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BACKGROUND: Impairment of smell is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially when asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation are also present. Therapeutic options include intranasal and systemic corticosteroids, surgery, and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP. METHODS: We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. The inclusion criteria were as follows: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab, or reslizumab; and studies published in English reporting outcomes for sense of smell based on psychophysical and/or subjective tools. We excluded reports that did not assess CRSwNP, loss of smell evaluated with a method other than those accepted in the inclusion criteria, review articles, and expert opinions. No funding was received. RESULTS: Dupilumab has demonstrated rapid and sustained long-term improvement in smell in clinical trials and in real life. Omalizumab improves smell at 24 weeks. This improvement is maintained in the long-term, although it is not clinically relevant. Mepolizumab and benralizumab improved smell in the long term based on a subjective scale. No studies examining the improvement in smell in patients with CRSwNP treated with reslizumab were found. Indirect comparisons by meta-analysis consistently conclude that dupilumab is the most effective biologic for improving impaired sense of smell. CONCLUSION: Dupilumab seems to be more efficacious for improving the sense of smell than omalizumab, mepolizumab, and benralizumab.
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Pólipos Nasais , Rinite , Rinossinusite , Sinusite , Adulto , Humanos , Anticorpos Monoclonais/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Omalizumab/uso terapêutico , Olfato , Doença Crônica , Sinusite/tratamento farmacológico , Rinite/tratamento farmacológico , Qualidade de VidaAssuntos
Asma/complicações , Asma/epidemiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Asma/diagnóstico , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Prevalência , Vigilância em Saúde Pública , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
INTRODUCTION: Urinary tract infection (UTI) is the most frequent bacterial infection in infants with nonspecific clinical manifestations. OBJECTIVE: To validate a predictive scale for UTI in febrile infants without apparent source and hospitalized in a neonatal unit. PATIENTS AND METHOD: A nested case-control study was conducted on 158 infants with febrile UTI, culture-confirmed, and on 346 febrile infants without apparent focus in whom UTI was ruled out, and also, hospitalized in a neonatal unit. The analysis was performed using Stata® 11. Associations were determined using odds ratio (OR) with 95% confidence interval. To find the predictive scale, multivariate analysis was performed using logistic regression and establishing major and minor criteria according to regression coefficient. Yield was calculated by sensitivity, specificity and area under ROC curve. The new predictive scale was validated by 108 new febrile neonates. RESULTS: The major criteria to predict UTI were abnormal urinalysis and Gram positive cells without centrifugation, and among the minor criteria, male, age at time of fever, previous neonatal hospitalization, abnormal temperature (38.5°C or more, persistent fever, hypothermia) and 1.7 mg/dL C reactive protein or higher, resulting positive with the presence of one mayor or three minor criteria. It showed good performance with 100% sensitivity (CI 95%:98.3-100%), 92.3% specificity (CI 95%: 85.8-98.9%) and 0.962 area under ROC (95% CI: 0.932-0.991) when validated on 108 new febrile neonates without focus. CONCLUSIONS: The new predictive scale allows predicting UTI with good yield in infants with fever without an identified source.
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Infecções Bacterianas/diagnóstico , Febre/microbiologia , Infecções Urinárias/diagnóstico , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Feminino , Hospitalização , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12â¯hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (Pâ¯<⯠.05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).
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Epilepsia , Estado Epiléptico , Acidente Vascular Cerebral , Benzodiazepinas/uso terapêutico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Uso Off-Label , Estudos Retrospectivos , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Acidente Vascular Cerebral/complicaçõesRESUMO
The Martian interaction with the solar wind leads to the formation of a bow shock upstream of the planet. The shock dynamics appear complex, due to the combined influence of external and internal drivers. The extreme ultraviolet fluxes and magnetosonic Mach number are known major drivers of the shock location, while the influence of other possible drivers is less constrained or unknown such as crustal magnetic fields, solar wind dynamic pressure, or the Interplanetary Magnetic Field (IMF) intensity, and orientation. In this study, we compare the influence of the main drivers of the Martian shock location, based on several methods and published datasets from Mars Express (MEX) and Mars Atmosphere Volatile EvolutioN (MAVEN) missions. We include here the influence of the crustal fields, extreme ultraviolet fluxes, solar wind dynamic pressure, as well as (for MAVEN, thanks to magnetic field measurements) magnetosonic Mach number and Interplanetary Magnetic Field parameters (intensity and orientation angles). The bias due to the cross-correlations among the possible drivers is investigated with a partial correlations analysis. Several model selection methods (Akaike Information Criterion and Least Absolute Shrinkage Selection Operator regression) are also used to rank the relative importance of the physical parameters. We conclude that the major drivers of the shock location are extreme ultraviolet fluxes and magnetosonic Mach number, while crustal fields and solar wind dynamic pressure are secondary drivers at a similar level. The IMF orientation also plays a significant role, with larger distances for perpendicular shocks rather than parallel shocks.
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We analyze observations of a solar energetic particle (SEP) event at Rosetta's target comet 67P/Churyumov-Gerasimenko during 6-10 March 2015. The comet was 2.15 AU from the Sun, with the Rosetta spacecraft approximately 70 km from the nucleus placing it deep inside the comet's coma and allowing us to study its response. The Eastern flank of an interplanetary coronal mass ejection (ICME) also encountered Rosetta on 6 and 7 March. Rosetta Plasma Consortium data indicate increases in ionization rates, and cometary water group pickup ions exceeding 1 keV. Increased charge exchange reactions between solar wind ions and cometary neutrals also indicate increased upstream neutral populations consistent with enhanced SEP induced surface activity. In addition, the most intense parts of the event coincide with observations interpreted as an infant cometary bow shock, indicating that the SEPs may have enhanced the formation and/or intensified the observations. These solar transient events may also have pushed the cometopause closer to the nucleus. We track and discuss characteristics of the SEP event using remote observations by SOHO, WIND, and GOES at the Sun, in situ measurements at Solar Terrestrial Relations Observatory Ahead, Mars and Rosetta, and ENLIL modeling. Based on its relatively prolonged duration, gradual and anisotropic nature, and broad angular spread in the heliosphere, we determine the main particle acceleration source to be a distant ICME which emerged from the Sun on 6 March 2015 and was detected locally in the Martian ionosphere but was never encountered by 67P directly. The ICME's shock produced SEPs for several days which traveled to the in situ observation sites via magnetic field line connections.
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The second Venus flyby of the BepiColombo mission offer a unique opportunity to make a complete tour of one of the few gas-dynamics dominated interaction regions between the supersonic solar wind and a Solar System object. The spacecraft pass through the full Venusian magnetosheath following the plasma streamlines, and cross the subsolar stagnation region during very stable solar wind conditions as observed upstream by the neighboring Solar Orbiter mission. These rare multipoint synergistic observations and stable conditions experimentally confirm what was previously predicted for the barely-explored stagnation region close to solar minimum. Here, we show that this region has a large extend, up to an altitude of 1900 km, and the estimated low energy transfer near the subsolar point confirm that the atmosphere of Venus, despite being non-magnetized and less conductive due to lower ultraviolet flux at solar minimum, is capable of withstanding the solar wind under low dynamic pressure.
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INTRODUCTION: Respiratory muscle function in the postoperative period is a key to whether a patient develops Postoperative Respiratory Failure (PRF) or not. PRF occurs when the gas exchange does not meet metabolic needs. Ipsilateral paralysis of the hemidiaphragm after interscalenic brachial plexus block (ISB) causes an acute reduction of respiratory muscle function. This reduction does not cause PRF when the contralateral hemidiaphragm generates enough gas exchange to meet metabolic demands. OBJECTIVES: To study the evolution of hemidiaphragmatic muscle function during the perioperative period with diaphragmatic ultrasound (D-POCUS), and use it as an innovative tool to predict PRF, assessing the contralateral hemidiaphragm in the event of acute hemidiaphragm paralysis. METHODS: Patients considered high risk, scheduled for shoulder surgery with ISB are studied. Both hemidiaphragms were evaluated by ultrasound, before and after the procedure, measuring Thickening Fraction (TF) and Diaphragmatic Excursion (DE). PACU patients with PRF were registered. RESULTS: There was a significant reduction in the TF and DE of the ipsilateral hemidiaphragm in the six patients studied. Only 1/6 patients showed signs of PRF. The evaluation of the contralateral hemidiaphragm during the postoperative period showed that in the five patients without signs of PRF, there were no significant changes in the function of the contralateral hemidiaphragm. The patient, who showed a reduction in contralateral hemidiaphragm function, was the only one who suffered PRF. CONCLUSIONS: In this case series, D-POCUS allows to know the perioperative function of the diaphragm in high-risk patients. All patients suffered an acute reduction of hemidiaphragm function after ISB; however, these patients did not develop PRF when the contralateral hemidiaphragm function was preserved.
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Diafragma , Insuficiência Respiratória , Anestésicos Locais , Diafragma/diagnóstico por imagem , Estudos de Viabilidade , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Período Pós-OperatórioRESUMO
INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).
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INTRODUCTION: Serum vitamin B12 concentration levels in children are essential to establish values in order to compare different regions or countries, and for considering e the possibility of supplementing diets with group B vitamins as a secondary prevention against cardiovascular diseases. MATERIAL AND METHODS: A cross-sectional epidemiological study was carried out to asses serum vitamin B12 levels in school children, 13-15 years of age, in Madrid. Folate and vitamin B12 vitamin determinations were performed on fasting blood samples. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by PCR. RESULTS: The mean vitamin B12 level obtained in our study was 503 pmol/l; CI 95 % CI (478-528 pmol/l). The median was 471 pmol/l; interquartile range (IR) (337-632 pmol/l). No statistically significant differences were found by age or C677T genotype for MTHFR. Serum vitamin B12 concentrations were significantly higher in females. Prevalence of vitamin B12 deficiency (< 224 pmol/l) was 6 % in males and 4 % in females. CONCLUSIONS: Reference values for serum vitamin B12 concentrations in an adolescent population are presented. Prevalence of vitamin B12 deficiencies is higher in males.
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Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/epidemiologia , Adolescente , Área Programática de Saúde , Criança , Estudos Transversais , Feminino , Genótipo , Humanos , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Prevalência , Espanha/epidemiologia , Deficiência de Vitamina B 12/genéticaRESUMO
Resumen Introducción: Esta sistematización recoge las riquezas de notas de campo escritas por siete encuestadoras de siete ciudades de Colombia (Bogotá, Medellín, Cali, Barranquilla, Bucaramanga, Manizales y Pasto), realizadas durante una prueba piloto, en donde se reconocieron sus dinámicas y aprendizajes. Objetivo: Sistematizar las experiencias de los traslados hacia los terrenos de campo y de las experiencias del parto de mujeres entrevistadas, a través de las voces de las encuestadoras. Método: Se plantearon tres fases para seguir la metodología de la sistematización de experiencias: fase de reconstrucción, fase de la interpretación y fase de la potenciación de la experiencia. Resultados: Se evidenciaron tres categorías de análisis: el trayecto y el entorno, las convergencias en la maternidad y la experiencia del parto. Conclusiones: Las notas de campo de las encuestadoras se convirtieron en fuente primordial de informaciones no homogéneas y muy diversas. Se hizo imprescindible analizar sus experiencias durante sus traslados a los terrenos de campo y, de esta forma, aplicar un enfoque intersectorial para entender e interpretar lo que ellas escucharon de parte de las madres encuestadas, por ejemplo: circunstancias cálidas y respetuosas a la hora de recibir la atención clínica del parto, así como situaciones de maltrato en la asistencia obstétrica, donde han sido culturalmente jerarquizadas por la medicalización del parto, lo que constituye una posición de subordinación hacia la paciente.
Abstract Introduction: This systematization gathers the richness of the field notes written by seven interviewers from seven cities in Colombia (Bogotá, Medellin, Cali, Barranquilla, Bucaramanga, Manizales and Pasto), carried out during a test pilot, where their dynamics and learning were recognized. Objective: To systematize experiences of itineraries to the territories, as well as childbirth from the voices of the interviewers. Method: The methodological process presented three phases designed to follow the methodology of systematization of experiences. Reconstruction phase; interpretation phase and experience empowerment phase. Results: Three categories of analysis were evidenced: the journey and the environment, the convergences in motherhood and the experience of childbirth. Conclusions: The field notes of the pollsters became a primary source of inhomogeneous and highly diverse information. It became essential to analyze their experiences during their transfers to the fields and thus apply an intersectoral approach to understand and interpret what they heard from the surveyed mothers: warm and respectful circumstances when receiving clinical care of childbirth, as well as situations of abuse in obstetric care that are and have been culturally hierarchical by the medicalization of childbirth, constituting a subordinate position towards the patient.
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Humanos , Feminino , Gravidez , Parto Humanizado , Serviços de Saúde , AprendizagemRESUMO
We present initial analysis and conclusions from plasma observations made during the reported "Mars plume event" of March - April 2012. During this period, multiple independent amateur observers detected a localized, high-altitude "plume" over the Martian dawn terminator [Sanchez-Lavega et al., Nature, 2015, doi:10.1038/nature14162], the cause of which remains to be explained. The estimated brightness of the plume exceeds that expected for auroral emissions, and its projected altitude greatly exceeds that at which clouds are expected to form. We report on in-situ measurements of ionospheric plasma density and solar wind parameters throughout this interval made by Mars Express, obtained over the same surface region, but at the opposing terminator. Measurements in the ionosphere at the corresponding location frequently show a disturbed structure, though this is not atypical for such regions with intense crustal magnetic fields. We tentatively conclude that the formation and/or transport of this plume to the altitudes where it was observed could be due in part to the result of a large interplanetary coronal mass ejection (ICME) encountering the Martian system. Interestingly, we note that the only similar plume detection in May 1997 may also have been associated with a large ICME impact at Mars.
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BACKGROUND: The uncertainty in clinical practice arise from the need of physicians to make decisions on a limited ground of knowledges. Guidelines are supposed to facilitate clinical decisions in such circumstances. Sharing knowledges on natural history of diseases and clinical expertise allow to define and array of steps structured on a formal flow-chart. The node of algorithms identifies decisions to analyze. This paper presents a taxonomy of specific questions related to each decision nodes for management of unstable angina and assesses the level of evidence available for each question. MATERIAL AND METHOD: A flow chart diagram display the conceptualized key nodes for clinical management of unstable angina. A set of specific question related to clinical exclusive circumstances, diagnostic approach, utility of diagnostic procedures, definition of prognosis and outcomes was raised for each decision node. From a systematic literature review the best available evidence was gathered. Each recommendation was linked to a level (A-C) of evidence, and to a body of consensus expert panel decisions. RESULTS: 34 decision nodes were identified, related with at least 1 question for appraisal of the best evidence. The solution to these questions yielded 40 recommendations scored by the strength of the evidence available. Five recommendations of diagnostic, 20 at prognostic and 15 at therapeutic step. The strength of evidence was A for 73% of recommendations at therapeutic step versus 40% at the two other steps. CONCLUSIONS: A clinical complex problem can be displayed in a continuous process, to allow identification and appraisal of decisions at different clinical nodes. The work-up to achieve a conceptualization of a clinical problem is the preliminary step to develop clinical practice guidelines. Identification of decision nodes allows to manage uncertainty in a explicit way and make policy statement more acceptable by managers and physicians.
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Angina Instável/diagnóstico , Angina Instável/terapia , Técnicas de Apoio para a Decisão , Medicina Baseada em Evidências , Algoritmos , Tomada de Decisões Gerenciais , Guias como Assunto , Hospitalização , Humanos , Índice de Gravidade de Doença , EspanhaRESUMO
Patients with ascites can develop spontaneous hemoperitoneum after injury or as a complication of diagnostic or therapeutic techniques. Spontaneous rupture of intra-abdominal varices is a rare complication of portal hypertension and an infrequent cause of hemoperitoneum that causes high mortality (75%). We present a new case of spontaneous hemoperitoneum secondary to umbilical vein rupture in a male patient with liver cirrhosis and review the cases previously described in the literature.
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Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Cirrose Hepática/complicações , Veias Umbilicais/patologia , Doenças Vasculares/complicações , Evolução Fatal , Hemoperitônio/diagnóstico por imagem , Humanos , Hipertensão Portal/complicações , Laparotomia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Veias Umbilicais/diagnóstico por imagem , Veias Umbilicais/cirurgia , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgiaRESUMO
The present study evaluated comparatively the laryngeal brainstem responses (LBR) evoked, through electrical stimulation of the superior laryngeal nerve, in 2 groups of mature rabbits, using a far field technique. Each group is formed according to the shifting of the stimulation parameters followed for the research, namely: intensity (from 0.5 to 3 mA), stimulus frequency (from 2 stimuli/second to 5 stimuli/second) and total stimulation time (between 200 microseconds to 500 microseconds). Afterwards the values attained are compared with those supplied for the control-group (having 2 mA intensity, 4 stimuli per second and 100 microseconds as time). We got significative statistical differences regarding the stimulus intensity and the outcome is a shortening in latency wawe of LBR when using 3 mA.
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Tronco Encefálico , Potenciais Evocados , Laringe , Animais , Estimulação Elétrica , Nervos Laríngeos/fisiologia , CoelhosRESUMO
The present study evaluated the laryngeal brainstem response evoked by electrical stimulation of the superior laryngeal nerve in rabbits, using a far-field technique with an intensity of 2 mA, 100 microseconds duration and frequency of 4/second. Five reproducible positive and four negative waves, both reproducible, were obtained and they may represent the laryngeal brainstem activity.
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Tronco Encefálico , Laringe , Coelhos , Animais , Estimulação Elétrica , Nervos Laríngeos , MasculinoRESUMO
In this paper are studied the prevalence of this syndrome (the PDCS) in 18 patients affected either of chronic sinusitis or bronchiectasias. Fourteen cases (77%) fulfil the diagnostic requirements in order to be considered as PCDS. Clinical differential features with regard to the idiopathic group are: situs inversus, male's infertility, perennial rhinorrhea and secretory otitis media. Mucociliary transport is studied through an isotopic technique and resulted absent in the PDCS group, being normal in the idiopathic one. The ultrastructure of nasal cilia is normal in the idiopathic representative, while in the cases with PDCS was verified the total or partly lack of dyneine arms in 8 cases, without cilia 3 cases, surnumerary central microtubules 3 cases and surnumerary peripheral microtubules in 2 cases. One sufferer of Kartagener's syndrome showed cilia structure in accordance with standard pattern.
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Bronquiectasia/complicações , Transtornos da Motilidade Ciliar/complicações , Transtornos da Motilidade Ciliar/diagnóstico , Sinusite/complicações , Sinusite/diagnóstico , Adolescente , Adulto , Bronquiectasia/diagnóstico , Criança , Pré-Escolar , Transtornos da Motilidade Ciliar/fisiopatologia , Diagnóstico Diferencial , Orelha Média/fisiopatologia , Feminino , Humanos , Infertilidade Masculina , Masculino , Pessoa de Meia-Idade , Otite Média com Derrame/complicações , Otite Média com Derrame/fisiopatologia , Seios Paranasais/fisiopatologia , Prevalência , Sinusite/fisiopatologia , Situs InversusRESUMO
Antrochoanal polyps are, basically, pathologies of children and young adults. The case here reported is really exceptional because its size and its appearance at so unusual age. Etio-pathogenesis, clinical course and differential diagnosis, face to other pathologies, are perused and also with several varieties of choanal polyps and the treatments proposed as well.
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Seio Maxilar/diagnóstico por imagem , Pólipos Nasais/diagnóstico por imagem , Idoso , Humanos , Masculino , Seio Maxilar/patologia , Seio Maxilar/cirurgia , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Dysphagia is common in head and neck cancer and feeding becomes difficult. Nasogastric tubes cannot by placed in some patients and are poorly tolerated in others. However, endoscopic laparotomy techniques have advanced to a point in which they allow feeding gastrostomies to be used, which are non-aggressive, well-tolerated and a satisfactory alternative for patients with contraindications for upper endoscopy.