Lesiones laringotraqueales traumáticas en niños: ¿cuándo operar? / Laryngotracheal traumatic injuries (LTI) in children: when to operate?

Introducción. Las lesiones laringotraqueales traumáticas pediátricas están asociadas a una importante morb-imortalidad. Aunque históricamente el tratamiento ha sido quirúrgico, en la actualidad el enfoque conservador ha adquirido una mayor importancia. Valoramos el tratamiento y las indicaciones quirúrgicas de los traumatismos laringotraqueales tratados en nuestro centro. Material y métodos. Análisis retrospectivo de pacientes con traumatismos laringotraqueales del 2007 al 2014. Resultados. Siete pacientes, mediana de edad 4 años (r: 2-15), 6 traumatismos cerrados y 1 abierto. El 71,4% presentaban dificultad respiratoria, dolor y enfisema subcutáneo. Cinco fueron intubados (3 en prehospitalaria y 2 en hospital). En todos ellos se realizó fibrobroncoscopia determinando la localización, la extensión de la lesión y la posibilidad de extubación. En dos de ellos se asoció esofagoscopia. Dos casos no presentaban clínica respiratoria y el enfisema no progresó por lo que se tomó una actitud expectante y no precisaron broncoscopia. El 71,4% se trataron conservadoramente, siendo el criterio de tratamiento conservador la no progresión del enfisema ni empeoramiento del estado respiratorio, independientemente del grado y localización de la lesión, con una tasa de éxito del 100%. Dos pacientes se intervinieron: una fístula tráqueo-esofágica producida por una quemadura (pila de botón) que requirió resección traqueal; y una sección traqueal abierta asociada a lesión vascular, ambas con correcta evolución posterior. Conclusiones. En caso de no progresión de la clínica respiratoria o del enfisema, e independientemente del grado y localización, las lesiones laringotraqueales pueden tratarse de manera conservadora con o sin intubación. Lesiones esofágicas asociadas y lesiones abiertas obligan a un abordaje quirúrgico. Un diagnóstico precoz minimiza la morbimortalidad

Introduction. Paediatric LTI is associated with significant morbidmortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution. Material and methods. Retrospective study of patients with LTI treated between 2007 and 2014. Results. Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma. Respiratory distress, pain and subcutaneous emphysema were presented in 71.4% of the patients. Five children were intubated (3 pre-hospital care and 2 after reaching the hospital), all of them underwent fibrobronchoscopy, determining the location, the extention, and assessing the possibility of extubation. Esophagoscopy was made in 2 cases. The remaining 2 cases were bounded to observation as they did not have respiratory symptoms or progressive emphysema, precluding bronchoscopy. Conservative management was followed in 71.4% of the patients, with a 100% success rate. Conservative management criteria were no progression of emphysema or respiratory distress, regardless the degree and location of the lesions. Two patients needed surgery: one tracheoesophageal fistula caused by a button battery, and the other was a tracheal open section associated with vascular injury. Both of them recovered uneventfully. Conclusions. If the respiratory symptoms or the emphysema do not progress, patients with LTI can be managed conservatively, regardless of size or location of the injury. Associated esophageal lesions and open injuries require surgical management. An early diagnosis is mandatory in order to minimize morbidity and mortality

[Laryngotracheal traumatic injuries (LTI) in children: when to operate?] / Lesiones laringotraqueales traumáticas en niños ¿cuándo operar?

INTRODUCTION: Paediatric LTI is associated with significant morbid-mortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution. MATERIAL AND METHODS: Retrospective study of patients with LTI treated between 2007 and 2014. RESULTS: Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma. Respiratory distress, pain and subcutaneous emphysema were presented in 71.4% of the patients. Five children were intubated (3 pre-hospital care and 2 after reaching the hospital), all of them underwent fibrobronchoscopy, determining the location, the extention, and assessing the possibility of extubation. Esophagoscopy was made in 2 cases. The remaining 2 cases were bounded to observation as they did not have respiratory symptoms or progressive emphysema, precluding bronchoscopy. Conservative management was followed in 71.4% of the patients, with a 100% success rate. Conservative management criteria were no progression of emphysema or respiratory distress, regardless the degree and location of the lesions. Two patients needed surgery: one tracheoesophageal fistula caused by a button battery, and the other was a tracheal open section associated with vascular injury. Both of them recovered uneventfully. CONCLUSIONS: If the respiratory symptoms or the emphysema do not progress, patients with LTI can be managed conservatively, regardless of size or location of the injury. Associated esophageal lesions and open injuries require surgical management. An early diagnosis is mandatory in order to minimize morbidity and mortality.

INTRODUCCION: Las lesiones laringotraqueales traumáticas pediátricas están asociadas a una importante morb-imortalidad. Aunque históricamente el tratamiento ha sido quirúrgico, en la actualidad el enfoque conservador ha adquirido una mayor importancia. Valoramos el tratamiento y las indicaciones quirúrgicas de los traumatismos laringotraqueales tratados en nuestro centro. MATERIAL Y METODOS: Análisis retrospectivo de pacientes con traumatismos laringotraqueales del 2007 al 2014. RESULTADOS: Siete pacientes, mediana de edad 4 años (r: 2-15), 6 traumatismos cerrados y 1 abierto. El 71,4% presentaban dificultad respiratoria, dolor y enfisema subcutáneo. Cinco fueron intubados (3 en prehospitalaria y 2 en hospital). En todos ellos se realizó fibrobroncoscopia determinando la localización, la extensión de la lesión y la posibilidad de extubación. En dos de ellos se asoció esofagoscopia. Dos casos no presentaban clínica respiratoria y el enfisema no progresó por lo que se tomó una actitud expectante y no precisaron broncoscopia. El 71,4% se trataron conservadoramente, siendo el criterio de tratamiento conservador la no progresión del enfisema ni empeoramiento del estado respiratorio, independientemente del grado y localización de la lesión, con una tasa de éxito del 100%. Dos pacientes se intervinieron: una fístula tráqueo-esofágica producida por una quemadura (pila de botón) que requirió resección traqueal; y una sección traqueal abierta asociada a lesión vascular, ambas con correcta evolución posterior. CONCLUSIONES: En caso de no progresión de la clínica respiratoria o del enfisema, e independientemente del grado y localización, las lesiones laringotraqueales pueden tratarse de manera conservadora con o sin intubación. Lesiones esofágicas asociadas y lesiones abiertas obligan a un abordaje quirúrgico. Un diagnóstico precoz minimiza la morbimortalidad.

¿Está indicado el tratamiento tópico en las otitis que cursan con otorrea en el niño? Aportación terapéutica de ciprofloxacina tópico / Is topical treatment indicated in otitis that occurs with otorrhea in the child? Therapeutic contribution of topical ciprofloxacin

La otorrea es un síntoma no un diagnóstico presente en distintas entidades clínicas. Existen diversas e importantes razones para considerar el abordaje tópico como una terapia útil en el tratamiento de la otorrea en el niño. La bajas concentraciones con las que son eficaces los agentes farmacológicos administrados por vía tópica, así como el bajo grado de reacciones adversas unido al bajo riesgo de complicaciones sistemáticas, son premisas lo suficientemente válidas para considerar el tratamiento tópico como una alternativa o complemento terapéutico altamente eficaz en distintas situaciones clínicas que cursan con otorrea. Los tratamientos tópicos incluyen habitualmente agentes antimicrobianos. Hay evidencia de que los aminoglucósidos tópicos pueden causar ototoxicidad. Los antimicrobianos noaminoglucósidos, especialmente las fluoroquinolonas, están recomendadas cuando hay que acceder a oído medio. Ciprofloxacina tópica ha demostrado su elevada eficacia terapéutica en otitis externa, otorrea persistente post otitis media aguada, otitis media crónica simple, profilaxis pre-timpanostomía y otorrea a través de tubos de ventilación transtimpánicos, todas ellas patologías de elevada prevalencia en la edad pediátrica (AU)

Otorrhea is a symptom present in different clinical conditions and not a diagnosis. There are several and important reasons to consider topical treatment as a useful therapy in the treatment of otorrhea in the child. The low concentrations needed for the pharmacological agents administered topically to be effective and the low grade of adverse events together with low risk of systemic complications are sufficiently valid premises to consider topical treatment as a higher effective alternative or therapeutic complement in different clinical conditions that occur with otorrhea. Topical treatments generally include antimicrobial agents. There is evidence that the topical aminoglycosides may cause ototoxicity. Non-aminoglycoside antimicrobial agents, especially fluoroquinolones, are recommended when it is necessary to access the middle ear. Topical ciprofloxacin has demonstrated its elevated therapeutic efficacy in external otitis, persistent otorrhea, post acute otitis media, simple chronic otitis media, pre-tympanostomy prophylaxis and otorrhea through transtympanic ventilationtubes, diseases with elevated prevalence in the pediatric age (AU)

Anatomical relationship between the position of the sigmoid sinus, tympanic membrane and digastric ridge with the mastoid segment of the facial nerve.

Our study was carried out to examine the relationships of the sigmoid sinus, tympanic membrane and digastric ridge with the mastoid segment of the facial nerve. We studied 33 adult temporal bones. The distances among these structures were evaluated according specific landmarks that can be repeated in a simple manner. We found a good relation, in a proportional and lineal order, between these three structures and the facial nerve. This study indicated a correlation between the position of these three structures and the mastoid segment of the facial nerve through a simple morphometric method.

Upregulation of COX-1 and COX-2 in nasal polyps in cystic fibrosis.

BACKGROUND: Since abnormalities in prostanoid metabolism occur in the lower airway of patients with cystic fibrosis (CF), it is likely that they could also be detected in the nose. METHODS: The degree of mRNA and protein expression of cyclo-oxygenase (COX) enzymes 1 (COX-1) and 2 (COX-2) was examined using quantitative reverse competitive polymerase chain reaction (RT-PCR) and Western blot analysis in the nasal polyps from 10 patients with CF, nasal polyps from 10 non-CF patients and 11 nasal mucosa specimens. The results are presented as 10(6) cDNA molecules/mug total RNA and the densitometric ratio between protein and beta-actin. RESULTS: COX-1 mRNA levels were significantly higher in CF nasal polyps (median 2.34, 25-75th percentiles 1.6-3.2) than in the nasal mucosa (0.78, 0.11-1.21), while there was no difference with non-CF nasal polyps (1.11, 0.80-3.15). COX-1 protein levels were significantly higher in CF nasal polyps (3.63, 2.71-4.27) than in nasal mucosa (1.55, 0.66-2.33) and non-CF nasal polyps (2.19, 1.72-3.68). COX-2 mRNA was significantly higher in CF nasal polyps (3.34, 2.42-7.05) than in nasal mucosa (1.69, 0.19-3.50). No differences were found in COX-2 mRNA expression between CF and non-CF polyps (1.38, 0.12-6.07). COX-2 protein levels were also significantly higher in CF nasal polyps (0.23, 0.04-0.34) than in non-CF nasal polyps (0.011, 0.009-0.016) or nasal mucosa (0.014, 0.014-0.016). CONCLUSIONS: Upregulation in the expression of COX-1 and COX-2 could explain the high production of prostanoids reported in CF. These findings raise questions regarding the potential use of selective or non-selective COX-2 non-steroidal anti-inflammatory treatment in CF.

[Stem cells for the treatment of hearing loss]. / Células madre en el tratamiento de la sordera.

One of the greatest challenges in the treatment of inner ear disorders is to find a cure for the hearing loss caused by the loss of cochlear hair cells or spiral ganglion neurons. The recent discovery of stem cells in the adult inner ear that are capable of differentiating into hair cells, as well as the finding that embryonic stem cells can be converted into hair cells, raise hope for the future development of stem-cell-based treatments.

Células madre en el tratamiento de la sordera / Stem cells for the treatment of hearing loss

Uno de los mayores retos en el tratamiento de las enfermedades del oído interno es conseguir un tratamiento para la sordera causada por pérdida de células ciliadas cocleares o de neuronas del ganglio espiral. El reciente descubrimiento de células madre (CM) en el oído interno adulto que son capaces de diferenciarse en células ciliadas, así como el hallazgo que las células madre embrionarias pueden convertirse en células ciliadas, han levantado esperanzas para el desarrollo futuro de tratamientos basados en células madre

One of the greatest challenges in the treatment of inner ear disorders is to find a cure for the hearing loss caused by the loss of cochlear hair cells or spiral ganglion neurons. The recent discovery of stem cells in the adult inner ear that are capable of differentiating into hair cells, as well as the finding that embryonic stem cells can be converted into hair cells, raise hope for the future development of stem-cell-based treatments

An alternative treatment for the reduction of tympanic membrane perforations: sodium hyaluronate. A double blind study.

Topical treatment with 1% sterile sodium hyaluronate solution applied on the tympanic perforation membrane has been suggested as an alternative to surgical treatment in one study only. To further investigate the effects of such a treatment, we designed a double blind study comparing topical administration of 1% sodium hyaluronate with that of 2% methylcellulose solution (placebo). After treatment the degree of perforation healing was evaluated and expressed in percentage of reduction area. The reduced area turned out to be significantly different in the group treated with sodium hyaluronate solution as compared to the placebo group. We believe that sodium hyaluronate is an alternative to myringoplasty for selected tympanic membrane perforations.

[Radiological contributions in perennial rhinitis]. / Aportaciones radiológicas en la rinitis perenne.

We considered over 500 cases of Perennial Rhinitis (PR). A radiologic study has been performed to determine mucosa alterations. The percentage of allergic PR is found to be of forty-eight percent. Radiologic alteration are found in 43% of non allergic PR. We considered also addition factors such as sex, age, occurrence of asthma and levels of IgE.