Prednisolona e Clarirtromicina no tratamento da rinossinusite aguda - estudo multicêntrico brasileiro / Predisolone and Clarythromicin in the treatment of acute rhinosinusitis - brazilian multicenter study

A rinossinusite bacteriana aguda é uma afecção de alta prevalência, na sua maioria originada de viroses das vias aéreas superiores. A terapia antimicrobiana com a claritromicina está bem estabelecida na literatura e corticoterapia sistêmica contribui como adjuvante no controle da inflamação, diminuindo o edema, facilitando a drenagem das secreções e a manutenção da permeabilidade dos óstios, favorecendo assim a cura clínica.

Changing patterns of buccal manifestations in AIDS.

INTRODUCTION: Since the new antiviral drugs, e.g. protease inhibitors, arrived for the treatment of HIV-infected patients, the main oral infections associated with HIV disease have been brought under wider control. MATERIAL AND METHOD: We examined 214 HIV-1 infected patients, that were in-patients or presented for consultation at the ENT department of the Hospital das Clinicas (São Paulo, University Medical School), between January 1996 and November 1998. We review the different disorders which may affect the buccal cavity of HIV patients, 57 patients (26.6%). We divided the patients into two groups to compare the differences in appearance of oral lesions in those ones receiving two or three antiviral drugs. We had 53 patients presenting with oral lesions, the majority of them from the group receiving two drugs. RESULTS: The "P" value test was used and we concluded that there was a significant correlation between the use of triple antiviral therapy and a decrease of buccal lesions in HIV-infected patients.

Morphological and functional study of the cochlea after administration of estrogen and progesterone in the guinea pig.

The aim of this study was to analyze the morphological cochlear changes and auditory function observed after the administration of estrogen or progesterone or both. Sixty-two guinea pigs were divided into four groups that received estrogen (group 1), progesterone (group 2), estrogen and progesterone (group 3), and saline solution (controls, group 4), respectively. The auditory evaluation consisted of brainstem evoked response audiometry, performed before and after drug administration. Structural analysis was based on histological hematoxylin and eosin staining preparations. Our results showed changes in latency and amplitude of waves in the study groups that received estrogen or progesterone. The main histological changes observed were inflammatory infiltrate and vacuolization of the stria vascularis. Our results suggest that both estrogen and progesterone lead to morphological and physiological lesions of the cochlea, the degree of the observed lesions depending not only on the presence of these hormones but also on the proportion between them.

The use of ultrasound evaluation in the diagnosis of peritonsillar abscess.

Peritonsillar Abscess (PTA) and Peritonsillar Cellulitis (PTC) are very similar clinical conditions. The differential diagnosis between them is made by needle aspiration, a very painful and invasive method. This study was performed at the Department of Otolaryngology at the Clinical Hospital of São Paulo University Medical School. It's aim was to evaluate the use of ultrasound as a noninvasive and inexpensive method of diagnosis, differentiating abscess from cellulitis. Twenty-one consecutive patients with a clinical diagnosis of peritonsillar infection were evaluated in the emergency service with a probable diagnosis of PTA. These patients were evaluated with intraoral and percutaneous ultrasound. Needle aspiration was used to compare and confirm the diagnosis. The sensitivity was 92.3% and specificity was 62.3%. The authors conclude that ultrasound is a good method to evaluate the differences between PTA and PTC.

Análise descritiva preliminar da resposta clínica de pacientes com faringotonsilite, comparando a terapêutica com amoxilina administrada duas vezes ao dis com amoxicilina administrada três vezes ao dia / Preliminary report evaluating the of amoxicillin on the clinical course of tonsillopharyngitis

Neste estudo observador-cego, cento e setenta e um pacientes com evidência clínica de faringotonsilite foram randomizados para serem submetidos ao tratamento com amoxicilina administrada duas vezes ao dia(bd)ou três vezes ao dia (tid). Este é um relatório descritivo preliminar, até o momento, a característica "observador-cego" do estudo. Assim, os grupos de pacientes estäo sendo caracterizados como "Tratamento A" e "Tratamento B". Ao final do tratamento, foi obtido um índice de cura clínica de noventa e seis e cinco por cento para os pacientes do grupo "Tratamento A" e noventa e seis e cinco por cento para pacientes do grupo "Tratamento B", sugerindo equivalência terapêutica entre os grupos quanto à eficácia clínica. Os dois esquemas posológicos foram bem tolerados. Em conclusäo, os dados apresentados sugerem que o regime terapêutico de amoxilina administrada duas vezes ao dia (bd) seja täo eficaz quanto o regime de amoxicilina administrada três vezes ao dia (tid) para o tratamento destes pacientes, com a vantagem de poder determinar maior aderência dos doentes ao tratamento

Microbiology of sinusitis in patients undergoing bone marrow transplantation.

