Carcinoma de seio maxilar: análise de dez casos Maxillary sinus carcinoma: an analysis of ten cases

OBJETIVO: Avaliar o papel, principalmente da tomografia computadorizada, no estadiamento dos carcinomas dos seios maxilares. MATERIAIS E MÉTODOS: Foram analisados dez casos de carcinoma diagnosticados e tratados pelos Departamentos de Diagnóstico por Imagem e Cirurgia de Cabeça e Pescoço do Hospital Heliópolis, São Paulo, SP, entre 1988 e 2002. RESULTADOS: Nove pacientes tiveram extensão tumoral para a bochecha, oito para o espaço mastigador, sete para o assoalho da boca e palato duro, cinco para a fossa pterigóide, cinco para a órbita, três para o etmóide e um para a base do crânio. Três pacientes foram classificados como T3 e sete, como T4. Dois tinham metástases linfonodais no momento da apresentação inicial, os quais pertenciam ao estágio T4. Todos os casos foram confirmados com exame histopatológico. CONCLUSÃO: A análise precisa da extensão local e disseminação tumoral fornecida pela tomografia computadorizada e ressonância magnética desempenha papel importante no planejamento cirúrgico, influenciando, também, na conduta terapêutica e prognóstico.<br>OBJECTIVE: To evaluate the role, especially of computed tomography, in the staging of maxillary sinus carcinomas. MATERIALS AND METHODS: Ten cases of carcinoma treated in Hospital Heliópolis Department of Diagnostic Imaging and Head and Neck Surgery, São Paulo, SP, Brazil, in the period between 1988 and 2002, were evaluated. RESULTS: Nine patients presented with tumor extension to the cheek, eight to the masticator space, seven to the mouth floor and hard palate, five to the pterygoid fossa, five to the orbit, three to the ethmoid bone, and one to the skull base. Three of the patients were staged T3, and seven T4. Two patients had lymph nodes metastases at their initial presentation, and were staged T4. All of the cases were histopathologically confirmed. CONCLUSION: The accurate analysis of the tumor local extent and dissemination by means of computed tomography and magnetic resonance imaging plays a relevant role in the surgical planning, besides influencing the therapeutic conduct and prognosis

A Reappraisal of Saphenous Vein Grafting

Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy