RESUMEN
Sjögren syndrome was chosen as a clinical model to study acinar salivary deficiencies in the development of laryngopharyngeal reflux (LPR). The objective of this prospective cohort study was to compare salivary epidermal growth factor (EGF) concentrations of patients with Sjögren syndrome with and without LPR and gastroesophageal reflux disease (GERD) with normal controls. LPR was diagnosed with positive scores on the Reflux Symptom Index and Reflux and Reflux Finding Score, corroborated by esophagogastroduodenoscopy and/or 24-hour pH-metry. Salivary EGF concentrations of both unstimulated and mechanically stimulated saliva were established using enzyme-linked immunosorbent assay, and the significance level was set at 95%. Twenty-one patients and 19 controls were studied. All patients had LPR and 60% also had GERD. The mean salivary EGF concentration of unstimulated and stimulated saliva in the control group was 1,751.37 pg/ml and 544.76 pg/ml, respectively. Unstimulated and stimulated salivary EGF concentrations in the study group were 2,534.65 pg/ml and 920.69 pg/ml, respectively. These differences were not statistically significant. Body mass index, presence of erosive esophagitis, or severity of hyposalivation did not significantly influence salivary EGF concentrations. LPR and GERD are highly prevalent in patients with Sjögren syndrome. Unlike previous studies in which significant EGF deficiencies were found in patients with reflux laryngitis and GERD, patients with Sjögren syndrome seem to have reflux caused by a decrease in clearance capacity and not in specific salivary components.
Asunto(s)
Factor de Crecimiento Epidérmico , Reflujo Gastroesofágico/metabolismo , Saliva , Glándulas Salivales , Síndrome de Sjögren , Células Acinares/metabolismo , Adulto , Brasil , Estudios de Cohortes , Endoscopía del Sistema Digestivo/métodos , Ensayo de Inmunoadsorción Enzimática/métodos , Factor de Crecimiento Epidérmico/análisis , Factor de Crecimiento Epidérmico/metabolismo , Monitorización del pH Esofágico/métodos , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Humanos , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/metabolismo , Reflujo Laringofaríngeo/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Saliva/química , Saliva/metabolismo , Glándulas Salivales/metabolismo , Glándulas Salivales/patología , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/metabolismo , Síndrome de Sjögren/fisiopatología , Estadística como Asunto , Evaluación de Síntomas/métodosRESUMEN
INTRODUCTION: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. OBJECTIVE: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. METHODS: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. RESULTS: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. CONCLUSION: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group.
Asunto(s)
Reflujo Laringofaríngeo/metabolismo , Saliva/química , Síndrome de Sjögren/metabolismo , Factor de Crecimiento Transformador alfa/metabolismo , Biomarcadores/análisis , Biomarcadores/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Factor de Crecimiento Transformador alfa/análisisRESUMEN
Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group. .
Introdução: A saliva exerce influência primordial na homeostase do sistema digestório, pelos seus componentes inorgânicos e pelos fatores de crescimento. Indivíduos com sindrome de Sjögren (SS) apresentam maior incidência da doença do refluxo gastroesofágico (DRGE) e do refluxo laringofaríngeo (RLF). Concentrações salivares diminuídas do fator transformador de crescimento alfa (TGF-α) foram observadas em doentes dispépticos, porém não há estudos em populações com SS e RLF. Objetivo: Comparar concentrações salivares do TGF-α; de indivíduos com SS e RLF a de controles saudáveis. Método: Trata-se de um estudo prospectivo controlado. Doze pacientes com SS e RLF e 11 indivíduos controles saudáveis tiveram amostras salivares espontâneas e estimuladas coletadas para estabelecer concentração de TGF-α. Resultados: A concentração salivar de TGF-α; foi estatisticamente maior no grupo estudo para ambas amostras. Este aumento foi confirmado nos sete indivíduos do grupo estudo que não apresentavam esofagite erosiva quando comparados ao grupo controle, porém não houve diferença estatística da concentração de TGF-α; entre pacientes do grupo estudo que apresentava mesofagite erosiva em comparação ao grupo controle. Conclusão: A concentração salivar de TGF-α; foi estatisticamente maior no grupo de indivíduos com SS e RLF, sem esofagite erosiva. .
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Reflujo Laringofaríngeo/metabolismo , Saliva/química , Síndrome de Sjögren/metabolismo , Factor de Crecimiento Transformador alfa/metabolismo , Biomarcadores/análisis , Biomarcadores/metabolismo , Estudios de Casos y Controles , Estudios Prospectivos , Factor de Crecimiento Transformador alfa/análisisRESUMEN
INTRODUCTION: Extramedullary plasmacytoma is a plasma cell tumor that grows within any of the soft tissues of the organism. Similar to all plasmacytic dyscrasia, the disease is extremely rare. AIM: This study reports a case of an extramedullary plasmacytoma of the nasal cavity and provides a literature review on the topic. CASE REPORT: A 51-year-old woman presented at our tertiary university hospital with a 6-month history of progressive nasal obstruction, predominantly to the right side, and self-limiting epistaxis. Examination revealed a large pale-reddish tumor within the right nasal cavity. Anatomopathological analysis showed features consistent with a plasmacytoma diagnosis, which was subsequently confirmed by immunohistochemical techniques. Further assessment revealed the solitary nature of the condition, consistent with extramedullary plasmacytoma. Radiotherapy was initiated, which led to partial regression of the symptoms. The tumor was surgically removed by using a mid-facial degloving approach. The patient evolved with a naso-oral fistula and underwent 3 corrective surgeries. No evidence of associated systemic disease was found after 5 years of follow-up. CONCLUSIONS: This case report, which describes a rare tumor of the nasal cavity, is expected to improve the recognition and referral of this condition by ear, nose, and throat (ENT) specialists for multidisciplinary management and long-term follow-up.
Asunto(s)
Femenino , Persona de Mediana Edad , Cavidad Nasal , Plasmacitoma/cirugía , Plasmacitoma/diagnóstico , Informes de Casos , SinusitisRESUMEN
INTRODUCTION: Extramedullary plasmacytoma is a plasma cell tumor that grows within any of the soft tissues of the organism. Similar to all plasmacytic dyscrasia, the disease is extremely rare. AIM: This study reports a case of an extramedullary plasmacytoma of the nasal cavity and provides a literature review on the topic. CASE REPORT: A 51-year-old woman presented at our tertiary university hospital with a 6-month history of progressive nasal obstruction, predominantly to the right side, and self-limiting epistaxis. Examination revealed a large pale-reddish tumor within the right nasal cavity. Anatomopathological analysis showed features consistent with a plasmacytoma diagnosis, which was subsequently confirmed by immunohistochemical techniques. Further assessment revealed the solitary nature of the condition, consistent with extramedullary plasmacytoma. Radiotherapy was initiated, which led to partial regression of the symptoms. The tumor was surgically removed by using a mid-facial degloving approach. The patient evolved with a naso-oral fistula and underwent 3 corrective surgeries. No evidence of associated systemic disease was found after 5 years of follow-up. CONCLUSIONS: This case report, which describes a rare tumor of the nasal cavity, is expected to improve the recognition and referral of this condition by ear, nose, and throat (ENT) specialists for multidisciplinary management and long-term follow-up.
RESUMEN
UNLABELLED: Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.
Asunto(s)
Reflujo Laringofaríngeo/metabolismo , Saliva/química , Síndrome de Sjögren/metabolismo , Adulto , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Concentración de Iones de Hidrógeno , Reflujo Laringofaríngeo/diagnóstico , Persona de Mediana Edad , Saliva/metabolismoRESUMEN
A saliva é fundamental para a homeostase digestiva. Alterações no seu volume e composição são correlacionadas com o refluxo laringofaríngeo (RLF). Estudos recentes demonstraram que pacientes com RLF apresentam acidificação do pH salivar. A síndrome de Sjögren (SS) foi eleita como modelo de hiposalivação, com objetivo de analisar as repercussões da diminuição salivar na laringe e faringe. CASUÍSTICA E MÉTODO: Estudo clínico transversal de 19 sujeitos com SS e RLF comparados com 12 indivíduos saudáveis. Obtidas amostras de saliva total não estimulada (STNE) e saliva total estimulada por mastigação de parafilm M® (STE). RESULTADOS: Todos os indivíduos eram mulheres, média de idade de 60 anos (estudo) e 44 anos. A prevalência de RLF foi 100 por cento. O pH médio na STNE foi 7,53 (grupo estudo) e 7,57(controle), aumentando para 7,87 e 7,93, respectivamente, após estimulação mecânica. Não houve diferença significante de pH entre os grupos. O volume salivar médio dos pacientes com SS foi 1,27mL (STNE) e 3,78mL (STE), sendo o volume salivar do grupo controle significativamente maior (4,02mL na STNE e 11,96mL na STE). CONCLUSÕES: Todos os indivíduos estudados apresentaram RLF, fato provavelmente relacionado à queda uniforme observada no volume salivar e de todos seus componentes, não sendo observadas mudanças no pH salivar no grupo estudado. Isso sugere fisiopatogenias diferentes do RLF para indivíduos com SS.
Saliva is one of the components for the digestive homeostasis. Recent studies have shown that patients with laryngopharyngeal reflux (LPR) present a drop in salivary pH. Patients with Sjögren's syndrome (SS) are a potential clinical research model for xerostomia and its laryngeal and pharyngeal consequences. The aim was to evaluate the characteristics of saliva of patients with SS and LPR. METHODS: 19 patients with SS plus LPR, and 12 healthy controls had their saliva studied prospectively for volume and pH. Two salivary samples were obtained from each participant: whole unstimulated saliva(WUS) and whole stimulated saliva(WSS) while chewing parafilm M®. All the participants were females. RESULTS: Mean age was 60 years (study group) and 44 years (control). LPR was diagnosed on all 19 subjects. The mean pH of WUS was 7.53 (SS) and 7.57 (controls), raising to 7.87 and 7.83 respectively after stimulation. The mean salivary volume of patients with SS was 1.27 mL (WUS) and 3.78 mL (WSS), whereas controls had a significantly higher salivary volume both before and after stimuli. CONCLUSION: A very high prevalence of LPR was found in patients with SS, which is probably caused by a uniform drop in salivary volume and all its contents, rather than a specific deficiency in its components, as shown previously in patients without SS.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Reflujo Laringofaríngeo/metabolismo , Saliva/química , Síndrome de Sjögren/metabolismo , Estudios de Casos y Controles , Estudios Transversales , Concentración de Iones de Hidrógeno , Reflujo Laringofaríngeo/diagnóstico , SalivaRESUMEN
OBJECTIVES: To report the findings of unsuspected underlying concurrent abnormalities of the vocal fold (VF) associated with polyps. STUDY DESIGN AND SETTING: Retrospective chart review at tertiary teaching institution. SUBJECTS AND METHODS: Operative and clinical notes of 81 adults submitted to suspension laryngoscopy for vocal fold polyp (VFP) excision from 1998 to 2007, which had no previous report of associated structural abnormalities. RESULTS: Associated lesions were described in 54 patients (67%) (35 contralateral, 16 ipsilateral, and three bilateral): 18 reactive nodules, 21 sulcus vocalis, five cysts, two microwebs, and eight capillary ectasias. A positive correlation was found between the presence of polyps and associated structural abnormalities (r=0.0035; P<0.05). CONCLUSIONS: The high incidence of concurrent previously unsuspected VF lesions suggests that either these minor underlying anatomical deviations render the VF more vulnerable to vocal abuse, or that phonotrauma may cause a number of VF lesions that can lead to dysphonia.
Asunto(s)
Hallazgos Incidentales , Enfermedades de la Laringe/cirugía , Laringoscopía , Pólipos/cirugía , Pliegues Vocales/anomalías , Pliegues Vocales/cirugía , Adulto , Anciano , Brasil , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Apesar do uso rotineiro da laringoscopia de suspensão (LS) na microcirurgia de laringe, poucos são os estudos na literatura que tratam das complicações deste procedimento. OBJETIVO: Avaliar as complicações extralaríngeas após a laringoscopia de suspensão e relacioná-las com o tempo de cirurgia. MATERIAL E MÉTODO: Trinta e sete procedimentos consecutivos foram analisados prospectivamente enfocando as lesões relacionadas à LS. A pesquisa incluiu análise pré e pós-operatória dos pacientes quanto aos critérios estudados. RESULTADO: O tempo cirúrgico foi menor de trinta minutos em quatorze casos, entre trinta e sessenta minutos em dezesseis casos e maior de uma hora em sete casos. Vinte e sete apresentaram lesão relacionada à LS, sendo mais comuns as lesões da mucosa oral. Lesão temporária dos nervos foi encontrada em cinco casos, e trauma dentário em um caso. Houve relação estatística entre o tempo de cirurgia e o índice de lesões de mucosa oral menores de 1 centímetro, confirmando que procedimentos mais longos apresentam maior risco para esta complicação. CONCLUSÃO: Esses achados demonstram que a LS não é um procedimento inócuo, produzindo complicações freqüentes. Ainda que não representem grande morbidade aos pacientes, tais danos são evitáveis desde que técnicas mais apuradas sejam utilizadas.
Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.
Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Adolescente , Adulto , Anciano de 80 o más Años , Femenino , Complicaciones Intraoperatorias , Laringoscopía/efectos adversos , Laringoscopía/métodos , Nervio Lingual/lesiones , Estudios Prospectivos , Factores de Tiempo , Traumatismos de los Dientes/etnologíaRESUMEN
UNLABELLED: Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.