Arnaldo Guilherme

Low-level laser therapy in the prevention and treatment of chemotherapy-induced oral mucositis in young patients.

OBJECTIVE A pilot clinical study was conducted to evaluate the efficacy and feasibility of low-level laser therapy (LLLT) in the prevention and treatment of chemotherapy (CT)-induced oral mucositis (OM) in young patients. BACKGROUND DATA Besides compromising the patients nutrition and well-being, oral mucositis represents a portal of entry into the body for microorganisms present in the mouth, which may lead to sepsis if there is hematological involvement. Oncologic treatment tolerance decreases and systemic complications may arise that interfere with the success of cancer treatment. LLLT appears to be an interesting alternative to other approaches to treating OM, due to its trophic, anti-inflammatory, and analgesic properties. MATERIALS AND METHODS Patients undergoing chemotherapy (22 cycles) without mucositis were randomized into a group receiving prophylactic laser-irradiation (group 1), and a group receiving placebo light treatment (group 2). Patients who had already presented with mucositis were placed in a group receiving irradiation for therapeutic purposes (group 3, with 10 cycles of CT). Serum granulocyte levels were taken and compared to the progression of mucositis. RESULTS In group 1, most patients (73%) presented with mucositis of grade 0 (p = 0.03 when compared with the placebo group), and 18% presented with grade 1. In group 2, 27% had no OM and did not require therapy. In group 3, the patients had marked pain relief (as assessed by a visual analogue scale), and a decrease in the severity of OM, even when they had severe granulocytopenia. CONCLUSION The ease of use of LLLT, high patient acceptance, and the positive results achieved, make this therapy feasible for the prevention and treatment of OM in young patients.

Reconhecimento de padrão temporal e escuta dicótica em descendentes de japoneses, falantes e não-falantes da língua japonesa

The aim of this study was to analyze the auditory behavior in Pitch(PPS) and Duration(DPS)Pattern Sequence tests and in the Dichotic Listening (Dichotic Digits Test/DDT) of familiar and unfamiliar words (Staggered Spondaic Words/SSW) in Japanese descendants that speak Japanese and Japanese descendants that do not speak Japanese, and to compare these findings with a group of non-Japanese descendants who have no contact with the Japanese language. METHOD: 60 High School graduates aged 17 to 40 years were evaluated. Subjects were divided into three groups: GJJ, Japanese descendants that speak Brazilian Portuguese and Japanese; GJP, Japanese descendants that speak Portuguese and do not speak Japanese; GBP non-oriental descendants that speak Brazilian Portuguese. All subjects filled in a questionnaire about their languages and musical abilities. Their ability in pattern-recognition tests was assessed by the PPS and DPS tests, their ability to recognize familiar words was tested by DDT and their ability to recognize unfamiliar words was tested by SSW. Results. GJJ and GJP showed higher performances than the group of Brazilians (GBP) in the PPS. RESULTS: show a statistically significant difference among the groups with a higher mean for the SSW results in GJJ compred to GJP and GBP. CONCLUSION:The results of SSW test seem to be influenced by bilingualism.

Variações anatômicas e sinusopatias: estudo por tomografia computadorizada

Introduction: Computed tomography has been increasingly used both to identify and to evaluate anatomy variations of nasal cavities that can lead to the development of sinusitis. Purpose: The purpose of the present study is to determine the incidence of mucosal abnormalities in paranasal sinuses found in CT scans of patients with symptons of sinusitis and analyze the correlation between sinusitis and presence of Hallers cell, concha bullosa and nasal septal deviation located in middle meatus. Study Design: Clinical retrospective. Material and Method: Paranasal sinus CT scans were obtained in 150 patients aged 13 years or more, from July 1999 to October 2001. The CT scans were performed in the Department of Radiology of Universidade Federal de Sao Paulo - Escola Paulista de Medicina. Patients with history of skull base or sinus surgery and tumor in these regions were excluded. Results: 70% of patients present mucosal abnormalities at least in one paranasal sinus. Maxillary sinusitis were observed in 52,7% of sinus, ethmoidal sinusitis in 28,0%, sphenoidal sinusitis in 13,0% and frontal sinusitis in 8,3%. Concha bullosa was observed in 33,3% of nasal cavities, nasal septal deviation (located in middle meatus) in 23,3% and Hallers cell in 9,3%. Conclusions: The most affected paranasal sinuses were: maxillary, ethmoid, sphenoid and frontal. Correlation between sinusitis and presence of Hallers cell, concha bullosa and nasal septal deviation (located in middle meatus) was not observed.

