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)

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico / Hypopharyngeal cancer: analysis of the evolution and surgical results

Objetivo: El cáncer de hipofaringe es un cáncer muy agresivo que generalmente se diagnostica en estadios muy avanzados, siendo su pronóstico desalentador y la tasa de supervivencia muy baja. El objetivo de este estudio es presentar la evolución y los resultados postoperatorios de pacientes tratados en nuestro servicio por cáncer de hipofaringe. Material y Método: Realizamos un estudio retrospectivo sobre 60 pacientes intervenidos quirúrgicamente entre los años 1980-1999. En su mayoría se trataba de estadios avanzados (III-IV) y el 75 por ciento presentaban adenopatías palpables en el momento del diagnóstico. Resultados: La supervivencia a los 5 años fue de 38,4 por ciento. Encontramos una incidencia de metástasis a distancia y segundos tumores de un 12,5 por ciento y un 10,4 por ciento respectivamente. Conclusiones: El carcinoma de hipofaringe continúa siendo el cáncer de cabeza y cuello de peor pronóstico. La tasa de supervivencia parece estar relacionada primeramente con el estadio tumoral de presentación y particularmente con el estatus de los ganglios linfáticos cervicales (AU)

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases (AU)

[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature]. / Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

¿Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura / Why does a mastoidectomy cavity suppurate? Our experience and revision of the literature

El objetivo principal de la cirugía de la otitis media crónica es eliminar la enfermedad y mejorar la audición siempre que sea posible. La supuración persistente de una cavidad de mastoidectomía supone un fracaso de la cirugía e impide que estos objetivos se alcancen. En el siguiente trabajo, presentamos la actitud de nuestro servicio ante las cavidades de mastoidectomía supurante y así mismo exponemos cuáles son las causas que impiden el adecuado control de la misma (AU)

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them (AU)

Surgical voice restoration after total laryngectomy: long-term results.

Tracheoesophageal puncture (TEP) with a voice prosthesis has been the preferred treatment for speech rehabilitation of total laryngectomies at the Dr. Peset Hospital since 1984. This study reviews 350 consecutive patients over a 15-year period. There were 334 patients with primary and 16 with secondary TEP. Long-term tracheoesophageal speech was achieved in approximately 70% of our patients. Problems related to or affecting TEP for voice restoration were studied. The different types of problems identified occurred in proportions ranging from 0.6% to 18%. Most of them were easily managed, but problems such as salivary leakage and dislodging of the prosthesis led to tracheoesophageal tract closure in 30% of the patients.

[Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis)]. / Enfermedad de Kikuchi-Fujimoto (linfadenitis necrotizante histiocitaria.

Kikuchi-Fujimoto's disease (histiocytic necrotizing lymphadenitis) is a benign, self-limited disease of unknown cause that often presents with persistently enlarged cervical lymph nodes that are unresponsive to antibiotic therapy. The disease should be considered in the differential diagnosis of cervical lymphadenopaty: viral infection, tuberculosis, hyperplastic lymphadenopathy, and metastatic disease. It can be confused histologically with malignant lymphoma.

[The study of survival in the glottic cancer]. / Estudio de la supervivencia en el cáncer de origen glótico.

The survival rate for glottic carcinoma was analyzed in the cases treated in our service in 1978-88. All cases had a minimum of 5 years of follow-up. Clinical manifestations, tumor site, TNM and pTNM stages, histopathologic type, treatment, and five-year survival and recurrence rates were studied.

[Survey of 80 myringoplasty]. / Revisión de 80 miringoplastias.

We report a retrospective study about 80 myringoplasties performed on 75 patients. The single occlusive myringoplasty technique was undergone in 33.7 percent of cases, while the tympanomeatal flap procedure was used in 66,2 percent. The grafted material was temporal muscle fascia (63.7%) or tragus perichondrium (36.2%). In 30 percent of instances some retouches were achieved on the ossicular chain. The anatomic success rate accounted for 67.5% and a good functional issues for 59.7% of cases.

[Vertical partial laryngectomies: our experience]. / Laringectomías parciales verticales. Nuestra experiencia.

This paper deals with a retrospective analysis of 162 patients with glottic cancer treated in our ENT-Department using vertical partial laryngectomies (cordectomy and partial surgery with cartilage resection. PSCR). The term of study comprise from 1975 till 1991. In this interval were performed 118 cordectomies and 44 partial laryngectomies including cartilage resection. The parameters considered were: clinical onset, tumor sitting, TNM and pTNM classification, histopathological findings and treatment and survival and recurrence rates at 5 years, as well.

[Supraglottic carcinoma]. / Carcinoma supraglótico.

We present the follow-up and end results of 98 horizontal supraglottic laryngectomies done for treatment of supraglottic carcinomata. Both functional and oncologic outcome as well the complications and 5-year survival of these laryngectomies are considered. We conclude that this surgical technique is a suitable one for the larger part of supraglottic carcinomas.

[Pharyngocele]. / Faringocele.

Pharyngocele is a lateral pharyngeal wall herniation located in the pyriform recess or at the vallecula. It is a rare condition and the patient complains of dysphagia, lateral cervical mass which increases in size with the Valsalva maneuver, and other symptoms of the upper digestive way. The elective diagnostic study is pharyngoesophageal swallow. We present the case report of a patient who had acute respiratory failure due to supraglottic mass occupation. The explorations are discussed and the case report is compared with those few reported in the literature.

[Non-Hodgkin lymphoma of the maxillary sinus]. / Linfoma no Hodgkin de seno maxilar.

Non-Hodgkin Lymphoma is an infrequent tumor at the paranasal sinuses site, representing no more than 5.8 to 8 percent of the entire malignant neoplasias in this localization. Clinical manifestations are insignificant and the definitive diagnosis comes through its pathological study. Treatment is fundamentally radiotherapy, either isolated or in association to polychemotherapy. Its prognosis use to be better than that of those lymphomas arising in Waldeyer's area. In this paper a case of a primary lymphoma of the maxillary antrum is reported and the literature about this condition is reviewed.

[Aggressive fibromatosis of the nasal sinuses]. / Fibromatosis agresiva nasosinusal.

A case report of a feminine patient who complained of nasal ventilatory obstruction and nasosinusal polyposis is presented. She underwent surgery and the pathological study revealed the existence of an aggressive fibromatosis. The AA. review the literature dealing with this illness and explain an update state of the clinical features, treatment and the course of this rare entity, closely related to fibrosarcoma.

[The ORL area as the seat of metastases. A case report of mandibular metastasis of adenocarcinoma of the prostate gland]. / La esfera O.R.L. como asiento de metastasis. A propósito de un caso de metástasis mandibular de adenocarcinoma de próstata.

Reporting a prostatic adenocarcinoma case which first manifestation was an osteogenic metastasis of the mandible. This is a very interesting event because of its unusual localization. Latest literature is reviewed.

[Adenomatoid hyperplasia of minor salivary glands]. / Hiperplasia adenomatoide de glandulas salivares menores.

Adenomatoid hyperplasia of minor salivary glands in an uncommon clinicopathologic entity, first reported, in 1971, by Giansanti and cols. The condition mimics a neoplasm because of its swelling, but the histologic picture agrees with that of normal appearing salivary gland tissue. The interest of this entity is that although benign pseudotumoral lesion, it can be clinically confused with benign or malignant tumors and even, through fine needle aspiration cytology, with low grade mucoepidermoid tumors. We present one case of this condition arising in the soft palate in a patient with unilateral serous otitis media. A review of the published literature on the subject is done.

[Oropharyngeal vascular lesions]. / Lesiones vasculares orofaríngeas.

In this paper a case report of a tonsillar cavernous Hemangioma is presented. A review of the literature about oropharyngeal vascular lesions is done and their diagnosis, classification and its treatment is discussed.