Surgery remember@: an innovation to reduce surgical cancellations.

The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

Assessment of carotid artery invasion by lymph node metastasis from squamous cell carcinoma of aero-digestive tract.

UNLABELLED: Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM: To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS: retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50% and from to 100%), and complex (0 to 25%; 26 to 50%; 51 to 75% and 76 to 100%). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS: The Kappa Index were moderate (0, 53%) for simple classification and minimum (0, 36%) for complex classification. CONCLUSIONS: The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

The importance of pre-epiglottis space invasion in the treatment planning of larynx and hypopharynx cancer.

UNLABELLED: The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.

Response time in the emergency services. Systematic review.

The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Surgery remember@: an innovation to reduce surgical cancellations / Surgery remember@: uma inovação para reduzir os cancelamentos cirúrgicos

ABSTRACT The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

RESUMO O uso de telefones celulares aumentou dramaticamente em todo o mundo. Essa revolução na comunicação entre os indivíduos tem impacto no cuidado ao paciente, apoiando sua autogestão e promovendo a responsabilidade compartilhada com os serviços de saúde. Tendo em vista que a melhoria da comunicação facilita o cumprimento dos procedimentos programados e reduz os cancelamentos cirúrgicos, o presente trabalho tem como objetivo desenvolver uma ferramenta de comunicação denominada Surgery Remember@ para mitigar as suspensões cirúrgicas por absenteísmo do paciente. O presente artigo é um estudo da produção tecnológica dividido em quatro capítulos: revisão de literatura; análise do perfil administrativo do hospital; desenvolvimento de software; e mapeamento de processos para implementação de software. Tendo em conta que nos últimos três anos o problema do absenteísmo foi a principal causa de cancelamentos cirúrgicos institucionais o desenvolvimento do Surgery Remember@ se apresenta como esforço para reduzir os cancelamentos de cirurgias, melhorando a eficiência e reduzindo custos. Sabe-se que o envio de mensagens três dias antes do procedimento cirúrgico possibilita a reposição de pacientes em caso de cancelamentos, otimizando os recursos humanos e materiais da sala cirúrgica. A confirmação da consulta pré-anestésica também é positiva, pois permite verificar a melhora da assistência perioperatória. Assim, além de viável e de fácil implementação, o software desenvolvido permite agregar outros recursos de acordo com a necessidade do usuário, mostrando-se uma ferramenta para redução de cancelamentos cirúrgicos.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer.

OBJECTIVE: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. METHODS: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic/tumoral. RESULTS: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. CONCLUSION: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

[Human papillomavirus (HPV) infection and its relation with squamous cell carcinoma of the mouth and oropharynx]. / Correlação da infecção viral pelo papilomavírus humano com as lesões papilomatosas e o carcinoma epidermóide na boca e orofaringe.

OBJECTIVE: To establish a connection between infection by the human papilloma virus (HPV) and development of malignant (squamous cell carcinoma) and benign lesions (epithelial hyperplasia papillomatosis and papilloma) of the oral cavity and oropharynx. METHOD: A retrospective study of 66 blades and paraffin blocks with biopsy tissue fixed with formalin. This material, collected in 2002, refers to a group of 44 men (66.7%) and 22 women (33.3%) with ages ranging from 11 to 100 years, with confirmed diagnoses of squamous cell carcinoma in 38 cases, of epithelial hyperplasia papillomatosis in 20 cases and of papillomas in 8 cases. This material was analyzed by immunohistochemistry and the presence of viral DNA in the biopsy samples was determined. RESULTS: Presence of the viral DNA (HPV) in 16 of the 38 cases of carcinoma (42.5%), 19 in 20 cases of hyperplasia (95%) and 8 in 8 cases of papilloma (100%) was detected. CONCLUSION: The samples in this study show the predominant incidence of the HPV in the epithelial hyperplasia papillomatosis and papilloma in relation to squamous cell carcinoma. This last lesion, on the other hand, did not show statistical correlation to the HPV.

