ABSTRACT
Abstract Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging (p = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality (p = 0.016), clinical T staging (p = 0.049), and histology (p = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age (p = 0.013), clinical N staging (p < 0.001), and presence of extranodal invasion (p < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.
ABSTRACT
@#BACKGROUND: Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important.METHODS: We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed.RESULTS: The study included 56 patients (44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4％ of the patients. Two (3.6％) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6％ of the patients, deep neck infection in 19.6％, and bilateral vocal fold paralysis in 10.7％. Stridor was the most frequent signal (51.8％). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated (average time: 4 months), and none of them were cancer patients. Complications occurred in 5 (12.2％) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure.CONCLUSION: Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with diffi cult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient''s clinical status turns into a surgical emergency situation.
ABSTRACT
Durante as últimas décadas, o Brasil tem experimentado alterações quanto ao perfil demográfico, epidemiológico e nutricional, repercutindo em modificações na saúde da população. Sedentarismo e alimentação inadequada são alguns hábitos para o aumento de risco de doenças e agravos não-transmissíveis. A Secretaria Municipal de Saúde de São José dos Campos (SP) apresenta o trabalho que tem desenvolvido na área de prevenção na rede básica, em consonância com a Estratégia Global da Organização Mundial da Saúde e a Política Nacional de Promoção da Saúde, que enfatizam a prática de atividade física e alimentação saudável. Dentre as atividades de prevenção, implantadas no município, relata-se o desenvolvimento do Programa Municipal de Promoção à Atividade Física e o Programa Municipal de Nutrição, com ênfase em atividades educativas. Apresenta como resultados: implantação de grupos de caminhada em todas as 40 Unidades Básicas de Saúde (UBS) e 4 Unidades de Saúde Mental, totalizando cerca de 1.600 participantes e atendimento nutricional referenciado em 23% das UBS, que é complementado pelo atendimento em 03 Unidades Especializadas.
During the last decades, our country has experienced alterationsrelated to the demographic profile, epidemiological and nutritional, causingmodifications on the population health. Inadequate life habits as sedentarismand unhealthy eating habits are some of the most important risk agents which canled to sicknesses and non transmissible aggravators. Because of this, the MunicipalHealth Department of São José dos Campos (SP) has intensified its preventionwork at the basic health units, according to the Global Strategy of the World HealthOrganization and the National Policy on Health Promotion, which emphasizethe practice of physical activities and healthy nutrition. Among the preventionactivities, we call attention to educational works, developed by the MunicipalProgram on Physical Activities and Nutrition. Results: Implementation of groupsof walking in all the 40 UBS and 4 Units of Mental Health, totaling some1,600 participants and nutritional care referenced in 23% of UBSs, which issupplemented by attendance in the 03 Specialized Units.