¿Existe agrupación en las epistaxis no traumáticas?

OBJECTIVE

Non traumatic epistaxis seems to be clustering in different periods. This paper tries to find out if there is any relationship between incidence of epistaxis and the year season, month, week, day, hour and/or lunar phase.

METHODS

We have retrospectively studied 754 episodes seen between May 2001 and April 2002 in our Hospital. The following parameters were registered in each patient: age, sex, number of episodes, season, month, week, day, hour and lunar phase.

RESULTS

Epistaxis represented 12.1% of the total otolaryngological emergencies. That means an incidence of 0.1% of non traumatic epistaxis which needed hospital specialized attention. We found statistical differences (p = 0.003) in the number of epistaxis per day and the different months (greater in june and november). No differences were found in the remaining periods studied.

CONCLUSIONS

This paper shows monthly clustering of epistaxis episodes.

Spontaneous resolution of recurrent tonsillitis in pediatric patients on the surgical waiting list

OBJECTIVE

To assess the impact of the waiting list on the spontaneous resolution of recurrent acute tonsillitis in children.

METHODS

We have evaluated 623 cases placed on the waiting list for elective tonsillectomy (with or without adenoidectomy) between February 1994 and May 1999 at our institution. In each child, age, time on the waiting list, type of procedure and outcome were registered. There were two possible outcomes after the preoperative evaluation: tonsillectomy was still indicated or tonsillectomy was not necessary.

RESULTS

Mean length of time on the waiting list was 10.8 months (range: 3.0-35.6 months; median: 8.2 months). In 507 of the 623 children (81.4%), the operation was still indicated. However, 116 patients (18.6%) did not need surgery because of spontaneous resolution of the clinical picture. No relation was found between outcome and age, time on the waiting list or type of procedure (P>0.05).

CONCLUSION

There was no clinical evidence for claiming that resolution of recurrent acute tonsillitis in children is spontaneous with time.

[Cost-benefit analysis of the anatomo-pathological study of tonsillectomy specimens in the pediatric population]

To study the cost-benefit of the histological examination of tonsilar samples, we evaluated 567 cases (547 routine and 20 nonroutine cases) of patients under 14 years of age, operated between 1st January 1996 and 30th November 2000. There were 2 routine cases (0.3%), and 6 nonroutine cases (30%) with a diagnosis different to follicular hyperplasia. In this way, our clinical preoperative sensitivity was 75% and specificity 97%. The average cost per case at our Centro to study the tonsilar samples was 30$. We conclude that the histological examination of tonsilar specimens is economically worth only in nonroutine cases, although additional factors (e.g. training of residents of Pathology and the quality control of the institution must be taken into consideration.

[The value of waiting in spontaneous remission of recurrent tonsillitis without associated adenoid pathology]

In order to assess the rate of spontaneous remission in children with recurrent acute tonsillitis (RAT), we revised the pediatric patients who were seen between 1994 and 1999. For this purpose, 123 cases that were on the waiting list for tonsillectomy under the indication of RAT without associated adenoid disease were selected. Only 23 (18.7%) of the children who were included in the study were removed from the waiting list after a mean time of 9 months because of spontaneous remission of the disease. Thus, there is no justification for claiming that long waiting lists for tonsillectomy are frequently associated with spontaneous remission of RAT.

[Electro-oculographic features of persons with vitamin E deficiency]

INTRODUCTION

Vitamin E (VE) deficiency is a very rare condition which may be due to an isolated deficit or be in the context of a malabsorption disorder.

OBJECTIVE

To evaluate the findings from an electrooculographic (EOG) point of view of patients with VE deficiency.

PATIENTS AND METHODS

We made a retrospective evaluation of all persons with a neurological diagnosis of VE seen in the otoneurological department of our hospital. In all patients an EOG recording was made of the saccadic jerks, and the spontaneous, provoked, positional and opticokinetic (NOC) mystagmus, visual suppression of the vestibulo ocular reflex (VOR) and follow up.

RESULTS

We found four cases, with an average age of 9.2 years (range 6 14 years). All the patients but one were male (75%). The EOG findings were related to cerebellar dysfunction (saccadic following) and central nervous system alterations of no value for localization (ataxic following and visual suppression of the VOR). In two patients no anomalies were seen on the EOG recording.

CONCLUSIONS

In persons with VE deficiency EOG alterations are not often seen. However, it may be useful to make the recording when it is thought necessary to detect subclinical cerebellar disorders.

[Aetiopathogenesis of Bell's idiopathic peripheral facial palsy]

INTRODUCTION

Bell's facial palsy is a common condition with an incidence varying between 11.5 and 40.2 cases per 100,000 persons per year. However, some aspects of its aetiopathogenesis are still not clear.

