Paulo Pontes

University of São Paulo, San Paulo, São Paulo, Brazil

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Publications (65)31.25 Total impact

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    Paulo Pontes
    Brazilian journal of otorhinolaryngology 06/2015; DOI:10.1016/j.bjorl.2015.05.001 · 0.62 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of the Comprehensive Voice Rehabilitation Program (CVRP) compared with Vocal Function Exercises (VFEs) to treat functional dysphonia. This is a randomized blinded clinical trial. Eighty voice professionals presented with voice complaints for more than 6 months with a functional dysphonia diagnosis. Subjects were randomized into two voice treatment groups: CVRP and VFE. The rehabilitation program consisted of six voice treatment sessions and three assessment sessions performed before, immediately after, and 1 month after treatment. The outcome measures were self-assessment protocols (Voice-Related Quality of Life [V-RQOL] and Voice Handicap Index [VHI]), perceptual evaluation of vocal quality, and a visual examination of the larynx, both blinded. The randomization process produced comparable groups in terms of age, gender, signs, and symptoms. Both groups had positive outcome measures. The CVRP effect size was 1.09 for the V-RQOL, 1.17 for the VHI, 0.79 for vocal perceptual evaluation, and 1.01 for larynx visual examination. The VFE effect size was 0.86 for the V-RQOL, 0.62 for the VHI, 0.48 for the vocal perceptual evaluation, and 0.51 for larynx visual examination. Only 10% of the patients were lost over the study. Both treatment programs were effective. The probability of a patient improving because of the CVRP treatment was similar to that of the VFE treatment. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
    05/2015; DOI:10.1016/j.jvoice.2015.03.013
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    ABSTRACT: To characterize the presence of hoarseness and the risk factors in male and female university teachers in private institutions in the city of São Paulo, Brazil. Cross-sectional survey. Voice self-evaluation forms prepared by the Brazilian Ministry of Labor were administered to 846 university teachers in a private institution in the city of São Paulo, Brazil. Prevalence of hoarseness in the sample is 39.6%. Percentage of hoarseness is higher in females (51.8%) than in males (32.6%). Comparing hoarseness and time of teaching, it was observed that the percentage of hoarseness is lower in a time shorter or equal to 1 year, and it is higher in a time between 10 and 20 years. Percentage of hoarseness is lower in the maximum workload of one to three class hours per day compared with the other workloads. Percentage of hoarseness is lower when the maximum number of students per classroom is less than 30 than when it is between 101 and 150 students. Other factors like in terms of noise and sound competition, air pollution, and in terms of causing stress and anxiety, besides habits and style/quality of life are related to the presence of hoarseness. University teachers show high percentage of hoarseness. Factors, such as time of teaching, females, work organization, workplace, in terms of noise and sound competition, air pollution, and in terms of causing stress and anxiety, besides habits and style/quality of life, are related to the presence of hoarseness in this group. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
    03/2015; 29(4). DOI:10.1016/j.jvoice.2014.09.008
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    ABSTRACT: Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient' s learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.
    10/2013; 25(5):492-6. DOI:10.1590/S2317-17822013000500015
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    ABSTRACT: The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. Thirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. No altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. No signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.
    Brazilian journal of otorhinolaryngology 12/2012; 78(6):7-14. DOI:10.5935/1808-8694.20120026 · 0.62 Impact Factor
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    ABSTRACT: The vibration of the vocal fold lamina propria is an important factor involved in vocal production and aging may change the amount of hyaluronic acid in the vocal fold leading to dysphonia. This study compares the concentration of hyaluronic acid in vocal folds of aged and young female rats. Study design: experimental. We used the vocal cords of 13 female rats divided into two groups: five aged rats and eight young ones. The tissue concentration of hyaluronic acid was determined using the fluorimetric method with the hyaluronic acid binding-protein coated on plates of enzyme-linked immunosorbent assay (ELISA), conjugated with biotin. Europium-labeled streptavidin was added and, after europium release with the use of enhancement solution, the final fluorescence was measured in a fluorometer. We found the following concentrations of hyaluronic acid in vocal fold according to the group: 581.7 ng/mg in old female rats and 1275.6 ng/mg in young female rats. Statistical analysis showed differences between groups. The vocal folds of old female rats have a lower concentration of hyaluronic acid when compared to such concentration on the vocal folds of young female rats.
    Brazilian journal of otorhinolaryngology 06/2012; 78(3):14-8. DOI:10.1590/S1808-86942012000300003 · 0.62 Impact Factor
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    ABSTRACT: To evaluate laryngeal sequelae from surgical treatment of recurrent respiratory papillomatosis in children, as well as associated risk factors. Case-control study. Medical record data analysis of 50 children with recurrent respiratory papillomatosis, divided into two groups: with and without laryngeal sequelae. The group of patients with laryngeal sequelae was compared to those without sequelae in regard to the onset of disease, age at first surgery, number and frequency of surgeries, disease stage, and type of surgery (CO2 laser, cold forceps). 23 patients (46%) sustained laryngeal sequelae. The most frequent sequela was anterior commissure synechia (17 patients [34%]), followed by glottic stenosis (six patients [12%]). There was no statistically significant difference between groups with and without laryngeal sequelae regarding the disease onset (p = 0.93), age at first surgery (p = 0.68), number of surgeries (p = 0.22), annual frequency of surgery (p = 0.93), presence of papilloma in anterior (p = 0.430) or posterior commissure (p = 0.39), and type of surgery (p = 0.27). The Derkay anatomical score (a staging system that assesses the extent of the disease in the aerodigestive tract) was significantly higher in the laryngeal sequelae group (p = 0.04). Laryngeal sequelae are a frequent complication of recurrent respiratory papillomatosis surgical treatment in children, particularly anterior commissure synechiae and glottic stenosis. Advanced stages are associated with increased risk of laryngeal sequelae after surgery.
    Revista da Associação Médica Brasileira 04/2012; 58(2):204-8. DOI:10.1590/S0104-42302012000200016 · 0.92 Impact Factor
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    ABSTRACT: Childhood oral breathing can alter muscular balance and lead to facial deformities. No articles in the literature have reported on the alteration of facial growth patterns in patients who have received tracheotomies. The purpose of this study was to evaluate craniofacial developmental consequences originating from variations in breathing mechanisms in children who are nasal breathers or oral breathers, and those who have been tracheotomized. The sample was divided into 3 groups of 10 each. The nasal group had a mean age of 13.9 years, the oral group had a mean age of 12.7 years, and the tracheotomy group had a mean age of 12.8 years. The masseter and suprahyoid muscles were evaluated with electromyography. The following measurements were made: facial, maxillary, and mandibular widths; nasion-sella-gnathion angle; and facial index. The tracheotomized group was similar to the nasal group for greater activity of the masseter muscles than of the suprahyoid muscles during mastication, as well as in the measurements of facial, maxillary, and mandibular widths. The oral group showed reductions in each category. The tracheotomized group was similar to the oral group during maximum dental occlusion for significantly higher activity of the suprahyoid muscles compared with the masseter muscles, with reductions in vertical values. A childhood tracheotomy might affect facial development in a way comparable with that of oral breathers, including abnormal facial growth variations.
    American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 10/2011; 140(4):486-92. DOI:10.1016/j.ajodo.2011.06.017 · 1.44 Impact Factor
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    ABSTRACT: Along the normal aging process, voice tends to become weak, breathy, and loses projection, which may interfere in the communication process. One reliable way to evaluate voice quality is through acoustical analysis using, for instance, the long-term average spectrum (LTAS). The aim of this study was to identify acoustic measures, particularly LTAS's, which characterize vocal aging in women without vocal complaints. For this purpose, 30 elderly and 30 young women were included in this study. All spoke standard Portuguese and none had a history of vocal and laryngeal alterations or respiratory diseases. On the basis of the reading task, in habitual and loud levels, the following parameters were assessed: the equivalent sound level (L(eq)), the speaking fundamental frequency (SFF) and, at the LTAS window, the difference between the levels of the regions of the first formant and fundamental frequency F(0) (L(1) - L(0)), alpha ratio, and the amplitude levels obtained at equal intervals of 160 Hz, ranging from 0 to 8 kHz. There were significant differences between young and old voices for SFF and L(eq) in both levels. In the LTAS window, amplitude levels were higher for young voices, comprising all frequencies except those in the regions between 4.6-6.7 and 4.8-6.5 kHz, in habitual and loud levels, respectively. There were also significant differences regarding L(1) - L(0) and alpha ratio between groups, in both levels.The observed differences in LTAS's slopes, L(1) - L(0) measures, and even L(eq) and SFF measures, may be attributed, to some extent, to lower subglottal pressure or a glottal setting providing a slower glottal closing speed for the elderly group.
    Journal of voice: official journal of the Voice Foundation 07/2011; 25(4):411-9. DOI:10.1016/j.jvoice.2010.04.002 · 0.94 Impact Factor
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    ABSTRACT: Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. To assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. A retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. The rate of recurrence after radiotherapy was 30.2% of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7% and 25% respectively. Our cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.
