[Current status of requirements in the design of healthcare facilities to ensure accessibility for patients with disabilities]. / Estado actual de los requerimientos en el diseño de centros sanitarios para asegurar accesibilidad a pacientes con discapacidad.

BACKGROUND AND OBJECTIVE: People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions. MATERIALS AND METHODS: A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase). RESULTS: Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings. CONCLUSIONS: The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.

[Fistula of the first branchial arch]. / Fístula de primer arco branquial.

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.

[Arterioveinous dural malformation in ENT]. / Malformaciones arteriovenosas durales en el ambito de la ORL.

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.

[An uncommon cause for unilateral vocal fold paralisis: aortic aneurysms. Case report and literature review]. / Una causa poco frecuente de parálisis recurrencial: aneurismas de aorta Aportación de un caso clínico y revisión de la literatura.

Unilateral vocal fold paralysis is frequently encountered during ENT practise. It may result from many different conditions and it always should be regarded as a sign revealingan underlaying disease that can be located anywhere along the traject of the tenth cranial nerve or at the cricoarytenoidjoint being malignancies and trauma the leading causes. Etiology, glottal characteristics and compensative maneuvers, and individual factors such as comorbility or age must be considered when treatment options are proposed to the patient. A case of an uncommon etiology for unilateral vocal fold paralysis, an aortic aneurysm, is presented and considerations about the management of this condition are provided.

[Indication for endoscopic procedures in maxiloethmoydal mucoceles]. / Indicación del tratamiento endoscópico de los mucoceles maxiloetmoidales.

The Functional Endoscopic Sinus Surgery has posibilitated a change in the diagnosis, treatment and postsurgical management of many nasosinusal diseases. Mucoceles of the paranasal sinuses are an ideal indication for performing these surgical procedures when good accesibility conditions are present. Under these circumstances, external approach, with the subsequent impairments and morbility, could be avoided. An endoscopically treated extensive maxilloethmoydal mucocele is presented and key points to endoscopic treatment indication are provided.

[Non Hodgkin's lymphoma in the ENT field]. / Linfomas no Hodgkin en patología cérvico-facial.

OBJECTIVES: Non Hodgkin's lymphoma (NHL) is a frecuent tumor in the ENT field althougt there are not too many publications with a large number of patients. PATIENTS AND METHODS: We have studied 300 patiens with NHL and analysed the head and neck affectation, the presence in Waldeyer's ring, the first symptoms and the stage of the disease. RESULTS: Over 50% had head and neck manifestation. Of them, the most frequent one were adenopathies. In the Waldeyer's ring, the tonsil was the most frecuently affected structure. CONCLUSION: There is an evident relationship between NHL and the Oto-Rhino-laringology area and it is necessary consider it in the differential diagnosis of head and neck adenopathies.

[Malignant low grade intestinal adenocarcinoma of the nasal cavity]. / Adenocarcinoma de tipo intestinal de bajo grado de malignidad clínica en fosas nasales.

Adenocarcinomata of the nose are scanty growths. They included primary adenocarcinomata not derived from salivary glands and these in its turn not share histological, pathogenical and prognostic characteristic, being the latter those of high degree or intestinal type and the other the lower degree. We report an unusual clinical case which should be classified among those of high degree, but because of its behavior showed totally benign.

[Morphometric and stereologic nuclear values obtained from the study of a population suffering from nasopharyngeal carcinoma]. / Valores morfométricos y estereológicos nucleares obtenidos en el estudio de una población con carcinoma de nasofaringe.

Computer nuclear morphometry and stereology are attractive methods because its objectivity and cheapness allowing histologic diagnosis when identifying minimal variations respectively the normality and also detect negligible disparities between anormal cells which could escape to the assessment of the pathologist. We present the data gained from several morphogenic and stereologic parameters resulting of measurements of tumoral cells procured from 40 patients with nasopharyngeal carcinomata. Middle values have been: nuclear area 27.70 microns 2; nuclear perimeter 20.80 microns; nuclear factor of form 0.81 microns; nuclear outline index 4.01; nuclear orientation angle 87.29 degrees; nuclear ellipsiticity 704.14; nuclear regularity 61.83; middle lineal length 4.30, middle linear distance 107.94; and nuclear volume 118.80 microns 3. Our series is the largest studied till now of all found in the literature. Comparison our data with those of previous publications.

[Tuberculous otitis media. Report of 3 cases]. / Otitis media tuberculosa. Estudio de 3 casos.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

[Surgical treatment of locally advanced cancer of the tongue by total glosso-pharyngo-laryngectomy]. / Tratamiento quirúrgico del cáncer de lengua, localmente avanzado, mediante glosofaringolaringectomía total.

Seven patients with advanced carcinoma of the tongue (T4) were treated with total glossectomy and laryngectomy, neck dissection (radical-functional or radical-traditional) and reconstruction with the pectoralis major myocutaneous flap. The AA. comment the surgical technique, the pros and the cons of the indications, the justification, the objectives and the consequences.

[Diagnostic and therapeutic management in malignant neck tumors of unknown origin. Our experience in the last 5 years]. / Manejo diagnóstico y terapéutico en tumores malignos cervicales de origen desconocido. Nuestra experiencia en los últimos cinco años.

The AA. analyzed 37 cases of metastatic neck cancer from unknown primary sites treated at the Oncologic Unit from 1986 to October 1991. This group account for 7 percent of total cervicofacial tumors seen. Factors that affected survival include the symptoms of consult, the control of cervical disease after treatment and surgery. The survival was 50 percent at two years and the rate of neck disease control amounted to 57.7 percent.

[Vagal chemodectoma with atypical cells. Case report]. / Quemodectoma vagal con atipias celulares. Presentación de un caso.

We report a clinical case of vagal chemodectoma with cell atypies, which was presented as slowly growing neck mass without any other symptoms. At the beginning and due to the histologic report of the needle biopsy, which morphologic study based on cellular atypia was misinterpreted as a malignant tumor and with the images obtained by computed tomography (CT) suggesting a malignant neoplasia, we proceeded to approach the case as a metastatic tumor of unknown origin. We made a revision of the epidemiologic factors, and diagnostic and therapeutic management of this type of growths.

[Microcytic carcinoma of the nose cavity. A case report]. / Carcinoma microcítico de fosa nasal. A propósito de un caso.

Tumors of the nasal cavity and sinuses are rather infrequent, being squamous carcinoma the predominant type, which accounts for the 80 percent of the totality of them. Maxillary sinus is the most affected, followed by nose cavity. Half of cases are originated on turbinates. We present the clinical case of a woman patient diagnosed of microcytic carcinoma of the right nasal cavity originated at the level of middle turbinate. The mass filled the width of the fossa getting in touch with the nasal septum, without encroaching it. According its extent the tumor was classified as T2, N0, M0 and treated with radiotherapy only. Microcytic carcinoma is an exceptional histological type in nasal cavity and next to its numeric meagerness in this location makes this case a very peculiar one.

[First year of experience in laryngectomy and pharyngolaryngectomy with Pearson type laryngotracheal myomucosal shunt]. / Primer año de experiencia en laringectomías y faringolaringectomías con shunt miomucoso laringotraqueal tipo Pearson.

In this essay we deal with different aspects of the techniques described by Pearson and cols. in 1980, carrying out an analysis of objectives, indications and contraindications, physiological fundamentals, description of the surgical technique, aftercare and exposition of the results achieved in patients operated from September 1996-97.

[Acute infectious mastoid complications in infancy]. / Complicaciones infecciosas agudas mastoideas en la infancia.

The incidence of acute mastoiditis accounts for 0.004% of acute middle otitis. Nowadays there is a decrease of number of mastoiditis and its complications, but from time to time are seen outbreaks without logical explanation of facts. We report 4 clinical cases of acute mastoiditis complicated with subperiosteal abscess, in children between 8 and 23 month old, seen at our department during the last 3 years, three of them diagnosed in a 4-month term.

[Solitary extramedullary plasmocytoma of oropharynx]. / Plasmocitoma solitario extramedular orofaríngeo.

Report on a solitary extramedullary plasmacytoma case, an entity rarely diagnosed in daily practice, because of its low incidence. When the process occurs is seen fundamentally located at upper aero-digestive tract. Our patient was a 34-year-old man, who was diagnosed as oropharyngeal plasmacytoma with the peculiarity that the lesion feigned a benign one wether for the clinical features or the macroscopical aspect. The patient underwent surgery and postoperative rontgentherapy, after discarding a systemic disease. Till now the evolution proved good.

[Deep neck infections]. / Infecciones cervicales profundas.

Deep neck infections are charts potentially dangerous though of low incidence. Few times linked to severe complications, as mediastinitis, of high morbi-mortality. They call for emergency procedures combining neck and thorax surgery, if there is a mediastinitis, with a broad-spectrum antibiotherapy within an Intensive Care Unit, with the aim of the maintain the patients's equilibrium constant till their reestablishment. We report 3 cases seen in a term lesser than one year at the Universitary Hospital of Salamanca. The 3 presented with thoracic complication because the spread of the neck's infect. Nevertheless the pending severity all three survived. We emphasize the necessity of realizing the pressing surgery and the utilitarianism of broad-spectrum antibiotherapy as key elements in order to get the patient's reestablishment. Literature review on the subject.

[Bioethics and implantation of cochlear devices in deaf-mute patients]. / Etica de la aplicación de implantes cocleares a sordomudos.

Bioethical principles are applied trying to solve some of the problems arose by the implantation of cochlear devices in deaf-mute patients, especially in the case of children. Justice problems due to the scarcity of resources are also described.

[Vogt-Koyanagi-Harada syndrome; a model of autoimmune neurosensory hypoacusia]. / Síndrome de Vogt-Koyanagi-Harada; un modelo de hipoacusia neurosensorial autoinmune.

The immunological disorders appearing in several kinds of autoimmune sensorineural hearing loss, are not unusual in daily practice. We present a case with Vogt-Koyanagi-Harada's disease with hearing impairment, and describe its clinics aspects, and the diagnosis and therapeutics methods we used.

[Changes in the nuclear morphometry in oropharyngeal epidermoid carcinoma after induction chemotherapy]. / Cambios en la morfometría nuclear del carcinoma epidermoide de orofaringe tras quimioterapia de inducción.

A cytomorphic, stereological study was made by computerized image analysis of six nuclear morphometric variables and one stereological nuclear variable. Variables were measured on 150 randomly selected tumor cells in oropharyngeal biopsies from 44 patients with oropharyngeal cancer who had not responded completely to induction chemotherapy. The nuclei of tumoral cells were larger (mean nuclear area, perimeter, and volume), more rounded, and had a less irregular nuclear contour index.