Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital.

BACKGROUND: The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm. METHOD: A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap. RESULTS: Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent). CONCLUSION: The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

[A brief history of the Union of Spychiatrists of the IVSS]. / Breve reseña historica de la Unidad de Psiquiatria del IVSS.

A historical review of the IVSS Unity of Psychiatry, from the beginning (1944) as consulting hour in its Center of Medical Specialties. Details about its changes of location and personal, while the service was increasing until the present condition as Unity of Psychiatry with several backing departments are presented.

[Psychiatric medicine]. / Medicina psiquiátrica.

The author, after a short historical introduction which shows the Medicine, especially the Neurology, as the predecessor of the Psychiatry, intents to relate in a theorico-practical way the anxiety and the depression within a bio-chemical and endocrinological frame. He presents the hipo and hipercalcemia signals and symptoms demonstrating with a casuistic from his clinical practice the similitude between anxiety and depression respectively. Finally he realizes a theorical analysis about the investigations published over the AMP-ciclic and infers about the hormonal interference and the clinical data linked with the manic-depressive disease.

Medicina psiquiátrica. / [Psychiatric medicine]

The author, after a short historical introduction which shows the Medicine, especially the Neurology, as the predecessor of the Psychiatry, intents to relate in a theorico-practical way the anxiety and the depression within a bio-chemical and endocrinological frame. He presents the hipo and hipercalcemia signals and symptoms demonstrating with a casuistic from his clinical practice the similitude between anxiety and depression respectively. Finally he realizes a theorical analysis about the investigations published over the AMP-ciclic and infers about the hormonal interference and the clinical data linked with the manic-depressive disease.