Endonasal localization of blood borne viable and non viable particulate matter

Oral manifestations in the American tegumentary leishmaniasis

Introduction

American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis – MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing.

Objectives

Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities.

Methods

A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant.

Results

The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites.

Conclusion

Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

Thermography of the nose and ear in relation to the skin lesions of lepromatous leprosy, tuberculosis, leishmaniasis, and lupus pernio

The nasal and aural temperature patterns of 100 normal subjects have been investigated by infrared thermography, paying particular attention to possible errors of instrumentation and technique which may arise in such areas of complex morphology. Although by no means invariable, the pattern of themograms confirms that certain areas which are relatively cool are often affected in lepromatous leprosy, tuberculosis, leishmaniasis, and lupus pernio. In lepromatous leprosy, low temperature appears to govern the localization of disease in most parts of the body, and the possible reasons for this are discussed. Thermography may have a place in the investigation of other skin diseases in which the distribution of lesions on the body surface is unexplained.

The blood vessels of the skin

During the last 25 years, cutaneous biologists have been particularly interested in abnormal cutaneous vascular patterns, the profusion of capillary anastomoses, the leakiness of venules, clotting, fibrinolysis, and blood viscosity. As a result, the effects of hypoxia and the factors that encourage new vessel proliferation are better understood than before. Only when the biologic behavior of the two extremes of growth from hypoplasia to hyperplasia is studied and compared can the blood supply of a tissue be understood. Hyperplastic tissues are seen in wounds, psoriasis, cancer, and in selected sites of chronic stasis and hypoxia where the vessels are extremely permeable, where blood cells easily escape, and where lymphatics dilate and proliferate. The proliferation of other tissues, such as endothelium, epithelium, mast cells, and probably of locally infective organisms, is also encouraged in hyperplasia. Moreover, fibrinolysis does not occur and fibrin is deposited, the electrostatic charge on the internal vascular surface becomes more positive, and the organ is more vulnerable to subsequent injury. Atrophic or hypoplastic tissues have a reduced cellular turnover and are less hypoxic. The vessels are less permeable, blood cells do not escape, there is only a slight tendency to clot, and fibrinolysis is often increased. Lymphatics are sparse and infection is not a feature. The electrostatic charge on the internal surface of the vessel is negative.

Endonasal venular permeability in rats exposed to the cold

Sixteen rats were killed 22 hrs after being injected with a dose of 4 mCi(198)Au mixed with 16 mg of inert colloidal gold/100g body wt. The anterior nasal mucosa of the septum and turbinates in 10 rats which were injected and kept in a temperature of 5-7 degrees C showed mean radioactive counts 2-3 times higher than those recorded in the same areas in 6 control rats kept in ordinary room temperature (22 degrees C). In all sixteen rats the highest counts were obtained in the RES organs, namely the liver, spleen, adrenals and the bone marrow, in descending order. Other tissues revealed no significant radioactivity except for minor counts in the lungs and kidneys. The importance of these findings regarding the localisation of granulomatous diseases and vasculitis in the nose is discussed.

Oxygen tension and surface temperature of the endonasal tissues in the goat. Preliminary report

Measurement of the PO2 in the mucosal cells and at various depths of the lamina propria lining the nasal cavity in five male goats using Silver's special microelectrodes, revealed relative hypoxia in the anterodorsal part of the nasal septum and tips of naso- and maxilloturbinals. In these sites PO2 values varied between 55-65 at the surface and 30-35 in the superficial subepithlial layer while elsewhere in the nose, lip and tongue, PO2 values of 85-90 were obtained. Temperature measurements with the thermistor in two goats yielded readings of 34-34-5 degrees C. in the hypoxic areas against 36-37 degrees C. in the posterior parts, the roof and floor of the nasal cavity. However, the oxygen tension diminished steadily in all areas as the microneedle electrode approached the chondro-osteal tissues but PO2 values of 0-10 in the perichondrium. The significance of these findings in the predilective localization of granulomata and various forms of vasculitis in the anterior endonasal tissues has been discussed.

Reddening of the upper central incisors associated with periapical granuloma in lepromatous leprosy

Four years after starting treatment for lepromatous leprosy in England a male Pakistani aged 26 was found to have red discoloration of the upper central incisor teeth. A radiograph suggested periapical abscess on the right with haziness in a corresponding area on the left. Right apicectomy was performed with removal of a solid mass attached to the apex, sections revealing a lepromatous infiltrate with acid-fast fragments of Mycobacterium leprae in the cytoplasm of foamy macrophages. Clinical and archaeological evidence for the frequent involvement of these teeth in lepromatous leprosy is reviewed. The upper incisor area is relatively cool, a factor which may be of critical importance for the lodgement and multiplication of this bacillus, as it is in other body sites in lepromatous leprosy.