Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses.

AIMS: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. STUDY DESIGN: Clinical-Prospective. MATERIAL AND METHODS: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. RESULTS: Intraoral US was performed on 35 cases and its sensitivity was of 95.2%, the specificity was of 78.5% and the accuracy was of 86.9%. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8%. There were 5 false-negatives and 1 false-positive result, sensitivity was 80%, specificity was 92.8% and accuracy was 84.5%. CONCLUSION: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Auditory brainstem response and otoacoustic emission assessment of hearing-impaired children of mothers who contracted rubella during pregnancy.

CONCLUSIONS: Based on the auditory brainstem response (ABR) results obtained in this study, the incidence of deafness in children whose mothers had rubella during pregnancy is high (29.5%), and deafness is profound in most cases (80%). Vaccinating women of childbearing age against rubella is essential to reduce the number of cases of childhood sensorineural hearing loss caused by gestational rubella. OBJECTIVE: It has been shown in the literature that, in Brazil, gestational rubella is responsible for approximately 21% of cases of deafness in children. The purpose of this study was to assess the incidence of deafness in children whose mothers had rubella during pregnancy. MATERIAL AND METHODS: Between February and July 2001, we conducted a prospective study assessing hearing status in 17 children (mean age 6 months). The mothers had serologically (ELISA) confirmed gestational rubella. We recorded ABRs and analysed distortion product otoacoustic emissions (DPOAEs). RESULTS: In 5 children (29.5%), ABRs revealed sensorineural hearing loss, which was moderate to severe in 1 (20%) and profound in 4 (80%). The hearing loss was bilateral in 3 children (60%) and asymmetrical in 4 (80%). Regarding DPOAEs, 7 children (41%) presented no response, and this occurred bilaterally in 4 (57%). All children with abnormal ABRs also presented abnormal DPOAEs. Two children with normal ABRs presented abnormal DPOAEs.

Brown tumor of the facial bones: case report and literature review.

Brown tumor, an uncommon focal giant-cell lesion, arises as a direct result of the effect of parathyroid hormone on bone tissue inpatients with hyperparathyroidism. The initial treatment involves the correction of hyperparathyroidism, which usually leads to tumor regression. We report a case of brown tumor of the right nasal fossa in a 71-year-old woman. The tumor had caused nasal obstruction and epistaxis. Laboratory evaluation revealed that the patient had primary hyperparathyroidism. Anatomicopathologic investigation revealed the presence of a giant-cell tumor We performed a partial parathyroidectomy, but the tumor in the right nasal fossa failed to regress. One year later we performed surgical resection of the lesion. The patient recovered uneventfully, and she remained asymptomatic and recurrence-free at the 1-year follow-up. Facial lesions with histologic features of a giant-cell tumor should be evaluated from a systemic standpoint. Hyperparathyroidism should always be investigated by laboratory tests because most affected patients are asymptomatic. Surgical resection of a brown tumor should be considered if the mass does not regress after correction of the inciting hyperparathyroidism or if the patient is highly symptomatic.

Ultra-sonografia intra-oral e transcutânea cervical no diagnóstico diferencial de celulite e abscessos periamigdalianos / Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses

OBJETIVOS: O objetivo deste estudo é determinar a especificidade, sensibilidade e a acurácia da ultra-sonografia (USG) intra-oral e transcutânea no diagnóstico de celulite e abscesso periamigdalianos. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: Trinta e nove pacientes foram atendidos no pronto-socorro de otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com diagnóstico clínico de celulite ou abscesso periamigdaliano. Em todos os pacientes, após a avaliação inicial, foram realizadas ultra-sonografias intra-oral e transcutânea. RESULTADOS: O USG intra-oral foi realizado em 35 casos e demonstrou sensibilidade de 95,2 por cento, especificidade de 78,5 por cento e a acurácia de 86,9 por cento. A USG transcutânea foi factível em todos os 39 pacientes e diagnosticou abscesso periamigdaliano em 53,8 por cento dos pacientes. A sensibilidade foi de 80 por cento, a especificidade de 92,8 por cento e a acurácia de 84,5 por cento. CONCLUSÕES: O USG intra-oral foi bastante sensível no diagnóstico de abscessos periamigdalianos. O USG transcutâneo obteve especificidade superior ao intra-oral. Porém, quando o USG transcutâneo foi realizado em pacientes com trismo, este diagnosticou todos os abscessos periamigdalianos, já que se tratava de coleções grandes, comuns em pacientes com trismo. Estes exames tiveram acurácia semelhantes.

AIMS: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. STUDY DESIGN: Clinical-Prospective. MATERIAL AND METHODS: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. RESULTS: Intraoral US was performed on 35 cases and its sensitivity was of 95.2 percent, the specificity was of 78.5 percent and the accuracy was of 86.9 percent. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8 percent. There were 5 false-negatives and 1 false-positive result, sensitivity was 80 percent, specificity was 92.8 percent and accuracy was 84.5 percent. CONCLUSION: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Aspectos clínicos e histopatológicos do linfoma nasossinusal / Clinical and histopathological aspects of the sinonasal lymphoma

Os linfomas do trato nasossinusal são neoplasias incomuns, que reconhecidamente causam importantes lesões destrutivas no nariz e terço médio da face. Sua raridade pode levar os profissionais da área médica a erros no diagnóstico clínico, além de representar um verdadeiro desafio aos patologistas, por sua natureza inflamatória. OBJETIVO: O objetivo deste estudo é determinar os aspectos clínicos e histopatológicos do linfoma não-Hodgkin (LNH) do trato nasossinusal, correlacionando sítio tumoral e comportamento biológico com os subtipos do LNH. FORMA DE ESTUDO: Estudo de série. MATERIAL E MÉTODO: Foi realizada uma análise retrospectiva que incluiu 7 pacientes atendidos no ambulatório do serviço de otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1985 a 2003. RESULTADOS: As linhagens de células B e T/NK têm comportamento biológico diferente, assim como o sítio e apresentação clínica, sendo o diagnóstico histopatológico de extrema importância. CONCLUSÃO: A biópsia realizada adequadamente favorecerá um diagnóstico mais precoce e preciso, instituindo rapidamente a terapêutica adequada e melhorando o prognóstico e a sobrevida destes pacientes.