[Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood]. / Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre.

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.

[Subdural empyema of sinus origin caused by Gemella morbillorum, a strange etiology]. / Empiema subdural de causa sinusal por Gemella morbillorum, una extraña etiología.

We present a case of frontal sinusitis complicated with a subdural empyema, in which the identified microorganism was Gemella morbillorum, a frequent host of the aerodigestive tract and occasionally related to infections. The problem was resolved successfully using endoscopic surgery and an external approach of the sinus. Afterwards it was completed with a subdural drainage through craniotomy. Subdural empyema is a rare complication of sinusitis although very severe. We want to emphasize the importance of early diagnosis of intracranial complications, the need of a detailed microbiology test the method used to obtain samples, and the convenience of a combined approach by the otolaryngologists and the neurosurgeons for its complete drainage.

Perfil oxidativo de la infección amigdalar. Estudio de las enzimas antioxidantes en amígdala y sangre / Oxidative profile in tonsillar infection. A study of the antioxidative enzymes in tonsil and in blood

Para valorar la influencia que el daño oxidativo por radicales libres determina en la patología infecciosa ORL, se estudió mediante espectrofotometría los niveles de superóxido dismutasa (SOD), glutation peroxidasa (GPx) y reductasa (GRt) y estado de antioxidación total (EAT) en el tejido amigdalar obtenido por amigdalectomía en 538 pacientes, divididos en tres grupos según su indicación quirúrgica: hipertrofia amigdalar (n=235), amigdalitis de repetición (n=280) o absceso periamigdalino (n=23). También se midió la concentración de SOD en el tejido adenoideo y exudado ótico de 75 pacientes pertenecientes en los dos primeros grupos. Los niveles de SOD eritrocitaria y amigdalar fueron significativamente mayores en el grupo con absceso, y bajos en el de hipertrofia. Para la GPx y EAT estas diferencias resultaron semejantes. Para la GRt, los niveles entre los abscesos resultaron inferiores a los de los otros dos grupos de forma estadísticamente significativa. Se observaron fuertes correlaciones entre la SOD eritrocitaria y amigdalar, SOD y GPx amigdalar, SOD y EAT amigdalar y GPx y EAT amigdalar. Las concentraciones de la SOD en el tejido adenoideo y el exudado ótico no influyeron en los niveles en sangre. Podemos concluir que el daño oxidativo en las amígdalas viene determinado por la frecuencia o gravedad de las infecciones locales, y es valorable mediante la concentración de SOD en el tejido amigdalar o en la sangre periférica, pudiendo considerarse un buen marcador de sufrimiento amigdalar (AU)

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage (AU)

Empiema subdural de causa sinusal por Gemella morbillorum, una extraña etiología / Subdural empyema of nasosinusal origin by Gemella morbillorum, an infrequent etyology

Presentamos un caso de sinusitis frontal complicada con empiema subdural, en la que el microorganismo identificado fue Gemella morbillorum, un comensal de la vía aerodigestiva que en ocasiones se asocia con infecciones fulminantes. El caso fue resuelto con éxito mediante cirugía endoscópica nasal y abordaje externo del seno, complementado posteriormente con drenaje subdural mediante craniectomía. El empiema subdural es una infrecuente pero muy grave complicación de la sinusitis. Mediante este trabajo hacemos énfasis en la importancia de la detección precoz de las complicaciones craneales, la necesidad de un estudio microbiológico detallado, el método utilizado para obtención de las muestras, y la conveniencia de un abordaje combinado ORL y neuroquirúrgico para su completo drenaje (AU)

We present a case of frontal sinusitis complicated with a subdural empyema, in which the identified microorganism was Gemella morbillorum, a frequent host of the aerodigestive tract and occasionally related to infections. The problem was resolved successfully using endoscopic surgery and an external approach of the sinus. Afterwards it was completed with a subdural drainage through craniotomy. Subdural empyema is a rare complication of sinusitis although very severe. We want to emphasize the importance of early diagnosis of intracranial complications, the need of a detailed microbiology test the method used to obtain samples, and the convenience of a combined approach by the otolaryngologists and the neurosurgeons for its complete drainage (AU)

[Tonsillar and erythrocyte levels of superoxide dismutase in children with and without recurrent tonsillitis]. / Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición.

BACKGROUND AND OBJECTIVES: Oxidative stress secondary to infant tonsillar infection produces the expression of local and systemic antioxidants. Its determination seems to be useful as a marker of tonsillar suffering before tonsillectomy but is currently unknown. The aim of this study was to determine the evolution of this parameter in tonsillectomized children during a long-term follow-up. METHODS: One hundred thirty-six children underwent tonsillectomy, 46 for tonsillar hypertrophy without infection and 90 for recurrent tonsillitis. Superoxide dismutase (SOD) concentrations were measured before tonsillectomy and at 6, 12, 24 and 36 months post-tonsillectomy. RESULTS: Infection provoked significantly higher SOD concentrations than tonsillar hypertrophy in tonsillar tissue (223.06 30.46 vs 156.39 54.05 U/l, p < 0.001) and in blood (1124.91 141.73 vs 1007.19 97.03 U/gr Hb, p < 0.001). There was a strong correlation between tonsillar and erythrocyte concentrations. During the 3-year follow-up, SOD concentrations in blood progressively decreased until stabilizing in all patients. Stabilization was reached at 6 months post-tonsillectomy in the group with tonsillar hypertrophy and at 2 years in the group with infection. Children with recurrent tonsillitis consistently showed higher SOD concentrations in blood throughout the follow-up. CONCLUSIONS: Oxidative damage in tonsillar tissue results from the incidence and severity of focal infections. Tonsillectomy reduces SOD levels but, as a consequence of oxidative stress, these do not return to normal.

Niveles de superóxido dismutasa amigdalar y eritrocitaria en niños con y sin amigdalitis de repetición / Superoxide dismutase levels from tonsil and erythrocytes in children with recurrent tonsillitis

Antecedentes y objetivos: El estrés oxidativo de la infección amigdalar infantil determina la expresión de antioxidantes locales y sistémicos. Su determinación parece tener valor como marcador de padecimiento amigdalar previo a la amigdalectomía, pero permanece desconocida, y es ésa nuestra meta, la evolución de este parámetro en niños intervenidos y seguidos a largo plazo. Métodos: Se estudiaron 136 niños amigdalectomizados, 46 por hipertrofia amigdalar sin infección, y 90 por amigdalitis recurrente. En ellos se midieron concentraciones de superóxido dismutasa (SOD) preoperatoria, así como a los 6, 12, 24 y 36 meses postamigdalectomía. Resultados: La infección generó concentraciones significativamente mayores que la hipertrofia amigdalar en tejido amigdalar (223,06 30,46 frente a 156,39 54,05 U/l; p < 0,001) y sangre (1.124,91 141,73 frente a 1.007,19 97,03 U/g Hb; p < 0,001), existiendo muy buena correlación entre las concentraciones amigdalares y eritrocitarias en ambos grupos. El seguimiento a 3 años permitió detectar una progresiva tendencia al descenso en los niveles de SOD en sangre en todos los casos hasta su estabilización. Este estado se alcanza antes en el grupo con hipertrofia amigdalar a los 6 meses postamigdalectomía, y a los 2 años en el de infecciones. En cualquier caso, en su seguimiento postamigdalectomía los niños con amigdalitis de repetición siempre mostraron concentraciones de SOD más altas. Conclusiones: El daño oxidativo en tejido amigdalar resulta de la incidencia y gravedad de las infecciones focales, y la anulación de éstas redunda en un descenso en los niveles de SOD que no llegan a la normalización, a modo de registro inmune frente a una agresión oxidativa (AU)

Un caso pediátrico de trastorno autoinmune del oído interno (síndrome de Cogan) / Inner ear autoimmune disorder (Cogan's syndrome) in a pediatric patient

Se presenta un caso de síndrome de Cogan (queratitis intersticial no sifilítica, hipoacusia neurosensorial de rápida evolución y vértigo) en una niña de 12 años. La sospecha diagnóstica se fundamentó en la exploración clínica y audiológica y en los hallazgos inespecíficos de laboratorio (velocidad de sedimentación globular [VSG] elevada, y títulos positivos de inmunoglobulinas A y M [IgA e IgM] de factor reumatoide, así como anticuerpos anticitoplasma de neutrófilo [ANCA]). La detección de autoanticuerpos específicos frente a la fracción antigénica coclear de 68 kDa mediante Western-blot permitió confirmar la autoinmunidad organospecífica del trastorno laberíntico. El tratamiento con deflazacort en dosis de 1 mg/kg/día durante 3 semanas y la reducción progresiva revirtió la sintomatología y normalizó la exploración. Hasta la fecha el cuadro no ha presentado reagudizaciones (AU)

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[Inner ear autoimmune disorder. Cogan's syndrome]. / Un caso pediátrico de trastorno autoinmune del oído interno (síndrome de Cogan).

We present a case of Cogan's syndrome (interstitial keratitis, rapidly evolving sensorineural hearing loss and vestibular dysfunction) in a 12-year-old girl. Diagnosis was made by clinical and audiologic examination as well as by nonspecific laboratory findings (increased erythrosedimentation rate and positive IgA and IgM rheumatoid factor titers and antineutrophil cytoplasmic autoantibodies). Detection of specific autoantibodies against cochlear antigenic epitopes with a molecular weight of 68 kDa by Western-blot assay confirmed an organ-specific autoimmune mechanism. Therapy with deflazacort 1 mg/kg per day 3 three weeks decreasing progressively thereafter was successful and the patient remains symptom-free.

Detección de patología amigdalar mediante los niveles de superóxido dismutasa. Estudio comparativo por indicaciones quirúrgicas de amigdalectomía / Detection of amygdala disease with superoxide dismutase levels. Comparative study of the surgical indications for amygdalectomly

Si los radicales libres derivados del oxígeno son considerados la causa última del daño amigdalar debido a infección, parece coherente pensar que los niveles de antioxidantes detoxificadores suponen una buena medida del deterioro tisular. Así, se calcularon las concentraciones de superóxido dismutasa (SOD) en amígdalas palatinas y sangre periférica en grupos de individuos diagnosticados de hipertrofia sin infección (HA, n = 83), amigdalitis de repetición (AR, n = 75), y absceso periamigdalino (APA, n = 12). Tanto en los sobrenadantes de los cultivos de amígdala como en eritrocitos de sangre periférica se detectaron niveles de SOD progresivamente crecientes en los grupos con HA, AR y APA, de forma estadísticamente significativa (ANOVA-test; p < 0,001). Estos niveles correlacionaron bien sus valores en tejido y sangre para todos los grupos. Pudo concluirse que la concentración de SOD en amígdala palatina y/o en sangre periférica aumenta de forma proporcional a la incidencia de infecciones, con lo que detecta al paciente con deterioro funcional, pudiendo indicar objetivamente la amigdalectomía o bien monitorizar la respuesta clínica del individuo al tratamiento. La utilidad práctica y los resultados obtenidos de la comparación con biopsias de amígdala son comentados (AU)

If oxygen-derived free radicals are considered the definitive cause of tonsillar damage after infection, it seems reasonable that scavenger antioxidants levels could be used as a detector of tissue impairment. So, superoxide dismutase (SOD) amounts were measured in palatine tonsils and peripheral blood on subjects bearing of hypertrophy without infection (H, n = 83), recurrent tonsillitis (RA, n = 75), and peritonsillar abscess (PA, n = 12). SOD levels in both tonsillar cultures supernatants and peripheral blood erythrocytes were detected progressively increased in groups with H, RA and PA, which were statistically significative (ANOVA-test; p < 0.001). A significative correlation between tissue and blood was observed for all the groups. We can conclude that SOD concentration in palatine tonsils and/or peripheral blood increases proportionally to infections incidence, which allows detecting patients with functional damage, and recommending objectively tonsillectomy or at least monitoring clinical response for a therapy. Practical use and results obtained from comparison to tonsil biopsies are discussed (AU)

Lesiones en cabeza y cuello por fibrodisplasia osificante progresiva sistématica (enfermedad de Munchmeyer) / Head and neck lesions from systemic fibrodysplasia ossificans progressiva (Munchmeyer disease)

La fibrodisplasia osificante progresiva es una rara conectivopatía hereditaria debida a una mutación desconocida que condiciona la osificación del músculo estriado y tejidos blandos a menudo relacionados con las articulaciones y potenciado por cualquier traumatismo o maniobra iatrógena agresiva. Ello provoca rigidez, dolor, incapacidad funcional, inflamación y tumoraciones fibro-óseas diseminadas en cualquier localización, siendo la clínica muy espectacular, invalidante e irreversible. Exceptuando la lesión de la musculatura esternocleidomastoidea o masticadora, la afectación de cabeza y cuello es infrecuente. Presentamos por ello un cuadro sistémico de fibrodisplasia osificante progresiva con expresión clínica y radiológica acentuadas en raquis cervical, faringo-laringe, cavidad oral, macizo facial y oído. La asociación de bifosfonatos y corticoides de forma prolongada ha permitido hasta la fecha estabilizar el cuadro, pero no revertir los hallazgos descritos (AU)

Fibrodysplasia ossificans progressiva is a rare hereditary connective tissue disorder due to an unknown mutation conditioning the ossification of striated muscle and soft tissues frequently related to joints and stimulated by traumatisms or aggressive iatrogenic manouvres. It produces stiffness, pain, disability, swelling and fibro-osseus masses disseminated everywhere, with a very spectacular, invalidant and irreversible clinical picture. Affection of head and neck is unusual, excepting lesions in sternocleidomastoid or masticatiry muscles. We show a systemic case of fibrodysplasia osificans progressiva with enhanced clinical and radiological findings in cervical rhachis, pharynx and larynx, oral cavity, facial bones and ear. Association of biphophonates and steroids for a long period of time seems up to now stopping the evolution but not its regression (AU)

[Pathophysiological rationale for the use of piracetam in sudden deafness]. / Argumentación fisiopatológica al empleo de piracetam en la sordera brusca.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

Argumentación fisiopatológica al empleo de piracetam en la sordera brusca / Pathophysiological rationale for the use of piracetam in sudden deafness

Con el objeto de valorar si los trastornos en la viscosidad de la sangre condicionan la evolución clínica en la Sordera Brusca Idiopática, se estudió la eficacia del agente reoactivo piracetam en pacientes afectos, comparando su asociación a prednisolona con un tratamiento vasodilatador/esteroideo. En el grupo con piracetam (n = 17) se evidenció mejoría subjetiva en el 82,3 por ciento, con un 54, 1 por ciento de ganancia media auditiva, mientras que sin piracetam (n = 16) mejoró clínicamente el 68,7 por ciento y la ganancia media fue del 49,3 por ciento. En ambos grupos en el debut clínico se observó correlación entre la intensidad del cuadro y un mayor deterioro en la viscosidad en sangre total y los índices de agregabilidad y filtrabilidad eritrocitarias. El estudio a los siete días del debut permitió observar una normalización en todos los parámetros de viscosidad en el grupo con piracetam, mientras que el grupo que no lo tomó aún no mejoraron la viscosidad en sangre total y la filtrabilidad. Concluimos que el piracetam parece ejercer un efecto rehabilitador en esta hipoacusia neurosensorial en función de su actividad sobre las propiedades viscoelásticas de la sangre, y que la valoración de estas a los siete días de tratamiento puede proporcionar información sobre la recuperación auditiva a largo plazo (AU)

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery (AU)

[Head and neck lesions caused by systemic progressive ossifying fibrodysplasia (Munchmeyer's disease]. / Lesiones en cabeza y cuello por fibrodisplasia osificante progresiva sistémica (enfermedad de Munchmeyer).

Fibrodysplasia ossificans progressiva is a rare hereditary connective tissue disorder due to an unknown mutation conditioning the ossification of striated muscle and soft tissues frequently related to joints and stimulated by traumatisms or aggressive iatrogenic manouvres. It produces stiffness, pain, disability, swelling and fibro-osseus masses disseminated everywhere, with a very spectacular, invalidant and irreversible clinical picture. Affection of head and neck is unusual, excepting lesions in sternocleidomastoid or masticatiry muscles. We show a systemic case of fibrodysplasia osificans progressiva with enhanced clinical and radiological findings in cervical rhachis, pharynx and larynx, oral cavity, facial bones and ear. Association of biphophonates and steroids for a long period of time seems up to now stopping the evolution but not its regression.

[Detection tonsillar pathology by superoxide dismutase levels. Comparative study of surgical indications for tonsillectomy]. / Detección de patología amigdalar mediante los niveles de superóxido dismutasa. Estudio comparativo por indicaciones quirúrgicas de amigdalectomía.

If oxygen-derived free radicals are considered the definitive cause of tonsillar damage after infection, it seems reasonable that scavenger antioxidants levels could be used as a detector of tissue impairment. So, superoxide dismutase (SOD) amounts were measured in palatine tonsils and peripheral blood on subjects bearing of hypertrophy without infection (H, n = 83), recurrent tonsillitis (RA, n = 75), and peritonsillar abscess (PA, n = 12). SOD levels in both tonsillar cultures supernatants and peripheral blood erythrocytes were detected progressively increased in groups with H, RA and PA, which were statistically significative (ANOVA-test; p < 0.001). A significative correlation between tissue and blood was observed for all the groups. We can conclude that SOD concentration in palatine tonsils and/or peripheral blood increases proportionally to infections incidence, which allows detecting patients with functional damage, and recommending objectively tonsillectomy or at least monitoring clinical response for a therapy. Practical use and results obtained from comparison to tonsil biopsies are discussed.

[Eosinophils in nasal secretion. Technique and clinical utility]. / El eosinófilo de la secreción nasal. Técnica y utilidad clínica.

The microscopic study of nasal secretions to identify eosinophils is a classic test in the diagnosis of allergic rhinitis. Modern immunologic diagnostic alternatives have reduced the frequency of its practice, but the information that it provides, although complementary, is quick, inexpensive and specific. Panoptic stains easily detect eosinophils, although the absence of these cells does not rule out any diagnosis.

[Clinical response of gabapentin for glossopharyngeal neuralgia]. / Respuesta clínica a la gabapentina en la neuralgia del glosofaríngeo.

INTRODUCTION: The analgesic effect of the antiepileptic drug gabapentin makes it useful as an alternative for neuropathic pain. Its structural resemblance to other GABAergic antiepileptic drugs does not explain its mechanism of action, which seems not to depend on the activation of GABA receptor. Glossopharyngeal neuralgia is a rare entity which presents paroxystic crisis of pain, often with unknown etiology and poor response to treatment. CLINICAL CASES: Nine patients bearing of IX root neuralgia resistant to other therapies and ages ranged from 43 to 71 years old are being treated with gabapentin at doses between 800 and 3,600 mg daily in a period of time between two and sixteen months. Four cases in which magnetic resonance detected a compression of the nerve by posterior inferior cerebellar artery were submitted to a decompression surgery, but it was not effective. Gabapentin, alone or in association to carbamazepine, reduced the frequency and severity of crisis in seven patients, but in those with vascular compression the response was poorer. CONCLUSION: Gabapentin can be considered as an useful option for the management of glossopharyngeal neuralgic crisis, associated or not to other agents, for a short and long time, because of its good tolerance and lack of interactions.