ABSTRACT
La granulomatosis con poliangitis (GPA) es una condición clínico-patológica que cursa con inflamación granulomatosa del tracto respiratorio superior e inferior, glomerulonefritis necrotizante focal y vasculitis necrotizante de vasos de pequeño y mediano tamaño (capilares, vénulas, arteriolas y arterias). La afectación de la GPA orbitaria oscila entre el 7 y el 45%. En ocasiones, la glándula lagrimal puede estar afectada de forma aislada y ser la manifestación inicial de la enfermedad. Presentamos el caso de una paciente con GPA y fístula nasolagrimal.
Granulomatosis with polyangiitis (GPA) is a clinical-pathological condition that presents with granulomatous inflammation of the upper and lower respiratory tract, focal necrotizing glomerulonephritis and necrotizing vasculitis of small and medium-sized vessels (capillaries, venules, arterioles and arteries). Orbital GPA involvement ranging from 7-45%. The lacrimal gland can occasionally be affected in isolation and be the initial manifestation of the disease. We present the case of a patient with GPA and nasolacrimal fistula.
Subject(s)
Nasal SeptumABSTRACT
Objective To observe therapeutic effect of repairing nasal septum perforation with auto temporal fascia wrapping ethmoid perpendicular plate through endoscopic surgery. Methods Retrospective analysis of 50 cases of nasal septum perforation patient, among whom 30 cases were repaired by traditional surgery and 20 cases were repaired by sand?wich surgery. All patients were examine by CT scan and nasal irrigation therapy were also performed through nasal endosco?py to improves nasal mucosa situation. Endoscopic procedures were performed in the traditional surgical group under local anesthesia, and septum mucosa was separated and shifted to repair septal perforation. On the other hand, temporal fascia of more than 2 times the diameter of the perforation were isolated then, wrapped around the perforation through front line of na?sal incision after separating membrane of the nasal septum cartilage. Now,temporal fascia wrapping autologous ethmoid per?pendicular plates form a rigid verticalsandwich prosthesisand were inserted into perichondrium of septal to repair perfora?tion. Anti-infection and nasal moisturizing treatment were given after operation. Postoperative symptoms and the perfor?mance in follow-ups were recorded. Results Intraoperative blood loss (mL:3.6±1.2 vs 13.4±2.9), operative time (min:25.2± 6.3 vs 46.5 ±10.3), mucosal damage range (mm2:10.2±3.2 vs 20.5±5.3) and mucosal repair time postoperation (d:19.5±3.9 vs 30.2±3.1) were all less in sandwich group than those in traditional group (P<0.05). Successful rate in sandwich group is also higher than that in the traditional surgical group (90.00%vs 46.67%, χ2=9.780, P<0.01) . No recurrence was found during follow-up from 6 months to 1 year in both groups. Conclusion Application of autologous temporalis fascia wrapping per?pendicular plate of ethmoid bone to form a rigidsandwich prosthesisto repair nasal septal perforation by endoscopic sur?gery were effective. It can restore the normal anatomy of the nasal septum.
ABSTRACT
Introducción: La mayoría de las perforaciones septales suelen ser asintomáticas, aunque algunas pueden presentar una rinitis costrosa, obstrucción nasal, epistaxis recidivante o sibilancias nasales. Su origen es sobre todo iatrogénico o idiopático, pero también podemos encontrar otras causas. Los botones septales constituyen una solución útil por la sencillez de su colocación, siendo de elección en pacientes que no deseen una intervención quirúrgica más compleja. Objetivo: Conocer las características de las perforaciones septales, además de, realizar un estudio sobre los resultados obtenidos en la cirugía de botón septal y el nivel de satisfacción obtenido por los pacientes tras esta intervención. Material y método: Análisis retrospectivo de 22 pacientes intervenidos quirúrgicamente de colocación de botón septal entre enero de 2008 a agosto 2010 en el Hospital Clínico Universitario Lozano Blesa de Zaragoza. El análisis incluye un estudio sobre la etiología, tamaño y sintomatologia de dichas perforaciones candidatas a la utilización del botón septal. Además del análisis de la presencia o ausencia de complicaciones tras la cirugía, la evolución y la mejoría o empeoramiento posoperatorio, en cuanto a los cinco síntomas principales; obstrucción nasal, las sibilancias, las costras endonasales con sequedad, la epistaxis y la rinorrea con tres posibles respuestas; igual, mejor o peor. En el consultorio y a los tres meses de la intervención, se realiza una encuesta con una escala analógica visual (EVA), en la que el paciente realiza una puntuación subjetiva del 1 al 10 para valorar su nivel de satisfacción tras la colocación del obturador Por último se le pregunta si volvería a ponérselo. Los resultados no fueron analizados con pruebas estadísticas dado el pequeño tamaño muestral. Resultados: Nuestros pacientes han presentado una importante mejoría en síntomas como la obstrucción nasal...
Introduction: Most of the septal perforations are usually asymptomatic, although some may have a crusty rhinitis, nasal obstruction, recurrent epistaxis or nasal wheeze. Its origin is mostly iatrogenic or idiopathic but can also find other causes. Septal buttons are a useful solution for the simplicity of their placement, being of choice in patients who do not want surgery more complex. Aim: Knowing the characteristics of septal perforations, in addition, a study on the results of septal button surgery and the level of satisfaction obtained by patients after the intervention. Material and method: Retrospective analysis of 22 patients with surgical septal button surgical placement between January 2008 to August 2010 at the Hospital Clinico Universitario Lozano Blesa from Zaragoza. The analysis includes a study on the etiology, symptoms of such size and drilling candidates for the use of septal button. Besides the analysis of the presence or absence of complications after surgery, and postoperative improvement or worsening in the five main symptoms, stuffy, nose, wheezing, endonasal crust with dryness, epistaxis and rhinorrhea with three possible answers, same, better or worse. Three months after surgery in the office is conducting a survey with a visual analogue scale (VAS), in which the patient makes a subjective score of 1 to 10 to assess their level of satisfaction after the placement of the shutter. Finally asked if he would wear it. The results were analyzed with statistical tests given the small sample size. Results: Our patients have experienced a significant improvement in symptoms such as nasal obstruction and wheezing. Nasal dryness has been with worse clinical outcomes after placement of the button. Subjectively 77.2(0) percent of patients would put him back. Conclusions: The septal buttons are a therapeutic tool to keep in mind for the closure of septal perforations with good results in patients unsuitable for surgical correction.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Nose Diseases/surgery , Prostheses and Implants , Nasal Septum/surgery , Nasal Septum/injuries , Surveys and Questionnaires , Nose Diseases/etiology , Retrospective Studies , Treatment Outcome , Patient Satisfaction , Silicones , Signs and SymptomsABSTRACT
Six cases of nasal septum perforation were found among welders during periodic physical checkup in 1997. Considering the size, shape and margin, the perforations were assumed to have been occurred several years before of which the diameter were 8~15 mm. To investigate the cause of perforation, we reviewed the past history of preemployment, the results of annual working environment survey and the material safety data sheets of welding rods and steels with which they have dealt, and analyzed the concentration of several metals of welding fume and the concentration of blood and urinary chromium. In the result, we presupposed that the nasal septum perforations of welders were due to chronic exposure to low level hexavalent chromium and/or nickel, and report these cases with literatures review.