Analysis of eating disorders among 12-17 year-old adolescents in the island of Gran Canaria.

A clinical pathology characterized by disturbances in eating behaviour has been often associated to socio-cultural factors that influence the psychopathology of these disorders. The alarming increase in the number of teenagers with eating disorders underscores the need to promote research on the underlying causes, and to identify high-risk subpopulations in need of effective targeted treatment. The objective of this study was to assess the prevalence of eating disorders among an adolescent population of both sexes on the island of Gran Canaria. The sample was composed of adolescent boys and girls aged 12 to 17 years old (N=1364) who resided in different municipalities of Gran Canaria. The EAT-40 questionnaire was administered (cut-off point at 30), and body mass index measurements were assessed. The mean BMI for the 1364 subjects was 21.8 Kg/m²; 15% were underweight, and of these at least 1% obtained BMI values below 15 Kg/m². Thus, 13.4% of adolescents were potentially at risk of eating disorders according to the EAT-40 questionnaire. Moreover, the BMI was not significantly correlated to the EAT-40 and was not considered a sufficient parameter to establish the incidence of eating disorders.

Extra-laryngeal head and neck tuberculosis.

OBJECTIVE: Extra-laryngeal head and neck tuberculosis is exceptional. Therefore, a retrospective multicenter study in patients with head and neck tuberculosis, excluding solitary lymphadenitis and laryngeal locations was carried out. METHODS: We reviewed the patients with these features and tuberculosis confirmation by culture and/or histologic granuloma with presence of acid-fast bacilli (AFB). RESULTS: We found 16 patients with the following locations: eight in oral cavity and/or pharynx, four in ear, two in salivary glands, one in nose and one in frontal sinuses. The average duration of symptoms was 11.5 months. Purified protein derivative (PPD) was positive (> 10 mm) in all but one patient in whom it was performed (six of seven). Except tuberculous otitis, which occured without reactive lymphadenitis, this was present in 50% of the rest (six of the 12). In all cases a biopsy was required for diagnosis. Only in four patients, all with pharyngeal locations, was coincident pulmonary tuberculosis confirmed. One patient with tuberculous otitis developed meningitis and died; three additional patients (two with otitis) were cured but with sequelae; the evolution of the remaining patients was satisfactory with medical therapy. CONCLUSIONS: Extra-laryngeal head and neck tuberculosis has a slow course. The diagnosis is difficult due to the common absence of lung involvement and the usual requirements for biopsy procedures. The outcome is usually favorable with antituberculous drugs alone although in tuberculous otitis there are possibilities of complications.

Haemangioma of the maxillary sinus.

Haemangiomas of the maxillary sinus are very rare. In this paper we present one case with an inaccurate preoperative diagnosis which was treated by entire excision of the tumour. One year after surgery there is no evidence of recurrence. The literature on the topic is reviewed.

Parapharyngeal emphysema--an unusual complication of temporal bone trauma.

We report a case of a 36-year-old woman who suffered a temporal bone trauma due to a bicycle crash. Computed tomography revealed parapharyngeal emphysema despite only minor temporal bone changes.

Craniofacial necrotizing fasciitis secondary to sinusitis.

Necrotizing fasciitis is a rare condition which usually affects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures. Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisive factors for the outcome of the patient.

[Long term outcome of phonatory fistulae]. / Resultados a largo plazo de las fístulas fonatorias.

Since January 1983 to January 1990 we have operated 84 Phonatory fistuloplasties (P.F.). The aim of this paper is an intend to know the long term results, farther than 3 years follow-up. We have practiced 70 primary P.F. and 14 secondary. The technique used have been plain puncture and Algaba's procedure. Myotomy of the cricopharyngeus muscle and Herrmann' flap (skin-platysma-fascia) was sometimes associated. The early success of the primary P.F. has been 95 percent and the late one 48 percent. In the secondary P.F. 54 percent and 29 percent, respectively. The most frequent causes of failure have been: enlargement, accidental loss of the prothesis and spontaneous closure and unhappy patient and fibrosis periprosthesis as well. Two factors have to be taken into account in late failures; the immediate postoperative positive psychological feeling and the fact that every patient uses the esophageal voice satisfactorily.

[Orbital complications of sinusitis. Study of 40 cases]. / Complicaciones orbitarias de las sinusitis. Estudio de 40 casos.

During the past few years we have seen an increasing number of orbital complications of sinusitis. In the whole there are summarized 40 complications: 34 cellulitis, 4 exophthalmos and 2 neuritis of the optic nerve. In our opinion the complications were due to the wrongly use of the antibiotics as well as to erroneous indications for surgery. After the survey of diagnosis and managements, the AA. believe the TAC technique is unavoidable for ranging the cellulitis cases in one of the 5 groups established by Chandler and accordingly to treat them medically (antibiotics through the vein) or by surgery (external ethmoidectomy, Caldwell-Luc or osteoplasty of the frontal sinus).

[Diagnostic evaluation of nasopharyngeal carcinoma: role of Epstein-Barr virus]. / Evaluación diagnóstica del carcinoma nasofaríngeo: papel del virus de Epstein-Barr.

