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1.
Semina cienc. biol. saude ; 43(1): 177-184, jan./jun. 2022.
Article in Portuguese | LILACS | ID: biblio-1354485

ABSTRACT

Objetivo: explorar a percepção de um paciente cirúrgico queimado em relação à sede e seu manejo no período pré-operatório e pós-operatório imediato. Relato de caso: trata-se de um estudo com abordagem qualitativa, exploratória, do tipo estudo de caso. Os critérios de inclusão foram: paciente estar internado no centro de tratamento de queimados, ser submetido a procedimento cirúrgico ou balneoterapia, ter experenciado a sede no período pré-operatório ou pós-operatório e ter recebido o manejo da sede. Para a coleta de dados utilizou-se entrevista semiestruturada, gravada e transcrita. Paciente do sexo feminino, de 32 anos, admitida com queimaduras de segundo grau em extensão de tórax, membros superiores e pescoço por tentativa de autoextermínio com álcool. Passou por seis procedimentos e esteve internada por 15 dias até o momento da coleta. Experienciou o desconforto sede durante o jejum pré-operatório e pós-operatório, considerado intenso e muito estressante durante sua internação. Conclusão: a partir da identificação do desconforto sede, utilizou-se como estratégia o picolé de gelo, que fez diferença em seu tratamento. O modelo de manejo da sede é pioneiro no cuidado ao paciente queimado e apresenta benefícios para minorar a sede.


Objective: explore thirst perception of a burnt surgical patient and its management in the preoperative and immediate postoperative period. Case report: study with a qualitative and exploratory approach, named as case study. Inclusion criteria were: inpatient at burnt treatment unit, undergone surgical procedure or balneotherapy, experienced thirst in the preoperative or postoperative period and received thirst management. For data collection, semi-structured interviews were performed, recorded and transcribed. Female patient, 32 years old, admitted with second degree burns in extension of thorax, upper limbs and neck due to attempted self-extermination with alcohol. Underwent six procedures and was hospitalized for 15 days until the data collection. Experienced thirst discomfort during preoperative and postoperative fasting, which was considered intense and very stressful during his hospitalization. Conclusion: since the identification of thirst discomfort, the ice popsicle was used as a strategy, which made difference in her treatment. The thirst management model is pioneer in care of burnt patients and has benefits to alleviate thirst.


Subject(s)
Humans , Female , Adult , Patients , Thirst , Balneology , Burns , Ice , Postoperative Period , Therapeutics , Data Collection , Fasting , Preoperative Period , Hospitalization , Inpatients , Neck
2.
Rev. colomb. anestesiol ; 49(2): e700, Apr.-June 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251505

ABSTRACT

Cervical kyphoscoliosis is an uncommon spinal deformity. Kyphosis or outward curvature of cervical-spine (Image A) has led to a fixed flexion state resulting in suspension of patient's head in the air while lying on the imaging table. Additionally, dextroscoliosis or rightward convexity of the cervical vertebral axis has resulted in a persistent leftward head tilt (Image B). Head and neck radiation and trauma can lead to cervical kyphoscoliosis. In addition to the cosmetic deformity, patients present with myelopathic sensorimotor symptoms such as weakness and tingling of upper extremities. The Poisson effect states that flexion of the spine lengthens and stretches the spinal canal, reduces its area and narrows its lumen. This causes spinal cord impingement and myelopathy.


La cifoescoliosis cervical es una deformidad de la columna vertebral poco frecuente. La cifosis o la curvatura hacia fuera de la columna cervical (imagen A) ha dado lugar a un estado de flexión fija que provoca la suspensión de la cabeza del paciente en el aire mientras está tumbado en la mesa de diagnóstico por imagen. Además, la dextroscoliosis o convexidad hacia la derecha del eje vertebral cervical ha dado lugar a una inclinación persistente de la cabeza hacia la izquierda (Imagen B). La radiación de cabeza y cuello y los traumatismos pueden provocar cifoescoliosis cervical. Además de la deformidad estética, los pacientes presentan síntomas sensoriomotores mielopáticos como debilidad y hormigueo en las extremidades superiores. El efecto Poisson establece que la flexión de la columna vertebral alarga y estira el canal espinal, reduce su área y estrecha su lumen. Esto provoca el pinzamiento de la médula espinal y la mielopatía.


Subject(s)
Humans , Spinal Cord Diseases , Spine , Congenital Abnormalities , Paresthesia , Radiology , Spinal Canal , Cervical Vertebrae , Neck
3.
Arch. argent. pediatr ; 119(5): e518-e521, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292695

ABSTRACT

La tiroiditis aguda supurada es una entidad poco frecuente en pediatría; de origen infeccioso, cuya etiología más frecuente es bacteriana. Su presentación típica en niños es la aparición de una tumoración en la cara anterior del cuello, con signos de flogosis, dolorosa, caliente y eritematosa, que excursiona con la deglución, y puede o no estar acompañada de fiebre, disfagia o disfonía. En niños, las anomalías congénitas, principalmente la fístula del seno piriforme, predisponen a la infección de la glándula, por lo que es importante la resolución quirúrgica del defecto anatómico para prevenir las recurrencias. El diagnóstico rápido, basado en la clínica y los estudios por imágenes, es importante para comenzar en forma temprana con un tratamiento antibiótico adecuado.Se presenta una paciente de 3 años, previamente sana, con tumoración cervical izquierda dolorosa y asociada a fiebre. Durante la internación, se arribó al diagnóstico de tiroiditis aguda supurada secundaria a fístula de seno piriforme.


