Meningioma como causa poco común de hiposmia. A propósito de un caso

Resumen La afectación del sentido del olfato puede pasar desapercibida en gran parte de los pacientes, siendo únicamente valorada cuando la alteración es importante. Sin embargo, la hiposmia es un síntoma asociado a numerosas patologías, de menor a mayor gravedad. Este sentido está relacionado con nuestros recuerdos y puede alertarnos de potenciales amenazas. Como médicos especialistas en Otorrinolaringología debemos estar alerta ante determinados síntomas que orienten a posible etiología central. Presentamos el caso de una mujer de 39 años que acudió al Servicio de Otorrinolaringología del Hospital General Universitario Morales Meseguer derivada por hiposmia de un año de evolución con cervicalgia y cefalea occipital progresiva, sin otra sintomatología asociada. La exploración otorrinolaringológica resultó normal. Debido a la persistencia sintomática se solicitó una tomografía computarizada de senos paranasales con hallazgos de masa intracraneal extraaxial compatible con meningioma de fosa craneal anterior.

Abstract The affectation of smell can go unnoticed in a great part of the patients, being only valued when the alteration is important. However, this sense is related to our memories and can alert us to potential threats. As otolaryngologists we must be alert to certain symptoms that may lead to a possible central aetiology. We present the case of a 39-year-old woman who went to the otolaryngology service at Morales Meseguer General University Hospital due to one-year evolution of hyposmia with cervicalgia and progressive occipital headache, with no other symptoms associated. The otolaryngology examination was anodyne. In view of symptomatic persistence, a paranasal sinus computed tomography scan was requested with findings of extra-axial intracranial mass compatible with anterior cranial fossa meningioma.

Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL? / Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?

Objetivo: Describir cómo se gestionaron las consultas de los servicios de Otorrinolaringología y Cirugía de Cabeza y Cuello (ORLCCC) del Hospital Morales Meseguer (HMM) de Murcia y del Hospital Virgen del Castillo (HVC) de Yecla durante el periodo de estado de alarma debido a la COVID-19 y analizar los resultados obtenidos para valorar la utilidad de la consulta telefónica en nuestra especialidad.Material y métodosDesde el día 16 de marzo en los servicios de ORLCCC de los hospitales HMM y HVC comenzamos a realizar la consulta de forma telefónica. Debido a la disparidad de actuación de los diferentes miembros de los servicios se decidió realizar un protocolo para la gestión de dichas consultas que se comenzó a aplicar el 23 de marzo.ResultadosDurante el periodo de estudio en las consultas de ambos servicios se atendieron 1.054 pacientes, de los cuales 663 (62,9%) fueron primeras visitas y 391 (37,10%) fueron visitas sucesivas. El 21,73% (229) de las consultas se pudieron resolver de forma telefónica, el 10,82% (114) precisaron atención de forma presencial, al 57,40% (605) se les indicó revisión a demanda según la evolución de su patología y el 10,05% (106) de los pacientes no se pudieron localizar de forma telefónica.DiscusiónLa situación de estado de alarma ocasionada por la COVID-19 ha supuesto un condicionante en el desempeño de nuestra labor asistencial. En los servicios ORLCCC de los hospitales HMM y HVC decidimos realizar la consulta de forma telefónica como alternativa a la consulta tradicional. Durante este periodo hemos observado que hasta el 21,73% de las consultas se pudieron solventar de forma telefónica.ConclusiónLa consulta telefónica parece una herramienta muy útil para atender a nuestros pacientes evitando el riesgo de contagio por COVID-19 durante el estado de alarma. Además, según los datos analizados y los diferentes estudios, parece una buena alternativa a la consulta tradicional en pacientes seleccionados. (AU)

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty.Material and methodsFrom March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23.ResultsDuring the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone.DiscussionThe state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone.ConclusionThe telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients. (AU)

Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful? / Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL?

OBJECTIVE: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. MATERIAL AND METHODS: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. RESULTS: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. DISCUSSION: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. CONCLUSION: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

[Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?] / Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL?

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. Material and methods: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. Results: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. Discussion: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. Conclusion: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. Es útil la consulta telefónica en ORL? / Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?

