Submandibular gland excision

OBJECTIVE: to analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates.

A mandibulectomia marginal no tratamento dos tumores de loja amigdalina e região retromolar

A ressecção do ramo ascendente da mandíbula ocasiona um déficit funcional e estético considerável. OBJETIVO: Comparar a mandibulectomia marginal e segmentar de tumores avançados de loja amigdalina e região retromolar sem envolvimento ósseo mandibular detectado no período pré-operatório, em relação à sobrevida e recidiva loco-regional. Forma de Estudo: Estudo de coorte contemporânea com corte transversal. MATERIAL E MÉTODO: Compararam-se 20 pacientes tratados com mandibulectomia marginal e 22 tratados com mandibulectomia segmentar de outubro de 1994 a dezembro de 2001 em serviço de referência em Cirurgia de Cabeça e Pescoço. RESULTADOS: Dos 20 pacientes tratados com mandibulectomia marginal, 35% morreram com doença, 15% por recidiva local, 15% por recidiva regional e 5% por recidiva loco-regional. Dos 22 pacientes tratados com mandibulectomia segmentar 45,4% morreram pela doença, sendo 31,8% por recidiva local e 13,6% por recidiva à distância. Na análise pelo método de Kaplan-Meier o grupo tratado com mandibulectomia marginal apresentou uma taxa de 55%, e o grupo tratado com ressecção segmentar 45% com p= 0,8329. CONCLUSÕES: A análise dos dois grupos evidenciou que a conservação do ramo ascendente da mandíbula, mesmo em lesões avançadas, sem envolvimento mandibular, não aumenta o índice de recidiva.

Mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva e retrognatismo mandibular

A Síndrome da Apnéia-Hipopnéia do Sono Obstrutiva (SAHSO) é um doença de fisiopatologia complexa, e sua etiologia é multifatorial e não entendida completamente. Cirurgia com avanço do músculo genioglosso é indicado em obstrução na região de hipofaringe. OBJETIVO: Avaliar a eficácia e complicações da técnica de mentoplastia para avanço do músculo genioglosso em pacientes com síndrome da apnéia-hipopnéia do sono obstrutiva (SAHSO). MÉTODOS: Polissonografia, exame físico e análise cefalométrica foram realizados em 10 pacientes não-obesos, que apresentavam SAHSO leve ou moderada, índice de apnéia-hipopnéia (IAH) entre 5 e 30, obstrução de hipofaringe e retrognatismo mandibular. RESULTADOS: IAH pré-operatório médio foi de 12,4±4,6 diminuindo a média pós-operatória para 4,4±5,7 (p < 0,001). Quando 50% de redução do IAH pré-operatório foram escolhidos como parâmetro, o índice de sucesso foi de 70%. A análise cefalométrica revelou um aumento do espaço aéreo posterior (EAP) em todos os pacientes, a média pré-operatória foi de 7,9±2,3mm para uma média pós-operatória de 10,8±2,5mm (p < 0,001). CONCLUSÃO: Mentoplastia para avanço do músculo genioglosso parece reduzir os sinais da SAHSO, podendo ser considerada uma opção com tratamento cirúrgico em pacientes com obstrução na hipofaringe. Os dados coletados indicam esse procedimento como opção em pacientes com SAHSO e retrognatismo mandibular.

Anquilose da articulação têmporo-mandibular

A anquilose pode ser definida como sendo a fusão das superfícies articulares e seu tratamento é um verdadeiro desafio devido à alta taxa de recorrência. OBJETIVO: Descrever seis casos clínicos tratados pela técnica da reconstrução articular, avaliar os resultados dessas cirurgias e fazer uma revisão da literatura. METODOLOGIA: A população estudada neste estudo retrospectivo foi obtida dos prontuários do hospital universitário e tinha que ter sido submetida a cirurgia para tratamento de anquilose por reconstrução aloplástica ou autógena entre os períodos de março de 2001 e outubro de 2005. Dados como a máxima abertura de boca (MAB), etiologia, tipo de anquilose e tratamento, e ocorrência de recidiva e lesão do nervo facial foram coletados no pré-operatório, através dos prontuários, e no pós-operatório, através de entrevista. RESULTADOS: A média da MAB no pré-operatório foi de 9,6mm (0 a 17mm) e no pós-operatório foi de 31,33mm (14mm a 41mm), não houve lesão do nervo facial e apenas em um caso houve recidiva da anquilose. CONCLUSÃO: A reconstrução da articulação com material autógeno ou alógeno, para o tratamento da anquilose da ATM se mostrou eficaz em relação à MAB pós-operatória, recidiva e função da articulação.

