Artroplastia de recubrimiento de cabeza humeral en paciente joven con necrosis avascular bilateral / Humeral head surface replacement arthroplasty in young patient with bilateral avascular necrosis

La artroplastia de recubrimiento de la cabezahumeral está indicada en pacientes con una deformidad leve o moderada de la cabeza del húmero que presentan dolor e impotencia funcional. Presentamos el caso de una paciente joven afectada de necrosis avascular humeral bilateral a la que se le colocó dicha prótesis en ambos hombros. Tras completar el tratamiento rehabilitador, se le realizó una valoración funcional mediante la escala de Constant, obteniendo unos resultadosmuy favorables respecto a su situación previa a la cirugía. Dadas las ventajas que presenta la artroplastia de recubrimiento de cabeza humeral (menor incidencia de complicaciones, disminución del tiempo quirúrgico y reducción de la duración del programa rehabilitador) asociadas a los buenosresultados funcionales obtenidos, consideramos que este tipode prótesis puede ser una buena alternativa a la artroplastiacementada convencional de hombro en pacientes con deformidadleve o moderada de cabeza humeral

Humeral head surface replacement arthroplastyis indicated in patients with a slight or moderate deformity of the humeral head with pain and functional impotence. We present the case report of a young female patient with bilateral humeral avascular osteonecrosis in whom this prosthesis in placed both shoulders. After a rehabilitation program, we made a functional evaluation with the Constant score, obtaining favorable outcomes in relationship to her previous situation. Given the advantages of this arthroplasty(lower incidence of complications, less surgical time and reduction in the length of the rehabilitation program) and the good functional outcome, we consider this type prosthesis to be a good alternative choice to the conventional stemmed arthroplasty of the shoulder in patients with slight or moderate deformity of the humeral head

Sinusitis fúngicas no invasivas: micetoma y sinusitis fúngica alérgica / Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis

Hemos realizado un estudio de diferentes casos de sinusitis fúngicas (SF) no invasivas vistas en nuestro hospital y tratadas mediante cirugía endoscópìca nasosinusal (CENS) y tratamiento médico. Presentamos 2 casos de SF no invasivas: Aspergiloma y sinusitis fúngica alérgica y realizamos el diagnóstico diferencial entre los diferentes tipos según la nueva clasificación. Por último resaltamos los aspectos más relevantes de cada tipo con una amplia revisión bibliográfica (AU)

[Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis]. / Sinusitis fúngicas no invasivas: micetoma y sinusitis fúngica alérgica.

We have made a study about different cases of non-invasive fungal sinusitis (FS) treated at our hospital with surgery (endoscopic sinus approach) and medical treatment. We review two cases: Mycetoma and allergic fungal sinusitis, following the recent classification based on physiopathology, treatment and prognosis. We review the clinical presentation of the different types.

[Efficiency of multidisciplinary treatment of chronic pain with locomotor disability]. / Eficacia del tratamiento multidisciplinario del dolor crónico incapacitante del aparato locomotor.

BACKGROUND AND OBJECTIVE: Disabling chronic pain is especially devastating among working population and, in many cases, it does not respond to conventional therapies. In chronic pain, the importance of psychosocial and occupational factors, in addition to biological ones, has prompted the development of successful multidisciplinary treatment programmes in various countries. We assessed the outcome of a multidisciplinary therapeutic program for work-disabled selected patients with chronic pain refractory to conventional treatment. PATIENTS AND METHOD: The study included 70 patients (58 women, mean age [SD]: 42 [9]years) with chronic pain and sick leave (mean [SD]: 7 [4] months of work disability) diagnosed with fibromyalgia (51%), chronic low back pain (16%), regional myofascial pain (15%), cervicocraneal syndrome (3%), anquilosing spondylitis (3%), and other conditions(12%). All patients had received previous pharmacological treatment,physical therapy and/or other measures (surgery in 12% cases)without improvement. All patients underwent an intensive multidisciplinary treatment of 4 weeks' duration including medical techniques for pain control, cognitive-behavioural therapy, physical therapy,and occupational therapy. Average follow-up was 10 (4) months(1-24 months) post-discharge. RESULTS: Significant improvements were observed with regard to all relevant variables, as reflected in pre and post-discharge measures: pain(Visual-Analogue Scale 1-10 cm): 7.4 (1.5) versus 3.2 (2) (p <0.01); anxiety (HARS), 19 (7) versus 14 (8) (p < 0.01); depression(BDI), 16 (8) versus 10 (8) (p < 0.01); functional ability(HAQ), 1.6 (0.4) versus 0.6 (0.5) (p < 0.001). At discharge,73% of patients returned to work. In addition, 69% of treated patients maintained the acquired improvement and their employment status at the end of follow-up. CONCLUSION: Multidisciplinary treatment of chronic pain with special attention to work return is useful for selected patients with a disabling chronic pain syndrome refractory to conventional treatment.

