Tumor risk markers in recurrent respiratory papillomatosis

Abstract Objectives: This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. Methods: Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. Results: Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ±SD (standard deviation) of 51.7±26. Conclusions: The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. Level of evidence:: 4.

Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE(c)). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures. .

Characteristics of polypoid lesions in patients undergoing microsurgery of the larynx

Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. AIM: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. METHOD: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. RESULTS: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. CONCLUSION: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy...

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts...

Avaliação sistematizada da dificuldade de exposição das pregas vocais na microcirurgia da laringe / Difficulty systematized evaluation of vocal folds exposure in microsurgery of the larynx

Introdução: Diversos estudos abordam fatores pré-operatórios que predizem dificuldade de intubação endotraqueal, graduada pelos anestesistas pela escala de Cormack-Lehane. Estes parâmetros foram pouco avaliados para a dificuldade de locação do laringoscópio nas microcirurgias da laringe. Não há uma escala padrão de dificuldade direcionada aos cirurgiões de laringe. Objetivo: Criar uma escala padrão de dificuldade de locação do laringoscópio durante microcirurgia da laringe, com foco na exposição das pregas vocais (PPVV); avaliar quais parâmetros clínicos predizem dificuldade de exposição das PPVV; verificar a melhora da exposição laríngea com o suspensor do laringoscópio. Método: Estudo prospectivo, randomizado, de 57 pacientes submetidos à microcirurgia de laringe. No pré-operatório foram avaliados: 3 dados epidemiológicos, 2 de anamnese e 13 de exame físico. No intra-operatório: o anestesista avaliava o escore de Cormack-Lehane e o cirurgião avaliava conforme a escala proposta, antes e após a colocação do suspensor. Resultados e Conclusão: Vários parâmetros apresentaram sensibilidade, especificidade, valor preditivo positivo altos para exposição inadequada da laringe. Porém, apenas distância hiomentual <6,05cm (p=0,003) e classe 2 de Cormack-Lehane (p=0,04) com significância estatística e alta sensibilidade, 100% e 81% respectivamente. O uso do suspensor do laringoscópio melhorou a exposição laríngea de forma significativa (p=0,04). A escala proposta padroniza a vizualização e gradua a dificuldade de exposição das PPVV, facilitando comparações entre estudos e comunicação entre otorrinolaringologistas.

Introduction: Several studies addressing preoperative factors that predict difficulty of endotracheal intubation graduated by anesthesiologists, for the scale of the Cormack-Lehane. These parameters were evaluated for the difficulty of location of the laryngoscope in microsurgery of the larynx. There is not a standard scale of difficulty targeted to surgeons of the larynx. Objective: Create a standard scale of difficulty leasing the laryngoscope during microsurgery of the larynx, with a focus on exposure of the vocal folds (vocal cords) to evaluate which clinical parameters predict difficulty of exposure of their vocal folds and verify the improvement of laryngeal exposure with the hanger of the laryngoscope. Method: A prospective randomized study, 57 patients undergoing laryngeal microsurgery. The preoperative parameters were evaluated: three epidemiological data, two of history and 13 physical examination. Intraoperatively: the anesthesiologist evaluated the Cormack-Lehane score and the surgeon evaluated according to the proposed scale, before and after placement of the hanger. Results and Conclusion: Several parameters showed sensitivity, specificity, positive predictive value for high inadequate exposure of the larynx. But only distance hiomentual <6.05 cm (p = 0.003) and 2 classes of Cormack-Lehane (p = 0.04) with statistical significance and high sensitivity of 100% and 81% respectively. The use of the hanger of laryngoscope laryngeal exposure improved significantly (p = 0.04). The proposed scale standardizes the visualization and grades the difficulty of exposure of their vocal folds, facilitating comparisons between studies and communication between otolaryngologists.

Incidência de sintomas de refluxo gastroesofágico em pacientes com rinossinusite crônica refratária ao tratamento clínico / Incidence of gastroesophageal reflux symptoms in patients with refractory chronic sinusitis upon clinical treatment

