[Study of in-patient hospital stay following total laryngectomy: multivariable retrospective analysis of a 442 total laryngectomies]. / Estudio de la estancia tras laringuectomía total: análisis retrospectivo multivariable de 442 laringuectomías totales.

INTRODUCTION: Pharyngocutaneous salivary fistula is the most common complication following total laryngectomy. Fistulae can lead to prolonged hospitalization and increased patient morbidity. OBJECTIVE: To investigate those factors related to increased length of stay following total laryngectomy. To further analyze those related with fistula after surgery. MATERIAL AND METHODS: Retrospective study on 442 patients who undenwent total laryngectomy. Study of the covariance (ANCOVA). Uni and multivariate analysis of factors related to salivary fistula. RESULTS: We identified alcohol intake, year of surgery and salivaly fistula as factors independently related with increased length of stay at the hospital. Factors independently related with fistula were alcohol intake, tumors affecting tongue base or pyriform sinus, surgeon, fever in the inmediate postoperative period, or wound closure using fibrin blue (negative association with the later). CONCLUSIONS: Pharyngocutaneous salivary fistula increases three times hospital length of stay in patients undergoing total laryngectomy. We identified the surgeon as the factor more closely related with this complication, and we suggest the need to create well-defined head and neck cancer groups to deal with these surgical procedures.

Differential metabolic response to 48 h food deprivation at different periods of pregnancy in the rat.

Since during pregnancy the mother switches from an anabolic to a catabolic condition, the present study was addressed to determine the effect of 48 h food deprivation on days 7, 14 and 20 of pregnancy in the rat as compared to age matched virgin controls. Body weight, free of conceptus, decreased with food deprivation more in pregnant than in virgin rats, with fetal weight (day 20) also diminishing with maternal starvation. The decline of plasma glucose with food deprivation was greatest in 20 day pregnant rats. Insulin was highest in fed 14 day pregnant rats, and declined with food deprivation in all the groups, the effect being not significant in 7-day pregnant rats. Food deprivation increased plasma glycerol only in virgin and 20 day pregnant rats. Plasma NEFA and 3-hydroxybutyrate increased with food deprivation in all groups, the effect being highest in 20 day pregnant rats. Food deprivation decreased plasma triacylglycerols in 14 day pregnant rats but increased in 20 day pregnant rats. In 20-day fetuses, plasma levels of glucose, NEFA and triacylglycerols were lower than in their mothers when fed, and food deprivation caused a further decline in plasma glucose, whereas both NEFA and 3-hydroxybutyrate increased. Liver triacylglycerols concentration did not differ among the groups when fed, whereas food deprivation caused an increase in all pregnant rats and fetuses, the effect being highest in 20-day pregnant rats. Lipoprotein lipase (LPL) activity in adipose tissue was lower in 20 day pregnant rats than in any of the other groups when fed, and it decreased in all the groups with food deprivation, whereas in liver it was very low in all groups when fed and increased with food deprivation only in 20 day pregnant rats. A significant increase in liver LPL was found with food deprivation in 20 day fetuses, reaching higher values than their mothers. Thus, the response to food deprivation varies with the time of pregnancy, being lowest at mid pregnancy and greatest at late pregnancy, and although fetuses respond in the same direction as their mothers, they show a specific response in liver LPL activity.

Hodgkin's disease of middle ear and mastoid.

We present a case of Hodgkin's disease of the mastoid associated with upper cervical lymph node involvement without disseminated disease. This patient was treated with chemotherapy alone and lesions responded rapidly. At present the patient is well, with no evidence of recurrence or extension of this disease. Hodgkin's disease of the middle ear and mastoid is an extremely rare disease. After a wide search in the literature no cases of Hodgkin's disease arising in the middle ear and mastoid have been found.

[Sudden deafness and Barlow disease]. / Surdité brusque et maladie de Barlow.

From January 1993 to December 1994 twelve patients were evaluated for sudden hearing loss. The median age was 49 years with a range of 18 to 71. All had severe or profound initial hearing loss. The incidence of bilateral disease was 25%. Total deafness occurred in five (33%) ears. Nine (75%) patients had vestibular symptoms and eight (67%) admitted experiencing tinnitus. Two-dimensional echocardiography revealed mitral prolapse in eight (67%) patients; another patient showed moderate to severe ischemic left ventricular dysfunction with apical aneurysm.

[Bilateral acoustic neurinomas (neurofibromatosis 2)]. / Neurinomas acústicos bilaterales (neurofibromatosis 2).

Type 2 neurofibromatosis is a rare genetic condition, with an autosomal (dominant) inheritance and a prevalence of 1/50.000 inhabitants, characterized by bilateral acoustic neuromas. We present here a 16-year-old patient with a greater growth of the right-sided neuroma. A review of the literature, regarding incidence, clinical presentation, diagnostic clues and treatment is also included.

[The usefulness of sucralfate in postoperative improvement of children's tonsillectomy]. / Utilidad del sucralfato en la mejora del posoperatorio de la amigdalectomía infantil.

INTRODUCTION: Sucralfate is an effective agent in the treatment of peptic ulcer, mixing up the fibrinous exudate of duodenal ulcer to form a protective barrier promoting its healing. Similarly the deprived muscle in the tonsillar bed results protected and consequently bring down the post-surgical morbidity. OBJECTIVE: The aim of this study has been to ascertain the suitability of sucralfate in alleviating symptoms after tonsil's removal. MATERIAL AND METHODS: 205 children were included in the study and randomly postoperative treated with sucralfate. A lot of different parameters were controlled afterwards such as days with pain, taken of analgesics, return to normal diet, fever, bloody saliva, halitosis or vomits. RESULTS: There was a significant association between the use of sucralfate and less days with sore throat, less pain and analgesia required. CONCLUSIONS: The use of sucralfate means and efficient measure in order to alleviate the pain and postoperative discomfort associated with tonsils removal, being a cheap drug and without having topical after-effects.

[Tonsillectomy by electrical dissection versus blunt dissection: a study of 838 cases (Randomized trial of 207 cases and non-randomized prospective study of 631 cases]. / Amigdalectomía por electrodisección frente a disección roma: estudio de 838 casos. (Estudio aleatorizado de 207 casos y prospectivo, no aleatorizado, de 631 casos).

Tonsillectomy is one of the most common operations performed in the world and various techniques and instruments have evolved for this purpose. We report the results of two prospective studies: in the first study, blunt dissection was compared with electrodissection tonsillectomy (207 cases), and in the second study, 631 patients had their tonsils removed using only the electrodissection technique. Although electrodissection tonsillectomy is not common in Spain, in our experience it is simple, reliable and easy to learn. Its advantages include minimal bleeding, shorter operating time, and less postoperative hemorrhage. The postoperative morbidity is similar to that of blunt dissection.

[The clinical importance of bacteremia during tonsillectomy]. / Importancia clínica de la bacteremia durante la amigdalectomía.

INTRODUCTION: Post-tonsillectomy bacteraemia is a well recognized aetiological factor in streptococcal endocarditis. Prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy. OBJECTIVE: The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia, identify the associated organisms, and review the suitability of penicillin in prophylactic regimens. MATERIAL AND METHODS: 102 children were included. Blood culture samples were taken after removal of the first tonsil, which was randomly electrodissected or blunt dissected. Statistical analysis was performed using ANOVA. RESULTS: Of the 102 patients included in the study, 41 (40.1%) had positive post-tonsillectomy blood cultures. Haemophilus influenzae was isolated from 23 (56%) of the positive cultures and Streptococcus viridans from 15 (36.5%). Twenty-five percent of H. influenzae and 50% of the viridans group produced beta-lactamase. CONCLUSIONS: A beta-lactamase stable antibiotic would be more appropriate than penicillin for prophylaxis during tonsillectomy.

["Usual" morbidity of pediatric tonsillectomy: a study of 126 cases]. / Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos.

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems.

[Hypopharynx and larynx basaloid squamous carcinoma: our experience with 6 cases]. / Carcinoma basaloide escamoso de laringe e hipofaringe: presentación de una serie de 6 casos.

