[Complications of thyroid surgery. Report of 683 thyroidectomies]. / Complicaciones de la cirugía tiroidea. A propósito de 683 tiroidectomías.

Most important complications of thyroid gland surgery are recurrent paralysis (which usually results from section, stretching or devascularization of this neural branch) and parathyroid lesions resulting from unnoticed removal of more than two of these glands or through necrosis because deficient blood supply. We present a study about the complications of thyroid surgery based on the thyroid surgery done in our ENT Service during 1979-1998 term. An amount of 683 cases make the series. The 86% were female and 14% male, with a mean age of 40-50. Surgical techniques realized were: hemithyroidectomy (15.3%) and isthmectomy (2.9%). About 7.4% of patients were reoperated. Stated complications were: local (serohematoma 4.1%, infection 1.2%, postoperative hemorrhage 1.2%) and recurrent paralysis (unilateral transitory 2.6% and unilateral definitive 1.6%; there wasn't any case of bilateral palsy) and superior laryngeal nerve paralysis (1.4% as well as hypoparathyroidism (transitory 22.7% and definitive 5.3%). These complications were most frequent in reoperated cases and in total and subtotal thyroidectomies. In most of these series the incidence of recurrent palsy range between 1.5% and increases more than 9.5% in surgical check and the hypoparathyroidism incidence ranges over 25%.

[Benign thyroid disease and cancer in our environment]. / Enfermedad tiroidea benigna y cáncer en nuestro medio.

We compile our experience about the association between benign thyroid disease and thyroid carcinoma, and perform a review on the literature about this theme. We conclude on the importance of knowing this association, even not statistically significative, when it is detected modifies totally our therapeutic attitude and the vigilance of these patients.

[Carcinoma of the thyroid gland. Correlation between diagnostic tests and pathogenic anatomy]. / Carcinoma tiroideo. Correlación entre las pruebas diagnósticas y la anatomía patológica.

We present the results of a retrospective study about 101 cases of thyroid carcinoma treated in our ENT-department during the period 1979-1998. We consider the epidemiologic, diagnostic and therapeutic aspects. Epidemiologically 82% of patients were female and 18% male, with a mean age of 51 year. About 12 percent of patients had familiar antecedents of thyroid pathology. The thyroid pathology affected preferently the right thyroid lobe in 40 percent of cases, the left lobe in 28.9 percent, the isthmus in the 6.7 percent and in 24.4 percent it was bilateral. Hormonal 93.8 percent were in euthyroid state and the 6.2 percent of the whole were tested and show hyperparathyroidism. Complementary examinations showed, in gammagraphy, a cold solitary nodule in 48 percent of patients. The echography more frequently discovered a solitary nodule in 36.7 percent or multiple solid nodules in 34.7 percent. Fine needle biopsy sensitivity was in 85.7 percent. Histologic types encountered were: papillary carcinoma (74.26), follicular carcinoma (14.85), Hürthle cells carcinoma (3.96), medullary carcinoma (3.96) and anaplastic carcinoma (2.97 percent). Choice treatment of thyroid carcinoma, in our Department, was total thyroidectomy.

[Pharmacologic treatment of vertigo]. / Tratamiento farmacológico del vértigo.

The goal of the present work is to present a review about the main pharmacological groups that are actually used in the treatment of dizziness.

[Treatment and development of thyroid carcinoma]. / Tratamiento y evolución del carcinoma tiroideo.

Reporting the results of a retrospective study on 101 cases of carcinoma of the thyroid gland, treated in our Service between 1979 and 1998. Analysis of the several anatomopathological variables found, the surgical treatment and also with radioactive isotopes, the complications and the condition evolution. Epidemiologically 82 percent of patients were women and men the 18 percent. Middle age 51 years. 12 percent of patients had familiar antecedents of thyroid pathology. The histological types found were: papillary carcinoma (74.26%), follicular carcinoma (14.85%), Hürthle's cellules carcinoma (3.96%) and anaplastic carcinoma (2.97%). In our Service elective treatment of thyroid gland carcinoma is total thyroidectomy with neck dissection in 18.3 percent of affected. The survival rate amount for 81.3 percent at five years. The aim of this article is to display the therapeutics and evolution of thyroid gland cancer, based in our own 18 years of experience acquired in the Service.

[Pedicled pectoralis major musculocutaneous flaps]. / Colgajo pediculado de pectoral mayor: nuestra experiencia en 76 casos consecutivos.

A retrospective series of 76 pedicled pectoralis major musculocutaneus flaps is presented. We used this technique in reconstruction after head and neck tumours resections and in complications of oncological surgery such as pharyngostomes or orostomes. Most of these flaps were used in reconstruction of oral cavity and in postradiotherapy salvaje surgery cases. We also analyse the presence of complications at the donor and receiver sites and its correlation with different parameters like protein levels, haemoglobin, administration of radiotherapy and its dose, previous quimiotherapy and the influence of systemic diseases.

[Spontaneous middle ear meningoencephalic herniation. 2 case reports]. / Herniación meningoencefálica espontánea en oído medio: a propósito de dos casos.

Two cases of idiopathic brain herniation into the middle ear without previous surgery are reported. Brain herniation is an unusual pathology, usually related to middle ear surgery. The idiopathic appearance of this disease is the secondly most frequent cause. Its origin is believed to be related to a congenital defect of tegmen timpani. Two elements, both rare, are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.

[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature]. / Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

Surgical voice restoration after total laryngectomy: long-term results.

Tracheoesophageal puncture (TEP) with a voice prosthesis has been the preferred treatment for speech rehabilitation of total laryngectomies at the Dr. Peset Hospital since 1984. This study reviews 350 consecutive patients over a 15-year period. There were 334 patients with primary and 16 with secondary TEP. Long-term tracheoesophageal speech was achieved in approximately 70% of our patients. Problems related to or affecting TEP for voice restoration were studied. The different types of problems identified occurred in proportions ranging from 0.6% to 18%. Most of them were easily managed, but problems such as salivary leakage and dislodging of the prosthesis led to tracheoesophageal tract closure in 30% of the patients.