Purpose Head and neck surgeons are among the highest risk for COVID-19 exposure, which also brings great risk to their mental wellbeing. In this study, we aim to evaluate mental health symptoms among head and neck surgeons in Brazil surrounding the time it was declared the epicenter of the virus. Materials and methods A cross-sectional, survey-based study evaluating burnout, anxiety, distress, and depression among head and neck surgeons in Brazil, assessed through the single-item Mini-Z burnout assessment, 7-item Generalized Anxiety Disorder scale, 22-item Impact of Event Scale-Revised, and 2-item Patient Health Questionnaire, respectively. Results 163 physicians completed the survey (74.2% males). Anxiety, distress, burnout, and depression symptoms were reported in 74 (45.5%), 43 (26.3%), 24 (14.7%), and 26 (16.0%) physicians, respectively. On multivariable analysis, female physicians were more likely to report a positive screening for burnout compared to males (OR 2.88, CI [1.07–7.74]). Physicians 45 years or older were less likely to experience anxiety symptoms than those younger than 45 years (OR 0.40, CI [0.20–0.81]). Physicians with no self-reported prior psychiatric conditions were less likely to have symptoms of distress compared to those with such history (OR 0.11, CI [0.33–0.38]). Conclusion Head and neck surgeons in Brazil reported symptoms of burnout, anxiety, distress and depression during our study period within the COVID-19 pandemic. Institutions should monitor these symptoms throughout the pandemic. Further study is required to assess the long-term implications for physician wellness.

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Background: Well-established conventional thyroidectomy has satisfactory outcomes; however, robotic and endoscopic thyroid surgery can avoid visible anterior neck scars. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recent of these techniques. Methods: This was a retrospective review of 412 patients who underwent TOETVA from 2017 to 2020 in 13 Brazilian centers. Results: The study included 359 (87.1%) females and 53 (12.9%) males, with a mean age of 40 years. There were 231 (56.1%) total thyroidectomies. The conversion rate was 0.7%. The transient vocal cord palsy rate was 7.6% (30 patients). Temporary and persistent hypocalcemia rates were 4.0% and 0.8%, respectively. There were two cases of infection (0.5%). Discussion: This is a large multi-institute TOETVA study, with one of the largest cohorts published to date that; despite its retrospective nature and selection bias, reached outcomes comparable to previously reported series, this study reinforced safeness, feasibility, and nationwide reproducibility for this technique.

Red blood cell (RBC) transfusions can alleviate symptoms like fatigue, dyspnea, and cardiac problems. This research aims at identifying, measuring, and valuing health care resources and activities needed to provide RBC transfusions in Italy. An empirical, retrospective cost description of the RBC transfusion process was performed following the viewpoint of a large Italian Local Health Authority based in Florence, Italy. Activity based costing (ABC) and traditional cost (direct costs plus a share of indirect costs) methods were applied. The RBC transfusion process was divided into 3 episodes (donation, processing, and transfusion) and 13 activities. Costs (in € 2008) were grouped in 5 categories (labor, disposables, lab tests, equipment, other costs). Costs for managing transfusion-related risks were not considered. The full cost for RBC transfusions is € 482.1 (donation: € 113.6; processing € 233.3; transfusion € 135.2) and € 346.9 for RBC units. ABC highlights that the most and the least expensive activities are quality assessment (€ 191.9) and waste management (€ 0.3). Labor is the most relevant cost item of the full cost for RBC transfusion. Pharmacologic research aiming at increasing the number of RBC transfusion-free patients should take into account, together with other parameters, also the real RBC transfusion costs

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Objective: The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Materials and methods: Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results: A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion: The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.

sumárioAproximadamente 15% a 20% dos sarcomas ocorrem na região da cabeça e pescoço, 80% em adultos, sendo apenas 0,014% leiomiossarcomas primários de tireoide. Existem apenas 16 casos relatados no mundo, dos quais não há nenhum em nosso meio. São tumores com diagnós-tico citológico pré-operatório difícil e podem ser confundidos com outras lesões mais comuns da tireoide, como carcinomas anaplásicos e medulares. O tratamento ideal ainda não está bem definido, visto que o prognóstico é ruim e a cirurgia radical associada à quimioterapia e à radioterapia adjuvantes não demonstra melhora nas taxas de recorrência e sobrevida. Relatou-se um caso de leiomiossarcoma primário da glândula tireoide em um paciente jovem, submetido a tireoidectomia total e esvaziamento cervical, associado à radioterapia adjuvante e realizou-se uma extensa revisão da literatura existente sobre o tema. Houve boa evolução pós-operatória, sem sinais de recidiva após quatro anos de seguimento. Arq Bras Endocrinol Metab. 2010;54(3):326-30 summary Despite the fact that 15% to 20% of sarcomas occur in the head and neck and 80% in adults, only 0.014% are primary thyroid leiomyosarcomas. To the best of our knowledge, only 16 cases have been reported around the world, none in South America. Cytologic diagnosis is challenging and these tumors may be mistaken by more common ones such as anaplastic or medullary carcinomas. The treatment of choice for thyroid leiomyosarcomas is not well established yet because of its poor prognosis. Radical surgery associated with chemoradiotherapy has not been effective and did not improve survival rates. The authors report a case of primary thyroid leiomyosarcoma in a young male, who has been submitted to total thyroidectomy and selective neck dissection. Extensive literature review was performed by the authors. The patient received adjuvant radiotherapy, presenting good postoperative course. After four years evolution, there was no local recurrence or distant metastasis. Arq Bras Endocrinol Metab. 2010;54(3):326-30 O s sarcomas correspondem a menos de 1% dos tumores malignos que acometem a cabeça e o pescoço em adultos (1). O leiomiossarcoma responde por apenas 2,3% a 5,3% dos tumores malignos dos tecidos moles, acometendo preferencialmente o trato genital feminino (sobretudo o útero), trato gastrointestinal, retroperitônio e tecido subcutâneo (2). Aproximadamente 1% dos sarcomas de cabeça e pescoço é leiomiossarcoma, ocorrendo principalmente na cavidade oral, nos tecidos moles superficiais, como couro cabeludo, seios paranasais e mandíbula (3); o acometimento da tireoide é extremamente raro (4). Existem apenas 16 casos relatados no mundo, dos quais não há nenhum deles em nosso meio. São tumores com diagnóstico citológico pré-operatório difícil e podem ser confundidos com outras lesões mais comuns da tireoide, como carcinomas anaplásicos e medulares (5). Alguns autores acreditam que os sarcomas tireoideanos são carcinomas anaplásicos com diferenciação sarcomatosa (6), no entanto estudos de imuno-histoquímica e micros...

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