Ameloblastoma mandibular tratado por ressecção óssea e reconstrução imediata

O ameloblastoma multicístico acomete principalmente pacientes adultos, entre a terceira e a sétima década de vida, freqüentemente na região posterior de mandíbula. A ressecção de um segmento mandibular, sem reconstrução adequada, produz grave seqüela estética e funcional levando a uma perda da qualidade de vida. O objetivo desta apresentação é mostrar que o tratamento multidisciplinar do ameloblastoma possibilita radicalidade oncológica associada à completa reconstrução da área lesada. Apresentamos um paciente de 47 anos, acometido por um ameloblastoma em região posterior de mandíbula tratado com ressecção completa de um segmento mandibular. A reconstrução no mesmo tempo operatório utilizou enxerto ósseo de crista ilíaca fixado com placas e parafusos de titânio. Após oito meses completou-se a reabilitação com implantes de elementos dentários na área do enxerto. As vantagens deste procedimento incluem a diminuição do risco de recidivas pelo uso da ressecção segmentar, reconstrução mandibular confiável e diminuição do número de procedimentos cirúrgicos, permitindo completa reabilitação em um período mais curto de tempo.

Macrófitas aquáticas de um lago marginal ao rio Embu-mirim, São Paulo, Brasil

Durante os anos de 1984/1985 obtiveram-se amostras sazonais para determinação de parâmetros físicos, químicos e biológicos de um lago marginal ao rio Embu-mirim, em Itapecerica da Serra, na bacia do reservatório de Guarapiranga (São Paulo, Brasil). Além de discutir os resultados obtidos quanto à flora de macrófitas aquáticas e suas relações com os outros parâmetros ambientais, são também analisados os efeitos da variação sazonal. As espécies encontradas estão presentes em diversos corpos d'água marginais, bem como ao longo do rio Embu-mirim, permitindo avaliar seu comportamento em corpos d'água semelhantes, da mesma bacia. A macrófita predominante foi Eichhornia crassipes (Mart.) Solms. Os resultados obtidos demostram a tendência de uma eutrofização acelerada e o risco de macrófitas potencialmente problemáticas, como E. crassipes e Salvinia auriculata, formarem camalotes de altas densidades, que podem chegar ao reservatório de Guarapiranga, através do rio Embu-mirim, causando problemas aos diversos usos da água.

Seroepidemiology of toxoplasmosis in women of childbearing age from a marginal community of Maracaibo, Venezuela

The aim of this study was to determine the prevalence of anti-T. gondii total and IgM antibodies in women of childbearing age. One hundred serum samples of women were studied with age range from 11 to 45 years old. Samples were chosen by random. The determination of total antibodies was carried out through the indirect hemagglutination technique and IgM antibodies by ELISA's technique. The statistical analysis was carried out through the Chi square and the Spearman correlation tests. The theoretical estimated incidence of congenital toxoplasmosis was calculated, according to the annual increment of antibody prevalence among the age groups. The overall prevalence of toxoplasmosis was 33%, while only six individuals (18.2%) were positive to IgM. The highest prevalence was observed in the 11-35 year-old age group. The theoretical estimated incidence was 1.5 for 100 pregnancies in women of 21-25 year-old group; it decreased until 0.1% in the 41-45 year-old age group. The findings show a high prevalence of toxoplasmosis in this community with a high infection risk in women of the studied age group and the high cat population observed, suggesting that the transmission way by contaminated soils may play a main role in the spreading of toxoplasmosis in this community.

Seroprevalence and sociocultural conditionants of Chagas disease in school aged children of marginal zones of Asunción

Chagas disease is becoming a public health problem in Latin America due to the wide distribution, the high prevalence, the magnitude of the damage caused and the difficulties to control it. In Paraguay, the disease is mainly distributed in the departments of Paraguari, Cordillera and Central. Prevalence in marginal zones, where migrations from rural populations and endemic areas make possible the urbanization of the disease, has no been studied yet. This is a descriptive study with a cross-sectional sampling and a probabilistic system recruitment carried out in school aged children from marginal zones of Asuncion to determine the prevalence of Chagas' disease. Serological methods, parasite isolation and questionnaires were used to achieve the goals. Nine hundred and fifty three children were studied to determine the prevalence of Chagas' disease in marginal zones which was 1.4%.

Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection

Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Although these tumors have different histologic aspects, they may cause similar abdominal and cardiac symptoms and are a serious risk factor for pulmonary embolism and sudden death when they reach the right atrium and tricuspid valve. The best treatment is radical surgical resection of the entire tumor using cardiopulmonary bypass with or without deep hypothermia and total circulatory arrest. We report the cases of two patients, the first with leiomyosarcoma of the inferior vena cava and the other with intravenous leiomyomatosis of the uterus that showed intravascular growth up to right atrium and ventricle, who underwent successful radical resection in a one-stage procedure with the use of cardiopulmonary bypass. We discuss the clinical and histologic aspects and imaging diagnosis and review the literature.

Intestinal intussusception and occlusion caused by small bowel polyps in the Peutz-Jeghers syndrome. Management by combined intraoperative enteroscopy and resection through minimal enterostomy: case report

The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome. CASE REPORT: This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception. DISCUSSION: An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful. CONCLUSION: We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.

Persistence of the embryonic lateral marginal vein: report of two cases

PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

Hypothyroidism following struma ovarii tumor resection: a case report

Struma ovarii is an infrequent ovarian tumor, and there are only few reports with detailed data of thyroid function. In several cases, malignant struma ovarii have been shown to produce hyperthyroidism, but there is no reported case of hypothyroidism following struma ovarii tumor resection. A 62-year-old white woman underwent right ovary resection that had a pathologic diagnosis of struma ovarii. After 6 days, she developed weakness, myalgia, somnolence, nausea, and arterial hypotension. Laboratory tests showed a high level of thyroid-stimulating hormone (TSH) and a decreased level thyroxin. Thyroxin replacement therapy was initiated, and the patient became completely asymptomatic. This is the first reported case of a previously asymptomatic woman who developed a definite clinical hypothyroidism after resection of a struma ovarii tumor.

Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial

OBJECTIVE: The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation. METHOD: Twenty eight patients with distal rectal adenocarcinoma were randomized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospectively. Thirteen underwent laparoscopic abdominoperineal resection and 15 conventional approach. RESULTS: There was no significant difference (p<0,05) between the two studied groups regarding: gender, age, body mass index, patients with previous abdominal surgeries, intra and post operative complications, need for blood transfusion, hospital stay after surgery, length of resected segment and pathological staging. Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach (p=0.04). Mean anesthesia duration was shorter (p=0.03) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes, respectively. There was no need for conversion to open approach in this series. After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery, local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group. CONCLUSIONS: We conclude that laparoscopic abdominoperineal resection is feasible, similar to conventional approach concerning surgery duration, intra operative morbidity, blood requirements and post operative morbidity. Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer.

Weight loss and morphometric study of intestinal mucosa in rats after massive intestinal resection: influence of a glutamine-enriched diet

Short-bowel syndrome is responsible for significant metabolic alterations that compromise nutritional status. Glutamine is considered an essential nutrient for enterocytes, so beneficial effects from supplementation of the diet with glutamine are hypothesized. PURPOSE: In this study, the effect of a diet enriched with glutamine was evaluated in rats undergoing extensive small bowel resection, with analysis of postoperative weight loss and intestinal morphometrics of villi height, crypt depth, and thickness of the duodenal and remnant jejunal mucosa. METHODS: Three groups of male Wistar rats were established receiving the following diets: with glutamine, without glutamine, and the standard diet of laboratory ration. All animals underwent an extensive small bowel resection, including the ileocecal valve, leaving a remnant jejunum of only 25 cm from the pylorus that was anastomosed lateral-laterally to the ascendant colon. The animals were weighed at the beginning and end of the experiment (20th postoperative day). Then they were killed and the remnant intestine was removed. Fragments of duodenal and jejunal mucosa were collected from the remnant intestine and submitted to histopathologic exam. The morphometric study of the intestinal mucosa was accomplished using a digital system (KS 300) connected to an optic microscope. Morphometrics included villi height, crypt depth, and the total thickness of intestinal mucosa. RESULTS: The weight loss comparison among the 3 groups showed no significant loss difference. The morphometric studies showed significantly taller duodenal villi in the glutamine group in comparison to the without glutamine group, but not different from the standard diet group. The measurements obtained comparing the 3 groups for villi height, crypt depth, and thickness of the remnant jejunum mucosa were greater in the glutamine-enriched diet group than for the without-glutamine diet group, though not significantly different from with standard-diet group. CONCLUSIONS: In rats with experimentally produced short-bowel syndrome, glutamine-enrichment of an isonitrogenous test diet was associated with an improved adaptation response by the intestinal mucosa but not reduced weight loss. However, the adaptation response in the group receiving the glutamine-enriched diet was not improved over that for the group fed regular chow.