ABSTRACT
Rosai-Dorfman Disease or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare benign disease of unknown etiology, which presents with cervical lymphadenopathy. It is usually seen in younger patients. The extranodal form affect various regions of the head and neck, and is more common in patients with immune abnormalities. It is a self-limited and seldom life-threatening disease, rendering therapy unnecessary in most cases. For those who require therapy because of persistent or worsening symptoms, treatments modalities include surgery, chemotherapy, radiotherapy and steroids. The authors describe one case of a 43-year-old man with bilateral cervical masses, nasal obstruction, fever, weight loss and decreased vision with 6 months duration. As his social history was positive for tobacco and alcohol use, the initial diagnosis was a possible rhinopharyngeal malignant tumor. Medical investigation established the diagnosis of SHML. After therapy, the 6-month follow-up evidenced the patient's clinical improvement, although cervical masses persisted. The clinical presentation, histological features, pathogenesis and treatment of this case are discussed.
Subject(s)
Histiocytosis, Sinus/diagnosis , Adult , Biopsy, Fine-Needle , Diagnosis, Differential , Glucocorticoids/therapeutic use , Histiocytosis, Sinus/drug therapy , Humans , Lymphatic Diseases/diagnosis , Male , Neck , Prednisone/therapeutic use , Tomography, X-Ray ComputedABSTRACT
BACKGROUND/AIMS: The objective of the present study was to measure gastric emptying time of solids and semisolids in dyspeptic individuals with cholecystolithiasis before and 6 months after cholecystectomy in order to determine whether cholecystectomy interferes with gastric emptying. METHODOLOGY: A prospective, self-pairing study was conducted on 29 patients selected according to appropriate inclusion and exclusion criteria. Gastric emptying time of solids and semisolids was determined before and six months after laparoscopic cholecystectomy by the 13C-octanoic acid and 13C-acetate breath tests, respectively. The samples were analyzed by infrared spectrometry. The gastric retention time (lag phase) and gastric emptying half-time of solid and semisolid were determined and the results obtained before and after surgery were compared in the same patient. In addition, the effects of surgery on dyspeptic symptoms were assessed. RESULTS: No significant differences (p>0.05) in gastric retention time and gastric emptying half-time of solid and semisolid test meals were observed before and after cholecystectomy. Dyspeptic symptoms (pain, upper abdominal gases, early satiety, nausea and vomiting) improved after surgery. CONCLUSIONS: Laparoscopic cholecystectomy does not interfere with the gastric emptying time of solids or semisolids in dyspeptic individuals with cholecystolithiasis.
Subject(s)
Breath Tests , Cholecystectomy , Dyspepsia/surgery , Gallstones/surgery , Gastric Emptying/physiology , Adolescent , Adult , Aged , Caprylates , Carbon Isotopes , Dyspepsia/physiopathology , Female , Follow-Up Studies , Gallstones/physiopathology , Gastroparesis/physiopathology , Gastroparesis/surgery , Humans , Male , Middle Aged , Reference Values , Sodium Acetate , Spectrophotometry, InfraredABSTRACT
A Doença de Rosai-Dorfman ou Histiocitose Sinusal com Linfadenopatia Maciça (SHML) é uma entidade clínica idiopática, rara e benigna, geralmente apresentando linfonodomegalia cervical. Usualmente acomete pacientes jovens. Manifestações extranodais na região da cabeça e pescoço são mais comuns em pacientes com anormalidades imunológicas. É uma doença autolimitada e, na maioria dos casos, não há necessidade de tratamento. Para os que requerem tratamento devido à persistência ou piora dos sintomas têm sido tentados tratamento cirúrgico, quimioterápico, radioterápico e corticoterapia. Os autores relatam um caso de um paciente do sexo masculino, 43 anos, com história de massas cervicais bilaterais, obstrução nasal, emagrecimento importante, febre e perda progressiva de acuidade visual há 6 meses. Trata-se de um paciente ex-tabagista e etilista crônico, onde a suspeita inicial foi de carcinoma espinocelular de rinofaringe. Realizada propedêutica, foi feito diagnóstico de doença de Rosai-Dorfman. Instituída a terapêutica, o seguimento de 6 meses revelou melhora do estado geral do paciente onde mantém as massas cervicais em regressão lenta. A apresentação clínica, as características histológicas, a patogênese e o tratamento são discutidos neste artigo.
Rosai-Dorfman Disease or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare benign disease of unknown etiology, which presents with cervical lymphadenopathy. It is usually seen in younger patients. The extranodal form affect various regions of the head and neck, and is more common in patients with immune abnormalities. It is a self-limited and seldom life-threatening disease, rendering therapy unnecessary in most cases. For those who require therapy because of persistent or worsening symptoms, treatments modalities include surgery, chemotherapy, radiotherapy and steroids. The authors describe one case of a 43-year-old man with bilateral cervical masses, nasal obstruction, fever, weight loss and decreased vision with 6 months duration. As his social history was positive for tobacco and alcohol use, the initial diagnosis was a possible rhinopharyngeal malignant tumor. Medical investigation established the diagnosis of SHML. After therapy, the 6-month follow-up evidenced the patient's clinical improvement, although cervical masses persisted. The clinical presentation, histological features, pathogenesis and treatment of this case are discussed.
Subject(s)
Adult , Humans , Male , Histiocytosis, Sinus/diagnosis , Biopsy, Fine-Needle , Diagnosis, Differential , Glucocorticoids/therapeutic use , Histiocytosis, Sinus/drug therapy , Lymphatic Diseases/diagnosis , Neck , Prednisone/therapeutic use , Tomography, X-Ray ComputedABSTRACT
UNLABELLED: Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. AIM: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients ages. METHODS: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. RESULTS: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). CONCLUSION: SNHL occurred in 13% of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.
Subject(s)
Cholesteatoma, Middle Ear/complications , Hearing Loss, Sensorineural/etiology , Otitis Media, Suppurative/complications , Adolescent , Adult , Audiometry , Auditory Threshold , Child , Chronic Disease , Female , Hearing Loss, Sensorineural/diagnosis , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Perda auditiva sensório-neural (PASN) relacionada a otite média crônica supurativa (OMCS) foi estudada para esclarecer a participação do colesteatoma nesse contexto. OBJETIVO: Avaliar ocorrência de PASN na OMCS, correlacionando com colesteatoma, duração da doença e idade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo de 115 pacientes com OMCS com e sem colesteatoma submetidos à cirurgia. Incluíram-se pacientes com doença unilateral, orelha contralateral normal e idade inferior a 60 anos. RESULTADOS: Idade média foi de 26 anos, sendo 58 homens e 57 mulheres. Tempo médio de duração da doença otológica de 12,4 anos. Limiar auditivo médio foi de 40 dB na orelha com OMCS e 22dB na orelha normal (P=0,002). Observou-se colesteatoma em 78 dos 115 casos. Na orelha com OMCS, ocorreram 15 (13 por cento) casos de PASN, sendo 7 associadas à colesteatoma e 8 não associadas. Seis casos de PASN foram severa/profunda, correlacionando-se com idade ajustada (P=0,003), ausência de colesteatoma (P=0,01), mas não com duração da doença (P=0,458). CONCLUSÃO: PASN ocorreu em 13 por cento dos pacientes com OMCS, correlacionando-se com o aumento da idade, mas não com a presença de colesteatoma ou com maior duração da doença otológica.
Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. AIM: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients ages. METHODS: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. RESULTS: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). CONCLUSION: SNHL occurred in 13 percent of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.
