[Pre-operative symptoms and post-operative improvement in patients diagnosed with hyperparathyroidism. Analysis of 120 consecutive cases]. / Clínica preoperatoria y mejoría postoperatoria en pacientes con diagnóstico de hiperparatiroidismo. Análisis de 120 casos consecutivos.

OBJECTIVE: To compare the pre-operative and post-operative clinical symptoms in patients diagnosed as having hyperparathyroidism and given surgical treatment, in order to prove the existence of statistically significant improvement. MATERIAL AND METHOD: We report here a retrospective study performed on 120 consecutive patients operated on following diagnosis of hyperparathyroidism between 1990 and 2003. RESULTS: Nephrolithiasis, generalized bone pain and HBP were the most common clinical manifestations. Primary hyperparathyroidisms represented 76.7 %, while secondary ones were 20.8 % and 2.5 % were tertiary. We carried out 85 adenoma removals, 30 sub-total and 5 total parathyroidectomies. We only encountered one case of recurrent palsy and about 25 % of hypocalcemias (2 of them permanent). Osteoarticular pathology and nephrolithiasis suffered by our patients clearly improved after surgery (P< .01) after 2 years of follow-up. There was no significant improvement in HBP, digestive and psychiatric pathology or pruritus. CONCLUSIONS: The improvement in quality of life for most of the patients operated on for this condition amply justifies parathyroidectomy by an experienced otolaryngology team.

Clínica preoperatoria y mejoría postoperatoria en pacientes con diagnóstico de hiperparatiroidismo. Análisis de 120 casos consecutivos / Pre-operative symptoms and post-operative improvement in patients diagnosed with hyperparathyroidism. Analysis of 120 consecutive cases

Objetivo: Comparar los síntomas clínicos preoperatorios y postoperatorios en pacientes diagnosticados de hiperparatiroidismo y sometidos a tratamiento quirúrgico, para comprobar si se produce mejoría estadísticamente significativa. Material y método: Estudio retrospectivo realizado sobre 120 pacientes consecutivos intervenidos con diagnóstico de hiperparatiroidismo entre 1990 y 2003. Resultados: La litiasis renal, los dolores óseos generalizados y la hipertensión fueron las manifestaciones clínicas más frecuentes. El 76,7 % eran hiperparatiroidismos primarios; el 20,8 %, secundarios y el 2,5 %, terciarios. Se practicaron 85 resecciones de adenoma, 30 paratiroidectomías subtotales y 5 paratiroidectomías totales. Sólo hemos constatado 1 caso de parálisis recurrencial y un 25 % de hipocalcemias (2 definitivas). Mejoraron significativamente tras la cirugía (p < 0,01) la afección osteo articular y la litiasis renal que presentaban los pacientes tras 2 años de seguimiento. No mejoraron de forma significativa la hipertensión, las enfermedades digestivas y psiquiátricas y elprurito. Conclusiones: La mejoría en la calidad de vida de la mayoría de los pacientes operados por esta enfermedad justifica sobradamente la paratiroidectomía por un equipo otorrinolaringológico experimentado (AU)

Objective: To compare the pre-operative and post-operative clinical symptoms in patients diagnosed as having hyperparathyroidism and given surgical treatment, in order to prove the existence of statistically significant improvement. Material and method: We report here a retrospective study performed on 120 consecutive patients operated on following diagnosis of hyperparathyroidism between 1990 and 2003. Results: Nephrolithiasis, generalized bone pain and HBP were the most common clinical manifestations. Primary hyperparathyroidisms represented 76.7 %, while secondary ones were 20.8% and 2.5 % were tertiary. We carried out85 adenoma removals, 30 sub-total and 5 total parathyroidectomies. We only encountered one case of recurrent palsy and about 25 % of hypocalcemias (2 of them permanent). Osteoarticular pathology and nephrolithiasis suffered by our patients clearly improved after surgery (P<0.01) after 2 years of follow-up. There was no significant improvement in HBP, digestive and psychiatric pathology or pruritus. Conclusions: The improvement in quality of life for most of the patients operated on for this condition amply justifies parathyroidectomy by an experienced otolaryngology team (AU)

[Acute epiglottitis in adults. Diagnosis and treatment in our experience of 30 cases]. / Epiglotitis aguda en adultos. Nuestra experiencia clínica en 30 casos.

OBJECTIVE: We present the 15-year-long experience of 2 hospitals in our region regarding the therapeutic management of acute epiglottitis in adults. PATIENTS AND METHOD: Thirty patients with an average age of 46 years were diagnosed as having acute epiglottitis, either by indirect laryngoscopy or fibroscopy, and studied through a series of clinical parameters: age, sex, personal history, complementary tests, clinical symptoms, treatment, evolution, and average stay in hospital. RESULTS: We found an obvious predominance of this urgent pathology in males, with most patients reporting dysphagia or odynophagia (90 %). Dyspnoea was confirmed in 40 % of the cases but only 7 required intubation, coniotomy, or tracheotomy. The complications recorded include one case of mediastinitis and another of death due to sudden cardiorespiratory arrest. CONCLUSIONS: We feel that a specific protocol must be established to take into account, apart from admission to hospital, personal contact with an intensive care unit (ICU) even though in most cases it is ultimately unnecessary to ensure airway patency as seen in the various case series published.

Epiglotitis aguda en adultos. Nuestra experiencia clínica en 30 casos / Acute epiglottitis in adults. Diagnosis and treatment in our experience of 30 cases

Objetivo: Dar a conocer la experiencia conjunta de 2 hospitales de nuestra región en los últimos 15 años sobre el manejo terapéutico de los casos de epiglotitis aguda en adultos. Pacientes y método: Se incluye a 30 pacientes con una media de edad de 46 años, diagnosticados de epiglotitis aguda mediante laringoscopia indirecta o fibroscopia, de los que se recogió una serie de parámetros clínicos: edad, sexo, antecedentes personales, estudios complementarios, síntomas clínicos, tratamiento, evolución y estancia hospitalaria. Resultados: Encontramos un claro predominio de esta enfermedad urgente en varones, que en su mayoría referían disfagia u odinofagia (90 %). Se constató disnea en un 40 % de los casos, de los que sólo 7 requirieron intubación, coniotomía o traqueotomía. Entre las complicaciones registramos un caso de mediastinitis y una muerte por parada cardiorrespiratoria súbita. Conclusiones: Creemos que se debe establecer un protocolo de actuación que incluya, aparte del ingreso hospitalario, un contacto personal con una unidad de cuidados intensivos (UCI) aunque en la mayoría de los casos finalmente no sea necesario asegurar la vía respiratoria, como se comprueba en las diferentes casuísticas publicadas

Objective: We present the 15-year-long experience of 2 hospitals in our region regarding the therapeutic management of acute epiglottitis in adults. Patients and method: Thirty patients with an average age of 46 years were diagnosed as having acute epiglottitis, either by indirect laryngoscopy or fibroscopy, and studied through a series of clinical parameters: age, sex, personal history, complementary tests, clinical symptoms, treatment, evolution, and average stay in hospital. Results: We found an obvious predominance of this urgent pathology in males, with most patients reporting dysphagia or odynophagia (90 %). Dyspnoea was confirmed in 40 % of the cases but only 7 required intubation, coniotomy, or tracheotomy. The complications recorded include one case of mediastinitis and another of death due to sudden cardiorespiratory arrest. Conclusions: We feel that a specific protocol must be established to take into account, apart from admission to hospital, personal contact with an intensive care unit (ICU) even though in most cases it is ultimately unnecessary to ensure airway patency as seen in the various case series published

[Surgical treatment of refractory hyperparathyroidism and usefulness of the intraoperative PTH]. / Tratamiento quirúrgico del hiperparatiroidismo refractario y utilidad de la paratirina intraoperatoria.

OBJECTIVE: To share our experience in the surgery of so-called refractory hyperparathyroidism (secondary and tertiary without response to therapy with calcitriol). MATERIAL AND METHODS: Retrospective study based on 41 patients-5 with secondary and 6 with tertiary hyperparathyroidism-referred by nephrology for surgical evaluation of their illness because of poor response to the medical treatment given. RESULTS: In 18 of the 41 cases we used the fast or turbo intra-operative PTH with reduction of more than 60 % in all patients. In the group in whom normal PTH was performed, we registered 2 secondary hyperparathyroidisms with no significant decrease and persistence of symptoms. One of them was reoperated successfully. DISCUSSION: Subtotal or total parathyroidectomy with reimplant represents the treatment of choice in refractory hyperparathyroidism with good results in most of the series reviewed.

[Contralateral hemithyroidectomy due to carcinoma of the thyroid. Our cases reviewed and updated]. / Hemitiroidectomía contralateral por carcinoma de tiroides. Nuestra casuística revisada y actualizada.

OBJECTIVE: We are reporting our 14 years' experience with prior hemithyroidectomies or contralateral hemithyroidectomies after a pathology result reporting malignancy (thyroid carcinoma) in the first surgery. MATERIAL AND METHOD: Twenty female patients with an average age of 45 years old have been studied and we have analyzed the initial symptoms, results of complementary tests, pathology diagnosis following initial surgery, and final outcome after a second intervention. RESULTS: The incidence of malignancy shown in our series after secondary surgery was 40 % and the percentage of hemithyroidectomy on hemithyroidectomy was 3 % after operating on 650 thyroid glands. CONCLUSIONS: Though opinions differ in the medical literature, we feel a total thyroidectomy must be performed after a casual finding of thyroid carcinoma because of the oncologically safer outcome and the better control of the patient.

Hemitiroidectomía contralateral por carcinoma de tiroides. Nuestra casuística revisada y actualizada / Contralateral hemithyroidectomy due to carcinoma of the thyroid. Our cases reviewed and updated

Objetivo: Se presenta nuestra experiencia de 14 años en hemitiroidectomías sobre hemitiroidectomías previas o hemitiroidectomías contralaterales tras un resultado anatomopatológico de malignidad (carcinoma de tiroides) en la primera cirugía. Material y método: Hemos incluido a 20 pacientes, todas ellas mujeres, con una media de edad de 45 años. Se analizan los síntomas clínicos iniciales, los resultados de las exploraciones complementarias, el diagnóstico anatomopatológico de la primera intervención y el resultado final tras la segunda cirugía. Resultados: En nuestra serie la segunda hemitiroidectomía resultó positiva en un 40 % y el porcentaje de hemitiroidectomías sobre hemitiroidectomías de 650 tiroides operados fue del 3 %. Conclusiones: Aunque hay diferentes opiniones en la literatura médica, nosotros creemos que ante el hallazgo casual de un carcinoma tiroideo se debe completar una tiroidectomía total, por su mayor seguridad oncológica y mejor control del paciente

Objective: We are reporting our 14 years' experience with prior hemithyroidectomies or contralateral hemithyroidectomies after a pathology result reporting malignancy (thyroid carcinoma) in the first surgery. Material and method: Twenty female patients with an average age of 45 years old have been studied and we have analyzed the initial symptoms, results of complementary tests, pathology diagnosis following initial surgery, and final outcome after a second intervention. Results: The incidence of malignancy shown in our series after secondary surgery was 40 % and the percentage of hemithyroidectomy on hemithyroidectomy was 3 % after operating on 650 thyroid glands. Conclusions: Though opinions differ in the medical literature, we feel a total thyroidectomy must be performed after a casual finding of thyroid carcinoma because of the oncologically safer outcome and the better control of the patient

Tratamiento quirúrgico del hiperparatiroidismo refractario y utilidad de la paratirina intraoperatoria / Surgical treatment of refractory hyperparathyroidism and usefulness of the intraoperative PTH

Objetivo: Dar a conocer nuestra experiencia en la cirugía del denominado hiperparatiroidismo refractario (secundario y terciario sin respuesta al tratamiento con calcitriol). Material y métodos: Estudio retrospectivo con revisión de 41 pacientes (35 con hiperparatiroidismos secundarios y 6 terciarios) remitidos por nefrología para valoración quirúrgica de su enfermedad ante la mala respuesta al tratamiento médico. Resultados: En 18 de los 41 casos se utilizó la determinación de paratirina rápida o turbo intraoperatoria, con descenso superior al 60 % en todos los pacientes. En el grupo en que se empleó paratirina normal registramos 2 hiperparatiroidismos secundarios en los que la citada hormona no descendió significativamente y los síntomas persistieron, uno de los cuales fue reintervenido con éxito. Conclusiones: La paratiroidectomía subtotal o total con autotrasplante es el tratamiento de elección en el hiperparatiroidismo refractario, con buenos resultados en la mayoría de las series consultadas

Objective: To share our experience in the surgery of so-called refractory hyperparathyroidism (secondary and tertiary without response to therapy with calcitriol). Material and methods: Retrospective study based on 41 patients­5 with secondary and 6 with tertiary hyperparathyroidism­referred by nephrology for surgical evaluation of their illness because of poor response to the medical treatment given. Results: In 18 of the 41 cases we used the fast or turbo intra-operative PTH with reduction of more than 60 % in all patients. In the group in whom normal PTH was performed, we registered 2 secondary hyperparathyroidisms with no significant decrease and persistence of symptoms. One of them was reoperated successfully. Discussion: Subtotal or total parathyroidectomy with reimplant represents the treatment of choice in refractory hyperparathyroidism with good results in most of the series reviewed

Sección laringotraqueal traumática. Presentación de un caso y revisión de la literatura / Laryngotracheal traumatic section. A case report and literature review

Las lesiones traqueales secundarias a traumatismos cerrados son raras y las que cursan con sección laringotraqueal casi completa o total son más raras aún. Presentamos el caso clínico de un paciente que sufrió accidente de tráfico con enfisema subcutáneo - profundo, disnea y estridor a su ingreso. Para asegurar la vía aérea, y al no ser posible la intubación orotraqueal (I.O.T.), fue necesario realizar traqueotomía en tercer anillo por debajo de la zona seccionada (cricoides-primer anillo traqueal) con reconstrucción posterior del defecto. Analizamos la evolución del paciente hasta su alta hospitalaria. Finalmente realizamos una revisión bibliográfica al respecto de esta patología

Tracheal injuries secondary to blunt trauma are rare and those with laryngotracheal section near complete or totalare more uncommon. We report the clinical case of a male who had suffered a traffic accidente resulted in subcutaneous - deep emphysema, dyspnea and stridor when he was admitted. For securing and effective airway because it was not possible an oro-tracheal intubation (O.T.I.), a tracheostomy was required on third ring below the sectioned zone (cricoides-first tracheal ring) followed by reconstruction of the defect. We have analysed the evolution of the patient until he was discharged from hospital. Finally, a bibliographic review has been performed at the respect of this pathology

[Hyperparathyroidism associated with thyroid disease. Retrospective study of 15 patients treated in 11 years]. / Hiperparatiroidismo asociado a patología tiroidea. Estudio retrospectivo de 15 pacientes intervenidos en 11 años.

The association of hyperparathyroidism with thyroid pathology previous to surgery is not very frequent in our cases, almost a 15%, but it means another difficulty for the diagnostic and treatment. Between 1991 and 2001 we have studied and operated 15 patients with this clinic association. 14 were female and only 1 male with a range age of 59 years old. We studied the type of hyperparathyroidism, personal history, clinic, type of thyroid pathology associated, complementary explorations, type of surgery, anatomopathology evolution, and hospital stay. We have done 12 adenoma resections, 1 subtotal parathyroidectomy, 2 total thyroidectomies and 5 hemithyroidectomies. Only in one patient the anatomopathology was informed as a thyroid carcinoma associated to a parathyroid adenoma, being the other patients benign pathologies. We did literaturer revision on this association. We believe that in all patients with a thyroid pathology we should an associated hyperparathyroidism and vice versa.

Hiperparatiroidismo asociado a patología tiroidea. Estudio retrospectivo de 15 pacientes intervenidos en 11 años / Hyperparathyroidism associated to thyroid pathology. A retrospective study of 15 operated patients in 11 years

La asociación de hiperparatiroidismo con patología tiroidea previa a la cirugía no es muy frecuente en nuestra casuística, alrededor de un 15 por ciento en la actualidad, pero supone una dificultad añadida tanto para el diagnóstico como el tratamiento. Entre 1991 y 2001 hemos estudiado e intervenido 15 pacientes que presentaban dicha asociación clínica. 14 eran mujeres frente a 1 solo varón siendo la edad media de 59 años. Las variables analizadas fueron el tipo de hiperparatiroidismo, antecedentes personales, clínica, tipo de patología tiroidea asociada, exploraciones complementarias, tipo de cirugía, anatomopatología, evolución y estancia hospitalaria. Practicamos 12 resecciones de adenoma, 1 paratiroidectomía subtotal, 2 tiroidectomías totales y 5 hemitiroidectomías. Sólo la AP de un paciente fue informada como carcinoma de tiroides asociado a adenoma paratiroideo, correspondiendo el resto de resultados a patologías benignas. Realizamos una revisión bibliográfica al respecto de esta asociación. Creemos que ante cualquier paciente que presente una patología tiroidea debería descartarse un hiperparatiroidismo asociado y viceversa (AU)

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Hiperparatiroidismo asociado a patología tiroidea / Hyperparathyroidism associated to thyroid pathology

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Nuevos avances en el tratamiento del hiperparatiroidismo primario / New advances in the treatment of primary hyperparathyroidism

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[Cavum carcinoma. A review of retrospective study about 18 patients in 12 year period]. / Carcinomas de cavum. Estudio descriptivo y retrospectivo de 18 pacientes en un período de 12 años.

The cavum or rhinopharynx carcinomas are rare tumors who are divided basically in two histologic types: epidermoid carcinoma and indiferenciated carcinoma. We present a personal revision of 18 patients (15 males and 3 females) diagnosed of cavum carcinoma, the majority (72.2% of indiferenciated type. We have done a descriptive-retrospective study of 12 years (1990-2001) with the following parameters: clinic presentation, associated symptoms, TNM stage, anatomopathology, treatment and clinic evolution. The 38.9% of the patients (7) are actually in complete remission after at last 2 years treatment completion. 3 patients have died and another 2 have not followed the periodic controls in our hospital. The others present a residual tumor in rhinopharynx or in ganglionar level. In one case there are distant metastasis (liver and lungs).

[Orbit complications of sinusitis in adults. Our cases during 10 years]. / Complicaciones orbitarias de la sinusitis en adultos. Nuestra casuística en 10 años.

The sinusites orbital complications usually associated to ethmoidites are rare in the childhood. We present a revision of 14 adults patients (10 males and 4 females) 18 to 61 years old. Seven presented a preseptal cellulitis, two had a subperiostial abscess and five an orbitary cellulitis in accordance with the Candler classification. We analyse the personal previous history, the clinical data, complementary tests and treatments (medical and surgical) evolution and hospital stay. We realise a literature revision about this subject.

[Killian antrum-choanal polyps. Analysis of 30 operated patients]. / Pólipos antrocoanales de Killian. Análisis de 30 pacientes intervenidos.

The antrochoanal polyps or solitary Killian polyps are seldom benign pathologies. Since 1990 to October 2002 we have registered a total of 30 patients with these diagnosis (20 male and 10 female) between 5 and 70 years old. The nasal obstruction, usually unilateral, has been constant in all of them and in more than a 63% they referred it since more than one year. They underwent surgery with Functional Endoscopic Endonasal Surgery. The postoperative results have been satisfactory except in two patients who have had a recidive with another surgery. We analyse also a bibliography revision on this pathology.

Complicaciones orbitarias de la sinusitis en adultos nuestra casuística en 10 años / Sinusites orbital complications in adults. Our 10 years experience

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Pólipos antrocoanales de Killian. Análisis de 30 pacientes intervenidos / Killian antrochoanal polyps. Study of 30 operated patients

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Carcinomas de cavum estudio descriptivo y retrospectivo de 18 pacientes en un período de 12 años / Cavum carcinomas. A descriptive and retrospective study about 18 patients in 12 years period

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