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1.
Clinics (Sao Paulo) ; 77: 100022, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35306374

RESUMO

OBJECTIVE: To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. METHODS: Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. RESULTS: A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). CONCLUSION: Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina/métodos , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia
2.
Clinics ; Clinics;77: 100022, 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1375195

RESUMO

Abstract Objective To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. Methods Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. Results A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). Conclusion Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.

3.
Clinics (Sao Paulo) ; 74: e605, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531572

RESUMO

OJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.


Assuntos
Anestesia Geral/efeitos adversos , Bloqueio do Plexo Cervical/métodos , Dor Pós-Operatória/prevenção & controle , Tireoidectomia/métodos , Adulto , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do Tratamento
4.
Clinics ; Clinics;74: e605, 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1039555

RESUMO

OJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Tireoidectomia/métodos , Bloqueio do Plexo Cervical/métodos , Anestesia Geral/efeitos adversos , Dor Pós-Operatória/etiologia , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do Tratamento , Analgésicos Opioides/efeitos adversos
5.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);64(8): 710-716, Aug. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-976847

RESUMO

INTRODUCTION Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. Objective To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. Material and methods 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. Results Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. Conclusion There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).


RESUMO INTRODUÇÃO As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. OBJETIVO Analisar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral, submetidos a operações radicais com intenção curativa. MATERIAL E MÉTODOS 47 pacientes portadores de carcinoma espinocelular de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Os pacientes foram submetidos ao teste de qualidade de vida após o tempo mínimo de seis meses do tratamento cirúrgico. RESULTADOS Dos 183 pacientes, com apenas 47 (25,7%) foi possível a realização da entrevista, compondo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos. A maioria dos pacientes apresentava estadiamento clínico IV (83%), sendo submetidos à radioterapia adjuvante (95,4%). A média do escore obtido após a avaliação dos questionários foi de 64,6. Os piores escores foram encontrados nos quesitos deglutição e mastigação. CONCLUSÃO Não houve diferenças estatisticamente significativas nos domínios de qualidade de vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea). Pacientes entrevistados dois anos ou mais após o tratamento apresentaram escores superiores (p=0,02).


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Qualidade de Vida , Neoplasias Bucais/cirurgia , Carcinoma de Células Escamosas/cirurgia , Osteotomia Mandibular/métodos , Reconstrução Mandibular/métodos , Fatores Socioeconômicos , Fatores de Tempo , Neoplasias Bucais/fisiopatologia , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas/fisiopatologia , Carcinoma de Células Escamosas/patologia , Modelos Lineares , Estudos Transversais , Inquéritos e Questionários , Análise de Variância , Resultado do Tratamento , Distribuição por Sexo , Distribuição por Idade , Pessoa de Meia-Idade , Estadiamento de Neoplasias
6.
Clinics (Sao Paulo) ; 73: e370, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29846414

RESUMO

OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.


Assuntos
Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/patologia , Ultrassonografia , Adulto Jovem
7.
Rev Assoc Med Bras (1992) ; 64(8): 710-716, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30673041

RESUMO

INTRODUCTION: Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. OBJECTIVE: To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. MATERIAL AND METHODS: 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. RESULTS: Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. CONCLUSION: There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).


Assuntos
Carcinoma de Células Escamosas/cirurgia , Osteotomia Mandibular/métodos , Reconstrução Mandibular/métodos , Neoplasias Bucais/cirurgia , Qualidade de Vida , Adulto , Distribuição por Idade , Idoso , Análise de Variância , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/fisiopatologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/fisiopatologia , Estadiamento de Neoplasias , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
8.
Clinics ; Clinics;73: e370, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-952815

RESUMO

OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/patologia , Estudos Retrospectivos , Ultrassonografia , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/patologia , Medição de Risco , Biópsia por Agulha Fina , Diagnóstico Diferencial , Biópsia Guiada por Imagem
9.
Arch. endocrinol. metab. (Online) ; 61(4): 348-353, July-Aug. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-887582

RESUMO

ABSTRACT Objective This study aims to compare the prevalence of laryngopharyngeal reflux signs between two groups of patients undergoing thyroidectomy for voluminous goiter: substernal goiters and voluminous cervical goiter without thoracic extension. Subjects and methods A retrospective case-control study was performed with data retrieved of the charts of the patients submitted to thyroidectomies occurred at a tertiary care center (Head and Neck Surgery Department, University of São Paulo Medical School) between 2010 and 2014. The selected thyroidectomies were allocated in two groups for study: patients with substernal goiters and patients with voluminous cervical goiter without thoracic extension. Cervical goiters were selected by ultrasonography mensuration. Clinical criterion was used to define substernal goiter. Results The average thyroid volume in patients with substernal goiter was significantly greater than the average volume in patients with only cervical goiter (p < 0.001). The prevalence of signs of reflux laryngitis at laryngoscopy was significantly greater in substernal goiter patients (p = 0.036). Moreover, substernal goiter was considered as the unique independent variable for high reflux laryngitis signs at laryngoscopy (OR = 2.75; CI95%: 1.05-7.20; p = 0.039) when compared to only cervical goiter patients. Conclusion This study shows a significant association between substernal goiters and signs of laryngopharyngeal reflux at preoperative laryngoscopy. Therefore, when compared with voluminous cervical goiters, the substernal goiters increase the chance of reflux laryngitis signs in patients.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Refluxo Laringofaríngeo/epidemiologia , Bócio Subesternal/epidemiologia , Tireoidectomia , Estudos de Casos e Controles , Prevalência , Estudos Retrospectivos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico por imagem , Bócio/cirurgia , Bócio/complicações , Bócio/fisiopatologia , Bócio/epidemiologia , Bócio Subesternal/cirurgia , Bócio Subesternal/complicações , Bócio Subesternal/fisiopatologia , Laringoscopia
10.
Arch. endocrinol. metab. (Online) ; 59(5): 428-433, Oct. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-764110

RESUMO

ObjectiveThe aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy.Materials and methodsOne hundred and forty medical records, which contained patients’ clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels.ResultsThere was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism.ConclusionIn conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.


Assuntos
Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cálcio/sangue , Hipoparatireoidismo/diagnóstico , Complicações Pós-Operatórias/etiologia , Tireoidectomia/efeitos adversos , Hipocalcemia/prevenção & controle , Hipoparatireoidismo/sangue , Hipoparatireoidismo/etiologia , Período Pós-Operatório , Hormônio Paratireóideo/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo
11.
Arch Endocrinol Metab ; 59(5): 428-33, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26201010

RESUMO

OBJECTIVE: The aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy. MATERIALS AND METHODS: One hundred and forty medical records, which contained patients' clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels. RESULTS: There was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism. CONCLUSION: In conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.


Assuntos
Cálcio/sangue , Hipoparatireoidismo/diagnóstico , Complicações Pós-Operatórias/etiologia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Hipocalcemia/prevenção & controle , Hipoparatireoidismo/sangue , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Período Pós-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
12.
Arq Bras Endocrinol Metabol ; 58(4): 402-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24936737

RESUMO

Solitary fibrous tumor (SFT) is an uncommon spindle-cell neoplasm that most often involves the pleura, rarely occurring in extra-thoracic locations. Twenty-six cases of SFT arising in the thyroid gland have been described. We report a case of a 60-year-old woman presenting an 8-month history of enlargement of the neck associated with dysphagia. The patient underwent a right hemithyroidectomy and SFT of the thyroid was diagnosed. Immunohistochemistry showed positivity for CD34 marker, and the high number of mitoses and the presence of cellular atypia suggested that the tumor was malignant. To our knowledge, this is the second case of malignant SFT of the thyroid gland ever reported. Due to the rarity of these tumors, the indication of adjuvant therapy and prognosis are uncertain. Long-term follow-up after surgical resection seems to be advisable.