INTRODUCTION: Basaloid squamous carcinoma (BSC) of the head and neck is an uncommon, recently described variant of epidermoid carcinoma. BSC appears biologically with a greater propensity to local aggressiveness and metastatic potential than the conventional type. OBJECTIVES: To determine the incidence of BSC of the larynx and hypopharynx in our area, and to evaluate its behavior and prognosis. PATIENTS & METHODS: 272 cases of squamous carcinoma of the larynx and hypopharynx were reviewed and 6 diagnosis of BSC were made, corresponding to 6 tumors in 5 patients. Their clinical records were analyzed. An immunohistochemical study was performed, including antibodies against cytokeratins (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), epithelial markers (EMA, CEA, Ber-EP4), vimentin and three neuroendocrine markers: neuron-specific enolase, chromogranin and synaptophisin. Bcl-2 expression was also investigated. RESULTS: Most tumors were supraglottic. 5 out of 6 tumors were clinically benign, without any metastases or recurrence after exclusive surgical resection and a follow-up ranging 42 to 142 months. We detected a trend toward a primitive pattern of keratin expression. All tumors were stained with EMA and CEA MoAbs, but we could not find Ber-EP4 nor endocrine markers staining in any of them. However, BCL-2 expression was widely found in 4 out of 5 tumors immunostained. CONCLUSION: It seems to be a progressive dedifferentiation of the basaloid cell component, probably a subpopulation with more primitive features responsible of the aggressiveness reported in the literature. However, the surprising good prognosis in most of our cases makes necessary more studies and wider series to confirm our data.

[Hypothyroidism in patients treated for laryngeal cancer: preliminary results]. / Hipotiroidismo en pacientes tratados de cáncer de laringe: resultados preliminares.

OBJECTIVE: The reported incidence of hypothyroidism following surgery and/or irradiation for laryngeal cancer varies widely and the condition often is misdiagnosed. This study examines the incidence of thyroid dysfunction in patients with laryngeal cancer. MATERIAL AND METHODS: Thyroid function tests were carried out in 75 patients with stage III and IV laryngeal carcinoma who were treated in our center with surgery (13 cases), radiotherapy (13 cases), or surgery and radiotherapy (49 cases) at least 18 months earlier. The clinical and histological variables recorded included T4 and TSH concentrations. Univariate and multivariate analysis was carried out with the BMDP program from UCLA (1995 version) to examine the relationship between hypothyroidism and clinical and pathological factors. RESULTS: Twenty-nine patients (38.6%) had high TSH or low T4 concentrations and were diagnosed as having hypothyroidism. Hypothyroidism was significantly related with date of surgery (before 1993) and the treatment used on the neck. Thyroid function was rarely affected in patients who underwent functional neck dissection, but radical neck dissection and irradiation of the neck always were followed by hypothyroidism. CONCLUSIONS: Thyroid testing should be performed routinely in the follow-up of laryngeal cancer. Many psychological symptoms attributed to total laryngectomy may be due to hypothyroidism, an easily treated condition.

Bacteraemia during tonsillectomy: a study of the factors involved and clinical implications.

Post-tonsillectomy bacteremia is a well-recognized aetiological factor in streptococcal endocarditis, and prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy. The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia, to identify the micro-organisms associated with it and to review the suitability of penicillin in prophylactic regimens. The relationship between positive blood cultures and several clinical parameters such as fever, vomiting, pharyngeal discomfort, or dysphagia was also analysed. Of the 102 patients included in the study, 41 (40.1%) had positive post-tonsillectomy blood cultures. Haemophilus influenzae were isolated from 23 (56%) of the positive cultures and Streptococcus viridans in 15 (36.5%). Twenty-five per cent of H. influenzae produced beta-lactamase and only 30% of streptococci of the viridans group were penicillin-sensitive. Positivity of the blood cultures was not related to fever, discomfort, surgical technique, type of tonsil, or any of the parameters studied. Bacteraemia seems to be related to traction of the tonsil before dissection rather than direct spread of bacteria into the opened vessels. Using a beta-lactamase stable antibiotic instead of penicillin for prophylaxis would be more appropriate.

Estudio de la estancia tras laringuectomía total: análisis retrospectivo multivariable de 442 laringuectomías totales / Study of in-patient hospital stay following total laryngectomy: multivariable retrospective analysis of a 442 total laryngectomies

Introducción: La fístula faringocutánea es la complicación más frecuente de la laringuectomía total. La fístula tiene un gran impacto respecto a la morbilidad y mortalidad posterior, así como en la prolongación de la estancia hospitalaria. Objetivo: Determinar los factores relacionados con la prolongación de la estancia en los pacientes que sufren una laringuectomía total. Analizar aquéllos relacionados con la aparición de la fístula postlaringuectomía total. Pacientes y métodos: Estudio retrospectivo sobre 442 pacientes que sufrieron laringuectomía total. Estudio de la covarianza (ANCOVA). Análisis uni y multivariable de los factores relacionados con la aparición de fístula salival. Resultados: La estancia prolongada se relacionó con el consumo de alcohol por parte del paciente, el año de la intervención y la aparición de fístula salival. Los factores relacionados de forma independiente con la aparición de fístula fueron: consumo de alcohol registrado, afectación de la base de lengua o seno piriforme por el tumor primitivo, el cirujano responsable de la intervención, la existencia de fiebre en el postoperatorio, el uso de Tissucol® para el cierre del colgajo (de forma negativa). Conclusiones: La presencia de una fístula triplica el tiempo de hospitalización de los laringuectomizados. El cirujano responsable de la intervención ha sido el factor que de manera más estrecha se ha relacionado con la presencia de fístulas faringocutáneas, por lo que creemos de primordial importancia la existencia de grupos oncológicos bien definidos que de forma exclusiva realicen estos procedimientos

Introduction: Pharyngocutaneous salivary fistula is the most common complication following total laryngectomy. Fistulae can lead to prolonged hospitalization and increased patient morbidity. Objective: To investigate those factors related to increased length of stay following total laryngectomy. To further analyze those related with fistula after surgery. Material and Methods: Retrospective study on 442 patients who undenwent total laryngectomy. Study of the covariance (ANCOVA). Uni and multivariate analysis of factors related to salivary fistula. Results: We identified alcohol intake, year of surgery and salivaly fistula as factors independently related with increased length of stay at the hospital. Factors independently related with fistula were alcohol intake, tumors affecting tongue base or pyriform sinus, surgeon, fever in the inmediate postoperative period, or wound closure using fibrin blue (negative association with the later). Conclusions: Pharyngocutaneous salivary fistula increases three times hospital length of stay in patients undergoing total laryngectomy. We identified the surgeon as the factor more closely related with this complication, and we suggest the need to create well-defined head and neck cancer groups to deal with these surgical procedures

Carcinoma basaloide escamoso de laringe e hipofaringe: presentación de una serie de 6 casos / Hypopharynx and larynx basaloid squamous carcinoma: our experience with 6 cases

Introducción: El carcinoma basaloide escamoso (CBE) de cabeza y cuello es una variante infrecuente de carcinoma epidermoide que se ha descrito muy recientemente, apuntándose que posee mayor agresividad y capacidad metastásica que el tipo convencional. Objetivos: El propósito de esteestudio ha sido establecer la incidencia del CBE de laringe e hipofaringe en nuestro medio en relación con las otras formas de carcinoma epidermoide, así como analizar su comportamiento biológico para determinar si representa una forma clínica más agresiva como se ha descrito en la literatura. Pacientes y métodos: Se revisaron 272 pacientes afectos de carcinoma epidermoide de laringe e hipofaringe, extrayéndose de la base de datos aquéllos con el diagnóstico histopatológico de variantes de carcinoma epidermoide. Se estudiaron las preparaciones en los casos sugerentes, dada la reciente descripción del CBE que impedía su diagnóstico en los casos más antiguos. Se extrajeron un total de 6 casos de carcinoma basaloide escamoso en 5 pacientes, de los que se revisó la historia clínica. Hemos realizado un estudio inmunohistoquímico de los cinco primeros casos, empleando una batería decitoqueratinas (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), marcadores epiteliales (EMA, CEA, Ber-EP4), vimentina y tres marcadores neuroendocrinos (enolasa neuronoespecífica, cromogranina y sinaptofisina). También se incluyó la expresión del gen Bcl-2. Resultados: Los tumores asentaron mayoritariamente en la región supraglótica. El comportamiento clínico en 4 de los 5 pacientes fue muy benigno, con crecimiento excrecente, poco infiltrante y sin metastatizar. Se detecta una tendencia a la expresión de un patrón de citoqueratinas más primitivo. Todos los tumores marcaron de forma variable con EMA y CEA. No se apreció expresión de Ber-EP4, ni tampoco de los marcadores neuroendocrinos. En cambio, el anticuerpo dirigido contra la proteína del bcl-2 marcó muy considerablemente cuatro de los cinco casos en que se envió. Conclusión: Pensamos que estos resultados indican una progresiva desdiferenciación del componente basaloide, el cual representaría una fracción constituida por elementos más primitivos, y conferiría posiblemente la mayor agresividad que aparece recogida en la mayor parte de las series informadas hasta el momento. Sin embargo, el sorprendente buenpronóstico de nuestros casos hace que sean necesarios ulteriores estudios con mayores series para confirmar los datos publicados (AU)

INTRODUCTION: Basaloid squamous carcinoma (BSC) of the head and neck is an uncommon, recently described variant of epidermoid carcinoma. BSC appears biologically with a greater propensity to local aggressiveness and metastatic potential than the conventional type. OBJECTIVES: To determine the incidence of BSC of the larynx and hypopharynx in our area, and to evaluate its behavior and prognosis. PATIENTS & METHODS: 272 cases of squamous carcinoma of the larynx and hypopharynx were reviewed and 6 diagnosis of BSC were made, corresponding to 6 tumors in 5 patients. Their clinical records were analyzed. An immunohistochemical study was performed, including antibodies against cytokeratins (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), epithelial markers (EMA, CEA, Ber-EP4), vimentin and three neuroendocrine markers: neuron-specific enolase, chromogranin and synaptophisin. Bcl-2 expression was also investigated. RESULTS: Most tumors were supraglottic. 5 out of 6 tumors were clinically benign, without any metastases or recurrence after exclusive surgical resection and a follow-up ranging 42 to 142 months. We detected a trend toward a primitive pattern of keratin expression. All tumors were stained with EMA and CEA MoAbs, but we could not find Ber-EP4 nor endocrine markers staining in any of them. However, BCL-2 expression was widely found in 4 out of 5 tumors immunostained. CONCLUSION: It seems to be a progressive dedifferentiation of the basaloid cell component, probably a subpopulation with more primitive features responsible of the aggressiveness reported in the literature. However, the surprising good prognosis in most of our cases makes necessary more studies and wider series to confirm our data (AU)

Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos / "Usual" morbidity of paediatric tonsillectomy: a study of 126 cases

La amigdalectomía pediátrica todavía sigue siendo un procedimiento muy común en la práctica otorrinolaringológica, realizándose generalmente dentro de un programa de cirugía mayor ambulatoria. El objetivo de este trabajo es la investigación de la morbilidad habitual de dicha intervención, con la finalidad de optimizar el tratamiento y la calidad de la asistencia. Se han encuestado 126 pacientes pediátricos intervenidos en nuestra Unidad de Cirugía de Día, contemplándose aspectos como la duración de las molestias a la deglución, la otalgia refleja o la halitosis, así como la existencia de hemorragias u otros motivos de consulta. Se registra un dolor faríngeo significativo que dura hasta el 3º ó 4º día en aproximadamente la mitad de los casos. A la semana, casi el 70 por ciento de los operados ya está bien, coincidiendo con el día en que un 55 por ciento comienza a comer con normalidad. Un tercio de los pacientes sufren vómitos, que suelen ser el día de la intervención. En nuestro medio, la amigdalectomía ambulatoria es un procedimiento muy seguro, con escasas complicaciones y de poca gravedad. Sin embargo, la demora en el retorno a la alimentación habitual y la relativa frecuencia de vómitos postoperatorios cuestionan en cierta forma la inclusión de la amigdalectomía dentro de los programas de Cirugía Mayor Ambulatoria, haciendo al menos necesaria la instauración de protocolos de tratamiento que minimicen dichos problemas (AU)

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems (AU)