Medicine by Sfakianakis Alexandros: 12/12/18

Τετάρτη 12 Δεκεμβρίου 2018

Effect of cosmetic chemical preservatives on resident flora isolated from healthy facial skin

Abstract

Background/Aims

Healthy skin harbors numerous microbes known to maintain its health and prevent attacks from external pathogens. The influence of chemical preservatives commonly used in cosmetic products on facial resident flora remains poorly characterized. In this study, we aimed to investigate the antibacterial activity of five such preservatives on in vitro cultivated skin‐resident bacteria.

Methods

Both Gram‐positive and Gram‐negative bacteria were isolated on blood agar, tryptic soy agar, and nutrient agar; Gram‐negative bacteria were then selected on Hank's balanced salt solution containing antibiotics and Reasoner's 2A. The minimum inhibitory concentrations (MICs) of methylisothiazolinone (MTI), iodopropynyl butylcarbamate (IPBC), ethylhexylglycerin (EHG), methylparaben (MP), and phenoxyethanol (PE) were estimated for nine facial resident bacteria, Escherichia coli, and Staphylococcus aureus using serial broth dilution in vitro.

Results

The maximum test concentrations coincided with the upper limits set by the "Cosmetic Safety and Technical Specification" (2015 edition, China). Nine facial resident bacteria were isolated from 14 healthy adults: Staphylococcus epidermidis, Staphylococcus capitis, Kocuria, Micrococcus luteus, Bacillus, Acinetobacter, Pseudomonas parafulva, Pseudomonas oleovorans, and Roseomonas cervicalis. MTI and IPBC displayed the strongest effect on all tested strains (MICs ≤0.01%), followed by EHG and MP (MICs ≤0.3%), and finally PE with the weakest effect (MIC ≤1%).

Conclusion

The five chemical preservatives assayed inhibited survival of the nine facial resident bacteria isolates, when tested at the maximum allowed limit. The corresponding MICs will provide a reference for the effective utilization of these compounds in product formulations.

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Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review

Abstract

Botulinum Toxin Type A is a potent neurotoxin that is produced by a gram‐positive bacteria clostridium botulinum. Its utilization in the treatment of various medical condition has expanded over the years in both medical and esthetic uses. It is being preferred by most physicians due to its efficacy and lack of side effects. It can be used as monotherapy or combined therapy. The aim of this review study was to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids. The clear mechanisms underlying hypertrophic scars and keloids are still not clearly understood; however, the mechanism of action of Botulinum toxin type A has been shown to include action on wound tension, action on collagen, and action on fibroblasts. Different randomized controlled trials, double‐blind, and placebo‐controlled studies have been conducted to investigate its use in treatment and prevention of hypertrophic scars and keloids, and it still is one of the active areas of research in Dermatology and related fields. Method: In March 2018, we performed a literature search in PubMed for clinical studies, clinical trials, case reports, controlled trials, randomized controlled trials, and systemic reviews. The search terms we used were "BOTULINUM TOXIN" AND "HYPERTROPHIC SCARS" OR "KELOIDS" (from 1980). The search resulted in 1000 articles, out of these 35 articles met our inclusion exclusion criteria. Our inclusion criteria included relevant original articles relevant, critical systemic reviews, and crucial referenced articles, exclusion criteria included duplicates and articles not published in English language. We have reviewed these papers to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids.

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Molecular diagnosis of Helicobacter pylori infection in gastric biopsies: Evaluation of the Amplidiag® H. pylori + ClariR assay

Abstract

Background

Adapted treatments for Helicobacter pylori infection, guided by determining antimicrobial resistance, are associated with high eradication rates. We evaluated the performance of the Amplidiag^®H. pylori + ClariR PCR assay (Amplidiag^®) for detecting H. pylori and its clarithromycin resistance from gastric biopsies taken during endoscopy in comparison to culture and our "in‐house" PCR.

Materials and Methods

A total of 127 gastric biopsies were analyzed (98 adults; 29 children). Culture, PCR Amplidiag^®, and in‐house PCR were performed in parallel. The in‐house PCR combined amplification and sequencing of a 267‐bp fragment of the H. pylori 23S rRNA gene. Discrepancies were controlled by amplification of glmM gene.

Results

For detection of H. pylori, Amplidiag^® and the in‐house PCR were concordant in 118 of 127 of cases: 66 negative and 52 positive. Discrepancies were observed in nine cases, all with low bacterial load: Amplidiag^® did not detect seven biopsies positive on in‐house PCR but detected two positive biopsies that were negative on in‐house PCR. Among the 19 of 52 (36%) H. pylori cases resistant to clarithromycin, only four biopsies with mixed populations exhibited discordant results between the two PCR methods. The A2142T mutation was not detected by Amplidiag^®. With the in‐house PCR and amplified glmM gene as the reference method, the sensitivity and specificity of Amplidiag^® was 88.5% (95% confidence interval 83‐94.1) and 100%.

Conclusion

This study demonstrated the high sensitivity of the PCR‐based Amplidiag^®H. pylori test, especially with low H. pylori load, and the probability of its clarithromycin resistance analysis. For clinical use, a well‐designed trial with a large scale of samples may still be needed.

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Multicenter prospective study on the use and outcome of rehabilitation after total laryngectomy in Germany

Abstract

Background

The purpose of this study was to assess the use and outcome of rehabilitation after total laryngectomy in Germany.

Methods

We enrolled patients who were scheduled for total laryngectomy, approached them again after surgery, after 3 months and 1 year. Patients completed questionnaires and were interviewed.

Results

Of 309 participants, 14% had not received any rehabilitation. Reasons for nonuse were primarily ongoing treatment and poor health. Users of rehabilitation had 4 times the odds of attaining any ability to speak compared to nonusers (odds ratio 3.8, P = .02). The main aim of rehabilitation from the perspective of the users was speech rehabilitation, mentioned by 71% before starting rehabilitation. This was also what most users (27%) found the most helpful part of rehabilitation.

Conclusions

Patients are interested in attending rehabilitation. They especially want to improve their speech capacity, which indeed is better among users of rehabilitation than in those without.

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Accuracy of fine needle aspiration cytology in suspicious neck nodes after radiotherapy: retrospective analysis of 100 patients

Abstract

Little data are available regarding the accuracy of FNAC performed without ultrasound‐guidance in neck nodes after radiotherapy.

Our retrospective analysis of 100 patients showed a high sensitivity (87%), specificity (83%), positive predictive value (98%) and accuracy (87%) of this method.

Nodal size or lymph node necrosis had no influence on the probability to obtain a diagnostic FNAC.

A positive FNAC result leads to a rapid and cost‐effective therapy decision preventing significant delay for salvage treatment.

A negative FNAC result does not exclude metastatic and/or recurrent disease and warrants further diagnostic work‐up.

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In response to Letter to the Editor regarding: Primary surgery versus primary radiation‐based treatment for locally advanced oropharyngeal cancer

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The impact of flake tool attributes and butcher experience on carcass processing time and efficiency during experimental butchery trials

Abstract

Butchery involves using tools to process animal carcasses during consumption of tissue packages, and this technological adaptation has a deep connection with evolving human dietary ecology. Studying butchery informs archaeological inferences about lithic artifact function and site formation and describes skeletal traces of carcass consumption, which may corroborate the butchery function of certain tools. Diverse methodologies including subjective personal observations and well‐controlled experiments that investigate abstracted slicing mechanics or realistic butchery scenarios provide mixed conclusions about which kinds of tools are more efficient for butchery and whether their archaeological traces can be discriminated. Much less analytical attention is devoted to investigating whether a butcher's experience using stone tools to process carcasses impacts their performance, which may confound experimental assessment of how tool attributes are related to butchery efficiency. These experiments examine butchery performance in two novices over 40 goat forelimb and hindlimb trials where a single flake was used to deflesh and disarticulate a limb. By measuring butchery performance as defleshing efficiency (the amount of meat removed per second) and the time necessary to disarticulate limb elements, we demonstrate that in general, both butchers performed similarly when butchering forelimbs and hindlimbs and did not exhibit a strong learning curve of performance improvement. As well, flake weight, size, and cutting‐edge length were positively related to defleshing efficiency and negatively related to disarticulation time, suggesting that larger flakes are better butchery tools. Our results suggest that anatomical differences between forelimbs and hindlimbs did not impact butchery timing or efficiency and butchery performance is similar across novices. To maximize comparability of experimental butchery results, we encourage future research to examine butchery performance with respect to animals or tissue package size and investigate how butcher experience impacts performance.

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20th National Voice Campaign

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Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis

Abstract Introduction: Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment. Objective: To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation. Methods: Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used. Results: Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery ± associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I 2 = 90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid. Conclusion: There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.

Resumo: Introdução: Granulomas laríngeos pós-intubação são lesões laríngeas benignas, porém recorrentes. Não há um consenso na literatura em relação ao seu tratamento. Objetivo: Descrever a eficácia de diferentes modalidades de tratamento para granulomas laríngeos primários ou recorrentes resultantes da intubação endotraqueal. Método: Estudo-revisão sistemática e metanálise proporcional. Critérios de elegibilidade: estudos experimentais ou observacionais com pelo menos cinco indivíduos. Desfechos estudados: resolução do granuloma, recorrência e tempo de resolução. Bases de dados usadas: Pubmed, Embase, Lilacs e Cochrane. Foi usado o software Stats Direct 3.0.121. Resultados: Foram selecionados seis estudos, com 85 pacientes. Os tratamentos registrados foram: terapia antirrefluxo, terapia da voz, medicamentos anti-inflamatórios, esteroides, antibióticos, sulfato de zinco e cirurgia. Receberam tratamento primário 85 pacientes de seis estudos: cirurgia ± associações (41 pacientes), chance de resolução de 75% (IC 95% 0,3% a 100%, I2 = 90%) e risco absoluto de recorrência de 25% (IC 95%: 0,2% a 71%); tratamento clínico (44 pacientes), chance de resolução de 86% (IC 95%: 67% a 97%) e risco absoluto de recorrência de 14% (IC 95%: 3% a 33%). Não houve diferença significante entre os grupos. Três estudos, que abrangeram 19 pacientes, analisaram o tratamento secundário (falha ou recorrência após o tratamento primário); três indivíduos apresentaram nova recorrência. O tempo necessário para resolver as lesões variou de imediato, logo após a cirurgia, até 23 meses, com tratamento com esteroides inalados. Conclusão: Não há evidências de alta qualidade que provem a eficácia de qualquer tratamento para granulomas laríngeos resultantes da intubação endotraqueal.

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Behavioural and objective vestibular assessment in persons with osteoporosis and osteopenia: a preliminary investigation

Abstract Introduction: Calcium is vital for the functioning of the inner ear hair cells as well as for the neurotransmitter release that triggers the generation of a nerve impulse. A reduction in calcium level could therefore impair the peripheric vestibular functioning. However, the outcome of balance assessment has rarely been explored in cases with osteopenia and osteoporosis, the medical conditions associated with reduction in calcium levels. Objective: The present study aimed to investigate the impact of osteopenia and osteoporosis on the outcomes of behavioural and objective vestibular assessment tests. Methods: The study included 12 individuals each in the healthy control group and osteopenia group, and 11 individuals were included in the osteoporosis group. The groups were divided based on the findings of bone mineral density. All the participants underwent behavioural tests (Fukuda stepping, tandem gait and subjective visual vertical) and objective assessment using cervical and ocular vestibular evoked myogenic potentials. Results: A significantly higher proportion of the individuals in the two clinical groups' demonstrated abnormal results on the behavioural balance assessment tests (p < 0.05) than the control group. However, there was no significant difference in latencies or amplitude of cervical vestibular evoked myogenic potential and oVEMP between the groups. The proportion of individuals with absence of ocular vestibular evoked myogenic potential was significantly higher in the osteoporosis group than the other two groups (p < 0.05). Conclusion: The findings of the present study confirm the presence of balance-related deficits in individuals with osteopenia and osteoporosis. Hence the clinical evaluations should include balance assessment as a mandatory aspect of the overall audiological assessment of individuals with osteopenia and osteoporosis.

Resumo: Introdução: O cálcio é vital para o funcionamento das células ciliadas, assim como para a liberação dos neurotransmissores que desencadeiam um impulso nervoso. Uma redução nos níveis de cálcio poderia, portanto, prejudicar o funcionamento vestibular periférico. No entanto, a avaliação do equilíbrio tem sido raramente explorada em casos de osteopenia e osteoporose, condições médicas associadas à redução dos níveis de cálcio. Objetivo: O presente estudo teve como objetivo investigar o impacto da osteopenia e da osteoporose nos resultados dos testes de avaliação comportamental e vestibular objetiva. Método: O estudo incluiu 12 indivíduos nos grupos controle e grupo de osteopenia e 11 indivíduos no grupo da osteoporose. Os grupos foram divididos com base nos achados da densidade mineral óssea. Todos os participantes foram submetidos a testes comportamentais (Prova dos Passos de Fukuda, Marcha em tandem e Vertical Visual Subjetiva) e à avaliação objetiva com o uso de potenciais evocados miogênicos vestibulares cervical e ocular (cVEMP e oVEMP). Resultados: Uma proporção significativamente maior de indivíduos nos dois grupos com condições clínicas mostrou resultados anormais nos testes de avaliação comportamental e do equilíbrio (p < 0,05) do que o grupo controle. Embora não tenha havido diferença significativa nas latências ou na amplitude de cVEMP e oVEMP entre os grupos, a proporção de indivíduos com ausência de oVEMP foi significativamente maior no grupo da osteoporose do que nos outros dois grupos (p < 0,05). Conclusão: Os resultados do presente estudo demonstram a presença de déficits de equilíbrio em indivíduos com osteopenia e osteoporose. Assim, as avaliações clínicas gerais e audiológicas de indivíduos com osteopenia e osteoporose deveriam incluir a avaliação do equilíbrio como um aspecto obrigatório.

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BJORL: moving forward, always

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Diagnosis and comprehensive therapy for cutaneous neuroendocrine carcinoma of the external auditory canal: a case report and literature review

Abstract Introduction: Solitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma. Objective: To carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects. Methods: A search of clinical case reports was performed in the PubMed database using Mesh Terms related to "plasmacytoma" under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits. Results: Of the 216 articles found, only 21 articles met the pre-established inclusion criteria. Conclusion: The occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.

Resumo: Introdução: O plasmocitoma solitário é um tumor maligno raro de células plasmáticas sem evidência de proliferação sistêmica e engloba dois subtipos: plasmocitoma solitário extramedular e plasmocitoma solitário ósseo. A etiologia ainda é desconhecida. Ambas as lesões apresentam risco de progressão para mieloma múltiplo. Uma série de abordagens tem sido usada para seu tratamento. Objetivo: Realizar uma revisão sistemática da literatura com enfoque nos aspectos terapêuticos e prognósticos. Método: Realizou-se uma busca de relatos de caso clínico na base de dados PubMed com termos de busca relacionados com "plasmocitoma" sob os seguintes critérios: tipo de estudo (relato de caso), artigos na língua inglesa, estudos realizados apenas em humanos, sem limites de data de publicação. Resultados: Dos 216 artigos encontrados, apenas 21 preencheram os critérios de inclusão pré-estabelecidos. Conclusão: A ocorrência de plasmocitoma solitário ósseo nos ossos da face é uma condição rara prevalente entre a 4a e a 6a décadas de vida, localizada na região posterior de mandíbula na maioria dos casos. O exame histopatológico e a investigação sistêmica são mandatórios para confirmação do diagnóstico.

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Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese

Abstract Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.

Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses". Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilaginosa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal", "recesso frontal" e "processo uncinado". Conclusão: Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil.

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Incidence of bifid uvula and its relationship to submucous cleft palate and a family history of oral cleft in the Brazilian population

Abstract Introduction: Bifid uvula is a frequently observed anomaly in the general population and can be regarded as a marker for submucous cleft palate. Objective: In this study aimed to determine the frequency of bifid uvula and submucous cleft palate and their relationship with oral clefts in a Brazilian population. Methods: We conducted a transversal, descriptive and quantitative study of 1206 children between August 2014 and December 2015. A clinical examination of the children was conducted by means of inspection of the oral cavity with the aid of a tongue depressor and directed light. After the clinical examination in children, parents answered a questionnaire with questions about basic demographic information and their family history of oral clefts in their first-degree relatives. After application of the questionnaires, the information collected was archived in a database and analyzed by the statistical program SPSS® version 19.0, by applying Chi-Square tests. Values with p < 0.05 were considered statistically significant. Results: Of the 1206 children included in this study, 608 (50.40%) were female and 598 (49.60%) were male (p = 0.773). The average age of children was 3.75 years (standard deviation ± 3.78 years). Of the 1206 children studied, 6 (0.5%) presented with bifid uvula. Submucosal cleft palate was not found in any child. When the family histories of children were examined for the presence of nonsyndromic cleft lip and/or cleft palate, no first degree relatives presented with the congenital anomaly. Conclusion: This study revealed that the incidence of bifid uvula and submucous cleft palate in this population was quite similar to previously reported incidence rates. Our study suggests an intensification of new reviews, with broader and diverse populations, seeking to associate the occurrence of bifid uvula, submucous cleft palate and oral clefts.

Resumo: Introdução: A úvula bífida é uma anomalia frequentemente observada na população em geral e pode ser considerada como um marcador de fissura palatina submucosa. Objetivo: Determinar a frequência de úvula bífida e fissura palatina submucosa e sua relação com fissura orais em uma população brasileira. Método: Realizamos um estudo transversal, descritivo e quantitativo de 1.206 crianças entre agosto de 2014 e dezembro de 2015. O exame clínico das crianças foi realizado por meio da inspeção da cavidade oral com auxílio de um abaixador de língua e luz direcionada. Após o exame clínico nas crianças, os pais responderam a um questionário com perguntas sobre informações demográficas básicas e antecedentes de fendas orais em familiares de primeiro grau. As informações coletadas foram arquivadas em um banco de dados e analisadas pelo programa estatístico SPSS® versão 19.0, aplicando testes de Qui-Quadrado. Os valores com p < 0,05 foram considerados estatisticamente significativos. Resultados: Das 1.206 crianças incluídas neste estudo, 608 (50,40%) eram do gênero feminino e 598 (49,60%) do masculino (p = 0,773). A idade média das crianças foi de 3,75 anos (desvio-padrão ± 3,78 anos). Das 1.206 crianças estudadas, seis (0,5%) apresentavam úvula bífida. A fissura palatina submucosa não foi encontrada em nenhuma criança. Quando as histórias familiares de crianças foram examinadas quanto à presença de fissura de lábio e/ou palato não sindrômica, nenhum parente de primeiro grau apresentava esta anomalia congênita. Conclusão: Este estudo revelou que a incidência de úvula bífida e fissura palatina submucosa nesta população é bastante semelhante às taxas de incidência previamente relatadas. Nosso estudo sugere uma intensificação de novas revisões, com populações mais amplas e diversas, buscando associar a ocorrência de úvula bífida, fissura palatina submucosa e fissura orais.

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Clinicopathologic factors associated with recurrence in parotid carcinoma

Abstract Introduction: Parotid carcinomas have varying histological types and diverse biologic behaviors. Establishing an adequate treatment plan and predicting recurrence is important. Objective: To analyze the risk factors associated with recurrence in our 5 year experience with 30 cases of primary parotid carcinoma undergoing surgery at a single institute. Methods: From January 2009 to December 2013, 30 patients with surgical treatment of parotid carcinoma were identified based on their medical records. Results: The 30 patients were comprised of 17 males and 13 females. Among 11 patients with T4 tumors, seven patients had recurrence. Among seven patients with cervical nodal metastasis, all patient except one had recurrence. Clinically late stages (stage III and IV) showed more common recurrence than early stage (stage I and II) lesions. Lymphovascular invasion was seen in 5 patients, and all patients had recurrence. Among 11 patients with extracapsular spread, 7 patients had recurrence. In 17 patients with high grade carcinomas, ten patients had recurrence. In 13 patients with low grade carcinomas, no patients experienced recurrence. Conclusion: T- and N-stage, clinical stage, lymphovascular invasion, extracapsular spread, and histopathologic grade correlate significantly with recurrence in parotid carcinoma.

Resumo: Introdução: Os carcinomas da parótida têm diferentes tipos histológicos e comportamentos biológicos diversos. O estabelecimento de um plano de tratamento adequado e a previsão de recorrência são muito importantes. Objetivo: Analisar os fatores de risco associados à recorrência em nossa experiência de cinco anos com 30 casos de carcinoma parotídeo primário submetidos a cirurgia em uma única instituição. Método: De janeiro de 2009 a dezembro de 2013, 30 pacientes com tratamento cirúrgico de carcinoma parotídeo foram identificados com base nos prontuários. Resultados: Entre os 30 pacientes, 17 eram homens e 13, mulheres. Dos 11 pacientes com tumores T4, sete apresentaram recorrência. Entre sete pacientes com metástase em linfonodo cervical, todos, exceto um, apresentaram recorrência. Lesões em estágios clínicos tardios (III e IV) apresentaram recorrência mais comumente do que as dos estágios iniciais (I e II). A invasão linfovascular foi observada em cinco pacientes e todos os cinco apresentaram recorrência. Entre 11 pacientes com disseminação extracapsular, sete apresentaram recorrência. Dos 17 pacientes com carcinomas de alto grau, dez apresentaram recorrência. Em 13 pacientes com carcinomas de baixo grau, nenhum apresentou recorrência. Conclusão: Estágios T e N, estágio clínico, invasão linfovascular, disseminação extracapsular e grau histopatológico correlacionam-se de maneira significante com recorrência do carcinoma de parótida.

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Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip,

Abstract Introduction: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Methods: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05). Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively). Conclusion: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Resumo: Introdução: A interpretação dos resultados de fala obtidos com o retalho miomucoso do músculo bucinador no tratamento da insuficiência velofaríngea em pacientes fissurados tem sido limitada pela restrição do número de pacientes e do tempo de seguimento pós-operatório. Objetivo: Avaliar o efeito do retalho miomucoso do músculo bucinador sobre a hipernasalidade da fala no tratamento de pacientes fissurados com insuficiência velofaríngea. Método: Foram avaliados pacientes com fissura palatina (± lábio) reparada, com retalho miomucoso do músculo bucinador bilateral para a correção cirúrgica da insuficiência velofaríngea. A hipernasalidade (escores 0 [ausente], 1 [leve], 2 [moderada] ou 3 [severa]) foi analisada por três avaliadores por meio da mensuração dos registros audiovisuais coletados nos períodos pré-operatório e pós-operatórios recente e tardio (3 e 12 meses, respectivamente). Os valores foram considerados significativos para um intervalo de confiança de 95% (p < 0,05). Resultado: Foram incluídos 37 pacientes fissurados com hipernasalidade moderada (16,2%) ou severa (83,8%) no período pré-operatório. As análises do período pós-operatório tardio revelaram que a hipernasalidade (0,5 ± 0,7) foi significativamente (p < 0,05) menor do que a hipernasalidade dos períodos pré-operatório e pós-operatório recente (2,8 ± 0,4 e 1,7 ± 0,9; respectivamente). Conclusão: O retalho miomucoso do músculo bucinador é eficaz na redução/eliminação da hipernasalidade nos pacientes fissurados com insuficiência velofaríngea.

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Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12)

Abstract Introduction: Measuring the impact on quality of life, especially after the beginning of the treatment, is becoming increasingly important in healthcare. Objective: The aim of this study was to translate the Chronic Otitis Media Questionnaire-12 (COMQ-12) into Portuguese language and validate this version in a group of patients with chronic otitis media. Methods: The Portuguese version of COMQ-12 was obtained by translation and back translation. Portuguese speaking patients with a history of active chronic otitis media were asked to complete the COMQ-12 Portuguese version. Cronbach's α coefficient was calculated for an estimation of the internal consistency of the questionnaire. Results: A total of 100 patients were included in the study; 49 women and 51 men, with a mean age of 39 years (range 12-77 years, median 40 years). The average COMQ-12 score was 29, out of a maximum score of 60. Cronbach's α result for the Portuguese version of the COMQ-12 was 0.85, indicating a high internal consistency. The participants presented with different forms of chronic otitis media, and almost all domains of the COMQ-12 questionnaire were able to differentiate between patients with healed chronic otitis media and patients with cholesteatoma or wet tympanic membrane perforation. Showing that patients with healed chronic otitis media have a better quality of life, measured by the COMQ-12, is a first step to guarantee the questionnaire's validity. The next step will consist on routinely using the questionnaire in patients undergoing surgery for chronic otitis media in order to evaluate their quality of life after treatment. Conclusion: The COMQ-12 Portuguese version showed high reliability, and may be used as an assessment of quality of life in patients with chronic otitis media

Resumo: Introdução: Medir o impacto na qualidade de vida, especialmente após o início do tratamento dos pacientes, está se tornando cada vez mais importante nos cuidados da saúde. Objetivo: O objetivo deste estudo foi traduzir o Questionário de Otite Média Crônica-12 (COMQ-12) para a língua portuguesa e validar essa versão em um grupo de pacientes com Otite Média Crônica. Método: A versão em Língua Portuguesa do COMQ-12 foi obtida através de tradução e posterior retrotradução. Pacientes nativos da língua portuguesa com histórico de OMC ativa foram convidados a completar o COMQ-12 em Português. O coeficiente α de Cronbach foi calculado para estimar a consistência interna do questionário. Resultados: Um total de 100 pacientes foram incluídos no estudo; 49 eram mulheres e 51 eram homens, com média de idade de 39 anos (variação: 12 a 77 anos, mediana de 40 anos). O escore médio do COMQ-12 foi 29, de um escore máximo de 60. O resultado do coeficiente α de Cronbach para a versão em português do COMQ-12 foi de 0,85, indicando que sua consistência interna era alta. Os participantes apresentavam diferentes formas de otite média crônica e quase todos os domínios do questionário COMQ-12 foram capazes de diferenciar entre pacientes com otite média crônica curada e pacientes com colesteatoma ou perfuração úmida de membrana timpânica. Demonstrar que pacientes com otite média crônica curada apresentam uma melhor qualidade de vida, medida pelo COMQ-12 é o primeiro passo para garantir a validade do questionário. O próximo passo será utilizá-lo rotineiramente em pacientes submetidos à cirurgia para otite média crônica e avaliar a qualidade de vida após o tratamento. Conclusão: A versão em português do questionário COMQ-12 mostrou alta confiabilidade e pode ser utilizada como questionário de medida de qualidade de vida em pacientes com otite média crônica.

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Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery

Abstract Introduction: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. Objective: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. Methods: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. Results: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p < 0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p < 0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p = 0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. Conclusion: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.

Resumo: Introdução: O trajeto do canal infraorbitário pode predispor o nervo infraorbitário a lesões durante cirurgias reconstrutoras e endoscópicas com manipulação do teto do seio maxilar. Objetivo: Investigamos a morfometria e as variações do canal infraorbitário e objetivamos demonstrar a relação entre elas, visando as abordagens endoscópicas. Método: Este estudo retrospectivo foi realizado em imagens de tomografia computadorizada multidetectora de seios paranasais de 200 pacientes. Resultados: Os tipos de corpos do canal infraorbitário foram categorizados como Tipo 1; inseridos no teto ósseo maxilar (55,3%), Tipo 2; projetando-se parcialmente dentro do seio maxilar (26,7%), Tipo 3; dentro do seio maxilar (9,5%), Tipo 4; localizado anatomicamente no limite externo do recesso zigomático do osso maxilar (8,5%). A angulação interna e o comprimento do canal infraorbitário, os ângulos de entrada do forame infraorbitário e as distâncias relacionadas à localização do forame foram medidos e suas relações com as variações do canal infraorbitário foram analisadas. Observamos que as angulações internas em ambos os cortes sagital e axial foram encontradas em sua maioria em canais infraorbitários Tipo 1 e 4 (69,2%, 64,7%) e, no geral, não houve angulação no canal Tipo 3 (68,4%) (p < 0,001). O comprimento do canal infraorbitário e as distâncias desde o forame infraorbitário até o rebordo infraorbitário e a abertura piriforme foram medidos e os mais longos foram identificadas no Tipo 3 e os mais curtos no Tipo 1 (p < 0,001). Os ângulos de entrada do forame infraorbitário em projeção sagital foram significativamente menores no Tipo 3 e maiores no Tipo 1, em relação aos outros tipos (p = 0,003). Septos nos seios maxilares e as células de Haller foram observados em 28% e 16% das imagens, respectivamente. Conclusão: O conhecimento preciso dos tipos de corpo do canal infraorbitário e a relação com a morfometria permitem que o cirurgião escolha uma abordagem cirúrgica apropriada para evitar lesões iatrogênicas do nervo infraorbitário.

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Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

Abstract Introduction: Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia. Objective: To verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit. Methods: This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the Speech Therapist assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval. Results: The prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence of dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold. Conclusion: Patients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.

Resumo: Introdução: Lesões na cavidade oral, faringe e laringe, em virtude de intubação endotraqueal, podem causar redução da motricidade e da sensibilidade local e comprometer o processo da deglutição, determinando disfagia orofaríngea. Objetivo: Verificar os fatores preditivos do desenvolvimento de disfagia orofaríngea e risco de aspiração em pacientes pós-intubação orotraqueal prolongada internados em uma unidade de terapia intensiva. Método: Estudo observacional, analítico, de delineamento transversal e retrospectivo de coleta de dados de 181 prontuários eletrônicos, de pacientes submetidos à intubação orotraqueal prolongada. Foram coletadas informações referentes a idade; sexo; doença de base, comorbidades associadas; tempo e motivo da intubação orotraqueal; Escala Glasgow no dia da avaliação fonoaudiológica; compreensão; qualidade vocal; presença de disfagia e a gravidade; risco de broncoaspiração; e via oral sugerida. Os dados foram analisados por meio da regressão logística. Adotou-se o nível de significância de 5% e intervalo de confiança de 95%. Resultados: A prevalência de disfagia neste estudo foi de 35,9% e de risco de aspiração de 24,9%. O aumento da idade, a qualidade vocal alterada e o grau de comprometimento da voz elevam os riscos de presença em disfagia em 5; 45,4 e 6,7 vezes, respectivamente, e de aspiração em 6; 36,4 e 4,8 vezes. Já o aumento do tempo de intubação orotraqueal elevou em 5,5 vezes o risco de aspiração. Conclusão: Pacientes submetidos a intubação prolongada que apresentam os fatores de risco relacionados às disfagia e aspiração devem ser submetidos a avaliação fonoaudiológica precoce e receber conduta adequada em tempo hábil. O reconhecimento desses fatores preditivos por toda a equipe multidisciplinar pode minimizar as possibilidades de complicações clínicas inerentes ao risco de disfagia e aspiração em pacientes extubados.

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Hashimoto's thyroiditis - an independent risk factor for papillary carcinoma

Abstract Introduction: The link between Hashimoto's thyroiditis and thyroid carcinoma has long been a topic of controversy. Objective: The aim of our study was to determine the prevalence of thyroid carcinoma and Hashimoto's thyroiditis coexistence in histopathologic material of thyroidectomized patients. Methods: In a retrospective study, the clinicohistopathologic data of 2117 patients (1738 females/379 males), who underwent total or partial thyroidectomy for thyroid gland disorder at a single institution from the 1st of January 2005 to the 31st of December 2014 were analyzed. Results: Thyroid carcinoma was detected in 318 cases (15%) and microcarcinoma (thyroid cancer ≤10 mm in diameter) was found in permanent sections in 169 cases (8%). Hashimoto's thyroiditis was detected in 318 (15%) patients. Hashimoto's thyroiditis was significantly more often associated with thyroid carcinoma and microcarcinoma compare to benign condition (p = 0.048, p = 0.00014, respectively). Coexistence of Hashimoto's thyroiditis and thyroid carcinoma/thyroid microcarcinoma did not affect tumor size (p = 0.251, p = 0.098, respectively), or tumor multifocality (p = 0.831, p = 0.957, respectively). Bilateral thyroid microcarcinoma was significantly more often detected when Hashimoto's thyroiditis was also diagnosed (p = 0.041), but presence of Hashimoto's thyroiditis did not affect bilateral occurrence of thyroid carcinoma (p = 0.731). Conclusion: Hashimoto's thyroiditis is associated with significantly increased risk of developing thyroid carcinoma, especially thyroid microcarcinoma.

Resumo: Introdução: A relação entre a tireoidite de Hashimoto e o carcinoma de tireoide tem sido um tema de controvérsia por um longo tempo. Objetivo: Determinar a prevalência da coexistência de carcinoma de tireoide e tireoidite de Hashimoto no exame histopatológico de amostras de pacientes tireoidectomizados. Método: Em um estudo retrospectivo, foram analisados os dados clinico-histopatológicos de 2.117 pacientes (1.738 mulheres/379 homens), submetidos à tireoidectomia total ou parcial por distúrbio da glândula tireoide em uma única instituição, de 1º de janeiro de 2005 a 31 de dezembro de 2014. Resultados: O carcinoma de tireoide foi detectado em 318 casos (15%) e o microcarcinoma (câncer de tireoide ≤ 10 mm de diâmetro) foi encontrado em secções permanentes em 169 casos (8%). A tireoidite de Hashimoto foi detectada em 318 (15%) pacientes e foi associada ao carcinoma da tireoide e ao microcarcinoma com maior frequência em comparação com condições benignas (p = 0,048, p = 0,00014, respectivamente). A coexistência de tireoidite de Hashimoto e carcinoma/microcarcinoma não influenciou o tamanho do tumor (p = 0,251, p = 0,098, respectivamente) ou a multifocalidade tumoral (p = 0,831, p = 0,957, respectivamente). O microcarcinoma de tireoide bilateral foi detectado com maior frequência quando a tireoidite de Hashimoto também foi diagnosticada (p = 0,041), mas a presença de tireoidite não influenciou na ocorrência bilateral de carcinoma (p = 0,731). Conclusão: A tireoidite de Hashimoto está associada a um aumento significativo do risco do desenvolvimento de carcinoma de tireoide, especialmente microcarcinoma da tireoide.

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Revision rhinoplasty: physician-patient aesthetic and functional evaluation

Abstract Introduction: Approximately 5-15% of patients submitted to rhinoplasty operations undergo revision surgery. Those patients have varied functional and aesthetic complaints that should receive a detailed assessment that includes all the expectations the patient had before the previous procedure. Objective: To draw the profile of the main aesthetic-functional complaints reported by patients to be submitted to revision rhinoplasty and to correlate them with the internal and external objective nasal evaluation performed by the surgeon. Methods: A prospective study was conducted with 43 patients to be submitted to revision rhinoplasty and their respective surgeons, by applying a questionnaire about the patients' epidemiological questions and subjective aesthetic-functional complaints as well as the respective functional deformities observed by the surgeons. Subsequently, these data were correlated with the purpose of observing the frequency of congruent reports between physicians and patients. Results: The presence of drooping tip and residual bridge hump were the patients' main complaints, confirmed by the surgeons. The correlation between subjective obstructive symptoms and the intranasal evaluation performed by surgeons was shown to be present in 87.5% of the cases. Among the patients with respiratory symptoms, the main deformity identified was residual septal deviation in 56.25% of the cases. Conclusion: The drooping tip followed by residual hump were the main complaints reported by the patients and confirmed by the objective examination by the physicians. The presence of nasal obstructive complaints in 37.2% of the patients shows that greater attention needs to be paid to functional deformities during the first surgical procedure. The differences observed between patients' complaints and surgeons' evaluations confirm the need for detailed assessment and clarification to the patients regarding their expectations and actual surgical possibilities.

Resumo: Introdução: As rinoplastias possuem índice de revisão em torno de 5% a 15% dos pacientes operados. Tais pacientes possuem queixas funcionais e estéticas variadas e a avaliação detalhada é de extrema importância, tendo em vista todas as expectativas em torno de um procedimento já anteriormente realizado. Objetivo: Traçar o perfil das principais queixas estético-funcionais referidas pelo paciente a ser submetido à rinoplastia revisional e correlacioná-las a avaliação nasal objetiva interna e externa realizada pelo cirurgião. Método: Foi realizado um estudo prospectivo com 43 pacientes a serem submetidos à rinoplastia revisional e com seus respectivos cirurgiões, através da aplicação de questionário acerca de questões epidemiológicas e queixas estético-funcionais subjetivas dos pacientes e as respectivas deformidades funcionais observadas pelos cirurgiões. Após, esses dados foram correlacionados com a finalidade de observar a frequência de relatos concomitantes entre os médicos e pacientes. Resultados: A presença de ponta caída e giba óssea residual foram as principais queixas dos pacientes confirmadas pelos cirurgiões. Já a correlação entre sintomas subjetivos obstrutivos e a avaliação intranasal realizada pelos cirurgiões demonstrou estar presente em 87,5% dos casos. Dentre os pacientes com sintomas respiratórios, a principal deformidade encontrada foi o desvio septal residual em 56,25% dos casos. Conclusão: A ponta caída seguida de giba óssea residual foram as principais queixas relatadas pelos pacientes e confirmadas ao exame objetivo pelos médicos. A presença de 37,2% dos pacientes com queixas obstrutivas nasais demonstra que maior atenção deve ser dada a deformidades funcionais já durante o primeiro procedimento cirúrgico. As diferenças observadas entre as queixas dos pacientes e avaliações dos cirurgiões comprovam a necessidade da avaliação pormenorizada e esclarecimento ao paciente com relação as suas expectativas e reais possibilidades cirúrgicas.

