BACKGROUND: Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up. METHODOLOGY: We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up. RESULTS: Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up. CONCLUSIONS: Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.
Objetivos: Enfatizar a importância do exame otorrinolaringológico e da biópsia de amígdalas no tratamento dessa doença potencialmente fatal. Métodos: Avaliamos, com base em ferramentas de busca do PubMed e do Google Scholar, estudos sobre Doença Linfoproliferativa Pós-transplante (DLPT), tendo sido selecionados dados internacionais de 19 diferentes estudos. Discussão: DLPT é uma complicação rara, porém potencialmente fatal após transplante de órgãos sólidos. O risco de DLPT varia com a idade do receptor, a soropositividade do doador e receptor do orgão para o vírus Epstein-Barr, o tipo de órgão transplantado e a intensidade da imunossupressão. Neste relato de caso, o paciente era jovem, do gênero masculino, submetido a transplante renal um ano antes do aparecimento dos sintomas nas amígdalas. O diagnóstico raro de DLPT nas amígdalas pode estar associado à sua não realização precoce. Quando os fatores de risco e o aspecto das amígdalas são considerados e a biópsia destas realizada, o tratamento é realizado com boa e rápida resposta. DLPT pode ser tratada com sucesso na maioria dos pacientes através da diminuição da dose de imunossupressores e da administração de agentes antivirais. Conclusão: A apresentação da DLPT tonsilar é raramente descrita na literatura e o conhecimento a respeito da evolução clínica, manifestações histológicas ou fatores prognósticos ainda é limitado. Assim, nos pacientes pós-transplante esse diagnóstico deve ser lembrado e tratado o mais precocemente possível. Alguns autores recomendam rotineiramente avaliação otorrinolaringológica periódica desses pacientes.
Functional rhinoseptoplasties were the most prevalent type, which highlights the relevance of teaching surgical techniques, not only for septoplasty, but also the inclusion of rhinoplasty techniques in teaching centers.
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