We present a retrospective series of 27 nasopharyngeal carcinomas, selected from those attended at Ramón y Cajal Hospital between 1977 and 1996, with the aim of review the role of the study of Epstein-Barr virus in the diagnostic process of nasopharyngeal carcinoma. Twenty-seven patients, ranging from 14 to 81 years, with an average age of 50 years were selected. Male/female ratio was 1,7. All but one case were Caucasian. A neck mass was the first symptom in 40% of cases, with a mean diagnostic delay of 17 months. Only 8 cases (23%) did not exhibit neck nodes at the moment of diagnosis. CT and MRI were essential to establish staging: 5 stage I, 7 stage II and 15 stage IV, due to regional extension and/or bone erosion. Radiotherapy was employed in all cases, helped by chemotherapy in 20% of them. With a mean follow-up of 62 months, 5-years survival was 32% (IC 14,06-52,09). Of 27 cases of nasopharyngeal carcinoma 4 were differentiated (type I), 2 moderately differentiated (type II) and 22 undifferentiated (type III). While LMP-1 was only expressed by 41% of cases, PCR detected Epstein-Barr virus genome in 26 cases (96%) and in situ hybridization for EBERs was positive in all cases. Thus, all nasopharyngeal carcinomas were related to Epstein-Barr virus. Expression of LMP-1 seemed to worse the prognosis of nasopharyngeal carcinoma.

[Post-tracheotomy pneumothorax. Is thoracic radiography required after each tracheotomy?]. / Neumotórax postraqueotomía. Es necesaria una radiografía de tórax después de cada traqueotomía?

Pneumothorax complicating a tracheotomy is a rare event, but it should be clinically considered in order to the early treatment, mostly in urgent or pediatric cases. We report 2 cases in which pneumothorax complicated postoperatively the tracheotomy and required early clinic and radiologic diagnosis followed by a promptly and satisfactorily evacuated. We review the need to perform a chest X-Ray after every tracheotomy or only following those cases found to be at risk, as well some effective preventive measures.

[Laryngeal tuberculosis and laryngeal cancer]. / Tuberculosis laríngea y cáncer de laringe.

Account of 2 synchronic cases of tuberculosis and laryngeal carcinoma. Apart from bacteriostatic drugs one of them underwent a cordectomy the other one a total laryngectomy and neck dissection. Despite the great majority of laryngeal cancer it is compulsory to take in account the differential diagnosis with the tuberculosis, because of its possible coexistence. Perusal of national and international literature, having found only 11 of similar instances reported.

[Congenital anomalies of the first branchial cleft. Retrospective study]. / Anomalías congénitas de primera hendidura branquial: estudio retrospectivo.

Anomalies of the first branchial cleft are occasional problems putting up diagnostic and therapeutic difficulties, because the imperfect settlement of reminders of this cleft, which can appear as cysts or branchial fistula, among patients of any age. Though there are several recommended classifications in order to achieve a precious diagnosis and a total surgical removal, sometimes is laborious to correlate the clinical and the histological findings. We report a sequence of congenital periauricular anomalies operated in our Department during a ten-years-term and compare our findings of those quoted after the literature series.

[Nasal encephalocele: differential diagnosis with nasal glioma]. / Encefalocele nasal: diagnóstico diferencial con el glioma nasal.

Congenital nose neoplasms are infrequent, between them neurogenic tumors of the middle line include nasal gliomata (glial ectopies) and nasal encephaloceles, according to an existing or lacking communicating link with the intracranial cavity. We report one congenital naso-encephalocele case in a 16-year-old girl suffering from repeated meningitis events after several nasal polypectomies performed in other departments. She underwent complete removal through fronto-neurosurgical and paralateronasal approach, being the young woman asymptomatic for 3 years. We discuss about both intranasal gliomata and encephaloceles, certainly of not easy pathologic identification, stressing the decisive value of imaging techniques, as magnetic resonance, in order to clearcut both the diagnosis and the therapeutical planning.

[Lateral cervical branchial cysts: a retrospective study]. / Quistes branquiales cervicales laterales: un estudio retrospectivo.

The cause of lateral cervical branchial cysts is debated. Some authors claim that they are congenital, whereas others believe that they are acquired, being their likely origin cystic degeneration of the cervical lymph nodes. Their protocol of study and differential diagnosis with respect to malignant neck masses are of special interest. A retrospective clinical study was made of 13 cervical branchial cysts seen by one of the authors over a decade-long period. Based on the results, their probable origin is discussed and a study protocol is proposed. Although it has been discussed by some authors, we conclude that the origin of branchial cysts cannot be determined through this type of clinical study. Computed tomography and fine-needle aspiration currently are essential diagnostic methods in the study protocol of these lesions.

[Parapharyngeal abscess: perilaryngeal infrahyoid extension]. / Absceso parafaríngeo: extensión infrahioidea perilaríngea.

Parapharyngeal abscesses are located between the skull base and the hyoid bone. Their infrahyoid extension is usually following the retropharyngeal space, but also can be through the medial aspect of the parapharyngeal space. Thus, surrounding the visceral fascia, they might invade the perilaryngeal and perihypopharyngeal spaces. This results in more significant airway compromise. Computed tomography is essential while locating and evaluating the extension of these infections, specially with regards to the great vessels. We report on 8 parapharyngeal abscesses with perilaryngeal and/or perihypopharyngeal extension. We review their clinical and radiological features, based on computed tomography, as well as their medical and surgical treatment. When medical therapy fails, as they are usually medial to the great vessels, it is possible to perform aspiration and drainage transorally, avoiding the need for cervicotomy, in selected cases.

[Osteoplastic frontal sinus flap. Study of 47 cases]. / Colgajo osteoplástico del seno frontal. Estudio de 47 casos.

Osteoplastic flap of the frontal sinus, described by Macbeth over 40 years ago, still is the best surgical approach for the diagnosis and definitive treatment of chronic disease. Forty-seven patients were treated with this technique between 1978 and 1995. The conditions treated were, by order of frequency: 16 fronto-ethmoidal mucocele, 12 osteoma, 12 hypertrophic sinusitis, and less frequent disorders, such as osteomyelitis (2), fibrous histiocytoma (2), tuberculosis (1), frontal fracture (1) and dilated pneumosinus (1). The surgical approach was coronal in 28 patients, brow in 18 and hemicoronal in 3. In some cases, other approaches were associated: 13 lateral rhinotomy, 6 sublabial and 1 intranasal. Nasofrontal duct obstruction was found in 89% of cases and erosion of one or more sinus walls in 70%. Intraoperative complications included 4 small dural tears, 1 with leakage of cerebrospinal fluid. Postoperative complications included 4 frontal deformity, 2 persistent frontal anesthesia, 1 supraorbital nerve neuralgia, 1 post-anticoagulant epistaxis and 1 death from pulmonary embolism.

[Neck lymph node metastases of unknown origin: nasopharyngeal origin and EBV (Epstein-Barr virus)]. / Metástasis ganglionares cervicales de origen desconocido: origen nasofaríngeo y el VEB (virus de Epstein-Barr)

We present a retrospective series of 16 cases of undifferentiated squamous carcinoma in cervical metastatic nodes of unknown primary. We review their clinical and radiological evaluation in search of a possible primary tumor, their response to treatment and the eventual development of a primary tumor. Furthermore, we study the presence of Epstein-Barr virus in the metastases as a predictor of their nasopharyngeal origin, in relation to the finding of primary lesions in the nasopharynx during further follow-up of the cases.

[Fibroglandular hamartoma of the nasal cavity: case description and review]. / Hamartoma fibroglandular de fosa nasal: descripción de un caso y revisión.

A fibroglandular hamartoma of the nasal cavity was found in a patient with nasal polyposis. The only symptom had been bilateral nasal obstruction for years. The tumor was removed by lateral rhinotomy. Our initial differential diagnosis included nasal glioma and inverted papilloma, but this rare tumor was not suspected. Four years after surgery, the patient is well and the risk of recurrence is deemed to be very low. Surgeons and pathologists must be aware of these and other uncommon tumors of the nose because some may require special diagnostic and therapeutic procedures.

[Mucoepidermoid carcinoma of the larynx]. / Carcinoma mucoepidermoide de laringe.

We report a case of poorly differentiated mucoepidermoid carcinoma of the larynx. The tumor was supraglottic, located on the left aryepiglottic fold, and produced left laryngeal paresis. The patient underwent total laryngectomy, functional neck dissection, and complementary radiotherapy. After 20 months, untreatable lung metastases appeared. Mucoepidermoid carcinomas of the larynx are rare. They are generally unresponsive to radiotherapy and are best treated surgically, although postoperative radiotherapy is advocated for high-grade, poorly differentiated cases.

[Peritonsillar abscess with parotid and peripharyngeal extension. Report of a case]. / Absceso periamigdalino con extensión parotídea y perifaríngea. A propósito de un caso.

Peritonsillar abscess is the most frequent complication of a tonsillar infection. The purulent material can spread from peritonsillar space to the fascial neck spaces. These deep neck infections may be a life threatening complication. The correct treatment of these infections is an appropriate antimicrobial therapy and abscess drainage, most of the times by surgery. We present a clinical case of a large perypharyngeal, and parotid abscess originated from a peritonsillar abscess. It was necessary surgical treatment to drain it.

[Thyroglossal cyst: retrospective study of 58 cases. Results of the Sistrunk operation]. / Quiste tirogloso: estudio retrospectivo de 58 casos. Resultados de la operación de Sistrunk.

Cysts of the thyroglossal duct are one of the most common causes of benign neck masses. They generally occur in young patients and are caused by a defect in thyroglossal duct closure, which sometimes is in close contact with the hyoid. Often several tracts are present. The most effective surgical procedure was originally described by Sistrunk in 1920 and modified in 1928. This technique is based on the removal of the central portion of the hyoid bone. This procedure has successfully reduced the number of recurrences compared to local excision of the cyst. A retrospective review was made of 58 cases to evaluate surgical results, especially recurrence rate, in relation to the resection or preservation of the hyoid bone. Results were compared with published series.