Comparison of inflammatory cytokine profiles in plasma of patients undergoing otorhinological surgery with propofol or isoflurane anesthesia.

OBJECTIVE AND DESIGN: The effects of anesthetics on cytokine release in patients without comorbidities who undergo minor surgery are not well defined. We compared inflammatory cytokine profiles in adult patients undergoing minimally invasive surgery who received isoflurane or propofol anesthesia. METHODS: Thirty-four patients without comorbidities undergoing minor surgery were randomly assigned to receive an inhaled anesthetic (isoflurane; n = 16) or an intravenous anesthetic (propofol; n = 18). Blood samples were drawn before premedication and anesthesia (T1), 120 min after anesthesia induction (T2), and on the first post-operative day (T3). Plasma concentrations of interleukins (IL-) 1ß, 6, 8, 10 and 12 and tumor necrosis factor (TNF)-α were measured using flow cytometry. RESULTS: The pro-inflammatory cytokine IL-6 was increased in the isoflurane group at T2 and T3 compared to T1 (P < 0.01). In the propofol group, IL-6 and IL-8 were significantly increased at T3 compared to T1. However, there were no significant differences in cytokine concentrations between the isoflurane and propofol groups. CONCLUSION: An inflammatory response occurred earlier in patients who received an inhaled agent compared with an intravenous anesthetic, but no differences in plasma cytokine profiles were evident between isoflurane and propofol anesthesia in patients without comorbidities undergoing minimally invasive surgeries.

Clinical, histological and electron microscopic aspects of vocal fold granulomas.

UNLABELLED: Granulomas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin. AIM: To analyze the clinical and morphological aspects of post intubation granulomas. METHODS: retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them. RESULTS: ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations. CONCLUSIONS: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

Treatment of Laryngeal Granulomas.

Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 µg 12/12 hours (1 month), proton pump inhibitor, omeprazole 40 mg/day (2 months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Voice Disorders: Etiology and Diagnosis.

OBJECTIVES: Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients. METHODS: We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses. RESULTS: Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated. CONCLUSIONS: In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly.

Larynx and cervical trachea in humidification and heating of inhaled gases.

To evaluate the participation of the larynx and cervical trachea in conditioning inspired gases, we randomly allocated 16 mixed-breed dogs to two groups: group TT (tracheal tube; n = 8) and group LMA (laryngeal mask airway; n = 8). The dogs were anesthetized with pentobarbital sodium and mechanically ventilated for 3 hours. The parameters studied were temperature and absolute humidities of ambient, inhaled, and tracheal air. There was a small increase in tracheal air temperature compared to inhaled air temperature, but no significant difference between groups. The absolute humidity of tracheal air was greater in group LMA than in group TT (23 mg H2O * L(-1) and 14 mg H2O * L(-1), respectively; p < .0001). The difference in absolute humidity between the tracheal air and the inhaled air was higher in group LMA at all times (p < .0001). We conclude that the larynx and cervical trachea of the dog participate in humidification and heating of inhaled air by means of air contact with mucosa in this airway segment.

Treatment of Laryngeal Granulomas

Abstract Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11%). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 μg 12/12 hours (1month), proton pump inhibitor, omeprazole 40 mg/day (2months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Scanning electron microscopy of the tongue, pharynx, and larynx of rats exposed to cigarette smoke.

OBJECTIVE: To examine, by using scanning electron microscopy, the surface of the tongue, pharynx, and larynx of animals exposed to tobacco. STUDY DESIGN: Experimental study. METHODS: Twenty rats were allocated to two groups: group I, control group: 10 rats not exposed to any inhaling pollutant and group II, tobacco group: 10 rats exposed to smoke from 10 cigarettes twice a day for 260 days. Animals of both groups had no restriction of food or water. After those 260 days, their aerodigestive segment was removed, and fragments of their tongue, hypopharynx, and right vocal fold were immersed in 2.5% glutaraldehyde and prepared for scanning electron microscopy. RESULTS: The filiform tongue papillae of the tobacco group were irregularly displayed, flattened, and adhered to each other. The hypopharynx mucosa was highly irregular, thickened, rough and had increased superficial peeling. The mucosa of the vocal folds had deep furrows surrounding the cells. These alterations were not identified for the control group. CONCLUSION: Several changes were recorded for the tongue, pharynx, and larynx of tobacco group animals, confirming the harmful effects of smoking to the respiratory and digestive epithelium.

Reducing accidents related to excessive alcohol intake? A retrospective study of polytraumatized patients undergoing surgery at a Brazilian University Hospital.

OBJECTIVE: To assess whether the Brazilian Driving Dry Law reached its goal after the three years following its enactment. METHODS: We conducted a retrospective study of patients with craniofacial fractures who underwent surgery at a university hospital in two periods: before the Law (2005 to 2008) and after the Law (2008 to 2011). RESULTS: 265 patients (220 men and 45 women) were operated on during this period, 149 (56%) before and 116 (44%) after the Law, which indicates a reduction in the number of traumatisms (p=0.04). The age range between 19 and 40 years predominated in both periods. The main causes of traumas were car accidents, physical aggression and falls. Alcohol abuse was identified in 15.4% patients before and 19% patients after the enactment. The jaw and the maxillo-zygomatic complex were the most affected bones. CONCLUSION: The drop in the number of polytraumatized patients operated on at this institution in the three years following the Driving Dry Law was 22%, which is below the expected and desired percentage. These results must be compared to those of different services offering the same attendance type in order to compile data and enlarge statistics. The low index of reduction in the number of traumatisms and the report of alcohol abuse by several patients at the moment of trauma, even after the law, evidence the need of adopting stricter measures to control and punish violators.

Internal nasal dimensions of adults with nasal obstruction.

UNLABELLED: Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.

Morphological findings in the tracheal epithelium of dogs exposed to the inhalation of poorly conditioned gases under use of an endotracheal tube or laryngeal mask airway.

PURPOSE: To study morphological findings in the tracheal epithelium of dogs exposed to the inhalation of poorly conditioned gases under use of an endotracheal tube (ET) or laryngeal mask airway (LMA). METHODS: Twelve dogs randomly were allocated to two groups: ET group (n-6) and LMA group (n-6), anaesthetized and mechanically ventilated, without CO(2) reabsorption. Haemodynamic and ventilatory parameters, tympanic temperature, temperature, relative and absolute humidity of the ambient and inhaled gases were analyzed during three hours. The animals were submitted to euthanasia and biopsies were carried out along the tracheal segment to morphological study. Three healthy dogs were used to morphological control. RESULTS: Inhaled gas temperature was maintained between 24ºC and 26ºC, relative humidity between 10% and 12%, and absolute humidity between 2 - 3 mg H(2)O.L(-1) with no significant differences between groups. In both groups, histological analysis showed epithelial inflammation and congestion in the corion and scanning electron microscopy showed ciliary grouping and disorganization. Transmission electron microscopy showed higher alterations in ET group than LMA group as widening of cell junctions, ciliary disorientation, cytoplasmic vacuolization, nuclear abnormalities, picnosis and chromatin condensation. CONCLUSION: LMA determined less pronounced changes in the tracheal epithelium in dogs exposed to the inhalation of poorly conditioned gases.

Audiologic evaluation in patients with acquired hypothyroidism.

UNLABELLED: Hearing loss in hypothyroidism has been reported by many authors but its pathophysiology is unclear. AIMS: to study the audiological evaluation of patients with acquired hypothyroidism. MATERIALS AND METHODS: two groups were included: a hypothyroidism group (HG, n-30), and a control group (CG, n-30). Parameters studied: gender, time of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemistry and hormonal exams (TSH, T4), tonal audiometry, TOAEs and BERA. RESULTS: all participants were women, 70% of the HG had Hashimoto thyroiditis, 60% of the HG had had the diagnostic of the hypothyroidism for at least five years. Depression and hypertension were frequent in HG. All HG patients had altered TSH values and 50% had diminished T4 values. Sensorineural hearing loss was detected in 22 ears from the HG and in seven from the CG. BERA was normal in the CG and altered in 10 ears from the HG, showing L-V increase. TOAEs were absent in 12 ears from the HG and in four from the CG. CONCLUSIONS: HG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in L-V in the BERA and absence or reduction in TOAEs amplitudes. Such alterations were not associated with THS and free T4 levels.

Reinkes' edema: immunoexpression study of fibronectin, laminin and collagen IV in 60 cases by immunohistochemical techniques.

UNLABELLED: Reinke's edema is chronic laryngeal disease in which the superficial layer of the lamina propria is expanded by thick mucus, giving it a gelatin aspect. The disease is directly related to smoking and more frequent in women, who end up having a lower tone of voice. Its histological characteristics cannot always distinguish it from other benign lesions of the larynx for which additional histological techniques are necessary. AIM: to study the immunoexpression of fibronectin, collagen IV and laminin in Reinke's edema by immunohistochemical technique. Prospective study. MATERIALS AND METHODS: histological blocks of 60 cases of surgical Reinke's edema were saved, submitted to new cross-sections and to immunohistochemical reactions for fibronectin, laminin and collagen IV by the Avidin-Biotin-Peroxidase method. Fragments of five normal vocal folds were used as control, removed during autopsy. All patients were chronic smokers and adults- 50 women and 10 men. RESULTS: the immunoexpression of fibronectin, collagen IV and laminin was more important in the endothelium of blood vessels (68.33%, 76.66%, 73.33%, respectively) and less relevant in the basement membrane (25.0%, 5.0% and 3.3%, respectively). CONCLUSIONS: the immunoexpression of fibronectin, laminin and of collagen IV in the basal membrane of Reinke's edema was not relevant, with a predominance of these antibodies in the endothelium of blood vessels.

A lei seca cumpriu sua meta em reduzir acidentes relacionados à ingestão excessiva de álcool? / Reducing accidents related to excessive alcohol intake? A retrospective study of polytraumatized patients undergoing surgery at a Brazilian University Hospital

OBJETIVO: avaliar se a Lei Seca cumpriu sua meta após três anos da promulgação. MÉTODOS: estudo retrospectivo dos pacientes com fraturas craniofaciais submetidos a tratamento cirúrgico em um hospital universitário, em dois períodos: antes (2005 a 2008) e após a implantação da lei (2008 a 2011). RESULTADOS:foram operados 265 pacientes (220 homens e 45 mulheres) nesse período sendo, 149 (56%) antes da lei e 116 (44%) após a lei, indicando redução no número de traumatismos (p=0,04). Houve predomínio da faixa etária entre 19 e 40 anos, em ambos os períodos. As principais causas dos traumas foram os acidentes automobilísticos, as agressões físicas e as quedas. O abuso de álcool foi identificado em 15,4% dos pacientes antes e 19% após a lei. A mandíbula e o complexo maxilozigomático foram os ossos mais acometidos. CONCLUSÃO:a redução no número de politraumatizados operados ficou aquém do esperado e almejado.

OBJECTIVE: To assess whether the Brazilian Driving Dry Law reached its goal after the three years following its enactment. METHODS: We onnducted a retrospective study of patients with craniofacial fractures who underwent surgery at a university hospital in two periods: before the Law (2005 to 2008) and after the Law (2008 to 2011). RESULTS: 265 patients (220 men and 45 women) were operated on during this period, 149 (56%) before and 116 (44%) after the Law, which indicates a reduction in the number of traumatisms (p=0.04). The age range between 19 and 40 years predominated in both periods. The main causes of traumas were car accidents, physical aggression and falls. Alcohol abuse was identified in 15.4% patients before and 19% patients after the enactment. The jaw and the maxillo-zygomatic complex were the most affected bones. CONCLUSION: The drop in the number of polytraumatized patients operated on at this institution in the three years following the Driving Dry Law was 22%, which is below the expected and desired percentage. These results must be compared to those of different services offering the same attendance type in order to compile data and enlarge statistics. The low index of reduction in the number of traumatisms and the report of alcohol abuse by several patients at the moment of trauma, even after the law, evidence the need of adopting stricter measures to control and punish violators.

Dimensoes internas nasais de adultos com obstrucao nasal / Internal nasal dimensions of adults with nasal obstruction

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico. .

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry. .

Morphological findings in the tracheal epithelium of dogs exposed to the inhalation of poorly conditioned gases under use of an endotracheal tube or laryngeal mask airway / Alterações morfológicas no epitélio traqueal de cães expostos à inalação de gases pouco condicionados, sob ventilação com tubo traqueal ou máscara laríngea

PURPOSE: To study morphological findings in the tracheal epithelium of dogs exposed to the inhalation of poorly conditioned gases under use of an endotracheal tube (ET) or laryngeal mask airway (LMA). METHODS: Twelve dogs randomly were allocated to two groups: ET group (n-6) and LMA group (n-6), anaesthetized and mechanically ventilated, without CO2 reabsorption. Haemodynamic and ventilatory parameters, tympanic temperature, temperature, relative and absolute humidity of the ambient and inhaled gases were analyzed during three hours. The animals were submitted to euthanasia and biopsies were carried out along the tracheal segment to morphological study. Three healthy dogs were used to morphological control. RESULTS: Inhaled gas temperature was maintained between 24ºC and 26ºC, relative humidity between 10 percent and 12 percent, and absolute humidity between 2 - 3 mg H2O.L-1 with no significant differences between groups. In both groups, histological analysis showed epithelial inflammation and congestion in the corion and scanning electron microscopy showed ciliary grouping and disorganization. Transmission electron microscopy showed higher alterations in ET group than LMA group as widening of cell junctions, ciliary disorientation, cytoplasmic vacuolization, nuclear abnormalities, picnosis and chromatin condensation. CONCLUSION: LMA determined less pronounced changes in the tracheal epithelium in dogs exposed to the inhalation of poorly conditioned gases.

OBJETIVO: Avaliar as alterações morfológicas no epitélio traqueal de cães expostos à inalação de gases pouco condicionados, sob ventilação com tubo traqueal (TT) ou máscara laríngea (ML). MÉTODOS: Doze cães adultos foram divididos aleatoriamente em dois grupos: grupo TT (n-6) e grupo ML (n-6), submetidos à anestesia venosa e ventilação mecânica, em sistema sem reabsorção de CO2. Foram registrados parâmetros hemodinâmicos e ventilatórios, temperatura timpânica, temperatura, umidade relativa e absoluta do ar ambiente e dos gases inalados durante 3 horas. Ao término do experimento, os animais foram submetidos a eutanásia e realizadas biópsias ao longo do segmento traqueal para estudo morfológico. Três cães saudáveis foram utilizados para controle morfológico. RESULTADOS: A temperatura dos gases inalados manteve-se entre 24ºC e 26ºC, a umidade relativa entre 10 por cento e 12 por cento, e umidade absoluta entre 2 -3 mg H2O.L-1 sem diferença significativa entre os grupos. Em ambos os grupos a análise histológica evidenciou processo inflamatório epitelial e congestão no córion, e a microscopia eletrônica de varredura mostrou agrupamento e desorganização ciliar. A microscopia eletrônica de transmissão detectou maiores alterações no grupo TT do que no ML, como alargamento das junções intercelulares, desorientação ciliar, vacuolização citoplasmática, alterações nucleares como pcinose e condensação da cromatina. CONCLUSÃO: A máscara laríngea determinou alterações menos pronunciadas no epitélio traqueal de cães expostos à inalação de gases pouco condicionados.

[Hoarseness after tracheal intubation.]. / Rouquidão após intubação traqueal.

BACKGROUND AND OBJECTIVES: To describe the main causes of hoarseness after undergoing tracheal intubation. CONTENTS: Hoarseness is one of the most common postoperatory symptoms after tracheal intubation and the effects vary in terms of duration, depending on the factors that caused it and on how severe the damage to the laryngeal structures. This study performed a brief check-up of the anatomical structures of the larynx, describing the main traumatic lesions in the region following tracheal intubation. It also emphasized the importance of caring for the larynx, as well as undergoing early diagnosis and treatment. CONCLUSIONS: Traumatic lesions of the laryngeal structures that occur during intubation are the most common causes of hoarseness. As such, it is important to perform an early diagnosis and adopt preventive measures.

Avaliação audiológica em pacientes portadores de hipotireoidismo / Audiologic evaluation in patients with acquired hypothyroidism

Surdez no hipotireoidismo já foi descrita por diversos autores, porém a fisiopatologia é incerta. OBJETIVOS: Realizar avaliações audiológicas de pacientes com hipotireoidismo adquirido. MATERIAL E MÉTODOS: Grupos de estudo: hipotireoidismo (GH, n-30) e controle (GC, n-30). Parâmetros estudados: gênero, tempo do hipotireoidismo, co-morbidades, sintomas cócleo-vestibulares, exames bioquímicos e hormonais, limiares audiométricos, PEATE e EOAT. RESULTADOS: Todos os participantes eram mulheres; em GH 70 por cento dos pacientes apresentavam tireoidite de Hashimoto e 60 por cento tinham diagnóstico de hipotireoidismo há mais de 5 anos. Depressão e hipertensão foram as principais co-morbidades do grupo GH. Todos os pacientes de GH tinham valores elevados de TSH e 50 por cento deles apresentavam diminuição de T4 livre. Surdez neurossensorial foi detectada em 22 orelhas de GH e em 7 de GC. PEATE mostrou-se normal nos participantes do GC e alterado em 10 orelhas do GH, havendo predomínio do aumento de L-V. EOAT estiveram ausentes em 12 orelhas de GH e em 4 de GC. CONCLUSÕES: Os pacientes com hipotireoidismo apresentaram mais sintomas cócleo-vestibulares, limiares audiométricos mais elevados, prolongamento das latências absolutas de L-V no PEATE e ausência ou redução as amplitudes das emissões otoacústicas. Tais alterações não estavam associadas aos níveis de TSH e T4 livre.

Hearing loss in hypothyroidism has been reported by many authors but its pathophysiology is unclear. AIMS: to study the audiological evaluation of patients with acquired hypothyroidism. MATERIALS AND METHODS: two groups were included: a hypothyroidism group (HG, n-30), and a control group (CG, n-30). Parameters studied: gender, time of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemistry and hormonal exams (TSH, T4), tonal audiometry, TOAEs and BERA. RESULTS: all participants were women, 70 percent of the HG had Hashimoto thyroiditis, 60 percent of the HG had had the diagnostic of the hypothyroidism for at least five years. Depression and hypertension were frequent in HG. All HG patients had altered TSH values and 50 percent had diminished T4 values. Sensorineural hearing loss was detected in 22 ears from the HG and in seven from the CG. BERA was normal in the CG and altered in 10 ears from the HG, showing L-V increase. TOAEs were absent in 12 ears from the HG and in four from the CG. CONCLUSIONS: HG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in L-V in the BERA and absence or reduction in TOAEs amplitudes. Such alterations were not associated with THS and free T4 levels.

Edema de Reinke: estudo da imunoexpressão da fibronectina, da laminina e do colágeno IV em 60 casos por meio de técnicas imunoistoquímicas / Reinkes'edema: immunoexpression study of fibronectin, laminin and colagen IV in 60 cases by imunohistochemical techniques

Edema de Reinke é doença crônica da laringe na qual a camada superficial da lâmina própria é expandida por muco espesso conferindo-lhe aspecto gelatinoso. Relaciona-se ao tabagismo e acomete, preferencialmente mulheres, as quais apresentam a voz mais grave. Suas características histológicas nem sempre conseguem diferenciá-lo das demais lesões benignas da laringe, havendo necessidade de técnicas histológicas adicionais. Objetivos: Estudar a imunoexpressão da fibronectina, do colágeno IV e da laminina no edema de Reinke por meio de técnicas imunoistoquímicas. Estudo prospectivo. Material e métodos: Blocos histológicos de 60 casos cirúrgicos de edema de Reinke foram resgatados, submetidos a novos cortes e às reações imunoistoquímicas para fibronectina, laminina e colágeno IV pelo método da Avidina Biotina Peroxidase. Todos os pacientes eram fumantes e adultos, sendo 50 mulheres e 10 homens. Resultados: As análises da imunoexpressão da fibronectina, do colágeno IV e da laminina foram mais expressivas no endotélio dos vasos (68,33 por cento, 76,66 por cento, 73,33 por cento, respectivamente), e menos relevantes na membrana basal (25,0 por cento, 5,0 por cento e 3,3 por cento, respectivamente). Conclusões: No edema de Reinke, a imunoexpressão da fibronectina, da laminina e do colágeno IV na membrana basal não apresentam relevância, havendo predomínio desses anticorpos no endotélio do vasos.

Reinke's edema is chronic laryngeal disease in which the superficial layer of the lamina propria is expanded by thick mucus, giving it a gelatin aspect. The disease is directly related to smoking and more frequent in women, who end up having a lower tone of voice. Its histological characteristics cannot always distinguish it from other benign lesions of the larynx for which additional histological techniques are necessary. AIM: to study the immunoexpression of fibronectin, collagen IV and laminin in Reinke's edema by immunohistochemical technique. Prospective study. Materials and methods: histological blocks of 60 cases of surgical Reinke's edema were saved, submitted to new cross-sections and to immunohistochemical reactions for fibronectin, laminin and collagen IV by the Avidin-Biotin-Peroxidase method. Fragments of five normal vocal folds were used as control, removed during autopsy. All patients were chronic smokers and adults- 50 women and 10 men. Results: the immunoexpression of fibronectin, collagen IV and laminin was more important in the endothelium of blood vessels (68.33 percent, 76.66 percent, 73.33 percent, respectively) and less relevant in the basement membrane (25.0 percent, 5.0 percent and 3.3 percent, respectively). Conclusions: the immunoexpression of fibronectin, laminin and of collagen IV in the basal membrane of Reinke's edema was not relevant, with a predominance of these antibodies in the endothelium of blood vessels.