Melanoma of sphenoid sinus. Case presentation and review of literature

The primary malignant melanomas of sphenoidal sinus are very uncommon tumours. We are reporting a clinical case of a 56 years-old male who was sent from the Neurology Department with ocular pain and headache of several months evolution and without personal history. Exploration revealed a VIth palsy, diplopia and ptosis. The complementary imaging tests (CT and MR) showed and expansive tumour of the sphenoidal sinus involving the right cavenous sinus. A F.E.S.S. with biopsy was performed to confirm the diagnosis. Our patient was treated by Radiotherapy and after a 4 year follow-up period he is still alive. We have carried to a bibliographic review of this pathology whose differential diagnosis must be done with epidermoid carcinomas, adenocarcinomas and lymphomas on that location.     

Prostitution and other cofactors in preinvasive and invasive lesions of the cervix

OBJECTIVE: To examine risk factors for preinvasive and invasive lesions of the cervix in Venezuelan female sex workers (FSW). METHODS: A total of 438 FSW were analysed. Each FSW had their clinical history recorded, a gynaecological examination, a Pap smear and a colposcopic examination of the cervix. A cervical biopsy was taken under colposcopic guidance when there was an abnormal epithelium. The statistical methods used were Student's t-test, chi(2) test and logistic regression. RESULTS: The sex workers' mean age was 32.1 +/- 7.9 years old (mean +/- standard deviation). The age of the first sexual intercourse activity for the FSW was 15.9 +/- 2.1 years. Sixty-four of the 84 women (76.2%) who had cervical biopsies had preinvasive and invasive lesions; 41 (9.4%) had cervical intra-epithelial neoplasia (CIN) 1, 12 (2.7%) had CIN 2, eight (1.8%) had CIN 3, two (0.5%) had microinvasive carcinoma, and one (0.2%) had invasive carcinoma. Forty of these 64 women (62.5%) with preinvasive or invasive lesions had a concurrent histological diagnosis of human papilloma virus (HPV) infection (P < 0.0001). The FSW with cervical pathology were younger (P < 0.05) and had their first sexual intercourse earlier (P < 0.02) than FSW with no pathology. Two hundred and seventy-six (63%) of the FSW were current smokers, and 47 of these women (17.6%) had cervical pathology (P < 0.03). CONCLUSIONS: First sexual experience before 20 years of age, cigarette smoking and HPV infection were high-risk factors for preinvasive and invasive lesions of the cervix in Venezuelan FSW.     

Free vascularized fibular grafts have a high union rate in atrophic nonunions

Free vascularized fibular grafting currently is an extremely useful tool in the armamentarium of the orthopaedic, reconstructive surgeon. Certain problematic nonunions, aseptic or infected, have to be treated by vascularized bone grafts when previous operations are not successful. The common characteristics of these nonunions are several previous operations and fixations, bone atrophy and damage of the surrounding soft tissue, and frequently focal, active infection. After the bone and soft tissue debridement, the bony defect is bridged by a vascularized fibula strut. Depending on the recipient bone, different methods of internal fixation can be used, usually plates and external fixators. Free vascularized fibular grafts in recalcitrant, atrophic nonunions provide a high success rate. According to the results, this is a safe, reliable method that is indicated when a fracture does not heal after several surgeries, when there is an associated bone lost, and when infection is present.     

Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels.

Patients with vascular calcifications often have low bone mineral density (BMD), but it is still uncertain if osteoporosis and peripheral vascular disease (VD) are interrelated and linked by a common pathomechanism. Moreover, data on bone turnover in patients with advanced atherosclerosis are lacking. We measured BMD by dual-energy X-ray absorptiometry (DXA) and quantitative bone ultrasound (QUS), as well as the serum levels of osteocalcin (OC), bone-specific alkaline phosphatase (BAP), osteoprotegerin (OPG) and its ligand RANKL, and the urinary concentration of the C-terminal telopeptides of type I collagen (CrossLaps), in 36 patient (20 male and 16 female) with serious atherosclerotic involvement of the carotid and/or femoral artery to investigate the underlying mechanism of vascular and osseous disorders. Thirty age-matched and gender matched healthy individuals served as controls. After adjustment for age, BMD was significantly reduced at the lumbar spine in 23/36 (63%) patients (mean T score –1.71±1.42) and at the proximal femur in 34/36 (93%) patients (neck mean T score –2.5±0.88). Ten patients (27%) had abnormal QUS parameters. Gender and diabetes had no effect on the relationship between vascular calcification and bone density at any site measured. VD subjects had OC and BAP serum levels lower than controls (13.3±3.1 vs 27.7±3.3 ng/ml, P<0.01, and 8.4±2.3 vs 12.5±1.4 g/l, P<0.01, respectively). Urinary CrossLaps excretion was not significantly different in patients with VD and in controls (257.9±138.9 vs 272.2±79.4 µg/mmol Cr, respectively). Serum OPG and RANKL levels were similar in patients and in controls (3.5±1.07 vs 3.4±1.05 pmol/l, and 0.37±0.07 vs 0.36±0.06 pmol/l, respectively). We proved high occurrence of osteoporosis in VD, with evidence of age and gender independence. Negative bone remodelling balance would be a consequence of reduced bone formation, with no apparent increased activation of the OPG–RANKL system.     

Post-tonsillectomy hemorrhage in adults. A retrospective study and literature review

We are reporting a review of 21 adults admitted with diagnosis of post-tonsillectomy hemorrhage between 1992 and 2001 (10 years). 14 were male and 7 female with 29 years-old average. We have studied the number of days from intervention to hemorrhage beginning, bleeding location, urgent analysis, the medical or surgical treatment that was performed and clinical evolution. A 85.7% were late bleeding (5th day or afterwards) being two times more frequent on the left fossae. It was required a hemostasia under general anestesia in 57.14% of the cases and the incidence of bleeding post-tonsillectomy has been estimated in 5.8% respect to global surgery of that kind.     

Amyloidosis of the larynx. A clinical case and literature review

The larynx is a rare site of deposition for amyloidosis. We are reporting the clinical case of a 73 years female with hoarseness of 2 years evolution due to a laryngeal mass which was informed as located primary amyloidosis after anatomopathologic exam (AP) and its extension study. A laryngeal microsurgery was performed and then we proceeded to send the patient to Internal Medicine Service with periodic controls by ORL. Surgery is the treatment of choice by microsurgery, laryngofissure or Laser with local excision. The prognosis of localized forms is better than systemic ones although recurrences are common and it is recommended a long-term follow-up. A bibliographic review about this pathology has been made.     

Lingual tonsillitis. Report of 3 cases and literature review

Lingual tonsillitits is a relatively uncommon pathology that affects specially patients with previous palatine tonsillectomy and its clinical behaviour is even more notorious than an acute tonsillitis. We report 3 cases hospitalized by our ENT Department analysing the initial symptoms, complementary tests, treatment and clinical evolution. In one of the patients that diagnosis probably was secondary to a complication due to an infectious mononucleosis and finally he was operated by surgical cauterization the lingual tonsils.