Pure-Tone Hearing Thresholds and Brainstem Auditory Evoked Potentials in Sporadic Ataxia

Abstract Introduction Spinocerebellar ataxia (SCA) is part of a genetic and clinical heteroge- neous group of neurodegenerative diseases characterized by progressive cerebellar ataxia. Objective To describe the results of audiological and electrophysiological hearing evaluations in patients with sporadic ataxia (SA). Methods A retrospective cross-sectional study was carried out with 11 patients submitted to the following procedures: anamnesis, otorhinolaryngological evaluation, tonal and vocal audiometry, acoustic immittance and brainstem auditory evoked potential (BAEP) tests. Results The patients presented with a prevalence of gait imbalance, of dysarthria, and of dysphagia; in the audiometric and BAEPs, four patients presented with alterations; in the acoustic immittance test, five patients presented with alterations, predominantly bilateral. Conclusion The most evident alterations in the audiological evaluation were the prevalence of the descending audiometric configuration between the frequencies of 2 and 4 kHz and the absence of the acoustic reflex between the frequencies of 3 and 4 kHz bilaterally. In the electrophysiological evaluation, the patients presented changes with a prevalence of increased I, III and V wave latencies and the interval in the interpeak I-III, I-V and III-V. In the present study, it was observed that auditory complaints did not have a significant prevalence in this type of ataxia, which does not occur in some types of autosomal recessive and dominant ataxia.

The Importance of Otoneurological Evaluation in Brazilian Workers Exposed to Pesticides: A Preliminary Study

Introduction: Agrochemicals, also known as pesticides, are widely used in agriculture and in public health. They are organic and inorganic chemical substances with a high level of toxicity not only for the environment, but also for human health. Objective: To verify findings on labyrinthine assessment in endemic disease control agents, and to recommend the inclusion of the vestibular exam in the set of tests for pesticide-exposed populations. Methods: Descriptive, prospective, cross-sectional study with a sample comprising 15 endemic disease control agents, males, mean age of 51.6 years old (standard deviation [SD] = 5.9). All of the participants were submitted to anamnesis, otorhinolaryngological screening, and vestibular assessment. Results: Regarding the most reported complaints, dizziness (73.4%), headache (60%), and tingling in the extremities (53.4%) were observed. The findings of the vestibular exams were normal in 53.3%, while 46.7% showed peripheral vestibular disorder, of which 26.7% were of deficitary type, and 20% of the irritative type. Conclusions: Alteration in the vestibular system was verified in 50% of the workers, with a greater prevalence in the caloric testing. Several disorders related to pesticides intoxication are scientifically known. Actions promoting knowledge and qualification of this population for the proper handling of chemicals are suggested, in addition to the elaboration and inclusion of protocols of vestibular assessment in hearing health programs for the prevention, diagnosis and treatment of vestibular disorders (AU)

Comparing Individuals through the Speech Recognition Test Applied to Regional Live Voice and Recorded Speeches from Paraná State in Five Brazilian Counties

Abstract Introduction Speech tests such as logoaudiometry measure the ability to perceive and recognize oral sounds. The Speech Recognition Index (SRI) is one of the speech tests adopted in clinical routine; it uses standardized live voice and recorded speeches. The live voice speech method can be influenced by intra and interspeaker variability, as well as by regionalism variability, whereas recorded tests show consistency in their presentation. Objective Analyzing results of the SRI test applied to live voiceand recorded speeches from Paraná State, in different Brazilian counties. Method The sample comprised 125 individuals, 25 fromeach county (Rio de Janeiro, Florianópolis, Porto Alegre, Salvador and Curitiba), from both sexes, in the age group 20 to 70 years; the SRI was applied in both techniques. Results The recorded speech method showed prevalence of hit improvement in Rio de Janeiro (40%), Salvador, Porto Alegre and Florianópolis (28%). Individuals from Salvador and Florianópolis subjected to the recorded speech method showed better results in the left ear. Individuals from Rio de Janeiro and Porto Alegre showed satisfactory results in both ears, whereas those from Curitiba did not show statistically significant difference between the left and the right ear. Conclusion The recorded CD application method showed prevalence of hit improvement (%) in the SRI responses in comparison to the live voice speech technique in most of the studied counties. According to the hit rate measured in the herein investigated counties, Rio de Janeiro showed the best results in the recorded speech method.

Pitch-Matching Accuracy and Temporal Auditory Processing

Abstract Introduction Pitch-matching refers to the ability to vocally reproduce an acoustic model in a corresponding tone to the presented sound. This ability, which is dependent on pitch perception ability, can vary among individuals, and some are not able to sing in the correct tune or discriminate differences between tones. Objective To correlate pitch-matching accuracy and auditory processing in individuals without musical training. Methods A Pitch-Matching Test (vocal reproduction of synthesized and human voice sounds) and two commercially available tests of auditory temporal processing (the Pitch Pattern Sequence Test and the Random Gap DetectionTest) were administered to all participants. A total of 62 college students of both genders, aged between 18 and 35 years old, were divided into 2 groups, according to their performances in the Pitch- Matching Test (the accurate match group and the inaccurate match group). Results In the Pitch-Matching Test, both groups achieved better results when reproducing vocalized sounds. The accurate match group achieved a significantly higher pitch pattern sequence test performance. In the Random Gap Detection Test analysis, there were no differences between the two groups. The Pearson's chi-squared test showed a direct correlation between the Pitch-Matching Test and the Pitch Pattern Sequence Test. Conclusion The findings of this study suggest the existence of a significant relationship between temporal auditory processing and pitch-matching, through which accurate pitch-matching individuals perform better in the Pitch Pattern Sequence Test. Inaccurate pitch-matching individuals may be skilled at discriminating pitch, despite their poor performance in the Pitch-Matching Test.

