[Etiopathogenia of the epistaxis admitted by emergencies service. Analysis and considerations in 250 consecutive patients]. / Etiopatogenia de las epístaxis ingresadas vía de urgencias. Análisis y consideraciones en 250 pacientes consecutivos.

Epistaxis represent a relatively common symptom in the hospitalary Emergencies Services. In our casuistry of 250 consecutive patients assisted and admitted because of that cause in 2 different hospitals of the region between 1996 and 2005, we have noticed the presence of one or more base pathologies or risk factors in originate most of them which could the nose bleeding. These causes are analysed beside the location of the epistaxis and the different treatment options that were used until its resolution.

[Frontoethmoidal mucocele. Diagnosis and treatment in 7 cases]. / Mucocele frontoetmoidal. Diagnóstico y tratamiento en 7 casos.

Mucocele has its origin by blockage of the paranasal sinuses ostium with mucinous retention inside, sometimes purulent (mucopiocele), and progressive slimming with gradual destruction on the bone walls. We report an own review of 7 patients with diagnosis of frontoethmoidal mucocele, 4 men and 3 women, 50-years average. The oftalmologic clinical symptoms (diplopia, exoftalmos and the eyeball movement restrictiv) were the most frequentjointly to cefalea. The kind of surgery that we have performed, in 6 of 7 cases, was FES with marsupialization (4 times) and external ethmoidectomy (2). We have performes a literature review at this respect.

Mucocele frontoetmoidal. Diagnóstico y tratamiento de 7 casos / Frontoethmoidal mucocele. Diagnosis and treatment in 7 cases

El mucocele se origina por una obstrucción de los conductos de drenaje de los senos paranasales con retención de exudado mucinoso, en ocasiones purulento (mucopiocele), y adelgazamieto progresivo con destrucción gradual de las paredes óseas. Presentamos una revisión propia de 7 pacientes con diagnóstico de mucocele frontoetmoidal, 4 varones y 3 mujeres, con una edad media de 50 años. Las manifestaciones clínicas oculares (diplopía, exoftalmos y desplazamiento del globoo ocular) fueron las más frecuentes junto con la cefalea. El tipo de cirugía, realizada en 6 de los 7 casos, consitió en CENS con marsupialización (4 ocasiones) y etmoidectomía externa (2). Realizamos una revisión de la literatura al respecto

Mucocele has its origin by blockage of the paranasal sinuses ostium with mucinous retention inside, sometimes purulent (mucopiocele), and progressive slimming with gradual destruction on the bone walls. We report an own review of 7 patients with diagnosis of frontoethmoidal mucocele, 4 men and 3 women, 50-years average. The oftalmologic clinical symptoms (diplopia, exoftalmos and the eyeball movement restrictiv) were the most frequentjointly to cefalea. The kind of surgery that we have performed, in 6 of 7 cases, was FES with marsupialization (4 times) and external ethmoidectomy (2). We have performes a literature review at this respect

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Morphology of the parathyroid glands. A study of 146 samples and review of the literature]. / Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura.

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic study of 146 parathyroid gland from patients diagnosed from hyperparathyroidism. About a 72.6% of the patients presented a parathyroid adenoma while in the rest 27.4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6 mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases the adenoma was located in the superior mediastine.

[Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature]. / Linfoma difuso de células b grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura.

Althouh lymphomas are an illness that characteristically affects the lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivary gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk of injury on the facial nerve.

[Sudden cardiorespiratory arrest in adults with acute epiglottitis. Report of 2 cases]. / Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda presentación de dos casos.

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance.

[Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks]. / Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena.

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally.

[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

[Recurrent intrathyroid abscess in children. Clinical case and review of the literature]. / Absceso recurrente intratiroideo en niños. Caso clinico y revisión de la literatura.

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations.

Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía urgente / Cervical Hematoma after disectomy for spondylosis. An idication of urgent tracheotomy

Se presenta un caso clínico de hematoma cervical tras cirugía de espondilosis cervical que precisó traqueotomía urgente por imposibilidad de intubación orotraqueal. Esta enfermedad en grado avanzado, denominada también mielopatía cervical espondilótica, es la consecuencia más seria de la degeneración del disco cervical intervertebral

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopahty, is themost serious consequence of cervical intervertebral disc degeneration

Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura / Morphology of the parathyroid glands. A study of 146 samples and review of the literature

Los estados de hiperfunción paratiroidea condicionan sintomatología clínica muy diversa e inespecífica en diferentes aparatos, órganos y sistemas del cuerpo humano. En este trabajo realizamos un estudio morfológico de 146 lesiones glandulares paratiroideas tras exéresis de las mismas en pacientes intervenidos por nuestro Servicio de ORL con diagnóstico de hiperparatiroidismo. Alrededor de un 72,6% de los pacientes presentó un adenoma de paratiroides mientras que en el 27,4% restante se evidenció una hiperplasia de células principales. Hasta la fecha no hemos registrado ningún caso de carcinoma de paratiroides. La mayoría de los adenomas (85%) predominaron en las paratiroides inferiores y su tamaño osció entre los 6mm y los 5 cm. En un caso se diagnosticó un adenoma doble y en otros dos se encontraba localizado en mediastino superior

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic rathyroidism. About a 72,6% of the patients presented a parthyroid adenoma while in the rest 27,4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases he adenoma was located in the superior mediastine

Linfoma difuso de células B grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura / Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature

Aunque los linfomas son una enfermedad con afectación típica de los ganglios linfáticos pueden presentarse en otras localizaciones (extranodales). El tejido linfoide de las glándulas salivares puede considerarse parte del denominado tejido linfoide asociado a mucosas (MALT). Presentamos un caso de linfoma parotideo difuso de células B grandes. La localización en la parótida, dentro de su rareza, es la más común para los linfomas de glándulas salivares cuyo diagnóstico definitivo es siempre anatomopatológico examinando la pieza extirpada ya que la biopsia puede noser suficiente y conducir a un diagnóstico erróneo aparte de un riesgo mayor de lesión del nervio facial

Although lymphomas are an illness that characteristically affects te lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivar gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk on injury on the facial nerve

Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda. Presentación de dos casos / Sudden cardiorrespiratory arrest in adults with acute epiglottiti. Report of 2 cases

Presentamos dos casos reales acontecidos en nuestro Hospital de parada cardiorrespiratoria brusca en sendos adultos con diagnóstico de epiglotis aguda. Aunque se trata de una patología poco común en la actualidad y de buen pronóstico en general pretendemos llamar la atención sobre esta complicación, que puede ocurrir de manera imprevisible incluso en ausencia previa de compromiso respiratorio. Uno de los pacientes requirió cricotomía en UCI por imposibilidad de intubación orotraqueal (IOT) y el otro fue éxitus a pesar de la actuación urgente practicada

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance

Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena / Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks

Presentamos el caso clínico de un varón de 86 años que en el curso de una crisis tusígena comienza con dolor cervical y faríngeo espontáneo acompañado de disfonía, disfagia y cierta diseña. La exploración reveló un discreto hematoma laterocervical derecho pero con infiltración de la orohipofaringe y hemilaringe derechas para extenderse con posterioridad a la pared faríngea posterior y repliegue aritenoepiglótico izquierdo. El paciente fue trasladado a la UCI aunque no precisó finalmente control de la vía aérea mediante intubación o traqueotomía

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally

Pseudomonas y otitis externa aguda. Resultados de un estudio microbiológico en pacientes sin tratamiento antibiótico previo / Pseudomonas and acute external otitis. Results of a microbiological study in patients without previous antibiotic treatment

Presentamos los resultados de un estudio clínico microbiológico realizado por nuestro servicio de ORL entre los años 2000 y 2001 cuyo objetivo principal fue determinar, en el área de Salud de Badajoz, qué bacterias estaban implicadas en las otitis externas agudas difusas de pacientes sin tratamiento antibiótico previo las dos semanas anteriores a la obtención de las muestras. Del total de 79 gérmenes aislados en los 62 pacientes que cumplían los requisitos establecidos las Pseudomonas, sobre todo P. aeruginosa, representaron el 46,83% del toal seguidas por los Estafilococos (18,98%). En casi una cuarta parte de los casos se identificaron cepas de hongos asociadas

We report the results of a microbiological clinic study that was performed by our ENT Department between years 2000 and 2001 whose main objective was to determine, in Badajoz Area of Health, which bacteria were involved in the acute diffuse external otitis of patients without previous antibiotic treatment (two weeks before obtaining the samples). Of 79 isolated microorganisms in 62 patients that fulfilled the requirements established Pseudomonas, mainly P. Aeruginosa, represented a 46.83% altogether followed by Staphylococcus (18.98%). In almost one fourth part of the cases strains of associated fungi were identified

Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de Epley / Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver

El vértigo posicional paroxístico benigno (V.P.P.B) es el más común de los v´rtigos periféricos. Presentamos el caso clínico de una mujer de 45 años con esta patología sospechada en base a la clínica que la paciente relacionaba con movimientos y cambios cefálicos. El diagnóstico fue confirmado con la maniobra de Dix-Hallpike, que fue positiva , y el tratamiento consistió en la maniobra de reposición canalicular según técnica de Epley. Dicha maniobra fue efectiva y actualmente la paciente se encuentra asintomática tras más de 2 años desde el primer episodio, Se realiza finalmente una revisión bibliográfica para comprobar la efectividad de este tratamiento

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment

Absceso recurrentee intratiroideo en niños. Caso clínico y revisión de la literatura / Recurrent intrathyroid abscess in children. Clinical case and review of the literature

Los abscesos tiroideos recurrentes en niños son una entidad clínica muy infrecuente que suelen ser debidos a anomalías del 3º ó 4º arcos branquiales y sfístula del seno piriforme. Presentamos el caso clínico de una niña de 6 años diagnosticada de absceso de 3 cm en lóbulo tiroideo izquierdo positivo para St viridans. Cuatro meses después reingresó por el mismo motivo y se procedió, bajo punción, a nuevo drenaje y cobertura antibiótica intravenosa para acrobios y anaerobios con buena evolución. Las pruebas de imagen no revelaron ninguna alteración anatómica

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations

[Practical aspects regarding endoscopic treatment for epistaxis]. / Aspectos prácticos sobre el tratamiento endoscópico de la epistaxis.

INTRODUCTION: A prospective study is presented to evaluate some practical and financial aspects regarding surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoidal (AE) arteries performed to control posterior nasal bleeding. PATIENTS AND METHODS: 35 patients admitted at the ENT ward between 2004 and 2006 were included in the study, and distributed into two groups depending on the protocol applied in each case. Until March 2005 the surgery was performed if there was failure or insecurity of the posterior packing, and since that date a substitutive surgical protocol (not including posterior packing) was applied. RESULTS: 82.9% of the patients were male, with a mean age of 55.74 years and a left bleeding in a 60% of the cases. Ligature/cauterization was performed on SP in 28 (80%) patients, on AE in 4 (11.4%), and on both arteries in 3 cases (8.6%). 38.7% of the SP approach only one sphenopalatine foramen was observed, through which an only branch of the artery passed; 42% of the cases two branches passed through an only foramen, and in 19.3% two or more branches were present, breaking into the nose through two or more independent clefts. AE was intradural in 3 cases, intranasal attached to the cranial base in other 3 and intranasal detached to the cranial base in 1 patient. Besides, highly significant differences were found between the two protocols, observing a mean reduction of hospital stay of 3.1 days, which throws up savings of 939.3 euros per patient. DISCUSSION AND CONCLUSIONS: Surgical treatment for epistaxis has proved to be effective (91.2% in our experience) and safe, determining an important reduction in hospital stay and avoiding the morbility of posterior packing. Accurate knowledge of the anatomy of the arteries implied and specific actuation upon the correct bleeding territory are essential to perform this surgery.

Melanoma maligno de pabellón auricular. Importancia del diagnóstico, tratamiento y factores pronósticos / Malignant melanoma of the pinna. Importance of its diagnosis, treatment and prognostic factors

Alrededor del 25%-30% de los melanomas malignos primarios afectan a la región de cabeza y cuello y de ellos menos del 10% se originan en el oído externo, sobre todo en la zona del hélix y el lóbulo de la oreja. La profundidad o espesor del melanoma y la presencia de metástasis ganglionares o a distancia son factores adversos para el pronóstico. Se presenta un caso de este tumor que asentaba sobre el pabellón auricular derecho y que fue intervenido por nuestro Servicio de ORL con buena evolución, encontrándose el paciente libre de enfermedad tras 5 años de seguimiento

About 25%-30% of the primary malignant melanomas occur in the headand neck regionand of these less than 10% arise on the external ear, mainly on helix and the lobule of the pinna. Melanoma thickness and nodal or distant metastases are advers factors for its prognosis. We report a case of a tumor that affected the right pinna and was removed by our ENT, department with good evolution, being the patient free of disease after 5 years follow-up