J.I. De Diego

Factors Related to Nerve Injury and Hypocalcemia in Thyroid Gland Surgery

To identify potential risk factors related to complications after thyroidectomy, a study was designed that included 675 patients. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated. The rate of paralysis of the RLN was calculated on nerves at risk for hypocalcemia (n = 890) in patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Multivariate analysis was used to identify the relationships between the variables included in the study. All statistical tests received the same level of significance of 0.05. Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral paralysis of the RLN developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis had a significant relationship with preoperative diagnosis of malignancy (P < 0.03). Likewise, hypocalcemia was related to sex and surgical procedure (P < 0.03). Serohematoma was linked with age (P < 0.001), and hemorrhage was associated with previous radiation of the neck (P < 0.03). (Otolaryngol Head Neck Surg 2001; 124:111-4.)

Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy

OBJECTIVES To assess the incidence of unexpected postoperative bleeding in children undergoing adenoidectomy and/or tonsillectomy (T&A), and to investigate its possible undetected haematological causes. METHODS We prospectively collected all patients under 14 years of age with a normal preoperative haematologic work-up (activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count), who underwent surgery of adenoids and/or tonsils at our institution between January 1997 and November 2000. RESULTS There were 1516 cases that accomplished the inclusion criteria in the period of survey. Thirteen patients bled after surgery. This represents an incidence of 0.8% of immediate postoperative haemorrhage among the 1516 procedures analyzed. No statistical differences were found between bleeding and non-bleeding patients according to age, sex, and type of procedure (P>0.05). In 6 of the 13 bleeding patients (46.1%) an alteration of the coagulation system was subsequently found: 5 von Willebrands disease, and 1 releasing thrombopathy. CONCLUSIONS The incidence of bleeding after adeno and/or tonsillectomy at our institution is comparable with series previously reported in the current medical literature. In nearly one half of the cases, undetected coagulation diseases (mainly von Willebrands disease) are diagnosed after surgery in the haematological study.

Comparison of amoxicillin and azithromycin in the prevention of recurrent acute otitis media

OBJECTIVE To compare the outcome of patients with recurrent acute otitis media (AOM) treated either with amoxicillin or with azithromycin. METHODS This prospective, controlled, and randomized study, compares the outcome of 71 patients with recurrent AOM treated with azithromycin (31 patients) or amoxicillin (40 patients) for the prevention of AOM. azithromycin was given at a dose of 10 mg/kg once a week, whereas amoxicillin was administered daily as a single intake of one third of the therapeutic dosage (20 mg/kg per day). All treatments were prescribed for 3 months. Both groups were homogeneous with regard to the currently accepted predisposing factors of recurrent AOM. Mean age of children was 35.3 months, and average follow-up was 11.5 months. The treatment was considered effective when the number of episodes of AOM dropped to less than 50% after the prophylaxis. RESULTS Patients in the azithromycin group had a clinical response to prophylaxis (80.6%) comparable to those treated with amoxicillin (89.5%) (P=0.300). The incidence of adverse effects was similar in both groups. CONCLUSION According to these results, a prophylaxis with azithromycin is as useful as amoxicillin to prevent recurrent AOM.

Post-transplant lymphoproliferative disease in tonsils of children with liver transplantation

OBJECTIVE To assess the incidence and characteristics of post-transplant lymphoproliferative disease (PTLD) in tonsils of the liver transplanted children. METHODS All patients under 14 years of age recipients of a liver transplant at the institution and operated on for tonsillectomy under suspicion of malignancy were included in this study. RESULTS Seven patients underwent surgery on their tonsils under suspicion of PTLD. One case of B-cell lymphoma, and three cases of polymorphic diffuse B-cell hyperplasia were found. This represents an incidence of 1.4% of PTLD in the tonsils of the 283 pediatric liver transplants performed at the hospital. CONCLUSION The incidence of PTLD in tonsils after liver transplantation is very low at the institution. However, it is very important to follow-up allograft recipients for early diagnosis of this entity.

Von Willebrand disease as cause of unanticipated bleeding following adeno–tonsillectomy

Von Willebrand disease (vWD) is a frequent autosomal bleeding disorder. We report two unsuspected patients over 6 years of age with this disease operated by tonsillectomy and adenoidectomy (T&A) at our Department. Preoperative hematologic work-up (with activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count) was normal. Both patients had undergone previous adenoidectomy without complications. In both cases, profuse bleeding was noted in the immediate postoperative period. The therapeutic measures in these situations are discussed and a review of the current literature concerning preoperative hematologic evaluation of T&A is included.

