RESUMO
OBJECTIVE: This study aimed to investigate the limitations, barriers, and complications in the early transition from the microscopic transsphenoidal approach (MTA) to the endonasal endoscopic approach (EEA) to the skull base in our institution. METHODS: Technical challenges, as well as clinical features and complications, were compared between MTA, EEA, and mixed cases during the early surgical curve. RESULTS: The period from the early learning curve was 1 year until the EEA protocol was used routinely. A total of 34 patients registered a resection using a transsphenoidal approach. Eighteen patients underwent EEA, 11 underwent MTA, and five underwent a mixed endonasal and microscopic approach. Non-significant differences were found in endocrine outcomes between the three groups. Patients with unchanged or improved visual function were higher in the EEA group (p = 0.147). Non-significant differences were found in terms of the extent of resection (EOR) between groups (p = 0.369). Only 1 (2.9%) patient in the whole series developed a post-operative CSF leaking that resolved with medical management, belonging to the EEA group (5.5%). CONCLUSIONS: The early phase of the learning curve did not affect our series significantly in terms of the EOR, endocrine status, and visual outcomes.
OBJETIVO: Investigar las limitaciones, las barreras y las complicaciones en la transición del abordaje transesfenoidal microscópico (ATM) al abordaje endonasal endoscópico (AEE) para la base del cráneo en nuestra institución. MÉTODO: Se compararon las características clínicas y las complicaciones entre ATM, AEE y casos mixtos durante la curva quirúrgica temprana. RESULTADOS: El periodo desde la curva de aprendizaje inicial fue de 1 año hasta que se utilizó el protocolo AEE de forma sistemática. Un total de 34 pacientes tuvieron una resección por vía transesfenoidal. A 18 pacientes se les realizó AEE, a 11 ATM y a 5 abordaje mixto endonasal y microscópico. Se encontraron diferencias no significativas en los resultados endocrinos entre los tres grupos. Los pacientes con función visual sin cambios o mejorada fueron más en el grupo AEE (p = 0.147). No se encontraron diferencias significativas respecto a la extensión de la resección (p = 0.369). Solo 1 (2.9%) paciente desarrolló una fístula de líquido cefalorraquídeo que se resolvió con manejo médico, perteneciente al grupo AEE (5.5%). CONCLUSIONES: La fase inicial de la curva de aprendizaje no afectó significativamente a nuestra serie en términos de extensión de la resección, estado endocrino y resultados visuales.
Assuntos
Curva de Aprendizado , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Neoplasias Hipofisárias/cirurgia , Idoso , Estudos Retrospectivos , Microcirurgia/métodos , Sela Túrcica/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Cavidade Nasal/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Endoscopia/métodosRESUMO
The title compound, C11H18O4, consists of an anti,anti,anti-stereo-tetrad with a 1,2-carbonate and an alkene motif. The mol-ecule displays a common zigzag conformation. The five-membered ring has a twisted conformation on the C-C bond. In the crystal, a strong inter-molecular hydrogen bond between the hy-droxy group and the carboxyl-ate moiety from an adjacent mol-ecule forms chains propagating along the b-axis direction. The absolute structure of the mol-ecule in the crystal was determined by resonant scattering [Flack parameter = 0.05â (6)].
RESUMO
The title compound, C20H42O3S2Si, crystallized with two independent mol-ecules (A and B) in the asymmetric unit. They consist of syn,anti,anti-stereo-tetrads with a 1,3-di-thiane motif and a primary alcohol protected as the triisopropyl silyl ether. The 1,3-di-thiane ring adopts a chair conformation, while the rest of each mol-ecule displays a common zigzag conformation. There is an intra-molecular O-Hâ¯O hydrogen bond in each mol-ecule. In the crystal, the A and B mol-ecules are linked via O-Hâ¯O hydrogen bonds, forming -A-B-A--B-- chains along [010]. The absolute structure was determined by resonant scattering (anomalous scattering) [Flack parameter = 0.035â (8)].
RESUMO
El Implante de Tallo Cerebral, es un dispositivo protésico diseñado inicialmente para restaurar la función auditiva, en pacientes sordos como consecuencia de neurofibromatosis tipo II. El Implante de Tallo Cerebral (ABI) es el más utilizado y está diseñado para estimular directamente los núcleos cocleares del tallo cerebral, haciendo un bypass de la cóclea y el nervio auditivo, representando una alternativa potencial en pacientes con aplasia del nervio coclear, osificación coclear severa y malformaciones del oído interno, que no permitan la colocación de un implante coclear convencional. Con este artículo se pretende hacer una introducción de nuevas indicaciones, técnicas y resultados de este dispositivo.
Brain stem implant is a prosthetic device that was initially designed to restore the auditory function in patients that had become deaf as a consequence of a neurofibromatosis type II. Brain Stem Implant (ABI) is the most use done and has been designed to directly stimulate the cochlear nucleus of the brain stem. This is done by making a bypass of the cochlea and the auditory nerve, which in turn represents a potential alternative in patients that suffer from aplasia of the cochlear nerve, a severe cochlear ossification and malformations of the inner ear, which do not allow for the insertion of a conventional cochlear implant. This article is intended to make an introduction to new indications, techniques and results of this device.
Assuntos
Humanos , Núcleo Coclear , Orelha InternaRESUMO
El implante coclear se ha convertido en la primera alternativa de rehabilitación auditiva en pacientes con hipoacusia neurosensorial severa a profunda bilateral. Sin embargo hay algunas situaciones especiales en las que la colocación del implante implica diferencias respecto a la cirugía rutinaria. Hay dos grupos importantes a este respecto: Las malformaciones congénitas de las estructuras del hueso temporal y la obliteración coclear, sobre los que hablaremos en los siguientes apartados. Una alteración, que se recomienda buscar en todo candidato a implante coclear es la estenosis del CAI. En presencia de una función facial normal, un CAI estrecho implica una agenesia de nervio coclear, usualmente asociado con aplasia coclear, que son contraindicaciones para un implante coclear e indicaciones para implante de tallo cerebral. De otro lado hay situaciones, como la cavidad común o la osificación total de la cóclea en las que el implante de tallo cerebral puede ser considerado como la alternativa inicial de manejo.
Cochlear implant has become the first alternative for auditory rehabilitation in patients that suffer from bilateral neural- sensorial hypoacusis from severe to deep. However, there are some special cases in which putting an implant does mean some differences in relation to the routine surgery. To these sense, there are two important groups: Congenital malformations of the structures of the temporal bone and cochlear occlusion. The following paragraphs will discuss these topics. It is wise to look for CAI stenosis, a type of alteration that may be present in every candidate to receive a cochlear implant. When we find a normal facial function, a narrow CAI means a defective development of the cochlear nerve, which is usually associated to cochlear aplasia which in term is a contraindication for a cochlear implant and the indication for a brain stem implant. On the other hand there are some situations such as the common cavity or the full ossification of the cochlea in which implanting the brain stem may be considered as the first alternative to handle the case.
Assuntos
Humanos , Cóclea , Implantes CoclearesRESUMO
La extrusión del implante coclear es una complicación mayor poco frecuente cuyas principales causas son una inadecuada técnica quirúrgica, una reacción de hipersensibilidad a los componentes del implante o el desarrollo de un proceso infeccioso ya sea agudo o crónico como en el caso de la formación de biofilms. La infección se puede presentar bajo dos formas: la primera como una infección por gérmenes asilados y la segunda que es la más severa conocida como biofilm, es decir una colonización de bacterias organizadas que les permite multiplicarse rápidamente y establecer un mecanismo de resistencia a los antibióticos que hace muy difícil su erradicación, llevando a extrusión y muy posiblemente a explantación si no se recurre a un tratamiento médico temprano. Reacciones de hipersensibilidad a alguno de los componentes del implante especialmente a la silicona debe ser sospechada en aquellos pacientes que presenten cambios inflamatorios a repetición en la piel sobre el implante sobre todo si los pacientes no presentan signos de infección sistémica y presentan cultivos negativos.
Cochlear implant extrusion is a not so frequent major complication whose main causes are an inadequate surgical technique, a hyper sensitivity reaction to the implant components or the presence of an infectious process be it acute or chronic as is the case of biofilm formation. The infection may appear in two forms: first as an infection that comes from isolated germs and the second which is the most severe one, known as biofilm, that is the colonization of organized bacteria which allows them to grow very rapidly and set a mechanism to resist antibiotics which makes it extremely hard to eradicate them, which leads to the extrusion and very likely to the removal in case the patient does not receive medical treatment soon. Hypersensitivity reactions to any of the implant components especially to silicone must be suspected in those patients that exhibit inflammatory changes repeatedly on their skin that is over the implant especially if the patients do not show the symptoms of a systematic infection and have negative cultures.
Assuntos
Humanos , Biofilmes , Implantes Cocleares , Infecções , HipersensibilidadeRESUMO
A concise nonaldol approach for the stereoselective construction of all-anti polypropionate fragments was developed. The iterative epoxide-based methodology consists of the syn-selective epoxidation of cis homoallylic alcohols with use of the VO(acac)(2)-catalyzed conditions followed by epoxide cleavage with a propynyl aluminum reagent as key steps. The methodology was applied to the synthesis of the all-anti C6-C10 fragment of streptovaricin U.
Assuntos
Macrolídeos/síntese química , Propionatos/química , Propionatos/síntese química , Catálise , Compostos de Epóxi/química , EstereoisomerismoRESUMO
OBJECTIVES: To implement a minimal invasive approach in cochlear implant surgery for children and adults. In order to decrease surgical complications and morbidity with the surgery. SUBJECTS AND METHODS: During a 1-year period, 12 consecutive patients (5 female and 7 male; age range, 1.5 to 78 years; mean age, 14.5 years), who had cochlear implantation (1 Nucleus and 11 Clarion) through a new surgical approach, were prospectively evaluated. RESULTS: The surgical approach was accomplished in all the patients with no major complications. The mean surgical time was 3.2 hours and the mean time between surgery and process of programming was 2.7 weeks. CONCLUSION: The surgical trauma and postoperatory edema was decreased and allowed programming of the implant in a shorter period of time.