RESUMEN
OBJECTIVES: Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. MATERIALS AND METHODS: A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. RESULTS: The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. CONCLUSION: In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.
Asunto(s)
Actitud del Personal de Salud , Endoscopía/métodos , Enfermedades de los Senos Paranasales/cirugía , Neoplasias de los Senos Paranasales/cirugía , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Enfermedad Crónica , Hueso Etmoides/cirugía , Senos Etmoidales/cirugía , Femenino , Humanos , Complicaciones Intraoperatorias/etiología , Masculino , Seno Maxilar/cirugía , Persona de Mediana Edad , Mucocele/cirugía , Pólipos Nasales/cirugía , Órbita/cirugía , Estudios Prospectivos , Sinusitis/cirugía , Seno Esfenoidal/cirugía , Cirugía Asistida por Computador/instrumentaciónRESUMEN
Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Cutáneas/cirugía , Carcinoma/patología , Carcinoma/cirugía , Diagnóstico por Imagen , Músculos Faciales/cirugía , Neoplasias de Cabeza y Cuello/patología , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Melanoma/patología , Melanoma/cirugía , Meninges/cirugía , Invasividad Neoplásica , Metástasis de la Neoplasia/diagnóstico , Evisceración Orbitaria , Glándula Parótida/cirugía , Neoplasias Cutáneas/patología , Cráneo/cirugía , Hueso Temporal/cirugíaRESUMEN
BACKGROUND: Bullous lesions of acral distribution are an uncommon finding in Bazex's syndrome (acrokeratosis paraneoplastica). We report here one of these rare cases. PATIENTS AND METHODS: A 65 year-old-man, an alcoholic and a smoker, presented with characteristic lesions of Bazex's acrokeratosis paraneoplastica associated with a right cervical lymph node mass. An epidermoid carcinoma of sinus piriformis was then discovered. The acrokeratosis lesions worsened and spread to the knees, elbows, trunk and genitalia, with an erosive aspect, pain in the extremities, and tender, hemorrhagic bullous lesions on the toes and sides of the feet. Histological examination of a biopsy sample showed a subepidermal blister with numerous eosinophilic leucocytes. Direct immuno-fluorescence showed C3 deposits on dermal capillaries and IgA and IgM on colloid bodies in the papillary dermis. Blood eosinophilia and high levels of IgE were noted. Indirect immunofluorescence was negative for anti-epidermal and anti-basement membrane antibodies. Radiation and chemotherapy for the neoplasia resulted in healing of the bullous lesions and almost complete disappearance of keratotic squamous lesions with residual hyperpigmentation. DISCUSSION: Although bullous lesions are rare in Bazex's syndrome (acrokeratosis paraneoplastica), they were noted as early as 1968 by Degos et al. These acral bullae mimic autoimmune bullous disease. An immunological reaction is thought to occur with antigens of the dermal-epidermal junction and eosinophils appear to be involved.
Asunto(s)
Queratosis/patología , Síndromes Paraneoplásicos/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Anciano , Carcinoma de Células Escamosas/diagnóstico , Humanos , Queratosis/terapia , Masculino , Neoplasias Nasofaríngeas/diagnóstico , Síndromes Paraneoplásicos/terapia , Enfermedades Cutáneas Vesiculoampollosas/terapiaRESUMEN
Cavernous hemangiomas are benign vascular orbital lesions that exert a slowly progressive mass effect. They usually occur in adults. The authors report an unusual case of a large orbito-palpebral cavernous hemangioma with peculiar history and symptoms. The main clinical and radiological characteristics of this tumor are recalled together with the basis of surgical management.
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Neoplasias de los Párpados/diagnóstico , Hemangioma Cavernoso/diagnóstico , Neoplasias Orbitales/diagnóstico , Adolescente , Neoplasias de los Párpados/cirugía , Femenino , Hemangioma Cavernoso/cirugía , Humanos , Aparato Lagrimal/cirugía , Neoplasias Orbitales/cirugía , Cirugía PlásticaRESUMEN
Intranasal (in) administration of GH-releasing hormone-40- (GHRH-40) has been demonstrated to be efficient in stimulating GH secretion at doses equal to or higher than 30 micrograms/kg in man. We performed a dose-response study with GHRH-44-NH2 (GHRH) given by nasal spray and closely monitored local tolerance. Twelve normal young men were given 5 GNRH doses (125, 250, 500, 750, and 1000 micrograms) and placebo in random order according to a latin square design. Mild symptoms of local intolerance, subjective, objective, or both, were noted in the first 20 min after spray in 30 of 72 tests, and a significant difference (P = 0.003) was obtained in their frequency between the group placebo plus the lowest dose and the group of the other doses. The areas under the GH curves were significantly different between the subjects and the doses (by analysis of variance, P = 0.001 and P = 0.025, respectively). Multiple comparison tests showed a significant difference between the 3 highest doses and the placebo (P = 0.005, P = 0.05, and P = 0.02, respectively) and a significant difference between the highest dose and the 2 lowest doses (P = 0.005). By weighted linear regression between GH areas under the curve and GHRH doses the dose-response relationship was established as: y = 1.226x + 457. The magnitude of the GH peaks induced by in GHRH was significantly lower than that induced by iv GHRH. We conclude that in the normal young men tested, who were high responders to GHRH (as demonstrated by iv test), a 500-micrograms dose is sufficient to elicit GH secretion. Local tolerance, although imperfect, appears satisfactory to permit a clinical trial in children.
Asunto(s)
Hormona Liberadora de Hormona del Crecimiento/análogos & derivados , Hormona del Crecimiento/metabolismo , Fragmentos de Péptidos/farmacología , Administración Intranasal , Adulto , Relación Dosis-Respuesta a Droga , Hormona del Crecimiento/sangre , Hormona Liberadora de Hormona del Crecimiento/administración & dosificación , Hormona Liberadora de Hormona del Crecimiento/efectos adversos , Hormona Liberadora de Hormona del Crecimiento/farmacología , Humanos , Cinética , Masculino , Fragmentos de Péptidos/administración & dosificación , Fragmentos de Péptidos/efectos adversos , Valores de ReferenciaRESUMEN
Extensive fibromatosis, also called desmoid tumor, is a histologically benign tumor, which is nonetheless serious due to its recurrent character and to its potential for infiltration of neighboring tissues. Extensive surgery is the only effective means of treatment, radiation therapy being used only as a complement. The authors describe an elective location of the lesion in the sheaths of the scalenus muscles. This development is usually observed in young women, as is the case in the observation reported here.
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Fibroma/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Músculos del Cuello , Adulto , Femenino , Fibroma/terapia , Neoplasias de Cabeza y Cuello/terapia , Humanos , Recurrencia Local de Neoplasia , Reoperación , Tomografía Computarizada por Rayos XRESUMEN
Nine cases of diffusal cervical cellulitis due to anaerobes were analysed. Some of them had right away extensions (to the inferior mediastinum or to the face). From these cases, the authors argue their treatment protocol. Surgery was performed immediately after diagnosis, and associated with intensive management. The excision of the necrotic tissue and the aperture of all cervical spaces (particularly the floor to the buccal cavity and the prevertebral space) were made. The source of infection was looked for (most often this being the teeth) and treated at the same time. Bacteriologic aero and anaerobic prelevements were done. A thoracic or facial surgery, being necessary because of persistency or appearance of extension, was performed secondary, after the patient was better prepared with a hyperoxygenation and a triple antibiotic therapy. Life prognosis improved with this treatment protocol. The gravity of the conditions presented by our patients depended more on the presence of an underlying disease (diabetes, immunosuppression, age...) or the delay of the diagnosis than on the cellulitis extension.
Asunto(s)
Infecciones Bacterianas , Celulitis (Flemón)/etiología , Adulto , Antibacterianos/uso terapéutico , Bacterias Anaerobias , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/terapia , Urgencias Médicas , Femenino , Humanos , Masculino , Mediastinitis/etiología , Persona de Mediana Edad , Cuello , Absceso Periapical/complicaciones , Pericarditis/etiología , Absceso Peritonsilar/complicaciones , PronósticoRESUMEN
Based on a review of 13 personal cases an attempt is made to isolate a specific laryngeal lesion: extensive papilloma durum of larynx of almost ineluctable malignant transformation. Clinical, histopathologic and therapeutic aspects of the affection are reviewed.