Retroauricular pain caused by Eagle syndrome: A rare presentation due to compression by styloid process elongation / Dor retroauricular causada pela síndrome de Eagle: uma apresentação rara por compressão pelo alongamento do processo estiloide

Summary Eagle syndrome is a rare condition presenting with retroauricular pain (usually as main symptom) associated with dysphagia, headache, neck pain on rotation and, much rarelier, stroke. This occurs due to styloid process elongation. Sometimes, there is also styloid ligament calcification, which can cause compression of nerves and arteries and the symptoms above. Treatment can be conservative with pain modulators (e.g. pregabalin) or infiltrations (steroids or anesthetics drugs). In refractory cases, surgical approach aiming to reduce the size of the styloid process can be performed. We present a rare case of Eagle syndrome (documented by computed tomography) with good response to clinical treatment.

Resumo A síndrome de Eagle é uma condição rara na qual ocorre dor retroauricular (usualmente é o principal sintoma) associada a disfagia, cefaleia, cervicalgia durante a rotação da cabeça e, mais raramente, a AVC. Isso ocorre por conta do alongamento do processo estiloide e, às vezes, há também calcificação do ligamento estiloide. Essas estruturas podem comprimir nervos e artérias causando os sintomas citados. O tratamento pode ser conservador com moduladores da dor, como pregabalina, ou com infiltrações (corticoides ou drogas anestésicas). Em casos refratários, cirurgia para reduzir o tamanho do processo estiloide pode ser realizada. É apresentado um caso raro de síndrome de Eagle (documentado com tomografia computadorizada) com boa resposta ao tratamento clínico.

Remodelación ósea en espondiloartritis / Bone remodeling in spondyloarthritis

Spondyloarthritis is a group of several related but phenotypically distinct chronic inflammatory diseases, characterized by progressive new bone formation which leads to ankylosis and functional disability. Radiographic images evidence not only erosive changes but also overgrowth of bony structures called syndesmophytes. These inflammation, bone destruction and new bone formation are located in the entheses, which constitutes the primary organ of the disease. As a consequence, the inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and local microenvironment factors. Several molecules playing a role as immune modulators or regulators of bone homeostasis, mediate the imbalance between bone resorption and formation. In the same way, animal models suggest that joint ankylosis may be independent from the effects of tumor necrosis factor alpha. Therefore, the process of new tissue (bone) formation can be considered as an additional therapeutic target. The Wnt signaling pathway, which is considered the primary regulator of osteoblastogenesis, constitutes a new research field of great interest in the last decade.

Sindrome de Eagle en otorrinolaringología / Eagle syndrome in otolaryngology

Eagle syndrome is characterized by recurrent clinical symptoms like globus, dysphagia and odynophagia, which can be explain by an abnormal elongation of the Estiloid Apophysis or the calcification of the estilohioid ligament. It affects in equal proportion to men and women, being most common in people older than 50 years. Its importance is that it appears as a differential diagnosis compared with other causes of cervicofacial pain, being its election treatment, the surgical resection of the Estiloid apophysis. The following is a review of the literature and a clinical case of a 44 years old man, who consulted with a history of 6 months of odynophagia, foreign body sensation and cervicalgia. After the clinical, endoscopic and the complementary study of images evaluation, it was concluded that this was an Eagle Syndrome.

Osificación parenquimatosa difusa del pulmón: prersentación de un caso

Presentamos el caso de un hombre de 49 años con osificación parenquimatosa difusa del pulmón. Los hallazgos clínicos y radiológicos orientaron el diagnóstico hacia una enfermedad intersticial. La biopsia pulmonar a cielo abierto fue requerida para el diagnóstico. Ninguna de las entidades relacionadas conla osificación pulmonar fue encontrada en este paciente.

Osificación del ligamento estilohioideo (Síndrome de Eagle): presentación de un caso / Ossification of the stylohyoid ligament (Eagle's Sindrome): presentation of 1 case

Se presenta el caso de una paciente femenina de 41 años con osoficación de los ligamentos estilohioideos (síndrome de Eagle), que simulaba dolor en la articulación témporo-mandibular. Esta es una patología que se presenta entre el 1 - 4 por ciento de la población en general, pero solo un número muy pequeño de estos se llegan a reconoer, ya que puede ser asintomáticos o presentar diversas manifestaciones clínicas. Se hace una revisión del tema

Tratamiento de las discrepancias de los miembros inferiores por el método de epifisiodesis de Phemister / Treatment of lower limbs lenght inequality by the phemister epyphisiodesis

Se evaluaron los caso de 36 niños, a los cuales de les practicó epifisiodesis con la técnica original descrita por Phemister; 12 del sexo femenino y 25 del masculino. La edad promedio fue de 11.3 años; el grupo de menor edad fue el de seis años, y el mayor, es de 15 años. el seguimiento promedio de los pacientes fue a 39.9 meses; el mínimo fue de tres meses en tres casos, los cuales acudieron a una sola evaluación posterior, y el máximo fue de 110 meses. Los resultados se clasificaron en excelentes, de 0 a 10 mm. de discrepancia; buenos, de 11 a 25 mm; regulares de 26 a 40 mm, y malos, de más de 40 mm. Se obtuvo un total de tres (9 por ciento) resultados excelentes, 16 (48 por ciento) buenos, 12 (36 por ciento) regulares y dos (6 por ciento) malos. Las complicaciones que se presentaron fueron cicatriz poco estética en todos los casos; sobrecrecimiento de las extremidades en dos casos; en ninguno se presentaron deformidades angulares

Effect of a persistent inflammatory process on experimental heterotopic ossification: the influence of macrophages

1. We investigated the effect of a persistent carrageenin- or nystatin-induced inflammatory reaction on heterotopic ossification produced by the subcutaneous implant of a demineralized bone matrix in female Swiss mice (25 to 35 g). 2. Subcutaneous carrageenin injection (0.3 ml of a 2 per cent solution in saline) into mice induced an inflammatory reaction characterized by a mature granuloma predominantly of macrophages containing particles of the irritant in their cytoplasm and which remained unchanged until the end of the experiment (40th day). 3. Subcutaneous nystatin inoculation (30,000 IU in 0.3 ml saline) induced an inflammatory reaction consisting initially of macrophages (4th day) but later turning into an epithelioid granuloma (7th day) consisting predominantly of epithelioid cells and which was present up to the 21st day when it was gradually replaced by adipocytes up to the 30th day. 4. An intramuscular implant of demineralized bone matrix (DBM, approximately 10 mg) induced the formation of cartilage and bone tissue and of hemopoietic bone marrow (heterotopic ossification) in 100 per cent of the control animals (N = 5). An intramuscular DBM implant in animals that received carrageenin (N = 19) or nystatin (N = 21) induced heterotopic ossification in 100 and 57 per cent (P < 0.01) of the animals, respectively. 5. The response to a dorsal subcutaneous DBM implant was essentially negative in control animals (N = 5), whereas implants performed near the site injected with carrageenin (N = 28) or nystatin (N = 31) produced a response in 71 (P < 0.01) and 36 per cent (P < 0.01) of the animals, respectively. A DBM implant into the contralateral (control) dorsal subcutaneous tissue of the same animals that received carrageenin (N = 25) or nystatin (N = 29) resulted in heterotopic ossification in 64 (P < 0.01) and 7 per cent of the animals, respectively. 6. The results suggest that the macrophages present in the mature granuloma induced by carrageenin somehow favored the development of metaplastic plates after subcutaneous DBM implant and that this effect may be systemic since the same response was observed in contralateral subcutaneous tissue