Aspergillus infection of the larynx in a solid organ transplant recipient.

Primary laryngeal aspergillosis is a rare condition. Only a few cases have been reported in the past years. Most of them have been reported in healthy patients or with a mild immunocompromised state. We report a case of primary laryngeal aspergillosis in a solid organ transplant recipient (SOT), an infection not previously described in this population; we reviewed the published literature in all populations.

Neuromas mucosos de localización laríngea en una neoplasia endocrina múltiple 2B / Multiple mucosal neuromas in the larynx as part of a multiple endocrine neoplasia type 2B

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Cumulative disease activity predicts incidental hearing impairment in patients with rheumatoid arthritis (RA).

We previously reported that 24% of 113 rheumatoid arthritis (RA) patients had hearing impairment (HI). We investigated if disease activity was a predictor of incidental HI. One hundred and four patients completed three consecutive 6 months-apart rheumatic evaluations and concomitant audiometric evaluations which included at least an interview, an otoscopic evaluation, and a pure tone audiometry. HI was defined if the average thresholds for at least one of low-, mid-, or high-frequency ranges were ≥25 decibels (dB) hearing level in one or both ears. Appropriated statistics was used. Internal review board approval was obtained. Patients were most frequently middle-aged (43.4 ± 13.3 years), female (89.4%), and had median disease duration of 5 years and low disease activity. All were receiving RA treatment. At inclusion, 24 patients had HI which was sensorineural in 91.7% of them. Among the 80 patients without HI at baseline, 10 (12.5%) developed incidental HI, and they had more disease activity either at baseline ([median, range] disease activity score-28 joints evaluated-C-reactive protein [DAS28-CRP], 3.9 [1.6-7.3] vs. 2.1 [1-8.7], p = 0.006) or cumulative previous incidental HI (3.4 [1.8-4.8] vs. 2 [1-6.2], p = 0.007) and were more frequently on combined methotrexate and sulfasalazine (20 vs. 1.4%, p = 0.05) than their counterparts. In the adjusted Cox proportional model, cumulative DAS28-CRP was the only variable to predict incidental HI (odds ratio, 1.8; 95% confidence interval, 1.1-2.7; p = 0.01). Almost 13% of RA patients with short disease duration and low disease activity developed incidental HI during 1 year. Cumulative disease activity predicted incidental HI.

Extramedullary plasmacytoma of the larynx: a case report of subglottic localization.

Extramedullary plasmacytoma (EMP) is a rare neoplasm of plasma cells, described in soft tissue outside the bone marrow. EMP of the larynx represents 0.04 to 0.45% of malignant tumors of the larynx. A male of 57 years old presented with hoarseness, dyspnea, and biphasic stridor of 2 months. The indirect laryngoscopy (IL) revealed severe edema of the posterior commissure and a polypoid mass in the right posterior lateral subglottic wall. A biopsy of the subglottic mass was performed by a direct laryngoscopy (DL). The histopathologic diagnosis was EMP CD138+, therefore radiotherapy was given at 54 Gy in 30 sessions. The patient had an adequate postoperative clinical course and a new biopsy was performed having tumor-free margins. All laryngeal lesions should be biopsied prior to treatment to determine an accurate diagnosis to guide a proper management of the condition. Radiation therapy to the EMP is considered the treatment of choice, having local control rates of 80% to 100%. The subglottis is the least accessible area of view and the least frequent location of a laryngeal mass, nevertheless the otolaryngologist should always do a complete and systematic exam of the larynx when a tumor is suspected, to detect diagnoses such as a subglottic plasmacytoma.

Laryngopharyngeal reflux mimicking limited wegener granulomatosis

We present a case of subglottic stenosis (SGS) in a young patient with positive ANCA but a wrong diagnosis of Wegener granulomatosis (WG). Instead, she was diagnosed as having laryngopharyngeal reflux (LPR). Pitfalls of ANCA testing in this scenario, the route to diagnosis of LPR and the contribution of this entity to subglottic stenosis (SGS) in WG are discussed. Caution when interpreting ANCA results is mandatory to avoid improper management (AU)

Presentamos un caso de estenosis subglótica (ESG) en una paciente joven con ANCA positivos, pero un diagnóstico erróneo de granulomatosis de Wegener (GW). El caso correspondió a reflujo laringofaríngeo (RLF). Se discuten los falsos positivos de la prueba de ANCA, la ruta diagnóstica del RLF y la contribución de esta entidad a la ESG en GW. Debe tenerse precaución en la interpretación de ANCA para evitar el tratamiento inapropiado (AU)

Laryngopharyngeal reflux mimicking limited wegener granulomatosis.

We present a case of subglottic stenosis (SGS) in a young patient with positive ANCA but a wrong diagnosis of Wegener granulomatosis (WG). Instead, she was diagnosed as having laryngopharyngeal reflux (LPR). Pitfalls of ANCA testing in this scenario, the route to diagnosis of LPR and the contribution of this entity to subglottic stenosis (SGS) in WG are discussed. Caution when interpreting ANCA results is mandatory to avoid improper management.

Palatal ulcers due to vomiting after gastric band tightening.

Adjustable gastric banding is a widely used modality in some countries for the treatment of morbid obesity, and several complications have been reported. We report the unusual case of a patient who developed bilateral ulcers of the palate after intense vomiting caused by tightening of her gastric band.

Association of HLA-DR3 and HLA-DR4 with sinonasal polyposis in Mexican Mestizos.

OBJECTIVE: The pathogenesis of sinonasal polyposis (SNP) is not clear; it has been suggested that it is polygenic and multifactorial. The major histocompatibility complex is a useful tool to predict genetic susceptibility to diseases, especially to autoimmune diseases. Since such susceptibility is influenced by ethnicity, it is necessary to have a wide knowledge of the structure of the population to which the patient belongs. The purpose of the study was to determine the association of HLA-DRB1 alleles with sinonasal polyposis in the Mexican Mestizo population. STUDY DESIGN: We studied the HLA-DR alleles in 34 adult Mexican Mestizo patients with SNP and compared them to those present in 99 healthy controls. METHODS: Genomic DNA from mononuclear cells was obtained by using the "salting out" technique and high-resolution DNA typing of the HLA-DRB1 alleles was performed after PCR amplification. RESULTS: We found a statistically significant increased frequency of the HLA-DRB1*03 allele (P = 0.03, odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.0-7.8) and of the HLA-DRB1*04 allele (P = 0.009, OR = 2.2, 95% CI: 1.2-4.2) in patients with SNP as compared to controls, and a statistically significant decreased frequency of the HLA-DRB1*08 allele (P = 0.01, OR = 0.2, 95% CI: 0.05-0.8). CONCLUSION: The HLA-DR locus seems to be associated with the genetic susceptibility to develop SNP in Mexicans. EBM RATING: B-2b.

Estapedectomía de revisión: análisis de casuística / Revisión stapedectomy: review of cases

Se analizó la experiencia de la estapedectomías de revisión efectuadas en un periodo de 12 años (1984-1996). Todas las cirugías se practicaron de manera convencional sin el uso de láser. Se incluyeron 16 pacientes, 12 (75 por ciento) del sexo femenino y 4 (25 por ciento) del sexo masculino entre 23 y 63 años con promedio de 42.5 años (DS 14.35). El tiempo entre la cirugía primaria y la cirugía de revisión fue de 3 meses a 12 años. A todos se les colocó prótesis de fluoroplástico de 0.6 de diámetro y de longitud variable (3-5 mm). La causa más frecuente de falla fue el desplazamiento de la prótesis en 6 (38 por ciento). La revisión resultó en un cierre de la brecha aéreo-ósea a 10 dB en 60 por ciento y a 15 dB en 80 por ciento. Se presentó deterioro sensorineural en tonos agudos de 15 a 30 dB sólo en 2 (13.3 por ciento) pacientes. Se compararon los resultados con los de otros autores de la literatura.

Hemangioma cavernoso de la membrana timpánica. Imagen otoscópica / Cavernous hemangioma of the tympanic membrane. Otoscopic image

Los hemangiomas cavernosos localizados en la membrana timpánica son extremadamente raros. Se han publicado solamente nueve casos en la literatura. Se presenta un caso documentando las características clínicas, la imagen otoscópica y los estudios diagnósticos. Se discuten las opciones de tratamiento y se hace una revisión de la literatura

Tumor pardo fronto-ethmoidal e hiperparatiroidismo secundario: presentación de caso / Fronto-ethmoidal brown tumor: case report

Los tumores pardos son lesiones óseas focales secundarias a hiperparatiroidismo. Se han descrito en la literatura 7 casos asociados a hiperparatiroidismo secundario localizados en hueso frontal, maxilar y etmoidal que involucran la órbita. Se presenta un caso clínico, en una mujer de 58 años de edad con insuficiencia crónica de 18 años de evolución; en diálisis peritoneal crónica ambulatoria y en programa de transplante renal. Seis meses antes inicia aumento de volumen inter ciliar de predominio izquierdo. presenta desplazamiento ocular izquierdo por tumor de aproximadamente 10 x 7 cm, fijo, no doloroso y sin cambios tróficos en la piel supra yacente. Se extirpó el tumor que fue diagnosticado como "tumor pardo"

Lesión tumefacta fibroinflamatoria de cabeza y cuello: primer caso comunicado en México / Head and neck tumefactive fibroinflammatory lesion: first case reported in Mexico

Se comunica por primera vez en México el hallazgo de un caso de "lesión tumefacta fibroinflamatoria de cabeza y cuello". Es una entidad rara, histológicamente benigna y localmente agresiva, descrita por primera vez en 1975, y de la que se han comunicado solamente 22 casos en la literatura mundial. El paciente, masculino de 47 años, presentaba tumor maxilar izquierdo de 4 cm de diámetro, duro, fijo, no doloroso y sin cambios de la piel supra yacente. Una tomografía computada mostró masa hipodensa anterior al seno maxilar izquierdo con destrucción de su pared. Fue sometido a resección total de una masa de color gris, firme, hemogénea, bien delimitada y sin cápsula, compuesta por tejido fibroso maduro, linfocitos y polimorfo nucleares dispersos. Esta lesión semeja tiroiditis de Riedel, mediastinitís fibroesclerosa, colangitis esclerosante y fibrosis retroperitoneal. El paciente se encontraba libre de tumor en una revisión seis meses posterior a su tratamiento