Clinical studies on nasal allergy

Orientador: Profº. Drº. Obdulio Gomes MiguelCoorientadora: Profª. Drª. Sila Mary Rodrigues FerreiraDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Alimentação e Nutrição. Defesa : Curitiba, 31/07/2018Inclui referências: p. 50-65Resumo: A espécie Xanthosoma sagittifolium (L.) Schott, popularmente conhecida como taioba, pertence ao grupo de Plantas Alimentícias Não Convencionais, possui poucos estudos. Assim, este é o primeiro trabalho que avalia as três partes (folha, caule e rizoma) da Xanthosoma sagittifolium (L.) Schott e a investigação do caule inédita. O objetivo desta pesquisa foi avaliar a composição físico-química, perfil fitoquímico e biológico das folhas, caules e rizomas da taioba. A X. sagittifolium (L.) Schott apresentou alto teor de fibras alimentares nas folhas (8,90%) e rizomas (3,0%), betacaroteno nas folhas (95,06 ?g/100 g), licopeno nas folhas (72,53 ?g/100 g), fonte de vitamina C no caule (24 mg/100 g) e folha (23 mg/ 100 g). Entre os metabólitos secundários, foi verificado presença de antocianinas no rizoma, saponinas e taninos nas folhas e esteroides/triterpenos no caule. Além de sugerir não toxicidade, mostrou presença de atividade antioxidante e antimicrobiana para Staphylococcus aureus. Na composição química, foram encontrados, nos rizomas, dois compostos formados por moléculas de glicose, ? - D - glucopiranose e ? - D - glucopiranose. Os resultados indicam que o avanço no conhecimento poderá proporcionar maior valor comercial a Xanthosoma sagittifolium (L.) Schott, que pode contribuir num contexto tecnológico e de sociobiodiversidade num sistema sustentável que promove à segurança alimentar e nutricional. Além disso, poderá contribuir para geração de renda aos agricultores familiares e comunidades tradicionais que tem a terra como seu sustento. Palavras-chave: Xanthosoma sagittifolium (L.) Schott; taioba; caracterização físicoquímica; fitoquímica; metabólitos secundários.Abstract: The species Xanthosoma sagittifolium (L.) Schott, popularly known as taioba, belongs to the group of Non-Conventional Food Plants. This is the first work that studies the three parts (leaf, stem and rhizome) of Xanthosoma sagittifolium (L.) Schott, the stem being an unpublished portion. The objective of this research was to evaluate the physico-chemical composition, phytochemical and biological profile of Taioba leaves, stems and rhizomes. X. sagittifolium (L.) Schott presented a high content and source of dietary fiber in leaves (8.90%) and rhizomes (3.0%), betacarotene in leaves (95.06 ?g / 100 g), lycopene in leaves (24 mg / 100 g) and leaf (23 mg / 100 g) and high carbohydrate content in the leaves (48.09), stems (42.68 ) and rhizomes (41,48). Among the secondary metabolites, anthocyanins were found in the rhizomes, saponins and tannins in the leaves and steroids / triterpenes in the stems. They did not present toxicity, it has antioxidant and antimicrobial activity for Staphylococcus aureus. In the chemical composition, two compounds formed by glucose molecules, ? - D - glucopyranose and ? - D - glucopyranose were found in the rhizomes. The results indicate that the leaves, stems and rhizomes of X. sagittifolium (L.) Schott have the potential to be included in the food habit and the elaboration of by-products can be economically feasible to add value to the plant and generate income for the family farmers. Key words: Xanthosoma sagittifolium (L.) Schott; taioba; physicochemical characterization; phytochemistry; secondary metabolite

Objective evaluation of nasal obstruction

Nasal obstruction is one of the most popular symptoms caused by the diseases of nose and paranasal sinus. We use rhinomanometry （RM） and acoustic rhinometry （AR） to evaluate the nasal patency objectively. RM is a physiological examination indicating the nasal resistance as an index of nasal patency. On other hand, AR is a morphological examination which could measure the cross-sectional area of nasal cavity. As unilateral nasal patency spontaneously changes in human beings, often referred to as‘ nasal cycle’, single measurement not seldom has insufficient reliability. Therefore, several measurements often are necessary to increase the accuracy of the examinations

Factors Affecting Postoperative Hearing Results in Type IV Tympanoplasty: Preliminary Study of the Influence of External Auditory Canal Packing Material

[Background] Postoperative hearing results of type IV tympanoplasty have been shown to have poorer results than other reconstruction techniques. There are numerous reports evaluating the factors for hearing improvement. This preliminary study aimed to analyze and determine the factors that affect hearing results. [Methods] A total of 80 patients who underwent type IV tympanoplasty were evaluated to participate in this study. The medical records of the candidate patients were collected retrospectively. Fifty out of the 80 recruited patients were excluded due to the following reasons: they could not be followed-up for more than a year after the final operation, their initial surgery was not performed in our department, or they needed a revision surgery. The pre-, intra-, and postoperative factors were evaluated and analyzed using EZR software. Cases were divided into two groups according to postoperative hearing results, and each factor was analyzed univariately. The explanatory variables included in the multivariate analysis were the variables that satisfied P < 0.1 in the univariate analysis. Furthermore, all cases were divided into two groups according to the qualitative variables that showed significant difference in the multivariate analysis, and the background factors were evaluated. [Results] The results of univariate analysis showed P < 0.1 for ‘Age’ and ‘Material of external auditory canal (EAC) packing’. Multivariate analysis showed P < 0.05 for both. The comparison between the two packing material groups showed that the gauze group was more likely to have improved hearing than Spongel? group, and the ossicular chain condition of the gauze group was maintained better. [Conclusion] ‘Age’ and ‘Material of EAC packing’ were considered to be significant factors affecting the postoperative hearing results. The selection and use of packing materials that provide stability should be considered to obtain better postoperative hearing results in type IV tympanoplasty

Successful Surgical Treatment for Dysphagia Secondary to Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis (DNM) is a life-threatening disease with a high fatality rate that occurs as a complication of deep neck abscess. DNM complicated by severe dysphagia during the postoperative period has been previously reported, but there have been no published cases of surgical treatment for severe dysphagia secondary to DNM. A 63-year-old man was diagnosed with a deep neck abscess followed by DNM. The patient had dysphagia after incision and drainage of the abscess and drainage for DNM with video-assisted thoracic surgery (VATS). A comprehensive long-term physiotherapy program with a speech and language therapist did not reduce his dysphagia. Thus, the patient underwent laryngeal elevation and cricopharyngeal myotomy, which enabled oral intake. Surgery should be considered for prolonged severe restriction of laryngeal elevation and esophageal introitus opening that is unresponsive to physiotherapy with a speech and language therapist

The effect of Hangeshashinto on Oral Mucositis Caused by Induction Chemotherapy in Patients with Head and Neck Cancer

[Background] Oral mucositis (OM) is a side effect of chemotherapy in head and neck cancer. Severe OM often has a large impact on quality of life. Therefore, the treatment of OM during chemotherapy is very important. It was recently reported that Hangeshashinto (TJ-14), a Japanese traditional medicine (Kampo), is effective for OM caused by fluorinated pyrimidinebased agents used in colon cancer. We investigated the efficacy of TJ-14 for OM. [Methods] We enrolled patients with head and neck cancer who were treated with induction chemotherapy between September 2014 and March 2016. In this double-blind trial, patients were randomly assigned to the TJ-14 group or placebo group. Patients were instructed to dissolve 2.5 g of TJ-14 or placebo in 100 ml of drinking water, rinse their mouths with the solution for 30 s and then spit it out. They were not allowed to eat anything for 30 minutes before or after using the mouthwash. [Results] The incidence of ≥ grade 2 OM was 37.5% (three patients) in the TJ-14 group and 50.0% (four patients) in the placebo group, with no significant difference between the two groups. The mean day of onset was 9.7 in the TJ-14 group and 6.7 in the placebo group. The mean duration of ≥ grade 2 OM was 1.3 days in the TJ-14 group and 3.7 days in the placebo group. Thus TJ-14 significantly reduced the duration of ≥ grade 2 OM. [Conclusion] Treatment of OM with TJ-14 was associated with a statistically significant reduction in the duration of ≥ grade 2 OM compared to placebo. Gargling with TJ-14 is a safe and effective method of administering the drug to patients with head and neck cancer

Malignant Oncocytoma of the Parotid Gland: Report of a Case and Review of Literature

We reported a case of malignant oncocytoma arising from the right parotid gland through neck metastasis. In 1992, the patient was treated by surgical removal of a lymph-node mass, diagnosed as malignant unclassified tumor. In 1995, a right parotid gland tumor and right neck lymph-node masses occurred. We suspected the patient of having a malignant tumor of the right parotid gland through neck metastasis, especially recurrence of the previous clear-cell carcinoma. In July 1995, a right-side total parotidectomy and a neck dissection were carried out. A definite diagnosis was based on histological findings of the resected tumor as malignant oncocytoma: large eosinophilic granular cells were detected, and electron-microscopically, cytoplasms of tumor cells were rich in mitochondria with no encapsulation, perineural and intravascular invasion, and metastases to the cervical lymph nodes. Additional therapy such as chemotherapy and irradiation were not applied. To date, he has had no evidence of disease for 6 years

Invasive Fungal Rhinosinusitis with Orbital Apex Syndrome Leading to Brain Abscess in a Patient with Ulcerative Colitis

We report the case of a 65-year-old male who presented with a 1-week history of right periorbital pain and progressive visual loss. He had a history of ulcerative colitis and was taking oral corticosteroids and mesalazine. Neurological and radiological examination demonstrated a rare case of invasive fungal rhinosinusitis that began with orbital apex syndrome. Initial endoscopic sinus surgery was performed and fungal culture identified Aspergillus fumigatus. Although antifungal treatment was started empirically before the operation, the patient had improved orbital pain but continued to have decreased right vision. Five months after the first surgical procedure, his condition deteriorated, including loss of consciousness, and a right temporal lobe abscess was found and surgically drained. Since then, the patient received antifungal treatment for 4 years without recurrence. Invasive fungal rhinosinusitis with orbital apex syndrome should be treated with long-term postoperative antifungal medication. It should be noted that even in immunosuppressive individuals such as ulcerative colitis, fungal rhinosinusitis with orbital apex syndrome may become severe

Application of an Immobilization Device for the Modified Killian’s Method

[Background] The hypopharynx is a closed space that is difficult to observe. The modified Killian’s (MK) method was introduced to obtain wider exposure. However, this method requires keeping the head forward during the examination. Postural maintenance might be problematic. To use the MK method safely for a thorough endoscopic examination, we introduced a new body immobilization device. The aim of this study was to evaluate the effectiveness of this body immobilization device. [Methods] Twenty-five patients underwent transnasal laryngoscopy using the MK method with the immobilization device. This device consists of a board to place the chest and a shaft. We classified hypopharynx visualization using a 5-point scale, in various combinations of head torsion, Valsalva maneuver, and MK position. Furthermore, we classified the feasibility of the MK method for 54 patients. Age, BMI, and performance status were evaluated by MK position feasibility class. [Results] The MK method with the body immobilization device was completed in all patients. It was significantly associated with higher hypopharyngeal visibility score. BMI and performance status were significantly associated with MK method feasibility. There were no significant differences in hypopharynx visualization scores with versus without this device for the patients that could maintain the MK position on their own. [Conclusion] For patients with poor nutrition or poor ability to perform activities of daily living, it was difficult to maintain the MK position. Thus, this immobilization device might be useful to complete the MK method and provide accurate detection of hypopharyngeal lesions in these patients