ABSTRACT
Immunocompromised individuals are susceptible to pulmonary Aspergillus infections, whereas invasive Aspergillus infection is extremely rare in the presence of normal immunity. A case of larynx-tracheobronchial-pulmonary aspergillosis in an immunocompetent 57-year-old female host who was successfully treated with amphotericin-B and voriconazole is reported here.
Subject(s)
Immunocompetence , Larynx/pathology , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/immunology , Trachea/pathology , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Bronchi/drug effects , Bronchoscopy , Female , Fiber Optic Technology , Humans , Immunocompetence/drug effects , Larynx/diagnostic imaging , Larynx/drug effects , Middle Aged , Pulmonary Aspergillosis/diagnostic imaging , Pulmonary Aspergillosis/pathology , Tomography, X-Ray Computed , Trachea/diagnostic imaging , Trachea/drug effects , Voriconazole/pharmacology , Voriconazole/therapeutic useABSTRACT
INTRODUCTION: Head and neck cancers are linked to smoking. The most affected sites are the oral cavity, pharynx and larynx. Experimental studies show epithelial lesions caused by cigarette smoke. OBJECTIVES: To investigate in rats the effects of acute cigarette smoke exposure on the mucosa of the tongue, pharynx and larynx. MATERIAL AND METHOD: Wistar rats were allocated into two groups of 20 animals: CG (control) receiving food and water ad libitum and TG (Tobacco) exposed to the smoke of 40 cigarettes/day for 60 days. Biopsy of their tongues, pharynxes and larynxes were subjected to histopathological, histomorphometric and immunohistochemical studies of protein p53 and ki-67. RESULT: The histological analysis of tongue from the Tobacco group revealed epithelial hyperplasia (90%), basal cell hyperplasia (95%) and mild to moderate dysplasia (85%). In pharynx showed basal cell hyperplasia (85%), dysplasia (25%) and vascular congestion (95%). In larynx showed basal cell hyperplasia (70%), epithelial hyperplasia (55%), congestion (100%) and inflammatory infiltrate (25%). Morphometric analysis revealed that keratin layer thickness was greater in the tobacco group. P53 immunoexpression was negative in both groups. Ki-67 immunoexpression was positive in basal cell nuclei but in parabasal cell nuclei it was positive only in the Tobacco group. CONCLUSIONS: The exposure of animals to cigarette smoke for 60 days resulted in benign lesions. The duration of exposure was not enough to cause the development cancer, as confirmed by the negative expression of p53 protein in all slides examined. Analysis of ki-67 expression showed intense epithelial proliferation in response to damage.
Subject(s)
Ki-67 Antigen/metabolism , Larynx/drug effects , Pharynx/drug effects , Tobacco Smoke Pollution/adverse effects , Tongue/drug effects , Tumor Suppressor Protein p53/metabolism , Animals , Immunohistochemistry , Inhalation Exposure , Ki-67 Antigen/genetics , Larynx/metabolism , Larynx/pathology , Male , Mouth Mucosa/drug effects , Mouth Mucosa/metabolism , Mouth Mucosa/pathology , Pharynx/metabolism , Pharynx/pathology , Rats , Tongue/metabolism , Tongue/pathology , Tumor Suppressor Protein p53/geneticsABSTRACT
Laryngeal dystonia (spasmodic dysphonia) is a movement disorder characterized by involuntary contractions of laryngeal muscles involved with vocalization. The introduction of botulinum toxin in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. We report the preliminary results of therapeutical use of botulinum toxin in the treatment of twelve patients with laryngeal dystonia. After an extensive clinical evaluation, the patients underwent a videostroboscopic exam for diagnostic confirmation. Botulinum toxin was injected in the cricothyreoid membrane, directed towards the thyreoaritenoid muscle, with the aid of eletromyography needles. Most of patients who underwent botulinum toxin injection had a significant improvement of their symptoms (83%), with effects lasting for four months in average and without important side effects.
Subject(s)
Anti-Dyskinesia Agents/therapeutic use , Botulinum Toxins/therapeutic use , Dystonia/drug therapy , Laryngeal Diseases/drug therapy , Adult , Aged , Anti-Dyskinesia Agents/pharmacology , Botulinum Toxins/pharmacology , Electromyography , Female , Follow-Up Studies , Humans , Larynx/drug effects , Male , Middle Aged , Treatment OutcomeABSTRACT
A distonia laríngea (disfonia espasmódica) é distúrbio do movimento caracterizado por contrações involuntárias da musculatura laríngea envolvida no processo de vocalização. A utilização da toxina botulínica no tratamento da distonia laríngea trouxe consideráveis benefícios clínicos. Descrevemos os resultados preliminares do uso terapêutico da toxina botulínica no tratamento da distonia laríngea em 12 pacientes. Após investigação clínica, os pacientes foram submetidos a videolaringoestroboscopia para confirmação diagnóstica e as injeções de toxina botulínica foram realizadas através de punção da membrana cricotireóidea em direção ao músculo tireoaritenóideo, com uso de eletromiografia. A maioria dos pacientes submetidos ao tratamento com toxina botulínica apresentou melhora significativa da distonia laríngea (83 por cento dos casos), com duração média do efeito de quatro meses, sem efeitos colaterais significativos