Ossamu Butugan

Ear and nose foreign body removal in children

The removal of foreign bodies in children is very common in the otolaryngologists daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

Endoscopic Ligature of the Sphenopalatine Artery for Severe Posterior Epistaxis

OBJECTIVE: To present our experience with endoscopic ligature of the sphenopalatine artery in the treatment of severe posterior epistaxis of patients who had previously undergone conservative procedures. METHODS: Eleven patients with severe posterior epistaxis were treated during a 25-month period with an endoscopic ligature of the sphenopalatine artery. The basic principle of the surgical technique is to identify the branches of the sphenopalatine artery through an endoscopic endonasal approach and to apply a titanium clip under direct vision. RESULTS: The endoscopic ligature of the sphenopalatine artery was performed unilaterally in 10 patients and bilaterally in 1 patient, with a total of 12 ligatures. It was possible to identify the sphenopalatine artery in all cases with a successful outcome using this surgical technique alone. CONCLUSION: Endonasal endoscopic ligature of the sphenopalatine artery has been an effective surgical technique for treating severe posterior epistaxis.

Expression of growth factors, proto-oncogenes, and p53 in nasopharyngeal angiofibromas

Biopsies from 25 juvenile nasopharyngeal angiofibromas (JNAs) and respective normal inferior turbinates were examined and compared. The expression patterns of the messenger RNAs (mRNAs) for various growth factors possibly involved in the growth of mesenchymal cells, as well as angiogenesis and fibrosis, were also compared. These growth factors included insulin‐like growth factor II (IGF‐II), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), transforming growth factors‐β1 (TGF‐β1) and platelet‐derived growth factors (PDGF‐A and PDGF‐B). Quantification of mRNA coding for proto‐oncogenes and suppressor genes related to proliferation (i.e., c‐myc, c‐fos, p53) was also undertaken.

Multiple steroid receptors in nasopharyngeal angiofibromas

Cytosols from 12 nasopharyngeal angiofibroma tissues were analyzed for the presence of estrogen (ER), progesterone (PR), androgen (AR), and glucocorticoid (GR) receptors, by using a dextran charcoal assay. Progesterone receptors (58%) clearly predominate over ER and AR (25%). Thus, nasoangiofibromas can be classified as ER‐PR+ tumors. Glucocorticoid receptors were found in 84% of the tumors. Steroid receptor levels, although slightly higher than those determined in three specimens of normal turbinate, were quantitatively low. Positive PR and AR tumors appeared to correlate with high density of fibroblasts and endothelial cells.

Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study

UNLABELLED Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique.

Nasal polyposis and allergy: is there a correlation?

Nasal polyposis (NP) is a chronic inflammatory disease of the nasal mucosa. The etiology and formation of NP are still not elucidated and have been debated for many years. The objective of the present study was to investigate the role of nasal allergy in the development of NP. The following aspects were analyzed: age, sex, and patients symptoms; correlation between asthma, aspirin intolerance, and NP; serum immunoglobulin levels and eosinophil; and concentration of interleukins 1β, 3, and 4 in NP. Thirty-nine patients with NP were selected, 13 of them allergic and 26 non-allergic. A control group of 11 individuals was also studied. The concentrations of interleukins 1β, 3, and 4 were measured by enzyme-linked immunosorbent assay (ELISA). There was a higher incidence of NP after the fourth decade of life and among men. We found no correlation of asthma or aspirin intolerance with the presence or absence of allergy. Serum levels of IgE and eosinophils were significantly higher in patients with allergy and NP and the concentrations of interleukins 3 and 4 were positively correlated with NP. There was no difference in interleukin 3 and 4 concentration between the non-allergic group with NP and the control group, suggesting that these interleukins do not play an important role in the etiology and formation of NP. These results suggest that the immunologic pathway involved in the etiology of NP is different from the one correlated with allergy (IgE-mediated).

Antibiotics in septoplasty: is it necessary?

UNLABELLED The use of antibiotics is a common practice among otorhinolaryngogists for surgical procedures. The majority of the American Rhinology Society members uses post-operative antibiotics routinely in septoplasties, which is considered unnecessary by many authors. AIM To study the real necessity of the antibiotic usage in septoplasties, as well as the main post-operative complications described in the literature. STUDY DESIGN clinical prospective with transversal cohort. MATERIAL AND METHOD We studied prospectively 35 patients who were undergone to septoplasty with or without turbinectomy, in the Clinical Hospital of the University of São Paulo. The patients were split in three groups: Group A: without antibiotics; Group B: antibiotics (cefazolin) only during the anesthesic induction; Group C: antibiotics both in the anesthesic induction and post-operatively for seven days. A questionnaire was applied in the immediate post-operatory, in the 7th post-operative day and in the 30th post-operative day asking for bleeding, fever, pain, nausea, vomits and followed by physical and endoscopic evaluation looking for hematoma, septal abscess and purulent secretion which as quantified. RESULT We do not observed significative difference among the groups concerning to pain, fever, nausea, vomits, bleeding and purulent secretion. None of the patients had hematoma or septal abscess. The groups also do not differ in respect to the quantity of purulent secretion. CONCLUSION The nasal surgeries are clean contamined and do not need antibioticprophilaxy because of the low infection risk.

Genetic alterations in Ki-ras and Ha-ras genes in Juvenile Nasopharyngeal Angiofibromas and head and neck cancer

CONTEXT Ras gene mutations have been associated to a wide range of human solid tumors. Members of the ras gene family (Ki-ras, Ha-ras and N-ras) are structurally related and code for a protein (p21) known to play an important role in the regulation of normal signal transduction and cell growth. The frequency of ras mutations is different from one type of tumor to another, suggesting that point mutations might be carcinogen-specific. OBJECTIVES To study the occurrence of Ki-ras and Ha-ras mutations. We also studied the relative level of Ha-ras mRNA in 32 of the head and neck tumors. DESIGN Case series. SETTING University referral unit. PARTICIPANTS 60 head and neck tumors and in 28 Juvenile Nasopharyngeal Angiofibromas (JNA). DIAGNOSTIC TEST Using PCR-SSCP we examined the occurrence of Ki-ras and Ha-ras mutations. The relative level of Ha-ras mRNA was examined by Northern blot analysis. RESULTS None of the head and neck tumors or JNA samples showed evidence of mutations within codons 12, 13, 59 and 61 of Ki-ras or Ha-ras genes. However, 17 (53%) of the tumors where gene expression could be examined exhibited increased levels of Ha-ras mRNA compared with the normal tissue derived from the same patient. CONCLUSIONS Our results demonstrate for the first time that mutations of Ki-ras and Ha-ras genes are not associated with the development of JNA and confirm previous reports indicating that activating ras mutations are absent or rarely involved in head and neck tumors from western world patients. Furthermore, our findings suggest that overexpression of Ha-ras, rather than mutations, might be an important factor in the development and progression of head and neck tumors.

Relaxation of imprinting of IGFII gene in Juvenile Nasopharyngeal Angiofibromas

IGFII and H19 genes are expressed only from one allele due to genomic imprinting, biallelic expression (loss of imprinting) being associated with the tumorigenic process of different types of tumors. The mechanism responsible for genomic imprinting is not yet determined, although DNA methylation has been considered the main genetic event for an imprinted mark. In the current study, the authors analyzed the imprinting status and expression levels of the IGFII and H19 genes in 27 cases of Juvenile Nasopharyngeal Angiofibroma (JNA) using RFLPs, RT-PCR, and Southern and Northern Blots. The authors found that four out of eight informative cases (50%) for ApaI/IGFII polymorphism showed biallelic expression of IGFII, whereas none of the nine informative cases for the RsaI/H19 polymorphism showed biallelic expression of the H19 gene. Overexpression of IGFII was observed in 8 out of 22 cases (36.4%), and 7 out of 19 cases (36.8%) showed H19 overexpression. Hypomethylation was found only in the H19 gene in six out of eight cases analyzed. Therefore, our results demonstrate that alterations in the IGFII/H19 imprinted region occur in JNA.

Bilateral ethmoidal mucocele in cystic fibrosis: report of a case.

The purpose of this study is to report a rare and interesting case of a 10-month-old boy who presented a bilateral ethmoidal mucocele associated with cystic fibrosis and to discuss, according to the literature, the sinonasal involvement in this disease. Only nine pediatric patients with both disorders have been reported previously in literature, and all of these cases were older than 1 year 4 months and presented with a unilateral mucocele.