Marcello Rosano

Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing CSCC is 65–250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases, and worse survival. Objective: To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LACSCC) of the head and neck region in transplant patients. Methods: 16-year retrospective, single-center series of patients with LACSCC in the head and neck region who underwent surgical treatment. Clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence, and survival were analyzed. Results: 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. The most affected regions were malar/nasal (28.8%) and auricular (19.2%). Surgeries included wide resection with reconstruction (58.9%), exenteration (14.1%), and temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (p = 0.009), transplanted (p = 0.006), compromised margin (p = 0.049); Mortality: immunosuppression (p = 0.028), total resection and reconstruction (p = 0.013), stage (8ed) III-IV (p < 0.001), compromised margin (p < 0.001), neck metastasis with extranodal extension (p = 0.018). Multivariate analysis: Recurrence: transplanted HR: 3.69 (p < 0.001), neck metastasis extranodal extension HR: 5.41 (p < 0.001), evolution to distant metastasis HR: 5.27 (p < 0.001); Mortality: neck metastasis extranodal extension HR: 1.94, (p = 0.032), compromised margins HR: 1.87 (p = 0.001). Main surgical procedures: temporalectomy HR: 2.83 (p = 0.007), major rhinectomy HR: 2.47 (p = 0.005); Worst overall survival: Tx compared to NonTx (p = 0.069); Worst survival with recurrence: Tx compared to NonTx (p = 0.005). Conclusions: The LACSCC and transplanted (immunosuppressed) group present low survival, worse prognosis; The formulation of specific guidelines to standardize treatment and predict outcomes on this population are strictly necessary.

Background: Squamous cell carcinoma of the skin (SCC) is the second most common neoplasm in humans and the most frequent in Brazil (80% in the head and neck region, 20% mortality). Brazil is a world leader in organ transplants (more than 30,000 transplants in 2019). The risk of transplant patients (Tx) developing SCC is 65-250 times higher, with deeper infiltration, advanced stage, higher local recurrence, occult metastases and worse survival. Objective: To investigate the prognostic factors of locally advanced cutaneous squamous cell carcinoma (LASCC) of the head and neck region in transplant patients. Methods:16-year retrospective, single-center series of patients with LASCC in the head and neck region who underwent surgical treatment. Were analyzed: clinical and Tx data, clinical/pathological stage, surgical treatment, parotid/regional and distant metastases, recurrence and survival. Results: 156 patients were included: 69.2% women, 65.3 years; mean primary size: 4.24 cm, 66% T3/T4 tumors, 71% grade 2/3 differentiation, 20.5% transplant recipients, follow-up: 33.6 months. Most affected regions: malar/nasal (28.8%), auricular (19.2%). Surgeries: wide resection with reconstruction (58.9%), exenteration (14.1%), temporalectomy (11.5%). Univariate analysis: Recurrence: immunosuppressor drugs (p=0.009), transplanted (p=0.006), compromised margin (p=0.049), Mortality: immunosuppression (p=0.028), Total Resection and reconstruction (p=0.013), Stage(8ed) III-IV (p<0.001), compromised margin (p<0.001), neck metastasis with extranodal extension (p=0.018). Multivariate analysis: Recurrence: Transplanted HR:3.69 (p<0.001), Neck metastasis extranodal extension HR:5.41 (p<0.001), Evolution to Distant metastasis HR:5.27 (p<0.001); Mortality: Neck metastasis extranodal extension HR:1.94, (p=0.032), Compromised Margins HR:1.87 (p=0.001), Main Surgical Procedures: Temporalectomy HR:2.83 (p=0.007); Major Rhinectomy HR:2.47 (p=0.005); Worst Overall Survival: Tx compared to NonTx (p=0.069), Worst Survival with Recurrence: Tx compared to NonTx (p=0.005). Conclusions: The LASCC and Transplanted (immunosuppressed) group present low survival, worse prognosis, high risk of recurrence and mortality outcome, formulation of specific guidelines to standardize treatment and predict outcomes in this population are strictly necessary.

Sialolithiasis is a common cause of obstructive salivary gland disease, occurring in both submandibular and parotid glands. The treatment has evolved with the introduction of Sialendoscopy and micro-instruments (baskets, wires, and balloons), which allow intraductal manipulations, including stone removal and strictures, to be dilated. Nowadays, it is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life. The objective of the present 10-year retrospective review is to standardize the basic steps involved in successfully removing intraductal sialolithiasis with a Basket instrument. A consecutive ten-year series (January/2014 to June/2024) of patients with obstructive submandibular and parotid glands due to sialolithiasis who underwent sialendoscopy using a basket successfully removed were analyzed. The procedure was conducted following the standards; all interventions were video-recorded and performed by the same surgical team using a semi-rigid modular sialendoscope (1.3 mm/1.7 mm diameter) with working channel, salivary probes, dilatators, different baskets (0.4 mm diameter and 3, 4 and 6 wires) for stones and dilatations, using some steps previously reported. In 10 years, we have performed 224 sialendoscopy due to salivary gland obstructive disease, 84.4% from sialolithiasis. The successful sialolith removal with the basket was performed using pure sialendoscopy (PS-study group) in 132 (69.8%) patients: 79.5% female patients, mean age 44.8 years; 68.9% in the submandibular gland, 65.9% single stones, with 0% major complications. The basic steps were a) how to localize; b) to evaluate (mobile/hard/single stone); c) to estimate sialolith size; d) to choose basket type; e) to choose approach technique (A: Frontal:9.1%, B: Side-to-Side: 35.6%, C: Back-to-Forward: 55.3%). All sialoliths were completely removed, and the patients recovered uneventfully. This article details the standardization of the use of basket in removing ductal stones during sialendoscopy, which is necessary to achieve a high success rate in its removal.

Sialolithiasis is a common cause of obstructive salivary gland disease, occurring in both submandibular and parotid glands. The treatment has evolved with the introduction of Sialendoscopy and micro-instruments (baskets, wires, and balloons), which allow intraductal manipulations, including stone removal and strictures, to be dilated. Nowadays, it is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life. The objective of the present 10-year retrospective review is to standardize the basic steps involved in successfully removing intraductal sialolithiasis with a Basket instrument. A consecutive ten-year series (January/2014 to June/2024) of patients with obstructive submandibular and parotid glands due to sialolithiasis who underwent sialendoscopy using a basket successfully removed were analyzed. The procedure was conducted following the standards; all interventions were video-recorded and performed by the same surgical team using a semi-rigid modular sialendoscope (1.3 mm/1.7 mm diameter) with working channel, salivary probes, dilatators, different baskets (0.4 mm diameter and 3, 4 and 6 wires) for stones and dilatations, using some steps previously reported. In 10 years, we have performed 224 sialendoscopy due to salivary gland obstructive disease, 84.4% from sialolithiasis. The successful sialolith removal with the basket was performed using pure sialendoscopy (PS-study group) in 132 (69.8%) patients: 79.5% female patients, mean age 44.8 years; 68.9% in the submandibular gland, 65.9% single stones, with 0% major complications. The basic steps were a) how to localize; b) to evaluate (mobile/hard/single stone); c) to estimate sialolith size; d) to choose basket type; e) to choose approach technique (A: Frontal:9.1%, B: Side-to-Side: 35.6%, C: Back-to-Forward: 55.3%). All sialoliths were completely removed, and the patients recovered uneventfully. This article details the standardization of the use of basket in removing ductal stones during sialendoscopy, which is necessary to achieve a high success rate in its removal.

Objective: This study aimed to assess the effectiveness of intraoperative parathyroid hormone (PTH) measurements from bilateral internal jugular veins (BIJVs) in determining parathyroid gland laterality during surgery for primary hyperparathyroidism (PHPT).Study Design: Prospective cohort study.Setting: Single tertiary care center, February 2021 to February 2023.Methods: All patients underwent intraoperative BIJV PTH measurements during parathyroidectomy. Preoperative localization of abnormal parathyroid glands was performed using cervical ultrasound (USG) and sestamibi scans (MIBI). Receiver operating characteristic (ROC) analysis was performed to determine the best performance (sensitivity and specificity) for predicting parathyroid gland laterality.Results: A total of 124 patients underwent surgery during the study. PTH measurements from BIJV successfully confirmed the laterality of parathyroid adenomas in 102 cases (82.3%, P = .001). Intraoperative BIJV PTH measurements proved to be the most effective method for determining parathyroid gland laterality, with an accuracy of 82.3%. ROC curve analysis identified an optimal cutoff point of 16.7% for the percentage difference between right and left BIJV PTH values. The area under the curve (AUC) was 0.882, indicating high diagnostic accuracy. This cutoff yielded a sensitivity of 76.5% and a specificity of 95.5%. Additionally, no patients experienced complications related to the internal jugular vein (IJV) procedure.Conclusion: Intraoperative BIJV PTH measurement is a valuable adjunct in parathyroidectomy, improving localization and enhancing surgical outcomes in PHPT patients.

A 32-year-old man with renal hyperparathyroidism was referred for surgical treatment after exhausting clinical measures for metabolic control.,Combined analysis of neck ultrasound () and Sestamibi ()/SPECT-CT () findings enabled the identification of three possible enlarged parathyroid glands.The right and left superior parathyroid glands were located in their usual positions beneath the thyroid gland, while the right inferior parathyroid gland was found in the upper mediastinum. […] Ectopic parathyroid and its role in surgical failure

Introduction: Sialolithiasis is major cause of the obstructive salivary gland disease, accounting for ∼60% of all cases. Other etiologies include strictures, mucoid debris, anatomic ductal abnormalities, and scar tissue. ¹ About 80% to 95% of sialolithiasis cases occur in the submandibular gland, 5% to 20% in the parotid gland, and only 1% to 2% in the remaining glands. The treatment of the obstructive salivary gland has evolved in the past 25 years with the introduction of thin semiflexible endoscopes and microinstruments such as forceps, baskets, wires, lasers, and balloons. These advancements allow for sialendoscopy and other intraductal manipulations including stone removal, dilatation of strictures, and cleansing of mucus plugs. ² In addition, these procedures can be used in combination with minimally invasive external approaches. ³ Sialendoscopy is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life. ⁴ The objective of the surgical video is to clarify the basic steps involved in effectively removing intraductal sialolithiasis. Materials and Methods: A 36-year-old man presented with complaints of pain, swelling, and difficulty swallowing during meals, in the right submandibular salivary gland area. The symptoms had been present for the past 2 years and had worsened progressively, with no improvements with analgesics. The patient had a history of drinking less water during the past 10 years, but otherwise had no remarkable medical history. During the neck clinical examination, the right submandibular gland was found to be smaller than the contralateral gland, and no atypical lymph nodes were detected. Intraoral examination revealed a palpable 8 mm sialolith in the right floor of the mouth, which caused a discharge of milky saliva on manipulation. The remaining mucosa appeared normal. A CT scan revealed a 9 mm elliptical sialolith in the middle third of the right submandibular duct, consistent with the clinical examination and suspicion of obstructive sialolithiasis. Laboratory tests were normal. As treatment, sialendoscopy was indicated. The procedure was conducted following the standards set by Marchal et al. ⁵ The intervention was performed for both diagnostic and therapeutic interventions, using a semirigid modular sialendoscope (Karl Storz, Tuttlingen, Germany) with a diameter of 1.7 mm, along with working channel, salivary probes, conic dilatators, bougies, baskets for stones, dilatator balloons, and silastic stents to the main duct to maintain papilla patency. ⁶ The sialolith was completely removed without any adverse events. Results: The patient recovered uneventfully postoperatively and was discharged the next day. Conclusion: Our findings support the use of sialendoscopy for obstructive sialolithiasis. Patients usually obtain a complete resolution of their clinical symptoms and the technology has a high success rate when performed by an experienced team. The patient who agreed to participate in the study has written and signed the informed consent statement. No competing financial interests exist. No funding was received for this article. Runtime of video: 4 mins 49 secs

Objective: The study sought to determine the clinical features of hyperparathyroid-induced hypercalcemic crisis (HIHC) along with treatment options and outcomes. Subjects and methods: This is a retrospective analysis of our historical cohort of patients with primary hyperparathyroidism (PHPT). Patients were divided in groups according to their calcium levels and clinical presentation. HIHC (group 1) was assumed when patients had high calcium levels and needed emergency hospitalization. Group 2 was composed of patients with calcium levels above 16 mg/dL or [...] ABSTRACT Objective: The study sought to determine the clinical features of hyperparathyroid-induced hypercalcemic crisis (HIHC) along with treatment options and outcomes. Subjects and methods: This is a retrospective analysis of our historical cohort of patients with primary hyperparathyroidism (PHPT). Patients were divided in groups according to their calcium levels and clinical presentation. HIHC (group 1) was assumed when patients had high calcium levels and needed emergency hospitalization. Group 2 was composed of patients with calcium levels above 16 mg/dL or