Rodrigo Oliveira Santos

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.

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

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

Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at [...] ABSTRACT Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at

Key words: Biochemical markers of bone turnover; parathyroid-related disorders; DXA; PTH; osteoporosis