Alteraciones vestibulares y del sistema oculomotor en sujetos tratados con cisplatino.

Resumen El cisplatino es un agente quimioterapico muy empleado en el tratamiento de diversos procesos oncologicos. Presentamos los hallazgos electro-oculograficos (EOG) de 6 pacientes vistos en nuestro Servicio con el diagnostico de intoxicacion cronica por cisplatino y afectacion vestibular asociada. La media de edad fue de 45 anos, siendo 3 del sexo femenino (50%). La alteracion mas frecuente fue el seguimiento ocular lento de tipo ataxico, en el 100% de los casos. Ademas, se encontro nistagmo espontaneo, alteraciones en los test posicionales y supresion del reflejo vestibulo-ocular. Estos resultados son discutidos, presentandose una revision de la literatura sobre el tema.

Spontaneous resolution of recurrent tonsillitis in pediatric patients on the surgical waiting list

OBJECTIVE To assess the impact of the waiting list on the spontaneous resolution of recurrent acute tonsillitis in children. METHODS We have evaluated 623 cases placed on the waiting list for elective tonsillectomy (with or without adenoidectomy) between February 1994 and May 1999 at our institution. In each child, age, time on the waiting list, type of procedure and outcome were registered. There were two possible outcomes after the preoperative evaluation: tonsillectomy was still indicated or tonsillectomy was not necessary. RESULTS Mean length of time on the waiting list was 10.8 months (range: 3.0-35.6 months; median: 8.2 months). In 507 of the 623 children (81.4%), the operation was still indicated. However, 116 patients (18.6%) did not need surgery because of spontaneous resolution of the clinical picture. No relation was found between outcome and age, time on the waiting list or type of procedure (P>0.05). CONCLUSION There was no clinical evidence for claiming that resolution of recurrent acute tonsillitis in children is spontaneous with time.

Long-term results of open cordectomy for the treatment of T1a glottic laryngeal carcinoma.

OBJECTIVE To assess the long-term results and prognostic factors in patients who have undergone open cordectomy (OC) for the treatment of T(1a) glottic laryngeal carcinoma. METHODS One hundred four epidermoid cancer patients operated from January 1989 through December 1999 were included in the study. Clinical parameters, postoperative complications, and postoperative stay were retrospectively evaluated in all cases. RESULTS Mean survival for the patients included in the study was 61.5+/-24.8 months after the date of operation (range: 11-121 months). Ninety-four patients did not have recurrent tumor (90.4%). Local, regional and distant recurrence were linked with a statistical negative impact on survival rates (p<0.05). Only sero-hematoma was significantly related to local recurrence (p<0.05), whereas the remainder complications did not. None of the complications was associated with neck recurrence or distant metastasis (p>0.05). CONCLUSIONS Open cordectomy is nowadays a valid technique for the surgical treatment of T(1a) glottic laryngeal carcinoma. Its results are comparable with those of other more recent techniques.

Resultados de la neurotomía por fosa media en la enfermedad de Ménière.

Resumen Se presentan los resultados y complicaciones de 224 neurotomias vestibulares por via transtemporal (NVT) realizadas entre los anos 1968 y 1994. Para ello se evaluaron los siguientes parametros: alivio sintomatico del vertigo, audicion y acufeno pre y postoperatorios, paralisis facial, infeccion de la herida, dehiscencia de sutura, fistula de liquido cefalo-raquideo, meningitis, hematoma subdural, estancia postoperatoria y muerte.La tecnica fue efectiva para la resolucion sintomatica del vertigo de Meniere en el 100% de los casos con afectacion unilateral de la enfermedad. Estos buenos resultados, junto con una aceptable incidencia de complicaciones, hacen de la NVT uno de los tratamientos quirurgicos mas adecuados para la enfermedad de Meniere.

Reproducibility of ultrasonographic measures in internal jugular veins of normal subjects

OBJECTIVE To assess the reproducibility of ultrasonographic quantitative parameters of internal jugular veins (IJV) in normal subjects. MATERIAL AND METHODS Thirty IJV of 15 normal volunteers were prospectively evaluated by means of duplex Doppler ultrasonography (US). Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Two measures were performed in each subject. RESULTS High reproducibility was encountered in jugular flow (R=0.95) and in area during Valsalva (R=0.90) in the left IJV. Low reproducibility was found in Valsalva flow speed of the left side (R=0.35). The remaining measurements had a good reproducibility (R=0.50-0.75). CONCLUSIONS The ultrasonographic parameters of IJV in normal subjects show an adequate grade of reproducibility. Thus, duplex Doppler US can be used as a reliable method for evaluation or comparison of IJV in different situations of future studies.