[Base tongue actinomycosis]. / Actinomicosis de base de lengua.

Actinomycosis is a bacterial, suppurative chronic infectious disease caused by Actinomyces israelii. Actinomycosis of the tongue is an uncommon form, and only 3% affect the base of the tongue. We report a case with dysphagia from an epiglottis, vallecula and tongue base mass. Diagnosis was made on histologic examination of a tissue biopsy. The disease completely resolved after chirurgical incision and drainage of the abscess and one month of oral amoxicillin therapy. The recurrence of the disease, five years later, made necessary a second surgical procedure and one year of penicillin therapy. We comment the possible causes of this recurrence.

Actinomicosis de base de lengua / Base tongue actinomycosis

La actinomicosis es una infección bacteriana, crónica y supurativa causada por Actinomyces israelii. La afectación lingual es rara, y sólo el 3% afectan la base de la lengua. Presentamos una paciente con disfagia por una masa en la base de la lengua, vallécula y cara lingual de epiglotis. Llegamos al diagnóstico mediante examen histológico de la biopsia realizada. La paciente curó tras incisión y drenaje del absceso y un mes de tratamiento con amoxicilina oral. Cinco años más tarde volvió a presentar el mismo cuadro, siendo necesario un segundo procedimiento quirúrgico y un año de tratamiento antibiótico. Comentamos las posibles causas de esta recidiva

Actinomycosis is a bacterial, suppurative chronic infectious disease caused by Actinomyces israelii. Actinomycosis of the tongue is an uncommon form, and only 3% affect the base of the tongue. We report a case with dysphagia from an epiglottis, vallecula and tongue base mass. Diagnosis was made on histologic examination of a tissue biopsy. The disease completely resolved after chirurgical incision and drainage of the abscess and one month of oral amoxicillin therapy. The recurrence of the disease, five years later, made necessary a second surgical procedure and one year of penicillin therapy. We comment the possible causes of this recurrence

[Distant metastases in patients with advance laryngeal carcinoma]. / Metástasis a distancia en pacientes con carcinoma de laringe avanzado.

Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases.

[Melanoma of the hard palate]. / Melanoma de paladar duro.

Oral melanomas are extremely rare and occur most often on the palate and gingiva. Its prognosis is poor. Surgical management remains the preferred treatment, sometimes in combination with chemotherapy. We report the case of a 72 years old woman with a malignant melanoma of the hard palate who developed three years later a gingival nevi and 5 years later metastatic cervical lymph nodes. Our treatment has been only radical surgery all times.

Melanoma de paladar duro / Melanome of the palate

Los melanomas de cavidad oral son extremadamente raros y aparecen de preferencia en paladar y encías. Su pronóstico es malo. El tratamiento de elección es quirúrgico, combinado según los casos con quimioterapia. Presentamos el caso de una mujer de 72 años, con un melanoma de paladar duro, que desarrolló 3 años más tarde un nevus de mucosa gingival y a los 5 años una adenopatía cervical metastásica. Nuestra forma de tratamiento ha sido exclusivamente quirúrquico en las tres ocasiones (AU)

Oral melanomas are extremely rare and occur most often on the palate and gingiva. Its prognosis is poor. Surgical management remains the preferred treatment, sometimes in combination with chemotherapy. We report the case of a 72 years old woman with a malignant melanoma of the hard palate who developed three years later a gingival nevi and 5 years later metastatic cervical lymph nodes. Our treatment has been only radical surgery all times (AU)

Metástasis a distancia en pacientes con carcinoma de laringe avanzado / Distant metastases in patients with advance laringeal carcinoma

Los pacientes con carcinoma de laringe en estadios avanzados tienen un alto riesgo de desarrollar metástasis a distancia, lo cual ensombrece considerablemente el pronóstico. En nuestro estudio tratamos de identificar cuáles son los factores de riesgo y planteamos someter a este grupo de pacientes a un tratamiento sistémico más agresivo. Analizamos los datos de 57 pacientes con carcinoma escamoso faringolaríngeo en estadios III y IV, tratados quirúrgicamente. Encontramos que los estadios T avanzados y la afectación cervical ganglionar causan más metástasis (p<0,05), así como la invasión tumoral de 3 o más ganglios (p=0,002), y los tumores pobremente diferenciados (p<0,05). La localización tumoral, su extensión en cm, la presencia de ulceración y la falta de control locoregional no se asociaron con una mayor incidencia de metástasis (AU)

Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases (AU)

[Pharyngoesophageal foreign bodies]. / Cuerpos extraños faringoesofágicos.

A review was made of 77 rigid esophagoscopies to remove a foreign body from the upper digestive tract. Mean age of patients was 59 years. Meat bones were the most frequent impacted foreign body and the cervical esophagus was the most frequent site of impactation. No foreign body was found in 22% of esophagoscopies, a high rate that could have been due to our lack of confidence in radiographic studies, which yield false positive and false negative information. Esophagoscopy is performed whenever patient-referred symptoms are clear. The only complications were three cases of major esophageal erosions without perforation and one pneumothorax. A case of intramural esophageal pseudodiverticulosis was found.

Cuerpos extraños faringoesofágicos / Pharynogesopnageal foreign bodies

Hemos realizado una revisión de 77 esofagoscopias rígidas para extraer cuerpos extraños del tracto digestivo superior. La edad media de los pacientes fue de 59 años, el cuerpo extraño más frecuente los huesos de carne y el esófago cervical el lugar más común de impactación. Un 22 por ciento de las esofagoscopias fueron negativas, una alta tasa que nosotros atribuimos a nuestra falta de confianza en los estudios radiológicos dada la existencia de falsos positivos y negativos, lo que nos lleva a realizar la esofagoscopia siempre que la clínica del paciente es clara. Como complicaciones sólo encontramos tres casos de erosiones esofágicas importantes sin ninguna perforación y un neumotórax. También encontramos un caso de pseudodivertículo esofágico intramural (AU)

A review was made of 77 rigid esophagoscopies to remove a foreign body from the upper digestive tract. Mean age of patients was 59 years. Meat bones were the most frequent impacted foreign body and the cervical esophagus was the most frequent site of impactation. No foreign body was found in 22% of esophagoscopies, a high rate that could have been due to our lack of confidence in radiographic studies, which yield false positive and false negative information. Esophagoscopy is performed whenever patient-referred symptoms are clear. The only complications were three cases of major esophageal erosions without perforation and one pneumothorax. A case of intramural esophageal pseudodiverticulosis was found (AU)