A correlation between age and Actinomyces in the adenotonsillar tissue of children.

The purpose of this study was to investigate the presence of actinomyces in adenotonsillar disease, recurrent infections, or tonsillar hypertrophy in children. The study included 64 patients, ranging in age from 2 to 16 years, who had elective adenotonsillar surgery to treat either adenotonsillar hypertrophy (36 children) or recurrent adenotonsillitis (28 children). Adenotonsillar Actinomyces was present in 30 children (48%). No statistical significance was found between Actinomyces and recurrent adenotonsillitis or adenotonsillar hypertrophy. However, there was a statistically significant relationship identified between the presence of actinomycosis and age, with a greater occurrence of actinomycosis in children between 5 and 16 years old.

Tumefactive fibroinflammatory lesion of the head and neck treated with steroids: a case report.

Tumefactive fibroinflammatory lesion is an idiopathic fibrosclerosing disorder of the head and neck region that clinically simulates a malignant process, but is histologically benign. This lesion is believed to be part of a broader fibrosclerotic syndrome that includes idiopathic mediastinal and retroperitoneal fibrosis, sclerosing cholangitis and Riedel's thyroiditis. The tumefactive fibroinflammatory lesion differs from other fibrosing conditions encountered in the head and neck region: fibromatoses, nodular fasciitis and fibrosarcomas. Although there is no optimum treatment, steroid therapy is suggested as the first line of management. Our patient was treated with corticosteroids and had a favourable response, supporting this approach as the initial treatment.

Prophylactic percutaneous sealing of lumbar postdural puncture hole with fibrin glue to prevent cerebrospinal fluid leakage in swine.

UNLABELLED: We explored the effect of fibrin glue injection at the site of dural puncture on cerebrospinal fluid (CSF) leakage in a swine model. Pigs were subjected to a lumbar dural CSF puncture in the sitting position with a 17-gauge Tuohy needle. Fibrin glue 1.4 mL was injected through the same needle into the epidural space. Evans blue dye was infused through the cisterna magna 15 min later, and the appearance of dyed CSF through the skin puncture and along the needle trajectory to the dura was inspected and categorized. In seven of eight animals, the CSF leak was sealed with fibrin glue. Control animals were injected with 1.4 mL saline. A sham operation group of animals underwent cisternal dye infusion without a lumbar puncture. CSF pressure at the cisterna magna was recorded throughout the procedure. No significant differences in the leakage indicators were found between the fibrin glue-injected and sham-operated group, whereas both groups showed significant differences with respect to the control group. The fibrin glue seal was effective against CSF pressures of 24.5 [17-31] cm H(2)O. We conclude that percutaneously injected fibrin glue is effective in stopping CSF leaks after dural puncture in this animal model. IMPLICATIONS: In this swine study, we repaired a cerebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue seems promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.

[Thymoma. A retrospective study]. / Timomas. Estudio retrospectivo.

We review cases of thymic cell tumor treated between January 1991 and March 1998. Nineteen of the 23 cases studied involved thymoma. Eight (42%) were asymptomatic, 4 (21%) were associated with myasthenia gravis and 7 (37%) were symptomatic. The most common symptom was non-specific chest pain, reported by 4 (47%) patients with symptoms. Classifying the cases of thymoma by Masaoka's system, we found that 12 were cases of thymoma in stage I (63.2%), 4 in stage II (21.1%) and 3 in stage III (15.8%). No stage IV patients were treated. Treatment consisted of full exeresis of the tumor in 17 (89.5%) cases, partial resection in one case (5.2%) and biopsy of the tumor in one non-resectable, case. Adjuvant radiotherapy was applied in seven cases. Chemotherapy was not prescribed. With follow-up ranging from 9 to 96 months, half the patients survived 21 months after surgery. Among the surviving patients, mortality was nil at the end of the study. The results of microscopic, cytologic and blood analyses were of scarce value in differentiating between benign and malignant tumors, even though p53 and bcl2 antigen positivity and clinical stage have been related to poor prognosis in recent years.

The effect of fibrin glue patch in an in vitro model of postdural puncture leakage.

UNLABELLED: We studied the possibility of stopping a continuing transdural leakage with fibrin glue, a biologic adhesive, in an in vitro model. The model was made by sealing the bottom of a tube filled with saline to a height of 50 cm with a human lyophilized dural specimen. Dural punctures were performed with a 17-gauge Tuohy needle. The needle was then withdrawn, and 0.8 mL of fibrin glue was injected through the same needle to seal the defect. The column was refilled 3 min after sealing. The pressure in the intrathecal chamber was measured during the procedure. Macroscopic and microscopic histological studies of the dura and the fibrin plug were performed. In the five cases studied, the leak was sealed by the fibrin plug at closing pressures of 25-35 cm H2O, and no further leakage was detected after refilling. The dural specimens showed a fibrin glue plug stuck at the edges of the hole. We conclude that fibrin glue stops leakage of fluid from dural holes created by a 17-gauge Tuohy needle in an in vitro pressurized model. IMPLICATIONS: We explored the possibility of repairing a cerebrospinal fluid leak produced by an accidental dural puncture during epidural anesthesia by percutaneously injecting tissue adhesive in vitro. This technique seems promising for the prophylaxis and treatment of the headache associated with this leakage but requires further study in vivo.

[Bronchial carcinoid tumors: a prospective study]. / Tumores carcinoides bronquiales: un estudio prospectivo.

We report the results of a study performed in the thoracic surgery department of Hospital General Universitario of Valencia from October 1989 to December 1996. Of the 621 patients diagnosed of lung cancer during this period, 320 underwent the usual surgical excision, 18 were confirmed histologically as bronchial carcinoid tumors, indicating an incidence of 5.6% of all pulmonary neoplasms resected in our department. The symptoms most often reported were recurring infection (44.5%) and chest pain (33.3%). Only one patient presented carcinoid syndrome. The most common radiologic presentation was solitary pulmonary nodule (50%). The tumor was visible by fiberoptic bronchoscopy in 9 cases. Diagnosis was by bronchial biopsy in four cases. Confirmation was by immunohistochemical analysis of the specimen in all cases. Electron microscopy and immunohistochemical techniques using neuroendocrine panmarkers is considered fundamental for differentiating between neuroendocrine neoplasms and typical and atypical carcinoid tumors. Thirteen (72.2%) of the 18 patients studied were diagnosed of typical carcinoids and 5 (27.8%) of atypical carcinoids. Neuroendocrine marking showed neurospecific enolase in 15 patients and chromogranin positivity in 10.

Cholesterol granuloma of the middle ear: report of 5 cases.

Cholesterol granulomas of the middle ear (CGME) constitute a focal inflammatory response with foreign body giant cells mobilized against the presence of cholesterol crystals. The air spaces within the temporal bone are commonly affected, especially in association with chronic disease of the middle ear involving diminished ventilation. The aim of this paper is to review 5 cases of CGME. The authors intend to establish the etiology of CGME and its likely relationship with other common middle ear diseases.