Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis

BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis

Invasive maxillary sinus aspergillosis: A case report successfully treated with voriconazole and surgical debridement.

INTRODUCTION: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. CASE REPORT: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. CONCLUSIONS: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment. Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.

Cavernous hemangioma of the parotid gland in adults.

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.

Hemangioma cavernoso sublingual / Sublingual cavernous haemanginoma

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[OK-432 therapy for cervicofacial lymphangioma in adults]. / OK-432 como tratamiento del linfangioma cervicofacial en el adulto.

The treatment of cervicofacial lymphangiomas has been changing in recent years. OK-432 appears to be a relatively safe and effective treatment option for patients of all ages. An intracystic injection of OK-432 produces a local inflammatory reaction, leading to resolution of the lesion. Cosmetically, the outcome is excellent, leaving no lesions on the skin at the injection site, unlike other sclerosing agents. It may thus be considered as the treatment of choice, especially in cases where surgical treatment is associated with the possibility of serious functional or cosmetic side effects.

OK-432 como tratamiento del linfangioma cervicofacial en el adulto / OK-432 Therapy for cervicofacial lymphangioma in adults

El tratamiento del linfangioma cervicofacial está cambiando en los últimos años. La solución de OK-432 se presenta como un tratamiento relativamente seguro y efectivo para los pacientes de cualquier edad. La inyección intraquística del OK-432 produce una reacción inflamatoria local que resuelve la lesión. El aspecto estético es excelente, ya que no deja lesiones cutáneas en el lugar de la inyección, a diferencia de otros agentes esclerosantes. Por ello se puede considerar el tratamiento de elección, especialmente en casos en que el tratamiento quirúrgico puede producir serias secuelas funcionales o estéticas

The treatment of cervicofacial lymphangiomas has been changing in recent years. OK-432 appears to be a relatively safe and effective treatment option for patients of all ages. An intracystic injection of OK-432 produces a local inflammatory reaction, leading to resolution of the lesion. Cosmetically, the outcome is excellent, leaving no lesions on the skin at the injection site, unlike other sclerosing agents. It may thus be considered as the treatment of choice, especially in cases where surgical treatment is associated with the possibility of serious functional or cosmetic side effects

Frontal sinus mucocele with intracranial and intraorbital extension.

INTRODUCTION: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. CASE REPORT: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. CONCLUSION: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications.

Frontal sinus mucocele with intracranial and intraorbital extension

No disponibleIntroducción: Los mucoceles del seno frontal pueden presentarse con multitud de síntomas diferentes, incluyendo alteracionesoftálmicas. Son benignos, aunque tienen tendencia a la expansión mediante erosión de las paredes adyacentes, lo que produce desplazamiento y destrucción de estructuras por presión y resorción ósea. Caso clínico: Se presenta el caso de un hombre de 32 años con diplopia, proptosis del ojo derecho y cefalea fronto-temporal, cuyo diagnóstico fue de mucocele del seno frontal con extensión intracraneal e intraorbitaria. Discutiremos las posibles manifestaciones clínicasde los mucoceles, las técnicas de imagen empleadas, así como el tratamiento realizado. Conclusión: Los mucoceles del seno frontal son benignos y curables, aunque un rápido diagnóstico y tratamiento son de vital importancia ya que pueden causar complicaciones locales, orbitarias o intracraneales

Introduction: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances.Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. Case report: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possibleclinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Conclusion: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications

Linfoma angiocéntrico centrofacial / Centrofacial angiocentric lymphoma

El linfoma angiocéntrico centrofacial es una neoplasia linfoide rara, con un diagnóstico a menudo difícil, debido al cuadro clínico inespecífico y a que muchas veces son necesarias varias biopsias para llegar a un diagnóstico correcto. Se trata de un linfoma no Hodgkin(LNH) agresivo, de localización preferente en el tracto respiratorio superior (sobre todo en cavidad nasal), y con un pronóstico ominoso, ya que la supervivencia media es de 12-18 meses aproximadamente(1). Predomina en orientales y sudamericanos, entre los 50-60 añosde edad, y con ligera preferencia por el sexo masculino (2:1).Se presenta el caso de una paciente ecuatoriana que acude anuestro servicio con edema hemifacial, rinorrea achocolatada y obstrucción respiratoria nasal de 1 mes de evolución, sin respuestaal tratamiento antibiótico y antiinflamatorio, que tras realizarvarias pruebas diagnósticas se evidenció histológicamente lapresencia de un linfoma T extranodal de tipo nasal (también llamado linfoma de células T angiocéntrico)

The centrofacial angiocentric lymphoma is a rare lymphoid neoplasm, with an often-difficult diagnosis due to the non-specific clinical picture. On many occasions it is necessary to perform various biopsies to reach the correct diagnosis.This lymphoma is an aggressive Non-Hodgkin`s (NHL) type,which is normally found in the upper respiratory tract (predominantly in the nasal cavity), and has an ominous prognosis, as the average survival rate is between 12 and 18 months (1). It is predominantly found in subjects of oriental and South American extraction, who are between the ages of 50 and 60 years and with a slight tendency towards males (2:1). This is the case study of a female Ecuadorian patient who was referred to our department with a hemifacial edema, chocolate-like rhinorrhea and nasal respiratory obstruction, which had been treated with antibiotics and anti-inflammatories for a month without success. After performing a number of diagnostic tests, it was found histologically that the patient had an extranodal T-cell lymphoma of the nasal type (also known as T-cell angiocentriclymphoma)

Centrofacial angiocentric lymphoma.

The centrofacial angiocentric lymphoma is a rare lymphoid neoplasm, with an often-difficult diagnosis due to the non-specific clinical picture. On many occasions it is necessary to perform various biopsies to reach the correct diagnosis. This lymphoma is an aggressive Non-Hodgkin's (NHL) type, which is normally found in the upper respiratory tract (predominantly in the nasal cavity), and has an ominous prognosis, as the average survival rate is between 12 and 18 months (1). It is predominantly found in subjects of oriental and South American extraction, who are between the ages of 50 and 60 years and with a slight tendency towards males (2:1). This is the case study of a female Ecuadorian patient who was referred to our department with a hemifacial edema, chocolate- like rhinorrhea and nasal respiratory obstruction, which had been treated with antibiotics and anti-inflammatories for a month without success. After performing a number of diagnostic tests, it was found histologically that the patient had an extranodal T-cell lymphoma of the nasal type (also known as T-cell angiocentric lymphoma).

Cemento-ossifying fibroma of mandibular gingiva: single case report.

We report a case of a woman presenting a giant cementoossifying fibroma depending of the mandibular gingivae. The evolution of the process was 20 years. Cemento-ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. This lesion appears within the bone although in some occasions it involves the gingivae soft tissues, as the case we present. It is a slow-growing and well-defined tumorous lesion, because of this, it is considered as a benign lesion. The histologic findings alone may be similar to other pathologies such as osteoblastoma, low-grade osteosarcoma and particularly to fibrous dysplasia. An accurate diagnosis requires careful clinical, radiological and histological correlation in order to make an optimal treatment and an excellent outcome.

Fibroma cemento-osificante gingival mandibular: presentación de un caso / Cemento-ossifying fibroma of mandibular gingiva: single case report

Presentamos el caso clínico de una mujer con un fibroma cemento-osificante gigante dependiente de la encía mandibular de 20 años de evolución. El fibroma cemento-osificante es un tumor poco frecuente, clasificado dentro de las lesiones fibroóseas. Aparece generalmente en hueso y en raras ocasiones afecta a tejidos gingivales, como ocurre en nuestro caso. Es una neoplasia de crecimiento lento y bien delimitada, lo que le confiere un carácter benigno. Con los hallazgos histológicos es difícil diferenciar el fibroma cemento-osificante de otras lesiones tales como el osteoblastoma, el osteosarcoma de bajo grado y particularmente de la displasia fibrosa. Para obtener un diagnóstico preciso es fundamental guiarnos además por la información clínica y radiológica y así llevar a cabo un tratamiento oportuno, que condicione un pronóstico excelente (AU)

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Aspergílosis maxilar invasiva: presentación de un caso clínico y revisión de la literatura / Invasive maxillary aspergillosis: report of a case and review of the literature

Se presenta un caso clínico de aspergilosis maxilar en un paciente inmunodeprimido. La aspergilosis de senos paranasales es una entidad poco común, sin embargo su frecuencia ha aumentado en los últimos años. Se puede manifestar de cuatro formas: alérgica, no-invasiva, invasiva y fulminante. La spergilosis invasiva fulminante es un proceso muy grave que afecta generalmente a pacientes inmunodeprimidos. Para evitar el elevado índice de mortalidad y morbilidad asociado con este proceso, es fundamental el realizar un diagnóstico y tratamiento precoz (AU)