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[PMID]:29400036
[Au] Autor:Sellami M; Mnejja M; Masmoudi M; Charfeddine I; Hammami B; Ghorbel A
[Ti] Título:[Predictive factors for recurrence after surgery of nasal polyposis].
[So] Source:Rev Laryngol Otol Rhinol (Bord);136(4):149-53, 2015.
[Is] ISSN:0035-1334
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Introduction: Endoscopic sinus surgery has become the treatment of choice in the surgical management of patients with nasal polyposis. The aim of our study is to identify the role of some epidemiological, clinical and therapeutic factors in recurrence after surgery of nasal polyposis. Materials and methods: We conducted a retrospective study over a period of 11 years (between 2000 and 2010) including 184 patients operated for nasal polyposis after failure of prolonged medical treatment. We evaluated the impact of epidemiological and clinical factors (age, sex, asthma, Widal disease, allergy and stage of nasal polyposis at the time of surgery) and treatment (surgical technique, observance of postoperative topical steroids ) on postoperative recurrence. Results: Nasal poly­posis recurred in 26.6% of patients after an average period of 23 months. Widal disease, asthma and bad observance of the intranasal steroid therapy were significantly associated with postoperative recurrence in the univariate analysis. In multi­variate analysis the bad observance of the intranasal steroid therapy was the only factor significantly associated with recurren­ce. Conclusion: Postoperative steroids prescribed routi­nely in our practice can effectively prevent recurrence after endonasal surgery and this result was found in both uni­variate and multivariate analysis.
[Mh] Termos MeSH primário: Pólipos Nasais/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Asma/epidemiologia
Criança
Feminino
Seguimentos
Glucocorticoides/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Cooperação do Paciente
Cuidados Pós-Operatórios
Recidiva
Estudos Retrospectivos
Tunísia/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Glucocorticoids)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE


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[PMID]:29429191
[Au] Autor:Zhang YY; Lou HF; Wang CS; Zhang L
[Ad] Endereço:Deparment of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institude of Otorhinolaryngology, Beijing 100005, China.
[Ti] Título:[Mechanisms underlying glucocorticoid resistance in chronic rhinosinusitis with nasal polyps].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;53(2):154-160, 2018 Feb 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease that occurs in the nasal and sinus mucosa, which is a common disease in otorhinolaryngology. At present, CRSwNP can be effectively treated by glucocorticoids (GC). GC binds to GC receptors in the nasal mucosa, affects the expression of inflammatory genes, inhibits the activation and action of eosinophils, T cell-associated inflammatory responses in nasal polyps, as well as tissue remodeling. However, there are some patients fall reponse to GC, so called GC resistance. The study suggests that the possible mechanism of CRSwNP GC resistance is mainly related to GC receptor abnormal, the role of cytokines and transcription factors, such as Th cells and IL-8. In addition, MAPK-related kinases and histone deacetylase in the GC signaling pathway also play important roles in the GC resistance process. This paper reviews the mechanism of GC treatment of CRSwNP, the mechanism of GC resistance and alternative treatment of GC.
[Mh] Termos MeSH primário: Glucocorticoides/uso terapêutico
Erros Inatos do Metabolismo
Pólipos Nasais/tratamento farmacológico
Receptores de Glucocorticoides/deficiência
Rinite/tratamento farmacológico
Sinusite/tratamento farmacológico
[Mh] Termos MeSH secundário: Doença Crônica
Citocinas/metabolismo
Resistência a Medicamentos
Glucocorticoides/metabolismo
Seres Humanos
Mucosa Nasal/metabolismo
Pólipos Nasais/complicações
Rinite/complicações
Transdução de Sinais
Sinusite/complicações
Fatores de Transcrição/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Cytokines); 0 (Glucocorticoids); 0 (Receptors, Glucocorticoid); 0 (Transcription Factors)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180213
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2018.02.017


