RESUMO
BACKGROUND: Interleukin-6 (IL-6) is an inflammatory mediator linked to nasal polyposis and asthma, with a single nucleotide poly- morphism -174 G/C that seems to promote an inflammatory status. We aimed to analyze the relationship between this poly-morhism and asthmatic nasal polyposis patients. METHODOLOGY: Cross-sectional study to investigate IL-6 - 174 G/C genotypes of 45 nasal polyposis with asthma patients, 63 nasal polyposis-only patients, 45 asthma-only patients and 81 subjects without both diseases. Aspirin intolerance and atopy were main exclusion criteria. IL-6 genotyping was performed using the PCR method with specific primers followed by restriction enzyme analysis, classifying patients in GG, GC or CC genotype. RESULTS: The GG genotype was the most frequent in all inflammatory groups. Less than 40% of controls presented with the GG ge- notype. There were significant differences between inflammatory groups and control group. No significant differences were seen when comparing inflammatory groups to each other, other than between nasal polyposis-only group and asthma-only group. CONCLUSION: The IL-6 74 GG genotype was found more frequently in all inflammatory groups than in controls. This genotype could influence nasal polyposis and asthma, and seems to be more important in the latter.
Assuntos
Asma/genética , Interleucina-6/genética , Pólipos Nasais/genética , Polimorfismo de Nucleotídeo Único , Alelos , Análise de Variância , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Genótipo , Humanos , Masculino , Reação em Cadeia da Polimerase , Regiões Promotoras Genéticas , Estatísticas não ParamétricasRESUMO
The evidence that exhaustive exercise may compromise the immune response is mainly confirmed by upper respiratory tract infections which are probably related to the decrease in secretory immunoglobulin A in the upper airway mucosa and/or profile changes of systemic cytokines as well as local cytokines of the upper respiratory tract. An extract from Pelargonium sidoides roots is currently used to treat infections in the upper airways. The aim of the present study was to evaluate the action of this herbal medicine on the immune response of athletes submitted to an intense running session by analyzing the production of immunoglobulin A in their saliva and of cytokines both locally and systemically, using a placebo as control. The results show that Pelargonium sidoides extract modulates the production of secretory immunoglobulin A in saliva, both interleukin-15 and interleukin-6 in serum, and interleukin-15 in the nasal mucosa. Secretory immunoglobulin A levels were increased, while levels of IL-15 and IL-6 were decreased. Based on this evidence, we suggest that this herbal medicine can exert a strong modulating influence on the immune response associated with the upper airway mucosa in athletes submitted to intense physical activity.
Assuntos
Imunoglobulina A Secretora/metabolismo , Interleucina-15/metabolismo , Interleucina-6/metabolismo , Pelargonium/química , Esforço Físico/fisiologia , Extratos Vegetais/imunologia , Adulto , Atletas , Método Duplo-Cego , Humanos , Imunoglobulina A Secretora/análise , Imunoglobulina A Secretora/sangue , Interleucina-15/análise , Interleucina-6/análise , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/imunologia , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Raízes de Plantas/química , Plantas Medicinais/química , Corrida/fisiologia , Saliva/imunologiaRESUMO
Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69 percent females, mean age 46.5 ± 10.8 years) with a body mass index (BMI) over 40 kg/m² underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 ± 7 kg/m² and mean neck circumference was 43.4 ± 5.1 cm. Polysomnographic findings showed that 22 percent had a normal apnea-hypopnea index (AHI) and 78 percent had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cabeça/anatomia & histologia , Pescoço/anatomia & histologia , Obesidade Mórbida/complicações , Apneia Obstrutiva do Sono/etiologia , Cefalometria , Exame Físico , Polissonografia , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnósticoRESUMO
Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69% females, mean age 46.5 +/- 10.8 years) with a body mass index (BMI) over 40 kg/m(2) underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 +/- 7 kg/m(2) and mean neck circumference was 43.4 +/- 5.1 cm. Polysomnographic findings showed that 22% had a normal apnea-hypopnea index (AHI) and 78% had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.
Assuntos
Cabeça/anatomia & histologia , Pescoço/anatomia & histologia , Obesidade Mórbida/complicações , Apneia Obstrutiva do Sono/etiologia , Adulto , Cefalometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Polissonografia , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnósticoRESUMO
The physiopathology of obstructive sleep apnea-hypopnea syndrome (OSAHS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. In obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. Therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese OSAHS patients with tonsil hypertrophy. Seven OSAHS patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. All patients were submitted to pre- and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. Patients' average age was 36.4 +/- 10.3 years and average preoperative body mass index was 36.6 +/- 6.3 kg/m(2). Postoperative weight did not differ significantly from preoperative weight (P = 0.27). Average preoperative apnea and hypopnea index (AHI) was 81 +/- 26/h and postoperative AHI was 23 +/- 18/h (P = 0.0005). Average preoperative minimum oxyhemoglobin saturation (SaO2 min) was 69 +/- 14% and the postoperative value was 83 +/- 3% (P = 0.038). In relation to AHI, 6 (86%) of the 7 patients studied showed a reduction of 50% in relation to preoperative level and of these, 4 (57%) presented AHI of less than 20%. Only one patient presented a reduction of less than 50% in AHI, but even so showed improved SaO2 min. Tonsillectomy treatment for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI, with improvement in SaO2 min. This procedure could be eventually considered as an option of treatment for obese OSAHS patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.
Assuntos
Obesidade/complicações , Tonsila Palatina/patologia , Apneia Obstrutiva do Sono/etiologia , Adulto , Índice de Massa Corporal , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Hipertrofia/complicações , Hipertrofia/cirurgia , Masculino , Pessoa de Meia-Idade , Oxiemoglobinas/análise , Tonsila Palatina/cirurgia , Polissonografia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/cirurgia , TonsilectomiaRESUMO
The physiopathology of obstructive sleep apnea-hypopnea syndrome (OSAHS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. In obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. Therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese OSAHS patients with tonsil hypertrophy. Seven OSAHS patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. All patients were submitted to pre- and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. Patients' average age was 36.4 ± 10.3 years and average preoperative body mass index was 36.6 ± 6.3 kg/m². Postoperative weight did not differ significantly from preoperative weight (P = 0.27). Average preoperative apnea and hypopnea index (AHI) was 81 ± 26/h and postoperative AHI was 23 ± 18/h (P = 0.0005). Average preoperative minimum oxyhemoglobin saturation (SaO2 min) was 69 ± 14 percent and the postoperative value was 83 ± 3 percent (P = 0.038). In relation to AHI, 6 (86 percent) of the 7 patients studied showed a reduction of 50 percent in relation to preoperative level and of these, 4 (57 percent) presented AHI of less than 20 percent. Only one patient presented a reduction of less than 50 percent in AHI, but even so showed improved SaO2 min. Tonsillectomy treatment for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI, with improvement in SaO2 min. This procedure could be eventually considered as an option of treatment for obese OSAHS patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Apneia Obstrutiva do Sono/etiologia , Tonsila Palatina/patologia , Índice de Massa Corporal , Pressão Positiva Contínua nas Vias Aéreas , Hipertrofia/complicações , Hipertrofia/cirurgia , Oxiemoglobinas/análise , Polissonografia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Tonsila Palatina/cirurgiaRESUMO
The presence of abnormalities of the respiratory center in obstructive sleep apnea (OSA) patients and their correlation with polysomnographic data are still a matter of controversy. Moderately obese, sleep-deprived OSA patients presenting daytime hypersomnolence, with normocapnia and no clinical or spirometric evidence of pulmonary disease, were selected. We assessed the ventilatory control and correlated it with polysomnographic data. Ventilatory neuromuscular drive was evaluated in these patients by measuring the ventilatory response (VE), the inspiratory occlusion pressure (P.1) and the ventilatory pattern (VT/TI, TI/TTOT) at rest and during submaximal exercise, breathing room air. These analyses were also performed after inhalation of a hypercapnic mixture of CO2 (delta P.1/delta PETCO2, delta VE/delta PETCO2). Average rest and exercise ventilatory response (VE: 12.2 and 32.6 l/min, respectively), inspiratory occlusion pressure (P.1: 1.5 and 4.7 cmH2O, respectively), and ventilatory pattern (VT/TI: 0.42 and 1.09 l/s; TI/TTOT: 0.47 and 0.46 l/s, respectively) were within the normal range. In response to hypercapnia, the values of ventilatory response (delta VE/delta PETCO2: 1.51 l min-1 mmHg-1) and inspiratory occlusion pressure (delta P.1/delta PETCO2: 0.22 cmH2O) were normal or slightly reduced in the normocapnic OSA patients. No association or correlation between ventilatory neuromuscular drive and ventilatory pattern, hypersomnolence score and polysomnographic data was found; however a significant positive correlation was observed between P.1 and weight. Our results indicate the existence of a group of normocapnic OSA patients who have a normal awake neuromuscular ventilatory drive at rest or during exercise that is partially influenced by obesity.
Assuntos
Polissonografia , Músculos Respiratórios/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Adulto , Teste de Esforço , Feminino , Humanos , Hipercapnia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Testes de Função Respiratória , Síndromes da Apneia do Sono/complicações , Estatísticas não ParamétricasRESUMO
The presence of abnormalities of the respiratory center in obstructive sleep apnea (OSA) patients and their correlation with polysomnographic data are still a matter of controversy. Moderately obese, sleep-deprived OSA patients presenting daytime hypersomnolence, with normocapnia and no clinical or spirometric evidence of pulmonary disease, were selected. We assessed the ventilatory control and correlated it with polysomnographic data. Ventilatory neuromuscular drive was evaluated in these patients by measuring the ventilatory response (VE) the inspiratory occlusion pressure (P.1) and the ventilatory pattern (VT/TI, TI/TTOT) at rest and during submaximal exercise, breathing room air. These analyses were also performed after inhalation of a hypercapnic mixture of CO2 (deltaP.11/deltaPETCO2, deltaVE/deltaPETCO2). Average rest and exercise ventilatory response (VE: 12.2 and 32.61/min, respectively), inspiratory occlusion pressure (P.1: 1.5 and 4.7 cmH2O, respectively), and ventilatory pattern (VT/TI: 0.42 and 1.09 1/s; TI/TTOT: 0.47 and 0.46 1/s, respectively) were within the normal range. In response to hypercapnia, the values of ventilatory response (deltaVE/deltaPETCO2: 1.51 lmin(-1) mmHg(-1)) and inspiratory occlusion pressure (deltaP.1/deltaPETCO2: 0.22 cmH2O) were normal or slightly reduced in the normocapnic OSA patients. No association or correlation between ventilatory neuromuscular drive and ventilatory pattern, hypersomnolence score and polymnographic data was found; however a significant positive correlation was observed between P.1 and weight. Our results indicate the existence of a group of normocapnic OSA patients who have a normal awake neuromuscular ventilatory drive at rest or during exercise that is partially influenced by obesity.
Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Obesidade/complicações , Polissonografia , Músculos Respiratórios/fisiopatologia , Síndromes da Apneia do Sono/complicações , Teste de Esforço , Hipercapnia/fisiopatologia , Testes de Função Respiratória , Síndromes da Apneia do Sono/fisiopatologia , Estatísticas não ParamétricasRESUMO
E apresentado um caso de carcinoma de seio maxilar associado a calculo unico de mais ou menos 0,5 cm de diametro, documentado e operado na Escola Paulista de Medicina.Trata-se de um caso diagnosticado como processo inflamatorio cronico associado a corpo estranho e tratado por um periodo de oito meses; ocasiao em que apresentou lesao ulcerada e fistulizada no sulco gengivo-jugal, ao nivel da fossa canina e por onde o paciente eliminou espontaneamente o corpo estranho. E feita uma revisao da literatura sobre o tema salientando a importancia do diagnostico precoce