[Pharmacological prophylaxis of gastroesophageal reflux. Incidence of pharyngocutaneous fistula after total laryngectomy]. / Profilaxis farmacológica del reflujo gastroesofágico. Incidencia de fístula faringocutánea tras laringuectomía total.

Pharyngocutaneous fistula is a serious complication of total laryngectomy. This problem increases morbidity, prolongs hospitalization, and occasionally causes death. Numerous contributing factors have been implicated in fistula formation (1). We propose that gastroesophageal reflux, which often is subclinical, is an important trigger and should be prevented. We evaluated the effect of associating an antireflux agent like metoclopramide hydrochloride to our usual ranitidine of our protocol after total laryngectomy on reducing the incidence (p<0.05) of pharyngocutaneous fistula.

Profilaxis farmacológica del reflujo gastroesofágico. Incidencia de fístula faringocutánea tras laringuectomía total / Pharmacological prophylaxis of gastroesophageal reflux. Incidence of pharyngocutaneous fistula after total laryngectomy

La fístula faringocutánea es una importante complicación frecuente tras la laringuectomía total. Dicha complicación aumenta la morbilidad, prolonga el período de hospitalización y ocasionalmente puede comprometer el estado vital del paciente. Son varios los factores involucrados en la génesis de fístulas faringocutáneas (1), entre los cuales, el reflujo gastroesofágico, en ocasiones silente, puede ser uno de los desencadenantes más habituales. Evaluamos si la incorporación de la medicación antirreflujo, Clorhidrato de Metoclopramida, a nuestro protocolo postquirúrgico que sólo incluía ranitidina, reporta diferencias estadísticamente significativas (p < 0,05) a favor de la disminución de la incidencia de fistulas faringocutáneas (AU)

Pharyngocutaneous fistula is a serious complication of total laryngectomy. This problem increases morbidity, prolongs hospitalization, and occasionally causes death. Numerous contributing factors have been implicated in fistula formation (1). We propose that gastroesophageal reflux, which often is subclinical, is an important trigger and should be prevented. We evaluated the effect of associating an antireflux agent like metoclopramide hydrochloride to our usual ranitidine of our protocol after total laryngectomy on reducing the incidence (p<0.05) of pharyngocutaneous fistula (AU)

[Effectiveness of external nasal dilators in nasal ventilatory obstruction. Objective improvement or placebo effect?]. / Eficacia de las tiritas nasales en la obstrucción ventilatoria nasal. Realidad objetiva o placebo?

External nasal dilators have become popular among athletes and the general public. When applied to the nares, the device theoretically increases the nasal valve area and decreases total airway resistance. There are doubts regarding the true benefits of this device as opposed to a possible placebo effect. In order to resolve this question, the subjective sensation was compared with an objective measurement in two different groups: a group of 20 persons who complained of nasal insufficiency and a group of 20 control subjects. Computer rhinometry was used for objective measurements and psychological parameters were evaluated with a questionnaire.

[Leishmaniasis and ENT]. / Leishmaniasis en O.R.L.

Three cases of the infrequent mucocutaneous Leishmaniasis, with nasal involvement in two of them and affection of the hypophrarynx and larynx in the other one are presented. We remark, in the case with laryngeal disease, that it was the onset of an AIDS in a patient unknown to be HIV+. Leishmaniasis of the larynx has not been described before as the onset of an AIDS. Symptomatology, evolution and treatment of this disease are revised, pointing out the increasing association, in our country, between leishmaniasis and AIDS, and considering the possibility of including the leishmania infection as an AIDS criteria in HIV+ patients, and to rule out an IVH infection in a patient with an atypical leishmaniasis either for the site involved or the evolutive course of the disease.

[Limitations of CAT scan in the diagnosis of myelolipoma of the adrenal gland]. / Limitaciones de la TAC en el diagnóstico del mielolipoma suprarrenal.

The suprarenal myelolipoma is a myeloid tissue and fat tissue tumor. It can undergo degenerative processes of haemorrhage, necrosis and calcification. The diagnostic key is based on the finding of fat tissue in the inside of a suprarenal mass. A CAT would be the method allowing a more accurate diagnosis. Its limitations came from the presence of myelolipomas with abundant myeloid tissue, or which have suffered major degenerative processes in which it is difficult to identify the fat tissue, and in large retroperitoneal masses in which it is impossible to recognize their suprarenal origin.