ABSTRACT
Although it is currently believed that the vocal ligament of humans undergoes considerable development postnatally, there is no consensus as to the age at which it first emerges. In the newborn infant, the lamina propria has been described as containing a sparse collection of relatively unorganized fibres. In this study we obtained larynges from autopsy of human fetuses aged 7-9 months and used light and electron microscopy to study the collagenous and elastic system fibres in the lamina propria of the vocal fold. Collagen fibres were viewed using the Picrosirius polarization method and elastic system fibres were stained using Weigert's resorcin-fuchsin after oxidation with oxone. The histochemical and electron microscopic observations were consistent, showing collagen populations with an asymmetric distribution across different compartments of the lamina propria. In the central region, the collagen appeared as thin, weakly birefringent, greenish fibres when viewed using the Picrosirius polarization method, whereas the superficial and deep regions contained thick collagen fibres that displayed a strong red or yellow birefringence. These findings suggest that the thin fibres in the central region consist mainly of type III collagen, whereas type I collagen predominates in the superficial and deep regions, as has been reported in studies of adult vocal folds. Similarly, elastic system fibres showed a differential distribution throughout the lamina propria. Their distribution pattern was complementary to that of collagen fibres, with a much greater density of elastic fibres apparent in the central region than in the superficial and deep regions. This distribution of collagen and elastic fibres in the fetal vocal fold mirrors that classically described for the adult vocal ligament, suggesting that a vocal ligament has already begun to develop by the time of birth. The apparently high level of organization of connective tissue components in the newborn is in contrast to current hypotheses that argue that the mechanical stimuli of phonation are essential to the determination of the layered structure of the lamina propria and suggests that genetic factors may play a more significant role in the development of the vocal ligament than previously believed.
Subject(s)
Vocal Cords/embryology , Collagen/ultrastructure , Elastic Tissue/embryology , Elastic Tissue/ultrastructure , Female , Gestational Age , Humans , Male , Mucous Membrane/chemistry , Mucous Membrane/embryology , Mucous Membrane/ultrastructure , Vocal Cords/chemistry , Vocal Cords/ultrastructureABSTRACT
OBJECTIVES: The high incidence of respiratory disorders is one of the main problems in perinatal medical care. With the increased use of intubation, the incidence of laryngeal injury causing stenosis has also increased. The principal constriction point in the infant's larynx is the midcricoid area. We sought to provide detailed morphometric data on the anatomy of the cricoid cartilage and its relationship with growth and body characteristics of fetuses at 5 to 9 months of gestational age. METHODS: Nineteen larynges obtained from 17 stillborn infants and 2 newborn infants ranging in gestational age from 5 to 9 months were studied. Measurements of the cricoid cartilage were made with a millimeter-graded caliper. RESULTS: Weight was the variable most correlated with cricoid measurements. The cricoid lumen configuration showed an almost elliptic shape and did not change with gestational age. The mean inner subglottic cricoid area was 19.27 +/- 9.62 mm2 and was related to weight and body surface area. Cricoid growth was more pronounced at the outer portion of the cartilage. CONCLUSIONS: The cricoid lumen configuration was elliptic, and its mean area was smaller than that of available endotracheal tubes. This lumen area was most influenced by weight and height.
Subject(s)
Cricoid Cartilage/anatomy & histology , Trachea/anatomy & histology , Cadaver , Cricoid Cartilage/growth & development , Female , Gestational Age , Humans , Infant, Newborn , Male , Organ Size , Trachea/growth & developmentABSTRACT
BACKGROUND: Few studies investigated brain abnormalities in early onset schizophrenia. OBJECTIVE: To assess computed tomography (CT) abnormalities in patients with childhood or adolescence onset schizophrenia. METHOD: CT scans of patients with childhood (6 to 11 years old) (N=6) or adolescence (12-17 years old) (N=9) schizophrenia were compared to normal controls. Patients were diagnosed based on the DSM-III-R criteria. Ventricular enlargement was measured by the Ventricle to Brain Ratio (VBR) and Cortical Atrophy (pre-frontal prominence) was measured by the Pre-Frontal Atrophy Index (PFAI). RESULTS: There was a significant difference in VBR, but not in PFAI, between subjects and controls [8.26+/-2.79, and 5.71+/-3.26 (p=0.029)], and [2.72+/-1.77, and 3.21+/-1.53 (p=0.424)], respectively. There were no differences of VBR and PFAI between children and adolescents with schizophrenia. CONCLUSION: Compared to controls, patients with child or adolescent onset schizophrenia exhibit more pronounced ventricular enlargement. There were no differences regarding prefrontal atrophy.
