Impact of 3-dimensional anatomical changes secondary to orthognathic surgery on voice resonance and articulatory function: a prospective study.

An evaluation was made of the impact of orthognathic surgery (OS) on speech, addressing in particular the effects of skeletal and airway changes on voice resonance characteristics and articulatory function. A prospective study was carried out involving 29 consecutive patientssubjected to OS. Preoperative, and short and long-term postoperative evaluations were made of anatomical changes (skeletal and airway measurements), speech evolution (assessed objectively by acoustic analysis: fundamental frequency, local jitter, local shimmer of each vowel, and formants F1 and F2 of vowel /a/), and articulatory function (use of compensatory musculature, point of articulation, and speech intelligibility). These were also assessed subjectively by means of a visual analogue scale. Articulatory function after OS showed immediate improvement and had further progressed at one year of follow up. This improvement significantly correlated with the anatomical changes, and was also notably perceived by the patient. On the other hand, although a slight modification in vocal resonance was reported and seen to correlate with anatomical changes of the tongue, hyoid bone, and airway, it was not subjectively perceived by the patients. In conclusion, the results demonstrated that OS had beneficial effects on articulatory function and imperceptible subjective changes in a patient's voice. Patients subjected to OS, apart from benefitting from improved articulatory function, should not be afraid that they will not recognise their voice after treatment.

[Clinical and functional characteristics of patients prior to lung transplantation: report of experience at the Clínica Puerta de Hierro]. / Características clínicas y funcionales antes del trasplante pulmonar. Experiencia en la Clínica Puerta de Hierro.

OBJECTIVE: The time at which lung transplantation is indicated is determined by clinical and functional criteria that vary according to the particular disease. The aim of our study was to present the criteria according to which patients were placed on waiting lists for lung transplantation in our hospital. PATIENTS AND METHODS: We analyzed retrospectively the clinical characteristics, lung function, heart function, and 6-minute walk test results of patients who had received a lung transplant in our hospital from January 2002 through September 2005. RESULTS: During the study period 100 lung transplants were performed. The mean age of the patients was 45 years (range, 15-67 years) and 57% were men. The diseases that most often led to a lung transplant were chronic obstructive pulmonary disease (COPD) (35%), pulmonary fibrosis (29%), and bronchiectasis (21%). Lung function values differed by disease: mean (SD) forced expiratory volume in 1 second (FEV1) was 20% (11%) and forced vital capacity (FVC) was 37% (15%) in patients with COPD; FEV1 was 41% (15%) and FVC, 40% (17%) in patients with pulmonary fibrosis; and FEV1 was 23% (7%) and FVC, 37% (10%) in patients with bronchiectasis. CONCLUSIONS: The patients who received lung transplants in our hospital were in advanced phases of their disease and met the inclusion criteria accepted by the various medical associations when they were placed on the waiting list.

[Lymphomatosis cerebri as the cause of leukoencephalopathy]. / Linfomatosis cerebral como causa de leucoencefalopatía.

INTRODUCTION: Lymphomatosis cerebri (LC) is an infrequent type of primary lymphoma of the central nervous system that is characterised by diffuse, infiltrating involvement of the white matter of the brain without the formation of a mass. AIM: To report the case of a patient with LC in order to draw attention to this disease, which is rarely diagnosed, and to its initial presentation in magnetic resonance imaging (MRI) as leukoencephalopathy. CASE REPORT: Our patient was a 56-year-old female who had clinical signs and symptoms of sub-acute dementia. Computerised axial tomography and MRI of the head revealed extensive, diffuse and bilateral involvement of the white matter, basal nuclei, mesencephalon and pons, with no mass effect or contrast enhancement. A stereotactic biopsy of the white matter (which was not conclusive) showed a perivascular mixed mononuclear-cell inflammatory infiltrate of B and T cells. No cytologic atypia was observed. Treatment was established with corticoids, which produced a clinical and radiological improvement in the first two months. During the next month the patient underwent rapid clinical deterioration with sleepiness and a worsening of the ability to walk. In an MRI scan the lesion had a more heterogeneous appearance with mass effect on adjacent structures and patchy contrast enhancement. A wedge biopsy of brain tissue led to a diagnosis of high-grade B-cell lymphoma. CONCLUSIONS: The imaging and histological appearance of LC may not be the one typically found in primary lymphomas of the central nervous system, and its clinical presentation may be similar to that of other diffuse processes involving compromise of the white matter (cerebral gliomatosis, inflammatory diseases of the white matter, such as Behçet's disease, Sjögren's disease or systemic lupus erythematosus).