Acute suppurative thyroiditis is an infectious disease, uncommon in children, caused by various microorganisms, being bacteria the most frequently involved. The typical presentation includes the appearance of a tumor in combination with signs of swelling in the anterior aspect of the neck, which is painful on palpation and is associated with warmth and erythema. It usually moves with swallowing and the patient can suffer fever, dysphagia or dhysfonia. In children, congenital anomalies can lead to the gland's infection, and the surgical excision of them is important to prevent recurrency. A quick diagnosis, based on clinical manifestations and imaging studies, is necessary to install an adequate antibiotic treatment. We present the case of a 3-year-old patient, who was previously healthy, with a painful left cervical tumor associated with fever. During the hospitalization, we reached the diagnosis of acute suppurative thyroiditis caused by an underlying pyriform sinus fistula


Subject(s)
Humans , Female , Child, Preschool , Thyroiditis, Suppurative/complications , Thyroiditis, Suppurative/diagnosis , Pharyngeal Diseases , Pyriform Sinus , Fistula/diagnosis , Acute Disease , Neck
4.
Article in Chinese | WPRIM | ID: wpr-880482

ABSTRACT

OBJECTIVE@#Whether the developed new type of radiotherapy auxiliary fixation device compatible with the head and neck joint coil can improve the quality of magnetic resonance images in radiotherapy and verify whether it can be applied to clinical treatment.@*METHODS@#The clinical trial selected patients with brain metastases and nasopharyngeal cancer patients, using thermoplastic film and head and shoulder molds for posture fixation, and treatment on the ELekta Versa accelerator. SPSS 20.0 statistical software was used to analyze the data. The measurement data were expressed by @*RESULTS@#Considering the influence of the outer contour of the device, the target dose meets the clinical requirements. The setting error is less than 2 mm in the three translation directions, and the rotation error is less than 2@*CONCLUSIONS@#There is no statistical difference between the treatment results of patients using the new type of fixation device and the conventional method. The target area threatens the organ dose, and the positioning error meets the treatment requirements.


Subject(s)
Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Nasopharyngeal Neoplasms , Neck , Posture
5.
Acta otorrinolaringol. cir. cabeza cuello ; 49(2): 101-103, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1280968

ABSTRACT

Este año celebramos los 60 años de fundada la Asociación Colombiana de Otorrinolaringología y cirugía de cabeza y cuello, estos sesenta años que se cumplen ,resultan ser una fecha muy importante para esta agremiación y donde considero importante recordar y homenajear a las cabezas lideres y fundadoras de esta sociedad. Descargas


Subject(s)
Humans , Otolaryngology/history , Academies and Institutes/history , Head/surgery , Neck/surgery , Colombia
6.
Acta otorrinolaringol. cir. cabeza cuello ; 49(2): 129-136, 2021. ILUS, TAB, GRAF
Article in Spanish | LILACS | ID: biblio-1253867

ABSTRACT

Introducción: la fascitis necrotizante cervical es una entidad poco frecuente en la cabeza y el cuello, pero su importancia está dada por la elevada tasa de mortalidad. La importancia clínica de este estudio se debe al hecho de que no hay muchos reportes de casos de esta patología en América Latina, por lo cual queremos describir la experiencia en nuestro Hospital. Objetivo: describir la experiencia en fascitis necrotizante cervical en el Hospital General Dr. Manuel Gea González. Materiales y métodos: estudio descriptivo, retrospectivo y transversal de historias clínicas del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital General Dr. Manuel Gea González, de 2011 a 2017. Resultados: se incluyeron 11 historias clínicas con diagnóstico de fascitis necrotizante cervical, de las cuales 8 (72,7 %) eran hombres y 3 (27,2%) mujeres, con una edad promedio de 49,1 años. 5 (45,4 %) pacientes debutaron con diabetes mellitus tipo 2 (DM2). El origen de la infección fue odontogénico en 3 (27,2 %) pacientes. Los microorganismos más frecuentes fueron Klebsiella pneumoniae, Streptococcus anginosus y Staphylococcus epidermidis. Los 11 pacientes (100 %) fueron intervenidos quirúrgicamente e impregnados con antimicrobianos empíricos, que posteriormente fueron modificados o no según los resultados del antibiograma. La hospitalización promedio fue de 18,7 días. 3 (27,2 %) pacientes presentaron mediastinitis como complicación. Hubo 2 muertes (18,1 %). Conclusión: el diagnóstico temprano y el tratamiento antimicrobiano empírico y quirúrgico agresivo pueden reducir significativamente la morbimortalidad.


Introduction: Cervical necrotizing fasciitis is a rare entity in the head and neck, but its importance is given by the high mortality rate. The clinical importance of this study is due to the fact that there are not many case reports of this pathology in Latin America, which is why we want to describe the experience in our hospital. Objective: To describe the experience in cervical necrotizing fasciitis at the Hospital General Dr. Manuel Gea González. Materials and methods: Descriptive, retrospective and cross-sectional study of medical records of the Otorhinolaryngology and Head and Neck Surgery Service of the Hospital General Dr. Manuel Gea González, from 2011 to 2017. Results: 11 medical records with a diagnosis of cervical necrotizing fasciitis were included, of which 8 (72.7%) were men and 3 (27.2%) were women, with a mean age of 49.1 years. 5 (45.4%) patients presented with type 2 diabetes mellitus. The origin of the infection was odontogenic in 3 (27.2%) patients. The most frequent microorganisms were Klebsiella pneumoniae, Streptococcus anginosus and Staphylococcus epidermidis. The 11 patients (100%) underwent surgery and impregnated with empirical antimicrobials, which were later modified or not, according to the results of the antibiogram. The average hospitalization was 18.7 days. 3 (27.2%) patients presented mediastinitis as a complication. There were two deaths (18.1%). Conclusion: Early diagnosis and aggressive empirical and surgical antimicrobial treatment can significantly reduce morbidity and mortality.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Fasciitis, Necrotizing/diagnosis , Neck , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/therapy
7.
Rev. baiana enferm ; 35: e43584, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1351619

ABSTRACT

Objetivo investigar a correlação da circunferência do pescoço com outros parâmetros antropométricos, com a pressão arterial, com a glicemia capilar e com fatores de risco modificáveis e não modificáveis presentes. Método estudo transversal descritivo, com pacientes de uma policlínica, mediante aplicação de questionário semiestruturado. Circunferência do pescoço aferida considerando posição natural da cabeça, entre ponto médio cervical e do pescoço anterior. Risco cardiovascular determinado pela medida da circunferência abdominal e pelos fatores de risco modificáveis ou não modificáveis. Resultados encontradas correlações positivas entre circunferência do pescoço e índice de massa muscular, circunferência abdominal, pressão arterial sistólica, glicemia capilar e idade, além de ter sido identificado alto risco cardiovascular na maioria dos participantes do sexo masculino, com tendência de medida ser maior em indivíduos com hipertensão, diabetes e dislipidemias. Conclusão circunferência do pescoço correlacionou-se significativamente com índice de massa corpórea, circunferência abdominal, pressão sistólica, glicemia capilar e idade.


Objetivo investigar la correlación de la circunferencia del cuello con otros parámetros antropométricos, con la presión arterial, la glucemia capilar y con los factores de riesgo modificables y no modificables presentes. Método estudio descriptivo transversal, con pacientes de una policlínica, mediante la aplicación de un cuestionario semiestructurado. Circunferencia del cuello medida considerando la posición natural de la cabeza, entre el punto medio cervical y el cuello anterior. Riesgo cardiovascular determinado por la medición de la circunferencia abdominal y factores de riesgo modificables o no modificables. Resultados se encontraron correlaciones positivas entre la circunferencia del cuello y el índice de masa muscular, la circunferencia abdominal, la presión arterial sistólica, la glucemia capilar y la edad, además de haber sido identificado un alto riesgo cardiovascular en la mayoría de los participantes masculinos, con tendencia a ser mayor en individuos con hipertensión, diabetes y dislipidemias. Conclusión la circunferencia del cuello se correlacionó significativamente con el índice de masa corporal, la circunferencia abdominal, la presión sistólica, la glucemia capilar y la edad.


Objective to investigate the correlation of neck circumference with other anthropometric parameters, with blood pressure, capillary glycemia and with modifiable and non-modifiable risk factors present. Method descriptive cross-sectional study, with patients from a polyclinic, by applying a semi-structured questionnaire. Neck circumference was measured considering the natural position of the head, between cervical midpoint and anterior neck. Cardiovascular risk was determined by measurement of abdominal circumference and modifiable or non-modifiable risk factors. Results positive correlations were found between neck circumference and muscle mass index, abdominal circumference, systolic blood pressure, capillary glycemia and age, besides identifying high cardiovascular risk in most male participants, with a tendency to be higher in individuals with hypertension, diabetes and dyslipidemias. Conclusion neck circumference was significantly correlated with body mass index, abdominal circumference, systolic pressure, capillary glycemia and age.


Subject(s)
Humans , Male , Female , Anthropometry , Heart Disease Risk Factors , Obesity/diagnosis , Cross-Sectional Studies , Neck/growth & development
8.
Repert.Med.Cir ; 30(3): 219-255, 2021.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362933

ABSTRACT

Introducción: revisión narrativa que explica el panorama actual de la hipocalcemia y el hipoparatiroidismo como complicaciones de la tiroidectomía, su diagnóstico y tratamiento; con una descripción de las nuevas estrategias de prevención y tratamiento. Métodos: los motores de búsqueda utilizados fueron PubMed, Clinical Key, Embase, Cochrane y Lilacs, se incluyeron referencias en español e inglés, publicadas entre 2016 y 2020. Los artículos seleccionados se revisaron utilizando CONSORT, STROBE o PRISMA, según el caso. Resultados: fueron seleccionados 35 artículos que tenían relación directa con el tema, entre ellos: metanálisis, revisiones sistemáticas, estudios prospectivos y observacionales, revisiones narrativas y consensos de expertos, procedentes de los cinco continentes. La hipocalcemia y el hipotiroidismo en sus dos formas se relacionan con la afectación de la vascularización de las glándulas paratiroides o su exérecis accidental, existiendo factores predisponentes propios del paciente, derivados de la técnica quirúrgica o la característica patológica de la lesión en el tiroides. Como estrategias de prevención disponemos de herramientas ópticas para definir en el perioperatorio la disposición de las paratiroides; además existe la posibilidad de autotrasplantarlas al identificarlas en la pieza anatómica. El mejor marcador del estado metabólico del calcio es la PTHi. Conclusiones: la preservación de las paratiroides y de su irrigación es la mejor estrategia para prevenir los trastornos posoperatorios del calcio


Introduction: narrative review explaining the current picture of hypocalcemia and hypoparathyroidism as complications of thyroidectomy, describing new strategies employed for their diagnosis and treatment. Methods: searches in the PubMed, Clinical Key, Embase, Cochrane and Lilacs databases; references in Spanish and English, published between 2016 and 2020 were included. The selected articles were reviewed using CONSORT, STROBE or PRISMA, as appropriate. Results: 35 articles directly related with the topic were selected, including meta-analyses, systematic reviews, prospective and observational studies, narrative reviews and expert consensus, on all five continents. The two forms of hypocalcemia and hypoparathyroidism can result from devascularization or accidental removal of the parathyroid glands, patient-specific factors, or from the surgical technique or the pathological characteristics of the thyroid lesion. Preventive strategies include the use of optical tools for preoperative determination of parathyroid glands location; as well as the possibility of autotransplantation after confirming parathyroid tissue in the biopsy specimen. The best marker of calcium metabolism is iPTH. Conclusions: preservation of the parathyroid glands and their irrigation is the best strategy to prevent postoperative calcium disorders.


Subject(s)
Calcium , Hypocalcemia , Metabolism , Thyroidectomy , Thyroid Neoplasms , Hypoparathyroidism , Neck/surgery
9.
Rev. Nutr. (Online) ; 34: e200190, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155454

ABSTRACT

ABSTRACT Objective To identify cut-off points of neck circumference measurement to predict insulin resistance in adolescents. Methods Cross-sectional analysis with data derived from the Study of Cardiovascular Risks in Adolescents, nationwide, multicenter, school-based survey. We evaluated 901 adolescents, aged 12 to 17, from public and private schools in two cities of Sergipe state in Brazil. We measured demographic, anthropometric, and biochemical data, and insulin resistance using Homeostasis Model Assessment-Insulin Resistance. We used multiple linear regression and logistic analysis to evaluate the association between dependent variables (biochemical) and independent variables (anthropometric) controlled by body mass index, age, gender, and Tanner's stage. We used the Receiver operating characteristic curve to determine cut-off points of neck circumference that can identify insulin resistance. Results The multiple linear regression analysis showed a positive association between neck circumference measurement with fasting glycemia and glycated hemoglobin (p<0.001) and a negative association with insulin (p<0.024). Furthermore, in logistic regression, the measurement of neck circumference was the only anthropometric indicator positively correlated with homeostasis model assessment-insulin resistance. The cut-off points of neck circumference for predicting insulin resistance were: 30.55cm for female pubertal and 32.10cm for post-pubertal adolescents; 35.90cm for male pubertal adolescents and 36.65cm for post-pubertal adolescents. Conclusions The measurement of neck circumference is a simple, practical anthropometric indicator and can be used as a screening tool to identify insulin resistance in adolescents.


RESUMO Objetivo Identificar pontos de corte da medida da circunferência do pescoço que possam predizer a resistência à insulina em adolescentes. Métodos Estudo transversal com uma subamostra do Estudo de Riscos Cardiovasculares em Adolescentes, um estudo multicêntrico nacional. Avaliaram-se 901 adolescentes de 12 a 17 anos de duas cidades do estado de Sergipe, Brasil. Fatores demográficos, antropométricos e bioquímicos e a resistência à insulina pelo homeostasis model assessment-insulin resistance foram mensurados. A associação entre as variáveis dependentes (bioquímicas) e independentes (antropométricas), controladas pelo índice de massa corporal, idade, sexo e estadiamento de Tanner, foi avaliada pela análise de regressão linear múltipla e logística, e a curva característica de operação do receptor foi utilizada para determinar os pontos de corte da circunferência do pescoço na predição da resistência à insulina. Resultados A análise de regressão linear múltipla mostrou uma associação positiva entre a medida da circunferência do pescoço com a glicemia de jejum e a hemoglobina glicada (p<0,001) e negativa com a insulina (p<0,024). Na regressão logística, a medida da circunferência do pescoço foi o único indicador antropométrico que se correlacionou positivamente com o Homeostasis Model Assessment-Insulin Resistance. Os pontos de corte da circunferência do pescoço para predição da resistência à insulina em adolescentes foram: 30,55cm feminino púberes e 32,10cm feminino pós-púberes; 35,90cm masculino púberes e 36,65cm masculino pós-púberes. Conclusão A medida da circunferência do pescoço é um indicador antropométrico simples e prático e pode ser utilizada como instrumento de triagem para identificar a resistência à insulina em adolescentes.


Subject(s)
Humans , Male , Female , Adolescent , Insulin Resistance , Adolescent , Neck , Anthropometry
10.
Rev. bras. anestesiol ; 70(6): 595-604, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155768

ABSTRACT

Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.


Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.


Subject(s)
Humans , Adult , Aged , Aged, 80 and over , Young Adult , Intubation, Intratracheal/methods , Neck/surgery , Neck Dissection/statistics & numerical data , Thyroid Gland/surgery , Tongue Neoplasms/surgery , Nasopharyngeal Neoplasms , Predictive Value of Tests , Prospective Studies , ROC Curve , Range of Motion, Articular , Sensitivity and Specificity , Outcome Assessment, Health Care , Mandibular Advancement , Head and Neck Neoplasms/surgery , Intubation, Intratracheal/instrumentation , Laryngectomy/statistics & numerical data , Maxillofacial Injuries/surgery , Middle Aged , Mouth/physiology , Neck/anatomy & histology
11.
Rev. bras. anestesiol ; 70(6): 583-587, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155765

ABSTRACT

Abstract Background and objectives Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures. Methods Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation. Results A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference. Conclusions Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.


Resumo Justificativa e objetivos Diversas complicações das vias aéreas podem ocorrer durante a artroscopia do ombro, incluindo obstrução das vias aéreas, punção pleural e enfisema subcutâneo. Levantou‐se a hipótese de que o fluido de irrigação utilizado durante artroscopia do ombro possa aumentar a pressão do balonete do tubo endotraqueal, podendo causar edema e lesão isquêmica na mucosa traqueal. Portanto, este estudo teve como objetivo avaliar a relação entre o fluido de irrigação e a pressão do balonete do tubo endotraqueal. Métodos Participaram do estudo 40 pacientes com idades entre 20 e 70 anos com classificação do estado físico I ou II da American Society of Anesthesiologists (ASA), programados para cirurgia artroscópica do ombro, eletiva e sob anestesia geral. Registramos as pressões do balonete do tubo endotraqueal e as circunferências do pescoço a cada hora, a partir do início da cirurgia. Também registramos a duração anestésica e cirúrgica, assim como o volume total de líquido de irrigação empregado. Resultados Foi encontrada correlação positiva entre a pressão do balonete do tubo endotraqueal e a quantidade de líquido de irrigação (r = 0,385; 95% IC 0,084 a 0,62; p = 0,0141). A pressão do balonete do tubo endotraqueal registrou aumento significante 2 e 3 horas após o início da cirurgia (p = 0,0368 e p = 0,0245, respectivamente). No entanto, a circunferência do pescoço não mostrou diferença significante. Conclusões As pressões do balonete do tubo endotraqueal aumentaram com o tempo de cirurgia e com o aumento do volume de líquido de irrigação utilizado em pacientes submetidos a artroscopia do ombro. Recomendamos a monitorização rigorosa da pressão do balonete do tubo endotraqueal durante artroscopia do ombro, especialmente nos procedimentos longos em que grandes volumes de fluido de irrigação são empregados, para evitar complicações causadas por pressões elevadas do balonete.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Pressure/adverse effects , Shoulder Joint/surgery , Intubation, Intratracheal/adverse effects , Time Factors , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Operative Time , Intubation, Intratracheal/instrumentation , Therapeutic Irrigation/adverse effects , Anesthesia, General/statistics & numerical data , Neck/anatomy & histology
12.
J. oral res. (Impresa) ; 9(6): 457-465, dic. 31, 2020. ilus, tab
Article in English | LILACS | ID: biblio-1178939

ABSTRACT

Soft tissue calcifications can indicate the presence of more serious, potentially life-threatening pathologies. Therefore, their study can lead to an early diagnosis of those conditions that have not yet become clinically apparent. Main objective: To determine the prevalence of calcifications in soft tissues of the head and neck in cone beam computed tomography images obtained from the Oral and Maxillofacial Radiology Service at Universidad Andrés Bello (UNAB), Viña del Mar, Chile. Material and Methods: Retrospective, cross-sectional, quantitative study. A total of 288 images of cone beam computed tomography (CBCT) were used. Images were obtained at random from the database of the Oral and Maxillofacial Radiology Service at UNAB, Viña Del Mar, between 2014 and 2019. Results: A prevalence of 59.72% of soft tissue calcifications was obtained. The most prevalent were: tonsilloliths and calcified stylohyoid ligament, accounting for 30.65% and 45.56%, respectively. Conclusion: A high prevalence of soft tissue calcifications was found in a population that has not been studied previously; therefore, it is important that the dentist perform a detailed analysis of the cone beam computed tomography.


Introducción: Las calcificaciones en tejidos blandos pueden indicar patologías más graves, que incluso pueden comprometer la vida. Por lo tanto, investigarlas puede conducir a un diagnóstico temprano de aquellas que aún no se han manifestado clínicamente. Objetivo principal: determinar la prevalencia de calcificaciones en tejidos blandos de cabeza y cuello en tomografía computarizada de haz cónico del Servicio de Radiología Oral y Maxilofacial de la UNAB, Viña del Mar, Chile. Material y Métodos: Estudio retrospectivo, transversal, cuantitativo. Se utilizaron 288 volúmenes de tomografía computarizada de haz cónico (CBCT, por las iniciales en inglés de Cone Beam Computed Tomography), obtenidas al azar, de la base de datos del Servicio de Radiología Oral y Maxilofacial de la Universidad Andrés Bello (UNAB), Viña del Mar entre 2014 y 2019. Resultados: Se obtuvo una prevalencia de 59.72% de calcificaciones en tejidos blandos. Las más prevalentes fueron: tonsilolitos, con un 30,65% y ligamento estilohioídeo calcificado, con un 45,56%. Conclusión: Se encontró una alta prevalencia de calcificaciones en tejidos blandos en una población que no ha sido estudiada previamente, por ello es importante que el odontólogo realice un análisis detallado de la tomografía computarizada de haz cónico.


Subject(s)
Humans , Male , Female , Calcinosis/diagnostic imaging , Cone-Beam Computed Tomography/methods , Head/diagnostic imaging , Neck/diagnostic imaging , Palatine Tonsil/diagnostic imaging , Calcinosis/epidemiology , Chile , Prevalence , Retrospective Studies , Ligaments
13.
Arq. bras. cardiol ; 115(5): 840-848, nov. 2020. tab, graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1142250

ABSTRACT

Resumo Fundamento: A circunferência do pescoço (CP) é uma medida indireta do tecido adiposo subcutâneo da parte superior do corpo, apontada como um preditor independente de doenças cardiometabólicas. Objetivos: Verificar a associação entre a CP e o risco cardiovascular em 10 anos (risco de doença cardiovascular [DCV] em 10 anos) em homens e mulheres separadamente. Métodos: Análise seccional com inclusão de 13.920 participantes da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). A associação entre a CP (utilizada como variável contínua e agregada em quartis) e o risco de DCV em 10 anos, estimado pelo Framingham Global Risk Score (FGRS), foi investigada por meio de modelos lineares generalizados após ajustes por características sociodemográficas, comportamentos em saúde, índice de massa corporal e circunferência da cintura. O nível de significância estatístico adotado foi de 5%. Resultados: A média da CP foi de 39,5 cm (desvio-padrão [DP] de ± 3,6) nos homens e 34,0 cm (DP de ±2,9) nas mulheres. Após ajustes, o aumento de 1 cm na CP foi associado ao incremento de 3% (IC 95%: 1,02 a 1,03) e 5% (IC 95%: 1,04 a 1,06) na média aritmética do risco de DCV em homens e mulheres, respectivamente. No último quartil da CP, homens e mulheres apresentaram um incremento de 18% (IC 95%: 1,13 a 1,24) e 35% (IC 95%: 1,28 a 1,43), respectivamente, na média aritmética do risco de DCV após ajustes. Conclusões: Verificamos associação positiva e independente entre a CP e o risco de DCV em 10 anos. Resultados sugerem que a CP pode contribuir para a predição de risco cardiovascular além daquele observado pelas medidas antropométricas clássicas.


Abstract Background: Neck circumference (NC), an indirect measure of upper-body subcutaneous adipose tissue, has been pointed out as an independent predictor of cardiometabolic diseases. Objectives: To assess the association between NC and 10-year cardiovascular risk in men and in women. Methods: Cross-sectional analysis of 13,920 participants of the (baseline) Longitudinal Study of Adult Health (ELSA-Brasil). The association between NC (used as continuous variable and grouped into quartiles) and the 10-year cardiovascular risk was estimated by the Framingham Global Risk Score and analyzed by generalized linear models after adjustments for sociodemographic characteristics, health behaviors, body mass index and waist circumference. The significance level adopted was 5%. Results: Mean NC was 39.5 cm (SD± 3.6) in men and 34.0 cm (SD±2.9) in women. After adjustments, a one-centimeter increase in NC was associated with an increment of 3% (95%CI1.02-1.03) and 5% (95% 1.04-1.05) in the arithmetic mean of the 10-year CVD risk in men and women, respectively. Men and women in the last quartile showed an increment of 18% (95%CI 1.13-1.24) and 35% (95%CI 1.28-1.43), respectively in the arithmetic mean of the 10-year CVD risk, after adjustments. Conclusions: We found a positive, independent association between NC and the 10-year cardiovascular disease risk. NC may contribute to the prediction of cardiovascular risk, over and above traditional anthropometric measures.


Subject(s)
Humans , Male , Female , Adult , Cardiovascular Diseases/etiology , Cardiovascular Diseases/epidemiology , Brazil/epidemiology , Body Mass Index , Cross-Sectional Studies , Risk Factors , Longitudinal Studies , Waist Circumference , Neck
14.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(3): 334-343, set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144898

ABSTRACT

Resumen El paraganglioma (PG) es una neoplasia infrecuente originada de las células paraganglionares, embriológicamente derivadas de la cresta neural. Se localizan en la cabeza, base de cráneo, cuello, mediastino, abdomen y pelvis. La mayor parte de los PG muestran un curso clínico benigno, sin embargo, algunos casos pueden mostrar un comportamiento biológico agresivo con invasión local y metástasis a distancia. Un avance significativo en patología molecular ha sido el reconocimiento que el 30%-40% de estas neoplasias presentan alteraciones genéticas. Se han descrito más de 45 genes involucrados, incluyendo mutaciones de la línea germinal succinato deshidrogenasa. Actualmente se recomienda hacer test genético a todos los portadores de PG incluyendo los de presentación esporádica. El PG más frecuente se ubica en la glándula suprarrenal llamado feocromocitoma. El diagnóstico definitivo se realiza con histología, sin embargo, el estudio imagenológico puede entregar una aproximación diagnóstica certera. Debido a la aceptación actual que todos los PG tienen potencial metastásico, el concepto de PG benigno y maligno ha cambiado a uno de estimación de riesgo de metástasis, aunque no existe un esquema único aceptado para tal efecto. El tratamiento considera la cirugía, la radioterapia, la observación y terapias combinadas. Dado el lento crecimiento de este tipo de neoplasia y las potenciales complicaciones de la terapia quirúrgica, la observación es una opción especialmente para pacientes añosos dejando las otras opciones para pacientes más jóvenes. En este trabajo se presenta un caso de paraganglioma yugular bilateral gigante tratado con radioterapia de intensidad modulada incluyendo una revisión bibliográfica pertinente.


Abstract Paraganglioma (PG) is a rare neoplasm derived from paraganglionic cells of the neural crest. They are located in the head, skull base, neck, mediastinum, abdomen and pelvis. Most PGs show a benign clinical course, however, some cases may show aggressive biological behavior with local invasion and distant metastasis. A significant advance in molecular pathology has been the recognition that 30%-40% of these neoplasms present genetic alterations; more than 45 genes have been described, including mutations of the germline succinate dehydrogenase. Currently it is recommended to make genetic test to all patients with PG, including sporadic presentation. The most frequent PG is located in the adrenal gland called pheochromocytoma. The definitive diagnosis is made with histology; however, the imaging study can provide an accurate diagnostic approach. It is now accepted that all PG have a metastatic potential, therefore the concept of benign or malignant has been changed to a metastasis risk stratification approach however no single scheme is been widely used. The treatment considers surgery, radiotherapy, observation and combination therapies. Given the slow growth of this type of neoplasia and the potential complications of surgical therapy, observation is an option especially for elderly patients leaving the other options for younger patients. In this work we present a case of giant bilateral jugular paraganglioma treated with intensity modulated radiation therapy, including a pertinent literature review.


Subject(s)
Humans , Female , Middle Aged , Paraganglioma/pathology , Glomus Jugulare Tumor/pathology , Neck/pathology , Paraganglioma/diagnostic imaging , Glomus Jugulare Tumor/genetics , Glomus Jugulare Tumor/radiotherapy , Glomus Jugulare Tumor/therapy , Glomus Jugulare Tumor/diagnostic imaging , Head and Neck Neoplasms/pathology , Neoplasm Metastasis
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(3): 367-375, set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1144902

ABSTRACT

Resumen En adultos, una masa cervical detectada mediante examen físico o un estudio de imagen puede ser la única manifestación de un cáncer proveniente de cabeza y cuello. Un retraso en el diagnóstico repercute en el pronóstico de la enfermedad, por lo que debe haber un alto índice de sospecha. Las metástasis cervicales con primario desconocido (MCCPD) son tumores metastásicos en los que el estudio diagnóstico no logró identificar el sitio primario del cáncer, con una histología predominantemente de tipo escamosa. Según algunos estudios, el origen más frecuente resultó ser la orofaringe, incluyendo amígdala palatina y base de lengua. Factores de riesgo conocidos son edades avanzadas, consumo de tabaco y de alcohol. Actualmente, la infección por el virus del papiloma humano (VPH) está teniendo un rol cada vez más importante como factor de riesgo, formando parte de entre 20%-25% de los cánceres de cabeza y cuello. Al enfrentarse a un paciente con masa cervical es importante realizar una completa anamnesis y examen físico acucioso para detectar cualquier elemento sugerente de malignidad. Se debe complementar con nasofibroscopía para visualizar estructuras que no alcanzan a evaluarse en el examen habitual. También se puede orientar la búsqueda del primario desconocido en base a los patrones de drenaje linfático. Dentro del estudio complementario se puede comenzar con una tomografía computada (TC) y se puede considerar también el ultrasonido o un PET/TC. Si con esto aún no se logra definir el primario, continuar con una punción aspirativa con aguja fina (PAAF), luego biopsia core que consiste en tomar una muestra del centro de la lesión guiada por ecografía, si fuese necesario, incluyendo inmunohistoquímica para VPH; ambos estudios histológicos son preferibles en vez de una biopsia abierta debido al menor riesgo de diseminación y complicaciones. El siguiente paso incluye estudio endoscópico y biopsias bajo anestesia. El tratamiento de los pacientes con MCCPD, va a depender de factores relacionados con el estadio de la enfermedad: desde cirugía o radioterapia (RT) únicas, cirugía más RT, y en algunos casos quimioterapia. Se recomienda seguimiento clínico frecuente durante los primeros años y con imágenes dentro de los 6 primeros meses postratamiento.


Abstract In adults, a cervical mass detected by physical examination or an imaging study may be the only manifestation of cancer from the head and neck. A delay in the diagnosis affects the prognosis of the disease, so there must be a high index of suspicion. Cervical metastases from unknown primary tumor (CUP) are metastatic tumors in which the diagnostic study failed to identify the primary site of cancer, with predominantly squamous histology. According to some studies, the most frequent origin was the oropharynx, including palatine tonsil and tongue base. Known risk factors are advanced ages, tobacco and alcohol consumption. Currently, human papilloma virus (HPV) infection is playing an increasingly important role as a risk factor, being the cause of between 20-25% of cancers of the head and neck. When confronting a patient with cervical mass it is important to carry out a complete anamnesis and a thorough physical examination to detect any element suggestive of malignancy. Physical examination could be complemented with a flexible nasal endoscopic to evaluate structures that can not be evaluated in the habitual examination. The search for the unknown primary can also be oriented based on lymphatic drainage patterns. Within the complementary evaluations, one can start with a study of images such as computed tomography (CT) or magnetic resonance imaging (MRI) with contrast, and also could consider ultrasound or PET/CT. If the primary can not be defined yet, fine needle aspiration (FNAP) can be the next choice and then a core biopsy that consisting of taking a sample from the center of the ultrasound-guided lesion, if necessary, including immunohistochemistry for HPV; both histological studies are preferable to an open biopsy because of the lower risk of complications. The next step searching for the primary includes endoscopic study and biopsies under anesthesia. Regarding to the management of patients with CUP, it will depend on factors related to the stage of the disease: from surgery or radiotherapy (RT) only, surgery and RT, and in some cases chemotherapy. Frequent clinical follow-up is recommended during the first years and images within the first 6 months after treatment.


Subject(s)
Humans , Neoplasms, Unknown Primary/pathology , Carcinoma, Squamous Cell/secondary , Head and Neck Neoplasms/pathology , Neoplasms, Unknown Primary , Neoplasms, Unknown Primary/radiotherapy , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/diagnostic imaging , Tomography, X-Ray Computed , Biopsy, Fine-Needle , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/diagnostic imaging , Neck
16.
Rev. chil. pediatr ; 91(3): 398-404, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126178

ABSTRACT

Resumen: Introducción: Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos. Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT. Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, duran te la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias. Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complica ciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.


Abstract: Introduction: Congenital head and neck masses are associated with perinatal asphyxia and brain injury, increasing the risk of death. The EXIT (Ex Utero Intrapartum Treatment) technique con sists of ensuring the newborn's airway while is still receiving placental support. This technique has not been standardized in developing countries. Objective: To describe the clinical outcomes of two infants who underwent the EXIT technique. Clinical Case: We present two cases, one with lymphatic malformation diagnosed at 20 weeks of gestational age (WGE) and the second one, a preterm newborn with thyromegaly and polyhydramnios, diagnosed at 35 WGE. In both cases, during the C-section, the EXIT technique was performed with a team of a neonatologist, a gyne cologist, an anesthesiologist, a pediatric surgeon, an otolaryngologist, a nurse, and a respiratory therapist. In both patients, the neonatologist achieved to secure the airway through orotracheal intubation at the first attempt. In the first case, lymphatic malformation was confirmed and re ceived sclerotherapy, and the second one was diagnosed with congenital hypothyroidism which was managed with levothyroxine. The patients needed invasive mechanical ventilation for 7 and 9 days, respectively, and were discharged without respiratory complications. Conclusions: In these patients, the EXIT technique was a safe procedure, carried out without inconvenience. A multi disciplinary approach and the availability of a neonatal intensive care unit are needed to reduce potential complications and ensure postnatal management. Timely prenatal diagnosis is essential to perform this technique.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Thyroid Gland/pathology , Cesarean Section , Perinatal Care/methods , Congenital Hypothyroidism/therapy , Lymphatic Abnormalities/therapy , Airway Management/methods , Prenatal Diagnosis , Colombia , Congenital Hypothyroidism/diagnosis , Congenital Hypothyroidism/pathology , Lymphatic Abnormalities/diagnosis , Tertiary Care Centers , Hypertrophy/diagnosis , Hypertrophy/therapy , Neck
17.
Rev. cuba. med. mil ; 49(2): e381, abr.-jun. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1138994

ABSTRACT

Introducción: La fístula quilosa posoperatoria debida a lesión iatrogénica del conducto torácico es una complicación infrecuente y grave de la cirugía de cabeza y cuello. Objetivo: Describir las opciones de tratamiento de la fístula quilosa cervical posquirúrgica. Caso clínico: Se presenta un paciente de 18 años de edad con diagnóstico de linfangioma quístico de la región lateral izquierda del cuello, intervenido en el Servicio de Cirugía General del Hospital "Mnazi Mmoja", de Zanzíbar, Tanzania. Durante la evolución posoperatoria se constató una fístula quilosa de bajo débito la cual resolvió mediante tratamiento médico. El enfermo egresó curado a los 28 días después de la intervención quirúrgica. Conclusión: El tratamiento conservador es efectivo en la mayoría de las fístulas quilosas cervicales de bajo débito, mientras que en las de débito alto la cirugía ofrece una rápida resolución, aunque no existe consenso en torno al momento ideal para realizarla(AU)


Introduction: Postoperative chylous fistula due to iatrogenic thoracic duct injury is an infrequent and serious complication of head and neck surgery. Objective: To describe the treatment options of postoperative cervical chylous fistula. Clinical case: It was presented an 18-year-old patient with diagnosis of cystic lymphangioma of the left lateral region of the neck, which was removed in the General Surgery Service of the National Hospital Mnazi Mmoja of Zanzibar, Tanzania. During the postoperative evolution, a low-output chylous fistula was found and resolved by medical treatment. The patient withdrew cured at 28 days after the surgical intervention. Conclusion: Conservative treatment is effective in the majority of low-out put cervical chylous fistulas, while in high-debit, surgery offers a rapid resolution, although there is no consensus about the ideal time to perform it(AU)


Subject(s)
Humans , Male , Adolescent , Surgical Procedures, Operative , Lymphangioma, Cystic , Fistula , Head , Neck
18.
Rev. bras. ortop ; 55(3): 347-352, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1138027

ABSTRACT

Abstract Objective To evaluate radiographically the postoperative results of patients with fracture of the proximal humerus in two parts of the surgical neck treated with threaded percutaneous fixation. Methods We evaluated the radiographic results of percutaneous fixation with threaded pins on the treatment of proximal humerus fractures in our service. Preoperative and postoperative images of 42 patients were evaluated, evaluating radiographs until 8 weeks postoperatively. We considered on evaluation the fracture deviation on preoperative images, the loss of reduction and no consolidation. Results Our consolidation rate was 90.4%, with loss of reduction in 16.6% of the cases and no consolidation rates in just 4 operated cases. We observed a predominance of a specific fracture pattern in the cases with loss of reduction. Conclusion The present study allows us to consider the percutaneous fixation technique with threaded pins as an alternative in our therapeutic arsenal for the proximal humerus fracture of the surgical neck. Contraindications are considered for low fracture trait on the metaphysis and with medial/lateral cortical impairment.


Resumo Objetivo Avaliar radiograficamente os resultados pós-operatórios dos pacientes com fratura da extremidade proximal do úmero em duas partes do colo cirúrgico tratados com fixação percutânea com fios rosqueados. Métodos Avaliamos radiograficamente os resultados da fixação percutânea com fios rosqueados das fraturas da extremidade proximal do úmero realizadas em nosso serviço. Foram avaliadas as imagens pré- e pós-operatórias de 42 pacientes, avaliando-se radiografias com até 8 semanas de pós-operatório. Consideramos na avaliação o desvio da fratura pré-operatório, a perda da redução e a consolidação da fratura. Resultados O índice de consolidação nos casos avaliados foi de 90,4%, com perda da redução em 16,6% dos casos e não obtida a consolidação em apenas 4 casos. Foi observada uma predominância de determinado padrão de fratura nos casos que perderam a redução. Conclusão O estudo permitiu considerar a técnica de fixação percutânea com fios rosqueados uma alternativa no arsenal terapêutico da fratura da extremidade proximal do úmero do colo cirúrgico, com contraindicação para os traços de fratura baixos na metáfise e com acometimento da cortical medial/lateral.


Subject(s)
Humans , Male , Female , Therapeutics , Fracture Healing , Fractures, Bone , Fracture Fixation, Internal , Humeral Fractures , Neck
19.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 69-74, mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1099204

ABSTRACT

Las masas cervicales representan un desafío habitual en pediatría, que en su mayoría son de etiología benigna. Una de las causas menos conocidas es el timo cervical aberrante, una entidad clínica resultante de anormalidades en el descenso del timo a lo largo de su ruta habitual (tracto timo-faríngeo). Este es un cuadro frecuentemente mal diagnosticado, del que se desconoce su incidencia real. Actualmente, su incidencia relativa parece ir en aumento en conjunto con la disponibilidad de la ecotomografía. En Chile no hay registro epidemiológico de este cuadro ni existen reportes de caso documentados. En este artículo se presenta una revisión bibliográfica sobre masa cervical pediátrica y un reporte de caso de un paciente chileno.


Cervical masses constitute a frequent challenge in pediatric care, mostly which are of benign nature. One of the lesser known causes is the aberrant cervical thymus, which results from embryological abnormalities during the thymus descent through its normal route (thymo-pharyngeal duct). This is a frequently misdiagnosed syndrome, for which its real incidence remains unknown. Nowadays, its relative incidence is on the rise along with ultrasound availability. There is no epidemiological record or documented case reports of this entity in Chile. In this article we present a bibliographic revision on cervical mass and a case report from a Chilean patient.


Subject(s)
Humans , Male , Child, Preschool , Thymus Gland/abnormalities , Thymus Gland/diagnostic imaging , Ultrasonography , Neck/diagnostic imaging
20.
An. bras. dermatol ; 95(1): 102-104, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1088736

ABSTRACT

Abstract White fibrous papulosis of the neck is a rare entity, with fewer than 50 cases described. It is a benign pathology whose main interest lies in its broad differential diagnosis, especially with pseudoxanthoma elasticum. The authors report the case of a 77-year-old woman with multiple yellow-white monomorphic papules on the posterior cervical region, with years of evolution. Cutaneous biopsy revealed a nodular area in the superficial and middle reticular dermis, with slight thickening of the collagen fibers and focally enlarged elastic fibers, aspects highlighted in the Verhoeff staining that additionally showed absence of elastic fibers in the papillary dermis.


Subject(s)
Humans , Female , Aged , Skin Diseases, Papulosquamous/pathology , Neck/pathology , Biopsy , Fibrosis , Dermis/pathology , Elastic Tissue/pathology
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