Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study.

Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.

Brief guideline for the prevention of COVID-19 infection in head and neck and otolaryngology surgeons.

IMPORTANCE: Anatomically, viral density is greater in the nasal cavity and the nasopharynx. It is to be expected that instrumentation in or through those areas will entail a higher risk of transmission. That's why head and neck and otolaryngologist surgeons are among the most vulnerable health professionals. OBSERVATIONS: Surgeons should essentially perform procedures they require. Surgeries should be performed with personal protective equipment suitable for the high risk of aerosolization: goggles, N95 face mask, facial mask, blood-repelling gown and gloves. It is advisable to have the cooperative COVID-19 test in all patients. Telemedicine is a useful resource if resources allow it. CONCLUSIONS AND RELEVANCE: Otolaryngologists and related specialists are among the groups at higher risk when performing surgeries and upper airway examinations. There are no emergencies in a pandemic. The care of health professionals is crucial to combating this health situation.

Renal clear cell carcinoma metastasis to submandibular gland: case report and review of the literature.

Metastases from renal clear cell carcinoma (RCCC) to the head and neck (HN) region are rare, representing 8-14% of all RCCC metastases, with the thyroid gland being the most common site of RCCC metastasis in the HN. Metastatic tumors that are located in the salivary glands have a prevalence of 5%, while the submandibular gland is only involved in 1% of the cases. We present the case of a 74-year-old female patient with metastasis to the submandibular gland, 11 years after radical nephrectomy for a RCCC.

Multidetector-row computed tomography in the planning of abdominal perforator flaps.

An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is extremely valuable in improving the surgical strategy in abdominal perforator flaps. The multidetector-row computer tomography offers thin slice coverage of extended volumes with an extremely high spatial resolution. From October 2003 to December 2004, 66 female patients had breast reconstruction surgery in our department using the deep inferior epigastric artery perforator flap. Our multidetector-row computer tomography studies were performed using a 16-detector-row computer tomography scanner. The image assessment was carried out using the following protocol: we first identified the best three perforators from each side of the abdomen. Then we conducted a three-dimensional reconstruction of the abdomen by identifying exactly where the three best perforators emerged from the rectus abdominis fascia. We then transferred the data obtained from the image to the patient using a coordinate system. In addition, we also placed the dominant perforators in the patient by using a conventional hand-held Doppler. During the operation we compared intra-operative findings, Doppler results and computer tomography outcomes. Neither false positive nor false negative results were found in the computer tomography outcome. Multidetector-row computer tomography provides us with an easy method of interpreting the virtual anatomic dissection in three dimensions. It has high sensitivity and specificity and provides a good quality evaluation of the perforator vessels. This information allows reduction of operating time and safer performance of surgery. The multidetector-row computer tomography is a highly effective tool in the preoperative study of abdominal perforator flaps.

Spontaneous vertebral artery dissection as a complication of autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) may be associated with a variety of cardiovascular complications, including intracranial saccular aneurysms. In ADPKD, intracranial saccular aneurysms tend to rupture more frequently and earlier than the sporadic variety with a tendency to cluster in families. In contrast, dissecting intracranial aneurysms are rarely associated with either intracranial saccular aneurysms or ADPKD. We describe an ADPKD-1 patient whose course was complicated by a spontaneous dissection of a vertebral artery aneurysm. This particular patient had previously experienced three episodes of ascending aortic dissection with cystic medial necrosis. Intracranial vascular and aneurysmal dissection may occur in select ADPKD patients with familial clusters.

[Analysis of energy intake, macronutrients and micronutrients in a child population]. / Análisis de la ingesta de energía, macronutrientes y micronutrientes en una población infantil.

With the objective to know precisely the qualitative and quantitative food intake of the infant population of a Health Care Area, the weekly intake of Energy, Proteins, Total and Saturated Fat, Food Fiber, Cholesterol, Calcium, Phosphorus, Magnesium. Iron, Zinc and Vitamin A is studied in 187 pupils, representative of the whole (835 children) population of two schools of Fuenlabrada and Leganés (Madrid), following the Weekly Register technique. Total consumption is quantified, and stratified according to sex and age groups. In order to perform a proper evaluation of these parameters, their adequacy to the Intake Recommendations for age and sex is analyzed, finding an excessive intake of calories, proteins and lipids in all age groups: being saturated Fat a third of the total daily Fat; Carbohydrates intake less than 50% of total energy, which would be desirable to maintain the nutritional ratio. Calcium intake, insufficient in some age group, together with the strong correlation proteins-phosphorus as well as total and saturated Fat with Cholesterol of the diet, allow to conclude that the excessive protein intake is predominantly due to meat products. It is also noted the lower intake of Zinc, Calcium, Magnesium, as to the recommended in certain age groups, therefore said individuals are at risk to suffer deficit of these micronutrients.

[The consumption of commercial foods in childhood. The influence of a nutritional information program]. / Consumo de alimentos comerciales en la infancia. Influencia de un programa de información en nutrición.

In order to perform an in-depth study on food standards among school children and evaluate the effect of a nutritional educational programme on eating habits, an analysis was made of the data on the intake of foods over a period of 1,890 days, in 187 school children from 2 schools in the Leganés-Fuenlabrada area. The consumption of global and stratified rations was quantified based on age, commercial foods (buns, fried foods and sweets) accounting for a large part of the children's diet, as well as dairy products, vegetables, fruit and fish, representing basic foodstuffs supposed to form part of their diet. The consumption of these was compared in two stages, before and after receiving the educational programme. It was observed that there was an excessive consumption of foodstuffs considered as lacking in nutritional value (commercial), which increased with age and a lack of natural foods evaluated in their food standards. We also observed that the applied health intervention modified the consumption of these foods recently incorporated into the children's diet, without achieving results with regard to family eating habits.

[Study on the activity of acromegaly: evaluation of IGF-I]. / Estudio sobre la actividad de la acromegalia: valoración del IGF-I.

The evaluation of acromegaly only with GH levels can be difficult. We have evaluated in 32 acromegalic patients the clinical activity and baseline GH after oral glucose and THR. IGF-I was also evaluated. According GH suppression by glucose, three groups were established. A) minimum GH less than ng/ml, B) minimum GH 2-5 ng/ml and C) GH less than 2 ng/ml. IGF-1 in group A was 8.8 +/- 4.1 U/ml (mean +/- SD) and in group C IGF-I was 1.4 +/- 0.5 U/ml. Group B presented heterogeneous clinic and IGF-I levels. A 4 years clinical and hormonal follow-up could be performed in 20 patients. Those patients who were clinically inactive maintained their GH levels less than 2 ng/ml, with normal IGF-I titers throughout the follow-up period. In summary, IGF-I is very reliable in the evaluation of acromegaly activity and only requires a baseline determination being thus very useful in initial screening. It also determines with great reliability the treatment effectiveness in the evolutive study.

Aspergillosis of the sphenoid sinus simulating a pituitary tumor.

Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimicked a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia.

Postnephrectomy arteriovenous fistula.

A new case of postnephrectomy arteriovenous fistula is reported. This is an uncommon acquired complication of a common surgical procedure. Clinical features, diagnostic procedures, surgical treatment and results are analysed and discussed. In this case, a direct communication between the right renal artery and the inferior vena cava was found.