ABSTRACT
Antecedentes: A pesar del gran número de autores que se refieren a esta complicación, no hay aún hoy acuerdo sobre causas. Objetivo: Reconocer los factores que favorecen su desarrollo. Lugar de aplicación: Hospital público de atención terciaria de pacientes oncológicos. Diseño: Prospectivo no randomizado. Población: 100 enfermos, 93 por ciento masculinos, edad media 59,13 años, 98 por ciento portadores de carcinoma epidermoide sometidos a laringectomía total. Método: Análisis uni y multivariado de 21 variables potencialmente favorecedoras de fístulas postoperatorias. Resultados: Ninguna de las vriables resultó estadísticamente significativa. La radioterapia previa se comportó como el factor de mayor probabilidad del evento. La incidencia de fístulas alcanzó el 55 por ciento de los operados. Su momento de aparición tuvo una media de 9 días. El 76,3 por ciento cerró espontáneamente. Las peores consecuencias del evento resultaron la prolongación en el uso 3,6 veces mayor a la media de la sonda de alimentación, la necesidad de nuevos tiempos quirúrgicos en 13 pacientes y la rehabilitación 2 meses después que el resto. Conclusiones: La dimensión de la muestra resultó insuficiente para desarrollar el modelo predictivo del fenómeno (AU)
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Aged , Laryngectomy/adverse effects , Fistula/etiology , Postoperative Complications , Retrospective Studies , Causality , Laryngeal Neoplasms/surgery , Multivariate Analysis , Risk Factors , PharynxABSTRACT
Antecedentes: A pesar del gran número de autores que se refieren a esta complicación, no hay aún hoy acuerdo sobre causas. Objetivo: Reconocer los factores que favorecen su desarrollo. Lugar de aplicación: Hospital público de atención terciaria de pacientes oncológicos. Diseño: Prospectivo no randomizado. Población: 100 enfermos, 93 por ciento masculinos, edad media 59,13 años, 98 por ciento portadores de carcinoma epidermoide sometidos a laringectomía total. Método: Análisis uni y multivariado de 21 variables potencialmente favorecedoras de fístulas postoperatorias. Resultados: Ninguna de las vriables resultó estadísticamente significativa. La radioterapia previa se comportó como el factor de mayor probabilidad del evento. La incidencia de fístulas alcanzó el 55 por ciento de los operados. Su momento de aparición tuvo una media de 9 días. El 76,3 por ciento cerró espontáneamente. Las peores consecuencias del evento resultaron la prolongación en el uso 3,6 veces mayor a la media de la sonda de alimentación, la necesidad de nuevos tiempos quirúrgicos en 13 pacientes y la rehabilitación 2 meses después que el resto. Conclusiones: La dimensión de la muestra resultó insuficiente para desarrollar el modelo predictivo del fenómeno
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Fistula , Laryngectomy , Postoperative Complications , Multivariate Analysis , Causality , Laryngeal Neoplasms , Pharynx , Retrospective Studies , Risk FactorsABSTRACT
Postoperative infection has influence on costs, quality of life, and outcome of the disease. It is suspected that post-total laryngectomy infections have increased in frequency and seriousness, because of the failure of the preservation protocol or the previous radiotherapy, making rescue surgery necessary. The objective of this study was to develop a predictive model of infection based on the pre- and intrasurgical variables considered risky. One hundred fifty five patients with E III-IV laryngeal cancer, with 24.8:1 male to female ratio (mean age, 58 years) who underwent total laryngectomy were evaluated for uni- and multivariate analysis of age, sex, histological grade, primary or recurrent disease, tobacco, alcohol, diabetes, tuberculosis/chronic emphysema, red and white cell counts, erythrosedimentation rate (ESR), albumin, chemotherapy, neck radiotherapy and/or previous surgery, confinement days, type and time of surgery, which were factors in the infection event. A predictive model of infection was developed and included albuminemia (<3.5 g%), >1 liter of alcohol daily, and exclusive surgery of the primary. The sensitivity was 90.5% and the specificity 68%. The variance reached 29.6%. The causes of infection were multiple, having analyzed only 30% of them. However, the resulting model was classified correctly in 83.2% of cases. A careful preoperative assessment, an adjusted planning of the surgery, an appropriate use of antibiotics, and a meticulous operative technique are needed to prevent infection.
