Evaluación del olfato en pacientes operados por adenoma hipofisario con acceso transesfenoidal en el Instituto de Neurocirugía Dr. Asenjo / Olfactory evaluation in patients operated for pituitary adenoma with transsphenoidal access at the Instituto de Neurocirugía Dr. Asenjo

Introducción: El olfato tiene una gran importancia en la calidad de vida. Los accesos quirúrgicos selares pueden realizarse por vía transcraneal, transeptal y transnasal, y pueden generar hiposmia al incluir resecciones que afectan a la mucosa olfatoria. Objetivo: Determinar la existencia de alteración persistente en el olfato ocasionado por los accesos quirúrgicos transeptal y transnasal en pacientes operados por adenoma hipofisiario en el Instituto de Neurocirugía Dr. Asenjo. Material y Método: Estudio prospectivo de cohorte con comparación de resultados olfatorios ("sniffin' sticks" versión extendida) y encuesta SNOT-22 pre y poscirugía por adenoma hipofisiario por vía transeptal o transnasal. Se utilizaron medidas estadísticas de comparación de pruebas pareadas paramétricas y no paramétricas según las características de las variables evaluadas. Resultados: Se reclutaron 60 pacientes, completando el seguimiento 39. En 21 se realizó acceso transeptal y en 18 transnasal. Al analizar el total de pacientes y por cada técnica quirúrgica, no hubo diferencias significativas en los puntajes del "sniffin' sticks" versión extendida y tampoco en SNOT-22. Conclusión: La literatura describe incidencia de hiposmia posoperatoria muy variable, entre 0% y 88%, con mediciones subjetivas y objetivas. Existe una predilección por la técnica endoscópica a nivel internacional, por lo que cuenta con estudios de mejor calidad. A nivel nacional existen dos estudios previos que han encontrado tasas de hiposmia posoperatoria de 10% y 14%. En este estudio no hubo diferencias significativas en los puntajes obtenidos en la prueba de olfato entre el pre y posoperatorio.

Introduction: Olfaction is of great importance in quality of life. Surgical accesses to the sellar region can be performed by transcranial, transseptal, and transnasal routes, which can generate hyposmia when including resections that affect the olfactory mucosa. Aim: To determine the existence of persistent alteration in olfaction caused by transseptal and transnasal surgical accesses in patients operated for pituitary adenoma at the Instituto de Neurocirugía Dr. Asenjo. Material and Method: Prospective cohort study with comparison of olfactory results ("sniffin' sticks" extended version) and SNOT-22 survey pre and post transseptal or transnasal surgery for pituitary adenoma. Parametric and non-parametric paired test comparison statistics were used according to the characteristics of the variables evaluated. Results: 60 patients were recruited and 39 completed follow-up. 21 patients underwent transseptal access and 18 underwent transnasal access. When analyzing the total number of patients and for each surgical technique, there were no significant differences in the scores obtained in the "sniffin' sticks" extended version and neither for the SNOT-22. Conclusion: The literature describes a highly variable incidence of postoperative hyposmia, between 0% and 88%, with subjective and objective measurements. There is a predilection for the endoscopic technique at an international level, which is why it has better quality studies. At the national level there are two previous studies that have found postoperative hyposmia rates of 10% and 14%. In this study there were no significant differences in the scores obtained between pre and postoperative olfaction test.

Hiperacusia en trastornos del espectro autista: una revisión de la literatura / Hyperacusis in autism spectrum disorders: a review of the literature

Resumen La hiperacusia se define como la intolerancia a ciertos sonidos cotidianos que causa angustia y discapacidad significativas en las actividades sociales, ocupacionales, recreativas y otras actividades cotidianas. Los sonidos pueden percibirse como incómodamente fuertes, desagradables, atemorizantes o dolorosos. Se encuentra presente en aproximadamente un 3% población general, y aumenta significativamente en trastornos del espectro autista (TEA), alcanzando entre un 15% a 40%. Los mecanismos fisiopatológicos no son del todo claros, pero se ha propuesto, una alteración en el funcionamiento de mecanismos reflejos y de regulación, tanto a nivel de la vía auditiva periférica, como central, incluyendo estructuras no relacionadas directamente con la vía auditiva. El siguiente texto tiene como objetivo analizar la relación entre hiperacusia y TEA, enfatizando en la frecuencia en que se presentan como comorbilidades, en los posibles mecanismos fisiopatológicos, y en actualizaciones en el abordaje diagnóstico y terapéutico. Se realiza una revisión bibliográfica cualitativa en Pubmed con artículos entre los años 2008-2020 utilizando los términos: "hyperacusis autism", "sistema olivococlear", arrojando 39 artículos, de los cuales se seleccionaron en base a la temática de cada uno, evaluada por los autores. A pesar de una significativa relación entre hiperacusia y TEA, los mecanismos fisiopatológicos de ambas patologías siguen siendo un misterio. Existen estudios que sugieren pruebas de screening no invasivas que relacionan ambas patologías, pero debido a los sesgos de selección, todavía no son factibles de usar en forma universal. El abordaje terapéutico ha sido poco explorado, y no se dispone de fármacos que hayan demostrado su efectividad, por el contrario, algunos de ellos empeoran la sintomatología. Se recomienda al tratante, seguir un camino largo, en conjunto con el paciente, donde las terapias no farmacológicas como la terapia cognitivo conductual han mostrado tener buenos resultados.

