Clara Mônica Figueiredo de Lima

A proposed new clinical staging system for patients with mucosal leishmaniasis

Mucosal leishmaniasis (ML) occurs mainly in areas where Leishmania braziliensis is transmitted. It affects predominantly the nasal mucosa and, in more severe forms, can lead to significant tissue destruction. There is no standard method for grading the severity of disease. We categorised 50 patients with ML according to a proposed new clinical staging system. Their age ranged from 10 to 86 y (mean ± SD: 36 ± 16 y) and 43 (86%) patients were male. The different degrees of evolution of mucosal disease, from the initial stage to the more severe long-term cases, enabled ML to be graded into five stages. Stage I is characterised by nodular lesions of the mucosa without ulceration. Stage II is represented by superficial mucosal ulcerations with concomitant fine granular lesions. Stage III is characterised by deep mucosal ulcerations with granular tissue formation. In stage IV there are irreversible lesions leading to perforation of the cartilaginous nasal septum with necrosis. In stage V the nasal pyramid is compromised with alterations of facial features as a consequence of severe tissue destruction. These stages may be useful in characterising the severity of the lesion and optimising therapeutic outcome.

Mucosal leishmaniasis: A Retrospective Study of 327 Cases from an Endemic Area of Leishmania (Viannia) braziliensis

Mucosal leishmaniasis (ML) is observed only in about 3% of patients with American tegumentary leishmaniasis (ATL) but has a high potential for destructive, disfiguring, and disabling sequelae. Prior reports of clinical and epidemiologic features of ML are limited by small numbers of cases. In this study, we evaluated changes in the demographic features and clinical presentation of ML in an endemic area of Leishmania braziliensis transmission over a period of 20 years. The charts of 327 patients with ML diagnosed between 1995 and 2014 were reviewed. The majority of patients (67%) were male. Age ranged from 8 months to 103 years, with a median age of 38.5 years (interquartile range: 22-58 years). The greatest number of patients was between 19 and 39 years (31%). Over the study period, there was an increase in patients with ML more than 60 years of age, an increase in ML with concomitant cutaneous lesions, a decrease in the period of time between the documentation of cutaneous lesions and the diagnosis of mucosal disease, and an increase in the frequency of patients presenting with stage I and V of ML. Moreover, there was a positive correlation between severity of mucosal disease and both age and the period of time between cutaneous lesion and mucosal disease. Response to therapy of ML remained similar over a period of 20 years. Despite the improvement in medical care during the study period, the prevalence of ML did not change and severe disease continues to be a major challenge for the management of these patients.

Association of Sicca Syndrome with Proviral Load and Proinflammatory Cytokines in HTLV-1 Infection

The Sjögren syndrome has been diagnosed in patients with HTLV-1 associated myelopathy and dry mouth and dry eyes are documented in HTLV-1 carriers. However the diagnosis of Sjögren syndrome in these subjects has been contested. In this cross-sectional study, we evaluated the role of immunological factors and proviral load, in sicca syndrome associated with HTLV-1 in patients without myelopathy. Subjects were recruited in the HTLV-1 Clinic, from 2009 to 2011. The proviral load and cytokine levels (IFN-γ, TNF-α, IL-5, and IL-10) were obtained from a database containing the values presented by the subjects at admission in the clinic. Of the 272 participants, 59 (21.7%) had sicca syndrome and in all of them anti-Sjögren syndrome related antigen A (SSA) and antigen B (SSB) were negatives. The production of TNF-α and IFN-γ was higher in the group with sicca syndrome (P < 0.05) than in HTLV-1 infected subjects without sicca syndrome. Our data indicates that patients with sicca syndrome associated with HTLV-1 do not have Sjögren syndrome. However the increased production of TNF-α and IFN-γ in this group of patients may contribute to the pathogenesis of sicca syndrome associated with HTLV-1.

Clinical and tomography evolution of frontal osteomyelitis: case report

Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Evolução clínica e tomográfica da osteomielite frontal: relato de caso

Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Acesso endoscópico para tratamento do papiloma nasossinusal: um estudo clínico retrospectivo

INTRODUCTION: Sinonasal Papilloma is a benign tumor originating from the epithelium schneiderian lateral nasal wall. Its incidence is rare and according to literature accounts for 0.5 to 4% of all nasal tumors. OBJECTIVE: To report our institutions experience in the treatment of sinonasal inverted papilloma using endoscopic approach and compare the results with the literature. METHODS: A retrospective study of all patients with sinonasal papillomas who underwent a purely endoscopic surgery in the Otorhinolaryngology, Hospital das Clinicas, Federal University of Bahia (UFBA), from January 2004 to May 2010. RESULTS: A total of 12 patients were included in this study. The median follow-up was 23 months. There was one case of recurrence. Malignant transformation has not occurred in these cases. CONCLUSION: The treatment of sinonasal papilloma has been largely benefited from the advances in endoscopic techniques, with recurrence rates equivalent to those reported for external access. Imaging exams are essential in preoperative planning and the decision of surgical technique. A regular follow-up and long term is essential for a good monitoring of the evolution of this pathology.

Nasolacrimal duct mucocele: case report and literature review.

Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium). Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access.

Complicação orbital e intracraniana devido à rinossinusite aguda: relato de caso

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.

Orbital and intracranial complication due to rhynosinusitis case's report

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.

Orbital and Intracranial Complication Resulting from Acute Rhinosinusitis: Case Report

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.