Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment.

STUDY DESIGN: A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up. OBJECTIVES: To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence. SUMMARY AND BACKGROUND DATA: Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial. METHODS: The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up. RESULTS: After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed. CONCLUSION: Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.

[Vernet's syndrome as an early manifestation of systemic erythematous lupus]. / Síndrome de Vernet como manifestación precoz de un lupus eritematoso sistemico.

Report of one case of Vernet's syndrome (involving the IX, X and XIth cranial nerves) in a young woman, as early sing of SEL. The patient presented the 4 criteria suggested by the American Society in order to diagnose SEL: arthritis, serositis, positive anti-nuclear antibodies and anemia. The AA. carry out a study in search of other cases sitting in the larynx and a perusal about etiopathogenical theories as well. Hinting, for the clinical picture, of being it due to a localised vasculitis of vasa nervorum, a treatment with corticoids and pentoxifylline was ordered, being the outcome, after 3 weeks, the eradication of ENT syndrome.

[ENT emergencies due to foreign bodies at a tertiary hospital]. / Urgencias Otorrinolaringológicas por cuerpos extraños en un hospital terciario.

A study of the patients who, through a year, came to the Emergencies Department showing foreign bodies in ENT-area has been accomplished. Among ENT urgencies foreign bodies constitute the most frequent cases. Age, sex, date, time of admission, sitting, kind of body and treatment are taken in consideration. The intruders were most commonly found in the pharyngeal area. A striking correspondence between age and location is underlined.

[Cervical emphysema caused by Forestier's disease]. / Enfisema cervical por enfermedad de forestier.

Diffuse idiopathic skeletal hyperostosis is a rare cause of dysphagia, preferentially affecting older men. This condition is also known as Forestier's malady, being characterized by a paravertebral ossification of 4 contiguous vertebrae at least. Seldom is the last etiology evoked for high dysphagia after other possible diagnosis exclusion. The diagnosis is confirmed by standard or contrast radiography. Introductory treatment is medical, being the surgery indicated for serious or resisting cases. One case is reported with dysphagia as primary sign of Forestier's malady, and review of possible diagnostic exams and treatments.

[Neuroendocrine carcinoma of the nasal fossa. An independent entity?]. / Carcinoma neuroendocrino de fosa nasal. Una entidad independiente?

We present one case of a neuroendocrine carcinoma of nasal fossa and paranasal sinuses, of aggressive behavior, which has been controlled with chemo-radiotherapy after a double postsurgical recurrence. We do a literature revision emphasizing the anatomopathologic differentiation of these tumors with the olfactory neuroblastomas, and the therapeutic controversies in advanced stages.

[Acute epiglottitis in the adult. Retrospective study of 14 cases]. / Epiglotitis aguda del adulto. Análisis retrospectivo de 14 casos.

Acute epiglottitis instead of been a well recognised disease in children, is a rare condition in adult patients. Failure to diagnose epiglottitis early, in adults, undoubtedly contributes to its continuing mortality. We report our experience with acute epiglottitis in grown-up people with a retrospective series of 14 patients seen in our Department from 1993 to 1997. We comment about clinical features and therapeutic management of these patients.

[Dilated vestibular aqueduct syndrome in children. Report of a case]. / Síndrome del acueducto vestibular dilatado en la infancia. A propósito de un caso.

Enlarged vestibular aqueduct syndrome is a clinical condition characterized for a progressive perceptive deafness linked to a broadening of vestibular aqueduct greater than 1.5 mm without other otic abnormal structures. We report the case of a 2-year-old child with such congenital malformation. We have reviewed the actual literature and point out its clinical and physiopathologic features as well treatment possibilities of these cases.

[Primary mucous melanoma of the nasal cavity: a case report]. / Melanoma mucoso primario de fosas nasales. A propósito de un caso.

Mucous melanoma in the nasal cavity are unusual tumours that develop from common melanocytes pre-existent in the respiratory epithelium. They manifest a high diagnostic and therapeutic difficulties as well as an obscure prognosis. A case of this rare tumour is exposed and a bibliographic review in which clinical, diagnostic, histological, therapeutic and prognostic features are contemplated.

[Neurinoma of the cervical hypoglossal nerve. A clinical case and review of the literature]. / Neurinoma del hipogloso cervical. Caso clínico y revisión de literatura.

Neurilemmomas are relatively rare tumors derived from Schwann cells that may occur at any part of the body. Many are encapsulated and they are more frequently encountered in adults. A neurilemmoma of the hypoglossal cervical nerve, an unusual site, is reported. Submaxillary angioma was initially suspected.

[Report of a case of pneumocephalus secondary to otologic surgery]. / Presentación de un caso de neumoencéfalo secundario a cirugía otológica.

Non-traumatic pneumocephalus of otic etiology, secondary to colesteatoma or the otologic surgery is extremely rare, and very few cases are described in the worldwide literature. The existence of air in the intracranial spaces/tracts is known as pneumocephalus. Symptoms are due to the increased intracranial pressure, therefore, a differential diagnosis should be made in order to rule out other expansive processes. Surgical treatment, with closure of the existing fistula, is conclusive. We present a case of tension pneumocephalus secondary to otologic surgery and review the literature existing on the topic.

[Nasal hemangiopericytoma]. / Hemangiopericitoma nasal.

We are submitting a case of haemangiopericytoma of the nasal fossae, diagnosed and treated in our department. This is the second case we have seen as the first one was published by J. Marin and al. (1) in 1979. The patient in question is male, 35 years of age, who suffered from a tumour in the nasal partition, in the left nasal fossa and which made itself evident through repetitious epistaxis. The tumour was removed and there has not, so far, been any relapse. We have carried out a study of the available literature concerning haemangiopericytomas located in the nasal fossae and in the paranasal sinuses and come across 50 cases. In 1987 Chawla compiled 23 cases (2). Of the 50 cases, only 6 are described as being located in the nasal wall. We are submitting a list of all the cases that we have published and gathered with the age and sex of each patient and year of their publication.

[Non-benign paroxysmal positional vertigo]. / Vértigo posicional paroxístico no benigno.

Positional vertigo is a frequent clinical manifestation of vertigo of very different etiologies, being the benign paroxystic positional vertigo (BPPV) the most frequent one of them, representing in some series even the most found etiology of peripheral vertigo. Usually of severe entities, positional vertigo may appear in the context of severe entities and of difficult diagnosis. In these cases, the bearing of the symptoms in spite of the repositioning manoeuvers, the association with otological or neurological symptoms, and the atypical nystagmus evoked by Dix-Hallpike manoeuver, must take the otolaryngologist to suspect of a feasible non benign pathology. We report a case of positional paroxysmal vertigo caused by an intracranial tumour and we review the clinical signs that shoved help us to suspect of non benign pathologies that can mimic a positional vertigo.

[Intra-tympanic gentamicin in the treatment of Ménière's disease: preliminary results ]. / Gentamicina intratimpánica en tratamiento de la enfermedad de Ménière: resultados preliminares.

In the majority of patients suffering of Ménière's disease, medical treatment is sufficient to control symptoms, albeit, in a small number of them, the high intensity and frequency of vertigo spells makes necessary to adopt more aggressive measures, like intratympanic or general aminoglycoside administration, as well as surgical procedures. We present a prospective and longitudinal descriptive study with the results of intratympanic gentamycin in 24 patients labeled of Ménière's disease in the Otolaryngology Department of "Miguel Servet Hospital" in the last two years, after a follow-up period of more than a year, during which controlled medical treatment had been proved unsuccesfull. We go over the efficacy in terms of frequency of vertigo crisis, audition average, logoaudiometry and functional level. We obtained good results over vertigo control (types A and B of the objective criteria based in the improvement index after treatment) in 16 out of the 24 patients (66.6%), (13 were type A with total absence of crisis and 3 were type B) and an acceptable result (type C) in three of them (12.5.%). In the other five patients (20.83%) results were disappointing (types D and E) compelling to apply surgical treatment. We have tried to evaluate intratympanic gentamycin as an alternative treatment to more aggressive technics and we consider it to be a good option, with a low risk and scarce complications in the no pharmacologically controlled Ménière's disease patients.

[Stapedectomy: long term results]. / Resultados a largo plazo de las estapedectomías.

Stapedectomy, with its most innovatory variations, constitutes the treatment of choice for otoesclerosis. Short term results are spectacular, getting GAP closures of less than 5 dB approximatelly in 94% patients, variations depending on the authors. Long term follow up check results show a gradual auditory deterioration. The aim of this study is to audiometric evolution of patients operated of stapedectomy 7 to 10 years ago in our department and to correlate the results with those obtained by other authors, in an attempt to unify conclusions.

[Congenital cholesteatoma of the petrous process and mastoid: a report of two cases]. / Colesteatoma congénito de peñasco y mastoides. A propósito de dos casos.

Congenital cholesteatoma are unusual. They may arise in different sites of the temporal bone: petrous process, middle ear and mastoid. Primary cholesteatomas originate from embryonary ectodermal inclusions but the pathogenesis is not clear and many different hypotheses regarding its origin have been suggested. The clinical diagnosis is not easy if the tympanic membrane is normal, and computerized tomography and magnetic resonance imaging are useful. We report two cases of congenital cholesteatoma: One located in the petrous process and the other in the mastoid without affection of the tympanic cavity.

[Laryngeal histoplasmosis]. / Histoplasmosis laríngea.

A case of laryngeal histoplasmosis is reported. This laryngeal mycosis was diagnosed by histological identification of intracellular hyphae of Histoplasma capsulatum. Laryngoscopy revealed edema, erythema and leukoplakia of the righ vocal cord. Itrakonazole treatment was successful. The relevant literature is reviewed.

[Reported case of cystic cervical lymphangioma in an adult]. / Presentación de un caso de linfangioma quístico cervical en adulto.

Cystic lymphangiomas are abnormalities derived from lymphatic vessels that are characterized by the formation of cysts. The are located generally in head and neck and occur most frequently in children. They rarely appear in adults. We present a case of lymphangioma and review the disorder.

[Cerebral abscess as a complication of the chronic otitis]. / Absceso cerebral como complicación de la otitis crónica.

Otogenic intracranial complications are now rare. Meningitis is the most frequent, followed by cerebral abscess. In spite of diagnostic and therapeutic advances, cerebral abscess has a high mortality. We report four cases seen in our service over the last five years and their treatment. The subject is reviewed.

[The effect of tobacco consumption on acoustic voice analysis]. / Efecto del consumo de tabaco en el análisis acústico de la voz.

An observational study of acoustic voice parameters was made in non-dysphonic adult smokers and non-smokers. The sustained vocal /a/ of 79 smokers and 169 non-smokers was recorded with Mini-Disk equipment. Acoustic analysis was performed with the Dr. Speech Science 3.0 program. Some acoustic parameters differed between smokers and non-smokers: the fundamental frequency (FQ) was lower in smokers. Average jitter (PPQ) and shimmer (APQ) were higher in smokers (Ji:0.27%, Shi: 2.56%) than in non-smokers (Ji: 0.23%, Shi: 2.02%). HNR and NNE values did not differ significantly.

[The role of video-nystagmography in the diagnosis of acoustic neuroma]. / El papel de la videonistagmografía en el diagnóstico del neurinoma del acústico.

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.