Manejo del absceso de la glándula tiroides / Management of thyroid gland abscess

Introducción: La enfermedad supurativa de la glándula tiroides-absceso de tiroides o tiroiditis supurativa aguda- supone una infrecuente situación clínica. Presentamos nuestra experiencia en los casos asistidos durante 41 años. Materiales y métodos: Estudio longitudinal retrospectivo anotando características epidemiológicas, conducta diagnóstico-terapéutica y resultado clínico, detectando 14 casos -9 varones y 5 mujeres, entre 19 y 68 años, con una media de edad de 40,6 ± 15,4 años- con 22 episodios. En 2 pacientes la condición se había reproducido hasta en 4 ocasiones. Resultados: Supusieron el 0,29% de todos los abscesos cervicales atendidos. La punción-aspiración fue efectuada en 13 de ellos para su tratamiento e identificación del agente causal. Los agentes más habitualmente implicados fueron Mycobacterium tuberculosis y Staphylococcus aureus. Se realizó un estudio de imagen mediante ecografía en 9 casos y de tomografía computarizada en 7. En 10 pacientes el tratamiento definitivo fue quirúrgico, efectuándose drenaje del absceso en 7 de ellos, tiroidectomía total en 4 y hemitiroidectomía en 2. Otros tratamientos admitidos fueron la antibioterapia sistémica o mediante irrigación intralesional y la esclerosis. Aunque en un caso la fase aguda comenzó con hipertiroidismo y tirotoxicosis, a los 6 meses del alta existió hipotiroidismo definitivo en 5 casos. Las opciones terapéuticas adoptadas consiguieron la curación en el 100% de los casos. Conclusión: La supuración de la glándula tiroidea es una circunstancia extremadamente rara en el contexto de la enfermedad cervical, variando las opciones terapéuticas desde alternativas conservadoras al drenaje con tiroidectomía según los hallazgos microbiológicos y radiológicos

Background: Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. Materials and methods: A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6±15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. Results: Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. Conclusion: Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings

Absceso de psoas y cuello por Nocardia farcinica / Psoas and neck abscess by Nocardia farcinica

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Management of thyroid gland abscess. / Manejo del absceso de la glándula tiroides.

BACKGROUND: Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. MATERIALS AND METHODS: A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6±15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. RESULTS: Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. CONCLUSION: Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea.

OBJECTIVE/HYPOTHESIS: This study examined correlations between surgical recommendations based on either drug-induced sleep endoscopy (DISE) or common awake examination methods in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective, blinded, clinical trial at a university hospital. METHODS: An otorhinolaryngologist designed surgical plans for patients with OSAS after clinical examination, lateral cephalometry, the Müller maneuver, and Friedman staging. A second otorhinolaryngologist blinded to the previous plans made surgical recommendations after DISE. A third person tested agreement between the two sets of plans using Cohen's kappa statistic and the chi-squared test. RESULTS: One hundred and sixty-two patients (15 females, 147 males) completed the protocol. Good correlation was observed between DISE and Friedman staging regarding recommendations for isolated oropharyngeal or multilevel surgery (kappa = 0.61). Correlations between DISE and clinical examination, lateral cephalometry, and the Müller maneuver regarding surgical procedures on specific structures contributing to upper airway obstruction ranged from fair for velum/tonsil surgery (k = 0.41-0.60) to poor (k = 0.01-0.20) for tongue-base, lateral pharyngeal wall, and epiglottal surgery. The most informative value was DISE versus clinical evaluation, lateral cephalometry, and the Müller maneuver, which changed surgical recommendations concerning the structures contributing to hypopharyngeal or laryngeal obstruction in > 40% of patients. CONCLUSIONS: Our results indicate that DISE provides more information about the anatomical locations and pattern of obstruction, particularly regarding the specific structures contributing to hypopharyngeal and laryngeal obstruction. DISE changes surgical decision making compared to awake evaluation methods.