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

Surgical disaster in temporomandibular joint: Case report

AbstractBackgroundTemporomandibular-ankylosis brings extensive limitations on the patient quality of life. Surgical treatment is frequently necessary associated with a continuous rehabilitation. The anatomy of this region and potential complications of this surgery must be thoroughly known to avoid iatrogenic injuries.Case presentationA young patient underwent surgical treatment of congenital bilateral ankylosis with disastrous consequences such as facial palsy, deafness and cerebrospinal leaks on the right side related to intraoperative trauma involving structures of the external, middle and inner ear.ConclusionSince there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported

Giant Keratocystic Odontogenic Tumor: Three Cases And Literature Review.

A keratocystic odontogenic tumor is a benign intra-bone mass originating from dental lamina or its residue. It represents 2-11% of jaw cysts, and has a slow but aggressive growth. The evaluation of molecular characteristics, immunohistochemistry, and genetic expression currently have no established classification regarding the evolution and pathophysiologic pattern of these lesions. This is a clinical retrospective study with a full analysis of patient history regarding physical evaluation, radiologic images, pathology results, and surgical resection. We performed a major literature review concerning current concepts relating to its biological characterization. Three cases of keratocystic odontogenic tumor were identified. Two of the cases were large, with aggressive behavior and significant bone destruction and recurrence, which had been overlooked for more than a decade. The third case had an early diagnosis, and the treatment led to full recovery and complete healing. The keratocystic odontogenic tumor is a benign lesion with slow growth, which lends itself to a more conservative treatment, even in cases of large lesions. A better understanding of these tumors, both at the biological and molecular level, could lead to guidelines for treatment and prognosis of such patients.25245-5

Study of the relationship between the degree of tinnitus annoyance the presence of hyperacusis✩✩Please cite this article as: Guimarães AC, Carvalho GM, Voltolini MM, Zappelini CE, Mezzalira R, Stoler G, et al. Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis. Braz J Otorhinolaryngol. 2014;80:24-8.

AbstractIntroductionHyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain.AimTo evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus.Materials and methodsRetrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale.ResultsWe analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis.ConclusionHyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved

Evaluation of the Digisonic® SP cochlear implant: patient outcomes and fixation system with titanium screws

Cochlear implants have revolutionized the way patients affected by severe hearing loss experience the world. Neurelec developed a fixation system with two titanium screws that requires no skull bone drilling. OBJECTIVE: To describe the outcomes and procedure-related details of a series of patients implanted with the Digisonic® SP cochlear implant. METHOD: This retrospective study analyzed patients submitted to cochlear implant placement within a period of 18 months. All patients had postlingual hearing impairment. Data was collected from patient charts and standard questionnaires answered by the surgeons in charge of carrying out the procedures. RESULTS: The six patients offered the Digisonic® SP cochlear implants were operated by experienced surgeons. The procedures took 95 to 203 minutes (mean = 135') to be completed, which is less time than what has been described for other fixation approaches. No complications were recorded and hearing improvement was satisfactory. CONCLUSION: The Digisonic® SP cochlear implant developed by Neurelec offered good audiological results for adult patients, shorter surgery time, and no surgical or postoperative complications.O implante coclear para pacientes com disacusia grave/profunda revolucionou o modo com que estes interagem com o meio ambiente. A Neurelec desenvolveu um sistema que permite fixação com uso de dois simples parafusos de titânio, sem necessidade de broqueamento do osso do crânio do paciente. Este artigo teve o objetivo de descrever uma casuística de pacientes submetidos a implante coclear com o Digisonic® SP, para mostrar os resultados cirúrgicos e detalhes do procedimento. MÉTODO: Estudo retrospectivo que avaliou os pacientes, no período de 18 meses, submetidos a implante coclear com o Digisonic® SP. Todos os pacientes eram pós-linguais. Coleta dos dados realizada por meio da análise dos prontuários dos pacientes, além de questionário padronizado aplicado nos cirurgiões que realizaram o procedimento. RESULTADOS: Os seis casos implantados com o Digisonic® SP foram realizados por cirurgiões experientes e o tempo cirúrgico variou de 95 a 203 minutos (média de 135 minutos), que é menor do que o descrito com outras formas de fixação. Não houve nenhum tipo de complicação e o ganho auditivo foi satisfatório. CONCLUSÃO: O implante Digisonic® SP desenvolvido pela Neurelec apresentou bons resultados audiológicos em adultos, tempo de cirurgia menor e não ocorreram complicações cirúrgicas ou pós-operatórias.566

