Gustavo Meyer de Moraes

Fatores preditores para hipocalcemia pós-tireoidectomia

OBJECTIVE: To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism. METHODS: We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed. Patients were grouped according to the presence or absence of hypocalcemia and evaluated according to age, gender, thyroid function, thyroid volume, number of parathyroid glands identified and need to parathyroid reimplantation, type of operation, operative time, and histopathological diagnosis. RESULTS: The incidence of temporary hypocalcemia was 40.8% (136 patients), and of definitive hypoparathyroidism 4.2% (14 patients). Reoperation or total thyroidectomy, neck dissection, hyperthyroidism, operative time and age above 50 years were factors related to higher incidence of hypocalcemia and definitive hypoparathyroidism (p 50 years), total thyroidectomy, reoperation, neck dissection and operative time. The predictors of post-thyroidectomy definitive hypoparathyroidism included type of operation, histological diagnosis and hyperthyroidism.

The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy

UNLABELLED Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications. OBJECTIVE This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL). MATERIALS AND METHOD This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%). RESULTS Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx (p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding. CONCLUSION The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.

Evolution of blood magnesium and phosphorus ion levels following thyroidectomy and correlation with total calcium values

CONTEXT AND OBJECTIVE magnesium ion concentration is directly related and phosphorus ion concentration is inversely related to calcemia. The aim of this study was to evaluate the evolution of magnesium and phosphorus ion levels in patients undergoing thyroidectomy and correlate these with changes to calcium concentration. DESIGN AND SETTING prospective study at the Alpha Institute of Gastroenterology, Hospital das Clínicas, Universidade Federal de Minas Gerais. METHODS the study included 333 patients, of both genders and mean age 45 ± 15 years, who underwent thyroidectomy between 2000 and 2005. Total calcium, phosphorus and magnesium were measured in the blood preoperatively and 24 and 48 hours postoperatively. Ionic changes were evaluated according to the presence or absence of postoperative hypocalcemia. RESULTS there were statistically significant drops in blood phosphorus levels 24 and 48 hours after thyroidectomy, compared with preoperative values, in the patients without hypocalcemia. In the patients who developed hypocalcemia, there was a significant drop in plasma phosphorus on the first postoperative day and an increase (also statistically significant) on the second day, in relation to preoperative phosphorus levels. A significant drop in postoperative magnesium was also observed on the first and second days after thyroidectomy in the patients with hypocalcemia, in relation to preoperative levels. In the patients without hypocalcemia, the drop in magnesium was significant on the first day, but there was no difference on the second day. CONCLUSION despite the postoperative changes, neither magnesium nor phosphorus ion levels had any role in post-thyroidectomy calcemia.

Cervical Lymph Node Dissection in Papillary Thyroid Cancer: Pattern and Predictive Factors of Regional Lymph Node Metastas

Background: Papillary thyroid carcinoma (PTC) exhibits a high index of cervical lymphatic dissemination. Methods: Retrospective study of 101 cases of PTC subjected to total thyroidectomy associated with cervical lymph node dissection. Results: The incidence of neck metastasis was 50.5%, and all the metastases wereipsilateral to the primary tumor. Although the participants with metastases (N+) hadmore dissected lymph nodes than the group without metastases (p = 0.01), the lymphnode size was not a determinant of malignancy (p=0.34). Uni and multivariate analyses showed tumor size ≥ 1.0 cm, angiolymphatic invasion, and multicentric diseases were associated with lymphatic dissemination (p < 0.05). Conclusions: Factors predictive of cervical lymph node metastasis were tumor size ≥ 1.0cm, multicentric disease and angiolymphatic invasion. All the metastases wereipsilateral to the primary tumor. Lymph node size was not a reliable predictor of thepresence or absence of metastasis.

Tolerance of early oral feeding in patients subjected to total laryngectomy

The purpose of this study was to assess the tolerance of early oral feeding after total laryngectomy.

Espondilodiscite causada por espinha de peixe migrada para faringe. Relato de caso

Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.La ingestion de cuerpos extranos es un problema comun en los puestos de primeros auxilios y, generalmente, ocurre con huesos de aves y espinas de pescados. Hay algunos relatos de casos de migraciones de cuerpos extranos para la retrofaringe, las cuales causan procesos infecciosos locales, pero no hay ningun caso descrito de espondilodiscitis (aun considerando la proximidad). Quizas la ausencia de infeccion en la columna vertebral resulte de la integridad de la fascia del musculo largo del cuello, que recubre y protege a la columna cervical. Describimos el primer caso de espondilodiscitis causado por la migracion de una espina serrada de pescado, la cual penetro profundamente en la fascia del musculo largo del cuello y alcanzo al cuerpo vertebral de C3.

Migrated pharyngeal fish bone causing spondylodiscitis. Case report

Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.La ingestion de cuerpos extranos es un problema comun en los puestos de primeros auxilios y, generalmente, ocurre con huesos de aves y espinas de pescados. Hay algunos relatos de casos de migraciones de cuerpos extranos para la retrofaringe, las cuales causan procesos infecciosos locales, pero no hay ningun caso descrito de espondilodiscitis (aun considerando la proximidad). Quizas la ausencia de infeccion en la columna vertebral resulte de la integridad de la fascia del musculo largo del cuello, que recubre y protege a la columna cervical. Describimos el primer caso de espondilodiscitis causado por la migracion de una espina serrada de pescado, la cual penetro profundamente en la fascia del musculo largo del cuello y alcanzo al cuerpo vertebral de C3.

Espondilodiscitis causada por espina de pescado migrada para la faringe. Relato de caso

Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.La ingestion de cuerpos extranos es un problema comun en los puestos de primeros auxilios y, generalmente, ocurre con huesos de aves y espinas de pescados. Hay algunos relatos de casos de migraciones de cuerpos extranos para la retrofaringe, las cuales causan procesos infecciosos locales, pero no hay ningun caso descrito de espondilodiscitis (aun considerando la proximidad). Quizas la ausencia de infeccion en la columna vertebral resulte de la integridad de la fascia del musculo largo del cuello, que recubre y protege a la columna cervical. Describimos el primer caso de espondilodiscitis causado por la migracion de una espina serrada de pescado, la cual penetro profundamente en la fascia del musculo largo del cuello y alcanzo al cuerpo vertebral de C3.