Elastic fibers in Reinke's edema.

OBJECTIVES: We describe the distribution of elastic system fibers in the superficial layer of the lamina propria of Reinke's edema, as compared with normal vocal folds. METHODS: Weigert's resorcin-fuchsin stain after oxidation with 10% oxone was used to study the arrangement of elastic fibers. The findings were categorized and afterward compared with the severity of Reinke's edema. RESULTS: Analysis of 20 specimens of vocal folds with Reinke's edema showed that the network of thin elastic fibers in Reinke's space lost their undulated appearance and had a tangled aspect. In addition, these fibers were no longer parallel to the epithelial basement membrane, but had a random distribution scattered throughout Reinke's space. The elastic fiber network immediately below the epithelial basement membrane also appeared more fragmented in Reinke's edema because of some alteration in organization combined with the 5-microm-thick histologic sectioning plane. No significant difference in the degree of elastic system fiber disarrangement was observed between severity grades II and III (p = 0.382). Large areas of disarrangement were predominant (80% of cases). CONCLUSIONS: The disarrangement of elastic fibers in Reinke's edema may cause insufficient tissue resistance and resilience, contributing to the hypermobility observed in Reinke's edema.

Uso de carbonos pirolíticos (Durasphere) no tratamento da insuficiência glótica: estudo experimental em cães / Use of pyrolytic carbon coated beads (Durasphere) to treat glottic failure: an experimental study in dogs

Nenhum tecido ou substância ideal foi encontrado para a injeção em pregas vocais. O objetivo deste estudo prospectivo foi avaliar o uso do Durasphere como substância de injeção na prega vocal canina. Materiais e métodos: Em seis cães adultos foram injetados 0,3mL de Durasphere no terço médio da prega vocal direita no músculo tireoaritenoideo e 0,3mL de soro fisiológico na prega contralateral. Os animais foram sacrificados após 7 dias (três cães) e 90 dias (três cães). Analisamos os processos inflamatórios no músculo vocal e na lâmina própria das pregas vocais. Resultados: No músculo vocal com Durasphere havia uma inflamação significativamente maior que no músculo controle, formouse um infiltrado linfomononuclear moderado após 7 dias e leve após 90 dias. Não observamos formação de corpos estranhos ou granulomas. Já na lâmina própria houve um processo inflamatório leve nos dois grupos, sem diferença entre eles. Conclusão: Trata-se de uma substância com biocompatibilidade comprovada em humanos, com resultados preliminares e inéditos de sua injeção em pregas vocais caninas que causou um processo inflamatório moderado no músculo vocal após 7 dias e leve após 90 dias, sem formação de corpos estranhos ou granulomas.

There is no ideal tissue or substance to be injected in the vocal folds. The objective of the present study was to assess the use of Durasphere in canine vocal fold injection. Materials and methods: in six adult dogs we injected 0.3 mL of Durasphere in the middle third of the thyroarytenoid muscle and 0.3 mL of saline solution in the contralateral vocal fold. The animals were slaughtered after seven days (three dogs) and after 90 days (three dogs). We analyzed the inflammatory process in the vocal fold and in the lamina propria of the vocal folds. Results: in the vocal muscle which received Durasphere there was a significantly more intense inflammation when compared to the control muscle - there was a moderate lymphomodular infiltrate after seven days and mild after 90 days. We did not observe foreign bodies nor granulomas. On the lamina propria there was a mild inflammatory process in the two groups, without difference between them. Conclusion: this is a substance of proven biocompatibility in humans, with preliminary and unprecedented results and its injection in canine vocal folds caused a moderate inflammatory process after seven days and mild after 90 days, without foreign bodies or granuloma formation.

Use of pyrolytic carbon coated beads (Durasphere) to treat glottic failure: an experimental study in dogs.

UNLABELLED: There is no ideal tissue or substance to be injected in the vocal folds. The objective of the present study was to assess the use of Durasphere in canine vocal fold injection. MATERIALS AND METHODS: in six adult dogs we injected 0.3 mL of Durasphere in the middle third of the thyroarytenoid muscle and 0.3 mL of saline solution in the contralateral vocal fold. The animals were slaughtered after seven days (three dogs) and after 90 days (three dogs). We analyzed the inflammatory process in the vocal fold and in the lamina propria of the vocal folds. RESULTS: in the vocal muscle which received Durasphere there was a significantly more intense inflammation when compared to the control muscle--there was a moderate lymphomodular infiltrate after seven days and mild after 90 days. We did not observe foreign bodies nor granulomas. On the lamina propria there was a mild inflammatory process in the two groups, without difference between them. CONCLUSION: this is a substance of proven biocompatibility in humans, with preliminary and unprecedented results and its injection in canine vocal folds caused a moderate inflammatory process after seven days and mild after 90 days, without foreign bodies or granuloma formation.

Disarrangement of collagen fibers in Reinke's edema.

OBJECTIVE/HYPOTHESIS: To describe the arrangement of collagen fibers in the superficial layer of the lamina propria of the vocal folds with Reinke' edema. STUDY DESIGN: Cross sectional analysis of the lamina propria of the vocal folds with Reinke's edema (RE). METHOD: The picrosirius polarization method was used to study the arrangement of collagen fiber. Findings of collagen disarrangement were categorized semiquantitatively and correlated with RE severity, age, cigarette smoking and duration of dysphonia. RESULTS: Analysis of 20 specimens of vocal folds with RE showed that the intertwined network of collagen fibers resembling a wicker-basket normally observed in vocal folds was disarranged in RE. The collagen fibers were loosely arranged, fragmented and intermixed with varying amounts of myxoid stroma. Moderate and large areas of disarrangement (90% of cases) predominated. Collagen fiber arrangement in the region underneath the epithelium was better preserved when compared with fibers in the deeper region of the superficial layer of the lamina propria. There was a statistical difference in collagen disarrangement between grade II and grade III severity (P = .007) that appeared to be due to the large areas of disarrangement observed in 73% of patients with grade III severity and in 44% of grade II severity. Age was the only variable correlated with collagen fiber disarrangement (r = 0.47, P = .037). CONCLUSION: Our findings suggest that the flexible framework which maintains the uniformity of the lamina propria was lost in RE caused by the disarrangement of the collagen fibers.

Tumor carcinóide atípico de laringe: 3 anos de acompanhamento clínico após tratamento cirúrgico conservador / Atypical carcinoid tumor of larynx: clinical evolution after 3 years with conservative surgery

Os tumores carcinóides atípicos são tumores raros na laringe. São considerados tumores agressivos com metástases precoces, principalmente para linfonodos cervicais. Descrever um caso de paciente com tumor carcinóide atípico na laringe...

Atypical carcinoid tumor is a rare neoplasm in the larynx. They are aggressive tumors with early metastases mainly for cervical nodes. Describe a case of a patient with a atypical carcinoid in the larynx...

Frontal recess anatomy study by endoscopic dissection in cadavers.

INTRODUCTION AND AIMS: The frontal sinus ostium is frequently difficult to recognize because of anatomical structures that hide it. The objective of the present study was to identify and describe the frontal recess anatomy that impairs the endoscopic recognition of the frontal sinus ostium. STUDY DESIGN AND METHODS: A prospective study was conducted by consecutive endoscopic dissections of 32 cadavers (59 sides), 10 (31.25%) females and 22 (68.75%) males. After resection of the lower portion of the uncinate process, with preservation of its upper insertion, we evaluated which anatomical structures needed to be removed for complete visualization of the frontal sinus ostium. RESULTS AND CONCLUSIONS: Visualization of the frontal sinus ostium after resection of the lower portion of the uncinate process was possible in only 11 (18.64%) nasal cavities. The uncinate process (terminal recess) was the main anatomical structure that impaired the recognition of the frontal sinus ostium, present in 45 (76.27%) nasal cavities, followed by the ethmoid bulla (16.95%) and agger nasi cells (6.78%).

Estudo da anatomia do recesso frontal por meio de dissecção endoscópica em cadáveres / Frontal recess anatomy study by endoscopic dissection in cadavers

INTRODUÇÃO E OBJETIVO: O óstio do seio frontal freqüentemente apresenta difícil reconhecimento devido a estruturas anatômicas que encobrem sua visibilização. O objetivo principal desse estudo foi identificar e descrever as estruturas anatômicas do recesso frontal que dificultam o reconhecimento do óstio do seio frontal. CASUíSTICA E MÉTODOS: Foi realizado um estudo prospectivo por meio de dissecção endoscópica consecutiva de 32 cadáveres (59 fossas nasais), 10 (31,25 por cento) do sexo feminino e 22 (68,75 por cento) do sexo masculino. Após exérese endoscópica da porção inferior do processo uncinado, com a preservação da sua inserção superior, avaliamos quais estruturas anatômicas necessitavam ser removidas até a completa visibilização endonasal do óstio do seio frontal. RESULTADOS E CONCLUSÃO: A visibilização do óstio do seio frontal após a exérese da porção inferior do processo uncinado foi possível em apenas 11 (18,64 por cento) fossas nasais. O processo uncinado (recesso terminal) representou a principal estrutura anatômica que dificultou o reconhecimento endonasal do óstio do seio frontal, ocorrendo em 45 (76,27 por cento) fossas nasais, seguido pela bolha etmoidal (16,95 por cento) e a célula agger nasi (6,78 por cento).

INTRODUCTION AND AIMS: The frontal sinus ostium is frequently difficult to recognize because of anatomical structures that hide it. The objective of the present study was to identify and describe the frontal recess anatomy that impairs the endoscopic recognition of the frontal sinus ostium. STUDY DESIGN AND METHODS: A prospective study was conducted by consecutive endoscopic dissections of 32 cadavers (59 sides), 10 (31.25 percent) females and 22 (68.75 percent) males. After resection of the lower portion of the uncinate process, with preservation of its upper insertion, we evaluated which anatomical structures needed to be removed for complete visualization of the frontal sinus ostium. RESULTS AND CONCLUSIONS: Visualization of the frontal sinus ostium after resection of the lower portion of the uncinate process was possible in only 11 (18.64 percent) nasal cavities. The uncinate process (terminal recess) was the main anatomical structure that impaired the recognition of the frontal sinus ostium, present in 45 (76.27 percent) nasal cavities, followed by the ethmoid bulla (16.95 percent) and agger nasi cells (6.78 percent).

Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses.

AIMS: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. STUDY DESIGN: Clinical-Prospective. MATERIAL AND METHODS: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. RESULTS: Intraoral US was performed on 35 cases and its sensitivity was of 95.2%, the specificity was of 78.5% and the accuracy was of 86.9%. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8%. There were 5 false-negatives and 1 false-positive result, sensitivity was 80%, specificity was 92.8% and accuracy was 84.5%. CONCLUSION: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Microbiology of peritonsillar abscesses.

AIM: The objective of the present study was to analyze the microbiology of peritonsillar abscesses. METHODS: Thirty patients, mean age 24,2 years, with peritonsillar abscesses underwent aspiration of at least 3 mL of pus, which was cultured for aerobes and anaerobes. RESULTS: 87% samples showed positive cultures. Aerobic or facultative aerobic bacteria were isolated from 23% aspirates, mixed aerobic and anaerobic bacteria from 60%, and anaerobic bacteria from only 3% aspirate. A total of 69 bacterial isolates (34 aerobic and 35 anaerobic) were recovered. The most common aerobic isolate was Streptococcus sp, with Streptococcus pyogenes being identified in 23% of aspirates. The predominant anaerobic isolates were Prevotella sp and Peptostreptococcus sp. Patients had received previous antimicrobial therapy in 63% cases. In this group, 1.8 isolates per specimen were recovered, a lower number than in the untreated group (3.0 per specimen). No significant difference in the species isolated was observed between these two groups. CONCLUSION: Peritonsillar abscess is usually a polymicrobial infection, with predominance of anaerobic bacteria. The number of agents isolated was larger in patients not previously treated with antibiotics, but the use of antimicrobial drugs did not interfere with the type of bacterium isolated.

Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis.

UNLABELLED: Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM: The objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN: Clinical prospective. METHODS: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Among the 81 studied patients, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed for 40.7% of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively. CONCLUSIONS: We concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Ultra-sonografia intra-oral e transcutânea cervical no diagnóstico diferencial de celulite e abscessos periamigdalianos / Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses

OBJETIVOS: O objetivo deste estudo é determinar a especificidade, sensibilidade e a acurácia da ultra-sonografia (USG) intra-oral e transcutânea no diagnóstico de celulite e abscesso periamigdalianos. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: Trinta e nove pacientes foram atendidos no pronto-socorro de otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com diagnóstico clínico de celulite ou abscesso periamigdaliano. Em todos os pacientes, após a avaliação inicial, foram realizadas ultra-sonografias intra-oral e transcutânea. RESULTADOS: O USG intra-oral foi realizado em 35 casos e demonstrou sensibilidade de 95,2 por cento, especificidade de 78,5 por cento e a acurácia de 86,9 por cento. A USG transcutânea foi factível em todos os 39 pacientes e diagnosticou abscesso periamigdaliano em 53,8 por cento dos pacientes. A sensibilidade foi de 80 por cento, a especificidade de 92,8 por cento e a acurácia de 84,5 por cento. CONCLUSÕES: O USG intra-oral foi bastante sensível no diagnóstico de abscessos periamigdalianos. O USG transcutâneo obteve especificidade superior ao intra-oral. Porém, quando o USG transcutâneo foi realizado em pacientes com trismo, este diagnosticou todos os abscessos periamigdalianos, já que se tratava de coleções grandes, comuns em pacientes com trismo. Estes exames tiveram acurácia semelhantes.

AIMS: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. STUDY DESIGN: Clinical-Prospective. MATERIAL AND METHODS: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. RESULTS: Intraoral US was performed on 35 cases and its sensitivity was of 95.2 percent, the specificity was of 78.5 percent and the accuracy was of 86.9 percent. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8 percent. There were 5 false-negatives and 1 false-positive result, sensitivity was 80 percent, specificity was 92.8 percent and accuracy was 84.5 percent. CONCLUSION: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Microbiologia dos abscessos peritonsilares / Microbiology of peritonsillar abscesses

OBJETIVO: O objetivo deste estudo é avaliar a microbiologia dos abscessos periamigdalianos. MATERIAIS E MÉTODOS: Trinta pacientes com diagnóstico de abscesso periamigdaliano, idade média de 24,2 anos, foram submetidos à punção na região periamigdaliana de maior abaulamento com aspiração do material purulento (volume maior que 3mL). O material foi separado para realização das culturas aeróbicas e anaeróbicas. RESULTADOS: Houve um índice de positividade das culturas de 86,7 por cento. Em 23,3 por cento aspirados houve crescimento apenas de bactérias aeróbicas ou facultativas, 3,3 por cento apenas de bactérias anaeróbicas e por fim em 60 por cento aspirados houve crescimento de bactérias aeróbicas e anaeróbicas. Um total de 69 bactérias foi isolado (34 aeróbios e 35 anaeróbios). Os aeróbios predominantes foram Streptococcus sp, sendo o Streptococcus pyogenes em 23 por cento dos casos. Os anaeróbios predominantes foram Prevotella sp e Peptostreptococcus sp. Pacientes receberam antibiótico prévio em 63 por cento dos casos. Neste grupo foram isolados 1,8 bactérias por aspirado, menor número que nos paciente que não utilizaram antibiótico (3,0 bactérias por aspirado). Não houve diferença significativa no tipo de bactéria isolada nestes dois grupos. CONCLUSÃO: Os abscessos periamigdalianos apresentam na maioria dos casos infecções polimicrobianas, sendo os organismos anaeróbicos agentes importantes. O número de agentes isolados é maior nos pacientes que não utilizaram antibioticoterapia prévia, mas o uso de antimicrobiano não interferiu no tipo de bactéria isolada.

Papel do teste de detecção rápida do antígeno do estreptococcus beta-hemolítico do grupo a em pacientes com faringoamigdalites / Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis

O Streptococcus beta-hemolítico do grupo A (SGA) é o agente etiológico mais comum das faringoamigdalites (FA). O diagnóstico etiológico correto e tratamento adequado evitam complicações supurativas e não-supurativas da faringoamigdalite estreptocócica, entretanto, métodos clínicos de diagnóstico não são confiáveis. Os métodos rápidos de detecção do antígeno do SGA podem ser utilizados no diagnóstico deste agente e evitar uso indevido de antibióticos. OBJETIVOS: Os autores objetivaram avaliar a sensibilidade e especificidade dos testes rápidos para detecção do antígeno do SGA em nosso meio. FORMA DE ESTUDO: Clínico prospectivo. METODOLOGIA: Oitenta e um pacientes com faringoamigdalite aguda, atendidos no PS-ORL do Hospital das Clínicas da FMUSP, no período de maio de 2001 a abril de 2002, foram submetidos a duas coletas simultâneas de material de orofaringe com swabs. O teste rápido de detecção do SGA foi confrontado com a cultura em placa agar-sangue ("gold standard" para o diagnóstico etiológico). RESULTADOS: De 81 pacientes, 56 por cento tiveram teste rápido positivo e 44 por cento negativo; 40.7 por cento apresentaram crescimento de SGA na cultura; a sensibilidade e especificidade do teste rápido foram, respectivamente, 93,9 por cento e 68,7 por cento. O valor preditivo negativo e positivo foram, respectivamente, 94,2 por cento e 67,4 por cento. CONCLUSÕES: A alta sensibilidade do exame permite utilizá-lo com intuito de identificar pacientes com SGA. Os testes de detecção rápida do antígeno estreptocócico se mostraram uma importante arma coadjuvante no diagnóstico etiológico das faringoamigdalites.

Group A beta-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent. AIM: The objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil. STUDY DESIGN: Clinical prospective. METHODS: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent. RESULTS: Among the 81 studied patients, the rapid test was positive in 56 percent and negative in 44 percent. GAS growth in culture was observed for 40.7 percent of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9 percent and 68.7 percent, and the negative and positive predictive values were 94.2 and 67.4 percent, respectively. CONCLUSIONS: We concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Auditory brainstem response and otoacoustic emission assessment of hearing-impaired children of mothers who contracted rubella during pregnancy.

