Reparación de lesiones en nervios mediante el implante de prótesis obtenidas de segmentos acelulares de nervio isogénico / Repair of nerve injury by implanting prostheses obtained from isogenic acellular nerve segments

Introducción. Cuando se produce una sección nerviosa con separación significativa de los cabos es necesario utilizar una prótesis, a modo de puente, para suturarlos. La mejor prótesis es un segmento de nervio autógeno, pero presenta importantes inconvenientes. Nuestro objetivo es comparar la eficacia de la sutura simple con la tubulización para el implante de una prótesis de nervio isogénico descelularizado. Material y método. Se utilizan 4 grupos de ratas Wistar. Grupo 0: animales donantes de nervio ciático. Grupo 1: recibió el implante con sutura término-terminal. Grupo 2: recibió el implante dentro de un tubo de ??-caprolactona. Grupo 3: lo recibió en un tubo de poliláctico-co-glicólico. Se evaluó la función motora (índice ciático) y la extensión de la regeneración (estudio histológico) a las 3 semanas del implante. Resultados. La regeneración ha sido irregular en los 3 grupos experimentales. En todos hay implantes en los que las fibras nerviosas regeneran la longitud máxima estudiada (15mm) y otros en los que la regeneración es muy escasa. La longitud media de regeneración es mayor en el grupo de sutura directa (G1), aunque la velocidad es similar en los 3. El grupo 1 muestra el mayor porcentaje de regeneración, aunque la variabilidad de los resultados impide que esta diferencia alcance significación estadística. No hemos hallado diferencias significativas entre los dos grupos con tubos de diferentes polímeros. Conclusión. Para implantar prótesis de nervios isogénicos descelularizados es más eficaz, en nuestras condiciones experimentales, la sutura término-terminal que los tubos de polímeros biocompatibles (AU)

Introduction. When a nerve section with a significant gap occurs, it is necessary to use a prosthesis to suture it. To date an autologous nerve segment graft appears to be the best treatment; but it has several important disadvantages. Our goal is to study the effectiveness of an isogenic acellular nerve prosthesis comparing a simple suture with tubulisation. Material and method. Four groups of Wistar rats were used. The animals in Group 0 served as donors of nerve segments to graft. Group 1 received the implant with an end-to-end suture. In group 2, the implant was sutured inside an ??-caprolactone tube. Group 3 received it in a polylactic-co-glycolic acid tube. We evaluated the motor function (sciatic index and step test in motion), and the regeneration length by histological study of regeneration, after a maximum of 3 weeks. Results. Regeneration was uneven in the three groups. In all groups, there were implants with regenerated nerve fibres at the maximum studied length (15mm) and others where regeneration was scarce. The mean regeneration length was greater in the direct end-to-end suture group (G1), although the regeneration speed was similar in the three groups. Group 1 showed the highest percentage of regeneration, but the variability of results prevents this difference reaching statistical significance. We found no significant differences between the two groups with polymer tubes. Conclusion. For the implantation of isogenic acellular nerve prosthesis, under our experimental conditions, the direct end-to-end suture was more effective than when it isprotected with biopolymer tubes (AU)

Repair of nerve injury by implanting prostheses obtained from isogenic acellular nerve segments. / Reparación de lesiones en nervios mediante el implante de prótesis obtenidas de segmentos acelulares de nervio isogénico.

INTRODUCTION: When a nerve section with a significant gap occurs, it is necessary to use a prosthesis to suture it. To date an autologous nerve segment graft appears to be the best treatment; but it has several important disadvantages. Our goal is to study the effectiveness of an isogenic acellular nerve prosthesis comparing a simple suture with tubulisation. MATERIAL AND METHOD: Four groups of Wistar rats were used. The animals in Group 0 served as donors of nerve segments to graft. Group 1 received the implant with an end-to-end suture. In group 2, the implant was sutured inside an ɛ-caprolactone tube. Group 3 received it in a polylactic-co-glycolic acid tube. We evaluated the motor function (sciatic index and step test in motion), and the regeneration length by histological study of regeneration, after a maximum of 3 weeks. RESULTS: Regeneration was uneven in the three groups. In all groups, there were implants with regenerated nerve fibres at the maximum studied length (15mm) and others where regeneration was scarce. The mean regeneration length was greater in the direct end-to-end suture group (G1), although the regeneration speed was similar in the three groups. Group 1 showed the highest percentage of regeneration, but the variability of results prevents this difference reaching statistical significance. We found no significant differences between the two groups with polymer tubes. CONCLUSION: For the implantation of isogenic acellular nerve prosthesis, under our experimental conditions, the direct end-to-end suture was more effective than when it isprotected with biopolymer tubes.

Amiloidosis localizada multifocal de la vía aérea superior en una paciente pediátrica / Multifocal localized amyloidosis in a pediatric patient

La amiloidosis localizada multifocal de la vía aérea superior en la edad pediátrica es excepcional. Se presenta un caso clínico de amiloidosis localizada en la nasofaringe y fosa nasal en una adolescente. Clínicamente debutó con obstrucción nasal y mucosidad. El diagnóstico se obtuvo del análisis histológico tras la resección local de las lesiones

Amyloidosis of the upper airway is rare in the pediatric age group. We present a primary amyloidosis in the nasopharynx and nasal cavity in a 14-year-old girl. The symptoms were nasal obstruction and mucoid discharge. The diagnostic was revealed by histologycal analysis obtained from local surgical excision

[Multifocal localized amyloidosis in a pediatric patient]. / Amiloidosis localizada multifocal de la vía aérea superior en una paciente pediátrica.

Amyloidosis of the upper airway is rare in the pediatric age group. We present a primary amyloidosis in the nasopharynx and nasal cavity in a 14-year-old girl. The symptoms were nasal obstruction and mucoid discharge. The diagnostic was revealed by histologycal analysis obtained from local surgical excision.

Quimioterapia de inducción con Vinorelbine cisplatino y UFT en carcinomas avanzados faringolaríngeos: resultados de un estudio fase II / Neoadjuvant chemotherapy with Vinorelbine cisplatin and uft in advanced laryngeal and pharyngeal squamous cell carcinoma: results of a phase II study

Objetivo: Evaluación de los resultados obtenidos con un protocolo de quimioterapia con Vinorebine, UFT y Cisplatino (UFTVP). Material y Métodos: 93 pacientes diagnosticados de carcinoma epidermoide faringo-laríngeo (estadios III y IV), entraron prospectivamente en un protocolo de tratamiento con el esquema UFTVP. Los pacientes con buena respuesta continuaron tratamiento definitivo mediante radioterapia, realizándose cirugía convencional y radioterapia postoperatoria en el resto. Resultados: Tras la quimioterapia se obtuvieron un 60 por ciento de respuestas completas y un 30 por ciento de respuestas parciales en la localización primaria del tumor, y sólo un 28 por ciento de respuestas completas y un 33 por ciento de respuestas parciales en los casos de extensión ganglionar (p = 0,002). Con un seguimiento medio de 62 meses, la supervivencia a los cinco años fue del 45 por ciento. Se consiguió preservar la función laríngea en el 50 por ciento de los pacientes con carcinoma laríngeo y sólo en el 29 por ciento de aquellos con localización hipofaríngea. La presencia de adenopatías y la localización faríngea del tumor fueron factores relacionados significativamente con una peor supervivencia. Conclusiones: El esquema UFTVP ha demostrado ser eficaz en el tratamiento de los carcinomas avanzados faringo-laríngeos, obteniéndose unos resultados de supervivencia y de preservación de órgano significativamente mejores en los tumores laríngeos que en los de localización faríngea (AU)

OBJECTIVE: To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP). METHODS: 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation. RESULTS: Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival. CONCLUSIONS: UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx (AU)

[Induction chemotherapy using vinorelbine, cisplatin, and UFT in advanced pharyngeo-laryngeal carcinomas: results of a phase II study]. / Quimioterapia de inducción con vinorelbine, cisplatino y UFT en carcinomas avanzados faringo-laríngeos: resultados de un estudio fase II.

OBJECTIVE: To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP). METHODS: 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation. RESULTS: Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival. CONCLUSIONS: UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx.