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1. Predictive value for malignancy of the thyroid nodule macroscopically

Author

Nardi, Carlos Eduardo Molinari, Barbara, Emanuel Casotti Duque de, Couto Netto, Sergio Dias do, Castro, Mario Augusto Ferrari de, Pfuetzenreiter Junior, Elio Gilberto, and Dedivitis, Rogério Aparecido

Subjects
Thyroid neoplasms, Thyroidectomy, Sensitivity and specificity, Biopsy, Needle, Frozen sections., Medicine, Otorhinolaryngology, RF1-547
Abstract

Introduction: The fine needle aspiration (FNA) is a method of high accuracy in the preoperative diagnosis of thyroid nodules, but the "follicular" remains a factor of failure. Furthermore, the usefulness of intraoperative examination of freezing is controversial. Macroscopic aspects of thyroid nodules may increase the diagnostic accuracy of preoperative and intraoperative FNA biopsy and freezing. Objective: To evaluate the macroscopic aspects of the surgical specimen in the decision facing the nodular disease of thyroid gland. Methods: During 2007, 85 patients underwent surgical treatment for thyroid nodular diseases were evaluated by prospective and macroscopic aspects of 125 nodules were compared with histopathological findings. Results: We found that the pattern of recent growth, the presence of adhesions of the thyroid, absence of hemorrhage, necrosis and poor demarcation of the nodule had statistical significance in the outcome of malignant disease. Conclusion:Pattern of growth, thyroid adhesions, necrosis and poor demarcation of the nodule are predictors of malignancy, while the presence of hemorrhage is a protective factor.

Published
2010

2. Aspiration Biopsy by Fine Needle of Cervical Adenopathy Guided by Ultrasonography

Author

Dedivitis, Rogério Aparecido, Pfuetzenreiter Junior, Elio Gilberto, and Castro, Mario Augusto Ferrari de

Subjects
Lymph nodes, Needle biopsy, Intervention ultrasonography, Lymphadenitis, Lymphoproliferative disorders, Lymphatic metastasis, Medicine, Otorhinolaryngology, RF1-547
Abstract

Introduction: The fine needle aspiration biopsy (FNAB) is deemed to be a diagnostic option replacing the lymph nodes open dissection. Nevertheless, the diagnosis obtained is frequently insufficient clinically. Objective: To evaluate the accuracy of FNAB diagnostic guided by ultrasonography (USG) in the cervical adenopathy approach. Methods: Consecutive series study of 186 patients who were submitted to retrospective USG-guided FNAB of cervical adenopathy. The final diagnosis was determined by the biopsy histopathological exam by excision of the lymph node when applied or clinical follow-up for more than one year. Sensitivity, specialty, predictive values and accuracy were evaluated. Results: There was a total of 54 malignancy diagnosis, five of tuberculosis and 127 of nonspecific chronic lymphadenitis. The sensitivity, specificity, predictive values of the negative and positive tests and FNAB accuracy were respectively of 79.5%, 99.1%, 88.2%, 98.3% and 91.4%. Conclusion: As the positive FNAB is highly predictive of the final histological diagnosis, the negative result must be carefully interpreted.

Published
2009

5. The methodological and reporting quality of randomized controlled trials of tyrosine kinase inhibitors for advanced differentiated thyroid cancer: Meta‐research study.

Author

Dedivitis, Rogério Aparecido, Castro, Mario Augusto Ferrari de, Boni, Alice Matos Dal, Alvares, Ana Carolina Beltrão, Tresso, Ana Júlia Piazentin, Oliveira, Andrea Davedovicz de, Vieira, Amanda Gonçalves da Silva Dourado, Mendes, Fernanda Assaf, Rossi, Giovana de Oliveira, Fava, Giullia Neworal, Pouza, Isabela Santos, Santana, Izabelle Pimenta, Laino, Julia Gibran, Lima, Letícia Barbosa de, and Martimbianco, Ana Luiza Cabrera

Subjects
PROTEIN-tyrosine kinase inhibitors, THYROID cancer, RANDOMIZED controlled trials, CLINICAL trials, OVERALL survival
Abstract

