Recurrent Pediatric Extranasopharyngeal Angiofibroma of the Epiglottis: Case Report.

Angiofibroma is a non-encapsulated, highly vascular tumor that usually originates in the nasopharynx. Laryngeal cases of extranasopharyngeal angiofibroma (ENA) are a very rare pathology, especially in children. Only eight ENA laryngeal cases have been described in the literature, and only one of them is a pediatric case. In this report we present an 11-year-old child with epiglottic ENA resected with transoral endoscopic ultrasonic surgery (TOUSS) with review of the literature. Because of reccurrence after five months he underwent re-excision with CO2 laser. Recurrences in ENA are infrequent, but as demonstrated in our case, close endoscopic follow-up is mandatory in this location. Endoscopic hemostatic procedures like TOUSS and CO2 laser ensure bloodless surgery for the management of this type of vascular laryngeal tumors.

Efficacy of intratympanic corticosteroid as a salvage treatment in idiopathic sudden sensorineural hearing loss. / Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática.

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. MATERIAL AND METHOD: An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. RESULTS: The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13dB and 66.11dB in the treatment group (P<.01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13dB in the control group, a significant difference (P<.0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. CONCLUSION: Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases.

The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting. / El perfil de disregulación del SDQ y su relación con conductas y pensamientos de suicidio en adolescentes evaluados en contexto clínico.

INTRODUCTION: Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, "affective storms", mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. METHODS: Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. RESULTS: Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. CONCLUSIONS: Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors.

The Strengths and Difficulties Questionnaire -Dysregulation Profile, Non-Suicidal Self-Injury Behaviors and the Mediating Role of Stressful Life Events.

Non-suicidal self-injury (NSSI) behaviors are self-injurious behaviors inflicted without intending death. Literature has shown the relationship between stressful life events (SLE) and NSSI behaviors. The Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) is defined as an index of self-regulatory problems, related to higher risk for suicidal ideation and attempts in adolescents. In this study the relationship between SDQ-DP and NSSI behaviors, mediated by SLE in a clinical sample of children and adolescents is analyzed. A cross-sectional study was conducted on 239 subjects (aged from 11 to 17) to test the mediation model. SDQ-DP significantly correlates with NSSI behaviors (Wald = 6.5477, p = .0105); SDQ-DP significantly correlates with SLE (T = 5.7229, p < .001); SLE significantly correlates NSSI behaviors, and the relation remains significant whilst controlling for SDQ-DP (Wald = 4.1715, p = .041); the relation between SDQ-DP and NSSI behaviors stops being significant whilst controlling for the potential mediator (SLE) (Wald = 2.9951, p = .0835). Study of indirect effect supports the mediation model (.0585 CI [.0016, .1266]). Findings are compatible with the complete mediation scenario. These results point out the importance of self-regulatory problems in coping strategies with regards to SLE and the development of NSSI behaviors.

The role of partial parotidectomy for benign parotid tumors: A case-control study.

OBJECTIVE: To evaluate the results and complications after partial parotidectomy vs superficial parotidectomy, as primary treatment of benign parotid tumors. STUDY DESIGN: Case-control study. SETTING: University hospital. SUBJECTS AND METHODS: A case-control study is presented on parotidectomy, comparing a group of 25 patients treated by partial parotidectomy vs a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow-up of 4 years. Independent variables included sex, age, medical history, intra-operative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine-needle aspiration cytology, computed tomography findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. RESULTS: Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Temporal facial paresis was found in 4% of partial surgeries, vs 12% of superficial parotidectomies, a significant difference. Three months after surgery, only one patient has a persistent marginal nerve paresis. In contrast, sialocele was more common after partial parotidectomy (28% vs 16%), a significant difference. CONCLUSIONS: Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.

Clinical Correlates of Non-Suicidal Self-Injury (NSSI) in an Outpatient Sample of Adolescents.

Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior.

Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting.

BACKGROUND: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. SAMPLING AND METHODS: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. RESULTS: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. CONCLUSIONS: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

Wildervanck's syndrome with severe inner ear dysplasia and agenesis of the right internal carotid artery.

We describe a case with Wildervanck syndrome (cervico-oculo-acoustic syndrome) comprising Klippel-Feil anomaly, retractio bulbi (Duane syndrome), and congenital sensorineural deafness. An 18-month male baby had a severe inner ear dysplasia, and MRI also showed a complex vascular carotid malformation associated.

Surgical complications of submandibular gland excision.

INTRODUCTION AND OBJECTIVES: Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. MATERIAL & METHODS: Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. RESULTS: A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. CONCLUSION: Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience.

[Surgical management of salivary gland tumours]. / Tratamiento quirúrgico de los tumores de glándulas salivales.

INTRODUCTION AND OBJECTIVES: Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. MATERIAL AND METHODS: This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up. RESULTS: Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%). CONCLUSIONS: Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.

[Nasosinusal endoscopic surgery as major out-patient surgery]. / Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria.

INTRODUCTION: Functional endoscopic sinus surgery (FESS) is a useful and widespread technique that allows the treatment of a large number of nasal pathologies. Nevertheless, although many ENT operations are carried out on an out-patient basis, FESS procedures commonly require at least 1 day of hospital admission in many centres. OBJECTIVES: To evaluate our experience in FESS as day-case, to study causes of unexpected overnight admission, and to identify any risk factors for failing to comply with early discharge. MATERIAL AND METHOD: We studied 145 patients consecutively subjected to out-patient FESS procedures for chronic rhinosinusitis, antrochoanal polyps, and dacryocystorhinostomy from August 2004 to June 2007. We analyzed sex, age, medical history (arterial hypertension, asthma, Widal syndrome), pathology, associated septoplasty, extent of the surgery, and revision surgery. RESULTS: The re-admission rate was 13.1% with the following as the most frequent causes: bleeding (31.6%), requiring only observation in over half the cases (ie, without changing the nasal packing), and dizziness/weakness (36.8%). Only revision surgery was associated with an increase in the re-admission rate (odds ratio, 3.5; 95% CI, 1.2-10.1). CONCLUSIONS: Our experience in FESS for out-patient surgery shows a readmission rate of 13.1 %, although most cases were related to minor complications. The revision surgery was the only variable that could be associated with an increase in re-admission rate.

Vocal pathologies of difficult diagnosis.

The objective of this study was to review four vocal pathologies difficult to diagnose (vocal sulci, submucosal cysts, pseudocysts, and mucosal bridges) seen in the Principe de Asturias University Hospital Voice Unit (Alcalá de Henares, Madrid, Spain) over a 9-year period. This study was to show the prevalence of these pathologies out of the total number of benign vocal pathologies, basing our findings on clinical and stroboscopic criteria; and to analyze the stroboscopic-surgical correlation of the series over the last 3 1/2 years. This study was a retrospective review of the stroboscopies carried out between 1993 and 2002, of the suspected diagnoses offered by three ENT specialists. The data were based on the video archives of the unit and surgical notes. We reviewed 4206 stroboscopies, 189 (4.5%) corresponded to new cases. Within this group, we found the following distribution: 48% of vocal sulci, 42% of submucosal cysts, 10% of pseudocysts, and 0% of mucosal bridges. Seventy-nine percent showed unilateral pathology. The sulci showed the highest percentage of bilaterality (33%). The stroboscopic-surgical correlation (1999-2002) was positive in 69% of the sulci, 78% of the cysts, and 100% of the pseudocysts. In our series, 4.5% of the stroboscopies were performed on these groups of difficult diagnosis. For these pathologies, the stroboscopy is the exploratory method that offers more information and that allows us to obtain an optimal correlation between diagnostic suspicion and surgical evidence.