Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature

Abstract Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

The use of Hypochlorous Acid as a Model for Investigating Bladder Overactivity

Involuntary detrusor contractions play an important role in the development of urge incontinence. Also in an in-vitro situation contractions which develop spontaneously can be seen; a parallel with the in vivo observations is likely. In order to study this muscle overactivity we investigated the possibility to induce this phenomenon with oxidative stress using hypochlorous acid (HOCl). Materials and Methods Urinary bladder muscle strips from pigs were mounted in a custom made organ bath and incubated for 20 minutes in Krebs solution. Next HOCl (10µM) was added to the organ bath and the onset of overactive contractions was closely followed. Overactivity was defined as a development of more than 5 phasic detrusor contractions per minute without any other provocation in the 30 minutes following addition of HOCl to the organ bath. Results Of the 50 strips which were used 36 (72%) became overactive after exposure to HOCl during 30 minutes recording. In 76% of the overactive strips overactivity occurred within 5 minutes, in 19% between 5 and 15 minutes, and in 5% it took longer than 15 minutes. The overactivity could be stopped by washing out HOCl for 10 minutes after which still a significant contraction after EFS and ACh stimulation was seen. Conclusions It can be concluded that an oxidative stressor, like HOCl, is capable of inducing smooth muscle overactivity. This model can be used for the development and testing of new treatment modalities for the overactive detrusor. Furthermore, this study provides evidence for a causal relationship between oxidative stress and detrusor overactivity. .

Antioxidant supplementation decreases the cell death rate in the prostatic stromal tissue of long-term castrated rats

OBJECTIVE: The purpose of this study was to compare the effects of castration on cell death rate of the adult rat prostates and to evaluate the benefic action of alpha tocopherol supplementation to avoid apoptosis post-orchiectomy. MATERIAL AND METHODS: Thirty male Wistar rats weighing 250-300g were divided into three groups: group I - they were subjected to bilateral orchiectomy and sacrificed eight weeks after the procedure; group II - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure; and group III - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the end of the experiment, the prostatectomy was performed in all rats. The presence of oxidative stress was determined by assaying the blood level of 8-isoprostane and the occurrence of apoptosis was evaluated by identification of active caspase-3 through immunohistochemical analysis. RESULTS: The statistic analysis of active caspase-3 showed that in the long-term castrated group the detection was higher than in groups were the alpha-tocopherol was supplemented (p=0.007). Analysis of 8-isoprostane levels showed higher concentrations of reactive oxygen species in group I compared to other groups (p<0.05). Groups II and III presented active caspase-3 lower than in group I (p<0.05). CONCLUSION: Our exploratory analyses demonstrate a method to study the aging process and its influence on oxidative stress of prostatic tissue and cells death rate. Based on our results we can suggest that alpha tocopherol supplementation can decrease the apoptotic process as well as the oxidative stress levels induced by androgen deprivation of the prostate gland.

Impact of castration with or without alpha-tocopherol supplementation on the urethral sphincter of rats

OBJECTIVE: To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. MATERIALS AND METHODS: Forty male Wistar rats weighing 250-300g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. RESULTS: The 8-epi-PGF2 levels were statistically higher (p < 0.0003) in the Orchiectomy group compared to others groups while Sham and Orchiectomy-full-Tocopherol groups presented statistically similar values (p = 0.52). Collagen volumetric densities were significantly lower in Sham and Orchiectomy-full-Tocopherol groups (p < 0.022). Sham group presented statistically greater muscle fiber percent. CONCLUSION: Castration caused oxidative stress in the urethral sphincter complex, with increased collagen deposition. Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

Elderly men's quality of life and lower urinary tract symptoms: an intricate relationship

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

Injeção roncoplástica: comparação entre etanol 50% e oleato de etanolamina 5% no tratamento do ronco / Injection snoreplasty: comparison between ethanol and ethanolamine oleate in snoring treatment

INTRODUÇÃO: O ronco acomete grande parte da população e o seu tratamento é um desafio, pois existem muitas opções terapêuticas e esta escolha deve ser individualizada. Entre vários procedimentos palatais para tratamento do ronco e da apneia do sono, a injeção roncoplástica (IR) surgiu como uma alternativa econômica para alguns casos selecionados. OBJETIVOS: Avaliar os resultados da IR no tratamento do ronco, comparando o oleato de etanolamina 5% e o etanol 50%. Além disso, descrever uma metodologia de aplicação própria e analisar seus resultados clínicos, complicações, medidas palatais por ressonância magnética (RM) e parâmetros polissonográficos. MÉTODOS: estudo clínico, duplo cego e randomizado, realizado de 2007 a 2010. Foram incluídos adultos roncadores com índice de apneia-hipopneia (IAH) <15. Critérios de exclusão: cirurgia palatal pregressa, IMC>35, obstrução nasal ou faríngea > 50% da via aérea, deformidade crânio-facial, gestação, ausência de acompanhante de quarto, alergia ou comorbidade grave. Sessões ambulatoriais de IR foram realizadas no palato mole (três pontos), máximo de três sessões, com quatro semanas de intervalo mínimo. Os pacientes foram divididos em dois grupos: um recebeu oleato de etanolamina 5% (A) e o outro, etanol 50%(B). A intensidade do ronco foi aferida por escala visual-analógica de 10cm (EVA). Foram analisados outros parâmetros clínicos, como sonolência e dor, além de RM e polissonografias. RESULTADOS: Dos 22 pacientes incluídos neste estudo (A=9 / B=13), 19 (86,4%) apresentaram diminuição importante ou desaparecimento do ronco. A intensidade de ronco (EVA) decresceu nos dois grupos: de 8,0 para 3,0 no Grupo A (p=0,007) e de 8,0 para 3,0 no Grupo B (p=0,001). A escala de sonolência de Epworth diminui de 8,0 para 6,0 no Grupo A (p=0,05) e de 11,0 para 5,0 no Grupo B (p=0,005). A dor durante o procedimento, aferida em EVA, foi de 4,0 nos dois Grupos. Nos dias subseqüentes, a dor foi de 3,5 no Grupo A e 2,0 no Grupo B, sem...

BACKGROUND: Snoring affects a significant portion of the population and the treatment is a challenge, because there are many options and the choice should be individualized. Among various palatal procedures for the treatment of snoring and sleep apnea, the injection snoreplasty (IS) has emerged as an economic alternative for selected cases. OBJECTIVES: To evaluate IS in the snoring treatment, comparing 5% ethanolamine oleate and 50% ethanol. Also, to describe a distinct method of injection and analyze its clinical results, complications, palatal measures by resonance imaging (MRI), and polysomnographic parameters. METHODS: Clinical, double-blind, randomized trial conducted from 2007 to 2010. Adult snorers with apneahypopnea index (AHI) <15 were included. Exclusion criteria: previous palatal surgery, BMI> 35, pharyngeal or nasal obstruction> 50% of the airway, craniofacial deformity, pregnancy, lack of room partner, allergy or severe comorbidity. IS outpatient sessions were held in the soft palate (three points), maximum of three sessions, with at least four weeks apart. Patients were randomized into two groups: 5% ethanolamine oleate (A) or 50% ethanol (B). The intensity of snoring was measured by visual-analogue scale of 10 cm (VAS). Other clinical parameters were analyzed, such as sleepiness and pain, as well as MRI and polysomnography. RESULTS: Of 22 patients enrolled in this study (A = 9 / B = 13), 19 (86.4%) showed significant reduction or disappearance of snoring. The snoring loudness (VAS) decreased in both groups: 8.0 to 3.0 in Group A (p=0.007) and 8.0 to 3.0 in Group B (p=0.001). The Epworth Sleepiness Scale decreased from 8.0 to 6.0 in Group A (p=0.05) and from 11.0 to 5.0 in Group B (p=0.005). The pain during the procedure, measured by VAS, was 4.0 in both Groups. On subsequent days, the pain was 3.5 in Group A and 2.0 in Group B, with no difference between groups. In the overall sample, the mean time to return to regular nourishing was 2.0 days...

