Probable benign paroxysmal positional vertigo, spontaneously resolved: Incidence in medical practice, patients' characteristics and the natural course.

BACKGROUND: Probable benign paroxysmal positional vertigo, spontaneously resolved (pBPPVsr), is a variant of benign paroxysmal positional vertigo (BPPV) in which there is no observable nystagmus and no vertigo with any positional maneuver. OBJECTIVES: To calculate the incidence pBPPVsr, compare the characteristics of the patients with pBPPVsr and BPPV not spontaneously resolved and describe the spontaneous resolution in the natural course of BPPV. METHODS: Multicenter prospective descriptive study. During a one-year period, all patients with suspected BPPV that presented to the Neurotology Units of five participating centers were recruited. The incidence of pBPPVsr was calculated as a percentage of the total number of patients with BPPV. The prevalence of several variables was compared between pBPPVsr and BPPV not spontaneously resolved. The timing of spontaneous resolution was estimated using Kaplan-Meier curves. RESULTS: 457 patients met the inclusion criteria. The incidence of pBPPVsr was 33.5%. It was significantly higher in males, in patients with normal bone mass and in patients who were not taking sulpiride. A rate of 18% of spontaneous resolution after the first month and 51% after the first year was found. This percentage did not change in a significant way after this moment. The curves for males, patients under 50 and patients with normal blood pressure decreased significantly faster. CONCLUSIONS: In our serie, BPPV spontaneously resolved in half of the patients with BPPV during the first year. This seemed to occur more commonly in males and could have been hindered by sulpiride intake, osteoporosis, advanced age and high blood pressure.

Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study.

OBJECTIVES: To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN: Multicenter observational prospective study. SETTING: Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS: All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA: Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES: Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS: 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION: Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Analysis of risk factors influencing the outcome of the Epley maneuver.

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Head and neck cancer. An aetiopathogenetic study of non-endemic lymphoepithelioma.

An aetiopathogenetic analysis of non-endemic nasopharyngeal carcinoma (NPC) in European and Southern American patient groups was performed. Specifically, the study sought to determine the proportion of Epstein-Barr Virus (EBV)-positive tumour cells in NPC patients in two very different populations (Europe and South America) in areas not associated with a high incidence of NPC. Clinical data (age, sex and onset of clinical disease) were also analyzed. A total of 50 NPC samples, 24 from a European hospital (EH) and 26 from two South American hospitals (SAH), were included. Nuclear staining for Epstein-Barr virus-encoded small RNA (EBER) was performed by in situ hybridization (ISH). Latent membrane protein 1 (LMP1) expression was measured by immunohistochemical (IHC) analysis. A higher incidence of NPC was observed in patients > 40 years of age in EH; in SAH, by contrast, the incidence was higher in patients aged ≤ 40 years. Cervical lymph node metastasis was detected in 31 patients (of whom 84.6% were from SAH). A total of 72% of samples were EBERpositive; the incidence of EBER positivity was greater in type 3 NPCs. EBV was detected in a large proportion of epithelial cells in samples from both EH and SAH (75% vs. 69.2%, respectively). An association was found between EBER detection in lymphocytes and patient origin (p = 0.0001). LMP1 expression was detected in 64% of patients. ISH for the detection of EBER is the most sensitive technique for demonstrating EBV in tumour tissue. The incidence of EBV was not significantly greater in either of the study populations, but was significantly higher in patients with type 3 NPC. Definitive histological diagnosis of NPC was reached earlier in EH than in SAH, where metastases were more frequently diagnosed, suggesting that the disease had reached a more advanced stage by the time treatment was started.

The cadherin-catenin complex in laryngeal squamous cell carcinoma.

Abnormal Wnt signaling and impaired cell-cell adhesion due to abnormal E-cadherin and ß-catenin function have been implicated in many cancers, but have not been fully explored in laryngeal squamous cell carcinoma. In this study, ß-catenin cellular location and E-cadherin expression levels were analyzed in 16 laryngeal squamous cell carcinomas (LSCCs) (9 glottic and 7 supraglottic) and 11 samples of non-tumoral inflammatory larynx tissue, using immunohistochemical methods. All non-tumoral tissues showed equally strong membranous expression of ß-catenin, while cytoplasmic expression was found in only 3 of the 11 samples. By contrast, whereas 8/9 glottic LSCCs exhibited only membranous expression of ß-catenin, 6/7 supraglottic LSCCs displayed both membranous and cytoplasmic expression (p = 0.003). Strong E-cadherin staining was observed in 9/11 non-tumoral tissues and 7/9 glottic LSCCs, whereas 4/7 supraglottic LSCCs exhibited weak expression. Reduced membrane expression of E-cadherin and cytoplasmic retention of ß-catenin in supraglottic LSCC seems to be related with more aggressive biological behavior which has been described in clinical studies. Further research is required to clarify the involvement of ß-catenin in the mechanism associated with malignant transformation in laryngeal tissues.

