RESUMEN
The relationship between emergency tracheotomy (ET) and stomal recurrence (SR) was evaluated in 369 patients who underwent surgery for laryngeal cancer. Emergency tracheostomy was performed in 31 patients. Age, sex, primary location, T stage, pN stage, histological grading, and time from emergency tracheotomy to definitive treatment were examined. Stomal recurrence occurred in 2.1% overall; in 1.2% of the tracheotomy-free group, and in 13% (4/31) of the emergency tracheotomy group (p < 0.0001). Recurrences were significantly more frequent in subglottic (p = 0.00007) and T3 lesions (p < 0.0001). Emergency tracheostomy often is needed in patients who have primary subglottic tumors or tumors than invade the subglottis. The relationship between ET and SR appears to be more circumstantial than causal. Aggressive local treatment is recommended in patients with subglottic lesions or subglottic tumor extension to prevent SR.
Asunto(s)
Traqueostomía , Traqueotomía , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Urgencias Médicas , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Laringe/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Cytomegalovirus (CMV) infection is a common opportunistic pathogen in transplant recipients; however, cytomegaloviral laryngitis is extremely rare. METHODS: We present a case of disseminated CMV infection and ulcerating necrotizing laryngitis situated in the subglottis of an immunocompromised patient with a renal and cardiac transplant. The patient was initially seen with discomfort in the throat. RESULTS: Physical examination of the head and neck, fiberoptic laryngoscopy, and CT scan of the larynx were normal. Histopathology of a laryngeal ulcer in the subglottic region showed intranuclear and intracytoplasmic bodies. Immunoperoxidase stain and in situ hybridization studies were positive for CMV. CONCLUSIONS: In immunosuppressed patients with persistent throat symptoms, the systematic exploration of larynx and bronchus is necessary to rule out the presence of opportunistic infections.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Laringitis/virología , Adulto , Resultado Fatal , Trasplante de Corazón , Humanos , Terapia de Inmunosupresión/efectos adversos , Trasplante de Riñón , Masculino , Infecciones Oportunistas/virologíaRESUMEN
A review was made of 150 cases of chronic otitis media caused by cholesteatoma that were operated consecutively; no complications or active otorrhea was present. In 61.3% of cases, prophylactic antibiotic (PA) treatment was given on the basis of the surgeon's criteria, which probably reflected the presence or absence of risk factors. Most patients were given a penicillin or penicillin derivative (amoxi-ampicillin followed by cephalosporins). Antibiotic administration was prolonged longer than necessary (mean 3.4 days). PA was not associated with important complications. Postoperative infection occurred in 10.7% of cases, usually infection of the surgical wound, most commonly by Staphylococcus aureus. Otorrhea occurred in 7.3% of cases in the 15 days after surgery and was more frequent in patients treated via an endomeatal approach and in those who had ossicular prosthesis. Prophylactic antibiotic treatment produced no benefit to our patients in the form of any reduction in number of surgical infections, postoperative otorrhea or mean hospital stay. Therefore, PA is not recommended in surgery for uncomplicated cholesteatoma. When risk factors are present, a suitable and complete antibiotic treatment may be indicated.
Asunto(s)
Antibacterianos/uso terapéutico , Colesteatoma/cirugía , Otitis Media/tratamiento farmacológico , Otitis Media/cirugía , Penicilinas/uso terapéutico , Adulto , Antibacterianos/administración & dosificación , Otorrea de Líquido Cefalorraquídeo/etiología , Colesteatoma/complicaciones , Femenino , Humanos , Masculino , Otitis Media/etiología , Penicilinas/administración & dosificación , Complicaciones Posoperatorias , Estudios Retrospectivos , Staphylococcus aureus/aislamiento & purificación , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Sialadenoma papilliferum is a rare, benign, exophytic tumour of the salivary glands. The prognosis is exceptionally good. Since the lesion was first described, 30 cases have been reported in the English literature, and only one of these is known to have recurred. A case of sialadenoma papilliferum occurring in the buccal mucosa with recurrence three years after local excision, is presented. The literature is briefly discussed.
Asunto(s)
Mucosa Bucal/patología , Neoplasias de las Glándulas Salivales/patología , Anciano , Femenino , Humanos , Recurrencia Local de Neoplasia/patología , Glándulas Salivales Menores/patologíaRESUMEN
The AA. present a retrospective study regarding their experience, in the last 20 years (1973-1993), on diagnosis and management of tumors localized in the parapharyngeal space. In this interval 16 patients, carrying on 17 parapharyngeal tumors, were diagnosed. The incidence was similar in both sexes, the ages ranging widely, the clinic inspecific and the diagnosis confirmed late. They advise the CT with opaque media, nowadays associated to NMR, as suitable diagnostic routine. Fine needle biopsy is not recommended as regular procedure. The great deal of cases carried benign tumors, though individually metastatic epidermoid carcinomas were the most prevalent, followed by salivary and neurogenic growths. 15 individuals underwent surgery. In all but one the cervical approach without mandibulotomy--supposed to be the selective procedure--was done. No one was tracheotomized. Four postoperative nervous complications presented: 2 corresponding to malingnancies. Neither major complications nor perioperative mortality resulted.
Asunto(s)
Neoplasias Faríngeas/diagnóstico , Neoplasias Faríngeas/cirugía , Faringe/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/patología , Faringe/patología , Complicaciones Posoperatorias , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
In spite of its rarity Wegener's granulomatosis is of great concern to be otolaryngologist because the malady may start in the territory of the speciality, challenging the actual diagnosis, owing to the inespecificity of the symptomatology, to its torpid evolution, as well as the potential harmfullness of process. This paper inform of the retrospective study done by the AA. in the last ten years, about 4 cases diagnosed and treated by them. All the possible diagnostic measures are contemplated: clinical and histopathological findings and the newly introduced tests for anticytoplasmatic antibodies against the neutrophiles. A review of the bibliography on the subject is adjoined. All the considered patients consulted at the beginning with the otolaryngologist. Diagnostic suspicion aroused only in patients with nasal complaints (50 percent) and were not under suspicion those with ear symptoms. Positive diagnosis were confirmed in all cases through renal biopsies. Nasal biopsies resulted negatives. When the syndrome started in low aged patients the evolutive course showed deleterious and the affected died after a short term of few months. In more aged a survival of 8-9 yeas was reached.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Otitis Media/complicaciones , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Autoanticuerpos , Biopsia , Ciclofosfamida/uso terapéutico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Riñón/cirugía , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Neutrófilos/inmunología , Otitis Media/tratamiento farmacológico , Senos Paranasales/cirugía , Diálisis Renal , Insuficiencia Renal/complicaciones , Insuficiencia Renal/cirugía , SíndromeRESUMEN
The biopsy of minor salivary glands has great value in the diagnosis of the pathology of salivary glands; however, this technique is little known and seldom used. During the last 18 months we have studied in order to describe the technique and its utility.
Asunto(s)
Biopsia , Glándulas Salivales Menores/cirugía , Femenino , Humanos , Linfocitos/química , Masculino , Glándulas Salivales Menores/patología , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/patologíaRESUMEN
Foreign bodies sitting in the E.N.T.-area are the most urgencies needing immediate attention by the specialist. The AA. study the 738 cases admitted at their Department, for correlative consultations, in one year-term, because of suspicion of accidental lodgements. They arrange the whole lot in 5 not specific localizations, with the aim of consider the peculiarities of each group. In the great deal of instances the patients were worried for oropharyngeal penetration, followed by a lower number complaining of oesophageal distress. Considerations regarding the usefulness of ancillary exploratory techniques, specially the Radiology.
Asunto(s)
Cuerpos Extraños/diagnóstico , Adolescente , Adulto , Anciano , Bronquios , Niño , Preescolar , Oído , Esófago , Femenino , Cuerpos Extraños/epidemiología , Hospitales Generales , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nariz , Orofaringe , Factores Sexuales , España , TráqueaRESUMEN
We present a retrospective epidemiological study about an analysis of the emergencies hospital admissions in an ENT service of a tertiary hospital with high assistencial pressure, during one year. We study the parameters: date, sex, age, complementary examinations, diagnosis and appropriateness of the admission following the AEP (Appropriateness Evaluation Protocol) criteria. A remarkable finding is the high incidence (31.74%) of emergency admissions in the total admission in the ENT service. There was a low frequency of inadequate admission of patients. The appropriateness of admissions was highest for foreign bodies and respiratory distress; the lowest was for cancer patients. The most frequent appropriateness criteria was the need of drugs and/or intravenous fluids.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Enfermedades Otorrinolaringológicas/epidemiología , Adulto , Urgencias Médicas , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
We present a retrospective study of 942 ENT emergencies in a Health Center (primary care), during the year 1990, treated by family physicians. They are analysed under different parameters such as date, time, sex, age, diagnosis, drug prescription and dispatch of the patients to the hospital. We carried out an analysis of the quality of the attention given.
Asunto(s)
Enfermedades Otorrinolaringológicas/epidemiología , Adulto , Anciano , Niño , Servicios de Salud Comunitaria , Urgencias Médicas , Femenino , Humanos , Incidencia , Masculino , Estudios RetrospectivosRESUMEN
We have studied the post-surgical results of 48 perforations of the nasal septum, regarding their etiology, location and size, which must be taken into account when deciding which closure technique to use.
Asunto(s)
Tabique Nasal/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Operativos/métodos , Resultado del TratamientoRESUMEN
The main point in managing suspected impaction of esophageal foreign bodies is to decide whether the patient needs an esophageal endoscopy. Decision-making is based on clinical history, physical examination, and radiographic studies. We review 100 cases of adults having esophagoscopy for removal of esophageal foreign bodies. Fish bones were the most frequently responsible foreign body and the cervical esophagus was the most frequent level of impaction. Decision-making based on clinical history and patient-referred symptoms revealed a positive esophagoscopy in 72% of the suspected cases. Radiographic studies gave falsely positive and falsely negative information in 30% of the cases. Rigid esophagoscopy was used successfully for foreign body removal in 99% of the cases. Average hospital stay was 3.2 days. No complications associated with the use of a rigid esophagoscope were found.