Leonardo Haddad

Head and neck hemangiopericytoma in a child: case report

CONTEXT Hemangiopericytoma is a relatively rare tumor, first described in 1942, with approximately 300 cases described in the literature to date. In most cases, it affects the trunk and lower extremities. The head and neck incidence is less than 20%, mostly in adults. We describe a case of malignant head and neck hemangiopericytoma in a child. TYPE OF STUDY Case report. CASE REPORT A twelve-year-old male patient noted the presence of a firm painless right-side retroauricular lymph node of 1 cm in diameter, which at first remained unchanged for six months, but subsequently enlarged progressively. He denied having had previous trauma at that site. In November 2000, he presented nasal obstruction and voluminous epistaxis that required hospitalization and blood transfusion. During dental treatment one month later, a cranial x-ray revealed bone alterations. A subsequent computed tomography scan showed an extensive lesion of soft tissue density that had invaded the maxillary fossa, eroding the skull base and middle and nasal fossa. The child was then referred to our service, where biopsy was performed, giving a diagnosis of hemangiopericytoma. Shortly afterwards, magnetic resonance imaging revealed that this lesion had undergone significant growth, while maintaining the same invasion pattern. The patient was submitted to conservative surgery in April 2001, with only partial resection of the tumor because of its extent. Histopathological examination of the specimen confirmed the presence of malignant hemangiopericytoma. Following the surgery, the patient presented fast regrowth of the lesion, with partial response to chemotherapy and radiotherapy.

Vocal assessment in patients submited to CO2 laser cordectomy

AIM To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Pólipos de pregas vocais: aspectos clínicos e cirúrgicos

Introduction: Vocal fold polyp is a commom benign lesion of the larynx which can be treated in various ways. This article intends to show how clinical and surgical work can be applied in the event of the vocal fold polyp. Study design: Clinical retrospective. Material and Method: A retrospective research analysing patients was carried out from February 2000 to July 2001 (18 months) by the Department of Larynx at the Faculdade de Medicina do ABC. A complete analysis of the results, as well as therapeutical techiniques applied and the results referred in the medical literature was done. Results: A number of 108 patients underwent the study. Polyp was found to be the most prevalent lesion (29,62%; n=32) among both male and female and the main symptom found was dysphonia (100%). Around 56,25% of the patients were smokers and approximately 25% related vocal abuse. A number of 26 (twenty-six) patients (81,25%) underwent microlaryngeal surgery with a suspension laryngoscope, general anesthesia, postsurgical voice and drugs therapy, whenever needed. As a result, 95% of the patients showed some improvement on their voice, within 60 days after surgery. Conclusions: Although surgical excision of the vocal polyp can be carried out in many ways, therapeutical success depends on the surgerons skills and standards of postoperative care, such as voice and drugs therapy.

Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2

OBJETIVO: Avaliar a voz de pacientes portadores de carcinomas iniciais gloticos submetidos a cordectomia com laser de CO2. METODO: Foram avaliados 15 pacientes com diagnostico de carcinoma espinocelular Tis e T1 gloticos. A avaliacao foi feita por meio da analise perceptivo auditiva da voz, pela analise acustica computadorizada e videolaringoestroboscopica. Os pacientes responderam a um questionario de avaliacao geral da voz e um protocolo de qualidade de vida relacionado a voz (QVV). Os resultados foram comparados aos de um grupo controle de individuos com laringes normais. RESULTADOS: A analise perceptivo-auditiva da voz revelou que a maioria dos pacientes submetidos a cordectomia apresentou algum grau de disfonia, a custa de rouquidao e soprosidade. Considerando os parâmetros acusticos analisados e os valores do grupo controle, observou-se a tendencia de um pequeno incremento da frequencia fundamental, mas sem diferenca estatisticamente significante; os valores de jitter, shimmer e da proporcao harmonico-ruido apresentaram-se significantemente alterados. Os aspectos analisados na videolaringoestroboscopia mostraram-se melhores nas cordectomias menos extensas. Os escores do QVV sugerem que os pacientes tiveram um discreto impacto na qualidade de vida relacionada a voz. CONCLUSOES: Apesar da presenca de alteracoes na qualidade vocal dos pacientes submetidos a cordectomia com laser de CO2, os resultados funcionais tendem a ser bem aceitos pelos pacientes, com discreta repercussao na qualidade de vida.

Manifestações otológicas em criança com síndrome da imunodeficiência adquirida

Patients infected with Human immunodeficiency virus (HIV) often present with otologic manifestations. The hearing loss may be condutive type, resulting from middle ear disease or sensorineural type due virus action or drug therapy. In this paper we describe and discuss a case of a ten years old child with HIV and otologic manifestations including hearing loss.

Eccrine sweat gland carcinoma

INTRODUCTIONThe differential diagnosis among the most frequent skin tumors, base-cell carcinoma and squamous-cell carcinoma, and the rare types, the sweat gland carci-nomas, is fundamental for the early diag-nosis and prognosis of a patient. These are classified as eccrine and apocrine, and the eccrine is the most common type. The eccrine sweat glands are most abundant in the palms of the hands and the feet soles, the forehead and the axilae.

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome

INTRODUCTION Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. OBJECTIVES To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. METHODS Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. RESULTS Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p=0.05). CONCLUSION The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

Transoral robotic supraglottic partial laryngectomy: report of the first Brazilian case.

In the past decade, we have witnessed the introduction and dissemination of transoral robotic surgery for the treatment of tumors, mainly of the oropharynx and larynx. The use of robotic surgery improves visualization of the operative field due to its three-dimensional image and enhances the surgeon’s dexterity due to bimanual control of the robotic arms. Furthermore, the assistant contributes with suction and tissue traction, which leads to the use of four instruments during surgery, something impossible during a transoral resection through laryngoscopy, for instance. Therefore,

Secondary hyperparathyroidism: total, subtotal, and autotransplantation surgical approaches

to evaluate our experience with radiation-induced malignancies (RIMs), compare that experience to the literature, and review treatment modalities. Methods: Following approval by our Investigational Review Board, a retrospective review of patient charts was performed to identify patients with RIMs. Patients were included in the study if they met the criteria for RIM as delineated in the literature. Data collected included patient demographics, primary diagnosis leading to radiation therapy, radiation-induced tumor type, tumor location, and treatment. Results: Twelve patients were identified over 15 years who met the criteria for RIM. Ages ranged from 13 to 72 years. Nine patients were irradiated for primary malignancies and 3 for benign conditions. The average latency period was 17 years. Sarcomas were the most common type of RIM. A 1% incidence of RIMs in relation to newly diagnosed primary malignancies of the head and neck was noted. Treatment generally consisted of aggressive surgical resection. Conclusions: We report the largest series of patients with RIMs of the head and neck. We noted a disturbing decrease in the average latency period of RIM as compared with other published studies. This may be related to more aggressive radiation therapy. Wide excision remains the treatment of choice. Although the risk of RIM is low, the aggressive nature of these tumors and the variability in their latency require indefinite follow-up for these patients.