[Well-differentiated basal cell adenocarcinoma of the lacrimal sac: a case report]. / Adenocarcinoma de células basales del saco lacrimal bien diferenciado. A propósito de un caso.

Basal cell adenocarcinoma is a rare tumor first considered to be a separate entity by the WHO in 1991. The mean age of presentation is 48 years and it does not affect one gender more than the other. It normally follows an insidious course with nonspecific signs and symptoms. We present a case of adenocarcinoma of the lacrimal sac diagnosed at histological study. We show the CT, MRI, and histological findings. We discuss the differential diagnosis and treatment for this tumor.

[Effect of smoking withdrawal on hearing loss induced by occupational exposure to noise. A preliminary study]. / Efecto de la supresión del tabaco en la hipoacusia inducida por ruido laboral. Estudio preliminar.

Smoking and occupational exposure to noise are factors with independent predisposition to sensorineural hearing loss. This is a sinergistic and additive effect. Nevertheless, we have observed that withdrawal of smoking stops the progression on hearing loss in occupational groups with an acoustic exposition lesser than 80 dB SPL. Actually, there is not an unique ethiologic hypothesis.

[Immunomediation or hyperviscosity in rapidly progressive sensorineural hearing loss. A therapeutic approach]. / Inmunomediación o hiperviscosidad en la hipoacusia neurosensorial rápidamente progresiva. Una aproximación terapéutica.

INTRODUCTION: To evaluate the therapeutic response and the rheologic and immunological characteristics in subjects bearing of rapidly progressive sensorineural hearing loss (RPSHL). PATIENTS AND METHODS: A comparative prospective study on three groups of damaged ears treated with piracetam (n=29), corticosteroids (n=32) and plabcebo (n=25). Hearing loss and recovery level, whole blood filterability (WBF) and a Western-blot (WB) to anticochlear antibodies were evaluated. RESULTS: Recovery average was 20,8 +/- 55,9% in the first group, with progressive of deafness in the rest (p<0,01). WB did not show differences among groups. The higher WBF at the end of therapy was detected on group 1 (20,36 +/- 2,54 Vs 18,42 +/- 3,42 microl/seg on group 3; p<0,05). Moreover, it impaired only on those treated with piracetam, with statistically significative differences over the other two groups. CONCLUSIONS: We detected alterations on WBF in patients with RPSHL that justify the use of rheoactive measures as a pathophysiological therapy.

[Cormobidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests]. / Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio.

OBJECTIVES: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. PATIENTS AND METHODS: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. RESULTS: Alterations in non-specific battery were similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. CONCLUSIONS: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high.

[Petrous bone fracture. Our experience: 1999-2004]. / Fracturas de peñasco. Nuestra experiencia: 1999-2004.

OBJECTIVE: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. MATERIAL AND METHODS: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. CONCLUSIONS: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.

[Near-total laryngectomy. Experience, complications and acoustic analysis]. / Laringuectomía casi total. Experiencia, complicaciones y análisis de voz.

OBJECTIVE: To investigate the oncological efficiency, voice and complications of Pearson's near-total laryngectomy for advanced laryngeal cancers (T3, T4). MATERIAL AND METHODS: A retrospective review of 23 cases of near-total laryngectomy (carried out in our Hospital in the last nine years) was undertaken. RESULTS: None of the cases developed laryngeal mucosal recurrences. The overall three and five years disease free survival were 91,3% and 86,9%. Mean phonation time was 51 days. A statistically significant results were observed in our voice analysis (words/minute, taking as a reference healthy people (Medivoz). The pharyngeal fistula was the most frequent complication (60,86%). CONCLUSIONS: The local control of cancer was similar to that expected with total laryngectomy. Near-total laryngectomy is a valid alternative for extended laryngeal and neighbouring cancers with an acceptable morbidity and success rate for voice preservation.

[Cerebro spinal fluid (CSF) leaks in ear: revision of 5 cases]. / Fístulas de líquido cefalorraquídeo en oído: a propósito de 5 casos.

CSF leaks in the ear are the result of an abnormal communication between subarachnoid and tympano mastoid areas, most of then as a result of trauma (90%). They mean a lisk of meningitis (4-50%) directly related to the etiology. Our aim is to present the CSF leak cases seen in our hospital in the last 2 years and a revision of their management. The main factor for a sucessful surgical repair is to use a multilayer tecnhique with a sucess rate close to 100%.

[Blood viscosity modifications in patients with presbycusis]. / Alteraciones en la viscosidad sanguínea en pacientes con presbiacusia.

OBJECTIVE: [corrected] To evaluate the existence of blood viscosity alterations in presbyacusis as an eventual pathophysiological mechanism. MATERIAL AND METHODS: Nine 75 year-old subjects bearing of bilateral slowly progressive sensorineural deafness were considered to be studied on a yearly basis in a ten year folow-up period, evaluating the binaural hearing loss in speech tones (500, 1000, 2000 and 3000 Hz). Hemorheological profile on peripheral blood included total blood viscosity (BV) at different shear rates (SR), blood filterability (BF), erythrocyte deformability and aggregability (EA). RESULTS: There was a trend of all parameters towards hyperviscosity, with an increase at ten years of BV at high SR and EA at total stasis which were statistically significant. The level of deafness correlated significativelly to low values of BF and increases on BV at high SR. CONCLUSIONS: Presbyacustic patients do show hemorheological evidences that suggest a tendency towards hyperviscosity as a predisposing factor for hearing loss.