Ricardo Yáñez M

Tumor de cuerpo carotídeo

Los tumores de cuerpo carotideo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presentan los casos de dos pacientes derivados por aumento de volumen cervical izquierdo, asintomaticos, con estudio preoperatorio realizado por TAC y angiografia por TAC, respectivamente, que resultan compatibles con tumores de cuerpo carotideo. Se resuelven quirurgicamente, mediante diseccion subadventicial, informando la biopsia paraganglioma. Los tumores fueron completamente removidos, sin evidencia de recurrencia y sin mayores complicaciones.

Gemelos onfalópagos con síndrome de transfusión Gemelo-gemelar. Preparación y técnica para una separación exitosa en Chile

. Se los clasifica en ocho tipos segun el sitio de union (Figura 1 y Tabla 1). Su infrecuencia y la variabilidad entre ellos, determinan que su separacion constituya uno de los mayores desafios medico-quirurgicos, ya que existen pocos casos comparables entre si y ademas escasos profesionales con experiencia acumulada en el tema. Se trata de la primera separacion quirurgica de gemelos siameses onfalopagos con un Sindrome de Transfusion Gemelo-Gemelar (STGG) realizada en nuestro pais.Presentamos la preparacion, estudio y aspectos de la tecnica quirurgica de una separacion quirur-gica electiva de dos hermanos gemelos siameses onfalopagos con un sindrome de transfusion gemelo-

ALTERNATIVAS RECONSTRUCTIVAS POST MAXILECTOMÍA POR ENFERMEDAD NEOPLÁSICA

Reconstructive alternatives post maxillectomy for oncologic disease Background: The reconstruction of midfacial defects is a major challenge. The maxillary bones are the more important of the facial skeleton, provide support between skull base and maxillary arches, separate cavities and are involved in swallowing, phonation, mastication, vision and appearance. The maxillectomy involves varying degrees of functional impairment. The maxillary reconstruction ranges from the use of obturator prosthesis, local flaps to free flaps. Aim: To present the different reconstructive alternatives used after a maxillectomy for oncologic disease in our hospital. Patients and Methods: Retrospective analysis of all patients that was submitted to a maxillectomy for oncologic disease between 2008 and 2011 in our center. Results: The series consisted of 12 patients, 8 women and median age 57 years (range, 25-84). We realized Type IIA maxillectomy in five patients, IIB to two patients, IIIA to four patients and IIIB to one patient. We achieved R0 in all cases. The reconstruction was realized with obturator prosthesis in four patients, three patients with pedicled flaps and five patients were reconstructed with free flaps. All patients obtain an adequate functional status. One patient has partial flap loss. Discussion: Is recommended adjust the surgical choice to the patient prognosis. The obturator prosthesis is a good choice for selected group. The temporal muscle flap presents adequate functional results and is recommended in advanced disease and poor prognosis. The microsurgical reconstruction is the best choice with better functional and aesthetics outcomes in type II, III and IV maxillectomy.

Traqueostomía percutánea en una unidad de cuidados intensivos

Percutaneous tracheostomy in an intensive care unit Background: Prolonged mechanical ventilation (PMV) is a main factor in a long stay at Intensive Care Units (ICU) in our country. The correct and prompt tracheostomy (TQT) indication has shown signifi cant reductions in ICU stay. The classic open technique has been progressively replaced by the percutaneous TQT. Aims: To describe the experience and the results of percutaneous TQT in a tertiary center ICU. Methods: Prospective study of patients in PMV who underwent a percutaneous tracheostomy in ICU at Hospital Dr. Sotero del Rio, since January 2009 to June 2010. We analyse patient characteristics, waiting time, duration of procedure and complications. Results: The series consist of 130 PMV patients, 101 men, median age 51 (17-22) years old, more frequent diagnoses were neurological disease, cerebrovascular disease and infectious disease. The mean waiting time for the procedure was 1 (0-3) day, the operative time was 11 (3-15) minutes, complications rate was 7.6%, and the most frequent was local hemorrhage. Discussion: Percutaneous TQT technique is a feasible and safe procedure in ICU at a Tertiary Hospital, with a short waiting time and a low complication rate.

Dispositivo endoscópico duodeno yeyunal restrictivo en pacientes obesos mórbidos, experiencia inicial en humanos

Initial human experience with a restrictive, duodenal-jejunal by-pass liner for the treatment of morbid obesity Background: The EndoBarrier TM Gastrointestinal Liner creates an endoscopic duodenal-jejunal bypass leading to weight loss in morbidly obese patients. Aim: To evaluate the safety and effi cacy of the EndoBarri- er TM with a 4 mm restrictor in morbidly obese patients. Material and Methods: Ten obese patients aged 18 to 54 years (eight women) with a body mass index (BMI) ranging from 35.8 to 45 kg/m 2 were enrolled. Patients were followed for 12 weeks after the placement of the device, when it was removed. Outcomes measured were percent excess weight loss (%EWL), minor and major adverse events. Results: The mean implant time was 33 ± 4 minutes with a mean fl uoroscopy time of 14.8 ± 3 minutes. There were no major adverse events. Periodic episodes of nausea and vomiting lead to the endoscopic dilation of the restrictor hole with a 6 mm balloon between 2nd and 8th weeks in seven patients (70%). One subject required a second dilation with a 10 mm balloon. The device was endoscopically removed at the 12 th week in all patients. The mean removal time was 47 ± 53.8 minutes (range 10-155 minutes). At week 12, BMI decreased from 40 ± 3.9 to 34.5 ± 3.1 kg/m 2 , and %EWL was 39.8% (range, 21.7% - 65.3%). The mean total weight loss was 16.7 ± 4.4 kg. Conclusions: The EndoBarrier TM Gastrointestinal Liner with the addition of a duodenal restrictor is a safe

Tratamiento quirúrgico en hepatocarcinoma: Experiencia preliminar

Resumen es: Introduccion: El carcinoma hepatocelular (HCC) es el principal tumor hepatico primario y es una importante causa de muerte a nivel mundial y nacional, ya...

Ameloblastoma mandibular maligno con metástasis hepática y pulmonar: Caso clínico

Malignant mandibular ameloblastoma with hepatic and lung metastases: a case report Ameloblastoma is a benign rare tumor, originated in the odontogenic epithelium, is locally invasive and with high tendency to local recurrence, a variety less common is the malignant or metastasizing ameloblastoma, where more frequent sites of deployment are the lung and cervical lymph nodes, being much less frequent sites the liver and skull among others. The surgical treatment is mainly the aggressive surgery of the primary tumor and metastases. We present a case of a patient with malignant mandibular ameloblastoma with metastases in liver and lung, which was subjected to a subtotal mandibulectomy, local radiotherapy and lung and liver metastasectomy in a second time, with late recurrence of the lesion.

Hepatectomía derecha extendida por colangiocarcinoma intrahepático en un paciente con síndrome de Dubin-Johnson*

Hepatectomy for cholangiocarcinoma in one patient with Dubin Johnson syndrome Dubin-Johnson syndrome (SDJ) is a rare benign autosomal recessive congenital disease that causes jaundice. We report a 71 years old male with a Dubin Jonson syndrome diagnosed at the age of 40. On a ultrasound examination and magnetic resonance imaging, a liver tumor was found, that was excised. The pathology report showed a cholangiocarcinoma. During the postoperative period, the patient had a hyperbilirubinemia that subsided slowly. There are reports of hyperbilirubinemia of difficult management after hepatectomy in patients with Dubin-Johnson syndrome.

RECONSTRUCCIÓN PERINEAL INMEDIATA EN EXTENSA RESECCIÓN ABDOMINOPERINEAL RECTAL

Introduccion: El tumor de Buschke-Lowenstein es una lesion cutanea benigna, secundaria a la infeccion por virus papiloma humano, usualmente se presenta como una gran masa exofitica genitoanal y tiene riesgo de evolucionar a carcinoma espinocelular. Dentro de su tratamiento existen varias alternativas, desde menos agresivas como quimio-radioterapia e inmunoterapia, que suelen tener alta tasa de recidiva, hasta la cirugia radical. Caso clinico: Presentamos el caso de un paciente masculino, con una lesion perianal de 15 anos de evolucion, inicialmente se sometio a terapias locales conservadoras y quimiorradioterapia y posteriormente recidivo con transformacion maligna. Habiendose confirmado histologicamente la presencia de carcinoma espinocelular, debio abordarse mediante una reseccion abdominoperineal rectal. Dicha cirugia determino un gran defecto de cobertura perianal y perineal que fue reparado mediante colgajos musculo-cutaneos de gracilis y fasciocutaneos de muslo. Discusion: Si bien se han descrito algunos metodos de reseccion local, solo la cirugia radical permite su eliminacion completa disminuyendo el riesgo de recurrencia. Ello genera un defecto perianal de dificil manejo, para el cual existen varias opciones reconstructivas: injertos, colgajos locales y regionales, y, con menor frecuencia, colgajos libres. Se debe considerar que en aquellos defectos de gran tamano, con gran perdida de tejido, las opciones de reconstruccion del defecto con volumen y cobertura cutanea adecuada son limitadas. Presentamos nuestra experiencia con algunas de estas tecnicas, entre las que destaca el colgajo de musculo gracilis, con los multiples beneficios que posee.

TRATAMIENTO QUIRÚRGICO DE LOS TUMORES DE PARÓTIDA: EXPERIENCIA DE 10 AÑOS

Abstract Surgical treatment of parotid neoplasms: A 10 years experience Background: Parotid neoplasms correspond to 3% of head and neck tumors. Most are benign, treatment is parotidectomy. Aims: To analyze the results of treatment, histology, complications and recurrence. Patients and Methods: Retrospective analysis of patients with parotid tumors treated in our center among 2001-2010. Results: The series consisted of 82 patients, 52 (63%) women. Average age: 46 years (range, 17-77), 73 (89%) had benign tumors, 7 (8.5%) were malignant and 2 (2.4%) had chronic inflammatory disease.The most common benign tumors were pleomorphic adenoma (55%) and Warthin’s tumor (20%). The most common malignant tumors were mucoepidermoid carcinoma (5%) and acinar cell carcinoma (4%).The technique was total parotidectomy in 10 patients (12%), total suprafacial 53 (64.6%) and partial in 19 (23%). The most com-mon complication was transient facial nerve dysfunction in the immediate postoperative period in 38 cases (46.3%), 14 (17%) had surgical bed depression, 15 (18.3%), dysesthesia periauricular, 2 (2.4%) permanent paralysis of the facial nerve (tumor) and 6 (7.3%) Frey Syndrome. No patient had a disagreement with his scar and pain periauricular, there were no recurrences. There was lesser transient facial nerve paralysis with partial suprafacial parotidectomy than with total suprafacial parotidectomy (21% and 53%), RR 0.4 IC 95% (0.16-0.99).