Introduction: Clinical trials on tyrosine kinase inhibitors (TKI) treatment have shown an improvement in overall and progression‐free survival in patients with advanced differentiated thyroid cancer. However, it is necessary to evaluate these studies to assess methodological biases and inconsistencies that may impact the effects. Objective: To map and assess the methodological quality of randomized clinical trials (RCTs) regarding randomization, allocation concealment, blinding, and selective reporting bias. Methods: RCTs assessing the efficacy and safety of TKI for the treatment of advanced differentiated thyroid cancer were included. The search was performed in the MEDLINE database. The included RCTs were assessed for the adequacy of the methodological steps, as recommended by the Cochrane Risk of Bias tool. Results: Nine studies were analyzed, of which 77.7% were classified as low risk of bias regarding selective reporting and 33.3% as high risk of reporting bias. The mean time between protocol registration and study publication was approximately 5.11 years. Moreover, 66.7% were classified as low risk of bias for randomization and allocation concealment, and 33.3% did not specify the randomization process and allocation concealment in a way that would allow the identification of occurrences of bias. Concerning blinding of participants and outcome assessors, 77.8% of the RCTs reported adequate blinding and were classified as having a low risk of bias, 11.1% had a high risk of bias, and 11.1% had insufficient information and were classified as having unclear risk of bias. Regarding the blinding of the outcome assessors, 33.3% did the blinding correctly, 11.1% did not blind, and 55.6% did not provide enough information. Conclusion: Overall, the assessed RCTs were predominantly at low risk of bias. The critical evaluation of these studies is essential to have confidence in the treatment estimated effect that will support clinical decision‐making and provide information to preclude future clinical study flaws. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Submandibular gland excision

Author

Carvalho, Alexandre Sanfurgo de, Dedivitis, Rogério Aparecido, Castro, Mario Augusto Ferrari de, and Nardi, Carlos Eduardo Molinari

Subjects
Submandibular gland, Doenças da Glândula Submandibular, Cálculos das glândulas salivares, Submandibular gland diseases, Salivary gland calculi, Neoplasias da Glândula Submandibular, Sialadenite, Glândula Submandibular, Submandibular gland neoplasms, Sialadenitis
Abstract

OBJECTIVE: to analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates. OBJETIVO: analisar o valor da punção aspirativa por agulha fina e os índices de complicações pós-operatórias em pacientes submetidos à ressecção da glândula submandibular. MÉTODOS: foram analisados os prontuários de pacientes tratados com a ressecção da glândula, de janeiro de 1995 a dezembro de 2008. Os dados coletados foram: idade, sexo, achados na história clínica, procedimento cirúrgico, resultados da punção por aspiração com agulha fina (PAAF), diagnóstico anatomopatológico e complicações. RESULTADOS: foram estudados 117 pacientes, com idade variando de 12 a 89 anos (média, 48 anos), sendo 70 mulheres e 47 homens. Trinta e nove pacientes (33,3%) foram acometidos por doenças inflamatórias (28 pacientes com litíase), 70 tiveram tumores benignos e oito tumores malignos. A respeito da PAAF, a sensibilidade e especificidade foram de 85,7% e 100%, respectivamente. Nove pacientes (7,7%) tiveram paralisia temporária do nervo mandibular marginal e um apresentou paralisia definitiva. CONCLUSÃO: a ressecção da glândula submandibular é um procedimento seguro, com baixa taxa de complicações.

Published
2015

12. Pharyngocutaneous fistula following total laryngectomy

Author

Aires,Felipe Toyama, Dedivitis,Rogério Aparecido, Castro,Mario Augusto Ferrari de, Ribeiro,Daniel Araki, Cernea,Claudio Roberto, and Brandão,Lenine Garcia

Subjects
cutaneous fistula, carcinoma de células escamosas, laryngeal neoplasms, squamous cell, neoplasias laríngeas, laringectomia, postoperative complications, fístula cutânea, carcinoma, complicações pós-operatórias, laryngectomy
Abstract

