David Herrero

Diagnóstico y tratamiento de los paragangliomas carotídeos. Presentación de nueve casos y revisión de la literatura

Resumen Los paragangliomas carotideos (PC) son tumors infrecuentes derivados de los paraganglios del cuerpo carotideo. Al diagnostico se llega por la clinica y las imagenes. El tratamiento es quirurgico, siendo fundamental la actitud ante la arteria carotida. Presentamos nueve pacientes, en tres de ellos el diagnostico es complejo. Un caso se trata con radioterapia. De los ocho pacientes operados: en tres se conserva la totalidad de la estructura arterial, en dos casos se reseca la carotida externa, en dos enfermos se sustituye la carotida (un injerto de safena, una protesis de gore tex),en una paciente se liga la carotida comun. Nuestro objetivo es referir las decisiones tomadas en los pacientes de nuestra casuistica, comparandolas con los datos de la literatura. Concluimos que el diagnostico puede ser enganoso y que la actitud ante la carotida es variable, debiendose tener siempre prevista la realizacion de tecnicas de sustitucion arterial

Arteria innominada aberrante alta en cirugía cervical

We present two cases of innominate artery (IA) in a cervical position. In the first case, surgery was not performed because there was no indication. In the second, it was possible to obtain surgical images of the AI and its branches located in front of the laryngotracheal axis. A warning about the serious risk involved in cervical surgery in these cases is indicated.

Estudio de las características mecanoacústicas del oído medio sometido a cirugía estapedial con y sin conservación del tendón del estribo

Introduccion y objetivos La cirugia de sustitucion estapedial realizada en casos de otosclerosis altera diversos elementos anatomicos del oido medio (osiculares, ligamentosos y tendinosos), lo que modifica sus propiedades fisicas. El objetivo del trabajo es determinar que tecnicas de las practicadas durante la cirugia de la otosclerosis respetan mas las caracteristicas mecanoacusticas del oido medio. Pacientes y metodo Estudiamos los resultados audiologicos y admitanciometricos de 100 pacientes sometidos a diversas tecnicas de sustitucion estapedial y los comparamos con los de 20 sujetos otologicamente sanos. Resultados Los resultados audiologicos obtenidos son similares en los diversos tipos de tecnicas quirurgicas comparadas; sin embargo, las que respetan el tendon del musculo estapedial presentan, tras la intervencion, frecuencias de resonancia del oido similares a los oidos sanos, lo que no ocurre con las demas tecnicas evaluadas. Conclusiones Ala luz de los resultados, consideramos que debe conservarse el tendon estapedial durante la cirugia de la otosclerosis, ya que de este modo se preservan mejor las caracteristicas mecanoacusticas del oido, lo que repercute en una mejor discriminacion del lenguaje en ambientes ruidosos.

[Analysis of the mechanical-acoustic features of the middle ear after stapedial surgery both with and without stapes muscle preservation].

INTRODUCTION AND OBJECTIVE Stapes replacement surgery performed in cases of otosclerosis alters various anatomical (ossicular, ligament, and tendon) elements of the middle ear affecting their physical properties. The goal of our work is to determine which of the surgical techniques applied during otosclerosis most respects the mechanical-acoustic features of the middle ear. PATIENTS AND METHOD We analyzed the audiological and admittance results of 100 patients who underwent various stapedial replacement techniques and compared them to 20 otologically healthy subjects. RESULTS The audiological results obtained are similar in the different surgical techniques compared. However, those techniques in which the stapedial muscle tendon is preserved offer similar hearing resonance frequencies post intervention as healthy ears, which was not found to be the case in the remaining techniques evaluated. CONCLUSIONS We feel that the stapedial tendon should be preserved during otosclerosis surgery as the mechanical-acoustic features of the ear are thus better conserved, leading to enhanced language recognition in noisy environments.

Análisis experimental mediante vibrometría láser doppler en huesos temporales de cadáver fresco de una nueva prótesis de maleovestibulopexia

INTRODUCTION AND OBJECTIVES One of the problems with total ossicular replacement prostheses is their stability. Prosthesis dislocations and extrusions are common in middle ear surgery. This is due to variations in endo-tympanic pressure as well as design defects. The design of this new prosthesis reduces this problem by being joined directly to the malleus handle. The aim of this study is to confirm adequate acoustic-mechanical behaviour in fresh cadaver middle ear of a new total ossicular replacement prosthesis, designed using the finite elements method. METHODS Using the doppler vibrometer laser, we analysed the acoustic-mechanical behaviour of a new total ossicular replacement prosthesis in the human middle ear using 10 temporal bones from fresh cadavers. RESULTS The transfer function of the ears in which we implanted the new prosthesis was superimposed over the non-manipulated ear. This suggests optimum acoustic-mechanical behaviour. CONCLUSIONS The titanium prosthesis analysed in this study demonstrated optimum acoustic-mechanical behaviour. Together with its ease of implantation and post-surgical stability, these factors make it a prosthesis to be kept in mind in ossicular reconstruction.

How can Apache help to teach and learn automatic control

Searching for examples to encourage and motivate students in a subject is not a trivial task. Future Computer Science and Telecommunications Engineers tend to look at Automatic Control reluctantly. They do not relate their working life to it. But, if we blend examples from two areas: telecommunications and control, maybe we can change their minds. These engineers work with web servers: systems that deal with a lot of requests and must give fast and reliable service to users. CPU and memory usage could improve their performance if automatic control techniques are applied. Apache is one of the most well known web servers and it is at this point where Apache can help us.

Reflejo acústico invertido: análisis de sus características morfológicas en distintas situaciones fisiológicas y patológicas

INTRODUCTION AND OBJECTIVES Inverted acoustic reflex (IAR) or inverted acoustic effect is the name given to the positive deflexion observed during the carrying out of an admittancemetry when the ear is subjected to a high intensity sound, rather than the typical negative deflexion due to the contraction of the middle ear musculature. The objective of the paper is to analyze the morphology of the IAR by relating it to the situations (physiological or pathological) in which this effect appears with the aim of establishing a pathogenic hypothesis. METHODS We study the admittance traces obtained in 50 patients on stimulating the ear with high sound intensities (between 100 and 110 dBs HL) in different situations (ageing, death, otosclerosis, facial palsy, perception hypoacusia and normoacusia). We analyse the morphologies of the resulting traces as well as the on-set and off-set latencies of the reflexes. RESULTS The morphology and latency parameters are similar in all cases in which IAR appears, regardless of the physical conditions of the ear but always with the prior condition of the absence of any contraction of the stapes bone muscle. The inverted acoustic effect does not disappear after deep muscular relaxation induced by anaesthesia and is present in corpses at a time when neural activity can no longer take place. CONCLUSIONS Although some of the characteristics of IAR cannot be explained by purely mechanical hypotheses, the appearance of this effect in a corpse and its non-disappearance with muscular relaxation means that we consider its origin to be a purely mechanical effect not mediated by any muscular reflex contraction in the human middle ear.

[Inverted acoustic reflex: an analysis of its morphological characteristics in different physiological and pathological situations].

Abstract Introduction and objectives Inverted acoustic reflex (IAR) or inverted acoustic effect is the name given to the positive deflexion observed during the carrying out of an admittancemetry when the ear is subjected to a high intensity sound, rather than the typical negative deflexion due to the contraction of the middle ear musculature. The objective of the paper is to analyze the morphology of the IAR by relating it to the situations (physiological or pathological) in which this effect appears with the aim of establishing a pathogenic hypothesis. Methods We study the admittance traces obtained in 50 patients on stimulating the ear with high sound intensities (between 100 and 110 dB HL) in different situations (ageing, death, otosclerosis, facial palsy, perception hypoacusia, and normoacusia). We analyse the morphologies of the resulting traces as well as the onset and offset latencies of the reflexes. Results The morphology and latency parameters are similar in all cases in which IAR appears, regardless of the physical conditions of the ear but always with the prior condition of the absence of any contraction of the stapes bone muscle. The inverted acoustic effect does not disappear after deep muscular relaxation induced by anaesthesia and is present in corpses at a time when neural activity can no longer take place. Conclusions Although some of the characteristics of IAR cannot be explained by purely mechanical hypotheses, the appearance of this effect in a corpse and its non-disappearance with muscular relaxation means that we consider its origin to be a purely mechanical effect not mediated by any muscular reflex contraction in the human middle ear.