Subject(s)
Brain/pathology , Schizophrenia/pathology , Adolescent , Age Factors , Age of Onset , Atrophy/diagnostic imaging , Case-Control Studies , Child , Female , Humans , Male , Psychiatric Status Rating Scales , Schizophrenia/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Few studies investigated brain abnormalities in early onset schizophrenia. OBJECTIVE: To assess computed tomography (CT) abnormalities in patients with childhood or adolescence onset schizophrenia. Method: CT scans of patients with childhood (6 to 11 years old) (N=6) or adolescence (12-17 years old) (N=9) schizophrenia were compared to normal controls. Patients were diagnosed based on the DSM-III-R criteria. Ventricular enlargement was measured by the Ventricle to Brain Ratio (VBR) and Cortical Atrophy (pre-frontal prominence) was measured by the Pre-Frontal Atrophy Index (PFAI). RESULTS: There was a significant difference in VBR, but not in PFAI, between subjects and controls [8.26±2.79, and 5.71±3.26 (p=0.029)], and [2.72±1.77, and 3.21±1.53 (p=0.424)], respectively. There were no differences of VBR and PFAI between children and adolescents with schizophrenia. CONCLUSION: Compared to controls, patients with child or adolescent onset schizophrenia exhibit more pronounced ventricular enlargement. There were no differences regarding prefrontal atrophy.
INTRODUÇÃO: Poucos estudos investigaram anormalidades cerebrais em esquizofrenia de início precoce. OBJETIVO: Avaliar anormalidades cerebrais em tomografias computadorizadas (TC) em pacientes com esquizofrenia de início precoce. Método: Foram comparadas TCs de pacientes com esquizofrenia de início na infância (6-11 anos de idade) (N=6) e na adolescência (12-17 anos de idade) (N= 9). O diagnóstico foi feito de acordo com os critérios do DSM-III-R. A dilatação ventricular foi medida pela Razão Ventricular-Cerebral (VBR) e a atrofia cortical (avaliação da proeminência pré-frontal), pelo índice de Atrofia Pré-Frontal (PFAI). RESULTADOS: Houve uma diferença do VBR, mas não do PFAI, entre pacientes e controles [8,26±2.79, e 5,71±3,26 (p=0,029), e [2,72±1,77, e 3,21±1,53 (p=0,424)]. A comparação entre crianças e adolescentes com esquizofrenia não revelou diferenças nestes parâmetros. CONCLUSÃO: Comparados aos controles, pacientes com esquizofrenia de início precoce na infância ou adolescência apresentam dilatação ventricular mais pronunciada. Nao houve diferenças em relação à atrofia pré-frontal.
Subject(s)
Adolescent , Child , Female , Humans , Male , Brain/pathology , Schizophrenia/pathology , Age Factors , Age of Onset , Atrophy , Case-Control Studies , Psychiatric Status Rating Scales , Schizophrenia , Tomography, X-Ray ComputedABSTRACT
Introdução: A tomografia computadorizada tem sido cada vez mais utilizada para o diagnóstico e avaliação das estruturas nasais, sendo considerado o exame de escolha na avaliação das afecções nasossinusais. Alterações anatômicas como desvio septal, alterações da concha média e células etmoidais anteriores, podem levar a dificuldade de drenagem do infundíbulo etmoidal gerando uma maior incidência de rinossinusites. Forma do estudo: C1ínico retrospectivo. Objetivo: O objetivo deste trabalho é analisar as principais alterações anatômicas encontradas em tomografias computadorizadas de pacientes com diagnóstico de rinossinusite crônica tratados cirúrgicamente. Material e método: Foram analisados retrospectivamente os prontuários de 93 pacientes operados por rinossinusite crônica, no período de dezembro de 1995 a dezembro de 1933. Resultados: Observamos uma distribuição de 48 pacientes do sexo masculino (51,6 por cento)e 45 do sexo feminino (49,4 por cento). A idade média foi de 35, 31 anos. As principais alterações anatômicas encontradas foram: concha média bullosa (12,89 por cento), desvio septal importante (4,30 por cento), concha inferior hipertrofiada (3,22 por cento), concha média paradoxal (2,15 por cento), célula de Haller presente (2,15 por cento)e hipertrofia de processo uncinado (2,15 por cento). Os seios paranasais mais acometidos foram os maxilares, etmoidais anteriores e etmoidais posteriores. Conclusão: não obtivemos achados tomográficos suficientes que pudessem sugerir a correlação entre a presença de alterações anatômicas e o desenvolvimento de rinossinusite crônica. Esperamos que novos estudos sejam desenvolvidos para que se possa estabelecer a real importância dessas variações anatômicas
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Paranasal Sinuses , Rhinitis , Sinusitis , Tomography, X-Ray Computed , Chronic Disease , Retrospective Studies , TurbinatesABSTRACT
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
