RESUMO
PURPOSE OF REVIEW: To look at the current rationale behind surgical candidacy for aural atresia. In addition, we review recent technical aspects of the procedure, as it relates to outcomes. RECENT FINDINGS: Traditionally, aural atresia repair has been mostly reserved for bilateral atresia patients or occasionally unilateral patients with ideal conditions. Repair has also typically followed microtia repair with cartilage reconstruction. Developing literature, however, shows that the critical period of central auditory development precedes the typical timing of repair, particularly after rib cartilage microtia reconstruction. Newer synthetic microtia repairs have allowed atresia repair prior to microtia repair to capture the developmental advantages of binaural hearing early in life. We also review recent data on the use of ossicular prostheses in atresia repair regarding audiologic outcomes and other techniques attributed to better outcomes. SUMMARY: Atresia repair remains one of the most challenging otologic procedures. As techniques improve and we understand the developing auditory system, surgical criteria may shift, with more patients becoming candidates at a younger age.
Assuntos
Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Cartilagem/transplante , Criança , Pré-Escolar , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/cirurgia , Microtia Congênita , Orelha/anormalidades , Orelha/cirurgia , Estética , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medição de Risco , Resultado do Tratamento , Cicatrização/fisiologiaAssuntos
Aorta Abdominal , Doenças da Aorta/complicações , Implante de Prótese Vascular/métodos , Neurofibromatoses/complicações , Anastomose Cirúrgica , Angiografia Digital , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Criança , Constrição Patológica , Seguimentos , Humanos , Masculino , Artérias Mesentéricas/cirurgia , Artéria Renal/cirurgia , SíndromeRESUMO
We describe six patients (five women and one man; median age, 47 years; range, 39 to 54) with postprandial symptoms of neuroglycopenia owing to endogenous hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass surgery. Except for equivocal evidence in one patient, there was no radiologic evidence of insulinoma. Selective arterial calcium-stimulation tests, positive in each patient, were used to guide partial pancreatectomy. Nesidioblastosis was identified in resected specimens from each patient, and multiple insulinomas were identified in one. Hypoglycemic symptoms diminished postoperatively. We speculate that hyperfunction of pancreatic islets did not lead to obesity but that beta-cell trophic factors may have increased as a result of gastric bypass.