Seudoaneurisma micótico de la arteria radial por Staphylococcus aureus. Una complicación de la cateterización arterial / Radial artery mycotic pseudoaneurysm due to Staphylococcus aureus: A complication of the arterial line

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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.

Angiofibroma nasofaringeo juvenil. Situación actual / Juvenile nasopharyngeal angiofibroma

El angiofibroma nasofaríngeo juvenil (AJN) es un infrecuente tumor benigno y altamente vascularizado. En esteartículo se presenta un caso tratado en nuestro servicio. Se describe la forma de presentación, pruebas diagnósticas, preparación previo al tratamiento mediante embolización de arterias nutricias por parte de los neurorradiólogos vasculares, y la vía de abordaje LeFort para el tratamiento.Debido a la complejidad del abordaje por su localización, alta recurrencia, e histopatología; la cirugía siempre ha tenido un cierto grado de morbilidad. La embolización preoperatoria ha contribuido a disminuirla.Se presenta una revisión bibliográfica de las últimastendencias sobre la situación actual sobre este tumor

Juvenile Juvenile nasopharyngeal angiofibroma (JNA) is a benign and highly vascular tumor. In this article we present a case treated in our institution. We present form of presentation, exploration and intra-arterial pre-operative embolization by neuroradiology, and the treatment with the Le Fort technique. JNA has a complex anatomy, high recurrence and special histopathology, therefore the surgery is very complex and as an with high morbidity. The pre-operative embolization has decrease the hemorragic complications. We review the literature the of the JNA nowadays

[Assessment of drug treatment for hypertension in a health centre as a function of associated chronic pathologies and degree of control of the hypertension]. / Valoración del tratamiento farmacológico antihipertensivo en un centro de salud en función de las patologías crónicas asociadas y grado de control de la HTA.

OBJECTIVE: To assess the suitability of whatever hypertension medication is prescribed for the associated pathology in each patient, and to analyse the monitoring of blood pressure figures. DESIGN: A cross-sectional descriptive study.Setting. Urban health centre. PATIENTS: The target population were the hypertension patients being treated with medication and monitored at the health centre. Stratified random sampling by quotas of the total number with hypertension was performed. The sample numbered 219 patients. MEASUREMENTS: The clinical history of each patient selected was reviewed. To evaluate the hypertension treatment, we established three levels of suitability with regard to the accompanying pathology of each patient (suitable, intermediate, unsuitable), using the 1999 Hypertension Protocol of the Spanish Society of Family and Community Medicine. RESULTS: Out of 219 cases, treatment was suitable in 71 (32.4%), intermediate in 91 (41.6%), and unsuitable in 57 (26%). The most frequently indicated drug group was the angiotensin converting enzyme inhibitor (ACEI) group and, jointly, ACEI and diuretics. Regarding the monitoring of blood pressure: 66.5% had very good monitoring, 23.2% partial and 9% poor. CONCLUSIONS: Most treatments are at an intermediate level of suitability: without beneficial or undesirable effects on the associated pathology. This makes us think we need to optimize the drug indicators for hypertension.

Valoración del tratamiento farmacológico antihipertensivo en un centro de salud en función de las patologías crónicas asociadas y grado de control de la HTA / Assessment of drug treatment for hypertension in a health centre as a function of associated chronic pathologies and degree of control of the hypertension

Objetivos. Valorar la adecuación del tratamiento farmacológico antihipertensivo prescrito según la patología asociada en cada paciente y analizar el control de cifras tensionales. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud de área urbana. Participantes. La población diana fueron los pacientes hipertensos en tratamiento farmacológico y controlados en el centro de salud. Se realizó muestreo aleatorio estratificado por cupos del total de hipertensos, y la muestra fue de 219 hipertensos. Mediciones. Se revisó la historia clínica de los pacientes seleccionados. Para la evaluación del tratamiento antihipertensivo establecimos tres niveles de adecuación (adecuado, intermedio y no adecuado) basándonos en el protocolo de hipertensión arterial de 1999 de la Sociedad Española de Medicina de Familia y Comunitaria, teniendo en cuenta la patología concomitante en cada paciente. Resultados. De 219 casos, el tratamiento fue adecuado en 71 (32,4 por ciento), intermedio en 91 (41,6 por ciento) y no adecuado en 57 (26 por ciento). El grupo farmacológico más frecuentemente indicado fue el de inhibidores de la enzima de conversión de la angiotensina (IECA) y en asociación: IECA + diuréticos. Respecto al control de tensión arterial, un 66,5 por ciento presentó un control óptimo, el 23,2 por ciento un control parcial y un 9 por ciento mal control. Conclusiones. La mayoría de los tratamientos se encuentran en un nivel de adecuación intermedio: sin efectos beneficiosos ni indeseables sobre la patología asociada. Esto nos hace pensar en la necesidad de optimizar las indicaciones farmacológicas antihipertensivas (AU)

[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.

[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.

[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.

Is conservative treatment of deep neck space infections appropriate?

BACKGROUND: A 31-patient prospective series on deep neck infections, managed at Hospital Ramón y Cajal in Madrid, Spain, is presented. METHODS: A prospective study was conducted from January 1994 to December 1997, including all parapharyngeal or retropharyngeal infections. Clinical and radiologic findings and length of stay in the hospital were registered. Medical treatment was instituted with broad-spectrum antibiotics, and surgery was reserved for those patients not responding to medical treatment. RESULTS: Twenty-four patients (77.42%) had parapharyngeal, 3 (9.68%) retropharyngeal and 4 (12.90%) mixed infections. On the basis of clinical and CT findings, 19 cases (61.29%) were considered abscesses and 12 (38.71%) cellulitis. Medical treatment was successful in all but 3 cases (90.32%), with no major complications. All the patients were discharged from the hospital within 20 days after admission (mean, 8.09 days). CONCLUSIONS: Despite the wide use of antibiotics, deep neck space infections are commonly seen. Although most reports are based on surgical treatment followed by antibiotics, medical treatment could be as successful as open surgical drainage in most cases.

[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.

Absceso parafaríngeo: extesnión infrahioidea perilaríngea / Parapharyngeal abscess: perilaryngeal infrahyoid extension

Los abscesos parafaríngeos están localizados entre la base del cráneo y el hueso hioides. Su extensión infrahioidea es generalmente por el espacio retrofaríngeo, pero también puede tener lugar por la cara medial del espacio parafaríngeo. Así, al rodear la fascia visceral, pueden invadir los espacios perilaríngeo y perihipofaríngeo, con mayor compromiso de la vía aérea. La tomografía computarizada resulta esencial para valorar la localización y extensión de la infección, especialmente en relación con los grandes vasos. Presentamos 8 abscesos parafaríngeos con extensión perilaríngea y/o perihipofaríngea. Se revisa su presentación clínica y radiológica, basada en la tomografía computarizada, así como su tratamiento médico y quirúrgico. Cuando fracasa el tratamiento médico, como su localización es medial a los grandes vasos, es posible su aspiración y drenaje transoral, sin necesidad de recurrir a la cervicotomía, en casos seleccionados (AU)

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 (AU)

Absceso periamigdalino con extensión parotídea y perifaríngea. A propósito de un caso / Periamydaline abscess with parotid and parapharyngeal extension. Based on one case

El absceso periamigdalino es la complicación más frecuente de una infección amigdalar. La acumulación de pus en el espacio periamigdalino puede extenderse por los espacios virtuales del cuello delimitados por las capas faciales cervicales. Estas infecciones cervicales profundas pueden representar una complicación seria que incluso amenace la vida del paciente. El tratamiento de estas infecciones incluye una correcta antibioterapia y el drenaje del absceso, casi siempre mediante cirugía. Presentamos un caso clínico de un gran absceso retrofaríngeo, parafarÍngeo y parotídeo, originado a partir de un absceso periamigdalino que precisó tratamiento quirúrgico para su drenaje (AU)

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 (AU)

[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.

[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.

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

Presentamos un tumor poco frecuente en lafosa nasal encontrado inesperadamente en el contexto de una poliposis nasal. El paciente se quejaba de obstrucción nasal bilateral de varios años de evolución como único síntoma. El tumor se resecó por rinotomía lateral. Nuestro diagnóstico diferencial incluía glioma nasal y papiloma invertido, pero todas las hipótesis preoperatorias fueron incorrectas al no sospechar esta variedad de tumor tan rara. Cuatro años después de la cirugía, el paciente se encontraba libre de enfermedad. El riesgo de recidiva de este tumor es bajo, según los casos descritos en la bibliografía. Tanto cirujanos como anatomopatólogos debemos tener en cuenta la existencia de éste y otros tumores poco frecuentes en la fosa nasal, ya que algunos requieren un diagnóstico especial y/o procesos terapéuticos específicos (AU)

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 (AU)

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

Los quistes del conducto tirogloso son una de las masas cervicales benignas más frecuentes. Suponen un fallo del cierre del conducto tirogloso que en ocasiones está en íntimo contacto con el cuerpo del hioides, con múltiples tractos, que se presentan especialmente en pacientes jóvenes. La técnica quirúrgica que hasta hoy ha demostrado mejores resultados es el procedimiento que introdujo Sistrunk en 1920 y que modificó en 1928, basado en la extirpación de la porción central del hueso hioides. Con esta técnica se consiguió reducir el número de recidivas con respecto a la excisión local del quiste. Presentamos una revisión retrospectiva de 58 casos valorando los resultados quirúrgicos, especialmente la tasa de recidiva encontrada en relación a la extirpación o no del hioides, comparándolo con las series publicadas (AU)

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 (AU)

[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.

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.

[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.

[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.