Human adenovirus replication and persistence in hypertrophic adenoids and palatine tonsils in children.

The role of human adenovirus (HAdV) infection in different acute diseases, such as febrile exudative tonsillitis, conjunctivitis, and pharyngoconjunctival fever is well established. However, the relationships, if any, of HAdV persistence and reactivation in the development of the chronic adenotonsillar disease is not fully understood. The present paper reports a 3-year cross-sectional hospital-based study aimed at detecting and quantifying HAdV DNA and mRNA of the HAdV hexon gene in adenoid and palatine tonsil tissues and nasopharyngeal secretions (NPS) from patients with adenotonsillar hypertrophy or recurrent adenotonsillitis. HAdV C, B, and E were detectable in nearly 50% of the patients, with no association with the severity of airway obstruction, nor with the presence of recurrent tonsillitis, sleep apnea or otitis media with effusion (OME). Despite the higher rates of respiratory viral coinfections in patients with HAdV, the presence of other viruses, including DNA and RNA viruses, had no association with HAdV replication or shedding in secretions. Higher HAdV loads in adenoids showed a significant positive correlation with the presence of sleep apnea and the absence of OME. Although this study indicates that a significant proportion (~85%) of individuals with chronic adenotonsillar diseases have persistent nonproductive HAdV infection, including those by HAdV C, B, and E, epithelial and subepithelial cells in tonsils seem to be critical for HAdV C production and shedding in NPS in some patients, since viral antigen was detected in these regions by immunohistochemistry in four patients, all of which were also positive for HAdV mRNA detection.

Ciliary ultrastructure in patients with chronic rhinosinusitis and primary ciliary dyskinesia.

The Cilia represent one of the main mechanisms contributing to the clearance of microorganisms and particles from the respiratory epithelium. Primary ciliary dyskinesia (PCD) is a genetically determined disorder characterized by irreversible systemic dysmotility of the cilia. Secondary ciliary dyskinesia (SCD) differs from primary defects on the reversible ultrastructural alterations that can occur after any insult to a previously normal mucosa. Hence, this study aimed to describe and compare the main ultrastructural ciliary features in PCD and SCD through transmission electron microscopy. The most frequent PCD abnormalities were missing or short dynein arms, missing central microtubules, and displacement of one of the nine peripheral doublets. The most common changes found in SCD were compound cilia and peripheral microtubule alterations associated with modifications of the respiratory epithelium. PCD presented a higher percentage of altered cilia (>30 %) when compared to SCD (5 %), demonstrating that SCD is more limited in area than PCD. Whereas in PCD the changes in the dynein arms and in the central microtubules are fundamental for diagnostic confirmation, the diagnosis of SCD usually involves compound cilia and disarrangements in peripheral microtubules.

Orbital complications of acute rhinosinusitis: a new classification.

UNLABELLED: Rhinosinusitis is a severe sickness and may have serious complications. Orbital complications happen more often, due to anatomical particularities and are lethal in 5% of patients. They vary from inflammatory signs to proptosis, loss of ocular motility and blindness. AIM: We propose a new classification of acute rhinosinusitis complications. METHODS: A review of 83 patients with CT scan and clinical reports. Patients were evaluated at HCFMRP-USP between 1995 and 2005 and were diagnosed with complicated rhinosinusitis. RESULTS: In sixty-six patients, were identified three types of orbital complications: orbital cellulitis (46.9%), subperiosteal abscess (40.9%) and orbital abscess (12.1%). Seventeen were considered as eyelid infections and excluded from this new classification system. CONCLUSIONS: The existing classifications of orbital complications, as Chandlers, do not consider the orbits anatomical characteristics and became obsolete after the development of the CT scan. This study proposes a new, more objective classification to guide the physician in establishing lines of conduct for each case.

Orbital endoscopic decompression in Graves ophthalmopathy.

Graves disease may lead to exophthalmos that is cosmetically unacceptable or causes visual loss. This has been managed surgically by external orbital decompression. However, a new minimally invasive endoscopic orbital decompression technique is now possible, with resection of the medial and posterior portion of the orbital limits requiring no cutaneous or gingival incisions. This technique produces decompression comparable to that obtained by external techniques. Endoscopic orbital decompression is a safe and effective procedure for the treatment of thyroid orbitopathy.

[Endoscopic nasal dacryocystorhinostomy: results and advantages over the external approach]. / Dacriocistorrinostomia endoscópica nasal: resultados e vantagens sobre a abordagem externa.

UNLABELLED: Dacryocystorhinostomy (DCR) is a procedure used to create a lachrymal drainage pathway into the nasal cavity in order to reestablish the permanent drainage of a previously obstructed excretory system. AIM: to report our results obtained with endoscopic DCR technique, describing its advantages and disadvantages STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: we retrospectively analyzed thirty-two dacryocystorhinostomies performed at the Otorhinolaryngology Discipline from March 2002 to January 2004 on patients with post-lachrymal sac obstruction confirmed by dacryocystorhinography (DCG). In all cases, the patients were submitted to probing with Crawford probe. RESULTS: surgery was bilateral in ten of the twenty-two analyzed patients, totaling thirty-two procedures, twenty-nine of which were primary surgeries and three revision procedures after unsuccessful external DCR. Our success rate was 79.12%. CONCLUSIONS: endoscopic DCR proved to be a safe and low morbidity technique, which also avoids facial scars and maintains the mechanism of the lachrymal pump, with results similar to those obtained with external DCR.

Maxillary sinuses microbiology from patients with chronic rhinosinusitis.

UNLABELLED: There isn't definitive and consistent data concerning the distribution of bacterial species in patients with Chronic Sinusitis (CS). The variability of the results from studies in CS may be due to the different techniques used as collection method, variations in culture methods, previous antibiotic use, and difficulty in distinguishing bacterial flora from pathogenic agents. STUDY DESIGN: Clinical prospective. AIM: To identify the incidence of microorganisms in patients with CRS by growing bacteria from the secretion of the maxillary sinus. PATIENTS AND METHODS: Cross-sectional study in 62 patients that had undergone FESS for treatment of chronic sinusitis; cultures from the maxillary sinus were obtained. RESULTS: 62 samples, 33 (53.2%) had no growth; 29 (45.2%) counts of aerobic bacteria; one case (1.6%) of fungus growth; we did not find anaerobic bacteria. Pseudomonas aeruginosa was the one more frequently found - 8 samples (27.6%), Staphylococcus aureus and Staphylococcus epidermidis in 4 samples each; Streptococcus pneumoniae in 3 samples (10.4%); other Gram negative agents in 17 samples (31%). CONCLUSION: In the present study we concluded that Pseudomonas aeruginosa, other Gram negatives bacteria and Staphylococcus spp were the representatives of the bacterial flora found in the paranasal sinuses of patients with CS.

Comparing different methods used to collect material for a microbiological evaluation of patients with chronic rhinosinusitis.

UNLABELLED: There is still controversy on which is the best method to collect the secretion directly from the middle meatus or maxillary sinus in patients with chronic rhinosinusitis. AIM: To evaluate the prevalence of bacteria in patients with chronic rhinosinusitis and compare the suction trap collector to direct aspiration attached to a syringe for the microbiological analysis of these secretions. MATERIALS AND METHODS: Prospective study involving 31 patients who underwent endoscopically guided maxillary secretion aspiration by two different methods (aspiration with the collector tube "suction trap" and aspiration with the use of a catheter connected to a syringe), to determine the microbiological diagnosis and to compare the two methods used. RESULTS: microorganisms grew samples collected from 55% of the 31 patients. The most frequent bacteria were S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria. The results from cultures were similar between the two methods in 71% of patients. CONCLUSION: S. aureus, Pseudomonas aeruginosa and other aerobic Gram-negative bacteria make up the main flora in the maxillary sinus of the patients. There was good correlation between the microbiological results obtained by using a catheter attached to a syringe and the "suction trap" nasal collector.

Surgical treatment of nasal packing refractory epistaxis.

UNLABELLED: Epistaxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. AIM: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. MATERIAL AND METHODS: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. RESULTS: Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. CONCLUSION: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.

Use of a hypodense sodium fluorescein solution for the endoscopic repair of rhinogenic cerebrospinal fluid fistulae.

BACKGROUND: Hypodense fluorescein solution can be used intrathecally to facilitate and accelerate the identification of the fistulous site. METHODS: Eighteen patients were submitted for nasal endoscopic correction of rhinogenic cerebrospinal fluid fistulas after their identification with a hypodense sodium fluorescein solution. RESULTS: Intrathecal injection of hypodense fluorescein permitted a rapid and safe identification of the leak and did not present significant side effects. The fistulous site was identified in all patients, and the time needed for staining was <30 minutes in all cases. Surgery was successful in 88% of the patients after only one intervention, with the rate reaching 100% after a secondary intervention in cases of recurrence. CONCLUSION: Intrathecal injection of a hypodense sodium fluorescein solution permits a more precise, rapid, and safe endoscopic approach, with no need to place the patient in the Trendelenburg position or to wait for a long period of time before starting the surgical procedure.

Histological evaluation of maxillary sinus mucosa after functional endoscopic sinus surgery.

BACKGROUND: This study was performed to evaluate the histological changes of the maxillary sinus mucosa of patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). METHODS: In a cohort study, biopsy specimens were collected from the maxillary sinus of patients submitted for FESS. One year after surgery, patients were clinically reassessed. Patients showing recurrence of disease (group 1) required a revision surgery, through which a second biopsy specimen was collected. Patients showing a favorable clinical response (group 2) were submitted to an outpatient maxillary biopsy through the previous opened middle meatus antrostomy. Biopsy material from four cadavers was used as control. The histological and electron microscope findings were analyzed. RESULTS: At the initial surgery, patients presented many histopathological alterations, such as an inflammatory process infiltrating the submucosa, atypical respiratory epithelium with an important increase in goblet cells, metaplasia, or mixed epithelium. Group 1 patients persisted with the same alterations 1 year later, but ciliary dysmorphy was more accentuated. Group 2 patients presented a predominantly pseudostratified epithelium, but some areas contained an increased number of goblet cells and a reduction in the number of ciliated cells. CONCLUSION: Recovery of the maxillary sinus mucosa of patients with CRS, observed by electron and light microscopy, was incomplete 1 year after endoscopic surgery, even in nonsymptomatic patients; nevertheless, these alterations were more important in symptomatic patients than in asymptomatic patients.