  3 / 5576 MEDLINE  
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[PMID]:28459386
[Au] Autor:Costa R; Königshoff M
[Ad] Endereço:1 Comprehensive Pneumology Center Helmholtz Zentrum München and University Hospital of the Ludwig Maximilians University Munich, Germany and.
[Ti] Título:Linking Wnt Signaling to Mucosal Inflammation.
[So] Source:Am J Respir Cell Mol Biol;56(5):551-552, 2017 05.
[Is] ISSN:1535-4989
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pólipos Nasais/imunologia
Rinite/imunologia
Sinusite/imunologia
Via de Sinalização Wnt/imunologia
[Mh] Termos MeSH secundário: Animais
Doença Crônica
Seres Humanos
Inflamação/imunologia
Inflamação/patologia
Pólipos Nasais/patologia
Rinite/patologia
Sinusite/patologia
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1165/rcmb.2017-0054ED


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[PMID]:28468172
[Au] Autor:Heo KW; Park SK; Lee YM; Choe SH; Gu PM; Hong TU; Hur DY
[Ad] Endereço:*Department of Otorhinolaryngology-Head and Neck Surgery †Department of Anatomy and Research Center for Tumor Immunology, Inje University Busan Paik Hospital, Busan, South Korea.
[Ti] Título:Methotrexate Induces Apoptosis in Organ-Cultured Nasal Polyps Via the Fas Pathway.
[So] Source:J Craniofac Surg;28(3):806-809, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Methotrexate (MTX) is very effective when used to treat chronic inflammatory diseases, and also induces apoptosis in nasal polyps (NPs). Increasing evidence suggests that Fas-Fas ligand (FasL) interactions activate multiple pathways involved in the regulation of immune and inflammatory cell functions. The aim of the present study was to identify pathways activated by Fas signaling when NPs were treated with MTX. METHODS: Nasal polyps tissues were cultured using an air-liquid interface organ culture method. Cultures were maintained in the absence or presence of MTX (10 or 100 µM) for 24 hours. The authors used the reverse transcription-polymerase chain reaction method and Western blotting to identify pathways activated by Fas when NPs were treated with MTX. RESULTS: The Fas mRNA expression ratio was unchanged upon MTX treatment, but the FasL mRNA expression ratio was significantly higher in MTX-treated than nontreated polyps. In addition, the expression levels of the Fas and FasL proteins were significantly higher in polyps treated with both 10 and 100 µM MTX compared with nontreated polyps. CONCLUSIONS: Methotrexate induces apoptosis in NPs via the Fas pathway. Future studies should explore the topical use of MTX for NP control. Methotrexate may be a useful alternative steroid-sparing agent for the treatment of NPs.
[Mh] Termos MeSH primário: Apoptose/efeitos dos fármacos
Proteína Ligante Fas/genética
Regulação da Expressão Gênica
Metotrexato/farmacologia
Pólipos Nasais/patologia
Técnicas de Cultura de Órgãos/métodos
RNA Mensageiro/genética
[Mh] Termos MeSH secundário: Apoptose/genética
Western Blotting
Proteína Ligante Fas/biossíntese
Seres Humanos
Imunossupressores/uso terapêutico
Pólipos Nasais/tratamento farmacológico
Pólipos Nasais/metabolismo
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Transdução de Sinais/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (FASLG protein, human); 0 (Fas Ligand Protein); 0 (Immunosuppressive Agents); 0 (RNA, Messenger); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003562


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[PMID]:28468203
[Au] Autor:Bayarogullari H; Burakgazi G; Okuyucu S
[Ad] Endereço:*Department of Radiology †Clinics of Otolaringology, Mustafa Kemal University Medical School, Hatay, Turkey.
[Ti] Título:Antronasal Polyp Extending to Orbital Fossa.
[So] Source:J Craniofac Surg;28(3):e239-e241, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sinonasal infections and nasal polyps can be taken as 2 components of a disease. Polyps due to chronic inflammations of nasal cavity and sinuses are not rare. They may present with various clinical signs and symptoms, while the secondary complications may cause serious problems. They are most commonly treated medically, although surgery is the therapy of choice in some conditions. The complications can be listed as mucocele formation, orbital inflammation, intracranial extension by erosion of the boney structures.
[Mh] Termos MeSH primário: Pólipos Nasais/diagnóstico por imagem
Pólipos Nasais/patologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Imagem por Ressonância Magnética
Meia-Idade
Cavidade Nasal/diagnóstico por imagem
Cavidade Nasal/patologia
Pólipos Nasais/cirurgia
Seios Paranasais/diagnóstico por imagem
Seios Paranasais/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003444


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[PMID]:29336419
[Au] Autor:Dutta M; Ghatak S; Sen I; Sinha R
[Ad] Endereço:Department of ENT and Head - Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India.
[Ti] Título:Variable Presentations of Sinonasal Polypoid Masses: A Tertiary Institution Experience.
[So] Source:Kathmandu Univ Med J (KUMJ);14(56):322-327, 2016 Oct.-Dec..
[Is] ISSN:1812-2078
[Cp] País de publicação:Nepal
[La] Idioma:eng
[Ab] Resumo:Background Lesions of the sinonasal area are varied, but they mostly present as polypoid masses which require meticulous work-up to reach at the most probable diagnosis. Objective Analysis of polypoid sinonasal masses in terms of etiology, clinical presentations, brief demographic profile, clinico-histologic correlate where possible, and follow-up results. Method In this descriptive, longitudinal study, 198 patients with polypoid sinonasal masses attending the otolaryngology clinic of a tertiary teaching institute were selected using proper selection criteria and analyzed through a pre-set proforma and algorithm for a diagnostic work-up (that included histopathology where necessary). Result Common presentations were nasal obstruction (~89%), discharge (~70%) and hyposmia (~22%). Though nearly 87% was clinically benign and 8% indeterminate, therapeutic and diagnostic interventions (including histopathology) showed 91% truly benign, of which polyposis formed the bulk. Sensitivity of clinical detection was 75% for benign lesions and 62% for malignancies. Diagnosis depended on histopathology in 52.52% cases, including the clinically malignant, the "grey zone", and more than 40% of the clinically benign lesions. There was male predilection (2.16 for benign lesions and 1.57 for malignant), rural preponderance, and above 60% of the patients were within 50-70 years. There was ~26% recurrence in the follow-up period of a minimum of one year, predominantly in polyposis (29.55%) and malignancies (~39%). Conclusion Presentations of polypoid sinonasal masses are variable, etiology of which is mostly benign. Proper clinico-histologic correlate is necessary for correct diagnosis. A low threshold of suspicion is required because of this variability, necessitating follow-up for further evaluation.
[Mh] Termos MeSH primário: Pólipos Nasais/diagnóstico
Pólipos Nasais/patologia
Neoplasias Nasofaríngeas/diagnóstico
Neoplasias Nasofaríngeas/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Obstrução Nasal/patologia
Sensibilidade e Especificidade
Centros de Atenção Terciária
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180117
[St] Status:MEDLINE


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[PMID]:29253858
[Au] Autor:Bohman A; Juodakis J; Oscarsson M; Bacelis J; Bende M; Torinsson Naluai Å
[Ad] Endereço:Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden.
[Ti] Título:A family-based genome-wide association study of chronic rhinosinusitis with nasal polyps implicates several genes in the disease pathogenesis.
[So] Source:PLoS One;12(12):e0185244, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The pathogenesis of chronic rhinosinusitis with nasal polyps is largely unknown. Previous studies have given valuable information about genetic variants associated with this disease but much is still unexplained. Our goal was to identify genetic markers and genes associated with susceptibility to chronic rhinosinusitis with nasal polyps using a family-based genome-wide association study. METHODS: 427 patients (293 males and 134 females) with CRSwNP and 393 controls (175 males and 218 females) were recruited from several Swedish hospitals. SNP association values were generated using DFAM (implemented in PLINK) and Efficient Mixed Model Association eXpedited (EMMAX). Analyses of pathway enrichment, gene expression levels and expression quantitative trait loci were then performed in turn. RESULTS: None of the analysed SNPs reached genome wide significant association of 5.0 x 10-8. Pathway analyses using our top 1000 markers with the most significant association p-values resulted in 138 target genes. A comparison between our target genes and gene expression data from the NCBI Gene Expression Omnibus database showed significant overlap for 36 of these genes. Comparisons with data from expression quantitative trait loci showed the most skewed allelic distributions in cases with chronic rhinosinusitis with nasal polyps compared with controls for the genes HLCS, HLA-DRA, BICD2, VSIR and SLC5A1. CONCLUSION: Our study indicates that HLCS, HLA-DRA, BICD2, VSIR and SLC5A1 could be involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. HLA-DRA has been associated with chronic rhinosinusitis with nasal polyps in previous studies and HLCS, BICD2, VSIR and SLC5A1 may be new targets for future research.
[Mh] Termos MeSH primário: Predisposição Genética para Doença
Estudo de Associação Genômica Ampla
Pólipos Nasais/genética
Rinite/genética
Sinusite/genética
[Mh] Termos MeSH secundário: Doença Crônica
Família
Feminino
Regulação da Expressão Gênica
Seres Humanos
Masculino
Meia-Idade
Pólipos Nasais/complicações
Polimorfismo de Nucleotídeo Único/genética
Locos de Características Quantitativas/genética
Rinite/complicações
Sinusite/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185244


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[PMID]:27770460
[Au] Autor:De Schryver E; Derycke L; Campo P; Gabriels E; Joos GF; Van Zele T; Bachert C; Hellings PW; Gevaert P
[Ad] Endereço:Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
[Ti] Título:Alcohol hyper-responsiveness in chronic rhinosinusitis with nasal polyps.
[So] Source:Clin Exp Allergy;47(2):245-253, 2017 Feb.
[Is] ISSN:1365-2222
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: An important percentage of subjects diagnosed with chronic upper airway disease report alcohol-induced worsening of their symptoms. The prevalence and characteristics of respiratory reactions provoked by alcohol-containing drinks have not been fully investigated yet. OBJECTIVE: The aim of this study was to estimate the prevalence and characteristics of alcohol hyper-responsiveness in patients with chronic airway disease and healthy controls. Furthermore, nasal inflammation was evaluated in nasal polyp patients with and without hyper-responsiveness. METHODS: We evaluated the prevalence and characteristics of alcohol-induced respiratory complaints in 1281 subjects. Chronic rhinosinusitis with nasal polyps (CRSwNP) patients with and without NSAID exacerbated respiratory disease (NERD), chronic rhinosinusitis patients without nasal polyps (CRSsNP), allergic rhinitis (AR) patients and healthy controls were approached by means of a questionnaire. Inflammatory markers (eosinophilic cationic protein (ECP), IL-5, IgE, SAE-specific IgE, IL-17, TNFα and IFNγ) in tissue were then compared between alcohol hyper-responsive and non-hyper-responsive CRSwNP patients. RESULTS: The highest prevalence of nasal and bronchial alcohol hyper-responsiveness was observed in patients with NERD, followed by CRSwNP, and less frequent in CRSsNP, AR and healthy controls. Alcohol hyper-responsiveness is significantly more prevalent in CRSwNP patients suffering from recurrent disease and in patients with severe symptomatology. In nasal tissue of the hyper-responsive CRSwNP group, we observed significantly higher nasal levels of the eosinophilic biomarker ECP. CONCLUSION AND CLINICAL RELEVANCE: Nasal hyper-responsiveness to alcohol is significantly more prevalent in severe eosinophilic upper airway disease.
[Mh] Termos MeSH primário: Álcoois/efeitos adversos
Pólipos Nasais/patologia
Rinite/etiologia
Rinite/patologia
Sinusite/etiologia
Sinusite/patologia
[Mh] Termos MeSH secundário: Adulto
Biomarcadores
Doença Crônica
Citocinas/metabolismo
Comportamento de Ingestão de Líquido
Feminino
Seres Humanos
Mediadores da Inflamação/metabolismo
Masculino
Meia-Idade
Pólipos Nasais/diagnóstico
Pólipos Nasais/imunologia
Pólipos Nasais/metabolismo
Prevalência
Rinite/diagnóstico
Rinite/metabolismo
Fatores de Risco
Sinusite/diagnóstico
Sinusite/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Alcohols); 0 (Biomarkers); 0 (Cytokines); 0 (Inflammation Mediators)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1111/cea.12836