Assuntos
Carcinoma/patologia , Doenças Raras/patologia , Tumores Fibrosos Solitários/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idade de Início , Antígenos CD34/análise , Carcinoma/cirurgia , Feminino , Seguimentos , Humanos , Assistência de Longa Duração , Pessoa de Meia-Idade , Doenças Raras/cirurgia , Tumores Fibrosos Solitários/cirurgia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
13.
Arq. bras. endocrinol. metab ; Arq. bras. endocrinol. metab;58(4): 402-406, 06/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-711639

RESUMO

Solitary fibrous tumor (SFT) is an uncommon spindle-cell neoplasm that most often involves the pleura, rarely occurring in extra-thoracic locations. Twenty-six cases of SFT arising in the thyroid gland have been described. We report a case of a 60-year-old woman presenting an 8-month history of enlargement of the neck associated with dysphagia. The patient underwent a right hemithyroidectomy and SFT of the thyroid was diagnosed. Immunohistochemistry showed positivity for CD34 marker, and the high number of mitoses and the presence of cellular atypia suggested that the tumor was malignant. To our knowledge, this is the second case of malignant SFT of the thyroid gland ever reported. Due to the rarity of these tumors, the indication of adjuvant therapy and prognosis are uncertain. Long-term follow-up after surgical resection seems to be advisable.


O tumor fibroso solitário (SFT) é uma neoplasia rara de células fusiformes que mais frequentemente envolve a pleura, raramente ocorrendo em áreas extratorácicas. Já foram descritos 26 casos de SFT da tiroide. Relatamos o caso de uma paciente de 60 anos de idade com um histórico de 8 meses de aumento do pescoço associado à disfagia. A paciente foi submetida a uma hemitiroidectomia direita e foi diagnosticado um SFT de tiroide. A imuno-histoquímica mostrou resultados positivos para o marcador CD34, e o grande número de mitoses e a presença de atipia celular sugerem que o tumor era maligno. Em nosso conhecimento, este é o segundo caso de STF da tiroide maligno já relatado. Dada a rara ocorrência desses tumores, a indicação de tratamento adjuvante e o prognóstico são incertos. Recomenda-se o acompanhamento de longo prazo depois da ressecção cirúrgica.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Carcinoma/patologia , Doenças Raras/patologia , Tumores Fibrosos Solitários/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idade de Início , /análise , Carcinoma/cirurgia , Seguimentos , Assistência de Longa Duração , Doenças Raras/cirurgia , Tumores Fibrosos Solitários/cirurgia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
14.
Rev. bras. cir. cabeça pescoço ; 38(1): 4-9, jan.-mar. 2009. graf, tab
Artigo em Português | LILACS-Express | LILACS | ID: lil-507528

RESUMO

Introdução: O hiperparatireoidismo foi considerado uma doença rara no Brasil, mas o incremento no diagnóstico tem ocasionado aumento na demanda de tratamento. Apesar do desenvolvimento de novos medicamentos, o tratamento cirúrgico ainda é considerado importante. Mesmo com os avanços tecnológicos de localização, a experiência do cirurgião prevalece como fator determinante dos resultados da operação. Desse modo, a avaliação da aquisição de competência do médico residente nesse tipo de operação é uma obrigação da instituição de ensino. Ela deve criar instrumentos para essa avaliação. Objetivo: Descrever o instrumento de avaliação do ensino de operações de paratireóide desenvolvido em uma instituição universitária e seus resultados preliminares. Métodos: Analisaram-se os resultados dos instrumentos aplicados aos médicos residentes no ano de 2007. Os formulários foram preenchidos por diferentes supervisores com a análise de aspectos psicomotores, cognitivos e afetivos. Durante o período analisado, houve a aplicação de dois instrumentos diferentes, em etapas seqüenciais. Resultados: Houve nove avaliações em cada instrumento. No formulário com três conceitos (fraco, regular e bom), quanto aos aspectos psicomotores houve 82,5% de regular e 17,5% de bom. Nos aspectos afetivos, 29,6% de regular e 70,4% de bom. No protocolo com cinco conceitos (muito fraco, fraco, regular, bom, muito bom), nos aspectos psicomotores observaram-se 22,2% de regular, 58,7% de bom e 19,1% de muito bom. Em relação aos aspectos afetivos, houve 1,6% de muito fraco, 4,8% de fraco, 14,3% de regular, 47,6% de bom e 31,7% de muito bom. Conclusões: A mudança no protocolo de avaliação aparentemente permitiu discriminação melhor dos aspectos afetivos.