A fístula faringocutânea (FFC) é a complicação mais comum após a laringectomia total. OBJETIVOS: Estabelecer a incidência dessa complicação e analisar seus fatores predisponentes. MÉTODO: Este estudo é uma coorte histórica transversal que incluiu 94 pacientes submetidos à laringectomia total. Os seguintes aspectos foram relacionados ao surgimento de FFC: gênero, idade, sítio do tumor, estadiamento patológico conforme o TNM, o tipo de esvaziamento cervical realizado, radioterapia e traqueostomia prévias e o uso de grampeador para fechamento faríngeo. Nos casos de FFC, considerou-se o dia pós-operatório de seu diagnóstico, duração e abordagem terapêutica. RESULTADOS: FFC foi diagnosticada em 20 pacientes (21,3%). Houve incidência significativamente maior na de FFC no estadiamento T4 comparado com T2/T3 (p = 0,03). Os demais aspectos não apresentaram diferença estatística. Entretanto, 40,9% dos pacientes que se submeteram à traqueostomia prévia desenvolveram fístula, contra 21,1% dos pacientes fora dessa condição. CONCLUSÕES: Estadiamento avançado do tumor primário é um fator prognóstico para FFC. Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. OBJECTIVES: To establish the incidence of this complication and to analyze the predisposing factors. METHOD: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment. RESULTS: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure. CONCLUSION: Advanced primary tumor staging is correlated with higher incidences of PCF.

Published
2012

13. Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Author

Castro,Mario Augusto Ferrari de, Dedivitis,Rogério Aparecido, Pfuetzenreiter Júnior,Elio Gilberto, Barros,Ana Paula Brandão, and Queija,Débora dos Santos

Subjects
larynx, artrite reumatóide, laringe, arthritis, rheumatoid, voice, voz, laringoscopia, laryngoscopy
Abstract

A artrite pode afetar a laringe com rouquidão e fadiga vocal. OBJETIVO: Avaliar as manifestações laríngeas da artrite reumatoide. MÉTODOS: Estudo prospectivo de 27 pacientes com artrite reumatoide por meio de videolaringoestroboscopia, avaliação perceptivo-auditiva da voz por meio da escala GIRBAS, análise acústica e questionário do Índice de desvantagem vocal. RESULTADOS: Queixas laríngeas foram descritas por 19 pacientes, principalmente disfonia intermitente e sensação de corpo estranho na garganta. O achado laringoscópico mais frequente foi o cavalgamento das aritenoides. Três pacientes apresentaram pitch considerada grave. Nove tiveram o grau de disfonia e rugosidade discretos. As medianas das medidas acústicas foram: F0, 198,39 Hz; Jitter, 0,815; Shimmer, 4,915; e NHR, 0,144. Em relação ao índice de desvantagem vocal, a mediana foi zero para todos os domínios. Existiu significância estatística relacionando a queixa vocal com todos os domínios desse índice. A classe funcional teve relação estatisticamente significante com: cavalgamento de aritenoides (p = 0,001), PPQ (p = 0,0257), Shimmer (p = 0,0295), APQ (p = 0,0195) e com o domínio físico e total do IDV (p = 0,0227 e p = 0,0425). CONCLUSÃO: Queixa laríngea foi referida por 70,4% dos pacientes e alterações laringoscópicas foram verificadas em 48%. A avaliação acústica da voz e a autopercepção mostraram-se alterados. Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Published
2012

14. Complicações dos esvaziamentos cervicais

Author

Dedivitis, Rogério Aparecido, Guimarães, André Vicente, Pfuetzenreiter Jr, Elio Gilberto, and Castro, Mario Augusto Ferrari de

Subjects
esvaziamento cervical, postoperative complications, intraoperative complications, complicações pós-operatórias, neck dissection, complicações intra-operatórias
Abstract

