Elio Pfuetzenreiter Jr - Academia.edu (original) (raw)

Papers by Elio Pfuetzenreiter Jr

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O impacto da invasão extracapsular em nos ... Bruno Conte 1 Mario Augusto Ferrari de Castro 2 Rog... more O impacto da invasão extracapsular em nos ... Bruno Conte 1 Mario Augusto Ferrari de Castro 2 Rogerio Aparecido Dedivitis 3 Elio Gilberto Pfuetzenreiter Jr. 4 Odilon Victor Porto Denardin 5 ... Introdução: O fator prognóstico mais importante de pacientes com carcinoma ...

PubMed, Apr 1, 2014

The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971... more The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.

PubMed, Dec 1, 2009

The duration of hospital stay, following surgical procedures, has undergone a significant reducti... more The duration of hospital stay, following surgical procedures, has undergone a significant reduction in recent years. However, there are some risks associated with short-stay thyroid surgery. An analysis has been made of data from patients who underwent short-stay thyroid surgery, analyzing the complications associated with this procedure. Overall 270 consecutive patients undergoing thyroidectomy in 2007 and 2008 were prospectively analyzed. Post-operative care included routine ward overnight observation. The discharge criteria were: stable vital signs; apyretic; no wound or airway problems; tolerating diet; and established autonomy at discharge. Data were collected regarding patients' discharge criteria status, length of hospital stay and readmission, as well as morbidity (post-operative haemorrhage, recurrent laryngeal nerve injury and hypocalcaemia) and mortality. This series comprised 175 total thyroidectomies, 93 hemi-thyroidectomies and 2 isthmusectomies. No cases of death or post-operative haemorrhage occurred in any of these patients. Permanent unilateral recurrent laryngeal nerve injury was observed in 4 patients (1.48%). Transient post-operative hypocalcaemia occurred in 23 patients, whereas permanent post-operative hypocalcaemia was observed in 8 patients (2.96%); 4 patients were re-admitted and required early calcium supplementation. Five patients failed to tolerate the diet during the immediate post-operative period. The average duration of hospital stay was 1.02 days. Considering the 4 patients who required re-admission due to hypocalcaemia, the total length of hospital stay was 1.05 days. In conclusion, the one-day surgery model is safe and effective in patients undergoing surgery for thyroid disorders.

A punção aspirativa por agulha fina (PAAF) é considerada uma opção diagnóstica em substituição à ... more A punção aspirativa por agulha fina (PAAF) é considerada uma opção diagnóstica em substituição à remoção do linfonodo a céu aberto. Entretanto, o diagnóstico obtido é frequentemente insuficiente clinicamente. Objetivo: Avaliar a acurácia diagnóstica da PAAF guiada por ultra-sonografia (USG) na abordagem da adenopatia cervical. Método: Estudo de série consecutiva de 186 pacientes que foram submetidos à PAAF guiada por USG de adenopatia cervical retrospectivo. O diagnóstico final foi determinado pelo exame histopatológico da biópsia por excisão do linfonodo, quando realizada ou pelo seguimento clínico por mais de um ano. Sensibilidade, especificidade, valores preditivos e acurácia foram avaliados. Resultados: No total, houve 54 diagnósticos de malignidade, cinco de tuberculose e 127 de linfadenite crônica inespecífica. A sensibilidade, especificidade, valores preditivos dos testes negativo e positivo e acurácia da PAAF foram respectivamente 79,5%, 99,1%, 88,2%, 98,3% e 91,4%. Conclusão: Enquanto a PAAF positiva é altamente preditivas do diagnóstico histológico final, o resultado negativo deve ser interpretado com cautela. Palavras-chave: linfonodos, biópsia por agulha, ultra-sonografia de intervenção, linfadenite, transtornos linfoproliferativos, metástase linfática.

Rev. bras. cir. cabeça pescoço, 2008

Introducao: a analise dos parâmetros vocais e importante na caracterizacao funcional apos realiza... more Introducao: a analise dos parâmetros vocais e importante na caracterizacao funcional apos realizacao da laringectomia frontolateral. Objetivo: realizar a avaliacao perceptivo-auditiva e acustica da voz nesse grupo de pacientes. Metodos: Foram avaliados 20 pacientes, sendo 18 do genero masculino, com idade media de 61 anos. A avaliacao perceptivo-auditiva foi realizada atraves da escala GIRBAS, enquanto a analise acustica foi feita pelo CSL modelo 4300B e pelo programa de analise vocal MDVP, Kay Elemetrics Corp. Resultados: A analise perceptivo-auditiva da voz revelou que todos os pacientes apresentaram algum grau de disfonia, caracterizado principalmente por rugosidade. Considerando os parâmetros acusticos, observou-se um importante incremento da frequencia fundamental e os valores de todos os parâmetros apresentaram-se alterados. Conclusao: A analise perceptivo-auditiva da voz indicou que todos os pacientes submetidos a laringectomia fronto-lateral apresentaram algum grau de disfonia, caracterizada principalmente pela presenca de rugosidade e tensao. Na analise acustica da voz, observou-se incremento da frequencia fundamental e medidas acusticas alteradas. Descritores: Qualidade da Voz. Percepcao da Fala. Acustica da Fala. Medida da Producao da Fala. Voz. Neoplasias Laringeas. Laringectomia.

ORL, 2018

The anterior commissure is an area of glottic cancer infiltration, even in early stages. To evalu... more The anterior commissure is an area of glottic cancer infiltration, even in early stages. To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. Forty-eight patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. Of the 48 patients, 42 (87.5%) had T1b lesions and 6 (12.5%) had T2. Thirty-four cases (70.8%) showed healthy tissue between the tumor and the thyroid cartilage, 10 cases (20.8%) had a tumor in close proximity to the cartilage, and in 4 cases (8.3%) there was cartilage invasion. There was no major risk of adverse outcome in the groups with infiltration or tumor adjacent to the cartilage. Level of differentiation, mitotic index, nuclear irregularity, and the presence of nucleolus and tumor necrosis were not related to cartilage invasion. The infiltration of thyroid cartilage occurred in 8.3% of tumors and did not change the outcome in patients submitted to frontolateral laryngectomy. The morphological characteristics did not present any statistical significance.

Laryngoscope, Sep 1, 2006

Objectives: Access to the thyroid compartment has traditionally been achieved by a Kocher incisio... more Objectives: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh).

Brazilian Journal of Otorhinolaryngology, Mar 1, 2009

The role of intraoperative frozen sections (FS) during thyroidectomy is controversial. Aim: to ev... more The role of intraoperative frozen sections (FS) during thyroidectomy is controversial. Aim: to evaluate the role of FS for thyroid nodules management. Patients and methods: All patients who had thyroid surgery for nodular disease and previous USG-guided FNAB in 2006 were prospectively analyzed. They underwent intraoperative FS evaluation, and the biopsy material was classified as benign, malignant or follicular neoplasm. FNAB, FS and paraffin sections were compared. Results: Under the FS, 54% of the nodules were benign, 30% were follicular neoplasms, and 16% were malignant. All cases considered benign and malignant under the FS evaluation were confirmed through the histological "paraffin" analysis. Since it is not considered a definitive indication for total thyroidectomy, if the follicular neoplasms were classified as "benign" under the FS, their sensitivity, specificity, positive and negative predictive values and global diagnostic accuracy were 69%, 100%, 100%, 91,5% e 77%, respectively. Among the 42 cases classified as "follicular neoplasm" under the FNAB, in 1 case the FS conclusion was for papillary carcinoma, in 3 cases as benign (all confirmed through the "paraffin"); and 38 cases continued as "follicular pattern", being 29 follicular adenomas and 9 carcinomas through the "paraffin". Conclusion: The FS is only indicated when the FNAB reports "follicular neoplasm".

O schwanoma é um tumor benigno encapsulado, que tem origem nas células de Schwann que revestem as... more O schwanoma é um tumor benigno encapsulado, que tem origem nas células de Schwann que revestem as fibras nervosas, fora do sistema nervoso central. É relatado aqui um caso raro de um schwanoma que surgiu da aritenoide esquerda. A paciente foi submetida à excisão da massa por meio de procedimento de endoscopia microlaríngea. Nenhuma recorrência foi observada durante o seguimento.

Contact laryngomicroscopy is in vivo laryngeal mucosa microscopic examination and rigid telescopy... more Contact laryngomicroscopy is in vivo laryngeal mucosa microscopic examination and rigid telescopy is a non-invasive technique that enables the systematic observation of many details in the large area of vocal fold mucosa. These are performed during laryngomicroscopy. This study was performed in order to evaluate the use of rigid and contact endoscopy effectiveness in establishing the margins in patients undergoing frontolateral laryngectomy. Ten patients with glottic squamous cell carcinoma underwent frontolateral laryngectomy from 2000 to 2003. Eight were staged as T1bN0M0, whereas two were staged as T2N0M0. During the frontolateral approach, the lesion and its limits were carefully defi ned, the surgical margins were established under the rigid telescope and the patients' margins were studied under contact endoscopy after methylene blue staining. Frozen section examination of the margins was performed and the histopathological analysis was compared to the surgical and endocopic fi ndings. The infraglottic region and the surgical margins were free of disease in all cases and there was a 100% correlation with the histopathological examination. All patients are alive with no evidence of disease after a minimum of 5 years' follow-up. In conclusion, rigid and contact laryngoscopy is effective in establishing the disease-free surgical margins in patients submitted to frontolateral laryngectomy.

Radi ation therapy is an adequate treatment for early laryngeal cancer, and it is important to st... more Radi ation therapy is an adequate treatment for early laryngeal cancer, and it is important to study the vocal fold vibratory pattern, which is essential for a favorable voice outcome. Aim: To analyze laryngostroboscopic findings in a group of patients who underwent radiation therapy for the treatment of early glottic cancer. Methods: A retrospective study was conducted in order to evaluate 20 patients staged as T1a glottic tumors in the period from 1995 to 2005. A laryngostroboscopic protocol was applied. Results: Glottic closure was complete in 17 patients. The amplitude was normal in 14 treated vocal folds and in 18 contralateral vocal folds. The mucosa wave vibratory pattern was totally present in all vocal folds. The periodicity was always regular in all cases. The vestibular fold and arytenoid symmetry and movements were normal. There was occasional supraglottic lateral constriction in 4 cases. The mucosal appearance was normal in 14 and edematous in 6 patients. Mucus build up was observed in 12 patients. Conclusions: The vibratory pattern was normal or slightly diminished in both vocal folds after radiation therapy for early glottic cancer.

Rev Bras Cir Cabeca Pescoco, Jun 1, 2007

Introducao: os habitantes da regiao de Blumenau tem pele clara e sao expostos a uma radiacao sola... more Introducao: os habitantes da regiao de Blumenau tem pele clara e sao expostos a uma radiacao solar com elevado indice ultravioleta durante o ano. Essas situacoes associadas favorecem o surgimento do melanoma. Objetivo: estudar o comportamento histologico dos melanomas na regiao de cabeca e pescoco. Pacientes e Metodo: foram analisados todos os casos de melanoma na regiao de cabeca e pescoco diagnosticados no Laboratorio de Anatomia Patologica CIPAC durante o periodo de janeiro de 2002 e abril de 2005, perfazendo 20 casos. Foram estudadas as seguintes variaveis dos casos: genero, idade, margens (livres ou comprometidas), presenca ou ausencia de regressao, invasao angiolinfatica e ulceracao, alem dos criterios de Breslow e Clark. Resultados: dos 20 casos, 11 correspondiam a mulheres. A idade media foi de 56 anos. Houve predominância histologica do tipo difusao superficial, com 65%. Oito casos tiveram Breslow menor ou igual a 1mm, com Clark II ou III e oito casos tiveram Breslow maior que 1mm, com Clark II ou III. Em tres casos, o Breslow era maior que 1mm, com Clark IV ou V. Ulceracao ocorreu em 40% dos casos e as margens comprometidas ocorreram em 25%. Conclusao: os fatores prognosticos de Breslow, Clark, ulceracao e indice mitotico estao relacionados ao padrao de crescimento (crescimento superficial, crescimento vertical e ulceracao). Os melanomas em regiao de cabeca e pescoco possuem um comportamento diferente daqueles que aparecem em outras partes do corpo, tendo evolucao e prognostico diferente. Descritores: melanoma; cabeca e pescoco; histologia.

Introdução: O estudo citológico do linfonodo pelo imprint é de grande importância para complement... more Introdução: O estudo citológico do linfonodo pelo imprint é de grande importância para complementar o histopatológico, sendo superior ao obtido pela punção aspirativa por agulha fina. método: Uma série consecutiva de 86 pacientes submetidos à ressecção de linfonodos cervical com a preparação de imprint foram avaliados retrospectivamente. O diagnóstico final foi determinado pelo exame histopatológico do espécime excisado. Sensibilidade, especificidade, valores preditivos e acurácia foram avaliados. Resultados: Houve o diagnóstico final de 54 casos de malignidade, oito casos de tuberculose e 24 casos de hiperplasia reativa não específica. A sensibilidade, especificidade, valores preditivos para os testes negativo e positivo e a acurácia do imprint foram 93,5%, 100%, 85,7%, 100% e 95,3%, respectivamente. Conclusão: O imprint positivo foi sempre coerente com o diagnóstico histopatológico final enquanto, com relação aos achados de negatividade, houve discordância 33% dos casos de linfoma não-Hodgkin e 25% nos casos de tuberculose ganglionar. Devido à sua alta acurácia, pode ser realizado como método auxiliar ao estudo histopatológico, que segue sendo o métodoouro.

Acadêmico de Medicina da Faculdade de Ciências Médicas da Fundação Lusíada, Santos. 2) Residen... more 1) Acadêmico de Medicina da Faculdade de Ciências Médicas da Fundação Lusíada, Santos. 2) Residente de Cirurgia Geral do Hospital Ana Costa, Santos. 3) Residente de Cirurgia de Cabeça e Pescoço do Hospital Ana Costa, Santos; Mestrando do Curso Pós-Graduação em Ciências da Saúde do Complexo Hospitalar Heliópolis, São Paulo. 4) Doutora em Oncologia pelo Curso de Pós-Graduação em Ciência da Fundação Antônio Prudente do Hospital do Câncer – A. C. Camargo, São Paulo. 5) Doutor em Medicina pelo Curso de Pós-Graduação em Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Universidade Federal de São Paulo – Escola Paulista de Medicina; Chefe da Divisão de Cirurgia e da Divisão de Ensino do Hospital Ana Costa, Santos; Docente do Curso Pós-Graduação em Ciências da Saúde do Complexo Hospitalar Heliópolis, São Paulo.

Revista Brasileira De Otorrinolaringologia, 2009

Otolaryngology -- Head and Neck Surgery, 2012

Objective: To measure comorbidity in patients with oral or oropharyngeal squamous cell carcinoma.... more Objective: To measure comorbidity in patients with oral or oropharyngeal squamous cell carcinoma. Method: Prospective cohort study performed in 2 hospitals in Santos. A total of 116 adult patients treated for a newly diagnosed oral or oropharyngeal squamous cell carcinoma were evaluated on this study from 1996 to 2007. We measured comorbidity illness applying the some validated scales. Results: After 4 years of follow-up the mortality rate was 47.4%. Patients with high values in ACE-27 and WUHNCI showed increased absolute risk of death in 25% and 31%, respectively. Of the 55 deaths in the period, 30.9% were due to other causes than cancer. Four indexes had predictive value on mortality due to other causes than cancer. Thus, patients who have high indexes on CIRS, KFC, ACE-27, and WUHNCI had increased risk of death of 33%, 23%, 44%, and 51%, respectively. Thirty-eight patients (69.1%) presented cancer-related mortality. Only the WUHNCI presented significant difference capable of pred...

Introdução: O tumor de Warthin é o segundo mais comum das glândulas salivares, aparecendo quase e... more Introdução: O tumor de Warthin é o segundo mais comum das glândulas salivares, aparecendo quase exclusivamente nas parótidas. objetivo: Apresentar a experiência em serviço de referência. método: Foram estudados, de janeiro de 1993 a junho de 2010, 60 pacientes com diagnóstico de tumor de Warthin. Foram analisados aspectos clínicos, radiológicos, citopatológicos, histopatológicos e as complicações cirúrgicas. Resultados: Do total de pacientes, foram 42 homens (70%) e 18 mulheres (30%). A idade variou entre 29 a 80 anos e a mediana de idade de 55 anos. Todos os tumores se desenvolveram na glândula parótida. 32 pacientes eram tabagistas (53,3%). O tamanho dos tumores variou de 2 a 10 cm de diâmetro no maior eixo. Pela ultrasonografia, a margem de todos os tumores foi evidente sugerindo tumor benigno. A punção aspirativa por agulha fina guiada por ultra-som foi compatível com tumor benigno em todos os casos. A excisão foi completa em todos dos casos. Em oito casos os tumores foram multifocais (13,3%) e, em outros três pacientes (5%) ocorreu bilateralidade. Quanto às complicações, houve dois casos de seroma e seis casos de paresia temporária do ramo mandibular marginal do nervo facial. Não houve casos de paralisia. Conclusão: O tratamento preconizado para o tumor de Warthin é a abordagem cirúrgica que, além de ter uma baixa taxa de recidiva, apresenta um índice baixo de complicações pós-operatórias.