Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Abstract Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is themost certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

Evaluación diagnóstica de la nasofibrolaringoscopia en síndrome de apnea-hipopnea obstructiva del sueño en pacientes pediátricos / Assessment of flexible nasolaryngoscopy in obstructive sleep apnea-hypopnea syndrome in pediatric patients

Introducción: La polisomnografía ha demostrado tener ciertas falencias en el diagnóstico del Síndrome de apnea-hipopnea obstructiva del sueño. Hay controversia respecto a las ayudas diagnósticas que requiere un paciente pediátrico antes de ser llevado a cirugía. Objetivo: Evaluar la utilidad diagnóstica de la fibronasolaringoscopia para detección de pacientes pediátricos con Síndrome de apnea-hipopnea obstructiva del sueño. Diseño: Estudio de pruebas diagnósticas.Materiales y métodos: Durante un año se realizaron 78 polisomnografías con igual número de fibronasolaringoscopias a pacientes pediátricos que por selección con encuestas podrían sugerir la presencia de un trastorno respiratorio del sueño. Se hizo posteriormente un análisis estadístico. Resultados: Encontramos una baja correlación entre los resultados con una sensibilidad del 71% y una especificidad del 62%. Sin embargo, la fibronasolaringoscopia presenta un valor predictivo negativo del 95%, que podría sugerir que las fibronasolaringoscopias normales se relacionan con una polisomnografía normal y ausencia de esta enfermedad. Conclusión: La fibronasolaringoscopia debe tomarse como una ayuda diagnóstica en casos de pobre correlación paraclínica-clínica y en pacientes sometidos a cirugía sin adecuada respuesta al manejo

Introduction: Polysomnography has shown to have certain shortcomings in the diagnosis of Obstructive Sleep Apnea syndrome. There is controversy regarding the appropriate workup required for pediatric patients when considering surgical treatment. Objective: To evaluate the diagnostic value of flexible nasolaryngoscopy in a pediatric population with Obstructive Sleep Apnea syndrome. Design: Diagnostic accuracy study. Methods: We included seventy-eight children with clinical suspicion of Obstructive Sleep Apnea, accordingly to a screening standard questionnaire. All children underwent polysomnography and flexible nasolaryngoscopy. Appropriate statistical analysis was performed. Results: We found a low correlation between polysomnography and flexible nasolaryngoscopy results. Flexible nasolaryngoscopy showed a sensitivity of 71% and a specificity of 62%, with a negative predictive value of 95%, indicating that a normal flexible nasolaryngoscopy correlates with a normal polysomnography. Conclusions: Flexible nasolaryngoscopy should be performed in cases with poor correlation between polysomnography results and clinical findings, and in all children with inadequate response to surgical treatment.

Marcadores de inmunohistoquímica P63 y Ki67 como factores pronósticos en recurrencia temprana y malignidad en paciente con lesiones premalignas en laringe / Immunohistochemical markers P63 and Ki67 as prognostic factors for early recurrence and malignancy in patients with precancerous lesions in the larynx

No existe un consenso sobre el manejo de las lesiones premalignas de laringe, en especial cuando se trata de displasias severas y carcinomas in situ. Por esto, se decidió evaluar el papel de los marcadores de inmunohistoquímica en displasias epiteliales, con el fin de definir su rol como factor de pronóstico durante el seguimiento. Se presenta una cohorte de pacientes mayores de 18 años, con diagnóstico de displasias laríngeas leves, moderadas y severas, con seguimiento mínimo de 6 meses. Se encontraron 4 pacientes con marcadores positivos con recidiva antes de los 6 meses, uno de ellos con malignización temprana. Un paciente adicional con recidiva y malignización 25 meses después del procedimiento inicial, 4 pacientes con marcadores positivos sin recidiva y un paciente con marcadores negativos sin recidiva. Tras más de 36 meses de seguimiento, se encontró una baja incidencia de displasias laríngeas, sin poder determinar la efectividad de los marcadores como factores pronósticos. Se analizan los datos como serie prospectiva, sentando una base para un estudio multicéntrico.

There is no consensus on the management of premalignant lesions of the larynx, especially when talking about severe dysplasia and carcinoma in situ. Therefore, we decided to evaluate the role of immunohistochemical markers as prognostic factors in epithelial dysplasia. A cohort of patients, 18 years old and older, diagnosed with mild, moderate and severe laryngeal dysplasia was followed since 2012 for up to at least 6 months. Four patients with positive markers had recurrence before 6 months of follow up, with one of them having an early malignancy. An additional patient had malignant recurrence identified 25 month after surgery. We found 4 markerpositive patients without recurrence, and one patient with negative markers with no recurrence. At 36 months follow-up, we found a low incidence of laryngeal dysplasia, therefore these results cannot rule out the effectiveness of immunohistochemical markers as prognostic factors for laryngeal dysplasia. The data are analyzed as a prospective series, laying the ground for an upcoming multicenter study.

Tabaquismo en Guatemala: situación actual / Guatemala smoking: current situation

Según la Organización Mundial de la Salud (OMS), el tabaquismo es una de las principales causas de enfermedad crónica y la principal causa de muerte prevenible a nivel mundial. De no abordarse de manera urgente, para el año 2030 podría llegar a matar a 8 millones de personas anualmente, 80% de estas muertes ocurriendo en países de mediano/bajo ingreso. Los datos sobre la prevalencia de tabaquismo en Guatemala son escasos, según la “Encuesta Global del Tabaco” en el 2008, en los primeros grados de secundaria hay una prevalencia de tabaquismo de 19.7% para hombres y 13.3% para mujeres.

According to the World Health Organization (WHO), smoking is a major cause of chronic disease and the leading cause of preventable death globally. If not addressed urgently, 2030 might get to kill 8 million people annually, 80% of these deaths occurring in middle / low income. Data on smoking prevalence are scarce in Guatemala, according to "Global Survey of Tobacco" in 2008, in the early grades of school is a smoking prevalence of 19.7% for men and 13.3% for women.

Relación entre diabetes gestacional y síndrome metabólico / Relationship between gestational diabetes and metabolic syndrome

Background: The metabolic syndrome (MS) is associated to a significant increase in the risk of diabetes, coronary heart disease and stroke, resulting in a 5-fold increase of the cardiovascular death rate. Aim: To determine the relationship between gestational diabetes (GD) and the development of MS at the end of puerperal period. Patients and Methods: We conducted a case-control study in the Curanilahue Hospital, in southern Chile, including 58 women with GD during their pregnancy, studied in day 42 of their puerperal period (study group) and 58 puerperal women from the same hospital, who had a physiological pregnancy (control group). Triglycerides, HDL cholesterol, fasting and post prandial blood glucose levels, blood pressure, waist circumference, weight and height were measured. MS was diagnosed using the National Cholesterol Education Program (NCEP - ATP III) criteria. Results: Mean weight, body mass index, waist circumference, blood glucose and triglycerides were significantly higher in the study group and HDL cholesterol was significantly lower in the control group. Conclusions: These results suggest a significant relationship between GD and the ocurrence of MS.