Josias de Andrade Sobrinho

Perioperative frozen section examination in parotid gland tumors

CONTEXT The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN Accuracy study by retrospective analysis. SETTING Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST Frozen section and pathological diagnosis. MAIN MEASUREMENTS Sensibility and specificity of the frozen section examination. RESULTS Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeons experience.

Head and neck squamous cell carcinoma in childhood

BACKGROUND Squamous cell carcinoma (SCC) of the head and neck region is rare in young patients and even less frequent in children 15 years or younger children. The patients reported in the literature are isolated cases and their management is always difficult because there is no large experience or a convincing theory to support treatment decisions for every child. PROCEDURES AND RESULTS Four patients aged 15 years or younger were treated for SCC of head and neck between 1977 and 1995 at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil, and with this paper we are reporting our experience with their treatment, including a genetic investigation in two cases (immunohistochemical analysis using monoclonal antibodies against p53 and c-erbB-2 oncogenes). These patients had no history of tobacco or ethanol abuse and no history of cancer in their families. Many authors attribute an unusual aggressiveness to SCC in childhood, with propensity to locoregional recurrence and high death rates and therefore, propose aggressive multidisciplinary therapy. Our cases, with the exception of one, had an early diagnosis and were treated using the same method we use for adults; the results were very good. CONCLUSIONS We recommend for these cases the same protocol as for older patients. In these cases, however, the primary lesion is resected with a safety margin which is usually 2 to 3 mm larger than usual safety margins and selective neck dissection is routinely indicated. This management is adopted in an attempt to avoid postoperative irradiation which may prove to be dangerous in the future for young patients. On the other hand, we recognize that due to a small number de patients, definitive treatment recommendations cannot be made at this time.

A ação do polímero de mamona durante a neoformação óssea

OBJETIVO: Devido a importância da cicatrizacao dos defeitos que venham a acometer os tecidos osseos, este estudo tem o objetivo de avaliar a acao do polimero de mamona durante a neoformacao ossea. METODOS: Para isto, um grupo de 45 ratos foi utilizado. Realizou-se a criacao de um defeito osseo na regiao do arco zigomatico de todos os animais, sendo que todos estes defeitos foram preenchidos com o polimero de mamona. Decorridos periodos de 15, 30, 60, 90 e 120 dias, os animais foram sacrificados e seguiram-se as tramitacoes laboratoriais de rotina para analise histologica. RESULTADOS: Os resultados mostraram que o polimero de mamona auxiliou no processo cicatricial. CONCLUSAO: Concluiu-se que o polimero de mamona auxiliou no processo regenerativo do defeito osseo criado experimentalmente, atuando como um agente osteocondutor.

Manifestações estomatológicas da paracoccidioidomicose

Study design: Clinical retrospective. Material and method: develop this research it had been realized a retrospective in reference book of 187 patients proceeding from the Infectology Service at the Deep Mycosis Ambulatory at Federal University of Parana, in Curitiba, between may 1985 and march 1998. The purpose of this paper was to delineate the epidemic outline describing the stomatologicals manifestations found in the sample, to discuss about the data found and to establish comparison with the pertinent literature, to observe possible changes and if they were significant as well as to notice the dyes sensibility that were used in the histopathology (HE, PAS and GROCOTT), in 20 microscopic slides. It had been settled a previous protocol to get the data concerning to the desease epidemiology such as oral manifestations, describing the kind and localization of the lesions. In the results that were found, references like sex, age, naturalness, origien and profession of the patients were determinant factors in the epidemiologic and demographic outline of the sample studied (187 cases) compared with the pertinent literature. Results: The evaluation of the results showed changes that were not to much significant in relation to the desease epidemiology. On the other hand, it was evidenced the exuberance in oral manifestations of the desease that is very commom and frequently leads the patient to a worse condition or even to a maintenance of the desease by the difficulty of nutrition that increases the immunesuppression. In the sample of these 187 patients studied, 167 (89,3%) were male and 20 (10,7%) female. In relation to the age, 75 (40,1 %) were between 40 and 50 years, with some relevant aspects:81 patients (43,3 %) were agricultural workers, 93 (49,7 %) were from inland areas of Parana. The loss of weight was related in 72 (17,22%) of the 187 complaints, followed dyspnea. In relation to the shape of the lesions, 85 (41,46%) of the patients did not show visible, the most commom were the ulcerated ones, the granulomatuos ones, followed by moriform one. The place with major incidence of lesions were lips, followed by oropharynx and hard palate, it was also noticed more than one kind of lesion in the same patient, between these 187 patients, five (2,65%) showed also tuberculosis, 140 (72,54%) did not palpable lymphonodes, 127 (67,91%) of the patients denied to use alcoholic drinks, 117 (62,57%) were smokers. The pulmonary envelopment was predominant in 166 (51,78%) of the analized cases. In the histopathology, the technique of dyeing by silver (GROCOTT) showed it self more sensitive than HE and PAS for visualization in demonstration of the etiologic agent P. brasiliensis.

