[Meatoplasty by intra-aural approach]. / La meatoplastia con abordaje endaural.

INTRODUCTION: The object of this communication was to discuss our experience with a new type of endaural meatoplasty. Auricular meatoplasty was described by Viennese otologists in the late nineteenth century. A hundred years later the procedure still is necessary for every open mastoidectomy. Most surgeons prefer to perform meatoplasty following traditional guidelines via a retroauricular incision. However, we have developed a new meatoplasty method using an endaural approach, similar to that described by Osborne Farrior and Fleury but performed at the beginning of the operation. The advantage of the procedure is that the size and shape of the cartilage to be removed are easily calculated. Therefore, the width of the future external canal can be predicted. Using this meatoplasty, the tragal cartilage can be removed as a whole piece with its perichondrium. This is important for middle-ear reconstruction. MATERIAL AND METHODS: Two hundred twenty-seven meatoplasties via an endaural approach were performed in the last 6 years, most as a step in open mastoidectomy. The procedure is described in detail for the cases in which it was used. RESULTS: Two parameters were considered in the evaluation of results: permanence of a dry and stable mastoid cavity and an intact eardrum. Only 3 (1.4%) ears out of 223 remained unstable after 3 years and 5 (2.24%) continued with a perforated eardrum. DISCUSSION: Meatoplasty via an endaural approach allowed us to design precisely the size and shape of the conchal cartilage to be removed and to calculate the volume of the future external canal. This approach can be used to remove a cartilaginous conchal fragment with its perichondrium. This piece is useful for the reconstruction of the middle ear or mastoid. Realization of this meatoplasty at the beginning of the procedure produces a broad exposure of the mastoid.

[Surgical treatment of hypertrophic stenosis of the pylorus at a general surgery service]. / Tratamiento quirúrgico de la estenosis hipertrófica del píloro en un servicio de cirugía general.

The authors purpose was to demonstrate that pyloromyotomy can be successfully carried out by nonspecialist surgeons. Eighty three cases admitted over a twelve-year period to the Department of Pediatrics of Montecelo Hospital, a district general hospital, were reviewed. Extramucosal pyloromyotomy was performed by general surgeons under general anaesthesia in all cases. There were no deaths. Three infants had postoperative complications and required treatment. All cases underwent prophylactic antibiotics and no wound infections were recorded. When compared with other published series, our study shows that extramucosal pyloromyotomy can be carried out safely by general surgeons and that prophylactic antibiotic treatment can decrease morbidity. Postoperative complications are not related to damage of the duodenal mucosa or the type of skin incision.

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study]. / Nutrición enteral y alteraciones del gusto en pacientes diabéticos: estudio prospectivo doble ciego.

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.