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Effects of diabetes mellitus and systemic arterial hypertension on elderly patients' hearing,

Abstract Introduction: Chronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus and systemic arterial hypertension have shown controversial conclusions. Objective: To compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with diabetes mellitus and/or systemic arterial hypertension, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions. Methods: 100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3-4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the diabetes mellitus group, 20 individuals in the systemic arterial hypertension group, 20 individuals in the diabetes mellitus/systemic arterial hypertension group and 40 individuals in the control group, matching them with each study group, according to age and gender. ANOVA and Kruskal-Wallis statistical tests were used, with a significance level set at 0.05. Results: When comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the diabetes mellitus group; for the systemic arterial hypertension group, significant differences were observed after 4 kHz. For the diabetes mellitus and systemic arterial hypertension group, significant differences were observed at the frequencies of 500, 2 kHz, 3 kHz and 8 kHz. Conclusion: It was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions, hypertension seems to have the greatest influence on hearing.

Resumo: Introdução: Doenças crônicas podem atuar como fator de aceleração na degeneração do sistema auditivo. Os estudos sobre a associação da presbiacusia com o diabetes mellitus e com a hipertensão arterial sistêmica mostraram conclusões controversas. Objetivo: Comparar a audiometria inicial (A1) com uma audiometria sequencial (A2) feita com um intervalo de três a quatro anos em uma população de idosos portadores de diabetes mellitus e/ou hipertensão arterial sistêmica, a fim de saber se a perda de acuidade auditiva nesses grupos é mais acelerada comparados com controles sem essas condições clínicas. Método: Participaram deste estudo 100 idosos. Para a análise dos limiares auditivos, foram usadas: uma avaliação audiológica completa feita anteriormente (A1) e uma nova avaliação audiológica (A2) feita após três a quatro anos da primeira. Os participantes foram distribuídos em quatro grupos: 20 indivíduos no grupo com diabetes mellitus, 20 no grupo hipertensão arterial sistêmica, 20 no grupo diabetes mellitus/hipertensão arterial sistêmica e 40 indivíduos no grupo controle, foram pareados com cada grupo de estudo, de acordo com as características referentes a idade e sexo. Foram usados os testes estatísticos Anova e Kruskal-Wallis, com nível de significância de 0,05. Resultados: Na comparação da média de aumento anual dos limiares auditivos da avaliação A1 com a avaliação A2, considerando cada grupo estudo e seu respectivo controle, pode-se observar que para o grupo diabetes mellitus não houve diferença estatisticamente significante para qualquer das frequências; para o grupo hipertensão arterial sistêmica foram observadas diferenças significantes a partir de 4 kHz. Já para o grupo diabetes mellitus/hipertensão arterial sistêmica foram observadas diferenças significantes nas frequências de 500, 2k, 3k e 8 kHz. Conclusão: Verificou-se que o grupo hipertensão arterial sistêmica foi o que apresentou maior queda dos limiares auditivos no segmento estudado, quando comparado com os outros grupos, sugeriu que entre as três condições estudadas a hipertensão parece ser a que teve maior influência sobre a audição.

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Neutrophil-lymphocyte ratios in the prognostication of primary non-metastatic nasopharyngeal carcinoma

Abstract Introduction: Nasopharyngeal carcinoma is a geographically and racially variable disease which has a high incidence in Malaysia. Based on current concepts in tumour related inflammation the inflammatory marker, neutrophil-lymphocyte ratio was tested to find its relationship with prognosis in nasopharyngeal carcinoma. Objective: To investigate the effect of the neutrophil-lymphocyte ratio on prognosis in non-metastatic primary nasopharyngeal carcinoma patients and to further refine the cut off between high and low neutrophil-lymphocyte ratio values. Methods: The medical charts of patients with histologically confirmed nasopharyngeal carcinoma from 1st January 2005 until 31st December 2009 were reviewed retrospectively and theneutrophil-lymphocyte ratio was calculated to see if there was any association between their higher values with higher failure rates. Results: Records of 98 patients (n = 98) were retrieved and reviewed. Only neutrophil-lymphocyte ratio (p = 0.004) and tumor node metastasis staging (p = 0.002) were significantly different between recurrent and non-recurrent groups, with the neutrophil-lymphocyte ratio being independent of tumor node metastasis staging (p = 0.007). Treatment failure was significantly higher in the high neutrophil-lymphocyte ratio group (p = 0.001). Disease free survival was also significantly higher in this group (p = 0.000077). Conclusion: High neutrophil-lymphocyte ratio values are associated with higher rates of recurrence and worse disease free survival in non-metastatic nasopharyngeal carcinoma patients undergoing primary curative treatment.

Resumo: Introdução: O carcinoma de nasofaringe é uma doença variável geográfica e etnicamente, com alta incidência na Malásia. Baseado em conceitos atuais sobre inflamação relacionada a tumores, o marcador inflamatório relação neutrófilos/linfócitos foi testado para verificar sua relação com o prognóstico dessa condição clínica. Objetivo: Investigar o efeito do marcador neutrófilos/linfócitos no prognóstico de pacientes com primários não metastáticos de nasofaringe e refinar o ponto de corte entre valores altos e baixos da relação neutrófilos/linfócitos. Método: Os prontuários médicos dos pacientes com carcinoma de nasofaringe confirmado histologicamente de 1º de janeiro de 2005 até 31 de dezembro de 2009 foram revisados retrospectivamente e a relação neutrófilos/linfócitos foi calculada para verificar se havia alguma associação entre valores maiores e aumento na taxa de falha de tratamento. Resultados: Os dados de 98 pacientes (n = 98) foram revisados. Apenas a relação neutrófilos/linfócitos (p = 0,004) e o estadiamento TNM (p = 0,002) foram significantemente diferentes entre os grupos recorrentes e os não recorrentes, a relação neutrófilos/linfócitos foi independente do estadiamento TNM (p = 0,007). A falha de tratamento foi significantemente maior no grupo com relação neutrófilos/linfócitos alta (p = 0,001). A sobrevida livre de doença também foi significantemente maior nesse grupo (p = 0,000077). Conclusão: Os altos valores da relação neutrófilos/linfócitos estão associados a maiores taxas de recorrência e menor tempo de sobrevida livre de doença em pacientes com carcinomas não metastáticos de nasofaringe submetidos a tratamento curativo primário.

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Side effects of intraoral devices for OSAS treatment

Abstract Introduction: Intraoral devices have increasingly assumed a key role in the treatment of obstructive sleep apnea syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the continuous positive airway pressure device. Objectives: To evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices. Methods: A prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle. An intraclass correlation test was performed and a correlation index > 0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t test), with a significance level set at 5%. Results: There was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences. Conclusion: After a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.

Resumo: Introdução: Os aparelhos intraorais têm assumido cada vez mais um papel importante no tratamento da síndrome da apneia obstrutiva do sono, mas existem limitações a sua indicação e efeitos colaterais com o seu uso contínuo, assim como com o uso do aparelho de pressão aérea positiva contínua. Objetivos: Avaliar as alterações no posicionamento dentário produzido pelo uso contínuo do aparelho de projeção mandibular. Método: Através de estudo longitudinal prospectivo com amostra de 15 pacientes, com avaliação de documentações completas após um tempo médio de 6,47 meses do uso do aparelho oral de Twin Block para tratamento de pacientes com apneia, foram avaliadas as alterações do posicionamento dos dentes decorrentes do seu uso. As seguintes variáveis foram avaliadas: overjet, overbite, distâncias intermolares superior e inferior, distâncias intercaninos superior e inferior, índice de irregularidade de Little e ângulo do plano incisivo mandibular. Foi feito teste de correlação intraclasse e foram aceitos índices de correlação acima de 0,08. Após atestada a distribuição normal da amostra (Shapiro-Wilks), foi usado um teste paramétrico (teste t), com nível de significância de 5%. Resultados: Houve diminuição nos valores de overjet, overbite e irregularidade de Little e aumento nos valores da distância intercanino inferior e do ângulo do plano incisivo mandibular. Todas essas variáveis sofrem influência, com diferentes expressividades, da inclinação para frente dos incisivos inferiores, uma ação que pode ser esperada devido à força aplicada pelo aparelho sobre a dentição. As demais variáveis não demostraram diferenças estatisticamente significativas. Conclusão: Houve mudanças estatisticamente significativas no posicionamento dos dentes, porém clinicamente sem relevância, com um tempo médio de uso de 6,47 meses do aparelho de avanço mandibular. Contudo, deve-se considerar que o uso dessa aparelhagem é comum durante longos períodos, fazendo com que seja de suma importância o acompanhamento desses pacientes a longo prazo.

https://ift.tt/2EiS8Wk

Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey

Transient ischemic attack: an unusual presentation of a carotid body tumor

In the first article in this continuing medical education series we review controversies and uncertainties relating to the epidemiology and initial diagnosis of localized cutaneous melanoma (ie, stage 0, I, or II). Many of these issues are unsettled because of conflicting evidence. Melanoma incidence appears to be increasing, yet its basis has not been fully explained. Despite the advantages of early detection, the US Preventive Services Task Force does not recommend skin screening for the general population.

https://ift.tt/2rwIac9

Answers to CME examination

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CME examination

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https://ift.tt/2rARGLb

Current controversies in early-stage melanoma

There are a number of controversies and uncertainties relating to the management and surveillance of patients with early-stage, localized (ie, stage 0, I, and II) cutaneous melanoma. While tumor stage is a critical predictor of clinical outcome and guides treatment, accurate determination of stage may be affected by the biopsy technique used and the method of sectioning before histologic review. A new molecular prognostic test is available but has not been formally incorporated into staging or treatment guidelines.

https://ift.tt/2GfUDLw

Journal Based CME Instructions and Information

The potential positive impact of alkaline, protein, low‐fat, low‐acid diet could be explained by many physiological effects on esophageal sphincter tonicity, acid and pepsin productions, and gastric emptying time.

Future controlled prospective studies are needed to confirm the potential key role of alkaline, protein, low‐fat, low‐acid diet and lifestyle modifications in the clinical improvement of patients with suspected LPR disease.

https://ift.tt/2zV06St

Primary cutaneous CD4+ small‐ to medium‐sized pleomorphic T‐cell lymphoproliferative disorder in a pediatric patient successfully treated with low‐dose radiation

Abstract

Primary cutaneous CD4+ small‐ to medium‐sized pleomorphic T‐cell lymphoproliferative disorder (PCSM‐LPD) is a rare and low‐grade form of cutaneous T‐cell proliferation with the average age of diagnosis of 54 years. Because of its rarity, the etiology or exact clinicopathology of PCSM‐LPD remains unclear, with < 10 pediatric cases reported. A 13‐year‐old boy presented to our clinic with a raised tumor with PCSM‐LPD histology and was successfully treated with ultra‐low‐dose radiation therapy. While no standard of care has been established for pediatric PCSM‐LPD, this report represents an example of achieving remission in a pediatric tumor with minimal potential for therapy‐related long‐term toxicity.

https://ift.tt/2PE90c8

Tinea faciei starting at day two of life

Abstract

Dermatophyte infections are exceedingly rare in neonates, possibly due to the thin stratum corneum and high sebum content of neonatal skin. Only a handful of cases of tinea faciei have been reported in neonates, with the majority of reports occuring in India. Here, we report what to our knowledge is the earliest reported presentation of tinea faciei in the United States. We also provide a brief literature review of other reported cases of tinea faciei in neonates less than 30 days of age.

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Alternate anti‐leprosy therapy for “Refractory Leprosy”!

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A Biocultural Analysis of Mortuary Practices in the Later Anglo‐Saxon to Anglo‐Norman Black Gate Cemetery, Newcastle‐upon‐Tyne, England

Abstract

The lack of grave goods in cemeteries from later Anglo‐Saxon England (8th to 11th century AD) has in the past been interpreted as reflecting standardisation of burial rites dictated by Christian doctrine. This study employed a biocultural approach to investigate whether variations in mortuary practices such as burial location, grave form and body disposition within the 8^th to 12^th‐century Black Gate cemetery, Newcastle‐upon‐Tyne represented alternative mediums of social display.

https://ift.tt/2UIhLpl

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Τετάρτη 12 Δεκεμβρίου 2018

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