Complications after superficial parotidectomy for pleomorphic adenoma.

BACKGROUND: The significance of complications after superficial parotidectomy remains unclear, since prospective studies are lacking. The aim of this study was to evaluate facial nerve dysfunction and other postoperative complications after superficial parotidectomy for pleomorphic adenoma of the superficial lobe and to identify the associated risk factors. MATERIAL AND METHODS: Prospective and descriptive clinical study on 79 patients undergoing formal superficial parotidectomy with the modified facelift incision, dissection of the facial nerve and reconstruction with the superficial musculoaponeurotic system flap. Function of the facial nerve using the House-Brackmann scale and the intra- and postoperative complications were recorded at 1 week and 1, 3, 6 and 12 months. A descriptive, inferential and binary logistic regression analysis were performed for the variables facial nerve dysfunction, tumor size and location, clinical presentation and duration of surgery. RESULTS: 77.2% of the patients presented facial paresis at 1 week, with the marginal-mandibular branch being the most commonly affected (64.5%). 94.9% recovered the facial function at 6 months and 100% at 12 months. A statistically significant relationship was found between the appearance of facial paresis and tumor location in the superior lateral area of the superficial lobe, size >2 cm and prolonged operative time. None of the remaining variables showed significant differences at any study timepoint. At 12 months, 57% of patients had recovered tactile sensitivity in the earlobe. The clinical occurrence of Frey's syndrome was 11.4%. CONCLUSIONS: Despite the high incidence of postoperative facial paresis at 1 week, its magnitude was low and the recovery time was short. Tumor location in the parotid superficial lobe upper area, size and prolonged operative time are risk factors that can worsen facial paresis at different study timepoints. The knowledge of these complications is relevant for patient´s counseling and to achieve better long-term outcomes.

Impact of dysfunction of the facial nerve after superficial parotidectomy: a prospective study.

To evaluate the impact of dysfunction of the facial nerve after superficial parotidectomy for pleomorphic adenoma of the superficial lobe, we prospectively analysed the data of 79 patients using the Facial Disability Index (FDI) and the Short-Form 36-Item (SF-36) questionnaires up to 12 months postoperatively. The function of the facial nerve was grading on the House-Brackmann Scale. Results at 1 week and 1, 3, 6, and 12 months were compared with preoperative (baseline) measurement. The maximum reduction in FDI scores coincided with the highest facial paresis values at one week. Physical values on the FDI significantly decreased during the first three months (p=.039 at 3 months) and psychosocial values improved significantly from then onwards (p=.001 at 12 months). At 12 months, there were signs of full recovery compared with the preoperative baseline, and it was even exceeded in some psychosocial items. The SF-36 questionnaire showed no significant differences at any time during the study. The FDI was a useful instrument with which to understand the impact of facial disability and wellbeing associated with physical, social, and emotional aspects after superficial parotidectomy. Unlike the SF-36 questionnaire, the FDI offers clinicians a tool with which to counsel patients and better inform them about the anticipated results of operation before superficial parotidectomy.

Vincristine-induced acute neurotoxicity versus Guillain-Barré syndrome: a diagnostic dilemma.

We report the case of a patient with acute lymphoblastic leukaemia who, after the initiation of treatment with vincristine (VCR), developed a fulminant motor polyradiculoneuropathy resembling an axonal variant of Guillain-Barré syndrome (GBS). This report shows that differentiating between axonal GBS and VCR-induced acute neurotoxicity may be a challenge for clinicians.

Neuralgia amiotrófica (síndromede Parsonage-Turner) de presentaciónbilateral en una paciente intervenida por abdomen agudo / Amytrophic neuralgia (Personage-Turner syndrome) with bilateral presentation in a patient operated on account of surgical abdomen

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[Alzheimer's disease and women]. / Enfermedad de Alzheimer y mujer.

INTRODUCTION AND DEVELOPMENT: This work reviews the relation between Alzheimer s disease (AD) and women, a very interesting issue both for its socio economic, and etiopathogenic and therapeutic aspects. Much of the prevalent research conducted in this field shows that a higher proportion of suffers from this disease are women, and in the work on incidence there is at least a tendency toward the same conclusion, especially at a very advanced age. In fact, the risk of suffering from AD is greater among women and most of the patients we attend are females, which is to a large extent associated with the fact that women live longer. However, it is possible that there are other biological factors involved and for this reason the action of estrogens on the brain and the consequences of women s being deprived of them during menopause is of special interest. CONCLUSIONS: Different studies have shown that the administration of hormone replacement therapy (HRT) lowers the risk of suffering from this disease, although design defects make it necessary to wait for the conclusions from other research work currently being conducted. There are also data that supports the idea that HRT can be beneficial in AD if it is administered in suitable doses. Obviously gender can influence or modulate other risk factors (RF). Genetic factors are not easily modified and for this reason research is currently aimed at factors in which a strong environmental component is involved. Another very controversial possible RF is lack of schooling, but some data support the notion that its influence can be especially harmful among females. This is a very important hypothesis because women make up the greater part of the illiterate population in Spain. Finally, women are also prevalent among caregivers and, therefore, suffer AD from both angles: they must care and be cared for. The reaction to this situation seems to be gender specific, which means that women in particular suffer the consequences of the lack of reciprocity brought about by AD something that does not happen in other equally devastating chronic processes, but which affect the physical sphere.

Enfermedad de Alzheimer y mujer / Alzheimer's disease and women

Introducción y desarrollo. Este trabajo revisa la relación entre la enfermedad de Alzheimer (EA) y la mujer, un capítulo muy interesante, tanto por sus aspectos socioeconómicos, como por los etiopatogénicos y terapéuticos. En efecto, gran parte de los trabajos de prevalencia muestran un predominio femenino en esta enfermedad, y en los trabajos de incidencia hay al menos una tendencia al predominio femenino, especialmente en edad muy avanzada. De hecho, el riesgo de padecer una EA es superior en el sexo femenino y la mayor parte de los enfermos que asistimos son mujeres, lo que se relaciona en gran medida con la mayor supervivencia de la mujer. No obstante, es posible que intervengan otros factores biológicos y, en este sentido, la acción de los estrógenos sobre el cerebro y las consecuencias de su deprivación durante la menopausia son muy interesantes. Conclusiones. Diversos estudios han mostrado que la administración de terapéutica hormonal sustitutiva (THS) disminuye el riesgo de padecer la enfermedad, aunque defectos de diseño hacen necesario esperar las conclusiones de otros trabajos en marcha. También existen datos que apoyan que la THS puede conseguir beneficios en la EA si se administra a dosis adecuadas. Por supuesto, el sexo puede influir o modular otros factores de riesgo (FR). Los factores genéticos se modifican poco y, por ello, se prefiere de momento dirigir la atención a los factores de fuerte componente ambiental. En este sentido, la falta de escolarización es un posible FR muy discutido, pero ciertos datos apoyan que su influencia puede ser especialmente perniciosa en el sexo femenino; este es un dato importante, porque precisamente entre los analfabetos de nuestro país predominan las mujeres. Finalmente, en lo que se refiere a los cuidadores, también aquí predominan las mujeres, que, por tanto, sufren la EA en ambas vertientes: recibir y administrar cuidados. La reacción a esta situación parece ser genero específica, de forma que la mujer sufre especialmente las consecuencias de la falta de reciprocidad que ocasiona la EA, algo que no ocurre en otros procesos crónicos igualmente devastadores, pero que afectan la esfera física (AU)