first zone of impact of the organism bound to suffer certain injuries. The Traumatology presented an important development in the diagnostic area by achieving a significant breaKthrough in obtaining images for diagnosis of facial fractures, such as the development of new computerized tomography techniques as a complementary examination in the treatment of patients suffering from facial trauma. Objectives: To assess the importance of computed tomography of face as a means of diagnosing facial injuries through the analysis of concordance intra and inter-observers in the detection of fractures of the face of patients suffering from facial injuries. Methods: In order to do the concordance analysis 40 computed tomography scans were used from 40 patients victims of facial trauma attended between 2000 and 2006. The 40 computed tomography of face were presented to 2 observers, in two tomographic films for each patient observed, one containing only coronal sections and the other with axial images. Then they were interpreted, to identify the intra and inter observers concordance for the detection of fractures of the face in two different intervals (initial and final or A and B), with a thirty-day difference of the initial period (A) and the final period (B). For the analysis of the inter and intra-observers? concordance, the index Kappa (K) form Cohen (1960) was used. Results: The equality of values found in both intervals of observation (A and B) reproduced a concordance considered excellent for the observers 1 and 2. Due to the fact that all values are exactly equal in both intervals for observer 1 and 2, but different between them, the Kappa index was not applied for the analysis intra-observer 1 and 2. In the analysis of inter-observer...

The importance of pre-epiglottis space invasion in the treatment planning of larynx and hypopharynx cancer.

UNLABELLED: The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.

Assessment of carotid artery invasion by lymph node metastasis from squamous cell carcinoma of aero-digestive tract.

UNLABELLED: Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM: To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS: retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50% and from to 100%), and complex (0 to 25%; 26 to 50%; 51 to 75% and 76 to 100%). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS: The Kappa Index were moderate (0, 53%) for simple classification and minimum (0, 36%) for complex classification. CONCLUSIONS: The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

Correlation between clinical and imaging findings in patients with temporomandibular disorders / Correlação entre os achados clínicos e imaginológicos nas disfunções temporomandibulares

OBJETIVO: Verificar a relação entre sinais e sintomas observados no exame clínico de pacientes com diagnóstico de disfunção temporomandibular, conforme os resultados fornecidos pelo exame de ressonância magnética. MATERIAIS E MÉTODOS: Trinta pacientes que apresentavam sinais e sintomas de disfunção temporomandibular foram submetidos a exame clínico e de ressonância magnética. Cada exame de ressonância magnética de articulação temporomandibular foi interpretado, independentemente, por dois radiologistas experientes. Os exames de ressonância magnética foram realizados com 12 cortes de 3 mm de espessura, em orientação coronal (T1) em posição de boca fechada, cortes sagitais em posição de boca aberta e fechada (T1 e T2) e em abertura e fechamento progressivos, com intervalo de 5 mm, para reproduzir toda a extensão do movimento mandibular. A significância estatística entre a análise clínica dos pacientes com disfunção temporomandibular e os resultados obtidos no exame de ressonância magnética foi avaliada pelo teste kappa. RESULTADOS: Obteve-se, na análise interobservadores de imagens, concordância bruta do lado esquerdo e direito, respectivamente, de 56,7 por cento (kappa = 0,1) e 56,7 (kappa = 0). CONCLUSÃO: Não foi encontrada correlação entre o diagnóstico clínico da luxação discal e imagens de ressonância magnética.

OBJECTIVE: To correlate the signals and symptoms observed on clinical examination of patients with temporomandibular disorder with the results demonstrated by magnetic resonance imaging. MATERIALS AND METHODS: Thirty patients presenting with signs and symptoms of temporomandibular disorders underwent clinical evaluation and subsequent magnetic resonance imaging. The magnetic resonance imaging studies were independently evaluated by two experienced radiologists. Magnetic resonance imaging studies consisted of 12 images in coronal, T1-weighted sequences with 3 mm-thick slices with the mouth closed, sagittal, T1- and T2-weighted sequences with both open and closed mouth positions, and on progressive opening/closing movement at 5 mm intervals, in order to demonstrate the full mandibular movement. The statistical significance between the clinical findings in the evaluation of the patients and results found on the magnetic resonance imaging studies was analyzed by means the kappa test. RESULTS: Interobserver agreement was respectively 56.7 percent (kappa = 0.1) and 56.7 (kappa = 0) for the left and right sides. CONCLUSION: No correlation was found between the clinical and magnetic resonance imaging findings in the diagnoses of disc displacement.