[Etiopathogenia of the epistaxis admitted by emergencies service. Analysis and considerations in 250 consecutive patients]. / Etiopatogenia de las epístaxis ingresadas vía de urgencias. Análisis y consideraciones en 250 pacientes consecutivos.

Epistaxis represent a relatively common symptom in the hospitalary Emergencies Services. In our casuistry of 250 consecutive patients assisted and admitted because of that cause in 2 different hospitals of the region between 1996 and 2005, we have noticed the presence of one or more base pathologies or risk factors in originate most of them which could the nose bleeding. These causes are analysed beside the location of the epistaxis and the different treatment options that were used until its resolution.

[Frontoethmoidal mucocele. Diagnosis and treatment in 7 cases]. / Mucocele frontoetmoidal. Diagnóstico y tratamiento en 7 casos.

Mucocele has its origin by blockage of the paranasal sinuses ostium with mucinous retention inside, sometimes purulent (mucopiocele), and progressive slimming with gradual destruction on the bone walls. We report an own review of 7 patients with diagnosis of frontoethmoidal mucocele, 4 men and 3 women, 50-years average. The oftalmologic clinical symptoms (diplopia, exoftalmos and the eyeball movement restrictiv) were the most frequentjointly to cefalea. The kind of surgery that we have performed, in 6 of 7 cases, was FES with marsupialization (4 times) and external ethmoidectomy (2). We have performes a literature review at this respect.

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Morphology of the parathyroid glands. A study of 146 samples and review of the literature]. / Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura.

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic study of 146 parathyroid gland from patients diagnosed from hyperparathyroidism. About a 72.6% of the patients presented a parathyroid adenoma while in the rest 27.4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6 mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases the adenoma was located in the superior mediastine.

[Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature]. / Linfoma difuso de células b grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura.

Althouh lymphomas are an illness that characteristically affects the lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivary gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk of injury on the facial nerve.

[Sudden cardiorespiratory arrest in adults with acute epiglottitis. Report of 2 cases]. / Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda presentación de dos casos.

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance.

[Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks]. / Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena.

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally.

[Pseudomonas and acute external otitis. Results of a microbiological study in patients without previous antibiotic treatment]. / Pseudomonas y otitis externa aguda. Resultados de un estudio microbiológico en pacentes sin tratamiento antibiótico previo.

We report the results of a microbiological clinic study that was performed by our ENT Department between years 2000 and 2001 whose main objective was to determine, in Badajoz Area of Health, which bacteria were involved in the acute diffuse external otitis of patients without previous antibiotic treatment (two weeks before obtaining the samples). Of 79 isolated microorganisms in 62 patients that fulfilled the requirements established Pseudomonas, mainly P. Aeruginosa, represented a 46.83% altogether followed by Staphylococcus (18.98%). In almost one fourth part of the cases strains of associated fungi were identified.

[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

[Recurrent intrathyroid abscess in children. Clinical case and review of the literature]. / Absceso recurrente intratiroideo en niños. Caso clinico y revisión de la literatura.

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations.

[Practical aspects regarding endoscopic treatment for epistaxis]. / Aspectos prácticos sobre el tratamiento endoscópico de la epistaxis.

INTRODUCTION: A prospective study is presented to evaluate some practical and financial aspects regarding surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoidal (AE) arteries performed to control posterior nasal bleeding. PATIENTS AND METHODS: 35 patients admitted at the ENT ward between 2004 and 2006 were included in the study, and distributed into two groups depending on the protocol applied in each case. Until March 2005 the surgery was performed if there was failure or insecurity of the posterior packing, and since that date a substitutive surgical protocol (not including posterior packing) was applied. RESULTS: 82.9% of the patients were male, with a mean age of 55.74 years and a left bleeding in a 60% of the cases. Ligature/cauterization was performed on SP in 28 (80%) patients, on AE in 4 (11.4%), and on both arteries in 3 cases (8.6%). 38.7% of the SP approach only one sphenopalatine foramen was observed, through which an only branch of the artery passed; 42% of the cases two branches passed through an only foramen, and in 19.3% two or more branches were present, breaking into the nose through two or more independent clefts. AE was intradural in 3 cases, intranasal attached to the cranial base in other 3 and intranasal detached to the cranial base in 1 patient. Besides, highly significant differences were found between the two protocols, observing a mean reduction of hospital stay of 3.1 days, which throws up savings of 939.3 euros per patient. DISCUSSION AND CONCLUSIONS: Surgical treatment for epistaxis has proved to be effective (91.2% in our experience) and safe, determining an important reduction in hospital stay and avoiding the morbility of posterior packing. Accurate knowledge of the anatomy of the arteries implied and specific actuation upon the correct bleeding territory are essential to perform this surgery.

