Adenitis cervical con anaerobios sin causa aparente en lactante / Cervical adenitis with anaerobes without apparent cause in infant

Las adenopatías cervicales benignas en lactantes son relativamente frecuentes, se definen como el aumento de volumen ganglionar de más de 1 cm, sin síntomas sistémicos y cuando están presentes, el término correcto es adenitis. Para su estudio, las adenitis se dividen en: locales, sistémicas, unilaterales, bilaterales, agudas, crónicas, y por edad, con diferentes etiologías. Se presenta el caso clínico de un lactante de 11 meses de edad con diagnóstico de adenitis cervical abscedada unilateral aguda, con cuadro de 72 h de evolución, con crecimiento constante a nivel cervical derecho, compromiso del estado general, fiebre y anorexia, por lo que se inician antibióticos de primera línea para los agentes bacterianos más frecuentes (Staphylococcus aureus y Streptococcus pyogenes), con evolución tórpida a las 48 h, por lo que se solicita ultrasonido cervical, ya que la familia no contaba con recursos para solicitar cultivo o tomografía, reportando el ultrasonido ganglio cervical de 3,5 cm de diámetro abscedado, por lo que se agrega cobertura para anaerobios, con respuesta muy favorable a las 24 h. Queda la duda del origen de los anaerobios en la paciente, sin antecedentes de importancia y en grupo etario diferente al afectado por esos gérmenes. Consideramos este caso interesante por su comportamiento atípico, para el enriquecimiento del ejercicio de la otorrinolaringología, recalcando el invaluable apoyo de la clínica y solo con un ultrasonido, ya que no siempre se tendrán todos los recursos disponibles, pero siguiendo las pautas de lo reportado en la literatura, se tuvo una resolución exitosa.

Benign cervical lymphadenopathies in infants are relatively frequent, they are defined as an increase in lymph node volume of more than 1 cm, without systemic symptoms, and when they are present, the correct term is adenitis. For its study, adenitis is divided into: local, systemic, unilateral, bilateral, acute, chronic, and by age, with different etiologies. An 11-month-old infant with a diagnosis of acute unilateral abscessed cervical adenitis, with a 72 h evolution, with constant growth at the right cervical level, fever and anorexia, for which first-line antibiotics were started to the most frequent bacterial agents (Staphylococcus aureus and Streptococcus pyogenes), with torpid evolution at 48 h, for which only cervical ultrasound is requested, since the family did not have the resources to request culture or tomography, reporting the cervical ganglion ultrasound of 3.5 cm of abscessed diameter, so coverage for anaerobes is added, with a very favorable response at 24 hrs. There remains the doubt of the origin of the anaerobes in the patient, without important antecedents and in an age group different from that affected by these germs. We consider this case interesting due to its atypical behavior, for the enrichment of the otolaryngology exercise, emphasizing the invaluable support of the clinic, and only with an ultrasound, since other clinical tools were not available, but following the guidelines of what is reported in literature, there was a successful resolution.

Sensorineural hearing loss and Mondini dysplasia caused by a deletion at locus DFN3.

OBJECTIVE: To study a family with inner ear malformations and sensorineural hearing loss. DESIGN: Clinical, radiological, and genetic study of the members of a family with different degrees of sensorineural hearing loss. RESULTS: The males in the family manifested profound congenital hearing loss with severe inner ear malformations, while the only affected female had progressive hearing loss that had begun during puberty. Computed tomography showed inner ear malformations in both males, with enlarged internal auditory meatus and Mondini dysplasia. Genetic analysis disclosed a microdeletion at the locus DFN3 on chromosome X. CONCLUSION: A familial Mondini dysplasia is associated to a microdeletion at the deafness locus DFN3.

Management of N0 neck in laryngeal carcinoma. Impact on patient's survival.

