RESUMEN
Unilateral diseases of the maxillary sinus are among the most common rhinologic diagnoses. The diversity of these diseases can represent a challenge for the treating physician. The spectrum ranges from harmless maxillary sinus cysts that seldom require treatment, to highly aggressive malignant tumors. Special attention should be given to the management of inverted papilloma. These benign tumors are characterized by high recurrence rates and the potential for malignant transformation. The key to minimizing recurrence is precise surgical intervention. Other unilateral maxillary sinus diseases such as the antrochoanal polyp and the fungus ball (aspergilloma) are also discussed in depth.
Asunto(s)
Pólipos Nasales , Papiloma Invertido , Enfermedades de los Senos Paranasales , Endoscopía , Humanos , Seno Maxilar , Pólipos Nasales/diagnóstico , Pólipos Nasales/cirugía , Recurrencia Local de Neoplasia , Papiloma Invertido/diagnóstico , Papiloma Invertido/cirugía , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/cirugíaRESUMEN
BACKGROUND: The combination of cisplatin, 5-fluorouracil (5-FU) and cetuximab (PFC) is the reference first-line treatment for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN). We analysed whether treatment intensification by the addition of docetaxel to PFC improved efficacy in R/M SCCHN. METHODS: A total of 180 patients with R/M SCCHN (1:1) were assigned to receive either cisplatin (40 mg/m2), docetaxel (40 mg/m2) and 5-FU (2000 mg/m2) at days 1 and 8 and cetuximab (400/250 mg/m2) at days 1, 8 and 15 (DPFC) or standard cisplatin (100 mg/m2) at day 1, 5-FU (1000 mg/m2) at days 1-4 and cetuximab (400/250 mg/m2) at days 1, 8 and 15 (PFC). Chemotherapy was repeated every 21 days and continued for a maximum of 6 cycles in absence of disease progression or limiting toxicity, followed by cetuximab maintenance (500 mg/m2 every 2 weeks). The primary end-point was progression-free survival (PFS). RESULTS: A preplanned interim analysis for toxicity after 20 patients/arm revealed excessive grade 3 and 4 gastrointestinal (65%) and infectious toxicities (35%) in arm A, which led to dose reduction of cisplatin to 30 mg/m2 and 5-FU to 1000 mg/m2 for subsequent patients. With a median follow-up of 2 years, grade 4 toxicities were 21.3% vs. 30.8% for DPFC and PFC, respectively. More treatment-related deaths occurred with DPFC vs. PFC, with 11.2% and 6.6%, respectively. For DPFC and PFC, the median PFS was 6.3 vs. 6.4 months (hazard ratio [HR] = 0.97, p = 0.87), the median overall survival was 8.9 vs. 10.6 months (HR = 1.29 p = 0.1) and response rates were 38.2% vs. 31.9% (p = 0.9), respectively. CONCLUSIONS: DPFC failed to improve efficacy in R/M SCCHN. On the contrary, a high toxicity and mortality rate was detected in both arms, which underscores the vulnerability of patients with R/M SCCHN, and research on the need for further optimisation of the front-line chemotherapy backbone is ongoing.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Adulto , Anciano , Cetuximab/administración & dosificación , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Docetaxel/administración & dosificación , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Epistaxis is a symptom with many causes, often multifactorial and a frequent cause of consultation in acute medicine. OBJECTIVES: The goal of this study is to analyse the diagnostics used for and therapy of epistaxis, complications and the predictive benefit of laboratory tests. MATERIALS AND METHODS: In this retrospective clinical analysis reports of 720 patients with epistaxis in the period from January 2005 to December 2015 were evaluated. The causes and the therapy of the epistaxis relapses were analysed. RESULTS: Male patients were predominant. Patients with relapses of epistaxis were significantly more likely to be older than 70 years, with higher multimorbidity and more often had used a combination of blood thinning medications. Posterior bleeding was the most found location and was associated with a longer hospitalization. In laboratory tests most patients with coumarins were shown to have inadequate INR (international normalized ratio) control. The prevalence of nicotine consumption was clearly increased compared to the total population. The most used therapy was nasal tamponade. The most complication was anemia with need of blood transfusion. CONCLUSIONS: High age and posterior bleeding source seem to raise the necessity of inpatient therapy. In most cases tamponade is sufficient for treatment. Initial laboratory tests are of limited use to estimate risk of recurrence, but is necessary for patients taking coumarins to determine INR control.
Asunto(s)
Epistaxis , Hospitalización , Anciano , Cumarinas/uso terapéutico , Epistaxis/epidemiología , Epistaxis/terapia , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Tampones QuirúrgicosAsunto(s)
Obstrucción Nasal/etiología , Dolor Postoperatorio/etiología , Cornetes Nasales/cirugía , Dermis Acelular , Endoscopía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Nasal/cirugía , Tabique Nasal/cirugía , Dolor Postoperatorio/cirugía , Reoperación , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The pre- and postoperative airway management during surgery of head and neck cancer is a clinically relevant and challenging task. Usually an epithelialised tracheostomy is used. The significance of percutaneous dilatational tracheostomy (PDT) in combination with tumour surgery of the head neck area has not yet been fully considered. MATERIAL AND METHODS: Within a surgical therapy of head neck tumours, 58 patients were treated with a PDT by Ciaglia or Fantoni at the Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle during the period from December 2002 to October 2007. The patient data were retrospective analyzed in a pseudonymous way. In a follow-up examination the resulting conditions of the PDT were reviewed. RESULTS: The median of the length of time till decannulation was 12 days. There were no documented disorders or complications after PDT at 25 patients (43%). As serious complications pneumothorax in 2 patients (3,4%), 9 bleedings (15,5%) and 1 infection (1,7%) were recorded. After occurrence of tracheostomy metastases in 2 patients with tracheostomy by Fantoni, this method was no longer used. For the subsequent follow-up examination 33 patients were included. No tracheal stenosis or serious long term complications were determined. CONCLUSIONS: Under consideration of the indications and contraindications, the percutaneous dilatational tracheostomy by Ciaglia with associated bronchoscopy is a safe method with low complication rate for the airway management of patients with head neck cancer. Long term complications and disorders after PDT are not to be expected. Tracheotomy according to Fantoni cannot be recommended for this treatment.
Asunto(s)
Manejo de la Vía Aérea/métodos , Dilatación/métodos , Neoplasias de Oído, Nariz y Garganta/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Traqueotomía/métodos , Manejo de la Vía Aérea/instrumentación , Terapia Combinada , Dilatación/instrumentación , Estudios de Seguimiento , Humanos , Siembra Neoplásica , Procedimientos Quirúrgicos Otorrinolaringológicos/instrumentación , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Traqueotomía/instrumentaciónRESUMEN
OBJECTIVE: Orbital complications of sinusitis represent serious diseases. In clinical practice, the term "orbital phlegmon" is often used, although this most serious expression of orbital infection is very rarely seen. However, a correct classification in each stage of orbital complications and resulting treatment recommendations are crucial for the prognosis of the patient. MATERIAL AND METHODS: Data from 49 patients who underwent treatment for orbital complications from 01/01/2000 until 31/12/2010 were retrospectively analysed. In particular, data on the epidemiology, diagnostic procedures and treatment methods were analyzed. RESULTS: From the observation period 109 patient records with the diagnosis "orbital affections" (ICD-10 H05) could be identified. Overall, data from 49 patients (36 male and 13 female) with orbital complications of sinusitis could be analyzed. 53.1% of the patient population were children and adolescents aged 1-20 years. Orbital complications were classified using the classification according to Chandler. The group I and II according to Chandler emerged most frequently. 26 patients (53.1%) showed a preseptal cellulitis (group I) and 11 patients (22.4%) had an orbital cellulitis (group II). Patients from group III or higher according to Chandler received a combined medical and surgical treatment. CONCLUSIONS: Orbital complications of sinusitis mostly seem to arise in infancy and adolescence. With prompt identification of the orbital complications in stage I and II of Chandler, conservative therapy only could be successful. From the third stage up, sinus surgery needs to be considered. The classification of Chandler allows a correct recommendation of therapy.
Asunto(s)
Enfermedades Orbitales/etiología , Enfermedades Orbitales/terapia , Sinusitis/complicaciones , Sinusitis/terapia , Adolescente , Adulto , Niño , Preescolar , Terapia Combinada , Estudios Transversales , Diagnóstico por Imagen , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/epidemiología , Pronóstico , Estudios Retrospectivos , Sinusitis/diagnóstico , Sinusitis/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Malignant tumors occur in up to 15 % of patients with paraneoplastic syndromes. The temporal association between malignancy and paraneoplasia is variable. Dermatomyositis belongs to the facultative cutaneous paraneoplasia. CASE REPORT: A patient presented with a cervical swelling and preexisting dermatomyositis. Staging revealed a tonsillar carcinoma with cervical, mediastinal and bone metastasis, and meningeal carcinomatosis. Systemic intrathecal chemotherapy was initiated. CONCLUSION: Dermatomyositis has only been described four times worldwide as a paraneoplastic disease with tonsillar carcinoma. Upon occurrence of a paraneoplastic syndrome, an intensive search for tumours is required at regular intervals until the primary tumor is diagnosed.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/terapia , Dermatomiositis/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/terapia , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/terapia , Dermatomiositis/prevención & control , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Sarcomas count among the very rare malignancies of the orbit. Epithelioid sarcomas typically occur in the subcutaneous tissue of younger patients; an affected orbit constitutes a rarity. OBJECTIVES: Only three cases of this extremely rare disease of the orbit, which is associated with marked aggressiveness and a very poor prognosis, have been analysed in the worldwide current literature. PATIENT AND METHODS: We present a case report together with a literature review. A rapidly progressing painful proptosis with visual loss occurred in a 30-year-old patient. Imaging and invasive diagnostic procedures were initiated as a consequence of this. RESULTS: Diagnostic imaging revealed an infiltrative process of the right orbit. Following endonasal decompression of the orbit and probe acquisition, histological and immunohistochemical tests showed the presence of a proximal type epithelioid sarcoma. Therapy consisted of orbit exenteration together with implantation of titanium miniplates for orbital prosthesis. During the course of disease, osseous metastases developed. The patient died during palliative chemotherapy, 14 months after the initial diagnosis. CONCLUSION: Epithelioid sarcomas are extremely rare, difficult to treat tumours in the head and neck region. The associated mortality rates are high. Aggressive surgical therapy with intensive follow-up is recommended. The prognosis depends upon the resection status.
Asunto(s)
Ceguera/etiología , Exoftalmia/etiología , Neoplasias Orbitales/diagnóstico , Sarcoma/diagnóstico , Adulto , Ceguera/diagnóstico , Diagnóstico Diferencial , Exoftalmia/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Orbitales/complicaciones , Sarcoma/complicacionesAsunto(s)
Seno Frontal , Neoplasias de los Senos Paranasales/patología , Biopsia , Progresión de la Enfermedad , Epilepsia Tónico-Clónica/etiología , Estesioneuroblastoma Olfatorio , Hueso Frontal/patología , Seno Frontal/patología , Seno Frontal/cirugía , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias de los Senos Paranasales/cirugía , Tomografía Computarizada por Rayos X , Trastornos de la Visión/etiologíaRESUMEN
OBJECTIVE: Peritonsillar abscess (PTA) is a common problem in otorhinolaryngology. The pathogenesis, supporting factors and optimal therapy are matter of numerous investigations. We studied retrospectively smoking habits, preoperative coagulation screening and the applied therapy of PTA. MATERIAL AND METHODS: Data from 460 patients who underwent treatment for PTA between 2000 and 2009 at Dessau Medical Center were retrospectively analysed. RESULTS: The highest incidence of PTA was found in young men, the prevalence of nicotine consumption was clearly increased in relation to the general population. The therapy of first choice was abscess tonsillectomy. Even with preoperative pathological coagulation-parameters no increased risk of secondary bleeding was shown. CONCLUSIONS: The part of smokers of patients with PTA is increased in comparison to the correspondent population of same age. A routine preoperative coagulation screening has a low benefit relating to the prediction of the risk of secondary bleeding. Abscess tonsillectomy is a safe method and has proved itself in clinical daily routine.
Asunto(s)
Pruebas de Coagulación Sanguínea , Tamizaje Masivo , Absceso Peritonsilar/etiología , Absceso Peritonsilar/cirugía , Hemorragia Posoperatoria/prevención & control , Cuidados Preoperatorios , Fumar/efectos adversos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Absceso Peritonsilar/diagnóstico por imagen , Absceso Peritonsilar/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Tomografía Computarizada por Rayos X , Tonsilectomía , Adulto JovenRESUMEN
Venous malformations as a cause of space-occupying lesions in the head and neck region are rare, especially at an advanced age. We report on a 74-year-old female patient with a venous malformation of the cheek and its successful surgical treatment.
Asunto(s)
Mejilla/anomalías , Mejilla/irrigación sanguínea , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Venas/anomalías , Venas/cirugía , Anciano , Femenino , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Necrotizing fasciitis is a potentially life-threatening complication of severe cervical soft tissue inflammation. The characteristic feature is the rapid spread of the infection, which descends and potentially leads to mediastinitis and sepsis. METHODS: Within a year, 4 patients with peritonsillar abscess (PTA) and necrotizing fasciitis were treated at Dessau Medical Center. Therapy consisted of abscess tonsillectomy, immediate surgical debridement, extensive wound drainage, early tracheostomy, and systemic antibiotics. RESULTS: Symptoms decreased after intensive care and surgical removal. All patients were discharged after wound healing. The death of the oldest, multimorbid patient several weeks later was ascribed to the accompanying diseases. CONCLUSION: Early diagnosis, aggressive surgical debridement in association with tracheostomy and intravenous antibiotic therapy may reduce mortality significantly.
Asunto(s)
Desbridamiento/métodos , Drenaje/métodos , Fascitis Necrotizante/cirugía , Absceso Peritonsilar/cirugía , Tonsilectomía/métodos , Traqueostomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Terapia Combinada , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Absceso Peritonsilar/complicaciones , Absceso Peritonsilar/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Already in ancient times honey was used as a drug and for the treatment of wounds. In recent years the different effects of honey on wound-healing processes have been reexamined. Based on this, the antibacterial and fungicidal qualities of honey could be confirmed. PATIENTS AND METHODS: Between January 2009 and July 2011 medical honey was used on 36 patients suffering from different wound-healing disorders in the head and neck area after unsuccessful conventional treatment. The healing process was registered by microbiological investigations, measurements of the wound edges and adequate photo documentation. RESULTS: Medical honey can be used without problems or detectable side effects on problematic wounds of the head and neck area. Constant treatment leads to fast wound lavation, granulation, reduction of putrid smells and a decrease in inflammation. CONCLUSIONS: In the treatment of poorly healing and infected wounds within the head and neck area, medical honey can be used successfully without problems as an effective alternative to conventional treatment options.
Asunto(s)
Traumatismos Craneocerebrales/tratamiento farmacológico , Miel , Traumatismos del Cuello/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacos , Adulto , Traumatismos Craneocerebrales/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos del Cuello/diagnóstico , Resultado del Tratamiento , Adulto JovenRESUMEN
Complex sensorimotor training can improve the postural stability of patients with vestibular neuropathy. Particularly the efficiency of the cerebellar system was significantly improved. In addition, the results show that the affected peripheral vestibular system cannot be influenced directly, regardless of the kind of rehabilitation measure used.
Asunto(s)
Biorretroalimentación Psicológica/métodos , Retroalimentación Sensorial , Equilibrio Postural , Recuperación de la Función , Enfermedades Vestibulares/enfermería , Enfermedades Vestibulares/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Enfermedades Vestibulares/diagnóstico , Adulto JovenRESUMEN
A 50-year-old male patient demonstrated an existing left proptosis for several weeks. The patient was suffering from physical exhaustion and had lost considerable weight. Furthermore, we observed greatly enlarged parotid and submandibular glands on both sides. MRI of the neck showed multiple, sharply circumscribed lesions in the major salivary glands and both lacrimal glands as well as in the orbit. Initially we suspected Heerfordt's syndrome, a manifestation of sarcoidosis, but laboratory diagnosis could not reveal a pathological erythrocyte sedimentation rate or an increased ACE titer. After exploratory excision from the right submandibular gland, histological examination revealed Castleman's disease. Therefore, we initiated an immunomodulatory therapy with interleukin-6 receptor antagonists.Castleman's disease is one of the very rare, benign, lymphoproliferative processes that have a tendency to turn malignant. Isolated findings of Castleman's disease should be completely resected. There are no clear treatment strategies for multiple localizations of Castleman's disease. The approaches range from systemic glucocorticoid therapy with chemotherapy to immunomodulatory treatment. In contrast to isolated findings, the prognosis for multicentric occurrence is unfavorable.
Asunto(s)
Enfermedad de Castleman/diagnóstico , Fiebre Uveoparotidea/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Lymphatic malformations are rare tumors of the head and neck region. Complete resection is the mainstay of treatment in these cases. Surgery of lymphatic malformations is accompanied by various complications because of the adjacency to neurovascular structures and the infiltrative nature of these masses. PATIENTS AND METHODS: Between March 2008 and April 2010 three patients with lymphatic malformations of the head and neck region were treated by sclerotherapy with OK-432 (Picibanil). Two young children and a male adult with a late relapse were enrolled. The children were treated under general anesthesia. RESULTS: A complete remission of lymphangiomas of the external nose as well of the lateral neck could be observed after a single sclerotherapy with OK-432. No response was seen after multiple injections of OK-432 into the orbital lymphangioma and treatment was finally successful after resection. CONCLUSIONS: Today sclerotherapy has to be considered in the planning of the treatment of lymphatic malformations. Intralesional treatment of lymphangiomas in the head and neck with OK-432 shows good clinical response. Sclerotherapy with OK-432 is safe, effective and associated with few side-effects. After sclerotherapy a surgical resection can be carried out without any problems.
Asunto(s)
Anomalías Linfáticas/diagnóstico , Anomalías Linfáticas/terapia , Escleroterapia/métodos , Preescolar , Femenino , Humanos , Lactante , Masculino , Resultado del Tratamiento , Adulto JovenAsunto(s)
Sinusitis del Etmoides/diagnóstico , Exoftalmia/etiología , Mucormicosis/diagnóstico , Enfermedades Orbitales/diagnóstico , Anciano , Antifúngicos/uso terapéutico , Terapia Combinada , Desbridamiento , Descompresión Quirúrgica , Progresión de la Enfermedad , Quimioterapia Combinada , Endoscopía , Senos Etmoidales/patología , Senos Etmoidales/cirugía , Sinusitis del Etmoides/patología , Sinusitis del Etmoides/cirugía , Exoftalmia/patología , Exoftalmia/cirugía , Resultado Fatal , Femenino , Lóbulo Frontal/patología , Humanos , Oxigenoterapia Hiperbárica , Mucormicosis/patología , Mucormicosis/cirugía , Órbita/patología , Órbita/cirugía , Enfermedades Orbitales/patología , Enfermedades Orbitales/cirugía , Lóbulo Temporal/patologíaAsunto(s)
Urgencias Médicas , Infecciones Estreptocócicas/diagnóstico , Tonsilitis/diagnóstico , Enfermedad Aguda , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Absceso Peritonsilar/diagnóstico , Absceso Peritonsilar/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Tonsilitis/tratamiento farmacológico , Adulto JovenRESUMEN
Meningitis in the case of spontaneous dehiscences of the lateral skull base is rare. We report on two patients with otogenic meningitis. High-resolution CT (HR-CT) showed bilateral dehiscences at the lateral skull base in both cases. Infection along the skull base was assumed. In the first case sufficient repair was achieved using a multilayered technique, while in the second case conservative treatment on an intensive care unit was successful. Conservative therapy can prove successful in exceptional cases.