Histopathologic features and management of ameloblastoma: study of 20 cases.

BACKGROUND Odontogenic ameloblastoma (OA) of the jaws is a rare neoplasia of the oral cavity (0.78%) with a 5:1 mandible/maxilla relation, with the molar region and the ascendant ramus being the most affected areas. Comparing our results with the literature demonstrated to us that this tumor may be considered to be a worldwide problem due to the similarity in clinical findings among different ethnic groups CASE SERIES The purpose of this study of 20 patients with ameloblastoma of the mandible and maxilla diagnosed at the Stomatology and Head and Neck Services of Heliópolis Hospital, São Paulo, Brazil, from 1980 to 1997, was to establish the histopathologic pattern of classification of those tumors through optical microscopy and the relation of this histopathology to therapeutic management. Using the Regeze, Kerr and Courtney classification (1978), we diagnosed follicular tumor in 11 cases, plexiform in 6 cases and unicystic in 3 cases, and performed surgical resection with a safety margin of 1.5 to 3.0 cm in the follicular and plexiform cases and bone curettage in the unicystic cases.

Estudo de variáveis demográficas, ocupacionais e co-carcinogenéticas no carcinoma espinocelular da base de língua nas mulheres

Avaliar a relacao entre carcinogenos e o carcinoma espinocelular no sexo feminino. FORMA DE ESTUDO: Retrospectivo nao randomizado. OBJETIVO: Determinar a relacao entre carcinogenos (alcool e fumo) e o carcinoma espinocelular no sexo feminino na base da lingua. MATERIAL E METODOS: Estudo retrospectivo de 31 pacientes do sexo feminino realizado no Departamento de Cirurgia de Cabeca e Pescoco e Otorrinolaringologia do Hospital Heliopolis, Hosphel, Sao Paulo (1977 a 2000). Foram analisados variaveis como etnia, idade, profissao, tabagismo, etilismo, queixa principal, o intervalo de tempo entre o inicio da queixa e a procura do medico e o estadiamento clinico. Quanto ao tratamento estatistico, foram utilizados os Testes de Kappa e o de Mc Nemar. RESULTADOS: Houve predominio da raca branca (58,1%) sobre a negra (35,5%) e a amarela (6,4%), bem como da 6a decadade vida; sendo profissionais do lar (83,9%) trabalhadoras na agricultura 6,4%). Industria (3,2%), comercio e liberais (3,2%). Houve mais consumo isolado do tabagismo (48,4%), ambos (45,2%) e nenhum (6,4%). Quanto a sintomatologia, odinofagia (48,4%), nodulo no pescoco (19,3%), disfagia (12,9%); otalgia (9,7%), ferida na lingua (6,4%) e rouquidao (3,2%). Quanto ao estadiamento, T3-4 (74,1%), T1-2 (25,8%), N0 (29,0%), N1(29,0%), N2-3 (42,0%). CONCLUSOES: O carcinoma espinocelular em mulheres predominou na 6a decada, na raca branca, tendo como principais sintomas odinofagia e linfonodo cervical metastatico. Houve predominio do tabagismo sobre o etilismo, em paciente T3-4, sendo que a maioria ja portador de metastase linfonodal a 1a consulta.

A importância da porosidade interna do polímero de mamona durante a neoformação óssea - Estudo em ratos

Varias sao as causas que podem levar a ocorrencia de defeitos no tecido osseo. Entre estas, podem ser citados os traumatismos, as infeccoes, as deformidades congenitas e as erradicacoes de condicoes patologicas. Com o passar dos anos, estudos foram surgindo com o intuito de que metodos auxiliares pudessem ser usados para realcar a resposta inerente ao organismo vivo no que diz respeito ao processo da neoformacao ossea. Desta forma, placas, fios e A importância da porosidade interna do polimero de mamona durante a neoformacao ossea Estudo em ratos

Estudo clínico-epidemiológico do carcinoma epidermóide da base da língua

INTRODUCTION: The asymptomatic evolution and early dissemination of squamous cell carcinoma (SCC) of the base of the tongue justify this report. AIM: clinical and epidemiological study of patients with SCC of the base of the tongue. STUDY DESIGN: Retrospective. MATERIAL AND METHOD: 290 patients with SCC of the base of the tongue (1977 to 2000), being 259 men (89,3%) and 31 women (10,7%) - relation 8:1; concerning race, 237 white (81,7%), 51 black (17,6%) and 2 yellow (0,7%) - relation 5:1. About age, the prevalence of 6th decade (41,0%) followed by 5th to 7th (22,7%), 8th (3,4%) and 9th (1,7%). These parameters were related to occupation, habits (tobacco and alcohol), TNM staging. For statistical analysis, were employed non-parametric tests: Wilcoxon, Kruskal Wallis, Kappa and McNemar. RESULTS: patients from industries (36,6%), trading, and high level education (34,5%), agriculture (7,9%) retired (7,3%) - with predominance of 30 to 59 years (61,1%) and time of complaint of 180 days (62,0%), the main symptom was odinophagia (37,2%), metastatic lymphonode (21,8%), disphagia (14,5%), tongue lesion (9,0%), hoarseness (6,9%), and others (10,2%). About habits, alcohol and tobacco (83,8%), tobacco alone (10,3%), alcohol (1,4%) and nobody (4,5%). Predominance of stages III and IV in relation to I and II - 9:1, being stages I, II and IV tobacco or alcohol addicts in 100%, followed by III, IVa, IVb and IVc (23,1%, 53, 8% and 23,1% respectively). About T, 241(83,1%) were T3 and T4, and 49 (16,9%) T1 and T2. For N, 61(21,6%) were N0, 39 N1(13,4%, 125 N2 (43,0%) and 65 N3 (22,4%), being level II(69,0%), followed by level III (13,5), I (11,6%) and IV (15,9%). CONCLUSIONS: The SCC of the base of the tongue is more usual in white men from 5th to 6th decade, having as risk factors alcohol and tobacco, tobacco among women, and the six initial months was prevalent concerning the complaint time is stages III and IV, being all cases I and II alcohol and tobacco users.

Paragangliomas of the head and neck: clinical, morphological and immunohistochemical aspects

CONTEXT Protein marker positivity can assist in the definition of the therapeutic approach towards head and neck paragangliomas. The establishment of the therapeutic approach should incorporate the results of such an investigation. OBJECTIVE To establish criteria for benignity and malignancy of vagal and jugular-tympanic paragangliomas, via the study of the relationships of sex, age, tumor size, duration of complaints, site, family history, presence of metastases, treatment, histological architecture and cell type with the immunohistochemical reactions to S100 protein, chromogranin and AgKi67. DESIGN A retrospective study of histological and clinical records. SETTING The Heliópolis and Oswaldo Cruz tertiary general hospitals, São Paulo. SAMPLE 8 cases of head and neck paragangliomas. MAIN MEASUREMENTS Determination of degree of positivity to paragangliomas via immunohistochemical reactions. RESULTS 1). The protein markers for the principal cells (AgKi67 and chromogranin) were sensitive in 100% of the tumors when used together. 2). S100 protein was well identified in the cytoplasm and nucleus of sustentacular cells and underwent reduction in the neoplasias. CONCLUSIONS Chromogranin was proven to be a generic marker for neuroendocrine tumors; S100 protein was positive in all 8 cases and the AgKi67 had low positivity in all cases.

Paradigma da disseminação linfática no carcinoma espinocelular da base da língua

BACKGROUND: Squamous cell carcinoma (SCC) of the base of the tongue is an asymptomatic and aggressive neoplasia, spreading uni or bilateral routinely to the neck. The objective is to establish the elective or therapeutic therapy for metastatic neck nodes for SCC of base of the tongue. METHOD: Through a retrospective analysis of 290 files of patients with SCC of the base of the tongue from Departamento de Cirurgia de Cabeca e Pescoco e Otorrinolaringologia do Hospital Heliopolis, Hosphel, Sao Paulo de 1997 a 2000, after a locoregional assessment, the patients were classified as levels I, II, III, IV, V from TNM staging of UICC (1998). The results were evaluated through Chi Square Test for the association of site, tumor size, metastases and medium line invasion. RESULTS: The relation between male and female were 9:1, the 6th decade and alcohol, tobacco were predominant (83.8%). Concerning lymph node spreading, N0 (21.0%), N1 (13.4%), N2 (43.1%), N3(22.5%) and level I (11.6%), II (69.0%), III (13.5%), IV (2.8%) and V (3.1%). About concerning medium line spread, it was not a significant relation with affected level. CONCLUSION: The treatment of SCC of the base of the tongue involve the primary lesion and the lymph node spread to uni and bilateral neck level.