INTRODUÇÃO: O colesteatoma do canal auditivo externo é raro e muitas vezes assintomático apesar da insidiosa destruição óssea que vai causando no canal auditivo externo e estruturas vizinhas. Relatos de doença bilateral são episódicos e de causa idiopática. A keratosis obturans é o principal diagnóstico diferencial.CASO CLÍNICO: Criança, 13 anos, com colesteatoma bilateral do canal auditivo externo, com invasão da mastoide e erosão da cadeia ossicular no ouvido esquerdo. A doente apresentava quadro arrastado de otalgia bilateral, com otorreia esporádica e hipoacusia progressiva à esquerda. Após vários procedimentos cirúrgicos para erradicação da doença, mantém-se em vigilância anual sem recidiva aos 4 anos.CONCLUSÃO: Este caso realça a necessidade do reconhecimento precoce desta entidade pouco frequente, mas que pode cursar com lesões extensas e até irreversíveis. O tratamento cirúrgico é curativo, mas a vigilância regular é mandatória.

Determine the efficacy of the lesser palatine nerve block (LPNB) in pain management during and after peritonsillar abscess (PTA) drainage. A single-center, prospective, controlled study conducted in a tertiary referral center between April 2015 and September 2017. Twenty-four patients with a PTA were selected initially for our study. Two patients were excluded due to parapharyngeal and mediastinal extension. The remaining 22 patients were divided into two groups: the first group comprised 10 patients who underwent ipsilateral LPNB before PTA drainage. The second (control) group consisted of 12 patients in which only 10% lidocaine spray was used before PTA drainage. Intraoperative and postoperative pain was evaluated using a questionnaire with a 10-point numeric scale. The mean pain score in the study group was 1.9 (50% of the patients reported no pain) and it was 8.4 in the control group. The mean postoperative pain score after surgical drainage was 0.8 (60% of patients reported no pain) in the study group and 3.3 in the control group. No complications of the procedure were reported. The LPNB is a simple, safe, and efficacious anesthetic technique to reduce pain in patients undergoing surgical drainage of a PTA.

No abstract

Background Endoscopic remission (ER) is currently endorsed as one of the main treatment targets in Crohn’s Disease (CD). In a previous study, we have shown that transmural remission (TR) is associated with better clinical outcomes up to 1-year. It is unknown if these results still hold over a longer follow-up Methods This was a multicenter study, including 333 CD patients with magnetic resonance enterography (MRE) and colonoscopy evaluation performed within a 6-month interval and at least 5-years of follow-up. Patients were classified as having TR (inactive MRE and colonoscopy), ER (active MRE and inactive colonoscopy), and no remission (NR) (active colonoscopy). The need for surgery, hospitalization, steroids, and biologics was evaluated at 5-years of follow-up. Results Patients with TR presented lower rates of surgery (1.9% vs 17.9% vs 23.7%, P<0.001 and P=0.008), hospitalization (13.2% vs 30.4% vs 37.9%, P=0.001 and P=0.038), steroids (11.3% vs 21.4% vs 33.0%, P=0.001 and P=0.2), biologics (18.9% vs 51.8% vs 66.5%, P<0.001 and P=0.001), and any adverse outcome (26.4% vs 64.3% vs 78.6%, P<0.001) compared to ER and NR. Comparisons between ER and NR were mostly non-significant in respect to surgery (P=0.474), hospitalization (P=0.352), steroids (P=0.106), biologics (P=0.045), and any adverse outcome (P=0.036). The time until reaching any individual outcome was also significantly longer for TR. In multivariate analysis, endoscopic remission (OR 0.234 95%CI 0.135–0.405, P<0.001) and MRE remission (OR 0.316 95%CI 0.187–0.536, P<0.001) were independently associated with a lower likelihood of reaching any adverse outcome. Conclusion TR was associated with improved clinical outcomes over 5-years of follow-up. Going beyond ER appears to provide significant clinical benefits in the short and long-term.

No abstract