A single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in type 2 diabetes mellitus

Abstract

Aims

SGLT2 inhibitors are a new class of oral hypoglycemic agents used in type 2 diabetes (T2DM). Their effectiveness in maturity onset diabetes of the young (MODY) is unknown. We aimed to assess the response to a single dose of 10 mg dapagliflozin in patients with Hepatocyte Nuclear Factor 1 Alpha (HNF1A)-MODY, Glucokinase (GCK)-MODY, and type 2 diabetes.

Methods

We examined 14 HNF1A-MODY, 19 GCK-MODY, and 12 type 2 diabetes patients. All studied individuals received a single morning dose of 10 mg of dapagliflozin added to their current therapy of diabetes. To assess the response to dapagliflozin we analyzed change in urinary glucose to creatinine ratio and serum 1,5-Anhydroglucitol (1,5-AG) level.

Results

There were only four patients with positive urine glucose before dapagliflozin administration (one with HNF1A-MODY, two with GCK-MODY, and one with T2DM), whereas after SGLT-2 inhibitor use, glycosuria occurred in all studied participants. Considerable changes in mean glucose to creatinine ratio after dapagliflozin administration were observed in all three groups (20.51 ± 12.08, 23.19 ± 8.10, and 9.84 ± 6.68 mmol/mmol for HNF1A-MODY, GCK-MODY, and T2DM, respectively, p < 0.001 for all comparisons). Post-hoc analysis revealed significant differences in mean glucose to creatinine ratio change between type 2 diabetes and each monogenic diabetes in response to dapagliflozin (p = 0.02, p = 0.003 for HNF1-A and GCK MODY, respectively), but not between the two MODY forms (p = 0.7231). Significant change in serum 1,5-AG was noticed only in T2DM and it was −6.57 ± 7.34 mg/ml (p = 0.04).

Conclusions

A single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in T2DM. Whether flozins are a valid therapeutic option in these forms of MODY requires long-term clinical studies.

http://ift.tt/2sCEuFg

Circulating anti-Müllerian hormone (AMH) associates with the maturity of boys’ drawings: Does AMH slow cognitive development in males?

Abstract

Purpose

High levels of circulating anti-Müllerian hormone are unique to developing males, but the function of anti-Müllerian hormone in boys is unknown. In mice, anti-Müllerian hormone contributes to the male biases in the brain, but its receptors are present throughout non-sexually dimorphic portions of the brain. In humans, the speed of maturation is the most overt difference between girls and boys. We postulate that this is because anti-Müllerian hormone slows the maturation of the male human brain.

Methods

One hundred and fourty three 5-year or 6-year-old boys and 38 age-matched girls drew a person and donated a blood sample. The children's drawings were blind-scored to generate a maturity index. The level of anti-Müllerian hormone and the other Sertoli cell hormone, inhibin B, were measured by ELISA. The relationship between the children's age, hormones and maturity index were examined by linear regression analysis.

Results

The girls drew more complex and realistic person than the boys (32%, p = 0.001), with their drawings also being larger (39%, p = 0.037) and more coloured-in (235%, p = 0.0005). The maturity index in boys correlated with age (+r = 0.43, p < 0.0005) and anti-Müllerian hormone level (−r = −0.29, p < 0.0005). The association between maturity index and anti-Müllerian hormone level persisted when corrected for age and for inhibin B (r = −0.24, p = 0.0005). The calculated effect of the median level of anti-Müllerian hormone (1 nM) was equal to 0.81 months of development. The size and colouring of the drawings did not correlate with the boys' age, anti-Müllerian hormone or inhibin B.

Conclusions

This exploratory study provides the first indicative evidence that circulating anti-Müllerian hormone may influence the development of the human brain.

http://ift.tt/2sBUXt5

Introduction to Special Issue “Redox regulation of cardiovascular signaling in health and disease”

Publication date: August 2017
Source:Free Radical Biology and Medicine, Volume 109
Author(s): Santiago Lamas, Thomas Michel




http://ift.tt/2s37gl7

Identification of a flavonoid C-glycoside as potent antioxidant

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Lingrong Wen, Yupeng Zhao, Yueming Jiang, Limei Yu, Xiaofang Zeng, Jiali Yang, Miaomiao Tian, Huiling Liu, Bao Yang
Flavonoids have been documented to have good antioxidant activities in vitro. However, reports on the cellular antioxidant activities of flavonoid C-glycosides are very limited. In this work, an apigenin C-glycoside was purified from Artocarpus heterophyllus by column chromatography and was identified to be 2″-O-β-D-xylosylvitexin by nuclear magnetic resonance spectroscopy. The cellular antioxidant activity and anticancer activity of 2″-O-β-D-xylosylvitexin were evaluated for the first time. The quantitative structure-activity relationship was analysed by molecular modeling. Apigenin presented an unexpected cellular antioxidation behaviour. It had an antioxidant activity at low concentration and a prooxidant activity at high concentration, whereas 2″-O-β-D-xylosylvitexin showed a dose-dependent cellular antioxidant activity. It indicated that C-glycosidation improved the cellular antioxidation performance of apigenin and eliminated the prooxidant effect. The ortho-dihydroxyl at C-3′/C-4′ and C-3 hydroxyl in the flavonoid skeleton play important roles in the antioxidation behaviour. The cell proliferation assay revealed a low cytotoxicity of 2″-O-β-D-xylosylvitexin.

Graphical abstract

http://ift.tt/2sCjONs

Editorial Board

Publication date: August 2017
Source:Free Radical Biology and Medicine, Volume 109





http://ift.tt/2sBWcsf

EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

http://ift.tt/2rTvaik

Announcements

Dear Colleagues,

http://ift.tt/2sRdWPO

Editorial Board

http://ift.tt/2rTv9uO

Reconstruction of the composite defect after extended abdominoperineal resection (eAPR): a clinical experience from Italy

Abstract

Background

Abdominalperineal resection (APR) represents the gold standard for lower third of rectum and anal cancer; after this wide excision, it results a large non-collapsible dead space that tends to collect fluid, increasing the risk of infection and wound dehiscence. Moreover, APR is associated to neoadjuvant/adjuvant radiation therapy with further risk of local complications. In this background, flap reconstruction after APR o eAPR represents the best strategy for minimizing tension in skin closure, providing healthy well vascularized and restoring a good functional local anatomy.

Methods

A retrospective study was performed at the Department of Plastic Reconstructive and Aesthetic Surgery at the University Hospital Città della Salute e della Scienza of Turin from March 2013 to November 2016: 11 patients were included in the study: 5 men and 6 women aged 53 to 76 years (mean ± SD age: 66 ± 7 years). All of them received eAPR (extended-APR). Seven patients required a total dose of 20Gy as neoadjuvant radiotherapy treatment and 6 patients needed adjunctive chemotherapy treatment. Skin defects size ranged from 56 to 180 cm2 (mean 114 ± 38 cm2). Skin defect less than 5 cm of maximum width was not included in the study because no major reconstructions were needed. Surgical reconstruction was planned depending on sacrectomy eventually associated to eAPR and defect size too. Planned follow-up was carried out at 1, 3, and 6 months recording clinical data, local and systemic complications, and pain evaluation at sitting position and during normal walking activity.

Results

Wound healing was achieved in all patients within a period of 21 days. Only one patient showed partial flap necrosis and required wound surgical revision with simple skin closure. Another one patient suffered from mild venous congestion and partial flap necrosis was observed: a period of 2 weeks of negative pressure wound therapy and dressing led to complete healing of the defect (both these patients received 20Gy neoadjuvant radiotherapy). Esthetic pleasant results, high patient satisfaction, and no significant motor impairment were recorded among all patients, excepting for just one patient who reports mild walking impairment and pain at sitting position, after the 6th month follow-up. None of the patient referred significant life quality impairment and all of them expressed general high satisfaction concerning reconstructive expectations.

Conclusions

Many flaps can be harvested to fill and close the large defect after eAPR, with respectively advantages and disadvantages, but we found the use composite gluteal flap technique suitable for most of the patients undergoing eAPR, with good functional results and low rates of morbidity and complications.

Level of Evidence: Level IV, therapeutic study.

http://ift.tt/2s2BDrR

A single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in type 2 diabetes mellitus

Abstract

Aims

SGLT2 inhibitors are a new class of oral hypoglycemic agents used in type 2 diabetes (T2DM). Their effectiveness in maturity onset diabetes of the young (MODY) is unknown. We aimed to assess the response to a single dose of 10 mg dapagliflozin in patients with Hepatocyte Nuclear Factor 1 Alpha (HNF1A)-MODY, Glucokinase (GCK)-MODY, and type 2 diabetes.

Methods

We examined 14 HNF1A-MODY, 19 GCK-MODY, and 12 type 2 diabetes patients. All studied individuals received a single morning dose of 10 mg of dapagliflozin added to their current therapy of diabetes. To assess the response to dapagliflozin we analyzed change in urinary glucose to creatinine ratio and serum 1,5-Anhydroglucitol (1,5-AG) level.

Results

There were only four patients with positive urine glucose before dapagliflozin administration (one with HNF1A-MODY, two with GCK-MODY, and one with T2DM), whereas after SGLT-2 inhibitor use, glycosuria occurred in all studied participants. Considerable changes in mean glucose to creatinine ratio after dapagliflozin administration were observed in all three groups (20.51 ± 12.08, 23.19 ± 8.10, and 9.84 ± 6.68 mmol/mmol for HNF1A-MODY, GCK-MODY, and T2DM, respectively, p < 0.001 for all comparisons). Post-hoc analysis revealed significant differences in mean glucose to creatinine ratio change between type 2 diabetes and each monogenic diabetes in response to dapagliflozin (p = 0.02, p = 0.003 for HNF1-A and GCK MODY, respectively), but not between the two MODY forms (p = 0.7231). Significant change in serum 1,5-AG was noticed only in T2DM and it was −6.57 ± 7.34 mg/ml (p = 0.04).

Conclusions

A single dose of dapagliflozin, an SGLT-2 inhibitor, induces higher glycosuria in GCK- and HNF1A-MODY than in T2DM. Whether flozins are a valid therapeutic option in these forms of MODY requires long-term clinical studies.

http://ift.tt/2sCEuFg

Circulating anti-Müllerian hormone (AMH) associates with the maturity of boys’ drawings: Does AMH slow cognitive development in males?

Abstract

Purpose

High levels of circulating anti-Müllerian hormone are unique to developing males, but the function of anti-Müllerian hormone in boys is unknown. In mice, anti-Müllerian hormone contributes to the male biases in the brain, but its receptors are present throughout non-sexually dimorphic portions of the brain. In humans, the speed of maturation is the most overt difference between girls and boys. We postulate that this is because anti-Müllerian hormone slows the maturation of the male human brain.

Methods

One hundred and fourty three 5-year or 6-year-old boys and 38 age-matched girls drew a person and donated a blood sample. The children's drawings were blind-scored to generate a maturity index. The level of anti-Müllerian hormone and the other Sertoli cell hormone, inhibin B, were measured by ELISA. The relationship between the children's age, hormones and maturity index were examined by linear regression analysis.

Results

The girls drew more complex and realistic person than the boys (32%, p = 0.001), with their drawings also being larger (39%, p = 0.037) and more coloured-in (235%, p = 0.0005). The maturity index in boys correlated with age (+r = 0.43, p < 0.0005) and anti-Müllerian hormone level (−r = −0.29, p < 0.0005). The association between maturity index and anti-Müllerian hormone level persisted when corrected for age and for inhibin B (r = −0.24, p = 0.0005). The calculated effect of the median level of anti-Müllerian hormone (1 nM) was equal to 0.81 months of development. The size and colouring of the drawings did not correlate with the boys' age, anti-Müllerian hormone or inhibin B.

Conclusions

This exploratory study provides the first indicative evidence that circulating anti-Müllerian hormone may influence the development of the human brain.

http://ift.tt/2sBUXt5

Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control

Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control

Wed, 07 Jun 2017 05:57:03 +0000

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Emergency front-of-neck access: scalpel or cannula

,The parable of Buridan's ass

Wed, 07 Jun 2017 05:46:05 +0000

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Intensity fading MALDI-TOF mass spectrometry and functional proteomics assignments to identify protease inhibitors in marine invertebrates

Publication date: Available online 6 June 2017
Source:Journal of Proteomics
Author(s): Giovanni Covaleda, Sebastian A. Trejo, Emir Salas-Sarduy, Maday Alonso del Rivero, Maria Angeles Chavez, Francesc X. Aviles
Proteases and their inhibitors have become molecules of increasing fundamental and applicative value. Here we report an integrated strategy to identify and analyze such inhibitors from Caribbean marine invertebrates extracts by a fast and sensitive functional proteomics-like approach. The strategy works in three steps: i) multiplexed enzymatic inhibition kinetic assays, ii) Intensity Fading MALDI-TOF MS to establish a link between inhibitory molecules and the related MALDI signal(s) detected in the extract(s), and iii) ISD-CID-T³ MS fragmentation on the parent MALDI signals selected in the previous step, enabling the partial or total top-down sequencing of the molecules. The present study has allowed validation of the whole approach, identification of a substantial number of novel protein protease inhibitors, as well as full or partial sequencing of reference molecular species and of many unknown ones, respectively. Such inhibitors correspond to six protease subfamilies (metallocarboxypeptidases-A and -B, pepsin, papain, trypsin and subtilisin), are small (1–10KDa) disulfide-rich proteins, and have been found at diverse frequencies among the invertebrates (13 to 41%). The overall procedure could be tailored to other enzyme-inhibitor and protein interacting systems, analyzing samples at medium-throughput level and leading to the functional and structural characterization of proteinaceous ligands from complex biological extracts.SignificanceInvertebrate animals, and marine ones among, display a remarkable diversity of species and contained biomolecules. Many of their proteins-peptides have high biological, biotechnological and biomedical potential interest but, because of the lack of sequenced genomes behind, their structural and functional characterization constitutes a great challenge. Here, looking at the small, disulfide-rich, proteinaceous inhibitors of proteases found in them, it is shown that such problem can be significatively facilitated by integrative multiplexed enzymatic assays, affinity-based Intensity-Fading (IF-) MALDI-TOF mass spectrometry (MS), and on-line MS fragmentation, in a fast and easy approach.

Graphical abstract

http://ift.tt/2s2xMuW

The combination of DEX and OND should be recommended in children with a high risk of POV.......Dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) FOR Children undergoing elective surgery under general anaesthesia and considered at high risk for postoperative vomiting (POV)

The combination of DEX and OND should be recommended in children with a high risk of POV.........................................................................................................Dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) FOR Children undergoing elective surgery under general anaesthesia and considered at high risk for postoperative vomiting (POV)

Wed, 07 Jun 2017 05:34:26 +0000

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Psychological Outcomes of Labiaplasty: A Prospective Study.

No abstract available

http://ift.tt/2r3OLIf

Comment to "Evidence-Based Medicine: A Graded Approach to Lower Lid Blepharoplasty".

No abstract available

http://ift.tt/2ryMUPi

Revision Buttock Implantation: Indications, Procedures, and Recommendations.

No abstract available

http://ift.tt/2r3DLec

Response to "Psychological Outcomes of Labiaplasty: A Prospective Study".

No abstract available

http://ift.tt/2rzbujf

Reply to Comment to "A Graded Approach to Lower Lid Blepharoplasty".

No abstract available

http://ift.tt/2r3Cpjq

Tissue Sample Collection From Patients With Head and Neck Cancer and From Healthy Participants

Condition:   Head and Neck Cancer
Interventions:   Other: biologic sample preservation procedure;   Other: medical chart review
Sponsors:   Vanderbilt University Medical Center;   National Cancer Institute (NCI)
Recruiting - verified June 2017

http://ift.tt/2rKjTyz

Tissue Sample Collection From Patients With Head and Neck Cancer and From Healthy Participants

Condition:   Head and Neck Cancer
Interventions:   Other: biologic sample preservation procedure;   Other: medical chart review
Sponsors:   Vanderbilt University Medical Center;   National Cancer Institute (NCI)
Recruiting - verified June 2017

http://ift.tt/2rKjTyz

Bilateral silent sinus syndrome: A rare case and review of literature

http://ift.tt/2seQ6R9

Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis

http://ift.tt/2qVf1W3

Complete response of skull base inverted papilloma to chemotherapy: Case report

http://ift.tt/2sewdK7

Differential diagnosis and proper treatment of acute rhinosinusitis: Guidance based on historical data analysis

http://ift.tt/2qVczin

Diagnosing environmental allergies: Comparison of skin-prick, intradermal, and serum specific immunoglobulin E testing

http://ift.tt/2semjYW

Landmarks for rapid localization of the sphenopalatine foramen: A radiographic morphometric analysis

http://ift.tt/2qVj98D

Differential expression of microRNAs and their possible roles in patients with chronic idiopathic urticaria and active hives

http://ift.tt/2seSEPg

Utility of intraoperative flexible endoscopy in frontal sinus surgery

http://ift.tt/2qVmHI4

Effect of topical beclomethasone on inflammatory markers in adults with eosinophilic esophagitis: A pilot study

http://ift.tt/2sehxLa

Myxofibrosarcoma of the maxillary sinus

http://ift.tt/2qVr0D0

Surgery-first approach in orthognathic surgery: psychological and biological aspects - a prospective cohort study

The aim of this pilot study was to investigate psychological and biological changes after application of a surgery-first orthognathic treatment approach.

http://ift.tt/2rSULb0

Achieved chin position after genioplasty follows the planned horizontal change better than the planned vertical change

The soft-tissue pogonion closely follows changes of the bony pogonion, but it is unknown how often an augmented bony pogonion reaches the intended position. Here we assessed the agreement between planned surgical changes and achieved results in chin surgery.

http://ift.tt/2sR7Fng

Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: „A preliminary report"

The purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF).

http://ift.tt/2sRczAu

Chemical Template-assisted Synthesis of Monodisperse Rattle-type Fe3O4@C Hollow Microspheres as Drug Carrier

Publication date: Available online 6 June 2017
Source:Acta Biomaterialia
Author(s): Lin Cheng, Weimin Ruan, Bingfang Zou, Yuanyuan Liu, Yongqiang Wang
A chemical template strategy was put forward to synthesize monodisperse rattle-type magnetic carbon (Fe3O4@C) hollow microspheres. During the synthesis procedure, monodisperse Fe2O3 microspheres were used as chemical template, which released Fe³⁺ ions in acidic solution and initiated the in-situ polymerization of pyrrole into polypyrrole (PPy) shell. With the continual acidic etching of Fe2O3 microspheres, rattle-type Fe2O3@PPy microspheres were generated with the cavity appearing between the PPy shell and left Fe2O3 core, which were then transformed into Fe3O4@C hollow microspheres through calcination in nitrogen atmosphere. Compared with traditional physical template, the shell and cavity of rattle-type hollow microspheres were generated in one step by using the chemical template method, which obviously saved the complex procedures including the coating and removal of middle shells. The experimental results exhibited that the rattle-type Fe3O4@C hollow microspheres with different parameters could be regulated through controlled synthesis of the intermediate Fe2O3@PPy product. Moreover, when the rattle-type Fe3O4@C hollow microspheres were investigated as drug carrier, they manifested sustained-release behaviour of doxorubicin, justifying their promising applications as carriers in drug delivery.Statement of SignificanceThe aim of the present study was first to synthesize rattle-type Fe3O4@C hollow microspheres through a simple synthesis method as a drug carrier. Here a chemical template synthesis of rattle-type hollow microspheres were developed, which saved the complex procedures including the coating and removal of middle shells in traditional physical template. Second, all the influence factors in the reaction processs was systematically investigated to obtain rattle-type Fe3O4@C hollow microspheres with controlled parameters. Third, the rattle-type Fe3O4@C hollow microspheres with controlled parameters were used as durg carriers and investigated for the influence on drug loading and releasing performance.

Graphical abstract

http://ift.tt/2qV5A9j

A quality study of family-centered care coordination to improve care for children undergoing tracheostomy and the quality of life for their caregivers

Approximately 4,000 U.S. children undergo tracheostomy yearly,1 and these surgeries often result in hospital re-admissions that have definite cost and caregiver burdens due to complications that are avoidable with proper training and support.

http://ift.tt/2s2s8cb

Bilateral silent sinus syndrome: A rare case and review of literature

http://ift.tt/2seQ6R9

Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis

http://ift.tt/2qVf1W3

Complete response of skull base inverted papilloma to chemotherapy: Case report

http://ift.tt/2sewdK7

Differential diagnosis and proper treatment of acute rhinosinusitis: Guidance based on historical data analysis

http://ift.tt/2qVczin

Diagnosing environmental allergies: Comparison of skin-prick, intradermal, and serum specific immunoglobulin E testing

http://ift.tt/2semjYW

Landmarks for rapid localization of the sphenopalatine foramen: A radiographic morphometric analysis

http://ift.tt/2qVj98D

Differential expression of microRNAs and their possible roles in patients with chronic idiopathic urticaria and active hives

http://ift.tt/2seSEPg

Utility of intraoperative flexible endoscopy in frontal sinus surgery

http://ift.tt/2qVmHI4

Effect of topical beclomethasone on inflammatory markers in adults with eosinophilic esophagitis: A pilot study

http://ift.tt/2sehxLa

Myxofibrosarcoma of the maxillary sinus

http://ift.tt/2qVr0D0

Colorectal cancer metastatic disease progression in Australia: A population-based analysis

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Qingwei Luo, Dianne L. O'Connell, Clare Kahn, Xue Qin Yu
BackgroundNo previous Australian population-based studies have described or quantified the progression of colorectal cancer (CRC) to metastatic disease. We describe patterns of progression to metastatic disease for an Australian cohort diagnosed with localised or regional CRC.MethodsAll localised and regional CRC cases in the New South Wales Cancer Registry diagnosed during 2000–2007 were followed to December 2011 for subsequent metastases (identified by subsequent disease episode notifications) or CRC death. Cox regression was used to identify factors associated with metastatic progression.ResultsAfter a median 5.3 years follow-up, 26.4% of the 12757 cases initially diagnosed with localised or regional colon cancer had developed metastatic disease, as had 29.5% of the 7154 rectal cancer cases. For both cancer sites, risk of metastatic progression was significantly higher for those initially diagnosed with regional disease (adjusted hazard ratio [aHR] 3.49 for colon, 2.66 for rectal cancer), and for older cases (e.g. aHR for >79years vs <60years: 1.38 for colon, 1.69 for rectal cancer). Risk of disease progression was significantly lower for females, and varied by histology type. For colon cancer, the risk of disease progression decreased over time. For rectal cancer, risk of metastatic progression was significantly higher for those living in more socioeconomically disadvantaged areas compared with those in the least disadvantaged area.ConclusionsAn understanding of the variation in risk of metastatic progression is useful for planning health service requirements, and can help inform decisions about treatment and follow-up for colorectal cancer patients.



http://ift.tt/2qZLn61

Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

The aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA).

http://ift.tt/2rJQyEt

Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery

The aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA).

http://ift.tt/2rJQyEt

Non-invasive papillary urothelial carcinoma of the vagina: molecular analysis of a rare case identifies clonal relationship to non-invasive urothelial carcinoma of the bladder

Abstract

We present a rare case of non-invasive papillary urothelial carcinoma of the vagina as the initial presentation of a multicentric urothelial carcinoma also involving bladder and renal pelvis and report for the first time in the literature the molecular alterations observed in the vaginal urothelial lesion and the synchronous lesions of the urinary tract. In this case, the non-invasive papillary urothelial carcinoma in the vagina displayed the same genetic alterations in the FGFR3 and PIK3CA genes as those seen in the non-invasive papillary urothelial carcinoma of the bladder contrasting with the wild phenotype observed in the invasive urothelial carcinoma of the renal pelvis. This observation could reinforce the theory of "seeding" of carcinoma cells as a valid and most likely explanation of this multifocality. In addition, we emphasize in this report the importance of recognizing this rare lesion in the female genital tract and its differential diagnosis.

http://ift.tt/2s2azZQ

Episodic acidification of 5 rivers in Canada's oil sands during snowmelt: A 25-year record

Publication date: 1 December 2017
Source:Science of The Total Environment, Volumes 599–600
Author(s): A.C. Alexander, P.A. Chambers, D.S. Jeffries
Episodic acidification during snowmelt is a natural phenomenon that can be intensified by acidic deposition from heavy industry. In Canada's oil sands region, acid deposition is estimated to be as much as 5% of the Canadian total and large tracks of northeastern Alberta are considered acid-sensitive because of extensive peatland habitats with poorly weathered soils. To identify the frequency, duration and severity of acidification episodes during snowmelt (the predominant hydrological period for delivery of priority pollutants from atmospheric oil sands emissions to surface waters), a 25-year record (1989 to 2014) of automated water quality data (pH, temperature, conductivity) was assembled for 3 rivers along with a shorter record (2012–2014) for another 2 rivers. Acidic episodes (pH<7, ANC<0) were recorded during 39% of all 83 snowmelt events. The severity (duration x magnitude) of episodic acidification increased exponentially over the study period (r²=0.56, P<0.01) and was strongly correlated (P<0.01) with increasing maximum air temperature and weakly correlated with regional land development (P=0.06). Concentrations of aluminum and 11 priority pollutants (Sb, As, Be, Cd, Cr, Cu, Pb, Se, Ag, Tl and Zn) were greatest (P<0.01) during low (<6.5) pH episodes, particularly when coincident with high discharge, such that aluminum and copper concentrations were at times high enough to pose a risk to juvenile rainbow trout (Oncorhynchus mykiss). Although low pH (pH<6.5) was observed during only 8% of 32 acidification episodes, when present, low pH typically lasted 10days. Episodic surface water acidification during snowmelt, and its potential effects on aquatic biota, is therefore an important consideration in the design of long-term monitoring of these typically alkaline (pH=7.72±0.05) rivers.

Graphical abstract

http://ift.tt/2sR4sUx

A facile coordination-assisted method to fabricate a FRET-based fluorescent probe for ratiometric analysis with improved selectivity

Publication date: November 2017
Source:Sensors and Actuators B: Chemical, Volume 252
Author(s): Wenjing Wang, Yameng Li, Police Vishnuvardhn Reddy, Xuanjun Zhang, Daqiang Yuan
Here we report a facile coordination-assisted method to construct a FRET-based probe that shows ratiometric detection of metal ions with improved selectivity. Probe 2 exhibits good sensitivity and selectivity towards the Fe³⁺ and Al³⁺ over other cations in aqueous acetonitrile solution. Probe 1 can be formed in situ by a convenient addition of Salen-Zn complex, which can further discriminate the Fe³⁺ from Al³⁺ with different ratiometric fluorescence responses.



http://ift.tt/2rSMIuR

Spatial patterns and temporal trends of trace metal mass budgets in the western Adriatic sediments (Mediterranean Sea)

Publication date: 1 December 2017
Source:Science of The Total Environment, Volumes 599–600
Author(s): Marilia Lopes-Rocha, Leonardo Langone, Stefano Miserocchi, Patrizia Giordano, Roberta Guerra
Spatial patterns of major (Al, Fe and Ti) and trace metals (Cu, Cr, Mn, Ni, Pb and Zn) measured in surficial sediments collected within the Late-Holocene mud-wedge in the western Adriatic Sea were analyzed to elucidate their sources, transport and mass budgets. Distributions of sedimentary trace metals, their fluvial inputs and accumulation loads reveal along-shore transport towards the southern Adriatic. Pb and to a lower extent Zn accumulation loads over time decreased significantly since 1988 in the North Adriatic, consistently with the implementation of regulations in the Western Europe, whereas Zn accumulation in the Po River prodelta remained unchanged since 1995. The Po River fluvial inputs accounted for half of Cr, Ni, Pb and Zn of the fluvial inputs into the western Adriatic Sea, contributing for the delivery of important amounts of Cr and Ni into the sediments, probably related to the natural occurrence of ultramafic rocks in the North sector. Collectively, ~30% of trace metal fluvial inputs discharged into the North sector are exported to the Central and South sectors. The Po River acts as both a bypass and an accumulation zone. In contrast, trace metal accumulation in the Central sector far exceed trace metal fluvial inputs, which suggested that this area is a preferential sink for particle-reactive river-borne material from the North Adriatic. The North sector shows moderate enrichment of Zn and Pb mainly related to the Po River influence. The anthropogenic fraction of Pb shows a large drop of ~30% from the North sector southwards, whereas Zn proportions remain fairly the same up to the Central sector only decreasing in the South sector.

Graphical abstract

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Abordaje endoscópico endonasal puro de estesioneuroblastoma

Presentamos el caso de una mujer de 56 años con diagnóstico de estesioneuroblastoma Kadish C/Hyams II tratado con resección quirúrgica mediante un abordaje endoscópico endonasal puro y radioterapia adyuvante. Describimos el caso y discutimos sus aspectos relevantes.

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We report the case of a 56-year-old woman with diagnosis of esthesioneuroblastoma Kadish C/Hyams II treated with a purely endonasal endoscopic resection and adjuvant radiotherapy. We described the case and discuss its relevant aspects.

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Repercusiones de la roncopatía y respiración bucal en el crecimiento facial

Los trastornos respiratorios obstructivos del sueño corresponden a un amplio espectro de patologías que incluyen a los roncadores primarios, el síndrome de resistencia de vía aérea superior y al síndrome de apnea obstructiva del sueño (SAOS). Dentro de sus manifestaciones clínicas se encuentra la roncopatía y la respiración bucal, las cuales generan alteraciones en el crecimiento craneofacial del niño pudiendo ser la causa de un SAOS residual. El objetivo de esta revisión es analizar las alteraciones del crecimiento craneofacial en niños generadas por la roncopatía y respiración bucal.

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Obstructive sleep breathing disorders correspond to a broad spectrum of diseases that include primary snorers, upper airway resistance syndrome and obstructive sleep apnea syndrome (OSAS). Its clinical manifestations include snoring and mouth breathing, which generates alterations in the craniofacial growth of the child that may be the cause of a residual OSAS. The objective of this review is to analyze the alterations of craniofacial growth generated by snoring and mouth breathing in children.

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Hallazgo de arteria lusoria en el estudio de otitis media a repetición: A propósito de una observación pediátrica y revista breve de la literatura

Arteria Lusoria (AL) o arteria subclavia aberrante derecha es una malformación vascular rara. Es la más común de las malformaciones del arco aórtico. Fue descrita por primera vez por Hunalud en 1735. La etiología no está clarificada hasta hoy en día. AL puede formar parte de un cuadro sindrómico (síndrome de Down, síndrome de Edwards) o de una malformación cardiaca compleja. Es casi siempre asintomática, pero algunas veces puede revelarse por signos respiratorios o disfagia. Se elige habitualmente el tratamiento conservador. Les presentamos el caso de un niño de 2 años que presentó una AL revelada atipicamente por otitis media a repetición.

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Arteria Lusoria (AL) or aberrant right subclavian artery is a rare congenital aortic arch malformation. Hunauld described it for the first time in 1735.The cause is until now no totally clarified. Usually it is associated with chromosomal disorders such as Down's syndrome, Edwards's syndrome or appears in childhood with complexes cardiovascular abnormalities. Patients are frequently asymptomatic, but it may be revealed by respiratories symptoms or by a dysphagia. The treatment is generally conservative. We expose a case report about a child of 2 years old with AL diagnosed after several episodes of purulent otitis.

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Cáncer de laringe: Serie de casos en 6 años en el Complejo Asistencial Doctor Sótero del Río

Introducción: El cáncer de laringe es la segunda causa de muerte en otorrinolaringología. Su tratamiento en estadios avanzados es agresivo y controversial. Objetivo: Reportar los datos de pacientes atendidos en el Complejo Asistencial Doctor Sótero del Río entre los años 2005-2011. Material y método: Análisis retrospectivo descriptivo. Resultados: Total de 38 pacientes, 30 (79%) hombres, mediana de edad 66 años. Los principales motivos de consulta fueron dificultad respiratoria en 18 pacientes (47%) y disfonía en 14 (37%). Se realizó estudio y etapificación con nasofibroscopía y tomografía computarizada. El 71% se presentó en estadio avanzado, de ellos, el 30% recibió quimiorradioterapia exclusiva. La sobrevida global a 2 y 5 años fue de 56% y 42% respectivamente en estadio avanzado y de 100% y 71% respectivamente en estadio precoz. Discusión: El cáncer de laringe es una enfermedad con sobrevida baja a pesar de tratamientos agresivos. Se han planteado alternativas al tratamiento estándar como terapia conservadora con quimiorradioterapia exclusiva o microcirugía láser transoral. Conclusiones: La epidemiología del cáncer laríngeo se ha mantenido relativamente estable y la clasificación TNM sigue siendo fundamental para el tratamiento, especialmente en contexto de nuevas alternativas de manejo de cáncer avanzado. Se espera evaluar estas terapias.

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Introduction: Laryngeal cancer is the second cause of death in otolaryngology. Its treatment in advanced stage is aggressive and controversial. Aim: To report data from patients treated in Complejo Asistencial Doctor Sótero del Río in the period between 2005-2011. Material and method: Descriptive retrospective analysis. Results: 38 patients in total, 30 (79%) men, median age 66 years. The main symptoms were breathing difficulty in 18 patients (47%) and dysphonia in 14 (37%). Every patient completed study and disease staging with nasofibroscopy and computed tomography. 71% presented in advanced stage, among them, 30% received exclusive chemoradiotherapy. Overall survival for 2 and 5-year in advanced stage was 56% and 42% respectively; and 100% and 71% in early stage. Discussion: Advanced laryngeal cancer has low survival rate in spite of aggressive treatments. Alternatives to standard care have been proposed, such as conservative therapy with exclusive chemoradiotherapy or transoral laser microsurgery. Conclusions: Laryngeal cancer's epidemiology remains relatively unchanged and TNM classification still remains fundamental for treatment, specially in the context of new therapeutic alternatives for advanced cancer. Evaluation of these therapies is expected.

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Importancia de la epidemiología en cáncer laríngeo: Incidencia y mortalidad por carcinoma escamoso de laringe

Actualmente se realiza un diagnóstico anual de 650.000 nuevos casos de carcinoma escamoso de cabeza y cuello en el mundo, siendo el carcinoma escamoso de laringe una patología neoplásica que compete al otorrinolaringólogo. La incidencia mundial del cáncer escamoso de laringe se estima en 3,9 por cada 100.000 habitantes con una mortalidad general de 2,0 por cada 100.000 habitantes. En Chile el registro de cáncer se realiza en base a los cinco registros poblacionales de cáncer que existen. No se tienen datos exactos respecto a incidencia y mortalidad por carcinoma escamoso de laringe, siendo la estimación de la incidencia de 1,2 casos por cada 100.000 habitantes y la estimación de mortalidad ajustada por edad de 0,7 casos por cada 100.000 habitantes. Se han descrito diversos factores de riesgo ambientales y estilos de vida para este cáncer, por lo tanto, las estrategias de prevención primaria en salud son claves a la hora de generar un impacto en la incidencia del carcinoma escamoso de laringe.

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The annual diagnosis of head and neck squamous cell carcinoma is 650,000 new cases. The laryngeal carcinoma is a malignant disease that should include an otolaryngologist in its evaluation. The global incidence of laryngeal carcinoma is estimated at 3.9 per 100,000 inhabitants with an overall mortality rate of 2.0 per 100,000 inhabitants. In Chile the cancer registry is based on the five population cancer registries that exist. There is no accurate data on incidence and mortality from laryngeal carcinoma, being an estimated incidence of 1.2 cases per 100,000 inhabitants and an age-adjusted mortality of 0.7 cases per 100.00 inhabitants. There have been described various environmental risk factors and lifestyles for this cancer, therefore, primary prevention strategies are key to generate an impact on the incidence of larynx carcinoma.

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Cirugía hipofisiaria endoscópica transesfenoidal, con realización de colgajo nasoseptal: Evaluación del impacto de la técnica en la olfación. Serie de casos

Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.

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Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.

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Injerto costal para reconstrucción nasal: Experiencia de 6 años en el Hospital San Juan de Dios

Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.

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Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.

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Cirugía endoscópica nasosinusal y de base de cráneo asistida por navegación

Introducción: La cirugía guiada por imágenes corresponde a una herramienta quirúrgica que comienza a desarrollarse a mediados del siglo XX. En 1990 comienza a utilizarse en otorrinolaringología, siendo sus principales indicaciones la cirugía endoscópica de cavidades paranasales y la cirugía de base de cráneo anterior. Objetivo: Analizar y presentar el resultado del uso de cirugía guiada por imágenes en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile (HCUCH). Material y método: Se realizó un estudio retrospectivo incluyendo todos los casos de cirugía endoscópica nasosinusal y base de cráneo asistida por imágenes en HCUCH. La selección para usar la navegación se hizo en base a las recomendaciones de la Academia Americana de Otorrinolaringología. Resultados: De un total de 12 pacientes intervenidos con el uso de navegación, se obtuvo 100% de éxito quirúrgico con disminución de los síntomas y sin complicaciones intraoperatorias. Conclusión: La cirugía asistida por navegación en cavidades paranasales y base de cráneo, es una herramienta de suma utilidad en casos seleccionados que potencia las habilidades quirúrgicas del cirujano sin reemplazar sus conocimientos anatómicos. Otorga seguridad y precisión en cirugías que comprometen estructuras nobles como base de cráneo y órbita entre otros.

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Introduction: Image Guided Surgery is a surgical tool that develop in the mid-twentieth century. In 1990 it began to be used in otolaryngology, being its main indications endoscopic surgery of paranasal sinuses and anterior skull base. Aim: To analyze and present the result of image-guided surgery in patients undergoing surgery at the Hospital of the University of Chile. Material and method: A retrospective study included all cases of endoscopic sinus surgery and skull base imaging assisted at the Clinical Hospital of the University of Chile from August 2015 to August 2016. The choice to use the navigation was made in based on the recommendations of the American Academy of Otolaryngology, and analyzed case by case. Results: A total of 12 patients were operated using Navigation, achieving 100 % of surgical success with decreased symptoms and without intraoperative complications. Conclusion: Image Guided Surgery in paranasal sinuses and skull base is a tool very useful in selected cases where enhances the surgeon skills without replacing their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others. their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others.

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Estesioneuroblastoma o neuroblastoma olfatorio

Estesioneuroblastoma o también llamado neuroblastoma olfatorio es un tumor maligno infrecuente derivado del neuroepitelio olfatorio. La historia clínica de un paciente con un neuroblastoma olfatorio es muy inespecífica. Durante la última década, los métodos endoscópicos se han aplicado gradualmente para el tratamiento de tumores de la base del cráneo. El tratamiento puramente endoscópico endonasal del estesioneuroblastoma ha mostrado excelentes resultados de supervivencia con disminución de las complicaciones. Presentamos un paciente afectado por un neuroblastoma olfatorio tratado solo con cirugía endoscópica endonasal.

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Esthesioneuroblastoma or olfactory neuroblastoma is an uncommon malignant tumor arising from the olfactory neuroepithelium. The clinical symptoms of a patient with olfactory neuroblastoma are very inespecific. During the past decade, endoscopic approaches have been gradually applied in treating skull base tumors. The purely endoscopic endonasal surgery for esthesioneuroblastoma showed successful survival results with remarkably decreased complications. We reported a patient who suffered olfactory neuroblastoma treated with only endoscopic endonasal surgery.

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Editorial

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Tiroplastía de medialización con Gore-Tex®: Experiencia de 8 años en Hospital Clínico de la Universidad de Chile

Introducción: La parálisis de cuerda vocal causa disfonía y puede ser complicación posterior a ciertas cirugías. Existen diversos tratamientos, uno de ellos es la tiroplastía de medialización, procedimiento realizado con anestesia local, permitiendo un fino ajuste de la voz. Objetivo: Analizar la experiencia en tiroplastía de medialización con Gore-tex® en el Hospital Clínico de la Universidad de Chile entre los años 2008-2016. Material y método: Estudio descriptivo, retrospectivo, con revisión de fichas clínicas de los pacientes que fueron sometidos a tiroplastía de medialización. Para el análisis de los datos se utilizará la prueba Wilcoxon. Resultados: Se analizaron datos de 21 pacientes, correspondientes a 24 tiroplastías de medialización. La edad promedio fue 54,2 años, 13 parálisis fueron secundarias a cirugía y 8 idiopáticas. En 17 pacientes se obtuvo la encuesta VHI-10 en el pre y posoperatorio, con valores promedio de 33,2y 17,4 (p =0,0003). Cinco pacientes requirieron de algún procedimiento complementario, entre 4 y 22 meses poscirugía: inyección de grasa, de Radiesse y refuerzo con otra prótesis de Gore-teX®. Conclusión: La tiroplastía de medialización es excelente para tratar la parálisis de cuerda vocal unilateral no recuperada en forma espontánea, siendo la encuesta VHI-10 una buena herramienta para evaluar la calidad de la voz.

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Introduction: Vocal cord paralysis can cause hoarseness and coud be a complications to following certain surgeries. In its treatment, there are several alternatives, one of them is the medialization thyroplasty. This procedure, is performed under local anesthesia, allowing the fine-tune of the voice. Aim: To analyze the experience in Medialization Thyroplasty with Gore-tex in the Clinical Hospital of the University of Chile between 2008 and 2016. Material and method: Retrospective and descriptive, with the review of patient's clinical records who were treated with medialization thyroplasty. The data analysis is done using Wilcoxon test. Results: Data from 21 patients, corresponding to 24 medialization thyroplasty. The average age was 54.2 years old, 13 paralysis were secondary to surgeries and 8 were Idiopathic. In 17 patients it was posible to get the VHI-10 survey in the pre and postoperative, with an average value of 33.2 and 17.4 (p =0.0003). Five patients required some additional procedure, between 4 and 22 months post surgery: injection of fat, Radiesse and installation of a new Gore-tex prosthesis Conclusions: Medialization thyroplasty is an excellent method to treat paralysis of unilateral vocal cord in cases when is not recovered spontaneously, being the VHI-10 survey a good tool for assessing voice quality.

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Tumor condroide del cartílago tiroides: Reporte de un caso clínico y revisión de la literatura

Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.

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Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.

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Malformación arteriovenosa en cavidad oral: A propósito de un caso y revisión de la literatura

Las malformaciones arteriovenosas (malformaciones A-V) de alto flujo en la cavidad oral no son una patología frecuente, existen pocos datos publicados sobre su tratamiento y sigue siendo muy controvertido debido a la alta tasa de complicaciones vitales que conlleva y la alta tasa de recurrencia. El único tratamiento curativo es la resección radical, con las consecuencias no sólo vitales, sino también desfigurativas que supone. Presentamos un caso de malformación A-V congénita en región submandibular, suelo de boca derecho y lengua, que tras varios episodios de dolor y aumento de tamaño, sin realizar ninguna medida agresiva, en el último control se observa trombosis espontánea de la misma. En este caso, la evolución con un tratamiento expectante sin cirugía, ha sido la trombosis con mejoría clínica, sin presentar nuevo episodio de aumento de tamaño, ni sangrado doce meses después, a pesar de seguir con una lesión de gran tamaño en el suelo de la boca.

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he high-flow arteriovenous malformations (A-V malformations) in oral cavity are not a common disease, there are few published data on treatment and it remains highly controversial because of the high rate of vital complications and the high rate of recurrence. The only curative treatment is radical resection, with not only vital consequences but also the disfigurement involved. We present a case of congenital A-V malformation in right submandibular region, floor of the mouth and tongue. After several episodes of pain and enlargement, in the last control without any aggressive action, the lesion presented spontaneous thrombosis. In this case, despite following with a large lesion on the floor mouth, the evolution with an expectant non-surgical treatment has been the thrombosis with clinical improvement, without presenting new episode of enlargement, nor bleeding twelve months later.

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Dolor cervical atípico: Síndrome de Eagle

Presentamos el caso de un varón de 45 años con dolor cervical derecho muy localizado, característico y persistente. El estudio radiológico nos permitió diagnosticar claramente un síndrome de Eagle. Por lo anterior el paciente fue sometido a cirugía de extirpación de apófisis estiloides derecha. El paciente evolucionó sin mayores complicaciones ni incidencias, y obteniendo la resolución del cuadro.

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Here we introduce a 45-year-old man suffering from an intense, unique and permanent pain, located in his right neck. Radiology showed us signs leading to the diagnosis of Eagle Syndrome. Surgery of right Styloid apophysis removal, with no complications, letting the patient free of symptoms.

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Manejo del cáncer de cabeza y cuello: ¿Radioterapia a quién, cuándo y por qué?

Revisión del enfrentamiento del paciente con cáncer escamoso de la vía aerodigestiva superior, orientada a la radioterapia. Las principales alternativas de tratamiento para los pacientes con cáncer escamoso de cabeza y cuello son la cirugía y la radioterapia (RT). La planificación del tratamiento debe considerar el tumor primario y la diseminación linfática cervical. La enfermedad subclínica es significativa en este grupo de pacientes. Cuando ésta es mayor a 20%, la disección cervical electiva ha mostrado mejorar la sobrevida libre de enfermedad y la sobrevida global. La RT por Intensidad Modulada (IMRT) permite mayor protección de los tejidos vecinos. El fenómeno de repoblación acelerada implica que dosis insuficientes o períodos largos de interrupción traducen persistencia o recidiva tumoral. Por esta razón, la adyuvancia con RT debe iniciarse precozmente. Para esto, es fundamental una evaluación dental oportuna. Los efectos adversos de la RT se dividen en agudos y tardíos, pudiendo estos últimos presentarse meses o años posterior a la terapia. Los pacientes con indicación de RT deben ser derivados tempranamente y con previa evaluación dental. La IMRT es una excelente herramienta terapéutica cuando es correctamente indicada y aplicada. Los principales beneficios en relación a la cirugía son menor morbilidad y mejor costo-efectividad por lo que suele ser la terapia de elección en enfermedad localizada y una alternativa a la disección cervical electiva.

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Radiation therapy for squamous cell carcinoma of the upper aerodigestive tract: review of management. Head and neck cancer treatment includes several treatment options. Surgery and radiotherapy are the most important local treatments. When planning the local treatment, the choices for the primary tumor, and the lymphatic spread to the neck must be considered. Subclinical metastatic disease to the neck is present in about 20% of patients, and can be controlled equally with surgery or radiation therapy. In a randomized trial, elective neck dissection has been shown to improve disease-free, and overall survival when compared with observation and salvage. Intensity-modulated radiotherapy (IMRT) allows a better sparing of normal tissues in the neck, and less morbidity from the treatment. Accelerated repopulation is a main determinant of poor local control in patients treated with radiotherapy who undergo treatment interruptions or a delay in its start. Thus, adjuvant radiotherapy must begin as early as possible, within six weeks of resection. Irradiated patients are at significant risk of dental complications, even when IMRT is used. That makes mandatory a dental evaluation and treatment prior to radiotherapy. Adverse radiation effects can occur during treatment (early reactions), or months to years after completion (late reactions). Patients with indication of radiotherapy must be referred early, preferably after dental evaluation. IMRT is an excellent tool when correctly indicated and uses. Main benefits of elective neck irradiation are less morbidity and higher cosst-effectiveness, making it a very useful treatment alternative to elective neck dissection in patients with localized disease.

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Prevención, diagnóstico y manejo de lesiones laringotraqueales agudas y subagudas posintubación en pacientes pediátricos

Las lesiones laringotraqueales asociadas a intubación se deben principalmente a una técnica defectuosa y a daño por presión del tubo endotraqueal sobre la mucosa; además influyen características propias del paciente y de los cuidados de enfermería. Hasta el 40% de los pacientes pediátricos intubados pueden presentar alteraciones laríngeas inmediatas y hasta 30% tienen estridor o disnea posextubación. Si estos síntomas persisten por más de 3 días tendrían indicación de laringotraqueoscopía. Las lesiones más habituales son edema, úlceras y tejido de granulación. El edema puede producir obstrucción respiratoria aguda que puede manejarse con reintubación con tubos más pequeños y aplicación tópica de crema de corticoides con antibióticos. Las úlceras y granulaciones pueden evolucionar hacia secuelas cicatriciales que comprometen la fisiología laringotraqueal; las granulaciones exofíticas deben retirarse endoscópicamente. Aunque la incidencia de estenosis subglótica posintubación ha disminuido en las últimas décadas, situándose entre 2,7%y 4,2%, algunos estudios sugieren un subdiagnóstico debido a lesiones poco sintomáticas al alta. En el período cicatricial activo, estas estenosis pueden dilatarse para evitar llegar a una cirugía abierta. El manejo otorrinolaringológico de estos pacientes en etapas tempranas es fundamental para evitar secuelas cicatriciales irreversibles que requieren de cirugías complejas, con riesgo vital por obstrucción de la vía aérea.

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Intubation-associated laryngotracheal injuries are mainly caused by a defective technique and endotracheal tube pressure-induced mucosal damage; patient factors and nursing care are also important. Up to 40% of intubated pediatric patients may show immediate laryngeal alterations and up to 30% have post-extubation stridor or dyspnea. If these symptoms last for over 3 days, laryngotracheoscopy is indicated. Edema, ulcers and granulation tissue are the most usual lesions. Edema can lead to acute airway obstruction, and is managed by reintubation with a smaller tube and topical application of a corticosteroid and antibiotic cream. Ulcers and granulations can lead to scarring that compromise laryngotracheal physiology; exophytic granulations must be removed endoscopically. Although the incidence of post-intubation subglottic stenosis has diminished over the last decades to about2,7% to 4,2%, some studies suggest that there is a subdiagnosis because of oligosymptomatic lesions at the time of discharge. On the active scarring period, dilatation of the stenosis can be used to avoid open surgery. Early otorhinolaryngologic management of these patients is fundamental for avoiding irreversible cicatricial sequels that require complex surgeries, with life risk due to airway obstruction.

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Manejo del cáncer de cabeza y cuello: ¿Radioterapia a quién, cuándo y por qué?

Revisión del enfrentamiento del paciente con cáncer escamoso de la vía aerodigestiva superior, orientada a la radioterapia. Las principales alternativas de tratamiento para los pacientes con cáncer escamoso de cabeza y cuello son la cirugía y la radioterapia (RT). La planificación del tratamiento debe considerar el tumor primario y la diseminación linfática cervical. La enfermedad subclínica es significativa en este grupo de pacientes. Cuando ésta es mayor a 20%, la disección cervical electiva ha mostrado mejorar la sobrevida libre de enfermedad y la sobrevida global. La RT por Intensidad Modulada (IMRT) permite mayor protección de los tejidos vecinos. El fenómeno de repoblación acelerada implica que dosis insuficientes o períodos largos de interrupción traducen persistencia o recidiva tumoral. Por esta razón, la adyuvancia con RT debe iniciarse precozmente. Para esto, es fundamental una evaluación dental oportuna. Los efectos adversos de la RT se dividen en agudos y tardíos, pudiendo estos últimos presentarse meses o años posterior a la terapia. Los pacientes con indicación de RT deben ser derivados tempranamente y con previa evaluación dental. La IMRT es una excelente herramienta terapéutica cuando es correctamente indicada y aplicada. Los principales beneficios en relación a la cirugía son menor morbilidad y mejor costo-efectividad por lo que suele ser la terapia de elección en enfermedad localizada y una alternativa a la disección cervical electiva.

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Radiation therapy for squamous cell carcinoma of the upper aerodigestive tract: review of management. Head and neck cancer treatment includes several treatment options. Surgery and radiotherapy are the most important local treatments. When planning the local treatment, the choices for the primary tumor, and the lymphatic spread to the neck must be considered. Subclinical metastatic disease to the neck is present in about 20% of patients, and can be controlled equally with surgery or radiation therapy. In a randomized trial, elective neck dissection has been shown to improve disease-free, and overall survival when compared with observation and salvage. Intensity-modulated radiotherapy (IMRT) allows a better sparing of normal tissues in the neck, and less morbidity from the treatment. Accelerated repopulation is a main determinant of poor local control in patients treated with radiotherapy who undergo treatment interruptions or a delay in its start. Thus, adjuvant radiotherapy must begin as early as possible, within six weeks of resection. Irradiated patients are at significant risk of dental complications, even when IMRT is used. That makes mandatory a dental evaluation and treatment prior to radiotherapy. Adverse radiation effects can occur during treatment (early reactions), or months to years after completion (late reactions). Patients with indication of radiotherapy must be referred early, preferably after dental evaluation. IMRT is an excellent tool when correctly indicated and uses. Main benefits of elective neck irradiation are less morbidity and higher cosst-effectiveness, making it a very useful treatment alternative to elective neck dissection in patients with localized disease.

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Estesioneuroblastoma o neuroblastoma olfatorio

Estesioneuroblastoma o también llamado neuroblastoma olfatorio es un tumor maligno infrecuente derivado del neuroepitelio olfatorio. La historia clínica de un paciente con un neuroblastoma olfatorio es muy inespecífica. Durante la última década, los métodos endoscópicos se han aplicado gradualmente para el tratamiento de tumores de la base del cráneo. El tratamiento puramente endoscópico endonasal del estesioneuroblastoma ha mostrado excelentes resultados de supervivencia con disminución de las complicaciones. Presentamos un paciente afectado por un neuroblastoma olfatorio tratado solo con cirugía endoscópica endonasal.

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Esthesioneuroblastoma or olfactory neuroblastoma is an uncommon malignant tumor arising from the olfactory neuroepithelium. The clinical symptoms of a patient with olfactory neuroblastoma are very inespecific. During the past decade, endoscopic approaches have been gradually applied in treating skull base tumors. The purely endoscopic endonasal surgery for esthesioneuroblastoma showed successful survival results with remarkably decreased complications. We reported a patient who suffered olfactory neuroblastoma treated with only endoscopic endonasal surgery.

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Tiroplastía de medialización con Gore-Tex®: Experiencia de 8 años en Hospital Clínico de la Universidad de Chile

Introducción: La parálisis de cuerda vocal causa disfonía y puede ser complicación posterior a ciertas cirugías. Existen diversos tratamientos, uno de ellos es la tiroplastía de medialización, procedimiento realizado con anestesia local, permitiendo un fino ajuste de la voz. Objetivo: Analizar la experiencia en tiroplastía de medialización con Gore-tex® en el Hospital Clínico de la Universidad de Chile entre los años 2008-2016. Material y método: Estudio descriptivo, retrospectivo, con revisión de fichas clínicas de los pacientes que fueron sometidos a tiroplastía de medialización. Para el análisis de los datos se utilizará la prueba Wilcoxon. Resultados: Se analizaron datos de 21 pacientes, correspondientes a 24 tiroplastías de medialización. La edad promedio fue 54,2 años, 13 parálisis fueron secundarias a cirugía y 8 idiopáticas. En 17 pacientes se obtuvo la encuesta VHI-10 en el pre y posoperatorio, con valores promedio de 33,2y 17,4 (p =0,0003). Cinco pacientes requirieron de algún procedimiento complementario, entre 4 y 22 meses poscirugía: inyección de grasa, de Radiesse y refuerzo con otra prótesis de Gore-teX®. Conclusión: La tiroplastía de medialización es excelente para tratar la parálisis de cuerda vocal unilateral no recuperada en forma espontánea, siendo la encuesta VHI-10 una buena herramienta para evaluar la calidad de la voz.

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Introduction: Vocal cord paralysis can cause hoarseness and coud be a complications to following certain surgeries. In its treatment, there are several alternatives, one of them is the medialization thyroplasty. This procedure, is performed under local anesthesia, allowing the fine-tune of the voice. Aim: To analyze the experience in Medialization Thyroplasty with Gore-tex in the Clinical Hospital of the University of Chile between 2008 and 2016. Material and method: Retrospective and descriptive, with the review of patient's clinical records who were treated with medialization thyroplasty. The data analysis is done using Wilcoxon test. Results: Data from 21 patients, corresponding to 24 medialization thyroplasty. The average age was 54.2 years old, 13 paralysis were secondary to surgeries and 8 were Idiopathic. In 17 patients it was posible to get the VHI-10 survey in the pre and postoperative, with an average value of 33.2 and 17.4 (p =0.0003). Five patients required some additional procedure, between 4 and 22 months post surgery: injection of fat, Radiesse and installation of a new Gore-tex prosthesis Conclusions: Medialization thyroplasty is an excellent method to treat paralysis of unilateral vocal cord in cases when is not recovered spontaneously, being the VHI-10 survey a good tool for assessing voice quality.

http://ift.tt/2rT31HQ

Cáncer de laringe: Serie de casos en 6 años en el Complejo Asistencial Doctor Sótero del Río

Introducción: El cáncer de laringe es la segunda causa de muerte en otorrinolaringología. Su tratamiento en estadios avanzados es agresivo y controversial. Objetivo: Reportar los datos de pacientes atendidos en el Complejo Asistencial Doctor Sótero del Río entre los años 2005-2011. Material y método: Análisis retrospectivo descriptivo. Resultados: Total de 38 pacientes, 30 (79%) hombres, mediana de edad 66 años. Los principales motivos de consulta fueron dificultad respiratoria en 18 pacientes (47%) y disfonía en 14 (37%). Se realizó estudio y etapificación con nasofibroscopía y tomografía computarizada. El 71% se presentó en estadio avanzado, de ellos, el 30% recibió quimiorradioterapia exclusiva. La sobrevida global a 2 y 5 años fue de 56% y 42% respectivamente en estadio avanzado y de 100% y 71% respectivamente en estadio precoz. Discusión: El cáncer de laringe es una enfermedad con sobrevida baja a pesar de tratamientos agresivos. Se han planteado alternativas al tratamiento estándar como terapia conservadora con quimiorradioterapia exclusiva o microcirugía láser transoral. Conclusiones: La epidemiología del cáncer laríngeo se ha mantenido relativamente estable y la clasificación TNM sigue siendo fundamental para el tratamiento, especialmente en contexto de nuevas alternativas de manejo de cáncer avanzado. Se espera evaluar estas terapias.

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Introduction: Laryngeal cancer is the second cause of death in otolaryngology. Its treatment in advanced stage is aggressive and controversial. Aim: To report data from patients treated in Complejo Asistencial Doctor Sótero del Río in the period between 2005-2011. Material and method: Descriptive retrospective analysis. Results: 38 patients in total, 30 (79%) men, median age 66 years. The main symptoms were breathing difficulty in 18 patients (47%) and dysphonia in 14 (37%). Every patient completed study and disease staging with nasofibroscopy and computed tomography. 71% presented in advanced stage, among them, 30% received exclusive chemoradiotherapy. Overall survival for 2 and 5-year in advanced stage was 56% and 42% respectively; and 100% and 71% in early stage. Discussion: Advanced laryngeal cancer has low survival rate in spite of aggressive treatments. Alternatives to standard care have been proposed, such as conservative therapy with exclusive chemoradiotherapy or transoral laser microsurgery. Conclusions: Laryngeal cancer's epidemiology remains relatively unchanged and TNM classification still remains fundamental for treatment, specially in the context of new therapeutic alternatives for advanced cancer. Evaluation of these therapies is expected.

http://ift.tt/2sQZtmO

Repercusiones de la roncopatía y respiración bucal en el crecimiento facial

Los trastornos respiratorios obstructivos del sueño corresponden a un amplio espectro de patologías que incluyen a los roncadores primarios, el síndrome de resistencia de vía aérea superior y al síndrome de apnea obstructiva del sueño (SAOS). Dentro de sus manifestaciones clínicas se encuentra la roncopatía y la respiración bucal, las cuales generan alteraciones en el crecimiento craneofacial del niño pudiendo ser la causa de un SAOS residual. El objetivo de esta revisión es analizar las alteraciones del crecimiento craneofacial en niños generadas por la roncopatía y respiración bucal.

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Obstructive sleep breathing disorders correspond to a broad spectrum of diseases that include primary snorers, upper airway resistance syndrome and obstructive sleep apnea syndrome (OSAS). Its clinical manifestations include snoring and mouth breathing, which generates alterations in the craniofacial growth of the child that may be the cause of a residual OSAS. The objective of this review is to analyze the alterations of craniofacial growth generated by snoring and mouth breathing in children.

http://ift.tt/2sQVhDD

Injerto costal para reconstrucción nasal: Experiencia de 6 años en el Hospital San Juan de Dios

Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.

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Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.

http://ift.tt/2rT5n9G

Abordaje endoscópico endonasal puro de estesioneuroblastoma

Presentamos el caso de una mujer de 56 años con diagnóstico de estesioneuroblastoma Kadish C/Hyams II tratado con resección quirúrgica mediante un abordaje endoscópico endonasal puro y radioterapia adyuvante. Describimos el caso y discutimos sus aspectos relevantes.

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We report the case of a 56-year-old woman with diagnosis of esthesioneuroblastoma Kadish C/Hyams II treated with a purely endonasal endoscopic resection and adjuvant radiotherapy. We described the case and discuss its relevant aspects.

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Cirugía hipofisiaria endoscópica transesfenoidal, con realización de colgajo nasoseptal: Evaluación del impacto de la técnica en la olfación. Serie de casos

Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.

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Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.

http://ift.tt/2rT6oP6

Importancia de la epidemiología en cáncer laríngeo: Incidencia y mortalidad por carcinoma escamoso de laringe

Actualmente se realiza un diagnóstico anual de 650.000 nuevos casos de carcinoma escamoso de cabeza y cuello en el mundo, siendo el carcinoma escamoso de laringe una patología neoplásica que compete al otorrinolaringólogo. La incidencia mundial del cáncer escamoso de laringe se estima en 3,9 por cada 100.000 habitantes con una mortalidad general de 2,0 por cada 100.000 habitantes. En Chile el registro de cáncer se realiza en base a los cinco registros poblacionales de cáncer que existen. No se tienen datos exactos respecto a incidencia y mortalidad por carcinoma escamoso de laringe, siendo la estimación de la incidencia de 1,2 casos por cada 100.000 habitantes y la estimación de mortalidad ajustada por edad de 0,7 casos por cada 100.000 habitantes. Se han descrito diversos factores de riesgo ambientales y estilos de vida para este cáncer, por lo tanto, las estrategias de prevención primaria en salud son claves a la hora de generar un impacto en la incidencia del carcinoma escamoso de laringe.

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The annual diagnosis of head and neck squamous cell carcinoma is 650,000 new cases. The laryngeal carcinoma is a malignant disease that should include an otolaryngologist in its evaluation. The global incidence of laryngeal carcinoma is estimated at 3.9 per 100,000 inhabitants with an overall mortality rate of 2.0 per 100,000 inhabitants. In Chile the cancer registry is based on the five population cancer registries that exist. There is no accurate data on incidence and mortality from laryngeal carcinoma, being an estimated incidence of 1.2 cases per 100,000 inhabitants and an age-adjusted mortality of 0.7 cases per 100.00 inhabitants. There have been described various environmental risk factors and lifestyles for this cancer, therefore, primary prevention strategies are key to generate an impact on the incidence of larynx carcinoma.

http://ift.tt/2rSVOI7

Editorial

http://ift.tt/2sQMaTE

Cirugía endoscópica nasosinusal y de base de cráneo asistida por navegación

Introducción: La cirugía guiada por imágenes corresponde a una herramienta quirúrgica que comienza a desarrollarse a mediados del siglo XX. En 1990 comienza a utilizarse en otorrinolaringología, siendo sus principales indicaciones la cirugía endoscópica de cavidades paranasales y la cirugía de base de cráneo anterior. Objetivo: Analizar y presentar el resultado del uso de cirugía guiada por imágenes en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile (HCUCH). Material y método: Se realizó un estudio retrospectivo incluyendo todos los casos de cirugía endoscópica nasosinusal y base de cráneo asistida por imágenes en HCUCH. La selección para usar la navegación se hizo en base a las recomendaciones de la Academia Americana de Otorrinolaringología. Resultados: De un total de 12 pacientes intervenidos con el uso de navegación, se obtuvo 100% de éxito quirúrgico con disminución de los síntomas y sin complicaciones intraoperatorias. Conclusión: La cirugía asistida por navegación en cavidades paranasales y base de cráneo, es una herramienta de suma utilidad en casos seleccionados que potencia las habilidades quirúrgicas del cirujano sin reemplazar sus conocimientos anatómicos. Otorga seguridad y precisión en cirugías que comprometen estructuras nobles como base de cráneo y órbita entre otros.

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Introduction: Image Guided Surgery is a surgical tool that develop in the mid-twentieth century. In 1990 it began to be used in otolaryngology, being its main indications endoscopic surgery of paranasal sinuses and anterior skull base. Aim: To analyze and present the result of image-guided surgery in patients undergoing surgery at the Hospital of the University of Chile. Material and method: A retrospective study included all cases of endoscopic sinus surgery and skull base imaging assisted at the Clinical Hospital of the University of Chile from August 2015 to August 2016. The choice to use the navigation was made in based on the recommendations of the American Academy of Otolaryngology, and analyzed case by case. Results: A total of 12 patients were operated using Navigation, achieving 100 % of surgical success with decreased symptoms and without intraoperative complications. Conclusion: Image Guided Surgery in paranasal sinuses and skull base is a tool very useful in selected cases where enhances the surgeon skills without replacing their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others. their anatomical knowledge. Provides security and accuracy in surgeries involving noble structures such as the skull base, orbit among others.

http://ift.tt/2sQDhcE

Tumor condroide del cartílago tiroides: Reporte de un caso clínico y revisión de la literatura

Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.

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Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.

http://ift.tt/2sQFXqs

Malformación arteriovenosa en cavidad oral: A propósito de un caso y revisión de la literatura

Las malformaciones arteriovenosas (malformaciones A-V) de alto flujo en la cavidad oral no son una patología frecuente, existen pocos datos publicados sobre su tratamiento y sigue siendo muy controvertido debido a la alta tasa de complicaciones vitales que conlleva y la alta tasa de recurrencia. El único tratamiento curativo es la resección radical, con las consecuencias no sólo vitales, sino también desfigurativas que supone. Presentamos un caso de malformación A-V congénita en región submandibular, suelo de boca derecho y lengua, que tras varios episodios de dolor y aumento de tamaño, sin realizar ninguna medida agresiva, en el último control se observa trombosis espontánea de la misma. En este caso, la evolución con un tratamiento expectante sin cirugía, ha sido la trombosis con mejoría clínica, sin presentar nuevo episodio de aumento de tamaño, ni sangrado doce meses después, a pesar de seguir con una lesión de gran tamaño en el suelo de la boca.

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he high-flow arteriovenous malformations (A-V malformations) in oral cavity are not a common disease, there are few published data on treatment and it remains highly controversial because of the high rate of vital complications and the high rate of recurrence. The only curative treatment is radical resection, with not only vital consequences but also the disfigurement involved. We present a case of congenital A-V malformation in right submandibular region, floor of the mouth and tongue. After several episodes of pain and enlargement, in the last control without any aggressive action, the lesion presented spontaneous thrombosis. In this case, despite following with a large lesion on the floor mouth, the evolution with an expectant non-surgical treatment has been the thrombosis with clinical improvement, without presenting new episode of enlargement, nor bleeding twelve months later.

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Hallazgo de arteria lusoria en el estudio de otitis media a repetición: A propósito de una observación pediátrica y revista breve de la literatura

Arteria Lusoria (AL) o arteria subclavia aberrante derecha es una malformación vascular rara. Es la más común de las malformaciones del arco aórtico. Fue descrita por primera vez por Hunalud en 1735. La etiología no está clarificada hasta hoy en día. AL puede formar parte de un cuadro sindrómico (síndrome de Down, síndrome de Edwards) o de una malformación cardiaca compleja. Es casi siempre asintomática, pero algunas veces puede revelarse por signos respiratorios o disfagia. Se elige habitualmente el tratamiento conservador. Les presentamos el caso de un niño de 2 años que presentó una AL revelada atipicamente por otitis media a repetición.

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Arteria Lusoria (AL) or aberrant right subclavian artery is a rare congenital aortic arch malformation. Hunauld described it for the first time in 1735.The cause is until now no totally clarified. Usually it is associated with chromosomal disorders such as Down's syndrome, Edwards's syndrome or appears in childhood with complexes cardiovascular abnormalities. Patients are frequently asymptomatic, but it may be revealed by respiratories symptoms or by a dysphagia. The treatment is generally conservative. We expose a case report about a child of 2 years old with AL diagnosed after several episodes of purulent otitis.

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Dolor cervical atípico: Síndrome de Eagle

Presentamos el caso de un varón de 45 años con dolor cervical derecho muy localizado, característico y persistente. El estudio radiológico nos permitió diagnosticar claramente un síndrome de Eagle. Por lo anterior el paciente fue sometido a cirugía de extirpación de apófisis estiloides derecha. El paciente evolucionó sin mayores complicaciones ni incidencias, y obteniendo la resolución del cuadro.

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Here we introduce a 45-year-old man suffering from an intense, unique and permanent pain, located in his right neck. Radiology showed us signs leading to the diagnosis of Eagle Syndrome. Surgery of right Styloid apophysis removal, with no complications, letting the patient free of symptoms.

http://ift.tt/2rSL646

Prevención, diagnóstico y manejo de lesiones laringotraqueales agudas y subagudas posintubación en pacientes pediátricos

Las lesiones laringotraqueales asociadas a intubación se deben principalmente a una técnica defectuosa y a daño por presión del tubo endotraqueal sobre la mucosa; además influyen características propias del paciente y de los cuidados de enfermería. Hasta el 40% de los pacientes pediátricos intubados pueden presentar alteraciones laríngeas inmediatas y hasta 30% tienen estridor o disnea posextubación. Si estos síntomas persisten por más de 3 días tendrían indicación de laringotraqueoscopía. Las lesiones más habituales son edema, úlceras y tejido de granulación. El edema puede producir obstrucción respiratoria aguda que puede manejarse con reintubación con tubos más pequeños y aplicación tópica de crema de corticoides con antibióticos. Las úlceras y granulaciones pueden evolucionar hacia secuelas cicatriciales que comprometen la fisiología laringotraqueal; las granulaciones exofíticas deben retirarse endoscópicamente. Aunque la incidencia de estenosis subglótica posintubación ha disminuido en las últimas décadas, situándose entre 2,7%y 4,2%, algunos estudios sugieren un subdiagnóstico debido a lesiones poco sintomáticas al alta. En el período cicatricial activo, estas estenosis pueden dilatarse para evitar llegar a una cirugía abierta. El manejo otorrinolaringológico de estos pacientes en etapas tempranas es fundamental para evitar secuelas cicatriciales irreversibles que requieren de cirugías complejas, con riesgo vital por obstrucción de la vía aérea.

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Intubation-associated laryngotracheal injuries are mainly caused by a defective technique and endotracheal tube pressure-induced mucosal damage; patient factors and nursing care are also important. Up to 40% of intubated pediatric patients may show immediate laryngeal alterations and up to 30% have post-extubation stridor or dyspnea. If these symptoms last for over 3 days, laryngotracheoscopy is indicated. Edema, ulcers and granulation tissue are the most usual lesions. Edema can lead to acute airway obstruction, and is managed by reintubation with a smaller tube and topical application of a corticosteroid and antibiotic cream. Ulcers and granulations can lead to scarring that compromise laryngotracheal physiology; exophytic granulations must be removed endoscopically. Although the incidence of post-intubation subglottic stenosis has diminished over the last decades to about2,7% to 4,2%, some studies suggest that there is a subdiagnosis because of oligosymptomatic lesions at the time of discharge. On the active scarring period, dilatation of the stenosis can be used to avoid open surgery. Early otorhinolaryngologic management of these patients is fundamental for avoiding irreversible cicatricial sequels that require complex surgeries, with life risk due to airway obstruction.

http://ift.tt/2rT30Ui

Chronic corticosterone-induced impaired cognitive flexibility is not due to suppressed adult hippocampal neurogenesis

Publication date: 14 August 2017
Source:Behavioural Brain Research, Volume 332
Author(s): E. Lui, M. Salim, M. Chahal, N. Puri, E. Marandi, J. Quadrilatero, E. Satvat
Hippocampal neurogenesis has been implicated in the etiology of depression. Recent studies suggest new neurons add flexibility to hippocampal-dependent learning and memory. We hypothesized that suppressed hippocampal neurogenesis may contribute to impaired cognitive flexibility associated with depression. The chronic corticosterone (CORT)-induced animal model of depression was used. In Experiment 1, rats received either CORT (40mg/kg) or vehicle injections for 21days and were subjected to Water maze during the last six days of drug treatment. No group differences were found during the spatial learning phase; however, cognitive flexibility, measured by reversal training, was significantly impaired in the CORT-treated rats. The probe test revealed enhanced memory of the new platform location for the CORT-treated rats. Given the time newborn neurons require to mature, we presumed if impaired cognitive flexibility seen in Experiment 1 were due to suppressed neurogenesis, terminating CORT treatment 3days prior to behavioural testing should still induce the impairment. Therefore, Experiment 2 was similar to Experiment 1, except that CORT injections were terminated 3days prior to behavioural assessment. However, not only was spatial learning significantly enhanced in the CORT-treated rats, but there were also no group differences during reversal or probe tests. Bromodeoxyruidine, administered a day after the first drug treatments in both experiments, was quantified and revealed the number of new neurons were the same in both groups in both experiments. Results suggest cognitive flexibility is impaired in the CORT-induced animal model of depression; an effect that is reversible and independent of suppressed hippocampal neurogenesis.



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The paracrine effect of cobalt chloride on BMSCs during cognitive function rescue in the HIBD rat

Publication date: 14 August 2017
Source:Behavioural Brain Research, Volume 332
Author(s): Ying Dai, Wendi Li, Min Zhong, Jie Chen, Qian Cheng, Youxue Liu, Tingyu Li
Hypoxia–ischemia (HI)-induced perinatal encephalopathy frequently causes chronic neurological morbidities and acute mortality. Bone mesenchymal stem cell (BMSC) transplantation could potentially promote functional and anatomical recovery of ischemic tissue. In vitro hypoxic preconditioning is an effective strategy to improve the survival of BMSCs in ischemic tissue. In this study, cobalt chloride (CoCl2) preconditioned medium from BMSC cultures was injected into the left lateral ventricle of HI rats using a micro-osmotic pump at a flow rate 1.0μl/h for 7 days. The protein levels of HIF-1α and its target genes, vascular endothelial growth factor and erythropoietin, markedly increased after CoCl2 preconditioning in BMSCs. In 7-week-old rats that received CoCl2 preconditioned BMSC medium, results of the Morris water maze test indicated ameliorated spatial working memory function following hypoxia-ischemia damage. Neuronal loss, cellular disorganization, and shrinkage in brain tissue were also ameliorated. Extracellular field excitatory postsynaptic potentials (fEPSPs) in the brain slices of 8-week-old rats were recorded; administration of CoCl2 preconditioned BMSC culture medium induced a progressive increment of baseline and amplitude of the fEPSPs. Immunohistochemical quantification showed that GluR2 protein expression increased. In conclusion, CoCl2 activates HIF-1α signals in BMSCs. CoCl2 preconditioned BMSC culture medium likely effects neuroprotection by inducing long-term potentiation (LTP), which could be associated with GluR2 expression. The paracrine effects of hypoxia preconditioning on BMSCs could have applications in novel cell-based therapeutic strategies for hypoxic and ischemic brain injury.



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A Modified Bifurcated Periosteal Flap for Simultaneous Reconstruction of Upper and Lower Lateral Canthal Tendons

Abstract: A bifurcated periosteal flap is useful for simultaneous reconstruction of the upper and lower lateral canthal tendons. The original technique harvested the flap horizontally from the frontal process of the zygoma, which mostly resulted in an insufficient flap length because of the narrowness of the zygoma. Here, the authors report the use of a modified bifurcated periosteal flap, raised from the superolateral orbital rim. The lower flap was positioned to slant inferiorly to create a downward slope of the lower eyelid for smooth lacrimal drainage by gravity. The authors applied this technique to 2 patients and obtained good cosmetic results without complications such as entropion, ectropion, lower-eyelid sagging, epiphora, or lateral canthal deformity.

http://ift.tt/2sBBQQ1

A Periodical Article Reviewer as Gottfried: The Uncle of Jean-Christophe

No abstract available

http://ift.tt/2sBLB0v

Goddess of Imagination

No abstract available

http://ift.tt/2sBQaI4

Management of Pharyngocutaneous Fistula With Negative-Pressure Wound Therapy

Background: Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery and is associated with increased morbidity and mortality. Beyond the classical management, negative-pressure wound therapy (NPWT) can be an alternative and effective treatment. Clinical Report: Two patients with pT3N0M0 squamous cell carcinoma of pyriform sinus were subjected to total laryngectomy and pharyngoesophageal reconstruction of a circular (patient 1) and an anterior wall defect (patient 2) with radial forearm free flap and pectoralis major muscle flap, respectively. Both developed a pharyngocutaneous fistula and NPWT was used. A significant decrease of the fistula aperture and exudate was observed after 22 and 21 days of NPWT in patients 1 and 2, respectively. After that standard wound care was instituted and closure of the fistulae was accomplished in 5 and 7 days, respectively. Conclusion: Negative-pressure wound therapy can be an effective treatment for pharyngocutaneous fistula closure, either in the setting of fistulae that persist besides multiple surgical revisions using muscle flaps or as a first-line therapy when fistulae develops.

http://ift.tt/2sBFYiK