Percutaneous tracheostomy in COVID patients. Experience in our hospital center after one year of pandemic and review of the literature

Background: The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. Material and Methods: A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. Results: From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. Conclusions: Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient.(AU)

Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis

BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis

Yu's Technique: An Optimal Local Flap for Lower Lip Reconstruction.

PURPOSE: The purpose of this study was to describe the authors' experience using the Yu flap, a rarely reported reconstructive technique that is an excellent method for lower lip reconstruction after sustaining large defects. MATERIALS AND METHODS: An observational retrospective study was designed to record all patients from 2010 through 2015 who had any lower lip disease that required wide resection and subsequent lip reconstruction using local flaps. The sample was supplied from the operating room database of the Department of Oral and Maxillofacial Surgery at Rio Hortega University Hospital (Valladolid, Spain). Patients with lower lip injuries treated using reconstructive techniques other than the Yu technique were excluded from the study. RESULTS: Seventeen patients (15 men, 2 women; age range, 41 to 91 yr) were treated by the Yu technique and the follow-up period was at least 9 months. Six left unilateral, 5 right unilateral, and 6 bilateral Yu flaps were performed during this period. No major complications occurred during follow-up. Good functional and esthetic results were observed after surgery in most patients. CONCLUSION: Although the Yu technique is a seldom used reconstructive method, it is a straightforward technique based on local flaps that offers excellent results for medium and large lower lip defects.

Invasive maxillary sinus aspergillosis: A case report successfully treated with voriconazole and surgical debridement.

INTRODUCTION: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. CASE REPORT: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. CONCLUSIONS: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment. Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.

Hemangioma cavernoso sublingual / Sublingual cavernous haemanginoma

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