ABSTRACT
Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored.
Subject(s)
Fibula/transplantation , Free Tissue Flaps , Plastic Surgery Procedures/methods , Skull Base Neoplasms/surgery , Thigh , Adult , Aged , Biopsy , Female , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción: la obesidad mórbida (OM) es una enfermedadcrónica que alcanza dimensiones epidémicas en los países desarrollados.La OM suele acompañarse de enfermedades graves asociadasque provocan una menor expectativa y peor calidad de vida.Objetivos: validar el cuestionario GIQLI (GastrointestinalQuality of Life Index) como herramienta fiable y eficaz en la evaluaciónde la calidad de vida en el paciente obeso mórbido.Pacientes y métodos: el cuestionario GIQLI consta de 36ítems cuya suma de cada puntuación individual otorga un valor final.A mayor puntuación, mejor calidad de vida. Dichos ítems seagrupan en 5 apartados: sintomatología digestiva, emocional,efectos sobre el tratamiento, disfunción física y social. Se ha aplicadoel GIQLI a una muestra aleatoria de 190 pacientes afectosde OM que cumplían los requisitos necesarios para someterse a cirugíabariátrica, y a un grupo control de 100 individuos sanos sinenfermedades orgánicas, funcionales, ni psíquicas conocidas. Seevaluó, en cada grupo, tanto la puntuación global del cuestionariocomo aquellas que hacían referencia a sus apartados específicos.Resultados: las puntuaciones fueron significativamente inferioresen los pacientes con OM frente al grupo control, tanto en lapuntuación global del cuestionario como en todas sus dimensiones.La puntuación global GIQLI disminuyó en función de la edady del número de enfermedades comórbidas asociadas.Conclusiones: el cuestionario GICLI se ha mostrado comouna herramienta útil en la valoración de la calidad de vida en elpaciente obeso mórbido. Los pacientes con OM tienen una peorpercepción en su calidad de vida que los pacientes no obesos, nosólo en cuanto a la presencia de síntomas digestivos, sino tambiénen la dimensión emocional, estado físico y vida de relación social
Introduction: morbid obesity (MO) is a chronic disease that isreaching epidemic proportions and becoming an increasing healthproblem in developed countries. Obesity-related comorbidities reduceboth the quality and expectancy of life.Objectives: to validate the GIQLI (Gastrointestinal Quality ofLife Index) test as a reliable and effective tool for the evaluation ofquality of life in morbidly obese patients.Patients and methods: the GIQLI test is made up of 36 individuallyscored items, the addition of which give up a final score.A higher score correlates with a better quality of life. Items can beseparated into five groups or dimensions: digestive symptoms,emotional status, effects of treatment, and physical as well as socialdysfunction. The GIQLI test was administered to a randomizedsample of 1990 morbidly obese patients who fulfilled the indicationcriteria for bariatric surgery, and to a control group of100 healthy individuals with no known medical, functional or psychiatricdisease. Overall test and specific dimension scores wereevaluated for each group.Results: overall test and specific dimension scores were significantlylower in patients with MO when compared to the controlgroup. The overall GIQLI score decreased as age increased, as didthe number of associated comorbidities.Conclusions: the GIQLI test proved to be a rather useful toolto evaluate quality of life in morbidly obese patients. These patientspresent a poorer quality of life not only because of the presenceof digestive symptoms but also because of their emotional,physical, and social status
