Linfoma tipo MALT primario de laringe / Primary MALT lymphoma of the larynx

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Infecciones cervicales profundas. Revisión de 286 casos / Deep neck infection. Review of 286 cases

Introducción: Las infecciones cervicales profundas (ICP) son afecciones potencialmente letales y susceptibles de complicaciones graves. En este estudio se constata el aumento de la incidencia y se trata de buscar las causas. Más del 30% son idiopáticas, pero suelen relacionarse con infecciones dentarias y orofaríngeas. Material y métodos: Se presentan 286 ICP consecutivas en un estudio retrospectivo de los últimos 11 años en nuestro centro y se analizan antecedentes y enfermedades concomitantes y aspectos diagnósticos y terapéuticos de los pacientes que pueden influir en el desarrollo de las ICP. Resultados: Se objetiva un repunte de la incidencia de las ICP en nuestro medio. Las complicaciones más frecuentes fueron mediastinitis, shock séptico con coagulación intravascular diseminada, fascitis necrotizante y compromiso respiratorio agudo. Las secuelas más frecuentes observadas fueron la disfagia por parálisis de pares craneales bajos y neuroencefalopatía. Se produjeron un 10% de neumonías aspirativas. La mortalidad por ICP en los adultos es del 5,9% y en los niños del 6,2%. Conclusiones: Las ICP debe ser consideradas una urgencia médicoquirúrgica. Son susceptibles de complicaciones graves en cuestión de horas. Debemos estar atentos a la aparición de síntomas de alarma como: disnea, estridor, dolor a la palpación en el suelo de la boca, sialorrea, trismus, etc.El avance en los diversos procedimientos diagnósticos (imagen, microbiología) y terapéuticos (antibióticos, cirugía), así como la mejor atención del paciente crítico (UCI- REA), han sido decisivos en el diagnóstico y tratamiento precoz, identificar y tratar las complicaciones y mejorar el pronóstico y la mortalidad de los pacientes (AU)

Introduction: Deep neck infections (DNI) are potentially lethal processes and are susceptible to severe complications. This study shows an increment of the incidence and investigated the cause. More than 30% of cases are idiopathic, but they are commonly related to a dental or oropharyngeal infection. Material and methods: We present 286 consecutive cases in a retrospective 11-year study. We analysed the clinical picture, antecedents and concurrent diseases, and diagnostic and therapeutic approaches that could be related to developing a DNI. Results: A mayor increase in DNI incidence in our setting was seen in the last few years. The mayor complications were mediastinitis, septic shock with disseminated intravascular coagulation syndrome, necrotising fasciitis and acute respiratory failure. A lower cranial nerve palsy that develops into dysphagia and leukoencephalopathy are the most frequent sequela. We found 10% of aspiration pneumonia. Mortality in adults was 5.9% and in children, 6.2%. Conclusions: Deep neck infections constitute a medical and surgical emergency. Severe complications may arise in a short time. We must be vigilant to alarm symptoms such as dyspnea, stridor, pain in the floor of the mouth, sialohrrea, trismus, etc. Improvements in antibiotic therapy, diagnostic imaging and critical patient support modalities have decreased mortality and there is a better prognosis, with complications being identified and treated earlier (AU)

Deep neck infection. Review of 286 cases.

INTRODUCTION: Deep neck infections (DNI) are potentially lethal processes and are susceptible to severe complications. This study shows an increment of the incidence and investigated the cause. More than 30% of cases are idiopathic, but they are commonly related to a dental or oropharyngeal infection. MATERIAL AND METHODS: We present 286 consecutive cases in a retrospective 11-year study. We analysed the clinical picture, antecedents and concurrent diseases, and diagnostic and therapeutic approaches that could be related to developing a DNI. RESULTS: A mayor increase in DNI incidence in our setting was seen in the last few years. The mayor complications were mediastinitis, septic shock with disseminated intravascular coagulation syndrome, necrotising fasciitis and acute respiratory failure. A lower cranial nerve palsy that develops into dysphagia and leukoencephalopathy are the most frequent sequela. We found 10% of aspiration pneumonia. Mortality in adults was 5.9% and in children, 6.2%. CONCLUSIONS: Deep neck infections constitute a medical and surgical emergency. Severe complications may arise in a short time. We must be vigilant to alarm symptoms such as dyspnea, stridor, pain in the floor of the mouth, sialohrrea, trismus, etc. Improvements in antibiotic therapy, diagnostic imaging and critical patient support modalities have decreased mortality and there is a better prognosis, with complications being identified and treated earlier.

[Merkel cell carcinoma: a presentation of 5 cases and a review of the literature]. / Carcinoma de células de Merkel: presentación de 5 casos y revisión de la literatura.

Merkel cell carcinoma is an unusual, aggressive skin tumour, with a tendency to recurrence after its surgical extirpation. Five cases of tumours in the cervicofacial region seen at our Centre in the last five years are presented, along with a review of the literature, focusing on its etiopathogeneis, approach and treatment.

Mucormicosis rinoorbitocerebral, un estudio retrospectivo de 7 casos / Rhino-orbito-cerebral mucormycosis, a retrospective study of 7 cases

La mucormicosis es una infección oportunista, producida por los hongos del orden mucorales. Tiene una baja incidencia. Es potencialmente letal y afecta a pacientes inmunocomprometidos. Presentamos 7 casos de mucormicosis rinocerebral en un estudio retrospectivo de 8 años (2000–2008) en pacientes hematológicos. Es preciso realizar un diagnóstico precoz, para lo cual se ha de mantener un alto índice de sospecha clínica en pacientes con factores predisponentes. El diagnóstico de certeza requiere la realización de cultivos o biopsias de las zonas afectadas que demuestren la invasión de los tejidos por las hifas características. La clave del tratamiento es el desbridamiento quirúrgico precoz y agresivo, junto con altas dosis de amfotericina B intravenosa. A pesar de este tratamiento, el pronóstico es desfavorable y la mortalidad es de un 70–80% (AU)

Mucormycosis is an opportunistic fungal infection caused by fungi of the Mucorales order. It has a low incidence and is a potentially lethal infection which generally affects patients who are immunocompromised due to systemic disease. We report 7 cases of rhinocerebral mucormycosis in a retrospective study of 8 years (2000–2008) in hematologyc patients. An early diagnosis is essential, and therefore there must be a high level of clinical suspicion in patients with predisposing factors. Certainty diagnosis requires fungal cultures or biopsies of the affected areas which prove an invasion of the tissues by the characteristic hyphae. The key to treatment is early and aggressive surgical treatment, together with high intravenous doses of B amphotericyn. Despite this, prognosis is poor and mortality is about 70–80% (AU)

Rhino-orbito-cerebral mucormycosis, a retrospective study of 7 cases.

Mucormycosis is an opportunistic fungal infection caused by fungi of the Mucorales order. It has a low incidence and is a potentially lethal infection which generally affects patients who are immunocompromised due to systemic disease. We report 7 cases of rhinocerebral mucormycosis in a retrospective study of 8 years (2000-2008) in haematological patients. An early diagnosis is essential, and therefore there must be a high level of clinical suspicion in patients with predisposing factors. Certainty diagnosis requires fungal cultures or biopsies of the affected areas which prove an invasion of the tissues by the characteristic hyphae. The key to treatment is early and aggressive surgical treatment, together with high intravenous doses of amphotericin B. Despite this, prognosis is poor and mortality is about 70-80%.

[Head and neck paragangliomas. Embryological origin and anatomical characteristics: topographic distribution and vascularization pattern]. / Paragangliomas cervicocefálicos. Origen embriológico y características anatómicas: distribución topográfica y patrón de vascularización.

Paragangliomas are tumors that arise in the extraadrenal paraganglia and result from migration of neural crest cells during embryonic development. Based on their anatomical distribution, innervation and microscopic structure, these tumors can be classified into interrelated families: branchiomeric paraganglia (related to the branchial clefts and arches), intravagal, aortic-sympathetic and visceral-autonomic. Head and neck paragangliomas belong mainly to the first two of these families. The present article is divided into two parts. The first part reviews the embryological origin of these tumors. Special emphasis is placed on the process of neurulation or neural tube formation, neurosegmentation (with a summary of the mechanisms involved in the initial segmentation of the neural tube and of the hindbrain and spinal medulla), and the development of the sensory placodes and secondary inductions in the cranial region. Subsequently, the neural crest is analyzed, with special attention paid to the cranial neural crest. The embryonogenesis of paragangliomas is also described. The second part describes the topographical distribution of head and neck paragangliomas according to their localization: jugulotympanic, orbit, intercarotid, subclavian and laryngeal. The embryonogenesis and most important anatomical characteristics are described for each type.

Paragangliomas cervicocefálicos. Origen embriológico y características anatómicas: distribución topográfica y patrón de vascularización / Head and neck paragangliomas. Embryological origin and anatomical characteristics: topographic distribution and vascularization pattern

Los paragangliomas son neoplasmas procedentes de paraganglios extra adrenales que derivan de la migración de las células de la cresta neural durante el desarrollo embrionario. Según su distribución anatómica, su inervación y su estructura microscópica, pueden ser agrupados en familias interrelacionadas, diferenciándose paraganglios branquioméricos (relacionados con los arcos y hendiduras branquiales),intravagales, aórtico-simpáticos y autonómicos-viscerales. Los paragangliomas cervicocefálicos pertenecen principalmente a las 2 primeras de estas familias. El presente capítulo está divido en 2 partes. En la primera parte se hace una revisión sobre su origen embriológico, poniendo especial énfasis en el proceso de neurulación o formación del tubo neural; la neurosegmentación, resumiendo los mecanismos implicados en la segmentación inicial del tubo neural y la segmentación del rombencéfalo y la médula espinal, y la evolución de las placodas sensitivas e inducciones secundarias en la región craneal. Posteriormente, se analiza la cresta neural, con especial atención a la cresta neural craneal, para terminar con la embriogénesis de los paragangliomas. En la segunda parte se desarrolla la distribución topográfica de los paragangliomas cervicocefálicos, diferenciándolos conforme a su localización: yúgulo-timpánicos, orbitarios, intercarotídeos, subclavios y laríngeos. Cada tipo se asocia con su embriogénesis y con los detalles anatómicos más relevantes (AU)

Paragangliomas are tumors that arise in the extra adrenalparaganglia and result from migration of neural crest cells during embryonic development. Based on their anatomical distribution, innervation and microscopic structure, these tumors can be classified into interrelated families: branchiomeric paraganglia (related to the branchial clefts and arches), intravagal, aortic-sympathetic and visceral-autonomic. Head and neck paragangliomas belong mainly to the first two of these families. The present article is divided into two parts. The first part reviews the embryological origin of these tumors. Special emphasis is placed on the process of neurulation or neuraltube formation, neurosegmentation (with a summary of the mechanisms involved in the initial segmentation of the neuraltube and of the hindbrain and spinal medulla), and the development of the sensory placodes and secondary inductions in the cranial region. Subsequently, the neural crest is analyzed, with special attention paid to the cranial neuralcrest. The embryonogenesis of paragangliomas is also described. The second part describes the topographical distribution of head and neck paragangliomas according to their localization: jugulotympanic, orbit, intercarotid, subclavian and laryngeal. The embryonogenesis and most important anatomical characteristics are described for each type (AU)

[PANDAS Syndrome: a new tonsillectomy indication?]. / Síndrome PANDAS: ouna nueva indicación de amigdalectomía?

PANDAS Syndrome (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) is a rare disease described in 1998. In this disease, there is a relationship between group A beta haemolytic streptococcal tonsil infections and the exacerbation of neuropsychiatric disorders. A case report of a 9-year-old child with PANDAS syndrome is presented. This child has had no further symptoms after tonsillectomy. The understanding about PANDAS syndrome and tonsillectomy is reviewed.

Síndrome PANDAS: ¿una nueva indicación de amigdalectomía? / PANDAS syndrome: a new tonsillectomy indication?

El síndrome PANDAS (pediatric autoinmune neuropsychiatric disorders associated with Streptococcus) es una entidad rara que se describió en 1998. Los pacientes con esta afección presentan una exacerbación de los síntomas neuropsiquiátricos coincidiendo con las infecciones amigdalares causadas por Streptococcus betahemolítico del grupo A. Presentamos el caso clínico de un paciente de 9 años con síndrome PANDAS sometido a amigdalectomía que mejoró de su sintomatología tras la intervención. Del mismo modo revisamos la literatura sobre esta entidad

PANDAS Syndrome (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) is a rare disease described in 1998. In this disease, there is a relationship between group A beta haemolytic streptococcal tonsil infections and the exacerbation of neuropsychiatric disorders. A case report of a 9-year-old child with PANDAS syndrome is presented. This child has had no further symptoms after tonsillectomy. The understanding about PANDAS syndrome and tonsillectomy is reviewed

[Aorto-oesophageal fistula in patient with Montgomery salivary bypass tube]. / Fístula aortoesofágica en paciente con tubo de derivación salival de Montgomery.

Aorto-oesophageal fistula is a well-reported pathology with several known causes. The co-existence of this pathology associated with the use of a Montgomery salivary bypass tube (MSBT) is exceptional and only one case is described in the literature. We present here a case report about an 81-year-old patient with an MSBT who died because of a massive upper gastrointestinal bleeding caused by an aorto-oesophageal fistula at the site of the MSBT. The literature on this pathology will also be reviewed.

Fístula aortoesofágica en paciente con tubo de derivación salival de Montgomery / Aorto-oesophageal fistula in patient with Montgomery salivary bypassttube

Las fístulas aortoesofágicas son afecciones sobradamente descritas y con múltiples etiologías. No obstante, es excepcional que se presenten por la utilización del tubo de derivación salival de Montgomery (TBSM), algo descrito en la literatura médica en una sola ocasión. Presentamos el caso clínico correspondiente a un paciente de 81 años que portaba un TBSM y falleció por una hemorragia masiva del tracto digestivo superior causada por una fístula aortoesofágica en la localización del TBSM. Se revisa la literatura sobre este tema

Aorto-oesophageal fistula is a well-reported pathology with several known causes. The co-existence of this pathology associated with the use of a Montgomery salivary bypass tube (MSBT) is exceptional and only one case is described in the literature. We present here a case report about an 81-year-old patient with an MSBT who died because of a massive upper gastrointestinal bleeding caused by an aorto-oesophageal fistula at the site of the MSBT. The literature on this pathology will also be reviewed