Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial.

OBJECTIVE: Evaluate the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder. METHODS: In a multicentre controlled randomized study, participants were recruited with a clinical diagnosis of unilateral subacromial syndrome from six rehabilitation medicine departments belonging to the Public Health System in two Spanish regions. All participants received 15 sessions of physiotherapy during the 3 weeks that the treatment lasted and were randomized to additionally receive, once a week, acupuncture or mock TENS (transcutaneous electrical nerve stimulation). The primary outcome measure was the change in the Constant-Murley Score (CMS) for functional assessment of the shoulder, at 4 weeks after randomization. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN28687220. RESULTS: A total of 425 patients were recruited. The mean score (s.d.) on the CMS had increased by 16.6 (15.6) points among the acupuncture group, compared with 10.6 (13.5) points in the control group, and the mean difference between the two groups was statistically significant (6.0 points; 95% CI 3.2, 8.8 points; P < 0.001). By the end of the treatment, 53% of the patients in the acupuncture group had decreased their consumption of analgesics, compared with a corresponding 30% among the control group (P < 0.001). CONCLUSIONS: Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments.

[Sump syndrome. Treatment by endoscopic biliary "rendez-vous" procedure]. / Síndrome del sumidero. Tratamiento mediante "rendez vous" biliar endoscópico.

Sump syndrome consists on an entity in which the distal portion of the biliary tree does not drainage by the major papilla, so food and bile are retained and infections could appear leading to cholangitis. The real incidence of the sump syndrome after side-to-side choledocoduodenostomy is unknown, but has been described less than 10%. Several procedures have been used to solve it but at present endoscopic sphincterotomy is of choice the treatment of this condition that is followed by a good outcome. When major papilla can not be negotiated, an endoscopic approach consisting in a biliary endoscopic <> procedure could be used, negotiating the biliary tree by the side-to-side choledocoduodenostomy in this case. We report a clinical case of a patient with a side-to-side choledocoduodenostomy because of choledocolithiasis who developed a sump syndome. He was treated by a biliary endoscopic <> procedure because a papillary stenosis did not allow a transpapillar access to the biliary tree.

[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.

[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.

[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.

[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.

[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.

Autotransplante de caninos incluidos / Remplantation of cuspid

Presemtamos un estudio realizado en 10 autotransplantes de caninos incluidos, colocados en neoalvéolos y puestos en función. El caso más antiguo lleva seis años de evolución y ninguno de ellos se ha perdido hasta el momento. Es un procedimiento poco usado y prácticamente inutilizado desde la llegada de los implantes oseointegrados. Creemos firmemente que en casos bien seleccionados este método es de elección sobre todos los demás