Non-pedicled vs vascular pedicled nasal flap in repair of cerebrospinal fluid rhinorrhea.

CONCLUSIONS: In our study, pedicled nasal flap (NF) did not provide better results than free nasal graft (NG) for primary closure of cerebrospinal fluid (CSF) rhinorrhea. In the future, a multicenter randomized study would be needed to confirm this result. The choice of surgical technique will depend on the surgeon's experience, and the position and size of the defect. OBJECTIVES: To evaluate our results in repairing CSF leaks, comparing the two techniques we used: free NG and pedicled NF. METHODS: A total of 33 patients diagnosed with CSF rhinorrhea were operated on between June 2000 and May 2010; 17 were women. The mean age was 44.7 years (± 13.0). Twenty-two (66.6%) NFs of the middle and lower turbinate and septum were performed, the rest being NGs of the middle and lower turbinate only. A descriptive statistical analysis and a Kaplan-Meier survival analysis were carried out and the log-rank statistic was used to compare both techniques. RESULTS: In the present study, 78% of defects were closed in all cases; NF was used in 86% (19) and NG in 63.63% (7). The mean follow-up was 71.5 (95% confidence interval (CI), 56.9-86.1) months. There were no statistically significant differences (p > 0.05).

Allergenic profile of nasal polyposis.

BACKGROUND: Nasal polyposis is highly prevalent in the general population. Its exact origin is unknown, although several factors are involved in the etiology and development of this condition. Clinical patterns, a history of atopy, environmental exposure, eosinophil-mediated inflammation, the presence of inflammatory mediators, and sensitization to some allergens indicate that nasal polyposis is associated with allergic phenomena. The aim of this study was to identify the association between nasal polyposis and allergic factors by examining hypersensitivity reactions to common allergens and environmental exposure that could lead to the development of atopy. METHODS: We conducted a comparative study of 190 patients with nasal polyposis and 190 healthy individuals. The study included clinical and epidemiological variables, environmental exposure factors, and an allergology workup using skin prick tests with 18 inhaled allergens. RESULTS: A total of 121 patients (63.7%) of the 190 were male; 62.1% had a family history of allergy. The incidence of asthma was 48.9% among the patients and only 2.3% among the controls (P < .001). The factor most frequently involved in the patients' symptoms was weather changes (67.4%). Skin prick tests were positive in 63.2% of the patients and 31.1% of the controls. The allergens that most frequently elicited a reaction from the patients in the prick tests were Dermatophagoides pteronyssinus (27.7%), Dermatophagoides farinae (21.3%), and Olea europaea (21.1%). The difference between these results and those of the controls was statistically significant. CONCLUSIONS: Patients with nasal polyposis are sensitive to the most common allergens in our environment and exhibit a clear-cut correlation with other allergic factors, as confirmed by personal and family histories, the presence of chronic rhinitis, and the results of in vivo tests.

Fungal sensitization in nasal polyposis.

BACKGROUND: There are indications that polyposis is somehow related to allergic phenomena. Fungal sensitization in substantial proportions of patients has been cited as a trigger of inflammatory mechanisms involving either an immunoglobulin (Ig) E-mediated reaction to fungal colonization or fungal invasion of tissues. OBJECTIVE: To confirm whether fungi were involved in the development of polyposis by examining sensitivity to fungal allergens and potential local contamination by fungal species. METHODS: We performed a study of 190 patients with polyposis and 190 controls in which we compared the results of skin prick tests to 12 fungi, total IgE, and specific IgE to 15 fungal extracts and nasal fungal cultures. RESULTS: The specific fungi eliciting a reaction from the largest proportion of patients in the skin prick tests were Fusarium solani (13.7%), Penicillium frequentans (12.6%), Trichophyton mentagrophytes (11.1%), and Candida albicans (8.4%) (P < .001). The proportion of individuals that tested positive for fungal-specific IgE was 22.4% (38/170) for patients and 10.1% (19/189) for controls (P = .04). The respective proportions of positive responses to fungal cultures were 58.7% and 60%. Furthermore, no significant differences between patients and controls were found for the results of in vitro tests with cultured fungal allergens. CONCLUSIONS: Although the patients with polyposis exhibited sensitization to fungal allergens, we found that nasal colonization by fungi was similar in patients and the general population. We were also unable to find a correlation between a positive response to the cultures and the presence of fungal allergen-specific IgE. It therefore seems that nasal colonization by fungi does not induce fungal sensitization.

Parálisis aguda del XII par craneal / Acute palsy of twelfth cranial nerve

La parálisis del nervio hipogloso o XII par craneal es una enfermedad infrecuente de forma aislada que puede ser debida a múltiples causas: Tumores o metástasis de la base del cráneo o del recorrido nervioso cervical, schwannoma del nervio, disección carotídea, traumatismo s cervicales, idiopática, radioterapia, infecciones (mononucleosis infecciosa) o neuropatías de diversa etiología. Presentamos un caso de parálisis aguda del hipogloso y realizamos el diagnóstico diferencial desde el punto de vista etiopatogénico y clínico

The hypoglossal nerve or Twelfth-nerve palsy is a rare damage with different causes: Tumors or metastases in skull base, cervicals tumors, schwannoma, dissection or aneurysm carotid arteries, stroke, trauma, idiopathic cause, radiation, infections (mononucleosis) or multiple cranial neuropathy. Tumors were responsible for nearly half of the cases in different studies. We studied a female with hypoglossal nerve acute palsy. We made a differential diagnostic with others causes and a review of the literature

[Acute palsy of twelfth cranial nerve]. / Parálisis aguda del XII par craneal.

The hypoglossal nerve or Twelfth-nerve palsy is a rare damage with different causes: tumors or metastases in skull base, cervicals tumors, schwannoma, dissection or aneurysm carotid arteries, stroke, trauma, idiopathic cause, radiation, infections (mononucleosis) or multiple cranial neuropathy. Tumors were responsible for nearly half of the cases in different studies. We studied a female with hypoglossal nerve acute palsy. We made a differential diagnostic with others causes and a review of the literature.

Mucormicosis rinocerebral: diagnóstico diferencial de las sinusitis fúngicas invasivas / Rhinocerebral mucormycosis: differential diagnosis of invasive fungal sinusitis

La mucormicosis es una infección oportunista causada por hongos Mucoraceae pertenecientes a la familia de los Phycomycetes. Suele afectar a pacientes debilitados e immunodeprimidos con neoplasias malignas, grandes quemados o diabéticos existiendo diferentes formas entre las que se incluyen rinocerebrales, pulmonares o diseminadas. Describimos un caso de mucormicosis rinocerebral con complicación intracraneal, visto en nuestro hospital que fue tratado mediante cirugía radical y tratamiento médico (AU)

Sinusitis fúngicas no invasivas: micetoma y sinusitis fúngica alérgica / Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis

Hemos realizado un estudio de diferentes casos de sinusitis fúngicas (SF) no invasivas vistas en nuestro hospital y tratadas mediante cirugía endoscópìca nasosinusal (CENS) y tratamiento médico. Presentamos 2 casos de SF no invasivas: Aspergiloma y sinusitis fúngica alérgica y realizamos el diagnóstico diferencial entre los diferentes tipos según la nueva clasificación. Por último resaltamos los aspectos más relevantes de cada tipo con una amplia revisión bibliográfica (AU)

[Endoscopic surgery of nasopharyngeal angiofibroma]. / Cirugía endoscópica del angiofibroma nasofaríngeo.

Juvinile nasopharyngeal angiofibromas are highly vascular benign tumors but with an agressive behaviour with invasion of skull base and vital structures. Our study includes 11 male patients that underwent surgery for angiofibromas between 1992-2002 with an endoscopic surgical approach and embolization before surgery. The average age was 14.7 years old. Using Fisch staging, 8 patients were stage II. All cases achieved symptomatic remission, with no complications but the recurrence was 36.3%. The endoscopic excision is a safe and effective minimally invasive surgical treatment in patients in stage I and II. It should be considered as a first-choice option for these cases.

Endoscopic surgery of nasopharyngeal angiofibroma / Cirugía endoscópica del angiofibroma nasofaríngeo

Juvenile nasopharyngeal angiofibromas are highly vascular benign tumors but with an agressiv ebehaviour with invasion of skull base and vital structures. Our study includes 11 male patients that underwent surgery for angiofibromas between 1992-2002 with an endoscopic surgical approach and embolization before surgery. The average age was14,7 years old. Using Fisch staging, 8 patients were stage II. All cases achieved symptomatic remission, with no complications but the recurrence was 36,3%.The endoscopic excision is a safe and effective minimally invasive surgical treatment in patients in stage I and II. It should be considered as a first-choice option for these cases (AU)

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[Rhinocerebral mucormycosis: differential diagnosis of invasive fungal sinusitis]. / Mucormicosis rinocerebral: diagnóstico diferencial de las sinusitis fúngicas invasivas.

Mucormycosis is an opportunistic infection caused by molds Mucoraceae of the family Phycomycetes. This invasive FS is found in debilitated hosts, most frequently in patients with hematologic malignancies, burn patients and diabetes mellitus. There are several differents forms: rhino-cerebral, pulmonary or disseminated. We describe a case of invasive fungal sinusitis (FS): Rhino-orbital-cerebral mucormycosis, treated at our hospital with radical surgery and medical treatmen We reviewed the clinical presentation of the different types.

[Non invasive fungal sinusitis: mycetoma and alergical fungal sinusitis]. / Sinusitis fúngicas no invasivas: micetoma y sinusitis fúngica alérgica.

We have made a study about different cases of non-invasive fungal sinusitis (FS) treated at our hospital with surgery (endoscopic sinus approach) and medical treatment. We review two cases: Mycetoma and allergic fungal sinusitis, following the recent classification based on physiopathology, treatment and prognosis. We review the clinical presentation of the different types.

[Metastatic neck adenopathies without known primary tumor. Incidence study 1996-2001]. / Adenopatías metastásicas cervicales sin tumor previo conocido. Estudio de incidencia 1996-2001.

We made a retrospective descriptive study reviewing 92 patients with cervical lymph node metastases from unknown primary tumour. The study was accomplished during 6 years. (January 1996 to December 2001) in the Department of Otorhinolaryngology of the Hospital Reina Sofia, Córdoba. The median age was 61.7 years old, male 96.7% and heavy smoker (89.1%) and drinkers most of them. According to TNM categories, 72.2% patients were in phase N2a and half of them were localized Level II. Squamous cell carcinoma was the predominant histologic type. The patients were treated with surgery in 70.6% of the cases with or without radiation therapy and/or chemotherapy.

[Forestier-Rotes Querol syndrome]. / Síndrome de Forestier-Rotes Querol.

The diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is characterized by an hyperostosis of the anterolateral margin of the vertebral bodies. It is an uncommon cause of dysphagia in old patients. In the differential diagnosis of mechanical dysphagia we must have present this disease. Cervico-dorsal spine radiographies reveal large anterior osteophytes creating pharyngeal encroachment.

Cirugía endoscópica nasal de procesos selares / Endoscopic nasal surgery in sellar tumors

Los grandes avances realizados en instrumental quirúrgico han revolucionado la cirugía, permitiendo el abordaje de la hipófisis de forma mínimamente invasiva, por medio de la endoscopia, a través de la cavidad nasal por el seno esfenoidal. En nuestro estudio analizamos los resultados quirúrgicos de 20 pacientes intervenidos de tumores selares mediante abordaje endoscópico transseptal transesfenoidal desde Marzo de 1999 hasta Junio de 2002 en nuestro hospital. La edad media de los pacientes fue de 45,6 años, siendo la mayoría mujeres. 6 de los casos fueron adenomas no secretores (30 por ciento) y otros 6 casos acromegalia, seguido de enfermedad de Cushing (25 por ciento) y prolactinoma (10 por ciento).No existieron incidencias intraoperatorias, destacando como complicaciones postquirúrgicas, la aparición de diabetes insípida en 2 casos (10 por ciento) y un solo caso de fístula de LCR. 2 pacientes están actualmente en tratamiento hormonal sustitutivo por panhipopituitarismo. El resto han presentado buena evolución, sin recidivas, normalizándose los niveles hormonales (AU)

Abordaje endoscópico transseptal de tumores hipofisarios / Transseptal endoscopic approach of sellar tumours

Los avances en óptica y endoscopia han revolucionado la cirugía, permitiendo el abordaje endoscópico de la región selar de forma mínimamente invasiva, a través de la cavidad nasal por el seno esfenoidal. Hemos realizado un análisis de los resultados quirúrgicos de 20 pacientes intervenidos de tumores hipofisarios mediante abordaje transseptal-transesfenoidal en los últimos 2 años en nuestro hospital. La edad media de los pacientes fue de 45,6 años, siendo mujeres el 75 por ciento. El 30 por ciento de los casos fueron adenomas no secretores y otro 30 por ciento acromegalia, seguido de enfermedad de Cushing (25 por ciento) y prolactinoma (10 por ciento). No existieron incidencias intraoperatorias, destacando como complicaciones postquirúrgicas, la aparición de diabetes insípida en 2 casos (10 por ciento) y un solo caso de fístula de LCR. Dos pacientes están actualmente en tratamiento hormonal sustitutivo por panhipopituitarismo. El resto han presentado buena evolución, sin recidivas, normalizándose los niveles hormonales (AU)

The advances in endoscopic instruments have eased the approach to the sellar region through the nasal cavity. We carry out an analysis of the surgical results on 20 patients that underwent surgery for sellar tumours through a transeptal-transphenoidal approach in the last 2 years in our hospital. The average was 45.6 years old, and 75% were females. 30% of cases were pituitary adenomas and another 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications were encountered during surgery being the most common postoperative complications, diabetes insipida in two cases (10%) and CSF leak in one case. At present 2 patients are having hormonal treatment for panhypopituitarism. No patients developed a septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula. The rest did have good results noith no recurrence and hormonal values back to normal (AU)

Adenopatías metastásicas cervicales sin tumor previo conocido: estudio de incidencia 1996-2001 / Cervical metastases without primary tumour. Incidence study 1996-2001

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Síndrome de Forestier-Rotes Querol / Forestier-rotes querol syndrom

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Síndrome de Forestier-Rotes Querol / Forestier-Rotes Querol syndrom

La Hiperostosis Esquelética Idiopática Difusa (HEID) Síndrome de Forestier-Rotes Querol es una enfermedad ósea vertebral caracterizada por una intensa calcificación y osificación de ligamentos a nivel de cuerpos vertebrales, sindo una rara causa de disfagia, sobre todo en pacientes de edad avanzada. Por tanto, debemos tener presente dicha entidad en el diagnóstico diferencial de la disfagia de causa mecánica, evidenciándola mediante radiología simple de columna cervical, donde se verifica la presencia de osteofitos a nivel cervical-dorsal (AU)

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Adenopatías metastásicas cervicales sin tumor previo conocido. Estudio de incidencia 1996-2001 / Cervical metastases without primary tumour. Incidence study 1996-2001

Realizamos un estudio Observacional Descriptivo Retrospectivo de 92 pacientes con adenopatías metastásicas cervicales sin antecedentes neoplásicos durante un período de 6 años en el servicio ORL del Hospital Universitario Reina Sofía de Córdoba. La edad media fue de 61,7 años, varones de 96,7 por ciento siendo la mayoría fumadores (89,1 por ciento) y bebedores importantes. El tiempo medio entre aparición de adenopatía y la primera consulta al otorrinolaringólogo fue de 4,12 meses. Según la clasificación TNM, el 72,2 por ciento de los casos se encontraban en fase ganglionar N2a en el momento de la consulta, localizándose en el nivel II en la mitad de los casos. La localización más frecuente del tumor primario fue el territorio faringolaríngeo (80,5 por ciento) encontrándose el 48,9 por ciento de tumores en laringe, seguido de lengua con el 11,9 por ciento. En 9 pacientes no se ha localizado hasta la fecha tumor primario. La exploración física fue suficiente para diagnosticar más del 80 por ciento de los tumores primarios, siendo hallados mayoritariamente en la primera consulta. l tipo histológico predominante fue de CA epidermoide. El tratamiento fue quirúrgico en el 70,6 por ciento de los pacientes, único o combinado con otros tratamientos (AU)

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[Endoscopic nasal surgery in sellar tumors]. / Cirugía endoscópica nasal de procesos selares.

The advances in endoscopy have improved the approach to the sellar region throught nasal cavity. We studied 20 patients with pituitary adenomas operated on using an endoscope through nasal cavity with transseptal- trassphenoidal approach during the last two years. Average age was 45.6 years, and 75% were females. 30% of the patients had non functioning adenomas, 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications occurred during surgery. The more common complications were diabetes insipidus (two cases) and CSF leak (one case). Two patients needed hormonal treatment because panhypopituitarism. No patients developed septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula.