Cláudia Regina Figueiredo

Microarray cDNA to Identify Inflammatory Genes in Nasal Polyposis

Background The objective of this study was to investigate the spectrum of inflammatory gene expression in patients with nasal polyposis. Methods The cDNA microarray technique was used to identify gene expression in tissue samples from nasal polyps and adjacent inflammatory nasal mucosa of 21 patients with nonallergic nasal polyposis. To validate the microarray analysis, we compared the expression of five genes by reverse transcription-polymerase chain reaction (RT-PCR): tumor necrosis factor, IL-5, IL-9, fibroblast growth factor, and transforming growth factor (TGF)-β1. Results We tested 96 different inflammatory genes in our samples. Thirty-six genes exhibited differences in expression between the two tissue types. In all 36 genes the level of expression was greater in the inflammatory mucosa than the polyps. The RT-PCR confirmed the cDNA results. Conclusion We believe that the high expression of TGF-β1 in inflammatory mucosa compared with the low expression in polyps may reflect an important role in the inhibitory mechanisms of nasal polyposis.

Hemorragia na adenoidectomia e/ou amigdalectomia: estudo de 359 casos

A adenoidectomia e a amigdalectomia sao historicamente os procedimentos cirurgicos mais realizados na especialidade otorrinolaringologica, tendo incidencia principal sobre a populacao pediatrica. A mais frequente e mais grave das complicacoes deste procedimento e a hemorragia no periodo pos-operatorio. FORMA DO ESTUDO: Clinico prospectivo. OBJETIVO: O objetivo deste estudo e o de contribuir para o manejo da principal complicacao da adenoamigdalectomia, o sangramento no intra-operatorio e no pos-operatorio imediato, analisando a frequencia de episodios hemorragicos, a necessidade de procedimentos hemostaticos, reintervencao cirurgica e hemotransfusao. METODO: Para a realizacao deste estudo, foram analisadas prospectivamente todas as criancas submetidas a adenoidectomia e/ou amigdalectomia pela Disciplina de Otorrinolaringologia Pediatrica da UNIFESP/EPM no periodo de marco de 2001 a marco de 2002, realizadas no Hospital Sao Paulo. RESULTADO: Foram incluidos no estudo 359 pacientes submetidos a adenoidectomia e/ou amigdalectomia. Observou-se hemorragia pos-operatoria em 3 criancas, sempre em casos de adenoamigdalectomia combinada e considerada primaria (nas primeiras 24 horas apos o procedimento). CONCLUSOES: Entre as criancas incluidas no estudo, ocorreu hemorragia no pos-operatorio de tres casos, representando incidencia de 0,8%.

Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil

UNLABELLED Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Rabdomiosarcoma de cabeça e pescoço na infância

Rhabdomyosarcoma (RMS) is a malignant tumor of immature mesenchymal cells; it can arise from any part of the body. RMS is the most common soft tissue sarcomain the childhood and its most frequent primary site is the head and neck. AIM: The purpose of this study was to review the occurrence of head and neck RMS in childhood and its clinical-histopathologic features. STUDY DESIGN: Clinical retrospective. METHOD: Eighty-two patients with soft tissue sarcoma treated in the Institute of Pediatric Oncology, UNIFESP-EPM, between 1988 and 2002 were included in this study. The medical records of the patients with head and neck soft tissue sarcomas were reviewed. The following parameters were analyzed: incidence of RMS in the childhood and in the head and neck, sex, age, histological classification, primary site, follow-up. RESULTS: In this study, 65% of soft tissue sarcomas were RMS; 33% of RMS were in the head and neck region; 77% of soft tissue sarcoma in this region were RMS. The mean age at diagnosis was 7.62 years, 41% were between 5 and 9 years. In this sample, there were 47% men and 53% women. Embryonic RMS was the predominant histological type (64.6%) and the orbit was the most common primary site (52.8%). One hundred percent, 50% and 33.3% of the parameningeal, nonparameningeal and orbital RMS, respectively, led to death. CONCLUSION: RMS is the most common soft tissue sarcoma in the childhood and the head and neck is the most frequent primary site. Males were more affected by RMS than females. The mean age at diagnosis was 7.62 years and the most frequent age interval was between 5 and 9 years old. The embryonic histological type and the orbit as primary site were predominant. The highest mortality was found for parameningeal RMS and the lowest, for orbital RMS.

An open multicenter study of the use of gatifloxacin for the treatment of non-complicated acute bacterial rhinosinusitis in adults

The bacteriological and clinical efficacy and the safety of gatifloxacin for the treatment of non-complicated acute rhinosinusitis was evaluated in 49 adult patients in an open-label multicenter study in Brazil. Patients under age 18, or with associated systemic diseases, were excluded. Diagnosis was based on symptoms, otorhinolaryngological examination, and X-rays of the sinus. At the first visit, all patients were treated with a single daily dose of 400 mg gatifloxacin for 10 days. Middle nasal meatus secretion was collected and sent for culture before and after treatment. Patients were all reevaluated at days 3 to 5; days + 1 to + 5 and 18 to 25 days + 7 to + 14 . Ninety three percent of the patients were considered clinically cured at the end of the treatment. The most frequent bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, and at the end of the treatment, presumed bacteriological eradication was observed in almost all patients. Adverse effects were observed in 19 of the cases, mostly mild and self limiting, including diarrhea, abdominal pain, nausea and vomiting. Treatment had to be interrupted in two cases. Gatifloxacin was found to be efficacious and safe for the treatment of acute rhinosinusitis in adults.

Prevalência de Streptococcus pyogenes em orofaringe de crianças que freqüentam creches: estudo comparativo entre diferentes regiões do país

Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM: to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS: A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS: The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION: These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Analgesia com laser terapêutico após tonsilectomia

Objective: The postoperative period of a tonsillectomy is usually very painful, requiring the use of painrelieving drugs. The aim of this study was to evaluate the efficacy of low-level laser therapy in post-tonsillectomy pain control. Methods: 18 children aged 5 to 15 years undergoing adenotonsillectomy between June 2005 and October 2006 were randomized to receive either local application of therapeutic laser immediately after surgery and 24 hours postoperatively (n=9) or routine analgesic drug therapy, if necessary. Pain was assessed by visual analog scale scores, need for analgesics, and acceptance of diet during the postoperative period. Results: Patients undergoing laser applications had lower median pain scores and required less analgesic medication postoperatively than the control group. Acceptance of diet was similar in both groups. Conclusions: Preliminary results showed that low-level laser therapy is effective in the reduction of post-tonsillectomy pain, minimizing the need of analgesic medication in children and adolescents.

Estudo clínico, randomizado, duplo-cego, em crianças com adenóide obstrutiva, submetidas a tratamento homeopático

AIM: the efficacy and security of homeopathic treatment was investigated on children with obstructive adenoid justifying an operation. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: In a prospective, randomized, double-blind clinical trial included 40 children between the ages of 3 to 7 years old, 20 children were treated with homeopathic medication, based in the principle of similarity (Simillimum), and 20 children with placebo. All the children of the homeopathic group/ adenoid, were treated daily with Agraphis nutans 6 CH, Thuya 6 CH and Adenoid 21CH, and the patients of the placebo group received daily placebo medication. The duration of the study of each children was 4 months. The evaluation of the results was clinical, and it was made by questionnaire standard, clinical examination and direct flexible fiberoptic nasopharyngoscopy, in the first and last day of treatment. The criterion of selection was the adenoid that occuped more than 70% of the coanal space. RESULTS: From the group of 20 children treated with homeopathic treatment, 13 did not show any change on the size of adenoid after nasopharyngoscopy, and 7 children had their adenoid decreased; from another group of 20 children that have treated with placebo for 4 months, 11 did not show any change on the size of their adenoid, 4 had their adenoid decreased and 5 had their adenoid increased. The statistical analysis showed a not significant difference (P= 0,069). The clinical evaluation of the patients showed that from the group of 20 patients treated with homeopathy, 17 kept unchanging, with oral breathing and snoring, one patient got better, eliminating the snoring and two were cured, which mean that their oral breathing turned to nasal breathing without snoring. From the group of 20 patients treated with placebo, 17 kept unchanging, one eliminated the snoring and two were cured; and these differences were not statistically significant (P> 0,999). CONCLUSIONS: the homeopathic treatment was not efficient in the patients with obstructive adenoid, remaining it surgical indication in 85% of the children. The homeopathic remedies did not provoke adverse events in the children.

Uso de peso de ouro palpebral para correção do lagoftalmo em pacientes com paralisia facial

Introduction: Lagophthalmus in facial palsy must be treated in order to avoid ocular complications. The gold weight eyelid implant as an alternative to tarsorrhaphy has been studied with good results. Aim: The purpose of this report is to study the effects of the gold weight eyelid implants for treatment of lagophthalmus. Study design: clinical retrospective not randomized. Material and method: 59 patients with Lagophthalmus associated with facial paralysis of many causes underwent gold weight implantation and were studied retrospectively. Results: All patients achieved satisfactory eyelid closure and improvement of ocular symptoms. 8.5% of patients had implant extrusion and 5% had infection. The average time with the implant varied from 6 months to 6 years, being removed in 20.3% of patients with recover of facial palsy. Discussion: Many methods have been described for enhance corneal protection in patients with facial palsy with different degrees of success and acceptance by the patient. The gold weight eyelid loading is a simple easy technique with good cosmetic result. The average time with the implant is inconstant and the complications are rare. Conclusion: Gold weight eyelid implants in patients with facial palsy have good results for the treatment of lagophthalmus and prevention of ocular complications.