Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients.

PURPOSE: We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. METHODS: Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student's T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant. RESULTS: The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876-0.918), MGAP 0.860 (95 % CI 0.835-0.886), GAP 0.849 (95 % CI 0.823-0.876) and T-RTS 0.796 (95 % CI 0.762-0.830). CONCLUSIONS: Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.

Extended high-frequency (9-20 kHz) audiometry reference thresholds in 645 healthy subjects.

OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.

Apoptosis of CD4+ T and natural killer cells in Alzheimer's disease.

BACKGROUND: Immunotherapy appears to be a potent treatment against Alzheimer's disease (AD), but the mechanisms underlying neural-immune interaction are still not known. METHODS: Here, we determined cell death and distribution of lymphocyte subsets of peripheral blood mononuclear cells (PBMC) in AD and aging, e.g. T (CD4+ CD3+, CD8+ CD3+), B (CD19+) and NK (CD16++CD56+) cells. RESULTS: Increased apoptosis was found in CD4+ T and NK cells in AD, while in aging all subsets were affected. The expression of anti-apoptotic Bcl2 correlated with observed cell death in T-helper and B cells irrespective of dementia. The levels of Bcl2 in T-cells were significantly increased in mild AD. Apoptosis and Bcl2 levels were also elevated in the APP (751SL)xPS1 (M146L) transgenic mouse model. CONCLUSION: The mechanisms triggering apoptosis and activation of lymphocytes in AD appear therefore to be different than those in immunosenescence and possibly bear an important biomarker to monitor immunotherapy in AD.

[Endoscopic sinus surgery. A review of 1,093 cases]. / Cirugía endoscópica nasosinusal: revisión de 1.093 casos.

We present a serie of 1,093 patients that underwent, along 10 years, endoscopic surgery due to paranasal sinus pathology in a third level hospital. The technique used is described, the long term results analysed, as well as the minor and major complications specially the CSF fistulas and their cause.

[Cervical lymph node involvement in laryngeal carcinoma: a retrospective study of 430 cases]. / Afectación ganglionar cervical en el carcinoma laríngeo. Un estudio retrospectivo de 430 casos.

Cervical lymph node involvement in laryngeal tumors could be a market impact on the disease prognosis. We performed a retrospective study of 430 patients who underwent surgery to treat laryngeal carcinoma in our center over a 10-year period. The objective was to correlate clinical and pathological lymph node involvement with the site of origin and size of the tumor, the treatment and its impact on patient survival. We observed a significantly greater incidence of lymph node involvement in tumors originating from supraglottis, with a rate of occult lymph node metastases of 31%. Patients with lymphadenopathy that remained undetected in the absence of surgical treatment and those with nonmetastatic lymphadenopathy presented similar 5-year survival rates, 83% y 98% respectively. However, the 5-year survival decreased to 24% in the presence of metastatic lymph node involvement. These results support the proposal that treatment of laryngeal carcinoma should include the region of the cervical nodes as well.

[Preliminary study by flow cytometry of the cell cycle and DNA quantification in cytokeratin-positive cells in tumors of the head and neck]. / Estudio preliminar del ciclo celular y cuantificación del ADN de células citokeratina positivas en tumores de cabeza y cuello mediante citometría de flujo.

DNA ploidy and cell-cycle distribution were determined by flow cytometry in fresh tumor tissue of 27 epithelial head and neck carcinomas. Epithelial cells were labeled with a fluorescein-isothiocyanate-conjugated cytokeratin antibody to study the possible influence of contaminating stromal and inflammatory cells on the results of cell-cycle analysis of tumor cells. The patient sample included 26 men and 1 women with a mean age of 60 years. Without cytokeratin gating, 11/27 tumors (40.74%) were aneuploid. After selecting the cytokeratin population, 10 more aneuploid tumors were found that had not been detected when considering the total population. Therefore, aneuploid tumors increased from 40.74% to 77.74%. The remaining 6/27 (22.26%) tumors were diploid. In the tumors that were either aneuploid without cytokeratin gating or diploid, the S-phase and G2M phase were significantly higher after cytokeratin staining, specially in diploid tumors (24.2% versus 10% and 6.8% versus 3.2%, respectively, p < 0.01). Therefore, in head and neck tumors cytokeratin staining optimizes both the determination of DNA ploidy and cell-cycle analysis, which is advantageous for tumor staging and prognosis assessment in these patients.

[Retrospective study of complications of surgery for laryngeal cancer]. / Estudio retrospectivo de las complicaciones en la cirugía del cáncer de laringe.

Surgery, alone or in combination with other therapeutic measures, is one of the main approaches to curing laryngeal cancer. The risk of complications is implicit in any surgical procedure. We describe our experience with general and local complications in surgery for laryngeal cancer and examine their relation to tumor extension and surgical technique. A review was made of a series of 431 patients who underwent surgery for laryngeal cancer over a 10-year period (1982-1991). Twenty-two patients (5.1%) had systemic complications, including upper gastrointestinal hemorrhage (n = 5), massive cervical hemorrhage (n = 5), and four renal failure. Minor complications were recorded in 77 cases (17.8%), predominantly pharyngocutaneous salivary fistula, which developed in 55 patients (13.8%). The incidence of local complications was significantly greater in patients with extensive local spread (T4). There were no differences among patients with regional spread. The surgical technique and type of pharyngoesophageal reconstruction played no role in the development of complications. Preoperative radiotherapy did not influence on the development of salivary fistulas.

Prognostic significance of natural killer cell activity in patients with laryngeal carcinoma.

BACKGROUND: For laryngeal carcinoma, the present TNM clinical staging system does not seem completely satisfactory as a guide for providing a prognosis for survival. We believe that natural killer cell activity would probably have a role in a more reliable system. Therefore, we analyzed the disease outcome with previously untreated epidermoid carcinoma of the larynx, evaluating classic clinical and pathologic factors, as well as natural killer cell activity in peripheral blood samples of the patients. OBJECTIVES: To determine the level of natural killer cell activity in patients with laryngeal carcinoma and to analyze the prognostic value of this finding when associated with other clinical and pathologic variables. DESIGN: Prospective cohort study of surveillance of laryngeal cancer. Mean follow-up of 42.8 months. SETTINGS: Tertiary care referral center and ambulatory and hospitalized care. PARTICIPANTS: We compared 81 men (mean age, 62.4 years; range, 35-89 years) with laryngeal carcinoma with 44 healthy men serving as control subjects (mean age, 57.6 years; range, 37-82 years). RESULTS: Natural killer cell activity was significantly reduced in patients who had died of cancer-related causes in comparison with tumor-free survivors. Overall actuarial survival differed significantly in histologically assessed nodal involvement and low natural killer cell activity. Use of the Cox proportional hazards regression model showed that the factors that seem to have a prognostic effect on survival are histologically determined nodal involvement and low natural killer cell activity. CONCLUSIONS: These results support the prognostic significance of the determination of pretreatment natural killer cell activity in peripheral blood samples from patients with laryngeal carcinoma and suggest that assessment of adding such a determination to the current tumor staging system is advisable.

Endothelin B receptor-mediated increase of cerebral blood flow in experimental pneumococcal meningitis.

Study investigates the role of endothelin (ET) receptors in mediating early changes in cerebral blood flow--as measured by laser Doppler flowmetry (CBFLDF)--during experimental pneumococcal meningitis. Meningitis was induced with heat-killed pneumococci and confirmed by a significant increase in CBFLDF (baseline 100%; 225.3 +/- 21.8% after 6 hours; mean +/- SD), intracranial pressure (ICP), brain water content, and white blood cell count in the CSF. Intravenous administration of the selective endothelin B (ETB) receptor antagonist BQ-788 immediately before pneumococcal challenge (but not 4 hours afterward) significantly attenuated these pathophysiologic alterations (e.g., CBFLDF 6 hours after pneumococcal challenge: 116.7 +/- 17.4%). Pretreatment with BQ-123, a selective endothelin A receptor antagonist, had no significant effect on ICP and brain water content, but augmented the increase in CBFLDF and CSF white blood cell count. Since ET is known to trigger the release of nitric oxide (NO) by ETB receptor activation, we examined specific ET-NO interactions in primary rat cerebromicrovascular endothelial cells after stimulation with heat-killed pneumococci. Pneumococci induced a significant increase in both ET and NO concentrations in endothelial cell culture medium. Treatment with phosphoramidon, an inhibitor of the endothelin-converting enzyme, prevented the production of endothelin and markedly reduced NO generation. Our data provide evidence that ET is involved as a mediator in early pneumococcal meningitis in the rat and contributes to the increase in CBFLDF, ICP, brain water content, and CSF pleocytosis, presumably through ETB receptor-mediated NO production.

[Oncologic surgery of the larynx after failure of radiotherapy]. / Cirugía oncológica de laringe tras fracaso del tratamiento radioterápico.

