Treatment of caustic ingestion: an analysis of 239 cases

The objective of the present study was to analyze a 37-year historical series of patients who had ingested caustic substances, and who were treated in a teaching hospital, to assess the effectiveness of the therapy administered during this period. We studied 239 patients who ingested caustic soda (NaOH) from 1957 to 1994. Data were collected from the medical records of the patients and from interviews with them and analyzed by software and by statistical tests of association. The results showed that more women than men ingested caustic substances (57%, n=153). Ingestion was associated with suicidal intent in 60% of cases and was accidental in 37.2% of cases. The amount of substance ingested ranged from a trace to as much as three tablespoons, with the amount tending to be larger in the suicide attempts. Of the 215 patients for whom information about complications due to ingestion was available, 88.4% (190) presented lesions of the esophagus (73% with stenosis), 1% died during the acute phase, and 10.6% did not present complications. The data revealed that the presence and severity of stenosis were correlated with the amount of caustic substance ingested. The treatment received by the patients in the study sample varied over the years according to the prevailing literature recommendations. Based on our review, we conclude that neither the use of an antidote nor early treatment immediately after ingestion is effective. Treatment with a corticosteroid (1.5-2 mg/kg/day prednisone), an antibiotic, and a high-protein and hypercaloric diet seems to be beneficial for patients who ingest small or medium amounts of caustic soda. When 2-3 tablespoons are ingested, corticosteroids, in addition to being unable to prevent the formation of esophageal stenosis, increase the risk of other complications.

Genomics and proteomics approaches to the study of cancer-stroma interactions

Background

The development and progression of cancer depend on its genetic characteristics as well as on the interactions with its microenvironment. Understanding these interactions may contribute to diagnostic and prognostic evaluations and to the development of new cancer therapies. Aiming to investigate potential mechanisms by which the tumor microenvironment might contribute to a cancer phenotype, we evaluated soluble paracrine factors produced by stromal and neoplastic cells which may influence proliferation and gene and protein expression.

Methods

The study was carried out on the epithelial cancer cell line (Hep-2) and fibroblasts isolated from a primary oral cancer. We combined a conditioned-medium technique with subtraction hybridization approach, quantitative PCR and proteomics, in order to evaluate gene and protein expression influenced by soluble paracrine factors produced by stromal and neoplastic cells.

Results

We observed that conditioned medium from fibroblast cultures (FCM) inhibited proliferation and induced apoptosis in Hep-2 cells. In neoplastic cells, 41 genes and 5 proteins exhibited changes in expression levels in response to FCM and, in fibroblasts, 17 genes and 2 proteins showed down-regulation in response to conditioned medium from Hep-2 cells (HCM). Nine genes were selected and the expression results of 6 down-regulated genes (ARID4A, CALR, GNB2L1, RNF10, SQSTM1, USP9X) were validated by real time PCR.

Conclusions

A significant and common denominator in the results was the potential induction of signaling changes associated with immune or inflammatory response in the absence of a specific protein.

Effects of time of contact and concentration of caustic agent on generation of injuries

OBJECTIVES

Solid caustic soda (CS) ingestion levels continue high in Brazil. The aggressiveness of a caustic agent depends, among other factors, on its concentration and time of contact with mucosa. However, the interdependence of these factors in the production of caustic lesion in the esophageal mucosa is not known, especially regarding CS as the strongest corrosive agent. We analyze the effects of concentration and time of contact on the aggressiveness of CS to the esophagus of live animals.

STUDY DESIGN/METHODS

One milliliter of CS at concentrations between 1.83% and 73.33% was applied to rats. The solution was kept in contact with the mucosa for 10 to 120 minutes. Internal and external organ aspects were analyzed and the epithelium, submucosa, muscle layer, and adventitia were analyzed microscopically

RESULTS

Epithelial necrosis was observed at all concentrations. Among the necrotic layers, the submucosa was observed starting at the 7.33% concentration, and the muscular layer and adventitia were observed at 14.66% concentration. Damage to the pulmonary parenchyma and trachea occurred at 33.66% after 10 minutes, and perforation of the esophagus was observed only after 120 minutes. After 10 minutes, important corrosive lesions installed in the esophageal layers, expanding in depth and superficial extension. The use of heparin had no effect on the production of lesions.

CONCLUSIONS

Ten minutes were sufficient to provoke necrosis, and longer contact increased the area of necrosis. Solution concentration levels were more important in damage production: 1.83% was sufficient for epithelial necrosis, 7.33% caused submucosal necrosis, and 14.66% muscle and adventitia necrosis; 33.66% solutions caused lung and trachea damage after 10 minutes and esophageal perforation after 120 minutes.

Expression of cancer-testis antigens MAGE-A4 and MAGE-C1 in oral squamous cell carcinoma

BACKGROUND

Tumor markers are genes or their products expressed exclusively or preferentially in tumor cells and cancer-testis antigens (CTAs) form a group of genes with a typical expression pattern expressed in a variety of malignant neoplasms. CTAs are considered potential targets for cancer vaccines. It is possible that the CTA MAGE-A4 (melanoma antigen) and MAGE-C1 are expressed in carcinoma of the oral cavity and are related with survival.

METHODS

This study involved immunohistochemical analysis of 23 patients with oral squamous cell carcinoma (SCC) and was carried out using antibodies for MAGE-A4 and MAGE-C1. Fisher's exact test and log-rank test were used to evaluate the results.

RESULTS

The expression of the MAGE-A4 and MAGE-C1 were 56.5% and 47.8% without statistical difference in studied variables and survival.

CONCLUSION

The expression of at least 1 CTA was present in 78.3% of the patients, however, without correlation with clinicopathologic variables and survival.

Resection of juvenile angiofibroma using the Le Fort I approach

BACKGROUND

Juvenile angiofibroma (JA) is a rare tumor that occurs exclusively in adolescent male patients. The mainstay treatment for JA is complete surgical excision. Acceptable surgical approaches for the resection of JA include transantral, transpalatal, combined, endoscopic, and Le Fort I procedures, among others. Because exposure of the entire extension of the tumor may not possible, the recurrence rates after surgical treatment of JA may be as high as 55%. The purpose of this study was to evaluate the results after using the Le Fort I technique for the resection of JA.

METHODS

We retrospectively studied 19 patients with JA submitted to surgical resection by using the Le Fort I approach from March 1983 to September 2002. Data regarding demographic characteristics, tumor topography, use of embolization, recurrence, and complication of treatment were obtained.

RESULTS

Patient age at the time of diagnosis ranged from 8 to 26 years with a mean age of 16 years. The most common tumor site was the nasopharynx in 100% of the cases, pterygopalatine fossa (95%), nasal cavity (84%), and sphenoid sinus (63%). Angiography and embolization were performed preoperatively in 57% of the patients. The follow-up period ranged from 1 to 19 years (mean, 9.7 years; median, 8.0 years). One patient experienced malocclusion after surgery. However, we did not observe any recurrences during the follow-up period.

CONCLUSION

We conclude that the Le Fort I approach is a safe technique that permits the total resection of the JA with a low rate of postoperative complications and a low rate of recurrence.

