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Projetos de Pesquisa
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Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 149
  • article 2 Citação(ões) na Scopus
    Morphological Evaluation of Thyroid Cartilage Invasion in Early Glottic Tumors Involving the Anterior Commissure
    (2018) SAVA, Henrique Wendling; DEDIVITIS, Rogerio Aparecido; GAMEIRO, Gustavo Rosa; PFUETZENREITER, Elio Gilberto; ALMEIDA, Ricardo Camillo de; MATOS, Leandro Luongo; CERNEA, Claudio Roberto
    Introduction: The anterior commissure is an area of glottic cancer infiltration, even in early stages. Objective: To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. Methods: 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. Results: 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. Conclusion: 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. (C) 2018 S. Karger AG, Basel
  • bookPart
    Retrograde Approach to Facial Nerve: Indications and Technique
    (2012) HOJAIJ, Flavio C.; PLOPPER, Caio; CERNEA, Claudio R.
  • article 230 Citação(ões) na Scopus
    Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Depth of Invasion An International Multicenter Retrospective Study
    (2014) EBRAHIMI, Ardalan; GIL, Ziv; AMIT, Moran; YEN, Tzu-Chen; LIAO, Chun-Ta; CHATURVEDI, Pankaj; AGARWAL, Jai Prakash; KOWALSKI, Luiz P.; KREPPEL, Matthias; CERNEA, Claudio R.; BRANDAO, Jose; BACHAR, Gideon; VILLARET, Andrea Bolzoni; FLISS, Dan; FRIDMAN, Eran; ROBBINS, K. Thomas; SHAH, Jatin P.; PATEL, Snehal G.; CLARK, Jonathan R.
    IMPORTANCE The current American Joint Committee on Cancer (AJCC) staging system for oral cancer demonstrates wide prognostic variability within each primary tumor stage and provides suboptimal staging and prognostic information for some patients. OBJECTIVE To determine if a modified staging system for oral cancer that integrates depth of invasion (DOI) into the T categories improves prognostic performance compared with the current AJCC T staging. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 3149 patients with oral squamous cell carcinoma treated with curative intent at 11 comprehensive cancer centers worldwide between 1990 and 2011 with surgery +/- adjuvant therapy, with a median follow-up of 40 months. MAIN OUTCOMES AND MEASURES We assessed the impact of DOI on disease-specific and overall survival in multivariable Cox proportional hazard models and investigated for institutional heterogeneity using 2-stage random effects meta-analyses. Candidate staging systems were developed after identification of optimal DOI cutpoints within each AJCC T category using the Akaike information criterion (AIC) and likelihood ratio tests. Staging systems were evaluated using the Harrel concordance index (C-index), AIC, and visual inspection for stratification into distinct prognostic categories, with internal validation using bootstrapping techniques. RESULTS The mean and median DOI were 12.9 mm and 10.0 mm, respectively. On multivariable analysis, DOI was a significantly associated with disease-specific survival (P < .001), demonstrated no institutional prognostic heterogeneity (I-2 = 6.3%; P = .38), and resulted in improved model fit compared with T category alone (lower AIC, P < .001). Optimal cutpoints of 5 mm in T1 and 10 mm in T2-4 category disease were used to develop a modified T staging system that was preferred to the AJCC system on the basis of lower AIC, visual inspection of Kaplan-Meier curves, and significant improvement in bootstrapped C-index. CONCLUSIONS AND RELEVANCE We propose an improved oral cancer T staging system based on incorporation of DOI that should be considered in future versions of the AJCC staging system after external validation.
  • article 1 Citação(ões) na Scopus
    Evaluation of a Training Model for Cervical Trauma Using Cadavers
    (2019) SIMOES, Cesar Augusto; JR, Marcelo A. F. Ribeiro; PORTILHO, Ana Sara; FAVARO, Murillo; SANTIN, Stephanie; FERRADA, Paula; DEDIVITIS, Rogerio Aparecido; CERNEA, Claudio Roberto
  • article 4 Citação(ões) na Scopus
    Quantitative analysis of lymph nodes in neck dissection specimens. Morphologic study
    (2016) CAPELLI, Fabio de Aquino; PAES, Vitor Ribeiro; MACHADO, Mariangela Marinheiro; MENEZES, Camila Lohmann; SILVA, Pablo Rodrigo Andrade da; SIQUEIRA, Sheila Aparecida Coelho; ALVES, Venancio Avancini Ferreira; MATOS, Leandro Luongo; CERNEA, Claudio Roberto
    PURPOSE: To quantify the amount of lymph nodes harvested in modified radical neck dissection. METHODS: Cross-sectional anatomical study conducted in 28 non-preserved cadavers. RESULTS: The mean number of lymph nodes found in each nodal level of the 56 modified radical neck dissections performed were: level IA - 1.5 (95% CI: 1.1 - 1.8), level IB - 2.5 (95% CI: 2.1 - 2.9), level IIA - 7.2 (95% CI: 6.0 - 8.5), IIB level - 6.5 (95% CI: 5.5 - 7.4), level III - 6.6 (95% CI: 5.7 - 7.4), level IV - 8.6 (95% CI: 7.1 - 10.1), level V - 11 (95% CI: 9.2 - 12.7), totalizing 43.8 lymph nodes (95% CI: 40.3 - 47.4). CONCLUSION: The results defined a parameter in relation to the minimum recommended nodal yield in a modified radical neck dissection, as well as the number of lymph nodes in each level of this dissection, performed in clinical practice.
  • article 6 Citação(ões) na Scopus
    Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction
    (2021) RAGHURAM, Anjali C.; MANFRO, Gabriel; TEIXEIRA, Gilberto V.; CERNEA, Claudio R.; DIAS, Fernando L.; MARCO, Mauricio De; POLO, Roger; ABU-GHNAME, Amjed; MARICEVICH, Marco
    Background Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap. Methods We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t -tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups. Results In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications ( p =0.41) or flap/skin paddle loss ( p =0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction. Conclusion As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.
  • bookPart 0 Citação(ões) na Scopus
    Indications for a ‘tactical’ parotidectomy in nonsalivary lesions
    (2012) PLOPPER, C.; CERNEA, C. R.
  • article 8 Citação(ões) na Scopus
    GTSP1 expression in non-smoker and nondrinker patients with squamous cell carcinoma of the head and neck
    (2017) SOARES, Pamela de Oliveira; CURY, Patricia Maluf; LOPEZ, Rossana Veronica Mendoza; CERNEA, Claudio Roberto; FUKUYAMA, Erika Erina; FIGUEIREDO, David Livingstone Alves; NOBREGA, Francisco Gorgonio da; CURIONI, Otavio Alberto; NUNES, Fabio Daumas; MOYSES, Raquel Ajub; GARCIA, Maria Lucia Bueno
    Introduction The main risk factors for head and neck squamous cell carcinoma (HNSCC) are tobacco and alcohol consumption and human papillomavirus (HPV) infection. However, in a subset of patients, no risk factors can be identified. Glutathione S-transferase p (GTSP1) is a carcinogen-detoxifying enzyme that is activated by exposure to carcinogens, and it is associated with a reduction in response to toxic therapies. We studied the expression of GTSP1 in tumor and non-tumor tissue samples from patients with and without these risks to identify whether GTSP1 expression differs according to exposure to carcinogens. Materials and methods Non-smoker/non-drinker (NSND) and smoker/drinker (SD) patients were matched according to age, gender, tumor site, TNM stage, grade and histological variants to establish 47 pairs of patients who have been previously tested for HPV. GTSP1 immunostaining was analyzed using a semi-quantitative method with scores ranging from 0 to 3 according to the area of immunostaining. Results GTSP1 expression was detected in the tumors of both groups. GTSP1 expression was higher in the non-tumor margins of SD patients (p = 0.004). There was no association between GTSP1 expression and positivity for HPV. No differences in survival were observed according to GTSP1 staining in tumors and non-tumor margins. Conclusion This study showed that GTSP1 was expressed in tumors of HNSCC patients regardless of smoking, drinking or HPV infection status. The difference in GTSP1 expression in non-tumor margins between the two groups may have been due to two possible reasons. First, elevated GTSP1 expression in SD patients might be the result of activation of GTSP1 in response to exposure to carcinogens. Second, alternatively, impairment in the detoxifying system of GTSP1, as observed by the reduced expression of GTSP1, might make patients susceptible to carcinogens other than tobacco and alcohol, which may be the underlying mechanism of carcinogenesis in the absence of risk factors.
  • article 4 Citação(ões) na Scopus
    Hypomagnesemia associated with hypocalcemia after total thyroidectomy: an observational study
    (2016) MAHMOUD, Renata Regina da Graca Lorencetti; ARAUJO NETO, Vergilius Jose Furtado de; ALVES, Wellington; LIN, Chin Shien; LEITE, Ana Kober Nogueira; MATOS, Leandro Luongo; ARAUJO FILHO, Vergilius Jose Furtado de; CERNEA, Claudio Roberto
    Introduction: Serum magnesium is frequently low in patients with hypocalcemia after total thyroidectomy. The aim of the present study was to analyze the variations in serum magnesium and calcium concentrations after total thyroidectomy, and the relationship between both ions. Materials and methods: We conducted an observational study of 142 patients who had undergone total thyroidectomy, measuring serum calcium and magnesium levels preoperatively and on the day following surgery. The incidence of postoperative hypocalcemia was compared with that of postoperative hypomagnesemia. Results: A total of 142, total thyroidectomies were performed: 54 patients (38%) presented with hypocalcemia on the first postoperative day. A marked decrease in blood magnesium in the group of patients with hypocalcemia was observed when compared to those with normal calcemia on the first postoperative day (mean variation respectively, 0.125 +/- 0.065 mmol/L versus 0.035 +/- 0.020 mmol/L; P = 0.0002). Conclusion: Hypomagnesemia is significantly associated with early hypocalcemia following thyroidectomy.
  • bookPart
    Infecções cervicais
    (2021) UEHARA, Thalita Mara; CERNEA, Claudio Roberto; ARAUJO FILHO, Vergilius José Furtado de