Assuntos
Brônquios/lesões , Corpos Estranhos/complicações , Brônquios/patologia , Pré-Escolar , Feminino , Humanos , Necrose/etiologia , RespiraçãoRESUMO
INTRODUCTION: A prospective study is presented to evaluate some practical and financial aspects regarding surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoidal (AE) arteries performed to control posterior nasal bleeding. PATIENTS AND METHODS: 35 patients admitted at the ENT ward between 2004 and 2006 were included in the study, and distributed into two groups depending on the protocol applied in each case. Until March 2005 the surgery was performed if there was failure or insecurity of the posterior packing, and since that date a substitutive surgical protocol (not including posterior packing) was applied. RESULTS: 82.9% of the patients were male, with a mean age of 55.74 years and a left bleeding in a 60% of the cases. Ligature/cauterization was performed on SP in 28 (80%) patients, on AE in 4 (11.4%), and on both arteries in 3 cases (8.6%). 38.7% of the SP approach only one sphenopalatine foramen was observed, through which an only branch of the artery passed; 42% of the cases two branches passed through an only foramen, and in 19.3% two or more branches were present, breaking into the nose through two or more independent clefts. AE was intradural in 3 cases, intranasal attached to the cranial base in other 3 and intranasal detached to the cranial base in 1 patient. Besides, highly significant differences were found between the two protocols, observing a mean reduction of hospital stay of 3.1 days, which throws up savings of 939.3 euros per patient. DISCUSSION AND CONCLUSIONS: Surgical treatment for epistaxis has proved to be effective (91.2% in our experience) and safe, determining an important reduction in hospital stay and avoiding the morbility of posterior packing. Accurate knowledge of the anatomy of the arteries implied and specific actuation upon the correct bleeding territory are essential to perform this surgery.
Assuntos
Endoscopia/economia , Endoscopia/métodos , Epistaxe/economia , Epistaxe/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. PATIENTS AND METHODS: 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). RESULTS: Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). DISCUSSION AND CONCLUSIONS: The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.
Assuntos
Angioscopia , Artérias/cirurgia , Epistaxe/cirurgia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Tampões Cirúrgicos , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Arachnoid cysts represent about 1% of all intracranial space-occupying lesions. Usually they are located in the middle cranial fossa while their localization in the posterior fossa is uncommon and generally remain asymptomatic or those are non-specific. The case of a 51 years old female is reported who was diagnosed by IRM of a 4,5 x 2 cm arachnoid cyst, situated on the left cerebello-pontine angle, with tinnitus, hearing loss and vertigo that mimicked a Meniere's attack. We think thees benign tumors must be included in the differential diagnosis of Meniere's disease because they can be indistinguishable from it clinically.
Assuntos
Cistos Aracnóideos/patologia , Ângulo Cerebelopontino/patologia , Doença de Meniere/diagnóstico , Cistos Aracnóideos/cirurgia , Ângulo Cerebelopontino/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Churg-Strauss Sindrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis.
Assuntos
Síndrome de Churg-Strauss/complicações , Dor/complicações , Doenças dos Seios Paranasais/complicações , Adulto , Diagnóstico Diferencial , Eosinofilia/complicações , Eosinofilia/diagnóstico , Feminino , Humanos , Hipertrofia/patologia , Dor/diagnóstico , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/patologia , RadiografiaRESUMO
The more common symptoms of the jugulotympanic paragangliomas are hearing loss, tinnitus and palsy of cranial nerves. Diagnosis is often delayed due to the slow growth of the tumour. We report one case with affectation of jugular foramen which clinically debuted as a peripheral vertigo and the diagnosis was made by CT, IRM and angiography. The patient was treated by Neurosurgery using Gamma Knife (radiosurgery) with good result.
Assuntos
Neoplasias Encefálicas/patologia , Veias Jugulares/patologia , Paraganglioma/patologia , Vertigem/diagnóstico , Adulto , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Artérias Carótidas/patologia , Angiografia Cerebral , Diagnóstico Diferencial , Humanos , Veias Jugulares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the utility of rapid or turbo intraoperative parathyroid (PTH) assay in the surgery of hyperparathyroidism. Since 2000 to july 2004 we have used this test on 39 patients. 24 of them corresponded to primary hyperparathyroidisms and 15 to secondary forms. Our results showed a PTH decreasing percentage >70% at 15 minutes in 92.3% of the cases. Only in two patients (5.1%) persisted the hypercalcemia after the surgery and one was reoperated with good clinic evolution. As advantages we stand out the reduction of surgical time, permitting unilateral parathyroid exploration instead a bilateral in primary HPT, and the prediction of success by confirming the excision of all hyperfunctionating parathyroid tissue in patients with multiple gland hyperplasia.
Assuntos
Hiperparatireoidismo/cirurgia , Cuidados Intraoperatórios , Hormônio Paratireóideo/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-OperatóriosRESUMO
We report the case of a 22 years old female who consulted us for facial parestesias, hearing loss in right ear and sudden tinnitus. Her audiometry showed an unilateral discreet sensorineural hipoacusia and the cranial IRM, a mass of 20 mm diameter in right pontine region and bulbus informed as cavernous angioma with signs of recent bleeding. The patient was sent to Neurosurgery but she refused the intervention. The risk of hemorrhage in the cavernomas is estimated at 0.25% to 1.6% per year and represents the main reason to advise a surgical treatment.
Assuntos
Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/patologia , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Ponte/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
We report the clinic and microbiological findings that were obtained in 10 adult patients admitted by our ENT Service with diagnosis of suppurative bacterial acute parotitis. S. aureus and Streptococcus sp were the most isolated organisms. All the patients were treated by hidratation, endovenous antibiotic therapy sometimes modified according to the antibiogram results, analgesics and antiinflammatories with success. In 3 times it was necessary to drain the purulent collection and in one of them there was a retroauricular abscess secondary to sialoadenitis.
Assuntos
Infecções Bacterianas/microbiologia , Parotidite/microbiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Berger's disease, so called IgA nephropathy, is a mesangioproliferative glomerulonephritis characterized by recurrent episodes of gross hematuria in relation with ENT infections like tonsillitis. We report a clinical case which presented that association and make a review of the literature about the possible advantages of tonsillectomy on the evolutive course and prognosis of the nephropathy.
Assuntos
Glomerulonefrite por IGA/complicações , Tonsilite/complicações , Adulto , Glomerulonefrite por IGA/imunologia , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , RecidivaRESUMO
Hemangiomas are the most common tumors in children. It id reported the case of 11 months girl with congenital hemangioma at internal orbitary edge. ENT exploration is essential to rule out the affectation of nose and paranasal sinuses as well as other associated similar injuries in head and neck. As complementary tests we asked for CT and IRM to delimit the tumoration whose classic treatment are oral corticoids in high doses. Surgery usually is reserved for refractory cases to the medical therapy although the present exposition is changing due to different factors that we expose in the final discussion.
Assuntos
Hemangioma , Neoplasias Orbitárias , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Feminino , Hemangioma/congênito , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Lactente , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/congênito , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia , Educação de Pacientes como Assunto , Tomografia Computadorizada por Raios XRESUMO
Parathyroid adenomas presenting as primary hyperparathyroidism are uncommon in children. We report a case in a 14 years-old male diagnosed as such illness who was studied by imaging tests (scintigraphy and IRM) that detected the responsible upper-left adenoma. He was operated without complications, with good postoperative evolution and normal calcium levels. Finally review the literature of this clinical entity in the pediatric population.
Assuntos
Encéfalo/patologia , Hipertireoidismo/diagnóstico , Adolescente , Criança , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias das Paratireoides/patologiaRESUMO
We are reporting the case of a 61-year-old female who developed an acute arthritis following parathyroidectomy because a primary hyperparathyroidism. The diagnosis of chondrocalcinosis or pseudogout was made by the clinical presentation, radiologic findings and demonstration of synovial fluid crystals of calcium pyrophosphate dihydrate. Rapid drops in serum calcium levels after removal of the adenoma may precipitate these acute articular inflammatory attacks that are not so uncommon as we can recognize if a bibliographic review about that association is performed.
Assuntos
Condrocalcinose/etiologia , Hiperparatireoidismo/cirurgia , Complicações Pós-Operatórias , Condrocalcinose/diagnóstico , Feminino , Humanos , Hiperparatireoidismo/diagnóstico , Pessoa de Meia-IdadeRESUMO
Olfactory neuroblastoma or esthesioneuroblastoma is a rare embrionary tumor, much more in old patients, which uses to present as a pollipoid mass with nasal obstruction, epistaxis and anosmia of long evolution. We report the case of a 82-year-old male with such symptoms diagnosed by biopsy as neuroblastoma class III according the histologic Hyams grading. Due to the age of the patient and grade of the tumor we did not perform surgery and, although a chemotherapy-radiotherapy treatment was suggested, the patient was not agree with it and he has not been attended or followed in our consulting rooms.
