Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2

OBJETIVO: Avaliar a voz de pacientes portadores de carcinomas iniciais glóticos submetidos à cordectomia com laser de CO2. MÉTODO: Foram avaliados 15 pacientes com diagnóstico de carcinoma espinocelular Tis e T1 glóticos. A avaliação foi feita por meio da análise perceptivo auditiva da voz, pela análise acústica computadorizada e videolaringoestroboscópica. Os pacientes responderam a um questionário de avaliação geral da voz e um protocolo de qualidade de vida relacionado à voz (QVV). Os resultados foram comparados aos de um grupo controle de indivíduos com laringes normais. RESULTADOS: A análise perceptivo-auditiva da voz revelou que a maioria dos pacientes submetidos à cordectomia apresentou algum grau de disfonia, à custa de rouquidão e soprosidade. Considerando os parâmetros acústicos analisados e os valores do grupo controle, observou-se a tendência de um pequeno incremento da freqüência fundamental, mas sem diferença estatisticamente significante; os valores de jitter, shimmer e da proporção harmônico-ruído apresentaram-se significantemente alterados. Os aspectos analisados na videolaringoestroboscopia mostraram-se melhores nas cordectomias menos extensas. Os escores do QVV sugerem que os pacientes tiveram um discreto impacto na qualidade de vida relacionada à voz. CONCLUSÕES: Apesar da presença de alterações na qualidade vocal dos pacientes submetidos à cordectomia com laser de CO2, os resultados funcionais tendem a ser bem aceitos pelos pacientes, com discreta repercussão na qualidade de vida.

Cicatrização da membrana timpânica na timpanocentese com laser de argônio comparado à técnica com microlanceta: estudo experimental em ratos

Otite média secretora (OMS) e otite média aguda recorrente (OMAR) podem necessitar tratamento cirúrgico para adequada ventilação da orelha média. A abertura clássica do tímpano (timpanocentese) requer incisão por microlanceta sob controle de microscópio cirúrgico e mantém-se patente por alguns dias. Estudos recentes sugerem que a timpanocentese feita por diferentes lasers pode permanecer permeável por maior tempo, o que possibilitaria a normalização da otite média. MATERIAL E MÉTODOS: Neste estudo experimental 34 ratos linhagem Wistar, albinos, machos adultos pesando cerca de 300g, foram anestesiados com cetamina 27 mg/kg e xilazina 2,7 mg/kg. A seguir, foram submetidos à timpanocentese incisional com microlanceta no ouvido direito (ML-OD), e à timpanocentese mediada por laser de argônio no ouvido esquerdo (LA-OE). RESULTADOS: Não houve diferença significativa no tempo de cicatrização das timpanocenteses feitas com laser de argônio ou microlanceta. Todas as timpanocenteses cicatrizaram em 10 dias. CONCLUSÃO: A timpanocentese com laser de argônio apresentou patência e cicatrização semelhantes à técnica clássica com microlanceta realizada em ratos Wistar sem enfermidades de orelha média.

Entamoeba histolytica: detection of coproantigens by purified antibody in the capture sandwich ELISA

A sensitive and specific Capture Sandwich ELISA (CSE) was developed using polyclonal purified rabbit antibodies against three different axenic strains of Entamoeba histolytica: CSP from Brazil and HM1 - IMSS from Mexico, for the detection of coproantigens in fecal samples. Immunoglobulin G (IgG) againstis E. histolytica was isolated from rabbits immunized with throphozoites whole extract in two stages: affinity chromatography in a column containing E. histolytica antigens bound to Sepharose 4B was followed by another chromatography in Sepharose antibodies 4B-Protein A. A Capture Sandwich ELISA using purified antibodies was able to detect 70ng of amebae protein, showing a sensitivity of 93% and specificity of 94%. The combination of microscopic examination and CSE gave a concordance and discordance of 93.25% and 6.75%, respectively. It was concluded that CSE is highly specific for the detection of coproantigens of E. histolytica in feces of infected patients, is quicker to perform, easier and more sensitive than microscopic examination.

Entamoeba histolytica: fecal antigen capture immunoassay for the diagnosis of enteric amebiasis by a monoclonal antibody

Amebiasis continues to be of epidemiological importance in underdeveloped countries. Clinical diagnosis and epidemiological setting in a region are based on the fecal microscopic identification of cysts or trophozoites. This procedure requires well trained personnel, is laborious, of low sensitivity and frequently yields false-positives results. The present study was designed to develop an immuno-enzymatic fecal 96 kDa antigen capture test (COPROELISA-Eh) more sensitive and specific than microscopic diagnosis of amebiasis. Triplicates of 177 stool samples processed by the formol-ether concentration method, were defined as positive or negative by three experienced microscopic observers. Another aliquot was submitted to the antigen capture test by a monoclonal antibody against a specific membrane antigen of pathogenic strains of Entamoeba histolytica. Optical densities were interpreted as positive when they exceeded the mean value of negative samples plus two standard deviations. COPROELISA-Eh showed a 94.4% sensitivity, 98.3% specificity, 96.2% positive predictive value and 97.6% negative predictive value for the detection of E. histolytica in feces. COPROELISA-Eh is more sensitive and specific than microscopic examination, does not require specially trained personnel and allows the simultaneous processing of a large number of samples.

