[Amyotrophic lateral sclerosis that begins with voice and deglution alterations]. / Ela que debuta con alteraciones en la voz y en la deglución.

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. In bulbar forms of Amyotrophic Lateral Sclerosis, voice and/or swallowing difficulties are often the initial signs of disturbance. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. We show a case and revise bibliography.

ELA que debuta con alteraciones en la voz y en la deglución / Amyotrophic lateral sclerosis that begins with voice and deglution alterations

La esclerosis lateral amiotrófica es una enfermedad neuromuscular degenerativa de comienzo insidioso. Afecta a las neuronas superiores e inferiores y causa síntomas espásticos y atróficos. Más de un cuarto de los pacientes tienen sintomatología referida a cabeza y cuello (parálisis bulbar), por lo que el otorrinolaringólogo puede ser el primer médico en diagnosticarlo. En las formas bulbares de esclerosis lateral amiotrófica, las alteraciones en la voz y la deglución son a menudo los síntomas iniciales de la enfermedad. Los sín tomas predominantes son los trastornos del habla, disfonía, disfagia y disnea. Debilidad muscular, atrofia y fasciculaciones pueden encontrarse también en la exploración. Presentamos un caso y revisamos la bibliografía al respecto

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. In bulbar forms of Amyotrophic Lateral Sclerosis, voice and/or swallowing difficulties are often the initial signs of disturbance. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination

Laringitis por rhodococcus equi en paciente con sida / Laryngeal infection by rhodococcus equi in a patient with aids

El Rhodococcus equies un bacilo aerobio gram positivo pleomórfico, que fue aislado por primera vez como productor de bronconeumonía en caballos jóvenes. Cada vez con mayor frecuencia, está siendo reconocido como patógeno en humanos, sobre todo en la población inmunocomprometida. Describimos un caso, hasta ahora excepcional, de infección laríngea por Rhodococcus equi en un paciente con serología positiva para el virus de la inmunodeficiencia humana (VIH), y revisamos algunas características clínicas y epidemiológicas de las infecciones por este germen. El tratamiento es rifampicina y/o eritromicina, siendo el pronóstico malo, pues suelen ser pacientes inmunocomprometidos (AU)

The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients (AU)

[Balloon catheter dilatation in pharyngo-esophageal stenosis]. / Dilatación con sonda-balón en estenosis faringo-esofágicas.

On the scarring strictures at the level of the pharyngo-esophageal junction, for example following surgery for pharyngo-laryngeal tumours, the treatment was traditionally the use of transoral dilators, as the metallic spark plugs or olives. At present the balloon catheters are the election technique for all cases. The advantages for the balloon catheters versus the traditional methods are the smaller morbidity and mortality, the effectiveness, simplicity and little cost. We show the protocol done in our center for the dilation of these strictures.

Dilatación con sonda-balón en estenosis faringo-esofágicas / Balloon catheter dilation in pharyngo-esophageal strictures

En las estenosis cicatriciales a nivel de la unión faringoesofágica, por ejemplo tras cirugía de tumores faringolaríngeos, tradicionalmente el tratamiento se basaba en el empleo de dilatadores transorales, como las bujías o las olivas metálicas. Actualmente se emplean los catéteres de balón como técnica de elección para todos los casos. La ventaja de la sonda-balón frente a la dilatación tradicional es su menor morbilidad y mortalidad, su eficacia, sencillez y poco coste. A continuación se muestra el protocolo seguido en nuestro centro para la dilatación de estas estenosis (AU)

On the scarring strictures at the level of the pharyngo-esophageal junction, for example following surgery for pharyngo-laryngeal tumours, the treatment was traditionally the use of transoral dilators, as the metallic spark plugs or olives. At present the balloon catheters are the election technique for all cases. The advantages for the balloon catheters versus the traditional methods are the smaller morbidity and mortality, the effectiveness, simplicity and little cost. We show the protocol done in our center for the dilation of these strictures (AU)

[Laryngeal infection by Rhodococcus equi in patient with AIDS]. / Laringitis por Rhodococcus equi en paciente con SIDA.

The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients.

[Mucinous cystadenoma of a minor salivary gland of the nasal fossa]. / Cistadenoma mucinoso de glándula salivar menor de fosa nasal.

Tumors of minor nasal salivary glands are relatively sparse. The case reported is a monomorph adenoma of benign character, which first clinical diagnosis mimicked a naso-sinusal polyposis. Examination of the removed piece by functional endoscopic surgery firstly was considered as an adenocarcinoma of low malignity degree but afterwards resulted as a mucinous cysto-adenoma of minor salivary glands with favorable clinical behaviour.

Microsomía hemifacial o sindrome del primero y segundo arco branquial: características clínicas y consideraciones terapéuticas / Hemifacial microsomy or syndrome of first and second branchial arch: clinical characteristics and therapeutic considerations

El síndrome de microsomía hemifacial está formado por una constelación de malformaciones congénitas de las estructuras faciales provenientes del I y II arcos branquiales, en las que intervienen la primera bolsa faríngea y el primer paladar blando, junto con el núcleo del hueso temporal. Presentamos un nuevo caso de microsomía hemifacial, y revisamos sus características clínicas y posibilidades terapéuticas (AU)

The syndrome of hemifacial microsomia is formed by a constellation of congenital malformations of the originating face structures of the I and II branchial archs, in which the first pharingeal stock and the first soft palate take part to, along with the nucleus of the temporary bone. We present a new case of hemifacial microsomia, and reviewed its clinical characteristics and therapeutic possibilities (AU)

[Epidermoid cyst of the cerebellopontine angle. Report of a case]. / Quiste epidermoide de ángulo pontocerebeloso. A propósito de un caso.

Epidermal cysts of the cerebello-pontine angle (CPA) are lesions arising from epidermal remainders having an expansive and slow growth sitting on the PCA space or on the temporal bone. Are diagnosed approximately in the fourth life's decade by its deficient or irritant symptoms related to VIIth and VIIIth cranial nerves. It is important the nuclear magnetic resonance exam because the specific radiologic characteristics that distinguish these cysts from other conditions of CPA as neuromata or meningiomata.

[Hemifacial microsomia or syndrome of the first and second branchial arch: clinical features and therapeutic considerations]. / Microsomía hemifacial o síndrome del primero y segundo arco branquial: características clínicas y consideraciones terapéuticas.

The syndrome of hemifacial microsomia is formed by a constellation of congenital malformations of the originating face structures of the I and II branchial archs, in which the first pharingeal stock and the first soft palate take part to, along with the nucleus of the temporary bone. We present a new case of hemifacial microsomia, and reviewed its clinical characteristics and therapeutic possibilities.

[Recurrential paralysis as the first manifestation of chordoma of the petrous apex]. / Parálisis recurrencial como primera manifestación de cordoma del peñasco.

We report the case of a 67-year-old woman with paralysis of the right recurrent nerve. Imaging studies showed a mass in the right petrous apex and jugular foramen. Surgery was performed using a lateral approach to the skull base. The tumor excised from the petrous apex was a chondroid chordoma. Chordomas are rare dysontogenic neoplasms that arise from notochord remnants, generally on the midline. It should be included in the differential diagnosis of tumors of the skull base.

[Retropharyngeal lipoma]. / Lipoma del espacio retrofaríngeo.

Although ordinary lipoma is the most common neoplasm of mesenchymal origin, retropharyngeal lipoma is a very rare tumour and only about 20 cases have been reported. We present a further case of this kind and discuss its most important clinical features, diagnosis and treatment. Updated theories on the lipoma's etiology and their evolutive course are reviewed.

[Giant dermoid cyst of the floor of the mouth]. / Quiste dermoide gigante de suelo de boca.

Report the case of a young feminine patient, 17, presenting since the first year of her life, a swelling of few milimeters diameter, close to the frenulum of the tongue, with progressive enlargement. At examination is verified a swelling about 10 cms. diameter filling the whole ground of the mouth and pulling backwards the tongue and producing a clear protrusion in the suprahyoid region. After lateral X-ray of the neck, echography and cervical TAC, surgery is advised with the suspicion of ranula sublingualis. Removal of the tumor through medial cervictomy, finding, besides the main mass, a second one about 3 cms. diameter. The histopathological diagnosis of a cyst of the thyroglossal duct, its sitting place and the clinical course, compelled the AA. to review the slides and being obvious the presence of sebaceus glands, they change the prior diagnosis for that of dermoid cyst.

[Solitary nasal plasmocytoma]. / Plasmocitoma solitario nasal.

Report of the case of one patient diagnosed of a nasal extramedullary solitary plasmacytoma, starting as an suppurated panophtalmia. Biopsy of the mass inside the nose led to diagnosis. Comments about the difficulties of histopathological differential diagnosis, underlying the need to rule out any other systemic process (multiple myeloma). The subject was treated with inductive chemotherapy and radiotherapy, being free of the illness after 4 years follow up.

[The demand for specialized care in otorhinolaryngology]. / Estudio de la demanda asistencial especializada en otorrinolaringologiá.

BACKGROUND: The specialized medical assistance knowledge improved in hospitals since the introduction of Clinical Documentation Services, but hardly anything is known about outpatient assistance, specially in otolaryngology. METHODS: In order to find out this information, during 1992 last quarter, we sampled 20 days of outpatient consult, studying the following variables in patients visited: age, sex, diagnosis, diagnostic-therapeutic procedures and motives for hospital attention. RESULTS: In the sample first visits are 63% and second visits 37%. Only 7.5% of patients were sent to hospital and we refer the diagnosis cause. In 5.6% of cases we couldn't establish any diagnosis, the 47% of cases presented otologic pathology and the rest 47% belonged to rhinologic pathology, pharyngeal and laryngeal troubles. The frequency of diagnosis were different in age groups. In 25% of patients diagnostic-therapeutic procedures were done. CONCLUSIONS: This study supplies us interesting information about the features of ENT outpatient assistance respect sex and age, more frequent diagnostics, procedures and causes for hospital attention.