Leiomiosarcoma radioinducido de la región posterior del cuello / Radiation-induced leiomyosarcoma of the posterior neck region

Los leiomiosarcomas son tumores mesenquimales malignos, que se originan en las células del músculo liso. Las localizaciones de aparición más frecuentes son el miometrio y el tracto gastrointestinal. En la región de cabeza y cuello los leiomiosarcomas aparecen de forma excepcional. Presentamos el caso de un leiomiosarcoma en la región posterior del cuello, en un paciente radiado 20 años antes por un tumor de nasofaringe. La incidencia de este tipo de tumores que cumple los criterios de tumor radioinducido se sitúa entre el 0,035 y el 0,2%. Los sarcomas radioinducidos son difíciles de diagnosticar en estadios tempranos, debido a la induración y la fibrosis de la zona radiada y a la sintomatología inespecífica que presentan. Su pronóstico es malo (AU)

Leiomyosarcomas are mesenchymal malignant tumours that appear in smooth muscle cells. Their most frequent locations are the uterus and gastrointestinal tract. Their occurrence in head and neck is considered exceptional. We present a patient with a posterior neck region leiomyosarcoma who had received radiation for a nasopharyngeal carcinoma 20 years earlier. The incidence ratio of these tumours in radiated patients (therefore considered radiation-induced) ranges from 0,035 to 0,2%. Radiation-induced sarcomas are difficult to diagnose due to the induration and fibrosis in the radiated area and the non-specific symptoms that they present. Their prognosis is very poor (AU)

Radiation-induced leiomyosarcoma of the posterior neck region.

INTRODUCTION: Leiomyosarcomas are mesenchymal malignant tumours that appear in smooth muscle cells. Their most frequent locations are the uterus and gastrointestinal tract. Their occurrence in head and neck is considered exceptional. We present a patient with a posterior neck region leiomyosarcoma who had received radiation for a nasopharyngeal carcinoma 20 years earlier. The incidence ratio of these tumours in radiated patients (therefore considered radiation-induced) ranges from 0,035 to 0,2%. Radiation-induced sarcomas are difficult to diagnose due to the induration and fibrosis in the radiated area and the non-specific symptoms that they present. Their prognosis is very poor.

Complicaciones de la cirugía endoscópica nasosinusal en un programa de entrenamiento de residentes / Complications of endoscopic sinus surgery in a residency training program

Introducción: La cirugía endoscopica nasosinusal presenta una serie de complicaciones que varían en función de la técnica usada y la experiencia del cirujano. Esta técnica requiere una curva de aprendizaje la cual se debe ir desarrollando a lo largo del programa de formación del residente. Métodos: Estudio descriptivo y retrospectivo, se realizó una revisión de las historias clínicas de 192 pacientes intervenidos de cirugía endoscopica por poliposis nasosinusal, todas estas cirugías fueron realizadas por residentes de nuestro departamento, entre enero de 2002 y enero de 2008. Se describe el sexo, edad, grado de poliposis, complicaciones mayores y menores. Todos estos procedimientos fueron realizados por residentes de 3.er y 4.° año bajo la supervisión de un especialista. Resultados: De 192 pacientes, 127 (66,14) eran varones y 65 (33,85%) mujeres, con edades comprendidas entre 24 y 78 años, con una media de edad de 49 años. El grado de poliposis por endoscopia era: grado i 19 (9,8%), grado ii 55 (28,6%) y grado iii 118 (61,45%). Ocurrieron 44 (22,9%) complicaciones totales, 40 (20,8%) menores y 4 (2,08%) mayores. La complicación menor mas frecuente fue la sinequia en 21 casos (10,93%) seguida de sangrado sin necesidad de transfusión en 12 (6,25%) pacientes. La complicación mayor fue ruptura de la lamina papiracea en 4 (2,08%) pacientes. No se presentó ningún caso de ceguera, rinolicuorrea, o muerte. Conclusión: La cirugía endoscopica nasosinusal en un programa de entrenamiento de residentes es un procedimiento relativamente seguro especialmente cuando se realiza bajo la supervisión de un especialista (AU)

Introduction: Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. Methods: Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. Results: Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade I, 19 (9.8%) cases; grade II, 55 (28.6%); and grade III, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21 (10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. Conclusions: Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision (AU)

[Complications of endoscopic sinus surgery in a residency training program]. / Complicaciones de la cirugía endoscópica nasosinusal en un programa de entrenamiento de residentes.

INTRODUCTION: Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. METHODS: Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. RESULTS: Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade i, 19 (9.8%) cases; grade ii, 55 (28.6%); and grade iii, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. CONCLUSIONS: Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.