[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

[Hearing loss associated to ulcerative colitis]. / Hipoacusia asociada a colitis ulcerosa.

OBJECTIVE: To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS: In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS: The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS: Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.

[Anticochlear antibodies titles measured by Western-blot and hearing recovery level after corticoid therapy in patients with sudden deafness]. / Titulación de anticuerpos anticocleares mediante Western-bloty grado de recuperación auditiva tras corticoterapia en pacientes con sordera súbita.

OBJECTIVES: Detection of antichoclear antibodies in patients with sudden deafness (SD) ranges from five to forty one percent depending on authors. We tried to correlate the level of antibodies measured by Western-blot (WB) and hearing loss. PATIENTS AND METHODS: Forty nine subjects bearing of SD and a positive WB for bovine cochlear antigen. Hearing loss average was measured at the onset and after treatment with deflazacort 1 mg/kg per day by means of audiometry, and antibody titles were quantified in the diluted sera. RESULTS: Initial loss was 49.4+/-20.6%, and after corticotherapy it was 15.9+/-18.0%. There was no statistically significative correlation titles-hearing loss (y=0.1122x+30.613; R2=0.7552) nor titles-recovery (y=-0.0818x+8.,65; R2=0.3229). CONCLUSIONS: Although predictive capability for treatment response is accepted for WB, quantifying of the antibody titles in patients with SD does not allow to make a prognosis about the average hearing recovery.

[A patient with hereditary spherocystosis and sudden deafness after splenectomy]. / Un paciente con esferocitosis hereditaria y sordera súbita tras esplenectomía.

We report the case of a 29 year-old male with of hereditary spherocytosis, who developed two episodes of sensorineural hearing loss in his right ear after splenectomy due to repetitive hemolytic crisis. We discuss the eventual altiopathogenic mechanism of this audiological disorder.

[Variations of salivary dismutase superoxide in tonsillar infection]. / Variaciones de la superóxido dismutasa salivar en la infección amigdalar.

The antioxidant effect of superoxido dismutase in saliva was measured in children bearing of tonsillar hypertrophy, recidivant tonsillitis or peritonsillar abscess. These levels were compared to those detected on tonsillar tissue obtained from tonsillectomy (p < 0.001). Although salivary SOD concentration in children with tonsillar infection was higher than hypertrophy, there was not a significative correlation to tonsillar value of the enzyme (R2 = 0.2276), so we can not accept a predictive value for salivary SOD of tonsillar suffering and, eventually, of tonsillectomy.

[Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood]. / Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre.

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.

[Tonsillar and erythrocyte levels of superoxide dismutase in children with and without recurrent tonsillitis]. / Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición.

BACKGROUND AND OBJECTIVES: Oxidative stress secondary to infant tonsillar infection produces the expression of local and systemic antioxidants. Its determination seems to be useful as a marker of tonsillar suffering before tonsillectomy but is currently unknown. The aim of this study was to determine the evolution of this parameter in tonsillectomized children during a long-term follow-up. METHODS: One hundred thirty-six children underwent tonsillectomy, 46 for tonsillar hypertrophy without infection and 90 for recurrent tonsillitis. Superoxide dismutase (SOD) concentrations were measured before tonsillectomy and at 6, 12, 24 and 36 months post-tonsillectomy. RESULTS: Infection provoked significantly higher SOD concentrations than tonsillar hypertrophy in tonsillar tissue (223.06 30.46 vs 156.39 54.05 U/l, p < 0.001) and in blood (1124.91 141.73 vs 1007.19 97.03 U/gr Hb, p < 0.001). There was a strong correlation between tonsillar and erythrocyte concentrations. During the 3-year follow-up, SOD concentrations in blood progressively decreased until stabilizing in all patients. Stabilization was reached at 6 months post-tonsillectomy in the group with tonsillar hypertrophy and at 2 years in the group with infection. Children with recurrent tonsillitis consistently showed higher SOD concentrations in blood throughout the follow-up. CONCLUSIONS: Oxidative damage in tonsillar tissue results from the incidence and severity of focal infections. Tonsillectomy reduces SOD levels but, as a consequence of oxidative stress, these do not return to normal.

[Co-administration of histamine H1 antagonist and oral anticoagulants]. / Empleo simultáneo de antihistamínicos H1 y anticoagulantes orales.

Indications for oral anticoagulation and antihistamine H1 antagonists therapies are increasingly. So, it is easy to find individuals who need both treatments. The unknowledgement about possible interferences of antihistamines over acenocumarin often makes to avoid them at the same time. A review on a population receiving anticoagulation on a Therapeutic Center allowed us to verify disorders secondary to the association of antihistamines into their therapeutic scheme. Loratadine, ebastine and cetirizine show similar records of interaction into acenocumarin pharmacokinetics, probably due to a liver enzymatic induction on the anticoagulant drug, producing a decrease on INR values in which anticoagulation is measured. This could make necessary to increase temporally acenocumarin dose. During coadministration no thromboembolic event nor bleeding were registered.

[Pathophysiological rationale for the use of piracetam in sudden deafness]. / Argumentación fisiopatológica al empleo de piracetam en la sordera brusca.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

[Lipoperoxidation in otorrhea of the middle ear as a marker of infection. Clinical application]. / Lipoperoxidación en otorreas del oído medio como marcador de infección. Aplicación clínica.

If the generation of free oxygen radicals is a pathophysiological finding in middle-ear infections, as has been reported, demonstration of the oxidative consequences of free radicals in middle-ear exudates may be a quick, simple, objective and accessible test for quantifying the degree of mucosal injury. Therefore, samples of the discharge fluid from cases of acute otitis media (n = 17), cholesteatoma (n = 17), chronic discharge in the absence of cholesteatoma (n = 10), and secretory otitis media (n = 15) were tested using an enzymatic colorimetric assay for lipid peroxide levels due to superoxide and hydroxyl radicals during infection. Lipid peroxide levels in acute otitis media, cholesteatoma, and chronic discharge without cholesteatoma ranged from 575 to 650 nmol/mg of exudate, and was 67 nmol/mg in secretory otitis media, which were statistically significant findings. Infectious otitis media showed findings secondary to increased oxidative metabolism, but not secretory otitis media. Measurement of this oxidative metabolism could serve to monitor the evolution of episodes, as well as to detect relapse or reinfection, and to evaluate response to new therapeutic options for suppurative otitis, such as topical antioxidants.

[Detection tonsillar pathology by superoxide dismutase levels. Comparative study of surgical indications for tonsillectomy]. / Detección de patología amigdalar mediante los niveles de superóxido dismutasa. Estudio comparativo por indicaciones quirúrgicas de amigdalectomía.

If oxygen-derived free radicals are considered the definitive cause of tonsillar damage after infection, it seems reasonable that scavenger antioxidants levels could be used as a detector of tissue impairment. So, superoxide dismutase (SOD) amounts were measured in palatine tonsils and peripheral blood on subjects bearing of hypertrophy without infection (H, n = 83), recurrent tonsillitis (RA, n = 75), and peritonsillar abscess (PA, n = 12). SOD levels in both tonsillar cultures supernatants and peripheral blood erythrocytes were detected progressively increased in groups with H, RA and PA, which were statistically significative (ANOVA-test; p < 0.001). A significative correlation between tissue and blood was observed for all the groups. We can conclude that SOD concentration in palatine tonsils and/or peripheral blood increases proportionally to infections incidence, which allows detecting patients with functional damage, and recommending objectively tonsillectomy or at least monitoring clinical response for a therapy. Practical use and results obtained from comparison to tonsil biopsies are discussed.

[Our experience in the management of peritonsillar phlegmon and abscess in children]. / Conducta ante el flemón y el absceso periamigdalinos en la infancia desde nuestra experiencia.

OBJECTIVE: Our objective was to evaluate the possible causes of the increased incidence of peritonsillar abscess in children during recent years, since up until now this condition has been unusual in children. PATIENTS AND METHODS: A retrospective study of all cases diagnosed in the Emergency Room between 1983 and 1998 detected nine children admitted to the hospital with painful swallowing, high fever and trismus. All of them underwent fine needle aspiration and transcutaneous ultrasound. RESULTS: The mean age was 9.8 years. Eight children suffered previous pharyngo-tonsillar infection, although emergency assistance was only confirmed in four cases. Six children were treated with macrolides, two with amoxicillin and one with cefuroxime. Exploration always diagnosed peritonsillar infection and needle aspiration detected an abscess in six cases. Ultrasound did not provide new information. In cases with abscess, drainage was performed and in three patients under general anesthesia. Bacteriologic cultures showed a lack of correlation between the isolates from the tonsillar surface and from pus from the abscess or tonsillar core. In the latter two there was a preponderance of Haemophilus influenzae and anaerobes. All children received intravenous antibiotic therapy and delayed tonsillectomy was done. There were no complications. CONCLUSIONS: Infant cases of peritonsillar abscess are increasing and there is no clear relationship with acute tonsillar infections, but probably with the use of inadequate antibiotics.

[The nonserological diagnostic approach to infectious mononucleosis in an emergency service]. / Aproximación diagnóstica no serológica a la mononucleosis infecciosa desde el Servicio de Urgencias.

Patients with infectious mononucleosis often are seen in Emergency Services because the infection may produce tonsillitis resistant to antibiotic therapy. However, the diagnosis of choice is specific serology, which usually takes days or weeks before results become available. Detection of lymphocytosis in peripheral blood, heterophilic antibodies, and the characteristic mononuclear cells by means of specialized blood counters, together with the clinical signs, have improved the quality of diagnosis in emergency services (93% sensitivity and 97.2% specificity). We found that simple identification by optical microscopy of the lymphomonocytes typical of infectious mononucleosis in a drop of peripheral blood, together with the clinical findings, have a better diagnostic sensitivity (96. 5%) and specificity (99.1%) than any other method available in emergency services.

[The measurement of superoxide dismutase levels in recurrent tonsillitis. Its practical use]. / Medida de los niveles de superóxido dismutasa en la amigdalitis de repetición. Utilidad práctica.

Superoxide radicals generated in the palatal tonsils by recurrent local infections cause an organic response consistent in synthesis of superoxide dismutase. Tonsillar concentrations of this enzyme correlate with the incidence of tonsillitis. Moreover, superoxide dismutase levels in erythrocytes rise in children proportional to tonsillar concentration in a statistically significant way (y = 0.2356x - 64.918; R2 = 0.9266). The similarities in local and systemic changes in recurrent tonsillitis suggest that the determination of superoxide dismutase in peripheral blood could be a good screening method for determining who should undergo tonsillectomy.

[Clinical response of gabapentin for glossopharyngeal neuralgia]. / Respuesta clínica a la gabapentina en la neuralgia del glosofaríngeo.

INTRODUCTION: The analgesic effect of the antiepileptic drug gabapentin makes it useful as an alternative for neuropathic pain. Its structural resemblance to other GABAergic antiepileptic drugs does not explain its mechanism of action, which seems not to depend on the activation of GABA receptor. Glossopharyngeal neuralgia is a rare entity which presents paroxystic crisis of pain, often with unknown etiology and poor response to treatment. CLINICAL CASES: Nine patients bearing of IX root neuralgia resistant to other therapies and ages ranged from 43 to 71 years old are being treated with gabapentin at doses between 800 and 3,600 mg daily in a period of time between two and sixteen months. Four cases in which magnetic resonance detected a compression of the nerve by posterior inferior cerebellar artery were submitted to a decompression surgery, but it was not effective. Gabapentin, alone or in association to carbamazepine, reduced the frequency and severity of crisis in seven patients, but in those with vascular compression the response was poorer. CONCLUSION: Gabapentin can be considered as an useful option for the management of glossopharyngeal neuralgic crisis, associated or not to other agents, for a short and long time, because of its good tolerance and lack of interactions.

[Bilateral peripheral facial paralysis and Guillain-Barré syndrome]. / Parálisis facial periférica bilateral y síndrome de Guillain-Barré.

The Guillain-Barrè syndrome is a polyneuropathy of acute onset that initially tends to produce motor damage of the lower limbs, albumin-cytological dissociation in cerebrospinal fluid and electrophysiological findings suggestive of demyelination. This entity produces a wide variety of symptoms, including damage to the facial nerve in as many as half of all episodes, which means that this syndrome should be considered in the differential diagnosis of facial palsy, particularly bilateral and synchronous cases. In a review of six cases of Guillain-Barrè syndrome in which bilateral facial palsy occurred at some point, a history of immediate infection was confirmed in five, mainly related to Herpesvirinae and Campylobacter. One case began with bilateral palsy, whereas palsy appeared almost simultaneously with the rest of the symptoms in the other cases. High protein levels without cells in cerebrospinal fluid and electrophysiological patterns of slow facial nerve conduction were confirmed in every patient. Treatment with intravenous immunoglobulins resolved all episodes in less than six months. We conclude by reiterating the need for awareness of this syndrome in every case of peripheral VIIth nerve palsy, especially bilateral cases, although the associated symptoms were not very useful, if at all useful.

[Clinical evaluation and application of lipid peroxidation produced by tobacco smoke in the tracheal mucosa]. / Evaluación y applicación clínicas de la peroxidación lipídica en mucosa traqueal por humo de tabaco.

The oxidative stress level produced by tobacco smoke on the respiratory system was evaluated by studying lipid peroxidation in the tracheal mucosa of samples obtained by tracheostomy from nonsmokers. Conjugated dienes, derived from fatty acids present in tissue, were measured in the sample. The absence of polymorphonuclear leukocytes and macrophages in the tracheal mucosa make it a more suitable model than lung parenchyma because it excludes the peroxidation produced by inflammatory cells. The tracheal mucosa was exposed to different numbers of smoke puffs, then submitted to recovery with humidified air for different time periods. The effect of diene production on several antioxidants--superoxide dismutase, catalase, deferroxamine--was studied. Exposure to four puffs of tobacco smoke from a cigarette was enough to produce lipid oxidation in samples. This activity was evident 15 minutes after exposure to smoke. When antioxidants were placed on sample surfaces, lipid peroxidation was abolished. We conclude that tobacco smoke has a peroxidant activity independent of that produced by inflammatory cells, but probably mediated by free radicals. Therefore, the tracheal model seems suitable for the evaluation of respiratory epithelial oxidation in response to tobacco smoke.

[Comparison of azithromycin, amoxicillin/clavulanic acid and cefaclor in the treatment of acute ENT infections]. / Comparación de azitromicina, amoxicilina/ácido clavulánico y cefaclor en el tratamiento de la infección aguda otorrinolaringológica.

A comparison was made of the clinical effectiveness of azithromycin (once daily for three days at a dose of 10 mg/kg in children or 500 mg/day in adults) and amoxicillin/clavulanic acid and cefaclor (standard doses for 7 to 14 days) in acute ear, nose and throat infections in an open randomized study. The group with azithromycin included 37 otitis media, 24 pharyngotonsillitis and 6 maxillary sinusitis (n = 67). The amoxicillin/clavulanic acid group, 22 otitis media, 19 pharyngotonsillitis and 6 maxillary sinusitis (n = 47) and the cefaclor group, 15 otitis media, 12 pharyngotonsillitis and 4 maxillary sinusitis (n = 31). Fifteen days after beginning treatment, 97% (65/67) of the patients who received azithromycin had improved or cured, compared with 85% (40/47) of those who received amoxicillin/clavulanic acid and 84% (26/31), cefaclor (p < 0.02). Pathogens were not eradicated in 3% (2/58) of the patients who received azithromycin, compared with 13% (4/28) who received amoxicillin/clavulanic acid and 15% (4/28) cefaclor. Patients with azithromycin showed an earlier clinical improvement and more rapid normalization of the leukocyte count, erythrocyte sedimentation rate and acute phase proteins. No patient with azithromycin had adverse effects, versus 15% (7/47) for patients with amoxicillin/clavulanic acid and 16% (5/31) for cefaclor. Treatment compliance was 100, 83 (39/47) and 84% (26/31), respectively (p < 0.01). We conclude that azithromycin treatment for three days is faster and more effective clinically and analytically than standard treatment with amoxicillin/clavulanic acid or cefaclor in acute infections of the ear, nose and throat.

[Facial paralysis after non-otologic surgery under general anesthesia]. / Parálisis facial tras cirugía no otológica bajo anestesia general.

Peripheral facial palsy is rare after non-otological surgery under general anesthesia. The condition generally is attributed to damage produced by endotracheal intubation maneuvers in patients with anatomic variants of the facial nerve. We report three cases of facial palsy which occurred after abdominal surgery. In every case, nitrous oxide gas was used in anesthesia. One patient had intubation via tracheostomy; all the patients had endocranial facial symptoms and a history of previous surgery. The diversity of these factors suggests that other mechanisms of production aside from damage produced by endotracheal intubation should be considered. The use of nitrous oxide increases middle ear pressure and could produce focal nerve compression. This does not invalidate earlier hypotheses, but does clarify pathophysiological concepts of this condition.

[Recurrent epistaxis in children as an indicator of hemostatic disorders]. / Epistaxis de repetición en niños como indicador de alteraciones de la hemostasia.

OBJECTIVE: To distinguish which nosebleeds in children hide an underlying coagulation disorder, characteristics of recurrent epistaxis were evaluated correlating the severity with a battery of specific tests on primary and secondary hemostasis. PATIENTS AND METHODS: Epistaxis of fifty-eight children were classified as mild or severe according to frequency, duration, amount of blood lost, proportion of life that nosebleeds have been recurrent and uni- or bilateral bleeding. Epidemiological characteristics were evaluated, as well as hemostatic tests including: platelet count, mean platelet volume, plasmatic fibrinogen level, prothrombine time, activated partial thromboplastin time, thrombin time, bleeding time, von Willebrand factor antigen and ristocetin cofactor, factor VIII coagulant, and platelet aggregation to different agents. The effect of drugs or the presence of tumors was discarded. RESULTS: In the group of children with mild epistaxis (n = 39) there were three cases with laboratory abnormalities (10.3%). In severe epistaxis (n = 19) abnormalities were found in eleven cases (57.9%) and specific entities were detected in six of them (three children with von Willebrand's disease, one Bernard-Soulier syndrome, one autoimmune thrombocytopenic purpura and one Rendü-Osler-Weber disease). Epistaxis labeled as mild needed less cauterizations and packings, were more related to seasonal prevalence and self-handling, and poorly influenced iron metabolism. CONCLUSIONS: The five qualities pointed out on recurrent epistaxis in children allow the identification of who must be thoroughly studied by means of specific tests to rule out any kind of hemostatic disorder.