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Biomedical subjects

J Gavilán

Publications and source records attributed to J Gavilán.

At least 19 recordsLinked to original sources
PubMed2001

[Post-surgical and post-infectious meningoencephalic herniation in the middle ear].

Meningoencephalic hernia of the middle ear, due to the advent of antibiotics, the surgical microscope, and the new surgical techniques for the treatment of chronic otitis media, is an infrequent pathology in the presents days. The goal of this paper is to present four cases of meningoencephalic hernia of the middle ear, three of then postsurgical and the remaining of inflammatory origin. Diagnosis, treatment and complications are discussed. Meningoencephalic hernia of the middle ear is usually asymptomatic and diagnosis is accidental. Immediate surgical treatment is indicated in order to avoid the potential complications of this disease. Transmastoid approach has been used for three cases and a middle cranial fossa approach was used in the fourth patient.

Adult↗
PubMed2001

[Result of middle fossa vestibular neurectomy in Meniere's disease].

The results and complications of 224 middle fossa vestibular neurectomies (MFVN) performed between 1968 and 1994 are reported. Relief of vertigo, hearing and tinnitus (both pre- and postoperative), facial paralysis, wound infection, suture dehiscence, cerebrospinal fluid (CSF) leak, meningitis, subdural hematoma, average hospitalization time, and death were evaluated. The procedure was effective against vertigo in Ménière's disease in 100% of the cases with unilateral involvement. The excellent results with regard to relief of vertigo and the acceptable incidence of complications make MFVN one of the most adequate surgical treatments for Ménière's disease.

Adolescent↗
PubMed2000

Complications after total laryngectomy in nonradiated laryngeal and hypopharyngeal carcinomas.

To study the complications of total laryngectomy, we evaluated 471 previously untreated patients who underwent total laryngectomy between 1980 and 1997. This series consisted of 358 patients with primary carcinoma of the larynx and 113 with carcinoma of the hypopharynx. Concurrent neck dissection was performed in 85% of patients. Complications were studied in relation to age, T and N stage, previous tracheostomy, neck dissection, margins, reconstruction, tracheoesophageal puncture, and surgeon. Complication treatment and hospitalization were also evaluated. The overall complication rate was 30.7%, with 29.2% major and 6.5% minor complications. The mortality rate was 0.6% (3/471). Pharyngocutaneous fistula was the most frequent wound complication (21%), followed by wound infection (4.2%) and hemorrhage (2.3%). Pneumonia (1.4%) and embolism (0.4%) were the most frequent medical complications. Hypopharyngeal tumors, neck dissection, and extended procedures had a significantly higher rate of complications. Complication causes, prevention, and treatment are discussed.

Adult↗
PubMed2000

Surgery for secondary hyperparathyroidism in patients undergoing dialysis.

Despite recent advances in the diagnosis and therapy of patients with chronic renal failure and secondary hyperparathyroidism (HPT), 5% of these patients may need parathyroidectomy. The purpose of this article is to present our experience with parathyroid surgery in 30 patients with chronic renal failure at "La Paz" University Hospital, analyzing the clinical and biochemical evolution after surgery as well as the recurrence rate. In the first month after surgery, calcium, parathyroid hormone, phosphorus, and alkaline phosphatase levels, as well as bone pain and pruritus, all decreased significantly. Within the first postoperative year, 24 patients remained asymptomatic, and no recurrent secondary HPT was detected. Within the second year after surgery, 15 patients were asymptomatic, and 3 patients showed a recurrence. According to these results, parathyroidectomy is an appropriate surgical procedure for patients with severe overt secondary HPT.

Adult↗
PubMed2000

Patency and flow of the internal jugular vein after functional neck dissection.

OBJECTIVES: To assess the patency and flow of the internal jugular vein after functional neck dissection. STUDY DESIGN: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. METHODS: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. RESULTS: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. CONCLUSIONS: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.

Adult↗
PubMed2000

Postoperative radiotherapy in patients with positive nodes after functional neck dissection.

A study was designed to assess the usefulness of postoperative radiotherapy (RT) in patients with surgically treated laryngeal and hypopharyngeal cancer with histologically proven positive neck nodes. Patients underwent operation between 1984 and 1995, with functional neck dissection (FND) being part of the treatment in all cases. The selection criteria included squamous cell carcinoma, negative margins for the primary tumor, and no previous treatment. For evaluation purposes, patients were divided into 2 groups: surgery alone versus surgery with postoperative RT. Eighty-three patients fulfilled the inclusion criteria and entered the study. All but 1 of the patients were men. The mean age was 58 years (range, 35 to 77 years). A multivariate analysis was used to analyze the prognostic parameters selected by univariate analysis, eg, age, alcohol, tumor location, T and N stages, and presence or absence of extracapsular spread and a desmoplastic pattern. Postoperative RT was not selected by univariate analysis as a prognostic factor, but was included in the multivariate analysis in order to assess its impact on survival and recurrence rates. Using the statistical method of multivariate analysis, we could not find evidence of a benefit to survival or local recurrence rates with postoperative RT in this series. Patients younger than 55 years and those with extracapsular spread had a decreased survival rate and a higher neck recurrence rate, irrespective of the treatment method.

Adult↗
PubMed1999

Seasonal patterns of idiopathic facial paralysis: a 16-year study.

The annual frequency of Bell's palsy in 16 consecutive years was investigated in a 465,000-person health area in Madrid, Spain. The annual incidence of Bell's palsy per 100,000 population was found to be 24.1. The male-to-female ratio was 46:54. Seasonal difference in the incidence was noted in our series with fewer cases during summer. According to these results, the illness in Spain seems to have a similar incidence to that in Western countries. In addition to this, Bell's palsy does not have an infectious epidemiologic pattern in our country, but its frequency decreases in warm weather.

Adolescent↗
PubMed1999

Extracapsular spread and desmoplastic pattern in neck lymph nodes: two prognostic factors of laryngeal cancer.

The influence of extracapsular spread (ECS) and a desmoplastic pattern (DP) of metastatic cervical lymph nodes in patients with laryngeal cancer is presented. The study includes 128 patients surgically treated between 1984 and 1992 for squamous cell carcinoma of the larynx with pathologically proven lymph node metastasis. The results were studied from 2 major standpoints: survival and recurrence. The 3-year survival rates were as follows: patients without ECS 73.4%, and with ECS 28.9% (p < .001); patients without a DP 76.9%, and with a DP 43.3% (p < .03). Also, the 3-year recurrence rates in the neck showed significant differences: patients without ECS 10.7%, and with ECS 49.6% (p < .001); patients without a DP 10%, and with a DP 31.6% (p = .1142). Postoperative radiotherapy did not appear to improve the outcome.

Actuarial Analysis↗
PubMed1999

Psychosocial adjustment after laryngeal cancer surgery.

The objective of the study was to assess the psychosocial adjustment of 111 patients, and 87 partners, after laryngeal cancer surgery. Sixty-nine patients were grouped as having had radical surgery (total or near-total laryngectomy), and 30 as having had functional surgery (horizontal supraglottic laryngectomy or cordectomy). The Psychosocial Adjustment to Illness Scale Self Report questionnaire was used as the primary outcome. No significant differences were found between groups when global adjustment or domain adjustment was compared. Patient and partner responses were almost identical. Work and family relationships were the domains with poorest adjustment for both patients and partners. Information about treatment expectations was negatively rated by functional surgery patients, especially by those who underwent a cordectomy. We conclude that patient perspectives should be considered and consulted to 1) evaluate patient opinion about treatment results, 2) identify patients with special support needs, and 3) inform patients according to other patients' priorities, based on their experience.

Adaptation, Psychological↗
PubMed1999

[Postoperative complications of surgery for malignant tumors of the thyroid gland].

In order to assess the main complications following surgical treatment of thyroid neoplasms, a prospective-historical study was made in 145 patients operated between 1985 and 1997. Permanent hypocalcemia was encountered in 3.3% of our cases, and unilateral nerve injury in 2.2%, with 0.7% of fatal complications. The remain complications evaluated include: serohematoma, postoperative bleeding, and wound infection. To sum up, surgery of the thyroid neoplasms is a relatively safety procedure. The incidence of complications is similar to the surgical treatment of the remainder thyroid diseases.

Adolescent↗
PubMed1998

Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily.

In a prospective, controlled, and randomized study, we compared the outcome of 101 Bell's palsy patients treated with acyclovir (54 patients) or prednisone (47 patients). The acyclovir dosage was 2400 mg (800 mg three times a day) for 10 days, and prednisone was given as a single daily dose of 1 mg/kg of body weight for 10 days and tapered to 0 over the next 6 days. Minimum follow-up was 3 months in all patients. Patients in the prednisone group had better clinical recovery than those treated with acyclovir. Less degree of neural degeneration was observed in the prednisone group compared with acyclovir patients. The incidence of sequelae was the same in both groups. According to these results, in a 10-day treatment cycle acyclovir given 800 mg three times is not as useful as prednisone given 1 mg/kg of body weight once a day in patients with idiopathic facial nerve paralysis.

Acyclovir↗
PubMed1998

Surgical treatment of laryngotracheal stenosis: a review of 60 cases.

Management of laryngotracheal stenosis (LTS) remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Sixty patients with LTS were surgically treated in our institution over a 20-year period. Most patients were adults; the mean age was 29 years. There were 39 males and 21 females. The most frequent cause of stenosis was intubation, in 25 patients, and tracheostomy was the cause in 21. Forty-two patients (70%) were successfully decannulated following 117 procedures in this series. An average of 1.95 procedures per patient was performed. The median time between treatment and decannulation was 561 days. These results confirm the complexity of the management of LTS. Decannulation is not always possible, and to achieve this goal, more than one treatment is frequently required. It is better to prevent LTS rather than to treat it once it has occurred.

Adolescent↗
PubMed1997

[Results of surgery for hyperparathyroidism].

Since 1983, we have performed 110 parathyroidectomies in 109 patients. The hyperparathyroidism was diagnosed as primary in 102 (93.6%) patients, secondary in 6 (5.5%), and tertiary in 1 (0.9%). Sixty-one patients (55.9%) had single adenomas, 2 (1.8%) had double adenomas, 44 (40.3%) had hyperplasia and 1 (0.9%) had parathyroid cancer. Sixty-five adenomas were resected (59.6%). Subtotal parathyroidectomy was performed in 34 cases (31.2%) and total parathyroidectomy with autotransplant in 10 cases (9.2%). In two cases, primary surgery did not solve hypercalcemia; one underwent successful surgery several months later. Twenty-two patients (20.2%) developed transient hypocalcemia. Persistent hypoparathyroidism was detected in 8 patients (7.3%). After exposure of 220 nerves, 2 patients (0.9%) developed permanent unilateral recurrent paralysis. Our results were similar to those of other series.

Adenoma↗
PubMed1996

Supraglottic laryngectomy: functional and oncologic results.

Between January 1980 and December 1989, 110 patients with squamous cell carcinoma of the supraglottis were treated with supraglottic laryngectomy and neck dissection. The stage distribution was stage I 23%, II 34%, III 15%, and IV 28%. Adjuvant radiotherapy (5,000 to 6,500 cGy) was given to all pN+cases. All patients were followed until death or for a minimum of 36 months, with an average of 65 months. Decannulation was achieved in 96% of the cases, with only 1 patient undergoing total laryngectomy because of aspiration. The average hospital stay was 22 days. Arytenoid edema was a frequent cause of delayed decannulation in patients undergoing radiotherapy. The overall 3-year survival was 78%, with 10 patients dying of unrelated causes. Local control was 94.6% and regional control was 83.6%. No significant difference was found in survival according to T stage, but survival rate was significantly influenced by N stage.

Adult↗
PubMed1996

Speech results and complications of near-total laryngectomy.

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.

Cutaneous Fistula↗