Pathology of the liver with bone marrow transplantation. Effects of busulfan, carmustine, acute graft-versus-host disease, and cytomegalovirus infection.

The morphologic changes in the livers of autopsy specimens from recipients of 62 allogeneic bone marrow transplants were reviewed and characterized in specimens from patients who had had apparent drug toxicity, graft-versus-host disease (GVHD), and disseminated cytomegalovirus (CMV) infection. Two conditioning protocols were associated with significant hepatic toxicity. Two of 3 recipients on whom autopsies were performed who had been prepared with high doses of carmustine, cyclophosphamide, and total body irradiation had undergone acute hepatic failure and submassive necrosis with periportal sparing. Seven of 9 patients prepared with busulfan (16 or 20 mg/kg) and cyclophosphamide had moderate to marked centrilobular sinusoidal fibrosis and associated hepatocellular atrophy and necrosis. Twenty of the patients had acute cutaneous GVHD with associated hepatic dysfunction, including 8 with disseminated CMV infection. Of the 12 patients without concomitant CMV infection, 5 had an early onset of GVHD and had predominantly periportal and focal midzonal hepatocellular necrosis, and 7 had acute GVHD with later onset with predominantly bile duct injury. Fifteen patients had evidence of disseminated CMV infection. Whereas CMV infection alone was associated with both hepatocellular and bile duct injury, detectable virus infection was not a requirement for hepatocellular or bile duct injury associated with GVHD.     

External severe laryngeal trauma with multiple fractures and airway compromise

External laryngeal traumas are rare but clinically can cause important life-threatening injuries. We report the case of a 33 yeras old male who suffered a severe traffic accident: TCE, facial trauma with multiple fractures and laryngeal trauma with fracture of the thyroid cartilage and the hyoid bone. Because an important edema in the airway, it was not possible an orotracheal intubation and he required urgent coniotomy with later reconstruction surgery and tracheostomy. Actually our patient has been decanulated and the fibroscopic image of the larynx and its functionality is correct.     

Risk factors and clinical variables in patients hospitalized for epistaxis. Review of 200 patients

It is reported a review of 200 adult patients admitted for epistaxis in our Hospital during a 10 years period (1992-2002). This study evaluates several factors included in the clinical histories: HTA, infection of the upper airway, EPOC, cardiovascular pathology, use of anticoagulant medication or other drugs, tobacco, alcohol, diabetes, etc. Besides we collected variables like age, sex, bleeding location, type of nasal packing made and evolution. Less than 20% of the cases were classified as idiopatic and the hospitalized patients had one or more known risk factors.     

Simultaneous bilateral sudden deafness. Report of a clinical case

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).     

Recurrent and severe epistaxis secondary to nasal trauma. Report of an atypical case in a 22-year-old male

We report the case of a 22-year-old male who presented a diferred, recurrent and severe epistaxis after nasal trauma which required several admissions in our hospital and different treatments. Concretely by chronological order it has been practiced anterior tamponades, endoscopic ligature-cauterization of the sphenopalatine artery, classic posterior packing and finally a new FENS with cauterization of anterior ethmoidal artery. Besides it was necessary a transfusion to go up the anemia suffered by the patient whose global stay was 16 days. Recurrent postraumatic epistaxis are very rare but can be represent a difficult problem to solve.     

Internal jugular vein spontaneous thrombosis. Clinical case and review of the literature

Internal jugular vein thrombosis (IJT) represents a potentially serious pathology that can be spontaneous or secondary to head and neck infections, surgery, venous catheterization and intravenous drug abuse among others. We report the case of a male affected with IJT without clear cause after performing a complete exam which included ultrasonography, Doppler and contrast-enhanced CT scanning to confirm the diagnosis. Actually its treatment is mainly mediacl by antibiotic therapy and anticoagulants. Besides, it must be excluded an associated neoplasm.     

Auricular perichondritis in adults. An evaluation-study of 12 hospitalized patients

Perichondritis of the auricle in adults can be secondary to traumatic agents, external otitis or surgery being Pseudomona aeruginosa the bacteria more often isolated. We have performed a retrospective study of 12 hospitalized patients with that diagnosis and these following variables have been evaluated: Age, sex, personal antecedents, clinical symptoms, affected auricle, complementary explorations, treatment, evolution and stay.     

Female reproductive cycle and obsessive-compulsive disorder

BACKGROUND: The aim of our study was to assess whether there is a relationship between reproductive cycle events and the initiation or changes in symptoms of obsessive-compulsive disorder (OCD). METHOD: Forty-six female outpatients meeting DSM-IV criteria for OCD completed a semistructured interview at our OCD unit to assess the relationship between reproductive cycle events and OCD. Dates of data collection were from January 2001 to December 2003. RESULTS: In our sample, OCD onset occurred in the same year as menarche in 22% (N = 10), at pregnancy in 2% (N = 1), at postpartum in 7% (N = 3), and at menopause in 2% (N = 1). Worsening of preexisting OCD was reported by 20% of patients (9/45) at premenstruum, 8% (1/12) at pregnancy, 50% (6/12) at postpartum, and 8% (1/12) at menopause. The number of premenstrual mood symptoms, which included anxiety, irritability, mood lability and depressed mood, was associated with both premenstrual worsening of OCD (OR = 5.1, p < .01) and onset or worsening of OCD at postpartum (OR = 2.7, p < .05). Patients with an onset or worsening of OCD at postpartum also more frequently reported pre-menstrual worsening of OCD and previous history of major depressive disorder, including postpartum depression (p < or =.05 for all). CONCLUSION: In a substantial number of patients, the onset or worsening of OCD was related to reproductive cycle events, especially at menarche and postpartum. Certain women with OCD seem to be vulnerable to worsening of OCD at different reproductive periods that imply hormonal fluctuations, and premenstruum and post-partum were the 2 reproductive events with a greater vulnerability. Those patients whose OCD symptoms appeared to be related to reproductive events also exhibited a greater history of mood symptoms (premenstrual depression and major depressive episodes).