Margarida Santos

Tracheal resection with primary anastomosis: 10 years experience

OBJECTIVE The aim of the study was to review clinical, imagiologic, and surgical outcomes of tracheal resection in the management of laryngotracheal stenosis. METHODS The study used a retrospective analysis of adult patients managed in a tertiary academic hospital who underwent thyrotracheal, cricotracheal, or tracheal end-to-end anastomosis between 1997 and 2006. RESULTS Twelve patients, aged 15 to 79 years old, were included. Prolonged tracheal intubation was the leading cause of stenosis (11 patients) that was classified according to Myer-Cotton (Ann Otol Rhinol Laryngol. 1994;103:319-323) classification as follows: grade II (25%), grade III (58%), and grade IV (17%). The stenosis extension ranged from 1 to 6 cm. Surgeries varied from tracheal end-to-end anastomosis (n = 5), cricotracheal anastomosis (n = 4), and thyrotracheal anastomosis (n = 3). Extubation was achieved in 11 patients (92%). One patient maintains a T tube stent. The most common complication was the presence of granulation tissue in the anastomosis region (33%). There was no mortality associated. CONCLUSIONS Tracheal resection with primary anastomosis appears to be a successful and safe procedure mainly due to its high decannulation rate and few complications associated.

Role of human leukocyte antigen, killer-cell immunoglobulin-like receptors, and cytokine gene polymorphisms in leptospirosis

Leptospirosis is an emerging zoonotic disease caused by pathogenic species of the genus Leptospira. It has a broad range of clinical presentations in humans. Although progress has been made in the characterization of the host immune system factors that may affect disease progression and outcome, to date few reports have addressed the role of genetic polymorphisms in the susceptibility to leptospirosis. In this work a group of patients with a history of leptospiral infection and a control group were compared for polymorphisms in the human leukocyte antigen (HLA), in killer-cell immunoglobulin-like receptors (KIR), and in cytokine genes. Alleles in the HLA-A and -B loci were associated with susceptibility, as were the class I haplotype A*01-B*08-Cw*07 and the 8.1 ancestral haplotype (A*01-B*08-Cw*07-DRB1*03-DQB1*02). Single nucleotide polymorphisms in the interleukin (IL)-4 and IL-4Ralpha genes also had significantly higher frequencies in the patient group. No association was reported between KIR gene profile and leptospirosis. This work highlights the importance of using genetic polymorphisms to better understand the mechanisms involved in the immune response to leptospirosis.

Parapharyngeal abscess in children: five year retrospective study

UNLABELLED Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. METHOD Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. RESULT The average age of presentation was 3.3 years. Neck stiffness (64%) and odynophagia (55%) were the most common symptoms. Fever (64%), stiff neck (64%), bulging of the oropharyngeal wall (55%), mass in the neck (55%) and lymphadenopathy (36%) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82% of the patients showed improvement after 48 hours, and 100% after 72 hours, without any complications. CONCLUSION Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.

Evaluation of two methods for computational HLA haplotypes inference using a real dataset

BackgroundHLA haplotype analysis has been used in population genetics and in the investigation of disease-susceptibility locus, due to its high polymorphism. Several methods for inferring haplotype genotypic data have been proposed, but it is unclear how accurate each of the methods is or which method is superior. The accuracy of two of the leading methods of computational haplotype inference – Expectation-Maximization algorithm based (implemented in Arlequin V3.0) and Bayesian algorithm based (implemented in PHASE V2.1.1) – was compared using a set of 122 HLA haplotypes (A-B-Cw-DQB1-DRB1) determined through direct counting. The accuracy was measured with the Mean Squared Error (MSE), Similarity Index (IF) and Haplotype Identification Index (IH).ResultsNone of the methods inferred all of the known haplotypes and some differences were observed in the accuracy of the two methods in terms of both haplotype determination and haplotype frequencies estimation. Working with haplotypes composed by low polymorphic sites, present in more than one individual, increased the confidence in the assignment of haplotypes and in the estimation of the haplotype frequencies generated by both programs.ConclusionThe PHASE v2.1.1 implemented method had the best overall performance both in haplotype construction and frequency calculation, although the differences between the two methods were insubstantial. To our knowledge this was the first work aiming to test statistical methods using real haplotypic data from the HLA region.

Characterisation of human papillomavirus (HPV) genotypes in the Azorean population, Terceira island

BackgroundHuman papillomavirus detection is very important for the evaluation of prevention strategies in cervical cancer. In the Azorean population, the virus prevalence has never been studied, and there is no data available to preview a successful outcome with HPV vaccination. In this article, our objective is to characterise the HPV genotypes in Terceira Island, contributing for the epidemiological knowledge on the virus infection.ResultsCervical samples were collected from 289 women aged 16–81 in the Gynaecological Outpatient Clinic of the Hospital de Santo Espírito de Angra do Heroísmo (HSEAH). HPV DNA was amplified by Polymerase Chain Reaction using the general consensus primers PGMYO9/PGMY11. Commercially available Papillomavirus Clinical Arrays® kits (Genomica) were used to perform HPV genotyping. 30 women were HPV positive, with a median age of 41 years old. Our results show that the overall HPV prevalence was 10.49%. Seventeen genotypes were identified, including 58.82% high risk, 17.65% low risk and 23.53% undetermined risk.ConclusionUnlike other epidemiological studies, HPV31 was the most frequent type (26.67%) in Terceira Island, followed by HPV16 (10.00%), HPV51, HPV53, HPV70 and HPV82 (6.67%). Further studies are needed to investigate if the HPV types found in our population are associated with the risk of progression to high-grade squamous intraepithelial lesions or cervical cancer.