[Lung transplant therapy for suppurative diseases]. / Trasplante pulmonar en enfermedades supurativas.

OBJECTIVE: Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes. PATIENTS AND METHOD: We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival. RESULTS: From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation. CONCLUSIONS: Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.

[Bone mineral density in leukemic children after completing one month of chemotherapy]. / Densitometría ósea en niños leucémicos al completar el primer mes de quimioterapia.

BACKGROUND: An important loss of bone mineral density, associated to pain and fractures, has been reported in children with acute lymphoblastic leukemia (ALL). AIM: To measure bone mineral density among children with acute lymphoblastic leukemia (ALL) that completed the remission induction phase with chemotherapy, that lasts 30 days. PATIENTS AND METHODS: children with ALL, admitted to the oncology unit of a general hospital were considered eligible for the study. body composition and bone mineral density were measured by dual energy x ray absorptiometry (DEXA). each child with ALL was paired with a healthy control. RESULTS: Fourteen children age 1 to 11 years, completed the study, Spine and femoral bone mineral densities were significantly lower than in their matched controls. No differences in total body bone mineral density or content were observed. Children with ALL had a lower fat free mass and a higher fat mass than their matched controls. There was a significant correlation between fat free mass and bone mineral content. CONCLUSIONS: After one month of chemotherapy, children with ALL had a lower bone mineral density in the spine and femur and a lower fat free mass.

Densitometría ósea en niños leucémicos al completar el primer mes de quimioterapia / Bone mineral density in leukemic children after completing one month of chemotherapy

Background: An important loss of bone mineral density, associated to pain and fractures, has been reported in children with acute lymphoblastic leukemia (ALL). Aim: To measure bone mineral density among children with acute lymphoblastic leykemia (ALL) that completed the remission induction phase with chemotherapy, that lasts 30 days. Patients and methods: children with ALL, admitted to the oncology unit of a general hospital were considered eligible for the study. body composition and bone mineral density were measured by dual energy x ray absorptiometry (DEXA). each child with ALL was paired with a healthly control. Results: Fourteen children age 1 to 11 years, completed the study, Spine and femoral bone mineral desities were significantly lower than in their matched controls. No differences in total body bone mineral density or content were observed. Children with ALL had a lower fat free mass and a higher fat mass than their matched controls. There was a significant correlation between fat free mass and bone mineral content. Conclusions: After one month of chemotherapy, children with ALL had a lower bone mineral density in the spine and femur and a lower fat free mass.

[Characteristics of lung cancer in patients exposed to silica at work. A comparison of exposed and non-exposed individuals]. / Características del cáncer de pulmón en pacientes con exposición laboral a la sílice. Estudio comparativo entre individuos expuestos y no expuestos.

INTRODUCTION: In 1977 silica was listed as a group 1 carcinogen (demonstrated in humans) by the International Agency for Research on Cancer. However, conflicting results from various studies have kept debate alive as to its carcinogenic capacity. The interest of this debate lies in the large number of workers exposed to silica. OBJECTIVE: To analyze the differential characteristics of lung cancer among silica exposed and silica non-exposed individuals, to identify indirectly a possible carcinogenic effect of silica. METHODS: For all males with a diagnosis of lung cancer over a period of 22 consecutive months at the National Silicosis Institute (Oviedo, Spain), we recorded work history, age, smoking habits, spirometry, the presence of pneumoconiosis and histology. RESULTS: Comparing the results for silica exposed and non-exposed individuals, we found significant differences for age (63.7 8.8 and 66.7 8.6 y, respectively; p < 0.05), smoking (44.1 22.4 and 48.9 22.3 packs/year; p < 0.05) and a Tiffeneau index under 70% (in 78% of exposed vs. 55% of non-exposed patients; p < 0.05). No significant differences in histology, signs and symptoms or radiographs were observed between the two groups. In the multifactorial analysis in function of age of onset, exposure to silica continued to be an independent predictor. CONCLUSION: Our results show that the clinical and radiological signs and histology of patients exposed or non-exposed to silica did not differ. However, lung cancer appears earlier among individuals with work-related exposure to silica and lower rates of tobacco smoking, suggesting some carcinogenic effect for silica.

