[Sentinel lymph node in tumors of the larynx: technique and results]. / El ganglio centinela en tumores de laringe: técnica y resultados obtenidos.

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.

El ganglio centinela en tumores de laringe: técnica y resultados obtenidos / Sentinel lymph node in tumors of the larynx: technique and results

Objetivos: Determinar la aplicabilidad de la técnica del ganglio centinela (GC) en tumores N0 de laringe. Material y métodos: Realizamos un estudio prospectivo en 19 pacientes con tumores N0 de laringe. Infiltramos peritumoralmente 1mCi de nanocoloides de albúmina marcados con 99mTc con endoscopio rígido bajo anestesia general. Detectamos el GC intraoperatoriamente con una sondagamma durante el vaciamiento cervical. Los resultados histológicos del GC se comparan con los del vaciamiento cervical. Resultados: Identificamos el GC en 17 pacientes (89,47%). Once pacientes presentaron GC libres de tumor, reflejando correctamente el estatus del cuello (pN0). Tres pacientes presentaron metástasis en el GC l. Encontramos 3 falsos negativos. La sensibilidad de la técnica fue 50,0% (3/6) y el VPN de un 78,6%. Conclusiones: Pensamos que para que la técnica del GC sea aplicable en tumores de laringe se precisan de un mayor número de estudios, siendo fundamental la realización de un correcta selección de los pacientes

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential

[Temporalis myofascial flap: technique description and results in our patients]. / Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes.

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes / Temporalis myofascial flap: technique description and results in our patients

Introducción: El tratamiento quirúrgico de los tumores de cavidad oral y seno maxilar precisa una reconstrucción del defecto. Es preferible realizarla en un solo tiempo quirúrgico para disminuir la morbilidad del paciente y el coste sanitario. El colgajo miofascial del temporal es muy versátil para la reconstrucción de defectos de cavidad oral, base de cráneo, orbitarios y maxilares. Material y métodos: Describimos la técnica quirúrgica y presentamos nuestros resultados tras la reconstrucción de defectos tras maxilectomía total o parcial con el colgajo miofascial del músculo temporal en 22 pacientes. Resultados: No se ha producido la necrosis total en ningún caso y en 4 hubo una pequeña dehiscencia de sutura. Conclusión: El colgajo miofascial es una opción excelente para la reconstrucción de cavidad oral y seno maxilar

Introduction: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. Material and methods: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. Results: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. Conclusion: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction

[Sentinel node in tumours of the lip and the oral cavity]. / Estudio del ganglio centinela en tumores de labio y cavidad oral.

OBJECTIVES: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. PATIENTS AND METHOD: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. CONCLUSIONS: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.

Estudio del ganglio centinela en tumores de labio y cavidad oral / Sentinel node in tumours of the lip and the oral cavity

Objetivos: Este estudio muestra los resultados obtenidos mediante la aplicación del ganglio centinela en tumores de labio y cavidad oral; elaboramos un mapa linfográfico de dichos tumores. Material y método: Estudiamos prospectivamente 14 pacientes con tumores de labio y cavidad oral N0 clínicos. Inyectamos de forma peritumoral, 1 mCi de nanocoloides de albúmina marcada con Tc99 preoperatoriamente, para posteriormente localizar el ganglio centinela. Una vez localizado éste, se envía separadamente del resto de cadenas ganglionares para su estudio anatomopatológico. Resultados: En todos los pacientes se identificó el ganglio centinela. En 11 casos el ganglio centinela fue negativo para metástasis prediciendo correctamente el estadio cervical. En 3 casos el ganglio centinela fue el único ganglio que contenía metástasis. No hubo ningún caso de falso negativo. La sensibilidad de la técnica fue del 100%. Conclusiones: Los resultados muestran esta técnica como un método fiable en esta localización que podría evitar los vaciamientos cervicales en pacientes N0 clínicos

Objectives: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. Patients and method: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. Results: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. Conclusions: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

[Benign tumors of the parotid gland]. / Tumores benignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We shelted an amount of 145 cases. The pathologic distribution between benign and malign tumors was as following: 119 benign tumors (83%) and 26 malign tumors (17%). Here we study benign parotid tumors, which represent 83% of total parotid tumors. We performed suprafacial parotidectomies in 72% and total parotidectomy in 19% of cases. Nodulectomy was realized in 9% of patients in those tumors that arise in the lower part of the parotid gland and usualy they were Warthin tumors. The main complications of surgery were facial nerve dysfunction and Frey syndrome. We didn't have any case of permanent facial nerve dysfunction but transitory facial nerve disfunction occurred in 26% of patients. Frey syndrome appeared in 10% of patients operated of parotidectomy. Benign mixed tumor was the only one benign tumor in recurring and the frequency was 5% of patients.

Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía / Changes in immunoglobulin levels following adenoidectomy and tonsillectomy

Introducción: Los órganos linfoides del anillo de Waldeyer producen todos los tipos de inmunoglobulinas (principalmente la G y la A), desarrollando su actividad principal entre los 4 y los 10 años de edad, es decir, aquella en la que la patología adenoamigdalar causa el mayor número de indicaciones quirúrgicas de las mismas. Nuestro estudio pretende analizar el impacto que la exéresis adenoamigdalar causa sobre los niveles de inmunoglobulinas en el niño.Material y métodos: Presentamos un estudio prospectivo de 89 pacientes sanos entre 4 y 10 años intervenidos en nuestro servicio de adenoidectomía y adenoamigdalectomía, a los cuales se les determinaron los niveles de inmunoglobulinas G, A y M preoperatoriamente y al mes y cuatro meses. Resultados: Las cifras de IgG sérica sufrieron un descenso postoperatorio, recuperándose parcialmente a los cuatro meses. La IgA descendió en menor medida y la IgM apenas sufrió variaciones. Ninguna de las inmunoglobulinas estudiadas descendió por debajo de niveles considerados normales. Discusión/Conclusiones: La intervención amigdalar y adenoidea causan descensos postoperatorios en las cifras séricas de inmunoglobulinas G y A, con recuperación parcial a medio plazo. En ningún caso las cifras séricas descienden por debajo de los niveles considerados normales, y en ninguno de los niños estudiados la intervención causó patología postoperatoria derivada de una alteración de la inmunidad (AU)

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency (AU)

Tumores benignos de la glándula parótida

Realizamos un estudio de los pacientes operados de parotidectomía en el Servicio de Otorrinolaringología del Hospital Dr. Peset de Valencia durante los años 1975-2001. Se recogieron un total de 145 casos. La distribución según patologías fue: 119 tumores benignos (83 por ciento) y 26 tumores malignos (17 por ciento). En el presente trabajo estudiamos los tumores benignos, que representan el 83 por ciento de los tumores parotídeos en nuestra casuística. Las técnicas quirúrgicas practicadas fueron la parotidectomía suprafacial (72 por ciento) y la parotidectomía total (19 por ciento). La nodulectomía está indicada en aquellos casos en los que el tumor está localizado en la cola de la parótida por debajo del ángulo de la mandíbula, la realizamos en el 9 por ciento de los casos y generalmente se trataba de cistadenoma papilar linfomatoso (tumor de Warthin). En cuanto a las complicaciones de la cirugía, en las lesiones del nervio facial, no tuvimos ningún caso de parálisis facial permanente en los tumores beningnos, en cambio las lesiones transitorias ocurrieron en el 26 por ciento de los casos. La aparición del síndrome de Frey fue del 10 por ciento en el total de pacientes operados de parotidectomía. El adenoma pleomorfo es el único tumor beningno que recidivó y la frecuencia de aparición de recidivas fue del 5 por ciento (AU)

Tumores malignos de la glándula parótida / Malignant tumors of the parotid

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Tratamiento del cuello NO en el cáncer supraglótico / Treatment of the NO neck in supraglottic cancer

Introducción: Las metástasis regionales ocultas en el cáncer supraglótico N0 son motivo de clásicas controversias. El objeto de nuestro estudio es aportar nuestra experiencia para determinar en qué medida influye el tratamiento cervical en la recidiva regional de los cánceres supraglóticos N0. Material y métodos: Presentamos un estudio retrospectivo de 246 pacientes con cáncer supraglótico y cuello clínicamente negativo, tratados en nuestro servicio entre los años 1977 y 1999. Resultados: El 11,4 por ciento del los pacientes no fue tratado a nivel cervical, presentando un 23 por ciento de metástasis o recidivas cervicales en la evolución. El 66,7 por ciento de los pacientes fueron tratados con cirugía ganglionar (vaciamiento cervical funcional), apareciendo metástasis ocultas en el 24 por ciento de los casos. La recidiva regional global fue de 2,9 por ciento en estadios iniciales (T1/T2) y 13,1 por ciento en estadios avanzados (T3/T4). En los pacientes pN+ se realizó tratamiento con radioterapia postoperatoria en el 85 por ciento de los casos, con un índice de recidiva del 8,8 por ciento. La observación en los pN0 arrojó un índice de recidiva regional del 6,1 por ciento. En los cuellos contralaterales, en aquellos casos en que la cirugía fue unilateral (tumor claramente lateralizado), el seguimiento clínico presentó un índice de recidivas del 5,5 por ciento. Los pacientes tratados con radioterapia aislada presentaron un índice de recidiva del 5,5 por ciento. Discusión/Conclusiones: El tratamiento cervical de los cánceres supraglóticos N0 está indicado. Realizamos el mismo tratamiento cervical (cirugía o radioterapia) que al tumor primario, obteniendo buenas tasas de control de recidivas, inferiores al 10 por ciento. En caso de vaciamiento patológicamente negativo realizamos seguimiento clínico. Si la anatomía patológica es positiva (pN+) realizamos radioterapia postoperatoria cuando hay más de dos ganglios afectos o rotura capsular en alguna de ellos (AU)

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them (AU)

[Preliminary results of the relevance the sentinel node in head and neck tumors]. / Resultados preliminares de la utilidad del ganglio centinela en tumores de cabeza y cuello.

OBJECTIVES: The objective of this study is to assess the value of the sentinel node (SN) in head and neck tumours and to create a lymphatic mapping of these tumors. PATIENTS AND METHODS: We prospectively studied 13 patients with head and neck tumours N0. We divided these patients in two groups depending on the location of the primary tumour. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: In the oropharynx and oral cavity group, with 5 patients, the SN correctly predicted the pathological status of the neck in all of them. In the group of larynx and hypopharynx, with 8 patients, in 6, the SN correctly predicted the pathological status of the neck. In 2 patients, the SN was negative for metastases but there were metastases in the neck dissection. CONCLUSIONS: This technique represents an advance over selective dissection as an accurate method of neck staging, but its value in this field remains unclear.

Transient rise in intact parathyroid hormone concentration after surgery for parathyroid adenoma.

OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. Study design and setting A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 +/- 0.6 mg/dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

Resultados preliminares de la utilidad del ganglio centinela en tumores de cabeza y cuello / Preliminary results of the relevance the sentinel node in head and neck tumours

Objetivos: El objetivo del presente estudio es comprobar el valor del ganglio centinela (GC) en tumores de cabeza y cuello y elaborar un mapa linfográfico de dichos tumores. Material y métodos: Estudiamos prospectivamente 13 pacientes con carcinomas de cabeza y cuello N0, divididos en dos grupos según la localización tumoral. Inyectamos peritumoralmente Tc-99 marcado con albúmina coloidal e identificamos el GC intraoperatoriamente. Éste es enviado para estudio anatomopatológico separadamente del vaciamiento cervical. Resultados: En el grupo de cavidad oral y orofaringe, con 5 pacientes, el GC predijo correctamente el estadio cervical en todos ellos. En el grupo de laringe e hipofaringe, con 8 pacientes, en 6 casos el GC predijo correctamente el estadio cervical. En 2 casos el GC resultó negativo para tumor, encontrándose metástasis en el resto del vaciamiento. Conclusiones: Esta técnica representa una ventaja sobre los vaciamientos cervicales como método de estadiaje cervical, pero su valor en este campo todavía permanece incierto (AU)

OBJECTIVES: The objective of this study is to assess the value of the sentinel node (SN) in head and neck tumours and to create a lymphatic mapping of these tumors. PATIENTS AND METHODS: We prospectively studied 13 patients with head and neck tumours N0. We divided these patients in two groups depending on the location of the primary tumour. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: In the oropharynx and oral cavity group, with 5 patients, the SN correctly predicted the pathological status of the neck in all of them. In the group of larynx and hypopharynx, with 8 patients, in 6, the SN correctly predicted the pathological status of the neck. In 2 patients, the SN was negative for metastases but there were metastases in the neck dissection. CONCLUSIONS: This technique represents an advance over selective dissection as an accurate method of neck staging, but its value in this field remains unclear (AU)

[Treatment of the NO neck in supraglottic cancer]. / Tratamiento del cuello NO en el cáncer supraglótico.

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

[Malignant tumors of the parotid gland]. / Tumores malignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We sheltered an amount of 147 cases. The pathologic distribution between benign and malign tumors was as following: 121 benign tumors (83%) and 26 malign tumors (17%). Here we study malign parotid tumors, which represent 17% of total parotid tumors. Sensibility and specificity of FNA was 54% and 96.5% respectively. We performed almost with similar frequencies total and suprafacial parotidectomies in 46% and 42% of cases respectively. Total parotidectomy with facial resection is indicated in cases with tumor nerve infiltration and has been done in 8% of cases. The main complications of surgery were facial nerve dysfunction and Frey syndrome. Permanent facial nerve dysfunction and and transitory facial nerve disfunction occurred in 3.8% and 30.8% of patients respectively. Frey syndrome appeared in 10% of patients operated of parotidectomy. Recurrences occurred in 15.4% of patients.

[Spontaneous middle ear meningoencephalic herniation. 2 case reports]. / Herniación meningoencefálica espontánea en oído medio: a propósito de dos casos.

Two cases of idiopathic brain herniation into the middle ear without previous surgery are reported. Brain herniation is an unusual pathology, usually related to middle ear surgery. The idiopathic appearance of this disease is the secondly most frequent cause. Its origin is believed to be related to a congenital defect of tegmen timpani. Two elements, both rare, are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.

Análisis descriptivo y resultados quirúrgicos del hiperparatiroidismo primario / Descriptive analysis and surgical outcome of primary hyperparathyroidism

El hiperparatiroidismo primario (HPP) ha pasado de ser una enfermedad rara caracterizada por presentar una sintomatología florida renal y esquelética, a ser una enfermedad más común con mínima sintomatología. El empleo difundido de los autoanalizadores ha conducido a un aumento en su incidencia y a que el diagnóstico se realice precozmente. El objetivo de este estudio es analizar la forma de presentación y alteraciones bioquímicas, así como los hallazgos quirúrgicos y resultados postoperatorios de un grupo de pacientes diagnosticados de HPP e intervenidos quirúrgicamente. De los 71 pacientes estudiados, la mayoría presentaban sintomatología en el momento del diagnóstico, 6 eran asintomáticos y 11 normocalcémicos. En 5 pacientes fue necesaria una reintervención por HPP persistente. El 95,77 per cent de los pacientes normalizaron los niveles de hormona paratiroidea tras la cirugía. La paratiroidectomía es una técnica segura y efectiva que debe ser indicada precozmente, incluso en los casos asintomáticos (AU)

Primary hyperparathyroidism (PHPT) was a rare but serious disease with massive biochemical, renal and skeletal signs at the time of diagnosis. In the last decades it has become a more common disorder often diagnosed by chance. The disease usually shows minimal symptoms. These clinical changes are due to advances in biochemical screening procedures, which have led to a remarkable increase in the incidence of PHPT. The aim of this study is to describe the clinical profiles, biochemical data, operative findings and postoperative results. Seventy one consecutive patients were prospectively enrolled and underwent surgical examination. Most of them showed symptoms: 6 patients were asymptomatic and 11 had a normocalcemic hyperparathyroidism. After surgery 5 patients showed persistent primary hyperparathyroidism. Parathyroid hormone concentration returned to normal levels in 95.77% of the patients studied. Parathyroidectomy is a safe and effective approach to the treatment of primary hyperparathyroidism (AU)

Timpanoplastia con cartílago: 3 años de experiencia / Timpanoplasty using cartilage: 3 years of experience

Presentamos nuestros resultados con la técnica de timpanoplastia con cartílago, en un estudio retrospectivo de 71 oídos intervenidos a lo largo de 3 años. Indicamos esta técnica en reintervenciones, grandes perforaciones, retracciones severas y membranas atróficas. En un 32% de los casos fue precisa la reconstrucción de cadena. Se logró un cierre completo del 86%, con un 14% de reperforaciones o defectos entre los fragmentos de cartílago. Estos resultados nos alientan a profundizar en el uso del cartílago en esta cirugía y la adquisición de más experiencia para valorar en su justa medida la eficacia de esta técnica (AU)

We present our results in a timpanoplasty technique using autologous cartilage, in a retrospective study of 71 cases within 3 years. We used this technique in revision surgery, large perforations, severe retractions, and atrophic membranes. 32% of cases needed ossicular chain reconstruction. A complete closing of the membrane was obtained in 86% of cases, while 14% remained re-perforated or discontinued between cartilage pieces. These results are comparable to other studies using cartilage graft with several techniques. These results encourage us to continue using this technique in order to acquire more experience and a better knowledge about the efficacy of this technique (AU)