Ester Maria Danielli Nicola

Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis

Objective To study the volatile sulphur compounds (VSC) halitometry profile in a population with chronic caseous tonsillitis (CCT) and halitosis and to evaluate the relationship between the presence of a tonsillolith and abnormal halitometry in this population.Design Clinical prospective non-randomised study.Subjects and methods Forty-nine patients with halitosis and CCT, 17 male (35%) and 32 female (65%), were selected among patients referred for CO2 laser cryptolysis. Anamnesis, physical examination and VSC halitometry were carried out. Halitometry values less than 150 ppb of VSC were considered normal.Results Patients were divided in two groups: Group A – normal halitometry (41 patients – 83.7%) and Group B – abnormal halitometry (8 patients – 16.3%). Halitometry results in Group B were 5.2 times (429%) higher than in Group A and the majority of the patients with abnormal halitometry presented with a tonsillolith at the moment of examination. A tonsillolith was present in 75% of the patients with abnormal halitometry and only 6% of patients with normal halitometry values.Conclusions The presence of a tonsillolith represents a tenfold increased risk of abnormal VSC halitometry and can be considered as a predictable factor for abnormal halitometry in patients with CCT.

Healing of Surgical Wounds Made with λ970-nm Diode Laser Associated or Not with Laser Phototherapy (λ655 nm) or Polarized Light (λ400–2000 nm)

OBJECTIVE The aim of this study was to analyze the effect of two phototherapies, laser and polarized light, on diode laser (970lambda nm) wounds. BACKGROUND DATA Lasers have been used in surgery, and some wavelengths may cause thermal damage to the tissue and affect healing. Several studies have shown that some wavelengths are effective in improving healing. Coherent and noncoherent light have been successfully used on the modulation of biological phenomena of several origins. ANIMALS AND METHODS Thirty-one Wistar rats were divided into 3 groups (GI to GIII). A 20-mm x 2-mm wound was created on the dorsum of each animal with a diode laser (Sirolaser, Sirona, Bensheim, Germany). Group GI acted as control. On GII, laser light (lambda655 nm, 30 mW, phi approximately 3 mm, 12 J/cm(2)) was used and on GIII illumination with polarized light (lambda400-2000 nm, 40 mW, phi approximately 5.5 cm, 12 J/cm(2)) was used, every other day (GII) or daily (GIII) for 7 days. The animals were killed at 0, 7, and 14 days after surgery. Specimens were taken, routinely processed, stained and imunnomarked [HE (hematoxylin-eosin), sirius red, alpha-smooth muscle actin (SMA)], and underwent histological analysis. RESULTS GII showed better response at day 14 when re-epithelialization was in a more advanced stage. The number of myofibroblasts was significantly different over the healing time (7 to 14 days); this number was smaller than that observed on G1. On GIII at day 7, the number of myofibroblasts was significantly higher than for GII. At day 14, a more pronounced deposition of collagen matrix was also seen, and inflammation was discrete and more advanced for GIII. CONCLUSION The results of the present study showed that the effect of the use of laser light was more evident at early stages of healing and that the use of polarized light improved the resolution of the inflammatory reaction, increased the deposition of collagen, increased the number of myofibroblasts, and quickened re-epithelialization during the experimental time.

Criptolise por coagulação com laser de CO2 em tonsilite crônica caseosa: método conservador e resultados

Introduction: Conventional cryptolysis with CO2 laser has been performed with success and in this case, a considerable volume of tissue is removed without warring about possible reduction of the immunological function of the tonsils. In the present paper we propose an alternative cryptolysis method with CO2 laser for chronic causeous tonsillitis. In this way, the desired effect is obtained by coagulation with laser and not by the volatilization of the tissues. The preservation of tissues is optimized. Method of study: Clinical prospective. Objectives: To present a modified cryptolysis technique with CO2 laser, which inhibits the retention of the caseous and preserves the tonsilar parenchyma. Material and Method: The cryptolysis were performed on a group of thirty-one individuals with chronic causeous tonsillitis, with great elimination of caseous and other associated symptoms. The patients were selected from the ORL HC-UNICAMP ambulatory. We used 6W CO2 laser in continuous mode, unfocused, and Swiftlase around the opening of the crypts, and, afterwards over the entire tonsilar surface producing only a superficial coagulation. To eradicate the symptoms we performed on average seven applications, repeated every three weeks. Results: The proposed technique was effective in 87% of the cases. For the remaining 13%, it was also necessary to volatize the regions adjacent to the crypts. There was a two-year follow-up without evidence of complications. Conclusion: We conclude this to be a safe and efficient method, able to be performed in the ambulatory under topic anesthesia; therefore, permitting to the patients immediate return to their activities.

