Gustavo Meyer de Moraes

Federal University of Minas Gerais, Belo Horizonte, Estado de Minas Gerais, Brazil

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Publications (10)12.4 Total impact

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    ABSTRACT: The objective of this study was to evaluate the impact of clinical variables on survival rates in patients with squamous cell carcinomas in the lower oral cavity. We conducted a retrospective study of patients who exhibited a histological diagnosis of squamous cell carcinoma of the lower oral cavity, who underwent surgery. Data on clinical, histological, and treatment variables were collected to assess the effect of these variables on global survival and disease-free curves. We studied 117 patients, 86 (73.5%) males and 31 (26.5%) females, who underwent surgery between January 2005 and June 2009. The overall survival rate was 74.4% after two years, and the disease-free rate was 67.5%. Midline invasion by the primary tumor negatively impacted overall survival (P=0.02) and disease-free survival (P=0.01). The disease-free survival rate of patients with histologically confirmed neck metastases was 76.8% versus 59% for patients without metastases (P=0.01). Disease-free survival of patients with one affected lymph node was 89.5%, and 45.2% for more than one affected lymph node (P<0.01). Patients who ended radiotherapy in less than 60 days exhibited a disease-free rate of 59.0%, and patients whose treatment lasted more than 60 days exhibited a rate of 77.1% (P=0.06). In our study, primary tumor invasion of the midline, the presence of more than one affected lymph node as confirmed by histology, the delaying radiotherapy for more than 56 days and radiotherapy that lasted longer than 60 days worsen patient prognosis.
    Minerva stomatologica 10/2014; 63(10):341-349.
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    ABSTRACT: Objective: This study compared the incidence of salivary fistula between groups with an early or late reintroduction of oral feeding, and identified the predictive factors for salivary fistula. Methods: A randomised trial was performed using 89 patients with larynx or hypopharynx cancer, assigned to 2 groups (early or late). In the early group, oral feeding was started 24 hours after total laryngectomy or total pharyngolaryngectomy, and in the late group, it was started from post-operative day 7 onwards. The occurrence of salivary fistula was evaluated in relation to the following variables: early or late oral feeding, nutritional status, cancer stage, surgery performed, and type of neck dissection. Results: The incidence of salivary fistula was 27.3 per cent (n = 12) in the early group and 13.3 per cent (n = 6) in the late group (p = 0.10). The following variables were not statistically significant: nutritional status (p = 0.45); tumour location (p = 0.37); type of surgery (p = 0.91) and type of neck dissection (p = 0.62). A significant difference (p = 0.02) between the free margins and invasive carcinoma was observed. Conclusion: The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.
    The Journal of Laryngology & Otology 04/2014; · 0.68 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the incidence of pharyngocutaneous fistula after total laryngectomy and try to identify its predictors. METHODS: From May 2005 to April 2010, 93 patients underwent total laryngectomy. We evaluated complications during and after surgery and compared them with the following variables: gender, nutritional status, previous tracheotomy, tumor location, type of surgery, TNM staging, prior treatment with chemotherapy and/or radiotherapy, use of flaps for reconstruction and surgical margin. All patients presented with advanced neoplastic disease according to TNM. RESULTS: 14 (15.1%) patients developed postoperative salivary fistula. The mean time to onset of salivary fistula was 3.5 days, with a standard deviation of 13.7 days. Comparing salivary fistula with TNM variables, type of operation and neck dissection, prior tracheotomy, use of flap, preoperative radio and chemotherapy and surgical margin, there was no statistically significant difference (p> 0,05). CONCLUSION: The incidence of salivary fistula was 15.1% and no predictive factor for its formation was found.
    Revista do Colégio Brasileiro de Cirurgiões 04/2013; 40(2):98-103.
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    ABSTRACT: OBJECTIVE: To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism. METHODS: We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed. Patients were grouped according to the presence or absence of hypocalcemia and evaluated according to age, gender, thyroid function, thyroid volume, number of parathyroid glands identified and need to parathyroid reimplantation, type of operation, operative time, and histopathological diagnosis. RESULTS: The incidence of temporary hypocalcemia was 40.8% (136 patients), and of definitive hypoparathyroidism 4.2% (14 patients). Reoperation or total thyroidectomy, neck dissection, hyperthyroidism, operative time and age above 50 years were factors related to higher incidence of hypocalcemia and definitive hypoparathyroidism (p <0.05). CONCLUSION: predictors of postoperative hypocalcemia included age (> 50 years), total thyroidectomy, reoperation, neck dissection and operative time. The predictors of post-thyroidectomy definitive hypoparathyroidism included type of operation, histological diagnosis and hyperthyroidism.
    Revista do Colégio Brasileiro de Cirurgiões 12/2012; 39(6):476-482.
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    ABSTRACT: Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications. This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL). This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%). Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx (p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding. The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.
    Brazilian journal of otorhinolaryngology 08/2012; 78(4):103-7. · 0.55 Impact Factor
  • Plastic and reconstructive surgery 07/2011; 128(1):328. · 2.74 Impact Factor
  • Plastic and reconstructive surgery 09/2010; 126(3):143e-4e. · 2.74 Impact Factor
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    ABSTRACT: The goal of the present study was to investigate the course of ionized calcium after thyroidectomy and to define a cut-off value that indicates symptoms of hypocalcemia. The sample included 333 patients undergoing thyroidectomy at the University Hospital of UFMG between September 2000 and December 2005. Ionized calcium was determined before and after surgery (days 1, 2, and 30) in all patients and on postoperative days 90 and 180 in those with hypocalcemia. Asymptomatic patients received no calcium replacement therapy, irrespective of calcium concentration. Patients with clinical manifestation of hypocalcemia were treated after laboratory confirmation. The presence or absence of postoperative hypocalcemia was associated with ionized calcium concentration measured on the reported days. Ionized calcium declined on the first two days after surgery in all patients when compared to preoperative levels (P = 0.000). Forty-seven (34.6%) of the 136 (40.8%) patients with postoperative hypocalcemia had symptoms. Patients with symptomatic hypocalcemia had significantly lower ionized calcium levels than those with asymptomatic hypocalcemia (P = 0.001). Fourteen (4.2%) patients progressed to definitive hypoparathyroidism by the end of 6 months. Measurement of ionized calcium on postoperative days 1 and 2 is sufficient for the evaluation of post-thyroidectomy hypocalcemia. Ionized calcium concentrations <1.03 mmol/l on postoperative day 1 are indicative of the presence of symptoms and the need for treatment.
    World Journal of Surgery 05/2010; 34(5):987-92. · 2.23 Impact Factor
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    ABSTRACT: magnesium ion concentration is directly related and phosphorus ion concentration is inversely related to calcemia. The aim of this study was to evaluate the evolution of magnesium and phosphorus ion levels in patients undergoing thyroidectomy and correlate these with changes to calcium concentration. prospective study at the Alpha Institute of Gastroenterology, Hospital das Clínicas, Universidade Federal de Minas Gerais. the study included 333 patients, of both genders and mean age 45 ± 15 years, who underwent thyroidectomy between 2000 and 2005. Total calcium, phosphorus and magnesium were measured in the blood preoperatively and 24 and 48 hours postoperatively. Ionic changes were evaluated according to the presence or absence of postoperative hypocalcemia. there were statistically significant drops in blood phosphorus levels 24 and 48 hours after thyroidectomy, compared with preoperative values, in the patients without hypocalcemia. In the patients who developed hypocalcemia, there was a significant drop in plasma phosphorus on the first postoperative day and an increase (also statistically significant) on the second day, in relation to preoperative phosphorus levels. A significant drop in postoperative magnesium was also observed on the first and second days after thyroidectomy in the patients with hypocalcemia, in relation to preoperative levels. In the patients without hypocalcemia, the drop in magnesium was significant on the first day, but there was no difference on the second day. despite the postoperative changes, neither magnesium nor phosphorus ion levels had any role in post-thyroidectomy calcemia.
    São Paulo medical journal = Revista paulista de medicina 01/2010; 128(5):268-71. · 0.75 Impact Factor
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    ABSTRACT: Solitary fibrous tumours are spindle-cell neoplasms that usually occur in the pleura and peritoneum, and rarely involve the oral mucosa. We report a 30-year-old man with a large solitary fibrous tumour on the buccal mucosa that resembled a salivary gland neoplasm. The lesion was excised and has not recurred.
    British Journal of Oral and Maxillofacial Surgery 07/2007; 45(4):323-5. · 2.72 Impact Factor