RESUMO
BACKGROUND: Ipsilateral hypoglossal nerve (XII) paresis has never been reported as the first and only complication of malignant otitis external (MOE). CASE REPORT: A 73-year-old diabetic male with persistent left temporomandibular joint ache and ear fullness was admitted with the diagnosis of MOE. He received intravenous ciprofloxacin for 14 days and then continued with oral administration (per os). After two months, he returned with otalgia, swallowing difficulty, and ipsilateral XII paresis. He was re-admitted, received intravenous ciprofloxacin for 6 weeks, and continued with per os ciprofloxacin for 6 months. A Ga67-scan 6 months after the first admission revealed no active infection. Two years after his last admission, the patient still has XII paresis. There is no other cranial nerve involvement and inflammatory markers continue to be normal. CONCLUSION: Doctors should consider MOE in the differential diagnosis when there is XII paresis, especially in diabetic and immunocompromised patients.
Assuntos
Doenças do Nervo Hipoglosso/etiologia , Nervo Hipoglosso , Otite Externa/complicações , Paresia/etiologia , Idoso , Diagnóstico Diferencial , Humanos , Doenças do Nervo Hipoglosso/diagnóstico , Masculino , Otite Externa/diagnóstico por imagem , Paresia/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Avaliação de Resultados em Cuidados de Saúde , Fumar , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Fibrous histiocytoma is a benign tumour composed of a mixture of fibroblastic and histiocytic cells. Based on the location of this tumour, fibrous histiocytoma are usually divided into cutaneous types and those involving deep tissues. These lesions most often arise on the skin, but may rarely occur in soft deep tissues. The diagnosis of fibrous histiocytoma may be clinically difficult when the lesion is located in the deep tissues, and is frequently confirmed after local excision. The most important diagnostic distinction is the separation of this tumour from aggressive forms of fibrohistiocytic neoplasms, including dermatofibrosarcoma protuberans and malignant fibrous histiocytoma. A 19-year-old male presented with a painless swelling on the right cheek. Detailed clinical and laboratory examinations were performed. The lesion had been totally excised under local anaesthesia, and histopathology revealed a benign fibrous histiocytoma. The diagnosis, location, treatment and prognosis of fibrous histiocytoma are also discussed.
Assuntos
Bochecha/patologia , Histiocitoma Fibroso Benigno/patologia , Adulto , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
PURPOSE: Stealth (ALZA Corporation, Palo Alto, CA) liposomal drug formulation allows a higher intratumoral accumulation and a prolonged plasma half-life of the encapsulated drugs. In the study presented here, we evaluated the feasibility of Stealth liposomal doxorubicin (Caelyx; ALZA Corporation) administered concurrently with conventionally fractionated radiotherapy in the treatment of non-small-cell lung cancer (NSCLC) and head and neck cancer (HNC). PATIENTS AND METHODS: Fifteen patients with NSCLC and 15 with squamous-cell HNC were recruited in two phase I dose-escalation trials. The starting dose of Caelyx was 10 mg/m(2) every 2 weeks (for three cycles during radiotherapy) and was increased by 5 mg/m(2) dose increments for every three patients. RESULTS: The maximum tolerated dose of Caelyx was 20 mg/m(2) for HNC and 25 mg/m(2) in NSCLC patients. Oral/pharyngeal mucositis was the dose-limiting toxicity for HNC patients. "In field" radiation skin toxicity was slightly increased. Hematologic toxicity was minimal. Single photon emission computed tomographic evaluation of Caelyx distribution, using technetium-99m-diethylenetriamine pentaacetic acid labeling, revealed a high intratumoral accumulation of the drug. The tumor to thoracic vessel area count ratio in the NSCLC cases ranged from 0.6 to 1.6 (mean +/- SD, 1.01 +/- 0.29), whereas this ratio was higher (0.8 to 1.85; mean +/- SD, 1.35 +/- 0.39) in HNC cases (P =.049). The complete response rate was 21% in the NSCLC cases and 75% in the HNC cases. NSCLC cases with higher Caelyx tumor accumulation responded better to the regimen. The tumor microvessel density assessed with the anti-CD31 monoclonal antibody directly correlated with the degree of the Caelyx accumulation (P =.007; r =. 92). CONCLUSION: We conclude that combination of radiotherapy with Stealth liposomal doxorubicin is feasible. The potential role of such a regimen in the treatment of highly angiogenic tumors requires further investigation.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Doxorrubicina/administração & dosagem , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Relação Dose-Resposta a Droga , Doxorrubicina/efeitos adversos , Portadores de Fármacos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Modelos Lineares , Lipossomos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
INTRODUCTION: The role played by Mycoplasma pneumoniae and Chlamydophila pneumoniae in the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls. METHODS: We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence of M pneumoniae and C pneumoniae DNA. RESULTS: Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative for M pneumoniae and C pneumoniae DNA. CONCLUSION: We have demonstrated that the likelihood of M pneumoniae and C pneumoniae acting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.
Assuntos
Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/epidemiologia , Chlamydophila pneumoniae , Mycoplasma pneumoniae , Pólipos Nasais/diagnóstico , Pólipos Nasais/epidemiologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/epidemiologia , Rinite/diagnóstico , Rinite/epidemiologia , Sinusite/diagnóstico , Sinusite/epidemiologia , Adulto , Doença Crônica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo RealRESUMO
Both docetaxel and irinotecan have shown strong radiosensitizing properties in vitro. Encouraging results have been reported by phase I/II studies on combined docetaxel or irinotecan with radiotherapy. In the present study we investigated the feasibility of double radiosensitization with weekly docetaxel and irinotecan in head and neck cancer. Twelve patients with locally advanced squamous cell head and neck cancer were recruited in a phase I/II dose escalation protocol. Radiotherapy was given as a standard fractionation regimen (2 Gy/day, 5 fractions/week) to a total dose of 66-70 Gy. Three Docetaxel/Irinotecan dose levels were examined thus, 20/25 mg/m2 (level 1), 20/40 mg/m2 (level 2) and, 25/55 mg/m2 (level 3). Severe asthenia was observed in 1/4 patients treated in the 2nd dose level and in all 4 patients treated in the 3rd. The onset of severe asthenia was associated with the onset of severe grade 3/4 mucositis during the 4th week of treatment. Radiation induced mucositis was accompanied by fungal infection in all 5 patients. The symptomatology persisted for 10-14 days. Mild grade 2 mucositis was observed in 7/8 patients treated at the 1st and 2nd dose level, which enforced treatment delay for 3-5 days. Neutrophil toxicity was minimal. There was only one patient treated at the 3rd dose level that presented with grade 2 neutropenia. Hemoglobin toxicity was also minimal, showing a median drop of 1.2 gr/dL. There was no platelet toxicity observed. Complete response was observed in 9/12 (75%) patients and partial response was observed in 3/12 patients. Of interest, the lowest CR rate was observed in the 3rd dose level (2/4; 50%), which may be a consequence of overall treatment time prolongation. It is concluded that docetaxel and irinotecan combination with radiotherapy is feasible and, a high CR rate can be expected. Combination of the regimen with cytoprotective agents warrant further investigation.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/análogos & derivados , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Paclitaxel/análogos & derivados , Taxoides , Adulto , Idoso , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Camptotecina/administração & dosagem , Camptotecina/efeitos adversos , Terapia Combinada , Docetaxel , Fracionamento da Dose de Radiação , Relação Dose-Resposta a Droga , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Irinotecano , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Radiossensibilizantes/administração & dosagem , Radiossensibilizantes/efeitos adversos , Radioterapia/efeitos adversosRESUMO
OBJECTIVE: This study was undertaken to assess the excess cost of hospitalization accrued to patients who develop postoperative wound infection following neck dissection in which the wound was not exposed to secretions from the upper aerodigestive tract. DESIGN: A retrospective cohort of patients who underwent "clean" neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), post-operative wound infection (yes or no), and duration and cost of hospitalization were assessed. SETTING: All surgeries were performed in a university medical center. PATIENTS: All patients underwent neck dissection in which the procedure was clean, ie, there was no exposure to secretions from the upper aerodigestive tract. MAIN OUTCOME MEASURES: Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duration and cost of hospitalization. RESULTS: Wound infection developed in 10 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant difference may have been missed (false-negative) as a result of the small number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36,000 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount. CONCLUSION: The decision to withhold antibiotic prophylaxis should not be made in an effort to reduce hospital costs.
Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Cabeça/cirurgia , Pescoço/cirurgia , Pré-Medicação/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/economia , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/prevenção & controle , Cefalosporinas/economia , Cefalosporinas/uso terapêutico , Clindamicina/economia , Clindamicina/uso terapêutico , Estudos de Coortes , Custos e Análise de Custo , Fístula Cutânea/economia , Fístula Cutânea/etiologia , Fístula Cutânea/prevenção & controle , Dissecação , Custos de Medicamentos , Feminino , Custos Hospitalares , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
Acute otitis media with complications is a persistent problem in the modern antibiotic era with a relatively high mortality rate. Acute mastoiditis is a serious complication of acute otitis media with potentially grave consequences and the epidural abscess constitutes the commonest of all intracranial complications, arising from middle ear infections. We report two cases of children with acute mastoiditis without evidence of intracranial complication or subperiosteal abscess, in whom the early evaluation with computed tomography (CT) disclosed an unsuspected epidural abscess. Therefore, we stress the use of CT as a rule of thumb for every child with acute mastoiditis.
Assuntos
Abscesso/etiologia , Mastoidite/etiologia , Otite Média Supurativa/complicações , Abscesso/diagnóstico por imagem , Doença Aguda , Pré-Escolar , Espaço Epidural , Feminino , Humanos , Masculino , Mastoidite/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS: In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS: In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION: More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.
Assuntos
Brônquios , Broncoscopia/métodos , Corpos Estranhos/cirurgia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Corpos Estranhos/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Distribuição por SexoRESUMO
Mucocele is a rare clinical entity in children. It is considered to be associated with fibrocystic disease. The capacity of mucocele to erode through the bone walls along with the increased density of its content, make the diagnosis difficult when mucocele has to be differentiated from benign or malignant tumors. In this paper, we present the case of an 8-year-old boy with mucocele of the left maxillary antrum. Both the differential diagnosis and the surgical treatment are described.
Assuntos
Seio Maxilar , Mucocele , Doenças dos Seios Paranasais , Criança , Diagnóstico Diferencial , Humanos , Masculino , Mucocele/diagnóstico , Mucocele/cirurgia , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/cirurgiaRESUMO
Adenotonsillar surgery remains among the most commonly-performed pediatric surgical procedures. The complication rate of tonsillectomy is generally considered to be in a range of 1-5%. Bacterial meningitis following adenotonsillectomy is a rarely reported complication. Bacterial meningitis is a potentially fatal acute infectious disease caused by a variety of micro-organisms. Current case fatality rates associated with this entity can be as low as 2% in infants and children and as high as 30% in neonates. The successful management of meningitis depends on early clinical suspicion and diagnosis, with prompt medical treatment using high-dose, broad-spectrum antibiotics that adequately cross the blood-brain barrier. We present a case of meningitis complicating a tonsillectomy procedure, in a 7-year-old girl. The diagnosis and treatment of this rare complication is illustrated, and the possible etiology is discussed.
Assuntos
Meningites Bacterianas/etiologia , Tonsilectomia/efeitos adversos , Criança , Feminino , Humanos , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/terapiaRESUMO
Cerebral frontal lobe abscess may be a frequent intracranial complication of paranasal sinusitis. An unusual case of cerebral abscess complicating massive polyposis is described in a patient with history of previous severe head trauma 30 years ago. Imaging evaluation using both computed tomography and magnetic resonance imaging is important to diagnose such rare entities.
Assuntos
Abscesso Encefálico/etiologia , Traumatismos Craniocerebrais/complicações , Lobo Frontal , Pólipos Nasais/complicações , Idoso , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Traumatismos Craniocerebrais/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pólipos Nasais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.
Assuntos
Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Idoso , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development--specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone. Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.
Assuntos
Displasia Fibrosa Óssea/diagnóstico , Osso Temporal , Displasia Fibrosa Óssea/cirurgia , Transtornos da Audição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Temporal/cirurgiaRESUMO
BACKGROUND: Successful local anaesthesia is of critical importance for the success of septoplasty, and many surgeons prefer to use cocaine for this purpose. The aim of this study was to evaluate the efficacy of cocaine 4 per cent solution, compared with tetracaine 2 per cent plus adrenaline, as a local anaesthetic for patients undergoing septoplasty. METHODS: From December 2002 to February 2005, a prospective, randomized, controlled trial was conducted. One hundred and eight patients underwent septoplasty under local anaesthesia. Patients were randomly classified into group A and group B, in which was used respectively cocaine 4 per cent solution and tetracaine 2 per cent solution plus adrenaline. A visual analogue scale was used to evaluate the severity of patients' pain during their procedure. RESULTS: Group B (tetracaine; mean rank=43.77) reported significantly less pain (p<0.001) compared with group A (cocaine; mean rank=65.23). CONCLUSIONS: On the basis of these findings, we recommend tetracaine as the first choice anaesthetic for nasal septoplasty; the use of cocaine should be limited.
Assuntos
Anestesia Local , Anestésicos Locais , Cocaína , Septo Nasal/cirurgia , Tetracaína , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos ProspectivosRESUMO
Laser-assisted uvulopalatoplasty (LAUP) is an outpatient mode of treatment for snoring and perhaps for some mild cases of obstructive sleep apnea syndrome. LAUP results in severe throat pain that usually lasts for 8 to 14 days. Sucralfate adheres to proteins at the duodenal ulcer site, forming a protective coating against gastric acid, pepsin, and bile salts, that promotes healing. If a similar protective coating could be created at the area of LAUP trauma, morbidity may be diminished. Twenty-eight patients have undergone LAUP treatment-2 with mild obstructive sleep apnea syndrome and 26 with simple snoring. A block-randomized, single blind clinical study was performed. Sucralfate was administered in 14 patients (group A) every 6 hours for 15 days as a swish and swallow, whereas the other 14 patients (group B) received water for injection with a strawberry flavor as placebo with the same dosing. As a conclusion, sucralfate significantly lowered postoperative pain and the need for analgesic drug use as well as the total number of the days the patients needed to almost reach their normal diet quantity (> or = 80% of normal quantity).
Assuntos
Antiulcerosos/uso terapêutico , Terapia a Laser/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Dor Pós-Operatória/tratamento farmacológico , Palato Mole/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Sucralfato/uso terapêutico , Úvula/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Método Simples-CegoRESUMO
Among all foreign bodies impacted at the esophagus, the safety pin still seems to be a challenge for the specialist. This is a report of 2 cases presenting infants with open safety pin impacted in the esophagus. The strategy and intraoperative management of this rare finding is discussed in detail.
Assuntos
Esofagoscopia/métodos , Esôfago/cirurgia , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Estômago/cirurgia , Endoscopia/métodos , Esôfago/diagnóstico por imagem , Feminino , Seguimentos , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , Radiografia , Estômago/diagnóstico por imagem , Resultado do TratamentoRESUMO
The hypertrophied inferior turbinates are responsible for nasal obstruction in patients with chronic rhinitis. Several methods have been applied to solve this problem. Recently, laser methods have produced good results. We present the management of 387 patients with hypertrophy of the inferior turbinates mucosa, using CO2 laser in combination with the Swiftlase apparatus. CO2 laser energy delivered through the Swiftlase apparatus provides a char-free ablation of a superficial tissue layer. Swiftlase is easily installed onto the existing CO2 laser units and provides a high-power density. The 1-year postoperative follow-up revealed good results in 261 (81%) of 321 patients, thus establishing CO2 laser in combination with the Swiftlase apparatus as a promising new approach for the management of inferior turbinate hypertrophy. CO2 laser energy delivered through the Swiftlase apparatus offers a treatment modality capable of achieving excellent results in hypertrophy of the inferior turbinates with minimal morbidity.
Assuntos
Terapia a Laser/instrumentação , Rinite/cirurgia , Conchas Nasais/cirurgia , Adolescente , Adulto , Idoso , Doença Crônica , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Seguimentos , Humanos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Satisfação do Paciente , Rinite/complicações , Rinite/diagnóstico , Rinoplastia/métodos , Resultado do Tratamento , Conchas Nasais/patologiaRESUMO
Chylous fistula complicates 1.1% of all radical neck dissections, and 2.4% of left-sided dissections. The standard treatment of established chylous leak in the reported cases is a pressure dressing applied to the lower neck. Here we present a case of chylous fistula, where conservative methods failed to cope with this complication. The additional application of a fibrin adhesive set was a successful modality of treatment.