Enfermedad relacionada con IgG4 con afectación exclusiva nasosinusal: presentación de un caso clínico y revisión de la literatura / IgG4 related disease with exclusive sinonasal involvement: A case report and literature review

La enfermedad relacionada con IgG4 (ER-IgG4) es un proceso patológico que ha unificado un gran número de enfermedades consideradas como propias de distintos órganos cuya etiopatogenia se desconocía. Su diagnóstico se establece mediante criterios histológicos, radiológicos y serológicos. El tratamiento se basa en corticoides durante tiempo prolongado, reservándose el uso de rituximab para casos refractarios. Es extremadamente inusual que esta entidad asiente solo en cabeza y cuello sin afectación sistémica, por lo que hay pocos casos como el que presentamos descritos en la literatura. Exponemos el caso de una paciente con una tumoración orbitaria con afectación de senos paranasales, diagnosticada de ER-IgG4 nasosinusal. La precisión del diagnóstico propició el inicio precoz de tratamiento corticoideo. En la actualidad la paciente se encuentra asintomática

IgG4 related disease (igG4-RD) is a pathological process which integrates a large number of diseases of unknown pathogenesis, considered as being exclusive to many different organs. Diagnosis is established through histological, radiological and serological criteria. Treatment is based on long term corticosteroids; rituximab being used only in refractory cases. It is unusual for this entity to be found exclusively in the head and neck, without systemic involvement; there are only a few reported cases to date. We present a case of a nasosinusal IgG4-RD orbital tumor with paranasal sinus involvement. The accurate diagnosis made early onset corticosteroid treatment possible and the patient is currently asymptomatic

[IgG4 related disease with exclusive sinonasal involvement: A case report and literature review]. / Enfermedad relacionada con IgG4 con afectación exclusiva nasosinusal: presentación de un caso clínico y revisión de la literatura.

IgG4 related disease (igG4-RD) is a pathological process which integrates a large number of diseases of unknown pathogenesis, considered as being exclusive to many different organs. Diagnosis is established through histological, radiological and serological criteria. Treatment is based on long term corticosteroids; rituximab being used only in refractory cases. It is unusual for this entity to be found exclusively in the head and neck, without systemic involvement; there are only a few reported cases to date. We present a case of a nasosinusal IgG4-RD orbital tumor with paranasal sinus involvement. The accurate diagnosis made early onset corticosteroid treatment possible and the patient is currently asymptomatic.

Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado / Assessment of degree of psychological health involvement in pre-laryngectomized patients

Introducción y objetivos: Diferentes autores han puesto en evidencia el aumento de ansiedad en los pacientes el día anterior a una intervención y su correlación con los niveles de ansiedad en el post-operatorio. En este trabajo estudiamos una serie de problemas que a menudo se obvian en el paciente intervenido de laringectomía total: la traqueotomía, el quedarse sin voz y el ser una agresiva e importante intervención quirúrgica. Nuestro objetivo es valorar el grado de ansiedad y los miedos del paciente previo a la laringectomía total. Material y métodos: Se comparan 2 grupos de 20 pacientes que fueron intervenidos de laringectomía total y de otras enfermedades de ORL. El día anterior a la operación, recogíamos sus datos sociodemográficos y médico-quirúrgicos, y se les aplicaba el Mini-Examen Cognoscitivo (MEC) de Folstein y el Cuestionario de Salud General de Goldberg (GQH-28) en sus versiones españolas. Exploramos si tenían algún temor o miedo ante la intervención y en qué consistía ese miedo. Resultados: Tras la realización del MEC, sólo un paciente presentó deterioro cognitivo. Posteriormente realizábamos el GHQ-28 y nos encontramos con un malestar psicológico entre el 20y el 25% de los casos. Al comparar mediante el X2 los diferentes miedos en los 2 grupos los resultados no son estadísticamente significativos. Conclusiones: La laringectomía total provoca la pérdida de la comunicación oral y la distorsión de la autoimagen, lo que contribuye a una fuerte alteración emocional. Es necesaria una rehabilitación efectiva, que considere todos los aspectos relacionados con el proceso salud enfermedad desde antes de la cirugía como la recuperación del lenguaje hablado, los aspectos sociales y sus características psicológicas, las cuales son vitales para el adecuado manejo integral del paciente (AU)

Introduction and objective: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. Material and methods: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. Results: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X2, the results were not statistically significant. Conclusions: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management (AU)

[Assessment of degree of psychological health involvement in pre-laryngectomized patients]. / Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado.

INTRODUCTION AND OBJECTIVE: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. MATERIAL AND METHODS: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. RESULTS: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X(2), the results were not statistically significant. CONCLUSIONS: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management.

Utilidad del material sustitutivo óseo en la cirugía del implante coclear, base de cráneo y senos paranasales: nuestra experiencia / Utility of bone replacement material in cochlear implant, skull base and sinus surgery: Our experience

Introducción: Para solucionar determinados problemas que nos surgen en la cirugía del implante coclear, de los senos paranasales y de la base de cráneo hemos introducido en nuestro servicio el uso de un cemento óseo (PolyBone®). Con el objetivo de lograr la elaboración de cementos óseos de uso quirúrgico, la unión de factores de crecimiento óseo y polifosfatos ha permitido el estudio de estos materiales biológicos. Material y resultados: Presentamos un total de 28 pacientes con edades comprendidas entre 2 y 69 años, y una edad media de 29,2 años en los que el PolyBone® nos ha servido como un arma terapéutica más en el área quirúrgica de la ORL. En dos de los pacientes (7,4%) aparecieron complicaciones. Una menor que solucionamos con tratamiento conservador y una complicación mayor, que requirió una cirugía de extracción del material y explantación del implante. En los otros 26 (92,6%) pacientes se obtuvieron excelentes resultados. Conclusiones: Existen diferentes materiales autólogos y aloplásticos que nos sirven de gran utilidad para el manejo de fístulas, relleno de cavidades, u obliteración de senos entre otros. El cirujano debe conocer las propiedades biológicas, características fundamentales, técnica de obtención y posibles aplicaciones quirúrgicas para ser capaz de prevenir futuras complicaciones. Entre estos materiales, el cemento óseo (PolyBone®) es una alternativa eficaz a tener en cuenta en el manejo quirúrgico de nuestra patología (AU)

Introduction: To solve certain problems that arise in cochlear implant, sinus and skull base surgery, the use of bone cement (PolyBone®) has been introduced in our department. With the goal of making use of surgical bone cements, combining bone growth factors and polyphosphates has allowed the study of these biological materials. Materials and Results: We present a total of 28 patients aged between 2 and 69 years (mean age of 29.2 years) in whom PolyBone® has been used as an additional therapeutic tool in the ENT surgical area. Complications occurred in 2 patients (7.4%). One was minor, solved with conservative treatment; one was a major complication that required surgery to extract the material and remove the implant. In the other 26 patients (92.6%), excellent results were achieved. Conclusions: Different autogenous and alloplastic materials are of great utility for fistula management, cavity filling or sinus obliteration, among other uses. The surgeon must understand their biological properties, fundamental characteristics, production technique and potential surgical applications to be able to prevent future complications. Among these materials, bone cement (PolyBone®) is an effective alternative that should be considered in surgical management of ENT pathology (AU)

[Utility of bone replacement material in cochlear implant, skull base and sinus surgery: our experience]. / Utilidad del material sustitutivo óseo en la cirugía del implante coclear, base de cráneo y senos paranasales: nuestra experiencia.