Management of patients with carcinoma of the larynx should systematically include an appropriate treatment of lymph nodes according to the TNM stage. One of the most controversial points of the treatment in these patients is the management of the clinically negative neck (N(0)). A retrospective study of 295 patients with laryngeal carcinoma and N(0) neck undergoing treatment in our centre between 1983 and 1993 is presented. We observed a significant decrease in the survival of clinically N(0) patients with histologically affected lymph nodes. Lymphadenopathy was more frequently detected in patients with supraglottic tumours (38 per cent) when compared to glottic tumours (16 per cent). In our experience, routine bilateral and unilateral dissection of N(0) necks in all supraglottic tumours and in T3-T4 glottic tumours, respectively, is the most beneficial approach for patients in terms of survival.

[Early cellular immune response in experimental labyrinthitis: immunohistochemical study]. / La respuesta celular inmune precoz en la laberintitis experimental: estudio inmunohistoquímico.

Labyrinthitis ossificans is a recently recognized entity with the extending cochlear implant surgery. Up to date there are not so many studies of the cellular response leading the organization of the inflammatory reaction within the cochlea. Immunemediated labyrinthitis is a valid experimental model that allow the knowledge of the cellular infiltration mechanisms within the cochlea. The inner ear communicates with systemic immunity via the circulation by the passage of cells through the spiral modiolar vein (SMV) and its collecting venules in the scala tympani. Inflammatory reaction within the cochlea lead to the formation of fibrotic tissue and bone (osteoneogenesis) inside it and injuring the neurosensory organs of hearing and balance. To test which cells are proliferating early in an inflammatory response, an animal model of Keyhole limpet haemocyanin (KLH) induced labyrinthitis was utilized, showing a granulomatous lesions not previously reported in this experimental model.

[Perilymphatic gushers: myths and reality]. / El gusher perilinfático: mitos y realidades.

The term perilymphatic gusher refers to the escape of inner ear fluid under pressure through the oval window, generally during surgery for otosclerosis. It also appears during cochlear implantation. We reviewed the morphological aspects of the temporal bone of patients with perilymphatic gusher. The cases of three patients with the features of cerebrospinal fluid leaks under pressure cited in the literature are described. Anatomic and pathologic features are discussed in the light of knowledge of molecular genetics.

[Treatment protocol for sudden deafness]. / Protocolo de tratamiento de la sordera súbita.

There are two types of rapidly progressive sensorineural hearing loss: sudden hearing loss, which is generally unilateral and develops in less than 72 hours, and rapidly progressive sensorineural hearing loss, which develops over days or months. The origin of sudden deafness is difficult to establish. Several etiopathogenic factors have been postulated, such as viral infection, autoimmune origin, vascular and metabolic disease, rupture of the labyrinthine membrane, and, recently, immune-mediated inner ear disease. We made a retrospective study of 40 patients seen in our department. Patients were given a combined treatment with steroids, nimodipine, heparin, and oxygen. Patients were divided into two groups by intravenous or oral treatment.

[Immune-mediated inner ear disease: report of clinical cases]. / Enfermedad inmunomediada del oído interno. Presentación de casos clínicos.

Many clinical and experimental studies have obtained evidence of immune-mediated inner ear disease. Discrepancies between theories of the mechanisms of injury to the inner ear and the laboratory tests that identify it mean that the diagnosis is based on clinical symptoms and a positive response to treatment. We report four cases of immune-mediated inner ear disease characterized by endolymphatic hydrops, fluctuating hearing loss, sudden deafness (first symptom of primary Sjögren's syndrome), and rapidly progressive sensorineural hearing loss.

[Experimental autoimmune labyrinthitis: evaluation of various models in guinea pigs]. / Laberintitis experimental autoinmune: evaluación de diversos modelos en cobayas.

Evidence of hearing loss in humans with systemic autoimmune disease has suggested the possibility of isolated forms of deafness originated by a autoimmune mechanism. Several authors reject McCabe's (1) proposed clinical description based mainly on response to treatment and have attempted to develop an animal model of autoimmune deafness. A comparative analysis was made of several experimental models of sensorineural hearing loss in guinea pigs developed in our laboratory for the study of this problem.

[Synthetic implants in the reconstruction of the ossicular chain]. / Implantes sintéticos en la reconstrucción de la cadena osicular.