Histopathological evaluation in biopsies of palatine tonsils submitted to cryptolysis by coagulation with CO2 laser for treatment of chronic caseous tonsillitis.

OBJECTIVE To perform histopathological evaluation in biopsies of palatine tonsils in a group of patients, with symptoms of chronic caseous tonsillitis, treated with an innovative and conservative method, using CO(2) laser. BACKGROUND DATA In general, the treatment of chronic caseous tonsillitis with CO(2) laser, as described in the literature, refers to the clinical experience of the authors and, the technique used for criptolysis encourages tissue vaporization, which leads to the consequent reduction of the tonsillar parenchyma. MATERIALS AND METHODS The individuals were submitted to cryptolysis coagulation with only 6 W of CW, CO(2) laser power, in scanned and unfocused mode, over a mean area of 2.2 mm diameter, leading to energy doses from 18 to 54.5 joules/cm(2). Biopsies were performed at the beginning and end of each treatment. A comparative analysis was performed between the initial and final biopsies taking into consideration possible alterations in the following: germinal centers, lymphoid tissue, sub-epithelial fibrosis, and parenchyma fibrosis. RESULTS The histopathological analysis of these biopsies showed that the laser, used at a specific energy density, could relieve the symptoms of the disease causing neither increase of the fibrotic content nor decrease of the lymphoid structure. The action of the laser, following the proposed technique, is superficial, causing only epithelial coagulation, which enables a weakening of the tension forces in the crypt borders, causing them to open. This effect results in the reduction and even disappearance of caseous retention. CONCLUSION We, therefore, conclude that the proposed method of treatment with CO(2) laser, called laser cryptolysis by coagulation (LCC) is an effective and conservative method, causing no significant morphological alterations to the tonsils.

Wavelength, frequency, and color: absolute or relative concepts?

OBJECTIVE The purpose of the present study is to call attention to well-established concepts in optics, which, however, are not necessarily known by medical laser users but may be important for interpretation of some data. BACKGROUND DATA In reviewing some aspects of the physical concepts of wavelength, frequency, photon energy, and color, it was possible to establish, beyond doubt, the right conditions to use these terms to classify specific laser radiations. This may help in the correct interpretation of some low-level laser therapy (LLLT) experimental results. MATERIALS AND METHODS In order to achieve our objective--maintaining the readers interest--we use the simplest physical concepts and equations necessary for nonphysicists to understand this subject. RESULTS The most important result pointed out through this study is the fact that the numerical value for wavelength, normally assigned to commercial lasers, should not be used to describe the light propagation inside the tissue. CONCLUSION The knowledge of the relation among the magnitudes discussed in the present study and their effects, although it does not add much to the use of a laser merely as a cutting instrument, becomes of fundamental significance when used to determine the effects that depend on light propagation within biological tissue and that do not result only from absorption of light energy. This will certainly help in the understanding of phenomena whose causes are attributed to the electric and magnetic polarization of laser radiation, as seems to be the case observed in laser biostimulation.

Photodynamic effect produced by HeNe radiation in Harderian glands of Wistar rats: an experimental model for PDT studies

In rats, the Harderian Gland secret Protoporphirin IX which is retained at acinar lumina. Since this photosensitizer is important for PDT of malignant tumors, we propose to study this gland as a model to help understanding PDT with endogenous photosensitizers. Twenty Wistar SPF adult rats were submitted to surgical exposure of both Harderian glands, revealing red fluorescence upon UV, characterizing the protoporphirin IX presence. After that, one gland of each pair (one kept as control) was irradiated with an 8 mW HeNe (6328 angstrom) for 45 minutes, delivering about 2.7 joules/mm2. After 24 hours a group of 10 animals were scarified and the glands removed for histological analysis. The remaining animals were subjected to the same procedure but the glands were removed immediately after laser treatment. Histological and fluorescence analysis immediately after laser irradiation showed cell fragmentation with loss of acinar architecture with diffusion of protoporphirin in the cytoplasm of damaged cells, as well as interstitial edema. After 24 hours these alterations were more pronounced with accentuated loss of intraluminal protoporphirin and beginning of leukocytic demarcation of necrotic areas. The innate Harderian glands of rats, exposed to HeNe laser, showed a similar behavior as tumor tissue under PDT.

