The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

[Unilateral vocal fold paralysis: quality of voice after speech therapy]. / Parálisis de cuerda vocal unilateral: estudio de la calidad vocaldespués del tratamiento logopédico

BACKGROUND: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. METHODS: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination,blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. RESULTS: The average age was 51 years (range 20-80), 60%women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001).Only 8.5% of the patients required surgical intervention after treatment. CONCLUSIONS: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis.

[Epidemiology, presentation forms, radiological stage and diagnostic methods of sarcoidosis in the area of Leon (2001-2008)]. / Epidemiología, formas de presentación, estadio radiológico y métodos diagnósticos de la sarcoidosis en el área de León (2001-2008).

BACKGROUNDS: The epidemiological studies of sarcoidosis in Spain and other countries are from more than one decade ago. OBJECTIVES: To know the current incidence in the health care area of Leon, the reasons for consultation, the thoracic radiologyl involvement, delay and diagnostic methods. PATIENTS AND METHODS: We reviewed the cases of sarcoidosis seen in our hospital between the years 2001-2008. The study is retrospective. RESULTS: 118 patients fulfilled the criteria for sarcoidosis with an incidence of 4.51/100,000 inhab./year. Of these, 53 (44.9%) were male with a mean age of 36.4 ± 12.2 and 65 (55.1%) women, with a mean age of 42.6 ± 17.2 years (P = 0.029). The most frequent presentation form was Löfgren Syndrome with 45.8%, followed by respiratory symptoms 20.3%, radiological findings 12.7%, general syndrome 10.2% and miscellaneous 11%. Thoracic radiological affectations at the time of diagnosis were: stage I: 59.3%, stage II: 19.8%, stage III: 10%, fibrosis 3.4% and stage 0: 8.5%. Transbronchial biopsy was the most frequent diagnosis. Time to diagnosis was very variable with a median of 24.5 days, when it debuted as erythema nodosum, 80 in the less frequent forms. CONCLUSIONS: The incidence of sarcoidosis was superior to that previously demonstrated. It affected young adults, but with an increase in the number of cases in those over 50 years with clear female predominance. Löfgren syndrome was the most frequent presentation form, with a higher incidence in spring. Diagnostic delay varied according to the different presentation forms. Transbronchial biopsy was the main diagnostic tool.

[Amyloidosis in the ORL field]. / La amiloidosis en el area otorrinolaringológica.

OBJECTIVES: To review the clinical and pathological characteristics of upper aerodigestive tract amyloidosis with particular attention to laryngeal amyloidosis. Amyloidosis of the upper aerodigestive tract is relatively rare. The larynx is the most common site of involvement in head and neck isolated amyloidosis and the supraglottic region represents the major site of involvement. MATERIAL AND METHODS: Retrospective review of 6 patients diagnosed with upper aerodigestive tract amyloidosis. Hoarseness and airway compromise were the main presenting symptoms. RESULTS: Laryngeal CO2 laser microsurgery was performed and then we refered the patients to the Medical Deparment seeking for systemic involvement and ENT Clinic follow up. CONCLUSIONS: In our experience, laryngeal CO2 laser microsurgery is a succesfull way to treat isolated laryngeal amyloidosis with clinical improvement and low recurrence rates.

[Antitumoral effect of HSV-tk suicide gene associated with ganciclovir in an experimental model of head and neck epidermoid carcinoma]. / Efecto antitumoral del gen suicida HSV-tk y ganciclovir en un modelo experimental de carcinoma epidermoide de cabeza y cuello.

INTRODUCTION: We studied the transfection by adenoviral vectors and the antitumoral effect of HSV-tk gene associated with ganciclovir (AdCMVtk/GCV) in KB human oral cavity squamous cell carcinoma, in vitro and in vivo. MATERIALS AND METHODS: Transfection was assessed by the X-gal stain. It was used in cell cultures and tumoral sections previously exposed to adenoviral vector AdCMVlacZ. In vitro, in order to study the antitumoral effect of AdCMVtk/GCV, survival of cell cultures exposed to AdCMVtk/GCV and to AdCMVlacZ/GCV was compared. In vivo, necrotic volume as a percentage of total tumoral volume, was compared between AdCMVtk/GCV treated group and AdCMVlacZ/GCV exposed group. Hepatic and renal toxicities were assessed. RESULTS: In vitro, survival of cell cultures treated with AdCMVtk/GCV was less than AdCMVlacZ/GCV exposed cells. In vivo, necrotic volume was larger in AdCMVtk/GCV treated group than in AdCMVlacZ/GCV exposed group. No toxicity was found (hepatic, renal). CONCLUSIONS: KB cells are transfected by adenoviral vectors and are killed by AdCMVtk/GCV, both in vitro and in vivo (no toxicity was found in the animal model).

[Respiratory effects of nicotine and naloxone]. / Efectos respiratorios de nicotina y naloxona.

The effect of an i.v. bolus injection of nicotine 50 micrograms/kg-1, was compared in 6 awake dogs with the effect of nicotine injection after naloxone, 400 micrograms/kg-1. Respiratory inhibition was produced immediately after beginning the nicotine injection, followed by hyperpnea. Naloxone produced a significant decrease of the respiratory inhibition followed by hyperpnea increase compared to the trial with only nicotine.