Langerhans Cell Histiocytosis in Sphenoid Sinus: Uncommon Bone Involvement.

BACKGROUND Langerhans cell histiocytosis (LCH) is a rare and uncontrolled proliferation of dendritic cells of myeloid origin. The incidence of LHC was estimated at 5 cases per million children ages 0-15 years old. The most common places for this tumor are the jaw, vertebra, pelvis, and the extremities. The disease with multisystem involvement can present a mortality rate of 20% and one-third of children have multisystem involvement. We present a case with unusual bone involvement of the anterior cranial base with a challenging diagnosis and a complex surgical approach. CASE REPORT We report the case of a 6-year-old boy who manifested the disease with daily holocranial headache, worse in the frontal region and refractory to analgesia for 10 days, strabismus homonymous, diplopia, and right palpebral ptosis. The tumor affected the sphenoid sinus, internal carotid artery, and sella turcica, and made contact with the pituitary gland. A joint surgery with Otorhinolaryngology and Neurosurgery was performed by nasal endoscopic access to the skull base by means of the right medial turbinectomy (for the access) and right sphenoid opening, septectomy and opening of the left sphenoid to work with 4 hands and, after resection of lesion, inside the sphenoid. CONCLUSIONS This patient had rare bone involvement from LCH and atypical clinical presentation next to the important and delicate structures of the anterior skull base, but had a satisfactory outcome.

Endoscopic endonasal approach for acromegaly: surgical outcomes using 2018 consensus criteria for remission.

Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission - the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

Endoscopic endonasal approach for acromegaly: surgical outcomes using 2018 consensus criteria for remission

ABSTRACT Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission - the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

Complicações em testes para COVID-19 com swab nasal: relatos de caso / COVID-19 nasal swab testing complications: case reports

Introdução: Atualmente, estamos enfrentando uma pandemia causada pela síndrome respiratória aguda grave coronavirus 2 (SARS-CoV-2) que é um vírus de RNA de uma única cadeia pertencente à família de coronavírus. O método mais utilizado para confirmar o diagnóstico da infecção pelo SARSCoV-2 é através de testes moleculares usando rRT-PCR (reações em cadeia de transcrição reversa em tempo real polimerase) para detectar o RNA viral. A maneira usual de colher amostras virais é através de cotonetes nasofaríngeos. Uma das formas efetivas de controlar a transmissão dessa doença é o diagnóstico precoce e isolamento dos pacientes infectados. Nesse relato abordaremos dois casos de complicações com swab nasal na coleta de rRT-PCR para COVID-19, atendidos em um pronto socorro de otorrinolaringologia. Relato de caso: O primeiro foi de uma paciente que teve a haste do cotonete quebrada em sua fossa nasal esquerda, necessitando de remoção do corpo estranho com por nasoendoscopia. Enquanto o segundo foi de uma paciente que apresentou epistaxe grave devido trauma do cotonete em esporão no septo nasal esquerdo, necessitando de abordagem em centro cirúrgico. Conclusão: É importante ressaltar que mesmo sujeito a complicações possivelmente graves, a realização de testes RT-PCR com cotonete nasal é o padrão ouro no diagnóstico de COVID-19. É muito importante advertir que o profissional treinado ao suspeitar de algum acidente durante o exame deve, precocemente, solicitar avaliação do especialista competente para abordagem adequada. [au]

Background: We are currently facing a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a single-stranded RNA virus belonging to the coronavirus family. The most widely used method to confirm the diagnosis of SARSCoV-2 infection is through molecular tests using rRT-PCR (real-time reverse transcription polymerase chain reaction) to detect viral RNA. The usual way to collect viral samples is through nasopharyngeal swabs. One of the effective ways to control the transmission of this disease is the early diagnosis and isolation of infected patients. In this report, we will approach two cases of complications with nasal swabs in the collection of rRT-PCR for COVID-19, treated in an otolaryngology emergency room. Case Report: The first was from a patient who had the swab rod broken in her left nasal cavity, requiring removal of the foreign body through nasoendoscopy. While the second was from a patient who had severe epistaxis due to trauma of the spur swab in the left nasal septum, requiring an approach in the surgery center. Conclusion: It is important to emphasize that, even subject to possibly serious complications, the performance of RT-PCR tests with a nasal swab is the gold standard in the diagnosis of COVID-19. It is very important to enhance that the trained professional, when suspecting an accident during the exam, should, early on, request an evaluation from the competent specialist for an adequate approach. [au]

