RESUMO
INTRODUCTION: Endoscopic, transnasal management of pituitary gland neoplasms is a widely accepted alternative to the traditional microscopic approach. This study aimed to determine outcomes and complication rates for the largest UK series of endoscopic, trans-sphenoidal hypophysectomies reported to date. METHODS: We performed a retrospective analysis of 136 primary resections and 35 revision cases performed at a tertiary referral centre. RESULTS AND ANALYSIS: Total tumour resection was confirmed in over 85 per cent of primary and revision cases, with biochemical remission in 60 per cent. The incidence of complications such as epistaxis, sphenoid sinus problems, endocrine insufficiency, visual disturbance, post-operative haemorrhage, cranial nerve injury and mortality was significantly lower, compared with similar series using the microscopic approach. CONCLUSION: Despite its steep 'learning curve', our series demonstrates that the endoscopic approach not only allows superior anatomical visualisation and therefore facilitates full oncological resection of tumours, but also reduces the incidence of peri-operative complications.
Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Hipofisectomia/métodos , Neoplasias Hipofisárias/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/efeitos adversos , Feminino , Humanos , Hipofisectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Adulto JovemRESUMO
OBJECTIVE: Cerebrospinal fluid leakage is the most common complication of endoscopic trans-sphenoidal pituitary surgery. However, there is no uniformly accepted way of managing this complication when it occurs intra-operatively. This paper describes a quick, simple technique, involving layered fibrin glue and gelatin sponge, which does not compromise post-operative patient follow up. METHOD: Retrospective review of all endoscopic pituitary surgery cases conducted at a single institution since the introduction of this technique in 2002. RESULTS: A total of 120 endoscopic pituitary operations were performed (96 primary procedures and 24 revisions). All intra-operative cerebrospinal fluid leaks were managed using the described method, with a failure rate of 3.6 per cent. The overall post-operative leakage rate was 1.7 per cent. CONCLUSION: This simple, conservative technique avoids the need for further dissection and the use of non-absorbable foreign material, and has a low incidence of post-operative cerebrospinal fluid leakage.
Assuntos
Adenoma/cirurgia , Hemostáticos/uso terapêutico , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Idoso , Bismuto/uso terapêutico , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/terapia , Combinação de Medicamentos , Endoscopia , Adesivo Tecidual de Fibrina/uso terapêutico , Esponja de Gelatina Absorvível/uso terapêutico , Humanos , Hidrocarbonetos Iodados/uso terapêutico , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Seio Esfenoidal/cirurgiaRESUMO
The authors describe a novel use of a de-epithelialized deltopectoral flap for the closure of tracheo-oesophageal fistulae, which have been resistant to other methods of closure.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Fístula Traqueoesofágica/cirurgia , Humanos , Laringectomia , Laringe Artificial , Complicações Pós-Operatórias/cirurgia , Fístula Traqueoesofágica/etiologiaRESUMO
The routine use of topical anaesthesia during flexible nasendoscopy has been questioned, and the degree to which topical vasoconstrictors can affect patient discomfort has yet to be elucidated. Patients' experiences with Lignocaineand phenylephrine, Lignocaine alone, xylometazoline and no preparation were compared. One hundred patients were recruited in this double-blind, randomised control trial and put into these four groups. Each patient completed a visual analogue scoring chart to determine the severity of unpleasantness and other undesirable effects (pain, bad taste, burning, choking, numbness and difficulty in swallowing). The results confirmed that vasoconstriction is a major contributing factor towards reducing overall unpleasantness (P = 0.022), topical anaesthesia can produce a bad taste (P = 0.022), and that none of the preparations have any effect on the pain during nasendoscopy. In conclusion, xylometazoline is recommended for nasendoscopy as it is effective and is significantly cheaper than the other preparations. Not using any preparations leads to the experience of severe symptoms.
Assuntos
Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Endoscopia/métodos , Cavidade Nasal/efeitos dos fármacos , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Vasoconstrição/efeitos dos fármacosRESUMO
The aim of this prospective study was to determine the suitability of 'direct listing' of patients for tonsillectomy by their General Practitioner. All General Practitioners were issued guidelines outlining the indications and contraindications for direct listing. One hundred consecutive patients, referred over a 6-month period, were screened by an otolaryngologist. Thirty-three of these patients were referred inappropriately. The high rate of inappropriate referrals would suggest that this is an unacceptable practice.
Assuntos
Medicina de Família e Comunidade , Encaminhamento e Consulta , Tonsilectomia , Contraindicações , Inglaterra , Humanos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Medicina Estatal , Tonsilectomia/estatística & dados numéricos , Listas de EsperaRESUMO
Benign necrotizing osteitis of the external auditory meatus is a rare condition which occurs in non-diabetic healthy people. The aetiology of the necrotic process with the formation of sequestrum in the bony external meatus is unknown. It is important to differentiate this benign process from malignant otitis externa and radionecrosis of the temporal bone as the management of these conditions differs. We present two cases, one managed surgically and the other medically, and review the literature. Immediate surgical excision of the sequestrum is advocated instead of long-term medical therapy and waiting for it to separate spontaneously.
Assuntos
Orelha Externa/cirurgia , Osteíte/cirurgia , Adulto , Idoso , Humanos , Masculino , Osteíte/terapiaRESUMO
The association of sensorineural hearing loss and ulcerative colitis is well documented and it is speculated that this is autoimmune in origin. A case in a 12-year-old boy is described, that initially responded to steroid therapy, but four years later resulted in bilateral, profound sensorineural hearing loss in spite of good control of his bowel disease. Immunological tests may provide a clue as to the aetiology of suspected cases of autoimmune inner ear disease. Immediate treatment with steroids with or without immunosuppressive therapy is essential as delay may lead to irreversible hearing loss.
Assuntos
Doenças Autoimunes/complicações , Colite Ulcerativa/complicações , Perda Auditiva Neurossensorial/etiologia , Ácidos Aminossalicílicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Audiometria de Tons Puros , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Criança , Colite Ulcerativa/tratamento farmacológico , Quimioterapia Combinada , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Humanos , Masculino , Prednisolona/uso terapêuticoRESUMO
Packing of the nasal cavity remains a common routine precautionary measure following septal surgery. The nasal pack and its removal 24 h later are often cited by patients as the most painful aspects of septal surgery. We present the results of a randomized, prospective controlled trial of the use of topical 5% lignocaine ointment as a method of pain relief following post-operative nasal packing. Post-operative pain as measured using a visual analogue scale at 3 h post-operatively was halved in patients receiving a lignocaine impregnated nasal pack compared with those having a standard vaseline gauze pack (P < 0.05). Pain scores at 6 h post-operatively and at pack removal were also reduced, but these failed to reach significance. No patients suffered reactionary haemorrhage. The use of topical lignocaine ointment is safe and may have a place in the relief of pain due to post-operative nasal packing.
Assuntos
Administração Tópica , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Lidocaína/administração & dosagem , Lidocaína/uso terapêutico , Obstrução Nasal , Septo Nasal/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias , Humanos , Septo Nasal/fisiopatologia , Medição da Dor , Estudos Prospectivos , Resultado do TratamentoRESUMO
This study was designed to investigate whether patients with a conductive hearing impairment derive more benefit from the provision of a hearing aid than comparable individuals with a sensorineural hearing impairment. A secondary aim was to assess the relative hearing disability of those with each type of impairment. Twenty-eight patients with a bilateral, symmetrical conductive impairment were selected. They were matched for age, sex and speech frequency average to individuals with a bilateral, symmetrical sensorineural hearing impairment. Each patient performed free-field audio and audio-visual tests in noise, both with and without a hearing aid, during which the non-test ear was acoustically occluded. When unaided, individuals with a conductive impairment were more disabled than those with a sensorineural impairment. On the other hand, those with a conductive impairment derived more benefit from an aid than those with a sensorineural impairment.
Assuntos
Auxiliares de Audição , Perda Auditiva Condutiva/reabilitação , Perda Auditiva Neurossensorial/reabilitação , Perda Auditiva/reabilitação , Adulto , Audiometria , Feminino , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/fisiopatologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
To date there is no ideal method of painlessly achieving anaesthesia of the ear drum for myringotomy and grommet insertion. In this double blind, placebo controlled prospective study we have assessed a new topical anaesthetic agent (EMLA Cream) for use on keratinised squamous epithelium. A comparison has been made with the anaesthesia achieved by an injected agent. Twenty individuals were randomly allocated to receive placebo or EMLA cream. Their relative discomfort was measured on a visual analogue scale. Ten individuals received injected anaesthetic prior to myringotomy and grommet insertion and the discomfort of injection and of the procedure were similarly measured. We found EMLA cream to be an equally effective method of anaesthetising the ear drum as an injected agent. In addition there was minimal discomfort in the achievement of this anaesthesia. The discomfort of injecting the ear canal is shown to be similar to that of performing myringotomy and grommet insertion without anaesthesia.
Assuntos
Anestésicos Locais , Dor/tratamento farmacológico , Prilocaína , Membrana Timpânica/fisiopatologia , Administração Tópica , Adulto , Método Duplo-Cego , Humanos , Injeções Subcutâneas , Pomadas , Membrana Timpânica/cirurgiaRESUMO
This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. A total of 130 individuals were randomly allocated to either an antibiotic or a non-antibiotic group. Each individual was clinically and audiometrically assessed preoperatively, and 8 weeks postoperatively. It was found that systemic prophylactic antibiotics did not influence either the success rate of myringoplasty surgery or the audiometric result.
Assuntos
Antibacterianos/uso terapêutico , Miringoplastia , Pré-Medicação , Adolescente , Adulto , Audiometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Distribuição AleatóriaRESUMO
Twenty-eight patients with nasal obstruction due to vasomotor rhinitis were assessed using anterior rhinomanometry before and six weeks after the operation of out-fracture and amputation of the posterior ends of the inferior turbinates. It was found that the operation did not significantly improve the nasal airway. Though just over half the patients had an objective improvement in nasal airflow, only half of this group reported a subjective improvement in their symptoms.
Assuntos
Ventilação Pulmonar , Rinite Vasomotora/cirurgia , Conchas Nasais/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Rinite Vasomotora/fisiopatologiaRESUMO
This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.
Assuntos
Antibacterianos/uso terapêutico , Orelha Média/microbiologia , Miringoplastia , Complicações Pós-Operatórias/microbiologia , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Quimioterapia Combinada , Feminino , Floxacilina/administração & dosagem , Floxacilina/uso terapêutico , Humanos , Injeções Intramusculares , Masculino , Otite Média/microbiologia , Otite Média/patologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Pseudomonas/isolamento & purificação , Distribuição Aleatória , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
A 64-year-old man underwent laryngectomy, partial pharyngectomy and right block dissection of the neck for a squamous cell carcinoma of the right pyriform fossa with an involved right neck node. He had received pre-operative radiotherapy. The operation was uneventful. A 'Drevac' wound drainage system (Astra Meditec) was inserted in each side of the neck.