Brown bone tumor as the first manifestation of primary hyperparathyroidism

We report a clinical case of a 26 years old female who had a 2 years evolution chin tumour with hypercalcemia (11.8 mg/dl) and PTH (paratohormone) of 761 pg/ml. She underwent a CT scan and MRI of the mandible, as well as a biopsy followed by excision of the tumour by the maxilofacial surgeons. Our ENT Department asked for a Scintigraphy (Tc99s-mibi) and thoracic-cervical CT, which showed a lesion that turned out to be an adenoma of the lower right parathyroid gland after surgery and pathological examination. The patient suffered a Primary hyperparathyroidism that was the main stimulus for the Brown Tumour made up by macrophagos and multinuclear giant cells, being this the first manifestation of the metabolic disorder. This form of hyperparathyroidism is very rare in the clinic. We do a literature review to establish the differential diagnosis for such pathology.     

Complications of thyroid and parathyroid surgery. Retrospective study and review of the literature

The number of ORL surgeons performing thyroid and parathyroid glands interventions is increasing more. Most of these surgeries are successful for us and our patients specially. However, this kind of operation can result in complications such as hypocalcemia and recurrential palsy, transitory or permanent, that it is necessary to know and avoid as far as possible. We are reporting a retrospective study of 12 years, based on our personal experience, where the real complications are analysed in 615 operated patients (500 with thyroid pathology and other 115 with parathyroid affectation) and after a comparation between both groups. The percentages of hypocalcemias were 25.6% and 24.3%, respectively. While in thyroid surgery (TS) the recurrential palsies showed a 6.6%, in parathyroid surgery (PS) were 0.8% only. The anatomical-embriologic knowledge, meticulousness and experience are three main qualities that are able to reduce the number of complications in the surgery of thyroid and parathyroid glands.     

Peritonsillar phlegmons and abscesses. Retrospective study of 100 cases

Our main goal was performing a retrospective study about peritonsillar cellulitis and abscess to prove the efficiency of treatment. So that we have collected 100 clinical histories of admitted patients in our ENT Service between 1990 and 2001 with such pathology and analysed a serie of variables and the treatment given in each case. It is one of the most common infectious diseases of the head and neck region. If aspiration positive, it require an incision and drainage to improve the symptoms (throat pain, fever, dysphagia and trismus). We have made no immediate tonsillectomies. All the patients were hospitalized and average stay was 3 days. 21 patients were re-admitted because of a recurrence pathology before the later programmed surgery.     

Hyperparathyroidism associated with thyroid disease. Retrospective study of 15 patients treated in 11 years

The association of hyperparathyroidism with thyroid pathology previous to surgery is not very frequent in our cases, almost a 15%, but it means another difficulty for the diagnostic and treatment. Between 1991 and 2001 we have studied and operated 15 patients with this clinic association. 14 were female and only 1 male with a range age of 59 years old. We studied the type of hyperparathyroidism, personal history, clinic, type of thyroid pathology associated, complementary explorations, type of surgery, anatomopathology evolution, and hospital stay. We have done 12 adenoma resections, 1 subtotal parathyroidectomy, 2 total thyroidectomies and 5 hemithyroidectomies. Only in one patient the anatomopathology was informed as a thyroid carcinoma associated to a parathyroid adenoma, being the other patients benign pathologies. We did literaturer revision on this association. We believe that in all patients with a thyroid pathology we should an associated hyperparathyroidism and vice versa.     

Nasopharyngeal angiofibroma. Our experience (1990-2001)

We present our experience in the treatment of nasopharyngeal angiofibromas, tumours not very common, with a benign histology but with the risk of severe epistaxis or possible involvement of vital structures. In a period of 12 years (1990-2001) we have treated 6 males with this pathology, operating 5 of them. We describe the clinical manifestations, the tumour stages following the Fisch classification, the diagnostic and surgical techniques used, the evolution of the patients and their postoperatory. We review also the literature about this subject.     

Sudden deafness. 12 year of experience

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.     

Benign symmetric lipomatosis (Madelung's disease)

We report on a 50-year-old man who presented with benign, symmetric lipomatosis and chronic alcoholic liver disease. The characteristic clinical features and a brief review of the current literature are presented.     

Breast-feeding and mental and motor development at 51/2 years.

OBJECTIVE: Breast-feeding is associated with better child development outcomes, but uncertainty remains primarily due to the close relationship between breast-feeding and socioeconomic status. This study assesses the issue in a low socioeconomic status sample where breast-feeding was close to universal. METHODS: Seven hundred eighty-four Chilean children were followed longitudinally from infancy. All but four were initially breastfed, 40% nursed beyond 12 months, and infant growth was normal. Child development was assessed at 5(1/2) years by a cognitive, language, and motor test battery. The duration of breast-feeding as the sole milk source was analyzed as a continuous variable, adjusting for a comprehensive set of background factors. RESULTS: The relationship between breast-feeding and most 5(1/2)-year developmental outcomes was nonlinear, with poorer outcome for periods of breast-feeding as the sole milk source for <2 months or >8 months--statistically significant for language, motor, and one comprehensive cognitive test, with a suggestive trend for IQ. CONCLUSIONS: The observed nonlinear relationships showed that breast-feeding as the sole milk source for <2 months or >8 months, compared with 2-8 months, was associated with poorer development in this sample. The latter finding requires replication in other samples where long breast-feeding is common and socioeconomic status is relatively homogeneous.