Olfactory dysfunction in the scenario of COVID-19 pandemic in patients screened by the telemonitoring.

OBJECTIVE: To assess the clinical and epidemiological profile of patients with olfactory dysfunction in the scenario of COVID-19 pandemic. METHODS: The study selected patients with loss of smell, previously screened by telemonitoring system of the Municipal Health Department of Goiânia (GO), Brazil, who agreed to answer a questionnaire about COVID-19 symptoms and findings of exams. The interviews were conducted by six otolaryngologists, who applied the specific questionnaire, over the phone. RESULTS: A total of 13,910 patients underwent telemonitoring, and 627 (4.51%) had olfactory loss complaints. Out of them, 330 were included in the survey. We observed a higher prevalence of altered smell in women (67%), and in patients aged under 50 years (86%). In most cases the manifestations had a sudden onset (70%), and in the first 5 days of illness (80%). The most prevalent associated symptom was a change in taste (89%), and only 2.7% of interviewed patients required hospitalization. CONCLUSION: Anosmia in COVID-19 is more prevalent in females and individuals aged under 50 years. It is a relevant initial symptom predictive of the disease, together with dysgeusia.

A Periorbital Abscess with Combined Retinal Artery Occlusion and Retinal Vein Occlusion: A Case Report.

BACKGROUND Periorbital abscesses are uncommon complications of acute bacterial rhinosinusitis; with the evolution of diagnostic and therapeutic methods, it is rare that the patient progresses to irreversible blindness. Central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) rarely occur simultaneously and the factors that influence this occurrence are not well understood. CASE REPORT This is a case report of an immunocompetent healthy adolescent girl, who developed irreversible blindness caused by a periorbital abscess secondary to acute bacterial rhinosinusitis due to CRAO and CRVO. Despite 6 days of clinical treatment, including intravenous antibiotics (vancomycin-associated piperacillin with tazobactam), she had a large periorbital abscess and could not open her left eye. Therefore, she was transferred to a tertiary hospital; 1 day after her admission, she underwent surgical treatment to drain the abscess through external and endoscopic access. In addition, she received broad-spectrum antibiotics (meropenem with vancomycin) for 3 weeks. She was no longer able to perceive light with the left eye, despite her clinical improvement. This case report discusses the factors that could have contributed to this poor outcome, despite clinical and surgical treatment. CONCLUSIONS We conclude that there are several mechanisms that can lead to the loss of vision and when the indicated surgical intervention is delayed, it can increase the risk of visual sequelae.

Olfactory dysfunction in the scenario of COVID-19 pandemic in patients screened by the telemonitoring / Distúrbio do olfato no cenário da pandemia de COVID-19 em pacientes triados por telemonitoramento

ABSTRACT Objective To assess the clinical and epidemiological profile of patients with olfactory dysfunction in the scenario of COVID-19 pandemic. Methods The study selected patients with loss of smell, previously screened by telemonitoring system of the Municipal Health Department of Goiânia (GO), Brazil, who agreed to answer a questionnaire about COVID-19 symptoms and findings of exams. The interviews were conducted by six otolaryngologists, who applied the specific questionnaire, over the phone. Results A total of 13,910 patients underwent telemonitoring, and 627 (4.51%) had olfactory loss complaints. Out of them, 330 were included in the survey. We observed a higher prevalence of altered smell in women (67%), and in patients aged under 50 years (86%). In most cases the manifestations had a sudden onset (70%), and in the first 5 days of illness (80%). The most prevalent associated symptom was a change in taste (89%), and only 2.7% of interviewed patients required hospitalization. Conclusion Anosmia in COVID-19 is more prevalent in females and individuals aged under 50 years. It is a relevant initial symptom predictive of the disease, together with dysgeusia.