Avaliação do risco de síndrome da apneia obstrutiva do sono (SAOS) nos pacientes internados em spa de emagrecimento / Evaluation of the risk of sleep obstructive apnea syndrome (SOAS) in patients admitted in a slimming spa

Introdução: A associação entre a Síndrome de Apneia Obstrutiva do Sono (SAOS) e a obesidade tem sido muito estudada. A SAOS é caracterizada pela obstrução repetitiva da via aérea superior durante o sono, muitas vezes acompanhada de roncos, dessaturação de oxigênio, fragmentação do sono e sonolência excessiva diurna (SED). Tipo do Estudo: Transversal Prospectivo. Objetivo: Analisar os resultados do Questionário de Berlim (QB) e da Escala de Sonolência de Epworth(ESE) preenchidos pelos pacientes internados no Spa Med Campus Sorocaba, procurando encontrar quais deles possuem sonolência diurna e alto risco para SAOS. Método: Os pacientes responderam voluntariamente aos Questionários de Berlim e ESE. O estudo foi do tipo transversal, com análise dos questionários preenchidos durante o ano de 2008. Resultados: Obtivemos um total de 276 pacientes, com um total de 183 mulheres e 93 homens. A prevalência de obesos foi de 111 pacientes (40,2%). No grupo QB positivo, obtivemos 84 pacientes no total; sendo 34 homens, quanto ao grupo ESE positivo, encontramos no total 67 pacientes, sendo 24 homens. Conclusão: A ESE e o QB têm servido atualmente de triagem para os distúrbios do sono e pode servir como possível indicador para a polissonografia. Os resultados dos questionários nos mostram a alta prevalência de indivíduos internados em SPA com risco de apresentar SAOS, especialmente os obesos.

Introduction: The association between Sleep Obstructive Apnea Syndrome (SOAS) and the obesity has been highly studied. The SOAS is characterized by the repetitive obstruction of the upper airways during the sleep, many times accompanied by snores, oxygen desaturation, sleep fragmentation and excessive daytime somnolence (EDS). Type of Study: Prospective Transversal. Objective: To analyze the results of the Berlin Questionnaire (BQ) and the Epworth Somnolence Scale (ESS) completed by the patients interned in the Spa Med Campus Sorocaba, attempting to find who has daytime somnolence and high risk for SOAS. Method: The patients completed the Berlin Questionnaire and the ESS voluntarily. The study was of transversal type with analysis of the questionnaires completed during the year of 2008. Results: We obtained a total of 276 patients with a total of 183 women and 93 men. The prevalence of obese patients was of 111 patients (40.2%). In the positive BQ group, we obtained a total of 84 patients; 34 male; as to the positive ESS group, we found a total of 67 patients, 24 male. Conclusion: The ESS and the BQ have been useful currently for selection of the sleep disorders and may serve as a possible indicator for polysonography. The questionnaires' results show us the high prevalence of individuals interned in SPA with the risk of having SOAS, specially the obese ones.

Complicaçöes orbitárias em pacientes com sinusite aguda / Orbital complications in patients with acute sinusitis