Effect of salinomycin and tiamulin association in broiler chicken diets

A seven week floor pen trial in boxes (1,8 x 1,7 m) were conducted with 648 male and 648 female commercial Ross broilers to determine the effects of association of constant level (60 ppm) of Salinomycin and six levels (0; 10; 15; 20; 30 and 40 ppm) of Tiamulin, in six replications of 36 birds each. The rations for all treatments from 1-11, 12-23, 24-44 and 45-49 days attended the needs according to the NRC-1984 specification. All drugs were withdrawn for the four days pryor to slaughter. Body weights, feed intake and efficiency were recorded at 23 and 49 days of age. Mortality was determined at 49 days of age. When chickens were 1, 35 and 45 days old eighteen birds from each treatment were randomly collected and tested sorologically for Mycoplasma sp. At this same age six birds from each treatment were taked randomly necropsied and submited to score evaluation for macro and microscopic lesions. The differences among treatments were not statistically significant (P>0.05) for any paramethers studies and with the following means: Body weight at 23 days (797.9 g) and 49 days (2,247.0 g). Average daily weight gain (45.0 g). Feed consumption 23 days (1,164 g) and 49 days (4,321 g). Feed efficiency 23 days (1.45) and 49 days (1.92) and mortality 49 days (6.7%). All samples presented no lesions and were negative for Mycoplasma galissepticum rapid soroaglulination. No detrimental effects were observed in broiler performance due to the association of salinomycin (60 ppm) and tiamulin (10 a 40 ppm).A pesquisa foi conduzida no Aviário Experimental do Departamento de Produção Animal da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, em Pirassununga, São Paulo, e teve a finalidade de verificar a possível toxicidade do anticoccidiano salinomicina pela administração simultânea do antibiótico tiamulin na ração. Foram utilizados 1.296 pintos de 01 dia, distribuídos em 36 boxes experimentais e submetidos a 6 tratamentos, com 6 repetições de 36 aves cada. O delineamento experimental foi o de blocos casualizados. Para os tratamentos foram empregados 60 ppm de salinomicina e 0; 10; 15; 20; 30 e 40 ppm de tiamulin. Os dados obtidos indicaram não haver depressão no crescimento das aves, nem tampouco no consumo de ração e conversão alimentar. Não ocorreram lesões nos sacos aéreos e os testes de soroaglutinação rápida para Mycoplasma gallissepticum apresentaram resultados negativos. Tendo em vista os resultados obtidos, pode-se dizer que a adição simultânea de tiamulin e salinomicina em rações de aves para corte, nos níveis utilizados, não acarreta toxicidade

Hormonal induction of ovulation and early weaning in postpartum fertility of homozigous and heterozigous beef cows for the microsatellite BMS3004

O objetivo deste experimento foi comparar a eficiência de um programa hormonal associado ao desmame temporário por 96 horas na indução do estro e ovulação com o desmame definitivo aos 60 dias em vacas de corte. Foram utilizadas 183 vacas de corte amamentando, das raças Charolês (C), Nelore (N) e suas cruzas recíprocas, as quais foram genotipadas como homozigotas (HOM) ou heterozigotas (HET) para o microssatélite (STR) BMS3004, que está localizado no mesmo cromossomo do gene da cadeia do LH. Entre 60 e 80 dias pós-parto (dia 0), as vacas foram distribuídas em dois grupos. No grupo indução hormonal (IH), as vacas (n=87) receberam (dia 0) 250 mg de acetato de medroxiprogesterona por 8 dias, 2,5 mg de benzoato de estradiol (dia 1) e 500 UI de gonadotrofina coriônica eqüina (dia 7). No dia 8, os bezerros foram desmamados por 96 horas. No mesmo dia (dia 8), as vacas (n=96) do outro grupo apenas foram submetidas ao desmame definitivo (grupo DP). Após, procedeu-se 4 dias de inseminação artificial (IA) e, passado esse período, foram entouradas. O primeiro diagnóstico de gestação (DG) foi realizado 60 dias após o período de IA e, o segundo, 60 dias após o final do entoure. As taxas de estro foram maiores nas vacas do grupo IH em relação as do grupo DP. As vacas com condição corporal 2,5 e 3,0 apresentaram menores percentuais de prenhez ao 1ºDG no grupo IH (29,6 e 46,4%) em relação ao grupo DP (56,0 e 72,2%). Os percentuais de prenhez das vacas com índice corporal 65-73 não diferiram entre os grupos IH e DP. As vacas N do grupo IH, apresentaram menor percentual de prenhez ao 1ºDG que as F1 (27,7 vs. 64,2%), mas não diferiram em relação às C (40,0%). No grupo IH, o percentual de prenhez ao 2ºDG foi menor nas vacas HOM do que nas HET. O desmame definitivo precoce mostrou-se mais eficaz no incremento dos percentuais de prenhez em vacas de corte. ___________________________________________________________________________________ ABSTRACTThe aim of this experiment was to compare the efficiency of a hormonal protocol, associated to the temporary weaning for 96 hours, with the definitive weaning at 60 days in beef cows, for the induction of estrus and ovulation. One hundred and eightythree suckled beef cows were used. The breeds of the cows were Charolais (C) and Nellore (N) and their crosses. The animals were genotyped as homozygous (HOM) and heterozigous (HET) for the microsatellite BMS3004, that is localized in the same chromossome of the LH chain gene. The cows were distributed in two groups between 60 and 80 days postpartum (day 0). In the hormonal induction group (HI), the cows (n=87) received (day 0) 250 mg of medroxiprogesteron acetate for 8 days, 2.5 mg of estradiol benzoate (day 1) and 500 UI of eCG (day 7). On day 8, the calves were weaned for 96 hours. In the same day (day 8), the cows (n=96) of the other group were just submitted to early weaning (group EW). Twelve hours after weaning, artificial insemination (AI) was done during four days. After this period, they were mated. The first diagnosis of pregnancy (DP) was performed 60 days after the AI period and, the second, 60 days after the end of mating. The estrus rates were higher in cows from HI group than in those of EW group. In the HI group, the cows with body condition 2.5 and 3.0 presented lower pregnancy rates at the 1st DP (29.6 and 46.4%) than in the EW group (56.0 and 72.2%). The rates of pregnancy in cows with body index 65-73 did not differ between the HI and EW groups. The N cows of HI group presented lower pregnancy rate at 1st DP than the F1 (27.7 vs. 64.2%), but was not different than the C cows (40.0%). In the HI group, the pregnancy rate at the 2nd DP was lower in HOM cows than in the HET ones. The cows in the early definitive weaning group showed to be more efficient than in the hormonal induction group to improve the pregnancy rate