A novel approach to human cranial tissue regeneration and frontal sinus obliteration with an autogenous platelet-rich/fibrin-rich composite matrix: 10 patients with a 6-10 year follow-up.

Advanced frontal sinus disease non-responsive to conservative therapy has been treated with fat obliteration for decades. More recently, a wide variety of autogenous, allogenic or synthetic materials have also been used. In this study we present a treatment based on totally autogenous procedures and materials that was successfully implemented in 10 patients and followed up for a period of 6-10 years, to evaluate the feasibility of a new approach for the treatment of frontal sinus disease and other related cranial osseous derangements, based on regenerative medicine as an alternative to fat or other obliterating or grafting materials. Platelet-rich and -poor plasma (PRP, PPP) are set to clot with cortical shavings from the skull surface. After surgically stimulating the sinus to encourage cell chemotaxis, migration and homing, the bioactive scaffold is placed and covered with a PPP membrane and a periosteal flap. Ten patients with pathologies ranging from devastating infection to invasive tumours or trauma were treated with this regenerative procedure in a single-stage surgery. All patients had an uneventful recovery with bone formation and no complications or recurrences over the years. The application of modern principles in tissue regeneration and wound healing has resulted in a favourable outcome, with no complications or sequelae, in a series of 10 patients with advanced frontal sinus disease over a long period of time.

Amiloidosis laringea / Laryngeal amyloidosis

Paciente de 48 anos quien ingreso al servicio de otorrinolaringologia del Hospital Clinica San Rafael de Bogota. Consulto por Disfonia progresiva de 2 anos de evolucion, como antecedentes, fumador ocasional durante 20 anos. Al examen fisico se encontro a la nasolaringoscopia masa de aspecto regular, de coloracion amarillo rojizo que ocupaba region supraglotica izquierda, region supraglotica y glotica derecha con disminucion del espacio glotico, no se observan las cuerdas vocales verdaderas y no habia compromiso del esofago. Estudios realizados: Rx de esofago RGE II: normal. Tomografia de laringe: lesion tumoral de la zona glotica la cual se extiende a la zona subglotica e infraglotica con fijacion de ambas cuerdas vocales especialmente la derecha y con compromisos de la comisura anterior. Biopsia: Amiloidosis laringea. Se practicaron todos los estudios por parte de Medicina Interna los cuales fueron negativos para Amiloidosis sistemica.En el trabajo se hace una revision completa de la Amiloidosis laringea. Esta enfermedad es una acumulacion de complejos proteinicos anormales (sustancia amiloidea) bastante rara en el tracto respiratorio superior. La laringe es el sitio masfrecuente y ocupa el 1% de la patologia. La sustancia amiloidea fue descubierta por Birchow en 1853. La clasificacion mas sencilla es: amiloidosis primaria sistematica. Se puede relacionar con mioloma multiple, TBC, artritis reumatoidea sifilis, lepra y a tumores preexistentes en laringe, ademas puede ser hereditaria. La Amiloidosis ataca los organos mesenquimatosos y parenquimatosos.