Tratamento cirúrgico de laringomalácia: casuística de hospital pediátrico terciário / Laryngomalacia surgery: a series from a tertiary pediatric hospital

Laringomalácia é o colapso supraglótico durante a inspiração; é responsável por até 75% dos casos de estridor em crianças de até 30 meses. O achado característico é estridor inspiratório; até 20% dos pacientes apresentam quadros graves, sendo necessária intervenção cirúrgica. A supraglotoplastia é o procedimento de escolha e se considera a presença de comorbidades como o maior fator prognóstico para o sucesso da cirurgia. OBJETIVOS: Descrever a casuística de hospital pediátrico terciário, índices de sucesso e analisando fatores prognósticos cirúrgicos. MÉTODO: Estudo de coorte retrospectivo. Incluídos 20 pacientes submetidos à supraglotoplastia no período de julho de 2007 a maio de 2011. RESULTADOS: Dos 20 pacientes, 13 (65%) eram do sexo masculino; a média de idade no procedimento foi de 6,32 meses. Na endoscopia, 12 apresentavam associações de tipos de laringomalácia, 40% apresentavam faringomalácia associada e três apresentavam também traqueomalácia. Treze crianças apresentavam laringomalácia isolada e sete pacientes apresentavam doença do refluxo gastroesofágico. Quinze (75%) pacientes foram submetidos à ressecção de pregas ariepiglóticas. Após o procedimento, 11 pacientes ficaram assintomáticos e dois necessitaram traqueostomia. A presença de comorbidades foi a variável preditora de desfecho desfavorável pós-operatório (p = 0,034). CONCLUSÃO: A supraglotoplastia é um procedimento seguro para tratamento de laringomalácia em casos selecionados.

Laryngomalacia is the condition responsible for 75% of the cases of stridor in children aged up to 30 months, in which there is supraglottic collapse during inhalation. Inspiratory stridor is a characteristic telltale. As many as 20% of the patients are severely affected and require surgery. Supraglottoplasty is the procedure of choice and the presence of comorbidities is the most relevant prognostic factor for surgery success. OBJECTIVE: To describe a series in a tertiary pediatric hospital, its success rates, and surgery prognostic factors. METHOD: This retrospective cohort study enrolled 20 patients submitted to supraglottoplasty between July 2007 and May 2011. RESULTS: Thirteen (65%) patients were males; mean age at the time of the procedure was 6.32 months. Endoscopic examination showed that 12 subjects had combined forms of laryngomalacia, 40% had associated pharyngomalacia, and three also had tracheomalacia. Thirteen subjects had isolated laryngomalacia and seven had gastroesophageal reflux disease. Fifteen (75%) patients underwent aryepiglottic fold resection. After the procedure, eleven patients were asymptomatic and two required tracheostomy. Presence of comorbidities was the strongest predictor of unfavorable postoperative outcome (p = 0.034). CONCLUSION: Supraglottoplasty is a safe therapeutical procedure for select patients with laryngomalacia.

Laryngomalacia surgery: a series from a tertiary pediatric hospital.

UNLABELLED: Laryngomalacia is the condition responsible for 75% of the cases of stridor in children aged up to 30 months, in which there is supraglottic collapse during inhalation. Inspiratory stridor is a characteristic telltale. As many as 20% of the patients are severely affected and require surgery. Supraglottoplasty is the procedure of choice and the presence of comorbidities is the most relevant prognostic factor for surgery success. OBJECTIVE: To describe a series in a tertiary pediatric hospital, its success rates, and surgery prognostic factors. METHOD: This retrospective cohort study enrolled 20 patients submitted to supraglottoplasty between July 2007 and May 2011. RESULTS: Thirteen (65%) patients were males; mean age at the time of the procedure was 6.32 months. Endoscopic examination showed that 12 subjects had combined forms of laryngomalacia, 40% had associated pharyngomalacia, and three also had tracheomalacia. Thirteen subjects had isolated laryngomalacia and seven had gastroesophageal reflux disease. Fifteen (75%) patients underwent aryepiglottic fold resection. After the procedure, eleven patients were asymptomatic and two required tracheostomy. Presence of comorbidities was the strongest predictor of unfavorable postoperative outcome (p = 0.034). CONCLUSION: Supraglottoplasty is a safe therapeutical procedure for select patients with laryngomalacia.

Endoscopic polipectomy with middle meatal antrostomy for antrochoanal polyp treatment.

UNLABELLED: Antrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. AIM: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. MATERIALS AND METHODS: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgical approach was endoscopic polypectomy with middle meatotomy. RESULTS: Twenty-nine patients with ACP, 17(58.6%) were females and 12(41.4%) males, age range, 7-75 years (average of 27.55 years) were included in this study. The main symptom were nasal obstruction 24(82%), oral breathing 11(37.9%), snoring nine (31%), rhinorrhea 5(17%), epistaxis 2(6.9%), headache 2(6.9%), and drip one (3.4%). The association with atopy was found in nine (31%). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9%) presented recurrence. CONCLUSION: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures.

Polipectomia endoscópica com meatotomia média como tratamento de pólipo antrocoanal / Endoscopic polipectomy with middle meatal antrostomy for antrochoanal polyp treatment

Pólipo antrocoanal (PAC) ou pólipo de Killian é uma lesão benigna, não atópica, do seio maxilar. O sintoma predominante é a obstrução nasal. Diversas opções cirúrgicas para o tratamento dos PACs têm sido sugeridas para minimizar a recorrência pós-operatória. A endoscopia vem sendo utilizada como opção terapêutica na ressecção intra-sinusal maxilar da implantação do pólipo através do próprio óstio maxilar ou de uma antrostomia meatal média, com uma menor morbidade que as outras condutas cirúrgicas. OBJETIVO: Avaliar o índice de recidiva da polipectomia endoscópica com meatotomia média no tratamento do PAC. MATERIAL E MÉTODO: Foram avaliados, em estudo retrospectivo, 29 pacientes com o diagnóstico de PAC baseado na história, exame físico, tomografia computadorizada e exame anatomopatológico, tratados entre 1997 e 2004. O procedimento cirúrgico adotado foi polipectomia endoscópica com meatotomia média. RESULTADOS: 29 pacientes com pólipo antrocoanal, 17 (58,6 por cento) do sexo feminino e 12 (41,4 por cento) do masculino, com idades entre 7 e 75 (média 27,55 anos), foram incluídos nesse estudo. Os principais sintomas apresentados foram obstrução nasal, 24 (82 por cento), respiração oral, 11 (37,9 por cento), roncos, 9 (31 por cento), rinorréia, 5 (17 por cento), epistaxe, 2 (6,9 por cento), cefaléia, 2 (6,9 por cento) e gotejamento, 1(3,4 por cento). A associação com atopia foi de 9 (31 por cento). A média de seguimento foi de 17 meses (3-63 meses). Apenas 2 pacientes (6,9 por cento) apresentaram recidiva. CONCLUSÃO: O índice de recidiva obtido por nosso trabalho não difere dos dados da literatura, mesmo quando comparado com procedimentos longamente estabelecidos.

Antrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. AIM: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. MATERIALS AND METHODS: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgical approach was endoscopic polypectomy with middle meatotomy. RESULTS: Twenty-nine patients with ACP, 17(58.6 percent) were females and 12(41.4 percent) males, age range, 7-75 years (average of 27.55years) were included in this study. The main symptom were nasal obstruction 24(82 percent), oral breathing 11(37.9 percent), snoring nine (31 percent), rhinorrhea 5(17 percent), epistaxis 2(6.9 percent), headache 2(6.9 percent), and drip one (3.4 percent). The association with atopy was found in nine (31 percent). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9 percent) presented recurrence. CONCLUSION: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures.

alpha-Tocopherol protects against pentylenetetrazol- and methylmalonate-induced convulsions.

Increased excitatory amino acid transmission and decreased GABAergic inhibitory responses seem to be important mechanisms in the genesis of convulsions, where reactive oxygen species (ROS) have recently been suggested to play a critical role. Therefore, administration of antioxidants may be potentially beneficial for the treatment of convulsive states. In the current study we investigated the effect of the systemic Vitamin E administration, an antioxidant, on the convulsions and oxidative damage induced by two convulsant agents with different mechanisms of action: methylmalonic acid (MMA), which induces convulsions through energy depletion and secondary activation of glutamatergic mechanisms and ROS production and pentylenetetrazol (PTZ), which is a chemical convulsant that causes convulsions by blocking the GABAA receptor-coupled chloride ionophore. Adult male Wistar rats (270-300 g) were injected with vehicle (5% Tween 80 in 0.9% NaCl; 1 ml/kg, i.p.) or alpha-tocopherol (25, 75 or 225 mg/kg, i.p.), once a day for 7 days. On the seventh day of antioxidant treatment, the animals were injected with the antioxidant (or vehicle) and, 30 min later, they were intrastriatally injected with NaCl (9 micromol/2 microl) or with MMA (6 micromol/2 microl) or PTZ (3.26 mmicromol/2 microl). The animals were observed for the appearance of convulsive behavior and the striatal content of thiobarbituric acid-reactive substances (TBARS) and total protein carbonylation were determined. Intrastriatal injection of increasing amounts of PTZ and of MMA caused the appearance of convulsive behavior. PTZ- and MMA-induced convulsions, TBARS production and total protein carbonylation were attenuated by alpha-tocopherol in a dose-dependent manner.