Laryngo-tracheal estenosis in adults. A restrospective study of 21 cases and literature review

We are reporting a retrospective study of 21 adults diagnosed of laryngo-tracheal stenosis and admitted to our Department between 1990 and 2001. In 9 cases (42.85%) it was due to prolonged orotracheal intubation; other 10 were secondary to tracheostomy (47.62%) and the rest, to coniotomy. We have studied and analysed these variables: Age, gender, personal history, level of stenosis, its grade according to Cotton's clasification, treatment and clinical evolution with an average follow-up of 12 months. Our main goal was to get people to know on experience with this pathology and to carry out a literature review in order to compare our data and results with other published series.     

Controversies and criticisms on designs for experimental autoimmune labyrinthitis

Although immune-mediated inner ear disease was reported around 25 years ago, numerous attempts to identify the inner ear antigens have been performed. Experimental animal models have been used to study the immune mechanisms involved in hearing loss and to develop new therapies. Because animal models of autoimmune labyrinthitis have been developed by means of different antigens, we cannot yet show a valid immunopathologic explanation. A critical analysis of the more relevant experimental models employed has been performed in order to validate the methodology. Comparison between these models and animals with spontaneous systemic autoimmune disease has raised more questions concerning the pathophysiology of autoimmune hearing loss. A new pathogenetic theory is suggested, involving the supporting cells of the organ of Corti.     

Second hemithyroidectomy for thyroid carcinoma. Our experience

Carcinomas as casual findings can be found in thyroid surgery. After the definitive AP result of malignant pathology, if a partial technique was performed, we can face problem of completing or not to a total thyroidectomy. We are reporting our 12 years experience about reinterventions because a diagnosis of thyroid carcinoma (hemithyroidectomies on previous one) was made after an anatomopathologic (AP) study on a sample from the first surgery for a supossed benign pathology. 18 patients have been studied, all of them were women, 45 year-old average and we have analysed the initial symptoms, results of basical complementary tests, diagnosis AP for first surgery and final result for second one. The incidence of malignancy showed in our series after the second intervention was 40% so we feel that a total thyroidectomy must be performed after a casual finding of thyroid carcinoma, because this allows oncological safety and a better control of the patient.     

Association among hypocalcemia, AP result and surgical technique in hyperparathyroidism. A statistical study

The main goal of this article was to know if there was any relations statistically significant among the post-operative hypocalcemia, type of surgery for hyperparathyroidism in our series and its anatomopathological result (AP). 122 patients affected of such illness (30 men and 92 women) were studied and operated and we obtained 30 hypocalcemias (27 transitory and 3 permanent ones). The subtotal and total parathyroidectomies compared with adenomas removal have showed us a percentage for that complication significantly higher (p<0.001). Besides we have found a clear association between parathyroid hyperplasia and hypocalcemia (p<0.05).     

Maxillary fungal sinusitis by Zygomicetos. Report of a case in an immunocompetent patient

We report the clinical case of a 36 years old female without significant previous history who was diagnosed with an acute maxillary sinusitis with not responding to antibiotic treatment. After her admission we asked for a CT which showed an occupation in the left maxillary sinus with a calcified area inside suggesting a mycetoma. The patient was operated by Functional Endoscopy Sinusal Surgery (FESS) plus Caldwell-Luc techniques sending the obtained sample for microbiological study, that was reported as sinusal mycosis by Zygomicetos. The postsurgical evolution was satisfactory.     

Cervical abscess after hemithyroidectomy. An unusual complication

Cervical abscesses secondary to hemithyroidectomy are an uncommon complication. We report the clinical case of a 37 years-old male, diagnosed and operated for nodular goiter, who suffered a paratracheal purulent collection three weeks later. He was reoperated by drainage of the neck abscess and antibiotic hospitalary treatment during 8 days. In a control CT showed an improvement despite the presence of a seroma on the surgical wound. Cervical exploration was normal two weeks later. Thyroid surgery is catalogued as clean and does requires antibiotic therapy. This must only be kept for cases of surgical wound infection or local abscess and both of them are rare in the literature.     

Latero-pharyngeal phlegmons and abscesses in adults. Reports of 6 cases and literature review

Lateropharyngeal phlegmons and abscesses are an uncommon complication actually but they are requiring an adequate knowledge to get later an adequate treatment. We are reporting a clinical review of 6 cases corresponding to adults admitted by our ENT service in 11 years period. Four were men and two women with ages between 21 and 92 years old. In most of them it was found a pharyngotonsillar focus and after the diagnosis they were treated by endovenous antibiotic therapy, corticoid and, in one case, surgery by incision and drainage. All the patients had a satisfactory evolution standing between 6-12 days in the hospital. We have performed a bibliographic review on this subject.     

Otogenic intracranial abscesses. Description of 6 cases

We are reporting 6 clinical cases corresponding to admitted patients with intracranial abscesses (4 in brain and 2 in cerebellum) due to chronic otogenic pathology. Five were men and one woman with ages between 25 and 74 years. We have analysed in each case the initial symptoms, otoscopic exam, the otic and cranial CT informed, diagnosis, treatment and evolution. In all of them, it was performed a drainage of the abscess by Neurosurgery and Radical mastoidectomy by our Service with positive result. Although it is an uncommon complication nowdays, the abscesses of otological cause must be always suspected in uncontrolled chronic otitis or poor response to medical treatment. Symptoms can be no characteristics and must be asked for a CT or IRM in case of doubt.     

Facial palsy caused by otitis media with effusion in a 9-year old child

We report the case of a 9 years old child diagnosed as right otitis media with effusion associated to homolateral and peripherical facial palsy, fact very uncommon in the reviewed literature. The patient was treated by miringotomy and insertion of transtympanic drainage recovering his facial function totally after 9 weeks.