RESUMO Objetivo Avaliar o perfil clínico-epidemiológico dos pacientes com distúrbios olfatórios no cenário de pandemia da COVID-19. Métodos Foram selecionados pacientes com queixa de perda de olfato, previamente triados pelo sistema de telemonitoramento da Secretaria Municipal de Saúde de Goiânia (GO), Brasil, que concordaram em responder um questionário sobre sintomas e achados de exame em relação à COVID-19. As entrevistas foram realizadas por seis médicos otorrinolaringologistas que, via telefonema, submeteram os participantes a questionário específico. Resultados Dos 13.910 pacientes em telemonitoramento, 627 (4,51%) apresentavam queixas de alteração do olfato, e, destes, 330 foram incluídos na pesquisa. A maior prevalência de alteração do olfato se deu em mulheres (67%), e em pacientes com menos de 50 anos (86%). Na maioria dos casos, as manifestações ocorreram de forma súbita (70%), e nos primeiros 5 dias de doença (80%). O sintoma associado mais prevalente foi alteração do paladar (89%), e houve necessidade de internação hospitalar somente em 2,7% dos pacientes entrevistados. Conclusão A anosmia na COVID-19 é mais prevalente no sexo feminino e em pacientes com menos de 50 anos. Juntamente da disgeusia, trata-se de importante sintoma inicial preditivo da doença.

Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization.

INTRODUCTION: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. MATERIAL AND METHODS: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. RESULTS: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. CONCLUSIONS: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.

Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization

ABSTRACT Introduction: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. Material and methods: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. Results: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. Conclusions: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.

Streptococcus spp em faringotonsilite aguda recorrente: frequência e perfil mde susceptibilidade a antimicrobianos / Streptococcus spp in recurrent acute sore throat: frequency and susceptibility profile to antimicrobial

O objetivo deste trabalho foi determinar a frequência e o perfil de susceptibilidade a antimicrobianosde Streptococcus em faringotonsilite aguda recorrente. Para o estudo foram coletadas tonsilas de122 pacientes com idade entre 3 e 38 anos (66 pacientes do sexo masculino e 56 do sexo feminino)com histórico de faringotonsilite aguda recorrente, associada à hipertrofia tonsilar, e submetidosà tonsilectomia em um hospital escola. Após isolamento e identificação bacteriana, testes deantibiograma foram realizados para determinar o perfil de susceptibilidade a antimicrobianos. Foram isoladas e identificadas 151 amostras bacterianas pertencentes ao gênero Streptococcus.Destas, 41,1 por cento foram identificadas como Streptococcus grupo viridans não hemolítico; 39,1 por cento como Streptococcus grupo viridans a-hemolítico; 7,3 por cento como Streptococcus dos grupos C, F ou G;5,3 por cento como Streptococcus spp. Beta-hemolítico; 4,6 por cento como Streptococcus spp. não hemolítico; 1,3 por cento como Streptococcus spp. grupo a-hemolítico e 1,3 por cento como Streptococcus Beta-hemolíticos do grupo A. Observou-se nos testes de antibiograma resistência aos antibióticos Beta-lactâmicos. É importante omonitoramento da microbiota que coloniza a orofaringe, visto que alguns de seus componentes têmse tornado resistentes aos medicamentos mais utilizados no tratamento das faringotonsilites, o quepode contribuir para os processos de recidiva.

The aim of this study was to determine the frequency and the antimicrobial susceptibility profileof Streptococcus spp. obtained from recurrent acute pharyngo-tonsillitis. For this study, tonsilsfrom 122 patients ranging from 3 to 38 years old (66 males and 56 females) were collected. Allpatients had a history of recurrent acute pharyngo-tonsillitis associated with tonsillar hypertrophyand were submitted for tonsillectomy at a teaching hospital. After isolation and identification,antimicrobial susceptibility tests were performed. A hundred and fifty one isolates of Streptococcusspp. were obtained from tonsils, consisting of 41.06 percent non-hemolytic Streptococcus viridans group,39.07 percent a-hemolytic Streptococcus viridans group, 7.30 percent Streptococcus of C, F or G groups, 5.30 percent beta-hemolytic Streptococcus spp., 4.63 percent non-hemolytic Streptococcus spp., 1.32 percent a-hemolytic Streptococcus spp. and 1.32 percent group A beta hemolytic Streptococcus. Some of the isolates were resistantto beta-lactamic antibiotics. The study showed that components of the oropharynx microbiotapresented resistance to drugs commonly used to treat pharyngo-tonsillitis infections. Correctdiagnosis would improve treatment and could prevent recurrent infections.

[Vocal care: question of prevention and health]. / Cuidados vocais: questão de prevenção e saúde.

Planned by Brazilian doctors, the National Week of the Voice (Semana Nacional da Voz) conquered the world due to the huge reached success. This study has the objective to demonstrate the results reached during the 9th National Week of the Voice (9ª Semana Nacional da Voz) that took place in the Hospital das Clínicas of the Federal University of Goiás. During the event, 125 patients had been selected by the phonoaudiology team and manually filled a questionnaire elaborated for the campaign in the validity of possible pharyngolaryngeal alterations. The patients had been examined by the otorhinolaryngologist using indirect laryngoscopy and, when necessary, submitted to videolaryngoscopy. After medical evaluation, it was observed that 52 people (41.6%) had presented alterations in the speech organs or in proximal regions, in one patient paralysis of left vocal fold was detected and one patient presented tumoral injury. Considering all the patients attended, only one presented malignant neoplasm (squamous cell carcinoma), confirmed later by biopsy.

Otomastoidite por lagochilascaris minor em criança: relato de caso / Minor lagochilascaris otomastoiditis in a child: case report

Introdução: A lagochilascariose é uma a zoonose emergente determinada pela presença do helminto Lagochilascaris minor em tecidos humanos. A infecção ocorre por meio da ingestão de larvas encistadas no tecido subcutâneo, na musculatura e vísceras de animais silvestres consumidos pelo homem de forma crua ou mal cozidos. A doença é rara, insidiosa, de caráter crônico, caracterizada pelo surgimento de lesões, principalmente na região do pescoço, mastoide, ouvido, rino e orofaringe. A gravidade, por vezes fatal, dependerá da localização do parasito. Objetivo: Descrever um caso de otomastoidite por L. minor em criança, atendida no Hospital das Clínicas da Universidade Federal de Goiás. Relato do Caso: Paciente 10 anos, sexo feminino, com queixa de otalgia intensa e otorreia purulenta à direita. À otoscopia, a orelha esquerda apresentava-se normal, enquanto na orelha direita havia edema retroauricular, pólipo no conduto auditivo externo e fístula com drenagem de secreção purulenta. A membrana timpânica estava íntegra. As etapas do atendimento foram descritas desde a consulta inicial até a recuperação da paciente. Comentários Finais: O clínico deve estar alerta para importância em se considerar o diagnóstico diferencial de tal afecção diante de indivíduos residentes em zonas rurais.

Introduction: The lagochilascariosis is an emerging zoonosis determined by the presence of helminth Lagochilascaris minor in human tissues. Infection occurs through ingestion of larvae encysted in the subcutaneous tissue, muscles and viscera of wild animals consumed by man so raw or undercooked. The disease is rare, insidious, chronic condition, characterized by the appearance of lesions, especially in the neck, mastoid, ear, nose and oropharynx. A serious, sometimes fatal, depend on the location of the parasite. Objective: To describe a case of otomastoiditis by L. minor in child, attended at the Hospital das Clinicas, Federal University of Goias. Case Report: Patient 10 years old female, complaining of otalgia and purulent otorrhea right. Otoscopy left ear was normal, while the right ear had retroauricular edema, polyps in the external ear canal and fistula with drainage of pus. The tympanic membrane was intact.The stages of treatment were described since the initial consultation to the recovery of the patient. Final Comments: The clinician should be alert to the importance in considering the differential diagnosis of this disease on individuals residing in rural areas.

Cuidados vocais: questão de prevenção e saúde / Vocal care: question of prevention and health

Idealizada por médicos brasileiros, a Semana Nacional da Voz conquistou o mundo devido ao enorme sucesso alcançado. Este estudo tem por objetivo demonstrar resultados obtidos durante a 9ª Semana Nacional da Voz, realizada no Hospital das Clínicas da Universidade Federal de Goiás (UFG). Durante o evento, 125 pacientes foram triados pela equipe de fonoaudiologia, preencheram manualmente um questionário elaborado para a campanha, na vigência de possíveis alterações laringofaríngeas. Os pacientes foram examinados pelo otorrinolaringologista por meio da laringoscopia indireta e, quando necessário, submetidos à videolaringoscopia. Após avaliação médica, observou-se que 52 pessoas (41,6 por cento) apresentaram alterações no aparelho fonador ou em regiões proximais, em um paciente foi detectada paralisia de prega vocal esquerda e em outra lesão tumoral. Do total de pacientes atendidos, apenas um apresentou neoplasia maligna (carcinoma escamoso), confirmada posteriormente por meio de biopsia.

Planned by Brazilian doctors, the National Week of the Voice (Semana Nacional da Voz) conquered the world due to the huge reached success. This study has the objective to demonstrate the results reached during the 9th National Week of the Voice (9ª Semana Nacional da Voz) that took place in the Hospital das Clínicas of the Federal University of Goiás. During the event, 125 patients had been selected by the phonoaudiology team and manually filled a questionnaire elaborated for the campaign in the validity of possible pharyngolaryngeal alterations. The patients had been examined by the otorhinolaryngologist using indirect laryngoscopy and, when necessary, submitted to videolaryngoscopy. After medical evaluation, it was observed that 52 people (41,6 percent) had presented alterations in the speech organs or in proximal regions, in one patient paralysis of left vocal fold was detected and one patient presented tumoral injury. Considering all the patients attended, only one presented malignant neoplasm (squamous cell carcinoma), confirmed later by biopsy.

Search for Herpesvirus 1 and 2 by in situ hybridization in tonsils and adenoids.

OBJECTIVE: Herpes simplex virus (HSV) has been described as cause of acute tonsillitis. It has also been found in nasopharyngeal florid lymphoid infiltrate, mostly composed of CD4+, CD56+ T-cells, simulating lymphoma. In spite of its widespread prevalence in latent form, to the best of our knowledge no study is available on in situ detection of HSV in chronically hyperplastic nasopharyngeal lymphoid tissue. The purpose of the present study was to search for the presence of HSV 1 and 2 in 21 adenoids and 15 tonsils from children (2-12 years of age) in which these organs had been surgically removed due to hypertrophy. METHODS: Paraffin wax-embedded sections from the 36 cases were submitted to the in situ hybridization technique, using the biotinilated probe to Herpes simplex virus 1 and 2 (Pan Path, Amsterdam) and the Rembrandt Universal DISH & HRP Detection Kit (Pan Path, Amsterdam). Positive control consisted of a previously tested Herpes infected lung. RESULTS: In none of the 36 cases studied were positive nuclei detected in adenoid and tonsils, either in lymphoid, in stroma or in epithelial cells, as those seen in the positive control. CONCLUSION: HSV does not seem to be implied in tonsil or adenoid chronic lymphoid hyperplasia. These organs do not seem to harbor the virus latently, or the amount of virus is too low to be detected without amplification methods.