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[PMID]:28743424
[Au] Autor:Brescia G; Barion U; Zanotti C; Cinetto F; Giacomelli L; Martini A; Marioni G
[Ad] Endereço:Department of Neurosciences DNS, Otolaryngology Section, Padova University, Padova, Italy. Electronic address: giuseppe.brescia@aopd.veneto.it.
[Ti] Título:Blood eosinophil-to-basophil ratio in patients with sinonasal polyps: Does it have a clinical role?
[So] Source:Ann Allergy Asthma Immunol;119(3):223-226, 2017 09.
[Is] ISSN:1534-4436
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In a recent preliminary study, eosinophil and basophil counts were calculated in chronic rhinosinusitis with nasal polyps (CRSwNP) using conventional histologic and immunohistochemical methods. The tissue eosinophil-to-basophil ratio differed in the CRSwNP endotypes considered. OBJECTIVE: To compare the blood eosinophil-to-basophil ratio (bEBR) in a large series of patients with CRSwNP with that in a control group of consecutive rhinological patients with no evidence of nasal, paranasal, or systemic inflammatory disorders. METHODS: A retrospective study was performed on 334 patients with CRSwNP to compare the preoperative bEBR among different endotypes and with controls (69 cases). RESULTS: The mean bEBR was significantly higher in the CRSwNP group than in the control group (P = .0006). The eosinophil and basophil counts were significantly and directly correlated in the CRSwNP cases (P = .0000). The mean bEBR was significantly higher in the sub-cohorts of CRSwNP with allergy (P = .0007), asthma (P = .0000), and aspirin-exacerbated respiratory disease (P = .0153). The mean bEBR was significantly higher in the sub-cohort with eosinophilic CRSwNP than in the sub-cohort with noneosinophilic CRSwNP (P = .0000). CONCLUSION: This study confirms the increasingly interesting role emerging for blood eosinophils and basophils in different CRSwNP endotypes. The bEBR seems to be a parameter worth investigating in different CRSwNP endotypes, because it is significantly higher in patients with allergy, asthma, and aspirin-exacerbated respiratory disease.
[Mh] Termos MeSH primário: Basófilos/imunologia
Eosinófilos/imunologia
Pólipos Nasais/sangue
Sinusite/sangue
[Mh] Termos MeSH secundário: Adulto
Doença Crônica
Feminino
Seres Humanos
Contagem de Leucócitos
Masculino
Meia-Idade
Pólipos Nasais/imunologia
Sinusite/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171205
[Lr] Data última revisão:
171205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE


  10 / 5576 MEDLINE  
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[PMID]:28744660
[Au] Autor:Lou Z
[Ad] Endereço:Department of Otorhinolaryngology, The Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China. louzhengcai@163.com.
[Ti] Título:Assessment of laryngopharyngeal reflux and the shape of the Eustachian tube should be considered in chronic rhinosinusitis with nasal polyps and chronic otitis media.
[So] Source:Eur Arch Otorhinolaryngol;274(12):4265-4266, 2017 12.
[Is] ISSN:1434-4726
[Cp] País de publicação:Germany
[La] Idioma:eng
[Mh] Termos MeSH primário: Tuba Auditiva
Pólipos Nasais
[Mh] Termos MeSH secundário: Doença Crônica
Seres Humanos
Refluxo Laringofaríngeo
Otite Média
Otite Média com Derrame
Sinusite
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1007/s00405-017-4684-7



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