Devido à proximidade de estruturas vitais, certas complicações são inerentes ao esvaziamento cervical (EC) para o tratamento de pacientes portadores de carcinoma epidermoide das vias aerodigestivas superiores. OBJETIVO: Determinar a incidência de complicações dos EC. MÉTODOS: Estudo retrospectivo transversal de avaliação de prontuários. Entre janeiro de 1995 e dezembro de 2008, foram avaliados EC com finalidade curativa em 480 pacientes portadores de carcinoma espinocelular das vias aerodigestivas superiores, sendo estudada a ocorrência de complicações perioperatórias. RESULTADOS: Considerando o número total de lados esvaziados, foram estudados 413 EC radicais e 295 EC seletivos, dos quais 220 foram EC supraomo-hioideos e 75 foram EC jugulares, totalizando 708 lados avaliados. Não houve óbito. A complicação mais frequente foi a lesão do nervo mandibular marginal (5,5%), seguida da lesão do nervo acessório (5,1%), contudo, destes, em 18/21 casos o nervo foi sacrificado por razões de radicalidade oncológica. CONCLUSÕES: Não houve óbito no período peroperatório. As lesões mais comuns são nervosas, com maior incidência de lesão do nervo mandibular marginal (5,5%). Because of the proximity of vital structures, certain complications are inherent to neck dissection (ND) for the treatment of patients with squamous cell carcinoma of the upper aerodigestive tract. AIM: To establish the incidence of complications of ND. METHODS: A cross-sectional retrospective study of patient registries. ND with curative intention was evaluated in 480 patients with squamous cell carcinoma of the upper aerodigestive tract from January 1995 to December 2008 to identify perioperative complications. RESULTS: Considering the total quantity of dissected neck sides, 413 radical ND and 295 selective ND were studied, of which 220 were supraomohyoid ND and 75 were jugular ND, totaling 708 sides. There were no deaths. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (5.1%). However, in 18 out of 21 cases this nerve was sacrificed for oncological completeness. CONCLUSIONS: There were no perioperative deaths. Nerves were the most commonly injured structures; the marginal mandibular branch is injured most (5.5%).

Published
2011

15. Submandibular gland excision

Author

Carvalho, Alexandre Sanfurgo de, primary, Dedivitis, Rogério Aparecido, additional, Castro, Mario Augusto Ferrari de, additional, and Nardi, Carlos Eduardo Molinari, additional

Published
2015
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19. [Pharyngocutaneous fistula following total laryngectomy].

Author

Aires FT, Dedivitis RA, Castro MA, Ribeiro DA, Cernea CR, and Brandão LG

Subjects
Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell surgery, Cross-Sectional Studies, Female, Humans, Laryngeal Neoplasms surgery, Male, Middle Aged, Risk Factors, Cutaneous Fistula etiology, Fistula etiology, Laryngectomy adverse effects, Pharyngeal Diseases etiology
Abstract

Unlabelled: Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy., Objectives: To establish the incidence of this complication and to analyze the predisposing factors., Method: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment., Results: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure., Conclusion: Advanced primary tumor staging is correlated with higher incidences of PCF.

Published
2012
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20. Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis.

Author

Castro MA, Dedivitis RA, Pfuetzenreiter Júnior EG, Barros AP, and Queija Ddos S

Subjects
Adult, Aged, Female, Humans, Laryngoscopy methods, Male, Middle Aged, Prospective Studies, Self Concept, Surveys and Questionnaires, Voice Disorders diagnosis, Arthritis, Rheumatoid complications, Voice Disorders etiology
Abstract

Unlabelled: Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue., Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis., Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire., Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425)., Conclusion: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Published
2012
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21. [Neck dissection complications].

Author

Dedivitis RA, Guimarães AV, Pfuetzenreiter EG Jr, and Castro MA

Subjects
Adult, Aged, Cross-Sectional Studies, Female, Humans, Incidence, Intraoperative Complications, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Carcinoma, Squamous Cell surgery, Head and Neck Neoplasms surgery, Neck Dissection adverse effects
Abstract

Unlabelled: Because of the proximity of vital structures, certain complications are inherent to neck dissection (ND) for the treatment of patients with squamous cell carcinoma of the upper aerodigestive tract., Aim: To establish the incidence of complications of ND., Methods: A cross-sectional retrospective study of patient registries. ND with curative intention was evaluated in 480 patients with squamous cell carcinoma of the upper aerodigestive tract from January 1995 to December 2008 to identify perioperative complications., Results: Considering the total quantity of dissected neck sides, 413 radical ND and 295 selective ND were studied, of which 220 were supraomohyoid ND and 75 were jugular ND, totaling 708 sides. There were no deaths. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (5.1%). However, in 18 out of 21 cases this nerve was sacrificed for oncological completeness., Conclusions: There were no perioperative deaths. Nerves were the most commonly injured structures; the marginal mandibular branch is injured most (5.5%).

Published
2011
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