Tonsils diseases, past, present and future and the impact in clinical practice in Brazil.

A simplified review of the research carried out in Brazil on tonsils is presented: histopathological findings in children's tonsils with allergy, the detection of Epstein-Barr virus, herpes virus (SV1 e SV2, HHV8) and the correlation between tonsil hypertrophy and recurrence of infection is discussed. The role of allergy in children with tonsillitis and/or tonsil and adenoid hypertrophy are analyzed. After participating in the Tonsils Symposium in 1991, the knowledge of tonsils morphology, immunology and histopathology increased, triggering a change in clinical practice in Brazil.

Is there a relationship between the detection of human herpesvirus 8 and Epstein-Barr virus in Waldeyer's ring tissues?

OBJECTIVE: Human herpesvirus 8 (HHV-8) and Epstein-Barr virus (EBV) are human pathogens associated to a number of neoplasms, including tumors of the Waldeyer's ring. Both viruses have been previously detected by in situ methods in tonsils and adenoids from children. HHV-8 was found in 6.8% of the cases and EBV in about one third of the cases. As they belong to the same gamma-herpesvirus subfamily and share some biological characteristics, it is of medical interest to further explore their possible relationship in the Waldeyer's ring, an issue not yet addressed in the specialized literature. The purpose of the present study is to compare the presence of EBV by in situ hybridization (ISH) in tonsils and adenoids from children up to 14 years of age in cases previously shown to be positive and negative for HHV-8. METHODS: Paraffin wax-embedded sections consisting of 38 tonsils and two adenoids from 40 patients were analyzed. HHV-8 was detected by ISH, using the T1-1 probe for the viral mRNA. EBV was also detected by ISH, using the EBER probe. Both probes and the detection systems were provided by Novocastra. RESULTS: HHV-8 was detected in 19 tonsils and one adenoid. The other 19 tonsils and one adenoid taken from the HHV-8-negative group were selected by pairing age and gender of patients with the HHV-8-positive group. In both groups EBV was detected in 13 cases and was negative in other 7. CONCLUSION: Although both viruses are related in many aspects, some biological and epidemiological features differ. This is reflected in the present results, as EBV is similarly detected in the groups negative and positive for HHV-8, favoring different mechanisms of spread.

Detection of herpesvirus type 8 (HHV8) in children's tonsils and adenoids by immunohistochemistry and in situ hybridization.

OBJECTIVE: Human herpesvirus 8 (HHV8) has been associated with multicentric Castleman's disease, Kaposi's sarcoma and effusion non-Hodgkin's lymphoma. Epidemiological studies have shown seropositivity in variable proportions of populations. It seems to be sexually transmitted among adults and through oral contact among children. The virus has been demonstrated in desquamating oral epithelial cells, but there is no report on its presence in the Waldeyer's ring. The purpose of the present study is to detect HHV8 in tonsils and adenoids from children up to 20 years of age in which these organs had been surgically removed due to hypertrophy, using immunohistochemistry and in situ hybridization. METHODS: Paraffin wax-embedded sections consisting of 181 tonsils and 162 adenoids from 293 patients were analyzed. HHV8 was detected by immunohistochemistry (IHC) using the anti-LNA1 antibody (Novocastra) and the LSAB+ detection system (Dako). For the in situ hybridization (ISH), the T1-1 probe for the viral mRNA and the detection system used were provided by Novocastra. RESULTS: In 20 cases (6.83%), HHV8 was detected in cells morphologically characterized as lymphoid. In three of them epithelial cells were also positive. In 19 cases, the virus was detected in tonsils and in just 1 case in an adenoid. In all 20 cases detection was possible by ISH, whereas in only 2 of them there was a concomitant positivity by IHC. CONCLUSION: Our data support the oral route of contamination by HHV8 in children, in whom tonsils and adenoids may harbor the virus. It is found especially in tonsils and only rarely in adenoids. In these organs, ISH is the method of choice to detect this virus, probably due to the small amount of viral proteins.

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.

Emprego da claritromicina em infecçöes respiratórias na otorrinolaringologia / The use of clarithromycin in the tretment of respiratory system in otorhinolyngology

Este estudo multicêntrico teve a finalidade de avaliar a eficácia e a tolerabilidade da claritromicina nas patologias otorrinolaringológicas. O estudo envolveu 1.448 pacientes com quadros de amigdalite, faringite, rinite, sinusite ou otite. Os pacientes foram tratados com claritromicina na dose de 7,5 mg/Kg de 12/12 horas, por um período variável de 6 a 12 dias; aqueles com mais de 25 Kg de peso receberam 1 comprimido (250 mg) de 12/12 horas pelo mesmo período de tempo. A avaliaçäo global dos resultados evidenciou que este novo macrolídeo apresenta desempenho excelente em 74,1 por cento e bom em 22,2 por cento dos pacientes com infecçöes otorrinolaringológicas. A droga foi bem aceita pelos pacientes, com boa tolerabilidade e com eventos adversos discretos, na sua maioria representados por náuseas e dores abdominais. A facilidade de administraçäo por via oral a cada 12 horas, aliada à eficácia e a boa tolerabilidade, permite concluir que a claritromicina é um antibiótico que deve ser lembrado em nossa prática clínica diária.