    Brazilian journal of otorhinolaryngology 06/2011; 77(3):299-302. · 0.62 Impact Factor
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    ABSTRACT: The ideal approach for the treatment of glottal insufficiency remains a challenge for laryngologists. This experimental study assessed the histological changes and fibrosis caused by autologous fascia lata grafts into the rabbit voice muscle. A clinical and experimental study. A 0.2 × 0.2 cm fragment of autologous fascia lata was grafted into the right voice muscle of 14 adult rabbits. Animals were euthanized 30 or 60 days post-procedure and histology of the excised vocal folds was carried out. No extensive edema, necrosis or foreign body-type reaction was observed at any time. No significant inflammatory reaction or fibrosis was seen at 30 or 60 days. The presence of fascia lata in the rabbit voice muscle had no significant influence on inflammation, and does not increase fibrosis. Rabbit voice muscle shows good tolerance to fascia lata grafting.
    Brazilian journal of otorhinolaryngology 04/2011; 77(2):185-90. DOI:10.1590/S1808-86942011000200008 · 0.62 Impact Factor
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    ABSTRACT: To assess the integration of an autologous composite fascia and fat graft implanted into the lamina propria of a porcine vocal fold using two different approaches. An experimental prospective study on the porcine larynx was conducted at a tertiary research institution. An external cervical approach was used to expose the thyroid cartilage of 24 healthy minipigs under general anesthesia. The composite fascia/fat graft was implanted through two distinct approaches, transmuscular and submuscular. Animals were sacrificed at 7, 30, 90, and 180 days for macroscopic and histological study of the larynx. Graft integration and local inflammatory response were studied. The survival rate of the experimental model was 100% and all animals had local inflammatory response to the surgical procedure. Only 41.7% of the grafts placed inside the thyroarytenoid (TA) muscle fibers were identified postmortem, whereas 83.3% of the submuscular grafts remained intact. Graft incorporation was better and there was less inflammation when the architecture of the TA muscle fibers was preserved. Graft extrusion was observed in the most of the cases where it was placed inside the muscle.
    Journal of voice: official journal of the Voice Foundation 11/2010; 25(5):626-31. DOI:10.1016/j.jvoice.2010.06.008 · 0.94 Impact Factor
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    ABSTRACT: The use of a material made of bacterial cellulose with the aim of obtaining vocal fold medialization has not hitherto been fully investigated. Although the material has been tested in other animal models, the evaluation did not include the larynx; hence, situations, such as tissue reaction, material absorption, and extrusion, need to be addressed to evaluate its usefulness as a material for laryngeal reconstruction. To evaluate the medialization, tissue response, and healing of rabbit vocal folds, after the implantation of a membrane of bacterial cellulose. Experimental study. A total of 32 rabbits were used, two of which were used to check out the adequacy of the implant location. The animals were followed for 4 months and grouped according to follow-up times of 2, 4, and 16 weeks. All test animals received an implant of bacterial cellulose in one vocal fold and the injection of distilled water in the other, both performed by videoendoscopic cervicotomy. At the end of the follow-up, the presence of inflammatory and medial displacement was evaluated. No statistically significant difference in the inflammatory parameters between the study and control vocal folds or among follow-up times was found. All animals receiving cellulose presented medial displacement of vocal folds, and all retained this material at the implant site up to study endpoint. Bacterial cellulose is a useful material for laryngeal medialization, showing no signs of rejection or absorption.
    Journal of voice: official journal of the Voice Foundation 11/2010; 25(6):765-9. DOI:10.1016/j.jvoice.2010.07.005 · 0.94 Impact Factor
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    Paulo Pontes, Mara Behlau
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    ABSTRACT: To present the accurate surgical indication for the slicing mucosal technique, the case selection, surgical aspects, rehabilitation concerns, and the characteristics of immediate and long-term outcomes. The literature is still scarce; few cases are submitted to the slicing mucosa technique due to its specific indication; an alternative procedure was designed for cases where mucosal movement is strongly reduced, the inner section of the vocal ligament or submucosal scar tissue, which can eventually be associated with fat inclusion. Some selected cases may require thyroplasty type III to optimize functional results. Slicing technique is an aggressive powerful resource for the surgical treatment of severe cases of sulcus striae major, in which mucosal wave is absent and glottic chink is moderate to severe; voice is intensely deviated immediately postoperation; vocal rehabilitation is mandatory and an intensive regimen is usually required for the first 2 months; final results can mostly be achieved up to 6 months.
    Current opinion in otolaryngology & head and neck surgery 10/2010; 18(6):512-20. DOI:10.1097/MOO.0b013e3283402a3b · 1.39 Impact Factor
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    ABSTRACT: The diversity of vestibular fold (VeF) behavior during phonation, as well as the lack of insight regarding both the anatomy and muscle fiber composition hinder our understanding of their role during phonation. The concave shape of the free margin of VeF appears to be standard, but little is known regarding the variability of this shape. We, therefore, sought to determine the laryngoscopic features related to changes in the free margin of the VeFs during phonation in patients with unilateral vocal fold paralysis. Laryngeal images from 39 patients with unilateral paralysis associated with recurrent laryngeal nerve damage were evaluated with regard to variations in length and shape of the VeFs (concave, straight, or convex) during both respiration and phonation. The VeFs on both the paralyzed and unaffected sides were analyzed during both phonation and respiration resulting in 156 total images. During phonation, all VeFs on the nonparalyzed side were straight or convex, whereas on the paralyzed side, only 20 of the 39 were straight or convex during phonation. During respiration, significant differences in the shape of the nonparalyzed side were observed. During phonation, a nonconcave appearance on the paralyzed side usually correlated with a similar appearance during respiration. VeF length decreased during phonation in 30 nonparalyzed VeFs in contrast to only 13 paralyzed folds. When subjects switched from respiration to phonation, the VeFs were typically nonconcave on the nonparalyzed side. In contrast, on the paralyzed side, nonconcave VeFs were consistent across both tasks. In patients with unilateral vocal fold paralysis, VeF conformation is likely determined from extralaryngeal than intrinsic muscle. These findings have important theoretical considerations for laryngeal treatment.
    Journal of voice: official journal of the Voice Foundation 03/2010; 25(1):111-3. DOI:10.1016/j.jvoice.2009.05.001 · 0.94 Impact Factor
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    ABSTRACT: To present an experimental model of qualitative and quantitative analysis of mesenchymal stem cells from fat of rabbits obtained by lipectomy. The fat could be a great source for obtaining mesenchymal stem cells and to create conditions for repairing injured tissues by bioengineering. New Zealand rabbits (n = 10) adipose panicle (2-3 cm) were removed by lipectomy, fragmented and washed with PBS and enzymatically dissociated with trypsin/EDTA. Lately, these cells were incubated in culture medium DMEM and after 20 days, was performed quantitative analysis of the accession of first and second mesenchymal cells in cell culture bottles. The fat total cells (CTF) were 1.62 x10(6) cells/mL and presented 98% of viability. These cells were taken for cultivation and after 20 days were counted 2.88 x10(6) cells/mL MSC. The same was done and after 20 days we quantified 4.28 x10(6) cells/mL MSC. The lipectomy of adipose panicule is a very satisfactory method to extract stem cells from fat, quantitatively and qualitatively.
    Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 02/2010; 25(1):24-7. DOI:10.1590/S0102-86502010000100007 · 0.48 Impact Factor
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    ABSTRACT: Introdução: A literatura não é clara nas manifestações ultra-estruturais das pregas vocais após lesão neural. Objetivo: Verificar as alterações que ocorrem numa prega vocal mecanicamente denervada. Método: Neste estudo prospectivo, foram utilizados 15 suínos de raça comercial (Sus scrofa domestica), com idade de 4 a 12 semanas. Os animais foram distribuídos em três grupos, escolhidos aleatoriamente. Todos foram submetidos à denervação da prega vocal direita, com remoção cirúrgica de um segmento com três centímetros do nervo laríngeo recorrente direito. Após 45, 90 e 180 dias das operações, procedeu-se a biópsia dos músculos vocais, processaram-se as amostras para microscopia eletrônica de transmissão e, para o estudo ultra-estrutural, utilizou-se o microscópio eletrônico de transmissão Philips, modelo EM208S. Resultado: Os grupos biopsiados com 45 e 90 dias após a operação de denervação mecânica, apresentaram desorganização miofibrilar, linhas Z somente vestigiais em muitas amostras, bem como mitocôndrias alteradas apresentando tamanhos reduzidos, e matriz mitocondrial rarefeita com raras cristas mitocondriais presentes. O grupo biopsiado com 180 dias após a operação de denervação, apresentou sarcômeros regulares, mitocôndrias com tamanhos e número regulares com posicionamento correto entre as unidades sarcoméricas. Conclusão: Os achados na ultra-estrutura dos músculos vocais sugerem a reinervação do músculo sendo que as mitocôndrias musculares foram as estruturas mais sensíveis à condição denervada, seguidas pela citoarquitetura das miofibrilas; os achados na ultra-estrutura dos músculos vocais sugere a reinervação do músculo no período de aproximadamente seis meses.
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    ABSTRACT: Introduction: The literature is not clear in the ultra-structural manifestations of the vocal wrinkles after neural wound. Objective: To verify the alterations that occur in a vocal fold mechanically denervated. Method: In this prospective study, it were utilized 15 hogs of commercial race (Sus scrofa domesticates), with age of 4 to 12 weeks. The animals were distributed in three groups, chosen at random. Everybody was submitted to the denervation of the right vocal fold, with surgical removal of a segment with three centimeters of the recurring right laryngeal nerve. After 45, 90 and 180 days of the operations, it was proceeded the biopsy of the vocal muscles, it was prosecuted the samples for transmission electron microscopy and, for the ultra-structural study, utilized the transmission electron microscopy Philips, model EM208S. Results: The biopsied groups with 45 and 90 days after operation of mechanical denervation, presented disorganization miofibrilar, only vestigial lines Z in many samples, as well like altered mithochondrions presenting limited sizes, and matrix mithocondrial rarefied with rare mithocondrial cristae present. The biopsied group with 180 days after operation of denervation, presented regular sarcomeres, mithocondrions with sizes and regular number with correct positioning between the sarcomerical units. Conclusion: The finds in the ultra-structure of the vocal muscles suggest to re enervation of the muscle being that the muscular mithochondrions were the most sensible structures to the denervated condition, successions by the cytoarchiteture of the miofibrilas; the finds in the ultra-structure of the vocal muscles suggests to reinervation of the muscle in the period of approximately six months.
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    ABSTRACT: To assess the technique for the collection of rabbit bone marrow stem cells from different regions to be used as an experimental model in regenerative medicine. Thirty rabbits were allocated into 2 groups: GROUP A, n=8, animals that underwent bone marrow blood (BMB) harvesting from the iliac crest; and GROUP B: including 22 rabbits that underwent BMB harvesting from the femur epiphysis. After harvesting, mononuclear cells were isolated by density gradient centrifugation (Ficoll - Histopaque). The number of mononuclear cells per ml was counted in a Neubauer chamber and cell viability was checked through Tripan Blue method. Harvesting from the iliac crest yielded an average of 1 ml of BMB and 3,6.10(6) cells/ml over 1 hour of surgery, whereas an average of 3ml of BMB and 11,79.10(6) cells./ml were obtained in 30 min from the femur epiphysis with a reduced animal death rate. The analysis for the obtention of a larger number of mononuclear cells/ml from rabbit bone marrow blood was more satisfactory in the femur epiphysis than in the iliac crest.
    Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 01/2009; 24(5):400-4. DOI:10.1590/S0102-86502009000500011 · 0.48 Impact Factor
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    ABSTRACT: Evaluate the efficacy of local application of cidofovir in association with surgical treatment of recurrent laryngeal papillomatosis in children. Study design: Prospective. Fourteen patients, with an average age of 4.7 years and with two or more relapses after surgical treatment, were submitted to resection of the papillomas and injection of 22.5 mg of cidofovir (7.5 mg/ml) in the tissue where the lesions had been removed. After 2 to 3 week intervals, the same dose of cidofovir was repeated two or three times. In the case of relapse, a new cycle of surgery followed by local applications of cidofovir was repeated. Five children presented HPV-6 and five HPV-11, while in four, the type was not determined. Before beginning of the study, patients were submitted, on the average, to 2 operations a year for control of relapses. After treatment with cidofovir, the annual rate for surgery dropped to 1.1 (p = 0.013). The average interval between relapses before beginning of the study was 1.4 months; at the end of the study, the interval reached 4.4 months (p = 0.014). Patients with HPV-6 did not show a significant change in the intervals between relapses after treatment with cidofovir, while 60% of the children with HPV-11 were disease free at the study end. Cidofovir was found to be an effective adjuvant in the treatment of recurrent laryngeal papillomatosis in children, when used in the form of local applications in association with surgical resection of the lesions. HPV-11 may be more susceptible to the beneficial effects of cidofovir.
    Revista da Associação Médica Brasileira 01/2009; 55(5):581-6. DOI:10.1590/S0104-42302009000500023 · 0.92 Impact Factor

Publication Stats

276 Citations
31.25 Total Impact Points

Institutions

  • 2008–2015
    • University of São Paulo
      San Paulo, São Paulo, Brazil
  • 2001–2015
    • Universidade Federal de São Paulo
      • • Departamento de Medicina
      • • Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço
      San Paulo, São Paulo, Brazil
  • 2002
    • University of Campinas
      Conceição de Campinas, São Paulo, Brazil