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Melo GM, Gonçalves AJ, Walder F, Ferraz C, Neves MC, Abrahão M, Cervantes O. Analysis of the status of treatment of benign thyroid diseases - a public health problem aggravated in the COVID-19 pandemic era. Braz J Otorhinolaryngol 2021; 88:982-989. [PMID: 34799264 PMCID: PMC8536560 DOI: 10.1016/j.bjorl.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications. METHODS This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited. RESULTS All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients' physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions. CONCLUSIONS Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.
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Affiliation(s)
- Giulianno Molina Melo
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), Departamento de Tireoide, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Antonio José Gonçalves
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Departamento de Cirurgia - Divisão de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), São Paulo, SP, Brazil
| | - Fernando Walder
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Sociedade Brasileira de Cirurgia de Cabeça e Pescoço (SBCCP), São Paulo, SP, Brazil
| | - Carolina Ferraz
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Murilo Catafesta Neves
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil; Beneficencia Portuguesa de São Paulo Hospital, Departamento de Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
| | - Marcio Abrahão
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
| | - Onivaldo Cervantes
- Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça Pescoço, São Paulo, SP, Brazil
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de Souza França PD, Guru N, Kostolansky AR, Mauguen A, Pirovano G, Kossatz S, Roberts S, Abrahão M, Patel SG, Park KJ, Reiner T, Jewell E. PARP1: A Potential Molecular Marker to Identify Cancer During Colposcopy Procedures. J Nucl Med 2021; 62:941-948. [PMID: 33188153 PMCID: PMC8882878 DOI: 10.2967/jnumed.120.253575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Despite efforts in prevention, cervical cancer still presents with a high worldwide incidence and remains a great problem in public health, especially in low-income countries. Screening programs, such as colposcopy with Papanicolaou testing, have greatly improved mortality rates. However, the agents currently used to delineate those lesions (topical application of acetic acid or Lugol iodine) lack specificity and sometimes can lead to unnecessary biopsies or even cervical excisions. A tool to enable in vivo histology to quickly and quantitatively distinguish between tumor, dysplastic tissue, and healthy tissue would be of great clinical interest. Methods: Here, we describe the use of PARPi-FL, a fluorescent inhibitor of poly[adenosine diphosphate-ribose]polymerase 1 (PARP1), which is a nuclear enzyme that is overexpressed in cancer when compared with the normal surrounding tissues. We exploit its use as an optical imaging agent to specifically target PARP1 expression, which was demonstrated to be higher in cervical cancer than the normal surrounding tissue. Results: After topical application of PARPi-FL on freshly excised cone biopsy samples, the nuclei of tumor cells emitted a specific fluorescent signal that could be visualized using a handheld fluorescence confocal microscope. Conclusion: This approach has the potential to improve in vivo identification of tumor cells during colposcopy examination, allowing a rapid, noninvasive, and accurate histopathologic assessment.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abigail R Kostolansky
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Chemistry, Princeton University, Princeton, New Jersey
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Giacomo Pirovano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Nuclear Medicine, University Hospital Klinikum Rechts der Isar and TranslaTUM, Technical University Munich, Munich, Germany
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
- Department of Radiology, Weill Cornell Medical College, New York, New York; and
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Jewell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Neves MCD, Abrahão AR, Abrahão M, Rosano M, Rocha LAD, Machado HKAG, Santos RO. Sestamibi scan in renal parathyroidectomy: a worthwhile preoperative exam? Braz J Otorhinolaryngol 2020; 88:740-744. [PMID: 33303418 PMCID: PMC9483931 DOI: 10.1016/j.bjorl.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Surgical treatment of hyperparathyroidism related to chronic kidney disease is a real challenge for Brazilian public health care. High cost medications and long waiting lines to perform preoperative exams, especially technetium Tc 99m Sestamibi (MIBI) are some of the reasons. Despite the reality that the aid of localization exams are questionable in this scenario, doctors are too apprehensive in performing surgery without it. Objective The study aimed at evaluating the efficacy of surgery for renal hyperparathyroidism without preoperative MIBI. Methods A total of 114 patients were surgically treated. Total parathyroidectomy with autotransplantation and subtotal parathyroidectomy were carried out without preoperative MIBI. Results and conclusion Among the 114 patients undergoing surgery, 37 had secondary hyperparathyroidism in dialysis replacement, and 77 patients had post-renal transplant persistent disease. We were successful in 107 cases with only 7 failures (93.8% of success rate). Among these failures, only one parathyroid gland was not found in 4 cases, 2 parathyroid glands were not found in 2 cases and in 1 patient the 4 glands were found but this patient remained hypercalcemic and a postoperative diagnosis of supernumerary parathyroid gland was made. Surgery for treatment of renal hyperparathyroidism proved to be an effective (93.8%) and reproductible procedure, even without MIBI.
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Affiliation(s)
- Murilo Catafesta das Neves
- Universidade Federal de São Paulo, São Paulo, SP, Brazil; Hospital de Transplantes Euryclides de Jesus Zerbine, São Paulo, SP, Brazil.
| | | | - Marcio Abrahão
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcello Rosano
- Hospital de Transplantes Euryclides de Jesus Zerbine, São Paulo, SP, Brazil
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Demétrio de Souza França P, Guru N, Roberts S, Kossatz S, Mason C, Abrahão M, Ghossein RA, Patel SG, Reiner T. Fluorescence-guided resection of tumors in mouse models of oral cancer. Sci Rep 2020; 10:11175. [PMID: 32636416 PMCID: PMC7341853 DOI: 10.1038/s41598-020-67958-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
Complete removal and negative margins are the goal of any surgical resection of primary oral cavity carcinoma. Current approaches to determine tumor boundaries rely heavily on surgeons' expertise, and final histopathological reports are usually only available days after surgery, precluding contemporaneous re-assessment of positive margins. Intraoperative optical imaging could address this unmet clinical need. Using mouse models of oral cavity carcinoma, we demonstrated that PARPi-FL, a fluorescent PARP inhibitor targeting the enzyme PARP1/2, can delineate oral cancer and accurately identify positive margins, both macroscopically and at cellular resolution. PARPi-FL also allowed identification of compromised margins based on fluorescence hotspots, which were not seen in margin-negative resections and control tongues. PARPi-FL was further able to differentiate tumor from low-grade dysplasia. Intravenous injection of PARPi-FL has significant potential for clinical translation and could aid surgeons in assessing oral cancer margins in vivo.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Christian Mason
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY, USA.
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Demétrio de Souza França P, Roberts S, Kossatz S, Guru N, Mason C, Zanoni DK, Abrahão M, Schöder H, Ganly I, Patel SG, Reiner T. Fluorine-18 labeled poly (ADP-ribose) polymerase1 inhibitor as a potential alternative to 2-deoxy-2-[ 18F]fluoro-d-glucose positron emission tomography in oral cancer imaging. Nucl Med Biol 2020; 84-85:80-87. [PMID: 32135475 PMCID: PMC7253343 DOI: 10.1016/j.nucmedbio.2020.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The evaluation of disease extent and post-therapy surveillance of head and neck cancer using 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) PET is often complicated by physiological uptake in normal tissues of the head and neck region, especially after surgery or radiotherapy. However, irrespective of low positive predictive values, [18F]FDG PET remains the standard of care to stage the disease and monitor recurrences. Here, we report the preclinical use of a targeted poly (ADP-ribose) polymerase1 (PARP1) binding PET tracer, fluorine-18 labeled poly (ADP-ribose) polymerase1 inhibitor ([18F]PARPi), as a potential alternative with greater specificity. METHODS Using an orthotopic xenograft mouse model injected with either FaDu or Cal 27 (human squamous cell carcinoma cell lines) we performed PET/CT scans with the 2 tracers and compared the results. Gamma counts and autoradiography were also assessed and correlated with histology. RESULTS The average retained activity of [18F]PARPi across cell lines in tumor-bearing tongues was 0.9 ± 0.3%ID/g, 4.1 times higher than in control (0.2 ± 0.04%ID/g). Autoradiography and histology confirmed that the activity arose almost exclusively from the tumor areas, with a signal/normal tissue around a ratio of 42.9 ± 21.4. In vivo, [18F]PARPi-PET allowed delineation of tumor from healthy tissue (p < .005), whereas [18F]FDG failed to do so (p = .209). CONCLUSIONS AND IMPLICATIONS FOR PATIENT CARE We demonstrate that [18F]PARPi is more specific to tongue tumor tissue than [18F]FDG. [18F]PARPi PET allows for the straightforward delineation of oral cancer in mouse models, suggesting that clinical translation could result in improved imaging of head and neck cancer when compared to [18F]FDG.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil.
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Christian Mason
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA; Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Abrahão M. The future … to whom it belongs? Braz J Otorhinolaryngol 2016; 82:371. [PMID: 27320650 PMCID: PMC9449079 DOI: 10.1016/j.bjorl.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Haddad L, Martinho Haddad FL, Bittencourt L, Gregório LC, Tufik S, Abrahão M. Impact of thyroidectomy on the control of obstructive sleep apnea syndrome in patients with large goiters. Sleep Breath 2014; 18:825-8. [PMID: 24535631 DOI: 10.1007/s11325-014-0950-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. The aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters. METHODS Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. Of these, 17 (70.8%) presented OSAS and formed the research group. The protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery. RESULTS The average age of the patients was 58.3±9.9 years, and there were 5 (29.4%) males and 12 (70.6%) females. The significant findings in the postoperative period included a reduced neck circumference (p=0.041), reduced Epworth sleepiness score (p=0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p<0.001), and a tendency for a significant reduction in snoring (p=0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery. CONCLUSION Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.
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Affiliation(s)
- Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
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Ohe MN, Santos RO, Hojaij F, Neves MC, Kunii IS, Orlandi D, Valle L, Martins C, Janovsky C, Ferreira R, Delcelo R, Domingos AM, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JGH. Parathyroid carcinoma and hungry bone syndrome. ACTA ACUST UNITED AC 2013; 57:79-86. [PMID: 23440103 DOI: 10.1590/s0004-27302013000100011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 09/08/2012] [Indexed: 11/22/2022]
Abstract
We hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma removal.
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Affiliation(s)
- Monique Nakayama Ohe
- Division of Endocrinology and Metabolism, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp/ EPM), Sao Paulo, SP, Brazil.
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Vanderlei FAB, Vieira JGH, Hojaij FC, Cervantes O, Kunii IS, Ohe MN, Santos RO, Abrahão M. Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy. ACTA ACUST UNITED AC 2012; 56:168-72. [DOI: 10.1590/s0004-27302012000300003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 03/23/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.
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López RVM, Zago MA, Eluf-Neto J, Curado MP, Daudt AW, da Silva-Junior WA, Zanette DL, Levi JE, de Carvalho MB, Kowalski LP, Abrahão M, de Góis-Filho JF, Boffetta P, Wünsch-Filho V. Education, tobacco smoking, alcohol consumption, and IL-2 and IL-6 gene polymorphisms in the survival of head and neck cancer. Braz J Med Biol Res 2011; 44:1006-12. [PMID: 21845339 DOI: 10.1590/s0100-879x2011007500097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 07/27/2011] [Indexed: 12/16/2022] Open
Abstract
The association of education, tobacco smoking, alcohol consumption, and interleukin-2 (IL-2 +114 and -384) and -6 (IL-6 -174) DNA polymorphisms with head and neck squamous cell carcinoma (HNSCC) was investigated in a cohort study of 445 subjects. IL-2 and IL-6 genotypes were determined by real-time PCR. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of disease-specific survival according to anatomical sites of the head and neck. Mean age was 56 years and most patients were males (87.6%). Subjects with 5 or more years of schooling had better survival in larynx cancer. Smoking had no effect on HNSCC survival, but alcohol consumption had a statistically significant effect on larynx cancer. IL-2 gene +114 G/T (HR = 0.52; 95%CI = 0.15-1.81) and T/T (HR = 0.22; 95%CI = 0.02-3.19) genotypes were associated with better survival in hypopharynx cancer. IL-2 +114 G/T was a predictor of poor survival in oral cavity/oropharynx cancer and larynx cancer (HR = 1.32; 95%CI = 0.61-2.85). IL-2 -384 G/T was associated with better survival in oral cavity/oropharynx cancer (HR = 0.80; 95%CI = 0.45-1.42) and hypopharynx cancer (HR = 0.68; 95%CI = 0.21-2.20), but an inverse relationship was observed for larynx cancer. IL-6 -174 G/C was associated with better survival in hypopharynx cancer (HR = 0.68; 95%CI = 0.26-1.78) and larynx cancer (HR = 0.93; 95%CI = 0.42-2.07), and C/C reduced mortality in larynx cancer. In general, our results are similar to previous reports on the value of education, smoking, alcohol consumption, and IL-2 and IL-6 genetic polymorphisms for the prognosis of HNSCC, but the risks due to these variables are small and estimates imprecise.
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Affiliation(s)
- R V M López
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
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Leonhardt FD, Quon H, Abrahão M, O'Malley BW, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck 2011; 34:146-54. [DOI: 10.1002/hed.21688] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 11/09/2022] Open
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Oliveira UEM, Ohe MN, Santos RO, Cervantes O, Abrahão M, Lazaretti-Castro M, Vieira JGH, Hauache OM. Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism. Braz J Med Biol Res 2007; 40:519-26. [PMID: 17401495 DOI: 10.1590/s0100-879x2007000400010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 01/03/2007] [Indexed: 11/22/2022] Open
Abstract
Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.
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Affiliation(s)
- U E M Oliveira
- Disciplina de Endocrinologia e Metabologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brasil
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de Miranda SL, Abrahão M. Intraoral Vertical Ramus Osteotomy Endoscopic Surgery. J Oral Maxillofac Surg 2007; 65:805-8. [PMID: 17368385 DOI: 10.1016/j.joms.2006.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2004] [Revised: 04/18/2006] [Accepted: 05/24/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Sérgio Luis de Miranda
- Researcher, Head and Neck Surgery, Department of Otolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
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Israel Y, Cervantes O, Abrahão M, Ceccon FP, Marques Filho MF, Nascimento LA, Zonato AI, Tufik S. Obstructive sleep apnea in patients undergoing supracricoid horizontal or frontolateral vertical partial laryngectomy. Otolaryngol Head Neck Surg 2007; 135:911-6. [PMID: 17141083 DOI: 10.1016/j.otohns.2006.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 02/22/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess obstructive sleep apnea (OSA) in patients undergoing supracricoid horizontal partial laryngectomy (SCPL) or frontolateral vertical partial laryngectomy (VPL) for the treatment of laryngeal carcinoma and correlate it with age, body mass index, physical examination, and upper airway evaluation. STUDY DESIGN AND SETTING A prospective study was carried out involving 22 patients between 50 and 80 years of age divided into 2 equal groups. The patients underwent SCPL and VPL, and were evaluated by anamnesis, otolaryngologic examinations, nasopharyngolaryngoscopy, and polysomnography. RESULTS A significant direct correlation was observed between the apnea/hypopnea index (AHI) and age of the patients. An inversely proportional relation was found between glottic opening and AHI. The presence of OSA was 81% in SCPL and 91% in VPL. CONCLUSION We observed a high incidence of OSA in patients undergoing SCPL and VPL.
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Affiliation(s)
- Yusef Israel
- Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
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Ohe MN, Santos RO, Barros ER, Lage A, Kunii IS, Abrahão M, Cervantes O, Hauache OM, Lazaretti-Castro M, Vieira JGH. Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002. Braz J Med Biol Res 2005; 38:1383-7. [PMID: 16138222 DOI: 10.1590/s0100-879x2005000900013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium +/- SD, 13.6 +/- 1.6 mg/dl), 8 of them (88.8%) defined as symptomatic. The second group comprised 30 patients (mean calcium +/- SD, 12.2 +/- 1.63 mg/dl), 22 of them defined as symptomatic (73.3%). The third group contained 65 patients (mean calcium 11.7 +/- 1.1 mg/dl), 34 of them symptomatic (52.3%). Patients from the first group tended to be younger (mean +/- SD, 43.0 +/- 15 vs 55.1 +/- 14.4 and 55.7 +/- 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 +/- 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 +/- 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.
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Affiliation(s)
- M N Ohe
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Nemr K, Amar A, Abrahão M, Leite GCDA, Köhle J, Santos ADO, Correa LAC. Análise comparativa entre avaliação fonoaudiológica perceptivo-auditiva, análise acústica e laringoscopias indiretas para avaliação vocal em população com queixa vocal. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s0034-72992005000100003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Com a evolução e o desenvolvimento tecnológico, houve mudanças nos métodos de avaliação da voz, tanto na prática médica como fonoaudiológica. OBJETIVO: Relacionar os resultados da avaliação perceptivo-auditiva vocal, análise acústica e avaliações médicas no diagnóstico de alterações vocais e/ou laríngeas em indivíduos com queixa vocal. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foram avaliados 29 indivíduos que participaram de uma ação de proteção de saúde. Os sujeitos foram submetidos à avaliação fonoaudiológica peceptivo-auditiva (AFPA), análise acústica (AA), laringoscopia indireta (LI) e telelaringoscopia (TL). RESULTADOS: Foram estabelecidas as relações entre os métodos de avaliação médica e fonoaudiológica, verificando possíveis significâncias estatísticas a partir da aplicação do Teste Exato de Fischer. Houve significância estatística na relação entre AFPA e LI, AFPA e TL, LI e TL. CONCLUSÃO: Esta pesquisa realizada numa ação de proteção de saúde vocal mostrou concordância entre a avaliação fonoaudiológica perceptivo-auditiva e as avaliações médicas, bem como os exames médicos entre si no diagnóstico de alterações vocais e/ou laríngeas.
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Nemr K, Amar A, Abrahão M, Leite GCDA, Köhle J, Santos ADO, Correa LAC. Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint. Braz J Otorhinolaryngol 2005; 71:13-7. [PMID: 16446885 PMCID: PMC9443496 DOI: 10.1016/s1808-8694(15)31278-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice. Aim To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint. Study design Clinical prospective. Material and Method 29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL). Results Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL. Conclusion This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams.
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Ohe MN, Santos RO, Kunii IS, Carvalho AB, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JGH. Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements. Braz J Med Biol Res 2003; 36:715-21. [PMID: 12792700 DOI: 10.1590/s0100-879x2003000600006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70 C for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.
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Affiliation(s)
- M N Ohe
- Disciplina de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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Affiliation(s)
- R A Dedivitis
- Discipline of Otorhinolaryngology and Surgery of Head and Neck, UNIMES, Santos, Brazil.
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Abstract
CONTEXT Paranasal sinus cancer is considered rare, with an incidence of less than 1 per 100,000 per year, with the frontal sinus being the primary site in only 0.3%. We report a case of adenocarcinoma arising in the frontal sinus. DESIGN Case report. CASE REPORT A 59-year-old woman, secretary, came in February 1998 with a 4-month history of low intensity frontal headache. She denied contact with wood dust. On examination a non-tender swelling was noted over her right forehead next to the medial aspect of the right orbit. CT scan showed a soft-tissue mass involving frontal sinus with intracranial invasion through the posterior wall. The anterior ethmoid sinus and the medial aspect of the right orbit were also involved. MRI demonstrated dural thickening in communication with the frontal mass. She underwent an en-bloc tumor resection by craniotomy including orbital clearance. Histology revealed an adenocarcinoma. After surgery she had tumor recurrence, and chemotherapy and radiotherapy were started resulting in partial improvement.
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Affiliation(s)
- M Abrahão
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
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Abstract
CONTEXT Many methods have been used successfully for the diagnosis and treatment of laryngeal diseases. Microscopic and, recently, telescopic surgery represent the state of the art in endoscopic laryngeal surgery but drawbacks are possible during their application. To keep the suspension apparatus adequately positioned, excessive force is sometimes placed on the upper teeth and tongue with the laryngoscope tube causing damage. Complications in relation to the pharynx, larynx and cardiovascular system have also been reported. OBJECTIVE In order to reduce complications resulting from the manipulation or stimulation of the upper aerodigestive tract and from torque forces on the upper teeth. We present a method of larynx surgery in which laryngeal suspension is not required. DESIGN Technical report. TECHNIQUES We have devised a fiber-optic telescope with its 40mm distal portion deviated 60 degrees from the direction of the proximal portion. This angle was taken by measuring patients immediately before standard microlaryngeal surgery was performed. The surgical instruments have the same angle as the telescope, in order to work on the larynx. This technique provides an image that is not limited by the distal aperture of the laryngoscope and has an advantage in that magnification and illumination may be provided by changing the distance of the lesion from the tip of the instrument. we have operated on four patients with laryngeal diseases and have had no complications as a result of this approach. We feel that this technique gives us the freedom to view the lesions better and helps to minimize the drawbacks caused by laryngeal suspension.
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Affiliation(s)
- P F Morgado
- Otolaryngology, Head and Neck Department, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil.
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Pontes PA, Gregório LC, Abrahão M, Cervantes O. [Invasive paraganglioma of the carotid body]. Rev Paul Med 1986; 104:330-2. [PMID: 3629107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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