The cadherin-catenin complex in nasopharyngeal carcinoma.

Abnormal Wnt signaling and impaired cell-cell adhesion due to abnormal E-cadherin and ß-catenin function have been implicated in many cancers, but have not been fully explored in nasopharyngeal carcinoma. The aim of this study was to analyze ß-Catenin cellular location and E-cadherin expression levels in nasopharyngeal carcinoma. E-cadherin expression levels were also correlated with clinical data and underlying pathology. ß-Catenin and E-cadherin expression were examined in 18 nasopharyngeal carcinoma and 7 non-tumoral inflammatory pharynx tissues using immunohistochemical methods. Patient clinical data were collected, and histological evaluation was performed by hematoxylin/eosin staining. ß-catenin was detected in membrane and cytoplasm in all cases of nasopharyngeal carcinoma, regardless of histological type; in non-tumoral tissues, however, ß-catenin was observed only in the membrane. As for E-cadherin expression levels, strong staining was observed in most non-tumoral tissues, but staining was only moderate in nasopharyngeal carcinoma tissues. E-cadherin expression was associated with ß-catenin localization, study group, metastatic disease, and patient outcomes. Reduced levels of E-cadherin protein observed in nasopharyngeal carinoma may play an important role in invasion and metastasis. Cytoplasmic ß-catenin in nasopharyngeal carcinoma may impair cell-cell adhesion, promoting invasive behavior and a metastatic tumor phenotype.

[Cervical myositis ossificans. A case report]. / Miositis osificante cervical. A propósito de un caso clínico.

This is the case of a middle-aged male with a slow growing lateral cervcal painful tumour, and without previous history of local trauma. Radiological testing reveals an ossifying soft tissue lesion without any osseous compromise. The lesion is completely resected, and the histological result is of ossifying myositis. It is an osseous tumour non neoplastic that originates within muscle and in particular the flexors of the inferior extremities and thigs or in the soft tissues. The incidence within the head and neck region is low (20%). There is an hereditary progressive form, Munchmeyer's disease, and another circumscribed, which can be subdivided in traumatic or atraumatic.

Miositis osificante cervical. A propósito de un caso clínico / Cervical myositis ossificans. A case report

Se presenta el caso clínico de un paciente varón de mediana edad con una tumoración laterocervical dolorosa y de crecimiento lento, y sin antecedentes de traumatismos sobre la zona. Las pruebas de imagen constatan que se trata de una lesión de partes blandas osificada, descartándose afectación ósea. Se practica la exéresis quirúrgica completa y el resultado histológico es de miositis osificante (MO). Se trata de una neoformación ósea no neoplásica que se origina en los músculos y en particular los flexores de los miembros superiores y muslos o en el tejido celular subcutáneo. La incidencia en la región de la cabeza y cuello es baja (20%). Existe una forma progresiva y hereditaria, la enfermedad de Munchmeyer, y otra circunscrita, que se subclasifica en traumática o atraumática

This is the case of a middle-aged male with a slow growing lateral cervcal painful tumour, and without previous history of local trauma. Radiological testing reveals an ossifying soft tissue lesion without any osseous compromise. The lesion is completely resected, and the histological result is of ossifying myositis. It is an osseous tumour non neoplastic that originates within muscle and in particular the flexors of the inferior extremities and thigs or in the soft tissues. The incidence within the head and neck region is low (20%). There is an hereditary progressive form, Munchmeyer's disease, and another circumscribed, which can be subdivided in traumatic or atraumatic

Hallazgo con PET-FDG de cáncer de amígdala en varón con tumor de origen desconocido / PET finding of primary tonsilar cancer in a man with unknown tumor

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[Ectopic Warthin's tumour in nasopharynx. Revision of one clinical case]. / Tumor de warthin ectópico en la nasofaringe. A propósito de un caso clínico.

This is a case report of a 69-year-old male patient referred to the ENT out patients with right-sided epistaxis and hipoacusis. Fibroptic examination reveals a cystic lesion at the exit of the right eustachian. A CT scan is informed as a well delimited and rounded-shaped tumour compatible with lymphoma. Excisional biopsy by a nasal rigid endoscopy is practiced and the histology result is Warthin's tumour. The nasopharynx is a rather unusual location for this type of tumours, almost exclusive in origin of major salivary glands. It's highlighted the unforeseeable histological diagnosis in this particular anatomical region, where the clinical differential diagnosis is broad and the access difficult.