CONCLUSIONS: Based on the auditory brainstem response (ABR) results obtained in this study, the incidence of deafness in children whose mothers had rubella during pregnancy is high (29.5%), and deafness is profound in most cases (80%). Vaccinating women of childbearing age against rubella is essential to reduce the number of cases of childhood sensorineural hearing loss caused by gestational rubella. OBJECTIVE: It has been shown in the literature that, in Brazil, gestational rubella is responsible for approximately 21% of cases of deafness in children. The purpose of this study was to assess the incidence of deafness in children whose mothers had rubella during pregnancy. MATERIAL AND METHODS: Between February and July 2001, we conducted a prospective study assessing hearing status in 17 children (mean age 6 months). The mothers had serologically (ELISA) confirmed gestational rubella. We recorded ABRs and analysed distortion product otoacoustic emissions (DPOAEs). RESULTS: In 5 children (29.5%), ABRs revealed sensorineural hearing loss, which was moderate to severe in 1 (20%) and profound in 4 (80%). The hearing loss was bilateral in 3 children (60%) and asymmetrical in 4 (80%). Regarding DPOAEs, 7 children (41%) presented no response, and this occurred bilaterally in 4 (57%). All children with abnormal ABRs also presented abnormal DPOAEs. Two children with normal ABRs presented abnormal DPOAEs.

Papel do teste de deteccão rápida do antígeno do estreptococcus pyogenes do grupo a em pacientes com faringoamigdalites / Role of rapid antigen detection test for the diagnosis of group A beta-hemolytic streptococcus in patients with pharyngotonsillitis

O Streptococcus pyogenes do grupo A (SGA) é o agente etiológico mais comum das faringoamigdalites (FA). O diagnóstico etiológico correto e tratamento adequado evitam complicacões supurativas e não-supurativas da faringoamigdalite estreptocócica, entretanto, métodos clínicos de diagnóstico não são confiáveis. Os métodos rápidos de deteccão do antígeno do SGA podem ser utilizados no diagnóstico deste agente e evitar uso indevido de antibióticos. OBJETIVOS: Os autores objetivaram avaliar a sensibilidade e especificidade dos testes rápidos para deteccão do antígeno do SGA em nosso meio. FORMA DE ESTUDO: Clínico prospectivo. CASUíSTICA E MÉTODO: Oitenta e um pacientes com faringoamigdalite aguda, atendidos no PS-ORL do Hospital das Clínicas da FMUSP, no período de maio de 2001 a abril de 2002, foram submetidos a duas coletas simultâneas de material de orofaringe com swabs. O teste rápido de deteccão do SGA foi confrontado com a cultura em placa agar-sangue ("gold standard" para o diagnóstico etiológico). RESULTADOS: De 81 pacientes, 56 por cento tiveram teste rápido positivo e 44 por cento negativo; 40.7 por cento apresentaram crescimento de SGA na cultura; a sensibilidade e especificidade do teste rápido foram, respectivamente, 93,9 por cento e 68,7 por cento. O valor preditivo negativo e positivo foram, respectivamente, 94,2 por cento e 67,4 por cento. COMENTARIOS FINAIS: A alta sensibilidade do exame permite utilizá-lo com intuito de identificar pacientes com SGA. Os testes de deteccão rápida do antígeno estreptocócico se mostraram uma importante arma coadjuvante no diagnóstico etiológico das faringoamigdalites.

Brown tumor of the facial bones: case report and literature review.

Brown tumor, an uncommon focal giant-cell lesion, arises as a direct result of the effect of parathyroid hormone on bone tissue inpatients with hyperparathyroidism. The initial treatment involves the correction of hyperparathyroidism, which usually leads to tumor regression. We report a case of brown tumor of the right nasal fossa in a 71-year-old woman. The tumor had caused nasal obstruction and epistaxis. Laboratory evaluation revealed that the patient had primary hyperparathyroidism. Anatomicopathologic investigation revealed the presence of a giant-cell tumor We performed a partial parathyroidectomy, but the tumor in the right nasal fossa failed to regress. One year later we performed surgical resection of the lesion. The patient recovered uneventfully, and she remained asymptomatic and recurrence-free at the 1-year follow-up. Facial lesions with histologic features of a giant-cell tumor should be evaluated from a systemic standpoint. Hyperparathyroidism should always be investigated by laboratory tests because most affected patients are asymptomatic. Surgical resection of a brown tumor should be considered if the mass does not regress after correction of the inciting hyperparathyroidism or if the patient is highly symptomatic.