Giant forehead plasmacytoma as a growing lump in a patient with multiple myeloma.

Extramedullary plasmacytoma represents less than 5% of plasma cell malignancies, 85% corresponding to head and neck masses. Symptoms are related to compressive effects according to location, aesthetics issues and can be misleading associated with soft tissue disorders. In this case report, we discuss a 70-year-old woman who presented with a 3-month history of a growing painless forehead lump and confusion, for which she had an emergent simple head computed tomography scan. The images revealed a well-defined mass eroding the frontal bone with multiple lytic lesions that were also found along with long bones radiography. The mass biopsy showed a monomorphic plasmatic cell infiltrate, bone marrow studies confirmed the diagnosis of a light chain secreting multiple myeloma. Extramedullary plasmacytoma is a very unusual first presentation form of multiple myeloma and represents a clinical and radiological challenge. A systematic approach of lytic bone lesions along with the differential diagnosis of head masses are skills the clinician should develop to promptly recognize this condition considering further complications of delayed treatment. In this case, the histopathological confirmation allowed the patient to avoid neurosurgery and the early start of systemic chemotherapeutic treatment.

[Skill in the handling of aerosols by health care personnel]. / Destreza en el manejo de los aerosoles por parte del personal sanitario.

Aerosol bronchodilators are extensively used in bronchial asthma treatment and other obstructive pulmonary diseases. Its therapeutic efficacy is closely related to a correct administration technique. We present the results obtained in a prospective study on the skill in the use of the health care professionals in our hospital. A total of 127 physicians and nurses were interviewed, being 110 finally included in the study. Only 22.7% of them used the aerosol correctly and we did not find significant differences between the three groups into which we divided the study (Staff physicians, Residents, and nurses). The most frequently found mistakes were not maintaining as correct apnea after inhalation (62.7%) and not shaking the aerosol before use (48.2%). Up to a 57.2% of those interviewed made two or more of the evaluated mistakes. We conclude that although aerosol bronchodilators and corticoids are extensively prescribed, the lack of knowledge about their correct use by health care professionals is very high, and this could contribute to their misuse by patients under their care.