[Sarcoidosis and berylliosis]. / Sarkoidose und Berylliose.

Sarcoidosis and berylliosis (chronic beryllium disease, CBD) are granulomatous diseases and are phenocopies which cannot be differentiated based on the clinical presentation. Whereas for sarcoidosis the eliciting agent is unknown, for berylliosis an exposure to beryllium (mostly as occupational exposure) can be confirmed that therefore induces a sensitization against beryllium. The diagnosis is generally made in patients with a typical clinical presentation, the histological proof of a non-necrotizing granuloma and the exclusion of other diseases causing granulomas. In most cases, granulomas can be detected in the lungs and/or (intrathoracic) lymph nodes. The proof of sensitization to beryllium for the differential diagnosis can be performed with a so-called beryllium lymphocyte proliferation test in peripheral mononuclear blood cells or cells from a bronchoalveolar lavage. The objectives of treatment are avoidance of functional organ impairment and symptom control. Immunosuppressive therapy (initially mostly with corticosteroids) and supportive measures can prove beneficial; however, in many cases clinical observation can be sufficient because of stable disease or spontaneous resolution. In addition, further beryllium exposure must be avoided, which mostly necessitates a change of the workplace.

HIF-1α, HIF-2α, and ProExC: diagnostic or prognostic relevance in conjunctival intraepithelial neoplasia?

PURPOSE: The aim of this study was to investigate HIF-1α, HIF-2α, and ProExC expression in conjunctival intraepithelial neoplasia (CIN), to differentiate between metaplasia and dysplasia, and to access their value as diagnostic and prognostic immunohistochemical markers. Recurrence and progression into SCC (squamous cell carcinoma) were defined as endpoints. METHODS: Forty-three specimens including CIN I (2), CIN II (9), CIN III (29), with and without metaplasia, and metaplasia alone (3), as well as 21 conjunctival control specimens, were stained with antibodies against HIF-1α, HIF-2α, and ProExC. The percentage of positively stained cells were calculated and used for further analysis. RESULTS: The mean percentages of HIF-1α and HIF-2α were not increased in CIN. In comparison, the expressions of these markers were even significantly elevated in control specimens (p < 0.001). Upper epithelial cells in CIN were more often ProExC-positive compared with normal conjunctiva or metaplasia (p = 0.06 and p = 0.07). Cox proportional-hazards analysis was performed for characterization of factors influencing the combined endpoint and showed a significant elevated hazard ratio for staining with ProExC (p = 0.04) compared with HIF-1α (p = 0.26) and HIF-2α (p = 0.49). CONCLUSION: Our study shows that HIF-1α and HIF-2α do not serve as diagnostic or prognostic markers in CIN. ProExC seems to be a potential indicator for CIN, but not a reliable diagnostic marker. However, control specimens occasionally also display a high percentage of ProExC-positive cells and staining over the entire epithelial layer.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study.

OBJECTIVES: After surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. METHODS: This randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3-6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. RESULTS: Five children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). CONCLUSION: While we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab. CLINICALTRIALS: gov Identifier: NCT02555800.

Relaxation dynamics of Pd-Ni-P metallic glass: decoupling of anelastic and viscous processes.

The stress relaxation dynamics of metallic glass Pd40Ni40P20was studied in both supercooled liquid and glassy states. Time-temperature superposition was found in the metastable liquid, implying an invariant shape of the distribution of times involved in the relaxation. Once in the glass state, the distribution of relaxation times broadens as temperature and fictive temperature decrease, eventually leading to a decoupling of the relaxation in two processes. While the slow one keeps a viscous behavior, the fast one shows an anelastic nature and a time scale similar to that of the collective atomic motion measured by x-ray photon correlation spectroscopy (XPCS). These results suggest that the atomic dynamics of metallic glasses, as determined by XPCS at low temperatures in the glass state, can be related to the rearrangements of particles responsible of the macroscopically reversible anelastic behavior.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study.

OBJECTIVES: After surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. METHODS: This randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3-6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. RESULTS: Five children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). CONCLUSION: While we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab. Clinicaltrials.gov Identifier: NCT02555800.

Association of HLA-DQA1*03011-DQB1*0301 haplotype with the development of respiratory scleroma.

OBJECTIVE: Respiratory scleroma (RS) is a progressive, chronic, granulomatous disease caused by Klebsiella rhinoscleromatis. There is only one report of RS association with HLA-DQ3. In this study, molecular association of HLA class II and RS was determined. STUDY DESIGN AND SETTING: Nine RS patients and 163 healthy controls were compared. DQA1, DQB1, and DRB1 loci were typed. RESULTS: Statistical analysis demonstrated association between DQB1*0301 and susceptibility to RS (P(c) = 0.004). Haplotype analysis showed an association of DQA1*03011-DQB1*0301 (P = 1.21E-19) and DRB1*0407-DQA1*03011-DQB1*0301 (P = 0.0002). CONCLUSIONS: Results established that DQA1*03011-DQB1*0301 haplotype is a strong risk factor for development of RS.

Eficacia de cidofovir frente a bevacizumab en la papilomatosis respiratoria recurrente: estudio piloto aleatorizado, doble ciego y controlado por placebo / Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

Objectives: After surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. Methods: This randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3–6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. Results: Five children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). Conclusion: While we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab. (AU)

Objetivos: Tras la extirpación quirúrgica de los papilomas, puede recomendarse terapia adyuvante para el control de la papilomatosis respiratoria recurrente (PRR). Como la eficacia de la terapia adyuvante no está demostrada, el objetivo de este estudio fue comparar la eficacia de cidofovir frente a bevacizumab, utilizados como terapias adyuvantes para el control de PRR. Métodos: Estudio piloto aleatorizado, doble ciego y controlado por placebo, realizado en un centro nacional de referencia de enfermedades respiratorias. Se reclutó prospectivamente a los pacientes con PRR, y se dividieron en 2 grupos: PRR de jóvenes y PRR de adultos. A los participantes se les asignó aleatoriamente la administración de terapia adyuvante de cidofovir, bevacizumab o placebo. La administración de los fármacos de estudio o placebo se realizó tras practicar microlaringoscopia directa con extirpación de papilomas, utilizando instrumental frío. Se llevaron a cabo evaluaciones utilizando la puntuación de gravedad de Derkay y la escala VHI (Voice Handicap Index) a intervalos de 3 a 6 semanas, con un total de 3 visitas. El seguimiento incluyó evaluación de las escalas VHI y Derkay a intervalos de 2 meses, durante el curso de un año. Se compararon las tasas anuales pre- y postratamiento quirúrgico. Resultados: El estudio incluyó 5 niños y 11 adultos. Transcurrido un año, el grupo tratado con cidofovir reflejó una reducción significativa en la escala Derkay (p=0,027). No se observó diferencia alguna entre las ramas terapéuticas en la tasa quirúrgica anual. Se vio una reducción significativa en la puntuación VHI en todos los grupos terapéuticos (p<0,001), y no se observó diferencia significativa entre los grupos (p=0,32). Conclusión: A pesar de verse una reducción significativa de la gravedad de PRR con la administración de cidofovir intralesional, no pudimos probar la eficacia de bevacizumab intralesional. (AU)

Increased prevalence of thrombophilia among women with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the prevalence of markers of thrombophilia in women hospitalized for severe OHSS. DESIGN: Prospective study. SETTING: Academic research center. PATIENT(S): Women undergoing induction of ovulation complicated by severe OHSS (n = 20) and women undergoing induction of ovulation without development of severe OHSS (n = 41). INTERVENTION(S): Blood samples to test for markers of thrombophilia were obtained during the luteal phase of the treatment cycle. MAIN OUTCOME MEASURE(S): Blood samples were analyzed for markers of thrombophilia, such as plasma levels of antithrombin, protein S and protein C, antiphospholipid antibodies, the factor V Leiden mutation, and 677T polymorphism in the 5,10 methyltetrahydrofolate reductase (MTHFR 677T) gene. RESULT(S): Seventeen of 20 patients with severe OHSS (85%) and 11 of 41 controls (26.8%) had one or more positive markers of thrombophilia. Of the women with severe OHSS, 6 had a decreased antithrombin level, 8 had decreased levels of protein S, 7 were homozygous for the MTHFR 677T mutation, 1 was heterozygous for the factor V Leiden mutation, and 5 had antiphospholipid antibodies. Eight women with OHSS and no controls had more than one positive marker of thrombophilia. CONCLUSION(S): The prevalence of thrombophilia is increased in women with severe OHSS. These findings suggest that prophylactic screening for this disorder and possible use of heparin prophylaxis for thromboembolic phenomena should be considered in these patients.

Infections after endoscopic polypectomy using nasal steroids.

BACKGROUND: Topical nasal steroids such as beclomethasone dipropionate and fluticasone propionate have been widely used in the treatment of rhinitis and polyposis. An increase in infection has occurred with the use of fluticasone propionate after endoscopic polypectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of nasal and paranasal infections with the use of topic nasal steroids after endoscopic polypectomy and to compare the recurrence rates of the polyposis. DESIGN AND SETTING: We conducted a prospective, comparative, open, experimental, longitudinal study at an academic tertiary referral medical center. METHODS: One hundred sixty-two patients in whom endoscopic polypectomy had been indicated were randomly divided into 3 groups of 54 patients each. The patients from the first group were treated with saline lavage only. Patients from the second group also received fluticasone propionate 400 microg/day in nasal spray after lavage. Patients from the third group received beclomethasone dipropionate 600 microg/day after lavage. The prevalence of infections and recurrence of polyposis was compared in the 3 groups. RESULTS: Three patients, 2 in the placebo group and 1 in the beclomethasone group, developed infections during the first 3 months after surgical procedure. The recurrence of polyps in the group without steroids was 44%. In contrast, 15% from the patients treated with fluticasone showed recurrence of polyposis; furthermore, 26% of the patients treated with beclomethasone showed recurrence of polypsosis, with a minimum follow-up of 12 months. CONCLUSIONS: The use of nasal steroids does not seem to increase the prevalence of infections after endoscopic polypectomy.

Management of Ludwig's angina with small neck incisions: 18 years experience.

OBJECTIVE: To review Ludwig's angina medical and surgical approach with small incisions. STUDY DESIGN: Retrospective, open, noncomparative, longitudinal. METHODS: All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000. STUDIED PARAMETERS: Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time. RESULTS: Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males). Thirty patients belonged to middle or high socioeconomic status. The primary site of infection was odontogenic in 107 of the patients. All the patients were managed with surgical drainage made within the first 12 hours after hospital admission. The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G. The hospital stay for more than half of patients was 6 days or less. In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina. Forty-six patients had or were diagnosed as having diabetes mellitus. Tracheotomy was required in 34 patients. The airway of the rest of patients was controlled with nasotracheal intubation. Only 33 patients had major complications, such as mediastinitis, sepsis, or death. CONCLUSIONS: Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.

Effects of three nasal topical steroids in the intraocular pressure compartment.

OBJECTIVE: The purpose of this study was to evaluate whether the use of fluticasone propionate, mometasone furoate, or beclomethasone dipropionate for the treatment of rhinitis produced, as a side effect, an increase in the intraocular pressure; only one printed article proclaims that the increase of secondary intraocular pressure is due to the use of local nasal steroids. PATIENTS AND STUDY DESIGN: We conducted a comparative, double-blind, experimental, prospective, longitudinal study in which 360 patients were divided at random into 4 groups; 90 of them were given a placebo (control group) and the other 270 were divided into 3 other groups of 90 patients each and given a different local nasal steroid for each group. Measurement parameters All patients had their intraocular pressure measured by Goldman's tonometry at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after using the placebo or local nasal steroid. RESULTS: Variations were found in the intraocular pressure of patients who used local steroid, with discreet elevations in the beclomethasone dipropionate and mometasone furoate groups; however, variations were always within normal limits. CONCLUSION: Fluticasone propionate, mometasone furoate, and beclomethasone dipropionate cause variations in the intraocular pressure, but the variations are within normal limits.

[Endoscopic adenoidectomy; use or abuse of the technology?]. / Adenoidectomía endoscópica, uso o abuso de la tecnología?

OBJECTIVE: To evaluate efficacy of the conventional technique of adenoidectomy by means of transoperative endoscopic revision of the nasopharynx and to evaluate the need for including telescopes as part of usual instruments used in adenoidectomy. MATERIAL AND METHODS: Prospective, open, comparative, and transversal study. We included the first 150 patients with absolute indication for adenoidectomy. We did 150 adenoidectomy procedures by conventional technique using Beckman adenotomes, and La Force adenotomes, using a laryngeal mirror to observe condition of nasopharynx once the surgeon thought the procedure was completed, we did a revision of adenoid area with Hopkins telescopes of 0 and 30; if we founded residues of adenoids, these were eliminated with Guggenheim forceps, adenotomes, or curved 40 degrees microdebrider tip, all after endoscopic viewing, which also helped in control of area bleeding. MEASURED PARAMETERS: Presence or absence of adenoids residue location, and presence or absence of active bleeding. RESULTS: Total removal of adenoids was carried in 43 patients, our finding adenoid residues in 107 of cases. Of these, 45.3% were occluding pharyngeal part of Eustachian tubes. CONCLUSIONS: Conventional technique for adenoidectomy was effective in < 30%; therefore, it is imperative to use endoscopic revision in each case.

Rendimiento de la biopsia por aspirado en el diagnóstico del carcinoma de endometrio / Performance of aspirate biopsy in the diagnosis of endometrial carcinoma

OBJETIVO: Analizar la concordancia histológica pre y postoperatoria del cáncer de endometrio (CE) diagnosticado por cánula de biopsia tipo Cornier. MÉTODOS: Se incluyen 82 pacientes sometidas a biopsia ambulatoria a ciegas por aspirado con diagnóstico anatomo-patológico final de CE en la pieza de histerectomía. Se estudia la concordancia atendiendo al tipo y al grado histológico haciendo dos grupos para cada análisis: CE endometrioide/no endometrioide y Ce de bajo/alto grado. RESULTADOS: La sensibilidad de la biopsia para detectar malignidad fue del 100%. El grado de concordancia atendiendo al tipo histológico fue de 94% (96,7% para los tipo endometrioide y del 85% para los tipos no endometrioides). En cuanto al grado histológico la precisión en el diagnóstico fue del 90,2% (94,3% en los tumores de bajo grado y 82,7% en los de alto grado) con una tasa de subestimación del grado tumoral del 6%. CONCLUSIONES: La biopsia por aspiración con cánula tipo Cornier detecta adecuadamente el CE y la concordancia entre la biopsia preoperatoria y la pieza quirúrgica es alta, por lo que puede considerarse una técnica fiable en el diagnóstico del cáncer de endometrio y precisa en la valoración del grado y tipo histológicos. El grupo más discordante es el CE G3 de tipo endometrioide.

OBJECTIVE: Analyze pre and post operative histological concordance of endometrial cancer (EC) diagnosed by Cornier biopsy cannula. METHODS: 82 patients under going out patient biopsy aspirate blindly with EC in the hysterectomy specimen. We study the type and histological grade accuracy by two groups for each analysis: EC endometrioid/non-endometrioid and low/high grade. RESULTS: The sensitivity for detecting malignancy was 100%. The histological type agreement was 94% (96.7% for the endometrioid type and 85% for non-endometrioid type). The histological grade accuracy was 90.2% (94.3% in low-grade tumors and 82.7% in high grade) with a rate of under estimation of tumor grade of 6%. CONCLUSIONS: Cornier aspiration biopsy is safe in the diagnosis of EC. Grade and histological type accuracy between preoperative biopsy and surgical specimen is high. The most discordant is EC G3 endometrioid type.

Manejo médico y quirúrgico del absceso periamigdalino: experiencia de cinco años / Medical and surgical management of peritonsillar abscess (QUINSY): five years experience

El absceso periamigdalino es una patología infecciosa grave, que frecuentemente se atiende en nuestra división. Para su manejo existen diversas opciones en la actualidad. La incisión y drenaje, acompañada de tratamiento con penicilina y clindamicina, es la elección de nuestro servicio. Se realizó una revisión de los expedientes de pacientes con diagnóstico de absceso periamigdalino del primero de enero de 1996 al 31 de diciembre del 2000, incluyéndose 117 casos en el presente estudio. Se midió la eficacia del tratamiento médico y quirúrgico, la frecuencia de complicaciones, así como la realización de amigdalectomía de intervalo. Se encontró una eficacia de 88.4 por ciento para el procedimiento de incisión y drenaje. En todos los casos el tratamiento antimicrobiano inicial fue efectivo, de los cuales 89.7 por ciento recibieron penicilina y clindamicina. La única complicación encontrada fue la persistencia del absceso en 11.6 por ciento de los casos, resuelta en todos con un segundo drenaje. Se realizó amigdalectomía de intervalo a 43.6 por ciento de los pacientes. Conclusión: La incisión y drenaje tiene una eficacia superior a otras técnicas para drenaje, el esquema antimicrobiano de penicilina y clindamicina puede considerarse de elección para el manejo del absceso periamigdalino. Un porcentaje relativamente bajo de nuestros pacientes acepta la realización de amigdalectomía, colocándolos bajo un mayor riesgo de recurrencia.

Modificaciones de la presión intraocular secundarias al uso del propionato de fluticasona en el paciente con rinitis: estudio comparativo / Changes in the intraocular pressure following long-term use of fluticasone propionate in the patients with rhinitis: a comparative study

Objetivo: Valorar si la utilización del propionato de fluticasona en el tratamiento de las rinitis provocaba aumento de la presión intraocular de manera secundaria. Material y métodos: Sesenta pacientes fueron incluidos en el estudio, distribuidos de manera aleatoria en dos grupos. A 30 se les administró placebo (grupo control) y a los otros 30 se les aplicó propionato de fluticasona tópica nasal. Diseño: Comparativo, doble ciego, experimental, prospectivo y longitudinal. Parámetros de medición: A todos los pacientes se les midió la presión intraocular por tonometría de Goldman a las tres semanas, seis semanas, tres meses, seis meses y un año, de utilizar el placebo o la fluticasona aplicados en forma de aerosol tópico nasal. Resultados: Aunque existieron modificaciones en la presión intraocular de los pacientes que utilizaron propionato de fluticasona, las cifras estuvieron dentro de los límites de normalidad y no hubo diferencia estadísticamente significativa entre uno y otro grupo. Conclusión: El propionato de fluticasona es seguro y no modifica la presión intraocular en los pacientes que la utilizan.

¿Varía la presión intraocular con el uso de dipropionato de beclometasona en pacientes con rinitis? Estudio comparativo / Does the use of beclometasone propionate produce variation of the intraocular pressure? A comparative trial

Propósito: El objetivo del estudio fue valorar si existía aumento de la presión intraocular en pacientes con el diagnóstico de rinitis que se encontraban bajo tratamiento con dipropionato de beclometasona aplicado a 400 mcg al día por vía nasal. Material y Métodos: Se seleccionaron 60 pacientes con el diagnóstico de rinitis sin importar la etiología, de entre 18 y 60 años de edad. Los pacientes se dividieron mediante un proceso aleatorio en dos grupos de 30 pacientes cada uno. El primer grupo recibió dipropionato de beclometasona. El segundo grupo recibió placebo. A todos los pacientes se les realizó tonometría por aplanamiento a las 3, 6 12, 26 y 52 semanas. Resultados: Se encontró que las variaciones de la presión intraocular en ambos grupos estuvieron dentro de limites de referencia. El promedio de la presión intraocular no mostró diferencias significativas en las mediciones realizadas de las 3 a las 52 semanas (p = 0.473). Conclusión: El dipropionato de beclometasona en aplicación tópica nasal no aumenta significativamente la presión intraocular, incluso después de un año de tratamiento

Micosis Nasosinusal. Espectro de la Enfermedad / Rhino-sinusal mycosis: range of the disease

Introducción. Las micosis de senos paranasales se han clasificado en invasiva y no invasiva; el tipo de micosis y su comportamiento clínico depende de la interacción entre la competencia inmunológica del paciente y la patogenicidad del microorganismo, en un determinado micro ambiente. Material y Métodos. Se realizó un estudio clínico prospectivo para evaluar las características de pacientes con sinusitis micótica. Se presentan todos los pacientes diagnosticados y tratados como sinusitis micótica en el periodo de 1994-1997. Resultados. Se encontraron 10 pacientes que correspondieron al 6 por ciento de los casos de sinusitis crónica tratados quirúrgicamente; Todos los pacientes con mucormicosis aguda invasiva recibieron tratamiento medico con anfotericina B, Insulina y refección quirúrgica con debridación extensa del tejido necrótico, resultando en control de la enfermedad subyacente y sobrevida del 50 por ciento de los pacientes. Conclusión. Es necesario diagnosticar precozmente, y dar tratamiento multi disciplinario médico y quirúrgico para lograr una mejor supervivencia de los pacientes

Frecuencia de pansinusitis en el postoperatorio de polipectomía endoscópica nasosinusal con la utilización de esteroide tópico nasal / Pansinsitis incidence in post-operative endoscopic nasosinusual polypectomy with the use of a topic nasal steroid

Introducción. El uso del propinato de fluticasona para el tratamiento de la rinitis, independientemente de la causa, así como su empleo como auxiliar en el tratamiento de las poliposis nasosinusales ha sido probado desde hace al menos 10 años; durante este tiempo ha mostrado buena seguridad y tolerancia. Uno de los problemas más complejos para el otorrinolaringólogo es el tratamiento de las poliposis sinusales, por su alta tasa de recurrencia. El tratamiento es múltiple, incluyendo la cirugía para mejorar la calidad de vida, ventilación por vía nasal y disminuir el volumen de la mucosa para que los medicamentos tópicos puedan llegar hasta el sitio donde se localiza la patología. Además de la cirugía se han utilizado antihistamínicos, esteroides tópicos y sistémicos, antibióticos y recientemente se ha inciado el estudio de antileucotrienos, así como el de antilinfocinas (se encuentran en fase II de investigación). Pese a la larga experiencia de la mayoría de los cirujanos en el manejo posoperatorio de la polipectomía por vía endoscópica, sólo existe un estudio, el efectuado por Mostapha en 1996, en el que se informa una mayor incidencia de pansinusitis durante el postoperatorio mediato de popectomía por vía endoscópica, con el uso del propionato de fluticasona. Aunque citado en forma reiterada por otros autores, el trabajo no ha sido reproducido, Material y métodos. Estudio prospectivo, abierto, comparativo, experimental y longitudinal, que incluyó 20 pacientes, 13 hombres y siete mujeres, con poliposis nasosinusal a los que se les efectuó resección de estas lesiones por vía endoscópica. Los sujetos fueron distribuidos en dos grupos similares. Uno de éstos (grupo control) lo integraron pacientes que no recibieron esteroides tópicos y que fueron manejados exclusivamente con los lavados nasales: El segundo grupo lo conformaron enfermos a quienes se aplicaron 200 µg propionato de fluticasona dos veces al día posteriores a lavados nasales con solución salina. Resultados. No se encontraron diferencias estadísticamente significativas entre uno y otro grupos ni en cuanto a frecuencia de presentación de infecciones o de recurrencias. Conclusiones. Los reusltados obtenidos en este estudio muestran que si se realiza un adecuado proceso de curaciones y control en el posoperatorio inmediato y mediato de las cavidades, no se presentarán cuadros de infecciones agudas, se utilice o no esteroides tópicos nasales, lo cual contradice lo notificado por Mostapha en 1996

Complicaciones y causas de falla en cirugía endoscópica y funcional de nariz y senos paranasales / Complications and failure in endoscopic and functional surgery of the nose and paranasal sinuses

Objetivo. Determinar las complicaciones, las fallas y la causa de las éstas en la cirugía endoscópica del área nasosinusal y de zonas vecinas. Material y métodos. Fueron incluidos todos los pacientes a quienes se les realizó cirugía endoscópica de nariz, senos paranasales y zonas circunvecinas en el periodo comprendido entre enero de 1994 y diciembre de 1998, en el Departamento de Otorrinolaringología del Hospital General "Dr. Manuel Gea González". Parámetros de evaluación: Ausencia o presencia de complicaciones locales, orbitarias o centrales, así como de recurrencia de la patología de base. Resultados. Se analizó un total de 220 casos de cirugías. La complicación más frecuente fue el sangrado posoperatorio (2.73 por ciento), pero sólo se requirió de transfusión sanguínea en un paciente (0.45 por ciento). La recidiva se dio por falla en la técnica; se registró en 3.6 por ciento de los casos y está relacionada con la experiencia del cirujano. Conclusión. La cirugía endoscópica es una técnica segura y bien tolerada, ya que la incidencia de complicaciones mayores es mínima y la de complicaciones menores inferior a 10 por ciento; mientras que la frecuencia de falla en la técnica no rebasa el 3 por ciento