Neurofibromatosis orbitotemporal gigante / Giant orbitotemporal neurofibromatosis / Neurofibromatose órbitotemporal gigante

La neurofibromatosis orbitotemporal es una enfermedad progresiva que comienza en la infancia y puede generar importantes alteraciones morfológicas y funcionales. Presentamos el caso de un paciente adulto con diagnóstico de neurofibromatosis orbitotemporal gigante, en el cual se realizó un tratamiento mediante embolización preoperatoria y resección quirúrgica con el fin de disminuir el tamaño tumoral.

Orbitotemporal neurofibromatosis is a progressive disease that begins in childhood and may cause important morphological and functional alterations. We present the case of an adult patient with a giant orbitotemporal neurofibromatosis, which was treated by preoperative embolization and a surgical resection to reduce the size of the tumor size.

A neurofibromatose órbito-temporal é uma enfermidade progressiva que começa na infância e pode gerar importantes alterações morfológicas e funcionais. Apresentamos o caso de um paciente adulto com diagnóstico de neurofibromatose órbito-temporal gigante, que foi submetido a tratamento com embolização pré-operatória e ressecção cirúrgica para diminuir o tamanho tumoral.

Tratamiento endovascular para epistaxis posterior / Endovascular treatment for posterior epistaxis / Tratamento endovascular para epistaxe posterior

INTRODUCCIÓN: Las complicaciones del tratamiento endovascular son infrecuentes. Las lesiones isquémicas a los tejidos de la cabeza y el cuello se han reportado de forma esporádica, siendo complicaciones raras gracias al aporte redundante de la amplia red anastomótica en esta región. OBJETIVOS: Realizar una análisis estadístico de los pacientes que se sometieron a tratamiento endovascular por epistaxis, identificando las complicaciones, y realizar una revisión comparada con la literatura disponible evaluando la efectividad del tratamiento...

INTRODUCTION: Complications of endovascular treatment are infrequent. Ischemic injuries to the tissues of the head and neck have been reported sporadically, being rare complications thanks to the redundant contribution of the extensive anastomotic network in this region. OBJECTIVES: Perform a statistical analysis of patients who underwent endovascular treatment for epistaxis, identifying complications and conducting a review compared to the available literature evaluating the effectiveness of the treatment...

INTRODUÇÃO: Complicações do tratamento endovascular são infrequentes. Lesões isquêmicas nos tecidos da cabeça e pescoço têm sido relatadas esporadicamente, sendo complicações raras graças à contribuição redundante da extensa rede anastomótica nessa região. OBJETIVOS: Realizar uma análise estatística dos pacientes que foram submetidos a tratamento endovascular para epistaxe, identificando complicações e realizando uma revisão em comparação com a literatura disponível que avalia a eficácia do tratamento...

Juvenile nasopharyngeal angiofibroma: a single institution study.

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor of adolescent males and there is a paucity of Indian studies on this subject. AIMS: To present the experience of management of JNA at a single institution. SETTING AND DESIGN: This is a retrospective observational study of patients with JNA who presented at the Tata Memorial Hospital between May 1988 and August 2001. MATERIALS AND METHODS: Thirty-two patients with JNA were treated in the study period. Since the time period was prolonged and diagnostic and therapeutic protocols had undergone many changes, the patients were divided into two groups, namely 1988-1996 and 1997-2001. The age distribution, disease patterns, management approaches and treatment outcomes of patients in the two groups were recorded. Statistical analyses were done using students 't' test and test for proportion. RESULTS: The mean age at presentation was 16 years and more than 90% of the patients had Stage III or IV disease. Preoperative embolization was carried out in 19 patients. The surgical approaches used were median maxillectomy, infratemporal fossa, transpalatal, maxillary swing and craniofacial approach. The recurrence rate, complete resection rate and cure rates were 12.5%, 41% and 63% respectively. CONCLUSION: Surgery is the mainstay of treatment of JNA. Preoperative embolization and newer surgical approaches result in less blood loss and complete resection. Aggressive re-resection should be done for resectable recurrences reserving radiotherapy for unresectable, recurrent/ residual disease.

safer splenectomy with critical thrombocytopenia: preoperative splenic artery embolization

Portal hypertension is sometimes associated with hypersplenism and pancytopenia. Splenectomy cures the hypersplenism in these circumstances. The presence of critical thrombocytopenia is usually associated with high morbidity and mortality of the splenectomy procedure. To evaluate the effect of preoperative splenic artery embolization on the outcome of splenectomy in these circumstances. From April 2000 to June 2002, 23 patients with pancytopenia associating portal hypertension were selected to be enrolled in the study. All patients had splenic artery embolization as a preoperative measure to improve their thrombocytopenic state. This was followed by a surgical splenectomy after reaching a platelet count above 100,000 /cm3. Post embolization all patients showed a progressive increase in platelet count from a mean of 51000/ cm3 to a mean of 122000/cm3 on day 6. Complications of the embolization procedure were bleeding at the puncture site, portal vein thrombosis, splenic abscess, and systemic sepsis. Complications of the splenectomy procedure were one mortality, post operative Heeding in one case, chest infection in one case and wound infection in 2 cases. Preoperative splenic artery embolization can be used to improve the outcome of splenectomy in the presence of thrombo-cytopenia. The technique should be used selectively and only when platelet counts drop below 50000/cm3 [critical thrombocytopenia]. Splenectomy timing at day 6 post embolization is safe as thrombocytopenia was corrected at that time in all patients