DEVELOPMENT

Over the years four theories have been suggested to explain the disorder: vascular, immunological, compressive and viral. The vascular theory (the oldest) has been ruled out by various studies. Subsequently, the immunological and compressive theories were described almost simultaneously. The former established the mechanisms generating a neural inflammatory response, and the second the morphological basis which made the nerve sensitive to these mechanisms. Both theories suggested, amongst other agents, a virus as the agent triggering the process. Recently a virus of the herpes simplex family has been identified as the cause of the disease.

CONCLUSION

At present there is broad general agreement that Bell s facial palsy is caused by reactivation of a latent infected with human herpes simplex virus, localized to the facial nerve.

[Vestibular and oculomotor changes in subjects treated with cisplatin]

Cisplatin is an agent used in the treatment of distinct oncologic diseases. We present the electrooculographic (EOG) findings of 6 patients which were seen at our Department under the diagnosis of chronic toxicity for cisplatin and associated vestibular alterations. Mean of age was 45 years. Three subjects were female (50%). The most frequent pathologic finding was ataxic pursuit tracking (100%). Additionally, spontaneous nystagmus, alterations in positional test, and vestibulo-ocular reflex suppression were also found. These results are discussed and the main literature concerning this matter is reviewed.

[Result of middle fossa vestibular neurectomy in Meniere's disease]

The results and complications of 224 middle fossa vestibular neurectomies (MFVN) performed between 1968 and 1994 are reported. Relief of vertigo, hearing and tinnitus (both pre- and postoperative), facial paralysis, wound infection, suture dehiscence, cerebrospinal fluid (CSF) leak, meningitis, subdural hematoma, average hospitalization time, and death were evaluated. The procedure was effective against vertigo in Ménière's disease in 100% of the cases with unilateral involvement. The excellent results with regard to relief of vertigo and the acceptable incidence of complications make MFVN one of the most adequate surgical treatments for Ménière's disease.

Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child

We report a rare case of dyspnea due to enlargement of the epiglottis in a severely immunocompromised patient. The child underwent a previous tracheostomy at another hospital because of respiratory distress under the diagnosis of acute epiglottitis. The patient was subsequently decannulated without incident. One year later, the child developed a new episode of dyspnea with inspiratory stridor. A new tracheostomy was neccessary, and a biopsy specimen of the enlarged epiglottis was taken to confirm the diagnosis of graft-vs-host disease. The therapeutic measures in these situations are discussed below, and a review of the current literature concerning the etiology and management of epiglottic enlargement is performed.

Factors related to nerve injury and hypocalcemia in thyroid gland surgery

To identify potential risk factors related to complications after thyroidectomy, a study was designed that included 675 patients. Recurrent laryngeal nerve (RLN) paralysis, hypocalcemia, serohematoma, wound infection, and postoperative hemorrhage were evaluated. The rate of paralysis of the RLN was calculated on nerves at risk for hypocalcemia (n = 890) in patients undergoing bilateral procedures or unilateral procedures if they had previously undergone a contralateral operation (n = 321). Multivariate analysis was used to identify the relationships between the variables included in the study. All statistical tests received the same level of significance of 0.05. Permanent hypocalcemia occurred in 2.2% of the patients, whereas unilateral paralysis of the RLN developed in 0.9%. Mortality was 0.1% in this series. The RLN paralysis had a significant relationship with preoperative diagnosis of malignancy (P < 0.03). Likewise, hypocalcemia was related to sex and surgical procedure (P < 0.03). Serohematoma was linked with age (P < 0.001), and hemorrhage was associated with previous radiation of the neck (P < 0.03).

Patency and flow of the internal jugular vein after functional neck dissection

OBJECTIVES

To assess the patency and flow of the internal jugular vein after functional neck dissection.

STUDY DESIGN

Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997.

METHODS

Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography.

RESULTS

In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery.

CONCLUSIONS

According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.

Von Willebrand disease as cause of unanticipated bleeding following adeno-tonsillectomy

Von Willebrand disease (vWD) is a frequent autosomal bleeding disorder. We report two unsuspected patients over 6 years of age with this disease operated by tonsillectomy and adenoidectomy (T&A) at our Department. Preoperative hematologic work-up (with activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count) was normal. Both patients had undergone previous adenoidectomy without complications. In both cases, profuse bleeding was noted in the immediate postoperative period. The therapeutic measures in these situations are discussed and a review of the current literature concerning preoperative hematologic evaluation of T&A is included.

Polymorphous low-grade adenocarcinoma of the tongue

Primary adenocarcinomas of the oral cavity in minor salivary glands are distinctive lesions which can be subclassified according to their growth patterns or histomorphology. Polymorphous low-grade adenocarcinoma (PLGA) of minor salivary tissue has been recognized as a distinct entity. We report an unusual case of PLGA of the tongue. Only a few previous cases have been reported in the English literature. The treatment is discussed and a review of the current literature concerning this tumour is included.