Atílio Maximino Fernandes

Mechanism of action of glucocorticoids in nasal polyposis.

UNLABELLED Glucocorticoids (GC) are the drugs of choice for the clinical treatment of nasal polyposis, according to the medical literature. Its mechanism of action in the regression of clinical symptoms and polyps, however, is not fully understood. The topical and/or systemic use of glucocorticoids lead to variable expression of cytokines, chemokines and lymphokines, as well as changes in cells. It is known that GC suppresses the expression of pro-inflammatory cytokines, chemokines and adhesion molecules such as ICAM-1 and E-selectin; GC also stimulate the transcription of anti-inflammatory cytokines such as TGF-b. GC suppress pro-fibrotic cytokines related to polyp growth, such as IL-11, the basic fibroblast growth factor (b-FGF), and the vascular endotelial growth factor (VEGF). The action of GC depends fundamentally on their interaction with receptors (GR); certain subjects have a degree of resistance to its effect, which appears to be related with the presence of a b isoform of GR. GC also act variably on the genes involved in immunoglobulin production, presentation, and antigen processing. AIM We present a review of the literature on the mechanisms of GC action in nasal polyosis. CONCLUSION Understanding the mechanism of action of GC in nasal polyposis will aid in the development of new, more efficient, drugs.

Expressão dos genes que codificam as proteínas anexina-1 e galectina-1 nos pólipos rinossinusais e sua modulação pelo glicocorticoide

A fisiopatologia da polipose rinossinusal nao e totalmente compreendida, apesar de varias hipoteses em relacao ao seu processo inflamatorio. OBJETIVOS: Estudo prospectivo da expressao dos genes das proteinas, anexina-1 e a galectina-1, que tem acao anti-inflamatoria, e sua modulacao pelo glicocorticoide. MATERIAL E METODOS: Onze pacientes portadores de polipose rinossinusal tiveram biopsiados seus polipos em dois momentos: na ausencia de glicocorticoide sistemico, e na sua presenca. Nas duas amostras, foi avaliada a expressao desses genes e comparada com a expressao na mucosa nasal normal do meato medio. RESULTADOS: Verificou-se que a media de expressao dos genes que codifica a anexina-1 e galectina-1 estava predominantemente aumentada, independente do uso do glicocorticoide em relacao a mucosa nasal controle. Entretanto, nos polipos sem uso de corticoide, a media de expressao do gene da anexina-1 foi significativamente maior do que nos polipos que estavam sob uso de glicocorticoide. Com relacao a galectina-1 nao houve diferenca significativa entre as medias de expressao antes e apos o uso de glicocorticoide sistemico. CONCLUSAO: Os genes apresentaram um aumento da expressao na mucosa nasal polipoide, independente do uso do glicocorticoide, porem a relacao destes dois genes das proteinas anti-inflamatorias com o glicocorticoide nao ocorreu da mesma maneira.

Gene expression analysis reveals novel altered genes in nasal polyps

Nasal polyposis (NP) is a chronic inflammatory disease of the nasal mucosa characterized by the infiltration of inflammatory cells, mainly eosinophils. Although nasal polyposis occurs in 4% of the population, its physiopathology remains unclear. The aim of this study was to identify and characterize differentially expressed genes that can be used in the prognosis, treatment and elucidation of this physiopathology. To identify novel genes differentially expressed in NP, we applied real-time quantitative PCR to 11 NP samples and to a pool of total RNA from a subset of 13 normal nasal mucosa samples from human autopsies. For selecting genes, the methylated CpG island amplification technique was used. Five differentially methylated clones (ATP2A1, NOVA1, PLCD3, SOLH and TGFβI) were identified. However, these genes presented methylated CpG islands between exons, i.e., not in the promoter regions of the genes. Thus, as shown by real-time PCR, the ATP2A1, SOLH, PLDC3 and TGFβI genes were overexpressed in NP. The genes identified in this study are probably involved in some stage of the process of formation and development of nasal polyposis, as they were highly expressed in the nasal polyp samples.

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.

Rhinosinusal Polyposis and Inverted Papilloma: A Morphometric Comparative Study

Introduction Nasal obstruction is one of the main rhinologic complaints, and two diseases must be investigated as differential diagnosis: rhinosinusal polyposis and inverted papilloma. Using traditional methods, the differential diagnosis between these diseases may be difficult. The morphometric study may be a useful tool for differential diagnosis and to define prognosis. Objective Calculate the morphometric values of rhinosinusal polyposis and inverted papilloma and compare the average of variables obtained between the groups. Methods The nasal mucus of 10 patients who had surgery in the Department of Otorhinolaryngology and Surgery of Head and Neck was studied; 5 had rhinosinusal polyposis and 5 had inverted papilloma. After the capture and print of corresponding data of each slide, the largest and smallest diameters of the nuclei were measured and the morphometric variables were calculated: average diameter, perimeter, ratio between largest and smallest diameter, volume, area, ratio of volume to area, form coefficient, contour index, and eccentricity. Results We found a significant difference (p < 0.05) between the two groups in the following morphometric variables: largest diameter, smallest diameter, average diameter, volume, area, perimeter, and ratio of volume to area, indicating that these parameters can be useful in diagnostic differentiation between these diseases. Conclusion We founded morphometric variables higher in patients with inverted papilloma, which can be related to the neoplastic origin of the inverted papilloma. The analysis of nuclear parameters is an instrument of great value in the differential diagnosis between rhinosinusal polyposis and inverted papilloma.

Abscesso de língua: relato de caso

INTRODUCAO: Os abscessos na lingua sao raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido as caracteristicas imunologicas da saliva e algumas caracteristicas histologicas e anatomicas da lingua. Este trabalho tem como objetivo relatar um caso de abscesso de lingua ocorrido em nosso servico, e fazer uma revisao da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a degluticao de evolucao progressiva ha uma semana, com piora importante ha 3 dias. Relata historia de cirurgia para implante dentario no inicio do periodo. Na admissao durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terco medio posterior de lingua a direita, doloroso a palpacao. Optou-se pela internacao do paciente. Solicitou-se uma ressonância nuclear magnetica que evidenciou lesao sugestiva de abscesso na base da lingua a direita. Foi submetido a tratamento clinico com antibioticoterapia drenagem cirurgica. O paciente evoluiu satisfatoriamente. DISCUSSAO: A manifestacao clinica do abscesso de lingua pode ser variada. O diagnostico deve ser feito pela historia clinica, correlacionando os fatores de risco associados, exame fisico e aos exames de imagem confirmatorios. A etiologia e os diagnosticos diferenciais devem ser considerados dependendo do local da manifestacao clinica. A abordagem deve incluir a permeabilidade da via aerea, suporte clinico, antibioticoterapia sistemica e drenagem do abscesso. CONSIDERACOES FINAIS: O abscesso de lingua deve entrar no diagnostico diferencial dos abaulamentos de lingua devendo ser conduzido com antibioticoterapia e drenagem cirurgica de maneira rotineira.Introduction: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. Case Report: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2 × 2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. Discussion: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. Final Considerations: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.

Tongue Abscess: Case Report

INTRODUCAO: Os abscessos na lingua sao raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido as caracteristicas imunologicas da saliva e algumas caracteristicas histologicas e anatomicas da lingua. Este trabalho tem como objetivo relatar um caso de abscesso de lingua ocorrido em nosso servico, e fazer uma revisao da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a degluticao de evolucao progressiva ha uma semana, com piora importante ha 3 dias. Relata historia de cirurgia para implante dentario no inicio do periodo. Na admissao durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terco medio posterior de lingua a direita, doloroso a palpacao. Optou-se pela internacao do paciente. Solicitou-se uma ressonância nuclear magnetica que evidenciou lesao sugestiva de abscesso na base da lingua a direita. Foi submetido a tratamento clinico com antibioticoterapia drenagem cirurgica. O paciente evoluiu satisfatoriamente. DISCUSSAO: A manifestacao clinica do abscesso de lingua pode ser variada. O diagnostico deve ser feito pela historia clinica, correlacionando os fatores de risco associados, exame fisico e aos exames de imagem confirmatorios. A etiologia e os diagnosticos diferenciais devem ser considerados dependendo do local da manifestacao clinica. A abordagem deve incluir a permeabilidade da via aerea, suporte clinico, antibioticoterapia sistemica e drenagem do abscesso. CONSIDERACOES FINAIS: O abscesso de lingua deve entrar no diagnostico diferencial dos abaulamentos de lingua devendo ser conduzido com antibioticoterapia e drenagem cirurgica de maneira rotineira.Introduction: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. Case Report: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2 × 2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. Discussion: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. Final Considerations: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.

Análise retrospectiva de cirurgias rinossinusais em um hospital escola

INTRODUCTION: The ENT is a medical specialty that covers 4.4% of all doctors in Sao Paulo, with a variety of surgical procedures distributed between pharynx, nose, ear and larynx. Knowing the profile of a reference service in otolaryngology allows for a better organization, scaling the volume of care and surgeries, providing better training to the student and resident physician. OBJECTIVE: To describe the profile of sinonasal surgery and patients to them in the department of otolaryngology and head and neck surgery at a teaching hospital. METHOD: We conducted a cohort study of cross-sectional retrospective study with review of 872 charts of patients undergoing surgery Sinus between January 2006 and December 2008. Used questionnaires, seeking sex, age, surgical diagnosis and surgery. RESULTS: Of 872 patients studied, 45.4% were female and 54.6% male, ranging in an age group 40-80 years (mean 29.8 years). The main surgical diagnoses were: nasal septum deviation (n=457), nasal deformity after trauma (n=287), enlarged turbinates (n=153), rhinosinusal polyposis (n=73), chronic sinusitis (n=32). Among the most frequently performed surgical procedures include: septoplasty (n=388), rhinoplasty (n=215), FESS (n=131), intra-turbinal cauterization (n=114), reconstructive rhinoplasty (n=73), turbinectomy (n=43), turbinoplasty (n=55). It is emphasized that patients may have received more than one surgical diagnosis and realized more than one surgery, depending on the alert. CONCLUSION: We present the volume and diversity of Sinus surgeries performed in our department, contributing to the scarce scientific literature on this type of case.

Comparative karyometric study of the glandular epithelium of normal nasal mucosa and rhinosinus polyposis.

Background Rhinosinus polyposis, characterized by a degeneration of the nasal mucosa of the middle meatus, is poorly understood but probably is correlated with several clinical and etiopathogenic entities. Although not definitely characterized, infectious, atopic, inflammatory, genetic, and other factors are involved. The occurrence of malignant degeneration also has been suggested. Methods To contribute to the elucidation of the etiopathogenicity of rhinosinus polyps, we performed a karyometric analysis of their glandular mucosa compared with the normal mucosa. Results A significant increase in nuclear volume was observed, which was not accompanied by changes in shape. Conclusion The results suggest that nuclear alterations may contribute to the pathogenicity of this condition.