Introduction: Sinonasal inverted papilloma (SNIP) is an uncommon benign tumor with a high recurrence rate, significant malignant potential and unknown etiology. The population in Hong Kong is unique in its high population density and having a majority of Chinese people who are ethnically and geographically predisposed to certain cancers. Research on the etiology, pathogenesis, diagnosis and treatment of the neoplasm and comparison with reported findings from other parts of the world may contribute to management of the condition in terms of prevention, staging and treatment. / Aims: The aim of the thesis is to describe the common and unique clinico-pathological characteristics of SNIP in Hong Kong and compare these with reported characteristics in populations from other geographical areas and in other races with the expectation of attaining new insights into the diagnosis and management of SNIP in Hong Kong patients. / Methods: Four studies designed to evaluate the risk factors, viral associations, cell-cycle protein expression, radiological features, clinical features, treatment approaches and treatment outcomes were conducted. The findings of these studies were compared with those reported from different geographical areas of the world. Study 1: Evaluation of the risk factors associated with SNIP by a case-controlled epidemiological study of 50 patients with SNIP and 150 matched control patients. Study 2: Evaluation of the prevalence of human papillomavirus (HPV), Epstein-Barr virus (EBV), p21 and p53 expression in SNIP and comparison with reports from the literature. In a case-control study, 73 SNIP, 48 nasal polyps (NP) and 85 hypertrophied turbinates (HT) specimens were examined by polymerase chain reaction (PCR) for HPV. Seventy-three SNIP, 30 NP and 32 HT specimens were examined by in-situ hybridization (ISH) for EBV and by immunohistochemistry (IHC) for p21 and p53. SNIP results were compared with those of NP and HT (as controls). Study 3: Evaluation of the radiological signs, accuracy of prediction of tumor origin and extent, and accuracy of preoperative staging of SNIP of plain computed tomography by an observational study of plain CT scans and operative findings from 30 patients with SNIP. Study 4: Evaluation of the clinico-pathological features and treatment outcomes of SNIP in 56 patients seen between 1990 and 2008 with follow-up of more than 2 years and comparison with the results of the literature. / Results and conclusions: There are certain unique clinico-pathological features of sinonasal inverted papilloma (SNIP) in Hong Kong which are related to its predominantly Chinese population, high population density, heavy pollution and, accessible and efficient specialist services. Concordant with the results of another case-control study in the literature, the study described herein demonstrated that occupational chemical exposure, but not smoking, is a risk factor for SNIP. This is the first case-control study demonstrating that alcohol intake, allergic rhinitis, nasal polyposis, sinusitis, non-sinonasal papilloma and non-sinonasal malignancy are not risk factors for SNIP. The low prevalence of HPV in non-malignant sinonasal inverted papillomas (NMIPs) in Hong Kong suggests that it does not play a significant pathogenic role. The absence of EBV in SNIPs in Hong Kong concurs with most reports that EBV is not a causative agent. The high p21 and low p53 expression in SNIPs compared with the average values reported from other studies further support the presence of a non-p53-dependent p21 regulatory pathway. The higher prevalence of both HPV and p53 in malignant sinonasal inverted papilloma (MIP) than in NMIP agrees with other reports that both could be markers of malignant transformation. However, their inverse relation suggests they are independent factors. Although most plain CT signs are the same as those previously reported and not pathognomonic for SNIP, the high predictive value of the “pedunculation sign and absence of intra-tumor calcification are unique to Hong Kong patients. Concordant with other reports, “bony strut or focal hyperostosis is highly accurate in predicting the site of SNIP origin. This is the first report on the accuracy of preoperative CT staging, which is slightly lower than that of preoperative MRI staging (80% versus 86%). The estimated incidence of SNIP (2.4/1,000,000/year) is low but may be an underestimation as the number from the private sector is undetermined. The male:female ratio of SNIP patients in both Hong Kong and Asia is low, suggesting a geographic or racial influence on sex predilection. The absence of extrasinonasal extension, low rates of cellular atypia, dysplasia and synchronous malignancy in the Hong Kong SNIPs may reflect less aggressive tumor behavior as well as accessibility to efficient specialist services. The distribution of tumor origins, presenting symptoms and presenting stages of the Hong Kong SNIPs are similar to those reported elsewhere. The higher recurrence rate in the Hong Kong series is related to inadequate treatment of the tumor origin and inadequate conversion to combined external approaches in the early cases. Contrary to previously reported statistics, combined extranasal approaches were used more often in secondary cases than in primary cases. As in previously reported series, the recurrence rate in secondary cases tended to be higher than that in primary cases. Concordant with previous reports from the endoscopic era, most recurrences in Hong Kong occurred at the original tumor site and were discovered within the first 2 years after surgery. The average time of diagnosis of the first recurrence was much shorter than that of the pre-endoscopic era (1.2 years vs. 4.3 years). As reported elsewhere, about one-third of recurrences required combined external approaches for salvage. This is the first report comparing 2-, 5- and 10-year-follow-up results, and suggesting a minimum of 2 years’ follow-up before reporting results to avoid underestimation of recurrences. / Sham, Cheuk-lun. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 215-237). / CHAPTER 1 / Introduction / Chapter 1.1 --- Sinonasal inverted papilloma --- p.1 / Chapter 1.1.1 --- Nomenclature and classification --- p.1 / Chapter 1.1.2 --- Etiology and pathogenesis --- p.4 / Chapter 1.1.3 --- Gross and histological pathology --- p.9 / Chapter 1.1.4 --- Site of tumor attachment and extension --- p.10 / Chapter 1.1.5 --- Association with malignancy --- p.11 / Chapter 1.1.6 --- Incidence and demographics --- p.11 / Chapter 1.1.7 --- Clinical features --- p.12 / Chapter 1.1.8 --- Radiological features --- p.13 / Chapter 1.1.9 --- Staging --- p.14 / Chapter 1.1.10 --- Treatment modalities --- p.16 / Chapter 1.1.11 --- Treatment outcomes, recurrence and residual disease --- p.17 / Chapter 1.2 --- Unique characteristics of the Hong Kong population --- p.19 / Chapter 1.3 --- Research aims, areas and hypotheses --- p.22 / Chapter 1.3.1 --- Research aims --- p.22 / Chapter 1.3.2 --- Research areas and hypotheses --- p.23 / Chapter 1.4 --- Research plan and methodology --- p.25 / Chapter 1.5 --- Summary of Chapter 1 --- p.28 / CHAPTER 2 / Risk factors associated with SNIP / Chapter 2.1 --- Background --- p.29 / Chapter 2.2 --- Hypothesis --- p.29 / Chapter 2.3 --- Patients and methods --- p.30 / Chapter 2.4 --- Results --- p.35 / Chapter 2.5 --- Discussion --- p.39 / Chapter 2.6 --- Summary of Chapter 2 --- p.45 / CHAPTER 3 / Evaluation of the prevalence of HPV, EBV, p21 and p53 expression in SNIP in Hong Kong and comparison with results reported in the literature / Chapter 3.1 --- Background --- p.46 / Chapter 3.2 --- Hypothesis --- p.48 / Chapter 3.3 --- Patients and methods --- p.48 / Chapter 3.4 --- Results --- p.55 / Chapter 3.4.1 --- Overall results --- p.55 / Chapter 3.4.2 --- Comparison of the results of HPV studies --- p.57 / Chapter 3.4.3 --- Comparison of the results of EBV studies --- p.68 / Chapter 3.4.4 --- Comparison of the results of p21 studies --- p.71 / Chapter 3.4.5 --- Comparison of the results of p53 studies --- p.74 / Chapter 3.5 --- Discussion --- p.79 / Chapter 3.5.1 --- HPV and SNIP --- p.79 / Chapter 3.5.2 --- EBV and SNIP --- p.95 / Chapter 3.5.3 --- p21 and SNIP --- p.98 / Chapter 3.5.4 --- p53 and SNIP --- p.103 / Chapter 3.6 --- Summary of Chapter 3 --- p.115 / CHAPTER 4 / Evaluation of the radiological signs, accuracy of prediction of tumor origin and extent, and accuracy of preoperative staging of SNIP by plain computed tomography / Chapter 4.1 --- Background --- p.117 / Chapter 4.2 --- Hypothesis --- p.118 / Chapter 4.3 --- Patients and methods --- p.118 / Chapter 4.4 --- Results --- p.120 / Chapter 4.5 --- Discussion --- p.135 / Chapter 4.6 --- Summary of Chapter 4 --- p.142 / CHAPTER 5 / Evaluation of the clinico-pathological features and treatment outcomes of SNIP and comparison with results reported in the literature / Chapter 5.1 --- Background --- p.143 / Chapter 5.2 --- Hypothesis --- p.144 / Chapter 5.3 --- Patients and methods --- p.144 / Chapter 5.4 --- Results --- p.148 / Chapter 5.4.1 --- Incidence --- p.148 / Chapter 5.4.2 --- Demographics --- p.150 / Chapter 5.4.3 --- Presenting symptoms --- p.154 / Chapter 5.4.4 --- Site of tumor origin --- p.156 / Chapter 5.4.5 --- Rate of association with malignancy --- p.158 / Chapter 5.4.6 --- Staging of disease (Krouse system) and recurrence rate --- p.163 / Chapter 5.4.7 --- Treatment approaches and recurrence rates --- p.165 / Chapter 5.4.8 --- Comparison between patients with and without previous surgery --- p.167 / Chapter 5.4.9 --- Time and site of recurrence --- p.170 / Chapter 5.4.10 --- Surgical approaches used in salvage surgery --- p.175 / Chapter 5.4.11 --- Complication rate --- p.176 / Chapter 5.5 --- Discussion --- p.178 / Chapter 5.5.1 --- Incidence --- p.178 / Chapter 5.5.2 --- Demographics --- p.179 / Chapter 5.5.3 --- Present symptoms and duration --- p.180 / Chapter 5.5.4 --- Sites of tumor origin --- p.181 / Chapter 5.5.5 --- Association with malignancy --- p.182 / Chapter 5.5.6 --- Disease stages (Krouse system) and recurrence rate --- p.184 / Chapter 5.5.7 --- Treatment approaches and recurrence rates --- p.186 / Chapter 5.5.8 --- Comparison between patients with and without previous surgery --- p.187 / Chapter 5.5.9 --- Time and site of recurrence --- p.189 / Chapter 5.5.10 --- Surgical approaches used in salvage surgery --- p.191 / Chapter 5.5.11 --- Complication rate --- p.192 / Chapter 5.5.12 --- Management principles based on clinico-pathological features --- p.193 / Chapter 5.6 --- Summary of Chapter 5 --- p.197 / CHAPTER 6 / Summary of thesis and future perspective --- p.201 / REFERENCES --- p.215 / APPENDIX / Questionnaire for study of risk factors of SNIP --- p.238

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Objectif - Réaliser une étude en morphométrie géométrique pour définir la variabilité des sinus frontaux et maxillaires au sein d’une population adulte et pour l’établissement du profil biologique des individus à partir de la géométrie des sinus frontaux et maxillaires.- Valider un modèle de simulation numérique des écoulements pour l’étude de la ventilation nasosinusienne chez l’adulte et observer l’influence de la conformation sinusienne sur la ventilation nasosinusienne.Nous avons défini 20 landmarks fiables et reproductibles pour les sinus frontaux et maxillaires. Nous avons décrit la variabilité des sinus frontaux et maxillaires au sein d’un échantillon de population adulte. Enfin, nous avons mis en évidence l’existence d’allométries pour les sinus frontaux et maxillaires mais aussi l’existence d’un dimorphisme sexuel pour la conformation des sinus maxillairesNous proposons un modèle fiable de simulation numérique des écoulements à partir d’examen tomodensitométriques. Sur la base de ce modèle, nous n’avons pas mis en évidence d’influence de la conformation sinusienne sur la ventilation nasale et le conditionnement thermique de l’air inspiré et expiré. / Objectives - to conduct a morphometric geometric study in order to define the variability of the frontal and maxillary sinuses in an adult population and to determinate the sex of individuals - to validate a Computational fluid dynamic model of the nasal airflow and to describe the influence of the sinus conformation on the nasal airflow.We defined twenty reliable and reproducible landmarks for frontal and maxillary sinuses. We described the variability of the frontal and maxillary sinuses in an adult population sample. Finally, we highlighted the existence of allometries for frontal and maxillary sinuses but also the existence of a sexual dimorphism in the conformation of the maxillary sinusesComputational fluid dynamics:We offer a reliable model for numerical simulation of flows from CT examination. Based on this model, we have not shown any influence of the conformation on the nasal sinus ventilation and thermal conditioning of the inhaled and exhaled air. We showed no ventilation in the sinuses in the nasal respiratory cycle. Future studies will endeavor to define a humidity conditioning air model and a simulation model of production of NO and gas exchange between sinuses and nasal cavities.

