ABSTRACT
RESUMEN La estenosis faríngea es una complicación muy poco frecuente de la adenoamigdalectomía. Consiste en un estrechamiento de la vía aerodigestiva superior secundaria a la adhesión parcial o total de las estructuras que componen la orofaringe producto de una disección extensa al realizar amigdalectomía. El objetivo de este trabajo es presentar tres casos clínicos tratamiento y correspondiente técnica quirúrgica. Se describen tres pacientes operados durante la edad preescolar de adenoamigdalectomía, que cursaron en el posoperatorio con estenosis faríngea. Todos presentaron roncopatía severa, respiración oral y resonancia hiponasal. La nasofibroscopía evidenció estrechez faríngea en distintos grados. A todos se les realizó resección del tejido cicatricial y faringoplastía con colgajo miomucoso y posterior rehabilitación con bulbo faríngeo. El uso de colgajos faríngeos posterior a la liberación de adherencias posadenoamigdalectomía permite aportar tejido sano a zonas cruentas, evitando la formación de nuevas adherencias y restituyendo la permeabilidad oronasal. El bulbo faríngeo es fundamental para mantener un apropiado lumen y manejo de la cicatrización en el posoperatorio. La técnica de colgajo faríngeo lateral, que interpone mucosa faríngea sana para la cobertura del lecho cruento, constituye una alternativa quirúrgica eficaz para resolver la estenosis faríngea posquirúrgica.
ABSTRACT Pharyngeal stenosis is a very rare complication of adenotonsillectomy. It is caused by a narrowing of the upper aerodigestive pathway secondary to the total or partial adhesion of the retropharyngeal structures as a result of extensive dissection during tonsillectomy. Our aim is to present three consecutive clinical cases of pharyngeal stenosis after adenotonsillectomy, discuss its treatment and corresponding surgical technique. We present three infants with adenotonsillectomy with postoperative pharyngeal stenosis. All had severe snoring, oral breathing and hyponasal resonance. The nasofibroscopy showed pharyngeal obliteration in several degrees. All patients underwent scar tissue resection and pharyngoplasty with myomucosal flap and subsequent use of pharyngeal bulb. The use of pharyngeal flaps after release of pharyngeal adhesions allows to provide healthy tissue to row areas, avoiding new postoperative adhesions and providing adequate oronasal permeability. The pharyngeal bulb is essential to maintain permeability and management of scarring in the postoperative period. The technique of lateral pharyngeal flap, which aims to interpose healthy pharyngeal mucosa to cover the bloody bed, is an effective therapeutic alternative to solve post-surgical pharyngeal stenosis.
Subject(s)
Humans , Male , Female , Child, Preschool , Postoperative Complications/etiology , Postoperative Complications/pathology , Adenoidectomy/adverse effects , Oropharynx/pathology , Postoperative Complications/surgery , Constriction, PathologicABSTRACT
The glycaemic response to feeding increased loads of glucose and sucrose was investigated in man and rat. Assessed were the tolerance tests after feeding 10-100 g glucose or 10-20 g sucrose to hospitalized diabetic or non-diabetic patients and after loading 30-450 mg glucose or sucrose per 100 g body weight to alloxan-diabetic or non-diabetic rats. The maximal levels of tolerance curves, the increase in blood glucose levels and the sum of the glycaemic values reflecting the areas under the curves were chosen as criteria. The correlation between the dose of ingested carbohydrates and the glyucaemic effect was not necessarily linear, but blood glucose values following the carbohydrate loads were concentrated in ranges, corresponding to groups of load sizes. These observations may be practical for the diagnostic procedure and dietetic treatment of the diabetic patient.
Subject(s)
Blood Glucose/analysis , Diabetes Mellitus, Experimental/metabolism , Diabetes Mellitus/metabolism , Dietary Carbohydrates/metabolism , Aged , Alloxan , Animals , Dose-Response Relationship, Drug , Female , Glucose Tolerance Test , Humans , Middle Aged , RatsABSTRACT
A study based on 55 hospital patients (age groups 40-59, 60-69, 70-79) demonstrated a significant correlation between the glomerular filtration rate (as expressed by endogenous creatinine clearance) and the mean urinary calcium concentration. Excluded were patients with thyroidal or hypophyseal disorders, osteoporosis, renal stones immobilizing conditions, or those treated with corticosteroids. The study patients had a normal fluid intake and did not receive any diuretics. The urinary calcium concentration test is less laborious and less liable to laboratory errors than the creatinine clearance test, which requires a 24-hour urine collection. Because of the gradual decrease in the glomerular filtration rate in the elderly, this test should be of value in geriatric practice.
