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Biomedical subjects

O Butugan

Publications and source records attributed to O Butugan.

At least 19 recordsLinked to original sources

Endoscopic ligature of the sphenopalatine artery for severe posterior epistaxis.

OBJECTIVE: To present our experience with endoscopic ligature of the sphenopalatine artery in the treatment of severe posterior epistaxis of patients who had previously undergone conservative procedures. METHODS: Eleven patients with severe posterior epistaxis were treated during a 25-month period with an endoscopic ligature of the sphenopalatine artery. The basic principle of the surgical technique is to identify the branches of the sphenopalatine artery through an endoscopic endonasal approach and to apply a titanium clip under direct vision. RESULTS: The endoscopic ligature of the sphenopalatine artery was performed unilaterally in 10 patients and bilaterally in 1 patient, with a total of 12 ligatures. It was possible to identify the sphenopalatine artery in all cases with a successful outcome using this surgical technique alone. CONCLUSION: Endonasal endoscopic ligature of the sphenopalatine artery has been an effective surgical technique for treating severe posterior epistaxis.

Adult↗

Bilateral ethmoidal mucocele in cystic fibrosis: report of a case.

The purpose of this study is to report a rare and interesting case of a 10-month-old boy who presented a bilateral ethmoidal mucocele associated with cystic fibrosis and to discuss, according to the literature, the sinonasal involvement in this disease. Only nine pediatric patients with both disorders have been reported previously in literature, and all of these cases were older than 1 year 4 months and presented with a unilateral mucocele.

Cystic Fibrosis↗

Genetic alterations in Ki-ras and Ha-ras genes in juvenile nasopharyngeal angiofibromas and head and neck cancer.

CONTEXT: Ras gene mutations have been associated to a wide range of human solid tumors. Members of the ras gene family (Ki-ras, Ha-ras and N-ras) are structurally related and code for a protein (p21) known to play an important role in the regulation of normal signal transduction and cell growth. The frequency of ras mutations is different from one type of tumor to another, suggesting that point mutations might be carcinogen-specific. OBJECTIVES: To study the occurrence of Ki-ras and Ha-ras mutations. We also studied the relative level of Ha-ras mRNA in 32 of the head and neck tumors. DESIGN: Case series. SETTING: University referral unit. PARTICIPANTS: 60 head and neck tumors and in 28 Juvenile Nasopharyngeal Angiofibromas (JNA). DIAGNOSTIC TEST: Using PCR-SSCP we examined the occurrence of Ki-ras and Ha-ras mutations. The relative level of Ha-ras mRNA was examined by Northern blot analysis. RESULTS: None of the head and neck tumors or JNA samples showed evidence of mutations within codons 12, 13, 59 and 61 of Ki-ras or Ha-ras genes. However, 17 (53%) of the tumors where gene expression could be examined exhibited increased levels of Ha-ras mRNA compared with the normal tissue derived from the same patient. CONCLUSIONS: Our results demonstrate for the first time that mutations of Ki-ras and Ha-ras genes are not associated with the development of JNA and confirm previous reports indicating that activating ras mutations are absent or rarely involved in head and neck tumors from western world patients. Furthermore, our findings suggest that overexpression of Ha-ras, rather than mutations, might be an important factor in the development and progression of head and neck tumors.

Adult↗

Microbiology of sinusitis in patients undergoing bone marrow transplantation.

As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapy, more patients have become susceptible to sinus disease caused by unusual organisms. Sinusitis caused by fungi and gram-negative bacteria can be difficult to treat, may lead to severe complications, and should be managed promptly in the bone marrow transplant patient. Here we present the results of 41 cultures of the paranasal sinuses obtained from 18 bone marrow transplant patients in whom sinusitis developed. The most common agents were gram-negative bacteria (56.7%), followed by gram-positive bacteria (26.7%) and fungi (16.6%). In 13 samples the cultures were negative. Nasal cultures were performed ipsilateral to the sinus drained in 28 cases. Concordance was obtained in only 5 (17.8%) samples. The antibiogram of the isolated agents from the maxillary sinuses in this series revealed that the most efficient antibiotics were those that covered gram-negative bacteria. Treatment was usually prolonged in these patients, and different antibiotics were necessary to clear infections from the sinuses. In conclusion, treating sinusitis in bone marrow transplant patients may be challenging. Considerations about the microbiology and antibiogram susceptibilities of this specific population should be kept in mind when dealing with such cases.

Anti-Bacterial Agents↗

Ear and nose foreign body removal in children.

The removal of foreign bodies in children is very common in the otolaryngologist's daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

Child↗

Frontoethmoidal mucocele with intracranial extension: a case report.

Mucoceles with intracranial extension are often reported by otolaryngologists and neurosurgeons. The authors present a case of a large frontoethmoidal mucocele with intracranial and intraorbital extension exerting a mass effect on the anterior cranial fossa. The patient experienced spontaneous drainage of the mucocele without evidence of recurrence of the lesion after a one-year period, suggesting that mucoceles, regardless of size, can be treated with conservative procedures such as functional endoscopic sinus surgery.

Aged↗

Nasal chondroma: a case report and review of the literature.

Although rare tumors, chondromas will on occasion be encountered by the otolaryngologist in his routine daily practice. The authors describe a nasal myxochondroma in an 8-year-old child, which was removed satisfactorily surgically, with no signs of recurrence even after 4 years of follow-up. Because chondromas may also present as nasal polyps, the knowledge of cartilaginous tumors in the nose plays a pivotal role for a better approach to these patients.

Child↗

Expression of growth factors, proto-oncogenes, and p53 in nasopharyngeal angiofibromas.

Biopsies from 25 juvenile nasopharyngeal angiofibromas (JNAs) and respective normal inferior turbinates were examined and compared. The expression patterns of the messenger RNAs (mRNAs) for various growth factors possibly involved in the growth of mesenchymal cells, as well as angiogenesis and fibrosis, were also compared. These growth factors included insulin-like growth factor II (IGF-II), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), transforming growth factors-beta1 (TGF-beta1) and platelet-derived growth factors (PDGF-A and PDGF-B). Quantification of mRNA coding for proto-oncogenes and suppressor genes related to proliferation (i.e., c-myc, c-fos, p53) was also undertaken. Tumor and turbinates expressed similar levels of bFGF, VEGF, TGF-beta1, c-myc, c-fos, and PDGF-A mRNAs. The presence of TGF-beta1 protein was confirmed by immunohistochemistry in several structures that characterize the lesions of JNA, which suggests that TGF-beta1 may play a role in the development of the fibrous component of this tumor. PDGF-B and p53 were overexpressed (i.e., twice the mean level found in turbinates) in 50% and 32% of JNAs, respectively but there was no statistical significance when compared with controls. Statistically significant increased expression of IGF-II mRNA was observed in JNA (P = .04). IGF-II mRNA levels were correlated to p53 (P = .05) and PDGF-B (P = .034), indicating a possible synergistic action of such factors in JNA. The results of this study suggest that IGF-II might be a potential growth regulator of nasopharyngeal angiofibromas.

Adolescent↗

Mucocele of the maxillary sinus.

The maxillary sinus mucocele is a rare condition and it usually presents clinically as a benign tumor. Sixteen patients were evaluated. A previous history of surgery or injury to maxillary sinus was obtained in 12 cases, the diagnosis being confirmed by computed tomography imaging. Recovery is often complete after Caldwell-Luc operation. The authors discuss some important aspects of diagnosis and treatment.

Adult↗

Rhinocerebral mucormycosis: predisposing factors, diagnosis, therapy, complications and survival.

Mucormycosis is the most acutely fatal fungal infection of the human being (5). Although relatively uncommon, its morbidity makes it an extremely important disease for the Otolaryngologist-Head and Neck Surgeon. A review of 11 cases of rhinocerebral mucormycosis (nine female and two male patients) admitted from 1961 to 1994 at Hospital das Clinicas, University of Sao Paulo was undertaken. The age range was from eight months to 49 years with a median age of 31 years. In the current study, we present and discuss the predisposing factors, the methods of diagnosis, the treatment given the complications observed and the survival of the disease. The survival rate for paranasal sinus mucormycosis in this study was 72.7% (8/11). All deaths occured within the first month after diagnosis and institution of treatment. All the patients that died presented with diabetic ketoacidosis. Hemiplegia as a neurological complication of the disease was seen in 66.6% (2/3) of the deaths. Survival analysis (Fisher Test p < 0.05) indicates that diabetic ketoacidosis and hemiplegia are negative prognostic factors in mucormycosis survival. The authors intend to add some more information to the limited literature on paranasal sinus mucormycosis.

Adolescent↗

Olfactory neuroblastoma. A report of 5 cases.

UNLABELLED: The present paper presents 5 cases of olfactory neuroblastoma (NO), showing the problems concerning the diagnosis and treatment. The olfactory neuroblastoma is a rare tumor that represents 1 to 5% of the malignant tumors of the nasal cavity. The wide range of the patient's age associated with variety clinical and histological findings, made the diagnosis often difficult. CONCLUSIONS: neuroblastoma has a difficult diagnosis; the histologic diagnosis should always be complemented by the immunohistochemical investigation; surgical resection with adequate margins is the first treatment on resectable lesions.

Adult↗

Schwannoma of the nasal septum. Apropos of 2 cases.

We present two cases of schwannoma of the nasal septum. One of the patients has neurofibromatosis type 2; however, her main complaint was nasal obstruction. Schwannoma deriving from the septum is an extremely rare pathology, both in systemic neurofibromatosis type 2 and as a solitary lesion. There are no characteristic symptoms. Histopathologic examination may be inconclusive so that the definitive diagnosis requires immunohistochemic studies or electron microscopy. Differential diagnosis includes several neurogenic and mesenchymal tumors. CT scan and MRI studies are helpful in evaluating the origin, localization and extension of the lesion. Complete resection of the mass is usually curative, although patients with neurofibromatosis present a higher risk of local recurrence and malignant transformation.

Adult↗

[Infantile fibromatosis: report on two cases].

Fibromatosis is an aggressive, infiltrating, non-metastasizing disease characterized by a benign neoplastic histology. These lesions tend to infiltrate the soft tissues and adjacent bony tissues, hence the term "aggressive infantile fibromatosis". Two cases of this rare pathology are presented and discussed.

Facial Neoplasms↗

Use of the Silvermann-Franklin biopsy needle for the diagnosis of intra-sinusal lesions, especially of the maxillary sinus.

This report proposes the use of a new technique in the diagnosis of pathology of the maxillary sinus, including neoplasm, using the Silvermann-Franklin" needle. The procedure consists of approaching the diseased sinus through the canine, as in conventional biopsies, with the removal of fragments using forceps. Ten patients with an X-ray suggesting a mass in the maxillary sinus were studied. An 80% correlation was found between the anatomical and pathological findings of the biopsy and the subsequent surgical findings. The advantages of this method include the low risk, performance under local anaesthetic in an out-patient mode, the possibility of obtaining the diagnosis prior to surgery, and the possibility of obtaining deep-seated tissue fragments.

Adolescent↗

Multiple steroid receptors in nasopharyngeal angiofibromas.

Cytosols from 12 nasopharyngeal angiofibroma tissues were analyzed for the presence of estrogen (ER), progesterone (PR), androgen (AR), and glucocorticoid (GR) receptors, by using a dextran charcoal assay. Progesterone receptors (58%) clearly predominate over ER and AR (25%). Thus, nasoangiofibromas can be classified as ER-PR+ tumors. Glucocorticoid receptors were found in 84% of the tumors. Steroid receptor levels, although slightly higher than those determined in three specimens of normal turbinate, were quantitatively low. Positive PR and AR tumors appeared to correlate with high density of fibroblasts and endothelial cells.

Adolescent↗

[Young's syndrome: recurrent respiratory tract infections and azoospermia].

INTRODUCTION: Young's syndrome is part of primary ciliary dyskinesia, characterized by repeated airway infections and congenital epididymis obstruction. CASE REPORT: The authors present the case of a 28-year old male with recurrent rhinosinusitis and pneumonia. Sweat and immunologic tests fell within the normal range. Sperm analyses revealed absence of spermatozoa although spermatogenesis was normal according to the findings in testis biopsy. DISCUSSION: The final diagnosis was Young's syndrome the first case of the disease reported in Brazilian literature. CONCLUSIONS: The authors emphasize the need for appropriate diagnosis and genetic counselling as well as differential diagnosis with cystic fibrosis in these cases.

Adult↗