[Surgical treatment of exostosis in the external auditory canal]. / Tratamiento quirúrgico de las exóstosis de conducto auditivo externo.

Exostoses of the external auditory canal are benign bony tumours very common in individuals who frequently participate in aquatic activities. Although most of the cases are asymptomatic, patients with more severe exostoses have recurrent episodes of external otitis and related conductive hearing loss. In the great majority of these cases, a medical treatment (aspiration and antibiotic drops) resolves the symptoms. Patients with more severe canal stenosis, resistant to medical treatment, are candidates for surgical removal of the exostoses. This report reviews our surgical experience with 45 patients, 52 ears, who have undergone surgical removal of exostoses in our Institution during the last 13 years. We describe the technique that we use a well as the results that we achieve.

[Pure red-cell aplasia associated with chronic myeloproliferative syndromes]. / Aplasia pura de serie roja asociada a síndromes mieloproliferativos crónicos.

Pure red cell aplasia is manifested by unregenerative anemia with intense erythroid hypoplasia in the bone marrow and absolute reticulocytopenia. Its association with chronic myeloproliferative syndrome (CMS) is infrequent. The appearance of both processes may or may not be simultaneous and accidental association cannot be ruled out. Two cases of pure red cell aplasia were studied; one associated to Philadelphia positive chronic chromosome myeloid leukemia and the other associated to atypical CMS. In the first case no response was obtained with prednisone alone or associated to cyclophosphamide. In the second patient treatment with danazol was not efficient, however, corticotherapy produced a positive and maintained response. Treatment of pure red cell aplasia associated to CMS must be the same as that employed when this disease is presented as isolated or associated to other processes.

[Malignant tumors of external ear. Review of cases in 1991-2001]. / Tumores malignos de conducto auditivo externo. Revisión de nuestra casuística 1991-2001.

Carcinoma of the external auditory canal is a rare tumor. Owing to the rarity of this disease, the literature provides very few publications of series. There is not a widely accepted staging system. The lack of a standarized staging system impedes meaningful interpretation of the literature. It is very difficult to compare different treatment strategies and results. The study is a retrospective case review. Seven patients with external auditory canal malignancies were studied. We used the staging system proposed by Arriaga et al. for both the Squamous cell carcinoma and non-SCC. We describe the risk factors, the symptoms, the treatment and the outcome and prognosis for our patients.

[Recurrent respiratory papillomatosis. Our experience and literature review]. / Papilomatosis respiratoria recurrente. Nuestra experiencia y revisión de la literatura.

The recurrent respiratory papillomatosis is a benign lesion induced by virus, with predisposal factors not yet clear out. Several treatment have been used, being the endoscopic surgery with laser CO2 the most used technique. We present our experience with laryngeal papillomatosis patients operated with laser CO2 in the last 15 years. The high rate of recidive in the youth pattern and the possibility of malignant degeneration in the adults charactherises this patients. Meanwhile without not other concluyent works surgery will be the first therapeutic alternative, avoiding mutilant operations, and paying attention in detecting lesions suggesting malignancy.

[Prevalence of exostoses among surfers of the Basque Coast]. / Prevalencia de exóstosis entre surfistas de la Costa Guipuzcoana.

Exostoses of the External Auditory Canal are benign bony tumours very common in individuals who frequently practice water activities. The objective [corrected] of this study is to determine the prevalence of exostoses in a population of surfers of the Basque Coast. We have studied the correlation between years surfing and the prevalence and severity of exostoses. We have done a cross-sectional epidemiological study giving a questionnaire Twenty-five of the 41 surfers had surfer's ear (61%) and the prevalence was significantly higher in those who had surfed for more than 10 years (p < 0.05). Severity was also higher in the first group (p < 0.05). The relation between the hours dedicated to the sport showed similar results. only one of the 24 cases needed surgery (4%).

[Palpation and CT to evaluate the cervical adenopathies in head and neck tumours]. / Palpación y TC para evaluar las adenopatías cervicales en los tumores de cabeza y cuello.

Lymphatic metastasis is an important prognostic factor in patients with head and neck squamous cell carcinomas. Diagnostic evaluation and treatment of this adenopathies is very important. We can use physical examination, computered tomography (CT), magnetic resonance, ultrasound... but none of these give us a 100% security. This study evaluates the accuracy of physical examination and CT in detecting cervical lymph nodes. 120 neck dissections were performed after palpation and CT of 72 patients with head and neck carcinoma. Sensitivity of palpation was 51.7 and specificity 96.7. CTs sensitivity was 65 and specificity 86.7. Both, physical examination and palpation have a high number of mistakes evaluating cervical nodes. N0 necks are still a problem for Head and Neck Surgeons.

Terminal differentiation of spontaneous rheumatoid factor-secreting B cells from rheumatoid arthritis patients depends on endogenous interleukin-10.

OBJECTIVE: The presence of serum rheumatoid factor (RF) and spontaneous RF-secreting B cells is a common feature in most patients with rheumatoid arthritis (RA). This study analyzed the cytokine(s) that controls the final maturation of B cells capable of spontaneous IgM-RF secretion in vitro. METHODS: RA patients' peripheral blood mononuclear cells (PBMC), as well as adherent and nonadherent cell fractions, were cultured, and spontaneous IgM-RF and interleukin-10 (IL-10) secretion were determined by enzyme-linked immunosorbent assay. RESULTS: The RF+ RA PBMC, but not PBMC from RF- RA patients or healthy controls, actively produced IgM-RF in a linear manner for 14 days. This activity depended on the presence of fetal calf serum and did not require cellular DNA synthesis. Spontaneous IgM-RF secretion depended on IL-10, as deduced from the following findings: 1) IL-10, but not a variety of cytokines including IL-6, restored missing IgM-RF secretion by PBMC in serum-free supplemented cultures; 2) the addition of anti-IL-10, but not anti-IL-6, blocking antibodies inhibited PBMC IgM-RF secretion, and this effect could be reversed by exogenous IL-10; and 3) RA PBMC actively produced IL-10 in vitro. The cells responsible for endogenous IL-10 production were found in the adherent cell fraction. Finally, IL-10 induced IgM-RF, but not total IgM, secretion by RA PBMC. CONCLUSION: In patients with RA, circulating B cells capable of spontaneous IgM-RF secretion require IL-10 production by adherent cells to reach terminal maturation.

Immunocytochemical demonstration of glial fibrillary acidic protein in the cortical perivascular glial sheat of the cat.

The peroxidase-antiperoxidase method was used on paraffin embedded material to demonstrate the distribution of the glial fibrillary acidic protein (GFA protein) in the perivascular glial membrane of the cortical blood vessels of cats. The nature of the dense zones was determined by ultrastructural immunocytochemistry with anti-GFA protein. Immunoreactivity was seen exclusively in the dense zones of the perivascular glia and in the astrocytic processes of the neuropil. The dense zones may exert a stabilizing function on the basal membrane during the changes in the caliber of the vessels.

[Multicentric abdominal angiofollicular hyperplasia: a clinical variant with exclusive involvement of the liver and abdominal lymph nodes]. / Hiperplasia angiofolicular multicéntrica abdominal: una variante clínica con afectación exclusiva del hígado y ganglios linfáticos abdominales.

Three patients with a non-malignant lymphoproliferative disease involving liver and abdominal lymph nodes, without peripheral lymphadenopathy, are presented. They had systemic symptoms, fever and/or arthralgia, a biochemical pattern of liver obstruction and signs of B-cell immune hyperactivity (hypergammaglobulinaemia and different autoantibodies). Abdominal lymph node enlargement was found on laparotomy; the lymph node histologic pattern was that of angiofollicular hyperplasia (AFH), malignant lymphoma being discarded. Several stages of involvement were present in all cases, made up of small lymphocytes, plasma cells, and centrofollicular cells forming portal nodules with cholangiole infiltrates in one case which gave rise to a lymphoepithelial lesion. Steroid therapy was effective in all cases, but the symptoms and the liver obstruction relapsed in two patients after steroid suppression. Persistent functional anomalies of B and T lymphocytes were present in all cases. No evidence of viral disease was seen. These patients form a clinicopathological variant of multicentric AFH on whom malignant lymphoma could be excluded only by the histological study of abdominal lymph nodes. The persistence of lymphocytosis (although polyclonal and lacking cytogenetic alterations) may suggest the possible evolution into true and malignant lymphoma in any case.

Glomerulonefritis membranosa en un caso de artritis reumatoide no tratada con oro ni D-penicilamina / Membranous glomerulonephritis in rheumatoid arthritis not treated with gold salts or D-penicillamine

El desarrollo de glomerulonefritis membranosa (GM) es relativamente frecuente en pacientes con artritis reumatoide (AR) tratados con fármacos antirreumáticos de acción lenta (FARAL) como las sales de oro o la D-penicilamina. Por otro lado, se han descrito casos de GM en sujetos con esta enfermedad no tratados con dichos fármacos. Estos casos son poco frecuentes según la bibliografía revisada. Describimos un caso de AR que desarrolla una GM sin haber recibido previamente tratamiento con ningún tipo de FARAL (AU)