Luiz Ubirajara Sennes

Descending necrotizing mediastinitis: a retrospective surgical experience

OBJECTIVE Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces. We reviewed the last 10 years of our surgical experience in DNM and commented on early diagnosis and aggressive surgical treatment in these patients. METHODS Five males (71%) and two females (29%), mean age 34 years, with DNM, were surgically treated. Primary oropharyngeal infection occurred in three (43%) and odontogenic abscess in four (57%) patients. All had serious cervical and mediastinal infections with severe respiratory and hemodynamic repercussions, i.e. bacteremia, systemic arterial hypotension and obnubilation. Diagnosis was confirmed by computerized chest tomography. RESULTS All patients underwent surgical drainage of the cervical region by bilateral transverse cervicotomy with debridement of the necrotic and infected tissues, associating ample mediastinal drainage with or without thoracotomy. Six patients (86%) evolved well and were discharged after a mean of 35 days. Two patients (29%) required reoperation due to local surgical complications: empyema and dehiscence of the sternum. One patient (14%) died on the second postoperative (p.o.) day due to renal and respiratory insufficiency. Cultures of DNM showed the development of associated aerobic and anaerobic flora in 71% of the operated patients and only aerobic in 29%. CONCLUSION Early diagnosis by CAT scan of the neck and thorax aids in rapid indication of a surgical approach of DNM. Performing ample cervicotomy with mediastinal drainage generally associated with thoracotomy can significantly reduce the mortality rate for this condition to 14%.

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.

Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction

Measure the dimensions of the nasoseptal (NS) flap and the anterior skull base (ASB) defect. Verify whether the flap is sufficient to cover the defect. Study the anatomy of the septal artery (SA).

Histologic Study of Acute Vocal Fold Wound Healing After Corticosteroid Injection in a Rabbit Model

Objectives: Injectable corticosteroids have been used in phonosurgery to prevent scarring of the vocal fold because of their effects on wound healing, and to ensure better voice quality. We histologically evaluated the effects of dexamethasone sodium phosphate infiltration on acute vocal fold wound healing in rabbits 3 and 7 days after surgically induced injury by quantification of the inflammatory reaction and collagen deposition. Methods: A standardized surgical incision was made in the vocal folds of 12 rabbits, and 0.1 mL dexamethasone sodium phosphate (4 mg/mL) was injected into the left vocal fold. The right vocal fold was not injected and served as the control. The larynges were collected 3 and 7 days after surgery. For histologic analysis, the vocal folds were stained with hematoxylin-eosin for quantification of the inflammatory response and with picrosirius red for quantification of collagen deposition. Results: There was no quantitative difference in the inflammatory response between vocal folds injected with the corticosteroid and control vocal folds. However, the rate of collagen deposition was significantly lower in the corticosteroid-treated group at 3 and 7 days after injury (p = 0.002). Conclusions: The present results suggest that dexamethasone reduces collagen deposition during acute vocal fold wound healing.

Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches.

Demonstrate the endoscopic anatomy of the palatovaginal (PV) canal and artery for identification and dissection of the vidian nerve during endoscopic transpterygoid approaches. Evaluate the length of the PV canal and its relation with the vidian nerve. Show that the traditionally known PV canal is a misnomer and should be renamed.

Variação da intensidade vocal: estudo da vibração das pregas vocais em seres humanos com videoquimografia

The increase of glottal resistance is the main mechanism to increase vocal intensity at low fundamental frequency. This increase is due to adductory forces provoked by the contraction of intrinsic laryngeal muscles that increases tension and approximates the vocal folds to the midline. However, the same behavior can be observed in functional disorders, like adductor spasmodic dysphonia and hyperfunctional dysphonia, even during soft phonation. AIM: To evaluate the vibratory pattern of the vocal folds in subjects with normal voice according to intensity variation, in order to establish standard values for the vibratory cycle phases. These values may improve the diagnosis and the follow up of those disorders. STUDY DESIGN: Clinical prospective. SUBJECTS AND METHODS: Fifty-eight adults were evaluated during habitual (soft) and loud phonation. Vocal folds vibration patterns were analyzed with videokymography. Vocal intensity variation was studied with acoustic analysis software, comparing the intensity levels during habitual phonation and loud phonation. RESULTS: The results showed a spontaneous fundamental frequency (F0) rise as vocal intensity grew and a decrease of the open quotient at loud intensity phonation. CONCLUSION: Sound intensity levels were established at habitual (63,46 dB) and loud phonation (72,55dB). Open quotient (OQ) values were also established for those intensity phonation levels.

Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis

UNLABELLED Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM The objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN Clinical prospective. METHODS Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS Among the 81 studied patients, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed for 40.7% of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively. CONCLUSIONS We concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Endonasal endoscopic exposure of the internal carotid artery: An anatomical study

The aim of this work was to define the anatomical landmarks, limitations, and difficulties of obtaining internal carotid artery (ICA) exposure via endonasal endoscopic approaches (EEA).

Granuloma de processo vocal: caracterização clínica, tratamento e evolução

O granuloma de processo vocal e uma doenca cuja etiopatogenia nao e bem definida. Assim, o tratamento clinico e cirurgico nao e padronizado e os resultados terapeuticos variam de acordo com o servico. OBJETIVO: Objetivando caracterizar os pacientes com granuloma de processo vocal tratados em nosso servico, a abordagem terapeutica utilizada e a evolucao clinica. MATERIAL E METODO: realizamos um estudo retrospectivo pela analise de seus prontuarios. Encontramos maior incidencia de granuloma de processo vocal em homens, exceto em casos associados a intubacao laringea. RESULTADO: O fator etiopatogenico associado mais frequente foi o refluxo laringo-faringeo (RLF), seguido de intubacao laringea e abuso vocal. O tratamento clinico com inibidor de bomba de protons (IBP), corticosteroide topico e fonoterapia foi suficiente para remissao da lesao em 48,6% dos casos. A cirurgia para remocao do granuloma associada ao tratamento clinico foi eficaz em cerca de 90% dos casos. Recidivas tardias (apos um ano) foram observadas em cinco pacientes, sugerindo que o controle dos fatores etiopatogenicos associados deve ser mantido por tempo prolongado.