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BACKGROUND: Chronic venous insufficiency (CVI) is characterized by progressive inflammatory changes. Inflammatory damage occurs in the veins, adjacent tissues, and can lead to structural changes in the arteries. The aim of this study is to analyze whether the degree of CVI is associated with arterial stiffness. METHODS: Cross-sectional study including patients with CVI classified by clinical, etiological, anatomical, and pathophysiological classification (CEAP) 1 to 6. We performed correlation between the degree of CVI, central and peripheral arterial pressure, and arterial stiffness measured by brachial artery oscillometry. RESULTS: We evaluated 70 patients, 53 of whom were women with a mean age of 54.7 years. Patients with advanced degrees of venous insufficiency CEAP 4,5,6, had higher levels of systolic, diastolic, central, and peripheral arterial pressures compared to those with early stages (CEAP 1,2,3). The CEAP 4,5,6 group had higher arterial stiffness indices than the CEAP 1,2,3 group: pulse wave velocity (PWV) 9.3 m/s vs. 7.0 m/s, P < 0.001; augmentation pressure (AP) 8.0 mm Hg vs. 6.3 mm Hg; P = 0.04. There was a positive correlation between the degree of venous insufficiency measured by the venous clinical severity score, villalta score and CEAP classification, and the arterial stiffness indices (Spearman's coefficient = 0.62 for PWV and CEAP, P < 0.01). The factors influencing PWV were age, peripheral systolic arterial pressure (SAPp), and AP. CONCLUSIONS: There is a correlation between the degree of venous disease and arterial structural changes characterized by arterial pressure and stiffness indices. Degenerative changes secondary to venous insufficiency are associated with impairment of the arterial system, which has implications for the development of cardiovascular disease.
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Rigidez Vascular , Insuficiência Venosa , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Análise de Onda de Pulso , Estudos Transversais , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/complicações , Artéria Braquial/diagnóstico por imagemRESUMO
Abstract Introduction The endoscopic anatomy of the middle ear (ME) and of the external acoustic meatus (EAM) has been described in cadavers, in fresh temporal bones, or in vivo using conventional video recording, but not in dry bones or using an alternative inspection and recording technique. Objective To study the anatomy of the ME and of the EAM in dry temporal bones using a smartphone-endoscope system. Methods The EAM and the ME were studied in dry temporal bones using an endoscopic transcanal approach with a telescope connected to a smartphone (M-scope mobile endoscope app and adaptador, GBEF Telefonia, São Paulo, SP, Brazil). Results Out of 50 specimens, 2 had exostosis of the EAM and 3 contained remains of the tympanic membrane. The anterior wall of the EAM was prominent in 10/48 specimens (20.8%). Ossicles were seen in 13/45 (28.8%), stapes at the oval window were seen in 12/45 (26.6%), and the incus was seen in 1/45 (2.2%) specimens. The facial canal was open and protruding in 15/45 (33.3%) and in 7/45 (15.5%) specimens, respectively. Of the 45 MEs evaluated, type A was predominant for finiculus (93.3%), subiculum (100%), and ponticulus (95.6%). The rest were type B. None was classified as type C. According to its position in relation to the round window, the fustis was classified into type A (68.9%) or B (31.1%). The pyramidal eminence, the bony portion of the Eustachian tube, the semicanal of the tensor tympani muscle, and the cochleariform process were visualized completely or partially in all cases. Conclusion The use of a smartphone-based endoscopic transcanal procedure in dry temporal bones allowed the evaluation of anatomical variations in the EAM and in the ME.
