Cervical metastasis on level IV in laryngeal cancer.

The presence of cervical metastasis has substantial negative impact on survival of patients with laryngeal cancer. Bilateral elective selective neck dissection of levels II, III and IV is usually the chosen approach in these patients. However, there is significant morbidity associated with level IV dissection, such as phrenic nerve injury and lymphatic fistula. The objective of the present study was to evaluate the frequency of metastatic nodes in level IV in clinically T3/T4N0 patients with laryngeal cancer. The pathological reports of 77 patients with clinically T3/T4N0 laryngeal squamous cell carcinoma were reviewed. Patients underwent bilateral lateral neck dissection from January 2007 to November 2012. The surgical specimens were subdivided in levels before evaluation. There were 12 patients with neck metastasis (15.58%). In 3 cases (3.89%), there were metastatic lymph nodes in level IV, all T4 and with ipsilateral metastasis. In conclusion, the incidence of level IV metastasis was 3.89%, an in all patients was staged as T4.

[Parathyroid cyst: case report]. / Cisto de paratireóide: relato de caso.

Parathyroid cysts are very uncommon lesions, with about 200 cases in the literature. Differential diagnosis is difficult, particularly with thyroid mass and symptoms of cervical compression and hyperparathyroidism are described. We present a case in which the diagnosis was intraoperative and discuss the treatment of this unusual disease.

[Incidence of oral cancer profile at a general hospital in Säo Paulo]. / Perfil de incidência do câncer oral em um hospital geral em São Paulo.

Cancer of the oral cavity are 4% of all cancers, being in 8th place in males and 11th in females. The world incidence in male sex is 7.9:100,000 and 2.2:100,000 in females. Squamous cell carcinoma is the most frequent, corresponding to 90-95% of the cases and tongue, lips and floor of the mouth are the most common sites. Fifty-four patients were surgically treated for cancer of the oral cavity in a General Hospital in São Paulo, during last ten years. It occurs more in males (81.5%), the age ranges of 35-97, with mean age of 58.1 years. Smoking was associated in 88.9%, at the time of treatment 50% of the patients had history of disease inferior of 6 months and 42% were T2 and 38% T4. These results agree with international literature and emphasize the importance of preventive aspects of this cancer.

Prospective study using skin staplers in head and neck surgery.

BACKGROUND: A prospective trial was undertaken to investigate the advantages and disadvantages of stapled skin closure versus conventional nylon sutures in head and neck surgery. PATIENTS AND METHODS: The study included 20 consecutive patients who underwent extensive surgery in which their skin was closed with staples. Another group of 20 matched patients receiving a noncontinuous nylon suture closure was followed in parallel. RESULTS: The complications recorded occurred in 5 patients in the stapled group and 3 in the sutured group. Analysis of cosmetic results showed 16 patients (80%) in the stapled group with good wound appearance and 17 (85%) in the sutured group. The mean closure time was 5 minutes for the stapled group and 25 minutes for the sutured group. Cost was $19.75 for conventional closure and $22.00 for mechanical suture. CONCLUSION: The use of skin staples speeds up closure time by 80%, yields similar cosmetic results with no increase in complications, although at a slightly higher cost.

Posterior trapezius myocutaneous flap.

Since last decade, myocutaneous flaps have appeared among the most versatile and safest options for the reconstruction of defects caused by large oncological resections, in the head and neck area. Undoubtedly, the myocutaneous flap of the pectoralis major muscle is the most widespread and accepted, due to the long experience obtained through its use. Nevertheless, it presents some restrictions related not only to its rotation arch, but also to the esthetic consequences for the donor site in females. Over the last years, there has been a growing interest in the posterior trapezius myocutaneous flap (PTMF), which proved to be a valuable alternative for reconstruction in selected cases. The experience of the Department of Head and Neck Surgery, at the University of São Paulo Medical School-Hospital das Clínicas, using this technique, is reported here in a detailed description.

Anestesia com quetamina. Estudo comparativo entre tiopental sodico e diazepam na prevencao de seus efeitos psicotomimeticos e circulatorios. / Ketamine anesthesia. A comparative study of sodic thiopental and diazepam in prevention of psucotomimetic and circulatory effects

Estudo de 150 pacientes submetidos a anestesia pela quetamina, avaliando com analise "duplo-cego", a eficiencia de duas medicacoes pre-anestesicas - pentotal sodico e diazepam - na prevencao dos efeitos psicotomimeticos e circulatorios deste tipo de anestesia. Com ambas as medicacoes pre-anestesicas obteve-se consideravel reducao das manifestacoes psiquicas. Da mesma forma observou-se reducao da taquicardia provocada pela quetamina, embora nao tenha havido protecao contra a hipertensao arterial