The importance of central auditory evaluation in Friedreich's ataxia / A importância da avaliação auditiva central na ataxia de Friedreich

ABSTRACT Objective To assess central auditory function in Friedreich's ataxia. Methods A cross-sectional, retrospective study was carried out. Thirty patients underwent the anamnesis, otorhinolaryngology examination, pure tone audiometry, acoustic immittance measures and brainstem auditory evoked potential (BAEP) assessments. Results The observed alterations were: 43.3% in the pure tone audiometry, bilateral in 36.7%; 56.6% in the BAEP test, bilateral in 50%; and 46.6% in the acoustic immittance test. There was a significant difference (p < 0.05) in the comparison between the tests performed. Conclusion In the audiological screening, there was a prevalence of the descending audiometric configuration at the frequency of 4kHz, and absence of the acoustic reflex at the same frequency. In the BAEP test, there was a prevalence of an increase of the latencies in waves I, III and V, and in the intervals of interpeaks I-III, I-V and III-V. In 13.3% of the patients, wave V was absent, and all waves were absent in 3.3% of patients.

RESUMO Objetivo Avaliar a função auditiva central na ataxia de Friedreich (AFRD). Métodos Foi realizado um estudo retrospectivo de corte transversal. 30 pacientes realizaram anamnese, avaliações otorrinolaringológica, audiológica, imitanciométrica e do potencial evocado auditivo de tronco encefálico (PEATE). Resultados As alterações observadas foram: 43,3% no exame audiométrico sendo 36,7% dos casos, bilateralmente; 56,6% na avaliação do PEATE com 50% dos casos, bilateralmente e 46,6% no exame imitanciométrico. Houve diferença significativa (p < 0,05) na comparação entre os exames realizados. Conclusão No exame audiológico, ocorreu uma preponderância maior da configuração audiométrica descendente a partir da freqüência de 4kHz e ausência do reflexo acústico na mesma frequência. No exame do PEATE, houve prevalência do aumento das latências nas ondas I, III e V, e nos intervalos dos interpicos I-III, I-V e III-V. Em 13,3% dos casos, a onda V estava ausente, e em 3,3% dos casos, todas as ondas estavam ausentes.

Otoneurological findings prevalent in hereditary ataxias / Alterações otoneurológicas prevalentes nas ataxias hereditárias

ABSTRACT Objective To describe and compare the vestibular findings most evident among the hereditary ataxias, as well as correlate their clinical features with the nervous structures affected in this disease. Methods Seventy-five patients were evaluated and underwent a case history, otorhinolaryngological and vestibular assessments. Results Clinically, the patients commonly had symptoms of gait disturbances (67.1%), dizziness (47.3%), dysarthria (46%) and dysphagia (36.8%). In vestibular testing, alterations were predominantly evident in caloric testing (79%), testing for saccadic dysmetria (51%) and rotational chair testing (47%). The presence of alterations occurred in 87% of these patients. A majority of the alterations were from central vestibular dysfunction (69.3%). Conclusion This underscores the importance of the contribution of topodiagnostic labyrinthine evaluations for neurodegenerative diseases as, in most cases, the initial symptoms are otoneurological; and these evaluations should also be included in the selection of procedures to be performed in clinical and therapeutic monitoring.

RESUMO Objetivo Descrever e comparar os achados vestibulares mais evidentes entre a ataxia hereditária, bem como correlacionar seus aspectos clínicos com o estudo das estruturas nervosas afetadas nesta doença. Métodos 75 pacientes foram avaliados e submetidos aos seguintes procedimentos: anamnese, avaliação otorrinolaringológica e vestibular. Resultados Clinicamente, os pacientes apresentaram sintomas de distúrbios da marcha (67,1%), tonturas (47,3%), disartria (46%) e disfagia (36,8%). No teste vestibular, as alterações foram predominantemente evidentes no teste calórico (79%), dismetria sacádicas (51%) e no teste rotatório (47%). A presença de alterações ocorreu em 87% dos pacientes. A maioria das alterações observadas foram da disfunção vestibular central (69,3%). Conclusão O estudo ressalta a importância da contribuição da avaliação labiríntica no topodiagnóstico para doenças neurodegenerativas, uma vez que, na maioria dos casos, os sintomas iniciais são otoneurológicos, e essas avaliações também devem ser incluídas na seleção de procedimentos a serem realizados no monitoramento clínico e terapêutico.

