Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes / Endoscopic management of paranasal sinus mucoceles: experience with 46 patients

Objetivo: El propósito de este estudio es determinar los cambios en el tratamiento quirúrgico de los pacientes con diagnóstico de mucocele paranasal manejados en un hospital terciario de Latinoamérica. Nuestra hipótesis es que en los últimos ocho años la cirugía endoscópica endonasal ha emergido como la principal opción de tratamiento para esta patología. Material y métodos: Estudio retrospectivo descriptivo de todos los pacientes que fueron diagnosticados y tratados por mucocele de seno paranasal en el Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello de nuestro hospital durante los años 2002 al 2010. Se registraron datos demográficos de los pacientes, localización del mucocele, síntomas, abordaje quirúrgico y complicaciones. Resultados: Se incluyeron un total de 46 pacientes (27 de sexo masculino y 19 femenino). Esta serie comprendió 29 pacientes con mucocele frontal o frontoetmoidal (63%), 14 con mucocele maxilar (30,4%) y 3 pacientes con mucocele esfenoidal (6,5%). El 95% de los pacientes fueron tratados con cirugía endoscópica endonasal. Sólo 7 casos presentaron complicaciones (15,2%).Conclusiones: Este estudio confirma que en los últimos 9 años ha ocurrido un cambio significativo en el tratamiento quirúrgico de los mucoceles de cavidades paranasales, con un aumento de la cirugía endoscópica de un 34% a más de un 90%, siendo la primera opción de tratamiento (AU)

Objective: The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. Methods: A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. Results: A total of 46 patients were included (27 males; 19 females). This series include 29patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). Conclusions: This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles (AU)

[Endoscopic management of paranasal sinus mucoceles: experience with 46 patients]. / Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes.

OBJECTIVE: The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. METHODS: A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. RESULTS: A total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). CONCLUSIONS: This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.

Paranasal sinuses computed tomography in the initial evaluation of patients with suspected invasive fungal rhinosinusitis.

Invasive fungal rhinosinusitis (IFR) is a complication that presents mainly in immunocompromised patients. Paranasal sinuses computed tomography (PCT) is frequently obtained during initial evaluation of suspected cases. The objective of the study was to determine the imaging findings that suggest IFR in patients with hematological malignancies. In the retrospective case/control study, we included 14 patients with hematological malignancies that developed IFR in the Hospital Clínico de la Pontificia Universidad Católica de Chile between January 2005 and June 2009. Twenty patients with hematological malignancies, with suspected sinonasal infectious involvement requiring a PCT for initial evaluation, were chosen as the control group. Thirteen imaging parameters were compared between both groups. Osseous erosion and facial soft tissue thickening were statistically associated with the presence of IFR (p < 0.05). The presence of osseous erosion, facial soft tissue thickening, extrasinus extension or unilateral involvement had a positive predictive value of 100%, with an incidence among the total group of 12, 15, 9 and 9%, respectively. No patients with IFR had a normal PCT. Most PCTs in the initial evaluation of suspected IFR had nonspecific findings. The clinician must have a high index of suspicion and complement the workup with other diagnostic techniques to initiate appropriate treatment.

[Cross sectional search for skin lesions in 118 diabetic patients]. / Manifestaciones cutáneas de diabetes mellitus.

BACKGROUND: Thirty percent of patients with diabetes mellitus have some skin lesion that is directly related to the disease or caused by infections, complications or treatments used. AIM: To determine the frequency and type of skin lesions in diabetic patients. MATERIAL AND METHODS: Cross sectional examination of 26 patients with type 1 diabetes, 75 patients with type 2 diabetes and 17 patients with gestational diabetes. A complete skin physical examination and a direct mycological examination and culture when Onychomycosis was suspected, were performed. RESULTS: In 56% of patients, diabetes lasted more than 10 years and 52% had some complication of the disease. A mean of 1.4+/-0.1 skin lesions per patient was found among subjects with type 1 or 2 diabetes. No skin lesion was found in patients with gestational diabetes. The lesions found were Onychomycosis in 27%, diabetic dermatopathy in 17%, macroangiopathy in 15%, tine a corporis in 14% and neurosis in 14%. CONCLUSIONS: Onychomycosis is the most commonly found skin lesion in diabetic patient.

Manifestaciones cutáneas de diabetes mellitus / Cross sectional search for skin lesions in 118 diabetic patients

Background: Thirty percent of patients with diabetes mellitus have some skin lesion that is directly related to the disease or caused by infections, complications or treatments used. Aim: To determine the frequency and type of skin lesions in diabetic patients. Material and methods: Cross sectional examination of 26 patients with type 1 diabetes, 75 patients with type 2 diabetes and 17 patients with gestational diabetes. A complete skin physical examination and a direct mycological examination and culture when Onychomycosis was suspected, were performed. Results: In 56 percent of patients, diabetes lasted more than 10 years and 52 percent had some complication of the disease. A mean of 1.4±0.1 skin lesions per patient was found among subjects with type 1 or 2 diabetes. No skin lesion was found in patients with gestational diabetes. The lesions found were Onychomycosis in 27 percent, diabetic dermatopathy in 17 percent, macroangiopathy in 15 percent, tine a corporis in 14 percent and neurosis in 14 percent. Conclusions: Onychomycosis is the most commonly found skin lesion in diabetic patient.

[Results of laparoscopic surgery for the treatment of diverticular disease of the colon]. / Resultados de la cirugía laparoscópica en el tratamiento electivo de la enfermedad diverticular de colon.

BACKGROUND: The laparoscopic approach is an alternative for the elective treatment of diverticular colon disease (DCD). AIM: To analyze the results of patients electively operated for DCD using a laparoscopic technique. MATERIAL AND METHODS: Data of patients with DCD operated using laparoscopy at the Catholic University of Chile Clinical Hospital were prospectively recorded from January 1999 to August 2006. Indications for surgery were repetitive crises of acute diverticulitis, the persistence of the symptoms or anatomic deformity after the first crisis and complicated diverticulitis (Hinchey 1-2) that responded to the medical treatment. The laparoscopic technique used five ports and the surgical specimen was extracted through a suprapubic approach. RESULTS: One hundred and six patients aged 32 to 82 years (49% females) were operated in the study period. Fifty five percent had a previous abdominal surgery. The mean operative time was 213 minutes (range: 135-360). Four patients were converted to open surgery (3.7%). One or more early post-operative complications were observed in five patients (4.7%). The mean time for passing gases and reinitiate liquid diet was 1.7 and 2.4 days respectively. The median post operative stay after surgery was 4 days. There was no operative mortality. Mean follow-up time was 27 months and only one patient (0.9%) had a new episode of acute diverticular disease, with a satisfactory response to medical treatment. No patient has developed bowel obstruction. CONCLUSIONS: The laparoscopic approach is a safe alternative in the elective surgical treatment of DCD.

Resultados de la cirugía laparoscópica en el tratamiento electivo de la enfermedad diverticular de colon / Results of laparoscopic surgery for the treatment of diverticular disease of the colon

The laparoscopic approach is an alternative for the elective treatment of diverticular colon disease (DCD). Aim: To analyze the results of patients electively operated for DCD using a laparoscopic technique. Material and Methods: Data of patients with DCD operated using laparoscopy at the Catholic University of Chile Clinical Hospital were prospectively recorded from January 1999 to August 2006. Indications for surgery were repetitive crises of acute diverticulitis, the persistence of the symptoms or anatomic deformity after the first crisis and complicated diverticulitis (Hinchey 1-2) that responded to the medical treatment. The laparoscopic technique used five ports and the surgical specimen was extracted through a suprapubic approach. Results: One hundred and six patients aged 32 to 82 years (49 percent females) were operated in the study period. Fifty five percent had a previous abdominal surgery. The mean operative time was 213 minutes (range: 135-360). Four patients were converted to open surgery (3.7 percent). One or more early post-operative complications were observed in five patients (4.7 percent). The mean time for passing gases and reinitiate liquid diet was 1.7 and 2.4 days respectively. The median post operative stay after surgery was 4 days. There was no operative mortality. Mean follow-up time was 27 months and only one patient (0.9 percent) had a new episode of acute diverticular disease, with a satisfactory response to medical treatment. No patient has developed bowel obstruction. Conclusions: The laparoscopic approach is a safe alternative in the elective surgical treatment of DCD.

Estudio y evaluación en niños con episodios recurrentes de rinosinusitis / Study and evaluation in children with recurrent rhinosinusitis

La Rinosinusitis (RS) es una patología frecuente en la población pediátrica. Anualmente un niño cursa aproximadamente 6 a 8 episodios de infecciones respiratorias altas de origen viral, de éstos, entre 5-13 por ciento se complican con una RS bacteriana. El diagnóstico del episodio agudo es esencialmente clínico. Se define RS recurrente a la presencia de 3 o más episodios de RS en 6 meses o 4 en un año con periodos libre de sintomatología entre los episodios. Estos niños requieren un manejo especial, basado en tratamiento antibiótico de segunda línea junto a la certificación con imágenes de la resolución del cuadro. Pasado el episodio agudo, es esencial realizar estudio de factores predisponentes, buscando causas potencialmente modificables, lo que conjuntamente con derivación oportuna al especialista determinará el manejo futuro.