Assuntos
Estesioneuroblastoma Olfatório/diagnóstico por imagem , Cavidade Nasal/diagnóstico por imagem , Neoplasias Nasais/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estesioneuroblastoma Olfatório/cirurgia , Humanos , Masculino , Cavidade Nasal/cirurgia , Neoplasias Nasais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Melkersson-Rosenthal syndrome is a rare illness characterized by secondary facial edema mainly located on the upper lip, recurrent facial palsy and plicated or fissured tongue. We report the clinical case of a 30-year-old female with the classic triad but severe bilateral affectation of the facial nerve. We describe the results of all the tests and complementary explorations we asked, besides the associated pathologies, that carried us to the definitive diagnosisjoint to her symptoms. Finally we have performed a short review of the literature at respect of this entity.
Assuntos
Paralisia Facial/diagnóstico , Síndrome de Melkersson-Rosenthal/diagnóstico , Adulto , Diagnóstico Diferencial , Eletrocardiografia , Eletroencefalografia , Eletromiografia , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
Medullary carcinoma represents about 5% of all malignant tumors located in thyroid gland and it can appear as sporadic or hereditary form. We report the case of a 58-year-old female who was initially operated by General Surgery Department of an infiltrating medullary carcinoma with cervical metastasic nodes having its origin on left thyroid lobe (LTL). The patient did not want any kind of control and 5 years later she suffered dyspnea due to the tumoral recurrence with invasion of the trachea and recurrential left palsy. Our ENT Service only performed a tracheostomy on fourth tracheal ring because the woman did not accept another surgical intervention. For 6 years she has been followed and reviewed in our consults beeing on alive up to now.
Assuntos
Carcinoma Medular/secundário , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Traqueia/secundário , Carcinoma Medular/diagnóstico por imagem , Carcinoma Medular/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/diagnóstico por imagem , Neoplasias da Traqueia/cirurgiaRESUMO
We report a 38 years old male admitted to our hospital with massive epistaxis secondary to nasal trauma which required to perform a posterior packing, transfusion and embolization of the internal maxillary artery for stopping the nosebleed. Then we made a FENS (Functional Endoscopic Nasal Surgery) by cauterization of several bleeding points on nasal septum following an anterior packing that was removed after 48 hours without new epistaxis. In a patient like this we think that an angiography with selective embolization is the main choice when other options have failed.
Assuntos
Lesões das Artérias Carótidas/complicações , Embolização Terapêutica/métodos , Epistaxe/etiologia , Epistaxe/terapia , Adulto , Angiografia , Lesões das Artérias Carótidas/diagnóstico por imagem , Epistaxe/diagnóstico , Humanos , MasculinoRESUMO
Hürthle cells carcinomas are considered a variant of folicular carcinomas and represent about 2% of all malignant thyroid tumours. We report 2 cases of 2 women of 46 and 43 years old confirmed by histological exam after total thyroidectomy with good postoperative evolution. The presence of capsular and vascular invasion is the most important criteria to distinguish this entity from the Hürthle cells adenomas.
Assuntos
Adenoma Oxífilo/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adenoma Oxífilo/patologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia Torácica , Neoplasias da Glândula Tireoide/patologiaRESUMO
Sonnography and Tc-99m sestamibi scintigraphy are the most requested preoperative imaging tests nowdays in the surgery of hyperparathyroidism. The aim of our article is to know if Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are useful as a location study and in which cases it would be more justified to ask these radiologic techniques. For that we report our results with 29 patients at all diagnosed as hyperparathyroidism (26 primary forms and 3 secondary ones) and operated by our E.N.T. Department later. On 20 of them a cervical CT was asked before the parathyroidectomy and on the rest 9, a MRI with sensitivities of 65% and 88.9% respectively. We think both complementary explorations must not be solicited by routine but they can represent a help in the cases in that sonnography and scintigraphy are not able to show the possible adenoma or hiperplasia, particularly in recurrent hyperparathyroidisms, reinterventions or suspect of parathyroid glands in an atypical location.
Assuntos
Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/cirurgia , Imageamento por Ressonância Magnética , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. MATERIAL AND METHODS: Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. RESULTS: We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. CONCLUSIONS: Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated.