Carlos Augusto Fischer

Apendicite aguda: existe relação entre o grau evolutivo, idade e o tempo de internação?

BACKGROUND: Acute appendicitis is a very common disease and elderly people appears to carry the worst prognostic outcome. The objective of this paper is to identify a possible relation between the evolutive phase of the appendicitis, age of the patient and hospital length of stay. METHODS: A total of 272 patients submitted to appendectomy were retrospectively evaluated regarding the evolutive phase of appendicitis, age of the patient and of hospital length of stay. The evolution of the inflammatory process was classified by the hystopathologic exam in four types: catarrhal, phlegmonous, suppurative and gangrenous. RESULTS: Males were 193 (70%) and the median age of all patients was 29 years. The mean hospital length of stay was 4.3 days. The incidence of the different evolution phases was: 88 cases (32.3%) for catarrhal, 79 (29%) for phlegmonous form, 70 (25.7%) for suppurative and 35 (12.8%) gangrenous. The analysis of the mean age and mean lenght of stay in the hospital was: 27.9 years and 3.7 days for the catarrhal type, 28.4 years and 3.9 days for phlegmonous type, 30.1 years and 5 days for the supurative type and 35 years and 5.2 days for the gangrenous type. When they were grouped, the mean age and length of stay were: 28.1 years and 3.8 for the group catarrhal + phlegmonous and 30.7 years and 5 days for the supurative + gangrenous group. There was statistical significance between the evolution phase of the appendicitis and the hospital length of stay (p=0.01) and between age and evolution of the appendicitis (p=0.01). CONCLUSION: Patients with advanced evolutive phases of appendicitis trends to stay longer in hospital, tends particularly in older patients.

Repeated fine-needle aspiration cytology for the diagnosis and follow-up of thyroid nodules

INTRODUCTION The recently-proposed Bethesda reporting system has offered clinical recommendations for each category of reported thyroid cytology, including repeated fine-needle aspiration (FNA) for non-diagnostic and atypia/follicular lesions of undetermined significance, but there are no sound indications for repeated examination after an initial benign exam. OBJECTIVE To investigate the clinical validity of repeated FNA in the management of patients with thyroid nodules. METHOD The present study evaluated 412 consecutive patients who had repeated aspiration biopsies of thyroid nodules after an initial non-diagnostic, atypia/follicular lesion of undetermined significance, or benign cytology. RESULTS The majority of patients were female (93.5%) ranging from 13 to 83 years. Non-diagnostic cytology was the most common indication for a repeated examination in 237 patients (57.5%), followed by benign (36.8%), and A/FLUS (5.6%) cytology. A repeated examination altered the initial diagnosis in 70.5% and 78.3% of the non-diagnostic and A/FLUS patients, respectively, whereas only 28.9% of patients with a benign cytology presented with a different diagnosis on a sequential FNA. CONCLUSIONS Repeat FNA is a valuable procedure in cases with initial non-diagnostic or A/FLUS cytology, but its routine use for patients with an initial benign examination appears to not increase the expected likelihood of a malignant finding.

Aplicabilidade da dosagem de paratormônio intacto imediato, tardio ou seriado após tireoidectomia total

UNLABELLED Hypocalcemia is the most common complication after total thyroidectomy. Intact parathyroid hormone (i-PTH) testing is a proven effective method to detect patients at risk for postoperative symptomatic hypocalcemia. However, there is still uncertainty as to the timing of i-PTH testing in a clinical setting. OBJECTIVE This study looked into the correlation between serum i-PTH levels measured at different times after total thyroidectomy and the risk of symptomatic hypocalcemia. METHODS This retrospective case series studied a group of 110 consecutive for hypocalcemia and intact parathyroid hormone (PTHi) levels four and twelve hours following total thyroidectomy. Statistical analysis was used to evaluate the performance of isolated and serial i-PTH measurements to determine the likelihood of symptomatic hypocalcemia. RESULTS I-PTH is highly sensitive (90.3%-96.8%) and specific (77.2%-87.3%) for symptomatic hypocalcemia. There was no significant difference in the sensitivity levels of the tests done four and twelve hours after surgery or in a serial fashion. However, the 12-hour i-PTH level was more specific (p < 0.0007). CONCLUSION Single i-PTH testing done 12 hours after total thyroidectomy may be used as a screening test to detect patients at risk for symptomatic hypocalcemia.

