ABSTRACT
OBJECTIVE: To compare the pre-operative and post-operative clinical symptoms in patients diagnosed as having hyperparathyroidism and given surgical treatment, in order to prove the existence of statistically significant improvement. MATERIAL AND METHOD: We report here a retrospective study performed on 120 consecutive patients operated on following diagnosis of hyperparathyroidism between 1990 and 2003. RESULTS: Nephrolithiasis, generalized bone pain and HBP were the most common clinical manifestations. Primary hyperparathyroidisms represented 76.7 %, while secondary ones were 20.8 % and 2.5 % were tertiary. We carried out 85 adenoma removals, 30 sub-total and 5 total parathyroidectomies. We only encountered one case of recurrent palsy and about 25 % of hypocalcemias (2 of them permanent). Osteoarticular pathology and nephrolithiasis suffered by our patients clearly improved after surgery (P< .01) after 2 years of follow-up. There was no significant improvement in HBP, digestive and psychiatric pathology or pruritus. CONCLUSIONS: The improvement in quality of life for most of the patients operated on for this condition amply justifies parathyroidectomy by an experienced otolaryngology team.
Subject(s)
Hyperparathyroidism/diagnosis , Hyperparathyroidism/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Objetivo: Comparar los síntomas clínicos preoperatorios y postoperatorios en pacientes diagnosticados de hiperparatiroidismo y sometidos a tratamiento quirúrgico, para comprobar si se produce mejoría estadísticamente significativa. Material y método: Estudio retrospectivo realizado sobre 120 pacientes consecutivos intervenidos con diagnóstico de hiperparatiroidismo entre 1990 y 2003. Resultados: La litiasis renal, los dolores óseos generalizados y la hipertensión fueron las manifestaciones clínicas más frecuentes. El 76,7 % eran hiperparatiroidismos primarios; el 20,8 %, secundarios y el 2,5 %, terciarios. Se practicaron 85 resecciones de adenoma, 30 paratiroidectomías subtotales y 5 paratiroidectomías totales. Sólo hemos constatado 1 caso de parálisis recurrencial y un 25 % de hipocalcemias (2 definitivas). Mejoraron significativamente tras la cirugía (p < 0,01) la afección osteo articular y la litiasis renal que presentaban los pacientes tras 2 años de seguimiento. No mejoraron de forma significativa la hipertensión, las enfermedades digestivas y psiquiátricas y elprurito. Conclusiones: La mejoría en la calidad de vida de la mayoría de los pacientes operados por esta enfermedad justifica sobradamente la paratiroidectomía por un equipo otorrinolaringológico experimentado (AU)
Objective: To compare the pre-operative and post-operative clinical symptoms in patients diagnosed as having hyperparathyroidism and given surgical treatment, in order to prove the existence of statistically significant improvement. Material and method: We report here a retrospective study performed on 120 consecutive patients operated on following diagnosis of hyperparathyroidism between 1990 and 2003. Results: Nephrolithiasis, generalized bone pain and HBP were the most common clinical manifestations. Primary hyperparathyroidisms represented 76.7 %, while secondary ones were 20.8% and 2.5 % were tertiary. We carried out85 adenoma removals, 30 sub-total and 5 total parathyroidectomies. We only encountered one case of recurrent palsy and about 25 % of hypocalcemias (2 of them permanent). Osteoarticular pathology and nephrolithiasis suffered by our patients clearly improved after surgery (P<0.01) after 2 years of follow-up. There was no significant improvement in HBP, digestive and psychiatric pathology or pruritus. Conclusions: The improvement in quality of life for most of the patients operated on for this condition amply justifies parathyroidectomy by an experienced otolaryngology team (AU)
Subject(s)
Humans , Adolescent , Male , Female , Adult , Middle Aged , Hyperparathyroidism/diagnosis , Hyperparathyroidism/surgery , Postoperative Care/methods , Paralysis/complications , Hypocalcemia/complications , Retrospective Studies , Adenoma/complications , Parathyroidectomy/methods , Quality of Life , Postoperative Complications/pathologyABSTRACT
OBJECTIVES: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. PATIENTS AND METHOD: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. RESULTS: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). CONCLUSIONS: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event.
Subject(s)
Health Status , Postoperative Complications , Voice Disorders/etiology , Female , Humans , Intraoperative Complications , Male , Prospective Studies , Recurrent Laryngeal Nerve/physiology , ThyroidectomyABSTRACT
Objetivos: Presentamos un estudio prospectivo para valorar la incidencia real de los trastornos vocales en la tiroidectomía total, así como su posible etiología y su evolución. Pacientes y método: Se incluyó en el estudio a 66 pacientes intervenidos de tiroidectomía total entre 2003 y 2006. Se comprobó en cada caso variables referidas a los cambios vocales, subjetivos y medidos atendiendo a la escala GRABS, aparecidos tras la intervención. Como grupo control se empleó una selección aleatoria de 25 pacientes intervenidos con anestesia general e intubación orotraqueal sin afección cervical. Resultados: De 30 (45,5 %) pacientes en que se desarrolló disfonía postoperatoria, sólo 2 (3 %) fueron definitivas y 11 se explicaron por lesión nerviosa (10 laríngeos inferiores y 1 superior). En 8 (12,2 %) pacientes la puntuación en la escala GRABS fue > 5. El resto de estos 30 pacientes refirió cambios vocales postoperatorios por disminución del tono (10 casos), de la intensidad (9 casos) o fatiga vocal (3 casos) de forma aislada, y con una repercusión en la escala GRABS siempre <= 2 puntos. La única variable estudiada que mostró una relación significativa con la aparición de cambios vocales postoperatorios fue la sección de músculos prelaríngeos (odds ratio = 12,5). Conclusiones: La relación de las disfonías con la tiroidectomía total es bien conocida, aunque encontramos una incidencia mucho mayor que la explicada simplemente por la lesión nerviosa. Factores técnicos (y en ocasiones evitables), como la sección de músculos prelaríngeos, podrían tener una relación importante con este evento postoperatorio
Objetives: We present a prospective study assessing the real incidence, aetiology, and evolution of vocal impairment following total thyroidectomy. Patients and method: Sixty-six patients who underwent total thyroidectomy between 2003 and 2006 were included, recording demographic and analytic variables, with emphasis on subjective vocal changes observed after surgery, measured by means of the GRABS scale. A control group of 25 patients operated under general anaesthesia and oro-tracheal intubation was chosen using random sampling. Results: In 30 patients (45.5 %), post-operative dysphonia was observed. Among these, only 2 (3 %) were permanent, and 11 were due to nerve damage (10 inferior and 1 superior laryngeal nerves). In 8 patients (12.2 %), GRABS score was above 5. In the rest of these 30 patients, the complaint was a single decreased tone (10 cases), lack of intensity (9 cases) and vocal fatigue (3 cases), always with a GRABS score equal to or less than 2 points. The most significantly related factor with the onset of dysphonia was the section of strap muscles (OR=12.5). Conclusions: Dysphonia is a common complication of total thyroidectomy, but its incidence is not always related to nerve injury. Some technical (and sometimes avoidable) factors, such as the section of prelaryngeal muscles, could have an important relationship with this adverse event
Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Voice Disorders/etiology , Thyroidectomy/adverse effects , Postoperative Complications , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: We present the 15-year-long experience of 2 hospitals in our region regarding the therapeutic management of acute epiglottitis in adults. PATIENTS AND METHOD: Thirty patients with an average age of 46 years were diagnosed as having acute epiglottitis, either by indirect laryngoscopy or fibroscopy, and studied through a series of clinical parameters: age, sex, personal history, complementary tests, clinical symptoms, treatment, evolution, and average stay in hospital. RESULTS: We found an obvious predominance of this urgent pathology in males, with most patients reporting dysphagia or odynophagia (90 %). Dyspnoea was confirmed in 40 % of the cases but only 7 required intubation, coniotomy, or tracheotomy. The complications recorded include one case of mediastinitis and another of death due to sudden cardiorespiratory arrest. CONCLUSIONS: We feel that a specific protocol must be established to take into account, apart from admission to hospital, personal contact with an intensive care unit (ICU) even though in most cases it is ultimately unnecessary to ensure airway patency as seen in the various case series published.
Subject(s)
Epiglottitis/diagnosis , Epiglottitis/drug therapy , Acute Disease , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo: Dar a conocer la experiencia conjunta de 2 hospitales de nuestra región en los últimos 15 años sobre el manejo terapéutico de los casos de epiglotitis aguda en adultos. Pacientes y método: Se incluye a 30 pacientes con una media de edad de 46 años, diagnosticados de epiglotitis aguda mediante laringoscopia indirecta o fibroscopia, de los que se recogió una serie de parámetros clínicos: edad, sexo, antecedentes personales, estudios complementarios, síntomas clínicos, tratamiento, evolución y estancia hospitalaria. Resultados: Encontramos un claro predominio de esta enfermedad urgente en varones, que en su mayoría referían disfagia u odinofagia (90 %). Se constató disnea en un 40 % de los casos, de los que sólo 7 requirieron intubación, coniotomía o traqueotomía. Entre las complicaciones registramos un caso de mediastinitis y una muerte por parada cardiorrespiratoria súbita. Conclusiones: Creemos que se debe establecer un protocolo de actuación que incluya, aparte del ingreso hospitalario, un contacto personal con una unidad de cuidados intensivos (UCI) aunque en la mayoría de los casos finalmente no sea necesario asegurar la vía respiratoria, como se comprueba en las diferentes casuísticas publicadas
Objective: We present the 15-year-long experience of 2 hospitals in our region regarding the therapeutic management of acute epiglottitis in adults. Patients and method: Thirty patients with an average age of 46 years were diagnosed as having acute epiglottitis, either by indirect laryngoscopy or fibroscopy, and studied through a series of clinical parameters: age, sex, personal history, complementary tests, clinical symptoms, treatment, evolution, and average stay in hospital. Results: We found an obvious predominance of this urgent pathology in males, with most patients reporting dysphagia or odynophagia (90 %). Dyspnoea was confirmed in 40 % of the cases but only 7 required intubation, coniotomy, or tracheotomy. The complications recorded include one case of mediastinitis and another of death due to sudden cardiorespiratory arrest. Conclusions: We feel that a specific protocol must be established to take into account, apart from admission to hospital, personal contact with an intensive care unit (ICU) even though in most cases it is ultimately unnecessary to ensure airway patency as seen in the various case series published
Subject(s)
Male , Female , Adult , Middle Aged , Humans , Epiglottitis/diagnosis , Epiglottitis/surgery , Laryngoscopy/methods , Intubation/methods , Tracheotomy/methods , Mediastinitis/complications , Cephalosporins/therapeutic use , Tomography, Emission-Computed/methods , Length of Stay/statistics & numerical data , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Retrospective StudiesABSTRACT
Choanal atresia is an infrequent congenital malformation. Classically, 4 surgical approaches have been described for its treatment: transnasal, transpalatal, trans-septal, and transantral. Of these, transpalatal was preferred. In recent years, the progress in nasal endoscopy has led to reconsideration of the transnasal route as being less invasive and providing excellent results. The use of stents to prevent re-stenosis is a controversial issue. However, the application of substances such as mitomycin may offer decreased need for stenting by reducing the development of cicatrix tissue. We report the case of a patient with bilateral choanal atresia and its surgical treatment using nasal endoscopy with topical mitomycin. We report the case of a patient with bilateral choanal atresia and the surgical treatment with topical mitomycin.
Subject(s)
Choanal Atresia/surgery , Endoscopy , Female , Humans , PregnancyABSTRACT
OBJECTIVE: To share our experience in the surgery of so-called refractory hyperparathyroidism (secondary and tertiary without response to therapy with calcitriol). MATERIAL AND METHODS: Retrospective study based on 41 patients-5 with secondary and 6 with tertiary hyperparathyroidism-referred by nephrology for surgical evaluation of their illness because of poor response to the medical treatment given. RESULTS: In 18 of the 41 cases we used the fast or turbo intra-operative PTH with reduction of more than 60 % in all patients. In the group in whom normal PTH was performed, we registered 2 secondary hyperparathyroidisms with no significant decrease and persistence of symptoms. One of them was reoperated successfully. DISCUSSION: Subtotal or total parathyroidectomy with reimplant represents the treatment of choice in refractory hyperparathyroidism with good results in most of the series reviewed.
Subject(s)
Hyperparathyroidism, Secondary/blood , Hyperparathyroidism, Secondary/surgery , Intraoperative Care , Parathyroid Hormone/blood , Parathyroidectomy/methods , Adult , Aged , Calcium/blood , Female , Humans , Male , Middle Aged , Reoperation/statistics & numerical data , Retrospective StudiesABSTRACT
OBJECTIVE: We are reporting our 14 years' experience with prior hemithyroidectomies or contralateral hemithyroidectomies after a pathology result reporting malignancy (thyroid carcinoma) in the first surgery. MATERIAL AND METHOD: Twenty female patients with an average age of 45 years old have been studied and we have analyzed the initial symptoms, results of complementary tests, pathology diagnosis following initial surgery, and final outcome after a second intervention. RESULTS: The incidence of malignancy shown in our series after secondary surgery was 40 % and the percentage of hemithyroidectomy on hemithyroidectomy was 3 % after operating on 650 thyroid glands. CONCLUSIONS: Though opinions differ in the medical literature, we feel a total thyroidectomy must be performed after a casual finding of thyroid carcinoma because of the oncologically safer outcome and the better control of the patient.
Subject(s)
Thyroid Neoplasms/surgery , Thyroidectomy/methods , Adult , Female , Humans , Male , Middle AgedABSTRACT
Objetivo: Se presenta nuestra experiencia de 14 años en hemitiroidectomías sobre hemitiroidectomías previas o hemitiroidectomías contralaterales tras un resultado anatomopatológico de malignidad (carcinoma de tiroides) en la primera cirugía. Material y método: Hemos incluido a 20 pacientes, todas ellas mujeres, con una media de edad de 45 años. Se analizan los síntomas clínicos iniciales, los resultados de las exploraciones complementarias, el diagnóstico anatomopatológico de la primera intervención y el resultado final tras la segunda cirugía. Resultados: En nuestra serie la segunda hemitiroidectomía resultó positiva en un 40 % y el porcentaje de hemitiroidectomías sobre hemitiroidectomías de 650 tiroides operados fue del 3 %. Conclusiones: Aunque hay diferentes opiniones en la literatura médica, nosotros creemos que ante el hallazgo casual de un carcinoma tiroideo se debe completar una tiroidectomía total, por su mayor seguridad oncológica y mejor control del paciente
Objective: We are reporting our 14 years' experience with prior hemithyroidectomies or contralateral hemithyroidectomies after a pathology result reporting malignancy (thyroid carcinoma) in the first surgery. Material and method: Twenty female patients with an average age of 45 years old have been studied and we have analyzed the initial symptoms, results of complementary tests, pathology diagnosis following initial surgery, and final outcome after a second intervention. Results: The incidence of malignancy shown in our series after secondary surgery was 40 % and the percentage of hemithyroidectomy on hemithyroidectomy was 3 % after operating on 650 thyroid glands. Conclusions: Though opinions differ in the medical literature, we feel a total thyroidectomy must be performed after a casual finding of thyroid carcinoma because of the oncologically safer outcome and the better control of the patient
Subject(s)
Humans , Adult , Female , Male , Middle Aged , Thyroidectomy/methods , Thyroid Neoplasms/surgery , Neoplasm Recurrence, Local/pathology , Thyroid Neoplasms/pathologyABSTRACT
Objetivo: Dar a conocer nuestra experiencia en la cirugía del denominado hiperparatiroidismo refractario (secundario y terciario sin respuesta al tratamiento con calcitriol). Material y métodos: Estudio retrospectivo con revisión de 41 pacientes (35 con hiperparatiroidismos secundarios y 6 terciarios) remitidos por nefrología para valoración quirúrgica de su enfermedad ante la mala respuesta al tratamiento médico. Resultados: En 18 de los 41 casos se utilizó la determinación de paratirina rápida o turbo intraoperatoria, con descenso superior al 60 % en todos los pacientes. En el grupo en que se empleó paratirina normal registramos 2 hiperparatiroidismos secundarios en los que la citada hormona no descendió significativamente y los síntomas persistieron, uno de los cuales fue reintervenido con éxito. Conclusiones: La paratiroidectomía subtotal o total con autotrasplante es el tratamiento de elección en el hiperparatiroidismo refractario, con buenos resultados en la mayoría de las series consultadas
Objective: To share our experience in the surgery of so-called refractory hyperparathyroidism (secondary and tertiary without response to therapy with calcitriol). Material and methods: Retrospective study based on 41 patients5 with secondary and 6 with tertiary hyperparathyroidismreferred by nephrology for surgical evaluation of their illness because of poor response to the medical treatment given. Results: In 18 of the 41 cases we used the fast or turbo intra-operative PTH with reduction of more than 60 % in all patients. In the group in whom normal PTH was performed, we registered 2 secondary hyperparathyroidisms with no significant decrease and persistence of symptoms. One of them was reoperated successfully. Discussion: Subtotal or total parathyroidectomy with reimplant represents the treatment of choice in refractory hyperparathyroidism with good results in most of the series reviewed
Subject(s)
Humans , Adult , Aged , Female , Male , Middle Aged , Hyperparathyroidism/surgery , Parathyroidectomy/methods , Parathyroid Hormone/blood , Intraoperative Care , Retrospective Studies , Calcitriol/therapeutic use , Transplantation, AutologousABSTRACT
La atresia de coanas es una malformación congénita poco frecuente. Clásicamente se han descrito cuatro vías de abordaje para su corrección quirúrgica: transnasal, transpalatina, transeptal y endonasal. De todas ellas se consideraba de elección la vía transpalatina. En los últimos años, debido al avance de la endoscopia nasal, se impone la vía endonasal, por ser menos invasiva y proporcionar excelentes resultados. En cuanto al empleo de stents para prevenir las reestenosis, hay controversia; sin embargo, la aplicación coadyuvante de sustancias como la mitomicina nos permite prescindir de ellos y reducir la formación de tejido de cicatrización. Presentamos el caso de un paciente con atresia de coanas bilateral y su manejo quirúrgico mediante cirugía endoscópica nasal con el empleo de mitomicina tópica
Choanal atresia is an infrequent congenital malformation. Classically, 4 surgical approaches have been described for its treatment: transnasal, transpalatal, trans-septal, and transantral. Of these, transpalatal was preferred. In recent years, the progress in nasal endoscopy has led to reconsideration of the transnasal route as being less invasive and providing excellent results. The use of stents to prevent re-stenosis is a controversial issue. However, the application of substances such as mitomycin may offer decreased need for stenting by reducing the development of cicatrix tissue. We report the case of a patient with bilateral choanal atresia and its surgical treatment using nasal endoscopy with topical mitomycin. We report the case of a patient with bilateral choanas atresia and the surgical treatment with topical mitomycin
Subject(s)
Humans , Pregnancy , Female , Endoscopy/methods , Nasal Cavity/surgery , Choanal Atresia/surgery , Mitomycin/therapeutic useABSTRACT
Presentamos el caso clínico de una mujer de 31 años con parotitidis supurada aguda bilateral de repetición severa que requirió ingreso, tratamiento antibiótico intravenoso, corticoides y drenaje periódico de ambas parótidas mediante punción-aspiración con salida dematerial purulento. El estudio microbiológico más antibiograma puso de manifiesto un Streptococcus pneumoniae como germen responsable del cuadro clínico. Realizamos una breve revisión de la literatura al respecto de las sialoadenitis bacterianas agudas, crónicas y de repetición
We report the clinical case of a 31 years old female with bilateral and severe recurrent suppurative parotitis which required admission, endovenous antibiotic treatment, corticoids and periodic drainage on both parotid glands by punction-aspiration with collection of purulent material. The microbiologic exam and antibiogram showed Streptococcus pneumoniae as the germen which caused the symptoms. We perform a short review of the literature at respect of acute, recurrent and chronic bacterial sialoadenitis
Subject(s)
Female , Adult , Humans , Streptococcus pneumoniae/isolation & purification , Parotitis/microbiology , Drainage , Abscess , Cefotaxime/therapeutic use , Anti-Bacterial Agents/therapeutic use , Recurrence , Severity of Illness IndexABSTRACT
Presentamos el caso clínico muy poco común de un varónde 43 años con una metástasis cervical de germinomay primario desconocido tras realizar un estudio de extensióncompleto, incluído urológico, que fue normal. Procedimosa realizar un vaciamiento ganglionar radicalizquierdo remitiendo la pieza a Anatomía Patológica (AP)cuyo resultado era compatible con un tumormesenquimal. Tras pruebas específicas fue informadocomo tumor de células germinales y en la evoluciónpostoperatoria apareció cierta disfagia en el paciente.Después de 5 años de seguimiento por ORL y Oncologíase encuentra libre de enfermedad o recidiva
We are reporting the very uncommon clinical case of a 43years male with a cervical metastasis of germinoma andunknown primary tumour after performing a completeextension study, including urologic one, that was normal.He was operated by left radical neck emptying procedureand sending the piece to Pathologic Anatomy (PA) withcompatible result of a mesenchimal tumour. After specifictests it was informed as germinal cells tumour and thepostsurgical evolution showed some of dysphagia in thepatient. The follow-up for him was 5 years by ORL andOncology being free of illness