RESUMO
Wound healing complications in irradiated tissues represent a major clinical challenge. Fistula or even major vessel rupture may occur. The injection of adipose tissue derived stem cells seem to be a promising therapeutical strategy. The article describes the clinical case of a patient suffering from a pharyngo-cutaneous fistula after laryngectomy and radiotherapy. The patient was successfully treated by the injection of fat tissue.
Assuntos
Gordura Abdominal/transplante , Neoplasias Otorrinolaringológicas/radioterapia , Lesões por Radiação/cirurgia , Transplante de Células-Tronco/métodos , Cicatrização/efeitos da radiação , Quimiorradioterapia Adjuvante , Terapia Combinada , Fístula Cutânea/cirurgia , Fístula/cirurgia , Humanos , Neoplasias Hipofaríngeas/radioterapia , Injeções , Laringectomia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Neoplasias Otorrinolaringológicas/cirurgia , Doenças Faríngeas/cirurgia , ReoperaçãoRESUMO
The purpose of our study was to demonstrate the clinical and radiographic findings in patients with dysphagia and ventral osteophytes of the cervical spine due to degeneration or as a typical feature of diffuse idiopathic skeletal hyperostosis (DISH, Forestier Disease). Since 2003 we encountered 20 patients with such changes in the cervical spine causing an impairment of deglutition. A total of 12 patients had one solitary pair of osteophytes of neighboring vertebrae, 4 patients revealed two pairs and 4 patients had triple pairs of osteophytes. Thirty-two osteophytes were observed totally. A total of 14 of these arose from the right, 15 from the left side and 3 from the middle of the anterior face of the vertebra. Ten patients suffered from DISH, while ten patients revealed osteophytes as a part of a degenerative disorder of the cervical spine. The osteophytes had an average length of 19 mm maximum anterior posterior range. Most of the osteophytes (16) were found in the segments C5/6 and C6/7. Osteophytes of vertebrae C3/4/5 occurred in six cases. Only in one case C2/3 was affected. Functional endoscopic evaluation of swallowing (FEES) revealed an aspiration of thin liquids in seven patients with osteophytes arising from the anterior face of the vertebra C3/4/5 restricting the motility of the epiglottis, which seemed not to close the aditus laryngis. Retention of solids in the piriform sinus on the side obstructed by an osteophyte (C4/5) could also be repeatedly evidenced through FEES. In one case, a strong impairment of the voice because of an immobility of the right vocal cord due to mechanical obstruction by an osteophyte was the indication for surgical removal of the structure. Thus, the dysphagia of this patient was reduced and his voice turned to normal. The development of symptoms in patients with ventral osteophytes was very much related to the location of the structures. Moreover, the clinical symptoms were to some extent dependent on the size of the osteophytes, although there was no direct correlation between size of the structure and severity of the patient's complaint.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Osteofitose Vertebral/complicações , Osteofitose Vertebral/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Estudos de Coortes , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Osteofitose Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 54 year old woman with idiopathic portal hypertension, CREST syndrome, protein "S" deficiency and multiple focal nodular hyperplasia is reported. The patient presented several episodes of upper digestive bleeding due to portal hypertension gastropathy and to esophageal varices. Treatment with propanolol and isosorbide 5-mononitrate failed to control recurrent bleeding and a portacaval shunt was performed. At operation, ten hepatic nodes were found, being diagnosed as focal nodular hyperplasia in the pathologic study. Congestive gastropathy, esophageal varices and splenomegaly disappeared after portacaval shunt and bleeding did not recur after a follow-up of twelve months. This results support the role of portal decompressive surgery in the bleeding due to portal hypertension gastropathy.
Assuntos
Síndrome CREST/diagnóstico , Hipertensão Portal/diagnóstico , Fígado/patologia , Deficiência de Proteína S/diagnóstico , Biópsia , Síndrome CREST/complicações , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Hiperplasia/complicações , Hiperplasia/diagnóstico , Hipertensão Portal/complicações , Pessoa de Meia-Idade , Deficiência de Proteína S/complicaçõesRESUMO
We report the case of a young female patient with a gastric duplication communicating with the pancreas, which manifested clinically as episodes of acute relapsing pancreatitis. We analyze the diagnostic procedures and treatment methods, and review similar cases reported in the literature.
Assuntos
Pseudocisto Pancreático/diagnóstico , Pancreatite/etiologia , Estômago/anormalidades , Doença Aguda , Adolescente , Feminino , Humanos , RecidivaRESUMO
It has been suggested that chronic hepatitis C virus (HCV) infection predisposes to the development of benign and malignant lymphoproliferative disorders. We present 2 cases of malignant lymphoproliferative neoplasias (a non-Hodgkin lymphoma [NHL] and a chronic lymphoid leukemia [CLL]) associated to chronic hepatitis C virus (HCV). The possible etiological role of HCV in the development of these tumors is discussed.
Assuntos
Hepatite C Crônica/complicações , Leucemia Linfocítica Crônica de Células B/complicações , Linfoma não Hodgkin/complicações , Adulto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Good's syndrome is an infrequent disorder associated with humoral immunodeficiency and thymoma. Patients usually present severe or chronic infections. The most frequent are sinopulmonary infections sometimes associated with bronchiectasias. Another complication is chronic diarrhea, frequently associated with malabsorption, which can be due to a mucosal lesion, infection with gastrointestinal pathogens, or bacterial overgrowth. We describe a patient with Good's syndrome and chronic diarrhea due to bacterial overgrowth.
Assuntos
Diarreia/etiologia , Síndromes de Imunodeficiência/complicações , Infecções Estreptocócicas/complicações , Agamaglobulinemia/etiologia , Idoso , Bronquiectasia/etiologia , Candidíase/complicações , Doença Crônica , Diarreia/microbiologia , Suscetibilidade a Doenças , Esofagite/complicações , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Síndromes de Malabsorção/etiologia , Masculino , Infecções Respiratórias/etiologia , Timectomia , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia , Redução de PesoRESUMO
Regenerative hepatic nodular hyperplasia is infrequent and generally appears in association with many other diseases, the most frequent being the Felty syndrome. It may cause portal hypertension and variceal bleeding. A histologic study is necessary for diagnosis since certain biologic data and the nodular appearance of the hepatic surface may be confused with hepatic cirrhosis from which it may basically be, apart from the histologic features, distinguished by its good prognosis due to the absence of liver failure. We present the case of a seropositive patient with regenerative hepatic nodular hyperplasia and rheumatoid arthritis with marked portal hypertension shown in the hemodynamic study performed by our department for presentation of a persistent elevation in transaminases and ultrasonography alterations suggesting hepatic cirrhosis.
Assuntos
Hipertensão Portal/etiologia , Regeneração Hepática , Fígado/patologia , Biópsia , Humanos , Hiperplasia/complicações , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hipertensão Portal/diagnóstico , Hipertensão Portal/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
For the self-acceptance and social approval of transsexuals in their new identity, the voice plays a very important role. The responsibility of the phoniatrician and voice therapist is to identify in advance what type of voice change options are possible. These can either be achieved by more conservative means or through operative procedures. Whether to undergo speech therapy or perform a laryngeal surgical intervention should be discussed with the patient and determined on an individual basis.
Assuntos
Procedimentos de Readequação Sexual/métodos , Transexualidade/psicologia , Transexualidade/reabilitação , Qualidade da Voz , Feminino , Identidade de Gênero , Glote/fisiopatologia , Glote/cirurgia , Humanos , Músculos Laríngeos/fisiopatologia , Músculos Laríngeos/cirurgia , Laringoscopia , Masculino , Comunicação não Verbal , Espectrografia do Som , Acústica da Fala , Fonoterapia , Transexualidade/fisiopatologia , Qualidade da Voz/fisiologia , Treinamento da VozRESUMO
BACKGROUND: Vocal fold augmentation through an indirect laryngoscopic injection has been largely supplanted by the external approach of vocal fold medialization. Vocal fold augmentation with collagen is still of clinical importance for the temporary treatment of glottic insufficiencies. The different elimination time of certain collagen compounds in the vocal fold tissue enables individual therapeutic applications. PATIENTS AND METHODS: The collagen compounds Zyderm I and II and Zyplast were injected into the vocal fold in 37 patients with neurogenic glottic insufficiency and 2 patients with vocal fold atrophy during indirect laryngoscopy. The choice of compound was made depending on the case, prognosis, severity of the disorder, the persistence of the glottic insufficiency, and the patient's age and condition. RESULTS: Thirty-three patients showed an significant improvement of the glottic closure. However, 6 patients showed hardly any change. CONCLUSION: Collagen augmentation can be used for the temporary medialization of the vocal fold. It is a suitable method for the treatment of vocal fold paralysis a) within the neural regeneration time, and b) in patients with reduced condition and/or a short life expectancy due to severe diseases.
Assuntos
Colágeno/administração & dosagem , Paralisia das Pregas Vocais/reabilitação , Adulto , Idoso , Feminino , Humanos , Injeções , Laringoscopia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Paralisia das Pregas Vocais/etiologia , Qualidade da VozRESUMO
We describe a 60-year-old man with idiopathic portal hypertension and hepatic angiosarcoma. The patient had taken an arsenical preparation for the treatment of psoriasis for 10 years. Five cases of this association have been reported previously; in one only, exposure to arsenical salts was present.