Introduction: Hyperparathyroidism was considered a rare disease in Brazil, but the increment in diagnosis has increased the need for treatment. Although new drugs have been developed, surgery is still considered an important therapy. Albeit the improvement in parathyroid localizing imaging studies, results of the operation are still affected by the experience of the surgeon. Thus, evaluation of residents' skills in this of operation is mandatory to teaching institutions. The institution should develop instruments for this evaluation. Objective: To report the initial experience with a rating system for evaluating parathyroid surgery teaching. Methods: The results of evaluation forms applied to head and neck surgery residents in the year of 2007 were analyzed. The evaluation was performed by different supervising surgeons and it included cognitive, operative skills and behavioral aspects. There were two different forms, developed consecutively. Results: Nine forms were filled for each type of chart. Regarding the chart with three possible options (poor, regular and good) the results for operative skills were 82.5% of regular and 17.5% of good. In behavioral aspects there were 29.6% of regular and 70.4% of good. In the forms with five possibilities (very poor, poor, regular, good, very good) there were 22.2% of regular, 58.7% of good and 19.1% of very good for technical skills aspects. In behavioral aspects, there were 1.6% of very poor, 4.8% of poor, 14.3% of regular, 47.6% of good and 31.7% of very good. Conclusion: The modification of the evaluation chart apparently improved the analysis of the behavioral aspects.

15.
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 55(4): 113-20, July-Aug. 2000. ilus, tab
Artigo em Inglês | LILACS | ID: lil-275063

RESUMO

We prospectively studied the effects of the ligation of the inferior thyroid artery (ITA) on postoperative hypoparathyroidism in 48 patients who underwent functional subtotal thyroidectomy. Patients were randomized into two groups: A, with bilateral ligation of the ITA and B, without ligation of the ITA. Parathyroid function was checked preoperatively and after surgery by clinical examination and measurement of total calcium, intact PTH, urinary calcium, and AMPc. RESULTS: A significant incidence of postoperative hypocalcemia occurred: 17 percent in group A and 13 percent in B on the 4th postoperative day. Six months later, the incidence was 5 percent in Group A and 0 percent in Group B. These differences were not statistically significant between the two groups, and neither were any of the other clinical and laboratory observations. CONCLUSION: The ligation of the ITA was not an important causal factor for the occurrence of postoperative hypocalcemia after subtotal thyroidectomy


Assuntos
Humanos , Masculino , Feminino , Doença de Graves/cirurgia , Hipocalcemia/etiologia , Glândulas Paratireoides/fisiopatologia , Glândula Tireoide/irrigação sanguínea , Tireoidectomia/métodos , Artérias/cirurgia , Cálcio/sangue , Cálcio/urina , AMP Cíclico/urina , Ligadura , Hormônio Paratireóideo/sangue , Período Pós-Operatório , Estudos Prospectivos , Tireoidectomia/efeitos adversos
16.
In. Parise Junior, Orlando. Câncer de boca: aspectos básicos e terapêuticos. Säo Paulo, Sarvier, 2000. p.206-11. (BR).
Monografia em Português | LILACS, BBO - Odontologia | ID: lil-298369
17.
Rev. med. (Säo Paulo) ; 77(3): 138-42, maio-jul. 1998. ilus, tab
Artigo em Português | LILACS | ID: lil-236678

RESUMO

Os tumores da laringe tem como caracteristica principal determinar disturbios da fala e da degluticao. Assim, as caracteristicas epidemiologicas, o quadro clinico, os exames necessarios para o diagnostico, o estadiamento e os diferentes tipos de tratamento serao discutidos


Assuntos
Humanos , Diagnóstico Clínico , Diagnóstico por Imagem , Neoplasias Laríngeas/cirurgia , Fatores de Risco , Estadiamento de Neoplasias , Carcinoma de Células Escamosas , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/terapia
18.
Rev. med. (Säo Paulo) ; 77(3): 149-57, maio-jul. 1998. ilus, tab
Artigo em Português | LILACS | ID: lil-236680

RESUMO

Os diferentes tipos de esvaziamentos cervicais e suas indicacoes sao discutidos em conjunto com uma breve revisao da sua evolucao historica e da divisao das cadeias linfaticas cervicais em uso corrente pelos cirurgioes. De 1993 a 1997, foram realizados 508 esvaziamentos na Disciplina de Cirurgia de Cabeca e Pescoco da Faculdade de Medicina da Universidade de Sao Paulo. Desses, 123 relacionaram-se ao tratamento de neoplasias da glandula tireoide e 385 a outros tumores, principalmente o carcinoma epidermoide da mucosa de revestimento das vias aereas e digestivas do segmento cervical e cefalico


Assuntos
Humanos , Esvaziamento Cervical , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Esvaziamento Cervical/classificação , Esvaziamento Cervical/história , Procedimentos Cirúrgicos Operatórios , Carcinoma de Células Escamosas
19.
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 53(3): 110-3, jun. 1998. tab
Artigo em Português | LILACS | ID: lil-217186

RESUMO

Admite-se que os tumores malignos da cavidade oral constituem 4 por cento de todas doenças neoplasicas, ocupando o 8. lugar entre os canceres em homens e o 11§ lugar em mulheres. Estima-se em 7,9:100.000 a incidência de casos novos por ano entre homens e 2,2:100.000 entre mulheres. O tipo histologico mais comum e o carcinoma espinocelular (CEC), responsável por 90 a 95 por cento dos casos, sendo lingua, labios e soalho da boca os locais mais frequentes. Com o fim de conhecer o perfil do cancer da cavidade oral em nosso meio, analisamos 54 casos operados de cancer da cavidade oral no Serviço Especializado de um Hospital Geral de Ensino em Säo Paulo, nos últimos dez anos. Houve predominio do sexo masculino (81,5 por cento) e a idade variou entre 35 e 97 anos, com media de 58,1 por cento. O tabagismo esteve presente em 88,9 por cento dos casos. Na ocasiäo do tratamento 50 por cento dos doentes relatavam evoluçäo inferior a seis meses e encontramos 42 por cento de T2 e 38 por cento de T4. Esses resultados concordam com os dados da literatura e ressaltam a importância dos aspectos preventivos ao lidar com o cancer dessa regiäo


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma de Células Escamosas/prevenção & controle , Neoplasias Bucais , Fumar/efeitos adversos , Alcoolismo , Brasil , Carcinoma de Células Escamosas/epidemiologia , Hábitos , Hospitais Gerais , Hospitais de Ensino , Estudos Retrospectivos
20.
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 53(2): 83-5, Apr. 1998. ilus
Artigo em Português, Inglês | LILACS | ID: lil-217168

RESUMO

Os cistos de paratireoide säo lesöes muito raras, com cerca de 200 casos descritos na literatura. Seu principal diagnóstico diferencial e com nódulo tireodiano, podendo causar sintomalogia de compressäo cervical e hiperparatireoidismo. Descrevemos um caso em que o diagnóstico foi realizado somente no exame de congelaçäo intra-operatório e discutimos aspectos relevantes na conduta nesses tumores infrequentes


Assuntos
Humanos , Feminino , Adulto , Hiperparatireoidismo/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Diagnóstico Diferencial , Bócio Nodular/fisiopatologia , Bócio Nodular/cirurgia , Neoplasias das Paratireoides , Neoplasias das Paratireoides/cirurgia , Fotomicrografia , Radiografia Torácica/métodos , Neoplasias da Glândula Tireoide/diagnóstico , Tireoidectomia
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