[Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation]. / Absceso cervical por Streptococcus anginosus-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica.

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High fever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification.

Absceso cervical por Streptococcus angious-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica / Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation

Presentamos un caso de absceso cervical tras ingestión de cuerpo extraño (pollo con hueso) secundario a probable perforación esofágica que nos fue remitido con sospecha de complicación mediastínica. Se trataba de una chica de 17 años que nada más llegar a nuestro centro hospitalario requirió ingreso en UCI dada la gravedad de su proceso: Fiebre alta, dolor intenso cérvico-torácico, tumefacción láterocervical izquierda difusa de carácter progresivo y mal estado general. El TAC informó de la presencia de un absceso bien definido y de abundante componente aéreo que disecaba la musculatura cervical por lo que fue necesario realizar drenaje comprobando intraoperatoriamente la no afectación del mediastino. El cultivo de la colección purulenta reveló Streptococcus anginosus-milleri resistente a clindamicina pero sensible a penicilina y derivados. Realizamos una serie de consideraciones al respecto de este microorganismo y su significación clínica

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High rever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification

[Paediatric tracheostomy]. / Traqueotomía pediátrica.

INTRODUCTION: Actually we are attending changes in the concept of pediatric tracheostomy. The most important of them is a change in its indications. The aim of our study is to provide our experience about pediatric tracheostomy. METHODS: We are reporting a retrospective study of 16 patients who underwent tracheotomy between 1994-May 2004, reviewing the indications, their complications and evolution. RESULTS: In our study we have only managed to close the tracheostomy in 5 patients and one is waiting surgery, in the rest the pathology has nos allowed us to close it. DISCUSSION/CONCLUSION: Actually the main indication for pediatric tracheostomy is prolonged intubation. Preterm children, the earlier age is done and the longer the intubation is increase the risk of complications but mainly it is the base illness of the patient which will determine the posterior evolution of the tracheostomy.

[Giant cells undifferentiated parotid carcinoma. Report of two cases]. / Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos.

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% of the cases. Most of them are benign. We are reporting two cases of patients diagnosed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years-follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type.

Traqueotomía pediátrica / Paediatric tracheostomy

Introducción: Actualmente estamos asistiendo a cambios en el concepto de traqueotomía pediátrica, el más importante de los cuales viene representado por un cambio en sus indicaciones. Objetivo: El objetivo de nuestro trabajo es aportar nuestra experiencia en traqueotomía pediátrica. Materiales y métodos: Presentamos un estudio retrospectivo sobre 16 pacientes traqueotomizados entre 1994-mayo 2004, revisando la indicación de la traqueotomía, sus complicaciones y su evolución posterior. Resultados: En nuestro estudio solamente se ha conseguido cerrar la traqueotomía en cinco pacientes y uno se encuentra a la espera de cierre quirúrgico; en el resto su patología no lo ha permitido o bien han sido exitus. No hemos tenido complicaciones mayores derivadas de la propia traqueotomía. Discusión/conclusiones: Actualmente la principal indicación de la traqueotomía pediátrica está representada por la intubación prolongada. La prematuridad, la menor edad de realización y la mayor duración aumentan las complicaciones pero fundamentalmente es la enfermedad de base del paciente lo que va a determinar la evolución posterior de la traqueotomía

Introduction: Actually we are attending changes in the concept of pediatric tracheostomy. The most important of them is a change in its indications. The aim of our study is to provide our experience about pediatric tracheostomy. Methods: We are reporting a retrospective study of 16 patients who underwent tracheotomy between 1994- May 2004, reviewing the indications, their complications and evolution. Results: In our study we have only managed to close the tracheostomy in 5 patiens and one is waiting surgery, in the rest the pathology has nos allowed us to close it. Discussion/Conclusion: Actually the main indication for pediatric tracheostomy is prolonged intubation. Preterm children, the earlier age is done and the longer the intubation is increase the risk of complications but mainly it is the base illness of the patient which will determine the posterior evolution of the tracheostomy

Carcinoma parotídeo indiferenciado de células grandes. Presentación de dos casos / Giant cells undifferentiated parotid carcinoma. Report of two cases

Los tumores de las glándulas salivares representan el 5% de las neoplasias de cabeza y cuello afectando en el 80% a la glándula parótida donde la mayoría son benignos. Presentamos dos casos de pacientes diagnosticados por nuestro Servicio de ORL de carcinoma indiferenciado de células grandes parotídeo con metástasis ganglionares. Fueron intervenidos mediante parotidectomía total y vaciamiento cervical radical con posterior tratamiento de radioterapia. Tras dos años de seguimiento ambos continúan vivos. El tamaño tumoral es el factor pronóstico más importante en este tipo histológico

Tumours of the salivary glands represent a 5% of all head and neck neoplasms. Their origin is the parotid gland in about 80% ofthe cases. Most ofthem are benigno We are reporting two cases ofpatients diagno sed, by our ENT Department, as undifferentiated giant cells parotid carcinoma with cervical metastasis. They were operated by total parotidectomy and radical neck disection and later recieved treatment with radiotherapy. After two years- follow-up both patients are standing alive. The tumoral size is the most important pronostic factor in this histological type

[Simultaneous bilateral sudden deafness. Report of a clinical case]. / Sordera súbita bilateral simultánea. Presentación de un caso.

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 yeras old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immuno-mediated inner ear disease (IMIED).

Sordera súbita bilateral simultánea. Presentación de un caso / Simultaneous bilateral sudden deafness. Report of a clinical case

La sordera súbita bilateral es poco frecuente y se caracteriza por una pérdida auditiva neurosensorial brusca en ambos oídos de al menos 30 dB en 3 frecuencias consecutivas. Presentamos el caso de una mujer de 57 años con este diagnóstico que presentaba cofosis derecha e hipoacusia profunda de oído izquierdo sin patología vestibular asociada. Fue ingresada y sometida al protocolo de tratamiento médico establecido por nuestro Servicio (4 días IV y 10 más vía oral) con mejoría de su audición 25-30 dB de media. Ante una hipoacusia brusca neurosensorial bilateral rápidamente progresiva se debe pensar en la enfermedad del oído interno inmunomediada (EOIIM)

Bilateral sudden deafness is uncommon and characterized by an acute sensorineural hearing loss in both ears of 30 dB or more in 3 consecutive frequencies. We report the case of a 57 years old female with this diagnosis who presented a right anacusia and a severe audiometric loss on left ear without vestibular pathology associated. She was admitted and treated by the protocol of medical therapy that we have performed in our E.N.T. Department (4 days EV and then 10 ones oral medication) with improvement in her audition 25-30 dB average. If sudden bilateral sensorineural deafnes is founded, we must consider an immune-mediated inner ear disease (IMIED)

[Review of acute otomastoiditis in the paediatric population. Our cases]. / Revisión de otomastoiditis agudas en la población pediátrica. Nuestra casuística.

The introduction of antibiotics has decreased the number of acute mastoiditis as complication of otitis media in children. However, this pathology still is a serious infection. Its incidence has increased in the last years and goes on getting diagnostic and therapeutic problems. We are reporting an own review about 18 children diagnosed as acute otomastoiditis, hospitalized in a 10 years period, with ages between 10 months and 14 years. We have analysed different parameters standing out the otoscopic and radiologic findings, clinical symptoms, previous antibiotic treatment, type of surgical intervention performed and complications.

Revisión de otomastoiditis agudas en la población pediátrica. Nuestra casuística / Review of acute otomastoiditis in the paediatric population. Our casuistry

Con la introducción de los antibióticos ha disminuido el número de casos de mastoiditis agudas como complicación de otitis medias en niños. No obstante, esta patología constituye aún una seria infección. Su incidencia ha aumentado en los últimos años y sigue planteando problemas diagnósticos y terapéuticos. Presentamos una revisión propia de 18 niños con otomastoiditis aguda, ingresados en un período de 10 años, con edades comprendidas entre los 10 meses y los 14 años. Analizamos diferentes parámetros entre los que destacamos los hallazgos otoscópicos y radiológicos, sintomatología clínica, tratamiento antibiótico previo, tipo de intervención quirúrgica practicada y complicaciones registradas (AU)

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[Epignathus. A case report and review of the literature]. / Epignatus. A propósito de un caso y revisión de la literatura.

Epignathus is an uncommon form of oropharyngeal teratoma that is associated with a high mortality during the neonatal period. We report the clinical case of a neonate born through cesarean in week 35, Apgar 2-4, neurologic breakdown and widespread hypotonia. The prenatal diagnosis was performed by ultrasonography; the diameter of the solid mass was 5 cm with inner calcium density. An urgent tracheostomy was carried out as it was not possible to get orotracheal intubation (IOT) and, later, we proceeded to remove the mass which was embedded in the hard palate. Our patient died three weeks later due to respiratory and heart failure. We carry out a review of the literature for this pathology.

[Sudden deafness. 12 year of experience]. / Sordera súbita. 12 Años de experiencia.

We report 48 cases of sudden deafness admitted in our Hospital between 1990 and 2001. A series of variables were analyzed like affected ear, evolution time, personal precedents, clinic, audiometry, complementary tests, treatments followed (according protocol), clinical evolve and average stay. Four cases annually, more or less, have been registered, with little predominance of men (28) than women (13), being the happy medium 48 years (between 22 and 74 years). 43 percent of cases came to Urgency ward before 24 hours since the beginning of symptoms and 31 percent came three or more days later. 45 patients (93.7%) with an audiometric loss of 500 Hz, 1,000 Hz and 2,000 Hz over 55 dB, with 11 cases of total deafness. In our Department two several treatment protocol have been employed, which results are considered in the paper. Generally 52 percent showed little improvement and only 7 cases gain more than 40 dB, with 2 complete recovery and 23 without improvement. We think that this pathology must be i.v. precociously treated with the selected protocols although without any warranty of hearing improvement, as reflected in our paper.

Epignatus. A propósito de un caso y revisión de la literatura / Epignathus. A case report and review of the literature

Epignatus es una forma infrecuente de teratoma orofaríngeo que se asocia a una alta mortalidad durante el período neonatal. Presentamos el caso clínico de un recién nacido con cesárea a las 35 semanas, Apgar 2-4 y depresión neurológica e hipotonía generalizada. El diagnóstico prenatal se realizó por ecografía; el diámetro de la masa sólida era de 5 cm con densidad calcio en su interior. Se procedió a traqueotomía urgente por imposibilidad de intubación orotraqueal y, posteriormente, a exéresis de la masa que se encontraba implantada en el paladar duro. El paciente falleció 3 semanas después por parada cardiorrespiratoria. Realizamos una revisión de la literatura al respecto de esta patología (AU)

Epignathus is an uncommon form of oropharyngeal teratoma that is associated with a high mortality during the neonatal period. We report the clinical case of a neonate born through cesarean in week 35, Apgar 2-4, neurologic breakdown and widespread hypotonia. The prenatal diagnosis was performed by ultrasonography; the diameter of the solid mass was 5 cm with inner calcium density. An urgent tracheostomy was carried out as it was not possible to get orotracheal intubation (IOT) and, later, we proceeded to remove the mass which was embedded in the hard palate. Our patient died three weeks later due to respiratory and heart failure. We carry out a review of the literature for this pathology (AU)

Sordera súbita. 12 años de experiencia / Sudden deafness. 12 years expierence

Presentamos 48 casos de sordera súbita ingresados en nuestro Hospital desde 1990 2001. Analizamos una serie de variables como oído afecto, tiempo de evolución, antecedentes personales, clínica, audiometría, pruebas complementarias, tratamiento seguido (según protocolo), evolución clínica y estancia media. Por término medio son unos cuatro casos por año, con un ligero predominio de varones (28) sobre mujeres (20). Edad media 48 años (rango entre 22 y 74 años). Un 43,7 por ciento de los pacientes acudieron a Urgencias antes de 24 horas del inicio del cuadro y más del 31 por ciento lo hicieron tres o más días después. 45 pacientes (93,7 por ciento) con pérdida audiométrica en 500 Hz, 1.000 Hz y 2.000 Hz superiores a 55dB, con 11 casos de cofosis o sordera total. En nuestro Servicio se han utilizado dos protocolos de tratamiento diferentes cuyos resultados analizamos. En general, el 52 por ciento presentó alguna mejoría auditiva, que sólo en 7 casos fue mayor de 40dB, con 2 pacientes con recuperación completa y 23 sin ninguna mejoría. Creemos que esta patología debe seguir un protocolo de tratamiento IV, de instauración precoz, aunque no garantice en muchos casos la recuperación de la audición, como reflejamos en nuestra casuística (AU)

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Epiglotitis aguda en adultos. Nuestra casuística en 11 años / Acute epiglottitis in adults. Our casuistry of 11 years

Presentamos un estudio retrospectivo sobre 20 casos de epiglotitis aguda en adultos ingresados en nuestro hospital entre 1991 y 2001. Recogemos una serie de variables: Sexo del paciente, edad, año y mes de ingreso, antecedentes personales, clínica de presentación, pruebas complementarias realizadas, tratamiento administrado, evolución y estancia media hospitalaria. Encontramos un claro predominio en varones (19:1 sobre mujeres), con una edad media de 45 años. Los síntomas mayoritarios fueron la disfagia-odinofagia (85%) seguido de fiebre (55%) y dolor faríngeo-cervical. Se constató disnea en 9 de los 20 pacientes (45%) de los que 5 precisaron control de la vía aérea mediante intubación en 1 paciente, coniotomía urgente en 3 casos y traqueotomía en otro. Un paciente desarrolló una mediastinitis aguda que requirió ingreso y tratamiento IV prolongado en UCI. Recogemos el caso de otro paciente que presentó parada cardiorrespiratoria súbita con exitus sin presentar disnea previamente. La epiglotitis aguda del adulto es una patología poco frecuente, de buen pronóstico en general, pero susceptible de complicación grave e imprevisible incluso en ausencia de compromiso de la vía aérea. Realizamos una revisión de la literatura al respecto (AU)

We report a retrospective study of 20 cases of acute epiglottitis in adults admitted at our hospital between 1991 and 2001. We gather a series of variables: Patient sex, age, year and month of admission, personal history, initial clinical symptoms, complementary tests asked, given treatment, evolution and hospital average stay. We found an obvious predominance in male (19:1 with respect to female), with an average age of 45 years. The main symptoms were dysphagia-odynophagia (85%), followed by fever (55%) and pharyngocervical pain. Dyspnea was confirmed in 9 of 20 patients (45%); 5 of them required airway control with the help of intubation in one case, urgent coniotomy in three cases and tracheotomy in another one. A patient suffered from an acute mediastinitis and required assistance and medical i.v. extended treatment in UCI. We show a case of another patient who suffered sudden cardiorespiratory arrest a followed by death. He did not present previous dyspnea. Acute epiglottitis in adults is a rare pathology with a good prognosis in general, but may lead to an unpredictable and serious complication even in the absence of airway blockage. We carry out a medical literature review in this respect (AU)

[Acute epiglottitis in adults. Our case load in 11 years]. / Epiglotitis aguda en adultos. Nuestra casuística en 11 años.

We report a retrospective study of 20 cases of acute epiglottitis in adults admitted at our hospital between 1991 and 2001. We gather a series of variables: Patient sex, age, year and month of admission, personal history, initial clinical symptoms, complementary tests asked, given treatment, evolution and hospital average stay. We found an obvious predominance in male (19:1 with respect to female), with an average age of 45 years. The main symptoms were dysphagia-odynophagia (85%), followed by fever (55%) and pharyngocervical pain. Dyspnea was confirmed in 9 of 20 patients (45%); 5 of them required airway control with the help of intubation in one case, urgent coniotomy in three cases and tracheotomy in another one. A patient suffered from an acute mediastinitis and required assistance and medical i.v. extended treatment in UCI. We show a case of another patient who suffered sudden cardiorespiratory arrest a followed by death. He did not present previous dyspnea. Acute epiglottitis in adults is a rare pathology with a good prognosis in general, but may lead to an unpredictable and serious complication even in the absence of airway blockage. We carry out a medical literature review in this respect.

[Bladder transitional cell carcinoma with metastasis to the maxillary sinus as first symptom]. / Carcinoma de células transicionales vesicales con metástasis en seno maxilar como primer síntoma.

Maxillary sinus metastasis are very uncommon tumors (fifty have been reported). The most frequent ones are renal adenocarcinoma, breast and lung tumors. Up to now there is only a reported case of bladder carcinoma in maxillary sinus. We report a 67 years old male with a right maxillary tumor two months ago. FNA demonstrated a transitional cell bladder tumor. The treatment was chemotherapy. The patient died two months later. We reported some considerations about metastatic tumors of paranasal sinus.

Carcinoma de células transicionales vesicales con metástasis en seno maxilar como primer síntoma / Transitional vesical cell carcinoma with maxillary sinus metastasis as first presentation symptom

Las metástasis sinusales son tumores extremadamente raros. Se han descrito unos 50 casos localizados en el seno maxilar. Las más frecuentes son las del adenocarcinoma renal, seguidas de los tumores de mama y pulmón. Hasta la fecha sólo se había descrito un caso a nivel mundial de metástasis en senos paranasales de un carcinoma de vejiga. Presentamos un paciente de 67 años que debutó con una tumoración maxilar derecha de 2 meses de evolución, que mediante PAAF se encontraba que era una neoplasia de células transicionales cuyo origen se demostró en la vejiga urinaria. Se instauró tratamiento con quimioterapia paliativa falleciendo el paciente al poco tiempo. Efectuamos algunas consideraciones sobre los procesos metastáticos en senos paranasales (AU)

Maxillary sinus metastasis are very uncommon tumors (fifty have been reported). The most frequent ones are renal adenocarcinoma, breast and lung tumors. Up to now there is only a reported case of bladder carcinoma in maxillary sinus. We report a 67 years old male with a right maxillary tumor two months ago. FNA demonstrated a transitional cell bladder tumor. The treatment was chemotherapy. The patient died two months later. We reported some considerations about metastatic tumors of paranasal sinus (AU)

[Thyroid teratomas in the adult]. / Teratomas tiroideos del adulto.

Thyroid teratomas are rare neoplasms in adults (only 19 cases have been reported in the world literature). We report the case of a 55-year-old woman with a paratracheal mass, paralysis of the recurrent nerve, dyspnea, and results of palpation suggestive of malignancy. Total thyroidectomy was performed and anatomopathological study disclosed a benign thyroid teratoma in adult. We discuss this case and review the literature on adult thyroid teratomas.