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Introduction The endoscopic anatomy of the middle ear (ME) and of the external acoustic meatus (EAM) has been described in cadavers, in fresh temporal bones, or in vivo using conventional video recording, but not in dry bones or using an alternative inspection and recording technique. Objective To study the anatomy of the ME and of the EAM in dry temporal bones using a smartphone-endoscope system. Methods The EAM and the ME were studied in dry temporal bones using an endoscopic transcanal approach with a telescope connected to a smartphone (M-scope mobile endoscope app and adaptador, GBEF Telefonia, São Paulo, SP, Brazil). Results Out of 50 specimens, 2 had exostosis of the EAM and 3 contained remains of the tympanic membrane. The anterior wall of the EAM was prominent in 10/48 specimens (20.8%). Ossicles were seen in 13/45 (28.8%), stapes at the oval window were seen in 12/45 (26.6%), and the incus was seen in 1/45 (2.2%) specimens. The facial canal was open and protruding in 15/45 (33.3%) and in 7/45 (15.5%) specimens, respectively. Of the 45 MEs evaluated, type A was predominant for finiculus (93.3%), subiculum (100%), and ponticulus (95.6%). The rest were type B. None was classified as type C. According to its position in relation to the round window, the fustis was classified into type A (68.9%) or B (31.1%). The pyramidal eminence, the bony portion of the Eustachian tube, the semicanal of the tensor tympani muscle, and the cochleariform process were visualized completely or partially in all cases. Conclusion The use of a smartphone-based endoscopic transcanal procedure in dry temporal bones allowed the evaluation of anatomical variations in the EAM and in the ME.
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OBJECTIVE: Describe a reliable anatomical landmark that can be used to locate the maxillary sinus natural ostium (MSNO) during endoscopic surgery, even if the uncinate process is preserved. DESIGN: Descriptive anatomical. SETTING: An anatomical and radiological study was performed to evaluate the consistency of the landmark, denominated "M" line. SUBJECTS AND METHODS: Dissections were performed in 57 cadaver heads (114 sides). In addition, 73 computerised tomography (CT) scans (146 sides) of patients with chronic inflammatory sinonasal disease were analysed using a three-dimensional (3D) reconstruction computer program. RESULTS: The "M" line crossed the MSNO in 112 dissected sides (98.2%) and 140 sides at CT 3D reconstruction (95.9%). CONCLUSION: The "M" line is a reliable anatomical landmark for predicting MSNO location. As such, it could improve and facilitate endoscopic sinus surgery, using traditional, minimally invasive or uncinate preserving techniques.
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Endoscopia/métodos , Seio Etmoidal/diagnóstico por imagem , Seio Maxilar/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Cadáver , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Primary spontaneous cerebrospinal fluid (CSF) rhinorrhea is an unusual phenomenon that may occur anywhere along the skull base. However, CSF leaks originating from clival defects are rarely reported in the literature. The majority of reported cases were managed with microscopic techniques, using free grafts. The present study discusses a case of spontaneous CSF rhinorrhea from a clival defect closed with our transnasal operative approach using endoscopic techniques. The skull base defect was successfully managed with an endoscopic binostril approach to create a nasal septal flap pedicled at the sphenopalatine artery, while also preserving the integrity of the nasal septum.
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Rinorreia de Líquido Cefalorraquidiano , Fossa Craniana Posterior , Imageamento Tridimensional/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos de Cirurgia Plástica/métodos , Tomografia Computadorizada por Raios X/métodos , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection. STUDY DESIGN: Case series with chart review. SETTING: Multi-institutional tertiary university medical centers. PATIENTS: Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015. INTERVENTION: All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone. MAIN OUTCOME MEASURES: The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications. RESULTS: Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2âmm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1âminutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9âdB (SD, 4.6) after surgery. CONCLUSIONS: Endoscopic management of middle ear paraganglioma is safe, feasible, and effective.
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Neoplasias da Orelha/cirurgia , Tumor de Glomo Timpânico/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Adulto , Idoso , Audiometria , Neoplasias da Orelha/patologia , Orelha Média/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
This article presents the endoscopic anatomy of the retrotympanum and its relationship to other important anatomic landmarks in the middle ear to provide understanding of its importance and relevance during surgeries. A well-detailed tour of the retrotympanum, its associated structures, variability of anatomic structures, and surgical relevance is presented.
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Cóclea/anatomia & histologia , Orelha Média/anatomia & histologia , Otoscopia/métodos , Membrana Timpânica/anatomia & histologia , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Cóclea/cirurgia , Orelha Média/cirurgia , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Membrana Timpânica/cirurgiaRESUMO
Endoscopic techniques have influenced almost all of the surgical specialties. From open procedures to minimally invasive approaches, the endoscope and its ability to reach areas within the human body has gained popularity among specialists, creating a revolution in some fields. Two of the fields in which endoscopes provided a true revolution are otolaryngology and neurosurgery. The authors discuss some important factors for the evolution of endoscopic skull base surgery and expanded endonasal approaches, highlighting historical landmarks but also addressing the current concepts, complications, and the future of this promising field for clinical research and surgical techniques and technology.
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Endoscopia/métodos , Otolaringologia/instrumentação , Otolaringologia/tendências , Base do Crânio/cirurgia , Previsões , Humanos , Robótica/instrumentaçãoRESUMO
OBJECTIVE: Assess the feasibility of the use of a life-size model for ESS to perform balloon catheter dilatation of the paranasal sinus ostia. STUDY DESIGN AND SETTING: Four validated sinus models were enrolled in this study. One experienced endoscopic surgeon performed all the dilatations of the paranasal sinus ostia. We used the Relieva Sinus Balloon Catheter System (Acclarent, Inc, Menlo Park, CA), and its described technique for fluoroscopic guided sinuplasty. RESULTS: Twenty-four ostia were available. All sinuses were successfully catheterized and dilated. The total fluoroscopic time was 18 minutes and 8 seconds (mean, 45.3 seconds per sinus) and the total procedure time was 50 minutes and 56 seconds (mean, 2 minutes and 7 seconds per sinus). CONCLUSION: It was feasible to perform a successful dilatation of the 24 available sinus ostia of the models: 8 maxillary, frontal and sphenoid. No major technical difficulties were encountered. SIGNIFICANCE: This model could help surgeons in the training of sinus ostia balloon dilatation.
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Cateterismo , Modelos Anatômicos , Cateterismo/métodos , Endoscopia , Estudos de Viabilidade , Fluoroscopia , HumanosRESUMO
The objective of this paper is to present a case of a 2-year-old girl diagnosed with a meningo-encephalocele after episodes of meningitis, and treated with a transnasal endoscopic approach using nasal septal flaps pediculated at the sphenopalatine artery. Endoscopic repair is a viable and minimally invasive alternative to traditional craniotomy, however technical difficulties encountered as well as questions that remain unanswered are discussed.
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Encefalocele/cirurgia , Endoscopia , Meningocele/cirurgia , Septo Nasal/cirurgia , Retalhos Cirúrgicos , Pré-Escolar , Encefalocele/diagnóstico , Encefalocele/etiologia , Feminino , Humanos , Meningocele/diagnóstico , Meningocele/etiologiaRESUMO
UNLABELLED: Ears, nose and throat have intrigued humanity since immemorial times. Treatments for the larynx, the nose and the ear and also surgeries were practiced by Greek, Hindu and Byzantine doctors. In the 20th century clinical and surgical innovations were incorporated, thanks to new anesthesia techniques, antibiotics, radiology and new technologies. AIM AND METHOD: show the evolution of this science throughout the times, recognizing important persons in otology, rhinology and laryngology. RESULTS AND CONCLUSION: Understanding the evolutions in clinical and surgical anatomy, physiology, treatment modalities, and the personalities that lead to these advances is of great importance for the evolution of medical science. Otorhinolaryngology has a very rich history, with important collaborators and personalities in the history of medicine. The specialty was one of the first to use local anesthesia for procedures, pioneer in treatments with devices that recouped hearing and the use of microscopes in surgeries. Few medical specialties had suffered as many changes and scientific developments in these last decades as Otorhinolaryngology had, with the advantage of incorporating technologies such as endoscopy, radiology, microsurgery and information technology.