An absence of cilia outer microtubules, an etiology not previously recognized in bilateral mucocele.

Most paranasal sinus mucoceles are unilateral and affect one or at most two contiguous sinuses. We describe the case of a 44-year-old woman with bilateral maxillary sinus mucoceles who presented clinically with left malar pain, right-sided swelling, and proptosis of the right eye. The diagnostic workup included computed tomography and magnetic resonance imaging. In addition, because of the atypical bilateral presentation, we analyzed mucosal sinonasal tissue samples by electron microscopy. Microscopic analysis revealed an absence of one of the microtubule doublets in three of the outer doublets of the axoneme, thereby establishing a diagnosis of isolated ciliary dysfunction. To the best of our knowledge, ciliary dysfunction as a cause of bilateral mucoceles has not been previously reported in the literature. The patient underwent successful surgery for removal of the mucoceles, and she exhibited no evidence of recurrence at the 18-month follow-up. When a diagnosis of bilateral mucocele formation is made, we suggest that ciliary dysfunction be considered in the differential diagnosis and that electron microscopy of the sinonasal mucosa be performed in the workup.

Pruebas de despistaje auditivo en adultos / Hearing loss screening tests for adults

Introducción: La detección temprana de hipoacusia ha sido ampliamente estudiada en recién nacidos gracias a las nuevas tecnologías en pruebas diagnósticas y tratamiento; existen protocolos bien establecidos de despistaje universal en esta población. Sin embargo, en adultos, el despistaje auditivo es un tema que también cobra importancia debido al aumento en la esperanza de vida, al cambio en la pirámide poblacional mexicana, que se estima que en los siguientes 50 años se transformará hacia una forma rectangular (con un aumento en la prevalencia de presbiacusia), y al establecimiento de programas de protección social en salud como el Seguro Popular. No se cuenta con investigaciones mexicanas sobre despistaje auditivo en adultos. El objetivo de este trabajo es evaluar una prueba de emisión tonal y un cuestionario como estrategias de despistaje en adultos. Métodos: Se tomó una muestra de 500 personas sin antecedente de patología otológica en la consulta externa de un hospital general. Se realizó otoscopia, 2 pruebas de despistaje auditivo (emisión tonal y cuestionario) y audiometría a todos los sujetos. Resultados: El cuestionario es una prueba sensible pero poco específica, mientras que la prueba de emisión de tono fue menos sensible pero más específica con tasa mayor de exactitud. La mejor estrategia resultó la combinación de ambas pruebas que alcanzó una exactitud del 90%. Conclusiones: Se propone como la mejor estrategia de despistaje en adultos un cuestionario y una prueba de emisión tonal que garantiza de forma rápida, sin necesidad de entrenamiento especial, una evaluación completa del estado de audición en lo objetivo y subjetivo (AU)

Introduction: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the «Seguro Popular». There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. Methods: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. Results: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. Conclusions: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training (AU)

Hearing loss screening tests for adults.

INTRODUCTION: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the "Seguro Popular". There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. METHODS: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. RESULTS: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. CONCLUSIONS: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training.

Difference between early clinical features of swine origin A H1N1 influenza confirmed and not confirmed infection in Mexico.

INTRODUCTION: The Swine Origin A H1N1 Influenza Virus (SOIV) pandemic emerged in April 2009 affecting people and health-care systems worldwide. This study examined the differences among the early clinical features presented in confirmed SOIV cases, those who tested negative for SOIV infection, fatalities, and hospitalized cases. METHODOLOGY: We reviewed 1,024 initial medical records of patients presenting with acute respiratory symptoms who attended the respiratory emergency room of a general hospital in Mexico and had a confirmatory test for influenza AH1N1 by RT-PCR from April to December 2009. RESULTS: Out of 1,024 cases, 457 (44%) were men with a mean age of 31±17 years; however, of these, SOIV confirmed cases were younger (26±8, p=0.000). SOIV infection was confirmed in 36% of the patients. Most (%?) cases presented mild infection, 20% of the patients required hospitalization, and 0.09% patients died. Asthma was more frequent in confirmed cases (p=0.028). Presence of COPD, systemic arterial hypertension, and diabetes mellitus was significant in confirmed hospitalized cases. Pulmonary rales, wheezing, and sudden symptom onset were more frequent and statistically significant in confirmed patients. Influenza-like illness was more frequent in confirmed cases (p=0.049).  CONCLUSIONS: This study presents one of the largest series of the new SOIV infection confirmed by RT-PCR reported. This infection is frequently mild and affects mainly young adults. Sudden symptoms onset, pulmonary rales, and wheezing are early features of this infection. Asthma, COPD, systemic arterial hypertension, and diabetes mellitus should be identified to identify potentially severe and fatal cases. ILI helps distinguish SOIV infection.

Histología de tumores de glándulas submandibulares. Experiencia de 10 años / Histology of submandibular gland tumours, 10 years’ experience

Introducción y objetivos: Hay pocos trabajos enfocados a neoplasias de glándulas submandibulares porque son poco comunes y se les agrupa con otras glándulas salivales. En los estudios clásicos se reporta que los tumores malignos en esta localización representan alrededor del 50%. Objetivos: Reportar la proporción de malignidad en pacientes con neoplasia de glándulas submandibulares y tipos histológicos más comunes que se trataron en nuestro hospital del año 2000 al 2010, así como la proporción por sexo y edad de presentación. Métodos: Se realizó una revisión retrospectiva de la base de datos de nuestro servicio de los pacientes que fueron atendidos en 10 años por neoplasia de glándula submandibular. Resultados: Se atendieron 22 pacientes con neoplasias de glándula submandibular, 19 (86%) de tipo benigno y tres malignos (adenocarcinoma, carcinoma epidermoide bien diferenciado y linfoma folicular), edad promedio en patología benigna: 40 años y 55 años en malignos. Hubo predominio del sexo femenino (76%), sin embargo dos de tres casos de neoplasia maligna se presentaron en el sexo masculino. Conclusiones: La mayoría de las neoplasias de glándula submandibular son benignas. El tumor benigno más frecuente es el adenoma pleomorfo. Las mujeres son afectadas con mayor frecuencia. Los tumores benignos se presentan en pacientes más jóvenes que los malignos (AU)

Introduction and objectives: There are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%. Objectives: Determining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010. Methods: A retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed. Results: Twenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men. Conclusions: A greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones (AU)

[Histology of submandibular gland tumours, 10 years' experience]. / Histología de tumores de glándulas submandibulares. Experiencia de 10 años.

INTRODUCTION AND OBJECTIVES: There are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%. OBJECTIVES: Determining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010. METHODS: A retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed. RESULTS: Twenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men. CONCLUSIONS: A greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones.

Effects of three nasal topical steroids in the intraocular pressure compartment.

OBJECTIVE: The purpose of this study was to evaluate whether the use of fluticasone propionate, mometasone furoate, or beclomethasone dipropionate for the treatment of rhinitis produced, as a side effect, an increase in the intraocular pressure; only one printed article proclaims that the increase of secondary intraocular pressure is due to the use of local nasal steroids. PATIENTS AND STUDY DESIGN: We conducted a comparative, double-blind, experimental, prospective, longitudinal study in which 360 patients were divided at random into 4 groups; 90 of them were given a placebo (control group) and the other 270 were divided into 3 other groups of 90 patients each and given a different local nasal steroid for each group. Measurement parameters All patients had their intraocular pressure measured by Goldman's tonometry at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after using the placebo or local nasal steroid. RESULTS: Variations were found in the intraocular pressure of patients who used local steroid, with discreet elevations in the beclomethasone dipropionate and mometasone furoate groups; however, variations were always within normal limits. CONCLUSION: Fluticasone propionate, mometasone furoate, and beclomethasone dipropionate cause variations in the intraocular pressure, but the variations are within normal limits.

Manejo médico y quirúrgico del absceso periamigdalino: experiencia de cinco años / Medical and surgical management of peritonsillar abscess (QUINSY): five years experience

El absceso periamigdalino es una patología infecciosa grave, que frecuentemente se atiende en nuestra división. Para su manejo existen diversas opciones en la actualidad. La incisión y drenaje, acompañada de tratamiento con penicilina y clindamicina, es la elección de nuestro servicio. Se realizó una revisión de los expedientes de pacientes con diagnóstico de absceso periamigdalino del primero de enero de 1996 al 31 de diciembre del 2000, incluyéndose 117 casos en el presente estudio. Se midió la eficacia del tratamiento médico y quirúrgico, la frecuencia de complicaciones, así como la realización de amigdalectomía de intervalo. Se encontró una eficacia de 88.4 por ciento para el procedimiento de incisión y drenaje. En todos los casos el tratamiento antimicrobiano inicial fue efectivo, de los cuales 89.7 por ciento recibieron penicilina y clindamicina. La única complicación encontrada fue la persistencia del absceso en 11.6 por ciento de los casos, resuelta en todos con un segundo drenaje. Se realizó amigdalectomía de intervalo a 43.6 por ciento de los pacientes. Conclusión: La incisión y drenaje tiene una eficacia superior a otras técnicas para drenaje, el esquema antimicrobiano de penicilina y clindamicina puede considerarse de elección para el manejo del absceso periamigdalino. Un porcentaje relativamente bajo de nuestros pacientes acepta la realización de amigdalectomía, colocándolos bajo un mayor riesgo de recurrencia.