Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital.

BACKGROUND: The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm. METHOD: A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap. RESULTS: Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent). CONCLUSION: The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

Manejo del vértigo posicional paroxístico benigno en atención primaria / Management of benign paroxysmal positional vertigo in first care centers

El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. Se caracteriza por crisis de vértigo desencadenadas por cambios posicionales de la cabeza y de corta duración. Suele presentarse en los mayores de 40-50 años, y hasta el 50% de los casos no se deben a una causa conocida, por lo que se habla de vértigo posicional paroxístico benigno idiopático. Debido a la alta incidencia del vértigo posicional paroxístico benigno, consideramos de especial trascendencia poseer los conocimientos necesarios para poder diagnosticar y tratar con eficacia esta afección en el ámbito de la medicina de atención primaria, ya que en la mayoría de los casos se obtienen excelentes resultados a través de unas maniobras específicas y fáciles de realizar (AU)

The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers (AU)

[Management of benign paroxysmal positional vertigo in first care centers]. / Manejo del vértigo posicional paroxístico benigno en atención primaria.

The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers.

Priapismo / Priapism

El priapismo ha sido definido por la AFUD como “la condición patológica caracterizada por una erección peneana que persiste más allá o no está relacionada con la estimulación sexual”. La fisiopatología del priapismo ha sido una gran desconocida hasta que se comienzan a hacer estudios clínicos en pacientes en su mayoría afectos de disfunción eréctil, en cuyo diagnóstico o tratamiento se veían involucrados los medicamentos vasoactivos por vía intracavernosa. El priapismo se clasifica en isquémico (veno-oclusivo) que es la forma más frecuente y Priapismo Arterial (no-isquémico) que es la presentación menos frecuente, causada por la entrada de flujo sanguíneo cavernoso no controlado. El propósito de esta revisión es documentar la fisiopatología de los tipos de priapismo y tratar de esquematizarla conducta diagnóstica y terapéutica ante ellos (AU)

Priapism has been defined by AFUD as a pathological condition which consists in a penile erection that persists moreover or is not related to sexual stimulation. Priapism pathophysiology has remained unknown until differents groups of clinical investigators began to research about this entity in patients complaining of erectile dysfunction, who where receiving treatment with intracavernosal vasoactive molecules. Priapism can be clasified into ischaemic (venocclusive): the most prevalent type, or Arterial (non-ischaemic). The purpose of this revision is to update the pathophysiology of the two types of priapism and to create an algorithm of therapeutical and diagnostic approach (AU)

[Priapism]. / Priapismo.

Priapism has been defined by AFUD as a pathological condition which consists in a penile erection that persists moreover or is not related to sexual stimulation. Priapism pathophysiology has remained unknown until differents groups of clinical investigators began to research about this entity in patients complaining of erectile dysfunction, who where receiving treatment with intracavernosal vasoactive molecules. Priapism can be clasified into ischaemic (venocclusive): the most prevalent type, or Arterial (non-ischaemic). The purpose of this revision is to update the pathophysiology of the two types of priapism and to create an algorithm of therapeutical and diagnostic approach.

[Testicular microlithiasis: is there a relationship with malignant tumour?]. / Microlitiasis testicular: existe relación con patología maligna?

The aim of this revision is to assess the relationship between testicular microlithiasis and malignant tumours. We reviewed 98 charts of patients with pathological diagnosis of testicular malignant tumour. Diagnosis of testicular tumour was made by ultrasound, and 6.02% (6 pts.) presented testicular lithiasis, and this finding makes us conclude that this is not a characteristic feature of this entity. We also reviewed bibliography related to this theme, and conclude that the management of microlithiasis remains being controversial.

Microlitiasis testicular: ¿existe relación con patología maligna? / Testicular microlithiasis: does exist any relationship with malignant tumour?

El propósito de esta revisión es evaluar la relación de microlitiasis testicular con tumor maligno, para lo que se realizó un estudio retrospectivo de 98 pacientes con diagnóstico histológico de tumor maligno testicular. El diagnóstico de estos pacientes se realizó ecográficamente, presentando calcificaciones testiculares el 6,02 por ciento (6 pacientes), lo que nos hace concluir que el hallazgo de litiasis testicular no es característico de esta patología. A propósito de esta revisión, se consultó bibliografía relacionada con el tema, evidenciándose que la conducta ante calcificaciones aisladas en ausencia de tumor sigue siendo controversial. El propósito de esta revisión es evaluar la relación de microlitiasis testicular con tumor maligno, para lo que se realizó un estudio retrospectivo de 98 pacientes con diagnóstico histológico de tumor maligno testicular. El diagnóstico de estos pacientes se realizó ecográficamente, presentando calcificaciones testiculares el 6,02 por ciento (6 pacientes), lo que nos hace concluir que el hallazgo de litiasis testicular no es característico de esta patología. A propósito de esta revisión, se consultó bibliografía relacionada con el tema, evidenciándose que la conducta ante calcificaciones aisladas en ausencia de tumor sigue siendo controversial (AU)

Clinical experience with apomorphine hydrochloride: the first 107 patients.

PURPOSE: We assessed the efficacy and safety of apomorphine hydrochloride in patients with erectile dysfunction. MATERIALS AND METHODS: A total of 107 patients who had consultations because of erectile dysfunction between July and November 2001 were assessed. The sample was randomly selected. RESULTS: Response to apomorphine hydrochloride was assessed in 107 patients complaining of erectile dysfunction, randomly selected at the office. With the 2 mg initial dose the response amounted to 23.5%, with 3 mg it amounted to 28.5% and the global response to the drug amounted to 26.1%. Positive response was obtained in 18.5% of those in whom the dose was increased from 2 to 3 mg. Obtaining an erection with enough rigidity to enable coitus satisfactory for the patient was accepted as a positive response. According to the clinical presentation of the erectile dysfunction, the highest efficacy was found in those cases with early detumescence, and the lowest one in those cases with complete affection. The overall incidence of adverse effects was 8.4%, with nausea being the most frequently reported. CONCLUSIONS: Apomorphine hydrochloride is the first central action erection inducing drug. Its use is encouraged by high tolerability, low rate of adverse effects and virtually nonexistent interaction with other drugs usually administered to patients with erectile dysfunction.