Elastic fibers in Reinke's edema.

OBJECTIVES: We describe the distribution of elastic system fibers in the superficial layer of the lamina propria of Reinke's edema, as compared with normal vocal folds. METHODS: Weigert's resorcin-fuchsin stain after oxidation with 10% oxone was used to study the arrangement of elastic fibers. The findings were categorized and afterward compared with the severity of Reinke's edema. RESULTS: Analysis of 20 specimens of vocal folds with Reinke's edema showed that the network of thin elastic fibers in Reinke's space lost their undulated appearance and had a tangled aspect. In addition, these fibers were no longer parallel to the epithelial basement membrane, but had a random distribution scattered throughout Reinke's space. The elastic fiber network immediately below the epithelial basement membrane also appeared more fragmented in Reinke's edema because of some alteration in organization combined with the 5-microm-thick histologic sectioning plane. No significant difference in the degree of elastic system fiber disarrangement was observed between severity grades II and III (p = 0.382). Large areas of disarrangement were predominant (80% of cases). CONCLUSIONS: The disarrangement of elastic fibers in Reinke's edema may cause insufficient tissue resistance and resilience, contributing to the hypermobility observed in Reinke's edema.

Uso de carbonos pirolíticos (Durasphere) no tratamento da insuficiência glótica: estudo experimental em cães / Use of pyrolytic carbon coated beads (Durasphere) to treat glottic failure: an experimental study in dogs

Nenhum tecido ou substância ideal foi encontrado para a injeção em pregas vocais. O objetivo deste estudo prospectivo foi avaliar o uso do Durasphere como substância de injeção na prega vocal canina. Materiais e métodos: Em seis cães adultos foram injetados 0,3mL de Durasphere no terço médio da prega vocal direita no músculo tireoaritenoideo e 0,3mL de soro fisiológico na prega contralateral. Os animais foram sacrificados após 7 dias (três cães) e 90 dias (três cães). Analisamos os processos inflamatórios no músculo vocal e na lâmina própria das pregas vocais. Resultados: No músculo vocal com Durasphere havia uma inflamação significativamente maior que no músculo controle, formouse um infiltrado linfomononuclear moderado após 7 dias e leve após 90 dias. Não observamos formação de corpos estranhos ou granulomas. Já na lâmina própria houve um processo inflamatório leve nos dois grupos, sem diferença entre eles. Conclusão: Trata-se de uma substância com biocompatibilidade comprovada em humanos, com resultados preliminares e inéditos de sua injeção em pregas vocais caninas que causou um processo inflamatório moderado no músculo vocal após 7 dias e leve após 90 dias, sem formação de corpos estranhos ou granulomas.

There is no ideal tissue or substance to be injected in the vocal folds. The objective of the present study was to assess the use of Durasphere in canine vocal fold injection. Materials and methods: in six adult dogs we injected 0.3 mL of Durasphere in the middle third of the thyroarytenoid muscle and 0.3 mL of saline solution in the contralateral vocal fold. The animals were slaughtered after seven days (three dogs) and after 90 days (three dogs). We analyzed the inflammatory process in the vocal fold and in the lamina propria of the vocal folds. Results: in the vocal muscle which received Durasphere there was a significantly more intense inflammation when compared to the control muscle - there was a moderate lymphomodular infiltrate after seven days and mild after 90 days. We did not observe foreign bodies nor granulomas. On the lamina propria there was a mild inflammatory process in the two groups, without difference between them. Conclusion: this is a substance of proven biocompatibility in humans, with preliminary and unprecedented results and its injection in canine vocal folds caused a moderate inflammatory process after seven days and mild after 90 days, without foreign bodies or granuloma formation.

Use of pyrolytic carbon coated beads (Durasphere) to treat glottic failure: an experimental study in dogs.

UNLABELLED: There is no ideal tissue or substance to be injected in the vocal folds. The objective of the present study was to assess the use of Durasphere in canine vocal fold injection. MATERIALS AND METHODS: in six adult dogs we injected 0.3 mL of Durasphere in the middle third of the thyroarytenoid muscle and 0.3 mL of saline solution in the contralateral vocal fold. The animals were slaughtered after seven days (three dogs) and after 90 days (three dogs). We analyzed the inflammatory process in the vocal fold and in the lamina propria of the vocal folds. RESULTS: in the vocal muscle which received Durasphere there was a significantly more intense inflammation when compared to the control muscle--there was a moderate lymphomodular infiltrate after seven days and mild after 90 days. We did not observe foreign bodies nor granulomas. On the lamina propria there was a mild inflammatory process in the two groups, without difference between them. CONCLUSION: this is a substance of proven biocompatibility in humans, with preliminary and unprecedented results and its injection in canine vocal folds caused a moderate inflammatory process after seven days and mild after 90 days, without foreign bodies or granuloma formation.

Disarrangement of collagen fibers in Reinke's edema.

OBJECTIVE/HYPOTHESIS: To describe the arrangement of collagen fibers in the superficial layer of the lamina propria of the vocal folds with Reinke' edema. STUDY DESIGN: Cross sectional analysis of the lamina propria of the vocal folds with Reinke's edema (RE). METHOD: The picrosirius polarization method was used to study the arrangement of collagen fiber. Findings of collagen disarrangement were categorized semiquantitatively and correlated with RE severity, age, cigarette smoking and duration of dysphonia. RESULTS: Analysis of 20 specimens of vocal folds with RE showed that the intertwined network of collagen fibers resembling a wicker-basket normally observed in vocal folds was disarranged in RE. The collagen fibers were loosely arranged, fragmented and intermixed with varying amounts of myxoid stroma. Moderate and large areas of disarrangement (90% of cases) predominated. Collagen fiber arrangement in the region underneath the epithelium was better preserved when compared with fibers in the deeper region of the superficial layer of the lamina propria. There was a statistical difference in collagen disarrangement between grade II and grade III severity (P = .007) that appeared to be due to the large areas of disarrangement observed in 73% of patients with grade III severity and in 44% of grade II severity. Age was the only variable correlated with collagen fiber disarrangement (r = 0.47, P = .037). CONCLUSION: Our findings suggest that the flexible framework which maintains the uniformity of the lamina propria was lost in RE caused by the disarrangement of the collagen fibers.

Tumor carcinóide atípico de laringe: 3 anos de acompanhamento clínico após tratamento cirúrgico conservador / Atypical carcinoid tumor of larynx: clinical evolution after 3 years with conservative surgery

Os tumores carcinóides atípicos são tumores raros na laringe. São considerados tumores agressivos com metástases precoces, principalmente para linfonodos cervicais. Descrever um caso de paciente com tumor carcinóide atípico na laringe...

Atypical carcinoid tumor is a rare neoplasm in the larynx. They are aggressive tumors with early metastases mainly for cervical nodes. Describe a case of a patient with a atypical carcinoid in the larynx...

Microbiology of peritonsillar abscesses.

AIM: The objective of the present study was to analyze the microbiology of peritonsillar abscesses. METHODS: Thirty patients, mean age 24,2 years, with peritonsillar abscesses underwent aspiration of at least 3 mL of pus, which was cultured for aerobes and anaerobes. RESULTS: 87% samples showed positive cultures. Aerobic or facultative aerobic bacteria were isolated from 23% aspirates, mixed aerobic and anaerobic bacteria from 60%, and anaerobic bacteria from only 3% aspirate. A total of 69 bacterial isolates (34 aerobic and 35 anaerobic) were recovered. The most common aerobic isolate was Streptococcus sp, with Streptococcus pyogenes being identified in 23% of aspirates. The predominant anaerobic isolates were Prevotella sp and Peptostreptococcus sp. Patients had received previous antimicrobial therapy in 63% cases. In this group, 1.8 isolates per specimen were recovered, a lower number than in the untreated group (3.0 per specimen). No significant difference in the species isolated was observed between these two groups. CONCLUSION: Peritonsillar abscess is usually a polymicrobial infection, with predominance of anaerobic bacteria. The number of agents isolated was larger in patients not previously treated with antibiotics, but the use of antimicrobial drugs did not interfere with the type of bacterium isolated.

Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis.

UNLABELLED: Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM: The objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN: Clinical prospective. METHODS: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Among the 81 studied patients, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed for 40.7% of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively. CONCLUSIONS: We concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Microbiologia dos abscessos peritonsilares / Microbiology of peritonsillar abscesses

OBJETIVO: O objetivo deste estudo é avaliar a microbiologia dos abscessos periamigdalianos. MATERIAIS E MÉTODOS: Trinta pacientes com diagnóstico de abscesso periamigdaliano, idade média de 24,2 anos, foram submetidos à punção na região periamigdaliana de maior abaulamento com aspiração do material purulento (volume maior que 3mL). O material foi separado para realização das culturas aeróbicas e anaeróbicas. RESULTADOS: Houve um índice de positividade das culturas de 86,7 por cento. Em 23,3 por cento aspirados houve crescimento apenas de bactérias aeróbicas ou facultativas, 3,3 por cento apenas de bactérias anaeróbicas e por fim em 60 por cento aspirados houve crescimento de bactérias aeróbicas e anaeróbicas. Um total de 69 bactérias foi isolado (34 aeróbios e 35 anaeróbios). Os aeróbios predominantes foram Streptococcus sp, sendo o Streptococcus pyogenes em 23 por cento dos casos. Os anaeróbios predominantes foram Prevotella sp e Peptostreptococcus sp. Pacientes receberam antibiótico prévio em 63 por cento dos casos. Neste grupo foram isolados 1,8 bactérias por aspirado, menor número que nos paciente que não utilizaram antibiótico (3,0 bactérias por aspirado). Não houve diferença significativa no tipo de bactéria isolada nestes dois grupos. CONCLUSÃO: Os abscessos periamigdalianos apresentam na maioria dos casos infecções polimicrobianas, sendo os organismos anaeróbicos agentes importantes. O número de agentes isolados é maior nos pacientes que não utilizaram antibioticoterapia prévia, mas o uso de antimicrobiano não interferiu no tipo de bactéria isolada.

Papel do teste de detecção rápida do antígeno do estreptococcus beta-hemolítico do grupo a em pacientes com faringoamigdalites / Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis

O Streptococcus beta-hemolítico do grupo A (SGA) é o agente etiológico mais comum das faringoamigdalites (FA). O diagnóstico etiológico correto e tratamento adequado evitam complicações supurativas e não-supurativas da faringoamigdalite estreptocócica, entretanto, métodos clínicos de diagnóstico não são confiáveis. Os métodos rápidos de detecção do antígeno do SGA podem ser utilizados no diagnóstico deste agente e evitar uso indevido de antibióticos. OBJETIVOS: Os autores objetivaram avaliar a sensibilidade e especificidade dos testes rápidos para detecção do antígeno do SGA em nosso meio. FORMA DE ESTUDO: Clínico prospectivo. METODOLOGIA: Oitenta e um pacientes com faringoamigdalite aguda, atendidos no PS-ORL do Hospital das Clínicas da FMUSP, no período de maio de 2001 a abril de 2002, foram submetidos a duas coletas simultâneas de material de orofaringe com swabs. O teste rápido de detecção do SGA foi confrontado com a cultura em placa agar-sangue ("gold standard" para o diagnóstico etiológico). RESULTADOS: De 81 pacientes, 56 por cento tiveram teste rápido positivo e 44 por cento negativo; 40.7 por cento apresentaram crescimento de SGA na cultura; a sensibilidade e especificidade do teste rápido foram, respectivamente, 93,9 por cento e 68,7 por cento. O valor preditivo negativo e positivo foram, respectivamente, 94,2 por cento e 67,4 por cento. CONCLUSÕES: A alta sensibilidade do exame permite utilizá-lo com intuito de identificar pacientes com SGA. Os testes de detecção rápida do antígeno estreptocócico se mostraram uma importante arma coadjuvante no diagnóstico etiológico das faringoamigdalites.

Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM: The objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN: Clinical prospective. METHODS: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Among the 81 studied patients, the rapid test was positive in 56 percent and negative in 44 percent. GAS growth in culture was observed for 40.7 percent of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9 percent and 68.7 percent, and the negative and positive predictive values were 94.2 and 67.4 percent, respectively. CONCLUSIONS: We concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Papel do teste de deteccão rápida do antígeno do estreptococcus pyogenes do grupo a em pacientes com faringoamigdalites / Role of rapid antigen detection test for the diagnosis of group A beta-hemolytic streptococcus in patients with pharyngotonsillitis

O Streptococcus pyogenes do grupo A (SGA) é o agente etiológico mais comum das faringoamigdalites (FA). O diagnóstico etiológico correto e tratamento adequado evitam complicacões supurativas e não-supurativas da faringoamigdalite estreptocócica, entretanto, métodos clínicos de diagnóstico não são confiáveis. Os métodos rápidos de deteccão do antígeno do SGA podem ser utilizados no diagnóstico deste agente e evitar uso indevido de antibióticos. OBJETIVOS: Os autores objetivaram avaliar a sensibilidade e especificidade dos testes rápidos para deteccão do antígeno do SGA em nosso meio. FORMA DE ESTUDO: Clínico prospectivo. CASUíSTICA E MÉTODO: Oitenta e um pacientes com faringoamigdalite aguda, atendidos no PS-ORL do Hospital das Clínicas da FMUSP, no período de maio de 2001 a abril de 2002, foram submetidos a duas coletas simultâneas de material de orofaringe com swabs. O teste rápido de deteccão do SGA foi confrontado com a cultura em placa agar-sangue ("gold standard" para o diagnóstico etiológico). RESULTADOS: De 81 pacientes, 56 por cento tiveram teste rápido positivo e 44 por cento negativo; 40.7 por cento apresentaram crescimento de SGA na cultura; a sensibilidade e especificidade do teste rápido foram, respectivamente, 93,9 por cento e 68,7 por cento. O valor preditivo negativo e positivo foram, respectivamente, 94,2 por cento e 67,4 por cento. COMENTARIOS FINAIS: A alta sensibilidade do exame permite utilizá-lo com intuito de identificar pacientes com SGA. Os testes de deteccão rápida do antígeno estreptocócico se mostraram uma importante arma coadjuvante no diagnóstico etiológico das faringoamigdalites.

Role of rapid antigen detection test for the diagnosis of group A beta-hemolytic streptococcus in patients with pharyngotonsillitis.

UNLABELLED: Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis; however, clinical diagnosis is not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM: The objective of the present study was to determine sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN: Clinical prospective. METHOD: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of the University Hospital, FMUSP, between May 2001 and April 2002 were submitted to two simultaneous collections of oropharyngeal material using swabs. The rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Among the 81 patients studied, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed in 40.7% of the patients. Sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively. CONCLUSIONS: We concluded that high sensitivity of the test allows its use in the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important adjuvant tool in the etiologic diagnosis of pharyngotonsillitis.

Pólipos de pregas vocais e alterações estruturais mínimas: lesões associadas? / Vocal fold polyps and cover minor structural alterations: associated injuries?

Pólipos são lesões comuns de pregas vocais. O fonotrauma é o principal fator relacionado com o início desta lesão. A associação entre pólipos de pregas vocais e alterações estruturais mínimas de cobertura mucosa (sulco vocal, cisto epidermóide, ponte de mucosa, microdiafragma laríngeo e vasculodisgenesia) foi pouco estudada na literatura, por isso o objetivo deste trabalho foi quantificar e analisar essa associação. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODOS: Realizamos um estudo retrospectivo com 68 pacientes, idade média de 39,5 anos, operados de pólipo de pregas vocais no período entre janeiro de 1999 e maio de 2003. Procuramos analisar a presença de pólipo de pregas vocais e as possíveis AEMC associadas no levantamento realizado. RESULTADOS: A presença de AEMC associada ao pólipo ocorreu em 16 (23,5 por cento) pacientes, sendo que em 8 (50 por cento) pacientes o achado foi o sulco vocal (7 sulco estria e 1 sulco bolsa). Em 4 (25 por cento) pacientes o achado foi o cisto de prega vocal, em 2 (12,5 por cento) pacientes a ponte mucosa, em 1 (6,25 por cento) a vasculodisgenesia e em 1 (6,25 por cento) paciente o microdiafragma laríngeo. A AEMC era contralateral ao pólipo de prega vocal em 11 pacientes. Dos sulcos, 6 (75 por cento) eram contralaterais e dos cistos, 3 (75 por cento) eram contralaterais ao pólipo. CONCLUSÃO: A associação entre pólipos de pregas vocais e alterações estruturais mínimas de cobertura mucosa é relativamente freqüente, 23,5 por cento em nosso estudo. A exploração cuidadosa de ambas pregas vocais é essencial no intraoperatório das cirurgias de exérese de pólipo na procura destas alterações estruturais associadas.