The treatment of early-stage laryngeal cancer using either partial surgical techniques or irradiation still is controversial. The performance of rescue surgical procedures after irradiation is related to increased postsurgical complications and lower survival rates. We made a retrospective study of 73 patients who underwent rescue surgery after failure of radiotherapy in our department in the last 10 years. A statistical analysis was made of the complications and survival rate of these patients in accordance with tumor location and clinicopathological stage compared with patients who underwent surgery alone (n = 435). More rescue surgery was performed for glottic carcinomas (52/73) than for supraglottic carcinomas (21/73). No significant differences were found in the complication rate (23.6%) compared with the control group (19.6%). There was a significant reduction in survival in patients who underwent previous irradiation of supraglottic tumors compared with glottic tumors and the control group. In view of these results, we conclude that irradiation is not a good option as an initial treatment for supraglottic tumors and that the procedure of choice should be surgical.

[Use of the Internet in otorhinolaryngology]. / Aplicaciones del internet a la otorrinolaringología.

The Internet is considered by some as one of the most important advances of the late 20th century. The Internet is the functional linking of personal computers via telephone lines to a worldwide network of millions of other computers, which enables them to exchange information freely. Although the Internet crops up in daily conversation, many persons are not aware of its usefulness and relevance for ear, nose and throat specialists. The Internet is accessed by special software that maximizes the potential of this vast computer network. The most important tools are e-mail and the World Wide Web. These tools make it possible to consult multimedia medical publications, access Medline, and carry out information searches, etc. The Internet and its most important uses in otolaryngology are summarized and a list of useful addresses is given. Although its advantages still are not widely appreciated, widespread Internet use is imminent and we think that it is a useful technology to know and use. Moreover, access is becoming easier and cheaper.

[Treatment protocol for sudden deafness]. / Protocolo de tratamiento de la sordera súbita.

There are two types of rapidly progressive sensorineural hearing loss: sudden hearing loss, which is generally unilateral and develops in less than 72 hours, and rapidly progressive sensorineural hearing loss, which develops over days or months. The origin of sudden deafness is difficult to establish. Several etiopathogenic factors have been postulated, such as viral infection, autoimmune origin, vascular and metabolic disease, rupture of the labyrinthine membrane, and, recently, immune-mediated inner ear disease. We made a retrospective study of 40 patients seen in our department. Patients were given a combined treatment with steroids, nimodipine, heparin, and oxygen. Patients were divided into two groups by intravenous or oral treatment.

Functional and phenotypic analysis of T-lymphocytes in laryngeal carcinoma.

We studied the functional response and phenotypic characterization of peripheral blood T cells and their correlation with the clinical stage of disease in 29 males with previously untreated carcinoma of the larynx and 24 healthy male controls. Peripheral blood T cells, phenotypically CD2+ CD3+, were significantly decreased in the patients relative to the controls. Patients with advanced locoregional extension (T4 and N1, 2, 3) also showed a diminution of the CD4+ subpopulation of T cells. DNA synthesis by purified T cells showed similar blastogenic responses in patients and controls; the interleukin-2 production of phytohemagglutinin stimulated lymphocytes was also normal. We conclude that in patients with laryngeal carcinoma there is a phenotypic alteration of the T cells that is variable according to tumor stage, without functional alterations in blastogenic capacity or IL-2 production.

[Image analysis of naso-sinusal pathology with computerized tomography]. / Análisis de imagen en tomografía computadorizada de patología nasosinusal.

Imaging analysis has been applied to study typical cases of nasosinusal diseases, in an attempt to determine its capabilities for CT scan interpretations. Thus, polyps with sinusitis, cerebrospinal fluid occupying sinuses, cysts and bone tumors may be compared in order to obtain objective results that may help in the differential diagnosis in these conditions.

[The protocol of endoscopic sinus surgery: preliminary analysis of 100 cases]. / Protocolo de cirugía endoscópica nasosinusal: análisis preliminar de 100 casos.

Since 1989 we have been using on a regular basis in our department endoscopic technics applied to fosas and paranasal sinuses. A methodological study of the first 100 cases of this type of surgery is presented. The indications, results, and complications of the surgical technique are analyzed. The cases included: sinusitis, nasosinusal polyposis, endoscopy of malignant tumors, epistaxis, various inflammatory processes, and plastic endonasal reparations. It is concluded that nasosinusal endoscopic surgery is an advantageous technique in the treatment of general nasosinusal conditions.

[Childhood depressions. Interview between a non-hospital affiliated pediatrician and 2 child psychiatrists]. / Las depresiones infantiles. Entrevista entre un pediatra extrahospitalario y dos paidopsiquiatras.

The present report reviews the problem of depression in children by means of an interview made by a pediatric to two paidopsychiatrists: concept, incidence, etiology and clinic, emphasizing un those features of interest and related to the pediatric and based on a bibliographic revision and the own experience of the authors, referring fifty cases of recent study. It is also showed the main exploratory and diagnosis methods: psychological, clinical and biological, as the evolution, treatment and some aspects of suicide in children.