Amigdalectomia unilateral / Unilateral tonsillectomy

Os autores apresentaram 20 casos de amigdalectomia unilateral e comenta os resultados obtidos no seguimento imediato e tardio. Dois casos apresentaram amigdalites de repetiçäo na amigdala remanescente e dois casos apresentaram hipertrofia, causando nova obstruçäo de VAS. O trabalho é útil para alertar os especialistas com relaçäo a estas possibilidades no pós-operatório, mas näo invalidando o procedimento, uma vez que a maioria foi beneficiada com ele. Salienta a necessidade de novos estudos com seguimento periódico para uma avaliaçäo mais detalhada deste procedimento

Otites média secretora: tratamento clínico / Otitis media with effusion: clinical treatment

É apresentado estudo de 100 casos de crianças com OMS bilateral. Foram excluídos 10 casos com dados incompletos e/ou duvidosos com abandono do tratamento ou do seguimento. Quanto a terapêutica utilizada, os pacientes foram divididos em cinco grupos: 1. Quimioterápico (sulfametoxazol + trimetoprima) + prednisona. 2. Prednisona isolada. 3. Antihistamínico ñ antibiótico ou quimioterápico. 4. Antibiótico ou quimioterápico isolado. 4. Assepsia nasal. O critério para a escolha do tratamento foi baseado no quadro clínico, idade e fatores coadjuvantes. Os resultados foram tabelados quanto a idade, freqüência de otites, presença de obstruçäo de vias aéreas superiores, otoscopia e terapêutica. Foi demonstrado que uma grande porcentagem obteve cura com tratamento clínico (76,6%) e apenas 16,6% necessitaram tratamento cirúrgico (timpanotomia com colocaçäo de tubo de ventilaçäo). O trabalho fortalece a idéia do valor do tratamento clínico precedendo qualquer indicaçäo cirúrgica, discutindo-se o uso de quimioterápicos, antibióticos, antihistamínicos e costicosteróides associados ou näo entre si

Otoscopia de recém-nascido normal: estudo preliminar / Otoscopy in normal newborn: preliminary study

Os autores fizeram 200 otoscopias em 100 RNs normais de seis horas a cinco dias de vida. Foi feita coleta de dados com relaçäo ao conduto auditivo externo (calibre, tipo de material existente) e a membrana timpânica (inclinaçäo, coloraçäo e transparência). O conduto era largo em 21% dos casos; regular, em 65%; e estreito, em 14%. O material encontrado no conduto era, na maioria dos casos (70%), constituido de vérnix caseoso, 15 crianças apresentaram condutos limpos. A MT estava horizontalizada em todos os casos, sendo 27%, leve (+); 57%, moderada (++) e 16%, acentuada (+++). Quanto a coloraçäo da MT, obtivemos: acinzentada, 58%; róseo-transparente, 25%; róseo-espessada, 9% e 8% com MT de aspecto igual ao de criança maior. Os nove casos de MT róseo-espessada sugeriam líquido na caixa média. Os autores discutem seus achados, comparam com os de outros autores e salientam a necessidade do otologista e do neomatologista näo só de serem treinados para otoscopia de recém-nascidos, mas também estarem cientes da variabilidade de achados otoscópicos. Sugerem que este exame seja feito de rotina em berçarios, para se fazer estudos prospectivos

Amiloidose de laringe: tratamento com "laser" de CO2 / Laryngeal amyloidosis: treatment with CO2

Apresenta-se um caso de amiloidose de laringe, discutindo a etiopatogenia da doença sob a luz das teorias atuais. Os tratamentos utilizados até entäo säo apresentados e, por fim, mostra-se o resultado do tratamento com aplicaçäo de raios laser de CO2, que, no caso, foi excelente

Cor pulmonale por hipertrofia de amigdalas e das adenoides. Fatores predisponentes. / Cor pulmonale ducto hypertrophy of tonsils and adenoids. Predisponent factor

Os autores apresentam 2 casos de cor pulmonale associado a hipertrofia de vegetacoes adenoides e amigdalas em criancas com possivel erro metabolico. Fazem revisao da literatura discutindo a mucopolissacaridose como possivel fator predisponente

Actinomicose das amigdalas palatinas.Valor do exame histopatologico de rotina / Actinomycosis of the palatine tonsils.Value of routine histopathological examination

Os autores apresentam tres casos de actinomicose amigdaliana que foram achados de exames anatomo-patologicos realizados de rotina. E salientada a importancia desse diagnostico e a necessidade do exame microscopico de todas as amigdalas retiradas cirurgicamente