Transmission Electron Microscopy of the Presbylarynx in the Process of Voice Aging.

INTRODUCTION: Microscopy studies of presbylarynx have identified epithelial atrophy, as well as vocal muscle atrophy, increased collagen, and decreased nonfibrous proteins of the extracellular matrix. Studies on the ultrastructure of presbylarynx are rare and can help us understand the pathophysiology of presbyphonia. OBJECTIVE: To describe details on the ultrastructure of presbylarynx by transmission electron microscopy (TEM). SUBJECTS AND METHODS: Sixteen human larynges were removed and distributed in two groups: control (n = 8; 30-50 years; six females, two males) and seniors (n = 8; 75-92 years; six females, two males). After preparation for TEM, the specimens, including epithelium and lamina propria, were examined and photographed at increasing magnification. RESULTS: Control: the epithelium was intact, with overlapped cells, and with desmosomes between the intercellular junctions. The basement membrane was continuous and uniform, and the lamina propria contained collagen and elastic fibers in a regularly distributed loose arrangement, as well as some fibroblasts of different shapes. Senior: the epithelial cells were separated by enlarged intercellular junctions. The basement membrane was delicate and continuous. In the lamina propria there was predominance of elongated fibroblasts. Under the basement membrane a dense network of collagen fibers could be identified. CONCLUSIONS: In this study with TEM some structural changes were identified, particularly in the larynx of the elderly, both in the epithelium and lamina propria, some of them with likely participation of fibroblasts, which reinforces the importance of additional ultrastructure as well as molecular studies targeting those cells, as they are the main precursors of the components of the extracellular matrix.

Scanning Electron Microscopy of the Presbylarynx.

OBJECTIVE: To describe the findings on the presbylarynx under scanning electron microscopy. STUDY DESIGN: Cadaver study. SETTING: Universidade Estadual Paulista (Botucatu, São Paulo, Brazil). SUBJECTS AND METHODS: Sixteen vocal folds were removed during necropsies and distributed into 2 age groups: control (n = 8; aged 30-50 years) and elderly (n = 8; aged 75-92 years). The right vocal fold was dissected, fixed in glutaraldehyde 2.5%, and prepared for scanning electron microscopy. The thickness of the epithelium was measured using a scandium morphometric digital program. RESULTS: In the control group, the epithelium had 5 to 7 overlapped cell layers, rare desquamation cells, and little undulation with protruding intercellular junctions. The lamina propria showed a uniform network of collagen and elastic fibers in the superficial layer. A dense network of collagen was identified in the deeper layer. In the elderly group, the epithelium was atrophic (2-3 cells), with more desquamation cells and intercellular junctions delimited by deep sulci. The epithelial thickness was lower in elderly than in controls (mean [SD], 221.64 [145.90] µm vs 41.79 [21.40] µm, respectively). The lamina propria had a dense and irregular distribution of collagen and elastic fibers in the superficial layer. In the deep layers, the collagen fibers formed a true fibrotic and rigid skeleton. CONCLUSION: Scanning electron microscopy identified several changes in the elderly larynx, differentiating it from the controls. These alterations are probably related to the aging process of the vocal folds. However, the exact interpretation of these findings requires additional studies, even to the molecular level, having the fibroblasts as targets.

Voice Disorders: Etiology and Diagnosis.

OBJECTIVES: Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients. METHODS: We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses. RESULTS: Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated. CONCLUSIONS: In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly.

Alterations in extracellular matrix composition in the aging larynx.

OBJECTIVE: To study by immunohistochemistry the alterations of collagens I, III, IV, and V and elastin in the aging process of the human larynx. STUDY DESIGN: Cadaver study. SETTING: Universidade Estadual Paulista, Botucatu Medical School, São Paulo State University (UNESP), Brazil. SUBJECTS AND METHODS: Thirty vocal folds were obtained at autopsy from 10 adult men (aged 30 to 50 years) and 20 geriatric men (10 aged 60 to 75 years and 10 aged >75 years). Mid membranous vocal fold slides were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the increase in brownish staining of the lamina propria structures of vocal folds, from superficial to deep layers. RESULTS: There was an increase of collagen I and III immunoexpression in the elderly larynges, in both layers. Collagens IV and V were immunoexpressed in the vessels endothelium of the lamina propria and in the basement membrane. The immunoexpression of elastin decreased in the elderly larynges, in both lamina propria layers of the vocal folds. CONCLUSION: A clear increase of collagens I and III and a decrease of elastic fibers were observed in the lamina propria of vocal folds. The concentration of collagens IV and V was the same across age groups. These findings suggest that as men age, the density of the extracellular matrix increases, brought about by an increase in collagen, while the loss of elastin results in decreased viscoelasticity.

Scanning electron microscopy of the tongue, pharynx, and larynx of rats exposed to cigarette smoke.

