Labyrinthine fístulae in chronic otitis media with cholesteatoma

The chronic otitis media with cholesteatoma (COMC) may evoluate to intracranial and extra cranial complications, including the labyrithine fístulae. In this study, we present the evolution of our patients with labyrinthine fístulae. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Ten out 82 patients with COMC had labyrinthine fístulae and underwent surgery from January/2001 to April/2002. They were assessed by clinical exam, computed tomography scans, and pre and postoperative audiogram. RESULTS: Hearing loss, otorrhea, tinnitus and dizziness were present in 100%, 90%,80%, and 40% of the cases. In one patient the fístulae was seen only in the coronal CT-scan, in another patient the fístulae was not seen neither in coronal nor axial images. Among the patients who had tinnitus, 66% referred improvement of this complaint after surgery. DISCUSSION: in the cases without invasion of the perilymphatic space, we noticed a tendency of improvement of the postoperative audiogram pattern and clinical outcome. In the extensive fístulae, on the other hand, there were no clinical changes. CONCLUSION: The CT-scan remains the best exam to assess the COMC with 90% of sensitivity for labyrinthine fístulae. In the stage II we had a good postoperative outcome.A otite média crônica colesteatomatosa (OMCC) pode cursar com complicações intra e/ou extracranianas, entre elas a fístula labiríntica. Neste trabalho, mostramos a incidência e a evolução dos casos de fístula labiríntica decorrentes da OMCC em nosso serviço. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Dez pacientes com fístula labiríntica, do total de 82 pacientes com OMCC, foram submetidos à cirurgia no período de janeiro de 2001 a abril de 2002 e avaliados através de exame otorrinolaringológico completo, tomografia computadorizada e audiometria pré e pós-operatória. RESULTADOS: Perda auditiva, otorréia, zumbido e vertigem estavam presentes em 100%, 90%, 80% e 40% dos casos respectivamente na avaliação clínica pré-operatória. Em um paciente a fístula aparecia apenas nos cortes tomográficos coronais e tivemos um caso de falso-negativo. Dos pacientes com zumbido, 66% apresentaram melhora deste quadro no pós-operatório. DISCUSSÃO: Nos casos de fístula sem invasão do espaço perilinfático (até grau II), notamos uma tendência de melhora dos quadros clínico e audiométrico após a cirurgia. Nas fístulas extensas, por outro lado, o resultado audiométrico se manteve inalterado. CONCLUSÃO: A tomografia continua sendo o exame de escolha para os quadros de OMCC com sensibilidade de 90% para fístulas labirínticas. Nas fístulas grau II a cirurgia apresenta bom resultado funcional.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Distúrbios da Comunicação HumanaUNIFESP, EPM, Depto. de Otorrinolaringologia e Distúrbios da Comunicação HumanaSciEL

Leukotriene B4 mediates γδ T lymphocyte migration in response to diverse stimuli

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141926/1/jlb0323.pd

Trypanosoma cruzi Adjuvants Potentiate T Cell-Mediated Immunity Induced by a NY-ESO-1 Based Antitumor Vaccine

Immunological adjuvants that induce T cell-mediate immunity (TCMI) with the least side effects are needed for the development of human vaccines. Glycoinositolphospholipids (GIPL) and CpGs oligodeoxynucleotides (CpG ODNs) derived from the protozoa parasite Trypanosoma cruzi induce potent pro-inflammatory reaction through activation of Toll-Like Receptor (TLR)4 and TLR9, respectively. Here, using mouse models, we tested the T. cruzi derived TLR agonists as immunological adjuvants in an antitumor vaccine. For comparison, we used well-established TLR agonists, such as the bacterial derived monophosphoryl lipid A (MPL), lipopeptide (Pam3Cys), and CpG ODN. All tested TLR agonists were comparable to induce antibody responses, whereas significant differences were noticed in their ability to elicit CD4+ T and CD8+ T cell responses. In particular, both GIPLs (GTH, and GY) and CpG ODNs (B344, B297 and B128) derived from T. cruzi elicited interferon-gamma (IFN-γ) production by CD4+ T cells. On the other hand, the parasite derived CpG ODNs, but not GIPLs, elicited a potent IFN-γ response by CD8+ T lymphocytes. The side effects were also evaluated by local pain (hypernociception). The intensity of hypernociception induced by vaccination was alleviated by administration of an analgesic drug without affecting protective immunity. Finally, the level of protective immunity against the NY-ESO-1 expressing melanoma was associated with the magnitude of both CD4+ T and CD8+ T cell responses elicited by a specific immunological adjuvant