OBJETIVO: Describir cómo se gestionaron las consultas de los servicios de Otorrinolaringología y Cirugía de Cabeza y Cuello (ORLCCC) del Hospital Morales Meseguer (HMM) de Murcia y del Hospital Virgen del Castillo (HVC) de Yecla durante el periodo de estado de alarma debido a la COVID-19 y analizar los resultados obtenidos para valorar la utilidad de la consulta telefónica en nuestra especialidad. MATERIAL Y MÉTODOS: Desde el día 16 de marzo en los servicios de ORLCCC de los hospitales HMM y HVC comenzamos a realizar la consulta de forma telefónica. Debido a la disparidad de actuación de los diferentes miembros de los servicios se decidió realizar un protocolo para la gestión de dichas consultas que se comenzó a aplicar el 23 de marzo. RESULTADOS: Durante el periodo de estudio en las consultas de ambos servicios se atendieron 1.054 pacientes, de los cuales 663 (62,9%) fueron primeras visitas y 391 (37,10%) fueron visitas sucesivas. El 21,73% (229) de las consultas se pudieron resolver de forma telefónica, el 10,82% (114) precisaron atención de forma presencial, al 57,40% (605) se les indicó revisión a demanda según la evolución de su patología y el 10,05% (106) de los pacientes no se pudieron localizar de forma telefónica. DISCUSIÓN: La situación de estado de alarma ocasionada por la COVID-19 ha supuesto un condicionante en el desempeño de nuestra labor asistencial. En los servicios ORLCCC de los hospitales HMM y HVC decidimos realizar la consulta de forma telefónica como alternativa a la consulta tradicional. Durante este periodo hemos observado que hasta el 21,73% de las consultas se pudieron solventar de forma telefónica. CONCLUSIÓN: La consulta telefónica parece una herramienta muy útil para atender a nuestros pacientes evitando el riesgo de contagio por COVID-19 durante el estado de alarma. Además, según los datos analizados y los diferentes estudios, parece una buena alternativa a la consulta tradicional en pacientes seleccionados

OBJECTIVE: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. MATERIAL AND METHODS: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. RESULTS: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. DISCUSSION: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. CONCLUSION: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients

¿Es la colecistectomía el tratamiento de elección en la colecistitis aguda alitiásica? Revisión sistemática de la literatura / Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature

Introducción y objetivos: actualmente no existe consenso entre colecistectomía o colecistostomía percutánea como elección terapéutica en la colecistitis aguda alitiásica. El objetivo de nuestro trabajo es revisar la evidencia científica acerca del tratamiento en estos pacientes según los hallazgos clínicos y radiológicos. Métodos: revisión sistemática de la literatura desde 2000 hasta 2016. La búsqueda se realizó usando PubMed, Índice Médico Español, Cochrane Library y Embase, siguiendo nuestros criterios de inclusión: idioma de publicación (inglés o español), pacientes adultos, etiología alitiásica y apropiado diseño de estudio. Resultados: se han identificado 1.013 artículos; finalmente, se han seleccionado para la revisión diez artículos que describían los resultados de pacientes tratados con colecistostomía percutánea y colecistectomía urgente, incluyendo cinco estudios observacionales controlados y cinco series de casos. No se han identificado estudios prospectivos o randomizados con los criterios de búsqueda. Los datos de la literatura y el examen de los resultados indicaron que, para la colecistitis aguda alitiásica, la colecistostomía percutánea puede ser un tratamiento definitivo sin requerir una colecistectomía electiva posterior. Conclusiones: la colecistostomía percutánea puede ser la primera opción de tratamiento en pacientes con colecistitis aguda alitiásica salvo en los casos que presenten perforación o gangrena vesicular. Los pacientes con bajo riesgo quirúrgico podrían beneficiarse de una colecistectomía, aunque ambas opciones de tratamiento pueden ser efectivas. La colecistostomía percutánea en pacientes con colecistitis aguda alitiásica puede ser un tratamiento definitivo sin necesidad de una colecistectomía electiva posterior. No obstante, la calidad de los estudios es, en general, baja y hace necesario tomar con cautela las recomendaciones finales (AU)

Background and objectives: there is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. Methods: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. Results: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. Conclusions: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution (AU)

Is cholecystectomy the treatment of choice for acute acalculous cholecystitis? A systematic review of the literature.

BACKGROUND AND OBJECTIVES: There is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. METHODS: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. RESULTS: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. CONCLUSIONS: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution.