The Lefschetz fixed point theorem states that whenever the Lefschetz number Λ(f) of a map /: X->X... more The Lefschetz fixed point theorem states that whenever the Lefschetz number Λ(f) of a map /: X->X is nonzero, then / must have a fixed point. The theorem is known to hold when X is an ANR and / is a compact continuous map. The theorem has been studied for compact, upper semi-continuous, acyclic multi-valued maps and is known to hold in this setting for topologically complete ANR's. A more general class of multi-valued maps is considered in this paper: the class of compact upper semi-continuous maps which can be written as a composition of acyclic maps. Using this class of maps, a theorem is proved which generates spaces for which the Lefschetz theorem holds. In particular, the Lefschetz theorem holds for all (metric) ANR's.
Objective: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. ... more Objective: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. Materials and Methods: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. Results: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. Conclusion: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method.
Background. Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) is a conservative surg... more Background. Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) is a conservative surgical procedure indicated in selected cases of advanced glottic carcinoma. Methods. This study is a review of our experience with 43 patients with T3/T4 glottic squamous cell carcinoma who underwent CHEP in our institution. All but two patients underwent selective neck dissections. All patients were staged on the basis of the 2002 TNM classification. Rates of recurrence and death were estimated by the Kaplan-Meier method. Results. The 5-year disease-specific survival and 5-year relapse-free survival rates were 78% and 83%, respectively. Neck metastases were found in three patients. Cartilage invasion occurred in 11 cases. The average length of hospital stay was 5.7 days. The mean time of enteral feeding tube was 33.8 days, and the mean time for tracheotomy was 29.6 days. Overall, normal swallowing was achieved in 74.4% of patients. Eleven patients had mild and major complications. Laryngeal stenosis emerged as the most frequent major complication. Three patients (6.9%) had local recurrences. Two patients (4.6%) had neck metastases. Conclusions. On the basis of this study, over a 7-year period with 43 patients with advanced glottic cancer, a successful oncologic outcome is confirmed. V
Brazilian Journal of Otorhinolaryngology, Apr 1, 2012
The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck can... more The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival. Objective: To assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis. Methods: A retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110 cases and bilateral in 33. Of these, 78 were radical and 98 selective. The patients were broken down into three groups, according to the 33 and 66 percentiles of the number of lymph nodes resected. The mean number of resected lymph nodes was 27; 24 in selective dissections and 31 in the complete ones. We did not have statistically significant differences when associated to the T and N stages. The larger number of lymph nodes dissected in the neck dissection identifies the group of better prognoses among pN0 cases.
Archives of Otolaryngology-head & Neck Surgery, Nov 1, 2009
To analyze the frequency of extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN)... more To analyze the frequency of extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) in a consecutive series of patients undergoing thyroidectomy by the same group of surgeons during an extended period and to compare our findings with the data available in the literature.
A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga... more A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinações, caminhando em direção ao respeito à dignidade da pessoa. Palavras-chave: Conflito de interesses. Pesquisa biomédica. Experimentação humana. Má conduta profissional. Má conduta científica. La investigación médico-farmacológica clínica corresponde a la aplicación experimental de determinado fármaco en seres humanos. Su control tiene como objetivo proteger los sujetos de efectos adversos inaceptables e ineficaces del fármaco probado. Relaciones entre la industria farmacéutica e investigadores externos establecen potenciales conflictos de intereses. En una consulta bibliográfica llevada a cabo en este estudio indica que investigaciones con financiación de la industria farmacéutica tienen proporción más elevada de resultados favorables y que los conflictos de intereses representan sesgos que pueden cambiar los resultados. Hay estudios que la eficiencia de distintos fármacos, mientras otros comparan sus costos. Todos los resultados obtenidos deben ser publicados, incluyendo cuando se los obtienen negativos. Se concluye que el sector privado deberá financiar la ciencia para beneficio del hombre, especialmente en el combate a la enfermedad. Sin embargo, La industria debería mantener su empeño en financiar las investigaciones sin influenciar su diseño, resultados y destinación caminando hacia a la comprensión de la persona en su dignidad. Palabras-clave: Conflicto de intereses. Investigación biomédica. Experimentación humana. Mala conducta profesional. Mala conducta científica.
W hen analyzing the literature published on thyroidectomy using a "timeline" we can observe that ... more W hen analyzing the literature published on thyroidectomy using a "timeline" we can observe that we have notoriously progressed from a procedure that was almost prohibited in the mid-nineteenth century due to complications to a point where it is considered safe, resolutive, and highly efficient. This progress is especially due to the advances in surgical techniques. Theodore Kocher (Nobel Prize in 1909 for his contribution to thyroidectomies) flawlessly described the anatomical basis for the success of this surgical technique 130 years ago. Besides this, advances in anesthetic procedures, surgical materials, and medications were fundamental to intraoperative and postoperative advances and patient management. With time, the knowledge on the different thyroid diseases has exponentially increased and serves as indicators for the extension of treatment and surgical procedures, all efforts should be directed to apply them into clinical practice (1). In the past twenty years, the introduction of new technologies such as the application of energy in surgical instruments and neuromonitoring brought advances to the procedure. These technologies helped providers to achieve a shorter surgical time, a shorter length of hospital stay, a reduction in the risk of bilateral laryngeal paralysis, and a reduced risk of intra and post-operative bleeding (2,3). In the last decade, stimulated by the current advances in endoscopic and robotic surgery, new approaches for thyroidectomy procedures were investigated to substitute the classic cervical incision, and are currently a theme for several scientific debates.
W e have examined with attention the comments of the letter to the Editor in regards to our recen... more W e have examined with attention the comments of the letter to the Editor in regards to our recently published article (1), and want to thank its authors for their interest in our work. After evaluating it, we would like to re-emphasize that have very different points of view, indeed! Two aspects deserve to be highlighted: 1. We strongly believe that any new complication event which was added by this new technique, thus not being ever observed in traditional and conventional thyroidectomy, must not ever be considered as "minor complication". 2. We positively do not consider that the technique presented by your group should be called "minimally invasive." As a matter of fact, the TOETVA involves extensive soft tissue manipulation, as well as the need to use gas insufflation (which was long time ago abandoned, when the endoscopic thyroidectomies were initially described) and a significant increase ein operative time, compared to the traditional and conventional thyroidectomy Last, but not least, there have been some serious complications, some even lifethreatening, which have not been mentioned.
Introduction: Supratracheal laryngectomy has been described as a surgical procedure for glottic o... more Introduction: Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective: To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods: This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results: Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence.
The purpose of the present study was to investigate the predictive factors for shorter disease-sp... more The purpose of the present study was to investigate the predictive factors for shorter disease-specific survival in patients with pulmonary disease secondary to differentiated thyroid cancer (DTC). Methods: This was a retrospective cohort study conducted over a 5-year period that included 54 patients with pulmonary disease secondary to DTC during the follow-up. Among these patients, 13 (24.1%) died from the disease. Dedifferentiation characteristics were identified at pathological examination of the metastatic disease (lymph node or distant metastases) and was defined as the abrupt transformation of a well-differentiated tumor into highgrade morphology lacking the original distinct histologic characteristics. Results: Tumor dedifferentiation marked by cellular aberrations and radioiodine (RAI) therapy resistance occurred in 5 (9.3%) patients. Four of them died due to pulmonary progression (80.0%), and the median survival of this group was 30 months compared to 279 months in the patients without dedifferentiation. The cumulative disease-specific survival was 20.0% in the patients with dedifferentiation during the follow-up versus 46.1% among the cases without this condition (P = .003, log-rank test). Moreover, dedifferentiation was independently associated with shorter disease-specific survival (hazard ratio [HR] = 31.607; 95% confidence interval [CI]: 4.815-207.478; P<.0001, Cox regression model) as were age over 45 years (HR = 10.904; 95% CI: 1.145-103.853; P = .038) and male sex (HR = 4.210; 95% CI: 1.056-16.783; P = .042). Conclusion: DTC patients with pulmonary disease exhibited shorter disease-specific survival, particularly those who developed tumor dedifferentiation, and these patients require special attention during follow-up.
Objective: To evaluate the influence of lymph node reactivity on recurrence and survival rates in... more Objective: To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma. Methods: Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival. Results:...
Background-The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity ... more Background-The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). Methods and patients-An international retrospective multi-center study of 1815 patients who were treated for OCSCC from 2003 to 2011.
Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of up... more Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of upper aerodigestive tract after neck dissection and the results of salvage treatment. Methods. 95 patients with regional recurrence as the first manifestation of relapse were selected between 943 patients who underwent neck dissection. We evaluated level and side of recurrence, as well disease control after salvage treatment. Results. Level II was the most frequent site of recurrence. Salvage treatment was performed in 51% of ipsilateral and in 75% of contralateral (nondissected neck) recurrences. Control of the disease 12 months after salvage surgery was 25% in the ipsilateral and 37% in contralateral recurrences. Conclusions. Cervical recurrences occur predominantly in level II. Relapse in level I is frequent only in oral cavity tumors and relapse in level V is rare. The neck recurrence carries a poor prognosis even among patients who underwent retreatment with curative intent.
A presença de linfonodos metastáticos é aspecto relevante no prognóstico do câncer bucal. Objetiv... more A presença de linfonodos metastáticos é aspecto relevante no prognóstico do câncer bucal. Objetivo: Avaliar a densidade do linfonodo metastático (pN+) em pacientes com carcinoma espinocelular (CEC) de língua e soalho bucal e sua relação com a sobrevida livre de doença (SLD). Métodos: De 1985 a 2007, 182 pacientes foram avaliados, dos quais 169 eram homens, sendo cinco estádio I, 35 estádio II, 56 estádio III e 85 estádio IV. A densidade do linfonodo foi mensurada por meio de sua mediana e a SLD pelo método de Kaplan-Meier e a diferença de grupo pelo teste log-rank. Resultados: Após média de dissecção de 3,2 linfonodos metastáticos com pacientes, a densidade variou de 0,009 a 0,4, com média 0,09. A SLD a 5 anos foi de 44% e 28% para grupos com densidade linfonodal abaixo e acima da mediana (p = 0,006). O controle loco-regional a 2 anos foi de 71% e 49% para os casos com densidade abaixo e acima da mediana (p = 0,01). Quanto ao estádio pN, o controle loco-regional foi de 70% e 54% para os casos pN1 e pN2, sem significância estatística (0,20%). Conclusão: A densidade linfonodal pode ser utilizada como indicador prognóstico no CEC de língua e soalho bucal.
A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga... more A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e dest...
Despi te the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has ... more Despi te the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality. Objective: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer. We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma. The mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. The main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). The clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). The treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment. Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.
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Papers by Claudio Cernea