Effect of virtual reality in Parkinson's disease: a prospective observational study / Efeito da realidade virtual na doença de Parkinson: estudo observacional prospectivo

ABSTRACT Objective: To assess the effectiveness of balance exercises by means of virtual reality games in Parkinson's disease. Methods: Sixteen patients were submitted to anamnesis, otorhinolaryngological and vestibular examinations, as well as the Dizziness Handicap Inventory, Berg Balance Scale, SF-36 questionnaire, and the SRT, applied before and after rehabilitation with virtual reality games. Results: Final scoring for the Dizziness Handicap Inventory and Berg Balance Scale was better after rehabilitation. The SRT showed a significant result after rehabilitation. The SF-36 showed a significant change in the functional capacity for the Tightrope Walk and Ski Slalom virtual reality games (p < 0.05), as well as in the mental health aspect of the Ski Slalom game (p < 0.05). The Dizziness Handicap Inventory and Berg Balance Scale showed significant changes in the Ski Slalom game (p < 0.05). There was evidence of clinical improvement in patients in the final assessment after virtual rehabilitation. Conclusion: The Tightrope Walk and Ski Slalom virtual games were shown to be the most effective for this population.

RESUMO Objetivo: Verificar a eficácia dos exercícios de equilíbrio com realidade virtual (RVi) na doença de Parkinson. Métodos: Dezesseis pacientes foram submetidos a uma anamnese, exames otorrinolaringológico e vestibular, ao Dizziness Handicap Inventory (DHI), Escala de Equilíbrio de Berg (EEB), questionário SF-36 e o Teste de Sentar e Levantar (TSL) que foram aplicados antes e após a reabilitação com RVi. Resultados: Os resultados dos escores finais do DHI e EEB foram melhores após a reabilitação. O TSL apresentou resultado significativo após a reabilitação. O SF-36 demonstrou alteração significativa da capacidade funcional para os jogos Tightrope Walk e Ski Slalom (p < 0,05) e da saúde mental para o jogo Ski Slalom (p < 0,05). O DHI e EEB apresentaram alterações significativas no jogo Ski Slalom (p < 0,05). Houve melhora clínica evidente dos pacientes após reabilitação virtual. Conclusão: Os jogos virtuais Tightrope Walk e o Ski Slalom foram os mais eficazes.

Otoneurological Abnormalities in Patients with Friedreich's Ataxia

Abstract Introduction Friedreich's ataxia is a neurodegenerative disease and progressive by nature. It has autosomal recessive inheritance and early onset inmost cases. Nystagmus and hearing loss (in some cases) make up some of the common symptoms seen in this disorder. Objective The objective of this study is to examine vestibular disorders in patientswith Friedreich ataxia. Methods We conducted a retrospective cross-sectional study. We evaluated 30 patients with ages ranging from six to 72 years (mean age of 38.6 ( 14.7). The patients underwent the following procedures: anamnesis, ENT, and vestibular evaluations. Results Clinically, the patients commonly had symptoms of incoordination of movement (66.7%), gait disturbances (56.7%), and dizziness (50%). In vestibular testing, alterations were predominantly evident under caloric testing (73.4%), gaze nystagmus testing (50.1%), rotational chair testing (36.7%), and optokinetic nystagmus testing (33.4%). The presence of alterations occurred under examination in 90% of subjects, with the majority occurring in those with central vestibular dysfunction (70% of the examinations). Conclusion The most evident neurotological symptoms were incoordination of movement, gait disturbances, and dizziness. Alterations in vestibular examinations occurred in 90% of patients, mostly in the caloric test, with a predominance of deficient central vestibular system dysfunction.

Neurotological Findings at a Health Unit for Adults with Cervicalgia

Abstract Introduction The cervical spine is a flexible link between the sensory platform of the skull and torso. The fundamental principle of its operation is due to the balance between muscle strength and flexibility, and any dysfunction of this balance causes neck pain, known as cervicalgia. Objective The objective of this study is to analyze the most prevalent neurotological findings in adults with neck pain. Method A cross-sectional study in which 33 adults from 50 to 83 years of age with neck pain were evaluated and underwent the following procedures: anamnesis, as well as ENT, audiological, and vestibular exams. Results The most evident neurotological symptoms were dizziness (75.7%), tinnitus, neck cracking, tingling in the extremities, and auditory problems (36.3% for each). The most frequently reported clinical symptoms were related to cardiovascular (69.7%), endocrine-metabolic (48.5%), and rheumatic (30.3%) systems. In the audiological assessment, 30 subjects (91.0%) presented hearing impairment in at least one ear, with sensorineural impairment being the most prevalent (88.0%). In the vestibular assessment, there were alterations in 13 subjects (39.0%) found in the caloric test. There was a prevalence of alterations in the peripheral vestibular system with a predominance of irritative peripheral vestibular dysfunction. Conclusion Neurotological complaints were frequent in this population, verifying the importance of these tests in the dysfunctions of the cervical region or the craniocervical junction.

Hearing Health in Agricultural Aviation Pilots from Cindacta II Wearing Earplugs and a Helmet

Abstract Introduction Agricultural aviation pilots, exposed daily to intense vibration and noise, are likely to develop noise-induced hearing loss (NIHL). Objectives The aim of this study was to investigate the presence of audiograms consistent with NIHL in agricultural aviation pilots who use earplugs and helmets. Methods We conducted a cross-sectional cohort and observational study. The data were taken from the medical records and audiograms of 94 pilots. Results NIHL was identified in 9.5% of individuals with hearing loss by audiograms at 3,000, 4,000, or 6,000 Hz. Normal audiograms were observed in 46.8% of pilots surveyed. Bilateral hearing loss was more frequent than unilateral hearing loss, occurring in 64.8% of cases. Conclusion Although there was a low incidence of audiograms compatible with NIHL in the records of the pilots examined, the disorder still occurs despite the doubled use of individual hearing protection equipment (helmets and earplugs) for agricultural aviation pilots. Nevertheless, even with the use of earplugs and helmets as noise protectors, the data showed that agricultural pilots suffer inner ear damage caused by occupational noise. Prevention and periodic audiologic evaluations must be conducted in noiseexposed occupational groups.

Prevention of the Evolution of Workers' Hearing Loss from Noise-Induced Hearing Loss in Noisy Environments through a Hearing Conservation Program

Introduction Noise-induced hearing loss (NIHL) is a serious problem for workers and therefore for businesses. The hearing conservation program (HCP) is a set of coordinated measures to prevent the development or evolution of occupational hearing loss, which involves a continuous and dynamic process of implementation of hearing conservation routines through anticipation, recognition, evaluation, and subsequent control of the occurrence of existing environmental risks or of those thatmay exist in the workplace and lead to workers hearing damage. Objective The aim of this study was to evaluate the effectiveness of the HCP in preventing further hearing loss in workers with audiograms suggestive of NIHL. The audiometric tests and medical records of 28 furniture company workers exposed to noise were reviewed and monitored for 2 years. Methods This retrospective, cross-sectional study examined five audiometric tests in the medical records (on admission and every semester) of 28 workers in a furniture company (totaling 140 audiometric exams) following the introduction of the HCP. Results Data analysis showed no differences between the audiometric tests conducted on admission and those performed every semester. Conclusions The HCP implemented was effective in preventing the worsening of hearing loss in workers already with NIHL when exposed to occupational noise. Therefore, such a measure could be useful for the employment of workers with hearing loss in job sectors that have noise exposure.

Assessment of the light intensity of otoscopes utilized in teaching hospitals / Avaliação da intensidade da luz dos otoscópios em hospitais-escola

ABSTRACT INTRODUCTION: To attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used. OBJECTIVE: Evaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied. METHODS: Cross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries. RESULTS: The mean of the sum of new batteries' charge was 3.19 V, and of the test batteries was 2.70 V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89 lumens, whereas in the test batteries it was 188.32 lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p = 0.0001; CI = 0.95). CONCLUSION: There was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.

RESUMO Introdução: Para a realização de um diagnóstico otoscópico preciso deve-se utilizar um aparelho funcionando com uma capacidade adequada. Objetivo: Avaliar a intensidade luminosa dos otoscópios comparando a intensidade da luz comas pilhas encontradas no momento da aferição e com pilhas novas. Método: Estudo de coorte histórica com corte transversal, onde foram analisados 38 otoscópios, sendo realizada a aferição da qualidade luminosa com a pilha utilizada e comparado com uma pilha nova, e a aferição da carga das pilhas novas e em utilização no momento do exame. Resultados: A média da soma das cargas das pilhas novas foi de 3,19 V, e a das pilhas testes foi de 2,70 V, representando decréscimo de 18,02% na carga das pilhas. A média da luminosidade comas pilhas novas foi de 366.89 lúmens, e com a pilha teste foi de 188.32 lúmens, representando decréscimo de 83,75% na intensidade luminosa. Foi aplicado o teste T para comparação entre os dados, onde percebe-se diferença estatística entre a intensidade luminosa com pilhas testes e novas (p = 0,0000; IC = 0,95). Conclusão: Houve diferença estatisticamente significativa entre a proporção de intensidade da luz dos otoscópios. Uma pequena variação da pilha proporciona uma grande variação na luz.

Estudo da prevalência de hipoacusia em indivíduos com diabetes mellitus tipo 1 / Hearing loss prevalence in patients with diabetes mellitus type 1

Diabetes mellitus (DM) é uma doença crônica causada pela não produção e uso inadequado de insulina. Enfermidade crônico-degenerativa. Complicações crônicas do DM, no sistema auditivo, podem causar atrofia do gânglio espiral, degeneração da bainha de mielina do VIII par craniano, diminuição de fibras nervosas na lâmina espiral ou espessamento das paredes capilares da estria vascular e das pequenas artérias. OBJETIVO: Verificar os limiares auditivos em indivíduos portadores de DM tipo 1. MATERIAL E MÉTODOS: Estudo clínico envolvendo 60 indivíduos, divididos em Grupo Estudo (GE) e Grupo Controle (GC), indivíduos diabéticos e não diabéticos. Realizada anamnese, exame físico, otorrinolaringológico e exame audiométrico. RESULTADOS:Quanto aos limiares de audibilidade, no GE, houve diferença estatisticamente significante nas frequências 250, 500, 10.000, 11.200, 12.500, 14.000 e 16.000 Hz em ambas as orelhas e médias das orelhas. Na comparação dos GE e GC, houve diferença estatisticamente significativa com maior probabilidade de ocorrência de hipoacusia em alguma frequência independente da orelha testada no GE. CONCLUSÕES: Houve diferenças estatisticamente significativas nos achados audiológicos no GE quando comparado com GC, justificando avaliação audiológica completa em pacientes diabéticos tipo 1, incluindo audiometria de altas frequências.

Diabetes mellitus (DM) is a chronic degenerative disease that impairs normal insulin production and use. DM chronic auditory complications may include spiral ganglion atrophy, degeneration of the vestibulocochlear nerve myelin sheath, reduction of the number of spiral lamina nerve fibers, and thickening of the capillary walls of the stria vascularis and small arteries. OBJECTIVE: This paper aims to verify the hearing thresholds of individuals with type 1 DM. MATERIALS AND METHODS: Sixty patients were enrolled in this trial and divided into case and control groups featuring diabetic and non-diabetic subjects respectively. All individuals were interviewed and underwent physical examination, ENT examination, and audiometric tests. RESULTS: Statistically significant difference was observed in hearing thresholds of case group subjects at 250, 500, 10,000, 11,200, 12,500, 14,000 and 16,000 Hz for both ears and ear average. Case group subjects had higher likelihood of having hypacusis at any frequency regardless of ear than controls. CONCLUSION: Statistically significant differences were seen in the audiological findings of case group subjects when compared to controls. Thorough audiological examination including high frequency audiometry is required for subjects with diabetes mellitus type 1.

Angiogenesis, fibrinogenesis and presence of synechiae after exeresis of a swine vocal fold mucosal microflap and use of topical mitomycin-C / Estudo da angiogênese, fibrogênese e presença de sinéquias após exérese de fragmento de mucosa de pregas vocais de suínos utilizando instrumental frio e mitomicina-C tópica

PURPOSE: To evaluate swine vocal fold healing in a period of 30 days after topical mitomycin-C application. METHODS: Twelve swine underwent exeresis of mucosal flaps from the free edge of the anterior third of both vocal folds with a cold instrument (laryngeal scissors). The animals were divided into two groups: EG (Experimental Group), consisting of 6 animals undergoing topical MMC application (4 mg/dL) on the operated area for 4 minutes; CG (Control Group), 6 animals undergoing topical saline solution application on the operated area for 4 minutes. After 30 days, the animals were sacrificed and the larynges were collected and examined for the presence of synechiae as well as a histological immunohistochemical assessment of immature and mature collagen deposition, number of blood vessels and myofibroblasts. RESULTS: Mature collagen deposition in the EG was 452.12 μm² and 1332.31μm² in the CG; immature collagen deposition was 1511.73μm² in the EG and 1020.61μm² in the CG. The number of myofibroblasts was 1.556 in the EG and 3.583 in the CG. The number of blood vessels was 2.565 in EG and 6.917 in the CG. There were no synechiae in the two studied groups. CONCLUSIONS: There was an increase in immature collagen deposition in the experimental group when compared with the control group. There was a decrease in mature collagen deposition in the experimental group when compared with the control group. There was a decrease in the number of myofibroblasts in the experimental group when compared with the control group. A decrease in blood vessels was observed in the experimental group when compared with the control group. There was no synechia formation in either studied group.

OBJETIVO: Avaliar a cicatrização de pregas vocais de suínos utilizando mitomicina-C tópica, em 30 dias. MÉTODOS: Doze suínos foram submetidos à exérese de mucosa do bordo livre do terço anterior de ambas as pregas vocais com instrumental frio (tesoura curva) e divididos em dois grupos: Grupo E (GE), composto por seis animais com utilização tópica de mitomicina-C(4 mg/dL) na área cruenta por quatro minutos e Grupo Controle (GC), composto por seis animais com utilização tópica de soro fisiológico na área cruenta por quatro minutos. Após 30 dias os animais foram sacrificados e coletadas amostras das pregas vocais para avaliação de sinéquias e análise histológica com quantificação da deposição de colágeno maduro e imaturo, quantificação do número de vasos sanguíneos e miofibroblastos, por método imunoistoquímico. RESULTADOS: A deposição do colágeno maduro no GE foi de 452,12 μm² e 1332,31μm² no GC. A do colágeno imaturo foi de 1511,73μm² no GE e de 1020,61μm² no GC. O número de miofibroblastos foi de 1,556 no GE e de 3,583 no GC. O número de vasos sanguíneos foi de 2,565 no GE e de 6,917 no GC. Não houve formação de sinéquias nos grupo s estudados. CONCLUSÕES: No grupo experimento, quando comparado ao controle, houve significativamente aumento da deposição do colágeno imaturo e diminuição da deposição do colágeno maduro, do número de miofibroblastos e de vasos sanguíneos. Não houve formação de sinéquias em ambos os grupos.

Anticorpos anticardiolipinas em úlceras de perna / Anticardiolipin antibodies in leg ulcers

Objetivo: Verificar a prevalência de anticorpos anticardiolipinas IgG e IgM em pacientes com úlcera de perna e se os seus portadores podem ser identificados clinicamente. Métodos: Estudaram-se 151 pacientes com úlcera de perna (81 venosas, 50 diabéticas e 20 arteriais) e 150 controles. Pesquisou-se, nos dois grupos, a presença de anticorpos anticardiolipina IgG e IgM pelo método de ELISA. No grupo úlcera foram coletados dados demográficos dos pacientes, de tamanho e número de úlceras e gravidade da dor medido por escala visual analógica. Os dados obtidos foram agrupados em tabelas de frequência e contingência. Adotou-se significância de 5%. Resultados: Encontrou-se prevalência de anticorpos anticardiolipina de 7.2% (n=12) no grupo com úlceras e de 1.3% (n=2) no controle (p=0.01). Comparando-se a prevalência dos anticorpos anticardiolipina nos diferentes tipos de úlcera verificou-se aumento nas de origem venosa (p=0.02) e diabéticas (p=0.01), mas não nas arteriais (p=0.31) em relação à população controle. As úlceras de perna anticardiolipinas positivas não diferiram daquelas sem anticardiolipinas quanto a tamanho da ferida (p=0.6); gravidade da dor (p=0.67), número médio de úlceras (p=0.38), tempo de duração de doença (p= 0.59), gênero do paciente(p=0.98) e história de trombose prévia (p=0.69). Conclusão: Existe aumento de prevalência de anticorpos anticardiolipinas nos portadores de úlceras de perna venosas e diabéticas, mas não nas arteriais. As características clínicas das úlceras anticardiolipinaspositivas não auxiliam na identificação desses pacientes.

Objective: To verify the prevalence of IgG and IgM anticardiolipin antibodies in patients with leg ulcer (venous, arterial and diabetic) and if these patients can be identified by clinical means. Methods: A serie of 151 patients with leg ulcer (81 venous, 50 diabetic and 20 arterial ulcers) and 150 controls were studied. In both groups it was searched the presence of IgG and IgM anticardiolipin by the ELISA method. In the leg ulcer group demographic data were obtained, data on the leg ulcer size and number as well as pain severity measured by an analogical visual scale. In statistic analysis, the adopted significance was of 5%. Results: It was found an anticardiolipin prevalence of 7.2% (n=12) in the leg ulcers group and of 1.3% (n=2) in the control group (p=0.01). Comparing the different ulcer types with control population, it was found that there was an increase in anticardiolipin antibodies in venous (p=0.02), and diabetic (p=0.01) but not in arterial ulcers (p=0.31). Leg ulcer patients with anticardiolipin did not differ from those without it in gender (p=0.98); ulcer size (p=0.6); pain severity (p=0.67), mean number of ulcers (p=0.38), mean disease duration time (p= 0.59) and previous history of venous thrombosis (p=0.69). Conclusion: There is an increased prevalence of anticardiolipin antibodies in patients with venous leg ulcers anddiabetic ulcers but not in those of arterial origin. Clinical characteristics of ulcers do not help in the identification of these patients.

Grau de satisfação do paciente e complicações pós-operatórias da cirurgia de septoplastia com e sem o uso de tampão nasal / Degree of the patient satisfaction and post-operative complications for septoplasty surgery with and without the use of nasal buffer

Objetivo: Avaliar o grau de satisfação dos pacientes a realização de septoplastia com e sem o emprego de tampões nasais e avaliar as complicações mais freqüentes em relação ao uso ou não de tampões nasais após a realização de septoplastia. Método: Clínico prospectivo randomizado comparativo entre pacientes com tampão nasal e sem tamponamento. Os autores observaram 152 pacientes, operados de septoplastia no Hospital Angelina Caron. Foram avaliados quanto ao grau de satisfação nas primeiras 72 horas e após 7 dias; e as principais complicações em intervalos seriados de 72 horas e após 7 dias. Resultados: Grupo sem tamponamento avaliou como de boa qualidade o pós-operatório, apenas 2 pacientes avaliaram como péssima a recuperação. O grupo que usou tampão nasal a recuperação não foi bem tolerada por mais da metade dos pacientes e o motivo por não submeter-se a nova cirurgia foi o tampão nasal, seguido pelo medo de realizar anestesia. Os pacientes que não usaram tampão também tiveram menor número de casos de complicações como hemorragia, abscesso, infecção, dor/queixas respiratórias e sinéquia/crostas no pós-operatório imediato, após 72 horas e após 7 dias. Conclusão: Tamponamento nasal embora bastante difundido no meio cirúrgico, não propicia contentamento do paciente. Assim como a maioria dos cirurgiões já propõe realização de cirurgia com anestesia geral ou local, também deveria avaliar a técnica a ser empregada e informar ao paciente sobre a possibilidade de realizar a cirurgia com e sem tamponamento nasal.

Objective: To assess the degree of satisfaction of pacients submitted the septoplasty with and without the use of nasal buffer and assess the most common complications pursuant to the use of tampons or not after nasal septoplasty. Method: Randomized prospective clinical method compared between patients with and without nasal buffer. The authors observed 152 patients operated on septoplasty in Hospital Angelina Caron. They were assessed for degree of satisfaction in the first 72 hours and after 7 days; and the major complications in intervals of 72 hours and after 7 days. Results: The group without nasal buffer assessed the post-operative as offering good quality, only 2 patients evaluated it as a bad recovery. For the group using nasal buffer the recovery was not well tolerated by more than a half of the patients and the reason for not undergoing a new surgery was the nose buffer, followed by the fear of undergoing anesthesia. Patients who did not use buffer also had fewer cases of complications such as bleeding, abscesses, infection, pain/respiratory complaints and synechia/crusts in the immediate postoperative period, after 72 hours and after 7 days. Conclusion: Although septoplasty with nasal buffer is very widespread in the surgical middle, It does not provide the patient satisfaction. As most surgeons now propose holding of surgery with general or local anesthesia, they should also assess the technique to be employed and inform the patient about the possibility of conducting the surgery with and without nasal buffer.

Perfil epidemiológico de pacientes com hérnia incisional / Epidemiological profile of patients with incisional hernias

RACIONAL: A hérnia incisional é uma das doenças mais freqüentes ligadas diretamente ao ato cirúrgico. Os principais fatores de risco do seu desenvolvimento estão relacionados ao paciente e pós-operatório, dificultando sua prevenção. Seu tratamento é difícil e as recidivas são comuns, com impacto socioeconômico substancial. OBJETIVO: Delinear epidemiologicamente os pacientes com hérnia incisional. MÉTODOS: A amostra foi composta por 46 prontuários de pacientes que foram submetidos à operações de correção de eventração no HUEC entre janeiro de 2005 e dezembro de 2006. RESULTADOS: Mostrou existir 45 pacientes de etnia leucodérmica, com idade média de 51,6 anos. Trinta e um apresentavam pelo menos uma co-morbidade associada, não havendo diferenças relevantes quanto ao sexo. Dentre elas sobressaíram-se obesidade, cardiopatia, neoplasia e diabetes, representando respectivamente 14,10, 9 e 7 pacientes. Foram diversas as causas que levaram ao procedimento cirúrgico, sendo 31 destas por afecções em trato gastrintestinal. A incisão mais herniogênica foi a mediana supra e infra-umbilical, em 16 pacientes. Infecção ocorreu no pós-operatório de 17 pacientes, sendo a intercorrência mais encontrada. As eventrações eram em sua maioria primárias, em 29 pacientes, sendo 19 destas localizadas em hipogástrio. CONCLUSÃO: O perfil de pacientes com evisceração é marcado por fatores como idade acima de 40 anos, co-morbidades existentes, infecção pós-operatória, operações em aparelho gastrintestinal e incisões em linha mediana, particularmente infra-umbilical.

BACKGROUND: Incisional hernias are one of the most frequent illnesses, which are directly linked to surgery. The main risk factors of its development are related to the patient per-say and to post-surgery, making its prevention a difficult task. Its treatment is difficult and recidives are common, having substantial social-economic impacts. AIM: To outline the epidemiology of incisional hernia patients. METHODS: The sample consisted of 46 patient records, of whom where submitted to correctional eventration surgeries at HUEC between the months of January 2005 to December 2006. RESULTS: Forty-five Caucasian patients, with an average age of 52,6 years, out of which thirty-one had at least one co-morbid condition associated with the present illness, without any relevant differences pertaining gender. Among the most frequent conditions was obesity, cardiopathy, neoplasia and diabetes, representing 14, 10, 9 and 7 patients respectively. Causes which lead to surgery varied, being thirty-one due to gastro-intestinal tract conditions. The most herniogenic incisions were the upper median and infraumbilical, in sixteen patients. Infection occurred post-surgery in seventeen patients, being intercurrence the most frequent. Eventrations were in most part primary ones, in twenty-nine patients, of which nineteen were located in the hypogastrium. CONCLUSION: The profile of patients with evisceration is marked by factors such as age above 40, the existence of co-morbid conditions, post-operative infection, gastrointestinal tract surgeries as well as median line and particularly infra-umbilical incisions.

Efeito da mitomicina C tópica na cicatrização de prega vocal em modelo suíno / Topical mitomycin C effect on swine vocal folds healing

Várias terapias adjuvantes à cirurgia vêm sendo usadas para modular o processo cicatricial nas pregas vocais, entre elas a Mitomicina tópica (MTC). OBJETIVOS: Avaliar os efeitos da MTC no processo de cicatrização de pregas vocais de suínos 30 dias após exérese de fragmento de mucosa com laser de CO2 mediante a mensuração da deposição de colágeno. FORMA DE ESTUDO: Experimental em suínos. MATERIAIS E MÉTODOS: Dois grupos de 6 suínos cada foram avaliados após exérese de fragmento de mucosa de prega vocal a laser de CO2 (grupo controle sem uso e grupo experimento com uso de MTC tópica). Após 30 dias os animais foram submetidos à eutanásia, sendo coletadas amostras das pregas vocais para análise histológica, a fim de quantificar a deposição de colágeno mediante coloração de Picrosirius Red. RESULTADOS: A média da área do colágeno total das pregas vocais do grupo controle foi de 2648,03 æm2, enquanto a média do colágeno total das pregas vocais do grupo experimento foi de 2200,30 æm2 (p = 0,0043). CONCLUSÃO: A MTC usada topicamente após a exérese de fragmento de mucosa da prega vocal a laser de CO2 em suínos, diminui, significativamente, a deposição do colágeno total.

several adjuvant therapies to surgery have been used to modulate the healing process of vocal folds, including topic mitomycin (MTC). AIM: to evaluate the effect of topical MTC in the healing process of vocal folds 30 days after the exeresis of a mucosal fragment with CO2 laser in a swine model (control group without mitomycin and study group with topical MTC), with collagen deposition measurement. STUDY TYPE: prospective experimental in swine. METHODS: two groups of 6 swine each were subjected to exeresis of a mucosal fragment of the vocal fold with CO2 laser. Immediately after the procedure MTC was applied topically for three minutes on the study group. Thirty days later the animals were slaughtered and samples of the vocal folds were collected for histological analysis, with the purpose of quantifying collagen deposition by Picrosirius Red stain. RESULTS: the average area of total collagen in the vocal folds in the control group was 2.648,03 æm2, whereas in the study group it was 2.200,30 æm2 (p = 0.0043). CONCLUSION: topical application of MTC after the exeresis of a mucous fragment of vocal fold with CO2 laser in swine significantly decreased total collagen deposition.

Avaliação do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) no processo de cicatrização de feridas em pele de ratos / Evaluation of hydroalcoholic extract of Aroeira (Shinus Terebinthifolius Raddi) in the healing process of wound skin in rats

OBJETIVO: Avaliar o efeito cicatrizante da administração tópica do extrato hidroalcoólico de aroeira em feridas abertas na região dorsocostal de ratos. MÉTODOS: Utilizou-se 60 ratos Wistar, machos, que tiveram retirado fragmentos de pele com dois centímetros de diâmetro, sob anestesia inalatória com éter etílico. Foram divididos em dois grupos de 30 animais: o grupo aroeira, que recebeu aplicação do extrato hidroalcoólico da planta, e o grupo controle, que recebeu aplicação de solução salina a 0,9 por cento. Cada grupo foi subdividido em 3 com 10 animais cada para serem observados aos sete, 14 ou 21 dias. As áreas das lesões foram analisadas pelo aspecto macroscópico e por planimetria digital. Os espécimes ressecados das feridas foram analisados por microscopia ótica em colorações de hematoxilina-eosina e tricrômio de Masson. RESULTADOS: Os achados macroscópicos demonstraram reepitelização completa mais precoce no grupo controle aos 14 dias. Pela planimetria digital as áreas médias das feridas dos ratos do grupo controle (0,5278 cm²) foram menores que as das feridas dos ratos do grupo aroeira (0,6897 cm²), com significância estatística aos 14 dias de pós-operatório (p=0,036). O estudo histológico demonstrou diferença estatística (p=0,023) em relação às células mononucleares no 14° dia de avaliação, com maior número no grupo aroeira, não havendo diferenças significantes em relação aos outros parâmetros em nenhum dos dias estudados. CONCLUSÃO: O extrato hidroalcoólico de aroeira retardou a reepitelização das feridas da pele dos ratos.

PURPOSE: To evaluate the healing effect of the topic administration of the hydroalcoholic extract of aroeira in open wounds in the dorsocostal region of rats. METHODS: Sixty Wistar rats, males, were used. In all animals one skin fragment was removed, with two centimeters in diameter. Inhalatory anesthesia with ethyl ether was done, The rats were divided in two groups of 30 animals: aroeira group, submitted to an topic application of the hydralcoholic extract of the plant, and control group, with the same process but with 0.9 percent saline solution. Each group was divided in three sub-groups of 10 animals according to the period of observation: 7, 14 and 21 days. The areas of the injuries were analyzed by the macrocospic aspect and digital planimetry, and the resected segments of the wounds were studied by optic microscopy stainned with hematoxilin-eosine and trichromium of Masson. RESULTS: The macrocospic findings showed early complete reepitelization in the control group by the 14th day. According to the digital planimetry the average wound areas of the rats from the control group (0.5278 cm²) had been smaller than those from the wounds of the rats of the aroeira group (0.6897 cm²), with statistical significance to the 14th day (p=0.036). The hystologic study showed statistical difference (p=0.023) regarding the mononuclear cells in 14th day of evaluation, with larger number in the aroeira group, without significant differences regarding other parameters in all the remaining days. CONCLUSION: The topic use of the hydralcoholic extract of aroeira delayed the reepitelization of the skin wounds in rats.