Search

Parathyroid tumors are very prevalent conditions among endocrine tumors, being the second most common behind thyroid tumors. Secondary hyperplasia can occur beyond benign and malignant neoplasia in parathyroid glands. Adenomas are the leading cause of hyperparathyroidism, while carcinomas represent less than 1% of the cases. Tumor suppressor gene mutations such as MEN1 and CDC73 were demonstrated to be involved in tumor development in both familiar and sporadic types; however, the epigenetic features of the parathyroid tumors are still a little-explored subject. We present a review of epigenetic mechanisms related to parathyroid tumors, emphasizing advances in histone modification and its perspective of becoming a promising area in parathyroid tumor research.

Background Increasing evidence shows that chronic inflammation plays an important role in thyroid tumorigenesis. Cytokines as central mediators in inflammatory microenvironment can present both pro-tumour and anti-tumour effects and cytokine release may be influenced by soluble HLA-G (sHLA-G), an immune checkpoint molecule whose expression can also be induced by certain cytokines. Aim To understand the role of these soluble factors in papillary thyroid cancer (PTC). Methods We evaluated plasma levels of sHLA-G and of 13 cytokines using ELISA and flow cytometry, respectively, in PTC patients at two time points: pre- and post-thyroidectomy; and control subjects. Results Compared with controls, IL-6 levels were increased, while IL-1β, IFN-α and TGF-β1 levels were decreased in pre-thyroidectomy PTC patients. IFN-α and TGF-β1 efficiently discriminated patients from controls and were associated with extrathyroidal extension and lymph node metastasis, respectively. In addition, TNF and IL-13 were associated with male gender, lymph node metastasis and Hashimoto thyroiditis, and sHLA-G with tumour invasion. Compared with pre-thyroidectomy, IL-4, IL-10, TNF, IFN-α and TGF-β1 levels were increased in post-thyroidectomy. Conclusion There are significant changes in the cytokine profile after surgical removal of the thyroid tumour, and IFN-α e TGF-β1 showed to be promising cytokines for discriminating PTC patients from controls. We also found that different cytokines are associated with clinicohistopathological characteristics of PTC related to poor prognosis, suggesting that cytokines seem to play an important role in PTC development and management.

Background Familial partial lipodystrophy of the Dunnigan type is one of the most common inherited lipodystrophies variables. These individuals have important metabolic disorders that cause predisposition to various diseases. In this study we aimed to demonstrate the relation between the metabolic abnormalities, inflammatory profile and the expression of genes involved in the activation of the endoplasmic reticulum stress (ERS) in subjects with FPLD. Methods We evaluated 14 female FPLD patients and compared with 13 female healthy individuals. The subjects were paired with their respective BMI and age and categorized into two groups: Familial partial lipodystrophy of the Dunnigan type (FPLD) and control. Patients were fasted for 12 h before blood collection for measurement of HbA1c, glucose, insulin, lipids and inflammatory markers. Subcutâneous adipose tissue was collected by puncture aspiration of submental region during ambulatorial surgical aesthetic procedure. Results We demonstrate that patients with FPLD show increased HbA1c (p mellitus and metabolic syndrome are associated with direct damage to the endoplasmic reticulum homeostasis. Ultimately, we note that individuals with lipodystrophy have an increase in serum interleukins, keys of the inflammatory process, as IL-1β, TNF-α and IL-6 (p Conclusion Individuals with FPLD besides having typical dysfunctions of metabolic syndrome, show a hyperactivation of ERS associated with increased systemic inflammatory profile, which together may explain the complex clinical aspect of this diseases. Trial registration HCRP no 6711/2012

Purpose Parathyroidectomy can be subtotal or total with an autograft for the treatment of renal hyperparathyroidism. In both cases, it may be extended with bilateral thymectomy and total or partial thyroidectomy. Thymectomy may be recommended in combination with parathyroidectomy in order to prevent mediastinal recurrence. Also, the occurrence of thyroid disease observed in patients with hyperparathyroidism is poorly understood and the incidence of cancer is controversial. The aim of the present study was to report the experience of a single center in the surgical treatment of renal hyperparathyroidism and to analyse the role of thyroid and thymus surgery in association with parathyroidectomy. Materials and methods We analysed parathyroid surgery data, considering patient demographics, such as age and gender, and surgical procedure data, such as type of hyperparathyroidism, associated thyroid or thymus surgery, surgical duration and mediastinal recurrence. Histopathological results of thyroid and thymus samples were also analysed. Results Medical records of 109 patients who underwent parathyroidectomy for secondary hyperparathyroidism were reviewed. On average, thymectomy did not have impact on time of parathyroidectomy (p = 0.62) even when thyroidectomy was included (p = 0.91). Intrathymic parathyroids were detected in 7.5% of the thymuses removed and papillary carcinoma was detected in 20,8% of thyroid tissue samples. Two patients showed recurrence of supernumerary intrathymic parathyroids and a single case of mediastinitis was observed. Conclusions Parathyroidectomy with thymectomy and/or thyroidectomy has an important role in the treatment of renal hyperparathyroidism since thyroid cancer can frequently occur and require surgery. Thymectomy should be considered to avoid recurrence and a risky re-operation.

Background: Dietary restriction (DR) reduces adiposity and improves metabolism in patients with one or more symptoms of the metabolic syndrome. Nonetheless, it remained elusive whether the benefits of DR in humans are mediated by calorie or nutrient restriction. Methods: Here we subjected 21 individuals diagnosed with the metabolic syndrome to short-term (i.e., 27-days) caloric restriction (CR; n = 11) or isocaloric dietary protein restriction (PR; n = 10) and compared the metabolic outcomes of the interventions. Findings: Like CR, PR promoted weight loss due to reduction in adiposity, and reduced blood glucose, lipid levels and blood pressure in these individuals. Hence, a reduction in calorie intake is not necessary to confer the metabolic benefits of DR. Instead, a reduction in protein intake with a mild increase in carbohydrate intake to maintain the caloric balance of the diet is sufficient to improve metabolic control in patients with the metabolic syndrome. Interpretation: Because PR is a less drastic food intervention to be conducted, it has a greater potential to be used as an adjuvant therapy to treat the metabolic syndrome. Trial Registration: This study is registered at the Brazilian Clinical Trials, ensaiosclinicos.gov.br, number RBR-3HKNRW. Funding Statement: This work was supported by grant 2015/12133-0 and 2017/01184-9 of Sao Paulo Research Foundation (FAPESP). Declaration of Interests: The authors declare they have no competing financial interests. Ethics Approval Statement: This study was approved by the Research Ethics Committee of the Clinics Hospital of Ribeirao Preto and by the Plataforma Brasil. The Helsinki Declaration Guidelines have been followed and the reports in this article are aligned with the CONSORT standards. All participants were informed about the procedures and signed a study consent form.

Objective: this study aims to evaluate the efficacy of diagnosis and treatment of oral lesions between different healthcare levels. Material and Methods: all information was obtained from the medical records of a University Hospital and Public Health Regulation System regarding clinical-demographic features such as oral diseases diagnosed, referral system and therapy employed. Evaluation was based on the relationship between final diagnosis, diagnostic hypothesis and the priority of medical appointments, time between referral and first appointment, date of final diagnosis and therapy onset. Latter, diagnostic hypothesis fulfilled between primary and tertiary healthcare providers were compared and the agreement between both were determined. Results: about half (51%) of the medical forms filled by primary healthcare professionals were incomplete, or diagnostic hypothesis was inadequately described. At the tertiary healthcare level, mean time between referral and first appointment was 23 days, and mean time between the final diagnosis and treatment was 22 days. Surgical treatment was faster (31 days) when compared to radiotherapy for malignant lesions (81 to 100 days). Conclusion: it is necessary to improve training of healthcare professionals in the primary healthcare regarding the recognition of malignant oral lesions. Clearly, appropriate filling of the diagnostic hypothesis with the corresponding degree of priority accelerates the diagnosis and treatment of the patient. Objetivo: O objetivo desse estudo foi avaliar a eficácia do diagnóstico e tratamento de lesões orais entre diferentes níveis de saúde. Material e Métodos: Todas as informações foram obtidas dos prontuários médicos de um Hospital Universitário e de fichas do Sistema Público de Regulação, considerando as características clínico-demográficas tal como, doenças orais diagnosticadas, sistema de referência e terapia empregada. A avaliação foi baseada na relação entre diagnóstico final, hipótese diagnóstica e prioridade para agendamento da consulta, também foi considerado o tempo decorrido entre o encaminhamento e o primeiro atendimento, data do diagnóstico final e início da terapia. Depois, a hipótese diagnóstica preenchida por profissionais de saúde do nível primário e terciário foram comparadas e a concordância entre ambos foi determinada. Resultados: Cerca de 51% dos encaminhamentos preenchidos pelos profissionais da atenção primária estavam incompletos, ou a hipótese diagnóstica estava descrita de forma inadequada. No nível terciário, o tempo médio entre o encaminhamento e a primeira consulta foi de 23 dias, a média entre o diagnóstico final e o início do tratamento foi de 22 dias. O tratamento cirúrgico foi o mais rápido (31 dias) quando comparado a radioterapia para lesões malignas (81 a 100 dias). Conclusão: É necessário melhorar o treinamento de profissionais de saúde da Atenção Básica no reconhecimento de lesões orais malignas. Claramente, o preenchimento adequado das hipóteses de diagnóstico, com o grau de prioridade correspondente acelera o diagnóstico e tratamento do paciente.

Pleomorphic adenoma is the most common benign tumor of the salivary glands, with a higher prevalence between the fourth and sixth decades of life and a predilection for women. A 48-year-old white woman with acute lymphoblastic leukemia was referred to the stomatology outpatient clinic, complaining of lesions in right upper gingiva with a recent episode of febrile neutropenia after a consolidation chemotherapy. At the extraoral examination no alterations were observed. On intraoral examination, small ulcers were observed in attached gingiva, and on right side of the hard palate a nodular and sessile lesion of approximately 2 cm was identified. Lesions on gingiva were as secondary herpes simplex identified by cytology and polymerase chain reaction. Incisional biopsy of nodule confirmed the diagnosis of pleomorphic adenoma. Radiographically, the bone structures were intact. Currently, 7 months after surgery, he is well clinically and without signs of relapse.

We report a series of 12 cases of oral aspergillosis with an age range from 21 to 63 years (mean, 42 y), 7 women, 5 men, whose underlying diseases were acute myeloid leukemia (n = 9) and chronic myeloid leukemia in blastic crisis (n = 3). Primary sites and symptoms were: 2 cases in the nasal cavity presenting as rhinorrhea and fever, 5 cases in the paranasal sinus (2 with pain, 1 with fever and 2 with pain and fever), and 5 cases in the oral mucosa who presented only with pain. All cases localized in paranasal sinuses were detected by computed tomography while in the nasal cavity; however, none were detected by imaging when localized to the oral mucosa. Galactomannan (GM) was positive only when fever was present. Histopathology (HP) and culture were all positive for Aspergillus sp., however HP diagnosis was within 48 hours. In conclusion, GM was not effective for localized lesions without systemic repercussion and histopathologic examination is strongly recommended for early aspergillosis diagnosis.

Texto completo: acesso restrito. p. 103–106 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-01-05T11:29:10Z No. of bitstreams: 1 João Paulo de Medeiros Vanderlei.pdf: 219590 bytes, checksum: 90d4fc09a9e7d6e2a7219d3344bb1979 (MD5) Approved for entry into archive by Delba Rosa (delba@ufba.br) on 2015-05-06T14:36:08Z (GMT) No. of bitstreams: 1 João Paulo de Medeiros Vanderlei.pdf: 219590 bytes, checksum: 90d4fc09a9e7d6e2a7219d3344bb1979 (MD5) Made available in DSpace on 2015-05-06T14:36:08Z (GMT). No. of bitstreams: 1 João Paulo de Medeiros Vanderlei.pdf: 219590 bytes, checksum: 90d4fc09a9e7d6e2a7219d3344bb1979 (MD5) Previous issue date: 2013 Background Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer. Methods A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm). Results The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3 + T4. Statistical comparison of the groups (p) revealed the following results: T2a X T2b = 0.03; T2a X T3 + T4 = 0.001. Conclusion PND is indicated for tumors larger than 3 cm.

Primary hyperparathyroidism occurs in only 10%-30% of patients with multiple endocrine neoplasia type 2A (MEN2A), rarely as the sole clinical manifestation, and is usually diagnosed after the third decade of life.A 5-year-old girl was referred for prophylactic thyroidectomy as she carried the p.C634R RET mutation. She was clinically asymptomatic, with a normally palpable thyroid and with the cervical region free of lymphadenopathy or other nodules. Preoperative tests revealed hypercalcemia associated with elevation of parathyroid hormone (PTH) (calcium = 11.2 mg/dL, calcium ion = 1.48 mmol/L, phosphorus = 4.0 mg/dL, alkaline phosphatase = 625 U/L, parathyroid hormone (PTH) PTH = 998 pg/mL). A thyroid ultrasound was normal and parathyroid scintigraphy with (99m)Tc-Sestamibi revealed an area of radioconcentration in the upper half of the left thyroid lobe suggesting hyperfunctioning parathyroid tissue. She underwent total thyroidectomy and parathyroidectomy and developed hypocalcemia. The anatomopathological examination showed no histopathological changes in the thyroid tissue and an adenoma of the parathyroid gland, confirming the diagnosis of hyperparathyroidism.Primary hyperparathyroidism can be a precocious manifestation of MEN2A. This case report highlights that asymptomatic hypercalcemia should be scrutinized in children related to patients with MEN2A who carry a mutation in the RET proto-oncogene, especially mutations in the codon 634, before the currently recommended age of 8 years.

Summary Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: “FB walk to the heart”. Aim describe the mechanisms involved in FB migration and how to diagnose them. Methodology From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. Results three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. Conclusions the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

The parathyroid glands are small and often similar to lymph nodes, fat, and thyroid tissue. These glands are difficult to identify during surgery and a biopsy of the parathyroid for identification can lead to damage of the gland. The use of static and time-resolved fluorescence techniques to detect biochemical composition and tissue structure alterations could help to develop a portable, minimally invasive, and nondestructive method to assist medical evaluation of parathyroid tissues. In this study, we investigated 10 human parathyroid samples using absorbance, fluorescence, excitation, and time-resolved fluorescence measurements. Moreover, we compared the results of time-resolved fluorescence measurements with 59 samples of thyroid tissues. The fluorescence lifetimes with emission at 340 nm were 1.09 ± 0.10 and 4.46 ± 0.06 ns for healthy tissue, 1.01 ± 0.25 and 4.39 ± 0.36 ns for benign lesions, and 0.67 ± 0.36 and 3.92 ± 0.72 ns for malignant lesions. The lifetimes for benign and malignant lesions were significantly different, as attested by the analysis of variance with confidence levels higher than 87%. For each class of samples (healthy, benign, and malignant) we perceived statistical differences between the thyroid and parathyroid tissue, independently. After further investigations, fluorescence methods could become a tool to identify normal and pathological parathyroid tissues and distinguish thyroid from parathyroid tissues.

INTRODUCTION: Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.OBJECTIVES: To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.METHODS: The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.RESULTS: This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).CONCLUSION: Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval. INTRODUÇÃO: Pacientes com carcinoma epidermoide de cavidade oral mostram déficits em sua imunidade celular, que contribuem para o crescimento neoplásico. Assim, a atividade inflamatória, como resposta imunológica ao tumor, pode servir como fator prognóstico.OBJETIVOS: Avaliar a correlação entre o processo inflamatório peritumoral com as características clínicas dos pacientes, com a sobrevida e com o tempo livre de doença.MÉTODO: A amostra deste estudo foi composta por uma coorte retrospectiva de base hospitalar com pacientes submetidos à cirurgia para remoção de carcinoma epidermoide de cavidade oral. O infiltrado inflamatório presente nas lâminas foi avaliado semi quantitativamente, sendo dividido em processo inflamatório: menor e maior.RESULTADOS: Analisaram-se 57 amostras tumorais, com infiltrado de linfócitos, plasmócitos e histiócitos. O teste log-rank não mostrou significância para as curvas de sobrevida e de recidiva dos processos "inflamatório menor" e "inflamatório maior", p = 0,14 e p = 0,24, respectivamente. Observou-se associação direta da idade com o processo inflamatório (p = 0,04), e relação indireta entre o grau de diferenciação tumoral e o processo inflamatório (p = 0,01).CONCLUSÃO: O processo inflamatório peritumoral, embora relacionado com a diferenciação histológica, não pode ser considerado fator prognóstico de carcinoma epidermoide de cavidade oral, pois não se relaciona com sobrevida e tempo livre da doença.

This article presents an overview of optical methodologies to aid the diagnosis and differentiation of thyroid and parathyroid tissues. In particular, we review the several techniques and associated methodologies that allow in vivo and ex vivo optical characterization of thyroid and parathyroid tissues. Emphasis is placed on the research potential of these techniques and whether intrinsic characteristics can provide useful contrast for the diagnosis of human thyroid and parathyroid malignant lesions.

Fine-needle aspiration cytology is the standard technique to diagnose thyroid pathologies. However, this method results in a high percentage of inconclusive and false negatives. The use of time-resolved fluorescence techniques to detect biochemical composition and tissue structure alterations could help to develop a portable, minimally invasive, and nondestructive method to assist during surgical procedures. This study aimed to use fluorescence lifetimes to differentiate healthy and benign tissues from malignant thyroid tissue. The thyroid tissue was excited at 298-300 nm and the fluorescence decay registered at 340 and 450 nm. We observed fluorescence lifetimes at 340 nm emission of 0.80 ± 0.26 and 3.94 ± 0.47 ns for healthy tissue; 0.90 ± 0.24 and 4.05 ± 0.46 ns for benign lesions; and 1.21 ± 0.14 and 4.63 ± 0.25 ns for malignant lesions. For 450 nm emissions, we obtain lifetimes of 0.25 ± 0.18 and 3.99 ± 0.39 ns and for healthy tissue, 0.24 ± 0.17 and 4.20 ± 0.48 ns for benign lesions, 0.33 ± 0.32 and 4.55 ± 0.55 ns for malignant lesions. Employing analysis of variance, we differentiate malignant lesions from benign and healthy tissues. In addition, we use quadratic discriminant analysis to distinguish malignant from benign and healthy tissues with an accuracy of 76.1%, sensitivity of 74.7%, and specificity of 83.3%. These results indicate that time-resolved fluorescence can assist medical evaluation of thyroid pathologies during surgeries.

INTRODUÇÃO: Desde a primeira laringectomia total, realizada em 1873, já se tem registro do interesse em se desenvolver e recuperar a comunicabilidade verbal desses pacientes. Porém grandes progressos foram observados depois de 1979, quando se pode contar com próteses traqueoesofágicas. Mesmo sendo um enorme progresso, as próteses vocais geram complicações. OBJETIVO: Avaliar as complicações com o emprego de próteses vocais e relaciona-las com fatores clínicos e tipo de prótese. MÉTODOS: Dez pacientes submetidos a laringectomia total portando prótese fonatória foram acompanhados no serviço de Cirurgia de Cabeça e Pescoço do HCRP-FMRP-USP buscando-se registrar as complicações e relaciona-las com fatores clínicos e tipo de prótese. RESULTADOS: Foram registrados: vazamento de saliva e/ou dieta da faringe para a traquéia, infecção fungica, ausência de função da prótese e esses achados foram quantificados avaliando-se os efeitos da radioterapia e do tipo de prótese usada. CONCLUSÃO: A prótese vocal apresenta dificuldades e complicações operacionais que merecem atenção e mais estudos são necessários para se ter o perfil mais completo destes aspectos.

Muitos estudos relatam o aumento da expressão de S100 A7 (psoriasina) em lesões neoplásicas. Destacam-se trabalhos em carcinoma da mama, espinocelular da bexiga, pele e cavidade oral. Não foi demonstrada expressão da S100 A7 em câncer de laringe. OBJETIVO: Identificar a expressão da proteína ligadora de cálcio S100 A7 e sua correlação com carcinomas espinocelular da laringe. MATERIAL E MÉTODOS: Amostras de tecido neoplásico de 63 pacientes foram submetidos à imunohis toquímica com o anticorpo S110 A7. Os resultados foram classificados e comparados. RESULTADOS: O grupo bem diferenciado teve a maior pontuação de falha no tratamento. O grupo moderadamente diferenciado apresentou escores mais elevados do que o grupo pouco diferenciado. Pontuações mais altas predominaram nos estágios I e II no grupo moderadamente diferenciado, enquanto a distribuição do escore foi mais homogênea em estados avançados (III e IV). Em relação às falhas no tratamento, o grupo pontuação zero (04/03 complicações: 75%) diferiu significativamente da pontuação restante (13/59: 22%). CONCLUSÕES: A S100 A7 foi expressa em 93,7% dos casos de câncer de laringe, com maior positividade nos tumores mais diferenciados e taxa significativamente menor de falha no tratamento. A pontuação obtida não teve impacto sobre a sobrevivência. Many studies have reported increased expression of S100 A7 (psoriasin) in neoplastic lesions. Among them are studies on breast carcinoma, bladder squamous cell carcinoma, skin tumors and oral cavity squamous cell carcinoma. The expression of S100 A7 has not been described for laryngeal cancer. OBJECTIVE: This study aims to identify the expression of the calcium-binding protein S100 A7 and its correlation with squamous cell carcinomas of the larynx. MATERIAL AND METHODS: Specimens from 63 patients were submitted to immunohistochemistry testing with antibody S100 A7. Results were classified and compared. RESULTS: The group with highly differentiated tumors had the highest treatment failure scores. Moderately differentiated tumors had higher treatment failure scores than poorly differentiated tumors. Higher scores were predominantly seen on stages I and II in moderately differentiated tumors, whereas score distribution was more homogeneous in advanced stage disease (III and IV). Regarding failure in treatment, the group scoring zero (3/4 complications: 75%) differed significantly from the remaining groups (13/59: 22%). CONCLUSIONS: S100 A7 marker was expressed in 93.7% of laryngeal cancer cases, with higher positive correlation rates in more differentiated tumors and significantly lower rates of treatment failure. Scores had no impact on survival rates.

Many studies have reported increased expression of S100 A7 (psoriasin) in neoplastic lesions. Among them are studies on breast carcinoma, bladder squamous cell carcinoma, skin tumors and oral cavity squamous cell carcinoma. The expression of S100 A7 has not been described for laryngeal cancer.This study aims to identify the expression of the calcium-binding protein S100 A7 and its correlation with squamous cell carcinomas of the larynx.Specimens from 63 patients were submitted to immunohistochemistry testing with antibody S100 A7. Results were classified and compared.The group with highly differentiated tumors had the highest treatment failure scores. Moderately differentiated tumors had higher treatment failure scores than poorly differentiated tumors. Higher scores were predominantly seen on stages I and II in moderately differentiated tumors, whereas score distribution was more homogeneous in advanced stage disease (III and IV). Regarding failure in treatment, the group scoring zero (3/4 complications: 75%) differed significantly from the remaining groups (13/59: 22%).S100 A7 marker was expressed in 93.7% of laryngeal cancer cases, with higher positive correlation rates in more differentiated tumors and significantly lower rates of treatment failure. Scores had no impact on survival rates.

A fixação dos CE, principalmente os pontiagudos, favorece a migração pelo corpo, gerando a expressão popular: "os CEs caminham pelo corpo em direção ao coração". OBJETIVO: Descrever os mecanismos envolvidos na migração do CE e a forma de diagnosticá-los. METODOLOGIA: Numa população de 3.000 casos de corpos estranhos, em 40 anos, foram analisados quatro que tiveram deslocamento extraluminal. Foram tomados os dados clínicos, radiológicos, endoscópicos e ultrassonográficos coletadas no serviço de documentação médica. RESULTADOS: São apresentadas três histórias clínicas em que o CE era de espinha de peixe e uma de cartilagem de peixe. Em todos se analisou o deslocamento. Em dois a migração se iniciou no esôfago, um para a aorta e outro para a região cervical e nos dois outros, o deslocamento ocorreu a partir da faringe: um para a fáscia pré-vertebral e outro se exteriorizou na região submandibular. Discutem os mecanismos pelos quais ocorre a migração dos CEs pelo corpo e os riscos que tais deslocamentos promovem para o paciente e a forma de diagnosticá-los. CONCLUSÕES: Os CE podem caminhar pelo corpo, porém não para o coração. Em casos de histórias arrastadas de ingestão de CEs, o estudo por imagens se faz obrigatório, previamente ao exame endoscópico. Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: "FB walk to the heart". AIM: describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

Background Juvenile angiofibroma (JA) is a rare tumor that occurs exclusively in adolescent male patients. The mainstay treatment for JA is complete surgical excision. Acceptable surgical approaches for the resection of JA include transantral, transpalatal, combined, endoscopic, and Le Fort I procedures, among others. Because exposure of the entire extension of the tumor may not possible, the recurrence rates after surgical treatment of JA may be as high as 55%. The purpose of this study was to evaluate the results after using the Le Fort I technique for the resection of JA. Methods We retrospectively studied 19 patients with JA submitted to surgical resection by using the Le Fort I approach from March 1983 to September 2002. Data regarding demographic characteristics, tumor topography, use of embolization, recurrence, and complication of treatment were obtained. Results Patient age at the time of diagnosis ranged from 8 to 26 years with a mean age of 16 years. The most common tumor site was the nasopharynx in 100% of the cases, pterygopalatine fossa (95%), nasal cavity (84%), and sphenoid sinus (63%). Angiography and embolization were performed preoperatively in 57% of the patients. The follow-up period ranged from 1 to 19 years (mean, 9.7 years; median, 8.0 years). One patient experienced malocclusion after surgery. However, we did not observe any recurrences during the follow-up period. Conclusion We conclude that the Le Fort I approach is a safe technique that permits the total resection of the JA with a low rate of postoperative complications and a low rate of recurrence.

O carcinoma espinocelular (CEC) é a neoplasia maligna mais comum (>90%) na região de cabeça e pescoço (CECCP). Apesar dos avanços científicos nos seus mecanismos moleculares e protocolos terapêuticos, a taxa de sobrevida global em 5 anos permanece em 90%) in the head and neck region (HNSCC). Despite scientific advances in its molecular mechanisms and therapeutic protocols, the overall 5-year survival rate remains at

Os genes HOX constituem um subgrupo da família Homeobox, que se caracterizam pelo alto grau de conservação entre organismos. Em mamíferos há 39 genes HOX que exercem papel importante no desenvolvimento embrionário e tecidos adultos normais, regulando processos biológicos como proliferação, diferenciação, migração, angiogênese e apoptose. Estudos apontam que os membros desta família podem exercer papel importante durante a carcinogênese de vários tipos de cânceres, recapitulando a regulação dos processos iguais aos do desenvolvimento embrionário. Em um estudo anterior do nosso grupo, realizado in vitro, mostramos que o HOXC13 regula a migração e a proliferação de linhagens de câncer de cabeça e pescoço. Posteriormente, identificamos por análise in silico aproximadamente mil possíveis genes alvos de regulação do HOXC13, sendo parte deles, enriquecidos em vias gênicas de interesse do grupo, que incluem as vias de migração e proliferação celular, bem como a via de transição epitelial-mesenquimal. Neste trabalho, sugerimos que o HOXC13 desempenha um papel importante na progressão do câncer de cabeça e pescoço através da regulação positiva de processos biológicos centrais da proliferação celular, como o ciclo celular e a via de sinalização PI3K-Akt-mTOR, pela regulação direta e/ou indireta de genes alvos, assim como de outras vias biológicas envolvidas no mecanismo de EMT, como por exemplo a via do receptor de TGF-β. HOX genes are a subgroup of the Homeobox family, which are characterized by a high degree of conservation between organisms. In mammals there are 39 HOX genes that play an important role in embryonic development and normal adult tissues, regulating biological processes such as proliferation, differentiation, migration, angiogenesis, and apoptosis. Studies point out that the members of this family can play an important role during the carcinogenesis of several types of cancers, recapitulating the regulation of the same processes as those of embryonic development. In a previous study by our group, conducted in vitro, we showed that HOXC13 regulates the migration and proliferation of head and neck cancer cell lines. Subsequently, we identified approximately 1,000 possible target genes for regulation of HOXC13 by in silico analysis, part of which were enriched in gene pathways of interest to the group, which include migration and cell proliferation pathways, as well as the epithelial-mesenchymal transition pathway. In this work, we suggest that HOXC13 plays an important role in the progression of head and neck cancer through the positive regulation of central biological processes of cell proliferation, such as the cell cycle and the PI3K-Akt-mTOR signaling pathway, by direct and/or indirect target genes, as well as other biological pathways involved in the EMT mechanism, such as the TGF-β receptor pathway.

Introdução: O carcinoma de células escamosas de cabeça e pescoço (CCECP) é um dos cânceres mais prevalentes do mundo e envolve os carcinomas de diversos sítios anatômicos, como boca (lábio e cavidade oral), faringe (nasofaringe, hipofaringe e orofaringe) e laringe. A taxa de recorrência do CCECP varia de 18 a 76% para pacientes em tratamento. O Ber-EP4 é um anticorpo monoclonal que reage contra um grupo de glicoproteínas transmembranares com 34kD e 39kD que são encontradas na superfície e no citoplasma de células epiteliais, exceto no epitélio escamoso e no mesotélio. Carcinoma de células basais (CBB) expressam Ber-EP4 na maioria dos casos, no entanto, alguns casos de CCECP podem expressar este marcador. Logo, este trabalho avaliou um painel imuno-histoquímico, incluindo o Ber-EP4, em 597 casos de CCECP, na tentativa de estabelecer correlações clinicopatológicas. Materiais e métodos: Foram selecionados 597 casos de CCECP dos arquivos do Serviço de Patologia (SERPAT) da Faculdade de Medicina de Ribeirão Preto (FMRP) que foram montados em blocos de microarranjo tecidual (TMA). Os cortes histológicos foram submetidos à técnica de imuno-histoquímica utilizando o anticorpo monoclonal Ber-EP4, bem como EMA, CD138, CD10, vimentina, Ki-67, ciclina D1, p21 e p27. Resultados: Dos 597 casos avaliados, 485 eram de pacientes homens e 112 de pacientes do gênero feminino. A idade média no diagnóstico foi 60,26 anos e a população leucoderma foi predominante. O tabagismo e etilismo, sincrônicos, somaram 271. A maioria das lesões ocorreu em orofaringe, seguido por cavidade oral, hipofaringe e laringe, lábio ou pele, nasofaringe e rinofaringe, e seios paranasais. O estadiamento foi realizado em 437 pacientes, sendo que tumores T4 foram mais vistos, N2 e N3 foram os mais prevalentes e a presença de metástase a distância foi constatada em 11 casos. 567 casos foram avaliados sobre a expressão de Ber-EP4, sendo destes 187 positivos este marcador, a maioria apresentando expressão focal de intensidade fraca. Os casos positivos e negativos para Ber-EP4 apresentaram o mesmo padrão de expressão para EMA, CD138, CD10, vimentina, Ki-67, ciclina D1, p21 e p27. A sobrevida de pacientes com tumores Ber-EP4 positivos foi menor do que os com tumores negativos. Conclusão: Uma parcela considerável dos CCECP expressou Ber-EP4. A expressão de Ber-EP4 foi maior em pacientes com história de tabagismo. O Ber-EP4 não influenciou a expressão de outros marcadores, nem alterou a taxa de proliferação celular. O BerEP4 atuou como marcador de prognóstico ruim para CCECP. Background: Head and neck squamous cell carcinoma (CCECP) is one of the most prevalent cancer worldwide including several anatomical sites as mouth (lips and oral cavity), pharynx (nasopharynx, hypopharynx and oropharynx) and larynx. CCECP recurrence rates vary from 18 to 76% in patients under treatment. Ber-EP4 is a monoclonal antibody reacting against a 34-39kD transmembrane glycoprotein family found in surface and cytoplasm of epithelial cells; but squamous epithelia and mesothelia. Basal cell carcinomas (BCCs) expresses Ber-EP4 in majority, however, some CCECPs can express it. This study aimed to evaluate an immunohistochemistry panel with Ber-EP4 in a large series of CCECP trying to stablish clinicopathological correlations. Material and methods: 597 CCECP cases were selected from Pathology Service (SERPAT) of Ribeirão Preto Medical School (FMRP) to compose a tissue microarray (TMA). Histological sections were obtained and submitted to immunohistochemical reactions using Ber-EP4, EMA, CD138, CD10, vimentin, Ki-67, cyclin D1, p21 and p27. Results: From the total, 485 cases were from male and 112 from female patients. Median age at diagnosis were around 60 years old and white people were predominant. Smoking and drinking, together, accounted 271 cases. Most of lesions occurred in oropharynx, followed by oral cavity, hypopharynx, larynx, lip, nasopharynx and rinopharynx, and paranasal sinuses. 437 cases had TNM staging. T4, N2/N3 tumors were more prevalent and distant metastasis were identified in 11 cases. 187 cases expressed Ber-EP4, with predilection to focal and weak expression. Both, positive and negative Ber-EP4 cases presented same expression profile on EMA, CD138, CD10, vimentin, Ki-67, cyclin D1, p21 and p27. Conclusion: A considerable part of CCECP expressed Ber-EP4, and the expression were higher on patients who asserted to tobacco abuse. Ber-EP4 expression did not influence on other expression levels neither altered cellular proliferation rates. In this study, Ber-EP4 acted as a poor prognosis marker.

INTRODUÇÃO: A monitorização do paratormônio rápido (PTHr) é padrão no tratamento cirúrgico do hiperparatireoidismo primário, para garantir a retirada da paratireoide doente e preservação das saudáveis. Sua utilidade no tratamento cirúrgico do hiperparatireoidismo secundário à doença renal crônica é controversa. Esse estudo tem como objetivo verificar: 1) se a medida PTHr auxilia na predição do resultado cirúrgico precoce; 2) se existem diferenças de comportamento do PTHr entre pacientes dialíticos e transplantados; 3) se existem diferenças de comportamento do PTHr entre modalidades de operações distintas; 4) a acurácia do método em predizer controle do hiperparatireoidismo renal. MÉTODOS: Trata-se de estudo de coorte retrospectiva e prospectiva observacional, de pacientes com diagnóstico de HPTr, dialítico ou persistência após transplante renal, submetidos a paratireoidectomia total ou subtotal em único centro, no período de 2011 a 2016. Durante a cirurgia, realizamos coletas seriadas do PTHr, sendo três dessas amostras antes da exérese das glândulas paratireoides (basal periférico, basal central e pré-retirada), e duas após ressecção (10 min e 15 min). O critério de queda porcentual igual ou maior a 80% do maior valor entre as amostras basais, em 10 minutos, foi arbitrado preditor de êxito intra-operatório. Os pacientes foram seguidos durante intervalos regulares (15 dias, 3, 6 e 12 meses). Foram divididos em dois grupos (sucesso e falha da operação) de acordo com o controle dos níveis de PTH, cálcio e fósforo conforme consensos internacionais, ao término do seguimento de 1 ano. RESULTADOS: Duzentos e vinte e oito pacientes foram elegíveis, sendo 186 (81,6%) dialíticos e 42 (18,4%) transplantados. A paratireoidectomia alcançou sucesso em 92,1% (210/228) e falha em 7,9% (18/228) dos pacientes, sem diferenças de resultados entre grupos de diagnósticos diferentes e/ou tipos de operações distintas. O principal motivo de falha foi presença de glândula supranumerária, em 61,1% dos casos (11/18). A amostra basal central (BC) representou o real maior valor basal do PTHr para ambos os diagnósticos, porém com maior chance de picos do PTHr na amostra pré-retirada (PRE) nos pacientes transplantados. Após remoção da massa de tecido paratireóideo doente, os níveis de PTHr foram menores em 10 minutos quando comparados com as amostras basais (resultado estatisticamente significativo) para todos diagnósticos, tipos de operações e desfechos terapêuticos. No grupo sucesso, houve diferença estatisticamente significativa, entre as medidas de 10 e 15 minutos entre si, com valores menores em 15 minutos, enquanto que no grupo falha, sem distinção de 10 e 15 minutos entre si e com valores médios maiores em 15 min. Os valores do PTHr foram maiores no paciente dialítico quando comparados com transplantado, em todas as amostras (p < 0,001). No grupo sucesso, os pacientes dialíticos e transplantados, e os pacientes dialíticos submetidos a exérese total e subtotal apresentaram porcentual de queda do PTHr semelhantes em 10 e 15 minutos para as amostras BC e PRE; o paciente transplantado obteve decaimentos porcentuais menores quando houve ressecção subtotal. O grupo falha apresentou queda porcentual nitidamente menor e com significância estatística (p < 0,001), para todas amostra basais e em qualquer momento, quando comparado ao grupo sucesso. A função renal pré-operatória dos transplantados não influenciou a cinética de decaimento do PTHr (não teve correlação, p=0,09). A monitorização do PTHr influenciou a conduta cirúrgica em 7% (16/228) da casuística; o principal motivo foi a ocorrência de localização ectópica de umas das quatros paratireoides, responsável por 75% (12/16) dos casos. A paratireiodectomia bem sucedida exibiu impacto negativo na função do enxerto renal no pós-operatório, porém com posterior recuperação ao término de 1 ano. O método da dosagem do PTHr com o critério de 80% de queda, apresentou acurácia de 87%, sensibilidade de 88% e especificidade de 67% para a amostra BC em 15 minutos, e melhor especificidade (74%) na amostra PRE em 10 min. CONCLUSÕES: Em pacientes com hiperparatireoidismo renal, uso de medidas intra-operatórias do PTHr apresenta alta sensibilidade para indicar o sucesso da operação quando há redução de 80% dos valores iniciais. Apesar de valores absolutos diferentes, as taxas de redução desse hormônio após uma paratireoidectomia bem sucedida não são significativamente diferentes em pacientes dialíticos e transplantados, em operação total com auto-enxerto ou subtotal, com efetiva queda em 10 minutos de amostragem. A utilização de uma medida adicional 15 minutos após a retirada das glândulas aumenta a acurácia do método. A medida intra-operatória do PTHr pode auxiliar na tomada de decisões durante a operação desses pacientes INTRODUCTION: Rapid Parathyroid Monitoring (rPTH) is standard in the surgical treatment of primary hyperparathyroidism, to ensure the excision of the diseased parathyroid and preservation of healthy parathyroid glands. Its usefulness in the surgical treatment of hyperparathyroidism secondary to chronic kidney disease is controversial. This study aims to verify: 1) whether the rPTH measure assists in the prediction of the early surgical outcome; 2) whether there are differences in rPTH pattern between dialytic and transplanted patients; 3) if there are differences in the decay of the rPTH between different operations modalities; 4) the accuracy of the method in predicting control of renal hyperparathyroidism. METHODS: This is a retrospective and prospective observational cohort study of patients with a diagnosis of PTH, dialysis or persistence after renal transplantation, who underwent total or subtotal parathyroidectomy in a single center from 2011 to 2016. During surgery, we performed serial samples of the rPTH, three of these were before excision of the parathyroid glands (peripheral basal, central basal and pre-withdrawal), and two after resection (10 min and 15 min). The criterion of percentage drop equal to or greater than 80% of the highest value of the basal samples, in 10 minutes, was arbitrated predictor of intraoperative success. Patients were followed at regular intervals (15 days, 3, 6 and 12 months). They were divided into two groups (success and failure of the operation) according to the control of the levels of PTH, calcium and phosphorus according to international consensus, at the end of the 1 year follow-up. RESULTS: Two hundred and twenty-eight patients were eligible, being 186 (81.6%) dialytic and 42 (18.4%) transplanted. Parathyroidectomy achieved success in 92.1% (210/228) and failure in 7.9% (18/228) of the patients, with no differences in results between groups of different diagnoses and/or different types of operations. The main reason for failure was the presence of supernumerary glands, 61.1% of the cases (11/18). The central basal (CB) sample represented the actual higher baseline PTHr for both diagnoses, but with a higher chance of rPTH peaks in the pre-withdrawal sample (PRE) in the transplanted patients. After removal of the diseased parathyroid tissue mass, rPTH levels were lower in 10 minutes compared to baseline (statistically significant) for all diagnoses, types of operations and therapeutic outcomes. In the success group, there was a statistically significant difference between the 10 and 15 minutes measurements, with smaller values in 15 minutes, while in the failure group, there was no distinction of 10 and 15 minutes between them and with mean values greater in 15 min. The rPTH values were higher in the dialytic patient when compared to transplanted in all samples (p < 0.001). In the success group, dialytic and transplanted patients, and dialytic patients submitted to total and subtotal excision, presented similar percent drop in rPTH at 10 and 15 minutes for CB and PRE samples; the transplanted patient had lower percentage decreases when subtotal resection. The failure group had a significantly lower percentage drop and with statistical significance (p < 0.001), for all baseline and at any time, when compared to the success group. The preoperative renal function of the transplanted patients did not influence the kinetics of rPTH decay (had no correlation, p=0.09). The rPTH monitoring influenced the surgical management in 7% (16/228) of the series; the main reason was the occurrence of ectopic localization of one of the four parathyroid glands, responsible for 75% (12/16) of the cases. In transplanted patients, successful parathyroidectomy had a negative impact on renal graft function in the postoperative period, but with a subsequent recovery at the end of 1 year. The rPTH dosage method with the 80% drop criterion showed an accuracy of 87%, a sensitivity of 88% and specificity of 67% for the CB sample in 15 minutes and a better specificity (74%) in the PRE sample in 10 min. CONCLUSION: In patients with renal hyperparathyroidism, the use of intraoperative measurements of rPTH has a high sensitivity to indicate the success of the operation when there is a reduction of 80% of the initial values. In spite of different absolute values, the rates of reduction of this hormone after successful parathyroidectomy are not significantly different in dialytic and transplant patients, in total autograft or subtotal operation, with an effective drop in 10 minutes of sampling. The use of an additional measurement 15 minutes after removal of the glands increases the accuracy of the method. The intraoperative measurement of rPTH may aid in decision making during the operation of these patients

O FTY720 foi considerado um agente antitumoral contra vários tipos de câncer na promoção da morte celular, diminuição da proliferação, angiogênese e metástase; no carcinoma espinocelular de cabeça e pescoço (CECP), ainda não foi descrito sua ação em todas as vias ativadas ou inibidas por este composto. O objetivo deste estudo foi avaliar a ação do FTY720 em modelo in vitro (cultura celular) e in vivo (camundongos) de CECP. Analisamos a atividade da PP2A, uma fosfatase antitumoral inibida em CECP, em um painel de linhagens de células de CECP, além de avaliar o tratamento com FTY720 nestas células e eleger duas linhagens para os posteriores experimentos. As células HN12 e SCC9 foram selecionadas para os estudos de mecanismo baseados nos menores níveis de atividade da PP2A sendo posteriormente incubadas com FTY720 e tendo as principais proteínas alvo analisadas por Westernblotting. Determinamos a viabilidade celular por citometria de fluxo, e estudos funcionais de sinalização de morte celular foram realizados utilizando-se inibidores de caspases/apoptose (Q-VD-OPh), necroptose (Necrostatina-1) e autofagia (3-metiladenina). A degradação de proteínas foi analisada com o inibidor de proteassoma MG132. A formação de tumor de xenoenxerto em camundongos Balb/c Nude foi utilizada, com a linhagem HN12, para avaliar o efeito de FTY720 in vivo. Como esperado, FTY720 aumentou as atividades de fosfatases em células CECP, incluindo PP2A, diminuiu os níveis de proteína SphK1 e ativou caspase-8 e -3 em ambas as células, bem como aumentou a lactato desidrogenase, que é marcador de necrose quando presente no meio extracelular. O bloqueio da apoptose recuperou a viabilidade celular enquanto a inibição da necroptose não afetou a morte celular promovida por FTY720. Por outro lado, a inibição da autofagia aumentou drasticamente a morte celular promovida pelo FTY720 in vitro, sugerindo autofagia como uma resposta protetora. In vivo, foi confirmado que a combinação de FTY720 com inibidor de autofagia (3-MA) reduz a formação do tumor xenoenxerto (HN12) em camundongos combinado ao aumento de ceramidas no sangue dos animais. Nós evidenciamos o FTY720, pelo seus efeitos antitumorais sinérgicos com inibidor de autofagia, como potencial estratégia antitumoral em CECP e talvez outros tipos de câncer, assim como os níveis de ceramidas no sangue como potencial marcador de resposta terapêutica FTY720 has been considered an antitumor agent against several cancer types decreased proliferation, angiogenesis and metastasis; in head and neck squamous cell carcinoma (HNSCC), it has not been addressed yet in all pathways activated or inhibited by this compound. The objective of this study was to evaluate the action of FTY720 in vitro (cell culture) and in vivo (mice) HNSCC models. PP2A, an inhibited antitumor phosphatase in HNSCC, activity was assessed in a panel of HNSCC cell lines. HN12 and SCC9 cells were selected for the studies of mechanisms based on the lower levels of PP2A activity were subsequently incubated with FTY720 and having the main target proteins analyzed by Western blot. Cell viability was determined by flow cytometry, and functional studies of cell death signaling were performed by using inhibitors for apoptosis (Q-VD-OPh), necroptosis (Necrostatin-1) and autophagy (3-Methyladenine). Protein degradation was analyzed with the proteasome inhibitor MG132. Xenograft tumor formation in Balb/c Nude, with HN12, mice was used to evaluate the FTY720 effect in vivo. As expected, FTY720 increased phosphatases activities in HNSCC cells, including PP2A, decreased SphK1 protein levels, and activated caspase-8 and -3 in both cells, as well as increased the release of lactate dehydrogenase activity, which is a marker of necrosis when present in the medium extracellular. Apoptosis blockage recovered cell viability while necroptosis inhibition did not affect FTY720-promoted cell death. On the other hand, autophagy inhibition drastically increased cell death promoted by FTY720 in vitro, suggesting autophagy as a protective response. In vivo, it was confirmed that the combination of FTY720 with autophagy inhibitor (3-MA) reduces the formation of xenograft tumor (HN12) in mice combined with increased blood ceramides in animals. We have shown FTY720, for its synergistic antitumor effects with autophagy inhibitor, as a potential antitumor strategy in HNSCC and perhaps other cancers types, as well as blood ceramides levels as a potential marker of therapeutic response

Introdução: O hiperparatireoidismo primário (HP) é a terceira maior causa de doenças endocrinológicas na população, sendo a principal causa de hipercalcemia. Caracteriza-se por hipersecreção do paratormônio (PTH) pelas células principais da paratireoide, levando a um distúrbio da homeostase do cálcio (Ca). O adenoma de paratireoide é a principal causa do HP, com 80-85% dos casos, sendo o objeto deste estudo. Mutações genéticas podem corresponder a mais de 11% da origem deste tumor benígno hipersecretor. Apesar dos avanços dos métodos de diagnóstico, o tratamento é essencialmente cirúrgico, havendo carência de tratamentos alternativos eficientes, que podem ser aprimorados com maior conhecimento fisiopatológico. Como as células do adenoma são hipersecretoras de proteínas, possuem abundante quantidade de retículo endoplasmático (RE), onde as proteínas sofrem dobramento, adquirindo sua conformação nativa. Em células hipersecretoras é comum o aumento da atividade da maquinaria de tratamento protéico, gerando sinais de sobrecarga no RE e citoplasma, sendo denominado de estresse do retículo endoplasmático (ERE). O ERE e as suas vias efetoras, a UPR (resposta a proteínas não-dobradas) e o ERAD (degradação associada ao retículo endoplasmático), estão presentes na fisiopatologia de diversas doenças ou de células hipersecretoras, servindo como importante alvo terapêutico. Objetivos: Analisar a atividade do ERE nas células do adenoma de paratireoide. Casuística e Métodos: Análise da expressão dos principais genes do ERE por RealTime-PCR, em 14 pacientes portadores de adenoma de paratireoide operados no Serviço de Cirurgia de Cabeça e Pesoco do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, comparando-se a expressão do adenoma em relação ao controle (tecido normal). Resultados: Houve aumento da expressão de vários genes relacionados ao ERE, ERAD e à UPR, com significância estatística, principalmente da via de PERK (Pancreatic endoplasmic reticulum kina), do ERAD e da autofagia, evidenciando um quadro de cronicidade e eficência da maquinaria do ERE, com finalidade antiapoptótica. O resultado foi compatível com a manifestação clínica do adenoma de paratireoide, que cursa com raros casos de remissão espontânea e necrose central. Conclusão: Verificou-se que há uma atividade do ERE na fisiopatologia do adenoma de paratireoide, com efetividade na síntese e seleção protéica do PTH, trazendo longevidade às células do adenoma por meio da prevalência dos mecanismos de citoproteção, em detrimento da via da apoptose. O estudo traz importantes informações que podem ser úteis na elaboração de novos tratamentos medicamentosos, fazendo com que o ERE seja um futuro alvo terapêutico também no adenoma de paratireoide, assim como já é a realidade em outras patologias. Background: Primary Hyperparathyroidism (PHP) is the third most common cause of endocrinologic disorders in the world, and the main cause of hypercalcemia. It is manifested by PTH (parathormone) hypersecretion by the parathyroid chief cells and consecutive calcium (Ca) homeostasis disturbance. Parathyroid adenoma (PA) is present in 80-85% of patients and, for this reason, is the aim of this study. Gene mutations is associated with at least 11% of this hypersecretory benign tumor. Even though the clinical presentation is much better than the past few decades, therapeutic options beside surgery do not advance along increasing efficiency in diagnostic tools. This is partly because there are many lacks in the pathophysiology of Pas, that would give new possibilities of medical treatment. PA is composed of hypersecretory cells and rich endoplasmic reticulum cytoplasm, where the main protein treatment and selection factors are situated. Considering that PA cells have protein hypersecretory activities, it is expected an abundant ER mass, that provides the machinery to treat and fold the great amount of nascent protein, to turn it to native form. As protein traduction increases, more energy is needed to keep ER function and this may result in the endoplasmic reticulum stress (ERE) in the cells. ERE and the downstream effectors, UPR (unfolded response protein) and ERAD (endoplasmic reticulum associated degradation), are acting in the physiology of several diseases and others hypersecretory cell types, providing important treatment targets. Objectives: To analyze ERE activity in PA cells. Casuistic and Methods: Evaluation of the main ERE genes expressed with Real Time-PCR analysis, in 14 patients with PA PHP and that were treated with conventional surgery, with further comparison between PA and control groups. Results: There were significant expression elevation of ERE, UPR and ERAD related genes, with statistical significance, specially of PERK downstream, ERAD and autophagy induction, suggesting efficient, though chronic, ERE activity level, with stimulated anti-apoptosis pathway. The final results confirmed our hypothesis that there is lower pro-apoptosis activity than expected by some authors, but this is compatible with low incidence of spontaneous remission or PA necrosis. Conclusion: There is contundent ERE activity in the PA pathophysiology, with great protein metabolism effectiveness expressed by PTH bioactivity, increasing cell longevity by stimulating cytoprotection pathways, instead of pro-apoptosis one. We believe this outcome will influence others research on this challenging and gratifying field of investigation, that will certainly provide new treatment options to PA, as ERE has been playing a significant role as therapeutic target with others hypersecretory diseases.

A função mastigatória é uma das principais constituintes do sistema estomatognático e impreterivelmente antecede a absorção de nutrientes pelo organismo humano. A força de mordida é um componente dessa função e um indicador clínico do funcionamento desse sistema. Em sujeitos com deformidade dentofacial, a mastigação está prejudicada devido ao desequilíbrio das relações esqueléticas e musculares maxilomandibulares e da oclusão. A abordagem investigativa tridimensional é única que possui a vantagem de avaliar a morfologia facial nos três planos do espaço, tal como se configura a face humana e a deformidade dentofacial. Portanto, o objetivo deste trabalho foi analisar a variação da morfologia facial em diferentes medidas tridimensionais, assim como verificar possível assimetria na força de mordida e diferenças na distribuição de força e área dos contatos oclusais entre sujeitos com deformidades dentofaciais padrão dentoesquelético II, padrão dentoesquelético III e controles. O estudo foi realizado com 77 sujeitos que compuseram dois diferentes grupos, a saber: deformidade dentofacial (DDF) e controle (GC). O grupo com o diagnóstico de deformidade dentofacial (DDF) foi subdividido segundo a classificação da mesma. Assim, 20 sujeitos classe II (4 homens e 16 mulheres, com média de idade de 26 anos) integraram o subgrupo DDF II, 32 classe III (15 homens e 16 mulheres, com média de idade de 27 anos) formaram o DDF III e 25 voluntários saudáveis (9 homens e 16 mulheres, idade média de 24 anos) compreenderam o GC. Todos foram submetidos à avaliação tridimensional da morfologia facial, por meio de escaneamento facial a laser, medidas de força de mordida pelo gnatodinamômetro, análise da distribuição de força oclusal e área de contato dentário pelo sistema T-Scan. As comparações entre GC e DDF foram realizadas pela Análise de Variância (ANOVA) para amostras independentes. O teste de correlação de Spearman foi aplicado para avaliar as possíveis associações entre as medidas de força de mordida e as medidas antropométricas, além da análise de regressão linear múltipla para identificar as variáveis antropométricas associadas à força de mordida. Foi adotado nível de significância de 5%. Na investigação da morfologia, os sujeitos com DDF apresentaram características específicas e compatíveis com as classes II e III esqueléticas, com aumento da altura facial principalmente em retrognatas. A força de mordida foi menor para o grupo DDF, porém não se diferenciou entre os grupos e não houve assimetrias nesse quesito. A área de contato oclusal evidenciou-se mais deficitária para sujeitos com padrão dentoesquelético III, porém a distribuição de força oclusal não demonstrou diferenças entre os grupos. Pode-se concluir o método de análise tridimensional confirmou achados específicos relevantes no que diz respeito às deformidades dentofacias estudadas. E as proporções faciais foram consideradas fatores influenciadores da magnitude da força de mordida em sujeitos com a deformidade dentofacial. The masticatory function is the one of the main constituents of stomatognathic system and necessarily precedes the absorption of nutrients by the human organism. Bite force is a component of this function and a clinical parameter of this system\'s health. In dentofacial deformity, chewing is impaired due the imbalance of skeletal and muscular maxillomandibular relationships and of the occlusion. Three-dimensioal investigative approach is unique and has the advantage about the evaluation of facial morphology in the three planes of space, such as the configuration of the human face and dentofacial deformity. Therefore, the objective of this study was to analyze the variation of facial morphology in different three-dimensional measurements, as well as to verify possible asymmetry in bite force and the difference in the distribution of force in dental arc and occlusal contact area between subjects with dentofacial deformities class II, class III and control. The study was performed with 77 subjects who composed two different groups: dentofacial deformity (DDF) and control (CG). The group of dentofacial deformity (DDF) was subdivided according to its classification. Thus, 20 class II subjects (4 men and 16 women, mean age of 26 years old) were included in the DDF II subgroup, 32 class III (15 men and 16 women, mean age of 27 years old) formed DDF III, and 25 healthy volunteers (9 men and 16 women, mean age of 24 years old) comprised the CG. All were submitted to the threedimensional assessment of the facial morphology by laser scanning, bite force measurements by gnatodynamometer, analysis of occlusal force distribution and occlusal contact area by the T-Scan system. Comparisons between CG and DDF groups were performed by Analyses of Variance (ANOVA) for independent samples. Spearman\'s correlation test was applied to evaluate the possible association between bite force and anthropometric measurements, as well as multiple linear regression analysis to identify the anthropometric variables associated to the bite force. A significance level of 5% was adopted. In the investigation of morphology the subjects with dentofacial deformities presented specific features and compatible with the skeletal class II and skeletal class III, with increase of facial height, mainly in retrognathic subjects. The bite force was lower for DDF, did not differentiate between the groups and there were no asymmetries about them. The occlusal contact area was found to be poorer for subjects with class III deformity, but the occlusal force distribution did not show differences between the groups. It can be concluded the three-dimensional analysis method confirmed specific and relevant findings to the studied dentofacial deformities. And the facial proportions were considered factors influencing the magnitude of the bite force in subjects with deformity.

Introdução: Nos últimos anos, procedimentos cirúrgicos envolvendo a glândula tireoide têm aumentado em todo o mundo, bem como a incidência de neoplasias malignas sem, no entanto, se observar aumento da taxa de mortalidade. Muitas técnicas foram propostas para alcançar um diagnóstico pré-operatório acurado em doenças da tireoide. As técnicas de espectroscopia de FTIV (Infravermelho por transformada de Fourier) já apresentam evidências na caracterização de múltiplos tecidos, entre eles a glândula tireoide, tendo como vantagem sua rapidez e preservação do tecido analisado. O estudo de novas técnicas na diferenciação dos nódulos tireoidianos pode auxiliar na seleção de pacientes que serão submetidos ao tratamento cirúrgico adequado, evitando o sobretratamento. Objetivos: Caracterizar os tecidos tireoidianos sadios e patológicos à luz da espectroscopia de infravermelho (IV), testar a viabilidade do método de espectroscopia no IV em diferenciar tecidos patologicamente alterados da glândula tireoide comparativamente aos achados espectroscópicos encontrados em tecidos sadios. Casuística e Métodos: Os pacientes foram selecionados no Serviço de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), no período de 2014 a 2015. A amostra foi composta por 44 pacientes de ambos os sexos, com idade acima de 18 anos, com indicação de tireoidectomia. Quarenta e quatro amostras de nódulos em tireoide e 44 de tecidos normais foram analisadas por espectroscopia no IV utilizando-se um espectrômetro Nicolet 380 - Nicolet USA® em tecidos a fresco. A análise foi realizada definindo-se as áreas de cada banda, utilizando-se para os cálculos o programa OriginPro 8.6.0 (OriginLab Corporation Northrampton, MA 01060 USA). A seguir, efetuou-se a normalização pela banda a 1240 cm-1. A comparação das áreas foi calculada por meio do teste t- Student com p

Introdução: O câncer de cabeça e pescoço vem aumentando sua incidência, sendo o quinto tipo de câncer mais comum e a sexta causa de morte por câncer no mundo, portanto é causa importante de morbimortalidade da população. O entendimento dos fatores de risco como tabagismo, etilismo e infecção pelo papilomavirus (HPV) é de fundamental importância, tanto para ações de prevenção e controle da doença, bem como avaliação de fatores prognósticos e terapêuticos. Objetivos: O presente estudo visa analisar as características clínicas, buscar o principal sítio anatômico tumoral e avaliar os fatores prognósticos entre os pacientes tabagistas ou não, e portadores ou não do HPV, que foram tratados cirurgicamente. Casuística e Métodos: Foram analisadas as variáveis clínicas e prognósticas dos grupos de pacientes tabagistas, não tabagistas, HPV negativo e HPV positivo. A amplificação do DNA viral, detecção e genotipagem do HPV se deu através da extração do DNA total a partir de blocos parafinados. Resultados: A amostra total foi composta por 399 pacientes, sendo que 266 eram tabagistas, 33 não tabagistas, e desses últimos, cinco eram HPV positivo. Houve diferença estatística em relação sexo, sendo que para o tabagista o predomínio foi do sexo masculino e para o HPV positivo foi o feminino. O paciente tabagista apresentou-se mais jovem (média 57,9 anos) que o não tabagista (média 64,1 anos). O sítio anatômico mais comum para os tabagistas foi a laringe e para o HPV positivo foi a cavidade oral e orofaringe. O tempo livre de doença foi de 63,6 meses para os tabagistas, 31,3 meses para os não tabagistas e 29,3 meses para os HPV positivo, havendo diferença quanto às curvas de sobrevidas livre da doença dos fumantes e não fumantes. Dos pacientes que foram á óbito pela neoplasia, o paciente HPV positivo foi o que apresentou menor tempo de sobrevida. Não houve diferença estatística entre os grupos quanto às curvas de sobrevidas global e da doença. Discussão: Apesar da literatura mostrar que o paciente não tabagista e o paciente HPV positivo geralmente serem mais jovens e apresentarem melhor prognóstico do que os típicos pacientes tabagistas, isso não foi observado nesse estudo, pois o paciente não tabagista apresentou-se com mais idade ao diagnóstico da doença e com pior prognóstico que o tabagista, e o paciente HPV positivo apresentouse com menor tempo até o óbito pela doença quando comparado ao paciente tabagista. Conclusões: O câncer nos pacientes tabagistas acometeu mais o sexo masculino, localizou-se principalmente na laringe e apresentou melhor prognóstico quando comparado aos não tabagistas. O câncer nos pacientes HPV positivo acometeu mais o sexo feminino e localização tumoral foi principalmente a cavidade oral e a orofaringe. Introduction: Head and Neck cancer has been increasing its incidence, and it is the fifth most common type of cancer and the sixth leading cause of cancer death in the world, so it is an important cause of morbidity and mortality of the population. Understanding the risk factors such as smoking, alcohol use and papillomaviruses (HPV) infection is of fundamental importance, both for prevention and control of disease like for assessment of prognostic and therapeutic factors. Objectives: This study aims to analyze the clinical, seek the main site anatomical of the tumor and evaluate the prognostic factors among smokers or not, with the presence or absence of the HPV, which were surgically treated. Methods: The variables clinical and prognostic were analyzed in the groups of smokers, nonsmokers, HPV negative and HPV positive. The amplification of viral DNA, detection and genotyping of the HPV were made through the extraction of total DNA from paraffin blocks. Results: The total sample consisted of 399 patients, 266 were smokers, 33 nonsmokers, and this latter group had five patients HPV positive. There was statistical difference regarding sex, for smokers the prevalence was male and for HPV positive was female. The smoker patient was younger (mean 57.9 years) than the non-smoker (mean 64.1 years). The most common anatomic site for the smokers was the larynx and for the HPV positive was the oral cavity and oropharynx. The diseasefree interval was 63.6 months for smokers, 31.3 months for nonsmokers and 29.3 months for HPV positive, with difference between free disease survival curves of the smokers and nonsmokers. Of the patients who died by disease, HPV positive patient showed the shorter survival. There was no statistical difference between the groups in terms of overall survival curves and of the disease. Discussion: Although the literature show that the nonsmoker patient and HPV positive patients are generally younger and present a better prognosis than the typical smokers, this was not observed in this study because the nonsmoker patient presented with more age at diagnosis of disease and a worse prognosis than the smoker, and the HPV positive patient presented with shorter survival of the disease when compared to smoking patients. Conclusions: The cancer in smokers affected more males, was located mainly in the larynx and showed better prognosis when compared to nonsmokers. The cancer in patients positive HPV affected more females and tumor location was mainly oral cavity and oropharynx.

O início e a progressão do carcinoma espinocelular oral (CEO) são caracterizados pela aquisição de alterações genéticas e epigenéticas. A proteína SET é descrita como uma oncoproteína e, recentemente, o seu acúmulo foi mostrado em CEO. Diversas funções têm sido atribuídas à SET, tais como controle do ciclo celular, sobrevivência celular, migração celular, acetilação de histonas, e resposta ao estresse oxidativo. Este contexto sugere a SET como alvo terapêutico, mas primeiramente, é essencial entender a sua ação na tumorigênese e progressão em CEO. A hipótese central no presente estudo refere-se ao papel da SET na instabilidade genômica e reparo de DNA, bem como na regulação epigenética da expressão de miRNA, com impacto no desenvolvimento e progressão de CEO. O silenciamento estável de RNA foi realizado usando plasmídeo contendo short hairpin RNA contra SET (shSET) em linhagens de CEO in vitro (HN12 e Cal27) e in vivo (tumores xenoenxerto de HN12). Efeitos da redução da SET em CEO, in vitro e in vivo, foram avaliados no perfil de metilação (MSP, methylation specific PCR), expressão de miR-9 (qRT-PCR) e reparo de DNA (reparo mismatch e de quebra de fita dupla - DSB). A instabilidade genômica foi abordada por meio de cinco microssatélites (PCR convencional) para avaliar a instabilidade de microssatélites (MSI), e ensaio cometa para avaliar danos ao DNA (SSB, DSB, cross-link, etc.). O status de proteínas envolvidas em reparo de DSB (ATM, BRCA1 e MLH1) foi avaliado por imunofluorescência e Western blotting (WB). A resposta aos danos no DNA (DDR) induzidos por radioterapia (raios-X) foram analisados nas células HN12 por meio de ensaios clonogênico e de ciclo celular; proteínas associadas à apoptose, autofagia, ciclo celular e reparo foram avaliadas por WB. A redução da SET nas células HN12 modificou a transcrição dos loci codificantes do miR-9 por meio da reversão parcial de hipermetilação, tanto in vitro quanto in vivo, para o locus miR-9-1, e in vitro para o miR-9-3, com aumento nos níveis de miR-9 e miR-9*. A análise de 5 microssatélites mostrou alteração no perfil alélico de dois marcadores, D5S346 e D2S123, nas células HN12 shSET e nos tumores xenoenxerto da HN12 shSET (in vivo) em relação aos respectivos controles, o que sugere a presença de MSI e é um indício do papel da SET no reparo de DNA tipo mismatch. A linhagem HN12 shSET apresentou diminuição de danos no DNA e aumento das proteínas de reparo de DSB, MLH1, ATM, p-ATM e BRCA1 em relação a células HN12 shCTRL. Na DDR induzida por raios-X as células HN12 shSET apresentaram nas primeiras 48 horas uma menor perda de viabilidade (menor % em sub G0/G1), com parada em G2/M, maior nível de ATM ativa, aumento dos níveis de p21 e LC3B-II, além de menor clivagem de PARP e caspase-8 em relação as células HN12 shCTRL; isto sugere uma melhor resposta a danos de DSB e ativação de vias de sobrevivência nas células HN12 shSET. Entretanto, após 12 dias de radioterapia as células HN12 shSET mostraram uma tendência a menor sobrevivência. Portanto, os nossos resultados indicam o envolvimento da SET na regulação transcricional do miR-9, nas vias de reparo do tipo mismatch e de DSB em CEO, com potenciais implicações tanto na tumorigênese quanto na progressão da doença. Oral squamous cell carcinoma (OSCC) onset and progression are characterized by acquisition of genetic and epigenetic alterations. SET protein is known as an oncoprotein and, recently, its accumulation was demonstrated in OSCC. Several functions have been attributed to SET, such as cell cycle control, cell survival, cell migration, histone acetylation, and response to oxidative stress. This context outstands SET as a therapeutic target, but first, it is essential to understand its role in tumorigenesis and progression in OSCC. The central hypothesis of this study refers to SET role in genomic instability and DNA repair, as well as miRNA epigenetic regulation, with impact in OSCC development and progression. Stable SET knockdown (shSET) was achieved using short hairpin RNA against SET mRNA in vitro (HN12 and Cal27, OSCC cell lines) and in vivo (HN12 xenografts tumors). Effects of SET knockdown were assessed in OSCC, in vitro e in vivo, regarding DNA methylation (MSP, methylation specific PCR) and expression of miR-9 (qRT-PCR), and DNA repair (mismatch and double-strand breaks/DSB repair). Genomic instability was addressed by means of five microsatellites (conventional PCR) to assess microsatellite instability (MSI), and comet assay to assess DNA damage (SSB, DSB, cross-link, etc.). The status of proteins involved in DSB repair (ATM, BRCA1 and MLH1) was assessed by immunofluorescence and Western blotting (WB). The DNA damage response (DDR) induced by ionizing radiation (X-rays) was assessed in HN12 cells through clonogenic and cell cycle assays; proteins associated with apoptosis, autophagy, cell cycle and repair were assessed by WB. SET knockdown in HN12 cells modified miR-9 transcription through hypermethylation partial reversal for miR-9-1 locus, both in vitro and in vivo, and for miR-9-3 in vitro, with increase of miR-9 and miR-9* levels. Analysis of 5 microsatellites showed changes in the allelic profile of two markers, D5S346 and D2S123, in HN12 shSET cells (in vitro) and HN12 shSET xenografts tumors (in vivo) compared to their controls, suggesting MSI and it\'s a clue of SET role in mismatch repair. HN12 shSET cells showed decreased DNA damage and increased DSB repair protein levels (MLH1, ATM, p-ATM and BRCA1) compared to HN12 shCTRL. In the first 48 hours, HN12 shSET X-rays-induced DDR showed lower loss of viability (lower % in subG0/G1), increased G2/M checkpoint, higher levels of active ATM, p21, LC3B-II, and less PARP and caspase-8 cleavage than HN12 shCTRL. These results suggest a higher efficiency of DSB damage response and activation of survival pathways in the presence of SET knockdown. However, 12 days after radiotherapy, HN12 shSET cells presented a tendency for higher intrinsic radiosensitivity in relation to control. Therefore, our findings indicate a SET involvement in miR-9 transcriptional regulation, and in mismatch and DSB repair, with potential implications in oral tumorigenesis and progression.

O hiperparatireoidismo (HPT) secundário é uma complicação da doença renal crônica. A paratireoidectomia total com autoimplante proporciona bons resultados no seu tratamento, mas alguns doentes não desenvolvem níveis adequados de hormônio da paratireóide (PTH) após a operação. Os objetivos, do presente estudo, foram analisar fatores que poderiam interferir no funcionamento do autoimplante de glândula paratireóide e quantificar a taxa de hipofunção segundo alguns critérios. Casuística e Métodos: em um estudo prospectivo e observacional, foram analisados a idade, sexo, peso, altura e a etnia. A causa da doença renal crônica (DRC), tempo de DRC antes da paratireoidectomia, tempo de diálise, antecedente de intoxicação por alumínio e tempo de diagnóstico do HPT. Os dados bioquímicos estudados foram os níveis pré-operatórios de fósforo, cálcio total, cálcio iônico, PTH e fosfatase alcalina e aos 6 meses e 1 ano de pós-operatório. Registrada a quantidade de cálcio (gluconato e carbonato) e calcitriol ofertada no pós-operatório sendo realizada durante a primeira semana, no primeiro, terceiro sexto mês de pós-operatório. A histologia da glândula implantada foi analisada. Os pacientes foram divididos, segundo os níveis preconizados de PTH para indivíduos normais e segundo as recomendações da Fundação Nacional do Rim dos Estados Unidos da América (K/DOQI), em grupos hipofuncionante (grupo 1) e funcionante ( grupo 2). Resultados: Entre julho de 2007 e dezembro de 2008, 48 pacientes (18 homens e 30 mulheres) foram submetidos à paratireoidectomia total com autoimplante imediato. A média de idade dos indivíduos foi 44,7 anos (EP: 12,6), a do tempo de diálise foi 9,6 anos (EP: 5,1), a média do tempo de diagnóstico do hiperparatireoidismo de 2,6 anos (EP: 2). A principal causa da doença renal crônica foi a hipertensão arterial em 16 indivíduos (33,3%) seguida de causa indefinida em 12 (25%), GESF em 5 (10,4%), diabetes mellitus em 4 (8,3%). Com relação ao número de fragmentos implantados, houve tendência a uma diferença entre os grupos 1 e 2 (p= 0,14). Houve tendência a uma diferença entre os grupos 1 e 2 (p= 0,1) no que diz respeito a histologia da glândula implantada. O índice de hipofunção do auto implante, em 1 ano, foi de 21,27% no critério do nível de PTH para indivíduos normais e de 72,9% segundo as recomendações do KDOIQ. As complicações e óbitos por causa cardiovascular não diferiram entre os grupos. CONCLUSÃO: a frequência de hipofunção do implante imediato de paratireóide foi de 21,27% e de 72,9% segundo as recomendações do KDOQ e não houve a identificação de fatores preditivos para sua hipofunção. The secondary hyperparathyroidism (HPT) is a complication of chronic kidney disease. A total parathyroidectomy with autograft provides good results in treatment, but some patients do not develop adequate levels of parathyroid hormone (PTH) after operation. The objectives of study were to analyze factors that could interfere with the function of the parathyroid gland autograft and measure the rate of hypofunction according several criteria. Patients and Methods: a prospective observational study were analyzed age, sex, weight, height and ethnicity. The cause of chronic kidney disease (CKD), duration of CKD prior to parathyroidectomy, duration of dialysis, previous aluminum intoxication and time of diagnosis of HPT. The biochemical data studied : preoperative levels of phosphorus, total calcium, ionized calcium, PTH and alkaline phosphatase and 6 months and 1 year postoperatively. Recorded the amount of calcium (gluconate and carbonate) and calcitriol offered postoperative being held during the first week, the first, third, sixth month postoperatively. Histology of the implanted gland was analyzed. Patients were divided according to the recommended levels of PTH for normal individuals and in accordance with the recommendations of the National Foundation Kidney the United States of America (K / DOQI) in hypofunction groups (group 1) and functional (group 2). Results: Between July 2007 and December 2008, 48 patients (18 men and 30 women) underwent total parathyroidectomy with immediate autograft. The mean age was 44.7 years (SE: 12.6), the duration of dialysis was 9.6 years (SE: 5.1), the average time of diagnosis of hyperparathyroidism 2.6 years (EP: 2). The main cause of chronic renal disease was hypertension in 16 patients (33.3%) followed by unknown cause in 12 (25%), FSGS in 5 (10.4%), diabetes mellitus in 4 (8.3%.). The number of implanted fragments, there was a trend to a difference between groups 1 and 2 (p = 0.14). There was a trend to a difference between groups 1 and 2 (p = 0.1) as regards the histology of the gland implanted. The rate of self hypofunction implant at 1 year was 21.27% at the discretion of the PTH level in normal individuals and 72.9% according to the recommendations of KDOIQ. Complications and deaths from cardiovascular causes did not differ between groups. CONCLUSION: The rate of hypofunction of the parathyroid immediate implant was 21.27% and 72.9% according to the recommendations of KDOIQ and there was no identification of predictive factors for its hypofunction.

A apneia obstrutiva do sono é uma síndrome que produz múltiplas comorbidades, aumentando significativamente a taxa de mortalidade dos seus portadores. A atresia maxilar vem sendo descrita como um dos fatores etiológicos da SAOS, entretanto não existem estudos que demonstrem a eficácia no tratamento em adultos com consequente redução dos eventos obstrutivos durante o sono. Este trabalho tem como objetivo principal a verificação da expansão rápida da maxila cirurgicamente assistida (ERMCA), nos eventos obstrutivos do sono e demais parâmetros polissonográficos, na sonolência diurna e no comportamento morfométrico da via aérea. A amostra foi realizada em indivíduos adultos com apneia obstrutiva do sono (SAOS), atresia maxilar e mordida cruzada. O método adotado foi um ensaio clínico prospectivo com 16 participantes (7 mulheres / 9 homens) com idade de 40,23 ± 10,23, todos portadores de SAOS comprovada por polissonografia (PSG) de noite toda (IDR superior a 5), atresia maxilar e mordida cruzada posterior. Previamente todos participantes foram submetidos a uma tomografia computadorizada (TC) da via aérea superior e foi aplicado o teste da Escala de Sonolência de Epworth (ESE). Todos os pacientes foram então submetidos à ERMCA, e posteriormente, todos os exames foram refeitos para comparação. Foi constatada uma redução no IDR de 35,46 ± 38,54 para 16,07 ± 19,73, uma redução média de 54,68% (p=0,0013) e no IAH em 56,24% (33,23 ± 39,54 para 14,54 ± 19,48: p=0,001), uma redução dos índices de microdespertares e dessaturação, além da melhora de diversos parâmetros polissonográficos. O ESE apresentou uma melhora de 12,50 ± 5,32 para 7,25 ± 3,53 (p