Long-term assessment of fecal incontinence after lateral internal sphincterotomy.

BACKGROUND: Lateral internal sphincterotomy (LIS) can cause fecal incontinence. The aim of this study was to evaluate this sequelae after long-term follow-up of patients treated by LIS and to identify possible associated factors. METHODS: Data were retrospectively collected for patients with chronic anal fissure who had LIS between 1994 and 1997. Continence was assessed according to the incontinence score (IS) obtained by medical record review and telephone questionnaire. Statistical analysis was performed using by Student's t test for qualitative variables and chi-square test for qualitative variables. RESULTS: All 68 patients evaluated had healed after fissure surgery. None of these patients had preoperative fecal incontinence neither recurrence at the time of follow-up. At a mean follow-up of 66.6 months (range, 30-84 months), 7 patients (10.2%) were incontinent (mean IS=8.2; range, 5-16) and none had recovered continence at the time of follow-up. There was no significant difference between patients with and without fecal incontinence relative to gender age, hemorrhoidectomy combined with LIS, or vaginal delivery. CONCLUSIONS: Incontinence due to LIS does not recover after long-term follow-up and appears to be an independent cause of fecal incontinence.

Doença pulmonar intersticial associada a bronquiolite respiratória / Respiratory bronchilitis-associated interstitial lung disease

A doença pulmonar intersticial associada a bronquiolite respiratória faz parte do espectro anatomopatológico das lesões pulmonares infiltrativas difusas induzidas pela fumaça de cigarro. Raramente tem apresentação clínico-funcional exuberante. Descrevemos dois casos diagnosticados por biópsia pulmonar aberta, caracterizados por dispnéia de evolução insidiosa, baqueteamento digital, lesões císticas à tomografia computadorizada e hipoxemia ao exercício. Enfatizamos considerar, em indivíduos tabagistas, a doença pulmonar intersticial associada a bronquiolite respiratória no contexto das pneumopatias intersticiais císticas, juntamente com a linfangioleiomiomatose, o granuloma eosinofílico e a fibrose pulmonar idiopática.

Complicaciones de la tiroidectomía total / Complications of total Thyroidectomy

La tiroidectoimía total es realizada con relativa frecuencia para el tratamiento tanto de patología maligna como en casos específicos de patología benigna de la glándula tiroides. La cifra de complicaciones varía en las distintas series publicadas. El objetivo de este trabajo es determinar las características y el porcentaje de complicaciones postoperatorias de la tiroidectomía total....La tiroidectomía total, realizada por cirujanos entrenados en la especialidad, es un procedimiento seguro y con una morbilidad aceptable

Complicaciones de la tiroidectomía total / Complications of total Thyroidectomy

La tiroidectoimía total es realizada con relativa frecuencia para el tratamiento tanto de patología maligna como en casos específicos de patología benigna de la glándula tiroides. La cifra de complicaciones varía en las distintas series publicadas. El objetivo de este trabajo es determinar las características y el porcentaje de complicaciones postoperatorias de la tiroidectomía total....La tiroidectomía total, realizada por cirujanos entrenados en la especialidad, es un procedimiento seguro y con una morbilidad aceptable

The effects of allopurinol in hepatic ischemia and reperfusion: experimental study in rats.

BACKGROUND/AIMS: Some studies have shown that postischemic hepatic dysfunction is mainly due to oxygen free radicals that are generated by xanthine oxidase. The present study was undertaken to determine the effect of allopurinol, an inhibitor of xanthine oxidase, on oxidative stress, liver injury and histologic alterations induced by hepatic ischemia-reperfusion in rats. METHODS: One hundred and sixty Wistar rats were used and divided into three groups. Group 1: sham operation; group 2: 50 min of ischemia followed by 1 h of reperfusion, and group 3: pretreatment with allopurinol and 50 min of ischemia followed by 1 h of reperfusion. The effect of allopurinol was evaluated by plasma levels of alanine aminotransferase and aspartate aminotransferase, histopathologic studies, and lipid peroxidation measured by the thiobarbituric acid reactive substances method and chemiluminescence initiated by tert-butyl hydroperoxide technique. RESULTS: Ischemia followed by reperfusion promoted an increase in lipid peroxidation of the hepatic cells when compared to the sham-operated group (p<0.05). This increase was attenuated in the group treated with allopurinol (p< 0.05). Allopurinol also showed a protective effect on hepatocellular necrosis (p<0.05), and the plasma levels of liver enzymes returned earlier to the normal range in rats pretreated with allopurinol in comparison to those that did not receive the drug (p<0.05). CONCLUSIONS: Allopurinol exerted a protective effect on hepatic ischemia and reperfusion in rats. The administration of this drug prior to liver operations should be considered to be submitted to trials in humans.

