Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
1.
Eur Arch Otorhinolaryngol ; 273(6): 1445-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26319275

RESUMO

Pre operative biopsy is important in obtaining preliminary information that may help in tailoring the optimal treatment. The aim of this study was to compare two sampling techniques of obtaining nasal biopsy-nasal forceps and nasal scissors in terms of pathological results. Biopsies of nasal lesions were taken from patients undergoing nasal surgery by two techniques- with nasal forceps and with nasal scissors. Each sample was examined by a senior pathologist that was blinded to the sampling method. A grading system was used to rate the crush artifact in every sample (none, mild, moderate, severe). A comparison was made between the severity of the crush artifact and the pathological results of the two techniques. One hundred and forty-four samples were taken from 46 patients. Thirty-one were males and the mean age was 49.6 years. Samples taken by forceps had significantly higher grades of crush artifacts compared to those taken by scissors. The degree of crush artifacts had a significant influence on the accuracy of the pre operative biopsy. Forceps cause significant amount of crush artifacts compared to scissors. The degree of crush artifact in the tissue sample influences the accuracy of the biopsy.


Assuntos
Biópsia/instrumentação , Biópsia/métodos , Nariz/patologia , Adulto , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Instrumentos Cirúrgicos , Adulto Jovem
2.
Eur Arch Otorhinolaryngol ; 273(11): 3993-4001, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27216303

RESUMO

To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA). DESIGN: Randomized, double-blind study. SETTING: tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO2 laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure. MAIN OUTCOME MEASURE: c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted. LEVEL OF EVIDENCE: Level 1, prospective randomized controlled trial.


Assuntos
Adenoidectomia/métodos , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Ronco/cirurgia , Tonsilectomia/métodos , Adenoidectomia/instrumentação , Tonsila Faríngea , Adolescente , Biomarcadores/sangue , Proteína C-Reativa/análise , Criança , Pré-Escolar , Desbridamento/instrumentação , Método Duplo-Cego , Eletrocoagulação/métodos , Feminino , Humanos , Interleucina-6/sangue , Terapia a Laser/métodos , Contagem de Leucócitos , Masculino , Neutrófilos , Dor Pós-Operatória , Tonsila Palatina/patologia , Pais , Hemorragia Pós-Operatória/cirurgia , Estudos Prospectivos , Inquéritos e Questionários , Tonsilectomia/instrumentação , Fator de Necrose Tumoral alfa/sangue
3.
Dermatol Surg ; 41(10): 1126-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26372123

RESUMO

BACKGROUND: Cutaneous squamous cell carcinoma (CSCC), the second most common cancer in whites, may result in nodal metastasis in 4% of patients. In the last decade, sentinel lymph node biopsy (SLNB) became the common practice for treating patients with invasive skin cancers such as melanoma, although its use in patients with CSCC is still under debate. OBJECTIVE: To find the rate of cervical lymph node metastasis in the series of patients with CSCC of the head and neck and to identify those who may need SLNB. MATERIALS AND METHODS: A retrospective data collection on all patients diagnosed with CSCC of head and neck during the years 1998 to 2005. RESULTS: A total of 572 patients with 725 head and neck CSCC were included in the study group. During the follow-up period, 10 (1.3%) patients developed lymph node metastases and no patient developed distant metastases. The probability of lymph node metastasis within 6 years for T1 and T2 tumors was 1.09% and 5.46%, respectively (p = .0387). CONCLUSION: Because of the relatively low incidence of cervical lymph node metastases in patients with CSCC of the head and neck, SLNB for clinically N0 patients is not justified.


Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias de Cabeça e Pescoço/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Metástase Linfática , Masculino , Esvaziamento Cervical , Avaliação das Necessidades , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Resultado do Tratamento
4.
Am J Otolaryngol ; 35(2): 180-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24060342

RESUMO

OBJECTIVES: The objectives of this study were to describe the clinical course and outcome of patients with sudden sensorineural hearing loss (SSNHL) in conjunction with benign paroxysmal positional vertigo (BPPV), and hypothesize the possible pathophysiology of this entity. STUDY DESIGN: Retrospective study of all patients with evidence of SSNHL with any type of BPPV between 2008 and 2012. SETTINGS: Tertiary care university hospital. SUBJECTS AND METHODS: Five patients aged 56 to 71 were diagnosed with unilateral profound SSNHL and BPPV. Neurotologic examination revealed an ipsilateral torsional, up-beating nystagmus on Dix-Hallpike exam. Severe or profound ipsilateral-sensorineural hearing loss was recognized on audiometry. The rest of the exam was normal; this was in keeping with the diagnosis of SSNHL with ipsilateral posterior semicircular canal BPPV. RESULTS: All patients were treated with a modified Epley maneuver; oral steroids were administered for two weeks. In all cases vertigo resolved and the Dix-Hallpike exam became normal within several weeks. However, the hearing loss remained unchanged in two patients. Magnetic resonance imaging of the head was normal and ENG caloric test demonstrated mild ipsilateral canal paresis in two patients. CONCLUSIONS: 1. Patients with SSNHL and BPPV can have a variable clinical course and outcome. This entity may be quite common, but the diagnosis of BPPV can be missed if a complete neurological physical examination is not performed. 2. Arterial occlusions or selective multiple vascular or neural involvement may explain the pathophysiology of SSNHL with BPPV of the posterior semicircular canal.


Assuntos
Perda Auditiva Neurossensorial/complicações , Perda Auditiva Súbita/complicações , Canais Semicirculares/fisiopatologia , Vertigem/complicações , Idoso , Audiometria , Vertigem Posicional Paroxística Benigna , Testes Calóricos , Feminino , Seguimentos , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vertigem/diagnóstico , Vertigem/fisiopatologia
5.
Oral Maxillofac Surg ; 2023 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-37985562

RESUMO

OBJECTIVES: To study the association between perforation dental implants into the maxillary sinus cavity and the development of sinus pathology. METHODS: We retrospectively examined 3732 computerized tomography (CT) scans to detect maxillary implants. The detected scans were grouped based on apparent or lack of perforated dental implants in the maxillary sinus (study and control group, respectively). Clinical data was gathered including the CT indication, patients' demographics, comorbidities and medications, implant features, and the radiographic appearance of the maxillary sinuses. We conducted a logistic regression to identify risk factors to develop radiopaque thickening in the sinuses. RESULTS: Included in the study were 198 patients with 719 maxillary implants; of these, 236 and 483 implants were in the study and control groups, respectively. Sinus opacification was associated with implants' perforations (p < 0.001), diameter, and side and place (p < 0.05). Implants' perforation (OR = 3.679; 95% CI = 1.891-7.157) and diameter (OR = 1.608; 95% CI = 1.067-2.424), sinus floor augmentation (OR = 2.341; 95% CI = 1.087-5.042), male gender (OR = 2.703; 95% CI = 1.407-5.192), and smoking (OR = 6.073; 95% CI = 2.911-12.667) were associated with ipsilateral sinus fullness. CONCLUSIONS: A first large study on the association between maxillary dental implant and sinus pathology. Dental implant perforation is associated with sinus opacification. Considering dental implant diameter, rather than vertical depth of penetration into the sinus, as an important criterion when examining perforated dental implants necessitates a new approach to clinical decision-making.

6.
Int J Audiol ; 50(8): 519-22, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21486123

RESUMO

OBJECTIVE: The purpose of our study was to evaluate the influence of epidural anesthesia on the hearing system in women undergoing normal labor. DESIGN: We examined two groups of patients: women with epidural anesthesia underwent four tests of distortion product otoacoustic emissions(DPOAEs): on admission, and fifteen minutes, one hour, and three hours after the last epidural bolus of local anesthetic. Auditory brainstem response (ABR) tests were performed on admission, and one hour, and three hours after the last epidural bolus. Women who gave birth without epidural anesthesia underwent DPOAEs tests on admission, during a uterine contraction, during active delivery, and three hours after labor. ABR tests were performed on admission, during a uterine contraction, and three hours after labor. STUDY SAMPLE: twenty patients participated in the study. Twelve gave birth with epidural anesthesia and eight without anesthesia. RESULTS: No significant changes in DPOAEs and ABR recordings were found between the two groups. CONCLUSIONS: Epidural anesthesia does not impair the sensory or the neural elements of the hearing system and therefore does not influence hearing.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia Epidural , Anestesia Obstétrica , Anestésicos Locais/administração & dosagem , Vias Auditivas/efeitos dos fármacos , Audição/efeitos dos fármacos , Trabalho de Parto , Estimulação Acústica , Audiometria de Tons Puros , Bupivacaína/administração & dosagem , Estudos de Casos e Controles , Potenciais Evocados Auditivos do Tronco Encefálico/efeitos dos fármacos , Feminino , Fentanila/administração & dosagem , Humanos , Israel , Emissões Otoacústicas Espontâneas/efeitos dos fármacos , Gravidez , Estudos Prospectivos , Fatores de Tempo , Contração Uterina
7.
Orbit ; 29(6): 334-40, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21158574

RESUMO

PURPOSE: To review the medical literature on mucinous sweat gland adenocarcinoma of the eyelid (MSA) and present two new cases. METHODS: Details of published case reports and small series (between 1971-2010) were evaluated and summarized including two patients diagnosed and treated at our institution. Data regarding age, gender, ethnicity, precise location, clinical presentation, treatment and follow up of each patient were collected. RESULTS: 25 reports describing 55 patients were found in the medical literature. The mean age was 61.3 years (30-87), 22(59%) were male and 28(80%) were Caucasian. In 23(44.2%) patients the lesion was in the lower lid, in 20(38.5%) in the upper lid, in 3(5.7%) involving both lids and in 6(11.6%) in a canthus. In 12(21.8%) patients a lesion with a benign diagnosis was previously excised from the same location. In 2 of them histological re-examination resulted in a diagnosis of MSA. Intraorbital involvement was found in 2(3.6%) patients. Regional lymph node metastasis was found in 2(4.4%) patients. Surgical excision was the treatment of choice using Mohs' micrographic-controlled excision technique in recent years. Radiotherapy was applied to 2 patients with clinical resolution in 1. Recurrence of the tumor was reported in 14(30%) patients. CONCLUSIONS: MSA is a rare tumor of the eyelid with no clinically distinguishing features. It should be suspected particularly with recurrent eyelid lesions and must be differentiated from metastatic disease. The tumor may extend into the orbit and metastasize regionally. Surgical removal with continued regular follow-up examination is the treatment of choice.


Assuntos
Adenocarcinoma Mucinoso/patologia , Neoplasias Palpebrais/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adenocarcinoma Mucinoso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Neoplasias Palpebrais/cirurgia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Doenças Raras , Medição de Risco , Neoplasias das Glândulas Sudoríparas/cirurgia , Resultado do Tratamento
8.
Int J Pediatr Otorhinolaryngol ; 72(4): 469-73, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18282613

RESUMO

OBJECTIVES: Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy. STUDY DESIGN: A prospective randomized double-blind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis. METHODS: Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate pain, ability to eat and analgesics consumption for 10 days after surgery. RESULTS: Ninety-six patients returned for postoperative follow up and filled in the questionnaire. As our medical center is the only hospital in the southern district of Israel and we hospitalize every person who presents with post-tonsillectomy bleeding, we can assume that any patient from either group who presented with post-tonsillectomy bleeding would be familiar to us. Analysis showed that no statistically significant differences relating to postoperative pain, bleeding, use of analgesics and postoperative eating resumption were detected between the patients treated with fibrin glue and controls. CONCLUSIONS: We cannot substantiate a significant beneficial effect of fibrin glue in post-tonsillectomy pain control, prevention of bleeding or facilitating eating and thus find no indication for the routine use of fibrin glue in tonsillectomy.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Tonsilectomia , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Inquéritos e Questionários
9.
Otolaryngol Head Neck Surg ; 137(5): 772-5, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17967644

RESUMO

OBJECTIVE: To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus. DESIGN: One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups. RESULTS: Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups. CONCLUSION: Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.


Assuntos
Zumbido/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído , Mascaramento Perceptivo , Percepção da Altura Sonora , Zumbido/etiologia , Zumbido/fisiopatologia
10.
Ann Otol Rhinol Laryngol ; 116(1): 7-10, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17305271

RESUMO

OBJECTIVES: We evaluated the correlation of asymmetric hearing loss, in a random population of patients with mild to moderate sensorineural hearing loss, to several clinical factors such as age, sex, handedness, and noise exposure. METHODS: We randomly selected, from 8 hearing institutes in Israel, 429 patients with sensorineural hearing loss of at least 30 dB at one frequency and a speech reception threshold not exceeding 30 dB. Patients with middle ear disease or retrocochlear disorders were excluded. The results of audiometric examinations were compared binaurally and in relation to the selected factors. RESULTS: The left ear's hearing threshold level was significantly higher than that of the right ear at all frequencies except 1.0 kHz (p < .05). One hundred fifty patients (35%) had asymmetric hearing loss (more than 10 dB difference between ears). In most of the patients (85%) the binaural difference in hearing threshold level, at any frequency, was less than 20 dB. CONCLUSIONS: Age, handedness, and sex were not found to be correlated to asymmetric hearing loss. Noise exposure was found to be correlated to asymmetric hearing loss.


Assuntos
Limiar Auditivo/fisiologia , Perda Auditiva Neurossensorial/epidemiologia , Adolescente , Adulto , Idoso , Audiometria , Feminino , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Estudos de Amostragem
11.
Int J Pediatr Otorhinolaryngol ; 71(4): 523-6, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17239447

RESUMO

Cleidocranial dysplasia is a rare developmental abnormality of bone that affects both the skeleton and the temporal bone. It is genetically characterized and the clinical signs and symptoms can be diverse. Aural pathologies may be the presenting symptoms of the disease. We reviewed the up to date literature on the syndrome with an emphasis on the otological and audiological manifestation.


Assuntos
Displasia Cleidocraniana/complicações , Otopatias/etiologia , Displasia Cleidocraniana/genética , Humanos
12.
Int J Pediatr Otorhinolaryngol ; 86: 60-2, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27260581

RESUMO

OBJECTIVE: Orbital involvement is the most common complication of sinus infections. The epidemiology of the disease is continuously changing in the antibiotic era. MATERIALS AND METHODS: Data on patients who were hospitalized due to acute sinusitis and orbital complications were retrospectively collected and analyzed from four medical centers in Israel during the years 2002-2012. RESULTS: 288 patients were included in the study, the average age was 14.4 years, 180 were males, and 220 were children. No significant annual increase in the number of patients was noted. The lowest number of patients was found during the summer 19.4%. A linear direct correlation was found between older age and prolonged hospital stay. Children were presented with a significantly higher Chandler score than adults. No patient had cavernous sinus thrombosis. 101 (35%) patients received antibiotics before hospital admission. Their average hospital stay was similar to those who were not treated prior to admission. 106 patients (39.8%) had fever. A direct correlation was found between older age and the presence of fever. 102 (35.4%) patients had leukocytosis. The difference in white blood cell count between patients younger than two years of age to the other groups was statistically significant. Forty four (15.3%) patients underwent surgical intervention. A direct correlation was found between leukocytosis and older age to surgery. CONCLUSIONS: Periorbital cellulitis occurs mainly in children and males and is less frequent in the summer. Children tend to have worse orbital involvement with lower temperatures than adults. Older age and leukocytosis are associated with surgical intervention.


Assuntos
Celulite (Flegmão)/epidemiologia , Doenças Orbitárias/epidemiologia , Sinusite/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Celulite (Flegmão)/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Israel/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/etiologia , Seios Paranasais/patologia , Estudos Retrospectivos , Adulto Jovem
13.
Clin Infect Dis ; 41(1): 35-41, 2005 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-15937760

RESUMO

BACKGROUND: Streptococcus pyogenes, or group A beta -hemolytic Streptococcus (GAS), is an important causative agent of bacterial pharyngotonsillititis and skin, soft-tissue, and invasive infections. Although it is also an important pathogen in acute otitis media (AOM), its exact role has not been determined. METHODS: Patients aged 0-18 years with AOM, from whom a specimen of middle-ear fluid was obtained and cultured during 1999-2003, were enrolled. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and GAS were considered pathogens. Information collected included demographic characteristics, clinical history, and signs and symptoms. RESULTS: GAS otitis was observed in 350 (3.1%) of 11,311 episodes (of which 117 were also culture-positive for other pathogens). The other 10,961 episodes involved H. influenzae only (n = 2507), S. pneumoniae only (n = 2131), dual infection with H. influenzae and S. pneumoniae (n = 1290), M. catarrhalis only (n = 129), and other combinations of pathogens (n = 271). Increased age and Jewish ethnicity were independent, significant, positive risk factors for GAS AOM, and fall season was a negative risk factor. Episodes of GAS infection were less frequently bilateral, febrile, and accompanied by other systemic findings than were other episodes of other types of infection. Most patients with GAS AOM presented with acute drainage from the ears. A lower proportion of cases of AOM were due to GAS in children with recurrent AOM and in patients recently treated with antibiotics, compared with patients with AOM who did not have these factors. The risk for mastoiditis was highest among patients with GAS AOM, compared with patients infected with other pathogens: 11.6 episodes per 1000 episodes of GAS AOM, compared with 2.2, 0.3, and 0 episodes of mastoiditis per 1000 episodes of AOM due to S. pneumoniae, H. influenzae, and M. catarrhalis, respectively. CONCLUSION: Compared with AOM caused by pathogens other than GAS, GAS AOM is characterized by older age and higher local aggressiveness manifested by lower rates of fever and respiratory symptoms and higher rates of tympanic perforation and mastoiditis.


Assuntos
Orelha Média/microbiologia , Otite Média/microbiologia , Otite Média/fisiopatologia , Infecções Estreptocócicas/fisiopatologia , Streptococcus pyogenes/patogenicidade , Doença Aguda , Adolescente , Criança , Pré-Escolar , Feminino , Infecções por Haemophilus/microbiologia , Infecções por Haemophilus/fisiopatologia , Haemophilus influenzae/isolamento & purificação , Haemophilus influenzae/patogenicidade , Humanos , Lactente , Recém-Nascido , Masculino , Moraxella catarrhalis/isolamento & purificação , Moraxella catarrhalis/patogenicidade , Infecções por Moraxellaceae/microbiologia , Infecções por Moraxellaceae/fisiopatologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/fisiopatologia , Fatores de Risco , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Streptococcus pyogenes/isolamento & purificação
14.
Otol Neurotol ; 26(5): 1011-5, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16151351

RESUMO

OBJECTIVE: This study was designed to quantitatively assess the contribution of various factors to the conductive hearing loss in otitis media. BACKGROUND: In the conductive hearing loss seen in cases of serous otitis media, various volumes of fluid of different viscosities along with subatmospheric (negative) pressure are found in the middle ear. METHODS: To evaluate the contribution of each of these factors to hearing loss, various volumes of saline, whole blood, or glycerol were applied to the open middle ear cavity of guinea pigs for short periods of time and auditory function was evaluated by recording the threshold of auditory nerve-brainstem evoked responses. In some of the saline experiments, the bulla cavity was also sealed, allowing a subatmospheric (negative) pressure to develop in the cavity as water was osmotically absorbed because of the gradient in colloid osmotic pressure between saline and blood in the vessels lining the middle ear cavity. In other experiments, a thoracic drainage system was connected to the middle ear cavity to induce desired negative middle ear pressures. RESULTS: The degree of hearing loss increased as larger volumes of fluid were introduced into the middle ear, reaching a maximum of 15 to 16 dB. There was no difference in the degree of hearing loss induced by saline or by fluids with viscosities up to 1,000 times greater than that of water (glycerol). A subatmospheric pressure in the middle ear contributed only a small additional (1-2 dB) threshold elevation. CONCLUSION: The major factor contributing to hearing loss in serous otitis media is the volume of fluid in the middle ear, irrespective of its viscosity. The contribution of negative middle ear pressure is much smaller.


Assuntos
Limiar Auditivo/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva Condutiva/etiologia , Otite Média com Derrame/complicações , Análise de Variância , Animais , Estudos de Casos e Controles , Estudos de Avaliação como Assunto , Cobaias , Otite Média com Derrame/fisiopatologia , Fatores de Risco , Viscosidade
15.
Int J Pediatr Otorhinolaryngol ; 69(10): 1311-9, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15955573

RESUMO

The treatment of children with AOM has to rely on an accurate diagnosis and a clear discrimination between AOM and serous otitis media. The last decade has seen major changes in the epidemiology of AOM with an earlier onset of disease and a greater proportion of children with recurrent/complicated AOM. The processes of changing susceptibility of bacterial pathogens added a major problem in treatment selection. Tastier, more efficient, safe and conveniently-dosing as well as cost effective drugs are required to achieve adherence to therapy. The recent published guidelines for the treatment of AOM in the present era of pneumoccocal resistance represent a major step forward in the approach to the management of this disease by establishing a clear hierarchy among the various therapeutic agents. A 48-72 h observation option without use of antibacterial therapy in selected children with uncomplicated AOM should be promoted. Immunization against S. pneumoniae with the heptavalent pneumococcal conjugated vaccines was showed to result in a decrease in the frequency of AOM caused by this pathogen, including AOM caused by antibiotic-resistant S. pneumoniae.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Doença Aguda , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Otite Média/microbiologia , Guias de Prática Clínica como Assunto
16.
Allergy Rhinol (Providence) ; 5(2): 53-5, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24684868

RESUMO

Unilateral nasal masses are considered suspicious for proliferative diseases. Several tools are routinely used to investigate unilateral lesions such as imaging and nasal biopsy. This study investigated the usefulness of nasal biopsy in predicting the actual nature of unilateral lesions. Preoperative nasal biopsy pathological results were compared with the final pathology obtained during an operation. Forty-six patients with unilateral nasal masses were included in the study group. In 40 patients the final pathology was similar to the preoperative nasal biopsy. In three patients the biopsy specimen was a benign polyp and the final pathology was of an inverted papilloma in two patients and hemangiopericytoma in one patient. In two patients the biopsy specimen was suspicious for an inverted papilloma and the final pathology was a benign polyp. In one patient the biopsy specimen was chordoma and the final pathology was osteosarcoma. The total agreement was 86.9%. The kappa value was 81.2%. Preoperative nasal biopsy is important and useful in evaluating unilateral nasal masses.

17.
Int J Pediatr Otorhinolaryngol ; 77(9): 1400-2, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23899701

RESUMO

OBJECTIVES: Dog bite injury of the head and neck is not rare in children although intracranial injury is reported anecdotally. Among the case reports there is a significant number of patients in whom the diagnosis of penetrating cranial injury was delayed. The aim of the study was to describe a patient with a trans mastoid head injury due to a dog bite that was not diagnosed at presentation and review similar cases in the literature. METHODS: A 13-year-old girl was admitted to the emergency room with severe head, neck and breast lacerations. She was transferred to the operating room for debridement and only then was a trans mastoid fracture diagnosed. We searched for case reports in the literature describing children suffering from dog bites in whom the diagnosis of intracranial injury was delayed. RESULTS: We found descriptions of five children, 4 after dog bite and one after tiger bite. Four of them were under two years of age and all had scalp lacerations that were treated at presentation. The time period to diagnosing the brain injury was one day to three weeks. The symptoms that led to the diagnosis were fever in 3 patients, meningitis in two, brain abscess in one child and four of them developed neurological signs. All of the children had surgical intervention after diagnosis. CONCLUSIONS: Intracranial injury after dog bite should be suspected in any child with scalp lacerations. Adequate investigations should be performed at presentation with careful attention to this specific type of trauma.


Assuntos
Mordeduras e Picadas/complicações , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Tardio , Fraturas Ósseas/diagnóstico , Processo Mastoide/lesões , Ferimentos Penetrantes/etiologia , Adolescente , Animais , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/cirurgia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/cirurgia , Desbridamento , Cães , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Lacerações/diagnóstico , Lacerações/cirurgia , Processo Mastoide/diagnóstico por imagem , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia
18.
Int J Pediatr Otorhinolaryngol ; 77(12): 1919-21, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24148862

RESUMO

Fossa navicularis magna is a congenital anomaly representing persistent dehiscence of the basiocciput. This tract from the nasopharynx to the brain is common and carries a potential risk for infection. Nevertheless reports on such dissemination are very rare. We present a child with brain infection via a fossa navicularis magna, the first description to our knowledge, and review the literature on this anomaly.


Assuntos
Infecções Bacterianas/diagnóstico , Fossa Craniana Posterior/anormalidades , Encefalite/diagnóstico , Base do Crânio/anormalidades , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Criança , Anormalidades Congênitas/diagnóstico , Progressão da Doença , Serviço Hospitalar de Emergência , Encefalite/tratamento farmacológico , Feminino , Escala de Coma de Glasgow , Humanos , Imageamento por Ressonância Magnética/métodos , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Int J Pediatr Otorhinolaryngol ; 75(7): 891-3, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21543124

RESUMO

OBJECTIVE: Acute invasive fungal sinusitis (AIFS) appears mainly in immunocompromized patients and may be caused by various pathogens. We describe a teenager with invasive sinonasal Scopulariopsis brevicaulis and review all the reports on this rare pathogen. METHODS: A literature search on Scopulariopsis sinonasal invasive infections was performed and clinical data including age, gender, co-morbidities, treatment and prognosis was collected on all the patients. RESULTS: A 17 years old boy with acute myelocytic leukemia and Scopulariopsis brevicaulis sinonasal infection was successfully treated at our department with a combination of extensive surgical debridement and antifungal antibiotics. We found six articled describing six patients with AIFS due to Scopulariopsis species. Four patients were adults and two were children, 3 males and 3 females. Two had an infection with Scopulariopsis acremoium, one with Scopulariopsis candida and for 3 patients no data was given on the specific Scopulariopsis species. All the patients except one were immunocompromized. One patient was treated with antifungal drugs, 2 with surgery and 4 patients received antifungals and were operated. One patient died due to the fungal infection and two patients died due to other causes. CONCLUSIONS: Scopulariopsis AIFS is a life threatening disease affecting mainly immunocompromized patients, both children and adults. No clear treatment regimen has been established yet. We describe the first case of a teenager with Scopulariopsis brevicaulis sinonasal infection treated successfully with a combination of wide local excision and antifungal therapy.


Assuntos
Ascomicetos , Hospedeiro Imunocomprometido , Micoses/diagnóstico , Rinite/diagnóstico , Doença Aguda , Adolescente , Adulto , Antifúngicos/uso terapêutico , Criança , Feminino , Humanos , Leucemia Mieloide Aguda/imunologia , Masculino , Micoses/tratamento farmacológico , Micoses/imunologia , Rinite/tratamento farmacológico , Rinite/imunologia , Rinite/microbiologia , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/imunologia , Sinusite/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA