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

Neck Neurofibromatosis: clinical and surgical features

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The effects of frenotomy on breastfeeding

Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. Objective : To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints. Material and Methods : Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups – control and post-frenotomy – were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis. Results : After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomy Conclusions : after lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy

The effects of frenotomy on breastfeeding

Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mother's complaints. Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups – control and post-frenotomy – were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis. After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomy. After lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.23215315

Papilomatose recorrente respiratoria na laringe : caracteristicas epidemiologicas, clinicas e os resultados de tratamento com laser de CO2

Orientador : Ester M. D. NicolaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: a presente trabalho constou do estudo retrospectivo de 72 pacientes, entre adultos e crianças de ambos os sexos, portadores de papilomatose recorrente respiratória na laringe, diagnosticados e acompanhados na Unidade Multidisciplinar de Medicina Laser e Serviço de Laringologia do Ambulatório de atorrinolaringologia da Unicamp, no período de março de 1986 até outubro de 2000. Primeiramente, foi realizado o estudo dos prontuários dos pacientes portadores da moléstia, objetivando conhecer os aspectos epidemiológicos e clínicos em nosso meio. Posterionnente, foram avaliados os resultados do tratamento com laser de caz, segundo técnica por nós desenvolvida, com relação às complicações, disseminação e recidiva. Na casuística apresentada, observou-se que esta enfermidade não tem prevalência quanto ao sexo e cor, atingindo uma população de baixo nível econômico. Apresenta uma distribuição por idade com característica bimodal, assimétrica, com uma incidência maior em jovens, próximos dos 5 anos, e uma outra em adultos entre os 25 e 35 anos. Entre os jovens, observou-se uma incidência maior de primogênitos e antecedentes de parto vaginal.Nos adultos tais características não foram encontradas. A disfonia, em ambas as populações, foi o sintoma mais importante e as regiões mais afetadas pela doença foram a glote e o vestíbulo da laringe. Entre os jovens as lesões se caracterizaram por serem exofiticas, múltiplas, morifonnes, coalescentes e de implantação séssil e pediculada e, entre os adultos, as lesões apresentaram-se únicas, verrucosas, leucoplásicase sésseis. Quanto ao tratamento com laser de caz, apresentamos e discutimos a técnica, na qual foram utilizadas duas densidades de potência, uma de corte (Dp max), próxima dos 35,0 W/mmz, para desobstrução da via respiratória, e uma de coagulação (Dp min), próxima dos 8,0 W/mmz, para a' desnaturação protéica dos tecidos. As complicações consideradas e encontradas foram: estenose de laringe, fibrose das pregas vocais e traqueotomias e todas abaixo dos índices da literatura. A disseminação dos brotos papilomatosos ocorreu, apenas entre a população jovem, tendo sido perfeitamente controlada durante o tratamento. Em mais da metade da população estudada, não foi verificada a presença de recidivas em três anos de acompanhamentoAbstract: A retrospective study of 72 patients with laryngeal recurrent respiratory papillomatosis was performed, from march 1986 to october 2000, at "Unidade Multidisciplinar de Medicina Laser" and "Serviço de Laringologia do Ambulatório da Unicamp", where they were diagnosed and folIowed. The study group was composed by adults and children from both sexo Their records were analysed in order to know epidemiology and clínical aspects. Treatment with CO2 laser was employed according to the technique we developed. Complications, dissemination and recurrence resulting from such treatments were also evaluated. The casuistry demonstrates that the disease affects low class patients, regardless of sex or coloro It shows an asymmetric bimodal distribution by age, being the incidence higher both in children around five years old and in adults from 25 to 35 years old. Among children, there was a higher incidence of first-borns and vaginal delivery. Such characteristicswere not found in adults. Dysphonia was the most important sympton found in both population and glottis and larynx vestible were the most affectted areas. In children, lesions were multiple, exofitics, mulberry-like, coalescent, with sessile and peduncled implantation. In adults, lesionswere unique, verrucous, leukoplasic and sessile. Regarding CO2 laser, two power densities were used: one for debuIking (Dpmax), around 35,0 W/mm2,for deobstruction the respiratory tract and the other one of coagulation (Dpmin), around 8,0 W/mm2, in order to denaturate tissue proteins. The complications were larynx stenosis, fibrosis of the vocal folds and tracheotomies, alI of them fewer than those found in literature. Dissemination of laryngeal papilloma occurred only in the young population, being perfectly controlIed during treatment. More than half of the studied population had not presented any recurrence in three years of folIow uDoutoradoOtorrinolaringologiaDoutor em Ciências Médica

Diagnostico de neoplasias malignas atraves da ação fotodinamica do derivado de hematoporfirina (HpD) : desenvolvimento de modelo experimental local

Orientador : Ester Maria Danielli NicolaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Neste trabalho, apresentamos os resultados experimentais de detecção de tumores malignos através da terapia fotodinâmica - PDT (do inglês, Photodynamic therapy) com o uso do derivado de hematoporfirina - HpD (do inglês Hematoporphyrin derivative), ativado por fonte de luz com comprimento de onda em torno de 365nm. Os resultados obtidos comprovam que o fotossensibilizador utilizado apresenta maior retenção nos tecidos malignos em relação ao tecido normal, servindo como delineador (Iocalizador) através de fluorescência avermelhada. Os estudos foram realizados em modelo experimental, especialmente montado para esse fim, utilizando tumores malignos do tipo sarcomatoso implantados em ratas, lâmpada ultravioleta e HpD preparado em nosso meio. São descritas a montagem e a metodologia empregadas neste modelo, que permitiram o presente estudo e que certamente servirão de embasamento em futuras pesquisas e/ou aplicações clínicas. Foi discutido, também, o modelo fotográfico empregado para efeito de documentação. A revisão bibliográfica da PDT é apresentada com seus aspectos históricos, físico-químicos, biológicos e aplicações clínicas, chamando a atenção para essa modalidade de diagnóstico e tratamento do câncer, desconhecida em nosso meio.Abstract: In this study, we present experimental results on the detection of malignant tumors using photodynamic therapy with the use of a hematoporphyrin derivative activated by a light source with a wavelength of approximately 365nm. The results showed that the photosensitizer used presented greater retention on the malignant tissues when compared with normal tissue, serving as a localizer by means of red fluorescence. An experimental model was created specially for this study utilizing sarcomatose malignant tumors implanted in female rats, an ultraviolet light and the hematoporphyrin derivative prepared in our laboratory. The methodology and the preparation of the model is described, which undoubtedly will serve as a basis for future studies and/or clinical applications. We also discuss the photographic model used for documentation. The bibliographic revision of photodynamic therapy is presented with historical, physical-chemical and biological aspects as well as clinical applications, paying special attention to the diagnostic and treatment of cancer, which is unknown in our milieu.MestradoMestre em Ciências Médica