Elevated hydroperoxide levels and antioxidant patterns in Papillon-Lefèvre syndrome.

BACKGROUND: Since it has been found that reactive oxygen species seem to be involved in the pathogenesis of both periodontitis and hyperkeratotic syndromes, we studied a group of patients belonging to 3 generations of a family with different degrees of severity of Papillon-Lefèvre syndrome (PLS) to ascertain whether altered concentrations of the most important hydrophobic and hydrophilic plasma antioxidants as well as products of oxidative damage are present in PLS. METHODS: Coenzyme Q (CoQ), vitamin E, glutathione (GSH), and uric acid were evaluated by high-performance liquid chromatography (HPLC) (supplied with electrochemical detector) techniques and hydroperoxides by a spectrophotometric method. RESULTS: GSH and uric acid were in the range of reference values; CoQ was very low in both the child of the third generation and his mother, and these 2 subjects had the highest hydroperoxide levels. The child also had extremely low values of vitamin E. In general, all family members showed abnormally high hydroperoxide levels, with the exception of those members who are phenotypically healthy. CONCLUSIONS: Since the subjects with the lowest hydroperoxide contents are phenotypically healthy, whereas the affected individuals presented lower antioxidant levels and very high hydroperoxide concentrations, it has been suggested that a specific antioxidant therapy could be a promising approach in treating some PLS subjects. Moreover, unexpected manifestations of heterozygosity in the child of the third generation were also detected.

[Lung transplantation in cystic fibrosis. The results of the Clínica Puerta de Hierro (Madrid) and the Hospital La Fe (Valencia)]. / Trasplante pulmonar en la fibrosis quística. Resultados de la Clínica Puerta de Hierro (Madrid) y el Hospital La Fe (Valencia).

UNLABELLED: Retrospective analysis of cystic fibrosis patients who underwent pulmonary transplantation at Clínica Puerta de Hierro, Madrid, and at Hospital La Fe, Valencia. Since the beginning of the programme and until March 1998, a total of 63 patients with cystic fibrosis were studied. Among transplanted patients, 18 were males and 16 females, with a mean age of 18.9 years. All patients underwent sequential bilateral pulmonary transplantation. After transplantation, the most common complication was bacterial pneumonia which affected all patients. Six patients had dehiscence or stenosis of the bronchial suture. Other specific complications of this condition by frequency were intestinal obstruction and diabetes mellitus. Six patients developed obliterans bronchiolitis and one of them underwent a repeat transplantation. Three out of the 34 patients died, and the likelihood of survival after one and three years was 94%. Respiratory function tests and PaO2 peaked at sixth post-transplantation month. CONCLUSION: Pulmonary transplantation is a therapeutic option to be considered for the patient with cystic fibrosis and severe involvement of his/her pulmonary disease.

[Survival of lung transplant at the Puerta de Hierro Clinic]. / Análisis de la supervivencia del trasplante pulmonar en la Clínica Puerta de Hierro.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

Update on oral lichen planus: etiopathogenesis and management.

Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma. This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management. The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory, and there is as yet no definitive treatment, but there have been advances in the control of the condition. There is no curative treatment available; immunomodulation, however, can control the condition. Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms. Follow-up may be particularly important in patients with atrophic/ulcerative/erosive affections of the tongue, the gingiva, or the buccal mucosa. Much more research is required into the genetic and environmental aspects of lichen planus, into the premalignant potential, and into the possible associations with chronic liver, and other disorders. More clinical studies are required into the possible efficacy of immunomodulatory drugs such as pentoxifylline and thalidomide.

Fluconazole response patterns in HIV-infected patients with oropharyngeal candidiasis.

