Setting of an endoscopic nasal reference point for surgical access to the anterior base through an anatomical study on cadavers

AbstractIntroductionDiseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are critical for safety.ObjectiveTo measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers.MethodsMeasures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides.ResultsThe measurements were >1.5cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied.ConclusionThe methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics

Anatomical Measurement as a Reference for Functional Endoscopic Sinus Surgery Based on CT Scans and Dissections

Introduction Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to safely perform these surgeries

Cicatricial pemphygoid in the upper aerodigestive tract: report of two cases

Summary: Cicatricial pemphygoid (mucous membrane cicatricial pemphygoid) is a chronic autoimmune inflammatory disease characterized by subepithelial bubbles in mucous membranes and, occasionally on the skin. It may affect the mouth, the nose, pharynx, larynx, the eyes, esophagus, anus, genitals and skin; especially affecting patients between fifty and sixty years of life. Treatment includes systemic steroids and immunosuppressive agents. In the present paper we describe two cases with the active disease, and one of them had sepsis because of using immunosuppressive agents and another that presented supraglottic stenosis requiring tracheostomy. Keywords: scars, pemphygoid, aerodigestive trac

RT-PCR cytokine study in patients with allergic rhinitis

Rinite alérgica é uma doença que decorre de um processo inflamatório da mucosa nasal conseqüente à reação de hipersensibilidade a alérgenos inalatórios e, eventualmente, alimentares. É mediada por IgE, envolvendo diferentes células, mediadores e citocinas. OBJETIVO: Avaliar as transcrições para as seguintes citocinas: IL-4, IL-5, IL-8 e IFN-gama, particularmente importantes no processo alérgico nasal, principalmente IL-4 e IL-5. Neste estudo, optou-se por avaliar os pacientes atópicos fora das crises alérgicas, com a finalidade de se conhecer as expressões das citocinas neste período. MATERIAL E MÉTODO: Realizou-se um estudo transversal e prospectivo, selecionando-se 30 pacientes, sendo 13 pacientes portadores de rinite alérgica paucissintomáticos e 17 pacientes não-atópicos. Os grupos foram selecionados através da história, do exame clínico otorrinolaringológico e do teste alérgico cutâneo - Prick Test. O perfil das citocinas foi pesquisado nos fragmentos de mucosa nasal, através da RT-PCR semiquantitativa, escolhida por apresentar boa reprodutibilidade e especificidade, utilizando-se como referência o gene da Beta-actina. RESULTADOS: Os valores de IL-5, IL-8, IFN-gama mantiveram-se homogêneos em relação ao grupo controle. A IL-4 apresentou diferença com significância estatística. CONCLUSÃO: Os pacientes alérgicos paucissintomáticos apresentaram normalização da expressão das citocinas na mucosa nasal à exceção de IL-4.Allergic rhinitis is an inflammatory reaction of the nasal mucosa, in consequence of an IgE mediated hypersensitive reaction to inhaling allergens, involving different mediators and cytokine cells. AIM: The purpose of this study was to evaluate the transcriptions for IL-4, IL-5, IL-8 and IFN-gama, particularly important in the nasal allergy process, especially IL-4 and IL-5. For this study we decided to evaluate atopic patients who were free from allergic crises, with the purpose of knowing the cytokine expressions during this period. MATERIALS AND METHODS: Another prospective and transversal study was carried out, selecting 30 patients, 13 of these patients were pauci-symptomatic and 17 were non atopic. The groups were selected by means of a medical interview, an otolaryngologic clinical exam and allergy skin tests - Prick Test. The cytokines were investigated in fragments of the nasal mucosa, using RT-PCR - chosen because it has good reproducibility and specificity. RESULTS: IL-5, IL-8, IFN-gama cytokine values were kept homogeneous in relation to the control group. Only IL-4 presented significant statistic differences. CONCLUSION: Asymptomatic patients with allergic rhinitis presented with normalization of cytokine expression in the nasal mucosa, with exception of IL-4

Setting of an endoscopic nasal reference point for surgical access to the anterior base through an anatomical study on cadavers

Abstract Introduction: Diseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are critical for safety. Objective: To measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers. Methods: Measures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides. Results: The measurements were >1.5 cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied. Conclusion: The methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics

Chemical and cytological analysis of cerebral spinal fluid after intrathecal injection of hypodense fluorescein

ABSTRACT INTRODUCTION: Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal fluorescein. OBJECTIVE: A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein. METHODS: Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48 h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells. RESULTS: The yellow-greenish color of CSF remained after 48 h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0-24 h and 0-48 h. In group 2, an increase in cell count was observed between 24 h and 48 h (p = 0.019). In both groups, there was an increase of neutrophils between 0 and 48 h (p = 0.048) and a decrease between 24 and 48 h (p = 0.05). CONCLUSION: Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48 h and an increase of neutrophils at 24 h, with a subsequent decrease at 48 h with no correlation with symptomatology

Brazilian Journal of Otorhinolaryngology

p.673-679A rinite alérgica acomete 10 a 30% da população, interferindo na qualidade de vida e na capacidade produtiva. Está associada à sinusite, otite, roncopatias e asma. A Rupatadina é um anti-histamínico de segunda geração, com elevada afinidade ao receptor histamínico H1 e potente inibição do fator ativador plaquetário (PAF). Tem rápido início de ação, longa duração e reduz os efeitos crônicos da rinite. Objetivo: Avaliar a eficácia e segurança da rupatadina no tratamento da rinite alérgica persistente. Material e Método: Estudo multicêntrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o período de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade após 1 e 2 semanas. Resultados: Redução do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com exceção da obstrução e secreção nasal, a partir do segundo dia (P<0,001). A frequência de eventos adversos foi 19,9%, sendo 27,7% na 1ª semana. Conclusões: A rupatadina é eficaz no controle da rinite alérgica persistente, é segura e apresenta baixos índices de efeitos colaterais

Brazilian Journal of Otorhinolaryngology

p.673-679A rinite alérgica acomete 10 a 30% da população, interferindo na qualidade de vida e na capacidade produtiva. Está associada à sinusite, otite, roncopatias e asma. A Rupatadina é um anti-histamínico de segunda geração, com elevada afinidade ao receptor histamínico H1 e potente inibição do fator ativador plaquetário (PAF). Tem rápido início de ação, longa duração e reduz os efeitos crônicos da rinite. Objetivo: Avaliar a eficácia e segurança da rupatadina no tratamento da rinite alérgica persistente. Material e Método: Estudo multicêntrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o período de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade após 1 e 2 semanas. Resultados: Redução do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com exceção da obstrução e secreção nasal, a partir do segundo dia (P<0,001). A frequência de eventos adversos foi 19,9%, sendo 27,7% na 1ª semana. Conclusões: A rupatadina é eficaz no controle da rinite alérgica persistente, é segura e apresenta baixos índices de efeitos colaterais

Reprodutibilidade do estadiamento endoscópico tridimensional da polipose nasal Reproducibility of the three-dimensional endoscopic staging system for nasal polyposis

A polipose nasossinusal é um processo inflamatório crônico da mucosa nasal, caracterizado pela presença de pólipos nasais múltiplos e bilaterais. Vários tipos de medicações têm sido usados no seu tratamento. Para estudar o resultado de diferentes formas de tratamento, é preciso alguma forma de estadiamento. OBJETIVOS: Apresentar um novo método endoscópico de estadiamento, baseado na endoscopia nasal e na avaliação tridimensional dos pólipos, comparar sua reprodutibilidade entre outros dois métodos já difundidos. FORMA DE ESTUDO: Estudo de coorte histórica com corte transversal. MATERIAL E MÉTODO: Três examinadores avaliaram exames de 20 pacientes portadores de polipose nasossinusal em diferentes momentos, antes e 15 e 30 dias após o início de um tratamento com prednisona, na dose de 1 mg/kg/dia por 7 dias. Foi avaliado o grau de concordância entre os examinadores para cada método, utilizando-se o Kappa múltiplo para análise estatística. RESULTADOS: Os três métodos mostraram-se reprodutíveis, sendo que o método proposto apresentou menor concordância entre os examinadores. CONCLUSÃO: O estadiamento proposto mostrou-se reprodutível, apesar de apresentar menor concordância do que os outros dois estadiamentos.<br>Nasal Polyposis is a chronic inflammatory process of the nasal mucosa, characterized by multiple and bilateral nasal polyps. Different drugs have been used in its treatment. In order to study the results of different treatment modalities it is necessary to have some kind of staging. AIM: to present a new endoscopic staging method, based on nasal endoscopy and on the three-dimensional nasal polyp assessment; and compare its reproducibility with that from two other systems already established in the literature. STUDY DESIGN: Cohort study. MATERIAL AND METHODS: Three experts assessed the exams of 20 patients with nasal polyposis at different times, before, at 15 and at 30 days after the start of oral prednisone, 1 mg/kg/day, during 7 days. We assessed the agreement rate among the experts, using Kappa for statistic analysis. RESULTS: The three methods were reproducible, and the method hereby proposed had the least agreement among the examiners. CONCLUSIONS: the three-dimensional staging system proposed proved reproducible, despite showing less agreement among the examiners than the other as the other two methods