Low-power CO2 laser in the treatment of chronic pharyngitis: a five-year experience

Spatial and temporal coherence are properties of laser light we studied for some time as responsible for biophysical phenomena, capable of significant contributions in the treatment of chronic inflammatory lesions. In this paper we present the results of five years experience in the application of CO2 low power laser (LPL) therapy as a new means of treating chronic pharyngitis. Based on our previous studies, we selected 85 patients with nonspecific chronic pharyngitis to be treated at our laser unit. The patients were grouped as follows: Group I, 40 patients, predominance of hyperemic aspect; and Group II, 45 patients, predominance of hypertrophied aspect. Both groups were submitted to low power irradiation of CO2 laser in eight to ten sessions, one week interval according to the evolution of symptoms. The good results obtained lead us to conclude that this new application for LPL is very suitable for systematic treatment of chronic pharyngitis: a very common and disturbing symptom for a great number of ear, nose, and throat patients, still lacking an effective form of therapy.

Rhinosinusitis in hematopoietic stem cell-transplanted patients: influence of nasosinus mucosal abnormalities?

IntroductionRhinosinusitis is characterized by inflammation extending from the mucosa of the nasal cavity into the paranasal sinuses. There are some aggravating features, such as immunosuppression, that can cause the nasal mucosal inflammation to linger for a long period, resulting in chronic or recurrent episodes. Such immunosuppression is the major feature of patients undergoing a hematopoietic stem cell transplant (HSCT); rhinosinusitis prevalence is higher in this group compared to immunocompetent patients. Nasal epithelial abnormalities have been described in, and may have some influence over, recurrent sinus infections among those patients. However, it is not clear whether rhinosinusitis can trigger mucosal abnormalities or whether a preexisting vulnerability for sinusitis recurrence is more likely. The objective of the study was to verify the influence of rhinosinusitis on nasal epithelial damage in patients undergoing hematopoietic stem cell transplantation.MethodA total of 30 allogeneic HSCT patients were divided into two groups: 24 patients with chronic or recurrent rhinosinusitis and 6 patients without rhinosinusitis. These patients underwent a biopsy of the uncinate process that was analyzed by transmission electron microscopy and optical microscopy.ResultsThe nasal mucosa analysis by optical microscopy showed no significant abnormalities. The ciliary orientation was obviously normal in the transplanted patients without rhinosinusitis. There was a trend toward a difference in the amount of cilia (decreased) and the primary modification of the ultrastructure of transplanted patients with rhinosinusitis.ConclusionHSCT patients, with and without rhinosinusitis, showed no significant histological abnormalities, except for ciliary disorientation and a possible decrease in ciliary and ultrastructural abnormalities in HSCT patients with rhinosinusitis.

Linear Epidermal Nevus of the Oral Cavity: A Rare Diagnosis

Linear epidermal nevus is an uncommon diagnosis of benign lesions of the oral cavity. It is characterized by a congenital malformation arising from the ectoderm cells, which are arranged according to a typical linear configuration known as Blaschkos lines. We report a case of linear epidermal nevus of oral cavity in a 51-year-old lady or woman. The linear epidermal nevus of the oral cavity, although rare, can be considered a differential diagnosis of oral papillomatosis (OP). The histopathological studies and detailed description are the center of the diagnostic and clinical evolution.

Comparative histologic study of alterations in rat skeletal muscles due to carbon dioxide laser with varying power but constant energy

The aim of our study was to compare biolgic effects such as tissue damage and regeneration in rat skeletal muscle after CO2 laser application with pulses of constant energy density, but with varying power and exposure time. We used three different laser conditions: 20 W by 0.5 s, 10 W by 1.0 s and 5.0 W by 2.0 s, all having the same energy density (10 joules in a constant area). The animals were sacrificed immediately after laser application, and after 1, 4, 7, 15 and 21 days. Tissue damage produced by the CO2 laser with high power provokes more profound craters with less tissue damage at the margins. As shown by lesser tissue carbonization, fewer foreign body giant cell granulomas and less tissue fibrosis and, on the other hand, an accelerated regeneration of muscle tissue.