José Eduardo Lutaif Dolci

Avaliação da escala de Epworth em pacientes com a Síndrome da apnéia e hipopnéia obstrutiva do sono

A sindrome da apneia e hipopneia obstrutiva do sono (SAHOS) e, atualmente, considerada um problema de saude publica por causar aumento da morbi-mortalidade cardiovascular e acidentes de trânsito. A polissonografia assistida e o padrao-ouro para o diagnostico e acompanhamento destes pacientes. No entanto, por ser onerosa, demorada e de acesso restrito, outros metodos tem sido desenvolvidos. A escala de sonolencia de Epworth (ESE) e uma avaliacao subjetiva, porem, rapida, sem custos e simples de ser aplicada. OBJETIVO: Avaliar a correlacao entre a pontuacao da ESE e o indice de apneia e hipopneia (IAH) da polissonografia de pacientes com SAHOS. FORMA DE ESTUDO: Clinico retrospectivo. MATERIAL E METODO: Revisao de prontuario de 66 pacientes com queixa de roncopatia que foram submetidos a procedimento cirurgico (uvulopalatofaringoplastia com ou sem abordagem nasal). Avaliaram-se a pontuacao da ESE e o IAH da polissonografia pre e pos-operatorios. RESULTADOS: 78,7% pacientes com grau normal de IAH tiveram pontuacao de ESE menor do que 10 e 65% pacientes com grau severo de IAH tiveram pontuacao maior do que 10. Nao houve resultados estatisticamente significantes para os grupos moderado e leve. CONCLUSAO: A escala de Epworth pode distinguir os graus normais e severos sem, no entanto, determinar os graus moderado e leve. Assim, pode ser utilizada para acompanhamento de pacientes com SAHOS sem, no entanto, substituir a polissonografia uma vez que nao consegue avaliar todos os graus de severidade.

Experimental comparative study in rabbits of three different ways of cartilage graft fixation: suture, gelatin-resorcin-formaldehyde and butyl-2-cyanoacrylate

CONCLUSION The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. OBJECTIVE Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. MATERIALS AND METHODS Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. RESULTS There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).Conclusion: The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. Objective: Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. Materials and methods: Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. Results: There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).

Estudo experimental comparativo entre o butil-2-cianoacrilato, a mistura gelatina-resorcina-formaldeído e sutura na estabilização de enxertos de cartilagem em coelhos

Os enxertos de cartilagem constituem-se em boa opcao tecnica para aprimoramento das rinoplastias. Procura-se um material para sua fixacao que seja de simples manuseio, e que provoque minima reacao tecidual. OBJETIVO: Comparar o uso do butil-2-cianoacrilato, mistura gelatina-resorcina-formaldeido (GRF) e sutura na estabilizacao de enxertos de cartilagem em coelhos. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Utilizaram-se 15 coelhos adultos da raca Nova Zelândia machos, de cujas orelhas foram ressecados 6 enxertos de cartilagem, fixados no periosteo da calvaria e unidos dois a dois com sutura, GRF e cianoacrilato. Apos 2, 6 e 12 semanas, grupos de 5 coelhos foram sacrificados e realizou-se avaliacao da distância de deslocamento do enxerto e analise histologica do processo inflamatorio tecidual e da adesao/deformidade das cartilagens. RESULTADOS: Houve deslocamento menor nas fixadas com GRF do que com cianoacrilato e sutura. O processo inflamatorio foi maior nos animais de 2 semanas, decaindo ate restar pequeno grau de fibrose em 12 semanas, de modo semelhante nas 3 fixacoes. Nao houve descolamento nem deformidade em nenhuma dupla de cartilagens fixada com sutura e o maior numero de cartilagens descoladas e deformadas se deu com o cianoacrilato. O numero de cartilagens deformadas foi diretamente proporcional ao numero de descoladas. Os dados foram significativos estatisticamente (p<0,05). CONCLUSAO: A mistura gelatina-resorcina-formaldeido mostrou ser um metodo de estabilizacao de enxertos de cartilagem em coelhos superior ao butil-2-cianoacrilato em todas as fixacoes, e a sutura na fixacao cartilagem-osso.

Fechamento de perfuração septal nasal em coelhos com celulose bacteriana

UNLABELLED Alloplastic materials can be used together with tissue and structure to close nasal septal perforation. AIM to test cellulose use in the closure of septal perforation in rabbits and to compare fibrosis, inflammation, vascular congestion and graft integrity. MATERIALS AND METHODS Fifteen rabbits. The rabbits were divided into two groups: CONTROL Five rabbits and Bionext and fibrin glue Tissucol: Ten rabbits. Septal perforations were done in all of them. In the Bionext group the closure was performed with the placement of cellulose. RESULTS Two rabbits died in the first week. Cellulose group: 2 closures without the cellulose in between the septum membrane and in 4 cases the graft stood in the middle of the perforation locked in place by the edges. No closure in the control group. CONCLUSION There was no closure of the perforation of the nasal septum with the graft between the septum membranes. There was no statistically significant difference concerning acute inflammation, vascular congestion and fibrosis between the 2 groups. In cases in which the graft remained in place, there was no change in its integrity. It may be used as a substructure for re-epithelization of the perforation edges.

Neuropeptide immunofluorescence in human nasal mucosa: assessment of the technique for vasoactive intestinal peptide (VIP)

UNLABELLED Neuropeptides are important neurotransmitters in nasal physiology and the increasing knowledge of their role in nasal diseases brings new therapeutic perspectives. The investigation of human nasal mucosa neuropeptides is based mostly on immunocytochemistry, a complex approach whose resulting factors may be variable. Aiming to make this kind of research available, an immunofluorescence approach for vasoactive intestinal peptide (VIP) in human nasal mucosa is proposed and evaluated. STUDY DESIGN Transversal cohort. MATERIAL AND METHOD Human inferior turbinate samples were obtained at time of nasal surgery from eight patients. The samples were fixed in Zamboni solution (4% phosphate-buffered paraformaldehyde and 0.4% picric acid), snap-frozen and stored at -70 degrees C. 14 microm sections were then obtained. Immunofluorescence staining for VIP (Peninsula Laboratories) was performed and its images documented by conventional photography. The methods specificity, sensitivity and reproducibility of execution were evaluated. Additionally, the reproducibility of interpretation of results was evaluated through the comparison of staining scores (0 to 4) attributed to the images by six observers. RESULTS The results showed the approach to be very specific and sensible, besides being reproducible in its execution. The interpretation of results may depend on the observers accuracy in judging immunofluorescence images, but it showed uniformity. CONCLUSION The proposed method was highly useful for research purposes in neuropeptides in human nasal mucosa.

Histological analysis of the distribution pattern of glandular tissue in normal inferior nasal turbinates

UNLABELLED Nasal turbinates play an important role in nasal physiology. These functions include the important function of particle filtration by the mucocilliary system. Many nasal mucosal diseases, such as rhinitis and rhinosinusitis, are directly related with structural alterations of the mucosal lining of the turbinates. AIM To study the distribution pattern of the glandular epithelium of the lamina propria in the normal lower nasal turbinate mucosa of the anterior, medium and posterior portions. MATERIAL AND METHOD A prospective study in which small linear fragment of the lower nasal turbinate was removed from ten patients undergoing aesthetic nose surgery. The slides were hematoxilin-eosin stained, examined histologically and photographed. Glandular epithelium was delimited individually, the total area of the lamina propria on the anterior, medium and posterior portions of nasal turbinates was calculated (microm2). RESULTS There was no statistically significant difference in the distribution pattern of the glandular epithelium of the lamina propria. CONCLUSION This study showed no predominance of glandular epithelium distribution in anterior and posterior portions of lower nasal turbinates in normal subjects.

Análise histológica do padrão de distribuição glandular em conchas nasais inferiores normais

As conchas nasais inferiores desempenham um importante papel na fisiologia nasal. Dentre as diversas funcoes, destaca-se a filtracao de particulas estranhas pelo sistema mucociliar. Muitas doencas relacionadas a mucosa nasal, como rinites e rinossinusites, tem relacao direta com alteracoes estruturais na mucosa de revestimento das conchas nasais. OBJETIVO: Verificar o padrao de distribuicao do epitelio glandular da lâmina propria na mucosa de conchas nasais inferiores normais, nas suas regioes da cabeca, corpo e cauda. MATERIAL E METODO: Estudo prospectivo com dez pacientes submetidos a procedimento nasal estetico, dos quais retirou-se pequeno fragmento linear de concha nasal inferior. Os cortes foram corados com hematoxilina e eosina e submetidos a exame histologico. Foram delimitadas individualmente as areas de epitelio glandular e a area total de lâmina propria da mucosa da cabeca, do corpo e da cauda das conchas nasais, que foram medidas em µm2. RESULTADOS: Nao houve diferenca estatisticamente significativa no padrao de distribuicao do epitelio glandular da lâmina propria. CONCLUSAO: O presente estudo mostra que nao existe predominio em uma regiao especifica, na distribuicao do epitelio glandular, nas diferentes areas das conchas nasais inferiores no sentido ântero-posterior em pacientes normais.

Análise histológica de 24 tonsilas faríngeas de pacientes submetidos à adenoidectomia ou à adenoamigdalectomia

Introduction: The epithelium of pharyngeal tonsil is described mostly as a pseudostratified columnar ciliated epithelium with globet cells. Study design: Experimental. Objective: Description of the types of overlay epithelium of pharyngeal tonsils and the frequency of occurrence of these diferent types. Material and Method: Histological study of twenty-four pharyngeal tonsils from children three to seven years old to adenoidectomy or adenoamigdalectomy inthe Departament of Otorrinolaringology, Irmandade da Santa Casa de Sao Paulo. Results: Only 4,15% of the tonsils presented the pseudostratified columnar ciliated epithelium with globet cells like covering epithelium of exclusive occurrence; 4,15% presented exclusively stratified squamous nonkeratinized epithelium; 41,70% of all observeded tonsils showed predominance of pseudostratified columnar ciliated epithelium with globet cells with some areas of stratified squamous nonkeratinized epithelium; 50% of the observed sampleshowed predominance of stratified squamous nonkeratinized epithelium with some areas of pseudostratified columnar ciliated epithelium with globet cells. Conclusion: The studied pharyngeal tonsils presented the stratified squamous nonkeratinized epithelium with areas of pseudostratified columnar ciliated epithelium with globet cells as the most frequent epithelium of linining.

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.

Osteitis and mucosal inflammation in a rabbit model of sinusitis

INTRODUCTION Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and perpetuation of this inflammatory disease. However, procedures commonly performed for the induction of sinusitis, such as antrostomies, can trigger sinusitis by themselves. OBJECTIVE To evaluate osteitis in an animal model of sinusitis that does not violate the sinus directly and verify whether this is limited to the induction side, or if it affects the contralateral side. METHODS Experimental study in which sinusitis was produced by inserting an obstructing sponge into the nasal cavity of 20 rabbits. After defined intervals, the animals were euthanized and maxillary sinus samples were removed for semi-quantitative histological analysis of mucosa and bone. RESULTS Signs of bone and mucosal inflammation were observed, affecting both the induction and contralateral sides. Statistical analysis showed correlation between the intensity of osteitis on both sides, but not between mucosal and bone inflammation on the same side, supporting the theory that inflammation can spread through bone structures, regardless of mucosal inflammation. CONCLUSION This study demonstrated that in an animal model of sinusitis that does not disturb the sinus directly osteitis occurs in the affected sinus and that it also affects the contralateral side.