Endoscopic Treatment of Sphenoid Sinus Mucocele: Case Report and Surgical Considerations.

INTRODUCTION: The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. OBJECTIVE: To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. CASE REPORT: 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. CONCLUSION: Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.

Morbimortalidad por hemorragia digestiva alta no varicosa / Morbimortality due to non varicose upper digestive bleeding

El objetivo del trabajo fue identificar la morbimortalidad por hemorragia digestiva alta no varicosa en nuestro medio y los factores que influyen sobre ella. Se realizó un estudio de series de casos de todos los pacientes con hemorragia digestiva alta, durante el periodo comprendido desde el 1ro de enero del 2009 al 31 de diciembre del 2010. Se evaluaron las siguientes variables: edad, sexo, enfermedades asociadas y causa de muerte. Como factores de riesgo se midieron el sangramiento activo, el uso de AINES, el tratamiento quirúrgico no definitivo, la úlcera gástrica, el re-sangrado intrahospitalario, la transfusión de más de 1 500 ml de sangre, el no diagnóstico precoz de la causa, la hemorragia digestiva anterior, el sangrado inicial intrahospitalario, las enfermedades asociadas, el sangrado de más de 24 h, la edad de más de 60 años, el alcohol, el sexo, el tabaco, y la hematemesis. La serie estuvo formada por 247 pacientes, con un predominio del sexo masculino, con 138 pacientes, para un 64 por ciento. La mortalidad general fue de 20 pacientes, lo que representa el 8 por ciento de la serie. Los factores que más influyeron en la mortalidad por hemorragia digestiva alta fueron el sangrado activo, el empleo de AINES y el no aplicar un tratamiento quirúrgico definitivo desde un inicio. En conclusiones, la determinación de los factores de riesgo en la morbimortalidad de los pacientes con hemorragia digestiva alta permite un mejor manejo de estos, con el fin de disminuir los resultados adversos (AU)

The work aims at identifying the morbimortality due to non varicose upper digestive bleeding in our environment and the factors that influence it. A study of a series of cases of all the patients with upper digestive bleeding in our environment was carried out during the period from the January 1srt, 2009 to December 31srt, 2010. The variables evaluated were: age, sex, associated illnesses, cause of death and risk factors like active bleeding, the use of NSAID, the non definitive surgical treatment, gastric ulcers, intrahospital re-bleeding, blood transfusions over 1 500 ml, the precocious non diagnosis of the cause, previous digestive bleedings, initial intrahospital bleeding, the associated illnesses, over 24 h of bleeding, being over 60 years old, alcohol, sex, tobacco, and hematemesis. The above mentioned series was formed by 247 patients with a predominance of 138 patients of the masculine sex for a 64 percent. General mortality included 20 patients representing the 8 percent of the series. The factors with more influence in mortality due to upper digestive bleeding in our environment were active bleeding, the use of NSAID and the non-application of a definitive surgical treatment from the beginning. As a conclusion, it was stated that the determination of the risk factors of the morbimortality of the patients with upper digestive bleeding allows a better treatment to diminish the adverse results (AU)