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1.
Acta Otorhinolaryngol Ital ; 35(3): 186-90, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26246663

RESUMEN

Several surgical solutions have been proposed for reconstruction of the auricle in patients whose ear is missing as a result of a traumatic accident, cancer resection, or a congenital condition. These include insertion of an autogenous rib cartilage framework or a porous polymeric material into an expanded postauricular pocket. Reconstruction with rib cartilage has given good results, but requires more than one surgical step and adverse events can occur at both the donor and acceptor site, while cases of prosthesis rejection have been described following application of polymeric prostheses with the expanded postauricular pocket technique. The use of a titanium dowel-retained silicone prosthetic pinna, fixed to temporal bone, has recently been proposed. This surgical technique is particularly indicated after resection of the pinna in cancer patients and in cases of traumatic auricular injury. Bone-anchored titanium implants provided the 15 patients in this study with a safe, reliable, adhesive-free method of anchoring auricular prostheses. The prostheses allowed recovery of normal appearance and all patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered.


Asunto(s)
Pabellón Auricular/cirugía , Oseointegración , Prótesis e Implantes , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Adulto Joven
2.
Acta Otorhinolaryngol Ital ; 29(1): 41-3, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19609382

RESUMEN

Solitary fibrous tumours are rare mesenchymal neoplasms usually arising in the pleura. Extra-pleural locations are uncommon although some cases of head and neck involvement have been reported in the recent literature. In such cases, nose, paranasal cavities and parapharyngeal spaces are the most frequently affected sites. The Authors present a case of a solitary fibrous tumour involving the laterocervical spaces. The histological diagnosis of solitary fibrous tumours gives rise to significant problems since parameters for determining their aggressiveness are still controversial. Immunohistochemical techniques are considered to provide a decisive identification. Follow-up plays a crucial role, as recurrences can occur even after several years. Usually, complete surgical excision is adequate whilst curative and radiochemotherapy may be indicated if complete resection of the tumour mass is impossible.


Asunto(s)
Neoplasias de Cabeza y Cuello , Tumores Fibrosos Solitarios , Anciano , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/cirugía
3.
Acta Otorhinolaryngol Ital ; 28(1): 1-6, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18533547

RESUMEN

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.


Asunto(s)
Adenoidectomía/estadística & datos numéricos , Tonsilectomía/estadística & datos numéricos , Niño , Preescolar , Humanos , Italia
4.
Acta Otorhinolaryngol Ital ; 24(3): 161-4, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15584588

RESUMEN

Parathyroid cysts are a relatively rare cause of neck swelling, and their anatomo-pathological and clinical features are still under debate. Two types of parathyroid cysts have been recognized: the non-functioning or essential forms, which are more frequent, and the adenomatous or functioning parathyroid cysts, which are rarer and cause hyperparathyroidism. Two cases of parathyroid cysts are reported and the treatment is described bearing in mind the various therapeutic procedures proposed in the literature. Attention is focused on pre-operative differential diagnosis from other masses, in the same area, and, to this end, the importance is stressed of assaying parathyroid hormone levels in the cystic fluid, obtained by fine-needle aspiration, and correlating these values with serum levels of the hormone.


Asunto(s)
Quistes/diagnóstico por imagen , Quistes/patología , Enfermedades de las Paratiroides/diagnóstico por imagen , Enfermedades de las Paratiroides/patología , Adulto , Quistes/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Paratiroides/cirugía , Tomografía Computarizada por Rayos X
5.
Acta Otorhinolaryngol Ital ; 24(6): 342-7, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15952684

RESUMEN

Cervical lymph node metastases may be the initial manifestation of occult cancer. Despite a very exhaustive search, the primary site of approximately 2-10% of these tumours remain undetected. Evaluation of the patient includes: detailed physical examination of skin, upper airways (fiberoptic endoscopy), salivary glands and thyroid; fine-needle biopsy, multiple endoscopic biopsies, and imaging studies (ultrasonography, computed tomography scan or magnetic resonance imaging). Recently, positron emission tomography scan has been demonstrated to be a useful diagnostic imaging study in these patients. The records of 11 patients were reviewed. End-points were the usefulness of positron emission tomography in the detection of an unknown primary tumour and/or distant metastatic disease. In 5 patients, positron emission tomography detected a primary lesion, confirmed pathologically and revealed distant metastases in 2 patients. Two cases were false-positive and 1 false-negative. In 3 patients no primary tumour was found after 3 years follow-up. In conclusion, positron emission tomography was not of any significant advantage in detecting occult primary tumour vs. computed tomography scan or magnetic resonance imaging. Positron emission tomography, as "ab initio" total body examination, is important in detection of unsuspected distant diseases.


Asunto(s)
Carcinoma/secundario , Neoplasias de Cabeza y Cuello/secundario , Neoplasias Primarias Desconocidas , Tomografía de Emisión de Positrones , Adulto , Carcinoma/clasificación , Carcinoma/diagnóstico , Endoscopía/métodos , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/diagnóstico
6.
Acta Otorhinolaryngol Belg ; 57(1): 79-81, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12642957

RESUMEN

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.


Asunto(s)
Histiocitoma Fibroso Benigno/diagnóstico por imagen , Histiocitoma Fibroso Benigno/patología , Neoplasias Faríngeas/diagnóstico por imagen , Neoplasias Faríngeas/patología , Histiocitoma Fibroso Benigno/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/cirugía , Tomografía Computarizada por Rayos X
7.
Spinal Cord ; 41(2): 97-104, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12595872

RESUMEN

STUDY DESIGN: Single case study. OBJECTIVES: To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the effect of inter-subject variability. SETTING: The Centre of Sport Medicine and Bioengineering Centre 'Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy. METHODS: A single patient (lesion level T5-T6) was trained specifically for each walking system and was evaluated after each training period. The effects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/VO2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at different speeds. RESULTS: The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/VO2 curves with ARGO was higher (slope difference=51.1 b 1O2(-1)), with ARGO+FES was similar (slope difference=-5.3 b 1O2(-1)) and with Parastep was smaller (slope difference=-55.6 b 1O2(-1)); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject. CONCLUSIONS: (a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric effort of the stimulated muscles. SPONSORSHIP: This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25).


Asunto(s)
Metabolismo Energético , Aparatos Ortopédicos , Paraplejía/fisiopatología , Caminata , Adaptación Fisiológica , Adulto , Terapia por Estimulación Eléctrica , Humanos , Masculino , Paraplejía/terapia
8.
Rev Laryngol Otol Rhinol (Bord) ; 123(4): 259-61, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12723493

RESUMEN

The schwannomas are nervous tissue tumours that arise from Schwann cells; they are uncommon in peripheral nerves and rare in the tongue. After, a review of the literature, we present a case of schwannoma which arose in the ventral part of the body of the tongue. The tumour presented as a slowly growing mass producing few symptoms. The diagnosis of schwannoma is usually made post-operatively by histological identification although modern imaging techniques can provide useful indications. The treatment is exclusively surgical and usually enucleation of the mass is uncomplicated. There are no reports of malignant transformation.


Asunto(s)
Neurilemoma/patología , Neurilemoma/cirugía , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Resultado del Tratamiento
9.
Auris Nasus Larynx ; 28(4): 345-7, 2001 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11694380

RESUMEN

Myositis ossificans traumatica (MOT) is a pathological condition characterized by extraskeletal formation of bony tissue, induced by violent or repeated trauma. Reports of this pathology occurring in the region of the head and neck are rare, and even more so in the muscles of mastication. We present the case of patient with MOT of the temporal muscle, the etiology of which seems to be related to traumatic manipulations during dental treatment. A review of the literature is presented and the surgical approach, which resolved this case is discussed.


Asunto(s)
Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Miositis Osificante/diagnóstico por imagen , Músculo Temporal/lesiones , Tomografía Computarizada por Rayos X , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Miositis Osificante/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Músculo Temporal/diagnóstico por imagen , Músculo Temporal/cirugía , Extracción Dental , Trismo/diagnóstico por imagen , Trismo/cirugía
10.
Acta Otorhinolaryngol Belg ; 55(3): 247-9, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11685963

RESUMEN

Nasal paraganglioma. A case report. Nonchromaffin paragangliomas or chemodectomas arise in paraganglia distributed in various parts of the body. The jugular bulb, the vagal body and the bifurcation of the carotid artery are the most common sites of origin of paraganglioma in the head and neck region. Paragangliomas in the nose and paranasal sinuses are extremely rare and very few cases of definite paraganglioma arising primarily in the nose or paranasal sinuses have been reported. The paraganglioma is a slow-growing tumour that produces nasal obstruction, profuse epistaxis and facial swelling. Complete excision of the glomus tumour is normally curative. We report a case of nasal paraganglioma and discuss the diagnosis and therapy.


Asunto(s)
Obstrucción Nasal/patología , Paraganglioma Extraadrenal/patología , Neoplasias de los Senos Paranasales/patología , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Obstrucción Nasal/cirugía , Paraganglioma Extraadrenal/cirugía , Neoplasias de los Senos Paranasales/cirugía
11.
Auris Nasus Larynx ; 27(3): 275-6, 2000 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10808119

RESUMEN

Changes in auditory perception can cause disturbances in development and personality. This phenomenon has been studied in particular in children hearing loss or in progressive or sudden hearing loss in the adult. We present the case of a patient with psychobehavioural alterations after restoration of hearing following a small fenestra stapedectomy for bilateral otosclerosis with moderate-severe hearing impairment. The diagnosis, physiopathology and medicolegal implications are discussed.


Asunto(s)
Trastornos Mentales/psicología , Cirugía del Estribo , Femenino , Audición , Humanos , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Otosclerosis/complicaciones , Otosclerosis/fisiopatología , Otosclerosis/cirugía , Periodo Posoperatorio , Recuperación de la Función , Acúfeno/complicaciones , Acúfeno/fisiopatología , Acúfeno/cirugía
12.
Acta Otorhinolaryngol Ital ; 19(3): 150-4, 1999 Jun.
Artículo en Italiano | MEDLINE | ID: mdl-10546372

RESUMEN

Experimental research conducted on normal subjects and on perennial rhinitis sufferers demonstrates that the application of metacholine stimulates nasal secretions and that this effect is inhibited by pretreatment with ipratropium bromide. Using the Baroody et al. method, a group of 20 healthy volunteers was used to check the effect metacholine and ipratropium/metacholine had on nasal secretions. At the same time a study was performed to determine whether these treatments modify other nasal functions: turbinate blood flow, nasal resistance, mucociliar transport. The data confirm earlier observations regarding the effect of metacholine and ipratropium on nasal secretions. A parallel effect is also seen in mucociliary transport time, most likely linked to modifications in the rheological characteristics of the mucous. On the other hand, no significant difference was found in the other functions studied: turbinate blood flow and nasal resistance. We can consider metacholine and ipratropium selective and specific, acting on the secretory function of the nasal mucosa.


Asunto(s)
Broncoconstrictores/farmacología , Ipratropio/farmacología , Cloruro de Metacolina/farmacología , Mucosa Nasal/efectos de los fármacos , Adulto , Femenino , Humanos , Masculino , Manometría/métodos , Depuración Mucociliar/efectos de los fármacos , Factores de Tiempo
13.
Radiol Med ; 96(3): 178-84, 1998 Sep.
Artículo en Italiano | MEDLINE | ID: mdl-9850708

RESUMEN

INTRODUCTION: Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique. MATERIAL AND METHODS: Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning. RESULTS: Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture. CONCLUSIONS: The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.


Asunto(s)
Huesos Faciales/diagnóstico por imagen , Huesos Faciales/lesiones , Fracturas Maxilares/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Masculino , Cuidados Preoperatorios , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
14.
Rev Laryngol Otol Rhinol (Bord) ; 119(3): 199-201, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9770069

RESUMEN

Since the introduction of antibiotic therapy, the incidence of intra- and extracranial suppurative complication of acute and chronic purulent otitis media has sharply decreased. In particular, reports of laterocervical abscesses secondary to this disorder are quite rare, not more than twenty cases of Bezold's or Mouret's abscesses having been reported in the literature during the last ten years. The authors present a case of retropharyngeal and Mouret's abscess developed as a consequence of acute purulent otitis media in a young Aids patient. True otologic manifestations of Aids are rare while the incidental association of otologic disease with Aids is more common. The development of complication in the present case is favoured by the patients severe immunodepression.


Asunto(s)
Absceso/etiología , Seropositividad para VIH/complicaciones , Otitis Media Supurativa/complicaciones , Enfermedades Faríngeas/etiología , Absceso/diagnóstico por imagen , Absceso/microbiología , Adolescente , Humanos , Masculino , Otitis Media Supurativa/microbiología , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/microbiología , Infecciones por Pseudomonas/microbiología , Radiografía , Infecciones Estafilocócicas/microbiología
15.
Cardiovasc Res ; 34(1): 185-91, 1997 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-9217889

RESUMEN

OBJECTIVE: Loss of spontaneous fluctuations in resting microcirculatory flow has been described in diabetes mellitus, but its mechanism remains unexplained. METHODS: The autonomic control of forearm skin microcirculation was investigated in 23 insulin-dependent diabetic human subjects (median age 39 years, range 27-50) and in 23 age-matched controls (median age 38 years, range 20-57), by laser-Doppler flowmetry. Using spectral analysis of spontaneous microvascular fluctuations, we measured the power of 0.1 Hz ('10-second rhythm') fluctuations, dependent on sympathetic control, and of respiration-related, high-frequency fluctuations, due to the transmission of mechanical chest activity. Autonomic function abnormalities were assessed by 5 tests of cardiovascular reflexes. RESULTS: Abnormalities in cardiovascular autonomic tests were present in 7/23 patients: deep breathing was abnormal 4 in patients, standing in 2, handgrip in 3, cross-correlation in 4, and Valsalva ratio in 0. The power of 0.1 Hz microcirculatory fluctuations was significantly lower in diabetic than in control subjects (2.57 +/- 0.16 vs 3.48 +/- 0.09 In-mV2, mean +/- s.e.m., P < 0.001), whereas that of respiratory fluctuations was similar (2.60 +/- 0.24 vs 2.56 +/- 0.19 In-mV2, P = n.s.). The 0.1 Hz power was 2 standard deviations below the mean of controls (P < 0.05) in 13/23 diabetic patients; this abnormality was significantly more frequent than abnormalities in any other autonomic test (P < 0.001). CONCLUSIONS: Since the observed reduction was confined to those microvascular fluctuations under autonomic control, but not to those dependent on passive mechanical transmission, the reduction in spontaneous microcirculatory vasomotion appears to be determined mainly by sympathetic dysfunction. Sympathetic impairment of skin microvascular control seems to be a common finding, and is probably an early index of autonomic dysfunction in insulin-dependent diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Microcirculación/fisiología , Piel/irrigación sanguínea , Adulto , Femenino , Antebrazo , Humanos , Flujometría por Láser-Doppler , Masculino , Persona de Mediana Edad , Procesamiento de Señales Asistido por Computador , Sistema Nervioso Simpático/fisiopatología
16.
Acta Otorhinolaryngol Ital ; 17(1): 64-7, 1997 Feb.
Artículo en Italiano | MEDLINE | ID: mdl-9412157

RESUMEN

Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngeal-tracheal area and of the esophagus. This disease normally affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Surgical removal of the lipomatose mass is the treatment of choice even though there are frequently recurrences. A case is presented of a rare laryngeal localization of this disease and diagnosis and treatment are discussed.


Asunto(s)
Enfermedades de la Laringe/patología , Lipomatosis Simétrica Múltiple/patología , Albuterol/uso terapéutico , Humanos , Enfermedades de la Laringe/terapia , Laringoscopía , Lipomatosis Simétrica Múltiple/terapia , Masculino , Persona de Mediana Edad , Tocolíticos/uso terapéutico
17.
Rhinology ; 34(4): 232-6, 1996 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9050103

RESUMEN

Sinusitis is a complication known to accompany nasotracheal intubation, but its frequency has not been well established. During a two-year-period, 1,126 patients in an intensive care unit have been studied. Twenty-seven of them (2%) developed a bacterial sinusitis. The diagnosis is established on the basis of an unexplained clinical sepsis, imaging evidence of fluid in the maxillary sinus, and antral puncture. Microbiological samples showed Gram-negative micro-organisms, in particular Pseudomonas aeruginosa, and an elevated percentage of Staphylococcus aureus and Escherichia coli. The likely predisposing factors (nasogastric and/or nasotracheal tubes) are discussed. Aetiology, diagnosis and management of the disease are discussed in detail. The importance of prompt removal of nasal instrumentation and of early sinus drainage, in addition to broad-spectrum antibiotic therapy, is emphasized.


Asunto(s)
Infecciones Bacterianas , Intubación Intratraqueal/efectos adversos , Sinusitis/etiología , Adulto , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Sinusitis/microbiología , Sinusitis/terapia
18.
Acta Otolaryngol Suppl ; 523: 101-4, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-9082749

RESUMEN

Activation of polymorphonuclear cells (PMNs), neutrophils and eosinophils, occurs in response to infections. Myeloperoxidase (MPO) is an enzyme contained in neutrophils with toxic activity for many microorganisms including bacteria. Fosinophil cationic protein (ECP) and eosinophil X protein (EPX) are released by activated eosinophils in response to different inflammatory stimuli. Determination of serum levels of MPO, ECP and EPX permits assessment of the state of activation of these cells. The purpose of this study was to evaluate the state of activation of neutrophils and eosinophils present in tonsillar tissue and peripheral blood from 30 children (18 boys and 12 girls) undergoing tonsillectomy for chronic tonsillitis. For determination of serum levels of MPO, ECP and EPX, peripheral blood samples were obtained at the time of surgery: PMNs were separated by erythrosedimentation from peripheral blood and from tonsillar tissue after surgery and cultured for 7 days. The cells were plated (10(5) well) and the plates were incubated in 5% CO(2), 7% O(2), 80% N(2). After 2, 24, 48, 72, 96, 120, 144 h, supernatants were removed from the cultures of both tonsillar tissue and peripheral blood PMNs for determination of in vitro release of MPO, ECP and EPX. The assays were carried out using a radioimmunotechnique (RIA, Pharmacia) and the concentrations of the three proteins (mean/6 wells) for each time were expressed in mu g/l. The data suggest activation of PMNs in children with chronic tonsillitis.


Asunto(s)
Proteínas Sanguíneas/fisiología , NADPH Oxidasas/sangre , Tonsila Palatina/fisiopatología , Peroxidasa/sangre , Ribonucleasas , Tonsilitis/fisiopatología , Adulto , Niño , Proteínas en los Gránulos del Eosinófilo , Femenino , Humanos , Técnicas In Vitro , Masculino , Recurrencia
19.
Acta Otolaryngol Suppl ; 523: 133-7, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-9082759

RESUMEN

Unsuccessful medical therapy for treatment of acute tonsillitis frequently results in onset of recurrent or chronic forms rendering surgical treatment necessary. We have studied some of the factors involved in the evolution of these chronic or recurrent forms and, in particular, the distribution of different bacterial strains in tonsillar tissue, their response to treatment with antibiotics and mechanisms of bacterial resistance. The distribution of bacterial flora (saprophytic and pathogenic) present on the surface of the tonsils, in the crypts and in the tonsillar tissue was studied in a control population of 30 children (20 boys and 10 girls) aged between 2-13 years, all affected with chronic tonsillitis and submitted to tonsillectomy. The same study was performed in a group of 80 sex and aged matched children, also presenting with chronic or recurrent tonsillitis and treated with amoxicillin or amoxicillin-clavulanic acid or cefaclor or clarithromycin 72 h before surgery. The 80 subjects were randomly divided into four groups so that each antibiotic was tested on 20 subjects. The distribution of the bacterial population on the surface of tonsillar tissue, in the crypts and in the deeper tonsillar tissue is of particular interest concerning the affinity of bacteria to the different tissue areas. In particular the interaction between crypt and tonsillar core, which could be a factor involved in the process of worsening of bacterial infection in the tonsils, is evidenced. The four antibodies tested showed different abilities to eradicate infection: Haemophilus influenzae was found to be the most resistant germ to antibiotic therapy and was thus the most frequent cause of recurrent infections. The characteristics and the mechanisms of adherence and resistance to beta lactam antibiotics were also analysed.


Asunto(s)
Haemophilus influenzae/aislamiento & purificación , Tonsilitis/microbiología , Adolescente , Antibacterianos/uso terapéutico , Niño , Preescolar , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Recién Nacido , Masculino , Moraxella/aislamiento & purificación , Recurrencia , Staphylococcus/aislamiento & purificación , Streptococcus pyogenes/aislamiento & purificación , Tonsilectomía , Tonsilitis/tratamiento farmacológico
20.
Acta Otorhinolaryngol Ital ; 15(6): 443-8, 1995 Dec.
Artículo en Italiano | MEDLINE | ID: mdl-8711998

RESUMEN

Three dimensional computer reconstruction of CT scans provide head and neck surgeons with an exciting interactive display of clinical anatomy. The 3D CT reconstruction of complex maxillo facial anatomic parts permits a more specific preoperative analysis and surgical planning. Its delineation of disease extension aids the surgeon in developing his own mental three-dimensional image of the regional morphology. Three-dimensional CT permits a clearer perception of the extent of fracture comminution and resulting displacement of fragments. In the case of maxillo-facial tumors, 3D images provide a very clear picture of the extent of erosion involving the adjacent critical organs. Three-dimensional imaging in first generation 3D scanners did have some limitations such as long reconstruction times and inadequate resolution. Subsequent generations, in particular the spiral 3D CT, have eliminated these drawbacks. Furthermore, costs are comparable with those of other computer reconstruction technology that might provide similar images. Representative cases demonstrating the use of 3D CT in maxillofacial surgery and its benefits in planning surgery are discussed.


Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Neoplasias Faciales/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Fracturas Mandibulares/diagnóstico por imagen , Neoplasias Maxilares/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adenocarcinoma/cirugía , Adolescente , Anciano , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Neoplasias Faciales/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Humanos , Masculino , Fracturas Mandibulares/cirugía , Neoplasias Maxilares/cirugía , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Fracturas Craneales/cirugía
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