Ricardo Pires de Souza

Correlação da infecção viral pelo papilomavírus humano com as lesões papilomatosas e o carcinoma epidermóide na boca e orofaringe

O objetivo deste trabalho e estabelecer a relacao entre a infeccao pelo virus do papiloma humano (HPV) e o desenvolvimento de lesoes malignas (carcinoma epidermoide) e benignas (hiperplasia epitelial papilomatosa e papiloma) de cavidade bucal e orofaringe. METODOS: Estudo retrospectivo de 66 lâminas e blocos de parafina com tecido biopsiado e fixado com formalina. Esse material, colhido no ano de 2002, refere-se a uma casuistica de 44 homens (66,7%) e 22 mulheres (33,3%) com idades que variavam entre 11 e 100 anos. O diagnostico foi confirmado em 38 casos de carcinoma epidermoide, 20 casos de hiperplasia epitelial papilomatosa e oito casos de papilomas. Utilizamos a imunohistoquimica para analisar este material e determinar a possivel presenca do DNA viral nas amostras citadas. RESULTADOS: Detectamos a presenca do DNA viral (HPV) em 16 dos 38 casos de carcinoma (42,5%), 19 em 20 casos de hiperplasia (95%) e em todos os oito casos de papilomas (100%). CONCLUSAO: Este estudo demonstrou que as lesoes papilomatosas e hiperplasicas da boca e orofaringe estao associadas ao HPV, ao contrario do carcinoma espinocelular que nao apresentou correlacao estatistica significante com este agente infeccioso.

Alongamento do processo estilóide (síndrome de Eagle): relato de dois casos

Elongated styloid process or Eagles syndrome is a multifactorial disease with unspecific characteristics on clinical and imaging examinations. The use of imaging methods in combination with the signs and symptoms are valuable in the confirmation of the diagnosis since they show the extension of the styloid complex, the muscles and ligaments, and adjacent structures. The diagnosis can be established when there is an association of clinical information and imaging findings. The authors report two cases of elongated styloid process including the imaging findings, mainly obtained using computed tomography.

Ameloblastoma da mandíbula: relato de dois casos

Ameloblastomas are benign odontogenic neoplasms of epithelial origin, nonmineralized, relatively uncommon which present an aggressive local behavior. They affect predominantly the mandible and they can reach varied proportions depending on the evolution time. Radiographically they appear as unilocular or multilocular cystic lesions. The clinical and radiological findings assist to the differential diagnosis, although the histologic evaluation is necessary in characterization of the lesions.

Correlação entre os achados clínicos e imaginológicos nas disfunções temporomandibulares

OBJECTIVE: To correlate the signals and symptoms observed on clinical examination of patients with temporomandibular disorder with the results demonstrated by magnetic resonance imaging. MATERIALS AND METHODS: Thirty patients presenting with signs and symptoms of temporomandibular disorders underwent clinical evaluation and subsequent magnetic resonance imaging. The magnetic resonance imaging studies were independently evaluated by two experienced radiologists. Magnetic resonance imaging studies consisted of 12 images in coronal, T1-weighted sequences with 3 mm-thick slices with the mouth closed, sagittal, T1- and T2-weighted sequences with both open and closed mouth positions, and on progressive opening/closing movement at 5 mm intervals, in order to demonstrate the full mandibular movement. The statistical significance between the clinical findings in the evaluation of the patients and results found on the magnetic resonance imaging studies was analyzed by means the kappa test. RESULTS: Interobserver agreement was respectively 56.7% (kappa = 0.1) and 56.7 (kappa = 0) for the left and right sides. CONCLUSION: No correlation was found between the clinical and magnetic resonance imaging findings in the diagnoses of disc displacement.

Carcinoma de seio maxilar: análise de dez casos

OBJECTIVE: To evaluate the role, especially of computed tomography, in the staging of maxillary sinus carcinomas. MATERIALS AND METHODS: Ten cases of carcinoma treated in Hospital Heliopolis Department of Diagnostic Imaging and Head and Neck Surgery, Sao Paulo, SP, Brazil, in the period between 1988 and 2002, were evaluated. RESULTS: Nine patients presented with tumor extension to the cheek, eight to the masticator space, seven to the mouth floor and hard palate, five to the pterygoid fossa, five to the orbit, three to the ethmoid bone, and one to the skull base. Three of the patients were staged T3, and seven T4. Two patients had lymph nodes metastases at their initial presentation, and were staged T4. All of the cases were histopathologically confirmed. CONCLUSION: The accurate analysis of the tumor local extent and dissemination by means of computed tomography and magnetic resonance imaging plays a relevant role in the surgical planning, besides influencing the therapeutic conduct and prognosis.

Valor da PET/CT na abordagem do câncer de cabeça e pescoço*

OBJECTIVE: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. MATERIALS AND METHODS: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. RESULTS: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. CONCLUSION: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method.

Complexo nasossinusal: anatomia radiológica

Este estudo propoe-se a avaliar o complexo nasossinusal, a fim de identificar os principais achados e determinar as doencas desta area. A analise precisa da extensao local e disseminacao tumoral, dada pela tomografia computadorizada e ressonância magnetica, desempenha papel importante no planejamento terapeutico, influenciando tambem o prognostico.

Conflitos de interesses na pesquisa médico-farmacológica

A pesquisa medico-farmacologica clinica corresponde a aplicacao experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitaveis e de ineficiencia do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a industria farmaceutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliografica realizada neste estudo indica que pesquisas com financiamento da industria farmaceutica tem proporcao mais alta de resultados favoraveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Ha estudos que comparam a eficacia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciencia para beneficiar o ser humano, especialmente no combate a doenca; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinacoes, caminhando em direcao ao respeito a dignidade da pessoa.

Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma

CONTEXT AND OBJECTIVE Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING Retrospective, non-randomized study of patients treated at Hospital Heliópolis, São Paulo, Brazil. METHODS Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0%. Accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. CONCLUSIONS Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.

Arco aórtico direito com artéria subclávia esquerda aberrante e divertículo de Kommerell

E relatado um caso de uma paciente do sexo feminino, 40 anos de idade, com queixas de disfagia e dor toracica retroesternal ha tres anos causadas pela presenca de arteria subclavia esquerda aberrante retroesofagica com origem em uma dilatacao aneurismatica (diverticulo de Kommerell). O arco aortico e a aorta toracica descendente estao localizados a direita. O diagnostico foi estabelecido por meio dos exames de esofagograma, tomografia computadorizada e angiorressonância magnetica. A paciente apresentou melhora importante com o tratamento clinico e, atualmente, segue em acompanhamento ambulatorial ha um ano.