Abstract Hyperacusis is defined as intolerance to certain sounds that causes significant distress and disability in social, occupational, recreational and other activities. Sounds can be perceived as uncomfortably loud, unpleasant, frightening, or painful. It is present in approximately 3% of the general population, and increases significantly in autism spectrum disorders (ASD), between 15% and 40%. The pathophysiological mechanisms are not entirely clear, but an alteration in the functioning of reflex and regulatory mechanisms has been proposed, both at the peripheral and central auditory pathways, including structures not directly related to the auditory pathway. The therapeutic approach has been little explored as there are no drugs that have demonstrated their effectiveness, on the contrary, some of them worsen the symptoms. The practitioner is recommended to follow a long path, in conjunction with the patient, where non-pharmacological therapies such as cognitive behavioral therapy have been shown to have good results. The following text shows a review of the literature with articles referring to the subject between the years 2008-2019.

Cuerpos extraños en otorrinolaringología: Experiencia en Clínica Santa María / Foreign bodies in otolaryngology: Experience at Clínica Santa María

Resumen Introducción: Los cuerpos extraños (CE) en oído, nariz y vía aéreodigestiva superior son el 30% de las urgencia en otorrinolaringología (ORL). No existen datos epidemiológicos nacionales que describan la casuística de CE. Objetivo: Describir la epidemiología de pacientes con diagnóstico de CE evaluados, entre el 2013-2018 en Clínica Santa María de Santiago, Chile. Describir las características de los CE, ubicación, método de extracción y complicaciones. Material y Método: Estudio descriptivo y retrospectivo, basado en revisión de fichas clínicas de pacientes con diagnóstico de CE, analizando variables epidemiológicas y clínicas. Resultados: Se revisaron 1.847 casos con diagnóstico de CE, confirmando 1.494. La mayoría de sexo masculino (53,3%), con un promedio de edad de 16,5 años (rango de 0-95 años). Los CE más prevalentes fueron ótico (52,9%) y nasal (27,9%). El síntoma asociado más frecuente fue la sensación de CE (18,1%). El diagnóstico fue principalmente por examen físico (84%), requiriéndose exámenes complementarios en 18,2%. La extracción fue ambulatoria en su mayoría (84,6%), requiriendo extracción en pabellón el 12,5%. El 5,5% presentó complicaciones, y la tasa de letalidad fue de 0,07%. Conclusión: Esta casuística, única a nivel nacional, nos permite conocer la epidemiología de los CE. Un bajo porcentaje de pacientes fue de riesgo vital, pero el manejo oportuno permite una baja tasa de complicaciones y letalidad.

Abstract Introduction: Foreign bodies (FB) in the ear, nose and upper airway-digestive tract are 30% of the emergencies in otolaryngology (ORL). There is no national epidemiological data that describes the FB casuistry. Aim: To describe the epidemiology of patients who have a diagnosis of a FB evaluated, between 2013-2018, at Santa María Clinic in Santiago, Chile. To describe the characteristics of FB, location, method of removal, and complications. Material and Method: A descriptive and retrospective study, based on review of clinical records of patients with the diagnosis of FB, analyzing epidemiological and clinical variables. Results: 1847 cases with a diagnosis of FB were reviewed, of which 1494 were confirmed. Most were male (53.3%), with an average age of 16.5 years (range 0-95 years). The most prevalent FB locations were otic (52.9%) and nasal (27.9%). The most frequent associated symptom was sensation of a FB (18.1%). The diagnosis was fundamentally based on physical examination (84%), requiring complementary tools in 18.2%. The extraction was mostly ambulatory (84.6%), requiring extraction in the operation room in 12.5%. 5.5% presented complications, and the fatality rate was 0.07%. Conclusion: This casuistry is unique at the national level, and allows us to know the epidemiology of FB. A low percentage of patients correspond to life-threatening locations, but timely management allows a low rate of complications and fatality.

Cáncer de cabeza y cuello asociado al virus papiloma humano: revisión de la literatura / Head and neck cancer associated with human papilloma virus: literature review

Oral cavity and oropharyngeal squamous cell carcinoma is the sixth most common cancer worldwide and human papillomavirus (VPH) is proposed as an etiologic risk factor. In our country there is no prevalence studies of this virus either in oral or oropharyngeal mucosa. This data would be useful at the moment of evaluating the risk in general population of developing head and neck cancer VPH related and also the impact that it could have the proved effective vaccines against VPH...

Parallel Group Comparison of the Effects on Skin Condition of Two Antimicrobial Hand Wash Products.

Aims: The aim of this study was to compare the effects on skin condition of a hand cleansing protocol comprising repeated use of alcohol rub supplemented with one of two different antimicrobial hand washes, Dermol Wash (DW) and Hibiscrub (HS) when used for 5 consecutive days. Methodology: Forty females applied the alcoholic rub 24 times and used their allocated antimicrobial wash product 13 times on test days (Days 1, 3 and 5) and applied the alcoholic rub 12 times and used the antimicrobial wash 7 times on intervening days. On test centre visit days, an investigator made visual assessments of skin condition and performed corneometry and pH measurements. Transepidermal water loss (TEWL) was measured at baseline and day 5. Subjects also assessed how their skin felt compared to baseline. Results: Investigator visual assessments of skin dryness barely changed for DW but significantly deteriorated by the end of each test day for HS. Subjects' assessments of how their skin felt significantly deteriorated for HS, with five withdrawals. There was one withdrawal in the DW group. Corneometry measurements significantly improved for DW by 19% over the study, compared to a significant deterioration by 18% for HS. Apparent skin surface pH tended to increase for HS only. TEWL increased in both groups. Conclusion: The use of an appropriate hand wash product, such as DW, even in conjunction with ubiquitous alcohol rubs, can achieve significant benefits- assessed in terms of subjects’ own assessments of how their skin feels, investigator visual assessments of skin dryness and skin hydration measured by corneometry.

Prevalencia de variantes anatómicas naso-sinusales: importancia en el informe radiológico y en la cirugía endoscópica funcional / Prevalence of sino-nasal anatomical variations: importance in the radiological report and functional endoscopic surgery

Resumen: Objetivo: Describir la prevalencia en tomografía computada (TC) de las principales variantes anatómicas de la región naso-sinusal en una muestra de población chilena y destacar la importancia de reportarlas en el informe radiológico. Materiales y método: Se evaluaron retrospectivamente 100 TC de cavidades para-nasales realizadas en nuestro hospital. Cada una de las TC fue evaluada por un neurorradiólogo y un residente de tercer año de Radiología, registrando las principales variantes anatómicas de la estructura y neumatización óseas de esta región. Se excluyó a pacientes menores de 18 años y a pacientes que presentaban distorsión significativa de la anatomía naso-sinusal (ej: tumores, antecedente de fractura facial). Resultados: Se encontraron las distintas variantes anatómicas en frecuencias similares a las descritas en la literatura internacional. La variante anatómica más común fue la desviación del tabique (83%), seguida de la presencia de celdilla Agger Nasi (66%) y espolón del tabique (45%). La inserción superior del proceso uncinado fue 68% en la lámina papirácea, 24% en la lámina cribosa y 8% en el cornete medio. La configuración del techo etmoidal, según la clasificación de Keros, fue 2% tipo I, 28% tipo II y 70% tipo III. La frecuencia de configuración etmoidal tipo III de Keros fue mayor que la descrita en estudios clásicos. El grado de neumatización del seno esfenoidal, según la clasificación de Hamberger, fue 80% selar, 19% preselar y 1% conchai. En 5% se registró dehiscencia de la pared ósea en relación al canal carotídeo, siendo uno de estos bilateral. Conclusión: El estudio con TC de cavidades paranasales resulta útil para caracterizar las variantes anatómicas de la región naso-sinusal. Es importante un conocimiento anatómico preciso de esta región, debiendo reportarse las variantes en el informe radiológico, en especial si se planea realizar cirugía endoscópica funcional.

Abstract. Objective: To describe the prevalence in computed tomography (CT) of the main anatomical variations of the sino-nasal region, in a sample of the Chilean population, and to emphasize the importance of reporting them in the radiology report. Materials and methods: 100 paranasal sinus CTperformed at our hospital were retrospectively evaluated. Each CT was evaluated by a neuro-radiologist and a third-year Radiology resident, recording the main anatomical variations of the structure and bone pneumatization of this region. Patients younger than 18 yrs of age, and patients with significant distortion of the sino-nasal anatomy (e.g. tumors, history of facial fracture), were excluded. Results: The different anatomical variations were found in frequencies similar to those described in the international literature. The most common anatomical variation was deviated septum (83%), followed by the presence of Agger nasi cell (66%) and septal spur (45%). The upper attachment of the uncinate process was 68% in the lamina papyracea, 24% in the cribriform plate and 8% in the middle turbinate. Configuration of the ethmoid roof, according to the Keros classification, was 2% type 1,28% type II and 70% type III. The frequency of Keros type III ethmoid configuration was higher than that described in classical studies. The degree of sphenoid sinus pneumatization, according to the Hamberger classification, was 80% sellar, 19% presellar and 1% concha!. In 5%, dehiscence of the bone wall in relation to the carotid channel was recorded, one of these being bilateral. Conclusion: The study of paranasal sinus CT is useful to characterize the anatomical variations of the sino-nasal region. A precise anatomical knowledge of this region is important; variations in the radiology report should be noted, especially if there is a plan to perform functional endoscopic surgery.

Evaluación del olfato en pacientes con patología tumoral en la región selar, intervenidos mediante abordaje endoscópico transesfenoidal transnasal / Assessment of smell in patients with tumor pathology in the sellar region, operated by transnasal transsphenoidal endoscopic approach

Introducción: Para acceder a la región selar, podemos utilizar las técnicas transcraneal, transeptal, o transnasal endoscópica, pudiendo provocar diferentes grados de hiposmia. Se ha descrito menor morbilidad al utilizar la técnica endoscópica, pero faltan estudios dirigidos a los resultados olfatorios. Objetivo: Determinar la presencia de deterioro olfatorio en los pacientes sometidos a un abordaje transnasal endoscópico. Material y método: Se reclutaron 12 pacientes con tumores en la región selar durante 8 meses. Se les realizó un test de olfato preoperatorio, fueron intervenidos mediante abordaje transnasal endoscópico y controlados al mes posoperatorio. Resultados: Se logró seguimiento a 10 pacientes. Seis (60%) presentaron un test de olfato preoperatorio normal. Al mes posoperatorio, se constató mejoría olfatoria en 1 (10%) paciente, 8 (80%) se mantuvieron en la misma categoría y 1 (10%) presentó deterioro olfatorio. En suma, 9 de 10 pacientes (90%) mantienen o mejoran su olfato al mes posoperatorio. Conclusión: Nuestros resultados sugieren que el abordaje transnasal endoscópico utilizado en este estudio no produce deterioro olfatorio. Dado que además es una técnica de abordaje efectiva y relativamente segura, consideramos que constituye una alternativa factible para utilizar en pacientes con patología tumoral en la región selar.

Introduction: To access the sellar region we can use the transcranial, transeptal, or transnasal endoscopic approaches, which may cause different degrees of hyposmia. It has described less morbidity to use the endocopic technique, however, there are few studies directed at olfactory outcomes. Aim: To determine the presence of olfactory impairment secondary to endoscopic transnasal approach. Material and method: 12 patients with tumors in the sellar region were enrolled during 8 months. They were underwent a smell test preoperatively, operated by endoscopic transnasal approach, and controlled with postoperative retesting, after one month. Results: Follow-up was achieved to 10 patients. 6 (60%) presented a normal preoperative smell test. Within one postoperative month, olfactory improvement was found in 1 (10%) patient, 8 (80%) remained in the same category and 1 (10%) had olfactory impairment. In all, 9 out of 10 patients (90%) maintain or improve their sense of smell after surgery. Conclusions: Our results suggest that the transnasal endoscopic approach used in this study, doesn't produce olfactory impairment. Given that is also an effective and relatively safe approach, we believe that is a feasible alternative for use in patients with tumor pathology in the sellar region.

Amigdalectomía en pacientes con asimetría amigdalina: análisis histopatológico y factores de riesgo de malignidad / Tonsillectomy in patients with tonsillar asymmetry: histopathological analysis and risk factors for malignancy

Introduction: Tonsillectomy is the most frequent ENT (ear nose and throat) surgery. An absolute indication is suspicion of a malignant tumor. Therefore the importance of determine whose patients are inherent to that risk. Objective: To conduct a histopathological analysis of asymmetrical tonsillar biopsies, correlate clinical suspicion of tumor with biopsy results, and compare patients with exclusive tonsillar asymmetry versus tonsillar asymmetry plus others symptoms or signs suggestive of malignant pathology. Methods: Retrospective analysis of tonsillar biopsies processed from patients diagnosed with tonsillar asymmetry at HCUCH (Hospital Clínico Universidad de Chile), February 2003 through June 2006 period. Two groups were selected: Exclusive tonsillar asymmetry (Group A) and asymmetry associated with clinical findings suggestive of malignancy (Group B). Results: 2083 Tonsillectomies, from which 135 (6,48 percent) where sent to biopsy. Of these, 41 (30,3 percent) had been diagnosed as tonsillar asymmetry (2 percent from total). 23 female and 18 male, age range: 2- 73 years old, (Average age: 27 years), 9patients had tonsillar asymmetry associated to a clinical suspicion finding of malignant pathology, while 32 patients had exclusive asymmetry. Group A histopathological analysis informed as Chronic Inflammation in 24 cases (75 percent), chronic inflammation plus actinomyces presence in 8 cases (25 percent), no malignant pathology; correlation Obs. Tumor/Real tumor: 4/0 = 0 percent. Group Bhistopathological analysis informed as chronic inflammation: 4 (44,4 percent), chronic Inflammation plus actinomyces presence 2 (22,2 percent), Squamous papilloma 1 (11,1 percent), Squamous Carcinoma 1 (11,1 percent), Lymphoma 1 (11,1 percent); correlation Obs. Tumor/Real Tumor: 6/3 = 50 percent. Discussion: Tonsillar asymmetry corresponded to 31 percent of tonsillectomies prescriptions in our center.

Epidemiología de la patología otorrinolaringológica ambulatoria y quirúrgica en población mayor de 65 años en el Hospital Clínico de la Universidad de Chile / Epidemiology otorhinolaryngological pathology ambulatory and surgery in population over 65 years at the Hospital Clínico de la Universidad de Chile

Introduction: The otolaryngology (ear, nose and throat (ENT)) pathology is a common ambulatory cause of consultation in an elderly country as Chile. Aims: Characterize the ENT diagnosis in ambulatory elderly population more than 65 years old consultant on ENT clinic of HCUCH (Hospital Clínico Universidad de Chile) during 2009. Patients and Methods: descriptive transversal retrospective study. ENT diagnosis was rescued of clinical archives. Anatomical functional groups, specific diagnosis and sex were tabulated. A patient could have more than one diagnosis. STATA statistical analysis was performed. Results: 148 elderly (204 diagnosis) consulted during 2009, average age 74,08+/-6,87 years old, 65,54 percent women. The most frecuent groups were the vestibular-auditive (n=133; 65,20 percent), naso-sinusal (n=36; 17,64 percent) and pharingo-laryngeal (n=17; 8,33 percent). The most frecuent specific diagnosis were prebycusis(n=43; 21,08 percent), earwax (n=28; 13,73 percent), allergic rhinitis (n=17; 8,33 percent) and unspecified vertigo (n=13; 6,37 percent). There were not significant differences between gender in any specific diagnosis. Discussion: The diagnostic profile is consistent to age group. Results agree with the high frequency of presbycusis, but differ in the high presence of earwax and allergic rhinitis above other expected diagnostics. Conclusion: new Chilean epidemiologic information of ambulatory and surgical ENT pathology was provided.

Dehiscencia del canal semicircular superior, un nuevo diagnóstico en pacientes con vértigo / Superior semicircular canal dehiscence, a new diagnosis in patients with vertigo

Introduction: The superior semicircular canal dehiscence syndrome (SSCD) is a pathology described in 1998, which presents several symptoms including sound induced vertigo, hearing loss and autophony due to bone dehiscence of this semicircular canal. Material and Methods: A retrospective and descriptive study was carried out, reviewing the medical records of patients with computed tomography suggestive of SSCD between 2006 and 2010 from the Radiology department of the Clinical Hospital of the University of Chile. Results: We obtained six cases of SSCD (4 female) with a mean age of 52.7 years. SSCD was observed in four cases bilaterally and in two cases on the left ear. We confirmed a clinical syndrome in two patients, based on the presence of hearing loss and sound induced vertigo. Conclusions: The diagnosis of SSCD syndrome should be supported on both clinical and imaging studies. We should maintain a high level of suspicion, particularly in cases of sound induced vertigo and of conductive hearing loss with normal otoscopy.

Hematoma masivo esofágico con compromiso supraglótico: reporte de un caso y revisión de la literatura / Massive esophageal hematoma with supraglottic extension: report of a case and review of the literature

Se presenta el caso de un paciente de 67 años de sexo masculino, hipertenso, diabético y usuario de aspirina en dosis anticoagulante, que consulta en el servicio de urgencia por un cuadro de inicio súbito de dolor retroesternal asociado a disnea severa y estridor. La evaluación mediante nasofibroscopfa muestra una gran masa supraglótica que obstruye el 80 por ciento del lumen, compatible con una masa esofágica. La tomograffa computarizada de tórax muestra una imagen compatible con un hematoma disecante esofágico de gran extensión, desde laringe hasta la unión gastroesofágica. El paciente se maneja en forma conservadora mediante observación, analgesia y alimentación párenteral. Se evalúa en forma periódica con tomograffa computarizada y nasofibroscopfa. Evoluciona con reabsorción progresiva del hematoma y disminución del compromiso laríngeo por lo que es dado de alta a los 10 días. Este caso ejemplifica una rara patología que además tiene una forma atípica de presentación, con obstrucción laríngea.

We present a case of a 67 years old hipertense and diabetic male. The patient refered a sudden onset of chest pain associated with severe dysnea and audible stridor. Nasofibroscopy showed a supraglottic mass that obstructed an estimated 80 percent of normal lumen, suggestive of an esophageal mass. Thorax CT scan revealed an ¡mage of a dissecting esophageal haematoma that compromised most of the esophageal extension, beggining at the laryngeal plane. The patient was managed by conservative means, through observation, analgesia and parenteral nutrition. Close follow up, by CT Scan as well as nasofibroscopy. The patient evolved well, with haematoma reabsorption and decrease of laryngeal obstruction being discharged after 10 days of hospitalization. We report a rare entity that presented in an unusual way.

Fibroangioma nasofaríngeo juvenil: experiencia de 12 años en el Hospital Clínico de la Universidad de Chile / Juvenile nasopharyngeal angiofibroma: 12 years experience at the University of Chile Clinical Hospital

Introducción: El fibroangioma juvenil es un tumor vascular que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 12 años en fibroangioma juvenil Material y método: Estudio descriptivo retrospectivo de los pacientes que ingresaron con diagnóstico de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile entre los años 1996 y 2008, caracterizando al grupo de estudio en cuanto a clínica, diagnóstico, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 22 pacientes, todos de sexo masculino, con un promedio de edad de 17,7 años. El síntoma de presentación más frecuente fue la epistaxis a repetición presente en el 81,8 por ciento de los casos. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo IIByllC (68,1 por ciento) según Radkowski y la técnica quirúrgica más empleada fue la endoscópica (54,5 por ciento). Hubo sólo una complicación mayor, pero derivada del procedimiento de embolización y no de la cirugía propiamente tal. Se encontró 22,7 por ciento de recurrencias (n =5, todas endoscópicas), con un tiempo libre de enfermedad de 8,2 meses promedio. Discusión y conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. La decisión terapéutica se basa en la determinación del tamaño tumoral y su extensión, prefiriendo inicialmente un abordaje endoscópico por su carácter poco invasivo y por presentar menor sangrado, tiempo quirúrgico y estadía hospitalaria; siempre que el estadio tumoral lo permita. La embolización arterial, independiente de la vía de abordaje, debe ser de rutina.

Introduction: Juvenile nasopharyngeal angiofibroma is a vascular tumor that occurs almost exclusively in the nasopharynx of adolescent males. Its management is complex because of its vascular nature and frequent recurrence. Aim: To review the experience of 12 years in juvenile nasopharyngeal angiofibroma. Material and method: Retrospective study of patients admitted with diagnosis of juvenile nasopharyngeal angiofibroma at the Otorhinolaryngology Department, University of Chile Clinical Hospital, between 1996 and 2008, characterizing the study group in terms of clinical features, diagnosis, treatment, complications and recurrences. Results: We obtained 22 patients, all male, with an average age of 17.7 years. The most common presenting symptom was recurrent epitasis, present in up to 81.8 percent of cases. All patients were studied with computed tomography and received preoperative arterial embolization. Most tumors were type IIB and C (68.1 percent) and the endoscopic surgical technique was predominant. There was only one major complication, but derived from the embolization procedure and not the surgery itself. There was a 22.7 percent recurrence, with disease-free time of 8.2 months on average. Discussion and Conclusion: Our results agree with most of the series published in the literature. The therapeutic decision is based on the determination of tumor size and extension, preferring an initial endoscopic approach, for its minimally invasive nature and because they present less bleeding, surgical time and hospital stay if the tumor stage allows. Arterial embolization, regardless of the surgical approach, should be routine.

Enfermedad de Ménière: caso clínico y revisión de la literatura / Meniere disease: clinical case and review of literature

Ménière’s disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The pathofisiology involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops. Initial management of Ménière’s diseasecan involve a low-salt diet and a diuretic. Treatment with intratympanic injection of gentamicin can be beneficial when vertigo persists despite optimal medical management. Recent studies have shown that gentamicin reduces vestibular function in the treated ear, and is not always necessary to forgo the remaining hearing of the affected ear to achieve control of vertigo.

Traqueostomía abierta vs traqueostomía percutánea / Open vs percutaneous tracheostomy

Introducción: La traqueostomía está indicada para prevenir el daño laríngeo producido por intubaciones prolongadas, mejorar la higiene traqueal, disminuir el espacio muerto y minimizar la estadía en Unidades de Pacientes Críticos (UPC). La técnica más utilizada es la abierta, que permite un adecuado control de la anatomía y de la hemostasia. Actualmente, en las UPC es cada vez más habitual, la realización de la técnica percutánea. Varios trabajos indican que es una técnica rápida y con menos complicaciones, pero aún existe controversia. Objetivo: Comparar a través de un estudio prospectivo, ambas técnicas en cuanto a duración del procedimiento y complicaciones peri y postoperatorias. Material y método: De un total de 91 pacientes, se seleccionaron 50 que no tenían contraindicación para realizar técnica percutánea. En esos 50 pacientes se realizó en forma aleatoria, técnica abierta y técnica percutánea obteniendo 2 grupos de 25 pacientes (Grupos AyP). Todos los pacientes fueron intervenidos en pabellón y bajo anestesia general. Resultados: La duración total del procedimiento incluida la anestesia fue de 65,8 min y de 59,2 min y la duración de la cirugía fue de 40,4 min y 32,2 min, respectivamente. Las complicaciones perioperatorias fueron: grupo A 16 por ciento (desaturación y sangrado lo más frecuente) y Grupo P: 40 por ciento (desaturación y pérdida de vía aérea lo más frecuente) y las posoperatorias de 8 por ciento y 12 por ciento (sangrado e infección lo más frecuente en ambos grupos) en los grupos AyP, respectivamente. Conclusión: Al comparar ambas técnicas, no hubo en nuestras manos diferencias estadísticamente significativas en cuanto al número de complicaciones ni en cuanto a la duración del procedimiento.

Introduction: Tracheostomy is indicated to prevent laryngeal injury in cases of long-term translaryngeal intubation, to improve tracheal hygiene, decrease the dead space and reduce the time spent in intensive care units (ICU). The open technique is the most commonly used technique, which allows for an adequate control of anatomy and haemostasis. Currently, the percutaneous technique is increasingly used in CPUs, since it is a fast technique, with less perioperative complications. However, there is still controversy on this issue. Aim: This paper is a prospective study, designed to compare both techniques in terms of procedure duration and peri- and postoperative complications. Material and method: Out of a total of 91 patients, 50 were selected that did not have any counterindications for the percutaneous technique. These 50 patients were randomly assigned to either the open or the percutanous technique groups, obtaining 2 groups of 25 patients (Groups A andP). All patients had the surgery performed in the operating room, undergeneral anesthesia. Results: Total duration of the procedure (including anesthesia) was 65.8 and 59.2 min, and surgery duration was 40.4 and 32.2 min, respectively. Perioperative complications were: Group A, 16 percent (oxygen desaturation and bleeding were the more frequent problems), and Group P, 40 percent (oxygen desaturation and airway loss were the more frequent problems). Postoperative complications In Groups A and P were 8 and 12 percent (bleeding and infection being the more frequent problems in both groups), respectively. Conclusion: In our study, a comparison of both techniques did not show significant differences regarding either number of complications or duration of the procedure.

Genomic instability in scleroderma.

Scleroderma is an enigmatic rheumatic disorder of uncertain etio-pathogenesis. Cancer has an approximately two-fold higher incidence in scleroderma patients than in the general population. There are preliminary data of acquired genetic damage in scleroderma but the significance of these observations are uncertain. To determine somatic mutation frequency at the glycophorin-A (GPA) locus in patients with limited and diffuse cutaneous scleroderma. The GPA assay measures the total somatic mutation frequency (Vf), composed of gene inactivating mutations (NO) and mutations arising from mitotic recombination (NN) in individuals heterozygous for the GPA MN blood group. Mutation frequency was determined using a validated GPA flow cytometric assay using fluorescent labeled monoclonal antibodies specific for the GPA blood groups M and N. This assay detects and enumerates progeny of red blood cell (rbc) precursor cells which have acquired genetic damage resulting in a loss of expression of one of the GPA alleles. It was found that patients with scleroderma (n = 23) had significantly elevated Vf as compared with young healthy controls (p < 0.001) and elderly controls (p = 0.03). Patients with diffuse scleroderma had higher mean Vf as compared with limited scleroderma (p = 0.055). In comparison with controls, patients with scleroderma exhibit a higher proportion of mitotic recombinant mutations than inactivating mutations (p < 0.002). There was no correlation between Vf and disease duration, age at onset or autoantibody status. We have documented evidence of acquired genetic damage at the GPA locus in scleroderma. Evidence of acquired genetic damage in this disorder may be importance in explaining both the etio-pathogenesis of scleroderma and the association of scleroderma with cancer.

Terapia de oxigenación hiperbárica en radionecrosis de cabeza y cuello / Hyperbaric oxygenation therapy in head and neck radio-necrosis

La terapia de oxigenación hiperbárica se ha utilizado en radionecrosis de cabeza y cuello, ya sea como indicación profiláctica o para su manejo terapéutico. El presente trabajo tiene como objetivo presentar la experiencia del Servicio de ORL del Hospital Clínico de la Universidad de Chile con el uso de la cámara hiperbárica en pacientes con radionecrosis de cabeza y cuello. Se presenta una casuística de 8 pacientes. En 5 casos la indicación de oxigenación hiperbárica fue terapéutica y, en 3 de ellos, profiláctica. En todos quienes fueron sometidos a oxigenación terapéutica se resolvió la radionecrosis. En los pacientes con indicación profiláctica no hubo radionecrosis del colgajo. Se concluye que la terapia de oxigenación hiperbárica es una herramienta coadyuvante terapéutica o profiláctica en la necrosis por radiación de cabeza y cuello.

Timpanoplastía en empalizada / Tympanoplasty in palisade

El objetivo de este trabajo es evaluar prospectivamente la técnica timpanoplastía en empalizada en pacientes seleccionados (perforaciones extensas y/o reperforaciones), es decir aquellos que habitualmente presentan un riesgo de fracaso con las timpanoplastías tradicionales. Se estudiaron 16 pacientes consignado edad, sexo, tipo de perforación, tipo de cirugía, tiempo quirúrgico, resultado anatómico, resultado auditivo, complicaciones intra- y post-operatorias. Los resultados obtenidos fueron concordantes con la literatura, presentando un mayor éxito anatómico y resultados auditivos similares a otras técnicas. Se recomienda como una alternativa terapeútica frente a la otitis media crónica y sus complicaciones

Five cases of neurocysticercosis diagnosed in Sydney.

Cysticercosis, once rare in Australia, is now more frequently diagnosed. This change reflects the countries of origin of new immigrants and the destinations of Australians travelling. Five cases of neurocysticercosis diagnosed at Westmead Hospital in Sydney are described. Two involved Australians, a father and son who had visited eastern and southeastern Asia 10 years before presentation. The other three included immigrants from Chile and India and a visitor from Timor. Ages ranged from 5 to 57 years. Three individuals presented after focal seizures involving the upper limb, one had a long standing history of neurological dysfunction and one suffered from persistent headaches. In all cases computed tomographic scanning (CT) or magnetic resonance imaging (MRI) revealed cystic brain lesions and three of the five were seropositive as well. Four were treated with praziquantel and in one the lesions regressed significantly following treatment. However, the lesion in one case had decreased in size prior to treatment and that in the untreated individual also became smaller.