Lucas Rodrigues Carenzi

High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease.

Chronic tonsillar diseases are an important health problem, leading to large numbers of surgical procedures worldwide. Little is known about pathogenesis of these diseases. In order to investigate the role of respiratory viruses in chronic adenotonsillar diseases, we developed a cross-sectional study to determine the rates of viral detections of common respiratory viruses detected by TaqMan real time PCR (qPCR) in nasopharyngeal secretions, tonsillar tissues and peripheral blood from 121 children with chronic tonsillar diseases, without symptoms of acute respiratory infections. At least one respiratory virus was detected in 97.5% of patients. The viral co-infection rate was 69.5%. The most frequently detected viruses were human adenovirus in 47.1%, human enterovirus in 40.5%, human rhinovirus in 38%, human bocavirus in 29.8%, human metapneumovirus in 17.4% and human respiratory syncytial virus in 15.7%. Results of qPCR varied widely between sample sites: human adenovirus, human bocavirus and human enterovirus were predominantly detected in tissues, while human rhinovirus was more frequently detected in secretions. Rates of virus detection were remarkably high in tonsil tissues: over 85% in adenoids and close to 70% in palatine tonsils. In addition, overall virus detection rates were higher in more hypertrophic than in smaller adenoids (p = 0.05), and in the particular case of human enteroviruses, they were detected more frequently (p = 0.05) in larger palatine tonsils than in smaller ones. While persistence/latency of DNA viruses in tonsillar tissues has been documented, such is not the case of RNA viruses. Respiratory viruses are highly prevalent in adenoids and palatine tonsils of patients with chronic tonsillar diseases, and persistence of these viruses in tonsils may stimulate chronic inflammation and play a role in the pathogenesis of these diseases.

Avaliação tardia em rinoplastia estética em um centro acadêmico de referência

UNLABELLED Plastic surgery is based on improving esthetic for the patient. In most services, the surgery outcome is evaluated in a subjective manner. AIM to objectively assess the degree of patient satisfaction one year after rhinoplasty using the Rhinoplasty Outcome Evaluation questionnaire at a referral academic center. MATERIALS AND METHODS 69 patients operated in the otorhinolaryngology service were selected. The patients were operated upon by third year residents during the period from January to December 2007 and answered the questionnaire translated by the authors of this study. RESULTS we obtained a mean value of 73.25% of satisfaction for primary rhinoplasty and a mean value of 72.02% of satisfaction for secondary rhinoplasty. CONCLUSION the level of satisfaction presented by the patients was considered to be very good.

Hypertrophic Adenoid Is a Major Infection Site of Human Bocavirus 1

ABSTRACT Human bocavirus 1 (HBoV1) is associated with respiratory infections worldwide, mainly in children. Similar to other parvoviruses, it is believed that HBoV1 can persist for long periods of time in humans, probably through maintaining concatemers of the virus single-stranded DNA genome in the nuclei of infected cells. Recently, HBoV-1 was detected in high rates in adenoid and palatine tonsils samples from patients with chronic adenotonsillar diseases, but nothing is known about the virus replication levels in those tissues. A 3-year prospective hospital-based study was conducted to detect and quantify HBoV1 DNA and mRNAs in samples of the adenoids (AD), palatine tonsils (PT), nasopharyngeal secretions (NPS), and peripheral blood (PB) from patients undergoing tonsillectomy for tonsillar hypertrophy or recurrent tonsillitis. HBoV1 was detected in 25.3% of the AD samples, while the rates of detection in the PT, NPS, and PB samples were 7.2%, 10.5%, and 1.7%, respectively. The viral loads were higher in AD samples, and 27.3% of the patients with HBoV had mRNA detectable in this tissue. High viral loads and detectable mRNA in the AD were associated with HBoV1 detection in the other sample sites. The adenoids are an important site of HBoV1 replication and persistence in children with tonsillar hypertrophy. The adenoids contain high HBoV1 loads and are frequently positive for HBoV mRNA, and this is associated with the detection of HBoV1 in secretions.

Orbital and central nervous system extension of nasal natural killer/T-cell lymphoma.

Background: To describe a case series of nasal natural killer (NK)/T-cell lymphoma (NKTL) with orbital and central nervous system extension. Methods: This is a retrospective study. The medical records of 9 patients with a diagnosis of NKTL were reviewed. All patients had a positive biopsy for CD3, CD56, T-cell-restricted intracellular antigen-1, and granzyme expression and CT imaging of nose, sinuses, orbits, and brain. Five patients were also examined with MRI. Results: Orbital extension occurred in 6 patients. All had extraocular muscle enlargement and 5 showed signs of perineural spread. Conclusions: NKTL is a polymorphous disease. Extraocular muscle involvement and perineural spread are overlooked features that explain dissemination of the tumor to both the orbit and the central nervous system.

The pathogens profile in children with otitis media with effusion and adenoid hypertrophy

Objectives To evaluate the presence of viruses and bacteria in middle ear and adenoids of patients with and without otitis media with effusion (OME). Methods Adenoid samples and middle ear washes (MEW) were obtained from children with OME associated with adenoid hypertrophy undergoing adenoidectomy and tympanostomy, and compared to those obtained from patients undergoing cochlear implant surgery, as a control group. Specific DNA or RNA of 9 respiratory viruses (rhinovirus, influenza virus, picornavirus, syncytial respiratory virus, metapneumovirus, coronavirus, enterovirus, adenovirus and bocavirus) and 5 bacteria (S. pneumoniae, H. influenzae, M. catarrhalis, P. aeruginosa and S. aureus) were extracted and quantified by real-time PCR. Results 37 OME and 14 cochlear implant children were included in the study. At the adenoid, virus and bacteria were similarly detected in both OME and control patients. At the middle ear washes, however, a higher prevalence of bacteria was observed in patients with OME (p = 0.01). S. pneumoniae (p = 0.01) and M. catarrhalis (p = 0.022) were the bacteria responsible for this difference. Although total virus detection was not statistically different from controls at the middle ear washes (p = 0.065), adenovirus was detected in higher proportions in adenoid samples of OME patients than controls (p = 0.019). Conclusions Despite both OME and control patients presented similar rates of viruses and bacteria at the adenoid, children with OME presented higher prevalence of S. pneumonia, M. catarrhalis in middle ear and adenovirus in adenoids when compared to controls. These findings could suggest that these pathogens could contribute to the fluid persistence in the middle ear.

Amoxicillin, Ibuprofen, or Prednisolone Does Not Modify Post-tonsillectomy Pain in Children: A Randomized Controlled Trial

Objectives: Evaluate the effect of amoxicillin, ibuprofen, or prednisolone on post-tonsillectomy pain in children. Methods: 225 children between 6-10 years-old undergoing cold knife adenotonsillectomy/tonsillectomy were included in the study. Pain was monitored in the first seven days after surgery by the parent’s (“Parents’ Post-Operative Pain” -PPPM) and child’s assignment (“Revised-Facial Pain Scale” -R-FPS). Pain was also indirectly analyzed by the number of analgesic administration and return to solid food intake. 45 children were randomized into 5 distinct groups, with the respective number of patients analyzed after losses and exclusions: 1) control n = 42; 2) amoxicillin 50mg/kg/day, n = 31; 3) oral prednisolone 0.5mg/kd/day, n = 30; 4) ibuprofen 5mg/kg/dose tid, n = 32; 5) amoxicillin plus prednisolone, n = 37. All groups received oral analgesics (dypirone and acetaminophen) to use as required. PPPM was analyzed by a linear regression model with mixed effects with Tukey post-test for multiple comparisons (SAS 9.0). R-FPS and analgesic intake were analyzed by Kruskal-Wallis. Return to solid intake was analyzed by Wilcoxon test, considering significant when P < 0.05. Results: Multiple comparisons demonstrated that the evolution of pain, matched day-per-day among the different groups, was not statistically different either by PPPM or R-FPS (P > 0.05). The number of analgesic intake was also similar in all groups (P = 0.10) as well as the return to solid food intake (P = 0.41). Also, all groups presented a similar standard of clinical improvement in intervals of two days (P < 0.01). Conclusions: Our data demonstrate that the addition of amoxicillin, ibuprofen, or prednisolone to simple analgesic prescription does not modify post-tonsillectomy pain in children.

