Primary small cell carcinoma of the larynx. Survival time of 47 months. Case report.

Small cell carcinoma (SCC) of the larynx is a rare type of neuroendocrine carcinoma (NEC), few cases of which have been described in the literature. The prognosis for this type of carcinoma is poor, with a survival time typically not exceeding two years. We describe the case of a 54-year-old male patient with a primary tumor in the right ventricular band and a biopsy compatible with SCC. The patient underwent radiotherapy (RT) and concomitant chemotherapy (QT) and, after a relapse at 17 months, underwent total laryngectomy with bilateral neck dissection. The survival time was 47 months. Further studies are required to elucidate the possible causes of the better prognosis in some cases.

[Results of applying a paediatric early warning score system as a healthcare quality improvement plan]. / Resultados de la aplicación de una escala de alerta clínica precoz en pediatría como plan de mejora de calidad asistencial.

OBJECTIVES: The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively. MATERIAL AND METHODS: An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score. RESULTS: The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases. CONCLUSIONS: PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.

[Mortality analysis in sector 7 of the community of Madrid during 1987]. / Análisis de la mortalidad en el sector 7 de la Communidad de Madrid durante 1987.

OBJECTIVE: To determine the level of health of individuals living in 1987 in Sector 7 of the Autonomous Community of Madrid (ACM). DESIGN: Crossover analysis of the mortality among residents of Sector 7 of the ACM in 1987. SETTING: The Madrid districts, Centro, Chamberí and Latina, which compose Sector 7 of the ACM. POPULATION UNDER STUDY: The 5,460 deaths of Sector 7 residents registered in 1987. MEASUREMENTS AND MAIN RESULTS: The mortality rates (both overall and broken down according to C.I.E. 9th causes), the mortality rates of those under 70 and the rates of years of life potentially lost were standardised by the direct method. The following results were obtained: 1. The mortality rates standardised according to age in the Centro district (7.82 per thousand) were significantly higher (p < 0.001) than those of the other Sector 7 districts (Chamberí and Latina were both at 6.25 per thousand) and of the ACM as a whole (6.63 per thousand). 2. The mortality rates, standardised by age for the population under 70 in the Centro district, were significantly higher (p < 0.001) than those of the other Sector 7 districts (Chamberí, 3.1 per thousand and Latina, 2.63 per thousand) and of the ACM as a whole (2.88 per thousand). CONCLUSIONS: Analysing mortality by Health Area reveals differences in communities' health levels. These findings will assist more rational planning of the distribution of resources.