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.

A detailed analysis of three pendular motion models is presented. Inertial effects, self-oscillation, and memory, together with non-constant moment of inertia, hysteresis and negative damping are shown to be required for the comprehensive description of the free pendulum oscillatory regime. The effects of very high initial amplitudes, friction in the roller bearing axle, drag, and pendulum geometry are also analysed and discussed. The model that consists of a fractional differential equation provides both the best explanation of, and the best fits to, experimental high resolution and long-time data gathered from standard action-camera videos.

Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

A self-consistent analysis of proton and deuterium nuclear spin relaxation times in the smectic phases of a partially deuterated smectogen is presented here. Proton spin-lattice relaxation times T-1Z were measured as a function of Larmor frequency over a range of 1kHz to 300MHz at selected temperatures. Deuterium spin relaxation times T-1Z and T-1Q were measured as a function of temperature at two different magnetic fields in the smectic A phase. The deuterium data provide dynamic parameters such as rotational diffusion constants and internal jump rates as well as the nematic order parameter S. The proton data are analyzed using a number of relaxation mechanisms, one of which is the molecular reorientation. It is found helpful in these latter analyses to use the nematic order parameter and to fix the contribution from molecular reorientations determined by the deuterium spin relaxation. The fits to the proton T-1 frequency and temperature dispersions by the remaining relaxation mechanisms such as layer undulations and translational self-diffusion will be discussed for the smectic A and chiral smectic C phases. Copyright (c) 2014 John Wiley & Sons, Ltd.

Pearls and Pitfalls in Head and Neck Surgery Introduction The EBSLN is the main motor supply to the CTM. The contraction of this muscle stretches the vocal fold, especially during the production of high frequency sounds [1] . Therefore, EBSLN paralysis leads to an important impairment of voice performance, mainly among women and voice professionals. This nerve crosses the superior thyroid vessels, usually more than 1 cm above the upper border of the superior thyroid pole, before reaching Cernea CR, Dias FL, Fliss D, Lima RA, Myers EN, Wei WI (eds): Pearls and Pitfalls in Head and Neck Surgery. Basel, Karger, 2012, pp 4–5 DOI: 10.1159/000337462

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.

AIMS:To analyse the expression of three homeobox genes (HOXA7, PITX1 and PRRX1) in oral squamous cell carcinomas (OSCC) and the relationship of such expression to certain distinct histopathological features of OSCC and in comparison to adjacent non-neoplastic epithelium (NT). METHODS AND RESULTS:Digoxigenin-labelled riboprobes that are specific for each homeobox gene were generated and in situ hybridization was carried out on frozen sections. In NT samples, HOXA7 and PITX1 transcripts were found more frequently in all epithelial layers, while PRRX1 was expressed in the basal layer. With OSCC samples, expression of the three genes was associated with all histological features. However, the HOXA7 and PITX1 signals were more intense in sheets and nests and PRRX1 in small nests and isolated cells. CONCLUSION:HOXA7, PIXT1 and PRRX1 homeobox genes have different patterns of expression in OSCC depending on its histological features.

A basic setup for data acquisition and analysis from an oscillatory circuit is described, with focus on its application as either low-pass, high-pass, band-pass or band-reject frequency filter. A homemade board containing the RLC elements allows for the interchange of some of them, in particular, for the easy change of the R value, and this makes apparent for the student its influence on the damping factor. The function generator operates in the swap frequency mode over a suitable frequency range and all the circuit parameters are chosen to provide a reasonable set of data for all the electronic filters studied. The output data are acquired through a commercially available DAQ board and data analysis is performed using a graphing and fitting workspace. The main objective is to develop a methodology of teaching the laboratory material through a computer-based environment devised to help students to appreciate how the governing equations work and to visualize their practical applications.

Introduction: Perineural invasion is a well-recognized form of cancer dissemination. However, it has been reported only in few papers concerning cutaneous carcinomas (basal cell, BCC, and squamous cell, SCC). Moreover, the incidence is considered to be very low. Niazi and Lambert [Br J Plast Surg 1993;46:156–157] reported only 0.18% of perineural invasion among 3,355 BCCs. It is associated with high-risk subtypes, as morphea-like, as well as with an increased risk of local recurrence. No paper was found in the literature looking for perineural invasion in very aggressive skin cancers with skull base extension, with immunohistochemical analysis. Methods: This is a retrospective review, including 35 very advanced skin carcinomas with skull base invasion (24 BCCs and 11 SCCs, operated on at a single institution from 1982 to 2000). Representative slides were immunohistochemically evaluated with antiprotein S-100, in order to enhance nerve fibers and to detect perineural invasion. The results were compared to 34 controls with tumors with a good outcome, treated in the same time frame at the same Institution. Results: Twelve (50.0%) of the BCCs with skull base invasion had proven perineural invasion, as opposed to only 1 (4.6%) of the controls, and this difference was statistically significant (p < 0.001). Regarding SCCs, 7 aggressive tumors (63.6%) showed perineural invasion compared to only 1 (10.0%) of the controls, but this difference did not reach significance (p = 0.08), due to the small number of cases. Conclusions: In this series, it was demonstrated that immunohistochemically detected perineural invasion was very prevalent in advanced skin carcinomas. In addition, it was statistically associated with extremely aggressive BCCs with skull base invasion.

