Ascending meningitis secondary to traumatic cerebrospinal fluid leaks.

Cerebrospinal fluid (CSF) leakage may cause immediate or delayed complications, such as ascending meningitis and brain abscess, potentially lethal complications that may appear years or decades after the trauma. Thus, the initial treatment of a CSF fistula may decisively influence long-term outcome. In a retrospective study including 1036 consecutive patients presenting with severe cranial trauma from May 1990 to March 1996, we identified 27 patients (2.6%) with CSF fistulas. Patients with a post-traumatic CSF leak were most commonly males between 15 and 40 years involved in a motor vehicle accident. The most common sites of injury were the frontal area and anterior skull base for those patients with rhinorrhea and the temporal bone for those patients with otorrhea. A transcranial repair was used for large cranial base defects (n = 10), while conservative treatment, comprised of bedrest, lumbar drainage, and medications, was used for smaller fistulas (n = 17). Four patients (40%) initially treated with a transcranial repair, and five patients (29%) initially treated conservatively, developed a meningitis. Therefore, neither the conservative approach nor the transcranial repair was able to prevent this considerable incidence of ascending meningitis. We believe that the high incidence of meningitis is not acceptable; thus, we are now evaluating early intervention using endoscopic techniques for the identification and/or repair of post-traumatic fistulas.

[Endoscopic surgery of turbinates and nasal obstruction]. / Cirugía endoscópica de cornetes y obstrucción nasal.

Nasal blockage is one of the most habitual symptoms in otolaryngologist office and the concha nasalis inferior hypertrophy the commonest cause of the trouble. Cases in which medical treatment is refractory, surgery could be an optional resort in accordance of a great deal of specialists. The possibility of give rise to atrophic rhinitis or even ozenatous lesions has been refraining this surgery lately. In our series are contemplated the outcomes of several surgical procedures as mode of management of the hypertrophy of the lower turbinal. In the article are assessed the results of several surgical techniques dealing with hypertrophy of concha nasalis inferior. 75 patients were operated under endoscopic control. Some underwent a submucous decompression (SD) other partial resection (PR). Results at half and long term of both techniques-the conservative one (SD) and that a little more aggressive (PR)-are compared, and so are the factors conditioning the selection of the surgical procedure done. We consider the partial resection of the inferior concha, under endoscopic vision, as the best way for improving the nose obstruction due to inferior concha hypertrophy, provided conservative measures are not wise at all. Furthermore because with our own hands we reach very good outcomes, both in breathing and nasal comfort. Only the patient's age may influence the last decision.