Percutaneous tracheostomy in COVID patients. Experience in our hospital center after one year of pandemic and review of the literature.

BACKGROUND: The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. MATERIAL AND METHODS: A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. RESULTS: From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. CONCLUSIONS: Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient.

Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis.

BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis.

Estudio experimental sobre la regeneración ósea mandibular de la rata con diferentes biomateriales / Experimental study in rats of mandibular bone regeneration with different biomaterials

Objetivo. Los defectos óseos mandibulares resultantes de infecciones,traumatismos o resecciones oncológicas, van a producir severos problemas funcionalesy/o estéticos, que van a precisar de un tratamiento complejo. Durante losúltimos años, las aportaciones al terreno de la reconstrucción ósea se han debatidoentre métodos tan dispares como la distracción ósea o la utilización de colgajos libresmicrovascularizados, pasando por un sin fin de biomateriales. El objetivo de este estudiofue comparar la formación de hueso nuevo tras la aplicación de una membranareabsorbible y dos tipos de sustitutivos óseos. Material y método. Se utilizaron 24ratas adultas macho tipo Wistar, en las que se crearon defectos circulares de 4 mmde diámetro en ambos lados de la mandíbula. Se formaron 4 grupos, un grupo controly 3 grupos experimentales. Los animales fueron sacrificados a las 3 y 6 semanasde la cirugía, realizándose un análisis radiológico e histológico. Resultados. Los defectoscontrol no mostraron formación ósea, apareciendo una reparación por tejidofibroso. La membrana de hueso utilizada de forma aislada, actuó como una barreraeficaz excluyendo los tejidos no osteogénicos, pero no se produjo reparación totaldel defecto en ningún caso. El grupo de Colloss® y membrana, mostró una regeneraciónósea completa del defecto a las 6 semanas. El grupo de NovaBone® y membrana,no mostró formación ósea, apareciendo las partículas del biomaterial ocupandoel defecto. Conclusiones. La regeneración ósea fue significativamente mayoren los defectos rellenos con Colloss® y cubiertos con la membrana de Lambone®,comparado con los otros grupos experimentales(AU)

Objective. Mandibular bone defects can occur as a resultof trauma, neoplasm, or infectious conditions. Such conditions oftenare associated with severe funtional and esthetic problems. Correctivetreatment often is complicated by limitations in tissue adaptation.The aim of this study was to compare new bone formation followingapplication of a bioabsorbable membrane and two types of bonesubstitutes. Material and method. In the present study, 24 fourmonth-old male Wistar rats were used. Standardized round throughand-through bone defects (4 mm in diameter) were made in bothmandibles and the rats were divided into four groups: one controlgroup and 3 experimental groups. Animals were killed 3 and 6 weeksafter surgery. Bone defect healing was assessed by radiologic andhistologic analysis. Results. The control defects showed no boneformation; holes were filled with fibrous connective tissue. Bonemembrane alone was an efficient barrier, excluding nonosteogenictissue. However, new bone formation underneath the membranewas incomplete. The Colloss® + membrane group showed completehealing after 6 weeks. The NovaBone® + membrane group showedno bone formation and particles appeared in the defect. Conclusions.The percentage bone regeneration was significantly better in thedefects filled with Colloss® and covered with Lambone® than theother experimental groups(AU)

Osteonecrosis de los maxilares inducida por bifosfonatos: prevención y actitud terapéutica / Bisphosphonate induced osteonecrosis of the jaws: prevention and therapeutic approach

Introducción. La osteonecrosis maxilar o mandibular por bifosfonatospuede convertirse en una epidemia debido a la amplia difusión deestos fármacos entre la población.Material y método. Se muestra un protocolo para la prevención y el tratamientode esta enfermedad. Se presentan tres casos de osteonecrosismaxilar/mandibular.Resultados. Es difícil lograr una curación completa; sin embargo es posibledetener la progresión de la enfermedad.Discusión. La cirugía y la suspensión de la terapia con bifosfonatos handemostrado poca utilidad. Los antibióticos y los enjuagues con clorhexidinason las únicas medidas eficaces.Conclusiones. Es imprescindible una planificación adecuada previa a la instauracióndel tratamiento con bifosfonatos. Ante una osteonecrosis establecida,la actitud debe ser conservadora (AU)

Introduction. Bisphosphonate-induced osteonecrosis of the jaws might reach epidemic proportions due tothe widespread use of this therapy.Materials and methods. A protocol for prevention and treatmentof this pathology is shown. Three clinical cases arereported.Results. It is quite difficult to reach restitutio ad integrum,but stopping the progress of the disease is possible.Discussion. Surgical treatment and cessation of bisphosphonatetherapy are of no use. Only antibiotics and oral chlorhexidinehave shown some benefits.Conclusions. An accurate preventive attitude is mandatoryprior to undergoing bisphosphonate therapy. If osteonecrosisof the jaws is present, management should be conservative (AU)

Quiste hemático crónico orbitario / Chronic hematic cyst of the orbit

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