Tumor de Warthin ectópico en la nasofaringe. A propósito de un caso clínico / Ectopic Warthin´s tumour in nasopharynx. Revision of one clinical case

Se presenta el caso clínico de un varón de 69 años, que es referido a consultas externas de ORL con epístaxis de repetición e hipoacusia derechas. La exploración fibroscópica demuestra una lesión de aspecto quístico en el rodete tubárico derecho. Se solicita TAC que se informa de tumoración redondeada y bien delimitada compatible con linfoma. Se practica biopsia excisional mediante abordaje endoscópico nasal y el resultado histológico es de tumor de Warthin. La nasofaringe es una localización inusual para este tipo de patología, casi exclusiva de las glándulas salivales mayores. Se destaca la imprevisibilidad del diagnóstico anatomopatológico en un área anatómica "sui generis" donde el diagnóstico diferencial es extenso y difícil el acceso

This is a case report of a 69-year-old male patient referred to the ENT out patients with right-sided epistaxis and hipoacusis. Fibroptic examination reveals a cystic lesion at the exit of the right eustachian. A CT scan is informed as a well delimited and rounded-shaped tumour compatible with lymphoma. Excisional biopsy by a nasal rigid endoscopy is practiced and the histology result is Warthin´s tumour. The nasopharynx is a rather unusual location for this type of tumours, almost exclusive in origin of major salivary glands. It´s highlighted the unforeseeable histological diagnosis in this particular anatomical region, where the clinical differential diagnosis is broad and the access difficult

[ENT expression of hypohidrotic ectodermal dysplasia]. / Manifestaciones ORL de la displasia ectodérmica hipohidrótica.

Hypohidrotic Ectodermal Dysplasia (HED) is a rare recesive genetic disease linked to chromosome X whose main characteristic is the reduction of sweat glands, leading to a deficient sweating and an increase in body temperature. In HED mainly the ectodermal structures are involved such, as epidermis and its anexes (hair and nails), although non-ectodermal tissue may also become involved. Otolaryngologicalmanifestations are related to hypoplasia of the mucous glands of the upper aerodigestive tract, as chronic infections, like rhinitis, pharyngitis, bronchitis and otitis, and also epistaxis, dysphagia, anodontia and, ozena, among others. A case of a young adult male affected with HED who is referred to the Otolaryngology Departament with a history of chronic pharyngitis and ozena, is presented and the literature reviewed.

[Papillary carcinoma of the thyroid metastatic to the parapharyngeal space]. / Tumoración parafaríngea metastásica de carcinoma papilar de tiroides.

This is a case report of a papillary thyroid carcinoma metastatic to the parapharyngeal space, that presented with local obstructive symptoms (dysphagia and displacement of the ipsilateral tonsil). The diagnosis was suspected by imaging studies (CT and MRI) but not confirmed until histological examination. It is not common for such tumors to metastasize to the parapharyngeal space. This is the reason why, to our knowledge, there have been described only five similar cases previously.

Manifestaciones ORL de la displasia ectodérmica hipohidrótica / ENT expression of hypohidrotic ectodermal dysplasia

La Displasia Ectodérmica Hipohidrótica (DEH) esuna rara enfermedad genética recesiva ligada al cromosoma X, que se caracteriza porque produce la afectación de estructuras derivadas principalmente del ectodermo, como piel y anejos (pelo y uñas), aunque tejidos no-ectodérmicos también pueden verse comprometidos. El cuadro clínico está dominado por la disminución del número de glándulas sudoríparas y sus más inmediatas consecuencias, escasa sudoración y aumento de la temperatura corporal. Las manifestaciones otorrinolaringológicas derivan de la hipoplasia de las glándulas mucosas del tracto aerodigestivo superior, y destacan por la frecuencia de presentación las infecciones crónicas, como rinitis, faringitis y otitis, y también epistaxis, disfagia, anodontia y ocena, entre otras. Se presenta el caso clínico de un paciente varón joven con DEH que se remite al Servicio de Otorrinolaringología con clínica de faringitis crónica y ocena, y a propósito del cual se revisa la bibliografía

Hypohidrotic Ectodermal Dysplasia (HED) is a rare recesive genetic disease linked to chromosome X whose main characteristic is the reduction of sweat glands, leadingto a deficient sweating and an increase in body temperature. In HED mainly the ectodermal structures are involved such, as epidermis and its anexes (hair and nails), although non ectodermal tissue may also become involved. Otolaryngological manifestations are related to hypoplasia of the mucousglands of the upper aerodigestive tract, as chronic infections, like rhinitis, pharyngitis, bronchitis and otitis, and also epistaxis, dysphagia, anodontia and, ozena, among others. A case of a young adult male affected with HED who is referred to the Otolaryngology Departament with a history of chronic pharyngitis and ozena, is presented and the literature reviewed

Tumoración parafaríngea metastásica de carcinoma papilar de tiroides / Papillary carcinoma of the thyroid metastatic to the parapharyngeal space

Se presenta un caso de metástasis de carcinoma papilar de tiroides de localización en el espacio parafaríngeo con clínica inicial de características obstructivas a nivel locorregional (disfagia progresiva y desviación contralateral de la amígdala correspondiente). En el estudio de imagen (TAC y RNM), la masa adoptaba una morfología especial, pero el diagnóstico no se confirmó hasta que se realizó el estudio anatomopatológico. Este espacio no es un lugar frecuente de asiento de metástasis ni de carcinomas tiroideos ni del resto de tumores de cabeza y cuello, por lo que, hasta la fecha, sólo se han descrito 5 casos similares en la literatura médica

This is a case report of a papillary thyroid carcinoma metastatic to the parapharyngeal space, that presented with local obstructive symptoms (dysphagia and displacement of the ipsilateral tonsil). The diagnosis was suspected by imaging studies (CT and MRI) but not confirmed until histological examination. It is not common for such tumors to metastasize to the parapharyngeal space. This is the reason why, to our knowledge, there have been described only five similar cases previously

[Malignant laryngeal fibrous histiocytoma (MLFH). Report of two unusual cases]. / Fibrohistiocitoma maligno laríngeo. A propósito de dos casos de localización infrecuente.

Laryngeal presentation of Malignat Fibrous Histiocytoma (MFH) is uncommon. It is more prevalent in elderly males. The most frequent form of laryngeal presentation is as subepithelial nodules, and its clinical behaviour is variable and unpredictable. Microscopically, it is a tumour with two well differentiated components: histiocitic and fibroblastic, with several different structural patterns that can make histologic diagnosis a difficult one. We present two cases of MFH of the larynx, and a review of the literature.

Fibrohistiocitoma maligno laríngeo. A propósito de dos casos de localización infrecuente / Laryngeal MFH. Two unusual cases

El fibrohisticitoma (FHM) es una tumoración infrecuente en cabeza y cuello, y todavía mas en la laringe. Es más prevalente en varones de mediana edad, pudiendo aparecer a cualquier edad. la presentación más habitual laringea es en forma de nódulos subepiteliales. el comportamiento clínico es variable e impredecible. Microscópicamente, es un tumor con dos componentes diferenciados: histiocítico y fibroblástico, con diferentes patrones estructurales que pueden dificultar el diagnostico histológico. Se presentan dos casos de FHM laríngeos y se revisa la bibliografía(AU)

Laryngeal presentation of Malignat Fibrous Histiocytoma (MFH) is uncommon. It is more prevalent in elderly males. The most frequent form of laryngeal presentation is as subepithelial nodules, and its clinical behaviour is variable and unpredictable. Microscopically, it is a tumour with two well differentiated components: histiocitic and fibroblastic, with several different structural patterns that can make histologic diagnosis a difficult one. We present two cases of MFH of the larynx, and a review of the literature (AU)

Valor pronóstico del parámetro inmunohistoquímico p53 en los estadios I y II del carcinoma epidermoide de lengua móvil / Pronostic value of the immunohistochemical p53 parameter in stages I and II of the epidermoid carcinoma of the mobile tongue

Objetivo: El propósito de este estudio fue evaluar el marcador inmunohistoquímico p53 como factor pronóstico en pacientes que presentaban carcinoma epidermoide de lengua móvil en estadios I y II. Material y método: Se realizó un estudio retrospectivo de 36 pacientes (grupo homogéneo), correspondientes a un periodo de estudio de 10 años, comprendido entre los años 1985 y 1994. Las muestras procedieron piezas quirúrgicas incluidas en bloques de parafina. Los estudios inmunohistoquímicos se han realizado aplican la técnica inmunoperoxidásica, método ABC (complejo streptavidina-biotina-peroxidasa). Resultados y conclusiones: En la muestra homogénea estudiada, se apreció una relación significativa directa entre la inmunotinción positiva para p53 y la probabilidad de aparición de recidiva y/o muerte por enfermedad, así como una relación inversa entre la inmunotinción positiva para p53 y el tiempo medio de supervivencia en pacientes que presentaban carcinoma epidermoide de lengua móvil. (AU)