[Sudden cervical hematoma after hypertensive crisis. Report of a case]. / Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso.

We report the case ofa 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We oractice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity.

[Adenoid cystic carcinoma of tongue. Report of a case and literature review]. / Carcinoma adenoide quístico de lengua. A propósito de un caso y revisión de la literatura.

We report the clinical case of an adenoid cystic carcinoma on the base of the tongue, a rare malignant tumor of slow-growing but aggressive with a propepnsity for perineural invasion. Treatment modalities more common include surgery and radiotherapy but locorregional recurrences are frequent and relatively early in the first years. A review of the literature of this pathology is performed.

[Retropharyngeal phlegmon in adults. Report of a case and literature review]. / Flemón retrofaríngeo en adultos. Presentación de un caso y revisión de la literatura.

Retropharyngeal phlegmons and abscesses in the adult are uncommon nowdays. We report the case of a 48 years old male diagnosed as retropharyngeal phlegmon of idiopatic cause because no reasons were able to justify the clinical symptoms. Cervical CT was negative for purulent collection and the patient was treated by endovenous antibiotics and steroids until the resolution of his process. The final hospital stay was 12 days and after 10 years follow-up he has not been readmitted due to that pathology.

[Otogenic cerebrospinal fistula. Report of an atypical case]. / Fístula otica de líquido cefalorraquídeo. Presentación de un caso atípico.

We report the case of a female patient who consulted to the Room Emergencies due to abundant watery otorrea of 3 months without another symptom or apparent cause. The studys confirmed the presence of cerebrospinal fluid (CSF) and the imaging tests (CT and MRI) demonstrated the existence of a communication between the right ear and middle cerebral fossa through tegmen timpani. The woman was operated by ORL (closing the fistula) and neurosurgery (placing an external lumbar drainage) with good postsurgical evolution.

[Ramsay-Hunt syndrome associated to unilateral recurrential paralysis]. / Síndrome de Ramsay-Hunt asociado a parálisis recurrencial unilateral.

Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricular pinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis nonexisting previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she returned to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck.

[Plaut-Vincent's acute necrotizing ulcerative fusospirillum tonsillitis associated to infectious mononucleosis]. / Amigdalitis aguda ulceronecrótica fusoespirilar de Plaut-Vincent asociada a mononucleosis infecciosa.

We report the case of a 14 years old girl patient with recurrent tonsillitis who had been diagnosed and admitted previously with Plaut-Vincent's angina. Six weeks after leaving the hospital she was assited in Emergencies by an infectious mononucleosis associated to unilateral tonsillar necrotizing ulceration from which a sample was taken to microbiological exam finding the fusospirochaetal complex Borrelia vincenti and Fusobacterium necrophorum. A literature review at the respect of such association and its treatment is performed.

[Bogorad syndrome or crocodile tears after Ramsay-Hunt]. / Síndrome de Bogorad o lágrimas de cocodrilo tras Ramsay-Hunt.

Crocodile tears or Bogorad Syndrome describes a complication or sequel after facial palsy with incomplete recovery characterized by an excessive hyperlacrimation during the food ingestion. We report the case of a 50 years old female with that pathology associated to facial syncinesias secondary to suffer a right Ramsay-Hunt syndrome. Its pathogenesis and different treatment modalities are analysed.

[Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation]. / Absceso cervical por Streptococcus anginosus-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica.

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High fever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification.