RESUMEN
The authors report the case of an 80-year-old male patient who had a modified left orbit exenteration with preservation of myocutaneus eyelid flap. The radical surgical treatment was performed due to high-grade recurrent pleomorphic conjunctival sarcoma with extension to the sclera and medial orbit. Five previous resection surgeries were performed, until the exenteration was considered. Prosthetic rehabilitation was planned integrating interdisciplinary biomedical knowledge, to create a new hybrid osteointegrated method with costume-made titanium miniplates and magnetic retention. During the second-year follow up, the system appeared osteointegrated. No failures from the retention mechanism have been reported. The patient reported to have a functional role inside and outside his house. Social interactions have not been limited by the anatomical facial defect. This new hybrid system is a feasible option to rehabilitate patients with orbital or facial defects, even for the elderly.
Asunto(s)
Recurrencia Local de Neoplasia , Procedimientos de Cirugía Plástica , Anciano , Anciano de 80 o más Años , Humanos , Fenómenos Magnéticos , Masculino , Órbita/cirugía , Evisceración Orbitaria , Estudios Retrospectivos , Colgajos QuirúrgicosRESUMEN
BACKGROUND AND OBJECTIVE: Thyroid-associated ophthalmopathy (TAO) is the most common extrathyroidal manifestation of Graves disease, occasionally severe and refractory to treatment, mainly in long-term disease. In these cases, one of the most important infiltrating cytokines in the orbital tissue is interleukin-6 (IL-6). METHODS: This is a case report, the methodology consisted of the application of tocilizumab in a patient with graves disease and the patient's follow-up. RESULTS: We present the case of a 54-year-old male with TAO who responded adequately to treatment with tocilizumab, an antibody directed against the IL-6 receptor. CONCLUSION: Tocilizumab could be an optional treatment in patients with TAO.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Oftalmopatía de Graves/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Enfermedad Crónica , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/inmunología , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: To determine the outcome and safety of pediatric endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. METHODS: A prospective, nonrandomized and noncomparative interventional case series study was performed in 71 consecutive procedures. Sixty patients 16 years of age and younger underwent nonlaser endonasal dacryocystorhinostomy with the use of adjunctive mitomycin C. Eleven patients had a simultaneous bilateral procedure performed. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac and surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was completely removed and a neurosurgical cottonoid soaked in mitomycin C at 0.5 mg/ml placed at the osteotomy site for 5 minutes. All patients underwent bicanalicular or monocanalicular silicone intubation. RESULTS: The main outcome measures were the resolution of epiphora, lacrimal discharge, and patency of the ostium confirmed either by endoscopic visualization and/or irrigation at 6 months or a normal dye disappearance test. Thirteen patients' (18%) final evaluation was via telephone survey. The mean follow-up was 12.3 months. Nonlaser endonasal dacryocystorhinostomy with adjunctive mitomycin C was successful in 67 cases (94.4%). African descent was strongly associated with a higher rate of obstruction (p < 0.001). Infection at the time of surgery (p = 0.051) and less than 3 months intubation (p = 0.059) were also borderline significant. Previous trauma, gender, age, and side operated had no influence on the final outcome. No significant complications were encountered. CONCLUSIONS: Nonlaser endonasal dacryocystorhinostomy with mitomycin C is a safe and successful procedure for the treatment of congenital nasolacrimal duct obstruction in children. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be successfully performed as a simultaneous bilateral procedure.