Fernando de Andrade Quintanilha Ribeiro

Clinical and histological healing of Surgical wounds treated with mitomycin C

Objectives/Hypothesis The proven ability of mitomycin C to inhibit fibroblasts in vitro has stimulated its use in research animals and in humans to control healing. The objective of the study was to follow the healing process of surgical wounds in the dorsum of rats treated topically with mitomycin C.

Tratamento da miíase humana cavitária com ivermectina oral

Introduction: Human myiasis is relatively common. It is unpleasant not only for the patients affected by this parasitical disease, but also for the doctors that must treat them. It is more common in undeveloped and tropical countries, although there have been reports of myiasis all over the Planet. It usually affects the elderly, the ill and the mentally disabled, but there have also been reports in healthy patients. The larvae usually lay their eggs in necrotic or infected tissues, however they may also lay eggs in areas of the body that are apparently healthy. Treatment of this parasitic infection is basically through removal of the larvae, a painful and cumbersome task, sometimes made impossible in smaller cavities. There have also been reports of drugs used topically to facilitate the removal, but with frustrating results. Study design: Prospective randomized. Methods: This study used oral ivermectin (until 300 µg/Kg). This drug has already been reported for the treatment of other diseases. The patients were submitted to hepatic and renal function tests before and after treatment, and followed as out patients. Results: The larvae were eliminated in all patients and there were no abnormalities in the blood tests.

Oral ivermectin for the treatment and prophylaxis of scabies in prison

Introduction: Oral ivermectin has been widely used to treat various human diseases, such as filariasis, myiasis, larva migrans, strongyloidiasis and scabies (both the common and crusted forms). However, there are only a small number of papers on the effects of this drug for the control of scabies in infested environments. The current study shows the results obtained with the collective treatment of inmates of a public jail. Materials and methods: A total of 123 inmates living in a restricted and contaminated environment were evaluated clinically by experienced dermatologists for the assessment of the degree of infestation by Sarcoptes scabiei, and were then treated with oral ivermectin (200–300 μg/kg single dose repeated after 7 days). Both clothing and environment were disinfected. Patients were re‐evaluated after 15 days. Results: In all, 78% of the inmates were infected upon initial evaluation. Re‐evaluation 15 days after repeat treatment revealed a cure rate of 91.05%. Prophylaxis was also highly effective, where 93.2% of the non‐infected inmates and virtually all the house staff remained disease‐free throughout the study period. Two of the 29 inmates (6.8%) who showed no apparent lesions upon initial examination were found to be infected upon re‐evaluation. These patients responded well to a third dose of ivermectin. Conclusions: Oral ivermectin at a dose of 300 μg/kg single dose repeated after 7 days proved effective for the treatment and prophylaxis of scabies in an infected institutional environment.

Analysis of histopathological aspects in acquired middle ear cholesteatoma

UNLABELLED Middle ear cholesteatomas are characterized by the presence of stratified squamous epithelium in this cavity with highly invasive properties causing bone destruction and it may lead to complications. AIM To study the histopathological features in acquired cholesteatomas of the middle ear, correlating this data with patient age. STUDY DESIGN clinical and experimental cross-sectional study. MATERIAL AND METHODS Samples were obtained from 50 patients submitted to otologic surgery for the removal of middle ear cholesteatomas from 2006 to 2007. Thirty four patients were adults and 16 were children. Samples were studied by histological analysis. RESULTS We found the presence of epithelial atrophy (78%), epithelial acanthosis (88%), hyperplasia of the basal layer (88%) and formation of epithelial cones (62%). There was a positive and significant correlation between histopathological variables (such as epithelial acanthosis, hyperplasia of the basal layer and formation of epithelial cones). Histopathological variables presented no statistical significant difference in both age groups (p>0,05). CONCLUSION Cholesteatomas have hyperproliferating characteristics with epithelial acanthosis, hyperplasia of the basal layer and the presence of epithelial cones in the matrix.

Revisão sobre a perda auditiva na Síndrome de Alport, analisando os aspectos clínicos, genéticos e biomoleculares

Alport Syndrome is a genetic disorder characterized by hematuria, which often leads to renal failure. It may also be accompanied by extra-renal alterations, such as: sensorineural hearing loss, and ocular abnormalities. Dominant forms related to the X chromosome and caused by mutations in the locus COL4A5 have been described, as well as an autossomic recessive form resulting from mutations in the locus COL4A3 or COL4A4. An autossomic dominant type of AS has also been reported. The disease is caused by changes in the collagen type IV chains, where symptoms reflect the damage to the basal membrane of several organs. The a3.a4.a5(IV) networks are found in the kidneys, cochlea and eyes. The objective was to characterize AS in this group of patients. In the current literature review it was found that: 1. AS is characterized by hematuria that may develop into renal failure and can also be accompanied by extra-renal manifestations. Hearing loss is a frequent extra-renal finding and one of the first symptoms of AS, therefore representing a relevant factor in the prognosis of the renal disease; 2. It is a genetic disorder resulting from abnormalities in the chains of collagen type IV in the basal membranes; 3. The hearing loss in AS is typically sensorineural with variable intensities, progressive and symmetrical, affecting middle and high frequencies; 4. Otolaryngologists should include a urine test in the SNHL work-up. It is essential to have an otologist involved in the treatment of these patients.

As deficiências auditivas relacionadas às alterações do DNA mitocondrial.

A deficiencia auditiva e sintoma comum que pode apresentar varias etiologias, entre elas as causadas por alteracoes geneticas. As mutacoes geneticas podem ocorrer em genes nucleares e mitocondriais. A mitocondria, uma organela intracelular, tem o seu proprio genoma (DNA), que e uma molecula circular e e transmitido exclusivamente pela mae. As mutacoes do DNA mitocondrial sao transmitidas pela linhagem materna, mas podem ocorrer mutacoes espontâneas. O fenotipo, ou expressao clinica, da mutacao mitocondrial vai depender da quantidade de DNA mitocondrial mutante existente na celula, situacao conhecida como heteroplasmia. A mitocondria tem a funcao de disponibilizar energia para as celulas sob a forma de ATP (trifosfato de adenosina). Os orgaos que requerem grande quantidade de energia sao mais comumente acometidos em casos de mutacoes do DNA mitocondrial, como celulas nervosas, musculares, endocrinas, opticas e auditivas. Como a coclea e grande consumidora de energia, uma mutacao no DNA mitocondrial de celulas ciliadas causa deficiencia auditiva do tipo neurossensorial, bilateral, simetrica e progressiva. As deficiencias auditivas causadas por mutacoes no DNA mitocondrial correspondem a 0,5% a 1% de todas as deficiencias auditivas de origem genetica. Foi realizada uma extensa revisao bibliografica, a fim de estudar as deficiencias auditivas causadas por alteracoes no DNA mitocondrial. A deficiencia auditiva pode se apresentar na forma isolada (forma nao sindromica), como nos casos de hiper-sensibilidade aos antibioticos aminoglicosideos e presbiacusia, ou associada a outras doencas (forma sindromica), como na sindrome de Kearns-Sayre e diabete e surdez de heranca materna.

The role of Tumor Necrosis Factor -Alpha (TNF-α) in bone resorption present in middle ear cholesteatoma

Summary Cholesteatoma may cause bone erosion, with high morbidity and mortality rates. Tumor Necrosis Factor - Alpha (TNF-a) is one of the main cytokines involved in this process. Our goal was to evaluate the role of TNF-a in Bone Resorption and its effect on cholesteatoma. Material and Methods analysis and critical literature review. Results Different studies have demonstrated that TNF-a is capable of causing bone erosion. It may stimulate the differentiation and maturation of osteoclasts or it may act on the bone matrix, exposing it to the action of the osteoclasts. It is possible to inhibit TNF-a, reducing its effects and prevent bone loss in illnesses such as rheumatoid arthritis, and there has been no specific investigation regarding cholesteatomas. All studies agree on the importance of TNF-a in the bone resorption process present in cholesteatomas, and on the degree of destruction observed; however, there is no consensus as to its location. These differences are probably due to receptor site. Conclusion TNF-a, present in cholesteatomas, promotes bone resorption, along with other cytokines (RANKL and IL-1) related to complications.

TNF-R2 expression in acquired middle ear cholesteatoma

UNLABELLED Acquired middle ear cholesteatoma is a disease which promotes bone erosion resulting in potentially serious complications. The tumor necrosis factor alpha (TNF-α) is present in cholesteatoma and it is related to bone erosion, as shown by different authors. To understand the aggressiveness characteristics of cholesteatoma is necessary, however, to better address the presence and distribution of their receptors. OBJECTIVE To evaluate the expression of type 2 TNF-α receptor (TNF-R2) in fragments of cholesteatoma and correlate it to the degree of inflammation present. MATERIAL AND METHODS observational cross-sectional study, which analyzed 33 fragments of cholesteatomas through histological analysis and immunohistochemistry (using as primary antibody to TNF-R2 LabVision® brand). The evaluation was performed by means of a qualitative and semi-quantitative agreement with the observed intensity. For statistical analysis we used the Fisher exact test and Spearmans correlation coefficient (considered statistically significant when p < 0. 05). RESULTS The expression of TNF-R2 was present in all fragments, however a statistical analysis showed no correlation or association between inflammation and the expression of TNF-R2. CONCLUSIONS TNF-R2 is present in cholesteatoma of the middle ear, however, its expression is not directly related to the degree of inflammation observed in patients with this disease.

O papel do Fator de Necrose Tumoral Alfa (TNF-alfa) no processo de erosão óssea presente no colesteatoma adquirido da orelha média

Cholesteatoma may cause bone erosion, with high morbidity and mortality rates. Tumor Necrosis Factor -Alpha (TNF-a) is one of the main cytokines involved in this process. Our goal was to evaluate the role of TNF-a in Bone Resorption and its effect on cholesteatoma. MATERIAL AND METHODS: analysis and critical literature review. RESULTS: Different studies have demonstrated that TNF-a is capable of causing bone erosion. It may stimulate the differentiation and maturation of osteoclasts or it may act on the bone matrix, exposing it to the action of the osteoclasts. It is possible to inhibit TNF-a, reducing its effects and prevent bone loss in illnesses such as rheumatoid arthritis,and there has been no specific investigation regarding cholesteatomas. All studies agree on the importance of TNF-a in the bone resorption process present in cholesteatomas, and on the degree of destruction observed; however, there is no consensus as to its location. These differences are probably due to receptor site. CONCLUSION: TNF-a, present in cholesteatomas, promotes bone resorption, along with other cytokines (RANKL and IL-1) related to complications.

Revision about hearing loss in the Alport's syndrome, analyzing the clinical, genetic and bio-molecular aspects

Alport Syndrome is a genetic disorder characterized by hematuria, which often leads to renal failure. It may also be accompanied by extra-renal alterations, such as: sensorineural hearing loss, and ocular abnormalities. Dominant forms related to the X chromosome and caused by mutations in the locus COL4A5 have been described, as well as an autossomic recessive form resulting from mutations in the locus COL4A3 or COL4A4. An autossomic dominant type of AS has also been reported. The disease is caused by changes in the collagen type IV chains, where symptoms reflect the damage to the basal membrane of several organs. The alpha3.alpha4.alpha5(IV) networks are found in the kidneys, cochlea and eyes. The objective was to characterize AS in this group of patients. In the current literature review it was found that: 1. AS is characterized by hematuria that may develop into renal failure and can also be accompanied by extra-renal manifestations. Hearing loss is a frequent extra-renal finding and one of the first symptoms of AS, therefore representing a relevant factor in the prognosis of the renal disease; 2. It is a genetic disorder resulting from abnormalities in the chains of collagen type IV in the basal membranes; 3. The hearing loss in AS is typically sensorineural with variable intensities, progressive and symmetrical, affecting middle and high frequencies; 4. Otolaryngologists should include a urine test in the SNHL work-up. It is essential to have an otologist involved in the treatment of these patients.