Joana Guimarães

Paroxysmal dystonia induced by exercise and acetazolamide.

We report a case of a 40‐year‐old woman with dystonic attacks precipitated by slight exercise. Episodes lasted 2–5 min and were not precipitated by sudden movements or by being startled, drinking alcohol, coffee or tea, or by stress. Secondary dystonia was ruled out and brain magnetic resonance imaging (MRI) was unremarkable. Routine and video electroencephalogram (EEG) during and between attacks were normal. Acetazolamide greatly worsened her condition, whereas gabapentin [1‐(aminomethyl) cyclohexaneacetic acid] treatment markedly reduced the frequency and severity of the episodes.

Tratamiento de la ingestión de cuerpos extraños en una unidad de urgencias de otorrinolaringología: estudio prospectivo de 204 casos

AIMS To determine how often ingested foreign bodies are found and what parameters may predict their retrieval. METHODS During 1 year, we prospectively studied all patients referred to our Ear Nose and Throat Emergency Unit because of foreign body ingestion. RESULTS During the study, 204 (median age-42 years [10 months-84 years]) patients were admitted because of ingested foreign body. The most common was fish bone (88%). Most patients were admitted <24-hour after ingestion (72%) and complained of symptoms above the cricoid cartilage (79%). A foreign body was removed by Ear Nose and Throat team in 108 (53%) patients. Twenty-three (11%) patients were referred to Gastroenterology. In 9 (39%) of these patients, a foreign body was identified by esophagogastroscopy, always from the esophagus. Predictive variables for retrieval of foreign body by Ear Nose and Throat team were ingested fish bone (P=.000; odds ratio [OR]=17.3), short duration (<6 hours) of symptoms (P=.001; OR=2.3) and symptoms above or at the level of cricoid cartilage (P=.000; OR=8.9). In patients with symptoms below the cricoid cartilage the rate of retrieval of foreign body by Ear Nose and Throat team (11%) was significantly increased by Gastroenterology (41%; P=.03). CONCLUSIONS Patients with ingestion of foreign body who ingest fish bone, present within the first 6 hours or complain of symptoms at or above cricoid cartilage deserve greater investment in terms of time and resources for retrieval of ingested foreign body by Ear Nose and Throat team.