OBJECTIVE: To examine, by using scanning electron microscopy, the surface of the tongue, pharynx, and larynx of animals exposed to tobacco. STUDY DESIGN: Experimental study. METHODS: Twenty rats were allocated to two groups: group I, control group: 10 rats not exposed to any inhaling pollutant and group II, tobacco group: 10 rats exposed to smoke from 10 cigarettes twice a day for 260 days. Animals of both groups had no restriction of food or water. After those 260 days, their aerodigestive segment was removed, and fragments of their tongue, hypopharynx, and right vocal fold were immersed in 2.5% glutaraldehyde and prepared for scanning electron microscopy. RESULTS: The filiform tongue papillae of the tobacco group were irregularly displayed, flattened, and adhered to each other. The hypopharynx mucosa was highly irregular, thickened, rough and had increased superficial peeling. The mucosa of the vocal folds had deep furrows surrounding the cells. These alterations were not identified for the control group. CONCLUSION: Several changes were recorded for the tongue, pharynx, and larynx of tobacco group animals, confirming the harmful effects of smoking to the respiratory and digestive epithelium.

Prevalence of broncopulmonary and otorhinolaryngologic symptoms in children under investigation for gastroesophageal reflux disease: retrospective analysis.

UNLABELLED: Gastroesophageal reflux disease (GERD) is a common ailment in children, adding up to the evidence that gastroesophageal reflux is an important cofactor in upper airway disorders, especially in the pediatric population. It is very common for it to impact the upper and lower airways. Our goal was to assess the presence of otorhinolaryngological symptoms in children aged between one and twelve years in whom gastroesophageal reflux is suspected. MATERIALS AND METHODS: We assessed data from the charts of patients up to 12 years of age submitted to 24 hour pH measuring of one of two channels, placed at 2 and 5 cm from the LEE in order to confirm the diagnosis of Gastroesophageal Reflux Disease. RESULTS: We studied 143 charts from children who underwent 24 hour pH measuring to investigate GERD; however, only 65 were included. The most prevalent symptoms in the children were bronchopulmonary, found in 89.2%, of sinonasal symptoms (72.3%), otologic (46.1%) and repetition UAW infections (44.6%). When we compared the presence of each group of symptoms of the results from the pH measuring, no significant differences were found between the symptoms and the pH measuring results. CONCLUSION: GERD can manifest in different ways and otorhinolaryngological symptoms are frequent in children.

Prevalence of broncopulmonary and otorhinolaryngologic symptoms in children under investigation for gastroesophageal reflux disease: retrospective analysis / Prevalência de achados broncopulmonares e otorrinolaringológicos em crianças sob investigação de doença do refluxo gastroesofágico: análise retrospectiva

Gastroesophageal reflux disease (GERD) is a common ailment in children, adding up to the evidence that gastroesophageal reflux is an important cofactor in upper airway disorders, especially in the pediatric population. It is very common for it to impact the upper and lower airways. Our goal was to assess the presence of otorhinolaryngological symptoms in children aged between one and twelve years in whom gastroesophageal reflux is suspected. MATERIALS AND METHODS: We assessed data from the charts of patients up to 12 years of age submitted to 24 hour pH measuring of one of two channels, placed at 2 and 5 cm from the LEE in order to confirm the diagnosis of Gastroesophageal Reflux Disease. RESULTS: We studied 143 charts from children who underwent 24 hour pH measuring to investigate GERD; however, only 65 were included. The most prevalent symptoms in the children were bronchopulmonary, found in 89.2 percent, of sinonasal symptoms (72.3 percent), otologic (46.1 percent) and repetition UAW infections (44.6 percent). When we compared the presence of each group of symptoms of the results from the pH measuring, no significant differences were found between the symptoms and the pH measuring results. CONCLUSION: GERD can manifest in different ways and otorhinolaryngological symptoms are frequent in children.

A Doença do Refluxo Gastroesofágico (DRGE) é uma afecção comum na infância, aumentando as evidências de que o refluxo gastroesofágico seja um cofator importante que contribui para as desordens de vias aéreas, principalmente na população pediátrica. É muito comum serem observadas manifestações em vias aéreas superiores e inferiores. Nosso objetivo é avaliar a presença de sintomas otorrinolaringológicos em crianças com idade de um a 12 anos e suspeita de doença do refluxo gastroesofágico. MATERIAIS E MÉTODO: Foram avaliados dados de prontuários de pacientes de até 12 anos submetidos à pHmetria de 24 horas de um ou dois canais, locados a 2 e 5 cm do EEI para confirmação de diagnóstico de Doença do Refluxo Gastroesofágico. RESULTADOS: Foram analisados 143 prontuários de crianças que realizaram pHmetria de 24 horas para investigação de DRGE; porém 65 foram incluídas. Os sintomas mais prevalentes nas crianças eram os broncopulmonares, encontrados em 89,2 por cento, de sintomas nasossinusais (72,3 por cento) , otológicos (46,1 por cento) e de infecções de VAS de repetição (44,6 por cento). Quando comparada a presença de cada grupo de sintomas com o resultado da pHmetria, não foi encontrada diferença significativa entre os sintomas e o resultado da pHmetria. CONCLUSÃO: DRGE pode se manifestar de diversas maneiras e os sintomas otorrinolaringológicos são frequentes em crianças.

Avaliação da enurese noturna em crianças com distúrbios respiratórios obstrutivos (DRO) durante o sono, antes e após adenotonsilectomia / Nocturnal enuresis in children with obstructive breathing disorders during sleep, before and after adenotonsilectomy

Introdução: Distúrbios respiratórios obstrutivos (DRO) são frequentes em crianças e têm como sua principal causa a hipertrofia das tonsilas. A enurese noturna tem sido associada aos DRO, causando assim importante impacto psicossocial. Objetivo: Avaliar a associação entre enurese e DRO em crianças e sua possível melhora após adenoidectomia e/ou tonsilectomia. Métodos: Foram estudadas 138 crianças do Ambulatório de Distúrbios do Sono, com idade entre 5 e 12 anos, com indicação de adeno e/ou tonsilectomia por DRO. Foram analisadas variáveis como: sexo, idade e presença de enurese. As crianças foram reavaliadas três a seis meses após o tratamento cirúrgico. Resultado: Dentre as 138 crianças, 31 (22,5%) apresentavam enurese noturna. Houve predomínio na faixa etária de cinco a sete anos, com distribuição igual entre os gêneros. Houve melhora da enurese em 21 (67,7%) dos pacientes após o procedimento cirúrgico, em sete (70%) das dez crianças nas quais persistiu a enurese, também houve persistência dos roncos. Conclusão: A enurese noturna é frequente em crianças com DRO e pode ter melhora após tratamento da causa da obstrução respiratória, sugerindo interação entre SAOS e enurese noturna.

Reações cutâneas desencadeadas por drogas / Skin reactions to drugs

FUNDAMENTOS: Drogas podem desencadear reações adversas. As manifestações cutâneas são as mais comuns. OBJETIVO: Analisar as farmacodermias e relacionar as drogas envolvidas e os tipos de reações cutâneas mais freqüentes. MÉTODOS: Estudo retrospectivo e descritivo. Avaliados pacientes com diagnóstico inicial de farmacodermia internados na Enfermaria de Dermatologia, no período de janeiro de 1999 a junho de 2004. Incluídos no estudo os pacientes que confirmaram o diagnóstico de farmacodermia, com base em critérios clínicos e histopatológicos, após a análise dos prontuários. RESULTADOS: Tiveram diagnóstico inicial de farmacodermia 121 pacientes. Incluídos 43 pacientes, dos quais 51,2 por cento eram do sexo feminino, e 86 por cento da raça branca. Destes, 48,8 por cento faziam uso de apenas uma medicação, sendo o grupo dos antibióticos o mais utilizado (20,9 por cento) e o principal responsável pela farmacodermia(33,3 por cento). O segundo grupo de drogas mais envolvido foi o dos antiinflamatórios (16,7 por cento), seguido pelo dos anticonvulsivantes (13 por cento), e analgésicos/antipiréticos (13 por cento). A forma clínica da erupção cutânea foi exantema maculopapular em 41,9 por cento dos pacientes, eritrodermia em 25,6 por cento e urticária em 23,3 por cento. CONCLUSÃO: O exantema maculopapular foi a principal forma de reação cutânea desencadeada por drogas, e os antibióticos, os medicamentos que mais freqüentemente desencadearam essas reações.

BACKGROUND: Drugs may trigger adverse reactions and skin manifestations are the most frequent ones. OBJECTIVE: To assess drug reactions and report the drugs involved and the most frequent types of skin reactions. METHODS: A retrospective and descriptive study. Data of inpatients at the Dermatology Ward with initial diagnosis of adverse drug reactions were evaluated from January 1999 to June 2004. Patients with confirmed diagnosis were included in the study based on clinical and histopathological criteria, after analysis of medical charts. RESULTS: Initial diagnosis of adverse drug reactions was confirmed in 121 patients. Forty-three patients were included in the study; 51.2 percent were females and 86 percent were caucasians. A total of 48.8 percent were on one drug only. Antibiotics were the most commonly used drug (20 percent) and accounted for 33 percent of the drug eruptions. The second group comprised anti-inflammatory drugs (16.7 percent), followed by anticonvulsants (13 percent), analgesic/antipyretic (13 percent) agents. Skin eruption manifested as maculopapular exanthema in 41.9 percent patients, erythrodermia in 25.6 percent, and urticaria in 23.3 percent. CONCLUSION: Maculopapular exanthema was the main type of skin reaction triggered by use of drugs, and these reactions were most frequently caused by antibiotics.