Complicações rinossinusais após descompressão orbital em técnica externa e endonasal combinada Sinus complications after orbital decompression by combined external and endonasal technique

Muitas técnicas de descompressão orbital têm sido utilizadas no tratamento da oftalmopatia por Graves. Recentemente, introduziu-se a cirurgia endoscópica endonasal na descompressão de órbita, como técnica isolada ou combinada com as já existentes, acreditando proporcionar melhor visão da parede medial da órbita e menor incidência de infecção bacteriana quando a parede medial é acessada por endoscópio. OBJETIVO: Avaliar as complicações após a descompressão orbital por técnica combinada assistida por endoscopia na prevenção de infecção rinossinusal. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: 16 pacientes 18 órbitas foram submetidos à descompressão orbital no Setor de Órbita do Departamento de Oftalmologia da Escola Paulista de Medicina UNIFESP. RESULTADOS: Quatro pacientes, durante o acompanhamento por tomografia no pós-operatório, apresentaram velamento do seio maxilar ou frontal, sem sintomatologia. CONCLUSÃO: A descompressão orbital por via externa combinada com a via endonasal auxiliada por endoscopia mostrou-se eficaz na prevenção de sinusite clinicamente manifesta e suas complicações, embora no acompanhamento tomográfico 22% dos pacientes apresentaram velamento do seio maxilar ou frontal.<br>Many techniques of orbital decompression have been used in the treatment of Graves ophthalmopathy. Recently endonasal endoscope surgery was introduced in the orbital decompression, as an isolated technique, or combined with existing techniques hopefully to give better visualization of medial wall and a lower incidence infection when the medial wall is acessed. AIM: To evaluate orbital decompression combined with endoscope in prevention of bacterial infection, we relate three cases of assyntomatic patients with computer tomography control of facial sinus presenting opacification of maxillary or frontal sinus. STUDY DESIGN: Clinical Prospective. MATERIAL AND METHOD: 16 patients with 18 orbita procedures underwent orbital decompression, in the Ophthalmology Department at the Escola Paulista de Medicina-UNIFESP an orbital decompression was obtained by combined technique using endonasal access with an endoscope. RESULTS: Four patients during postoperative CT scan presented assymtomatic opacification of the maxillary or frontal sinuses. CONCLUSION: A combination of endoscopy in orbital decompression by external approach showed the effectiveness in prevention of sinusitis clinically manifested and its complications, although a longer time of follow-up is needed to understand better radiological findings 22% presented opacification of the sinuses and their consequences

Remodeling and Repair In Rhinosinusitis

Remodeling refers to the development of specific but potentially irreversible structural changes in tissue. Caucasian eosinophilic chronic rhinosinusitis (CRS) with polyps associated or not with cystic fibrosis was discriminated by edema from CRS without nasal polyps, characterized by extensive fibrotic fields. However, changes in epithelial and extracellular matrix structures are common findings in all types of chronic inflammatory diseases of upper airways, but rarely specific and highly variable in extend. Recent studies have shown that remodeling in CRS appears to occur in parallel, rather than purely subsequent to inflammation. Furthermore,some preferential remodeling associations can be recognized. Tremendous efforts have been put in research on coagulation factors,cytokines,growthfactors,and proteases supporting all phases of upper airway remodeling. The current exploration of other CRS sub-groups and of the particular link with concomitant asthma aims to optimize the classification of CRS and its staging modes and to develop novel therapies

Filaggrin gene mutations and new SNPs in asthmatic patients: a cross-sectional study in a Spanish population

BACKGROUND: Several null-mutations in the FLG gene that produce a decrease or absence of filaggrin in the skin and predispose to atopic dermatitis and ichthyosis vulgaris have been described. The relationship with asthma is less clear and may be due to the influence of atopy in patients with associated asthma. METHODS: Four hundred individuals were included, 300 patients diagnosed with asthma divided into two groups according to their phenotype (allergic and non-allergic asthma) and 100 strictly characterized controls. The coding region and flanking regions of the FLG gene were amplified by PCR. We proceeded to the characterization of potential gene variants in that region by RFLP and sequencing and analysed their association with lung function parameters, asthma control and severity, and quality of life. RESULTS: We identified two null-mutations (R501X and 2282del4), seven SNPs previously described in databases and three SNPs that had not been previously described. One of the SNP identified in this study (1741A > T) was more frequently detected in patients with non-allergic asthma, worse FVC, FEV1 and PEF values and a higher treatment step. In addition, lowered spirometric values were observed in the non-allergic group carrying any of the nonsynonymous SNPs. CONCLUSIONS: In the association study of genetic variants of the FLG gene in our population the 1741A > T polymorphism seems to be associated with non-allergic asthma