Introdução: Não existem recomendações baseadas na evidência para realização de endoscopia digestiva alta (EDA) em doentes com sintomas extra-esofágicos da doença de refluxo gastroesofágico (DRGE). No entanto, EDAs são frequentemente realizadas na orientação clinica destes doentes. O nosso objectivo foi avaliar a prevalência de lesões gastro-esofágicas em doentes com sintomas atípicos de DRGE. Métodos: Doentes com pelo menos um sintoma extra-esofágico de DRGE e que realizaram EDA em 7 centros foram prospectivamente recrutados. Lesões clinicamente relevantes (esófago de Barrett, esofagite erosiva, condições pré-malignas gástricas, úlcera péptica, cancro e infecção H. pylori) foram estatisticamente comparadas entre os grupos tendo em conta sintomas de DRGE (atípicos vs. quer típicos e atípicos), tipo de sintomas atípicos, idade e presença de hérnia do hiato. Resultados: Duzentos e onze doentes foram recrutados (H/M: 74/137; Idade média: 55.5 ±} 14.7 anos). Esófago de Barrett foi detetado em 4 (1.9%), esofagite erosiva em 12 (5.7%), condições pré-malignas gástricas em 22 (10.4%) e infeção H. pylori em 38 (18%) doentes. A prevalência de lesões clinicamente relevantes foi inferior em doentes com apenas sintomas atípicos (28.6 vs. 42,5%; p = 0.046; teste de qui-quadrado), doentes com ≤50 anos (20 vs. 44.8%; p = 0.004; teste de qui-quadrado), e nos doentes medicados com iniciadores da bomba de protões (IBP) (21.1 vs. 40.2%; p = 0.01; teste de qui-quadrado). Nenhuma lesão clinicamente relevante foi detectada nos doentes com ≤50 anos, sem sintomas de alarme e medicados com IBP. Hérnia do hiato foi diagnosticada apenas em 6 doentes com sintomas do tipo cardíaco e em 41 com sintomas ORLs (11.3 vs. 35.1%; p = 0.03; teste de qui-quadrado). Conclusões: Lesões clinicamente relevantes são incomuns em doentes jovens com sintomas extra-esofágicos de DRGE. Hérnia do hiato não e mais prevalente em doentes com sintomas do tipo cardíaco e suspeita de DRGE. A utilidade da EDA nestes doentes e discutível.

Background: There are no evidence-based recommendations for performing upper gastrointestinal endoscopy (UGIE) in patients with extra-oesophageal symptoms of gastro- oesophageal reflux disease (GORD). However, UGIEs are often performed in clinical practice in these patients. We aimed to assess the prevalence of gastro-oesophageal lesions in patients with atypical GORD symptoms. Methods: Patients complaining of at least one extra-oesophageal GORD symptom and undergoing UGIE in seven centres were prospectively enrolled. Clinically relevant lesions (Barrett’s oesophagus, erosive oesophagitis, gastric precancerous conditions, peptic ulcer, cancer, and H. pylori infection) were statistically compared between groups regarding GORD symptoms (atypical vs. both typical and atypical), type of atypical symptoms, age, and presence of hiatal hernia. Results: Two hundred eleven patients were enrolled (male/female: 74/137; mean age: 55.5 ±} 14.7 years). Barrett’s oesophagus was detected in 4 (1.9%), erosive oesophagitis in 12 (5.7%), gastric precancerous conditions in 22 (10.4%), and H. pylori infection in 38 (18%) patients. Prevalence of clinically relevant lesions was lower in patients with only atypical GORD symptoms (28.6 vs. 42.5%; p = 0.046; χ2 test), in patients ≤50 years (20 vs. 44.8%; p = 0.004; χ2 test), and in those in ongoing proton pump inhibitor (PPI) therapy (21.1 vs. 40.2%; p = 0.01; χ2 test). No clinically relevant lesions were detected in patients ≤50 years, without alarm symptoms, and receiving PPI therapy. Hiatal hernia was diagnosed in only 6 patients with cardiologic and in 41 patients with earnose- throat symptoms (11.3 vs. 35.1%; p = 0.03; χ2 test). Conclusions: Clinically relevant lesions are uncommon among young (≤50 years) patients with extra-oesophageal GORD symptoms. Hiatal hernia is not more prevalent in patients with cardiologic symptoms and suspicion of GORD. The usefulness of UGIE in these patients is questionable.

Abstract Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

Involuntary detrusor contractions play an important role in the development of urge incontinence. Also in an in-vitro situation contractions which develop spontaneously can be seen; a parallel with the in vivo observations is likely. In order to study this muscle overactivity we investigated the possibility to induce this phenomenon with oxidative stress using hypochlorous acid (HOCl). Materials and Methods Urinary bladder muscle strips from pigs were mounted in a custom made organ bath and incubated for 20 minutes in Krebs solution. Next HOCl (10µM) was added to the organ bath and the onset of overactive contractions was closely followed. Overactivity was defined as a development of more than 5 phasic detrusor contractions per minute without any other provocation in the 30 minutes following addition of HOCl to the organ bath. Results Of the 50 strips which were used 36 (72%) became overactive after exposure to HOCl during 30 minutes recording. In 76% of the overactive strips overactivity occurred within 5 minutes, in 19% between 5 and 15 minutes, and in 5% it took longer than 15 minutes. The overactivity could be stopped by washing out HOCl for 10 minutes after which still a significant contraction after EFS and ACh stimulation was seen. Conclusions It can be concluded that an oxidative stressor, like HOCl, is capable of inducing smooth muscle overactivity. This model can be used for the development and testing of new treatment modalities for the overactive detrusor. Furthermore, this study provides evidence for a causal relationship between oxidative stress and detrusor overactivity.

OBJECTIVE: The purpose of this study was to compare the effects of castration on cell death rate of the adult rat prostates and to evaluate the benefic action of alpha tocopherol supplementation to avoid apoptosis post-orchiectomy. MATERIAL AND METHODS: Thirty male Wistar rats weighing 250-300g were divided into three groups: group I - they were subjected to bilateral orchiectomy and sacrificed eight weeks after the procedure; group II - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure; and group III - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the end of the experiment, the prostatectomy was performed in all rats. The presence of oxidative stress was determined by assaying the blood level of 8-isoprostane and the occurrence of apoptosis was evaluated by identification of active caspase-3 through immunohistochemical analysis. RESULTS: The statistic analysis of active caspase-3 showed that in the long-term castrated group the detection was higher than in groups were the alpha-tocopherol was supplemented (p=0.007). Analysis of 8-isoprostane levels showed higher concentrations of reactive oxygen species in group I compared to other groups (p<0.05). Groups II and III presented active caspase-3 lower than in group I (p<0.05). CONCLUSION: Our exploratory analyses demonstrate a method to study the aging process and its influence on oxidative stress of prostatic tissue and cells death rate. Based on our results we can suggest that alpha tocopherol supplementation can decrease the apoptotic process as well as the oxidative stress levels induced by androgen deprivation of the prostate gland.

OBJECTIVE: To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. MATERIALS AND METHODS: Forty male Wistar rats weighing 250-300g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. RESULTS: The 8-epi-PGF2 levels were statistically higher (p < 0.0003) in the Orchiectomy group compared to others groups while Sham and Orchiectomy-full-Tocopherol groups presented statistically similar values (p = 0.52). Collagen volumetric densities were significantly lower in Sham and Orchiectomy-full-Tocopherol groups (p < 0.022). Sham group presented statistically greater muscle fiber percent. CONCLUSION: Castration caused oxidative stress in the urethral sphincter complex, with increased collagen deposition. Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

Introdução: As complicações orbitárias das sinusites permanecem como tópico importante dentro da otorrinoloringologia, a despeito do decréscimo de sua prevalência observado após o advento da antibioticoterapia. Objetivo: Tendo por objetivo determinar as características clínicas e terapêuticas nos casos de sinusites complicadas. Forma de estudo: Clínico prospectivo randomizado. Material e método: Realizamos um estudo retrospectivo de 128 pacientes internados nos últimos 15 anos na Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A maior parte destes pacientes eram crianças ou adultos jovens (82,81% dos pacientes tinham menos de 30 anos de idade) e 57,81% eram do sexo masculino. Todos os pacientes apresentaram evolução satisfatória, sem seqüelas tardias. Conclusão: Observamos que o diagnóstico precoce destas patologias é importante, bem como o é a instituição de terapêutica adequada e agressiva (clínica ou cirúrgica). É a ação conjunta destes dois fatores que irá promover uma diminuição da morbimortalidade destas afecções.

Introduction: The orbital complications of sinusitis continue to be an important topic in otolaryngology despite the reduction in their prevalence observed after the advent of antibiotic therapy. Aim: With the objective to determine the clinical and therapeutic characteristics of cases of complicated sinusitis. Study design: Clinical prospective randomized. Material and method: We conducted a retrospective study on 128 patients admitted to the Department of Otorhinolaryngology, University of São Paulo Medical School, over the last 15 years. Most of these patients were children or young adults (82,81% were less than 30 years old) and 57,81% were males. All of the patients had a favorable outcome, with no sequels. Conclusion: An early diagnosis and the institution of adequate treatment are of fundamental importance for the prognosis and outcome of these patients. The observation of these two factors contributes to the low mortality of these conditions.