Evaluation of the relationship between tonsilar asymmetry and tonsilar lymphoma in children

Orientador: Reinaldo Jordão GusmãoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O linfoma é a terceira neoplasia mais frequente da infância correspondendo a cerca de 12% de todas neoplasias em indivíduos com menos de 15 anos, e é a neoplasia maligna mais frequente em cabeça e pescoço. Aproximadamente 15% dos linfomas de cabeça e pescoço em crianças acometem o anel de Waldeyer. O diagnóstico e o tratamento precoce têm grande importância no prognóstico dos pacientes com linfoma de tonsilas palatinas. Os objetivos deste trabalho são avaliar a prevalência das manifestações clínicas de crianças com linfoma de tonsila palatina e identificar a associação entre a assimetria tonsilar e o linfoma de tonsila palatina em crianças. Foram realizadas revisões sistemáticas da literatura com artigos que incluíam crianças até os 18 anos com linfoma de tonsila palatina ou assimetria tonsilar. Foram encontrados 66 casos de crianças com linfoma; a assimetria tonsilar foi a manifestação clinica mais frequente, presente em 72,7% dos casos, seguida pela alteração na aparência da tonsila palatina em 45,4% e linfonodomegalia cervical em 30,3% dos casos. O linfoma de Burkitt foi o tipo mais frequente. A principal causa de assimetria tonsilar foi a hiperplasia linfóide seguida pelo linfoma e por alterações benignas inespecíficas. Foi encontrada associação entre a assimetria tonsilar e o linfoma de tonsilas palatina, sendo a razão de verossimilhança de 43,5 para crianças com assimetria de tonsilas e de 8938,4 para crianças com assimetria de tonsilas e outros sinais de suspeição para malignidadeAbstract: Lymphoma is the third most common malignancy of childhood, accounting for approximately 12% of all cancers in individuals under 15 years of age and is the most common malignancy in the head and neck. About 15% of head and neck lymphomas in children affect the Waldeyer's ring. The early diagnosis and early treatment are very important in the prognosis of patients with palatine tonsils lymphoma. The objectives of this thesis are to evaluate the prevalence of the clinical manifestations of children with tonsillar lymphoma and identify the association between the tonsillar asymmetry and the tonsillar lymphoma in children. Systematic reviews of the literature were conducted with articles that included children up to 18 years with tonsillar lymphoma or tonsillar asymmetry. 66 cases of children with lymphoma were included; the tonsillar asymmetry was the most common clinical manifestation, present in 72.7% of cases, followed by the change in appearance of the palatine tonsil in 45.4% and cervical lymphadenopathy in 30.3% of cases. Burkitt's lymphoma was the most common type. The most frequent cause of tonsillar asymmetry was lymphoid hyperplasia followed by lymphoma and nonspecific benign changes. There was an association between the tonsillar asymmetry and tonsillar lymphoma with the likelihood ratio of 43.5 for children with tonsillar asymmetry and 8938.4 for children with asymmetry of tonsils and other signs of suspicion for malignancyDoutoradoOtorrinolaringologiaDoutor em Ciências Médica

Tonsillar lymphoma in children with unilateral tonsillar enlargement

OBJECTIVE: To demonstrate the importance of a medical examination with emphasis on changes of the palatine tonsils (PT) and proper anamnesis to early identify patients with tonsillar lymphoma. CASE DESCRIPTION: Case 1 - 5-year-old girl with a muffled voice noted by her mother and a report of feeling a strange sensation in the throat for two weeks. She was previously treated in another service at the beginning of the symptoms with amoxicillin without improvement. An important increase in the right PT was noted, with smooth surface and absence of crypts. The diagnosis of non-Hodgkin lymphoma (NHL) was confirmed after surgery. On further investigation, positive mesenteric lymph nodes were noted. Case 2 - 11-year-old girl came to the emergency service to investigate a painless nodule in the left palatine tonsil with progressive growth for one year, without other complaints. She had previously undergone other medical consultations, but no importance was given to the patient's complaint. Oroscopy showed that the left PT was increased crossing the midline and with a nodule in the upper pole. Patient also had NHL. COMMENTS: A detailed examination of the oral cavity and neck is essential to identify suspicious tonsillar lymphoma. Patients with unilateral tonsillar enlargement and other findings suggestive of malignancy should undergo tonsillectomy.OBJETIVO: Demonstrar a importância do exame físico com ênfase nas alterações das tonsilas palatinas (TP) e na anamnese direcionada para a identificação precoce de pacientes com linfoma de TP. DESCRIÇÃO DO CASO: Caso 1 - Menina de cinco anos com voz abafada, observada pela mãe, e sensação de algo estranho na garganta há duas semanas. Foi atendida em outro serviço no início do quadro, sendo medicada com amoxicilina, sem melhora. Apresentava aumento importante da TP direita com superfície lisa e ausência de criptas. Após cirurgia, foi confirmado o diagnóstico de linfoma não Hodgkin (LNH). Na investigação também foi identificado acometimento dos linfonodos mesentéricos pelo linfoma. Caso 2 - Menina de 11 anos procurou o pronto-socorro para investigar nódulo em TP esquerda, indolor, de crescimento progressivo há um ano, sem outras queixas. Já havia passado por consultas médicas anteriores, não tendo sido valorizada a queixa da paciente. A TP esquerda encontrava-se aumentada, ultrapassando a linha média e com nódulo no polo superior. Também foi diagnosticado LNH após exame anatomopatológico. COMENTÁRIOS: Um exame minucioso da cavidade oral e do pescoço é essencial para identificar alterações suspeitas de linfoma tonsilar. Pacientes com assimetria tonsilar e outros achados sugestivos de malignidade devem ser submetidos à tonsilectomia.OBJETIVO: Demostrar la importancia de un examen físico con énfasis en las alteraciones de las tonsilas palatinas (TP) y en la anamnesis dirigida a la identificación temprana de pacientes con linfoma de TP. DESCRIPCIÓN DEL CASO: Caso 1 - Niña de cinco años, con voz velada, observada por la madre, y «sensación de algo extraño en la garganta» hace dos semanas. Fue atendida en otro servicio en el inicio del cuadro, siendo medicada con amoxicilina, sin mejora. Presentaba aumento importante de la TP derecha con superficie lisa y ausencia de criptas. Después de la cirugía, se confirmó el diagnóstico de linfoma no Hodgkin (LNH). En la investigación también se identificó acometimiento de los nodos linfáticos mesentéricos por el linfoma. Caso 2 - Muchacha de 11 años buscó al servicio de urgencia para investigar nódulo en TP izquierda, indolora, de crecimiento progresivo hace un año, sin otras quejas. Ya había pasado por consultas médicas anteriores, no habiendo sido valorizada la queja de la paciente. La TP izquierda se encontraba aumentada, sobrepasando la línea media y con nódulo en el polo superior de esa. También se diagnosticó LNH después de examen anatomopatológico. COMENTARIOS: Un examen minucioso de la cavidad oral y del cuello es esencial para identificar alteraciones sospechosas de linfoma tonsilar. Pacientes con asimetría tonsilar y otros hallazgos sugestivos de malignidad deben ser sometidos a tonsilectomía.28829

Mediastinitis: Parotid Abscess Complication.

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Surgical disaster in temporomandibular joint: Case report

AbstractBackgroundTemporomandibular-ankylosis brings extensive limitations on the patient quality of life. Surgical treatment is frequently necessary associated with a continuous rehabilitation. The anatomy of this region and potential complications of this surgery must be thoroughly known to avoid iatrogenic injuries.Case presentationA young patient underwent surgical treatment of congenital bilateral ankylosis with disastrous consequences such as facial palsy, deafness and cerebrospinal leaks on the right side related to intraoperative trauma involving structures of the external, middle and inner ear.ConclusionSince there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported

Neuropatia auditiva: avaliação clínica e abordagem diagnóstica

Auditory neuropathy is a condition in which there is a change in the neuronal transmission of the auditory stimuli. Our objective was to describe the patients’ series within the clinical spectrum of auditory neuropathy. We designed a transversal, retrospective study, with a description of a consecutive case series. Auditory neuropathy was defined by the presence of acoustic otoemissions plus absent/abnormal auditory brainstem responses with cochlear microphonism. 34 patients with bilateral hearing loss, 23 males and 11 females, were included in the study. Eighty percent of the cases had congenital onset of hearing loss. Acoustic otoemissions were absent in 67% of them. Cochlear microfonism was present in 79% of all cases. Prenatal, perinatal or ambiental factors were present in 35.2% of the cases. Medical literature shows great variability in findings related to auditory neuropathy, both in its etiology and epidemiological data. Auditory neuropathy presents a broad spectrum of changes that may result from mild to severe changes in the functioning of the auditory pathway, and in our sample we observed that 80% of Auditory neuropathy have congenital onset of hearing loss and/or with cochlear microphonism identified. 91% of patients experience significant hearing impairment and 53% suffer from severe or profound deafness6353359CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESnão temnão temA neuropatia auditiva é uma condição na qual há alteração na condução neuronal do estímulo sonoro. Este trabalho pretende descrever e caracterizar a casuística de doentes com neuropatia auditiva. Realizámos um estudo transversal, retrospetivo, com descrição de uma série de casos consecutivos. O diagnóstico da neuropatia auditiva foi definido nas seguintes situações: Presença de otoemissões acústicas com potenciais auditivos de tronco encefálico ausente ou anormal e presença do microfonismo coclear independentemente da presença de otoemissões acústicas. Foram avaliados 34 doentes com perda auditiva bilateral, 67% deles do sexo masculino. O aparecimento dos sintomas foi congênito em 80% dos casos. Na pesquisa das otoemissões acústicas, a resposta foi ausente em 67% dos doentes. O microfonismo coclear foi detetado em 79% dos doentes. Antecedentes gestacionais, perinatais ou ambientais relevantes estiveram presentes em 35,3% dos casos. A literatura médica ainda apresenta grande variabilidade nos achados relacionados com a neuropatia auditiva, tanto na sua etiologia quanto nos dados epidemiológicos. A neuropatia auditiva apresenta um amplo espectro de alterações que podem resultar em disfunções leves a severas no funcionamento da via auditiva. Na nossa amostra, observámos que 80% das neuropatias auditivas terão tido origem congênita e/ou apresenta microfonismo coclear, 91% dos doentes apresenta défice auditivo significativo e 53% sofrem de surdez severa ou profunda

Giant Keratocystic Odontogenic Tumor: Three Cases And Literature Review.

A keratocystic odontogenic tumor is a benign intra-bone mass originating from dental lamina or its residue. It represents 2-11% of jaw cysts, and has a slow but aggressive growth. The evaluation of molecular characteristics, immunohistochemistry, and genetic expression currently have no established classification regarding the evolution and pathophysiologic pattern of these lesions. This is a clinical retrospective study with a full analysis of patient history regarding physical evaluation, radiologic images, pathology results, and surgical resection. We performed a major literature review concerning current concepts relating to its biological characterization. Three cases of keratocystic odontogenic tumor were identified. Two of the cases were large, with aggressive behavior and significant bone destruction and recurrence, which had been overlooked for more than a decade. The third case had an early diagnosis, and the treatment led to full recovery and complete healing. The keratocystic odontogenic tumor is a benign lesion with slow growth, which lends itself to a more conservative treatment, even in cases of large lesions. A better understanding of these tumors, both at the biological and molecular level, could lead to guidelines for treatment and prognosis of such patients.25245-5

Evaluation of the Digisonic® SP cochlear implant: patient outcomes and fixation system with titanium screws

Cochlear implants have revolutionized the way patients affected by severe hearing loss experience the world. Neurelec developed a fixation system with two titanium screws that requires no skull bone drilling. OBJECTIVE: To describe the outcomes and procedure-related details of a series of patients implanted with the Digisonic® SP cochlear implant. METHOD: This retrospective study analyzed patients submitted to cochlear implant placement within a period of 18 months. All patients had postlingual hearing impairment. Data was collected from patient charts and standard questionnaires answered by the surgeons in charge of carrying out the procedures. RESULTS: The six patients offered the Digisonic® SP cochlear implants were operated by experienced surgeons. The procedures took 95 to 203 minutes (mean = 135') to be completed, which is less time than what has been described for other fixation approaches. No complications were recorded and hearing improvement was satisfactory. CONCLUSION: The Digisonic® SP cochlear implant developed by Neurelec offered good audiological results for adult patients, shorter surgery time, and no surgical or postoperative complications.O implante coclear para pacientes com disacusia grave/profunda revolucionou o modo com que estes interagem com o meio ambiente. A Neurelec desenvolveu um sistema que permite fixação com uso de dois simples parafusos de titânio, sem necessidade de broqueamento do osso do crânio do paciente. Este artigo teve o objetivo de descrever uma casuística de pacientes submetidos a implante coclear com o Digisonic® SP, para mostrar os resultados cirúrgicos e detalhes do procedimento. MÉTODO: Estudo retrospectivo que avaliou os pacientes, no período de 18 meses, submetidos a implante coclear com o Digisonic® SP. Todos os pacientes eram pós-linguais. Coleta dos dados realizada por meio da análise dos prontuários dos pacientes, além de questionário padronizado aplicado nos cirurgiões que realizaram o procedimento. RESULTADOS: Os seis casos implantados com o Digisonic® SP foram realizados por cirurgiões experientes e o tempo cirúrgico variou de 95 a 203 minutos (média de 135 minutos), que é menor do que o descrito com outras formas de fixação. Não houve nenhum tipo de complicação e o ganho auditivo foi satisfatório. CONCLUSÃO: O implante Digisonic® SP desenvolvido pela Neurelec apresentou bons resultados audiológicos em adultos, tempo de cirurgia menor e não ocorreram complicações cirúrgicas ou pós-operatórias.566

Study of the relationship between the degree of tinnitus annoyance the presence of hyperacusis✩✩Please cite this article as: Guimarães AC, Carvalho GM, Voltolini MM, Zappelini CE, Mezzalira R, Stoler G, et al. Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis. Braz J Otorhinolaryngol. 2014;80:24-8.

AbstractIntroductionHyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain.AimTo evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus.Materials and methodsRetrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale.ResultsWe analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis.ConclusionHyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved

Hearing preservation and cochlear implants according to inner ear approach: multicentric evaluation

AbstractIntroductionElectroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery.ObjectivesTo evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear.Methods19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX™ EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation.Results17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation.ConclusionThe hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach

Facial palsy and pregnancy: management and treatment

PURPOSE: To compare the degree of peripheral facial palsy of pregnant women and puerperae at admission and at discharge and to evaluate related factors. METHODS: Retrospective, cross-sectional study, with analysis of medical records of pregnant and postpartum women with facial palsy, over a period of 12 months, with application of a standardized protocol for patient evaluation and of the House-Brackmann scale on the occasion of the first visit and at discharge. RESULTS: Six patients were identified, mean age of 22.6 years. Five cases were classified as stage IV and one as stage II on the House-Brackmann scale, being two of them puerperae and four pregnant. All showed improvement on the House-Brackmann scale. CONCLUSION: The Bell's palsy has a good prognosis even in pregnant and postpartum women, being important to perform the correct treatment to reduce the sequelae in this group identified as more susceptible to peripheral facial palsy.OBJETIVO: Comparar o grau da paralisia facial periférica de gestantes e puérperas no momento da admissão e na alta e avaliar outros fatores associados. MÉTODOS: Estudo retrospectivo, transversal, com análise dos prontuários de gestantes e puérperas atendidas no ambulatório de paralisia facial, em um período de 12 meses, com aplicação de protocolo padronizado de avaliação das pacientes e da escala de House-Brackmann na primeira consulta e na data da alta. RESULTADOS: Foram identificadas 6 pacientes, com média de idade de 22,6 anos. Cinco casos foram classificados com estadiamento IV e um com II na escala de House-Brackmann, sendo que duas eram puérperas e quatro gestantes. Todas evoluíram com melhora na escala de House-Brackmann. CONCLUSÃO: A paralisia de Bell tem bom prognóstico mesmo em gestantes e puérperas, sendo importante realizar tratamento adequado para diminuir as sequelas neste grupo apontado como mais susceptível à paralisia facial periférica.36837