A prospective study to assess the efficacy of fluconazole in oropharyngeal candidiasis in patients with HIV was conducted. A cohort of 30 HIV-positive persons with clinical and microbiologic confirmed oropharyngeal candidiasis (Candida albicans > 1000 CFU/ml) received fluconazole 100 mg daily for 7 days. In vitro antifungal susceptibility tests demonstrated a lack of fluconazole resistances. Cultures of mouth swabs were performed at the end of therapy and 2 weeks later. There was a clinical and microbiologic cure in 26 patients (87%). In 10 of these 26, cultures remained negative after 2 weeks; most of them had CD4 lymphocyte count > 400/ml. In the other 16 patients (53%), cultures showed a microbiologic relapse 2 weeks after treatment. In spite of clinical improvement, treatment failure was observed in four patients, all of them with CD4 lymphocyte count < 50 ml.

Functional consequences of partial glossectomy.

The postsurgical deglutition, oral suction, and speech capabilities of 11 patients who had undergone partial glossectomy for squamous cell carcinoma of the lateral aspect of the tongue were compared with that of 20 healthy control subjects. Volume swallowed per second and speech quality were significantly correlated with the area of tongue removed. Three patients subjected to a second operation to improve the mobility of the residual tongue regained almost normal speech intelligibility. In general, functional performance was better than expected, which justifies a radical surgical approach to this kind of tumor.

A new expert system for histopathological diagnosis of human ovarian epithelial cancer.

A new rule-based expert system designed to assist pathologists in the histological diagnosis of human ovarian epithelial cancer has been developed. The system was implemented using the INSIGHT II+ EXPERT System Shell and runs on IBM compatible microcomputers. It operates using knowledge acquired through the literature, research and experience, formulated into a total of 195 IF-THEN rules. The WHO International Histological Classification of Tumours is being used throughout. The system can quickly focus on a differential problem, thereby reducing the time necessary to reach a conclusion. It has been tested on a set of 34 cases, previously examined by pathologists of the Metaxas Memorial Cancer Institute, and has been found to reach good agreement with the pathologists' diagnoses.

[Prospective payment per case and length of stay at coordinated private hospitals]. / Pago prospectivo por caso y duración de la estancia en hospitales privados concertados.

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

[Malignant fibrous histiocytoma of the larynx]. / Histiocitoma fibroso maligno de laringe.

Clinical description of a case of FMH in a 77 years-old man, heavy smoker and diabetic. At the beginning its appearance mimic a small polyp of the middle third of the right vocal cord. The patient refused any treatment at first, but one year later, when seen again in the office, a mass covering-up the right hemilarynx was detected and a total laryngectomy was advised and done. In spite of the correctness of the follow-up in the next six months, the unhappy commit suicide.

Estudio comparativo de tizanidina con baclofen en pacientes con espesticidad crónica / Comparative study of tizanidine and baclofen in patients with chronic spasticity

En un estudio realizado a doble ciego, randomizado, en que se comparó el efecto de tizanidina (TZ) con baclofén (BF), en 27 pacientes con espasticidad crónica de diferentes etiologías (grupo TZ n=14 y grupo BF n=13), se observó que ambas drogas produjeron ligeras mejorías en varios de los ítems estudiados. Aunque no se registraron diferencias significativas entre los resultados de un grupo comparado con el otro, se evidenció un efecto favorable de ambos fármacos (P<0,05) sobre el tono muscular, la eficiencia personal y la intensidad de los espasmos. En este último ítem en particular, fue algo más acentuada la tendencia a la mejoría observada con TZ. En la evaluación final, hecha por el médico, se consideró que la eficacia del tratamiento fue buena en 3 pacientes del grupo TZ y 1 del grupo BF, moderada en 6 pacientes del grupo TZ contra 7 del grupo BF y deficiente en 2 del grupo TZ contra 3 del BF. En la evaluación efectuada por los pacientes se consideró como buena la eficacia del tratamiento en 8 casos del grupo TZ, contra 6 del grupo BF. Si bien los efectos colaterales fueron en general moderados, 3 pacientes del grupo TZ y 2 del grupo BF debieron suspender el tratamiento a consecuencia de los mismos. En base a estos resultados puede concluirse que, en este tipo de pacientes particularmente difíciles de tratar, TZ resultó de una efectividad y tolerancia semejante o ligeramente superior a BF.