BACKGROUND:The vascular endothelial growth factor (VEGF) is a major promoter of endothelial growth and migration. Some studies have shown a correlation between expression of this growth factor and prognosis in several cancers, including well-differentiated thyroid cancer.AIM:We studied VEGF expression, local invasiveness, and other prognostic factors in papillary thyroid carcinoma (PTC) to test the hypothesis that the expression of VEGF is correlated with the degree of invasion of PTC.PATIENTS AND METHODS:Clinical and pathological data of 76 patients with PTC were retrospectively reviewed. Group 1 consisted of patients with gross locally invasive tumors, group 2 consisted of patients with only invasion of the thyroid capsule, and group 3 consisted of patients with noninvasive PTC.RESULTS:VEGF expression was noted within the tumor in all groups of PTC patients but was absent in the surrounding normal tissue. Older patients had higher expression of VEGF than younger patients. The age of patients with strong reaction to VEGF was 46 +/- 14 (mean +/- standard deviation), and that in patients with a weaker reaction was 39 +/- 16 (p < 0.05). Only 20% of patients with a follicular variant of PTC had a strong reaction to VEGF compared with 68% of patients with classical PTC (p < 0.01).CONCLUSIONS:VEGF expression appears to be an early event in the development of PTC. Whether VEGF expression promotes the progression of PTC is not known, but the answer to this question may be important in view of its greater expression in older patients, a group whose prognosis in PTC is worse.

Introducao: Os nodulos da glândula tireoide podem ser tratados durante a exploracao cervical por afeccao da paratireoide. Objetivo: A frequencia de doencas da tireoide em pacientes com hiperparatireoidismo primario e secundario foi revista. Metodos: Foram avaliados os dados disponiveis de 199 pacientes operados consecutivamente por hiperparatireoidismo primario (95 casos) ou secundario (104 casos). Os achados na glândula tireoide desses casos foram pesquisados. A glândula tireoide foi considerada normal quando nenhuma resseccao dela fora realizada ou quando o exame histopatologico relatava tecido tireoideo normal. A doenca da tireoide foi avaliada em relacao ao tipo de hiperparatireoidismo. Resultados: A glândula tireoide foi ressecada parcialmente ou totalmente em 126 situacoes (63,3%). Em 44 casos, a tireoide foi considerada normal pelo anatomopatologico e foi presumidamente normal em 117 pacientes ao todo (58,8%). Diferentes doencas da tireoide foram demonstradas com comprovacao histopatologica em 41,2% de todos os casos tratados por hiperparatireoidismo (bocio em 28,1%, tireoidite em 6,5%, carcinoma papilifero em 6% e outros em 0,5%). Nao houve diferenca entre as doencas da tireoide no hiperparatireoidismo primario e o secundario, embora o carcinoma papilifero tenha sido mais frequente no hiperparatireoidismo primario do que no secundario (9,5% no primario e 2,8% no secundario, p=0,07; Teste exato de Fisher). Conclusao: Doencas da tireoide sao frequentes nos pacientes operados por hiperparatireoidismo. A avaliacao pre-operatoria bem como atencao durante a operacao sao recomendaveis nesses doentes. Descritores: Hiperparatireoidismo. Glândula Paratireoide. Glândula Tireoide. Paratireoidectomia. Tireoidectomia.

This anatomical study examines the anatomic topography and landmarks for localization of the spinal accessory nerve (SAN) during surgical dissections in 40 fresh human cadavers (2 females and 38 males; ages from 22 to 89 years with a mean of 60 years). In the submandibular region, the SAN was found anteriorly to the transverse process of the atlas in 77.5% of the dissections. When the SAN crossed the posterior belly of the digastric muscle, the mean distance from the point of crossing to the tendon of the muscle was 1.75 ± 0.54 cm. Distally, the SAN crossed between the two heads of the SCM muscle in 45% of the dissections and deep to the muscle in 55%. The SAN exited the posterior border of the sternocleidomastoid muscle in a point superior to the nerve point with a mean distance between these two anatomic parameters of 0.97 ± 0.46 cm. The mean overall extracranial length of the SAN was 12.02 ± 2.32 cm, whereas the mean length of the SAN in the posterior triangle was 5.27 ± 1.52 cm. There were 2–10 lymph nodes in the SAN chain. In conclusion, the nerve point is one of the most reliable anatomic landmarks for localization of the SAN in surgical neck dissections. Although other anatomic parameters including the transverse process of the atlas and the digastric muscle can also be used to localize the SAN, the surgeon should be aware of the possibility of anatomic variations of those parameters. Similar to previous investigations, our results suggest that the number of lymph nodes of the SAN chain greatly varies. Clin. Anat. 22:471–475, 2009. © 2009 Wiley‐Liss, Inc.

1) Médico Assistente da Disciplina de Cirurgia de Cabeça e Pescoço (DCCP), Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Laboratório de Investigação Médica (LIM) 28 – Doutor pela FMUSP. 2) Médico Assistente da DCCP. Professor Livre-Docente pela FMUSP. 3) Médico Pós-graduando da DCCP-FMUSP. 4) Médico Colaborador da DCCP-FMUSP. 5) Professor Titular da DCCP-FMUSP. Instituição: Disciplina de Cirurgia de Cabeça e Pescoço e Laboratório de Investigação Médica 28 Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo – USP, São Paulo/SP, Brasil. o Correspondência: Fábio Luiz de Menezes Montenegro, Avenida Dr. Enéas de Carvalho Aguiar, 255, Instituto Central – 8 andar Sala 8174 – 05403-000 São Paulo/SP, Brasil. E-mail: fabiomonte@uol.com.br Recebido em: 03/10/2008; aceito para publicação em: 03/01/2009; publicado online em: 10/03/2009. Conflito de interesse: nenhum. Fonte de fomento: nenhuma. Artigo Original

Introduction: Hyperparathyroidism was considered a rare disease in Brazil, but the increment in diagnosis has increased the need for treatment. Although new drugs have been developed, surgery is still considered an important therapy. Albeit the improvement in parathyroid localizing imaging studies, results of the operation are still affected by the experience of the surgeon. Thus, evaluation of residents' skills in this of operation is mandatory to teaching institutions. The institution should develop instruments for this evaluation. Objective: To report the initial experience with a rating system for evaluating parathyroid surgery teaching. Methods: The results of evaluation forms applied to head and neck surgery residents in the year of 2007 were analyzed. The evaluation was performed by different supervising surgeons and it included cognitive, operative skills and behavioral aspects. There were two different forms, developed consecutively. Results: Nine forms were filled for each type of chart. Regarding the chart with three possible options (poor, regular and good) the results for operative skills were 82.5% of regular and 17.5% of good. In behavioral aspects there were 29.6% of regular and 70.4% of good. In the forms with five possibilities (very poor, poor, regular, good, very good) there were 22.2% of regular, 58.7% of good and 19.1% of very good for technical skills aspects. In behavioral aspects, there were 1.6% of very poor, 4.8% of poor, 14.3% of regular, 47.6% of good and 31.7% of very good. Conclusion: The modification of the evaluation chart apparently improved the analysis of the behavioral aspects.

1) Médico da Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. 2) Médico da Disciplina de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. 3) Professor Titular da Disciplina de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina da Universidade de São Paulo. 4) Professor Associado da Disciplina de Cirurgia de Cabeça e Pescoço da Faculdade de Medicina da Universidade de São Paulo 5) Médico Assistente da Disciplina de Cirurgia de Cabeça e Pescoço. Professor Livre-Docente pela Faculdade de Medicina da Universidade de São Paulo da Faculdade de Medicina da Universidade de São Paulo. Instituição: Disciplina de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Correspondência: Marco Aurelio V. Kulcsar, Alameda Franca, 84 ap 111 – 01422-000 São Paulo/SP, Brasil. E-mail: kulcsar@uol.com.br Recebido em: 27/11/2008; aceito para publicação em: 20/03/2009; publicado online em: 15/08/2009. Conflito de interesse: nenhum. Fonte de fomento: nenhuma. Artigo Original

The aim of this study was to investigate loss of heterozygosity (LOH) of the APC tumor suppressor gene loci, using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) in 40 cases of oral squamous cell carcinoma (OSCC). Observed informativity was 72.5% for APC exon 11 and 82.5% for APC exon 15. LOH at APC exon 11 was observed in 2 (6.9%) of 29 informative cases, and no LOH was observed for APC exon 15. Our results suggest that inactivation of the APC gene plays a minor role in the carcinogenesis of OSCC.

Considering that mycobacterial heat-shock protein 65 (hsp65) gene transfer can elicit a profound antitumoral effect, this study aimed to establish the safety, maximum-tolerated dose (MTD) and preliminary efficacy of DNA-hsp65 immunotherapy in patients with advanced head and neck squamous cell carcinoma (HNSCC). For this purpose, 21 patients with unresectable and recurrent HNSCC were studied. Each patient received three ultrasound-guided injections at 21-day intervals of: 150, 600 or 400 μg of DNA-hsp65. Toxicity was graded according to CTCAE directions. Tumor volume was measured before and after treatment using computed tomography scan. The evaluation included tumor mass variation, delayed-type hypersensitivity response and spontaneous peripheral blood mononuclear cell proliferation before and after treatment. The MTD was 400 μg per dose. DNA-hsp65 immunotherapy was well tolerated with moderate pain, edema and infections as the most frequent adverse effects. None of the patients showed clinical or laboratory alterations compatible with autoimmune reactions. Partial response was observed in 4 out of 14 patients who completed treatment, 2 of which are still alive more than 3 years after the completion of the trial. Therefore, DNA-hsp65 immunotherapy is a feasible and safe approach at the dose of 400 μg per injection in patients with HNSCC refractory to standard treatment. Further studies in a larger number of patients are needed to confirm the efficacy of this novel strategy.