Predictores de hipocalcemia postquirúrgica tras tiroidectomía total / Predictors of post-surgical hypocalcaemia following total thyroidectomy

Introducción y objetivo: Dado el número creciente de cirugía de tiroides, la incidencia de hipoparatiroidismo postquirúrgico está en aumento. La frecuencia de la hipocalcemia por hipoparatiroidismo tras tiroidectomía total es muy variable según la literatura (0,3-68%). El objetivo principal del presente estudio es analizar los factores bioquímicos, quirúrgicos y demográficos relacionados con un mayor riesgo de hipocalcemia.Metodología: Se trata de un estudio retrospectivo, sobre un total de 297 pacientes intervenidos de tiroidectomía total en un periodo de 8 años en un hospital terciario. Se analizan datos demográficos, clínicos y bioquímicos, tanto preoperatorios, intraoperatorios como postoperatorios y su relación con la hipocalcemia postquirúrgica.Resultados: La tasa de hipocalcemia total fue de 40,2%, siendo transitoria en el 26,1%.Fueron variables estadísticamente significativas la edad (p=0,04), la enfermedad de Graves (p=0,04), el carcinoma confirmado por anatomía patológica (p=0,04), la tiroidectomía en dos tiempos (p=0,00), el número de paratiroides trasplantadas (p=0,00) y la PTH pre y post –operatorias (p=0,03 y p=0,00) y el gradiente de PTH (p=0,00).Conclusiones: Este estudio demuestra que hay una serie de factores de riesgo intrínsecos al paciente y al acto quirúrgico capaces de predecir el riesgo de hipocalcemia tras la tiroidectomía total. Posiblemente, la optimización de la técnica quirúrgica podría evitar la aparición de hipocalcemia tras la tiroidectomía total en algunos casos, mientras que en otros, la identificación de dichos factores en el postoperatorio podría permitir la detección temprana y el tratamiento eficaz de estos pacientes. En el presente estudio, la edad, la enfermedad de Graves y el autotrasplante de paratiroides se asociaron con hipocalcemia postquirúrgica; mientras que el carcinoma de tiroides y la tiroidectomía en dos tiempos fueron factores protectores. (AU)

[Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism]. / Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario.

Primary hyperparathyroidism diagnosis and radioguided surgery by (99m)Tc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful.

Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario / Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism

En los últimos años se ha generalizado el uso de la gammagrafía paratiroidea con 99mTc-MIBI para el diagnóstico preoperatorio e intraoperatorio del hiperparatiroidismo primario. La aparición de un nuevo modelo de minigammacámara portátil (MGP) abre nuevas perspectivas en el campo de la detección intraoperatoria. Presentamos un estudio preliminar de tres pacientes con hiperparatiroidismo primario en el que se demuestra la utilidad del empleo de la MGP

Primary hyperparathyroidism diagnosis and radioguided surgery by 99mTc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful (AU)

[Sentinel lymph node in tumors of the larynx: technique and results]. / El ganglio centinela en tumores de laringe: técnica y resultados obtenidos.

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.

El ganglio centinela en tumores de laringe: técnica y resultados obtenidos / Sentinel lymph node in tumors of the larynx: technique and results

Objetivos: Determinar la aplicabilidad de la técnica del ganglio centinela (GC) en tumores N0 de laringe. Material y métodos: Realizamos un estudio prospectivo en 19 pacientes con tumores N0 de laringe. Infiltramos peritumoralmente 1mCi de nanocoloides de albúmina marcados con 99mTc con endoscopio rígido bajo anestesia general. Detectamos el GC intraoperatoriamente con una sondagamma durante el vaciamiento cervical. Los resultados histológicos del GC se comparan con los del vaciamiento cervical. Resultados: Identificamos el GC en 17 pacientes (89,47%). Once pacientes presentaron GC libres de tumor, reflejando correctamente el estatus del cuello (pN0). Tres pacientes presentaron metástasis en el GC l. Encontramos 3 falsos negativos. La sensibilidad de la técnica fue 50,0% (3/6) y el VPN de un 78,6%. Conclusiones: Pensamos que para que la técnica del GC sea aplicable en tumores de laringe se precisan de un mayor número de estudios, siendo fundamental la realización de un correcta selección de los pacientes

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential

[Clinical evaluation of the patient with a chronic snoring disease]. / Evaluación clínica del paciente con roncopatía.

INTRODUCTION: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. MATERIALS AND METHODS: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. RESULTS: The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. CONCLUSIONS: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

Evaluación clínica del paciente con roncopatía / Clinical evaluation of the patient with a chronic snoring disease

Introducción: Los pacientes con trastornos respiratorios relacionados con el sueño son sometidos habitualmente a un examen otorrinolaringológico antes de tomar una decisión terapéutica. Este examen debería ser predictivo sobre la existencia de síndrome de apnea obstructiva del sueño (SAOS), reproducible y debería determinar las zonas de obstrucción de la vía aérea. Hemos evaluado el examen clínico ORL y comparado con la literatura con el ánimo de estandarizar el mismo. Material y métodos: Hemos realizado el mismo protocolo de anamnesis y exploración a 181 pacientes, de los cuales 127 tienen realizada también una polisomnografía (PSG). Resultados: La edad media de los pacientes fue de 49,6 años, con un IMC de 29,3 kg/m2. El 92,7% presentaron un paladar patológico, el 4,5% presentaron una hipertrofia amigdalar importante y el 66,5% índices de Mallampati modificados elevados. El 68,8% se estadió como Fujita IIb y un 39,2% presentó obstrucción nasal. Conclusiones: La exploración de la vía aérea superior (VAS) es muy importante para el diagnóstico de la roncopatía crónica. La mayoría de los pacientes presentan alteraciones morfológicas que se pueden representar mediante escalas visuales para hacerla más reproducible. La zona de obstrucción no predice la severidad del síndrome de apnea del sueño

Introduction: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. Materials and methods: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. Results: The patient’s mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. Conclusions: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS

[Temporalis myofascial flap: technique description and results in our patients]. / Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes.

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes / Temporalis myofascial flap: technique description and results in our patients

Introducción: El tratamiento quirúrgico de los tumores de cavidad oral y seno maxilar precisa una reconstrucción del defecto. Es preferible realizarla en un solo tiempo quirúrgico para disminuir la morbilidad del paciente y el coste sanitario. El colgajo miofascial del temporal es muy versátil para la reconstrucción de defectos de cavidad oral, base de cráneo, orbitarios y maxilares. Material y métodos: Describimos la técnica quirúrgica y presentamos nuestros resultados tras la reconstrucción de defectos tras maxilectomía total o parcial con el colgajo miofascial del músculo temporal en 22 pacientes. Resultados: No se ha producido la necrosis total en ningún caso y en 4 hubo una pequeña dehiscencia de sutura. Conclusión: El colgajo miofascial es una opción excelente para la reconstrucción de cavidad oral y seno maxilar

Introduction: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. Material and methods: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. Results: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. Conclusion: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction

[Sentinel node in tumours of the lip and the oral cavity]. / Estudio del ganglio centinela en tumores de labio y cavidad oral.

OBJECTIVES: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. PATIENTS AND METHOD: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. CONCLUSIONS: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.

Estudio del ganglio centinela en tumores de labio y cavidad oral / Sentinel node in tumours of the lip and the oral cavity

Objetivos: Este estudio muestra los resultados obtenidos mediante la aplicación del ganglio centinela en tumores de labio y cavidad oral; elaboramos un mapa linfográfico de dichos tumores. Material y método: Estudiamos prospectivamente 14 pacientes con tumores de labio y cavidad oral N0 clínicos. Inyectamos de forma peritumoral, 1 mCi de nanocoloides de albúmina marcada con Tc99 preoperatoriamente, para posteriormente localizar el ganglio centinela. Una vez localizado éste, se envía separadamente del resto de cadenas ganglionares para su estudio anatomopatológico. Resultados: En todos los pacientes se identificó el ganglio centinela. En 11 casos el ganglio centinela fue negativo para metástasis prediciendo correctamente el estadio cervical. En 3 casos el ganglio centinela fue el único ganglio que contenía metástasis. No hubo ningún caso de falso negativo. La sensibilidad de la técnica fue del 100%. Conclusiones: Los resultados muestran esta técnica como un método fiable en esta localización que podría evitar los vaciamientos cervicales en pacientes N0 clínicos

Objectives: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. Patients and method: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. Results: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. Conclusions: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Nuestros hallazgos en la videofibrosomnoscopia / Our findings in the sleep endoscopy exams

Introducción: La videofibrosomnoscopia es una técnica que permite la visualización de la faringe de un paciente al que se le ha inducido el sueño farmacológicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibración y colapso de los pacientes con roncopatía crónica. Material y métodos: La prueba se realizó a un total de 51 pacientes. A todos se les realizó una anamnesis estándar y una exploración otorrinolaringológica como parte del diagnóstico habitual. Resultados: La zona de obstrucción más frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstrucción hallada en la consulta y la vista durante la VFS. Conclusiones: La VFS es una técnica útil en el diagnóstico del paciente con roncopatía y es aconsejable su utilización para saber con certeza el tipo de obstrucción del paciente

Introduction: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. Materials and methods: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. Results: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. Conclusions: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient´s obstruction

[Incompetent tracheoesophageal fistula following phonatory puncture. Surgical resolution]. / Fístula traqueoesofágica incompetente tras punción fonatoria. Solución quirúrgica.

Large tracheoesophageal fistulas (TEF) following a total laryngectomy are rare. Most often are associated with the creation of a surgical speech fistula or puncture. We describe the surgical technique used in 3 patients with large TEF after a total laryngectomy and the creation of a speech fistula with a voice prosthesis, followed by radiation therapy. Pertinent literature is reviewed.

Fístula traqueoesofágica incompetente tras punción fonatoria. Solución quirúrgica / Incompetent tracheoesophageal fistula following phonatory puncture surgical resolution

Las fístulas traqueoesofágicas (FTE) son una complicación rara de la cirugía laríngea, los casos de presentación se deben generalmente a la creación de una fístula fonatoria. Presentamos la técnica quirúrgica empleada para el cierre de una FTE en 3 pacientes a los que se les había realizado años atrás una laringuectomía total con punción traqueoesofágica y colocación de prótesis fonatoria, seguida de radioterapia. Revisamos la literatura al respecto (AU)

Large tracheoesophageal fistulas (TEF) following a total laryngectomy are rare. Most often are associated with the creation of a surgical speech fistula or puncture. We describe the surgical technique used in 3 patients with large TEF after a total laryngectomy and the creation of a speech fistula with a voice prosthesis, followed by radiation therapy. Pertinent literature is reviewed (AU)

[Benign surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology]. / Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica.

In our milieu, Dr. Peset Hospital, Valencia, we have collected between 1979 and 1998, a total amount of 683 thyroidectomies. Between them 101 carcinomata and 582 bening thyroid pathology. In this work are studied the bening pathology treated surgically. 86.4 percent were women and 13.6% men. Middle age 45 years. By complementary explorations, echography the solid single node by 41.9 percent of cases and solid numerous nodes by 34.7% were the more important findings found. By gammagraphy with greater frequency discovered a cold single node by 44.2% of cases. Anatomopathological types more frequently found were single hyperplastic node (13.3%), multiple hyperplastic nodes (27.6%), spreading hyperplasy (9.1%) and follicular adenoma (37.4%). The aim of this work is the comparative study of findings of complementary explorations with the anatomopathological results gained through the surgical pieces.

Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica / Benin surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology

En nuestro medio del Hospital Dr. PEset de Valencia hemos recogido, en el período comprendido entre 1979-1998 un total de 683 tiroidectomías. En ellas se detectaron 101 carcinomas y 582 patologías benignas de tiroides. En el presente trabajo vamos a estudiar la patología benigna tratada quirurgicamente en nuestro Servicio. De los pacientes con patología benigna el 86,4 por ciento fueron mujeres y el 13,6 por ciento varones, con una edad media de 45 años. En las exploraciones complementarias en la ecografía los principales hallazgos encontrados fue el nódulo sólido único en el 41,9 por ciento y nódulos sólidos múltiples en el 31,7 por ciento. En la gammagrafía el hallazgo observado con mayor frecuencia fue el nódulo frío único en el 44,2 por ciento de los casos. Los tipos anatomopatológicos hallados con mayor frecuencia fueron los siguientes: hiperplasia nodular única (13,3 por ciento), hiperplasia nodular múltiple (27,6 por ciento), hiperplasia difusa (9,1 por ciento) y adenoma folicular (37,4 por ciento). El objetivo del presente trabajo es realizar un estudio estadístico comparando los hallazgos de las exploraciones complementarias (ecografía y gammagrafía) con los resultados anatomopatológicos definitivos de las piezas quirúrgicas (AU)

[Treatment and development of thyroid carcinoma]. / Tratamiento y evolución del carcinoma tiroideo.

Reporting the results of a retrospective study on 101 cases of carcinoma of the thyroid gland, treated in our Service between 1979 and 1998. Analysis of the several anatomopathological variables found, the surgical treatment and also with radioactive isotopes, the complications and the condition evolution. Epidemiologically 82 percent of patients were women and men the 18 percent. Middle age 51 years. 12 percent of patients had familiar antecedents of thyroid pathology. The histological types found were: papillary carcinoma (74.26%), follicular carcinoma (14.85%), Hürthle's cellules carcinoma (3.96%) and anaplastic carcinoma (2.97%). In our Service elective treatment of thyroid gland carcinoma is total thyroidectomy with neck dissection in 18.3 percent of affected. The survival rate amount for 81.3 percent at five years. The aim of this article is to display the therapeutics and evolution of thyroid gland cancer, based in our own 18 years of experience acquired in the Service.

[Spontaneous middle ear meningoencephalic herniation. 2 case reports]. / Herniación meningoencefálica espontánea en oído medio: a propósito de dos casos.

Two cases of idiopathic brain herniation into the middle ear without previous surgery are reported. Brain herniation is an unusual pathology, usually related to middle ear surgery. The idiopathic appearance of this disease is the secondly most frequent cause. Its origin is believed to be related to a congenital defect of tegmen timpani. Two elements, both rare, are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.