As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapy, more patients have become susceptible to sinus disease caused by unusual organisms. Sinusitis caused by fungi and gram-negative bacteria can be difficult to treat, may lead to severe complications, and should be managed promptly in the bone marrow transplant patient. Here we present the results of 41 cultures of the paranasal sinuses obtained from 18 bone marrow transplant patients in whom sinusitis developed. The most common agents were gram-negative bacteria (56.7%), followed by gram-positive bacteria (26.7%) and fungi (16.6%). In 13 samples the cultures were negative. Nasal cultures were performed ipsilateral to the sinus drained in 28 cases. Concordance was obtained in only 5 (17.8%) samples. The antibiogram of the isolated agents from the maxillary sinuses in this series revealed that the most efficient antibiotics were those that covered gram-negative bacteria. Treatment was usually prolonged in these patients, and different antibiotics were necessary to clear infections from the sinuses. In conclusion, treating sinusitis in bone marrow transplant patients may be challenging. Considerations about the microbiology and antibiogram susceptibilities of this specific population should be kept in mind when dealing with such cases.

Continuous, high-frequency objective tinnitus caused by middle ear myoclonus.

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.

Comparaçäo da eficácia e tolerabilidade da azelastina spray nasal e loratadina comprimidos em pacientes com rinite alérgica perene / A comparison of efficacy and tolerability of azelastine nasal spray and loratadine tablets in patients with perennial allergic rhinitis

Cinquenta e seis pacientes com rinite alérgica perene foram tratados por duas semanas em um estudo duplo-cego, "double-dummy", randomizado, comparando azelastina spray nasal (0,14 mg/narina, duas vezes ao dia) e loratadina comprimidos (10 mg, uma vez ao dia). Os sintomas avaliados foram espirros, prurido nasal, rinorréia, edema da mucosa nasal, obstruçäo nasal, tosse, alteraçöes do olfato, prurido ocular, vermelhidäo conjuntival, lacrimejamento, fotofobia, vermelhidäo da mucosa faríngea e prurido faríngeo. Estes sintomas da rinite foram avaliados pelo investigador, de acordo com uma escala de quatro pontos (0 = ausente, 1 = leve, 2 = moderado, 3 = severo), antes do tratamento, uma e duas semanas após seu início. Espirros, obstruçäo nasal, prurido nasal e rinorréia foram avaliados diariamente pelos pacientes de acordo com a mesma escala. Ao final da primeira e da segunda semanas de tratamento uma avaliaçäo global da resposta terapêutica e da tolerabilidade foi feita pelos pacientes e pelo investigador. Comparado à avaliaçäo pré-tratamento, verificou-se uma reduçäo da pontuaçao de cada um dos sintomas em ambas as avaliaçöes, tanto para os pacientes que receberam azelastina como para os que receberam loratadina. Näo foram observadas diferenças estatisticamente significantes entre os dois grupos. Concluindo, a azelastina mostrou-se ser täo eficaz quanto a loratadina no alívio dos sintomas da rinite alérgica perene.

Nasal chondroma: a case report and review of the literature.

Although rare tumors, chondromas will on occasion be encountered by the otolaryngologist in his routine daily practice. The authors describe a nasal myxochondroma in an 8-year-old child, which was removed satisfactorily surgically, with no signs of recurrence even after 4 years of follow-up. Because chondromas may also present as nasal polyps, the knowledge of cartilaginous tumors in the nose plays a pivotal role for a better approach to these patients.

Septic thrombosis of orbital vessels due to cutaneous nasal infection.

The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. Patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.

Mucocele of the maxillary sinus.

The maxillary sinus mucocele is a rare condition and it usually presents clinically as a benign tumor. Sixteen patients were evaluated. A previous history of surgery or injury to maxillary sinus was obtained in 12 cases, the diagnosis being confirmed by computed tomography imaging. Recovery is often complete after Caldwell-Luc operation. The authors discuss some important aspects of diagnosis and treatment.

Rhinocerebral mucormycosis: predisposing factors, diagnosis, therapy, complications and survival.

Mucormycosis is the most acutely fatal fungal infection of the human being (5). Although relatively uncommon, its morbidity makes it an extremely important disease for the Otolaryngologist-Head and Neck Surgeon. A review of 11 cases of rhinocerebral mucormycosis (nine female and two male patients) admitted from 1961 to 1994 at Hospital das Clinicas, University of Sao Paulo was undertaken. The age range was from eight months to 49 years with a median age of 31 years. In the current study, we present and discuss the predisposing factors, the methods of diagnosis, the treatment given the complications observed and the survival of the disease. The survival rate for paranasal sinus mucormycosis in this study was 72.7% (8/11). All deaths occured within the first month after diagnosis and institution of treatment. All the patients that died presented with diabetic ketoacidosis. Hemiplegia as a neurological complication of the disease was seen in 66.6% (2/3) of the deaths. Survival analysis (Fisher Test p < 0.05) indicates that diabetic ketoacidosis and hemiplegia are negative prognostic factors in mucormycosis survival. The authors intend to add some more information to the limited literature on paranasal sinus mucormycosis.

A pathway for information transmission to the ear.

The use of implantable hearing aids and cochlear implants as an aid to neurosensory deafness is becoming an established procedure. The transmission of a processed speech signal is accomplished either transcutaneously via radiofrequency or percutaneously by connector coupling. Whereas the former is sensitive to electromagnetic interference, the latter increases the risk of infection. To overcome these disadvantages, an infrared (IR) system for transmission through the tympanic membrane was devised and tested. The transmitter/receiver consisted of an IR light emitting diode (LED; 920nm) and a photovoltaic cell. The LED was placed inside the auditory canal of four dogs and the photovoltaic cell in the tympanic cavity over the cochlear promontory. A sinusoidal signal modulation was applied to the LED. The emitted signal was detected undistorted after crossing the tympanic membrane, with an average absorbance of 20%. High-frequency cut-off was adequate for cochlear implant purposes and audio prosthetic devices in general. The authors conclude that the tympanic membrane may be used as a translucent sealed interface to transmit data in the audio range to the middle and inner ears, with small power loss, good frequency response, and immunity to interface.

[Choristoma of the gastric mucosa: report of a case]. / Choristoma de la muqueuse gastrique: description d'un cas.

Choristomas are tumor like masses consisting of tissues that are histologically normals but in abnormal location. These are rare in oral cavity and occur generally in tongue. There are seven categories of choristomas on the basis of types of tissues recognized. The presenting case in a gastric mucosal choristoma type, and the treatment was surgical excision. No recurrence of the mass was revealed. Special care should be taken with lingual thyroïd choristoma, because 86% of the cases is the only functional thyroide tissue in the body.

Anastomosis of the intratemporal facial nerve using fibrin tissue adhesive.

This work aimed at studying the results obtained by the repair of complete lesions of the facial nerve in its intratemporal portions. Clinical, electrophysiological and surgical techniques were studied. Twenty-three patients with traumatic facial nerve lesions were operated. Nerve grafts were made in 10, and end-to-end anastomosis in thirteen. The surgical technique performed was the coaptation of the stumps and stabilization with fibrin tissue adhesive. Sixteen months after surgery, a clinical and electrophysiological evaluation was made. The use of fibrin tissue adhesive to stabilize intratemporal anastomosis of facial nerve showed clinical and electrophysiological evidence of axonal growth and reinnervation of mimical muscles of the face. These results were similar to that obtained by other authors that used other methods of microanastomosis. The use of fibrin tissue adhesive is an effective technique to utilize in intratemporal anastomosis of the facial nerve.

Human lagochilascariasis treated successfully with ivermectin: a case report.

A 15 year old male patient was diagnosed as being infected with the nematode Lagochilascaris minor, presenting as abscesses over the left mastoid region, and invading the temporal bone, mastoid sinuses and possibly the CNS. Surgical drainage and administration of cambendazole and levamisole led to improvement, followed by an early relapse and poor tolerance to the antihelminthic drugs. Repeated doses of ivermectin (an animal preparation) were used for the first time to treat this condition and resulted in complete remission of signs of infection, maintained for 15 months after the end of drug therapy, indicating cure of the disease.

Schwannoma of the nasal septum. Apropos of 2 cases.

We present two cases of schwannoma of the nasal septum. One of the patients has neurofibromatosis type 2; however, her main complaint was nasal obstruction. Schwannoma deriving from the septum is an extremely rare pathology, both in systemic neurofibromatosis type 2 and as a solitary lesion. There are no characteristic symptoms. Histopathologic examination may be inconclusive so that the definitive diagnosis requires immunohistochemic studies or electron microscopy. Differential diagnosis includes several neurogenic and mesenchymal tumors. CT scan and MRI studies are helpful in evaluating the origin, localization and extension of the lesion. Complete resection of the mass is usually curative, although patients with neurofibromatosis present a higher risk of local recurrence and malignant transformation.