RESUMEN
Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomic dominant disorder, which is characterized by the development of multiple arteriovenous malformations in either the skin, mucous membranes, and/or visceral organs. Pulmonary arteriovenous malformations (PAVMs) may either rupture, and lead to life-threatening hemoptysis/hemothorax or be responsible for a right-to-left shunting leading to paradoxical embolism, causing stroke or cerebral abscess. PAVMs patients should systematically be screened as the spontaneous complication rate is high, by reaching almost 50%. Neurological complications rate is considerably higher in patients presenting with diffuse pulmonary involvement. PAVM diagnosis is mainly based upon transthoracic contrast echocardiography and CT scanner examination. The latter also allows the planification of treatments to adopt, which consists of percutaneous embolization, having replaced surgery in most of the cases. The anchor technique consists of percutaneous coil embolization of the afferent pulmonary arteries of the PAVM, by firstly placing a coil into a small afferent arterial branch closely upstream the PAVM. Enhanced contrast CT scanner is the key follow-up examination that depicts the PAVM enlargement, indicating the various mechanisms of PAVM reperfusion. When performed by experienced operators as the prime treatment, percutaneous embolization of PAVMs, is a safe, efficient and sustained therapy in the great majority of HHT patients.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/terapia , Diagnóstico por Imagen/métodos , Pulmón/irrigación sanguínea , Telangiectasia Hemorrágica Hereditaria/diagnóstico , Telangiectasia Hemorrágica Hereditaria/terapia , Malformaciones Arteriovenosas/complicaciones , Embolización Terapéutica/métodos , Estudios de Seguimiento , Humanos , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Telangiectasia Hemorrágica Hereditaria/complicacionesAsunto(s)
Glándula Parótida/lesiones , Adolescente , Adulto , Anciano , Cateterismo , Drenaje , Traumatismos del Nervio Facial , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Glándula Parótida/cirugía , SialografíaRESUMEN
The authors report a case of Wegener's disease starting in the sub-maxillary region and spreading to the auricular region. The diagnosis was evoked by the correlation between the granulomatous lesions observed in the sub-maxillary region and on the tympanic membrane; there was also renal failure of rapid onset. A remission of five months has been obtained by treatment with corticosteroids and immunodepressant agents. Around this case the authors collected 267 cases from the literature and point out the rarity of the auricular form and the exceptional nature of the sub-maxillary localization of this disease.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Corticoesteroides/uso terapéutico , Oído Externo , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/patología , Humanos , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/etiología , Masculino , Maxilar , Persona de Mediana EdadRESUMEN
So-called "hyperfractionated" radiotherapy is aimed at obtaining synchronisation of tumour cells and to kill the cells synchronised in this way. The technique has been used now for approximately a year and a half in the treatment of 45 advanced or inoperable squamous carcinomas of the upper respiratory and digestive tract. The initial results are encouraging. Oncological sterilisation of the lesions is obtained at the price of actinic reactions which rapidly disappear, but also tumour necrosis, which indicates the need for review of the protocol.