Introduçäo: As complicaçöes orbitárias das sinusites permanecem como tópico importante dentro da otorrinoloringologia, a despeito do decréscimo de sua prevalência observado após o advento da antibioticoterapia. Objetivo: Tendo por objetivo determinar as características clínicas e terapêuticas nos casos de sinusites complicadas. Forma de estudo: Clínico prospectivo randomizado. Material e método: Realizamos um estudo retrospectivo de 128 pacientes internados nos últimos 15 anos na Divisäo de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. A maior parte destes pacientes eram crianças ou adultos jovens (82,81 por cento dos pacientes tinham menos de 30 anos de idade) e 57,81 por cento eram do sexo masculino. Todos os pacientes apresentaram evoluçäo satisfatória, sem seqüelas tardias. Conclusäo: Observamos que o diagnóstico precoce destas patologias é importante, bem como o é a instituiçäo de terapêutica adequada e agressiva (clínica ou cirúrgica). É a açäo conjunta destes dois fatores que irá promover uma diminuiçäo da morbimortalidade destas afecçöes

Tumor carcinóide de seio esfenoidal: relato de caso / Carcinoid tumor of sphenoid sinus: case report

Os tumores neuroendócrinos do trato nasossinusal são extremamente raros. Os tumores carcinóides têm origem nas células neuroendócrinas de todo, corpo, mas são encontradas principalmente no trato gastrintestinal, brônquios e pâncreas. Outras localizações são extremamente incomuns e, na revisão de literatura realizada, só foram encontrados dois casos de tumor carcinóide localizados em seio maxilar. O objetivo deste estudo é relatar um caso de tumor carcinóide localizado em seio esfenoidal. Paciente masculino, com 33 anos de idade, apresentando há 10 anos quadro de cefaléia bitemporal, sem melhora com uso de analgésicos ou antiinflamatórios não hormonais. Não apresentava sintomas de obstrução nasal, rinorréia ou epistaxe. Negava outra sintomatologia sistêmica. Ao exame otorrinolaringológico, venficava-se somente retração bilateral de membrana timpânica. Submetido à tomografia computadonzada (TC) de seios paranasais, verificou-se massa ocupando seio esfenoidal e sela túrcica. O laudo anatomopatológico da biópsia da massa foi de tumor carcinóide. O paciente foi submetido a tratamento radioterápico por dois meses, e a TC de controle evidenciou novamente massa ocupando o seio esfenoidal. Optamos por nova intervenção cirúrgica, com o objetivo de remoção tumoral, mas, devido ao intenso sangramento intraoperatório, foi somente possível remover parcialmente o tumor. O resultado anatomopatológico da peça cirúrgica confirmou tumor carcinóide. Atualmente, o paciente encontra-se em tratamento radioterápico e quimioterápico, apresentando boa resposta terapêutica. Os tumores nasossinusais são raros e podem apresentar pouca sintomatologia. Descrevemos um caso de um tumor extremamente incomum no trato respiratório superior, cujo diagnóstico só foi possível através da TC e anatomia patológica

Atresia congênita bilateral de coanas em paciente de 13 anos: relato de caso / Congenital bilateral choanal atresia in a 13-year old patient: case report

A atresia de coana congênita é uma falha no desenvolvimento de comunicação entre as fossas nasais e a porção nasal da faringe. Sua incidência varia de 1:5000 a 1:8000 nascimentos, sendo mais comum no sexo feminino, em uma razão de 2:1. O tratamento cirúrgico é preconizado nas primeiras semanas de vida nos pacientes com acometimento bilateral, pois representa uma situação de risco de vida. Paciente de 13 anos de idade procurou nosso Serviço com queixa de rinorréia e obstrução nasal bilateral desde a infância, na qual se diagnosticou atresia congênita de coanas bilateral. O diagnóstico foi confirmado pela endoscopia nasal e tomografia computadorizada, que mostrou uma atresia do tipo óssea. Optou-se pelo tratamento cirúrgico através da técnica endoscópica endonasal. Não se utilizou nenhum tipo de stent após a cirurgia. A paciente encontra-se em acompanhamento ambulatorial e apresenta resultado favorável até o presente momento. A atresia coanal bilateral é uma doença que coloca em risco a vida da criança, sendo que, na maioria dos casos, é nas primeiras semanas. Entretanto, em raros casos, pode ser encontrada durante a investigação de adultos com obstrução nasal e rinorréia bilateral