CLAUDIO ROBERTO CERNEA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
LIM/28 - Laboratório de Cirurgia Vascular e da Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina
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- 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 RobertoIntroduction: 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- Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial(2019) GOULART, Tais Fonseca; ARAUJO-FILHO, Vergilius Jose Furtado De; CERNEA, Claudio Roberto; MATOS, Leandro LuongoOJECTIVES: The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy. METHODS: In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted. RESULTS: The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p < 0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p < 0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively). CONCLUSIONS: The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.
bookPart Apresentação do Volume(2021) ARAUJO FILHO, Vergilius José Furtado de; CERNEA, Claudio Roberto- Practical tips to reduce complication rate in thyroidectomy(2017) CERNEA, Claudio; BRANDAO, Lenine G.; HOJAIJ, Flavio C.; CARLUCCI, Dorival De; VANDERLEI, Felipe; GOTODA, Renato; LEITE, Ana K.; KULCSAR, Marco A. V.; MATOS, Leandro L.; DEDIVITIS, Rogerio A.; ARAUJO-FILHO, Vergilius J. F.; TAVARES, Marcos R.Introduction: Thyroid cancer is the most frequent endocrine neoplasm, and its incidence has been consistently rising during the last decades. Surgical treatment is the choice, but the complications can be truly devastating. Methods: The objective of this article is to present some practical tips to reduce the complication rate in thyroid surgery. Results: The more frequent complications during a thyroidectomy are mentioned, as well as practical tips to try to prevent them: acute airway compression, nerve injuries (both inferior laryngeal and external branch of the superior laryngeal nerves), and hypoparathyroidism. Conclusion: The prevention of complications during a thyroidectomy is imperative. The only way that the surgeon can assure the safety is to strictly adhere to technical principles, with diligent hemostasis, thorough anatomical knowledge, and gentle handling of the anatomic structures adjacent to the thyroid gland.
- Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?(2018) KOYAMA, Leonardo Kenji Sakaue; MATOS, Leandro Luongo; KULCSAR, Marco Aurelio Vamondes; ARAUJO FILHO, Vergilius Jose Furtado de; CERNEA, Claudio RobertoIntroduction: Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications. Objective: To evaluate the possibility of a watchful waiting approach in oral cancer. Methods: We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident. Results: The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences. Conclusion: A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost effective and less harmful than elective neck dissection. (C) 2018 S. Karger AG, Basel
- Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB)(2018) MOSCA, Leticia; SILVA, Luiz Fernando Ferraz da; CARNEIRO, Paulo Campos; CHACON, Danielle Azevedo; ARAUJO-NETO, Vergilius Jose Furtado de; ARAUJO-FILHO, Vergilius Jose Furtado de; CERNEA, Claudio RobertoOBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p < 0.001) and Bethesda Class IV (p < 0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p < 0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.
- Active Surveillance of Thyroid Microcarcinomas: a Critical View(2022) CERNEA, Claudio R.; MATOS, Leandro Luongo; EUGENIO, Cecilia; FERREIRA, Giovanna Mattos; CERQUEIRA, Yasmin Sa; LEITE, Ana Kober N.; VANDERLEI, Felipe A. B.; CARLUCCI, Dorival de; GOTODA, Renato N.; HOJAIJ, Flavio C.; ARAUJO-FILHO, Vergilius J. F.Purpose of the Review There has been an increasing interest on active surveillance for papillary thyroid microcarcinomas (PTMC) in the literature. We will analyze the contributions of those authors who support this approach in most patients with low-risk tumors. Recent Findings The development of molecular methods to effectively detect aggressive PTMC at the fine-needle aspiration biopsy will enable the sound indication of immediate surgery in those patients, assuring the other individuals with the far more frequent indolent PTMC will undergo active surveillance with less anxiety. Several studies compared the quality of life between patients with PTMC who underwent active surveillance with immediate total thyroidectomy. However, thyroid lobectomy is a quite acceptable intermediate alternative for most patients with PTMC, with less surgical morbidity. Summary It is important to wait for worldwide validation, with reports from low- and middle-income areas, before recommending the routine adoption of active surveillance for patients with PTMC, due to difficult logistic obstacles in those environments.
bookPart Hematoma cervical pós-tireoidectomia(2019) ARAúJO NETO, Vergilius José Furtado de; ARAúJO FILHO, Vergilius José Furtado de; CERNEA, Claudio Roberto- Malignant solitary fibrous tumor of the thyroid: a case-report and review of the literature(2014) ALVES FILHO, Wellington; MAHMOUD, Renata Regina da Graca Lorencetti; RAMOS, Daniel Marin; ARAUJO-FILHO, Vergilius Jose Furtado de; LIMA, Patricia Picciarelli de; CERNEA, Claudio Roberto; BRANDAO, Lenine GarciaSolitary fibrous tumor (SFT) is an uncommon spindle-cell neoplasm that most often involves the pleura, rarely occurring in extra-thoracic locations. Twenty-six cases of SFT arising in the thyroid gland have been described. We report a case of a 60-year-old woman presenting an 8-month history of enlargement of the neck associated with dysphagia. The patient underwent a right hemithyroidectomy and SFT of the thyroid was diagnosed. Immunohistochemistry showed positivity for CD34 marker, and the high number of mitoses and the presence of cellular atypia suggested that the tumor was malignant. To our knowledge, this is the second case of malignant SFT of the thyroid gland ever reported. Due to the rarity of these tumors, the indication of adjuvant therapy and prognosis are uncertain. Long-term follow-up after surgical resection seems to be advisable.