Evaluation of time of nasal packing after nasal surgery: a randomized trial.

A randomized, prospective trial was carried out to compare the rate of hemorrhagic complications after removal of nasal packing left for 24 and 48 hours. A total of 104 patients underwent nasal surgery and were randomly assigned to 1 of 2 groups: group 1, 24 hours of nasal packing; group 2, 48 hours of nasal packing. No statistical difference was observed between the groups in terms of occurrence of hemorrhagic complications. Hypertension was the only prognostic factor for postoperative bleeding. The routine use of 48-hour postoperative nasal packing after nasal surgery is not justified because of the low incidence of bleeding and the potential associated morbidity. At the end of the procedure, surgeons should evaluate the risk of postoperative bleeding (ie, presence of hypertension) and decide whether 24-hour nasal packing is enough.

Air gun dart injury in paranasal sinuses left alone.

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice and papers dealing with this issue are rare in the English literature. One case of penetrating sinus injury due to air gun dart is presented to illustrate the potentially serious consequences of air gun injuries. The clinical presentation, diagnostic pitfalls and the treatment aspects are discussed.

Pneumosinus dilatans of the maxillary sinus. Case report.

A case of the rare condition pneumosinus dilatans of the maxillary sinus is presented. This is a rare differential diagnosis of a maxillary disease. The diagnostic imaging features of this condition are described, and a recommendation of views for adequately delineating this disorder is given. Only a few cases of pneumosinus dilatans of the maxillary sinus are described in the English-language literature, and the precise cause and pathogenesis remain obscure. We performed an enlargement of the maxillary ostium in order to increase the ventilation of the paranasal sinus. In the short-term follow-up, this patient has been asymptomatic. The postulated mechanism of air trapping in the sinus cavity seems to be logical in this case, because the symptoms were eliminated by surgically decompressing the sinus to overcome this valve mechanism.

Effects of ischemia and reperfusion on oxidative stress in hepatic cirrhosis induced by carbon tetrachloride in rats.

The present study was undertaken to determine the effect of ischemia and reperfusion on oxidative stress in hepatic cirrhosis induced by carbon tetrachloride (CCl4) in rats by the evaluation of lipid peroxidation products (LPO). Cirrhosis of the liver was induced by CCl4 administration. This drug was dissolved in mineral oil and the control group received only mineral oil intraperitoneally. Forty-five minutes of ischemia followed by one hour of reperfusion were performed. LPO products were evaluated by the thiobarbituric acid reactive substances method (TBARS) and chemiluminescence initiated by tert-butyl hydroperoxide technique (CL). The liver was submitted to histologic evaluation to check whether cirrhosis was present. The results demonstrated that ischemia-reperfusion caused an increase of LPO products in cirrhotic rats when compared to the control group (p < 0.05). Hepatic cirrhosis was present in all animals treated with CCl4 and no significant histologic alterations were observed in the control group. According to this study, we can conclude that the effect of ischemia and reperfusion in a rat model of hepatic cirrhosis caused a significant increase of the hepatic-levels of LPO products when compared to the noncirrhotic livers.

Protective effect of allopurinol in the renal ischemia--reperfusion in uninephrectomized rats.

The effect of allopurinol (an inhibitor of xanthine oxidase) on oxidative stress, renal dysfunction, and histologic alterations was evaluated during the renal ischemia--reperfusion in uninephrectomized rats. Renal malondialdehyde and serum creatinine levels significantly increased after renal ischemia--reperfusion. However, the pretreatment with allopurinol demonstrated a protector effect in these parameters. Renal ischemia--reperfusion provoked a significant renal damage in the operated group. Tubular atrophy and interstitial fibrosis were attenuated by allopurinol when given prior to the surgery. In our study, allopurinol had a strong tendency to exert a beneficial effect during renal ischemia--reperfusion in uninephrectomized rats.

Internal jugular phlebectasia in children.

Phlebectasia is an abnormal dilatation of an isolated vein, may affect any vein, and is usually asymptomatic. When the internal jugular vein is involved, it presents as a cervical swelling that can mimic the signs of either pharyngocele or a laryngocele and, because of its rarity, is frequently misdiagnosed. We describe 2 cases of phlebectasia of internal jugular vein in children with voice change in one of them. No treatment is necessary for this benign, self-limiting condition. Clinical features, diagnosis, treatment options, and a review of the literature about this rare venous lesion are presented.

Laryngeal manifestations of paracoccidioidomycosis (South American blastomycosis).

OBJECTIVE: To report clinical manifestations, diagnosis, and epidemiologic characteristics of laryngeal paracoccidioidomycosis. DESIGN: Case series. SETTINGS: Tertiary care institutional hospital. PATIENTS: We reviewed the hospital records of 7 patients with laryngeal paracoccidioidomycosis diagnosed by histopathological examination. MAIN OUTCOME MEASURE: Clinical manifestations of laryngeal paracoccidioidomycosis. RESULTS: All patients were men and were middle-aged (range, 43-65 years), and most (86% [6/7]) were farm workers. All 7 patients regularly used tobacco, but only (43% [3/7]) were alcohol users. Clinical manifestations were dysphonia (86% [6/7]), dyspnea (71% [5/7]), dysphagia (43% [3/7]), and cough (29% [2/7]). Laryngeal examination revealed ulcerative lesions with a mulberrylike appearance in 3 patients and vegetative lesions in 4 patients. Many had multiple laryngeal lesions with involvement of the true and false vocal cords, the epiglottis, and the arytenoid and interarytenoid areas. The first diagnostic impression was carcinoma in all patients. CONCLUSIONS: Laryngeal paracoccidioidomycosis may be a difficult diagnosis for the unsuspecting clinician to make. Examination of the larynx can reveal lesions similar to laryngeal cancer; therefore, diagnosis of carcinoma must be ruled out by histopathological examination or culture of a specimen.

Encephalocraniocutaneous lipomatosis with otolaryngologic manifestations: a rare neurocutaneous syndrome.

Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital disorder and was first described in 1970. The main clinical features of the syndrome include convulsions beginning in infancy, mental retardation, and unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral manifestations. A 14-year-old caucasian boy with ECCL associated with otolaryngologic manifestations is reported. To our knowledge, this is the first case of ECCL with otolaryngologic manifestation in the English literature.

The role of colchicine in prevention of hepatic cirrhosis induced by carbon tetrachloride.

BACKGROUND/AIMS: The present study was undertaken to determine whether colchicine has a beneficial effect in the prevention of hepatic cirrhosis when it is given simultaneously with CCl4. METHODOLOGY: Wistar rats were employed as experimental animals and divided into 6 groups: Group I received saline solution, Group II, saline solution and mineral oil; Group III, colchicine (10 micrograms/100 g) and mineral oil; Group IV, colchicine (10 micrograms/100 g) and CCl4; Group V, colchicine (5 micrograms/100 g) and CCl4; and, Group VI received saline solution and CCl4. The effect of colchicine was evaluated by liver function tests, serum total proteins, electrolytes and histological evaluation. RESULTS: The results demonstrated higher values of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin in groups IV and V when compared with group VI (p < 0.05). No difference between group VI and groups IV and V was observed in histological evaluation, serum total proteins and electrolytes (p < 0.05). CONCLUSIONS: Colchicine, as given in this study, did not have any protective effect in the prevention of cirrhosis induced by carbon tetrachloride.

[Protective effect of colchicine on tissue damage caused by free radicals in hepatic cirrhosis: an experimental study in rats]. / Efeito protetor da colchicina no dano tecidual causado por radicais livres na cirrose hepática: um estudo experimental em ratos.

The present study was undertaken to evaluate the effect of colchicine on oxidative stress in cirrhosis assessed by lipid peroxidation products. Wistar rats were used and induced hepatic cirrhosis by carbon tetrachloride. After the cirrhosis-induced period colchicine was administrated daily during 90 days. Lipid peroxidation was evaluated by the thiobarbituric acid reactive substances method (TBARS) and chemiluminescence initiated by tert-butyl hydroperoxide. The liver was submitted to histological evaluation to check whether cirrhosis was present. The results demonstrated an higher increase in lipid peroxide levels in cirrhotic tissue when compared with normal tissue and it was decreased by colchicine treatment (P < 0.05). Observing this study, we can conclude that hepatic cirrhosis produce an higher oxidative stress than normal liver and it can be decreased by colchicine treatment.