Lesión bronquial por aspiración de una pila alcalina (pila de botón) / Bronchial lesion due to aspiration of a button-type alkaline battery

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[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.

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

Introducción: Presentamos un estudio prospectivo para valorar algunos aspectos técnicos y económicos sobre el tratamiento quirúrgico de la epistaxis posterior mediante ligadura/cauterización de las arterias esfenopalatina (SP) y etmoidal anterior (EA). Pacientes y métodos: 35 pacientes ingresados en nuestro servicio por epistaxis posterior y sometidos a cirugía para su control entre 2004 y 2006, fueron incluidos y distribuidos en dos grupos según el protocolo de actuación empleado en cada caso. Hasta marzo de 2005 se empleó la cirugía por fracaso o inestabilidad del taponamiento posterior, y a partir de esa fecha un protocolo de cirugía sustitutiva (la cirugía sustituyó al taponamiento posterior). Realizamos un estudio comparativo de los dos protocolos y discutimos aspectos prácticos sobre esta cirugía. Resultados: El 82,9% de los pacientes fueron hombres, con una edad media de 55,74 años y un sangrado procedente del lado izquierdo en el 60% de los casos. En 28 (80%) pacientes se actuó sobre la SP, en 4 (11,4%) sobre la EA y en 3 (8,6%) sobre ambas. En el 38,7% de los casos se observó un solo orificio esfenopalatino por el que salía una sola rama bifurcada a los pocos milímetros de su salida, en el 42% de los casos un orificio por el que salían dos ramas, y en el 19,3% se objetivaron dos o más ramas que salían de dos o más orificios distintos. La EA fue intradural en 3 casos, intranasal en íntima relación con la base del cráneo en otros 3, y totalmente intranasal separada de la base del cráneo en 1 caso. Además, se encontraron diferencias altamente significativas entre los dos protocolos, observándose una reducción media de la estancia hospitalaria de 3,1 días con la cirugía sustitutiva, lo que supone un ahorro estimado de 939,3 euros por paciente. Discusión y conclusiones: El tratamiento quirúrgico de la epistaxis ha demostrado ser eficaz (91,2% en nuestra serie) y seguro en el manejo de estos pacientes, determinando una reducción importante de su estancia hospitalaria y eliminando la morbilidad de los taponamientos posteriores. El adecuado conocimiento de la anatomía de las arterias implicadas en estas técnicas y la actuación específica sobre el territorio sangrante son de vital importancia para la correcta realización de este tipo de cirugía

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

[Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries]. / Utilidad del tratamiento quirúrgico de la epistaxis grave mediante abordaje endoscópico de las arterias esfenopalatina y etmoidal anterior.

INTRODUCTION: To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. PATIENTS AND METHODS: 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). RESULTS: Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). DISCUSSION AND CONCLUSIONS: The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.

[Arachnoid cyst of cerebellar-pontine angle clinically mimicking Meniere's disease]. / Quiste aracnoideo de angulo pontocerebeloso simulando clínicamente enfermedad de Meniere.

Arachnoid cysts represent about 1% of all intracranial space-occupying lesions. Usually they are located in the middle cranial fossa while their localization in the posterior fossa is uncommon and generally remain asymptomatic or those are non-specific. The case of a 51 years old female is reported who was diagnosed by IRM of a 4,5 x 2 cm arachnoid cyst, situated on the left cerebello-pontine angle, with tinnitus, hearing loss and vertigo that mimicked a Meniere's attack. We think thees benign tumors must be included in the differential diagnosis of Meniere's disease because they can be indistinguishable from it clinically.

Utilidad del tratamiento quirúrgico de la epistaxis grave mediante abordaje endoscópico de las arterias esfenopalatina y etmoidal anterior / Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries

Introducción: Presentamos un estudio de intervención (prospectivo-retrospectivo) para valorar la eficacia y relación coste-beneficio de distintos tratamientos para el control de la epistaxis posterior grave, y en especial para determinar si la cirugía de ligadura/cauterización de las arterias esfenopalatina (SP) y etmoidal anterior (EA) puede emplearse como alternativa a los medios convencionales. Pacientes y métodos: 184 pacientes consecutivos ingresados en nuestro servicio por epistaxis posterior fueron incluidos en el estudio entre los años 1997 y 2005, y asignados a uno de los tres grupos en función del último tratamiento que recibieron para el control de su sangrado: TA.- taponamiento anterior (98 pacientes); TP.- taponamiento posterior (66 pacientes); CE.- cirugía de ligadura/cauterización de las arterias SP y EA (20 pacientes). Resultados: Se encontraron diferencias altamente significativas entre los distintos tratamientos tanto en la eficacia (90% de la cirugía comparada con un 41,3% del taponamiento anterior y un 63,1% del posterior), tanto en lo que se refiere a la estancia media postratamiento (TA.-4,92 días; TP.- 6,3 días; CE.- 2,15 días). Discusión y conclusiones: La necesidad de repetición de los tratamientos en el control de la epistaxis posterior grave y el aumento de los factores de riesgo que la condicionan, junto con el avance de las técnicas endoscópicas y anestésicas, hacen posible la aplicación de una solución quirúrgica que demuestra una mayor eficacia y un acortamiento evidente de la estancia hospitalaria de estos pacientes. Los resultados de este estudio demuestran la viabilidad de estas técnicas como alternativa a los tratamientos convencionales, e incluso su conveniencia ética y económica como sustitutivas del taponamiento posterior

Introduction: To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. Patients and methods: 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). Results: Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). Discussion and conclusions: the lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing

Quiste aracnoideo de ángulo pontocerebeloso simulando clínicamente enfermedad de Meniere / Arachnoid cyst of cerebellar-pontine angle clinically mimicking Meniere´s disease

Los quistes aracnoideos representan alrededor del 1 % de todas las lesiones intracraneales ocupantes de espacio. Generalmente se localizan en la fosa craneal media mientras que su ubicación en fosa craneal posterior es rara y normalmente no dan síntomas o éstos son inespecíficos. Presentamos el caso de una mujer de 51 años diagnosticada por RMN de un quiste aracnoideo de 4,5 x 2 cm, situado en el ángulo pontocerebeloso izquierdo, con clínica de acúfenos, hipoacusia y vértigo que simulaba una crisis menieriforme. Creemos que estos tumores benignos deberían incluirse en el diagnóstico diferencial de la enfermedad de Meniere pues pueden ser clínicamente indistinguibles de ella

Arachnoid cysts represent about 1 % of all intracranial space-occupying lesions. Usually they are located in the middle cranial fossa while their localization in the posterior fossa is uncommon and generally remain asymptomatic or those are non-specific. The case of a 51 years old female is reported who was diagnosed by IRM of a 4,5 x 2 cm arachnoid cyst, situated on the left cerebello-pontine angle, with tinnitus, hearing loss and vertigo that mimicked a Meniere's attack. We think thees benign tumors must be included in the differential diagnosis of Meniere's disease because they can be indistinguishable from it clinically

[Otolaryngologic manifestations of Churg-Strauss sindrome. Report of a case and review of the literature]. / Manifestaciones otorrinolaringológicas del sindrome de Churg-Strauss. A propósito de un caso y revisión de la literatura.

Churg-Strauss Sindrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis.

[Paraganglioma of the jugular foramen presenting with initial isolated vertigo]. / Paraganglioma del agujero rasgado posterior o foramen yugular presentándose con vértigo aislado inicial.

The more common symptoms of the jugulotympanic paragangliomas are hearing loss, tinnitus and palsy of cranial nerves. Diagnosis is often delayed due to the slow growth of the tumour. We report one case with affectation of jugular foramen which clinically debuted as a peripheral vertigo and the diagnosis was made by CT, IRM and angiography. The patient was treated by Neurosurgery using Gamma Knife (radiosurgery) with good result.

[Advantages of the determination of parathyroid hormone (PTH) intraoperatively in hyperparathyroidism surgery]. / Ventajas de la determinación de paratohormona (PTH) intraoperatoriamente en la cirugía del hiperparatiroidismo.

OBJECTIVE: To evaluate the utility of rapid or turbo intraoperative parathyroid (PTH) assay in the surgery of hyperparathyroidism. Since 2000 to july 2004 we have used this test on 39 patients. 24 of them corresponded to primary hyperparathyroidisms and 15 to secondary forms. Our results showed a PTH decreasing percentage >70% at 15 minutes in 92.3% of the cases. Only in two patients (5.1%) persisted the hypercalcemia after the surgery and one was reoperated with good clinic evolution. As advantages we stand out the reduction of surgical time, permitting unilateral parathyroid exploration instead a bilateral in primary HPT, and the prediction of success by confirming the excision of all hyperfunctionating parathyroid tissue in patients with multiple gland hyperplasia.

[Pontine cavernous angioma (cavernoma) with initial ENT manifestations]. / Angioma cavernoso del tronco cerebral (cavernoma) con manifestaciones orl iniciales.