Abcessos parafaríngeos na criança: estudo retrospectivo de 5 anos

Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM: To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. METHOD: Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. RESULT: The average age of presentation was 3.3 years. Neck stiffness (64%) and odynophagia (55%) were the most common symptoms. Fever (64%), stiff neck (64%), bulging of the oropharyngeal wall (55%), mass in the neck (55%) and lymphadenopathy (36%) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82% of the patients showed improvement after 48 hours, and 100% after 72 hours, without any complications. CONCLUSION: Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.

Urgent tracheostomy: four-year experience in a tertiary hospital

BACKGROUND Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important. METHODS We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed. RESULTS The study included 56 patients (44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two (3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal (51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated (average time: 4 months), and none of them were cancer patients. Complications occurred in 5 (12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure. CONCLUSION Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with difficult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patients clinical status turns into a surgical emergency situation.

Audiometric Outcome Comparison between Titanium Prosthesis and Molded Autologous Material

Objective To evaluate and compare the audiometric outcomes of ossicular reconstruction with titanium prosthesis and autologous material. Study Design Retrospective cohort study. Setting Tertiary referral center. Subjects and Methods Audiometric results of consecutive patients who performed ossiculoplasty with titanium prosthesis (n = 43) or autologous material (n = 48), from October 2008 to December 2011, were reviewed retrospectively and compared. The association between air-bone gain and age, ossiculoplasty material (autologous or titanium), preoperative diagnosis (chronic otitis media without cholesteatoma, cholesteatoma, or conductive hearing loss with intact tympanic membrane), and type of surgery (tympanoplasty, canal wall-down mastoidectomy, or canal wall-up mastoidectomy) was explored using regression analysis. Results Preoperative audiometric evaluation did not show differences between titanium and autologous groups in air-bone gap and pure-tone average. A postoperative decrease of 11.0 dB in air-bone gap and 12.4 dB in pure-tone average was observed in titanium ossiculoplasty compared with a reduction of 4.0 dB in air-bone gap and 5.1 dB in pure-tone average when autologous reconstruction was used. Mann-Whitney test revealed superior results in the titanium group compared with autologous reconstruction patients in air-bone gap (P = .02) and pure-tone average (P = .02). However, no statistically significant associations were observed after multivariate linear regression analysis of air-bone gap gain when adjusted for age, ossiculoplasty material, type of surgery, and preoperative diagnosis. One titanium prosthesis extrusion occurred during follow-up (2%). Conclusion Audiometric results achieved by titanium prosthesis are promising, but significant differences compared with autologous ossiculoplasty were not present.

Repositioning nystagmus: prognostic usefulness?

Abstract Conclusions: The presence of orthotropic nystagmus (ON), in multiple positions, appears to predict the success of canalith repositioning maneuvers (CRMs). In this sense CRMs under video-Frenzel are informative for the immediate follow-up, although not related to the degree of disability or emotional distress. Still, attention should be given to psychological assistance even in cases of clinically cured benign paroxysmal positional vertigo (BPPV). Objective: The aim of the study was to highlight the prognostic value of nystagmus in CRMs for BPPV and its relevance for emotional and patient-perceived disability. Methods: A group of 57 patients were selected from 3 balance disorders centers. CRMs were performed under video-Frenzel control. Assessment of patient disability and positional nystagmus was performed 2 months later. Emotional (Cuestionario de Impacto Emocional del Vértigo, CIEV) and quality of life (Dizziness Handicap Inventory, DHI) impact were evaluated. Results: The posterior semicircular canal (SCC) was affected in 84.2% of cases, the horizontal SCC in 10.5%, and the anterior SCC in 5.1%. Appropriate CRMs were performed. ON was present in 67% of cases. Overall resolution after the first treatment was achieved in 56% of cases. With ON present the success rate was 63% and when not observed the rate was 42%. DHI or CIEV scores were not significantly different when comparing the presence vs absence of ON. In nine patients (16%) an abnormal CIEV score was observed after treatment, even though a cured status was achieved in six of these nine patients.

Novel fast reverse transcriptase PCR assay for molecular detection of human influenza A (H1N1) virus.

A novel subtype of influenza A pandemic virus, A(H1N1)v, was recently reported by the Centers for Disease Control and Prevention (CDC) (Atlanta, GA) and WHO in April 2009 ([1][1]). Infection most commonly results in a mild respiratory tract infection, but there are reports of severe cases with