Cervicomastoidfacial versus modified rhytidectomy incision for benign parotid tumors

UNLABELLED The modified rhytidectomy incision is an alternative to the classic cervicomastoidfacial approach for parotid surgery, camouflaging the scar in barely visible areas, resulting in better cosmesis. However, there are very few studies comparing the incidence of complications and functional results of patients submitted to parotidectomy through these two different approaches. OBJECTIVE Compare the incidence of complications and functional results of patients with benign parotid neoplasms submitted to surgery through the classical incision versus the modified rhytidectomy approach. METHOD Retrospective cohort study evaluating the demographics, surgical and post-operative characteristics of an equally distributed group of sixty patients submitted to parotidectomy via cervicomastoidfacial incision or modified rhytidectomy approach. RESULTS There were no significant differences in complications rates and functional results between the groups, except for a lower incidence of early facial movement dysfunction for the modified rhytidectomy approach - which was 86% lower in this group of patients. CONCLUSION Modified rhytidectomy incision has shown comparable complication rates to those of the classic approach and a lower incidence of immediate facial movement impairment.

Efficacy of ultrasound‐guided fine‐needle aspiration performed by surgeons newly trained in thyroid ultrasound

There are a growing number of thyroid ultrasound courses to train endocrinologists, pathologists, and surgeons to perform ultrasound‐guided fine‐needle aspiration (FNA). However, there are limited data to support the efficacy of ultrasound‐guided FNA performed by nonradiologists.

Partial laryngectomy in glottic cancer: complications and oncological results

INTRODUCTION Most patients with laryngeal carcinoma present tumors in the glottis that can be treated by different treatment modalities. Some authors consider open partial laryngectomy as obsolete, while others still deem this as a viable and cost-efficient option. OBJECTIVES To compare the oncological and functional results of a series of patients undergoing partial laryngectomy vs. external radiotherapy for the treatment of glottic cancer. METHODS Historical cohort study with a series of glottic carcinoma patients undergoing partial laryngectomy or external radiotherapy during a period of ten years. RESULTS Sixty-two patients with glottic carcinoma were included. Group A comprised those submitted to partial laryngectomy (n=30), and Group B, those who underwent radiotherapy (n=32). They were homogeneous in the comparison of mean age, 56.4 vs. 60.4 years (p=0.12) and distribution in pathological stage (p=0.91). With regard to oncological outcome, there were no differences in distant metastasis rates, or second primary tumor between groups (p=1.0), as well as in disease-free time, laryngeal rescue-free time, and overall five-year survival. Severe complication rates were also similar between groups. CONCLUSION Open partial laryngectomy had complication rates and oncological results similar to those of radiotherapy for patients with glottic carcinomas and should still be considered among the main available therapeutic options.

Esophageal perforation in closed neck trauma

Medico (Cirurgiao de Cabeca e Pescoco e Cirurgiao Crânio-Maxilo-Facial - Hospital Sao Jose e Centro Hospitalar Unimed - Joinville - SC).Centro Hospitalar Unimed - Joinville - Santa Catarina.Endereco para correspondencia: Agnaldo Jose Graciano. Rua 3 de Maio, no 58, sala 104. Centro. Joinville - SC. Brasil. CEP: 89201-030.Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 15 de novembro de 2011. cod. 8904.Artigo aceito em 3 de fevereiro de 2012.

Case ReportEsophageal perforation in closed neck trauma

Medico (Cirurgiao de Cabeca e Pescoco e Cirurgiao Crânio-Maxilo-Facial - Hospital Sao Jose e Centro Hospitalar Unimed - Joinville - SC).Centro Hospitalar Unimed - Joinville - Santa Catarina.Endereco para correspondencia: Agnaldo Jose Graciano. Rua 3 de Maio, no 58, sala 104. Centro. Joinville - SC. Brasil. CEP: 89201-030.Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 15 de novembro de 2011. cod. 8904.Artigo aceito em 3 de fevereiro de 2012.

Fatores preditores de malignidade em neoplasias de células de Hurthle

BACKGROUND: Hurthle cell neoplasms are uncommon thyroid gland tumors that present a diagnostic challenge due to difficulties to differentiate between adenomas and carcinomas. The purpose of this study is to identify preoperative predictor factors of malignancy. METHODS: A retrospective study of patients and tumor characteristics of 56 Hurthle cell tumors cases diagnosed in our institution between January 1999 and June 2006 was done. RESULTS: Thirty-seven patients presented with adenoma, 35 women (94.5%) and 2 men (4.5%) with average age of 47.8 years. Medium tumor size in this group was 2.1 cm (ranging from 0.3 to 6.0 cm). Nineteen patients with Hurthle cell carcinoma were found in this series with 14 (73%) female and 5 male patients with average age of 51.1 years. Tumor size in this group ranged between 2.0 and 7.5 cm (medium of 3.8 cm). CONCLUSION: Patients with Hurthle cell neoplasm nodules larger than 3.0 cm, in the greatest diameter, especially in male patients, are predictor factors of having malignancy.