RESUMEN
BACKGROUND: Staged thyroidectomy has been recommended when loss of the signal from intraoperative nerve monitoring is observed after first-side dissection of the recurrent laryngeal nerve. There is no high-quality evidence supporting this recommendation. In addition, it is not clear whether signal loss predicts postoperative vocal cord paralysis. METHODS: This was a prospective observational study of consecutive adult patients undergoing neuromonitored total thyroidectomy for either malignancy or multinodular goitre. The prevalence of first-side loss of signal was recorded. Surgery was completed, and vagus and laryngeal nerves on the first side were rechecked at the end of the procedure. RESULTS: Two-hundred and ninety patients were included. Loss of signal on the first side was noted in 16 procedures (5.5 per cent). Thyroidectomy was completed and, at retesting, 15 of 16 initially silent nerves recovered an electromyographic signal with a mean(s.d.) amplitude of 132(26) mcV. Mean time to recovery was 20.2 (range 10-35) min. In no patient was the signal lost on the opposite side. Only three of 15 nerves with a recovered signal were associated with transient vocal cord dysfunction. CONCLUSION: After loss of signal of the recurrent laryngeal nerve dissected initially, there was a 90 per cent chance of intraoperative signal recovery. In this setting, judicious bilateral thyroidectomy can be performed without risk of bilateral recurrent nerve paresis.
Asunto(s)
Monitoreo Intraoperatorio/métodos , Complicaciones Posoperatorias/etiología , Nervio Laríngeo Recurrente/cirugía , Tiroidectomía/métodos , Parálisis de los Pliegues Vocales/etiología , Adulto , Disección/métodos , Electromiografía , Femenino , Bocio Nodular/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/fisiopatología , Estudios Prospectivos , Recuperación de la Función/fisiología , Nervio Laríngeo Recurrente/fisiología , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Neoplasias de la Tiroides/cirugía , Parálisis de los Pliegues Vocales/fisiopatologíaRESUMEN
Nasal and paranasal malignant tumours account for less than 5% of all head and neck malignancies. Epithelial malignancies overwhelmingly predominate, with squamous cell carcinomas representing the most frequent histological subtype in this location. Soft-tissue sarcomas of the nasal cavity and paranasal sinuses are exceedingly rare. Here, we report two cases of myxoid liposarcomas that occurred in the nasal and paranasal regions, both of which presented diagnostic challenges and could not be diagnosed definitively from intraoperative frozen sections. These cases reinforce the notion that, while they are uncommon, sarcomas in general and liposarcomas in particular should still be considered as part of the differential diagnosis in patients presenting with obstructive symptoms in the nasal and paranasal sinuses.
Asunto(s)
Liposarcoma Mixoide/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Seno Esfenoidal , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Liposarcoma Mixoide/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias de los Senos Paranasales/patología , Tomografía Computarizada por Rayos XRESUMEN
Two cases of rhinoentomophthoromycosis are presented. This rare disease can produce progressive deformity of the nose and facial structures. A review of the clinical symptoms along with its diagnosis and treatment is described.
Asunto(s)
Entomophthora , Micosis/diagnóstico , Enfermedades Nasales/microbiología , Adulto , Antifúngicos , Niño , Humanos , Itraconazol/uso terapéutico , Masculino , Micosis/tratamiento farmacológico , Enfermedades Nasales/tratamiento farmacológico , Clima TropicalRESUMEN
Mediante la presentación de un caso de rhinosporidiosis se hace una detallada revision de esta rara enfermedad. Se discute su frecuencia en Colombia comparándola con la de otros paises, asi como sus manifestaciones clinicas, su diagnostico, su tratamiento y su pronostico
Asunto(s)
RinosporidiosisRESUMEN
La amigdalectomia es hoy en dia un procedimiento relativamente seguro gracias a las tecnicas quirurgicas y de anestesia. Sin embargo, pese a los estudios prequirurgicos, usualmente recomendados para su ejecución tales como hemograma, pruebas de coagulación etc. se pueden presentar complicaciones como la expuesta en este caso, en un paciente con sangrado masivo de etiologia desconcertante
Asunto(s)
Hemorragia , Complicaciones Posoperatorias , TonsilectomíaRESUMEN
Although rare in North America and Europe, myiasis is seen occasionally in tropical and undeveloped countries. This disorder results from the penetration of a fly larva into a part of the human body, and it causes various symptoms in the host. The exposed areas of the skin are the ones predominantly affected and the eyes, ears, nose, and paranasal sinuses are less commonly affected. We review our experience with 12 patients with myiasis of the ears, nose, and paranasal sinuses.