Geographical distribution and intra-domiciliary capture of sylvatic triatomines in La Convención province, Cusco, Peru

The geographical distribution and intra-domiciliary capture of sylvatic triatomines in three districts of the province of La Convención, Cusco, Peru are presented. In the district of Vilcabamba, eight adults of Rhodnius pictipes and five adults of Panstrongylus geniculatus were found. In the district of Ocobamba, 19 adults, 14 nymphs, and eggs of P. rufotuberculatus were found. In the district of Echarate, six adults and 10 nymphs of Eratyrus mucronatus, an adult of R. pictipes and P. geniculatus, and a nymph of P. rufotuberculatus were also found. The geographical distribution of E. mucronatus has extended to Cusco. This is the first report in Peru of household colonization by this triatomine.

Impacto do laser de baixa intensidade na supressão de infecções pelos vírus Herpes simplex 1 e 2: estudo in vitro

O uso do laser de baixa intensidade na supressão de infecções pelos vírus Herpes simplex 1 e 2 foi avaliado após uma a cinco aplicações, sendo observada uma redução gradual na replicação dos vírus Herpes simplex 1 e 2 com 68,4% e 57,3% de inibição, respectivamente, após 5 aplicações, indicando o seu uso clínico.

Espécimes de Schistosoma mansoni descritos por Pirajá da Silva no Brasil (1908) reexaminados pela técnica de microscopia de varredura a laser confocal

INTRODUÇÃO: Pirajá da Silva fez contribuição magnífica à helmintologia ao descrever ovos de Schistosoma mansoni nas fezes de um paciente, no Estado da Bahia e a morfologia de vermes adultos. MÉTODOS: Neste estudo, apresentamos uma avaliação microscópica das lâminas montadas e depositadas na Coleção Helmintológica do Instituto Oswaldo Cruz. A técnica empregada nesta nova análise foi a microscopia de varredura a laser confocal. RESULTADOS: Na parte anterior dos vermes adultos machos, observamos ventosas com musculatura bem desenvolvida e células germinativas dentro dos lobos testiculares. Visualizamos, também, espinhos localizados na região mediana do canal ginecóforo. Na superfície dorsal, encontramos tubérculos e feixes musculares transversais e longitudinais. Em relação ao aparelho reprodutivo feminino, pudemos distinguir um ovo no interior do útero e o ovário alongado com células germinativas. As glândulas vitelínicas estavam restritas à parte posterior das fêmeas conectadas por um ducto vitelínico curto. CONCLUSÕES: As características morfológicas são similares as estudadas anteriormente por Pirajá da Silva com vermes frescos. Além disso, este estudo demonstra a importância de se depositar espécimes nas coleções helmintológicas abrindo possibilidade de novos estudos com estas lâminas.

Recurrent herpes simplex infections: laser therapy as a potential tool for long-term successful treatment

Herpes simplex virus types 1 and 2 are the main infectious agents associated with oral and genital ulcerations. These infections are now widely recognized as sexually transmitted diseases. Among treatment options, low-level laser therapy (LLLT) has shown promising clinical results as a longer-lasting suppression therapy. Two clinical cases are described with recurrent labial herpes for which LLLT was used. Following treatment, both patients remained symptom free during the 17-month clinical follow-up period.

Comparison of capture methods for the diagnosis of adult anopheline populations from State of Mato Grosso, Brazil

INTRODUCTION: The present study compares human landing catches of primary malaria vectors with two alternative methods of capture: the Shannon trap and the Mosquito magnet. METHODS: This study used regression models to adjust capture data to a negative binominal distribution. RESULTS: Capture numbers and relative percentages obtained from the three methods vary strongly between species. The highest overall captures were obtained for Anopheles triannulatus with captures for the Shannon trap and the Mosquito magnet measuring more than 330% higher than captures obtained by human landings. For Anopheles darlingi, captures by the Shannon trap and the Mosquito magnet were about 14% and 26% of human landing catches, respectively. Another species with malaria transmission potential that was not sampled by human landing captures weascaptured by the Shannon trap and the Mosquito magnet (Anopheles oswaldoi). Both alternative sampling techniques can predict the human landing of Anopheles triannulatus, but without proportionality. Models for Anopheles darlingi counts, after totaling daily captures, are significant and proportional, but prediction models are more reliable when using the Shannon trap compared with the Mosquito magnet captures. CONCLUSIONS: These alternative capture methods can be partially recommended for the substitution of human landing captures or, at least, as complementary forms of monitoring for malarial mosquitoes.

Capture of Triatoma arthurneivai (Hemiptera: Reduviidae) using a new luminous trap in Southeast Brazil

INTRODUCTION: Triatomine bug captures in the wild are laborious and time-consuming. Some traps may assist in this task. We report a new trap design and the capture of a specimen of a triatomine rarely found. METHODS: Two luminous traps were installed in the city of Diamantina, State of Minas Gerais, and surveyed weekly for a year. RESULTS: A Triatoma arthurneivai female and other triatomine bugs were caught. CONCLUSIONS: A new trap design may be used in triatomine bugs field captures, mainly in low density areas. We assume the center of endemism of Triatoma arthurneivai is the Espinhaço Mountain range.

Hybrid capture II and PapilloCheck® tests for detection of anal high-risk human papillomavirus

Introduction This study evaluated the level of concordance between hybrid capture II (HCII) and PapilloCheck® for the detection of high-risk human papillomavirus (HPV) in anal samples. Methods Anal cell samples collected from 42 human immunodeficiency virus (HIV)+ patients were analyzed. Results Considering only the 13 high-risk HPV types that are detectable by both tests, HCII was positive for 52.3% of the samples, and PapilloCheck® was positive for 52.3%. The level of concordance was 80.9% (Kappa = 0.61). Conclusions Good concordance was observed between the tests for the detection of high-risk HPV.

Transmyocardial laser revascularization. Early clinical experience

OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR) in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor), University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG). All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score) unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA). Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months), with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

In-stent restenosis. Acute and long-term outcomes after excimer laser coronary angioplasty

OBJETIVE: With the increased use of intracoronary stents, in-stent restenosis has become a clinically significant drawback in invasive cardiology. We retrospectively assessed the short- and long-term outcomes after excimer laser coronary angioplasty of in-stent restenosis. METHODS: Twenty-five patients with 33 incidents of in-stent restenosis treated with excimer laser coronary angioplasty (ELCA) were analyzed. Sixty-six percent were males, mean age of 73±11 years, and 83% were functional class III-IV (NYHA). ELCA was performed using 23 concentric and 10 eccentric catheters with a diameter of 1.6-2.2 mm, followed by balloon angioplasty (PTCA) and ultrasound monitoring. The procedure was performed in the following vessels: left anterior descending artery, 10; left circumflex artery, 8; right coronary artery, 6; left main coronary artery, 2; and venous bypass graft, 7. RESULTS: The ELCA was successful in 71% of the cases, and PTCA was 100% successful. The diameter of the treated vessels was 3.44±0.5mm; the minimal luminal diameter (MLD) increased from 0.30mm pre-ECLA to 1.97mm post-ELCA, and to 2.94mm post-PTCA (p<0.001). The percent stenosis was reduced from 91.4±9.5% before ECLA to 42.3±14.9% after ELCA and to 14.6 ± 9.3% after PTCA (p<0.001). Seventeen (68%) patients were asymptomatic at 6 months and 15 (60%) at 1 year. New restenosis rates were 8/33 (24.2%) at 6 months and 9 /33 (27.3%) at 12 months. CONCLUSION: ELCA is safe and effective for the treatment of in-stent restenosis. In the present sample, a slight increase in new restenotic lesions between 6 and 12 months was found.

Laser assisted extraction of pacemaker and implantable defibrillator leads

OBJECTIVE: To analyze the results of laser-assisted extraction of permanent pacemaker and defibrillator leads. METHODS: We operated upon 36 patients, whose mean age was 54.2 years, and extracted 56 leads. The reasons for extracting the leads were as follows: infection in 19 patients, elective replacement in 13, and other causes in 4 patients. The mean time of catheter placement was 7.5±5.5 years. Forty-seven leads were from pacemakers, and 9 were from defibrillators. Thirty-eight leads were in use, 14 had been abandoned in the pacemaker pocket, and 4 had been abandoned inside the venous system. RESULTS: We successfully extracted 54 catheters, obtaining a 96.4% rate of success and an 82.1% rate for complete extraction. The 2 unsuccessful cases were due to the presence of calcium in the trajectory of the lead. The mean duration of laser light application was 123.0±104.5 s, using 5,215.2±4,924.0 pulses, in a total of 24.4±24.2 cycles of application. Thirty-four leads were extracted from the myocardium with countertraction after complete progression of the laser sheath, 12 leads came loose during the progression of the laser sheath, and the remaining 10 were extracted with other maneuvers. One patient experienced cardiac tamponade after extraction of the defibrillator lead, requiring open emergency surgery. CONCLUSION: The use of the excimer laser allowed extraction of the leads with a 96% rate of success; it was not effective in 2 patients who had calcification on the lead. One patient (2.8%) had a complication that required cardiac surgery on an emergency basis.