INTRODUCTION: To solve certain problems that arise in cochlear implant, sinus and skull base surgery, the use of bone cement (PolyBone®) has been introduced in our department. With the goal of making use of surgical bone cements, combining bone growth factors and polyphosphates has allowed the study of these biological materials. MATERIALS AND RESULTS: We present a total of 28 patients aged between 2 and 69 years (mean age of 29.2 years) in whom PolyBone® has been used as an additional therapeutic tool in the ENT surgical area. Complications occurred in 2 patients (7.4%). One was minor, solved with conservative treatment; one was a major complication that required surgery to extract the material and remove the implant. In the other 26 patients (92.6%), excellent results were achieved. CONCLUSIONS: Different autogenous and alloplastic materials are of great utility for fistula management, cavity filling or sinus obliteration, among other uses. The surgeon must understand their biological properties, fundamental characteristics, production technique and potential surgical applications to be able to prevent future complications. Among these materials, bone cement (PolyBone®) is an effective alternative that should be considered in surgical management of ENT pathology.

Evolución de la actividad mucociliar tubotimpánica, estudiada por gammagrafía, tras la colocación de tubos de ventilación en adultos con otitis media seromucosa crónica / Evolution of the tubotympanal mucociliary system activity evaluated with scintigraphy, after ventilation tube insertion in adults with chronic otitis media with effusion

Introducción y objetivos: La función mucociliar tubotimpánica está alterada en los pacientes con otitis media seromucosa. Nuestro objetivo es estudiar su situación y recuperación tras la colocación del drenaje transtimpánico. Métodos: Hemos evaluado la actividad mucociliar del oído medio y de la trompa de Eustaquio por gammagrafía, en 4 grupos de adultos con otitis media seromucosa crónica, tras la colocación del tubo de ventilación. La exploración se llevó a cabo 3 días (grupo I), 6 días (grupo II), 9 días (grupo III), y 12 días (grupo IV) tras la colocación del drenaje. Resultados: Tras excluir algunos pacientes con otorrea autolimitada, los que normalizaron la función mucociliar, resultaron ser en cada grupo: grupo I, 0 de 13, 0%; en el grupo II, 4 de 15 pacientes, 26,6%; para el grupo III: 14 de 18 casos, 88,8% y, por último, en el grupo IV, 18 de 18, 100%. Conclusiones: En los pacientes con otitis media seromucosa crónica la función mucociliar está alterada. La inserción del tubo de ventilación reestablece el aclaramiento mucociliar de forma progresiva, alcanzando la normalidad tras 12 días en todos los pacientes (AU)

Introduction and goals: Tubotympanal mucociliary function is damaged in patients with otitis media with effusion. Our objective was to study its situation and recovery after timopanostomy tube insertion. Methods: We evaluated the mucociliary activity of the ear and Eustachian tube with scintigraphy in four groups of adults with chronic otitis media with effusion after ventilation tube insertion. The test was performed on 3 days (Group I), 6 days (Group II), 9 days (Group III) and 12 days (Group IV) after tympanostomy tube insertion. Results: After excluding some patients with limited otorrhea, the percentages of patients that normalised mucociliary function in the different groups were: Group I, 0 of 13, 0%; Group II, 4 of 15 patients, 26,6%; Group III, 14 de 18 cases, 88,8%; and, in Group IV, 18 of 18, 100%. Conclusions: Mucociliary function is altered in patients with chronic otitis media with effusion. With the insertion of tympanostomy tubes, mucociliary clearance is restored progressively, reaching normal after 12 days in all the patients (AU)

[Evolution of the tubotympanal mucociliary system activity evaluated with scintigraphy, after ventilation tube insertion in adults with chronic otitis media with effusion]. / Evolución de la actividad mucociliar tubotimpánica, estudiada por gammagrafía, tras la colocación de tubos de ventilación en adultos con otitis media seromucosa crónica.

INTRODUCTION AND GOALS: Tubotympanal mucociliary function is damaged in patients with otitis media with effusion. Our objective was to study its situation and recovery after timopanostomy tube insertion. METHODS: We evaluated the mucociliary activity of the ear and Eustachian tube with scintigraphy in four groups of adults with chronic otitis media with effusion after ventilation tube insertion. The test was performed on 3 days (Group I), 6 days (Group II), 9 days (Group III) and 12 days (Group IV) after tympanostomy tube insertion. RESULTS: After excluding some patients with limited otorrhea, the percentages of patients that normalised mucociliary function in the different groups were: Group I, 0 of 13, 0%; Group II, 4 of 15 patients, 26,6%; Group III, 14 de 18 cases, 88,8%; and, in Group IV, 18 of 18, 100%. CONCLUSIONS: Mucociliary function is altered in patients with chronic otitis media with effusion. With the insertion of tympanostomy tubes, mucociliary clearance is restored progressively, reaching normal after 12 days in all the patients.

[Study of olfactory function for pyridine in healthy population: influence of variations in humidity]. / Estudio de la sensibilidad olfativa a la piridina en población sana: influencia de las variaciones de humedad.

OBJECTIVES: We study the influence of humidity and its variations on human olfactory threshold for pyridine. MATERIAL AND METHOD: Olfactory function was tested on 154 healthy volunteers without rhino-sinusal pathology. Pyridine was used as odorant in four different concentrations investigating the ability to detect the stimulus and the acuity to estimate its intensity. All subjects were exposed to four pre-set concentrations of pyridine and their ability to detect the stimulus and its intensity was assessed. We measured the variations in ambient humidity and evaluated its effects on the results. RESULTS: A total of 154 healthy volunteers between 20 and 60 years old (69 men and 85 women) were tested for different concentrations of pyridine with an ambient humidity variation of 50 % +/- 20 %. The average humidity was 50.74 % with a standard deviation of 4.95 %. We did not find significant differences (P>.05) for mean humidity measures between volunteers who detected the odorant and those who did not. Nor did we find significant differences when estimating intensity. CONCLUSIONS: We did not find any effect of ambient humidity variation between 42 % and 67 % on human olfactory sensitivity for pyridine.

Estudio de la sensibilidad olfativa a la piridina en población sana: influencia de las variaciones de humedad / Study of olfactory function for pyridine in healthy population: influence of variations in humidity

Objetivo: Se estudia la influencia de la humedad y sus variaciones en el estudio de la sensibilidad olfativa humana ala piridina. Material y método: Hemos estudiado la influencia de la humedad ambiental en la capacidad olfativa humana en un grupo de 154 voluntarios sin afecciones rinosinusales. Como sustancia odorante se usó piridina en cuatro concentraciones distintas, para estudiar la capacidad de detección del estímulo y la valoración de la intensidad. Todos los sujetos fueron expuestos a cuatro concentraciones fijas de piridina y se valoró la capacidad para detectar el estímulo y sus intensidades. Estudiamos las variaciones de la humedad ambiental y su influencia. Resultados: Se sometió a 154 (69 varones y 85 mujeres) sujetos sanos de entre 20 y 60 años de edad a estímulos con piridina en condiciones de humedad ambiental del 50% ± 20 %. Tuvimos una humedad media del 50,74 % con una desviación media de 4,95 %. No hay diferencias significativas (p > 0,05) al comparar las humedades medias entre los que detectaron el estímulo y los que no. Tampoco hubo diferencias significativas al estudiar la intensidad del estímulo. Conclusiones: Las variaciones de humedad comprendidas entre el 42 y el 67 % no influyen en la sensibilidad olfativa humana a la piridina (AU)

Objectives: We study the influence of humidity and its variations on human olfactory threshold for pyridine. Material and method: Olfactory function was tested on 154 healthy volunteers without rhino-sinusal pathology. Pyridine was used as odorant in four different concentrations investigating the ability to detect the stimulus and the acuity to estimate its intensity. All subjects were exposed to four pre-set concentrations of pyridine and their ability to detect the stimulus and its intensity was assessed. We measured the variations in ambient humidity and evaluated its effects on the results. Results: A total of 154 healthy volunteers between 20 and 60 years old (69 men and 85 women) were tested for different concentrations of pyridine with an ambient humidit y variation of 50% ± 20 %. The average humidity was 50.74% with a standard deviation of 4.95%. We did not find significant differences (P>0.05) for mean humidity measures between volunteers who detected the odorant and those who did not. Nor did we find significant differences when estimating intensity. Conclusions: We did not find any effect of ambient humidity variation between 42 % and 67 % on human olfactory sensitivity for pyridine (AU)