Severe hypertrophy of the base of the tongue in adults

The lymphoid follicles at the base of the tongue can be detected when examining the pharynx of adults, but the presence of large follicles, denoted "severe" hypertrophy of the base of the tongue (HBT) is rare. The objective of the present study was to identify severe HBT cases and their symptoms and to correlate them with the presence of pharyngolaryngeal signs and esophageal symptoms of gastroesophageal reflux (GER) in patients seen at a laryngology clinic. Severe HBT was considered to be present when the follicles prevented the view of the epiglottis or were massively distributed through the pharynx and larynx. Five cases of severe HBT were detected among 306 patients submitted to videolaryngoscopy over a period of 2 years, corresponding to 1.6% (5/306) of the total sample studied. However, this index markedly increases to 4% (4/101) among patients with pharyngolaryngeal signs of GER and reached 7.5% (4/53) among patients presenting GER symptoms such as heartburn, regurgitation, retrosternal burning feeling, and dysphagia. The complaints due to severe HBT were noisy respiration, hoarseness, throat clearing, dry cough, globus pharyngeus, and nasal voice. We conclude that the frequency of hypertrophied follicles is increased in the presence of signs and symptoms of GER and those HBT symptoms are confused with those of GER, except for nasal voice and noisy respiration.

Central mucoepidermoid carcinoma: Report of 2 cases

Central mucoepidermoid carcinoma is a rare mandibular neoplasm. The objective of this paper was to report two cases.

Proximal Esophageal Contractions in Laryngectomized Patients

After laryngectomy for treatment of laryngeal cancer, the distal esophageal contractions have low amplitude. Our hypothesis is that proximal esophageal contractions are also impaired. We studied the proximal esophageal contractions in 20 laryngectomized patients (16 men) with a mean age of 44.2 years, 12 rehabilitated patients with esophageal speech, and 12 controls (7 men, mean age of 46.5 years). We used the manometric method with continuous perfusion. All subjects were studied in the sitting position and performed five swallows of a 5-ml bolus of water alternated with five dry swallows. The contractions were measured 2 cm below the high-pressure zone of the pharyngoesophageal transition. The results showed that the amplitude and duration of contractions were different in laryngectomized patients compared with controls. The amplitude of contractions of patients (wet swallows: 37.3+/-20.7 mmHg, mean+/-SD) was lower than that of controls (81.1+/-31.7 mmHg). The duration of contractions was also lower in laryngectomized patients (2.2+/-0.7 s) than in controls (2.6+/-0.6 s). We conclude that the proximal esophageal contraction amplitude and duration of laryngectomized patients are lower than controls, a fact suggesting that laryngectomy may affect the proximal esophageal contractions.

Assessment of MLL methyltransferase gene expression in larynx carcinoma

Larynx cancer is the second most common type of cancer among all head and neck cancers. Deregulation of epigenetic effectors, including altered expression of histone methyltransferases from the MLL (mixed lineage leukemia) family, have been reported in many cancer types, yet little is known concerning their involvement in larynx cancer. Our objective was to determine the expression profile of MLL genes in larynx carcinoma and normal adjacent tissues and correlate this profile to tumor characteristics. We analyzed the expression profile of 5 MLL genes in 13 cases of larynx carcinoma and their adjacent non-tumor tissues using quantitative real-time PCR. MLL3 was significantly downregulated in tumor samples compared to their normal counterparts, and all MLL genes showed decreased expression in advanced tumors compared to tumors in the initial stage. Altered expression in a single MLL gene was associated with a similar alteration in the other MLL genes, revealing a strong correlation of expression in each individual patient. In conclusion, MLL genes may have similar transcriptional control, and decreased expression of these genes may contribute to larynx cancer progression.

Effect of BCG stimulus on proinflammatory cytokine production in laryngeal cancer

BACKGROUND

Evaluate the production of TNF and IL-6 in the supernatant of peripheral blood mononuclear cell (PBMC) cultures of patients with supraglottic laryngeal cancer before and after surgical treatment.

MATERIALS AND METHODS

Adherent cell cultures were stimulated with LPS and BCG. Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cytokine concentration was determined by ELISA in supernatants of mononuclear cell cultures.

RESULTS

In non-stimulated cultures, lower TNF cytokine levels were detected during the late postoperative (LP) period compared to control (P = 0.02). LP TNF and IL-6 levels were high in cultures stimulated with LPS compared with the preoperative period (PREOP) (P = 0.007; P = 0.008, respectively). Stimulation with BCG led to increased levels of TNF and IL-6 during the LP period compared to control (P = 0.001; P = 0.04, respectively).

CONCLUSION

BCG is able to modulate the immune response of patients with advanced supraglottic laryngeal cancer in vitro, increasing the secretion of TNF and IL-6 by macrophages during the postoperative period.

Midfacial translocation, a variation of the approach to the rhinopharynx, clivus and upper odontoid process

OBJECTIVE

A surgical variation of the technique of facial translocation procedure is proposed, which has been called midfacial translocation for approach to the entire medial and lateral region of the middle third of the face, including the rhinopharynx, sphenoid sinus, pterygomaxillary fossa, odontoid process, and clivus.

PATIENTS AND METHODS

The medical records of five treated patients accordingly were reviewed for an analysis of the surgical technique, the disease, the topography of the lesion, and the complications.

RESULTS

The approach permitted ventral decompression of the bulbomedullary junction with resection of the C1 arch and the odontoid process in four patients and resection of a chordoma of the clivus located along the midline and extending intradurally in the fifth patient. Only one patient presented with dehiscence of the posterior half of the soft palate, this being the only complication observed following surgery in these patients. Three months postoperatively, no patient presented any aesthetic alteration of the face. Functionally, there was only infraorbital hypoaesthesia on the side of flap rotation.

CONCLUSION

The technique of midfacial translocation provides both good surgical approach and access to the rhinopharynx, pterygomaxillary fossa, high odontoid process and clivus, with few adverse sequelae for the patient.

Comparison between general anesthesia and superficial cervical plexus block in partial thyroidectomies

Aim

Case report and Methods

Results

Conclusion

Neck Mass Due to Thrombosis of the Jugular Vein in Patients with Cancer

The hypothesis that jugular thrombosis (JT) may cause a mass in the cervical region is usually overlooked. The objective of the present study was to identify the characteristics of neck masses resulting from JT in cancer patients and to analyze the possible reasons for their formation. A retrospective study was conducted on 8 patients with JT affected by 3 types of neoplasia, ie, carcinomas (3 cases), adenocarcinomas (3 cases), and lymphomas (2 cases) located in the breast, digestive apparatus, lymphatic system (2 cases each), lung and an undetermined site (1 case each), diagnosed over the last 12 years. The most frequent symptom of JT was the presence of a mass in the supraclavicular space (62.5% of cases) deeply located on the anterior margin of the sternocleidomastoid muscle and diagnosed by computed tomography and ultrasound. The masses were slightly hardened, with a clearly defined upper limit and an imprecise lower limit and with an irregular surface. The patients also presented with cough, hoarseness, pain during movements, facial edema, and collateral circulation. In one of the patients with a lung cancer, JT symptoms preceded the symptoms of cancer by 2 months. Hypercoagulation, compression, and invasion of a vessel possibly explain the occurrence of JT in these patients.

Study Protocol on Intentional Distortion in Personality Assessment: Relationship with Test Format, Culture, and Cognitive Ability

Self-report personality questionnaires, traditionally offered in a graded-scale format, are widely used in high-stakes contexts such as job selection. However, job applicants may intentionally distort their answers when filling in these questionnaires, undermining the validity of the test results. Forced-choice questionnaires are allegedly more resistant to intentional distortion compared to graded-scale questionnaires, but they generate ipsative data. Ipsativity violates the assumptions of classical test theory, distorting the reliability and construct validity of the scales, and producing interdependencies among the scores. This limitation is overcome in the current study by using the recently developed Thurstonian item response theory model. As online testing in job selection contexts is increasing, the focus will be on the impact of intentional distortion on personality questionnaire data collected online. The present study intends to examine the effect of three different variables on intentional distortion: (a) test format (graded-scale versus forced-choice); (b) culture, as data will be collected in three countries differing in their attitudes toward intentional distortion (the United Kingdom, Serbia, and Turkey); and (c) cognitive ability, as a possible predictor of the ability to choose the more desirable responses. Furthermore, we aim to integrate the findings using a comprehensive model of intentional distortion. In the Anticipated Results section, three main aspects are considered: (a) the limitations of the manipulation, theoretical approach, and analyses employed; (b) practical implications for job selection and for personality assessment in a broader sense; and (c) suggestions for further research.

Short telomere length in peripheral blood leukocytes in head and neck cancer: Findings in a Brazilian cohort

BACKGROUND

Telomeres are specialized DNA structures that are critical to maintain cell homeostasis and to avoid genomic instability. Epidemiological studies have examined the association between leukocyte telomere length (LTL) and risk of cancers, but the findings remain conflicting.

METHODS

Mean LTL was measured by quantitative PCR in 97 patients with head and neck cancer (HNC) and 262 healthy controls. The association between LTL and patients' clinical status, such as smoke, alcoholism, and overall survival, were also evaluated.

RESULTS

The age-adjusted LTL was significantly shorter in patients with HNC in comparison to healthy controls (P = .0003). Patients with shortest LTL had an increased risk to develop HNC (P < 0.0001). No significant correlation was observed between LTL and patients' clinical features and personal habits.

CONCLUSIONS

Our data support the hypothesis that LTL is a risk factor for HNC. The use of LTL as a biomarker can help physicians to identify high-risk individuals for HNC.

Vestibular fold flap for post-cordectomy laryngeal reconstruction

OBJECTIVES:

The development of techniques causing fewer sequelae without compromising oncologic control has led to better phonation, breathing, and postoperative swallowing in patients submitted to cordectomy. The objective of the present study was to describe post-cordectomy laryngeal reconstruction with a vestibular fold flap and to analyze the resulting laryngeal functions.

STUDY DESIGN:

Prospective study.

METHODS:

Ten patients, 9 males and 1 female, aged 45 to 75 years (mean, 64.5 years), were evaluated. The patients had squamous cell carcinomas in the glottic region and were treated surgically by laryngofissure and cordectomy with the use of a vestibular fold flap for laryngeal reconstruction. The patients were followed up for functional laryngeal analysis that consisted of videolaryngostrobos-copy, endoscopic evaluation of swallowing, and voice recording for perceptive auditory analysis, and for computing purposes.

RESULTS:

No patients depended on tracheostomy during the late postoperative period. No stenosis, anterior synechia, granuloma, or laryngocele were detected, although 1 patient developed immobility in the median position of the operated hemilarynx, which, however, was not sufficient to impair the respiratory function. No alterations in the pharyngeal phase of swallowing were observed by endoscopic evaluation. Using the GRBAS scale, we observed moderate (30%) and severe (20%) dysphonia in 50% of the patients and grade 1 dysphonia (40%) or normal (10%) dysphonia in the remaining ones. Computing analysis revealed the following mean values: fundamental frequency of 177.5 Hz, jitter 1.11%, and shimmer 7.04%.

CONCLUSIONS:

We conclude that reconstruction with a vestibular fold flap permitted the maintenance of the laryngeal functions of breathing and airway protection during swallowing, as well as the maintenance of phonation function, providing perfect voice emission according to perceptive auditory or acoustic analysis in 1 patient and moderate or severe dysphonia in one half of the cases when technical faults occurred.

Expressão da proteína ligadora de cálcio S100 A7 (psoriasina) no carcinoma laríngeo

Many studies have reported increased expression of S100 A7 (psoriasin) in neoplastic lesions. Among them are studies on breast carcinoma, bladder squamous cell carcinoma, skin tumors and oral cavity squamous cell carcinoma. The expression of S100 A7 has not been described for laryngeal cancer.

Objective: This study aims to identify the expression of the calcium-binding protein S100 A7 and its correlation with squamous cell carcinomas of the larynx.

Material and Methods: Specimens from 63 patients were submitted to immunohistochemistry testing with antibody S100 A7. Results were classified and compared.

Results: The group with highly differentiated tumors had the highest treatment failure scores. Moderately differentiated tumors had higher treatment failure scores than poorly differentiated tumors. Higher scores were predominantly seen on stages I and II in moderately differentiated tumors, whereas score distribution was more homogeneous in advanced stage disease (III and IV). Regarding failure in treatment, the group scoring zero (3/4 complications: 75%) differed significantly from the remaining groups (13/59: 22%).

Conclusions: S100 A7 marker was expressed in 93.7% of laryngeal cancer cases, with higher positive correlation rates in more differentiated tumors and significantly lower rates of treatment failure. Scores had no impact on survival rates.

Effect of surgical treatment on lymphoproliferation in advanced supraglottic laryngeal cancer

OBJECTIVES

The capacity of cell immunity to act against tumor cells has been presented as a decisive influence in the prognosis of patients with cancer. The aim of this study was to evaluate lymphoproliferation in nonadherent peripheral blood cell cultures of patients with advanced supraglottic laryngeal cancer.

STUDY DESIGN

Fourteen patients with advanced supraglottic laryngeal cancer were studied prospectively. Lymphoproliferation was quantified by adding 3H-thymidine and measured in counts/minute using liquid scintillation spectrometry. Based on the ratio between stimulated and baseline cultures, the proliferation index was calculated before and 236 +/- 18 days after the surgery.

RESULTS

Lymphoproliferation was lower in patients than in healthy controls (P = .01) in the preoperative as well as in the late postoperative period (P = .006 and P = .02, respectively). However, there was no change from preoperative to late postoperative.

CONCLUSION

Pre- and postoperative results show that patients with advanced supraglottic laryngeal cancer present lymphoproliferation diminished before the surgery, and in the late postoperative period, there was no recovery of immune capacity evaluated by lymphoproliferation measurement.

Avaliação da eficácia do cidofovir na papilomatose respiratória recorrente juvenil

Aim

Study design

Methods

Results

Conclusion

Electrophysiologic activity of the vestibular fold

OBJECTIVES

To assess the vestibular fold muscle after cordectomy and laryngeal reconstruction, the pattern of motor unit recruitment during sound emission, and the morphologic characteristics of motor unit action potentials.

DESIGN

Prospective analysis.

SETTING

Tertiary academic hospital.

PATIENTS

We evaluated 11 men (mean age, 65.7 years; age range, 53-82 years) who underwent laryngofissure, cordectomy, and laryngeal reconstruction with a vestibular fold flap.

INTERVENTIONS

Laryngeal electromyography with the insertion of a needle electrode for the assessment of the electrophysiologic activity of thyroartenoid muscle fibers and of the cricothyroid muscle on the operated on and nonoperated on sides. The thyroarytenoid muscle was evaluated by introducing a needle electrode through the thyroid cartilage and the cricothyroid membrane.

MAIN OUTCOME MEASURES

Activities of needle insertion, spontaneous muscle activity during rest, and pattern of motor unit recruitment.

RESULTS

Seven patients (64%) had vestibular fold muscle fiber, all of whom showed motor unit recruitment in response to sound emission. No neurogenic muscle injuries were observed except in 1 patient with evidence of chronic injury.

CONCLUSION

After cordectomy and laryngeal reconstruction, thyroarytenoid muscle fibers are present in the vestibular fold, with motor unit recruitment during sound emission.

Expression of MAGE-A4 and MAGE-C1 tumor-associated antigen in benign and malignant thyroid diseases

BACKGROUND

A subset of thyroid tumors characterized by a follicular growth pattern can represent a serious diagnosis. Immunohistochemistry and molecular pathology for genetic profiling have been used in an attempt to resolve some of these issues.

METHODS

Tumor tissue samples of thyroid were obtained from 70 patients who underwent surgical therapy. They were divided into 4 groups: 20 adenomatous goiters, 10 follicular adenomas, 24 papillary carcinomas, and 16 follicular carcinomas. Immunohistochemical analysis was carried out using antibodies for MAGE-A4 (melanoma antigen-encoding gene A4) and MAGE-C1 (melanoma antigen-encoding gene C1).

RESULTS

Standard histologic analysis and immunohistochemistry analysis of MAGE-A4 and MAGE-C1 expression were performed in all patients. The antigens examined were not expressed in any of the tissues.

CONCLUSIONS

The malignant degeneration of normal tissues is a multifactorial process, varying considerably both among tumor types and among individual patients. The present study showed that there was no immunolabeling of the MAGE-A4 and MAGE-C1 antigens.

CAAtivas: Aprender com jogos em Comunidade

O Projeto CAAtivas consiste numa plataforma de Aprendizagens Ativas, em comunidade de prática apoiada por investigação. Aposta num modelo dinâmico e inclusivo de aprendizagens significativas ao longo da vida, e de verificação de competências. Com análise de jogos, formação de mentores e preparação de toolkits propõe imersão em contextos de jogabilidade, com correspondência a critérios de avaliação autêntica, seja, referidos a metas curriculares. O estudo do impacto, e.g. no rendimento e adaptação escolar, requer avaliações psicopedagógicas criteriosas, cujos guias de estruturação de programas visam a promoção de aprendizagens do Ensino Básico e capacitação em competências para o séc. XXI.

Complicações decorrentes do uso de prótese vocal

INTRODUÇÃO: Desde a primeira laringectomia total, realizada em 1873, já se tem registro do interesse em se desenvolver e recuperar a comunicabilidade verbal desses pacientes. Porém grandes progressos foram observados depois de 1979, quando se pode contar com próteses traqueoesofágicas. Mesmo sendo um enorme progresso, as próteses vocais geram complicações. OBJETIVO: Avaliar as complicações com o emprego de próteses vocais e relaciona-las com fatores clínicos e tipo de prótese. MÉTODOS: Dez pacientes submetidos a laringectomia total portando prótese fonatória foram acompanhados no serviço de Cirurgia de Cabeça e Pescoço do HCRP-FMRP-USP buscando-se registrar as complicações e relaciona-las com fatores clínicos e tipo de prótese. RESULTADOS: Foram registrados: vazamento de saliva e/ou dieta da faringe para a traquéia, infecção fungica, ausência de função da prótese e esses achados foram quantificados avaliando-se os efeitos da radioterapia e do tipo de prótese usada. CONCLUSÃO: A prótese vocal apresenta dificuldades e complicações operacionais que merecem atenção e mais estudos são necessários para se ter o perfil mais completo destes aspectos.

Transformação anaplásica em carcinoma papilífero de tireóide

OBJETIVO: Escrever a transformação de um Carcinoma Papilífero de Tireóide em Carcinoma Anaplásico. MÉTODOS: relato de caso de uma paciente portadora de Carcinoma Papilífero de glândula tireóide e tratada no Serviço de Cirurgia de Cabeça e Pescoço do HCMRPUSP. Espécimes histológicos foram colhidas durante o decorrer do tratamento e estudos anatomopatológico e imuno-histoquímico foram realizados para direcionar conduta médica. RESULTADOS: A análise anatomopatológica e imuno-histoquímica realizada mostrou mudança de padrão de diferenciação celular durante a evolução da doença em questão. Tais dados, correlatados às características clínico-radiológicas tornam o caso compatível com a transformação anaplásica tireoideana a partir de um tumor bem diferenciado-Carcinoma Papilífero de tireóide. CONCLUSÕES: Observa-se nítida diferença das características evolutivas dos dois tipos de tumores malignos presentes nesta paciente: a primeira com comportamento "benigno" e indolente e a segunda agressiva, e fatal, sugerindo transformação anaplásica - como já descrita previamente na literatura.