Robotic Surgery in Otolaryngology and Head and Neck Surgery: A Review

Recent advancements in robotics technology have allowed more complex surgical procedures to be performed using minimally invasive approaches. In this article, we reviewed the role of robotic assistance in Otolaryngology and Head and Neck Surgery. We highlight the advantages of robot-assisted surgery and its clinical application in this field

Carcinoma da Tireóide

Os autores apresentam um estudo pré, intra e pós-operatório precoce e tardio sobre 69 casos de carcinoma da glândula tireóide, acompanhados e ocorridos num período de 9 anos. Tais tumores ocorreram em 745 tireoidectomias realizadas nesse período. Numa primeira parte, é estudada a incidência em múltiplos aspectos; a seguir, os autores comentam a patologia, comportamento clínico e diagnóstico. Na segunda parte, analisam diversos aspectos do tratamento, dividindo os casos em dois grupos; um que não teve planificação sistematizada (17 casos) por motivos vários. Outro grupo (52 casos) teve orientação terapêutica planificada e sistematizada. Neste último grupo, os autores analisam o tratamento cirúrgico, o actínico, o hormonal e o quimioterápico. Em todos os tópicos comparam a experiência obtida com a revista na literatura

The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy

We prospectively studied the effects of the ligation of the inferior thyroid artery (ITA) on postoperative hypoparathyroidism in 48 patients who underwent functional subtotal thyroidectomy. Patients were randomized into two groups: A, with bilateral ligation of the ITA and B, without ligation of the ITA. Parathyroid function was checked preoperatively and after surgery by clinical examination and measurement of total calcium, intact PTH, urinary calcium, and AMPc. RESULTS: A significant incidence of postoperative hypocalcemia occurred: 17% in group A and 13% in B on the 4th postoperative day. Six months later, the incidence was 5% in Group A and 0% in Group B. These differences were not statistically significant between the two groups, and neither were any of the other clinical and laboratory observations. CONCLUSION: The ligation of the ITA was not an important causal factor for the occurrence of postoperative hypocalcemia after subtotal thyroidectomy.Com o objetivo de observar os efeitos da ligadura da artéria tireoidiana inferior (ITA) no hipoparatireoidismo, 48 pacientes submetidos à tireoidectomia subtotal funcional foram estudados de forma prospectiva. Dois grupos foram randomizados, A: com a ligadura troncular bilateral da ITA e B: sem a ligadura troncular da ITA. A função paratireoidiana foi verificada no período pré-operatório e após a cirurgia através de exame clínico e dosagens de cálcio total, PTH, cálcio urinário e cAMP. Os resultados demostraram incidência importante e significativa de hipocalcemia pós-operatória, de 17% no grupo A e 13% no grupo B no 4º PO. Seis meses após, a incidência foi de 5% no grupo A e 0% no grupo B. Estas diferenças não foram estatisticamente significativas entre os dois grupos, nem nenhum dos outros dados clínicos ou laboratoriais estudados. Concluímos que a ligadura da ITA não é um fator causal importante de hipocalcemia pós-operatória após tireoidectomia subtotal

Actinomycosis of the central nervous system: a rare complication of cervicofacial actinomycosis

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.A actinomicose do sistema nervoso central (SNC) é afecção rara, caracterizada pela formação de abscesso único e de evolução crônica. Os autores descrevem o caso de um paciente jovem, imunocompetente, com actinomicose cerebral oriunda de foco primário cervicofacial, submetido a ressecção cirúrgica e antibioticoterapia. Ressalta-se a importância do conhecimento da entidade e de suas principais formas de acometimento, como a base do diagnóstico precoce dessa enfermidade potencialmente curável e de bom prognóstico.Escola Paulista de MedicinaUNIFESP, EPMSciEL

Características clínicas e epidemiológicas do câncer da boca em hospital-escola de 1994 a 2002: aumento da incidência em mulheres, predomínio de doença local avançada e baixa incidência de metástases regionais

PURPOSE: Description of clinical and epidemiological characteristics of patients who underwent surgery for oral cancer in a Medical School Teaching Hospital, and determination of differences with respect to other institutions and/or periods of time. METHOD: The charts of patients undergoing surgery for oral cancer from 1994 to 2002 were reviewed. Data were collected in a spreadsheet in order to analyze clinical and epidemiological features.. RESULTS: A total of 374 patients having undergone 406 operations was identified. Their ages varied from 14 to 94 years (mean = 57.4 years), with 255 men (68.2%), and 295 out 366 Caucasian (80.6%). A majority had tumors of the tongue and/or floor of mouth (55.6%), while 20.3% had lip cancer. Squamous cell carcinoma was found in 90.3%, and glandular carcinoma in 4%. T4 tumors in 39.6%, Tis or T1 lesions in 15.2% of all patients. Nearly 62% had no regional metastases, and the relative incidence in young patients (40 years or younger) reached 8.6%. CONCLUSION: In spite of the predominance of locally advanced tumors, a majority of patients had no neck metastases. The 31.8% incidence in females indicates an increasing incidence of oral cavity cancer among women when compared to previous periods at the same institution.OBJETIVO: Caracterizar epidemiológica e clinicamente a população atendida por câncer de boca em hospital-escola de atenção terciária e quaternária e verificar variações em relação a outras casuísticas e períodos. MÉTODO: Procedeu-se à revisão dos prontuários dos operados por câncer oral de 1994 a 2002. As características clínicas e epidemiológicas foram colocadas em planilhas e analisadas. RESULTADOS: Foram identificados 374 portadores de câncer da boca que foram submetidos a 406 operações. A idade dos doentes variou de 14 a 94 anos (média = 57,4 anos). Duzentos e cinqüenta e cinco eram do gênero masculino (68,2%). Duzentos e noventa e cinco entre 366 doentes eram caucasianos (80,6%). A maioria era portadora de tumores da língua e/ou do soalho da boca (194 entre 349 doentes; 55,6%), e 71 (20,3%) tinham tumores dos lábios. O carcinoma epidermóide foi encontrado em 90,3% e carcinomas glandulares em 4%. Os tumores T4 estavam presentes em 39,6% dos doentes; 15,2% tinham lesões Tis ou T1. Quase 62% dos pacientes não tinham metástases cervicais. A incidência relativa em jovens (com até 40 anos de idade) atingiu 8,6%. CONCLUSÃO: Apesar dos achados freqüentemente referidos na literatura terem se confirmado (como o predomínio de lesões avançadas localmente), a maioria dos doentes não apresentava metástases cervicais. Acima do observado em outras casuísticas, os 31,8% de mulheres na presente casuística indica a preocupante e crescente incidência no gênero feminino

Subtractive phage display selection from canine visceral leishmaniasis identifies novel epitopes that mimic leishmania infantum antigens with potential serodiagnosis applications

Visceral leishmaniasis (VL) is a zoonotic disease that is endemic to Brazil, where dogs are the main domestic parasite reservoirs, and the percentages of infected dogs living in regions where canine VL (CVL) is endemic have ranged from 10% to 62%. Despite technological advances, some problems have been reported with CVL serodiagnosis. The present study describes a sequential subtractive selection through phage display technology from polyclonal antibodies of negative and positive sera that resulted in the identification of potential bacteriophage-fused peptides that were highly sensitive and specific to antibodies of CVL. A negative selection was performed in which phage clones were adhered to purified IgGs from healthy and Trypanosoma cruzi-infected dogs to eliminate cross-reactive phages. The remaining supernatant nonadhered phages were submitted to positive selection against IgG from the blood serum of dogs that were infected with Leishmania infantum. Phage clones that adhered to purified IgGs from the CVL-infected serum samples were selected. Eighteen clones were identified and their reactivities tested by a phage enzyme-linked immunosorbent assay (phage-ELISA) against the serum samples from infected dogs (n 31) compared to those from vaccinated dogs (n 21), experimentally infected dogs with cross-reactive parasites (n 23), and healthy controls (n 17). Eight clones presented sensitivity, specificity, and positive and negative predictive values of 100%, and they showed no crossreactivity with T. cruzi- or Ehrlichia canis-infected dogs or with dogs vaccinated with two different commercial CVL vaccines in Brazil. Our study identified eight mimotopes of L. infantum antigens with 100% accuracy for CVL serodiagnosis. The use of these mimotopes by phage-ELISA proved to be an excellent assay that was reproducible, simple, fast, and inexpensive, and it can be applied in CVL-monitoring programsThis work was supported by grants from the Pró-Reitoria de Pesquisa of UFMG (supported 03/2013), the Instituto Nacional de Ciência e Tecnologia em Nano-Biofarmacêutica (INCT Nano-Biofar), Rede Nanobiotec/Brasil-UFU (CAPES), PRONEX-FAPEMIG (APQ-01019- 09), FAPEMIG (APQ-00496-11 and APQ-00819-12), and CNPq (APQ- 472090/2011-9 and APQ-482976/2012-8). E.A.F.C. and L.R.G. are recipients of grants from CNPq. M.A.C.-F. is the recipient of a grant from FAPEMIG/CAPE

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Recent updates and perspectives on approaches for the development of vaccines against visceral leishmaniasis

All rights reserved. Visceral leishmaniasis (VL) is one of the most important tropical diseases worldwide. Although chemotherapy has been widely used to treat this disease, problems related to the development of parasite resistance and side effects associated with the compounds used have been noted. Hence, alternative approaches for VL control are desirable. Some methods, such as vector control and culling of infected dogs, are insufficiently effective, with the latter not ethically recommended. The development of vaccines to prevent VL is a feasible and desirable measure for disease control, for example, some vaccines designed to protect dogs against VL have recently been brought to market. These vaccines are based on the combination of parasite fractions or recombinant proteins with adjuvants that are able to induce cellular immune responses, however, their partial efficacy and the absence of a vaccine to protect against human leishmaniasis underline the need for characterization of new vaccine candidates. This review presents recent advances in control measures for VL based on vaccine development, describing extensively studied antigens, as well as new antigenic proteins recently identified using immuno-proteomic techniquesThis work was supported by grants from Instituto Nacional de Ciência e Tecnologia em Nano-Biofarmacêutica, Rede Nanobiotec/Brasil-Universidade Federal de Uberlândia/CAPES, PRONEX-FAPEMIG (APQ-01019-09), FAPEMIG (CBB-APQ-00819-12 and CBB-APQ-01778-2014), and CNPq (APQ-482976/2012-8, APQ-488237/2013-0, and APQ-467640/2014-9). EAFC and LRG are recipients of the grant from CNPq. MACF is the recipient of grants from FAPEMIG/CAPE