Eulalia Sakano

Endoscopic study of the intranasal ostium in external dacryocystorhinostomy postoperative. Influence of saline solution and 5-fluorouracil

PURPOSE To study, through endoscopy, the postoperative structural changes of the intranasal ostium following external dacryocystorhinostomy and to evaluate the influence of saline solution and 5-fluorouracil. METHODS Fifty patients were distributed into the following groups: Group SS-dacryocystorhinostomy and an injection of saline solution during surgery (13 patients); Group 5--FU1-dacryocystorhinostomy and an injection of 5 fluorouracil during surgery (17 patients); Group C--dacryocystorhinostomy only (11 patients); Group 5--FU3-dacryocystorhinostomy and 3 injections, 1 during surgery and 1 on the third and fifth postsurgical days (9 patients). RESULTS Pair-wise group comparisons using the nonparametric Mann-Whitney test revealed that there was a significant reduction of the ostium area only in Group 5-FU1 vs. Group SS on the 60th postoperative day (P <.01); however, a comparative study among the 4 groups using the Kruskal-Wallis test showed no significant changes in the ostium area on the 60th postoperative day. The ostium area within groups at the 30th vs 60th postoperative day was significantly reduced for Group C (P < .05; Mann-Whitney test); no significant changes were found for the other groups. DISCUSSION These results suggest that the use of 5-fluorouracil in external dacryocystorhinostomy does not significantly influence the final size of the surgical fistula as determined 2 months postsurgery.

Respiração bucal e anteriorização da cabeça: efeitos na biomecânica respiratória e na capacidade de exercício em crianças

OBJECTIVE To evaluate submaximal exercise tolerance and respiratory muscle strength in relation to forward head posture (FHP) and respiratory mode in children, comparing mouth-breathing (MB) children with nasal-breathing (NB) children. METHODS This was a controlled, analytical cross-sectional study involving children in the 8-12 year age bracket with a clinical otorhinolaryngology diagnosis of MB, recruited between October of 2010 and January of 2011 from the Mouth Breather Clinic at the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. The exclusion criteria were obesity, asthma, chronic respiratory diseases, heart disease, and neurological or orthopedic disorders. All of the participants underwent postural assessment and the six-minute walk test (6MWT), together with determination of MIP and MEP. RESULTS Of the 92 children in the study, 30 presented with MB and 62 presented with NB. In the MB group, the differences between those with moderate or severe FHP and those with normal head posture, in terms of the mean MIP, MEP and six-minute walk distance (6MWD), were not significant (p = 0.079, p = 0.622, and p = 0.957, respectively). In the NB group, the mean values of MIP and MEP were higher in the children with moderate FHP than in those with normal head posture (p = 0.003 and p = 0.004, respectively). The mean MIP, MEP, and 6MWD were lower in the MB group than in the NB group. Values of MIP and MEP were highest in the children with moderate FHP. CONCLUSIONS Respiratory biomechanics and exercise capacity were negatively affected by MB. The presence of moderate FHP acted as a compensatory mechanism in order to improve respiratory muscle function.OBJECTIVE: To evaluate submaximal exercise tolerance and respiratory muscle strength in relation to forward head posture (FHP) and respiratory mode in children, comparing mouth-breathing (MB) children with nasal-breathing (NB) children. METHODS: This was a controlled, analytical cross-sectional study involving children in the 8-12 year age bracket with a clinical otorhinolaryngology diagnosis of MB, recruited between October of 2010 and January of 2011 from the Mouth Breather Clinic at the State University of Campinas Hospital de Clinicas, located in the city of Campinas, Brazil. The exclusion criteria were obesity, asthma, chronic respiratory diseases, heart disease, and neurological or orthopedic disorders. All of the participants underwent postural assessment and the six-minute walk test (6MWT), together with determination of MIP and MEP. RESULTS: Of the 92 children in the study, 30 presented with MB and 62 presented with NB. In the MB group, the differences between those with moderate or severe FHP and those with normal head posture, in terms of the mean MIP, MEP and six-minute walk distance (6MWD), were not significant (p = 0.079, p = 0.622, and p = 0.957, respectively). In the NB group, the mean values of MIP and MEP were higher in the children with moderate FHP than in those with normal head posture (p = 0.003 and p = 0.004, respectively). The mean MIP, MEP, and 6MWD were lower in the MB group than in the NB group. Values of MIP and MEP were highest in the children with moderate FHP. CONCLUSIONS: Respiratory biomechanics and exercise capacity were negatively affected by MB. The presence of moderate FHP acted as a compensatory mechanism in order to improve respiratory muscle function.

Avaliação da postura corporal em crianças e adolescentes respiradores orais

OBJECTIVE To investigate associations between mouth breathing (MBr), nose breathing (NBr) and body posture classification and clinical variables in children and adolescents, by comparing patients with mouth breathing syndrome with a control group of similar age. METHODS This was an observational, analytical, controlled, cross-sectional study conducted at a university hospital. Children aged 5 years or more were recruited to one of two groups: healthy controls (NBr) or an MBr group. The MBr group comprised patients with a diagnosis of mouth breathing syndrome confirmed by clinical examination by a physician plus nasal endoscopy. The control group comprised healthy volunteers of the same age, with NBr confirmed by medical examination. All participants underwent postural assessment. Data were analyzed using the Mann-Whitney nonparametric test, the chi-square test and Fishers exact test, to a significance level of 0.05%. RESULTS A total of 306 MBr and 124 NBr were enrolled. Mouth breathers were more likely to be male (p = 0.0002), have more frequent and more severe nasal obstruction and larger tonsils (p = 0.0001) than NBr. Mouth breathers also exhibited higher incidence rates of allergic rhinitis (p = 0.0001), of thoracic respiratory pattern (p = 0.0001), high-arched palate (p = 0.0001) and unfavorable postural classifications (p = 0.0001) with relation to the control group. Postural classification scores were directly proportional to nasal obstruction (p = 0.0001) and male sex (p = 0.0008). CONCLUSIONS Postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome.

Proposta de documentação fotográfica em motricidade oral

PURPOSE: to propose a specific protocol for photographic register of Oral Motricity patients. METHODS: a digital camera mounted on a tripod was used. Standardized photos of body and face were taken. A tele-radiography modified by using contrast with barium which was spread over the patients tongue was taken. RESULT: the pictures made easy the visualization of our therapeutic results. CONCLUSION: so far it is possible to conclude that the proposed documentation helps in the diagnosis process and prognosis analysis, and it may be used as supplementary material for guiding patients and parents on the best treatment to follow.

Exercise capacity, respiratory mechanics and posture in mouth breathers

UNLABELLED Chronic and persistent mouth or oral breathing (OB) has been associated with postural changes. Although posture changes in OB causes decreased respiratory muscle strength, reduced chest expansion and impaired pulmonary ventilation with consequences in the exercise capacity, few studies have verified all these assumptions. OBJECTIVE To evaluate exercise tolerance, respiratory muscle strength and body posture in oral breathing (OB) compared with nasal breathing (NB) children. MATERIAL AND METHOD A cross-sectional contemporary cohort study that included OB and NB children aged 8-11 years old. Children with obesity, asthma, chronic respiratory diseases, neurological and orthopedic disorders, and cardiac conditions were excluded. All participants underwent a postural assessment, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), the six-minute walk test (6MWT), and otorhinolaryngologic evaluation. RESULTS There were 107 children (45 OB and 62 NB). There was an association between abnormal cervical posture and breathing pattern: 36 (80.0%) OB and 30 (48.4%) NB presented abnormal head posture (OR=4.27 [95% CI: 1.63-11,42], p<0.001). The mean MIP and MEP were lower in OB (p=0.003 and p=0.004). CONCLUSION OB children had cervical spine postural changes and decreased respiratory muscle strength compared with NB.

Predictability of quantification of beta-trace protein for diagnosis of cerebrospinal fluid leak: cutoff determination in nasal fluids with two control groups.

Background Cerebrospinal fluid (CSF) leak of the anterior skull base is an abnormal communication between the subarachnoid space and the nasal cavity or the paranasal sinus. Its presence increases the incidence of complications, as meningitis, with risk of sequelae. The early and correct diagnosis of the CSF leaks is important to perform surgical treatment as soon as possible. The CSF detection in nasal fluids could be made through the beta2-transferrin (beta2Tr) immunoelectrophoretic test, an expensive and cumbersome immunologic test, not available to the majority of the Brazilian hospitals. Recently, the detection of beta-trace protein (betaTP) for identification of CSF leaks has been described. The literature suggests there may be similar sensitivity and specificity to tests of beta2Tr, because betaTP is also a specific brain protein and it is present in CSF in high concentrations. The majority of Brazilian hospitals have the nephelometric equipment for betaTP detection. This study was designed to determine threshold values for betaTP concentrations in nasal cavity secretions as a predictor of CFS leak. Methods Nasal secretions were collected from patients with suspicion of CSF leak and from healthy volunteers. Pure CSF samples were used. A nephelometric assay was used to determine the betaTP concentration in samples. Results Values between 0.244 and 0.496 mg/L were determined for the cutoff. Conclusion Beta-trace concentrations above 0.496 mg/L are highly suggestive of the presence of CSF in examined nasal secretion. Positive predictive value and negative predictive value were 100%. BetaTP nephelometric test can predict the side of the CSF leak.

Detection of Epstein–Barr virus and subsets of lymphoid cells in adenoid tissue of children under 2 years of age

Epstein-Barr virus (EBV) has been closely associated with undifferentiated nasopharyngeal carcinoma (NPC) and T/NK nasal non Hodgkin lymphoma. Nevertheless, the presence of EBV in non neoplastic lymphoid tissue of the nasopharynx has been rarely investigated. In a previous study by our group, using in situ hybridization to detect EBV in adenoids of children (2-13 years old) resected because of nasal obstruction due to hypertrophy, we found EBV genome in 72% of the cases. It was now intended to study the frequency of EBV expression in adenoids from children that underwent surgical removal, belonging to a lower age group (1-2 years old). It was also intended to establish which lymphoid subsets are involved in this infection. Adenoidal paraffin sections from 21 patients aged 1-2 years old (mean 1.6 years), 15 males and six females were submitted to double labeling: in situ hybridization with EBER 1/2 probes to detect EBV and immunohistochemistry to determine the lymphocyte typing of EBV-positive cells (CD20 for B-lymphocytes, CD3 for T-lymphocytes and CD56 and CD57 for NK-cells). Among 21 patients, seven showed positive lymphoid cells for EBV (33%). In almost all cases, EBV-positive cells were also CD20-positive. Some EBV-positive cells showed no labeling with any of the lymphoid markers, but in no instance they were positive for CD3, CD56 or CD57. This study confirms the preferential infection of B-lymphocytes by EBV, which in some instances can down regulate the expression of CD20.

Walk test and school performance in mouth-breathing children

UNLABELLED In recent decades, many studies on mouth breathing (MB) have been published; however, little is known about many aspects of this syndrome, including severity, impact on physical and academic performances. OBJECTIVE Compare the physical performance in a six minutes walk test (6MWT) and the academic performance of MB and nasal-breathing (NB) children and adolescents. METHOD This is a descriptive, cross-sectional, and prospective study with MB and NB children submitted to the 6MWT and scholar performance assessment. RESULTS We included 156 children, 87 girls (60 NB and 27 MB) and 69 boys (44 NB and 25 MB). Variables were analyzed during the 6MWT: heart rate (HR), respiratory rate, oxygen saturation, distance walked in six minutes and modified Borg scale. All the variables studied were statistically different between groups NB and MB, with the exception of school performance and HR in 6MWT. CONCLUSION MB affects physical performance and not the academic performance, we noticed a changed pattern in the 6MWT in the MB group. Since the MBs in our study were classified as non-severe, other studies comparing the academic performance variables and 6MWT are needed to better understand the process of physical and academic performances in MB children.

Schwannoma of the nasal septum: evaluation of unilateral nasal mass

1 Medico (Medico residente de Otorrinolaringologia da UNICAMP). 2 Mestre em medicina (Medico Otorrinolaringologista (fellow em otologia na UNICAMP)). 3 Mestre em ciencias medicas (Medica otorrinolaringologista do Servico de Otorrinolaringologia do Hospital Estadual de Sumare, Disciplina de Otorrinolaringologia, Cabeca e Pescoco, UNICAMP). 4 Doutora em ciencias medicas (Medica otorrinolaringologista, Chefe do Servico de Rinologia, Disciplina de Otorrinolaringologia, Cabeca e Pescoco, UNICAMP). Disciplina de Otorrinolaringologia, Cabeca e Pescoco. Hospital das Clinicas (HC) Faculdade de Ciencias Medicas (FCM) Universidade Estadual de Campinas (UNICAMP) Campinas, Sao Paulo, Brasil. Endereco para correspondencia: Henrique Furlan Pauna. Rua Aldo de Oliveira Barbosa, no 170. Parque das Universidades. Campinas SP. Brasil. CEP: 13086-030. E-mail: h_pauna@hotmail.com Este artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 21 de abril de 2012. cod. 9165. Artigo aceito em 20 de outubro de 2012. CASE REPORT Braz J Otorhinolaryngol. 2013;79(3):403.

Ressecção endoscópica transesfenoidal de adenomas de hipófise: avaliação preliminar de pacientes consecutivos,

INTRODUCTION Endoscopic endonasal transsphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. In many centers throughout the world, this technique is now routinely used for the same indications as conventional microsurgical technique for pituitary tumors. OBJECTIVE To present a surgical experience of consecutive endoscopic endonasal trans-sphenoidal resections of pituitary adenomas. METHODS In this study, consecutive patients with pituitary adenomas submitted to endoscopic endonasal pituitary surgery were evaluated regarding the rate of residual tumor, functional remission, symptoms relief, complications, and tumor size. RESULTS Forty-seven consecutive patients were evaluated; 17 had functioning adenomas, seven had GH producing tumors, five had Cushings disease, and five had prolactinomas. Of the functioning adenomas, 12 were macroadenomas and five were microadenomas; 30 cases were non-functioning macroadenomas. Of the patients with functioning adenomas, 87% improved. 85% of the patients with visual deficits related to optic nerve compression progressed over time. Most of the patients with complaints of headaches improved (76%). Surgical complications occurred in 10% of patients, which included with two carotid lesions, two cerebrospinal fluid leaks, and one death of a patient with a previous history of complications. CONCLUSION Endoscopic endonasal pituitary surgery is a feasible technique, yielding good surgical and functional outcomes, and low morbidity.