Assessment of the accuracy of portable monitors for halitosis evaluation in subjects without malodor complaint. Are they reliable for clinical practice?

Halitosis is defined as a foul odor emanated from the oral cavity, with great impact in quality of life and social restraints. Recently, the use of Breath Alert™ in research increased significantly. Halimeter™, another portable device, is often used in clinical practice. Nevertheless, not many studies have verified the accuracy and compared the results of both devices simultaneously. OBJECTIVE: To verify the accuracy of Breath Alert™ and Halimeter™ in patients without chief complaint of halitosis, using the organoleptic test (OT) as "gold standard." The second aim was to verify whether their concomitant use could enhance the diagnostic accuracy of halitosis. MATERIAL AND METHODS: A cross-sectional analytical study was performed. The quality of expired air of 34 subjects without chief complaint of halitosis was assessed. Two experienced examiners carried out the OT. Afterward, a third blinded examiner performed Halimeter™ (HT) and Breath Alert™ (BA) tests. RESULTS: The OT identified halitosis in 21 subjects (62%). The area under the ROC curve (95% confidence interval) was 0.67 (0.48-0.85) and 0.54 (0.34-0.75) for HT and BA, respectively. The accuracy for HT and BA was 59% and 47%, respectively. The combined usage of HT and BA provided 11 positive results, being 9 subjects (43%) out of the total of 21 positive cases. CONCLUSIONS: Halimeter™ and Breath Alert™ were not able to diagnose halitosis in non-complainer subjects at the same level as the organoleptic examination, since their accuracy were low. Our results suggest that such portable devices are not reliable tools to assess halitosis and may neglect or misdiagnose a considerable number of patients in clinical practice.

Assessment of the accuracy of portable monitors for halitosis evaluation in subjects without malodor complaint. Are they reliable for clinical practice?

Abstract Halitosis is defined as a foul odor emanated from the oral cavity, with great impact in quality of life and social restraints. Recently, the use of Breath Alert™ in research increased significantly. Halimeter™, another portable device, is often used in clinical practice. Nevertheless, not many studies have verified the accuracy and compared the results of both devices simultaneously. Objective: To verify the accuracy of Breath Alert™ and Halimeter™ in patients without chief complaint of halitosis, using the organoleptic test (OT) as "gold standard." The second aim was to verify whether their concomitant use could enhance the diagnostic accuracy of halitosis. Material and Methods: A cross-sectional analytical study was performed. The quality of expired air of 34 subjects without chief complaint of halitosis was assessed. Two experienced examiners carried out the OT. Afterward, a third blinded examiner performed Halimeter™ (HT) and Breath Alert™ (BA) tests. Results: The OT identified halitosis in 21 subjects (62%). The area under the ROC curve (95% confidence interval) was 0.67 (0.48-0.85) and 0.54 (0.34-0.75) for HT and BA, respectively. The accuracy for HT and BA was 59% and 47%, respectively. The combined usage of HT and BA provided 11 positive results, being 9 subjects (43%) out of the total of 21 positive cases. Conclusions: Halimeter™ and Breath Alert™ were not able to diagnose halitosis in non-complainer subjects at the same level as the organoleptic examination, since their accuracy were low. Our results suggest that such portable devices are not reliable tools to assess halitosis and may neglect or misdiagnose a considerable number of patients in clinical practice.

Hearing preservation in cochlear implant surgery.

In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual low-frequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving low-frequency hearing by a "soft surgery" cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients.

Sarcoma sinovial cervical / Neck Synovial Sarcoma

Introdução: O sarcoma sinovial (SS) é uma neoplasia rara e agressiva, sendo a região da cabeça e pescoço envolvida em 5% a 10% dos casos. A apresentação clínica é uma massa indolor de crescimento progressivo. As metástases ocorrem em 10% a 15% dos casos, principalmente por via hematogênica, para pulmões, linfonodos e medula óssea. O tratamento inclui exérese cirúrgica ampla e radioterapia. Ainda não existem dados que comprovem a eficácia da quimioterapia neste tipo de tumor; seu principal benefício consistiria na prevenção de metástases à distancia. A sobrevida em 5 anos varia de 40% a 50%. Objetivo: Relatar um caso de sarcoma sinovial cervical em mulher de 21 anos. Resultados: Paciente com história de tumor cervical de crescimento rápido há 05 meses, inicialmente indolor. Ao exame a lesão apresentava consistência fibroelástica, superfície lisa, aderida a planos profundos, comprometendo os níveis II, III, IV e V à direita e dor à palpação. Tomografia Computadorizada evidenciando grande tumor homogêneo com efeito de massa nos níveis II a V à direita e ocupando espaço parafaríngeo. Punção aspirativa (PAAF) sugestivo de sarcoma. Foi submetida à ressecção do tumor cervical e quimioterapia adjuvante. O anatomopatológico da lesão, com estudo imunohistoquímico, foi compatível com sarcoma sinovial cervical. Está no o 3º ano de seguimento pós-operatório e encontra-se sem sinais de lesão residual ou recidiva. Conclusão: o sarcoma sinovial cervical é uma neoplasia rara e agressiva que demanda ressecção cirúrgica ampla.

Introduction: The synovial sarcoma (SS) is a rare and aggressive neoplasm, with the head and neck involved in 5% to 10% of cases. The clinical presentation is a painless mass with progressive growth. Metastases occur in 10% to 15% of cases, mainly hematogenic to lungs, lymph nodes and bone marrow. Treatment includes wide surgical excision and radiotherapy. There are no data to prove the effectiveness of chemotherapy in this tumor type, but its main benefit would be the prevention of distant metastases. The 5-year survival ranges from 40% to 50%. Objective: To report a case of synovial sarcoma of the neck in a 21 years old female. Results: female with history of cervical tumor of rapid growth for 05 months, initially painless. On examination the lesion presented fibroelastic consistency, smooth surface, adhered to deep planes, compromising levels II, III, IV and V to the right. Computed tomography revealed a large homogenous tumor with mass effect on levels II to V and occupying the right parapharyngeal space. Needle aspiration were suggestive of sarcoma. Underwent resection of the cervical tumor and adjuvant chemotherapy. Histopathological examination of the lesion with immunohistochemical study was consistent with cervical synovial sarcoma. She is in the 3rd year of postoperative follow-up and found no signs of residual lesion or recurrence. Conclusion: synovial sarcoma of the neck is a rare and aggressive neoplasm that requires wide surgical resection.

Comparação dos fatores de risco e complicações da síndrome coronariana aguda entre pacientes com idade superior ou igual a 65 anos e aqueles com menor idade / Comparison of risk factors and complications of the acute coronary syndrome in patients aged over or equal to 65 years and those with younger age

Objetivo. Analisar os principais fatores de risco de síndrome coronariana aguda e as complicações mais frequentes em pacientes com idade igual ou superior a 65 anos hospitalizados em unidade de terapia intensiva, inclusos os casos de óbito após o evento coronariano. Método. Estudo retrospectivo, de revisão de prontuários de 740 pacientes admitidos com síndrome coronariana aguda na unidade de terapia intensiva do Hospital Santa Lúcia, Brasília, DF, no período de outubro de 2003 a fevereirode 2009. Compararam-se os dados dos 377 (51%) pacientes com idade igual ou superior a 65 anos com aqueles dos 363 (49%) pacientes com menos de 65 anos, com os testes qui ao quadrado ou exato de Fisher e Mann-Whitney. Considerou-se estatisticamente significante o valor de p ? 0,05. Resultados. Os portadores de síndrome coronariana aguda com idade igual ou superior a 65 anos, em relação àqueles com idade inferior a 65 anos, apresentam, com mais frequência, infarto agudo do miocárdio sem supradesnivelamento do segmento ST (p = 0,001), hipertensão arterial sistêmica (p = 0,009), diabetes melito tipo 2 (p < 0,0001), insuficiência renal crônica (p = 0,04), antecedente de acidente vascular encefálico (p = 0,01), arritmias (p = 0,01), insuficiênciacardíaca congestiva (0,01) e óbito (p < 0,0001). Conclusões. Houve diferença entre os fatores de risco com relação à idade. A hipertensão arterial sistêmica e o diabetes foram prevalentes na faixa etária igual ou acima dos 65 anos. Esses doentes têm seu curso hospitalar frequentemente acompanhado de complicações, principalmente arritmias e insuficiência cardíaca congestiva. O índice de mortalidadefoi maior nos pacientes com 65 anos de idade ou acima.

Objective. To analyze the risk factors for acute coronary syndrome and the complications in patients aged over or equal to 65 years hospitalized in an intensive care unit, including the mortality after coronary event.Method. Retrospective data collection with 740 patients admitted with acute coronary syndrome in an intensive care unit of Hospital Santa Lucia (Brasilia-DF, Brazil), from October 2003 to February 2009. Comparative analysis between the group of 377 (51%) patients aged over or equal to 65 years, and 363 (49%) patients younger than 65 yearswere performed. Data collection was based on the records, exams and interviews with patients or family members. Results. Patients aged over or equal to 65 years with acute coronary syndrome often have acute myocardial infarction without ST-segment elevation (p = 0.001), hypertension (p = 0.009), type 2 diabetes mellitus (p <0.0001), chronicrenal failure (p = 0.04), previous stroke (p = 0.01), arrhythmias (p = 0.01), congestive heart failure (0.01) and death (p <0.0001). Conclusions. There were differences of risk factors with age. High blood pressure and diabetes mellitus were prevalent in patients aged over or equal to 65 years. These patients have their hospital course frequently accompaniedby complications, especially arrhythmias, congestive heart failure. The mortality rate was higher in patients aged over or equal to 65 years.