Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge.

OBJECTIVE: This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy. METHOD: A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected. RESULTS: Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy. CONCLUSION: Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

La colección de drogas vegetales del Museo de Historia de la Farmacia “Prof. José Mª Suñé Arbussᔠde Granada / Drug plant collection of The museum of History of Pharmacy

La colección de drogas vegetales está compuesta por una serie de 663 botes grandes de vidrio y conteniendo ambos drogas vegetales procedentes de la antigua Cátedra de Farmacognosia de la Facultad de Farmacia de Granada. Catalogado dentro de los fondos del Museo “Profesor José Mª Suñé Abrussà” como material docente de la propia Facultad de Farmacia, forma una colección interesante desde el punto de vista científico-farmacéutico y de alto valor estético. El objetivo del trabajo es dar a conocer esta importante colección, sistematizar el diverso contenido y proceder a su catalogación en el Museo(AU)

The collection of drug plants is composed of a series of 663 large glass jars containing both herbal drugs from the former Department of Pharmacognosy, Faculty of Pharmacy, Granada. Cataloged in the Museum's "Professor José Mª Suñé Abrussà" as teaching material it self Faculty of Pharmacy, is an interesting collection from the scientific point of view, high-value pharmaceutical estético. El paper aims to present this important collection, systematize the different contents and proceed to their classification in the Museum(AU)

[Epidemiological notes on nasal bleeding]. / Notas epidemiológicas sobre el sangrado nasal.

The incidence of epistaxis is difficult to calculate because only a 10% of them look for medical attention. In this study the nasal bleeding means the 13.3% of the ENT emergencies (279 patients). Its incidence was 6 cases/10,000/year. The majority were over 50 years old (57.3%). There was season variations. The anterior epistaxis were more frequent but he posterior ones increased over the 40. An 18% had rebleeding more significatively with age and localization. We discuss the mechanisms that can explain the male dominance, the season incidence, and the old ages of the patients with hospital epistaxis.

Notas epidemiológicas sobre el sangrado nasal / Epidemiologic notes on nasal bleeding

La incidencia de la epistaxis es difícil de calcular porque sólo un 10 por ciento buscan atención médica. En el presente estudio prospectivo el sangrado nasal supone el 13,3 por ciento de las urgencias ORL (279 pacientes), su incidencia fue 6 casos/10.000/año. Los mayores de 50 años fueron mayoría (57,3 por ciento), y existió variación estacional. Las epistaxis anteriores fueron más frecuentes aunqeu las posteriores aumentaron tras los 40. Resangraron un 18 por ciento teniendo significación la edad y la localización. Discutimos los mecanismos que expliquen la predominancia masculina, la incidencia estacional, y la edad avanzada de los pacientes con epistaxis hospitalarias (AU)

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[Surgical treatment of laryngotracheal stenoses. Our experience]. / Tratamiento quirúrgico de las estenosis laringotraqueales: nuestra experiencia.

Laryngo-tracheal stenoses (LTS) treatment is a problem of difficult management for the otolaryngologist. There are many and varied techniques in order to solve the conundrum. The aim of this article is to analyze retrospectively the outcomes of surgical treatment of LTS in our Institution. We have checked 11 cases (9 men and 2 women, arithmetic mean 30.7 years) operated through surgical procedures during a 6 years lapse of time. All patients were endotracheally intubated prior the stenosis appearance. Stenosis location most encountered were subglottic-tracheal combination. To the end of the study 44 percent of the series was successfully cured and the 33 percent only partially recovered. The employed techniques (endoscopic or open surgery) are revised at the light of today's literature.

Tratamiento quirúrgico de las estenosis laringotraqueles: nuestra experiencia / Surgical treatment of laryngo tracheal stenoses. Our experience

El tratamiento de las estenosis laringotraqueales (ELT) es un problema de difícil manejo para el otorrinolaringólogo. Para su resolución existen numerosas y variadas técnicas. EL objetivo de este estudio es analizar retrospectivamente los resultados del tratamiento quirúrgico de las ELT en nuestra institución. Revisamos 11 pacientes () varones y 2 mujeres, edad media de 30,7 años) en los que se realizaron 20 procedimientos quirúrgicos en un período de 6 años. Todos los pacientes estuvieron intubados endotraquealmente antes de la formación de la estenosis. La localización de la obstruciión más frecuente fue la subglototraqueal combinada. Al final del estudio el 44 por ciento de la serie fue tratado con éxito y en un 33 por ciento adicional se obtuvo un éxito parcial. Las técnicas empleadas (endoscópicas o quirúrgicas abiertas) son revisadas a la luz de la literatura (AU)

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[Possible factors influencing rehabilitation of the total laryngectomy patient using esophageal speech]. / Estudio de posibles factores que influyen en la rehabilitación del laringuectomizado total mediante voz esofágica.

