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.

Mandibular bone regeneration with autologous adipose-derived mesenchymal stem cells and coralline hydroxyapatite: experimental study in rats.

The purpose of this paper was to investigate the bone regeneration effect of autologous adipose tissue mesenchymal stem cells (ATMSC) in a small animal model. Twelve Wistar rats were given bilateral critical-size defects in the mandible. The defects were filled with coralline hydroxyapatite alone or combined with autologous undifferentiated ATMSC obtained from the dorsal fat pad. Studies were conducted at three and six weeks. Descriptive histology and histomorphometry revealed a significant (p < 0.05) increased bone regeneration values in the cell-treated defects at both three and six weeks. ATMSC promoted the formation of new bone in the central areas of the defects and in the scaffold micropores, both in a higher state of maturation. Autologous undifferentiated ATMSC enhanced bony healing of mandibular critical-size defects in rats when implanted with a coralline hydroxyapatite scaffold.

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)

Quiste hemático crónico orbitario / Chronic hematic cyst of the orbit

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[A study of spontaneous regeneration of defected short nerve gaps in rats]. / Estudio de la regeneración espontánea en defectos nerviosos de poca longitud en ratas.

Nerve trunk gaps can be repaired with different anastomosis methods. We investigate if spontaneous regeneration can yield results similar to artificial repair, and have compared the degree of nerve regeneration in nerve defects of extratemporal facial nerve trunk in Wistar rats. The lesions measured 4 millimeters long. Three groups were studied: 0. Normal nerve (control). 1. No treatment (therapeutic abstention). 2. Autografts. The considered parameters were: clinical outcome (degree of postoperative facial function, aspect of the defectuous region, nerve conduction latency, and number of axons that managed to penetrate the defect as well as their morphometric characteristics (nerve area). Our conclusion is that in this model placement of autografts yielded significantly better results in all the parameters studied, in spite of the scant defect length. These results likewise allow us to use this model to compare repair by means of different graft types.

Fístula cutánea parotídea de origen litiásico / Cutaneus fistulae of the parotid gland of litiasic origin

Presentamos el caso clínico de un varón de 63 años con fístula cutánea en la región parotídea izquierda secundaria a un cálculo intraparotídeo de gran tamaño. Los cálculos salivares son más frecuentes en la glándula submaxilar, y en su mayoría son de pequeño tamaño; la presencia de una fístula cutánea en su diagnóstico y tratamiento de la litiasis parotídea (AU)

[Tularemia in the differential diagnosis of cervical lymph node enlargement. An outbreak of tularemia in Castilla-León, Spain]. / La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A propósito de un brote tularémico en Castilla-León.

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region.

[Gold weights for the treatment of lagophthalmos caused by facial paralysis. Our experience and review of the literature]. / Pesas de oro en el tratamiento de lagoftalmos por parálisis facial. Experiencia y revisión de la literatura.

Paralysis of the orbicularis oculi muscle in patients with facial palsy can originate serious functional and esthetic problems. The implantation of a gold weight in the upper eyelid is one of the many surgical techniques that have been described for the correction of lagophthalmos in these patients. In this article we review the literature and present our experience with gold weight implantation for eyelid reanimation in patients with facial palsy. This procedure is technically simple to perform, produces good functional and cosmetic results, has a relatively low complication rate and is reversible should facial function return.

Oral sarcoidosis with tongue involvement.

A case of oral sarcoidosis involving the tongue and buccal region is reported in a 56-year-old woman. Intraoral presentations of sarcoidosis are uncommon, and sarcoidosis of the tongue is particularly rare. In this case the tongue lesion was asymptomatic, and unusual clinical behavior. In this article, we review the clinical manifestations, diagnostic procedures, differential diagnosis and treatments of oral sarcoidosis.