[Influence of the nasogastric tube in the pathology of the maxillary sinus]. / Influencia de la sonda nasoesofágica en la patología del seno maxilar.

INTRODUCTION: Nasoesophageal tube (NT) is very often used by the ear, nose and throat specialists in head and neck oncological surgery. It is well known the irritative effect that it has on the nasosinusal mucosa. The aim of this study is to analyze the relationship between the use of the NT and the pathology of the maxillary sinuses. MATERIAL AND METHOD: The study was carried out in 25 patients treated in our department who had been fed by NT, after surgery. A plain sinus X-ray was performed in the pre-operatory period and a control radiograph in the post-operatory period, and the results have been analyzed. RESULTS AND CONCLUSIONS: No sinusitis had been observed whatever length of time the NT remained in situ.

Arteriovenous haemangioma of the pterygoid process. Report of a case.

Arteriovenous haemangioma is a benign tumor which in ear, nose and throat practice is generally found in the soft tissues of the oral cavity. Bone involvement is very uncommon. These lesions typically manifest themselves in infancy, with a tendency towards spontaneous resolution. The management options comprise simple observation, embolization or surgical removal--depending on the location of the tumour and its symptoms. A correct diagnosis is essential to ensure the adoption of adequate measures during surgery. The present case describes an exceptional location of arteriovenous hemangioma of the pterygoid process, and discusses the associated diagnostic and treatment problems.

Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.

A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.

Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction.

A prospective controlled randomized trial was performed in order to assess the effectiveness and safety of photodynamic therapy versus laser resection in 31 patients with partial or complete tracheobronchial obstruction due to inoperable non-small cell lung cancer. Fourteen patients received dihaematoporphyrin ether and argon dye laser photoradiation, and 17 patients received Nd-YAG laser resection. Endoluminal obstruction of >75% was found in 77.4% of the patients. Among the symptoms, cough was more severe in the Nd-YAG group (p=0.02). Patients in both groups experienced symptomatic relief after treatment (p=0.003). Patients in the photodynamic therapy (PDT) group showed a significantly longer time until treatment failure (p=0.03) and longer median survival (p=0.007). Bronchitis and photosensitization (both in the PDT group) were the most common adverse effects. There was one death, probably related to treatment, in the PDT group. Photodynamic therapy and neodymium-yttrium aluminium garnet laser resection showed similar effectiveness and safety in the palliation of symptoms. The more prolonged survival in the photodynamic therapy group may have been due to differences in tumour stage between the groups. The degree of obstruction improved after treatment in both groups. In conclusion, photodynamic therapy is a valid method of palliation in partially or totally obstructing non-small cell lung carcinoma.

Idiopathic chondrolysis of the hip: long-term evolution.

Idiopathic chondrolysis of the hip is characterized by the destruction of the articular cartilage due to an unknown cause, principally affecting women during adolescence and producing premature degeneration of the hip. Twelve cases (11 patients) were reviewed at our hospital, with an average follow-up period of 13.2 years, during which a clinical and radiologic study was performed. Despite the treatment implemented, idiopathic chondrolysis of the hip causes progressive degeneration of the joint with the appearance of almost constant pain, stiffness, and anomalous positions. Radiologic studies show concentric narrowing of the articular space, decrease in the width of the femoral head and neck, and shortening of the affected member due to alteration in the growth physis of the upper extremity of the femur.

[The 1st case in Spain of detection of occult squamous carcinoma using LIFE system]. / Primer caso en España de detección de un carcinoma escamoso oculto mediante la utilización del sistema LIFE.

LIFE system (lung imaging fluorescence endoscope) is a new system of detection for early lung cancer using a He-Cd laser through a conventional fiberoptic bronchoscope. This system is able to capture and processing the autofluorescence from the bronchial mucosa and to show it in a video screen in real time. In the screen the normal tissue appears in green colour and the neoplastic tissue in brown colour. The first studies performed with LIFE system show the same specificity of the conventional bronchoscopy but the sensibility is 50% higher. In this paper we present the first case of detection of a occult squamous cell carcinoma with sputum and bronchial aspiration cytology positive for carcinoma but chest X ray, CT scanner and bronchoscopy negative for lung cancer. The LIFE system was able to detect carcinoma in the carina.

Late infection after total knee arthroplasty caused by Pasteurella multocida.

The authors report a case of Pasteurella multocida infection in a total knee arthroplasty as a result of a dog bite. The patient was treated with one-stage reimplantation of a new prosthesis and with intravenous antibiotics, resulting in complete relief of symptoms with no evidence of recurrence of infection after 24 months.

Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients.

STUDY OBJECTIVE: To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction. DESIGN: Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study. SETTING: Tertiary-referral teaching hospital. PATIENTS: Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients. INTERVENTIONS: In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia. RESULTS: Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients). CONCLUSIONS: Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.

[The psychiatric consultation-liaison program and posttraumatic stress disorder due to burns]. / Psiquiatría de enlace y trastorno por estrés postraumático en la unidad de quemados.

Sixty-five acute burned inpatients were evaluated prospectively by structured questionnaire and clinical interview. All of the subjects hospitalized in a Burn Unit were referred for psychiatric examination to a psychiatric consultation-liaison programme. Most of the patients suffered adjustment disorders (n = 40), and post-traumatic stress disorder (PTSD) was diagnosed in 5 cases. The carefully assessment of PTSD was an objective of the Study. There were no significant differences among patients with PTSD and Adjustment Disorder for severity and type of burn injuries. The discussion deals with PTSD is a frequent missed disorder by the medical staff of burn units, and also the importance of the patients subjective appraisal of the stressor as a factor precipitating PTSD.

Video endoscopy for laser photoresection in tracheobronchial pathology: some considerations after 9 years experience with 2105 treatments.

Between 1984 and 1993 we performed 2105 laser treatments in 1210 patients: 52% of treatments were done for malignant pathology, 45% for benign tracheal stenoses and 3% were in a miscellaneous group. The procedure was carried out with a rigid bronchoscope under general anaesthesia. In patients with malignant tumors, it is a good palliative treatment-safe, well tolerated and with immediate results; it can be repeated as many times as needed with and is well accepted by the patient. In patients without tumors, this method avoids emergency tracheotomies. The long term results are now under evaluation.

Psychiatric consultation and post-traumatic stress disorder in burned patients.

We report a prospective study of 65 burned inpatients referred for psychiatric consultation. All of the subjects in the sample were evaluated by a structured questionnaire and clinical interview. Reasons for referral were: suicide attempt by burning (n = 7), substance dependence (n = 8) and behaviour disturbed by coping difficulties (n = 50). The diagnoses were adjustment disorder (n = 40), alcohol dependence (n = 7), opiate dependence (n = 2), dementia (n = 3), depressive disorder (n = 5), schizophrenia (n = 1), delirium (n = 1) and post-traumatic stress disorder (n = 5). Patients with post-traumatic stress disorder (PTSD) were specifically and carefully evaluated. There were no significant differences between patients with PTSD and adjustment disorder for severity and type of burn injuries. We conclude that PTSD is apt to be missed by the medical staff of burn units.

A fundamental dilemma of psychoanalytic technique: reflections on the analysis of a perverse paranoid patient.

The work refers to the general topic of the traumatic effects of transference in the analytic situation. The author defines the fundamental dilemma of interpretive technique as the technical difficulty, sometimes insurmountable, faced by the therapist in the treatment of severely ill patients, particularly in the case of narcissistic, self-centred disorders, where the interpretive action itself often produces negative side effects that are not countered by the curative effect of the insight achieved through interpretation. In a brief theoretical introduction, this dilemma is described as a longstanding problem in psychoanalysis that has been systematically concealed by the protracted discussion on the subject of 'analysability' and which has still not been resolved by the theory of technique. Clinical case material on a perverse patient is then presented to illustrate the dilemma described and to demonstrate some general strategies by which it may be overcome.

Nd:YAG laser photoresection of low-grade malignant tumors of the tracheobronchial tree.

Nineteen patients with low-grade malignant tumors of the tracheobronchial tree received Nd:YAG laser treatment. They were referred for palliation of symptomatic airway obstruction due to carcinoid (14 cases) or adenocystic carcinoma (five cases). In all patients, laser treatment was followed by symptomatic relief. Fifteen patients have done well and remain in good condition between six months and four years after laser photoresection. Two of the five patients with adenocystic carcinoma died because of hemoptysis at one and 49 months after laser therapy. In the group of 14 patients with carcinoids, two episodes of bleeding (more than 250 ml) occurred that were controlled by tamponade with the tube and coagulation by the laser beam itself. Two patients with carcinoid died of unrelated causes (stroke and gastric carcinoma).

[Treatment of obstructive tracheobronchial disease with the Yag-Nd laser: 400 procedures in a 4-year experience]. / Tratamiento con láser Yag-Nd en patología traqueobronquial obstructiva: 400 administraciones en 4 años de experiencia.

Overall, 400 procedures with the Yag-Nd laser were carried out in 252 patients with tracheobronchial disease susceptible to photoresection during a 4-year period. Most procedures were carried out under general anesthesia and with a rigid bronchoscope. 149 tumors were treated. Of these, 118 were malignant, 16 had low malignancy and 15 were benign. These patients received overall 203 procedures. 92 patients with 113 tracheal stenoses underwent overall 185 procedures. Finally, a miscellaneous group of 11 patients with several conditions underwent 12 procedures. Immediate results were classified as excellent, good or poor, depending on the achieved tracheal or bronchial diameter. No significant complications were found. After a 4-year experience, the authors believe that laser photoresection is currently the most effective and safe procedure to relieve obstruction in the stenoses caused by malignant proliferative tracheal or bronchial diseases not amenable to surgery. It is also the ideal substitute for surgery in benign tumors and in some cases of non-tumoral tracheal stenosis.