Polysomnographic studies in children with adenotonsillar hypertrophy and suspected obstructive sleep apnea.

Upper airway obstruction causes many sleep-related respiratory disorders that can culminate in obstructive sleep apnea syndrome (OSAS). Polysomnography is routinely used to define OSAS in adults, but problems remain in diagnosing children by this method. The current study was designed to analyze the polysomnographic patterns in children with symptomatic adenotonsillar hypertrophy and to determine whether obstructive respiratory events shorter than 10 sec could have pathophysiological significance. Furthermore, we analyzed the correlation between clinical data on children with adenotonsillar hypertrophy and polysomnographic findings. Twelve children (mean age, 4.5 +/- 1.5 years) with airflow obstruction due to adenotonsillar hypertrophy were observed in our Sleep Laboratory. Prior to study, a questionnaire was used to score symptom severity. Overnight polysomnography was then performed to measure total sleep time, sleep efficiency, desaturation index, minimal arterial oxygen saturation (SaO2), apneahypopnea (AH) episodes < or = 5 sec and those > or = 10 sec, and AH index, AH percentage of total test time, and number of spontaneous and respiratory event-associated desaturations were recorded. Respiratory events of 5 sec or longer resulted in increases in the AH index and an increase in the number of oxyhemoglobin desaturations due to respiratory events. A significant relationship was found between the AH index and AH episodes > or = 5 sec and > or = 10 sec. There was, however, no association between polysomnographic parameters and symptom severity scores. An appraisal of AH recordings > or = 10 sec showed that desaturation episodes were more frequent than respiratory events, and the desaturation index was closely related to spontaneous and respiratory event-associated desaturations. When considering all obstructive episodes > or = 5 sec, the number of desaturations did not exceed the number of respiratory events. The correlation between the desaturation index and spontaneous or respiratory event associated desaturations was similar. The occurrence of short AH episodes that lead to hemoglobin desaturation are important in the evaluation of OSAS in children.

[Advances in the diagnosis of ENT tumors in childhood]. / Avances en el diagnóstico de los tumores otorrinolaringológicos.

In the present study we review ENT tumor pathology in childhood. Only the most salient aspects are emphasized and the variety of entities reviewed was restricted. Molecular biology techniques reveal infection by human papilloma virus (types 6 and 11) in 50 % of papillomas, while immunohistochemical techniques are less effective in papilloma virus detection. The myofibroblastic nature of nasal angiofibroma has been demonstrated and its incidence is 25 times more frequent in patients with familial polyposis of the colon. Overexpression of p53 occurs in the initial stages of nasopharyngeal carcinoma, while overexpression of c-myc is correlated with an unfavorable prognosis. Recently, olfactory neuroblastoma has been shown not to express the protein product of the MIC-2 gene (antibody 12E7), thus the hypothesis that it could be a member of the Ewing tumor family (neuroectodermal peripheral tumors) has not been confirmed, although it is a primitive neural tumor. The head and neck rhabdomyosarcoma with the best prognosis is that located in the orbit, and cytogenetic studies have shown chromosomic translocation t(2;13) in 50 % of these childhood tumors when they are of the alveolar-type, while trisomy of chromosome 2 or 20 is more characteristic of the embryonic-type. Currently, any classifying features of ENT lymphomas must be based on the Revised European-American Classification of Lymphoid Neoplasms (REAL). Papillary and medullary carcinomas are the most common histological types of thyroid carcinoma in childhood. Alterations in ret/PTC play a significant role in the pathogenesis of both.

[Endobronchial hamartoma: a case report]. / Hamartoma endobronquial. A propósito de un caso.

We described a case of endobronchial hamartoma diagnosed in a seven years-old-child (which presented with chronic cough as the only symptom). The chest radiographs showed left lung global condensation. We did rigid bronchoscopy to discard a bronchial foreign body and confirmed the existence of a white-yellowish colour, smooth surface mass obliterating the left main bronchus. Biopsy and anatomopathology study give the result of hamartoma. We performed thoracotomy, bronchotomy and enucleation of the mass. The frequency, clinic, diagnosis and treatment of endobronchial hamartoma are analyzed.

[Lymphocytes of patients with auto-immune deafness present type II collagen hyporeactivity in the presence of the pineal hormone melatonin]. / Linfocitos de pacientes con sorderas autoinmunitarias presentan hiporreactividad a colágeno tipo II en presencia de la hormona pineal melatonina.

A study was made of the behavior of peripheral blood lymphocytes in healthy controls and patients with various types of hearing loss. Hearing loss of auto-immune origin was studied in the presence and absence of melatonin, activated or not by concanavalin A. In patients with auto-immune hearing loss, lymphocytes showed hyporeactivity to type II collagen in terms of proliferative activity in the presence of concavalin A. Hyporeactivity was especially relevant in melatonin-incubated cells. In different nosologic entities, lymphocyte hyporeactivity to type II collagen was similar in bilateral sensorineural hearing loss, Ménière's disease and otosclerosis. We conclude that the lymphocytes of patients with autoimmune hearing loss showed hyporeactivity to type II collagen when compared to lymphocytes from control subjects. This hyporeactivity was revealed when lymphocytes were activated in the presence of melatonin.

[Congenital choanal atresia: transpalatal approach]. / Atresia congénita de coanas: abordaje por vía transpalatina.

From 1975-1990, we have diagnosed and treated 17 cases of choanal atresia. The clinical findings, diagnosis and surgical management by transpalatal means, are reviewed.

[Tracheostomy as a solution for subcutaneous emphysema and pneumomediastinum with severe respiratory failure]. / Traqueostomía como solución de enfisema subcutáneo y neumomediastino con compromiso respiratorio grave.

Subcutaneous emphysema and pneumomediastinum have many causes. Generally they course without severe pathophysiological complications and severe respiratory complications are rare. However, cases with progressive dyspnea should be treated with tracheostomy or superficial incisions. A case is reported of a patient who underwent hip surgery under general anesthesia with tracheal intubation and later presented progressive dyspnea with subcutaneous emphysema and neuromediastinum. Tracheostomy yielded satisfactory results.

[Auricular chondritis. Experimental model in rats]. / Condritis auricular. Modelo experimental en rata.

The general pattern of local inflammation in the rat is developed in the pad of the paw. In otorhinolaryngology a model of local inflammation can be reached in the rat ear by means of the production of an auricular chondritis. For that, we have protocolized the methodology. The induction of inflammation is carried out by the substance vegetable carrageenan. It has been verified by histological studies the inflammation generated, as well as studying the action of antiinflammatory, proinflammatory and inflammatory compounds. The inflammation has been measured by nonius and by determination of the activity of the myeloperoxidase enzyme. After these studies we can validate the auricular chondritis in rat as an experimental model of local inflammation in otorhinolaryngology.

[Tracheobronchial foreign bodies in childhood. Study of 133 cases and review of the literature]. / Cuerpos extraños traqueobronquiales en la infancia. Estudio de 133 casos y revisión de la literatura.

We present a series of 133 cases of children under 10 years of age with solid foreign bodies in lower respiratory tract. These cases were analysed under clinic, diagnostic and therapeutic aspects. The index of clinical diagnosis is taken into consideration, based on the respiratory symptoms and the aspirative antecedent, the radiologic diagnosis; bronchoscopy as diagnosis and therapeutic procedure, and the use of other medical and surgical treatments.

[Congenital paralysis of the vocal cords: a review of 14 cases]. / Parálisis congénita de cuerdas vocales: una revisión de 14 casos.

Were performed 220 direct laryngoscopys and bronchoscopys, from 1981 to 1990, in newborns and infants that showed as a main finding: stridor, voice change or aspiration syndromes. Fourteen (20.28%) of the 69 congenital laryngeal anomalies were vocal cord paralysis: 13 (92.8%) unilateral paralysis and 1 (7.2%) bilateral paralysis. Eleven (84.6%) of the 13 unilateral paralysis were left and 2 (15.4%) were right. The vocal cord position was noted to be median or paramedian in 13 (92.8%) patients. The etiology was idiopathic in 11 (78.5%) of the cases. The bilateral paralysis required tracheotomy and in the unilateral paralysis wasn't necessary it.

[Congenital cystic adenomatoid malformation of lung]. / Malformación adenomatoidea quística congénita pulmonar.

In the differential diagnosis of the bronchial aspiration syndrome of foreign bodies, we must place the congenital malformations among the rare causes that can simulated it. In this work, we present a case in which bronchoscopy was indicated because the existence of intrabronchial foreign body was suspected.

[Laryngomalacia: a review of 42 cases]. / Laringomalacia: una revisión de 42 casos.

In the period from 1981 to 1990, in the Children's Hospital from Sevilla were performed 220 direct laryngoscopies and bronchoscopies to newborns and infants that showed as a main finding: stridor voice change or aspiration syndromes. In the 30 percent the main cause was a congenital laryngeal anomalies. Laryngomalacia is the most common congenital laryngeal anomaly with 42 cases. For it frequency, the otolaryngologist should be familiar with the clinical findings, diagnosis and actual management.

[Neuroendocrine carcinoma of the larynx]. / Carcinoma neuroendocrino de la laringe.

A case of small-cell carcinoma of the larynx was diagnosed in a 65-year-old man whose only symptom was voice change. Two cervical lymph nodes were present. Indirect laryngoscopy demonstrated a smooth-surfaced mass on the lingual face of the epiglottis, which was confirmed by CAT of the larynx and throat. Histological study was consistent with small-cell carcinoma, is a rare neuroendocrine tumor for this site. The therapeutic strategy is described. A bibliographic review was made to clarify reports of these rare tumors using different nomenclature and classifications.

