Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomised patients: an open, randomised, crossover trial.

OBJECTIVE: This study aimed to assess individual preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomised patients. METHOD: This was an open, randomised, crossover trial for 25 days. After this first study period and a 5-day wash-out period, treatments were switched for another 25 days. RESULTS: A total of 28 patients were enrolled. Differences were found (p = 0.009) in the incidence of dermatological problems with XtraFlow (46.4 per cent) versus Provox Luna (14.3 per cent), as well as in the need to abandon the use of adhesives (46.4 per cent vs 10.7 per cent; p = 0.003). A total of 60.7 per cent of the patients preferred the Provox Luna system as their preference for heat and moisture exchanger therapy. CONCLUSION: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in patients who desire dermatological relief overnight.

Benign symmetric lipomatosis with lingual involvement: Case report and literature review.

Benign symmetrical lipomatosis (BSL) is a rare disorder characterized by diffuse, multiple, symmetric and non-encapsulated fat masses generally localized in the face, neck and upper trunk. An uncommon case of lingual affliction in BSL, presented with macroglossia, sleep apnea, dysphagia and dysartria is described. Bilateral partial glossectomy was performed, with an improvement in initial symptoms one year after surgery. Only seven other BSL cases with lingual involvement have been reported in the literature. This case report and literature review highlights that BSL with lingual affliction is extremely rare, almost exclusive for BSL Type I and affects predominantly middle-aged males from Mediterranean countries. Surgical treatment with unilateral or bilateral partial glossectomy usually restores normal tongue function, but most be accompanied with a postoperative follow up to assure that recurrence does not occur.

[Deep neck infections: etiology, bacteriology and treatment]. / Infecciones cervicales profundas: etiología, bacteriología y terapéutica.

Deep neck infections are dangerous for its potential ease to fascial spread, sepsis, and upper airway obstruction. This article reviews 77 cases of deep cervical infection, focus on etiological, clinical and therapeutic aspects. The most frequent location was the submaxillary area (29%), followed by the parapharyngeal space (28%), floor of the mouth (27%) and retropharyngeal (14%) spaces. Etiology was dental in 32%; pharyngoamigdalar infection in 27%; foreign bodies in 13%. In 22% the cause is unknown. Two or more bacteria were isolated in 72%, with Streptococcus B haemolytic being the most frequent germ. All patients were treated with intravenous broad-spectrum antibiotics. Surgical drainage was needed in 54%, and tracheotomy in 18%. Four patients developed mediastinitis, and one died as a consequence of it. The incidence of deep neck infections has decreased after the itroduction of antibiotics but they still may be lethal especially when life-threatening complications occur. Early recognition and management are necessary.

[Topical liquid nasal gel, its anatomical distribution and transport]. / Distribución anatómica y transporte de un gel líquido tópico nasal.

The objectives of this study are: 1) to assess the anatomical distribution of a topical liquid nasal gel in patients with and without rhinitis using a metered dose nasal pump, and 2) to determine whether the distribution pattern is influenced by dosage and delivery technique. Thirty-nine volunteers were evaluated, 26 without nasal inflammation and 13 with rhinitis. Patients self-administered the nasal spray according to the specifications in one fossa and incorrectly in the other one (sniffing and double doses). The findings showed that the nasal gel delivered by spray did not penetrate beyond the inferior part of the middle turbinate, regardless of delivery technique (double dose with sniffing or single dose without sniffing) and the presence or absence of inflammation.

[Endoscopic thyroidectomy: preliminary report]. / Tiroidectomía endoscópica: estudio preliminar.

The Minimally Invasive Video-Assisted Thyroidectomy, described by P. Miccoli in 1998, is a safe and feasible procedure, for the surgical treatment of thyroid nodules of less than 3.5 centimeters. After our first 11 cases, we conclude that only a large experience with the technique will reduce the operating time and the percentage of conversions into a conventional technique. But, as soon as it is possible to succeed already in the first procedures, the benefits of a good cosmetic result and less postoperative pain are evident since the beginning of the learning curve.

[Foreign bodies in ENT analysis after one year's assistance]. / Cuerpos extraños del área O.R.L. Análisis de un año de asistencia.

Foreign bodies sitting in the E.N.T.-area are the most urgencies needing immediate attention by the specialist. The AA. study the 738 cases admitted at their Department, for correlative consultations, in one year-term, because of suspicion of accidental lodgements. They arrange the whole lot in 5 not specific localizations, with the aim of consider the peculiarities of each group. In the great deal of instances the patients were worried for oropharyngeal penetration, followed by a lower number complaining of oesophageal distress. Considerations regarding the usefulness of ancillary exploratory techniques, specially the Radiology.

[Quality of life and cancer of the larynx]. / Calidad de vida y cáncer de laringe.

The quality of life of patients who underwent surgery for cancer of the larynx was analyzed. Two groups of patients were separated by the type of surgical intervention: functional surgery (supraglottic, 19 patients, and cordectomy, 11 patients) and radical surgery (total laryngectomy, 69 patients, and near-total laryngectomy, 12 patients). The Psychosocial Adjustment to Illness Scale- Self Report (PAIS-SR) was used for evaluation. No statistically significant differences in overall adjustment were found between groups. Patients did not consider the permanent stoma and voice loss to be the most important determinant of quality of life. Lack of social and family support was the most important negative factor affecting patients. The need for support groups and additional studies of quality of life to identify potential problems areas for the postoperative adjustment of patients to normal life should be addressed.

[How to make slides]. / Cómo hacer diapositivas.

Quality of oral presentation slides is based on content and design. The most common fault is presentation of slides with too much writing, or with type to small to be seen by the audience. With a few design rules and a minimum of photographic equipment, high quality slides are to be obtain. Slides are projected to be read and communicate an idea, make them nice, simple and readable; there is no need for fancy art works. Format and color are important but not the main point, and they will depend on available material, time and money.

[How to write and present a scientific work]. / Cómo escribir y presentar un trabajo científico.

The goal of a scientific work is to give to the reader clear information in the shortest time. To achieve this goal depends on the writer's technique and experience. In this article we will review the essential ingredients of a scientific paper, and which is the role of each one. We will also make some comments on lecture presentation and on paper preparation for journal submission.

[Near-total laryngectomy: multicenter experience]. / Laringuectomía casi-total: experiencia multicéntrica1.

Near-total laryngectomy (NTL) produces good functional and oncological results that are reproducible in different institutions. It is an alternative to total laryngectomy in patients with laryngeal or hypopharyngeal tumors who meet selected criteria. This study analyzed 245 patients treated with NTL in three different institutions. Functional and oncological results were remarkably consistent between the institutions. Local control in previously untreated patients was 98%. A useful voice was obtained in 80% of patients and voice quality was better than that obtained with tracheoesophageal puncture and a voice prosthesis. NTL was not recommended for salvage surgery after radiation failure because recurrences occur in up to 20% of patients.

[Supraglottic laryngectomy: 3-year and 5-year results]. / Laringectomía supraglótica: resultados a tres y cinco años.

A series of 84 patients who underwent horizontal supraglottic laryngectomy between 1980 and 1995 were analyzed. All patients were men, mean age 56 years. Neck metastases were found in 37 patients; 17 patients had stage I disease, 22 stage II, 13 stage III and 32 stage IV. One patient died in the postoperative period. Pharyngocutaneous fistula was the most frequent complication, being present in 10.7% of patients. The 3-year and 5-year survival rates were 78.9 and 74.2%, respectively. Local control was 91.6% at 3-years and 90.4% at 5-years. Local recurrences occurred in 6 patients, all of whom were salvaged by total laryngectomy and radiotherapy. Neck failure occurred in 15 patients, 2 of who were salvaged with further treatment. Second primary tumors appeared in 10 patients, 30% in the head and neck, after a mean interval of 77 months.

[Spindle cell carcinoma of the larynx]. / Carcinoma fusocelular de laringe.

A spindle cell carcinoma is a rare variant of squamous cell carcinoma often presenting as a polypoid or fungating neoplasm and characterized histologically by a biphasic pattern with foci of conventional in situ or invasive squamous cell carcinoma and a fusiform cell population with a sarcomatous appearance. Most tumors of this type appear in the head and neck areas and particularly in the larynx. We have treated seven laryngeal spindle cell carcinomas in the last ten years. The object of this article is to refer their clinical presentation, biological course, histological findings, and results of treatment.

[Experience with the HME-Provox Stomafilter in laryngectomized patients]. / Experiencia con el uso del HME-Provox Stomafilter en pacientes laringuectomizados.

Respiratory symptoms after total laryngectomy are both frequent and troublesome. Previous studies have demonstrated the positive effect of a heat and moisture exchanger (MHE) on the respiratory system in patients after total laryngectomy. In the present study we analyze the opinion of 40 total laryngectomized patients regarding the use of the MHE-Provox Stomafilter kit. Focus has been directed to speech function parameters and pulmonary symptoms. Benefits in phonatory parameters--intelligibility, fluency, pressure and telephone intelligibility, have been over 70%. Reduction in pulmonary symptoms--coughing, sputum production, forced expectoration, stoma cleaning--have also been significant. Our results support the use of MHE Provox Stomafilter for minimizing and preventing respiratory problems and increasing the quality of the voice through the tracheoesophageal puncture system.

[Second primary tumors in patients with carcinoma of the head and neck]. / Segundos tumores primarios en pacientes con carcinoma de cabeza y cuello.

With improved loco-regional control of cancer of the head and neck, second primary tumors (SPT) have an increasingly negative impact on survival. The appearance of SPT depends on the location and extension of the primary and is associated with lower survival. SPT were studied in a series of 1493 previously untreated patients with carcinoma of the head and neck and a minimum follow-up of 2 years. SPT occurred in 6.3% (96/1493). SPT were associated with the following primary tumor sites: 10.8% (57/727) larynx, 4% (6/153) hypopharynx, 4% (16/404) oral cavity, and 4% (6/153) oropharynx. Forty-three percent (42.7%) of SPT were carcinomas of the head and neck, 27% bronchogenic carcinomas, and 17.7% esophageal carcinomas. Survival at 6 months, 1 year, 3 years, and 5 years of patients diagnosed as SPT was 62%, 43%, 21%, and 16%, respectively.

[Factors affecting local and regional control and survival of carcinomas of the tongue and floor of mouth]. / Factores que afectan el control local, regional y supervivencia en carcinomas de lengua móvil y suelo de boca.

A retrospective study of 142 patients that had previous surgery for carcinoma of the tongue or floor of mouth looking into the factors that affect significantly the evolution of our patients and in which circumstances we could benefit from new therapeutic techniques. Cause specific survival at 3 and 5 years was 63.4% and 56.9% respectively. Recurrences were found locally in 32 patients (22.5%), regional in 32 (22.5%) and metastasis in 11 (7.4%). T staging had no did impact on local recurrence, but the presence of positive margins (p = 0.0323). Regional control for N0/N1 was 85% (90/106) versus 55.5% (20/36) for N2/N3 (p = 0.001). Regional control by N staging was 84.5% (73/86) for N0, 85% (17/20) for N1, 57% (30/35) for N2 and 0% for N3 (0/1). Both, N staging and number of positive nodes had a significant impact in specific survival. Positive margins and the presence of positive nodes have the greatest impact on survival and regional control. Adjuvant postoperative radiotherapy did not increase survival, but not prospective random selection was performed. To evaluate this.

[Postoperative enteral nutrition in patients with cancer of the neck and head]. / Nutrición enteral postoperatoria en pacientes con cáncer de cabeza y cuello.

Nutritional management of patients with head and neck cancer have received little attention in the literature, but its role in the management of patients undergoing surgical, chemotherapeutic, or radiotherapeutic treatment is gaining more importance. We present the nutritional results obtained in 69 patients who underwent oncological surgery for head and neck malignant tumours. Nutritional requirements were administered by enteral via, through a nasogastric tube. The results show no deterioration of the nutritional status during the postoperative period, with a positive nitrogenun balance from the beginning of the nutritional program. Results were measured using two anthropological measures (PCT and CMB) and two laboratory datas (Albuminum and transferrin).

[Appropriateness emergency hospital admissions at an ORL service of a third level hospital]. / Adecuación de los ingresos hospitalarios urgentes en un servicio de ORL de un hospital de tercer nivel.

We present a retrospective epidemiological study about an analysis of the emergencies hospital admissions in an ENT service of a tertiary hospital with high assistencial pressure, during one year. We study the parameters: date, sex, age, complementary examinations, diagnosis and appropriateness of the admission following the AEP (Appropriateness Evaluation Protocol) criteria. A remarkable finding is the high incidence (31.74%) of emergency admissions in the total admission in the ENT service. There was a low frequency of inadequate admission of patients. The appropriateness of admissions was highest for foreign bodies and respiratory distress; the lowest was for cancer patients. The most frequent appropriateness criteria was the need of drugs and/or intravenous fluids.

