Randomized, double-blind study comparing percutaneous electrolysis and dry needling for the management of temporomandibular myofascial pain.

BACKGROUND: To assess whether the techniques of percutaneous needle electrolysis (PNE) and deep dry needling (DDN) used on trigger points (TrP) of lateral pterygoid muscle (LPM) can significantly reduce pain and improve function in patients with myofascial pain syndrome (MPS) compared to a control group treated with a sham needling procedure (SNP). MATERIAL AND METHODS: Sixty patients diagnosed with MPS in the LPM were selected and randomly assigned to one of three groups. The PNE group received electrolysis to the LPM via transcutaneous puncture. The DDN group received a deep puncture to the TrP without the introduction of any substance. In the SNP group, pressure was applied to the skin without penetration. Procedures were performed once per week for 3 consecutive weeks. Clinical evaluation was performed before treatment, and on days 28, 42 and 70 after treatment. RESULTS: Statistically significant differences (p <0.01) were measured for the PNE and DDN groups with respect to pain reduction at rest, during chewing, and for maximum interincisal opening (MIO). Values for the PNE group showed significantly earlier improvement. Differences for PNE and DDN groups with respect to SNP group were significant (p <0.05) up to day 70. Evaluation of efficacy as reported by the patient and observer was better for PNE and DDN groups. No adverse events were observed for either of the techniques. CONCLUSIONS: PNE and DDN of the LPM showed greater pain reduction efficacy and improved MIO compared to SNP. Improvement was noted earlier in the PNE group than in the DDN group.

Carcinoma nasofaríngeo: conducta del médico internista ante un caso de adenopatía cervical con sospecha de malignidad / Nasopharyngeal carcinoma: behavior of internist facing a case of cervical lymphadenopathy with suspected malignancy

Resumen El carcinoma nasofaríngeo es un tumor de células escamosas que comúnmente aparece alrededor del ostium de la trompa de Eustaquio en la pared lateral de la nasofaringe. En términos generales, es una causa rara de cáncer en el mundo, aunque llega a ser muy frecuente en países del sureste de Asia y en Alaska. En México, el carcinoma nasofaríngeo no figura entre las 20 principales causas de cáncer. Esta neoplasia se ha relacionado con el virus Epstein-Barr, pero en su aparición también intervienen factores genéticos, raciales, ambientales y dietéticos. Los síntomas iniciales son inespecíficos, por lo que el paciente y el médico de primer contacto los pasan por alto. La manifestación sintomática más común es la linfadenopatía cervical, que puede ser bilateral y voluminosa incluso en 50% de los afectados. Se comunica el caso de un paciente de 70 años de edad con diagnóstico de carcinoma nasofaríngeo, que acudió al servicio de medicina interna por adenopatía cervical bilateral, y cuyo diagnóstico final requirió un enfoque multidisciplinario.

Abstract Nasopharyngeal carcinoma (NPC) is a squamous cell tumor that usually develops around the lateral wall of the nasopharynx near the Eustachian tube ostium. Overall it is a rare cause of cancer worldwide, although it has a high frequency in some endemic regions of Southeast Asia and Alaska. In Mexico, nasopharyngeal carcinoma is not listed among the 20 leading causes of cancer in the country. The etiology of NPC has been linked mainly to Epstein-Barr virus (EBV), but also involves genetic, racial, environmental and dietary risk factors. The clinical presentation is non-specific and this can be misleading to the primary care physician. The most common symptomatic presentation is cervical lymphadenopathy, which can be bilateral and voluminous up to 50% of patients. This paper reports the case of a 70 year-old man diagnosed with NPC, who was admitted in the internal medicine ward because of bilateral cervical lymphadenopathy, and a multidisciplinary approach was required to establish the final diagnosis.