[Endoscopic diagnosis and treatment of tracheobroncheal tubercular granuloma]. / Diagnóstico y tratamiento endoscópico del granuloma tuberculoso traqueobronquial.

A retrospective study was made of ten tracheobronchial tuberculous granulomas diagnosed and treated at our Hospital. We used a fiberoptical endoscope for diagnosis and a rigid endoscope for treatment with good results.

[Melatonin in palate tonsils with recurrent acute tonsillitis and tonsillar hypertrophy]. / Melatonina en amígdalas palatinas de amigdalitis aguda recurrente e hipertrofia amigdalar.

Tonsils are a point of contact between the environment and the immune system. The pineal hormone melatonin is influenced by environmental dark-light variations and modulates the immune system. We measured the amount of melatonin present in pediatric tonsillar infectious and obstructive processes. The highest levels of tonsillar melatonin were found in tonsillar hypertrophy and the lowest levels in recurrent acute tonsillitis, with or without hypertrophy. Melatonin has an immunostimulative function and an antiapoptotic effect. The relationship between low tonsillar melatonin concentrations and infection, as well as high melatonin levels and increased tonsillar size is discussed.

[Bacteriology in infectious and obstructive adenoid-tonsillar pathology]. / Bacteriología en patología adenoamigdalar infecciosa y obstructiva.

Infectious and obstructive adenotonsillar processes are common in the pediatric population. Bacteriological and serological studies were made of acute tonsillitis, recurrent acute tonsillitis with tonsillar hypertrophy, and tonsillar hypertrophy. Positive cultures were more frequent in tonsils than in adenoids. Pathogenic microorganisms were isolated more often in infectious than in obstructive processes. Anti-streptococcal antibody titers were raised in infectious processes, but remained within normal limits in obstructive processes. Serum total IgE levels were similar in both processes. These findings show that tonsillar hypertrophy is not related directly with microorganisms or atopic pathology.

[Hypertrophy of lingual ectopic thyroid gland in pregnancy. A clinical case]. / Hipertrofia del tiroides ectópico lingual durante el embarazo. Caso clínico.

A 28-year-old female, diagnosed two years ago of euthyroid lingual thyroid, has been asymptomatic under observation without treatment until her first pregnancy. During her first pregnancy the lingual thyroid tissue increases of size and produces dysphagia, pain and oral hemorrhages. We realize a thyroid hormone treatment (thyroxine) with regular results. Two months after child-birth the female was completely asymptomatic and doesn't need actually thyroxine suppression. Various aspects are reviewed, such as the predisposing factors (puberty, pregnancy, trauma ...), clinical manifestations, diagnosis and medical and surgical treatments in this rara congenital anomaly.

[Unusual congenital laryngeal anomalies: a review of 13 cases]. / Anomalías congénitas laríngeas raras: una revisión de 13 casos.

In this study we presents: 6 subglottic stenosis, 2 subglottic hemangiomas, 2 laryngeal webs, 2 laryngeal cysts and 1 laryngoesophageal cleft. Were diagnosed during laryngotracheobronchoscopies performed to 220 newborns and small children that showed as main finding: stridor, voice change or aspiration syndrome. The stenosis, hemangiomas and cleft were resolved spontaneously. In the webs and cysts surgical correction was required. Here we will expound upon clinical, diagnostical and therapeutic aspects of these rare congenital laryngeal anomalies.

[ORL pathology in cystic fibrosis]. / Patología ORL en la fibrosis quística.

We have studied during 1991 a randomized group of 25 cystic fibrosis children whose ages were between 1 and 18 years, analyzing the disease's ENT signs. We have found polyps in the 20% of the patients points up for its high incidence, and the practical absence of otologic, pharyngeal and laryngeal processes.

[Subcutaneous emphysema and pneumomediastinum after tonsillectomy and adenoidectomy]. / Enfisema subcutáneo y neumomediastino tras amigdaloadenoidectomía.

In children, subcutaneous emphysema and pneumomediastinum are produced by bronchopulmonary infections, increased transalveolar pressure, bronchotracheal foreign bodies, and anesthetic or dental procedures. The case of a child with subcutaneous emphysema and pneumomediastinum after tonsillectomy and adenoidectomy is reported. The etiopathogenesis is discussed and the literature is reviewed.

[Tuberculosis of the cavum]. / Tuberculosis de cávum.

An elderly woman had a history of hemimandibulectomy for mandibular ameloblastoma performed 24 years earlier. In the last follow-up visit, an excrescent and ulcerative lesion was detected in the posterior wall of the cavum, below and medial to Rosenmüller's fossa, with clamps of enlarged, consistent cervical lymph nodes that was more marked on the right side. Cavum biopsy and needle biopsy of the lymph nodes revealed tuberculosis. This diagnosis usually is incidental and the differential diagnosis includes tumoral and granulomatous processes. Biopsy of the cavum is important for regional lesions with cervical lymph node enlargement.