Lesiones laríngeas post-intubación en adultos y su relación con el tiempo de intubación: Estudio de nasofibrolaringoscopia diagnóstica

Objetivo: Determinar las lesiones laríngeas post-intubación endotraqueal en la unidad de cuidado intensivo (UCI) y cirugía ambulatoria y evaluar su asociación con respecto al tiempo de intubación y otras variables clínico-demográficas en un hospital universitario. Materiales y métodos: Estudio de cohorte analítico incluyendo 60 pacientes (30 de UCI y 30 de cirugía ambulatoria) a quienes se les realizó nasofibrolaringoscopia a las 24 horas post-extubación y a las 3 semanas de control y se registran las lesiones laríngeas encontradas. Resultados: En la primera endoscopia el 70% de los pacientes de cirugía ambulatoria presentaban al menos una lesión laríngea con un promedio de duración de intubación de 0.12 días DS±0.05 desapareciendo todas las lesiones en la segunda endoscopia. En el análisis del grupo de UCI se encontraron lesiones en el 76.6% de los pacientes con un promedio de duración de intubación de 6.0 días DS±3.3. La presencia de edema en pacientes con intubación prolongada por más de 6 días mostró diferencias estadísticamente significativa con respecto al grupo con menos días de intubación (RR 3.048, 95% IC 0.9-9.3, P=0.03) al igual que con antecedente de EPOC (P=0.032) y APACHE II mayor de 17 (RR 1.8, 95% IC 1.114-3.0, P=0.013). EPOC tiene una diferencia estadísticamente significativa con hiperemia (P=0.02) y granuloma (P=0.019). En la segunda endoscopia se encontró mayor frecuencia de hiperemia en los pacientes con intubación prolongada (>6 días) con una diferencia estadísticamente significativa (P=0.01). Conclusión: La intubación prolongada se encuentra asociada a la aparición edema e hiperemia en la laringe. EPOC y puntaje superior de APACHE II se relacionan con hiperemia y granulomas glóticos.

Osteopontin involvement in granuloma formation and in the severity of Paracoccidioides brasiliensis infection

The participation of osteopontin (OPN) in Paracoccidioides brasiliensis infected mice, its association to granulomatogenesis, severity of infection, pattern of lesions, nitric oxide (NO) levels and fungal load were evaluated in this investigation. Immunohistochemistry analysis showed marked OPN staining in extracellular matrix and in macrophages and multinucleated giant cells at the center of lesions, suggesting a possible role of OPN in the distribution of these cells within the granulomas. At 15 days post-infection with a virulent P. brasiliensis isolate, OPN(+) cells were more numerous and intensely immunostained in the loose granulomas of susceptible mice than in those of resistant mice. In addition, high fungal loads and low NO levels were observed in susceptible mice. At 120 days after infection, resistant mice had increased total OPN levels (ELISA) and OPN positivity in compact granulomas, higher NO levels and lower fungal loads than susceptible mice. Residual lesions associated with low OPN levels, high NO and control of fungal dissemination were observed in both mouse strains at 120 days post-infection with the slightly virulent fungal isolate. Therefore, OPN could be associated with higher severity of the disease in an early phase of infection and with a degree of control of the progressive infection.

Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler

COSTA MIGUEL, M. C.; NONAKA, C. F. W.; GERMANO, A. R.; SOUZA, L. B.; SOUZA, L. B. Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler. International journal of oral and maxillofacial surgery, v. 38, p. 385-387, 2009.

Larynx and cervical trachea in humidification and heating of inhaled gases

To evaluate the participation of the larynx and cervical trachea in conditioning inspired gases, we randomly allocated 16 mixed-breed dogs to two groups: group TT (tracheal tube; n = 8) and group LMA (laryngeal mask airway; n = 8). The dogs were anesthetized with pentobarbital sodium and mechanically ventilated for 3 hours. The parameters studied were temperature and absolute humidities of ambient, inhaled, and tracheal air. There was a small increase in tracheal air temperature compared to inhaled air temperature, but no significant difference between groups. The absolute humidity of tracheal air was greater in group LMA than in group TT (23 mg H2O center dot L-1 and 14 mg H2O center dot L-1, respectively; p < .0001). The difference in absolute humidity between the tracheal air and the inhaled air was higher in group LMA at all times (p < .0001). We conclude that the larynx and cervical trachea of the dog participate in humidification and heating of inhaled air by means of air contact with mucosa in this airway segment.

Aspectos clínicos, histológicos e de microscopia eletrônica dos granulomas de intubação das pregas vocais

Granulomas são lesões bilaterais e pediculadas das apófises vocais. Etiologias: intubação, refluxo, traumatismos, fonotraumatismo e idiopática. OBJETIVO: Analisar aspectos clínicos e morfológicos dos granulomas de intubação. MATERIAL E MÉTODOS: Estudo retrospectivo dos pacientes submetidos à microcirurgia por granulomas de intubação, atendidos na Instituição onde foi realizado, a partir de 2002. Analisaram-se: idade, sexo, indicação e tempo da intubação, sintomas, laudos de videolaringoscopia e número de biópsia. Realizou-se estudo histológico em todos os casos e de microscopia eletrônica em três deles. RESULTADOS: 10 pacientes (7 F e 3 M), idade entre 2 anos e 72 anos e tempo de intubação entre 4 horas e 21 dias. Rouquidão foi o principal sintoma. A histologia mostrou hiperplasia epitelial, intenso inflamação importante no corion e proliferação vascular. Na MEV observou-se epitélio escamoso com escassa descamação. À MET, junções intercelulares alargadas e desmossomos alterados. No corion havia lagos sanguíneos, intensa inflamação, e fibroblastos com alterações estruturais como núcleos irregulares e cisternas dilatadas. CONCLUSÕES: Granulomas pós-intubação aparecem em qualquer idade, mesmo em intubação por curto período, e causam rouquidão precocemente. As principais alterações morfológicas são observadas no corion, como proliferação vascular, inflamação e alterações estruturais em fibroblastos indicando disfunção e dano celular.

Histological and immunohistochemical study of the expression of p53 and ki-67 proteins in the mucosa of the tongue, pharynx and larynx of rats exposed to cigarette smoke

Introduction: Head and neck cancers are linked to smoking. The most affected sites are the oral cavity, pharynx and larynx. Experimental studies show epithelial lesions caused by cigarette smoke. Objectives: To investigate in rats the effects of acute cigarette smoke exposure on the mucosa of the tongue, pharynx and larynx.Material and method: Wistar rats were allocated into two groups of 20 animals: CG (control) receiving food and water ad libitum and TG (Tobacco) exposed to the smoke of 40 cigarettes/day for 60 days. Biopsy of their tongues, pharynxes and larynxes were subjected to histopathological, histomorphometric and immunohistochemical studies of protein p53 and ki-67.Result: The histological analysis of tongue from the Tobacco group revealed epithelial hyperplasia (90%), basal cell hyperplasia (95%) and mild to moderate dysplasia (85%). In pharynx showed basal cell hyperplasia (85%), dysplasia (25%) and vascular congestion (95%). In larynx showed basal cell hyperplasia (70%), epithelial hyperplasia (55%), congestion (100%) and inflammatory infiltrate (25%). Morphometric analysis revealed that keratin layer thickness was greater in the tobacco group. P53 immunoexpression was negative in both groups. Ki-67 immunoexpression was positive in basal cell nuclei but in parabasal cell nuclei it was positive only in the Tobacco group.Conclusions: The exposure of animals to cigarette smoke for 60 days resulted in benign lesions. The duration of exposure was not enough to cause the development cancer, as confirmed by the negative expression of p53 protein in all slides examined. Analysis of ki-67 expression showed intense epithelial proliferation in response to damage.

Epidemiology, clinical signs, histopathology and molecular characterization of canine leproid granuloma: a retrospective study of cases from Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Annexin 1: differential expression in tumor and mast cells in human larynx cancer

Annexin 1 protein (ANXA1) expression was evaluated in tumor and mast cells in human larynx cancer and control epithelium. The effect of the exogenous ANXA1 (peptide Ac 2-26) was also examined during the cellular growth of the Hep-2 human larynx epidermoid carcinoma cell line. This peptide inhibited the proliferation of the Hep-2 cells within 144 hr. In surgical tissue specimens from 20 patients with larynx cancer, ultrastructural immunocytochemistry analysis showed in vivo down-regulation of ANXA1 expression in the tumor and increased in mast cells and Hep-2 cells treated with peptide Ac2-26. Combined in vivo and in vitro analysis demonstrated that ANXA1 plays a regulatory role in laryngeal cancer cell growth. We believe that a better understanding of the regulatory mechanisms of ANXA1 in tumor and mast cells may lead to future biological targets for the therapeutic intervention of human larynx cancer. (c) 2007 Wiley-Liss, Inc.

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.

Searching for molecular markers in head and neck squamous cell carcinomas (HNSCC) by statistical and bioinformatic analysis of larynx-derived SAGE libraries

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Imunoglobulinas e C3 no granuloma paracoccidióidico

Utilizou-se o modelo experimental de paracoccidioidomicose, em camundongos, induzida pela inoculação endovenosa de suspensão de formas cerebriformes do P. brasiliensis (cepa Bt2; 1x10(6) formas viáveis/animal), para avaliar, após 2, 4, 8, 16 e 20 semanas: 1. A presença de imunoglobulinas e C3 nos granulomas pulmonares, por imunofluorescência direta; 2. A resposta imune humoral (imunodifusão) e celular (teste do coxim plantar), e 3. A histopatologia das lesões. Os camundongos apresentaram resposta imunocelular positiva desde a 2a. semana, com depressão transitória na 16a. semana, e anticorpos desde a 4a. semana, com pico na 16a. semana. Os granulomas pulmonares foram epitelióides, com numerosos fungos e microabscesses; a extensão das lesões foi progressiva até a 16a. semana, com regressão discreta na 20a. semana. Desde a 2a. semana, houve deposição de IgG e C3 na parede dos fungos no interior dos granulomas e a presença de células IgG positivas no halo linfomononuclear periférico; estes achados foram máximos entre a 4a. e 16a. semanas. Não se detectou depósito de IgG e C3 no interstício dos granulomas. IgG e C3 parecem exercer papel precoce e importante na defesa do hospedeiro contra o P. brasiliensis, contribuindo possivelmente para a destruição dos fungos e bloqueando a difusão de antígenos para fora dos granulomas.