Coriocarcinoma: importancia del diagnóstico precoz / Choriocarcinoma: importance of an early diagnosis

El coriocarcinoma es un tumor poco frecuente. El diagnóstico temprano es difícil. Presentamos un caso de coriocarcinoma que debuta con síntomas no ginecológicos. En el momento del diagnóstico presenta metástasis pulmonares y cerebrales. A pesar de la buena respuesta inicial al tratamiento la paciente fallece por complicaciones secundarias. No debemos olvidar la posibilidad de este tumor ante una mujer joven con síntomas y/o signos neurológicos o respiratorios que no responden al tratamiento inicial

Choriocarcinoma are unusual tumors. Early diagnosis is difficult. We present a case of choriocarcinoma, the first symptoms of which were non-gynaecological. At the time of diagnosis both pulmonary and cerebral metastasis were confirmed. In spite of the good initial therapeutic response, the patient died due to secondary complications. We should not forget the possibility of this tumor in a young patient with neurological and respiratory symptoms that do not respond to initial treatment

[Results of three different stapedectomy techniques: a comparative study]. / Estudio comparativo de los resultados de tres tipos diferentes de estapedectomía.

We perform a comparative study on the results obtained through three stapedectomy techniques. The hearing gain was evaluated in 107 ears with total footplate removal, Shea prosthesis and connective tissue graft, in 81 ears with particular footplate removal, the same prosthesis, and no tissue graft, and in 66 ears with stapedectomy. The differences between the three groups in the air-bone gap closure or postoperative complications were not statistically significant. We conclude that results depend more on the surgeon than on the technique.

Chondro-perichondrial connection in middle ear surgery.

Hearing conservation or gain are important parameters of tympanoplastic surgery. The frequency of this surgical procedure and the difficulty in obtaining tissues due to the increased risk of H.I.V. transfer has made the use of synthetic products somewhat more acceptable in contrast with the use of organic substances (homograft ossicles, bone, cartilage and perichondrium, etc...). We have been using tissues of the same patient (50), during a period of three years with a specimen constituted of cartilage and perichondrium designed as a "butterfly" and with very promising tympanoplastic and functional results. The tympanoplastic results were evaluated eighteen months postoperatively as follows: good: 86%, aural discharges that disappeared later 12%, perforations: 0%, keratin neoformations: 2%. Functional results were evaluated three years later as follows: gain more than 15 dB: 72%, same: 14%, worse: 14%.

[Revision of stapedectomy (110 ears)]. / Revisión de estapedectomía (110 oídos).

We have carried out a retrospective study of 110 ears in patients affected with otosclerosis who underwent revision of stapedectomy, from 1979 to 1991, because they did not achieve hearing improvement or still presented persistent dizziness after primary stapedectomy. In our series, the most common causes of surgical failure after the first surgery are: displacement of the prosthesis (36.3%), ossicular chain alterations (21.8%) and regrowth of otosclerotic bone in the oval window (19.9%). One year after surgery, hearing test was compared with preoperatory tonal audiometry, finding and improvement in 48.1% (closure of 20 dB HL or more of the air-bone GAP), no changes in 43.6% and deterioration of the audition in 8.1%. Finally, we give some advises to prevent hearing loss in the revision of stapedectomy.

[Chondro-perichondrial connections in otic surgery (CPC)]. / Conexiones condropericóndricas en la cirugía ótica (CCP).

Tympanoplasty does not resolve problems such as tympanic reconstruction, pneumatic cavity and ossicular transmission mechanism. With the purpose to solve these problems, we used autografts of tragal cartilage with its perichondrial membrane. In just one surgical procedure, we built a transmission mechanism and a consistent new tympanic membrane. Results obtained after 2 years of experience are very encouraging, since postoperative auditive function improves up to 75%; also, a good pneumatic cavity and a well vascularized new tympanic membrane are achieved. Reabsorption of the cartilage was not seen in any case.

[Computerized study of perioperative difficulties of stapedectomy]. / Estudio computarizado de las dificultades perquirúrgicas de la estapedectomía.

A retrospective study of 1035 stapedectomies was performed to assess the incidence of intraoperative complications between 1972-1990. We found 45.89% of complications. We divided this alterations in 6 groups: 1) hemorrhage (20.67%), 2) stapes, foot plate, oval window (8.40%), 3) alterations in the middle ear (6.85%), 4) alterations in the incus (3.76%), 5) alterations in the external ear canal (3.57%) and 6) problems with protesis or graf (2.60%). We have analyzed these complications. We propose to carry out the solutions.

[Our current criteria in tympanoplasty surgery]. / Nuestro criterio actual en la cirugía de las timpanoplastias.

The choice of surgical techniques has gone through a great evolution during the last few years in our service. Closed techniques were formally used in 80 per 100 of our operations (1974-1979) and now this has dropped to 12.5 per 100 (1979-1983) motivated by the failures we obtained with the closed techniques. This is similar to the observations of other services. We have determined the causes of failure to be related to: difficulties in dominating the surgical field, treatment of the cavity, or reconstruction of the walls. We present the antro-exclusion attic elimination on demand (A.A.D) technique which is designed to resolve not only the elimination of the lesion, but also the cavity problem. We have also evaluated the possibility of reconstructing the mastoid and pneumatic cavities connected to the tympanic case.

Tympanoplasty: a 5-year review of results using the a la demanda (AAD) technique.

The effectiveness of different surgical procedures to eradicate cholesteatoma in the middle ear was studied. The author reviewed 1405 cases conducted during 10 years (1974 to 1984) and found that the most important causes of failure are pocket cholesteatoma and residual cholesteatoma. With the goal of diminishing these factors, a la demanda (AAD) technique has been used for the past 5 years, with optimistic results--only 2.4% failures during this period. Other causes of failures have also been studied. The evolution of the surgical technique has had two orientations: to improve the results and to eliminate the failures. In the author's clinic there has been a percentage of failures, which has motivated an orientation toward more resolutive and destructive instead of conservative, techniques.

Audiometric study of the neonate: impedance audiometry. Behavioural responses and brain stem audiometry.

The following clinical measurements of acoustic impedance were carried out successfully on 25 neonates. Average compliance was 0.48 cm3, with a range from 0.28 to 0.81 cm3. Tympanometry showed a high percentage of maximum compliance curves with positive pressures. In a notably high percentage, the stapedial reflex was combined with generalized body movements and was therefore considered a behavioural response. Behavioural responses of the child were also observed separately. Ipsilateral stimulation did not evoke a measurable stapedius reflex in any of the cases, but with contralateral stimulation some babies did show this reflex. The most intense behavioural responses occurred when white noise was used as the stimulus. Of the 25 children studied with impedance audiometry, 10 were evaluated audiologically by brain stem electric potentials. The latency of wave V was within the normal range in all the cases. Electric response audiometry could be a promising method for audiological evaluation of the neonate.