Subject(s)
Laryngeal Neoplasms/surgery , Laryngectomy , Surgical Wound Infection/etiology , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Humans , Intraoperative Period , Length of Stay/statistics & numerical data , Logistic Models , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Risk Factors , Sensitivity and Specificity , Surgical Wound Infection/mortality , Surgical Wound Infection/prevention & controlABSTRACT
A new solitary extramedullary plasmacytoma of nasal localization meeting the conditions for definition is reported. The patient was treated with surgery and irradiation, which controlled the disease and produced excellent cosmetic results. The bibliography is reviewed and the pathologic, clinical, and evolutive characteristics are discussed.
Subject(s)
Nose Neoplasms/diagnosis , Plasmacytoma/diagnosis , Antibodies, Monoclonal/immunology , Combined Modality Therapy , Humans , Male , Middle Aged , Nose/diagnostic imaging , Nose/pathology , Nose/surgery , Nose Neoplasms/immunology , Nose Neoplasms/therapy , Plasmacytoma/immunology , Plasmacytoma/therapy , Tomography, X-Ray ComputedABSTRACT
A retrospective analysis is made of 61 patients with clinical and histological diagnosis of pure sarcomas of the jaw treated between 1950 and 1984. Surgery was the treatment of choice in 41 cases. Biopsy or palliative treatment were undertaken in the remaining patients. Twenty-four cases relapsed before 12 months, and 12 relapsed before 3 years. Twenty-four died before 12 months, nine before 2 years, and three after 2 years. At present there is no evidence of disease in eight patients: three out of 25 fibrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), three out of 15 chondrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), and two out of 15 osteosarcomas (one more than 18 years). The prognosis is gloomy. However, an early diagnosis and radical surgery contribute to an improvement in the course of the disease.
Subject(s)
Chondrosarcoma/therapy , Fibrosarcoma/therapy , Jaw Neoplasms , Myxosarcoma/therapy , Osteosarcoma/therapy , Sarcoma/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Chondrosarcoma/diagnosis , Chondrosarcoma/surgery , Female , Fibrosarcoma/diagnosis , Fibrosarcoma/surgery , Fibrous Dysplasia of Bone/pathology , Humans , Jaw Neoplasms/diagnosis , Jaw Neoplasms/surgery , Jaw Neoplasms/therapy , Male , Middle Aged , Myxosarcoma/diagnosis , Myxosarcoma/surgery , Osteosarcoma/diagnosis , Osteosarcoma/surgery , Prognosis , Retrospective StudiesABSTRACT
This report covers the authors' experience during 19 years with patients at Buenos Aires Municipal School of Oral, Cervical, and Thyroid Surgery at Rawson Hospital; at the Municipal Hospital of Oncology; and in their private practice. During this period, 165 patients underwent surgery for thyroid cancer. An analysis is made of the surgical treatments chosen, the different histological types encountered, and the lymph node and radical neck dissections performed. The advantages and drawbacks of total thyroidectomy, as well as the survival rates, are commented upon.
Subject(s)
Thyroid Neoplasms/surgery , Thyroidectomy/methods , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Lymph Node Excision , Male , Mediastinal Neoplasms/secondary , Mediastinal Neoplasms/surgery , Middle Aged , Neck Dissection , Postoperative Complications/therapy , Thyroid Neoplasms/diagnosisABSTRACT
Se presenta la casuistica desde 1962 hasta 1981 periodo en el cual se atendieron 2159 pacientes, con tiroideopatias y se operaron 1200 casos. De estos ultimos el 2,08% o sea 45 enfermos, correspondieron a bocios penetrantes, sumergidos y cervicotoracicos, de los cuales solo 15 (0,69%), se ajustan a la definicion propuesta en el tratabjo. Se hacen consideraciones de orden epidemiologico, clinico y diagnostico, se proponen las pautas referidas a la tactica y tecnica operatoria de estos casos
Subject(s)
Adult , Middle Aged , Aged , Humans , Male , Female , Goiter, Substernal , ThyroidectomyABSTRACT
Se presenta la casuistica desde 1962 hasta 1981 periodo en el cual se atendieron 2159 pacientes, con tiroideopatias y se operaron 1200 casos. De estos ultimos el 2,08% o sea 45 enfermos, correspondieron a bocios penetrantes, sumergidos y cervicotoracicos, de los cuales solo 15 (0,69%), se ajustan a la definicion propuesta en el tratabjo. Se hacen consideraciones de orden epidemiologico, clinico y diagnostico, se proponen las pautas referidas a la tactica y tecnica operatoria de estos casos