Introdução: A rinossinusite crônica (RNSC) é uma patologia que apresenta alterações estruturais e histológicas. A associação entre RNSC e a doença do refluxo gastroesofágico (DRGE) vem sido bastante debatida nos últimos anos. Para que esta relação seja comprovada é necessário que haja evidências de que pacientes com RNSC apresentem maior incidência de DRGE, de que a fisiopatologia de ambas as doenças explique a associação entre elas e de que o tratamento do DRGE cure ou melhore os sintomas de RNSC. Objetivo: Avaliar a incidência de DRGE em pacientes portadores de RNSC e grau de melhora dos sintomas da doença nasossinusal após o tratamento com inibidores de bomba de prótons. Método: Estudo retrospectivo com 30 pacientes com RNSC refratária ao tratamento clínico e/ou patologia polipoide da cavidade nasal com indicação de cirurgia endoscópica funcional dos seios paranasais. Foi aplicado um questionário para avaliação da sintomatologia e tratamento prévio para refluxo Gastroesofágico. Os dados foram submetidos à análise estatística por método do Qui-Quadrado ou teste exato de Fisher com significância de 5%. Resultados: Associação entre RNSC e doença do RGE ocorreu em 40% dos pacientes. Dos pacientes portadores de RGE, 33% apresentaram melhora da sintomatologia da RNSC com medicações para tratamento da patologia gástrica. Conclusão: Ainda não é possível afirmar que o RGE seja um fator responsável pela RNSC, e este deve ser investigado como cofator ou fator desencadeante quando não houver outra etiologia evidente. Há, entretanto, mecanismos biológicos plausíveis para esta associação.

Introduction: The chronic rhinosinusitis (CRS) is a pathology that has structural and histological alterations. The association between CRS and the gastroesophageal reflux disease (GERD) has been widely discussed in the last years. For this relationship to be confirmed, it is necessary to find evidences that the patients with CRS present a major incidence of GERD, that the physiopathology of both diseases explains the association between them and that the GERD treatment cures or improves the CRS' symptoms. Objectives: To evaluate the incidence of GERD in patients with CRS and a level of improvement of the nasosinusal disease symptoms after treatment with protons pump inhibitors. Methods: Retrospective study with 30 patients with CRS refractory to the clinical treatment and/or nasal cavity polypoid pathology with indication of the paranasal sinuses functional endoscopic surgery. We applied a questionnaire for evaluation of the symptomatology and previous treatment for gastroesophageal reflux. The data were submitted to statistical analysis by the Chi-Square test or Fisher's exact test with a significance of 5%. Results: Out of the patients with GERD, 33% had an improvement of the CRS' symptomatology with medications for treatment of the gastric pathology. Conclusion: It is not possible yet to state that the GER is a factor responsible for the CRS and it must be researched as a cofactor or eliciting factor when there is not other evident etiology. However, there are plausible biological mechanisms for such association.

Evolução de pacientes com disfagia orofaríngea em ambiente hospitalar / Evolution of patients with oropharyngeal dysphasia in hospital environment

Introdução: A disfagia orofaríngea de etiologia neurogênica pode causar risco clínico nutricional e comprometimento laringo traqueal por aspiração, podendo culminar em broncopneumonia aspirativa. Esta condição está presente na rotina das avaliações do fonoaudiólogo que atua em ambiente hospitalar junto a pacientes pós acidente vascular encefálico (AVE). Objetivo: O objetivo deste estudo foi avaliar a evolução de pacientes portadores de disfagia orofaríngea neurogênica pós AVE, durante o período de internação até o momento da alta hospitalar, analisando grau da disfagia no pré-tratamento; diagnóstico instrumental; condutas fonoaudiológicas; condições do paciente na alta hospitalar. Método: Foram estudados 39 pacientes no período de dezembro de 2003 a junho de 2004, com queixa de dificuldade de deglutição sugestiva de disfagia. Foi elaborado um protocolo padronizado para a coleta dos dados clínicos. Conclusão: Os resultados permitiram concluir que: houve prevalência da disfagia de grau moderado, seguida pelos graus leve e severo; no diagnóstico instrumental ocorreu à prevalência de aspiração laríngea, seguida de alteração na fase orofaríngea, penetração laríngea, alteração na fase oral da deglutição; nas condutas fonoaudiológicas a manipulação de alimentos apresentou excelente resultado seguida das manobras posturais e das manobras protetivas; na alta hospitalar a prevalência foi de sujeitos que apresentaram estado clínico de nível bom, alimentando-se por via oral, com algumas modificações posturais e/ou da consistência alimentar sem o uso de sonda, seguido pelos que apresentaram nível regular, iniciando com dieta via oral fazendo uso de sonda, mas com possibilidade de retirada entre 30 a 60 dias do período hospitalar.

Introduction: Neurogenic etiology oropharyngeal dysphagia may lead to clinical malnutrition, laryngotracheal damage, and result in aspirative bronchopneumonia. This condition is present in the evaluations routine of the phonoaudiologist who works in hospitals with post CVA (cerebral vascular accident) patients. Objective: The objective of this study is to evaluate the evolution of neurogenic oropharyngeal dysphagia patients after CVA, during interment period until hospital discharge, and to analyze the dysphagia degree before treatment; diagnostic tools; phonoaudiologic routines; state o the patients upon discharge. Method: Thirty-nine (39) patients were studied from December 2003 through June 2004 complaining of deglutition disorder, that indicates dysphagia. A standardized protocol was prepared for collection of clinical data. Conclusion: The results allowed to conclude that there was moderate degree dysphagia, followed of light and severe degrees; in the instrumental diagnosis there was a prevalence of laryngeal aspiration, followed of a change in the oropharyngeal phase, laryngeal penetration, change in the deglutition oral phase; in the phonoaudiological procedures, the food manipulation presented excellent results followed of postural and protective maneuvers; upon hospital discharge there was a prevalence of individuals who had a good level clinical state and were eating orally with some postural and/or food consistency modifications without the use of probe, followed by those who presented a regular level beginning the oral diet with the use of probe, but able to be discharged between 30 to 60 days after the hospital period.

Seção interna do ligamento vocal: nova técnica para tratamento do sulco vocal / Internal section of the vocal ligament: a new technique for the treatment of the sulcus vocalis

O sulco vocal é uma lesão em forma de fenda ou depressão longitudinal na prega vocal que provoca importante impacto negativo na qualidade vocal. Seu dignóstico e tratamento continuam sendo um grande desafio para os médicos laringologistas...

The sulcus vocalis is a congenital laryngeal lesion that provokes important negative impact in the vocal quality. Its diagnosis and treatment remains a great challenge for the laryngologists. To present a new micro-surgical technique for the treatment of the sulcus vocalis defined as internal section of the vocal ligament...

A relação entre o tempo máximo de fonação, frequência fundamental e a proteção de vias aéreas inferiores no paciente com disfagia neurogênica / The relationship between the maximum time for fonation, fundamental frequency and protection of the lower airways in patients with neurological disfagy

Na abordagem fonoaudiológica das disfagias orofaríngeas, a avaliação clínica constitui o método mais comum e de grande valia. Objetivo da presente pesquisa foi de esclarecer os padrões do tempo máximo de fonação, da frequência fundamental e a relação com a proteção das vias aéreas inferiores no paciente com disfagia neurogênica...

In a speech therapy approach of oropharyngeal dysphagia, the clinical evaluation is common and valuable. The objective of this piece of research is to clarify the patterns of the phonation maximum time, the fundamental frequency and the relationship between them and the protection of the lower air passage ways in patients with neurogenic dysphagia...

Gastrostomia endoscópica percutânea: experiência de 136 casos / Percutaneous endoscopic gastrostomy: experience in 136 cases

A gastrostomia endoscópica percutânea (GEP) foi descrita inicialmente por Gauderer e Ponsky em 1980 e hoje vem sendo utilizada como metódo de escolha na realização de uma gastrostomia. dentre suas vantagens destacamos a não necessidade de laparotomia, menor custo e, principalmente, menor morbimortalidade. Foram avaliados 136 pacientes, sento 75 homens (55,1 por cento) e 61 mulheres (44,9por cebnto) A média de idade foi de65,7 anos com extremos de 1,5 e 98 anos. Em relação à doença de base , a mais como foi o AVC 55,9por cento) seguido de demência (6,6por cento), esclerose lateral amiotrófica (5,9por cento), obstrução tumoral (5,9por cento) e TCE (5,9por cento). outras causas foram doença de Parkinson, Alzheimer, miastenia gravis, paralisia central entre outras. Em relação à indicação da GEP, o distúrbio motor da deglutição correspondeu a 94por cento dos casos, seguidos por 4,5por cento de obstrução esofágica. A grande maioria (90,5por cento) das GEP foi com anestesia local mais sedação. As complicações corresponderam a 11,7por cento, sendo a mais comum a infecção (5,8por cento), Somente um paciente foi a óbito devido a complicações anstésicas durante o procedimento. O óbito em 30 dias não relacionado ao procedimento foi de 11,7por cento. Os nossos resultados estão de acordo com a literatura. Nossa experiência sugere que a GEP é um método que pode ser utilizado sem anestesia geral, com segurança, mesmo em pacientes debilitados devido a sua doença de base. Assim a GEP é um método perfeitamente aceitável e seguro de proporcionar dieta enteral aos pacientes