Disfagia orofaríngea na distrofia miotônica: avaliaçäo fonoaudiológica e análise nasofibrolaringoscópica

We here in present twenty myotonic dystrophy of Steinert patients with the main objective to evaluate and classify the oropharyngeal swallowing by the phonoaudiological clinical and nasofibrolaryngoscopical analysis. The age of the patients varied from 12 to 53 years, being 13 male and 7 female. The mean data: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing disorders present in 95%, when clinically evaluated, and in 70% when evaluated by the nasofibrolaryngoscopy; (4) higher difficulty to swallow consistent feed; (5) stomatognatical muscles very altered, pharyngeal phase disorders, cough after swallowing, antecedents of pneumonia and complaints of chewing/swallowing presented statistically significant correlation with severity of the sickness. The analysis were able to evaluate statical and functionally the involved structures in the swallowing, having got to take part of the routine of attendance to the patients with myotonic dystrophy of Steinert.

Matrix Metalloproteinase 2: an important genetic marker for cholesteatomas

AIM This study is to determine the MMP2s presence in cholesteatomas and whether complicating cholesteatomas show a higher immunohistochemical expression of matrix metalloproteinase 2. Cholesteatoma produces enzymes that cause bone erosion like matrix metalloproteinase 2 (MMP2). MATERIAL AND METHODS We analyzed the expression of MMP2 in invasive (causing complications) compared to latent cholesteatomas (not causing complications). A cross-sectional study with nineteen slides and paraffin blocks of cholesteatomas derived from mastoidectomies were located and processed, including 8 invasive and 11 latent cholesteatomas. Immunohistochemical technique was empregated to MMP2. RESULTS The results are expressed as 0, + (to low), ++ and +++(high) according to the quantity and color of the immunohistochemical staining of MMP2. Higher expression of MMP2 was observed in 7 (87.5%) of the 8 invasive cholesteatomas. With respect to latent cholesteatomas, higher expression of MMP2 was observed in 27.3% (3 cases), with Fishers exact test indicating a significant difference (p=0.015). CONCLUSIONS Cholesteatoamas express MMP2 and Invasive cholesteatomas had high MMP2 compared to latent cholesteatomas.

Temporal Processing and Dichotic Listening in bilingual and non-bilingual descendants

UNLABELLED The aim of this study was to analyze the auditory behavior in Pitch(PPS) and Duration(DPS)Pattern Sequence tests and in the Dichotic Listening (Dichotic Digits Test/DDT) of familiar and unfamiliar words (Staggered Spondaic Words/SSW) in Japanese descendants that speak Japanese and Japanese descendants that do not speak Japanese, and to compare these findings with a group of non-Japanese descendants who have no contact with the Japanese language. METHOD 60 High School graduates aged 17 to 40 years were evaluated. Subjects were divided into three groups: GJJ, Japanese descendants that speak Brazilian Portuguese and Japanese; GJP, Japanese descendants that speak Portuguese and do not speak Japanese; GBP non-oriental descendants that speak Brazilian Portuguese. All subjects filled in a questionnaire about their languages and musical abilities. Their ability in pattern-recognition tests was assessed by the PPS and DPS tests, their ability to recognize familiar words was tested by DDT and their ability to recognize unfamiliar words was tested by SSW. Results. GJJ and GJP showed higher performances than the group of Brazilians (GBP) in the PPS. RESULTS show a statistically significant difference among the groups with a higher mean for the SSW results in GJJ compared to GJP and GBP. CONCLUSION The results of SSW test seem to be influenced by bilingualism.

Análise do clearance mucociliar nasal e dos efeitos adversos do uso de CPAP nasal em pacientes com SAHOS

Since 1981 the use of positive airway pressure through the nasal CPAP has been considered the main clinical treatment of the SAOS- sleep obstructive apnea syndrome, despite its low adhesion on a long- term. Some authors report that the nasal complaints from the continuous positive airway pressure in the nasal cavity are the main causes for the therapy discontinuance. This would probably occur because the treatment would lead to epithelium alterations and changes in the mucociliarytransport and hence, a greater number of upper respiratory infections. AIM: To evaluate the nasal mucociliary clearance in patients with SAHOS under nasal CPAP use through saccharin test, and correlate the adverse effects of this therapy with the treatment endurance and the pressure level used in it. STUDY DESIGN:Clinical study case-control. MATERIAL AND METHOD: Twenty five patients, carriers of SAHOS - between their 18 and 70 - submitted to nasal CPAP use for one month, were followed-up at the Instituto do Sono (UNIFESP-EPM) and subjected to the saccharin test. The results were compared to a group of 25 normal individuals. RESULTS: There was no statistical difference among the groups regarding the saccharin test. The adverse effects were present in 84% of the sample, being 60% for nasal dryness and 36% for nasal obstruction. CONCLUSIONS: The mucociliary transport stays normal in the SAHOS group submitted to nasal CPAP use and the nasal obstruction and nasal dryness do not present correlation with the treatment time and pressure level used by the device.

Hemorragia pós-operatória em 397 adenotonsilectomias realizadas nos Hospitais Geral de Pirajussara (HGP) e Hospital Estadual de Diadema (HED) / UNIFESP-EPM

Adenotonsillectomy is a common procedure in otorhinolaryngology, and it is recommended for tonsil and adenoid hypertrophy. Hemorrhage is the most common complication of this procedure. In this study, we present the incidence of postoperative hemorrhage following adenotonsillectomy carried out at Hospital Geral de Pirajussara (HGP) and Hospital Estadual de Diadema (HED), whose purpose was to identify cases of bleeding. STUDY DESIGN: Historic transversal cohort. MATERIAL AND METHOD: We analyzed 397 patients who underwent adenoidectomy, tonsillectomy and adenotonsillectomy. Adenotonsillectomy represented 91.7% of all surgeries. Patients were aged 2 to 39 years. Preoperative tests were conducted in all patients, with weekly follow-up up to the first month after surgery. RESULTS: 397 surgeries were performed in the hospitals (HGP and HED), 364 adenotonsillectomies (91.7%), 16 tonsillectomies (4.03%) and 17 adenoidectomies (4.28%). There were 5 cases of postoperative bleeding, 3 of which occurred in the early postoperative period and 2 in the middle postoperative period. There were no reports of bleeding in late postoperative period. The incidence of hemorrhage was 1.37% (5 out of 364 cases). CONCLUSION: Postoperative hemorrhage possibly results from poor surgical technique and blood clotting disorder in some patients.

Effects of ionizing radiation on bone neoformation: histometric study in Wistar rats tibiae

PURPOSE Comparing the ionizing radiation effects on bone neoformation of rats tibiae previously submitted to radiotherapy with a single dosage of 30Gy with the contralateral tibiae that have received secondary radiation. METHODS In thirty male Wistar rats, 30 days before surgical procedure when round defects would be created on the bone, the right tibia was irradiated with 30Gy and the left tibia received a calculated secondary radiation dose of 7Gy. Sacrifices were performed after 4, 7, 14, 21, 56 and 84 postoperative days and both tibiae were removed for histological processing. RESULTS The left tibiae that received the dose of 7Gy has shown more bone neoformation from 14(th) postoperative days, giving evidences of less damage to cellular population responsible by bone neoformation. On the other hand, the dose of 30Gyon right tibiae did not exhibit significant differences among the periods, suggesting damage of long-lasting or even permanent duration. CONCLUSION Tibiae submitted to radiation dose of 30Gy have shown more damage to bone cells than tibiae that received secondary radiation dose of 7Gy, especially observed on 14(th), 56(th) and 84(th) postoperative days.

A ansiedade materna durante o diagnóstico da deficiência auditiva: contribuição da intervenção psicológica

The goal of this paper was to evaluate the level of anxiety of mothers of hearing impaired children through the application of the Sate-Trait Anxiety Inventory (STAI), before and after audiological diagnosis procedures, counseling and psychological orientation were carried out by an interdisciplinary team. The participants were 164 mothers of children under six years old. During the psychological sessions we observed that the group helped the mothers, through sharing of experience among people that have experienced the same problems. The results indicated that the levels of Trait Anxiety and State Anxiety were reduced in a statistically significantly manner on the second application on the STAI. The highest levels of reduction were noticed among married mothers, aged 21 to 30 years, from low-medium social-economical level, incomplete elementary education, with children aged three to four years, with bilateral severe hearing loss.