[The role of the intraoperative manometry in the esophageal achalasia surgical treatment]. / Il ruolo della manometria intraoperatoria nel trattamento chirurgico dell'acalasia esofagea.

INTRODUCTION: The authors report their experience about the intraoperative manometry in the achalasia surgical treatment. PATIENTS AND METHODS: We have considered 239 patients with achalasia observed from 1994 to 2006; only 79 continued the path diagnostic therapeutic and 31 underwent Heller longitudinal miotomy, with Dor anti-reflux plastic in 25 patients and in 6 Nissen anti-reflux plastic. In 24 we performed the intraoperative manometry (MI) recording the high pressure areas. RESULTS: The patients underwent Heller's procedure with manometric check of the gastric muscular fibre sectioned areas reported the disappearance of the dysphagia. Three of the operated ones without using the MI complained about the persistence of mild dysphagia and it did not depend from the antireflux surgical procedure used. CONCLUSIONS: Our findings confirm that the extramucosal miotomy is the treatment of choice for the achalasia and suggest that by MI a complete miotomy is allowed mostly on the gastric side where the muscular fibres get an important role in the maintenance of the high pressure areas.

El colesteatoma yatrógeno. A propósito de un caso muy extendido de evolución intratemporal y endocraneal / Iatrogenic cholesteatoma. About a widespread case of intratemporal and intracranial evolution

Los autores proporcionan la definición del colesteatoma yatrógeno y examinan las diferentes causas que pueden originar su formación. Incluyen una casuística de siete casos observados en los últimos diez años. Describen de manera completa un caso muy interesante, ya sea por el notable volumen alcanzado (ha afectado a la mastoides y al peñasco, con evolución endocraneal) como porque apareció después de una cirugía destructiva por un carcinoma del oído externo y de la parótida, seguida de una reconstrucción con colgajo tipo chino (AU)