Introdução: No Brasil, a leishmaniose tegumentar americana (LTA) é uma importante antropozoonose endêmica na maioria das regiões do país. Apesar da expansão da doença nos últimos anos, a LTA continua a ser uma doença negligenciada. A leishmaniose mucosa (LM) tem como principal agente causador a Leishmania (V.) brasilienses, e habitualmente ocorre meses ou anos após a infecção cutânea sintomática ou assintomática. Aproximadamente 5% dos pacientes com leishmaniose cutânea não tratada adequadamente irão desenvolver a LM, forma que causa importante morbidade aos pacientes. A LM é uma doença progressiva, que acomete cartilagens e estruturas ósseas da face, faringe e laringe. Complicações associadas à leishmaniose mucosa já foram descritas, embora não existam estudos que avaliem as alterações estruturais da face e seios paranasais utilizando métodos radiológicos e que estimem a prevalência de sinusopatia nesta população ou que a compare com a população geral. Objetivo: Avaliar o grau de opacificação dos seios paranasais em pacientes com leishmaniose mucosa tratada, assim como eventuais alterações anatômicas na face associadas à LM, através de tomografia computadorizada multislice (TCM) dos seios paranasais e comparar os achados encontrados nesta população com um grupo controle formado por pacientes que realizaram TCM de órbita. Este estudo também tem o escopo de determinar a prevalência de sinusopatia crônica nos pacientes com LM pós-tratamento, bem como encontrar prováveis variáveis preditoras que possam estar relacionadas com a gravidade da sinusopatia e das alterações tomográficas encontradas. Métodos: Foram avaliados 54 pacientes com LM tratada, que foram submetidos à TCM dos seios da face, e comparados com grupo controle de 40 pacientes que realizaram TCM de órbita. A análise das tomografias foi realizada a partir de reconstruções multiplanares nos planos axial, coronal e sagital. Foram avaliados o grau de opacificação (sinusopatia) dos seios paranasais, bem como a existência de eventuais alterações na face que pudessem estar relacionadas à LM. O grau de sinusopatia foi estabelecido seguindo-se os critérios de Lund-Mackay, segundo os quais foram atribuídos um valor para o grau de opacificação de cada sistema sinusal e dos complexos ostiomeatais, comparando o score dos casos com o dos controles. Posteriormente foi realizada uma análise comparativa entre os pacientes do grupo leishmaniose mucosa, que foram divididos em dois subgrupos, de acordo com a presença (Lund-Mackay >= 4) ou ausência (Lund-Mackay < 4) de doença sinusal, sendo 40 e 14 pacientes respectivamente. Após esta divisão foram feitas análises univariadas exploratórias em busca de variáveis preditoras que pudessem estar associadas com uma maior gravidade de sinusopatia apresentada. O nível de significância foi estabelecido com p<0,05. Resultados: Quarenta dos 54 pacientes com antecedente de LM (74,1%) apresentaram score tomográfico compatível com sinusopatia crônica (Lund-Mackay >= 4). Os pacientes do grupo leishmaniose mucosa apresentaram maior score de Lund-Mackay que os pacientes do grupo controle, bem como maior número de alterações na TCM dos seios paranasais, provavelmente associadas à leishmaniose. Estes pacientes também apresentaram graus mais severos de opacificação parcial e espessamento mucoso pansinusal 23/54 (42.6%). Além disso, opacificação total de pelo menos um dos seios paranasais só foi observada nos pacientes do grupo leishmaniose mucosa. Os pacientes com leishmaniose com score de Lund-Mackay >= 4 apresentaram maior tempo de sintomas até o primeiro tratamento e doença mais grave no momento do diagnóstico, sendo portanto prováveis variáveis preditoras de gravidade da sinusopatia. Conclusão: As tomografias computadorizadas dos seios paranasais dos pacientes com LM apresentaram diversas alterações estruturais, demonstrando o poder destrutivo desta doença. A alta prevalência de sinusite crônica observada nas tomografias computadorizadas desses pacientes quando comparados ao grupo controle, sugere que a LM pode ser um fator de risco para o desenvolvimento de sinusite crônica nesta população. Sexo masculino, tempo de sintomas até o primeiro tratamento e gravidade da LM no momento do diagnóstico podem ser consideradas prováveis variáveis preditoras de sinusite crônica nesses pacientes / Introduction: American tegumentary leishmaniasis (ATL) is an important anthropozoonosis that is endemic in most regions in Brazil. Despite the spread of the disease in recent years, ATL remains a neglected disease. Mucosal leishmaniasis (ML) is mainly caused by Leishmania (V.) brasiliensis agent, and usually occurs months or years after symptomatic or asymptomatic skin infection. Approximately 5% of patients with untreated