One of the handicaps of patients that have had a total laryngectomy is the loss of oral speech. There are three possibilities to rehabilitate these patients; surgery, voice prosthesis or esophageal speech. This last one appears as an inexpensive, non-invasive rehabilitation method; it does not need a complex learning and in spite of new technics, it continues to be an effective method in the social rehabilitation of laryngectomized patients. We have made a retrospective study of patients who underwent TL between 1992-1998 and that were rehabilitated by esophageal voice learning. Three factors have been evaluated: first, those related to the patient (gender, age, study level...); second, those related to the treatment itself [TL, pharyngolaryngectomy (PTL), TL plus radiotherapy...] and third, those related to the rehabilitation (technics, delayed on starting, number of sessions...). Data were compared with rehabilitation outcome: good (usually using esophageal voice), medium (speaking sometimes) and bad (not speaking). 74.1% had an acceptable outcome and they use esophageal voice with more or less difficulty to communicate, and this outcome increases to 95.8% when we do not take into account 7 patients who gave-up rehabilitation before finishing the first five sessions.

Estudio sobre las metástasis cervicales de primario desconocido / Study of cervical metastases from unknown primary tumour resumen

Las metástasis cervicales por un tumor de origen desconocido (MCOD), aunque infrecuentes, suponen un reto diagnóstico y terapéutico para el otorrinolaringólogo. Presentamos un estudio retrospectivo sobre 22 pacientes con MCOD diagnosticados en nuestro Servicio en un período de 13 años (3,4% de los pacientes con cáncer cérvico-facial). La sensibilidad de la PAAF fue de 94,7%. El 54% correspondieron a N2a, el 9% a N2b, y el 36% a N3. El 73% de los casos fueron carcinomas epidermoides y un 27% eran indiferenciados. Presentamos nuestro protocolo diagnóstico y terapéutico: una panendoscopia con biopsia a ciegas de nasofaringe, vallécula y seno piriforme; y amigdalectomía homolateral asociada. Con su utilización encontramos el tumor primario en un 23 per cent de los casos. Todos los carcinomas epidermoides fueron tratados mediante vaciamiento cervical radical y radioterapia, y los 6 carcinomas indiferenciados fueron tratados mediante quimioterapia y radioterapia. Hemos obtenido una supervivencia global a los tres años del 62%. El estadio N influyó en la supervivencia (AU)

Cervical metastases of cancer of an unknown primary tumour (CMUPT) are infrequent but they represent both a diagnostic and therapeutic challenge for ENT physicians. We present a retrospective study over 22 patients with CMUPT diagnosed in our hospital during 13 years (3.4% of the patients with head and neck cancer). The sensitivity of the fine-needle aspiration technique was 94.7%. 54% were N2a, 36% N3 and 9% N2b. 73% were squamous cell carcinoma and 27% were undifferentiated carcinoma. We established our protocol on diagnosis and management: panendoscopy with biopsies of nasopharynx, vallecula and pyriform sinus and ipsilateral tonsillectomy. The primary source was identified in 23% of the series. All squamous cell carcinoma were treated with radical neck surgery plus radiotherapy and the undifferentiated carcinoma with chemotherapy and radiotherapy. The overall survival was 64% at 3 years. The N-stage affected the survival rate (AU)

Estudio de posibles factores que influyen en la rehabilitación del laringuectomizado total mediante voz esofágica / A study of the factors that may affect the rehabilitation using the esophageal voice method in total laryngectomized

La ausencia de lenguaje oral es una de las dificultades a las que se enfrenta un paciente intervenido de laringuectomía total (LT). La rehabilitación puede realizarse mediante tres métodos: quirúrgico, prótesis eléctricas o la erigmofonía. Esta última representa un método de rehabilitación poco costoso, no invasivo, que no requiere un aprendizaje complejo, y que a pesar de las nuevas técnicas sigue siendo un método eficaz en la recuperación social del enfermo laringuectomizado. Realizamos un estudio retrospectivo con pacientes intervenidos de LT entre 1992-1998, y que fueron rehabilitados con el aprendizaje de la voz esofágica. Se han analizado tres factores: primero, relacionados con el paciente (sexo, edad, estudios...); segundo, con el tratamiento [LT, faringolaringuectomía total (FLT), LT más radioterapia...]; y tercero, con la rehabilitación (técnicas, retraso en el inicio, número de sesiones...). Estos datos fueron relacionados con el resultado de la rehabilitación: buena (emplea habitualmente la voz esofágica para relacionarse), regular (habla a intervalos) y mala (no habla nada).El 74,1 por ciento de los pacientes alcanzaron un resultado aceptable y emplean con mayor o menor dificultad la voz esofágica para comunicarse, resultados que ascienden al 95,8 por ciento cuando descartamos a los 7 pacientes que abandonaron la rehabilitación antes de completar cinco clases (AU)

One of the handicaps of patients that have had a total laryngectomy is the loss of oral speech. There are three possibilities to rehabilitate these patients; surgery, voice prosthesis or esophageal speech. This last one appears as an inexpensive, non-invasive rehabilitation method; it does not need a complex learning and in spite of new technics, it continues to be an effective method in the social rehabilitation of laryngectomized patients. We have made a retrospective study of patients who underwent TL between 1992-1998 and that were rehabilitated by esophageal voice learning. Three factors have been evaluated: first, those related to the patient (gender, age, study level...); second, those related to the treatment itself [TL, pharyngolaryngectomy (PTL), TL plus radiotherapy...] and third, those related to the rehabilitation (technics, delayed on starting, number of sessions...). Data were compared with rehabilitation outcome: good (usually using esophageal voice), medium (speaking sometimes) and bad (not speaking). 74.1% had an acceptable outcome and they use esophageal voice with more or less difficulty to communicate, and this outcome increases to 95.8% when we do not take into account 7 patients who gave-up rehabilitation before finishing the first five sessions (AU)

[A study of cervical metastases from unknown primary tumor]. / Estudio sobre las metástasis cervicales de primario desconocido.

Cervical metastases of cancer of an unknown primary tumour (CMUPT) are infrequent but they represent botha diagnostic and therapeutic challenge for ENT physicians. We present a retrospective study over 22 patients with CMUPT diagnosed in our hospital during 13 years (3.4% of the patients with head and neck cancer). The sensitivity of the fine-needle aspiration technique was 94.7%. 54% were N2a, 36% N3 and 9% N2b. 73% were squamous cell carcinoma and 27% were undifferentiated carcinoma. We established our protocol on diagnosis and management: panendoscopy with biopsies of nasopharynx, vallecula and pyriform sinus and ipsilateral tonsillectomy. The primary source was identified in 23% of the series. All squamous cell carcinoma were treated with radical neck surgery plus radiotherapy and the undifferentiated carcinoma with chemotherapy and radiotherapy. The overall survival was 64% at 3 years. The N-stage affected the survival rate.

[Splenic abscess and cat-scratch disease]. / Abscesos esplénicos y enfermedad por arañazo de gato.

Cat-scratch disease is caused by a Gram-negative bacillus known as Bartonella henselae. This disease is usually benign and causes regional adenitis that does not require treatment. However, some patients develop more serious atypical forms of the disease including prolonged systemic illness with hepatic and splenic abscesses.A 14-year-old girl was admitted to hospital with a 12-day history of persistent high fever and abdominal pain. Ultrasonography and computerized tomography of the abdomen revealed splenic abscesses. These findings, together with an antecedent of cat exposure, led to the suspicion of cat-scratch disease, which was confirmed by serology. The girl was treated with intramuscular ceftriaxone and clinical evolution was favorable. Splenic cat-scratch disease is infrequent. Cat-scratch disease sometimes presents as fever of unknown origin and consequently this disease should be considered in the differential diagnosis of prolonged fever. Although evolution is usually favorable, antibiotic therapy is recommended in systemic manifestations of cat-scratch disease.

Abscesos esplénicos y enfermedad por arañazo de gato / Splenic abscess and cat-scratch disease

La enfermedad por arañazo de gato es una infección causada por un bacilo gramnegativo conocido como Bartonella henselae. Esta enfermedad se comporta habitualmente de forma benigna causando un cuadro de adenitis regional que no precisa tratamiento; sin embargo, algunos pacientes desarrollan formas atípicas y más graves entre las que se encuentra un cuadro caracterizado por una afectación visceral en forma de granulomas hepáticos y esplénicos. Se presenta el caso de una niña de 14 años con síntomas de fiebre elevada de 12 días de evolución y abdominalgia. La ecografía y la tomografía computarizada (TC) abdominal mostraron abscesos esplénicos que junto al antecedente de exposición a gatos hizo sospechar el diagnóstico de enfermedad por arañazo de gato que se confirmó por serología. Fue tratada con ceftriaxona intramuscular con muy buena evolución clínica. La afectación hepatoesplénica suele ser una forma poco común de la enfermedad. En ocasiones se presenta como un síndrome febril de origen desconocido por lo que debemos tener en cuenta esta enfermedad en el diagnóstico diferencial de fiebre prolongada. Aunque la evolución suele ser favorable se recomienda tratamiento antibiótico en las formas atípicas de la enfermedad por arañazo de gato (AU)

[High-frequency audiometry: hearing thresholds in normal ears]. / Audiometría de alta frecuencia: umbrales de audición en oídos normales.

High tone audiometry is an audiometric test serviceable in order to discover with precocity conditions affecting first the basal cochlear turn, as in ototoxicity occurs. Despite its increasing diffusion there are not fixed values allowing the use of a HL decibels scale generally introduced, like the adopted for low tone frequencies. This is partly due to difficulties for gauging several devices employed. Besides the age has an important influence in hearing of high tones and as a result the valutations given by distinct AA., disagree among them and each laboratory must establish their normal values grouped according to ages. However the knowledge of these figures is useful because they get a referent when one looks through the literature. This paper reflect our experience with normal population after being realized a brief medical history including an otoscopy and a diagnostic audiometry with the aim to eliminate possible otological pathology undiagnosed. Our results are compared with those of other authors.

[Smooth muscle tumor of the lower lip. A report of a case of rapid growing and increased mitotic activity]. / Tumor de músculo liso de labio inferior. Reseña de un caso de rápido crecimiento y elevada actividad mitósica.

Smooth-muscle tumors are not often found in the oral cavity. The tumors found usually are benign tumors of the angioleiomyoma type. We report a new case of oral smooth-muscle tumor, in the lower lip of a 74-year-old woman. Immunohistochemistry and electron microscopic study confirmed the nature of the lesion. Although some mitoses were visible, the outcome has been favorable.

[Carcinoma of small neuroendocrine cells in major salivary glands. Presentation of two clinical cases and literature review]. / Carcinoma de células pequeñas neuroendocrino de glándulas salivares mayores. Presentación de dos casos clínicos y revisión de la literatura.

To date, only 45 cases of oat cell carcinoma of the major salivary glands have been reported in the literature, which represents less than 1% of primary malignant tumors of the parotid glands. Two subtypes exist: ductal and neuroendocrine. We report two new cases of neuroendocrine oat cell carcinoma of the parotid gland which were treated by surgery associated with radiation therapy and chemotherapy. The literature review showed a predominance of males (61.7%), age 50-70 years, and location in parotid gland (83%). Treatment consists of radical surgery of the tumor associated with radiation therapy and chemotherapy. The prognosis is poor, with survivals at one, three and five years of 77.7%, 40.7%, and 29.6%, respectively, although this is better than the prognosis for other sites.

Tumor-associated paralysis of the mastoid portion of the facial nerve: report of three unusual cases.

Tumors of the mastoid portion of the facial nerve are rare and often are misdiagnosed because they have subtle clinical manifestations. We have described three cases of tumor affecting the mastoid portion of the facial nerve seen in our hospital. In all cases, diagnosis proved problematic. Routine and careful use of imaging techniques and a certain amount of intuition are necessary to reach the correct diagnosis. Facial paralysis diagnosis requires histopathological examination following mastoidectomy.