Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis.

OBJECTIVES: To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN: A cross-sectional study with a two-step cluster analysis. SETTINGS: A tertiary referral multicenter study. PARTICIPANTS: Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES: best predictors to define clinical subgroups with potential different aetiologies. RESULTS: We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS: Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.

Diabetes insipida central asociada a sindrome de silla turca vacia / Central diabetes insipidus associated with empty sella syndrome

Una mujer de cuarenta años se presenta por tener cuadro clínico de aproximadamente 14 años de evolución de polidipsia y poliuria de inicio repentino y precedido por cefaleas frecuentes e intensas. Sin antecedentes de enfermedades psiquiátricas ni de diabetes mellitus. Tuvo galactorrea durante cuatro arios después de su último parto asociado a oligomenorrea y cefaleas intensas. La galactorrea desapareció espontáneamente y después de esto inició con la poliuria y la polidipsia marcadas; se le practicó histerectomía al parecer por miomas uterinos. El citoquímico de orina mostraba una densidad de 1,002; la diuresis promedio diario era de 12 litros (incluyendo la nocturna). La RNM de silla turca mostró un aracnoidocele (Silla Turca Vacía); la hormona del crecimiento estaba en el límite inferior. La prueba de deshidratación documentó diuresis abundante con densidades urinarias bajas e hiperosmolaridad sérica marcada; la aplicación de vasopresina confirmó el diagnóstico de diabetes insípida central.

[Cartilaginous tumors of the larynx. A report of 3 cases]. / Tumores cartilaginosos de la laringe. A propósito de tres casos.

Cartilaginous tumours of the larynx are very seldom encountered. Worldwide literature report until now no more than 250 cases. The greatest number of cases (72%) are benign and localized on cricoid cartilage. They are characterized by its slow pace spread and chondrosarcomata shows scant tendency to metastasize, prevailing, instead, local increase. Best treatment resulted the conservative surgery. We report 3 cases (1 chondroma and 2 low ranked chondrosarcomata) diagnosed and treated in our Hospital in the last 15 years. Clinical and anatomopathologic features are exposed and the management as well, and also the postoperative course of each patient.

[Thyroplasty in the treatment of functional or paralytic dysphonias]. / Tiroplastia en el tratamiento de algunas disfonías funcionales o paralíticas.

In phonosurgery, the laryngeal framework surgery, with several types of thyroplasty, allow a modification of the vocal function through an indirect action over the thyroid cartilage, without surgical invasion of the vocal fold tissues. We describe our experience and review the literature in this field.