João Aragão Ximenes Filho

Distribution of Collagen in the Lamina Propria of the Human Vocal Fold

Objectives To describe the arrangement of collagen fibers in the lamina propria of the human vocal fold.

Histologic Changes in Human Vocal Folds Correlated with Aging: A Histomorphometric Study

The voice of aged persons is usually different from that of younger adults — a fact indicating that aging induces changes in the human larynx. The aim of this study was to perform a histomorphometric analysis of the vocal fold and of a fragment of skin in order to determine the modifications related to aging and possible differences between genders. Twenty cadavers, 10 men and 10 women, were studied. Stereological methods were used for histologic analysis. In the vocal folds, we observed a reduction of the lamina propria thickness (p < .001) and of epithelial cell density (p < .001) as a function of age. In the skin, there was a reduction of chorion thickness (p = .02) and of epithelial cell density (p = .01). The decrease in the thickness of the lamina propria of the vocal folds with aging may contribute to the vocal pattern present in the elderly. These changes were more evident in men.

Length of the human vocal folds: proposal of mathematical equations as a function of gender and body height.

To obtain a mathematical equation that could estimate the length of the intermembranous part of the vocal fold as a function of body height and gender, we removed the larynges from 39 cadavers (22 men and 17 women) after recording the subjects height, age, and cause of death. The dimensions of the vocal folds were determined with a digital pachymeter. The following equations were obtained: y = 0.18x − 15.8 for men and y = 0.24x − 28.1 for women, where y is the length of the intermembranous part of the vocal folds in millimeters and x is the height of the individual in centimeters. We conclude that it is possible to estimate the normal expected length of the intermembranous portion of the male and female vocal folds on the basis of body height.

Acometimento oral no pênfigo vulgar

Pemphigus vulgaris (PV) is a bullous disease characterized by the presence of autoantibodies against intra-epidermal adhesion molecules. AIM: The aim of this study was to identify the characteristics of PV in each gender, forms of clinical presentation, age, diagnosis methods and management. STUDY DESIGN: historical cohort. METHOD: Patients with PV treated in Otolaryngology Department from HC-FMUSP between 1990 and 2001. RESULTS: From 23 patients, 91,3% were women and 8,7% men (p <0,01), proportion of 9:1. The age of diagnosis varied between 26 and 80 years, with average of 53 ± 18,4 years. In males, PV begun 24,6 ± 5,9 years earlier than in females (p=0,026). The most frequently sign in physical examination were bullous lesions in oral mucosa. Biopsy was used in 95% of the cases, direct immunofluorescence in 17,4% and indirect 8,7%. Prednisona was the therapeutic option in 78% of the patients, while deflazacort was used in 22%. Dapsona was associated in 4 cases. We obtained control of the disease in 74% of the cases and loss of the continuation after partial improvement in more 13% of the patients. We observed larger difficulty in disease control in males (p=0,04). CONCLUSIONS: The females prevailed over males. The age of diagnosis was higher in women. The treatment of choice was prednisona. PV was more easily controlled in females.

Estudo da audição de crianças de gestantes expostas ao ruído ocupacional: avaliação por emissões otoacústicas - produto de distorção

AIM: To detect early on a probable hearing loss in children of women exposed to occupational noise during their pregnancy and to verify if there is any difference between the children from those women exposed to occupational noise during their pregnancy and the ones from mothers that do not work under the same conditions. METHODS: Children from women exposed to occupational noise during their pregnancy and children from women who were not exposed were evaluated through distortion product otoacoustic emissions, using the GSI 60 DPOEA SYSTEM equipment and the frequency-ratio F2/F1 equal to 1.2 and the geometric average of 2F1-F2. The intensity of the primary frequencies were kept steady with values of L1=65dBSPL and L2=55dBSPL for F1 and F2, respectively. Student T test in paired samples and independent samples were used. RESULTS: There were no differences in the response amplitude of distortion product otoacoustic emissions between the control and the study groups. There was no statistically difference between male and female children in response amplitude for the two groups aforementioned; and there were no differences between right and left ears from each group. CONCLUSION: We did not observe hearing impairment in children whose mothers were exposed to occupational noise during pregnancy when compared to the children from mothers who were not. There was no difference between the right and left ears, nor between male and female children in each group.

Study of the hearing in children born from pregnant women exposed to occupational noise: Assessment by distortion product otoacoustic emissions

AIM To detect early on a probable hearing loss in children of women exposed to occupational noise during their pregnancy and to verify if there is any difference between the children from those women exposed to occupational noise during their pregnancy and the ones from mothers that do not work under the same conditions. METHODS Children from women exposed to occupational noise during their pregnancy and children from women who were not exposed were evaluated through distortion product otoacoustic emissions, using the GSI 60 DPOEA SYSTEM equipment and the frequency-ratio F2/F1 equal to 1.2 and the geometric average of 2F1-F2. The intensity of the primary frequencies were kept steady with values of L1=65dBSPL and L2=55dBSPL for F1 and F2, respectively. Student T test in paired samples and independent samples were used. RESULTS There were no differences in the response amplitude of distortion product otoacoustic emissions between the control and the study groups. There was no statistically difference between male and female children in response amplitude for the two groups aforementioned; and there were no differences between right and left ears from each group. CONCLUSION We did not observe hearing impairment in children whose mothers were exposed to occupational noise during pregnancy when compared to the children from mothers who were not. There was no difference between the right and left ears, nor between male and female children in each group.

Assessment of collagen deposits after implant of fascia lata and fat in the vocal folds of rabbits: histomorphometric study

UNLABELLED Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. AIM The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit. STUDY DESIGN experimental. MATERIAL AND METHOD Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software. RESULTS There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days. CONCLUSION The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat.

Avaliação da deposição de colágeno após implante de fáscia lata e de gordura na prega vocal de coelho: estudo histomorfométrico

Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. AIM: The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit STUDY DESIDN: experimental MATERIAL AND METHOD: Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software RESULTS: There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days CONCLUSION: The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat.

Células de Langerhans no epitélio da prega vocal humana: estudo imunoistoquímico

Langerhans Cells (LC) are a type of dendritic cells that have functions which involves antigen presentation and the stimulation of a T cell response. They represent about 4% of the laryngeal epithelial cells. AIM: The aim of this study was to identify the presence of LC in the epithelium of the vocal folds, to compare their subpopulations, as well as to compare the capacity of four immunohistochemistry markers. STUDY DESIGN: Experimental. MATERIAL AND METHOD: Six cadavers, 3 men and 3 women, were studied. Analysis of vocal folds and skin paraffin blocks stained with commercially available polyclonal S-100, vimentin, CD-68 and fascin were done. After histological analysis, Student t test and Analysis of Variance (ANOVA) were accomplished in the statistical study. RESULTS AND CONCLUSIONS: It was possible to identify the presence of LC in the epithelium of the human vocal folds in no smokers of both sexes. Fascin, vimentin and CD-68 were superior markers of LC than S-100 polyclonal antibody in vocal folds (p=0,01) and in the skin (p=0,02). It was also possible to identify three different subpopulations of LC in the vocal folds and skin. However, just in the skin it was observed larger amount in the basal layer of the epithelium statistically significant.

Residência médica em otorrinolaringologia no Ceará em 2003: oferta de vagas e perfil da concorrência

AIM: Analyze and compare the openings for medical residency in Otorhinolaryngology in Ceara in 2003 along with the profile of the applicants. STUD DESIGN: cross-sectional. METHODS: Data on medical residency programs in Ceara as of September 2003 were obtained electronically from the web page of the National Commission of Medical Residency (CNRM). The information regarding the applicants was retrieved directly from the institutions offering medical residency programs in Otorhinolaryngology in 2003 and complemented by searches in the databases of the Ceara State Regional Council of Medicine and the Federal Council of Medicine. RESULTS: The total number of openings in Otorhinolaryngology authorized by CNRM is 12. Nine (75%) of the total and 4 (100%) of First Year Residence are currently filled. The hospital occupancy rate was 66.67% for HGF and 83.33% for HUWC. Competition per residency was 13.0 at both hospitals. The 48 applications received by the two hospitals were submitted by 37 doctors, 66.67% of whom were male. The largest number of candidates came from the medical schools of the Federal Universities of Ceara (62.50%), Paraiba (15.63%) and Alagoas (9.38%). Approximately 41% of the candidates had graduated in 2002. CONCLUSION: This study presents a profile of medical residency in Otorhinolaryngology.