p27 and BCL2 expression predicts response to chemotherapy in head and neck squamous cell carcinomas.

OBJECTIVES: Head and neck squamous cell carcinomas (HNSCCs) are characterized by marked heterogeneity in their biological behavior and response to treatment. Our goal was the identification of biomarkers that can be used to predict response to chemotherapy in these patients. MATERIALS AND METHODS: The expression of EGFR, p53, Cyclin D1, p16, p21, p27, p-AKT, HIF-1α, Caspase 3 and BCL2 was analyzed by immunohistochemistry in 41 primary laryngeal/hypopharyngeal squamous cell carcinomas of patients that received induction chemotherapy (cisplatin and 5-fluorouracil) as part of their treatment. RESULTS: Positive expression of p27 and BCL2 had a significant predictive value for chemotherapy response in univariate analysis. The combination of both proteins was not superior in predicting the response to chemotherapy. Furthermore, p27 expression was the only significant predictor of chemotherapy response in multivariate analysis (P=0.015). CONCLUSION: p27 Expression may serve as predictive biomarker of response to induction chemotherapy in HNSCC patients.

[The effect of anchor voices and visible speech in training in the GRABS scale of perceptual evaluation of dysphonia]. / El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía.

INTRODUCTION: Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. MATERIAL & METHODS: Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then, 6 months later, with anchors and a narrow band spectrogram as additional information. RESULTS: The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. DISCUSSION: This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram.

[Peritonsillar infections: prospective study of 100 consecutive cases]. / Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos.

INTRODUCTION: Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS: We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS: Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS: Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.

[Neurolaryngology]. / Neurolaringología.

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function.

Replica a la carta «Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos» / Reply to the letter «Comments on peritonsillar infections: a prospective study of 100 consecutive cases»

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Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos / Peritonsillar infections: prospective study of 100 consecutive cases

Introducción: La infección periamigdalina supone la complicación más frecuente de una amigdalitis. Se define como una colección purulenta localizada entre la cápsula amigdalar y el músculo constrictor superior de la faringe. Puede clasificarse en flemón y absceso periamigdalino. Material y métodos: Presentamos un estudio prospectivo descriptivo de 100 infecciones periamigdalinas diagnosticadas entre los años 2008 y 2010. Se analizaron diversas variables clínico-epidemiológicas y el manejo de estos pacientes. El diagnóstico de flemón o absceso periamigdalino se basó fundamentalmente en la obtención de pus mediante punción-aspiración. Resultados: El 77% de los pacientes no tenían antecedentes de amigdalitis de repetición y el 55% estaban recibiendo tratamiento antibiótico. En el 62% de los casos se clasificó como absceso y en el 38% como flemón periamigdalino. La presencia de trismus, desviación contralateral de la úvula y el abombamiento del pilar anterior se relacionó con la presencia de absceso (p<0,001). Todos los pacientes fueron ingresados y tratados con punción-drenaje, antibioterapia intravenosa (amoxicilina/clavulánico en el 83% de los casos) y una dosis de corticoides. Al alta, todos los pacientes recibieron antibioterapia oral. La estancia media fue de 3 días y la tasa de recurrencias del 5%. Conclusiones: Debido a la ausencia de guías de práctica clínica, existen diversos protocolos terapéuticos. De acuerdo a nuestra experiencia, la punción-aspiración y la administración de antibioterapia intravenosa, es una opción segura y eficaz en el manejo de estos pacientes. Para determinar la eficacia y seguridad del manejo ambulatorio o mediante ingreso de estos pacientes, serían necesarios estudios controlados(AU)

Introduction: Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. Material and methods: We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. Results: Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. Conclusions: Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed(AU)

El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía / The effect of anchor voices and visible speech in training in the GRABS scale of perceptual evaluation of dysphonia

Introducción: La evaluación perceptual de la calidad vocal sigue siendo un importante método para evaluar los trastornos vocales. El método GRABS se ha consolidado como una escala frecuentemente utilizada para puntuar la severidad de una disfonía, pero no se ha publicado un protocolo estándar para guiarse. El entrenamiento es importante para alcanzar una buena concordancia en la calificación de sus parámetros entre distintos observadores, sin embargo, las referencias bibliográficas más citadas no describen orientaciones para su uso clínico, muestras a analizar o calibración. Material y método: Este estudio investigó el efecto de voces patrón y la espectrografía debanda estrecha en el entrenamiento del GRABS de profesionales no expertos. Las voces de 107 pacientes fueron evaluadas por 4 profesionales no expertos utilizando la escala GRABS en 2 sesiones, primero sin voces patrón ni espectrograma y 6 meses después con voces patrón y espectrograma de banda estrecha. Resultados: Los resultados muestran que las voces patrón y el espectrograma ayudaron a mejorarla fiabilidad de los parámetros G, B, A y S. La concordancia entre los distintos observadores de acuerdo al estadístico k fue significativamente mayor con la adición de la información espectrográfica para los parámetros B y S. Discusión: Este estudio demuestra que los profesionales no expertos mejoran significativamente sus puntuaciones tras el entrenamiento con voces patrón y la visualización del espectrograma de banda estrecha(AU)

Introduction: Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. Material & Methods: Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then,6 months later, with anchors and a narrow band spectrogram as additional information. Results: The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. Discussion: This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram(AU)

Neurolaringología / Neurolaryngology

La neuroanatomía de la voz y el habla es compleja. Una intrincada red neural se responsabiliza de que se ejecuten las principales funciones de la laringe: la protección de la vía aérea, la producción de la tos y el Valsalva y la fonación. La coordinación de esos roles es muy susceptible de verse afectada por enfermedades neurológicas, tales como la enfermedad de Parkinson, los accidentes cerebrovasculares, la esclerosis lateral amiotrófica, la esclerosis múltiple, la distonía y el temblor. Una cuidadosa evaluación neurológica debe ser llevada a cabo en todo paciente que presente síntomas vocales que orienten a una causa neurológica. La visualización endoscópica mediante fibrolaringoscopio, que permita una evaluación dinámica de la voz, es una parte esencial de la valoración y en algunas ocasiones se emplean otras pruebas complementarias. La evaluación otorrinolaringológica es importante en el diagnóstico y el tratamiento de las enfermedades neurológicas con expresión al nivel laríngeo(AU)

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function(AU)