Experience has revealed a higher rate of functional failure of biocompatible prostheses used in the surgical reconstruction of the middle ear than was reported initially. The cause of these failures was analyzed in a retrospective study of 135 patients who underwent middle ear reconstructive procedures: 47 of them involved implantation of plastic prostheses. Proplast or Plastipore, and had a sufficient follow-up. We evaluated the prosthetic material and middle-ear conditions for which they were implanted.

[Effectiveness of imaging diagnosis in chronic otitis media]. / Eficacia del diagnóstico por imagen en la otitis media crónica.

The value of imaging methods for the diagnosis of different forms of chronic otitis media is debated, in spite of widespread use. A retrospective study was made of 50 patients who underwent tympanoplasty, with or without mastoidectomy, in our department. Otoscopic, radiological, and computed tomographic findings were analyzed and correlated statistically with surgical findings. Attic perforation was associated significantly with presence of cholesteatoma. Computed tomography was inadequate for differentiating forms of chronic otitis media.

[Tympanomastoid glomus tumor and persistent stapedial artery]. / Tumor glómico timpanomastoideo y persistencia de la arteria estapedial.

A case of tympanic glomic tumor associated with vascular malformation of the perifacial plexus is reported. The case and its possible relation with persistent stapedial artery are discussed. The embryological development of the middle-ear vessels and blood supply to glomic tumors were reviewed.

[Protocol for the endoscopic sinus surgery: comparative analysis of 200 cases]. / Protocolo de cirugía endoscópica nasosinusal: análisis comparativo de 200 casos.

A preliminary analysis was published in 1993 of 100 cases of endoscopic sinus surgery (ESS) carried out in our service following a protocol that included sinusitis, nasal polyps, and other endoscopic nasal procedures. Another 100 cases of ESS were analyzed for the present study and compared with the 1993 group. Comparative analysis showed improved results in the second series, with fewer minor complications and no major complications. These findings confirm the general opinion that endoscopic sinus surgery requires an adequate training period before optimal results are obtained.

[Oncologic surgery of the larynx after failure of radiotherapy]. / Cirugía oncológica de laringe tras fracaso del tratamiento radioterápico.

The treatment of early-stage laryngeal cancer using either partial surgical techniques or irradiation still is controversial. The performance of rescue surgical procedures after irradiation is related to increased postsurgical complications and lower survival rates. We made a retrospective study of 73 patients who underwent rescue surgery after failure of radiotherapy in our department in the last 10 years. A statistical analysis was made of the complications and survival rate of these patients in accordance with tumor location and clinicopathological stage compared with patients who underwent surgery alone (n = 435). More rescue surgery was performed for glottic carcinomas (52/73) than for supraglottic carcinomas (21/73). No significant differences were found in the complication rate (23.6%) compared with the control group (19.6%). There was a significant reduction in survival in patients who underwent previous irradiation of supraglottic tumors compared with glottic tumors and the control group. In view of these results, we conclude that irradiation is not a good option as an initial treatment for supraglottic tumors and that the procedure of choice should be surgical.

[Cervical teratoma in an adult]. / Teratoma cervical en un adulto.

Teratomas are germ-cell tumors that usually originate in the gonads. Extragonadal teratomas are rarely found in the neck, particularly in adults. A case of cervical teratoma that presented as a rapidly growing mass in a young man is described. The diagnostic problems are commented.

[Retrospective study of complications of surgery for laryngeal cancer]. / Estudio retrospectivo de las complicaciones en la cirugía del cáncer de laringe.

Surgery, alone or in combination with other therapeutic measures, is one of the main approaches to curing laryngeal cancer. The risk of complications is implicit in any surgical procedure. We describe our experience with general and local complications in surgery for laryngeal cancer and examine their relation to tumor extension and surgical technique. A review was made of a series of 431 patients who underwent surgery for laryngeal cancer over a 10-year period (1982-1991). Twenty-two patients (5.1%) had systemic complications, including upper gastrointestinal hemorrhage (n = 5), massive cervical hemorrhage (n = 5), and four renal failure. Minor complications were recorded in 77 cases (17.8%), predominantly pharyngocutaneous salivary fistula, which developed in 55 patients (13.8%). The incidence of local complications was significantly greater in patients with extensive local spread (T4). There were no differences among patients with regional spread. The surgical technique and type of pharyngoesophageal reconstruction played no role in the development of complications. Preoperative radiotherapy did not influence on the development of salivary fistulas.

[Use of the Internet in otorhinolaryngology]. / Aplicaciones del internet a la otorrinolaringología.

The Internet is considered by some as one of the most important advances of the late 20th century. The Internet is the functional linking of personal computers via telephone lines to a worldwide network of millions of other computers, which enables them to exchange information freely. Although the Internet crops up in daily conversation, many persons are not aware of its usefulness and relevance for ear, nose and throat specialists. The Internet is accessed by special software that maximizes the potential of this vast computer network. The most important tools are e-mail and the World Wide Web. These tools make it possible to consult multimedia medical publications, access Medline, and carry out information searches, etc. The Internet and its most important uses in otolaryngology are summarized and a list of useful addresses is given. Although its advantages still are not widely appreciated, widespread Internet use is imminent and we think that it is a useful technology to know and use. Moreover, access is becoming easier and cheaper.

[Prevalence of the A1555G mutation in the mitochondrial DNA in patients with cochlear or vestibular damage due to aminoglycoside-induced ototoxicity]. / Prevalencia de la mutación A1555G en el ADN mitocondrial en pacientes con patología auditiva o vestibular debida a la ototoxicidad de los aminoglucósidos.

OBJECTIVE: To determine the frequency of the A1555G mutation in the mitochondrial genome among Spanish patients with aminoglycoside-induced ototoxicity. PATIENTS AND METHODS: We screened 25 unrelated cases, totalling 39 individuals with cochlear or vestibular damage due to aminoglycoside-induced ototoxicity. This group was made up of 18 subjects from 4 unrelated families with a history of aminoglycoside ototoxicity in more than one relative, 8 subjects from 8 families that also had other relatives with hearing loss in absence of aminoglycoside exposure, and 13 sporadic cases. Among the 13 sporadic cases, there were 3 patients with vestibular involvement. Detection of the A1555G mutation was seen by mean of techniques for molecular diagnosis. RESULTS: The A1555G mutation was identified in all of the individuals from 4 families with aminoglycoside-induced cochlear damage and in 6 of 8 individuals with familial hearing loss. None of the sporadic cases carried the mutation. CONCLUSIONS: A high proportion of patients with cochlear damage due to aminoglycoside ototoxicity and having a familial history of hearing loss, related or not to aminoglycoside exposure, harbor the A1555G mutation.

[Inflammatory pseudotumor of the larynx]. / Pseudotumor inflamatorio de laringe.

Inflammatory pseudotumors are rare and usually located in lung, although they can develop in any organ. They are unusual in head and neck and very rare in the larynx. A case of laryngeal pseudotumor in a patient with odinophagia and neck pain is reported. After diagnosis, the patient was treated with steroids, which produced complete resolution. These lesions can simulate malignant neoplasms and must be considered in the differential diagnosis.

[Study of spontaneous cytotoxic activity in laryngeal carcinoma: prognostic value]. / Estudio de la actividad citotóxica espontánea en el carcinoma de laringe: valor pronóstico.

The status of natural killer (NK) cell activity in peripheral blood, based on number and functional state, was studied in relation to the clinical and histopathologic stage of 52 patients with laryngeal carcinoma and in 23 healthy controls. The number of NK cells, estimated using CD16 and CD56 monoclonal antibodies, was similar in patients and controls and showed no relation to tumor size and nodal involvement. NK cell function did not show significant differences in spontaneous cytotoxic activity either overall or in relation to tumor size and the presence of palpable lymph nodes. However, cytotoxic activity was significantly lower in patients who had histologically confirmed nodal involvement. NK activity under 36% (the percentage of specific lysis at an effector:target dilution of 50:1) was suggested the probable presence of nodal metastases and was a highly sensitive and specific test. In patients with laryngeal carcinoma, NK-cell cytotoxic activity may be an independent prognostic parameter for evaluating cervical lymph node involvement.