Response time in the emergency services. Systematic review

Abstract The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

Extracranial neurogenic tumors of the head and neck, / Tumores neurogênicos extracranianos na cabeça e pescoço

ABSTRACT INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Resumo INTRODUÇÃO: Tumores dos nervos periféricos tipicamente derivam das células de Schwann da bainha dos nervos periféricos. Por serem incomuns, devem ser lembrados no diagnóstico diferencial pré-operatório. OBJETIVO: Relatar a experiência de serviço de referencia terciária. MÉTODO: De 1977 a 2013, 42 pacientes com tumores neurogênicos periféricos da cabeça e pescoço foram operados e analisados retrospectivamente. A confirmação diagnóstica pré-operatória deu-se por biópsia ou método de imagem. RESULTADOS: A média da idade foi de 41,7 anos, sendo 15 indivíduos (36%) do gênero masculino. O tamanho médio foi de 5,5 cm e 26 (61%) localizavam-se na face lateral do pescoço. A maior parte (39,9%) apresentou-se como tumor palpável assintomático. A maioria (39,9%) foi ressecadapor acesso cervical. A maioria originou-se de nervos cranianos. CONCLUSÕES: Tumores neurogênicos extracranianos apresentam-se com tamanho médio de 5,5 cm, na face lateral do pescoço, costumam originar-se de nervos cranianos e ser ressecados por via cervical.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer / Prevalência das alterações em tomografias computadorizadas de tórax em pacientes com câncer de cabeça e pescoço

Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Objetivo: avaliar a prevalência de alterações encontradas na tomografia computadorizada (TC) de tórax em pacientes com carcinoma epidermóide de cabeça e pescoço. Métodos: Foram analisadas retrospectivamente 209 TC de tórax de pacientes com carcinoma epidermoide de cabeça e pescoço. As alterações tomográficas foram estratificadas como: inflamatórias/infecciosas, parenquimatosas, nodulares incaracterísticas e nodulares metastáticas/tumorais Resultados: foram diagnosticadas alterações em 66,6 % dos exames. Destes, 25,3% representaram enfisema pulmonar; 18,8% micronódulos incaracterísticos; 12,9% metástases; 11,9% de linfonodomegalias torácicas; e, em 6,6%, foram detectadas tuberculose pulmonar ativa ou sequela, pneumonia ou sinais inflamatórios/infecciosos e espessamento ou derrame pleural. Conclusão: a prevalência de exames com alteração e o considerável índice de metástases detectadas, indicam que a TC de tórax deve ser solicitada para complementação diagnóstica e/ou estadiamento nos casos de câncer de cabeça e pescoço.

Conflitos de interesses na pesquisa médico-farmacológica / Conflicts of interest in the medical pharmacological research

A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinações, caminhando em direção ao respeito à dignidade da pessoa.

The clinical medical pharmacological research corresponds to the experimental application of specific drug in human beings. Such application aims to protect them from unacceptable adverse effects and its inefficiencywhen comparing with other possibilities, more efficient. Partnerships between the pharmaceutical industryand external researchers establish potential conflict of interest. Literature use for this work indicates that researches performed under the sponsorship of pharmaceutical industry have a high rate of favorable results,and the conflicts of interest represent gaps which may interfere the result. There are studies that compare theefficiency of different drugs, whereas others compare their costs. All results should be published, even whennegative. The present work concludes that the private sector must sponsor the science in order to improve human beings, especially to avoid diseases. However, it must keep its engagement in sponsoring the research withany influence on its methods, results and application, for a respectful understanding of the dignity of a person.

Valor da PET/CT na abordagem do câncer de cabeça e pescoço / Value of PET/CT in the approach to head and neck cancer

OBJETIVO: Avaliar a PET/CT na abordagem de pacientes com câncer de cabeça e pescoço. MATERIAIS E MÉTODOS: Estudo retrospectivo de 63 prontuários e exames de PET/CT de pacientes com câncer de cabeça e pescoço. RESULTADOS: Foram encontradas alterações em 76% dos exames. Destes, 7 (11%) foram considerados falso-positivos, com SUV < 5,0. A PET/CT mostrou-se negativa em 15 situações (24%). Dos 14 casos nos quais se utilizou o exame para estadiamento, em 3 (22%) houve aumento no estadiamento. CONCLUSÃO: A PET/CT mostra-se como exame de potencial valor na rotina de avaliação de pacientes com câncer de cabeça e pescoço, entretanto, necessitamos de maior número de casos para definirmos protocolo de uso.

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

Análise do PET-CT no estadiamento do câncer epidermoide de cabeça e pescoço / Analysis of PET-CT in the staging of head and neck cancer

Introdução: O carcinoma epidermoide na cabeça e pescoçotem uma recidiva loco-regional em 40% dos casos em dois anos,tornando necessário o seguimento convencional e por meio deexames de imagens, somando-se a técnica do 18F-FDG-PET.Objetivo: Demonstrar os primeiros dois anos de indicações eresultados da PET-CT em uma instituição pública. Método: Estudoretrospectivo de 50 exames de julho de 2009 a junho de 2012,realizados consecutivamente em 49 pacientes com carcinomaepidermoide das vias aerodigestivas superiores de estádiosclínicos I (4,1%), II (10,2%), III (32,7%) e IV (53%). Resultados:Em 12 casos, o exame foi realizado durante o estadiamento inicial.Em quatro casos, a PET foi realizado por tumor primário oculto naapresentação inicial. A PET-CT foi realizada pós-tratamento em31 casos, sendo que houve mudança de estádio clínico em 12desses pacientes após a realização da PET-CT. Foram realizadosdois exames em pacientes sob cuidados paliativos com sobrevidasuperior à esperada, sendo um diagnosticado sem doença e outrocom segunda lesão. Conclusão: O diagnóstico e estadiamento docâncer na cabeça e pescoço fazem-se por meio de exame diretocom biópsia e exame histológico. Exames de imagem metabólicose anatômicos - PET-CT - auxiliam, especialmente, no diagnósticodas recidivas loco-regionais.

Correlation between clinical and imaging findings in patients with temporomandibular disorders / Correlação entre os achados clínicos e imaginológicos nas disfunções temporomandibulares

OBJETIVO: Verificar a relação entre sinais e sintomas observados no exame clínico de pacientes com diagnóstico de disfunção temporomandibular, conforme os resultados fornecidos pelo exame de ressonância magnética. MATERIAIS E MÉTODOS: Trinta pacientes que apresentavam sinais e sintomas de disfunção temporomandibular foram submetidos a exame clínico e de ressonância magnética. Cada exame de ressonância magnética de articulação temporomandibular foi interpretado, independentemente, por dois radiologistas experientes. Os exames de ressonância magnética foram realizados com 12 cortes de 3 mm de espessura, em orientação coronal (T1) em posição de boca fechada, cortes sagitais em posição de boca aberta e fechada (T1 e T2) e em abertura e fechamento progressivos, com intervalo de 5 mm, para reproduzir toda a extensão do movimento mandibular. A significância estatística entre a análise clínica dos pacientes com disfunção temporomandibular e os resultados obtidos no exame de ressonância magnética foi avaliada pelo teste kappa. RESULTADOS: Obteve-se, na análise interobservadores de imagens, concordância bruta do lado esquerdo e direito, respectivamente, de 56,7 por cento (kappa = 0,1) e 56,7 (kappa = 0). CONCLUSÃO: Não foi encontrada correlação entre o diagnóstico clínico da luxação discal e imagens de ressonância magnética.

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

Importância da invasão do espaço pré-epiglótico no planejamento terapêutico do câncer da laringe e faringe / The importance of pre-epiglottis space invasion in the treatment planning of larynx and hypopharynx cancer

O comprometimento do espaço pré-epiglótico pode alterar a indicação de cirurgias parciais da laringe. OBJETIVO: Avaliar a concordância inter e intra-observadores da análise da tomografia computadorizada do envolvimento do espaço pré-epiglótico (EPE) por carcinoma epidermóide do trato aerodigestivo superior e sua repercussão no planejamento terapêutico. MATERIAL DE MÉTODO: Foram analisadas retrospectivamente as tomografias computadorizadas, do período de 1990 a 2004, de 95 pacientes com carcinoma epidermóide, sendo 87 do sexo masculino e apenas 8 eram do sexo feminino, com idade variando de 32 a 73 anos. Os exames foram avaliados duas vezes por três radiologistas, separadamente, sem o conhecimento prévio do estadiamento clínico. Todos os pacientes não haviam recebido qualquer tratamento até o momento do exame de imagem, como cirurgia, quimioterapia ou radioterapia. Todos os casos tiveram o diagnóstico confirmado por biópsia. As informações foram obtidas baseadas na revisão de prontuários médicos. RESULTADOS: O índice Kappa foi calculado para estimar a concordância entre os três observadores. A força de concordância variou de boa a excelente. CONCLUSÃO: Após um Kappa geral de 0,72, o resultado sugere uma concordância geral boa na avaliação do envolvimento do espaço EPE através de tomografia computadorizada.

The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.

Análise da invasão da artéria carótida por metástases linfonodais de carcinoma epidermóide de vias aero-digestivas superiores / Assessment of carotid artery invasion by lymph node metastasis from squamous cell carcinoma of aero-digestive tract

Invasão carotídea por linfonodos metastáticos altera a abordagem dos tumores de cabeça e pescoço. OBJETIVO: Avaliação interobservadores de imagens de TC do envolvimento do complexo carotídeo por linfonodos metastáticos de neoplasias vias aero-digestivas superiores e estabelecimento de critérios de ressecabilidade cirúrgica. MATERIAL E MÉTODO: Estudo retrospectivo não-randomizado, de 99 pacientes com CEC com linfonodos metastáticos envolvendo o complexo carotídeo. Oitenta e seis casos eram homens e 13 mulheres, idade entre 32 a 76 anos. As imagens foram avaliadas por quatro especialistas sem conhecimento do estadiamento clínico. Os pacientes não receberam tratamento prévio. Quanto à extensão do envolvimento da circunferência da carótida, empregamos 2 classificações: simples (de 0 a 50 por cento e de 51 a 100 por cento), e complexa (de 0 a 25 por cento; de 26 a 50 por cento; de 51 a 75 por cento e de 76 a 100 por cento). O nível de concordância interobservadores foi aferido pelo índice Kappa (p < 0,05) e a força de concordância variou de desprezível à excelente. RESULTADOS: O índice Kappa foi moderado (0,53 por cento) para a classificação simples e mínima (0,036) para a complexa. CONCLUSÃO: A TC mostrou baixa efetividade na avaliação de ressecabilidade quando do comprometimento do complexo carotídeo por linfonodos metastáticos de neoplasias malignas de cabeça e pescoço.

Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM: To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS: retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50 percent and from to 100 percent), and complex (0 to 25 percent; 26 to 50 percent; 51 to 75 percent and 76 to 100 percent). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS: The Kappa Index were moderate (0, 53 percent) for simple classification and minimum (0, 36 percent) for complex classification. CONCLUSIONS: The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

Diagnóstico por imagem dos tumores da nasofaringe / Imaging diagnosis of nasopharyngeal tumors

A nasofaringe é a parte mais superior das vias aéreas superiores. Seu limite superior é a base do osso esfenóide e occipital, situa-se anteriormente às duas primeiras vértebras cervicais e à frente do clivo. Seus limites laterais são formados pelas margens do músculo constritor superior da faringe e pela fáscia faringobasilar, recessos faríngeos, toro tubário e tuba auditiva. O limite inferior é um plano horizontal que passa pelo palato duro e pelo músculo palatofaríngeo. Anteriormente, comunica-se com a cavidade nasal via coana posterior. Mede cerca de 2,0 cm de diâmetro ântero-posterior e cerca de 4,0 cm de extensão crânio-caudal. O carcinoma de células escamosas compreende aproximadamente 70 por cento a 98 por cento de todas as neoplasias malignas da nasofaringe em adultos. Este tipo de tumor apresenta alta incidência na população asiática, sendo mais comum entre os homens e o terceiro mais comum entre as mulheres. A manifestação clínica do carcinoma da nasofaringe depende do tamanho da lesão e da sua localização, sendo que as lesões de pequenas dimensões são geralmente assintomáticas. A tomografia computadorizada e a ressonância magnética desempenham papel essencial e complementar no estadiamento e no tratamento dos pacientes portadores de câncer da nasofaringe.

The nasopharynx is located in the upper aerodigestive tract. Its roof is formed by the basisphenoid, basiocciput and the anterior aspect of the first two cervical vertebrae, in front of the clivus. The lateral walls are formed by the margins of the superior constrictor muscle and the pharyngobasilar fascia, pharyngeal recess, torus tubarius and pharyngeal opening of auditory tube. The inferior margin of the nasopharynx is a horizontal plane passing through the hard palate and palatopharyngeal muscle. Anteriorly, it is in direct continuity with the nasal cavity through the posterior choanae. It is approximately 2.0 cm in anteroposterior diameter and about 4.0 cm in craniocaudal extent. Squamous cell carcinoma accounts for about 70 percent to 98 percent of nasopharyngeal malignant lesions found in adults. This tumor presents a high incidence in Asians, most frequently in men, and is the third most frequent cancer in women. The clinical presentation of this disease depends on the size and site of the lesion, with small-sized lesions being asymptomatic. Computed tomography and magnetic resonance imaging play essential and complementary roles in the staging and treatment of patients with nasopharyngeal cancer.

Contribuição da tomografia computadorizada no estadiamento do carcinoma de células escamosas da supraglote / Computed tomography contribution to the staging of supraglottic squamous cell carcinoma

OBJETIVO: Este trabalho tem como objetivos avaliar a influência da tomografia computadorizada no estadiamento local da classificação TNM dos tumores da supraglote e avaliar a concordância interobservadores na detecção da extensão tumoral. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, 39 pacientes com carcinoma de células escamosas da supraglote atendidos no Hospital Heliópolis entre 1988 e 1998. Os exames de tomografia computadorizada foram analisados por dois radiologistas individualmente. Para a avaliação da concordância interobservadores utilizou-se o índice kappa. RESULTADOS: A tomografia computadorizada foi determinante no estadiamento mais avançado em 38,5 por cento dos casos, decorrente de extensão tumoral profunda não-identificada no exame clínico. CONCLUSÃO: A concordância interobservadores foi considerada ótima para as pregas vocais e subglote; boa para a supraglote, espaços paraglótico e pré-epiglótico, cartilagens cricóide e tireóide e para extensão tumoral extralaríngea; e regular para a base da língua.

OBJECTIVE: The present study was aimed at evaluating the role of computed tomography in the local clinical staging of supraglottic tumors according to the TNM classification, as well as the interobserver agreement on the detection of the tumor extent. MATERIALS AND METHODS: Thirty-nine dossiers of inpatients of Hospital Heliópolis with supraglottic squamous cell carcinoma in the period between 1988 and 1998 were retrospectively evaluated. CT studies were individually analyzed by two radiologists. The kappa test was utilized for evaluating the interobserver agreement. RESULTS: Computed tomography has played a decisive role in the upstaging of 38.5 percent of cases, as a result of a deep tumor extent undetected at clinical examination. CONCLUSION: Interobserver agreement was considered as excellent for vocal folds and subglottis; good for supraglottic, paraglottic and preepiglottic spaces, thyroid and cricoid cartilages and for extralaryngeal tumor extension; and regular for the base of the tongue.

O valor da tomografia computadorizada na mudança do paradigma cirúrgico do carcinoma epidermóide de boca e orofaringe / The value of computed tomography on surgical paradigm changing of squamous cell carcinoma of mouth and oropharynx

OBJETIVO: Determinar a importância da tomografia computadorizada na mudança do paradigma cirúrgico no carcinoma espinocelular (CEC) da boca e orofaringe. MÉTODO: De 1991 e 2004, nos Departamentos de Cirurgia de Cabeça e Pescoço/ORL e Radiologia do Hospital Heliópolis, foram analisados, retrospectivamente, tomografias computadorizadas de 30 pacientes, 25 homens e cinco mulheres, com idades variando de 25 a 77 anos, todos com diagnóstico de carcinoma epidermóide do soalho da boca e/ou da língua oral e orofaringe. Todos os exames foram avaliados por dois radiologistas, separadamente, sem o conhecimento prévio do estadiamento clínico, sendo analisada a disseminação local-regional para os diferentes sítios. Para análise interobservadores, o índice Kappa foi calculado para estimar a concordância entre os mesmos, sendo o nível de significância adotado o valor de 0,05. RESULTADO: A análise da concordância entre os observadores foi considerada excelente (Kappa: 0,81 - 1,00) para três subsítios (linha média, espaço mastigador e cadeia linfonodal jugulo-carotídea alta); boa (Kappa: 0,61 - 0,80) para 10 subsítios (soalho da boca e língua oral, ramo da mandíbula, trígono retromolar, espaço submandibular, loja amigdalina e cadeias linfonodais submentoniana, submandibular, jugulo-carotídea média, jugulo-carotídea baixa e espinal); moderada (Kappa: 0,41 - 0,60) para dois subsítios (corpo da mandíbula e base da língua) e não foi possível calcular o Kappa para um subsítio (cadeia linfonodal retrofaríngea). CONCLUSÃO: A concordância interobservadores predominou de boa a excelente, sendo os valores estatisticamente significantes.

BACKGROUND: The aim of this study is to evaluate the interobserver agreement, using computed tomography, regarding the local and regional extension of mouth and oropharynx squamous cell carcinoma. METHOD: From 1991 through 2004, thirty patients, with available CT examinations, were examined at the Head and Neck Surgery, Otorhinolaryngology and Imaging Departments of Heliópolis Hospital, São Paulo, Brazil. They were included in this retrospective non-randomized study. We performed biopsies and histopathologic examinations in all cases. There were 25 males and 5 females, with ages ranging from 25 to 77 years. Two radiologists evaluated all cases individually, without previous clinical staging data, analyzing local and regional sites of lesion dissemination. No patients had received any previous treatment up to the moment of CT examination. RESULTS: We calculated the kappa index by assessing agreement between the two observers, and the significance level was assumed 0.05. Agreement was excellent (Kappa: 0.81 - 1.00) in three analyzed subsets (middle line, masticator space and high jugular lymph node chains). It was good (Kappa: 0.61 - 0.80) in ten subsets (floor of the mouth and oral tongue, mandibular branches, retromolar trigone, submandibular space, tonsillar fossa and submentonian, submandibular, middle jugular, low jugular and spinal lymph node chains). It was moderate (Kappa: 0.41 - 0.60) in two subsets (mandibular body and base of the tongue), and in one subset the analysis was not possible using this coefficient where the Kappa index was not feasible. CONCLUSION: The interobserver agreement was of significant statistical value, predominating from good to excellent.