[Recurrence of peritracheostoma and emergency tracheotomy]. / Recidiva peritraqueostoma y traqueotomía de urgencia.

The relationship between emergency tracheotomy (ET) and stomal recurrence (SR) was evaluated in 369 patients who underwent surgery for laryngeal cancer. Emergency tracheostomy was performed in 31 patients. Age, sex, primary location, T stage, pN stage, histological grading, and time from emergency tracheotomy to definitive treatment were examined. Stomal recurrence occurred in 2.1% overall; in 1.2% of the tracheotomy-free group, and in 13% (4/31) of the emergency tracheotomy group (p < 0.0001). Recurrences were significantly more frequent in subglottic (p = 0.00007) and T3 lesions (p < 0.0001). Emergency tracheostomy often is needed in patients who have primary subglottic tumors or tumors than invade the subglottis. The relationship between ET and SR appears to be more circumstantial than causal. Aggressive local treatment is recommended in patients with subglottic lesions or subglottic tumor extension to prevent SR.

[Ambulatory septopyramidal surgery: methods, results and patient satisfaction]. / Cirugía septopiramidal ambulatoria: métodos, resultados y satisfacción de los pacientes.

Outpatient surgery is an activity that increases constantly in Otolaryngology. There are studies about some nasal surgery techniques, such as septoplasty or endonasal endoscopic performed as outpatient surgery, but so far nobody has reported any comparative analysis on the results of outpatient septorhinoplasty, although this is a frequent practice. We report our experience with 40 cases of outpatient septoplasty and 40 outpatient septorhinoplasty, performed by the same surgeon, and we make a comparative study with the same number of operations performed on in-patients with traditional surgical techniques. Aesthetic and functional results and satisfaction level in postoperative interviews were compared in both cases. No serious complications were present in either group. The number of complications, the functional and aesthetic results and the degree of patients satisfaction were similar in both groups. Septopyramidal surgery (septoplasty and septorhinoplasty) is suitable to be performed on outpatient with the same quality as in-patients.

Carcinoma epidermoide de laringe estadio IV. Evolución a largo plazo / Epidermoid carcinoma larynx in stage IV

Objetivo: Analizar supervivencia, recidiva local, regional, a distancia y segundos primarios en estadios IV de laringe tratados con cirugía y radioterapia. Material: Estudio retrospectivo de 147 pacientes tratados con cirugía ± radioterapia, con un seguimiento mínimo de 5 años. Resultados: Supervivencia global y causa específica a 5 y 10 años de 42%, 35% y 49%, 45,8% respectivamente. Control locoregional del 57,7 % y 54,7% a los 5 y 10 años. Recidivas locales 25,7%, recidivas regionales 74,2%, y metástasis a distancia 10,9%. Segundos primarios 12%, el 50% en pulmón. Se analizan factores que pueden influir en la supervivencia. Conclusiones: En nuestra experiencia, la cirugía, con radioterapia complementaria en N+, permite curar un 45% de los estadios IV de laringe. La recidiva regional es la causa más frecuente de fracaso, influida por el N+, apareciendo en los primeros 36 meses de evolución

Objective: To determine the survival, loco-regional control, distant metastases and second primary in stage IV laryngeal carcinoma treated by surgery and radiotherapy. Material: Retrospective study of 147 patients treated with surgery and radiotherapy with a 5 year minimun follow-up. Results: Overall and cause specific survival at 5 and 10 years was 42%, 35% and 49%, 45.8% respectively. Loco-regional control was 57.7 % and 54.7% at 5 and 10 years. Local recurrences presented in 25.7%, regional recurrences in 74.2%, and distant metastases 10.9%. Second primary tumors developed in 12% of the patients, 50% of the cases in the lungs. Factors related to survival are evaluated. Conclusions: In our experience, surgery with postoperative radiotherapy in N+, controls 45% of stage IV laryngeal carcinoma. Regional recurrencies are the main cause of failure, more frequent in N+ patientes, present in the first 36 months after treatment