cutaneous leishmaniasis will develop ML, a presentation that causes significant morbidity to patients. The mucosal leishmaniasis is a progressive disease that affects cartilage and bone structures of the nose and paranasal sinuses as well as other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies which evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. Objective: To assess the degree of opacification of the paranasal sinuses in patients with treated mucosal leishmaniasis as well as any anatomic changes in the face associated with ML through multidector computed tomography scans (MDCT) of the sinuses, and compare the findings in this population with a control group. This study also aims at determining the prevalence of chronic sinusitis in patients with treated ML as well as finding probable predictive variables that may be related to the severity of sinus disease and CT findings. Methods: We evaluated 54 patients with treated ML who were submitted to MDCT of the sinuses, and compared with a control group of 40 patients who underwent MDCT of orbit. Analysis of the scans was performed from multiplanar reconstructions in the axial, coronal and sagittal views. The degree of sinus disease was assessed according to the Lund-Mackay criteria, in which a value was assigned to the degree of opacification of each sinus system and ostiomeatal complexes, and the scores from the mucosal leishmaniasis group were compared to the control group. A comparative analysis was then performed among patients in the mucosal leishmaniasis group, who were divided into 2 subgroups according to the presence (Lund-Mackay >= 4) or absence (Lund-Mackay < 4) of sinus disease, with 40 and 14 patients respectively. Following this subdivision, exploratory univariate analysis were performed to identify predictive variables that could be associated to the presentation of greater severity of sinus disease. The level of significance was defined as p <0.05. Results: Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund- Mackay >= 4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structural alterations. Patients from the mucosal leishmaniasis group showed more severe levels of partial opacification and pan sinus mucosal thickening 23/54 (42.6%), furthermore complete opacification of at least one paranasal sinus was only observed in the leismaniasis group. Patients from the mucosal leishmaniasis group with Lund-Mackay score >= 4 presented greater length of symptoms before treatment and more severe presentation of the disease at the diagnosis. Conclusion: CT scans of the sinus of patients with ML also presented several structural alterations, expressing the prominent destructive feature of the disease. The higher prevalence of chronic rhinosinusitis observed in CT scans of patients with treated ML in this study when compared to the control group suggests that ML can be seen as a risk factor for chronic rhinosinusitis in this population. Male sex, having the disease for more than two years before first treatment and/or a more severe presentation of ML at diagnosis, can be considered as predictive variables of chronic sinusitis in these patients

Introdução: No Brasil, a leishmaniose tegumentar americana (LTA) é uma importante antropozoonose endêmica na maioria das regiões do país. Apesar da expansão da doença nos últimos anos, a LTA continua a ser uma doença negligenciada. A leishmaniose mucosa (LM) tem como principal agente causador a Leishmania (V.) brasilienses, e habitualmente ocorre meses ou anos após a infecção cutânea sintomática ou assintomática. Aproximadamente 5% dos pacientes com leishmaniose cutânea não tratada adequadamente irão desenvolver a LM, forma que causa importante morbidade aos pacientes. A LM é uma doença progressiva, que acomete cartilagens e estruturas ósseas da face, faringe e laringe. Complicações associadas à leishmaniose mucosa já foram descritas, embora não existam estudos que avaliem as alterações estruturais da face e seios paranasais utilizando métodos radiológicos e que estimem a prevalência de sinusopatia nesta população ou que a compare com a população geral. Objetivo: Avaliar o grau de opacificação dos seios paranasais em pacientes com leishmaniose mucosa tratada, assim como eventuais alterações anatômicas na face associadas à LM, através de tomografia computadorizada multislice (TCM) dos seios paranasais e comparar os achados encontrados nesta população com um grupo controle formado por pacientes que realizaram TCM de órbita. Este estudo também tem o escopo de determinar a prevalência de sinusopatia crônica nos pacientes com LM pós-tratamento, bem como encontrar prováveis variáveis preditoras que possam estar relacionadas com a gravidade da sinusopatia e das alterações tomográficas encontradas. Métodos: Foram avaliados 54 pacientes com LM tratada, que foram submetidos à TCM dos seios da face, e comparados com grupo controle de 40 pacientes que realizaram TCM de órbita. A análise das tomografias foi realizada a partir de reconstruções multiplanares nos planos axial, coronal e sagital. Foram avaliados o grau de opacificação (sinusopatia) dos seios paranasais, bem como a existência de eventuais alterações na face que pudessem estar relacionadas à LM. O grau de sinusopatia foi estabelecido seguindo-se os critérios de Lund-Mackay, segundo os quais foram atribuídos um valor para o grau de opacificação de cada sistema sinusal e dos complexos ostiomeatais, comparando o score dos casos com o dos controles. Posteriormente foi realizada uma análise comparativa entre os pacientes do grupo leishmaniose mucosa, que foram divididos em dois subgrupos, de acordo com a presença (Lund-Mackay >= 4) ou ausência (Lund-Mackay < 4) de doença sinusal, sendo 40 e 14 pacientes respectivamente. Após esta divisão foram feitas análises univariadas exploratórias em busca de variáveis preditoras que pudessem estar associadas com uma maior gravidade de sinusopatia apresentada. O nível de significância foi estabelecido com p<0,05. Resultados: Quarenta dos 54 pacientes com antecedente de LM (74,1%) apresentaram score tomográfico compatível com sinusopatia crônica (Lund-Mackay >= 4). Os pacientes do grupo leishmaniose mucosa apresentaram maior score de Lund-Mackay que os pacientes do grupo controle, bem como maior número de alterações na TCM dos seios paranasais, provavelmente associadas à leishmaniose. Estes pacientes também apresentaram graus mais severos de opacificação parcial e espessamento mucoso pansinusal 23/54 (42.6%). Além disso, opacificação total de pelo menos um dos seios paranasais só foi observada nos pacientes do grupo leishmaniose mucosa. Os pacientes com leishmaniose com score de Lund-Mackay >= 4 apresentaram maior tempo de sintomas até o primeiro tratamento e doença mais grave no momento do diagnóstico, sendo portanto prováveis variáveis preditoras de gravidade da sinusopatia. Conclusão: As tomografias computadorizadas dos seios paranasais dos pacientes com LM apresentaram diversas alterações estruturais, demonstrando o poder destrutivo desta doença. A alta prevalência de sinusite crônica observada nas tomografias computadorizadas desses pacientes quando comparados ao grupo controle, sugere que a LM pode ser um fator de risco para o desenvolvimento de sinusite crônica nesta população. Sexo masculino, tempo de sintomas até o primeiro tratamento e gravidade da LM no momento do diagnóstico podem ser consideradas prováveis variáveis preditoras de sinusite crônica nesses pacientes / Introduction: American tegumentary leishmaniasis (ATL) is an important anthropozoonosis that is endemic in most regions in Brazil. Despite the spread of the disease in recent years, ATL remains a neglected disease. Mucosal leishmaniasis (ML) is mainly caused by Leishmania (V.) brasiliensis agent, and usually occurs months or years after symptomatic or asymptomatic skin infection. Approximately 5% of patients with untreated cutaneous leishmaniasis will develop ML, a presentation that causes significant morbidity to patients. The mucosal leishmaniasis is a progressive disease that affects cartilage and bone structures of the nose and paranasal sinuses as well as other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies which evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. Objective: To assess the degree of opacification of the paranasal sinuses in patients with treated mucosal leishmaniasis as well as any anatomic changes in the face associated with ML through multidector computed tomography scans (MDCT) of the sinuses, and compare the findings in this population with a control group. This study also aims at determining the prevalence of chronic sinusitis in patients with treated ML as well as finding probable predictive variables that may be related to the severity of sinus disease and CT findings. Methods: We evaluated 54 patients with treated ML who were submitted to MDCT of the sinuses, and compared with a control group of 40 patients who underwent MDCT of orbit. Analysis of the scans was performed from multiplanar reconstructions in the axial, coronal and sagittal views. The degree of sinus disease was assessed according to the Lund-Mackay criteria, in which a value was assigned to the degree of opacification of each sinus system and ostiomeatal complexes, and the scores from the mucosal leishmaniasis group were compared to the control group. A comparative analysis was then performed among patients in the mucosal leishmaniasis group, who were divided into 2 subgroups according to the presence (Lund-Mackay >= 4) or absence (Lund-Mackay < 4) of sinus disease, with 40 and 14 patients respectively. Following this subdivision, exploratory univariate analysis were performed to identify predictive variables that could be associated to the presentation of greater severity of sinus disease. The level of significance was defined as p <0.05. Results: Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund- Mackay >= 4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structural alterations. Patients from the mucosal leishmaniasis group showed more severe levels of partial opacification and pan sinus mucosal thickening 23/54 (42.6%), furthermore complete opacification of at least one paranasal sinus was only observed in the leismaniasis group. Patients from the mucosal leishmaniasis group with Lund-Mackay score >= 4 presented greater length of symptoms before treatment and more severe presentation of the disease at the diagnosis. Conclusion: CT scans of the sinus of patients with ML also presented several structural alterations, expressing the prominent destructive feature of the disease. The higher prevalence of chronic rhinosinusitis observed in CT scans of patients with treated ML in this study when compared to the control group suggests that ML can be seen as a risk factor for chronic rhinosinusitis in this population. Male sex, having the disease for more than two years before first treatment and/or a more severe presentation of ML at diagnosis, can be considered as predictive variables of chronic sinusitis in these patients

Orientador: Jose Dirceu Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T02:23:41Z (GMT). No. of bitstreams: 1 Sakano_Eulalia_D.pdf: 4393830 bytes, checksum: 9f6f7365bd3d89dbba87535f36bbc052 (MD5) Previous issue date: 2006 / Resumo: Muitos estudos têm avaliado os aspectos clínicos e funcionais do comprometimento das vias aéreas inferiores na fibrose cística (FC). Entretanto, poucos estudos têm sido realizados para avaliar as alterações clínicas e funcionais das vias aéreas superiores. O objetivo do presente trabalho foi correlacionar variáveis obtidas por endoscopia nasossinusal, laboratoriais e tomográficas dos seios paranasais e, verificar a associação com a gravidade e o genótipo de pacientes com fibrose cística, de um centro universitário de referência em tratamento de FC no Brasil. Realizou-se um estudo clínico, laboratorial com 50 fibrocísticos. Todos foram submetidos a tomografia computadorizada dos seios paranasais, estudo genético das mutações da FC, endoscopia nasossinusal e bacterioscopia dos seios maxilares, orofaringe e traquéia. A gravidade da FC foi avaliada pelo escore de Shwachman. A prevalência de polipose na população estudada foi de 36% e maior entre homozigotos para ?F508. O escore de Shwachman correlacionou-se com a idade. Não houve correlação do genótipo e do grau de gravidade com as outras variáveis estudadas. Os sujeitos apresentaram alta prevalência de colonização precoce para P. aeruginosa. Concluiu-se que a doença sinusal em pacientes fibrocísticos é muito freqüente, apresenta alterações nasofibroscópicas, tomográficas e clínicas, embora a maioria das variáveis estudadas, não apresenta correlação com a gravidade e o genótipo da doença / Abstract: Many studies have assessed clinical and functional aspects of lower airway affections in cystic fibrosis. Conversely, few studies have been performed to assess the clinical and functional affections of upper airways. The objective of the present study was to correlate the variables obtained by nasal and paranasal sinuses endoscopy, paranasal sinus laboratory and computed tomography (CT) scan findings, and to check the association with severity and genotype of cystic fibrosis patients. Clinical and laboratory study of 50 patients with cystic fibrosis at a university center. All patients were submitted to CT scan, nasal and paranasal endoscopy and bacterioscopy of maxillary sinus, trachea and oropharynx secretion. Severity of cystic fibrosis was assessed by Shwachman score and the most frequent genetic mutations were identified. The prevalence of polyposis in the studied population was 36% and it was greater among homozygote for ?F 508. Shwachman score was correlated with age (p=0,003). The genotype was correlated with nasal polyposis (p=0,006). There was no association between affections in CT scan and severity of cystic fibrosis (CF). Patients presented high prevalence of early colonization of Pseudomonas aeruginosa. Sinus disease in CF patients are very frequent and presents several clinical, endoscopic and tomographic affections and most of them are not correlated with severity and disease genotype / Doutorado / Otorrinolaringologia / Doutor em Ciências Médicas