We report the case of a 22 years old female who consulted us for facial parestesias, hearing loss in right ear and sudden tinnitus. Her audiometry showed an unilateral discreet sensorineural hipoacusia and the cranial IRM, a mass of 20 mm diameter in right pontine region and bulbus informed as cavernous angioma with signs of recent bleeding. The patient was sent to Neurosurgery but she refused the intervention. The risk of hemorrhage in the cavernomas is estimated at 0.25% to 1.6% per year and represents the main reason to advise a surgical treatment.

[Suppurative bacterial acute parotitis in adults. Clinic and microbiological findings in 10 admitted patients]. / Parotiditis aguda bacteriana supurada en adultos. Hallazgos clínicos y microbiológicos en 10 pacientes ingresados.

We report the clinic and microbiological findings that were obtained in 10 adult patients admitted by our ENT Service with diagnosis of suppurative bacterial acute parotitis. S. aureus and Streptococcus sp were the most isolated organisms. All the patients were treated by hidratation, endovenous antibiotic therapy sometimes modified according to the antibiogram results, analgesics and antiinflammatories with success. In 3 times it was necessary to drain the purulent collection and in one of them there was a retroauricular abscess secondary to sialoadenitis.

[Relationship between repeating tonsillitis and Berger's disease. Report of A case and review of the literature]. / Relación entre amigdalitis de repetición y enfermedad de Berger. Presentación de un caso y revisión de la literatura.

Berger's disease, so called IgA nephropathy, is a mesangioproliferative glomerulonephritis characterized by recurrent episodes of gross hematuria in relation with ENT infections like tonsillitis. We report a clinical case which presented that association and make a review of the literature about the possible advantages of tonsillectomy on the evolutive course and prognosis of the nephropathy.

[Congenital hemangioma arising of internal orbitary edge. Importance of ENT exploration and treatment options]. / Hemangioma congénito del canto interno orbitario. importancia de la exploración O.R.L. y opciones de tratamiento.

Hemangiomas are the most common tumors in children. It id reported the case of 11 months girl with congenital hemangioma at internal orbitary edge. ENT exploration is essential to rule out the affectation of nose and paranasal sinuses as well as other associated similar injuries in head and neck. As complementary tests we asked for CT and IRM to delimit the tumoration whose classic treatment are oral corticoids in high doses. Surgery usually is reserved for refractory cases to the medical therapy although the present exposition is changing due to different factors that we expose in the final discussion.

Manifestaciones otorrinolaringológicas del síndrome de Churg-Strauss. A propósito de un caso y revisión de la literatura / Otolaryngologic manifestations of Churg-Strauss sindrome. Report of a case and review of the literature

El Síndrome de Churg-Strauss o granulomatosis alérgica es una mvasculitis sistémica de pequeños vasos que se caracteriza por asma, hipereosinofilia y vasculitis necrotizante con granulomas eosinófilos extravasculares. Describimos un caso atendido en Urgencias de nuestro hospital que presentaba además infiltrados pulmonares, fiebre, neuropatía periférica, pérdida de peso, mialgias, rinosinusitis, con antecedentes de poliposis nasal, y edema facial. Nuestro objetivo es revisar las principales manifestaciones otorrinolaringológicas de esta rara enfermedad multisistémica cuyo tratamiento incluye los corticoides orales, inmunosupresores como la ciclofosfamida y plasmaféresis

Churg-Strauss Síndrome or allergic granulomatosis is a small vessel systemic vasculitis characterized by asthma, hypereosinophilia and necrotizing vasculitis with extravascular eosinophil granulomas. We describe a case assisted in our hospital who presented pulmonary infiltrates, fever, peripherical neuropathy, weight loss, myalgia, rhinosinusitis, with antecedents of nasal polyposis, and facial edema. Our aim is to review the main otolaryngologic manifestations of this rare illness that is treated with oral corticosteroids, immunosupresor drugs like ciclofosfamide and plasmapheresis

Paraganglioma del agujero reagado posterior o foramen yugular presentándose con vértigo aislado inicial / Paragnaglioma of the jugular foramen presenting with initial isolated vertigo

Los síntomas más frecuentes de los paragangliomas yúgulotimpánicos son pérdida de audición, acúfenos y la parálisis de pares craneales. El diagnóstico a menudo se ve retrasado por el lento crecimiento del tumor. Presentamos un caso con afectación del foramen yugular que debutó clínicamente como un vértigo periférico y fue diagnosticado mediante TAC, RMN y angiografía. El paciente fue tratado por Neurocirugía mediante Gamma Knife (radiocirugía) con buena respuesta

The more common symptoms of the jugulo tympanic paragangliomas are hearing loss, tinnitus and palsy of cranial nerves. Diagnosis is often delayed due to the slow growth of the tumour. We report one case with affectation of jugular for a men which clinically debuted as a peripheral vertigo and the diagnosis was made by CT, IRM and angiography. The patient was treated by Neurosurgery using Gamma Knife (radiosurgery) with good result

Ventajas de la determinación de paratohormona (PTH) intraoperatoriamente en la cirugía del hiperparatiroidismo / Advantages of the deterination of parathyroid hormone (PTH) intraoperatively in hyperparathyroidism surgery

Nuestro objetivo es evaluar la utilidad de la determinación intraoperatoria de paratohormona (PTH) rápida o turbo en la cirugía del hiperparatiroidismo. Desde el año 2000 hasta julio del 2004 hemos utilizado esta prueba en un total de 39 pacientes de los que 24 correspondían a hiperparatiroidesmos primarios y 15 a formas secundarias. Los resultados mostraron un porcentaje de descenso de PTH superior al 70% a los 15 minutos en el 92,3% de los caoss. Sólo en dos pacientes (5,1%) persistió la hipercalcemia en el posoperatorio y uno fue reintervenido con buena evolución clínica. Como ventajas destacamos la reducción del tiempo quirúrgico, al facilitar una exploración unilateral sobre la bilateral en el HPT primario, y la predicción del éxito de la intervención al confirmar la excisión de todo el tejido paratiroideo hiperfuncionante en paciente con hiperplasia gladular múltiple

Objective: To evaluate the utility of rapid or turbo intraoperative parathyroid (PTH) assay in the surgery of hyperparathyroidism. Since 2000 to july 2004 we have used this test on 39 patients. 24 of them corresponded to primary hyperparathyroidisms and 15 to secondary forms. Our results showed a PTH decreasing percentage >70% at 15 minutes in 92,3% of the cases. Only in two patients (5,1 %) persisted the hypercalcemia after the surgery and one was reoperated with good clinic evolution. As advantages we stand out the reduction of surgical time, permitting unilateral parathyroid exploration instead a bilateral in primary HPT, and the prediction of success by confirming the excision of all hyperfunction ating parathyroid tissue in patients with multiple gland hyperplasia

Angioma cavernoso del tronco cerebral (cavernoma) con manifestaciones ORL iniciales / Pontine cavernous angioma (cavernoma) with initial ENT manifestations

Presentamos el caso de una mujer de 22 años que consultó por parestesias faciales, pérdida de audición por oído derecho y acúfenos de forma brusca. En la audiometría se apreciaba una hipoacusia neurosensorial unilateral discreta y en la RMN craneal una masa de 20 mm de diámetro en región protuberancial derecha y bulbo informada como angioma cavernoso con signos de sangrado reciente. La paciente fue remitida a Neurocirugía pero rechazó la intervención propuesta. El riesgo de hemorragia de los cavernomas se estima de un 0,25% a un 1,6% por año y es la principal razón que aconseja un tratamiento quirúrgico

We report the case of a 22 years old female who consulted us for facial parestesias, hearing loss in right ear and sudden tinnitus. Her audiometry showed an unilateral discreet sensorineural hipoacusia and the cranial IRM, a mass of 20 mm diameter in right pontine region and bulbus informed as cavemous angioma with signs of recent bleeding. The patient was sent to Neurosurgery but she refused the intervention. The risk of hemorrhage in the cavemomas is estimated at 0,25% to 1,6% per year and represents the main reason to advise a surgical treatment

Parotiditis aguda bacteriana supurada en adultos. Hallazgos clínicos y microbiológicos en 10 pacientes ingresados / Supurative bacterial acute parotitis in adults. Clinical and microbiological findings in 10 admitted patients

Se presentan los hallazgos clínicos y microbiológicos obtenidos en 10 pacientes adultos ingresados por nuestro Servicio de ORL con diagnóstico de parotiditis aguda bacteriana supurada. S. aureus y Streptococcus sp fueron los gérmenes aislados en la mayoría de los casos. En todos los pacientes se instauró hidratación, antibioticoterapia intravenosa que en ocasiones se modificó en función del antibiograma, analgésicos y antiinflamatorios con buen resultado. En 3 ocasiones fue necesario proceder a drenaje de la colección purulenta y en una de ellas existía un absceso retroauricular secundario a la sialoadenitis

We report the clinic and microbiological findings that were obtained in 10 adult patients admitted by our ENT Service with diagnosis of suppurative bacterial acute parotitis. S. aureus and Streptococcus sp were the most isolated organisms. All the patients were treated byhidratation, endovenous antibiotic therapy sometimes modified according to the antibiogram results, analgesics and antiinflammatories with success. In 3 times it was necessary to drain the purulent collection and in one of them there was a retroauricular abscess secondary tosialoadenitis