Fungal mastoiditis in patients with AIDS: case report

Instituicao: Departamento de Otorrinolaringologia, Oftalmologia e Cirurgia de Cabeca e Pescoco do Hospital das Clinicas de Ribeirao Preto da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Ribeirao Preto / SP – Brasil. Endereco para correspondencia: Lucas Rodrigues Carenzi Avenida Bandeirantes, 3900 Hospital das Clinicas 12o Andar Campus Universitario da USP -Monte Alegre Ribeirao Preto / SP Brasil CEP: 14049-900 – Telefone: (+55 16) 3602-2321 – E-mail: lucas_carenzi@yahoo.com.br Artigo recebido em 10 de Agosto de 2009. Artigo aprovado em 23 de Outubro de 2009.INTRODUCAO: Mastoidite fungica por Aspergillus fumigatus ocorre predominantemente em pacientes imunossuprimidos. O diagnostico geralmente e dificil e a doenca e potencialmente fatal. O tratamento consiste em terapia antifungica, desbridamento cirurgico e correcao da imunossupressao. RELATO DE CASO: Este artigo trata-se de um relato de um caso de mastoidite fungica em um paciente com sindrome da imunodeficiencia adquirida (SIDA). O tratamento realizado foi o cirurgico associado a terapia antifungica. O nervo facial deste paciente nao estava afetado, o que nao exclui complicacoes potencialmente fatais da mastoidite.

Fungal Mastoiditis in AIDS Patients: Reported Cases

Instituicao: Departamento de Otorrinolaringologia, Oftalmologia e Cirurgia de Cabeca e Pescoco do Hospital das Clinicas de Ribeirao Preto da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Ribeirao Preto / SP – Brasil. Endereco para correspondencia: Lucas Rodrigues Carenzi Avenida Bandeirantes, 3900 Hospital das Clinicas 12o Andar Campus Universitario da USP -Monte Alegre Ribeirao Preto / SP Brasil CEP: 14049-900 – Telefone: (+55 16) 3602-2321 – E-mail: lucas_carenzi@yahoo.com.br Artigo recebido em 10 de Agosto de 2009. Artigo aprovado em 23 de Outubro de 2009.INTRODUCAO: Mastoidite fungica por Aspergillus fumigatus ocorre predominantemente em pacientes imunossuprimidos. O diagnostico geralmente e dificil e a doenca e potencialmente fatal. O tratamento consiste em terapia antifungica, desbridamento cirurgico e correcao da imunossupressao. RELATO DE CASO: Este artigo trata-se de um relato de um caso de mastoidite fungica em um paciente com sindrome da imunodeficiencia adquirida (SIDA). O tratamento realizado foi o cirurgico associado a terapia antifungica. O nervo facial deste paciente nao estava afetado, o que nao exclui complicacoes potencialmente fatais da mastoidite.

Mastoidite fúngica em paciente com SIDA: relato de caso

Instituicao: Departamento de Otorrinolaringologia, Oftalmologia e Cirurgia de Cabeca e Pescoco do Hospital das Clinicas de Ribeirao Preto da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo. Ribeirao Preto / SP – Brasil. Endereco para correspondencia: Lucas Rodrigues Carenzi Avenida Bandeirantes, 3900 Hospital das Clinicas 12o Andar Campus Universitario da USP -Monte Alegre Ribeirao Preto / SP Brasil CEP: 14049-900 – Telefone: (+55 16) 3602-2321 – E-mail: lucas_carenzi@yahoo.com.br Artigo recebido em 10 de Agosto de 2009. Artigo aprovado em 23 de Outubro de 2009.INTRODUCAO: Mastoidite fungica por Aspergillus fumigatus ocorre predominantemente em pacientes imunossuprimidos. O diagnostico geralmente e dificil e a doenca e potencialmente fatal. O tratamento consiste em terapia antifungica, desbridamento cirurgico e correcao da imunossupressao. RELATO DE CASO: Este artigo trata-se de um relato de um caso de mastoidite fungica em um paciente com sindrome da imunodeficiencia adquirida (SIDA). O tratamento realizado foi o cirurgico associado a terapia antifungica. O nervo facial deste paciente nao estava afetado, o que nao exclui complicacoes potencialmente fatais da mastoidite.