[Laryngeal chondrosarcoma of low grade of malignancy. Report of a case located on thyroid cartilage]. / Condrosarcoma laríngeo de bajo grado de malignidad. A propósito de un caso localizado en cartílago tiroides.

Cartilaginous tumors of the larynx are rare. Only a 2-5% of all chondrosarcomas arise on head and neck area while the laryngeal forms represent less than 1% of the malignant neoplasms in that location. Laryngeal chondrosarcoma is three times more frequent in men than in women with average age of presentation about the 6th - 7th decades. Most of them are originated on cricoid (70-75%) followed by the thyroid cartilage (10-20%) as in the case that we are reporting. Its growth often is very slow with delayed clinic being hoarseness, dyspnea and dysphagia the most common symptoms. Laryngeal chondrosarcomas use to be tumors with low-grade of malignancy and their elective treatment is surgery preserving the laryngeal function. Local and late recurrences are frequent and the definitive diagnosis is the anatomopathological exam.

[Paraganglioma of the jugular foramen presenting with initial isolated vertigo]. / Paraganglioma del agujero rasgado posterior o foramen yugular presentándose con vértigo aislado inicial.

The more common symptoms of the jugulotympanic paragangliomas are hearing loss, tinnitus and palsy of cranial nerves. Diagnosis is often delayed due to the slow growth of the tumour. We report one case with affectation of jugular foramen which clinically debuted as a peripheral vertigo and the diagnosis was made by CT, IRM and angiography. The patient was treated by Neurosurgery using Gamma Knife (radiosurgery) with good result.

[Chondrocalcinosis (pseudogout) after surgical treatment of primary hyperparathyroidism. Report of a case and review of the literature]. / Condrocalcinosis (pseudogota) despúes de tratamiento quirúrgico de hiperparatiroidismo primario. Presentación de un caso y revisión de la literatura.

We are reporting the case of a 61-year-old female who developed an acute arthritis following parathyroidectomy because a primary hyperparathyroidism. The diagnosis of chondrocalcinosis or pseudogout was made by the clinical presentation, radiologic findings and demonstration of synovial fluid crystals of calcium pyrophosphate dihydrate. Rapid drops in serum calcium levels after removal of the adenoma may precipitate these acute articular inflammatory attacks that are not so uncommon as we can recognize if a bibliographic review about that association is performed.

[Recidived medullary thyroid carcinoma with neck metastases and tracheal invasion]. / Carcinoma medular de tiroides recidivado con metástasis ganglionares e invasión traqueal.

Medullary carcinoma represents about 5% of all malignant tumors located in thyroid gland and it can appear as sporadic or hereditary form. We report the case of a 58-year-old female who was initially operated by General Surgery Department of an infiltrating medullary carcinoma with cervical metastasic nodes having its origin on left thyroid lobe (LTL). The patient did not want any kind of control and 5 years later she suffered dyspnea due to the tumoral recurrence with invasion of the trachea and recurrential left palsy. Our ENT Service only performed a tracheostomy on fourth tracheal ring because the woman did not accept another surgical intervention. For 6 years she has been followed and reviewed in our consults beeing on alive up to now.

[Hürthle cells carcinoma. Report of two operated cases and review of the literature]. / Carcinoma de células de hürthle. Descripción de dos casos intervenidos y revisión de la literatura.

Hürthle cells carcinomas are considered a variant of folicular carcinomas and represent about 2% of all malignant thyroid tumours. We report 2 cases of 2 women of 46 and 43 years old confirmed by histological exam after total thyroidectomy with good postoperative evolution. The presence of capsular and vascular invasion is the most important criteria to distinguish this entity from the Hürthle cells adenomas.

[Usefulness of computed tomography and magnetic resonance in the preoperative diagnosis for hyperparathyroidism]. / Utilidad de la tomografía axial computerizada y la resonancia magnética nuclear en el diagnóstico preoperatorio del hiperparatiroidismo.

Sonnography and Tc-99m sestamibi scintigraphy are the most requested preoperative imaging tests nowdays in the surgery of hyperparathyroidism. The aim of our article is to know if Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are useful as a location study and in which cases it would be more justified to ask these radiologic techniques. For that we report our results with 29 patients at all diagnosed as hyperparathyroidism (26 primary forms and 3 secondary ones) and operated by our E.N.T. Department later. On 20 of them a cervical CT was asked before the parathyroidectomy and on the rest 9, a MRI with sensitivities of 65% and 88.9% respectively. We think both complementary explorations must not be solicited by routine but they can represent a help in the cases in that sonnography and scintigraphy are not able to show the possible adenoma or hiperplasia, particularly in recurrent hyperparathyroidisms, reinterventions or suspect of parathyroid glands in an atypical location.

[Thyroglossal duct cysts and fistulae. Review of 30 consecutive operated patients]. / Quistes y fístulas del conducto tirogloso Revisión de 30 pacientes consecutivos intervenidos.

Thyroglossal duct cysts represent a very common pathology among the benign neck masses. An own review of 30 consecutive operated patients between 1994-2003 by our ENT Department is reported. There have been analysed different parameters like age, sex, personal antecedents, clinical symptoms, complementary explorations, surgical treatment, evolution and anatomopathologic result (AP). We think the Sistrunk procedure is the best operatory technique or strategy to perform to avoid recurrences.

[Multiple brown tumours in a patient with tertiary hyperparathyroidism]. / Múltiples tumores pardos en paciente con hiperparatiroidismo terciario.

We describe the case of a 49-year-old female with chronic renal failure and secondary hyperparathyroidism that not dissapeared after kidney transplant and turned into an autonomous form (tertiary hyperparathyroidism). The xRays and CT showed the presence of multiple brown tumors in iliac bones and tibia. We performed a parathyroidectomy removing a lower left adenoma confirmed in the histological exam the renal. After the surgery the osteoarticular manifestations improved and lithiasis dissapeared. There were not any postoperative complications such as hypocalcemia or recurrential palsy although Nephrology Department had to control her renal function.

[Association between primary hyperparathyroidism and Paget's disease. Report of a case]. / Asociación entre hiperparatiroidismo primario y enfermedad de paget Presentación de un caso.

Although the association between hyperparathyroidism and Paget's disease is known, in the clinical practice occurs very rarely. We report the case of a 68 years old female who was diagnosed as such disease more than 5 years ago and later she got an increment of PTH levels and hypercalcemiajoint to other biochemical disorders that made to suspect a primary hyperparathyroidism. Besides the osteoarticular manifestations, clinically the patient suffered recurrent kidney lithiasis. She was operated by removal of one adenoma (1,5 cm) located in lower right parathyroid gland and her evolution was satisfactory without complications.

[External severe laryngeal trauma with multiple fractures and airway compromise]. / Traumatismo laríngeo externo severo con fracturas mújltiples y compromiso de la vía aérea.

External laryngeal traumas are rare but clinically can cause important life-threatening injuries. We report the case of a 33 yeras old male who suffered a severe traffic accident: TCE, facial trauma with multiple fractures and laryngeal trauma with fracture of the thyroid cartilage and the hyoid bone. Because an important edema in the airway, it was not possible an orotracheal intubation and he required urgent coniotomy with later reconstruction surgery and tracheostomy. Actually our patient has been decanulated and the fibroscopic image of the larynx and its functionality is correct.

[Acute confusional syndrome as first manifestation of primary hyperparathyroidism]. / Síndrome Confusional Agudo como manifestación inicial de hiperparatiroidismo primario.

Hyperparathyroid crisis is an uncommon clinical state characterized by severe hypercalcemia which can produce an acute confusional syndrome (ACS) or delirium. We are reporting the case of a 58-year male with calcemias greater than 14 mg/dl, that were due to a parathyroid adenoma (primary hyperparathyroidism), and caused his admission in UCI with change in the conscience level, global afectation of the cognitive functions, letargia and disorentiation among other clinical symptoms. The patient was operated by our Service on lower left parathyroidectomy with PTH rapid or turbo assay and decreasing such hormone levels about 75%. After the surgery his evolution was satisfactory obtaining the normocalcemia.

[Chronic otitis media in adults complicated with meningitis. Report of two cases]. / Otitis media crónica en adultos complicada con meningitis. A propósito de dos casos.

Although rare, meningitis secondary to chronic media otitis represent an intracranial complication of importance nowdays. We are reporting two clinical cases diagnosed by symptoms, CT and lumbar punction as meningeal syndrome with otogenic cause that required endovenous wide spectrum antibiotic treatment and surgery later. We consider essential an early diagnosis and close cooperation with other departments to try to decrease the associated mortality, greater than 30% in some series.

[Our current results in the surgical treatment of hyperparathyroidism]. / Nuestros resultados actuales en el tratamiento quirúrgico del hiperparatiroidismo.

We are reporting a descriptive study with our current results in the surgery of hyperparathyroidism. On 14 years experience we have operated 124 patients by performing 122 parathyroidectomies. A 74.2% were primary hyperparathyroidism; a 21.7%, secondary and 4.1% tertiary ones. Among other parameters we have analyzed the clinical symptoms, complementary explorations, surgical technique, anatomopathologic result (AP), location for the removal glands, thyroid pathology associated and complications. Our percentage of success was 96%. We only have registered one recurrent palsy after exposing 190 nerves and 30 hypocalcemias (27 were transitory and 3 permanent). Finally, a literature review has been carried out in order to compare our data with other published series.

[Association among hypocalcemia, AP result and surgical technique in hyperparathyroidism. A statistical study]. / Asociación entre hipocalcemia, resultado AP y técnica quirúrgica en el hiperparatiroidismo. Estudio estadístico.

The main goal of this article was to know if there was any relations statistically significant among the post-operative hypocalcemia, type of surgery for hyperparathyroidism in our series and its anatomopathological result (AP). 122 patients affected of such illness (30 men and 92 women) were studied and operated and we obtained 30 hypocalcemias (27 transitory and 3 permanent ones). The subtotal and total parathyroidectomies compared with adenomas removal have showed us a percentage for that complication significantly higher (p<0.001). Besides we have found a clear association between parathyroid hyperplasia and hypocalcemia (p<0.05).

