RESUMO
Introducción: La epistaxis corresponde al motivo de consulta de urgencia más frecuente en otorrinolaringología. Su etiología es multifactorial, predominantemente de causa traumática. Una alternativa de manejo quirúrgico en los casos de epistaxis significativa es la cauterización o ligadura endoscópica de la arteria esfenopalatina (AEP). Objetivos: Este estudio pretende revisar la experiencia del Hospital Clínico de la Universidad de Chile en el manejo endoscópico de pacientes con epistaxis posterior. Material y método: Se revisaron los registros quirúrgicos del servicio entre los años 2007y 2011 considerando todos los pacientes que fueron tratados por epistaxis posterior mediante cirugía endoscópica nasal. Resultados: Se revisó un total de 23 casos. La edad promedio de los pacientes fue 52±18 años. Sesenta por ciento presentaba el antecedente de hipertensión arterial en tratamiento. Se realizó ligadura con clips más electrocauterización de AEP en 52,1% de los casos, ligadura con clips de AEP en 26,2%%, y electrocauterización de AEP en 21,7%% de los casos. Discusión y conclusiones: El manejo endoscópico de las epistaxis posteriores es una técnica sencilla y reproducible, constituyendo una herramienta terapéutica segura y eficaz para estos pacientes.
Introduction: Epistaxis is by far the most common emergency complaint in otolaryngology. Its etiology is multifactorial, predominantly by traumatic causes. An alternative in surgical management of significant epistaxis cases, is the endoscopic cauterization or ligature of the sphenopalatine artery (SPA). Aim: This study aims to review the experience of the Hospital Clínico de la Universidad de Chile in the endoscopic management of patients with posterior epistaxis. Material and methods: The surgical records have been reviewed between the years 2007and 2011, considering all patients who were treated for posterior epistaxis, by endoscopic nasal surgery. Results: A total of 23 cases were reviewed. The average age of patients was 52 ± 18 years. 60% of patients had a history of hypertension in treatment. Clip ligature with electrocauterization of the SPA was performed in 52.1% of cases, clip ligature of the SPA in 26.2%%, and isolated electrocauterization of the SPA in 21.7%% of cases. Discussion and conclusions: Endoscopic treatment of posterior epistaxis is a simple and reproducible technique, being a safe and effective therapeutic tool for these patients.
Assuntos
Humanos , Epistaxe/terapia , Endoscopia/métodos , Epistaxe/cirurgia , Estudos RetrospectivosRESUMO
Streptococcal pharyngitis is common in children and adolescents. It is strongly suggested by the presence of fever, tonsillar exudate, tender enlarged anterior cervical lymph nodes and absence of cough (Centor criteria). Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. Treatment of acute streptococcal pharyngitis is important for preventing acute rheumatic fever and suppurative complications, hastening illness resolution, and preventing transmission. Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin is equally effective and more palatable. Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy.