RUI IMAMURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
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Resultados de Busca
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- Extracellular Matrix Composition of the Cricopharyngeus Muscle(2012) TAVARES, Raquel Aguiar; SENNES, Luiz Ubirajara; MAUAD, Thais; IMAMURA, Rui; SILVA, Luiz Fernando Ferraz da; CARRAU, Ricardo LuisThe aim of this study was to analyze the presence and distribution of total collagen, type I and type III collagen, elastic fibers, fibronectin, and versican in the endomysium of cricopharyngeus muscles from adults of various ages. The study was a cross-sectional analysis of human cricopharyngeus muscles. Twenty-seven muscles obtained from autopsies of men and women ranging in age from 28 to 92 years were analyzed with the Picrosirius method, oxidized Weigert resorcin-fuchsin, immunohistochemistry, and image analysis. Collagen had the highest density among the analyzed components. Elastic fibers surrounded each muscle cell; they were aligned longitudinally by their long axis and associated with traversing fibers, thereby forming a fiber network with embedded muscle cells. The fibronectin and versican contents varied widely among the specimens. We found no statistically significant differences between the proportion of extracellular matrix (ECM) components and factors such as gender and race. We conclude that the higher proportion of type I and type III collagen is compatible with the cricopharyngeus muscle's sphincteric behavior, and the arrangement of the elastic fibers may also contribute to the muscle's elasticity. We found no statistically significant correlation between the ECM components and age.
- Management of laryngopharyngeal reflux in Brazil: a national survey(2022) LECHIENA, Jerome R.; PERAZZOE, Paulo S.; CECCONF, Fabio P.; ECKLEYG, Claudia A.; LOPESH, Karen de Carvalho; MAUNSELLI, Rebecca; AVELINOJ, Melissa A. G.; AKSTK, Lee M.; SANT'ANNAL, Geraldo D.; IMAMURAM, RuiIntroduction: Studies assessing the management of laryngopharyngeal reflux by otolaryngologists have reported an important heterogeneity regarding the definition, diagnosis, and treatment, which leads to discrepancies in the management of the patient. Information about the current knowledge and practices of Brazilian otolaryngologists in laryngopharyngeal reflux is lacking. Objective: To investigate the trends in management of laryngopharyngeal reflux disease among Brazilian otolaryngologists. Methods: A survey was sent by email to the members of the Brazilian Association of Otolaryngology-Head Neck Surgery. This survey has initially been conducted by the laryngopharyngeal reflux study group of young otolaryngologists of the International Federation of Otolaryngological Societies. Results: According to the survey responders, the prevalence of laryngopharyngeal reflux was estimated to be 26.8% of patients consulting in otolaryngology and the most common symptoms were globus sensation, throat clearing, cough and stomach acid reflux. Nasal obstruction, Eustachian tube dysfunction, acute and chronic otitis media, vocal fold nodules and hemorrhage were considered not associated with laryngopharyngeal reflux by the majority of responders. About 2/3 of Brazilian otolaryngologists based the diagnosis of laryngopharyngeal reflux on the assessment of both symptoms and findings and a positive response to empiric therapeutic trials. Proton pump inhibitor utilized once or twice daily, was the most commonly used therapeutic scheme. Only 21.4% of Brazilian otolaryngologists have heard about nonacid and mixed laryngopharyngeal reflux and the awareness about the usefulness of multichannel intraluminal impedance pH monitoring (MII-pH) was minimal; 30.5% of responders did not consider themselves as well-informed about laryngopharyngeal reflux. Conclusion: Although the laryngopharyngeal reflux-related symptoms, main diagnostic and treatment approaches referred by Brazilian otolaryngologists are consistent with the literature, the survey identified some limitations, such as the insufficient awareness of the role of laryngopharyngeal reflux in many otolaryngological conditions and of the possibility of non-acid or mixed reflux in refractory cases. Future studies are needed to establish international recommendations for the management of laryngopharyngeal reflux disease.
- Management of Laryngopharyngeal Reflux Around the World: An International Study(2021) LECHIEN, Jerome R.; ALLEN, Jacqueline E.; BARILLARI, Maria R.; KARKOS, Petros D.; JIA, Huan; CECCON, Fabio P.; IMAMURA, Rui; METWALY, Osama; CHIESA-ESTOMBA, Carlos M.; BOCK, Jonathan M.; CARROLL, Thomas L.; SAUSSEZ, Sven; AKST, Lee M.Objective To investigate worldwide practices of otolaryngologists in the management of laryngopharyngeal reflux (LPR). Methods An online survey was sent on the management of LPR to members of many otolaryngological societies. The following aspects were evaluated: LPR definition, prevalence, clinical presentation, diagnosis, and treatment. Results A total of 824 otolaryngologists participated, spread over 65 countries. The symptoms most usually attributed to LPR are cough after lying down/meal, throat clearing and globus sensation while LPR-related findings are arytenoid erythema and posterior commissure hypertrophy. Irrespective to geography, otolaryngologists indicate lack of familiarity with impedance pH monitoring, which they attribute to lack of knowledge in result interpretation. The most common therapeutic regimens significantly vary between world regions, with a higher use of H2 blocker in North America and a lower use of alginate in South America. The duration of treatment also significantly varies between different regions, with West Asia/Africa and East Asia/Oceania otolaryngologists prescribing medication for a shorter period than the others. Only 21.1% of respondents are aware about the existence of nonacid LPR. Overall, only 43.2% of otolaryngologists believe themselves sufficiently knowledgeable about LPR. Conclusions LPR knowledge and management significantly vary across the world. International guidelines on LPR definition, diagnosis, and treatment are needed to improve knowledge and management around the world. Level of Evidence N.A. Laryngoscope, 2020
- Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study(2022) SHRECKENGOST, C. S. Harrell; FOIANINI, J. E.; ENCINAS, K. M. Moron; GUARACHI, H. Tola; ABRIL, K.; AMIN, D.; BERKOWITZ, D.; CASTATER, C. A.; DOUGLAS, J. M.; GRANT, A. A.; KHULLAR, O. V.; LANE, A. N.; LIN, A.; NIROULA, A.; NIZAM, A.; RASHIED, A.; REITZ, A. W.; ROSER, S. M.; SPYCHALSKI, J.; ARAP, S. S.; BENTO, R. F.; CIARALO, P. P. D.; IMAMURA, R.; KOWALSKI, L. P.; MAHMOUD, A.; MARIANI, A. W.; MENEGOZZO, C. A. M.; MINAMOTO, H.; MONTENEGRO, F. L. M.; PêGO-FERNANDES, P. M.; SANTOS, J.; UTIYAMA, E. M.; SREEDHARAN, J. K.; KALCHIEM-DEKEL, O.; NGUYEN, J.; DHAMSANIA, R. K.; ALLEN, K.; MODZIK, A.; PATHAK, V.; WHITE, C.; BLAS, J.; EL-ABUR, I. Talal; TIRADO, G.; BENíTEZ, C. Yánez; WEISER, T. G.; BARRY, M.; BOECK, M.; FARRELL, M.; GREENBERG, A.; MILLER, P.; PARK, P.; CAMAZINE, M.; DILLON, D.; SMITH, R. N.OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either ""early""(within 14 d of intubation) or ""late""(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity. Copyright © 2022 The Authors.
- The laryngectomee guide for COVID-19 is now available in Portuguese(2021) BROOK, Itzhak; VARTANIAN, Jose Guilherme; IMAMURA, Rui
- Impact of subspecialty training on management of laryngopharyngeal reflux: results of a worldwide survey(2021) LECHIEN, Jerome R.; CARROLL, Thomas L.; ALLEN, Jacqueline E.; AYAD, Tareck; ENVER, Necati; EUN, Young-Gyu; PERAZZO, Paulo S.; CECCON, Fabio Pupo; SANT'ANNA, Geraldo D.; IMAMURA, Rui; RAGHUNANDHAN, Sampath Kumar; CHIESA-ESTOMBA, Carlos M.; CALVO-HENRIQUEZ, Christian; SAUSSEZ, Sven; KARKOS, Petros D.; REMACLE, Marc; AKST, Lee M.; BOCK, Jonathan M.Objective To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees. Methods A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment. Results Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management. Conclusions LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.