[Tertiary hyperparathyroidism. Report of 5 cases]. / Hiperparatiroidismo terciario. Presentación de 5 casos.

Tertiary hyperparathyroidism represents an autonomous proliferation state of the parathyroid glands that takes place in spite of performing a renal transplantation in patients with chronic renal failure due to the illness. We are reporting 5 own clinical cases collected in a 14 years period corresponding to 2 men and 3 women, with ages between 43 and 53, that were sent from Nephrology for surgical intervention. The AP result was hyperplasia in 4 samples and 1 adenoma in the rest. 2 transitory hypocalcemias were registered but not recurrential palsies. After the surgery we got the normalization of hypercalcemia in all of them and improvement of skeletal symptoms.

[Maxillary fungal sinusitis by Zygomicetos. Report of a case in an immunocompetent patient]. / Sinusitis fúngica maxilar por Zygomicetos. Presentación de un caso en paciente inmunocompetente.

We report the clinical case of a 36 years old female without significant previous history who was diagnosed with an acute maxillary sinusitis with not responding to antibiotic treatment. After her admission we asked for a CT which showed an occupation in the left maxillary sinus with a calcified area inside suggesting a mycetoma. The patient was operated by Functional Endoscopy Sinusal Surgery (FESS) plus Caldwell-Luc techniques sending the obtained sample for microbiological study, that was reported as sinusal mycosis by Zygomicetos. The postsurgical evolution was satisfactory.

[Melanoma of sphenoid sinus. Case presentation and review of literature]. / Melanoma del seno esfenoidal. Presentación de 1 caso y revisión de la literatura.

The primary malignant melanomas of sphenoidal sinus are very uncommon tumours. We are reporting a clinical case of a 56 years-old male who was sent from the Neurology Department with ocular pain and headache of several months evolution and without personal history. Exploration revealed a VIth palsy, diplopia and ptosis. The complementary imaging tests (CT and MR) showed and expansive tumour of the sphenoidal sinus involving the right cavenous sinus. A F.E.S.S. with biopsy was performed to confirm the diagnosis. Our patient was treated by Radiotherapy and after a 4 year follow-up period he is still alive. We have carried to a bibliographic review of this pathology whose differential diagnosis must be done with epidermoid carcinomas, adenocarcinomas and lymphomas on that location.

[Cochlear-vestibular ototoxicity by gentamicin. Report of a case and literature review]. / Ototoxicidad cócleo-vestibular por gentamicina. Caso clínico y revisión de la literatura.

Gentamicin is an antibiotic member of the aminoglycosides family with well known potential to cause permanent ototoxicity by damaging more likely the cochlea vestibular system. We are reporting the clinical case of a 48 year-old female who was treated with such IV drug because of abdominal surgery. She had no otologic past history, and was complaining of tinnitus, periferical vertigo and progressive bilateral neurosensorial hearing loss, it est, cochlear-vestibular symptoms. After the withdrawol of gentamicin, the vestibular pathologic symptoms but not the hearing loss had improved, docummented by the persistance of the audiometric decay in the acute frequencies. Prevention is the best way to avoid iatrogenic lesions with thesse climps.

[Hyperparathyroidism due to chronic renal failure. Analysis of 32 operated patients]. / Hiperparatiroidismo debido a insuficiencia renal crónica. Análisis de 32 pacientes operados.

We report our study of 32 patients diagnosed as hyperparathyroidism due to chronic renal failure (27 secondary forms and 5 tertiary ones), between June 1990 and 2003, that were sent from Nefrology Department for to surgical intervention. The following parameters have been analysed: Age, sex, clinical symptoms, kind of surgery performed, postoperative complications and anatomopathologic result (AP). On 64 nerves exposed, there were no recurrent nerve palsies. 12 patients suffered a symptomatic hypocalcemia (37,5%) although only one was permanent. The control of calcium, phosporus and calcitriol is essential to try to avoid a hyperplasia of the parathyroid glands.

[Brown bone tumor as the first manifestation of primary hyperparathyroidism]. / Tumor pardo óseo como primera manifestación de hiperparatiroidismo primario.

We report a clinical case of a 26 years old female who had a 2 years evolution chin tumour with hypercalcemia (11.8 mg/dl) and PTH (paratohormone) of 761 pg/ml. She underwent a CT scan and MRI of the mandible, as well as a biopsy followed by excision of the tumour by the maxilofacial surgeons. Our ENT Department asked for a Scintigraphy (Tc99s-mibi) and thoracic-cervical CT, which showed a lesion that turned out to be an adenoma of the lower right parathyroid gland after surgery and pathological examination. The patient suffered a Primary hyperparathyroidism that was the main stimulus for the Brown Tumour made up by macrophagos and multinuclear giant cells, being this the first manifestation of the metabolic disorder. This form of hyperparathyroidism is very rare in the clinic. We do a literature review to establish the differential diagnosis for such pathology.