RESUMEN
OBJECTIVE: The purpose of this study was to compare closure rates of CO2 laser myringotomies with those produced conventionally with a knife. STUDY DESIGN AND SETTING: We investigated closure rates in 3 experimental groups of chinchillas: (1) semicircular myringotomy in both ears either produced with a knife or CO2 laser; (2) CO2 laser myringotomy, round in one ear and kidney shaped in the other; (3) CO2 laser myringotomy, incisional in one ear and kidney shaped in the other. RESULTS: Patency of knife myringotomies was shorter (P < 0.01) than of similar laser myringotomies, means 10.0 and 21.8 days, respectively. The patency of kidney-shaped laser myringotomies was longer (P < 0.05) than of round ones. Incisional laser myringotomies remained open longer (P < 0.01) than round ones. CONCLUSION: Use of CO2 laser as well as certain geometries delay the closure of myringotomies. By allowing perforations of different shapes and sizes, CO2 laser myringotomy may become an alternative in the treatment of otitis media.
Asunto(s)
Terapia por Láser , Procedimientos Quirúrgicos Otológicos , Membrana Timpánica/cirugía , Cicatrización de Heridas , Animales , Dióxido de Carbono , Chinchilla , Modelos Animales , Distribución AleatoriaRESUMEN
AIMS: To investigate the expression of alpha, beta, and gamma catenins in oropharyngeal and hypopharyngeal squamous cell carcinoma and their relations to each other, as well as to clinical data, tumour differentiation, and prognosis. METHODS: Primary tumours for analysis were obtained from 138 patients diagnosed with squamous cell carcinoma of the oropharynx or hypopharynx between 1975 and 1998 in eastern Finland. Immunohistochemistry was used to evaluate the expression of alpha, beta, and gamma catenins. The expression patterns of all catenins were related to clinical data and survival. RESULTS: The expression patterns of all three catenins were significantly interrelated. Reduced gamma catenin expression was significantly associated with poor histological differentiation. No association was found between alpha or beta catenin expression and clinicopathological characteristics. In univariate analysis, patients whose tumours had nuclear beta catenin expression had shorter overall survival than patients with no nuclear expression. In Cox multivariate analysis, nuclear beta catenin expression, tumour status (T class), and Karnofsky performance index were independent prognostic factors of overall survival. CONCLUSIONS: Reduced expression of gamma catenin is associated with dedifferentiation in primary squamous cell carcinoma of the oropharynx and hypopharynx. The fact that nuclear beta catenin expression independently predicts short overall survival suggests that it might be a valuable prognostic marker in pharyngeal squamous cell carcinoma.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/metabolismo , Proteínas del Citoesqueleto/metabolismo , Neoplasias Hipofaríngeas/metabolismo , Neoplasias Orofaríngeas/metabolismo , Transactivadores , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Diferenciación Celular , Núcleo Celular/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hipofaríngeas/patología , Técnicas para Inmunoenzimas , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Proteínas de Neoplasias/metabolismo , Neoplasias Orofaríngeas/patología , Pronóstico , Tasa de Supervivencia , beta CateninaRESUMEN
OBJECTIVE: Hemorrhages are main complications after tonsillectomy, whatever technique is used. This prospective study aimed at revealing pros and cons associated with monopolar electrodissection tonsillectomy. STUDY DESIGN: A prospective study. METHODS: A prospective study on all patients undergoing tonsillectomy or adenotonsillectomy in Central Hospital of Central Finland in 1997. Operation time and bleeding, as well as perioperative and postoperative complications, were recorded. RESULTS: Inpatient tonsillectomy was performed in 440 patients (mean age, 17.9 y). Primary post-tonsillectomy hemorrhage (within 24 h) occurred in 2.3%. A total of 15.9% of patients searched for medical help because of secondary post-tonsillectomy hemorrhage, 7.7% receiving active treatment and 8.2% not. Post-tonsillectomy hemorrhages proved to be most common in older patients and when peritonsillar abscess was in patient history. CONCLUSIONS: Monopolar electrodissection tonsillectomy was fast and resulted in little intraoperative bleeding. However, postoperative hemorrhages were common, and the mean use of analgesics was for more than 10 days. Preoperative counseling must be thorough and realistic. Our results indicate that better methods for tonsillectomy still need to be developed.
Asunto(s)
Electrocoagulación/métodos , Hemostasis Quirúrgica , Hemorragia Posoperatoria/etiología , Tonsilectomía/métodos , Adenoidectomía , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Factores de RiesgoRESUMEN
OBJECTIVE: The purpose of this prospective study was to investigate the role of adenoidectomy in children undergoing elective adenotonsillectomy. PATIENTS AND METHODS: All consecutive children less than 15 years of age operated on over a 12-month period were included. Adenoidectomy was done with curettes and forceps under mirror visualization and tonsillectomy with a unipolar electrodissection technique. Duration of the operation, intra-operative blood loss, and post-operative complications were recorded. RESULTS: Adenotonsillectomy was done in 98 children with a mean age of 7.8 years. The mean duration of adenoidectomy was 10.3 min (S.E. 0.7), 51.8% of the time used for adenotonsillectomy and 25. 9% of the total operating room time. The blood loss was 43.6 ml (S.E. 5.4) and 7.8 ml (S.E. 2.5) for adenoidectomy and tonsillectomy, respectively. Both the duration (P=0.04) and blood loss (P=0.0005) of adenoidectomy increased significantly with the increasing age of children. Post-adenoidectomy complications did not occur. CONCLUSION: Even though adenoidectomy prolonged the operating time and increased the intra-operative blood loss, especially in older children the procedure in general remained relatively short and safe. However, adding adenoidectomy to tonsillectomy should always be carefully considered, particularly in children 10 years or older operated on principally because of palatine tonsil disease.
Asunto(s)
Adenoidectomía/métodos , Complicaciones Intraoperatorias , Hemorragia Posoperatoria , Tonsilectomía/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores de TiempoRESUMEN
The surgical management of subglottic stenosis may be complicated by reformation of strictures. A slow-release combination of 5-fluorouracil, which has an antiproliferative effect on fibroblasts, and the corticosteroid triamcinolone acetonide has been used experimentally to control scar production in ophthalmic operations. This study was performed to determine if this material also can be used to reduce formation of subglottic stenosis. Subglottic stenosis was induced in rabbits by means of injury to the subglottic mucosa and submucosa. A suspension of the compound at a concentration of 2.5 mg/ml or 12.5 mg/ml was injected into the adjacent soft tissues. A control group of rabbits received the same volume of the suspension fluid but no compound. Two rabbits from each group were killed 1, 2, and 12 weeks postoperatively. No stenosis was seen at 1 or 2 weeks, but at 12 weeks the rate of formation of subglottic stenosis was decreased to a mean of 15.20% in the experimental groups compared with 47.37% in the control group. There were no indications of local or systemic toxicity. The promising results from this preliminary study suggest that use of this compound may reduce restenosis among patients treated surgically for subglottic stenosis. Further studies are being conducted.
Asunto(s)
Antiinflamatorios/uso terapéutico , Antimetabolitos Antineoplásicos/uso terapéutico , Fluorouracilo/uso terapéutico , Laringoestenosis/tratamiento farmacológico , Triamcinolona/uso terapéutico , Animales , Antiinflamatorios/farmacología , Antimetabolitos Antineoplásicos/farmacología , Movimiento Celular/efectos de los fármacos , Preparaciones de Acción Retardada/farmacología , Preparaciones de Acción Retardada/uso terapéutico , Fibroblastos/efectos de los fármacos , Fluorouracilo/farmacología , Conejos , Ratas , Triamcinolona/farmacología , Cicatrización de Heridas/efectos de los fármacosRESUMEN
HYPOTHESIS: The purpose of this prospective study was to determine if direct inspection of air cells using endoscopy could reduce the occurrence of cerebrospinal fluid (CSF) leak in suboccipital acoustic neuroma surgery. BACKGROUND: Cerebrospinal fluid leak remains one of the most common complications after acoustic neuroma surgery. The suboccipital approach for excision of acoustic neuromas has been used increasingly since gadolinium-enhanced magnetic resonance imaging has improved the ability to diagnose smaller tumors. Suboccipital approaches are reported to have CSF leak rates of as high as 27% with an average rate of 12%, most presenting as rhinorrhea. Ideally, this complication could be avoided by careful closure of all air cells exposed during the approach, especially those commonly found in the posterior wall of the internal auditory canal and in the retrosigmoid area. Packing these cells with a variety of materials has been done but often indirectly, as visualization of all cells by the conventional operating microscopes may not be possible. Failure to recognize patent cells because of limited visualization may be an important cause of postoperative CSF leak. METHODS: This study compared CSF rhinorrhea rates of 38 consecutive suboccipital acoustic neuroma operations, in which conventional techniques were used to pack the temporal bone defect around the internal auditory canal, with the succeeding 24 consecutive operations, in which endoscopes were used to visualize all exposed air cells directly. After locating all patent air cells endoscopically, they were specifically sealed with bone wax, and then a small fat graft harvested from the wound margin was used to fill the remaining defect. RESULTS: Postoperative CSF rhinorrhea occurred in 7 of 38 (18.4%) operations in which no endoscopic technique was used and in 0 of 24 operations in which endoscopes were used. CONCLUSIONS: The use of endoscopes to visualize the temporal bone air cells that cannot be directly observed otherwise appears to reduce the incidence of postoperative CSF leak in suboccipital acoustic neuroma surgery.