Carotid atherosclerosis in virologically suppressed HIV patients: comparison with a healthy sample and prediction by cardiovascular risk equations.

OBJECTIVES: To compare the prevalence of carotid atherosclerosis in virologically suppressed HIV patients with that of a community sample, and to evaluate the capacity of various cardiovascular risk (CVR) equations for predicting carotid atherosclerosis. METHODS: This was a cross-sectional study with two randomly selected groups: HIV patients from an HIV unit and a control group drawn from the community. Participants were matched by age (30-80 years) and sex without history of cardiovascular disease. Carotid plaque, common carotid intima-media thickness (cc-IMT) and subclinical atherosclerosis (carotid plaque and/or cc-IMT > 75th percentile) were assessed by carotid ultrasound. The Systematic Coronary Risk Evaluation (SCORE), Framingham, REGICOR, reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), and COMVIH equations were applied, and their abilities to predict carotid plaque were compared using the area under the curve (AUC). RESULTS: Each group included 379 subjects (77.8% men, age 49.7 years). Duration of antiretroviral therapy was 15.5 years. There were no differences between the groups for carotid plaque (HIV, 33.2%; control, 31.3%), mean cc-IMT (HIV, 0.63 mm; control, 0.61 mm) or subclinical atherosclerosis (HIV, 42.9%; control, 47.9%). Thymidine analogues were independently associated with subclinical atherosclerosis in HIV-infected patients. CVR equations revealed AUCs between 0.715 and 0.807 for prediction of carotid plaque; prediction was better in the control group and did not improve when HIV-adapted scales were used. CONCLUSIONS: The features of carotid atherosclerosis did not differ between the HIV-infected and the control group, although CVR equations were more predictive for carotid plaque in controls than in HIV-infected patients. HIV-specific equations did not improve prediction.

A randomized controlled double-blind study of rotigotine on neuropsychiatric symptoms in de novo PD.

Management of apathy, depression and anxiety in Parkinson's disease (PD) represents a challenge. Dopamine agonists have been suggested to be effective. This multicenter, randomized (1:1), double-blind study assessed the 6-month effect of rotigotine versus placebo on apathy, depression and anxiety in de novo PD. The primary outcome was the change of apathy, measured with the LARS. The secondary outcomes were the change in depression and anxiety, measured with BDI-2 and STAI-trait and state. Forty-eight drug-naive PD patients were included. The primary outcome was not reached, with a surprisingly high placebo effect on apathy (60%). There was no significant difference in the change of depression at 6 months between rotigotine and placebo. Trait-anxiety was significantly improved by rotigotine compared to placebo (p = 0.04). Compared to placebo, low dose rotigotine significantly improved trait anxiety, but not apathy and depression. The major placebo effect on apathy points towards the importance of a multidisciplinary and tight follow-up in the management of neuropsychiatric symptoms.

Moderate alcohol consumption is associated with increased radiological progression in women, but not in men, with early rheumatoid arthritis: results from the ESPOIR cohort (Étude et Suivi des Polyarthrites Indifférenciées Récentes).

OBJECTIVE: We conducted this study to determine whether alcohol consumption influences radiological progression in early rheumatoid arthritis (RA). METHOD: Patients fulfilling the European League Against Rheumatism/American College of Rheumatology 2010 criteria in the early arthritis cohort ESPOIR (Étude et Suivi des Polyarthrites Indifférenciées Récentes) were included in this study. Alcohol consumption was collected at baseline and at each visit. We classified alcohol consumption into three groups: abstinent (0 g/day), moderate (≤ 20 g/day for women, ≤ 30 g/day for men), and abuse (> 20 g/day for women, > 30 g/day for men). The primary outcome was the occurrence of radiological progression, defined as an increase ≥ 5 points in the total Sharp/van der Heijde score. We investigated whether alcohol consumption is predictive of radiological progression at 1, 3, and 5 years by univariate and multivariate analysis adjusted for age, baseline erosion, rheumatoid factor, anti-citrullinated peptide antibody, smoking status, body mass index, and treatment with leflunomide or methotrexate and biologics. RESULTS: The study included 596 patients. When considering the influence of gender on the interaction between alcohol consumption and radiological progression, we showed a deleterious effect of moderate consumption in women [odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.01; 2.96, p = 0.045] and a trend towards a protective effect of moderate consumption in men (OR = 0.50, 95% CI 0.21; 1.16, p = 0.106) in multivariate analysis. CONCLUSION: Our data suggest a deleterious effect of moderate consumption of alcohol on radiological progression in women, but not in men, with early RA.

Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients.

This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period. Mortality was 5.9% (11/186 patients). Mean age was 36 years (range: 13-87). Seventy-eight percent (145 patients) suffered stab wounds. Most patients were hemodynamically stable or stabilized upon arrival at the hospital (163 patients: 87.6%). Six resuscitative thoracotomies were performed, five for gunshot wounds, one for a stab wound. When abdominal exploration was necessary, laparotomy was chosen most often (78/186: 41.9%), while laparoscopy was performed in 46 cases (24.7%), with conversion to laparotomy in nine cases. Abdominal penetration was found in 103 cases (55.4%) and thoracic penetration in 44 patients (23.7%). Twenty-nine patients (15.6%) had both thoracic and abdominal penetration (with 16 diaphragmatic wounds). Suicide attempts were recorded in 43 patients (23.1%), 31 (72.1%) with peritoneal penetration. Two patients (1.1%) required operation for delayed peritonitis, one who had had a laparotomy qualified as "negative", and another who had undergone surgical exploration of his wound under general anesthesia. In conclusion, management of clear-cut or suspected penetrating injury represents a medico-surgical challenge and requires effective management protocols.

Electronegative LDL induces priming and inflammasome activation leading to IL-1ß release in human monocytes and macrophages.

BACKGROUND: Electronegative LDL (LDL(−)), a modified LDL fraction found in blood, induces the release of inflammatory mediators in endothelial cells and leukocytes. However, the inflammatory pathways activated by LDL(−) have not been fully defined. We aim to study whether LDL(−) induced release of the first-wave proinflammatory IL-1ß in monocytes and monocyte-derived macrophages (MDM) and the mechanisms involved. METHODS: LDL(−) was isolated from total LDL by anion exchange chromatography. Monocytes and MDM were isolated from healthy donors and stimulated with LDL(+) and LDL(−) (100 mg apoB/L). RESULTS: In monocytes, LDL(−) promoted IL-1ß release in a time-dependent manner, obtaining at 20 h-incubation the double of IL-1ß release induced by LDL(−) than by native LDL. LDL(−)-induced IL-1ß release involved activation of the CD14-TLR4 receptor complex. LDL(−) induced priming, the first step of IL-1ß release, since it increased the transcription of pro-IL-1ß (8-fold) and NLRP3 (3-fold) compared to native LDL. Several findings show that LDL(−) induced inflammasome activation, the second step necessary for IL-1ß release. Preincubation of monocytes with K+ channel inhibitors decreased LDL(−)-induced IL-1ß release. LDL(−) induced formation of the NLRP3-ASC complex. LDL(−) triggered 2-fold caspase-1 activation compared to native LDL and IL-1ß release was strongly diminished in the presence of the caspase-1 inhibitor Z-YVAD. In MDM, LDL(−) promoted IL-1ß release, which was also associated with caspase-1 activation. CONCLUSIONS: LDL(−) promotes release of biologically active IL-1ß in monocytes and MDM by induction of the two steps involved: priming and NLRP3 inflammasome activation. SIGNIFICANCE: By IL-1ß release, LDL(−) could regulate inflammation in atherosclerosis.

Telemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control?

AIM: In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS: Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS: Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION: The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.

[Treatment of head and neck squamous cell carcinoma of an unknown primary (HNCCUP): oncologic analysis of 35 cases]. / Traitement des adénopathies cervicales malignes en apparence primitive (AMAP): résultats carcinologiques à propos de 35 cas.

OBJECTIVE: The aim of our study was to perform an oncologic analysis of patients treated for head and neck squamous cell carcinoma of an unknown primary (HNCCUP). PATIENTS AND METHODS: 35 cases were included in our monocentric restrospective study (1999-2010). All patients had a complete clinical exam as well as head, neck and chest CT scans. The primary tumour remained undetected after panendoscopy 25 patients underwent a routine tonsillar biopsy ipsilateral to the lymphadenopathy. In 9 cases (36%), an invasive squamous cell carcinoma was detected on pathological examination. These patients were excluded from further study. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were also performed using Cox's regression model. RESULTS: The therapeutic management of patients' majority (73%) consisted of lymphadenectomy with frozen section examination which confirmed the presence of an invasive squamous carcinoma in the resected lymph node(s). This was followed by ipsilateral neck dissection and radiotherapy or radiochemotherapy. Patients with unresectable lymph node(s) underwent exclusive radiochemotherapy. Specific survival rates at 1, 3 and 5 years were respectively 77%, 52% and 47%. The median survival time was 3 years. The comparison of univariate and multivariate survival curves confirmed that the lymph node status is an important factor for survival (HR 8.3 [2.03-33.96]). CONCLUSION: Our results are consistent with those found in the medical literature. HNCCUP has a poor prognosis which correlates with the lymph node status.

Community-acquired invasive aspergillosis and outdoor filamentous fungal spore load: a relationship?

The daily number of outdoor spores was counted and the cases of community-acquired invasive aspergillosis (IA) were observed over a period of 31 months. The outdoor fungal load preceding IA occurrences was significantly higher than that measured during IA-free periods, underlining the importance of preventive measures to protect high-risk patients, even at home.

Prevalence of metabolic syndrome among human immunodeficiency virus-infected subjects is widely influenced by the diagnostic criteria.

BACKGROUND: The aim of this study was to compare the prevalence of metabolic syndrome in human immunodeficiency virus (HIV)-infected patients treated with highly active antiretroviral therapy (HAART), using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), European Group for the Study of Insulin Resistance (EGIR), and International Diabetes Federation (IDF) definitions. METHODS: A cross-sectional study was carried out with 159 consecutive adult HIV-infected subjects (120 males and 39 females) under HAART. Anthropometric and laboratory parameters were measured by standard methods. Hyperinsulinemia was defined by a fasting concentration >75th percentile of values obtained in healthy individuals (107.5 pmol/L). RESULTS: The prevalence of ATP III-defined metabolic syndrome was 10.1%; it was 28.3% according to EGIR criteria and 15.1% using the IDF definition. The concordance between the definitions was low (kappa coefficient ranging between 0.134 and 0.296). All subjects with EGIR-defined metabolic syndrome had hyperinsulinemia, but only 50% of those with ATP III-defined metabolic syndrome and 62.5% in the IDF metabolic syndrome population had hyperinsulinemia. CONCLUSIONS: The inclusion of hyperinsulinemia as a criterion in the EGIR metabolic syndrome definition made it more discriminative than the ATP III definition, both in men and women, and than the IDF definition in men to identify metabolic syndrome in HIV-infected subjects under HAART.

[Prospective comparative study on 50 patients between microsurgical sublabial transsphenoidal approach and endoscopic endonasal transsphenoidal approach]. / Comparación del abordje transesfenoidal microquirúrgico frente al abordaje endonasal transesfenoidal endosócpico. Estudio prospectivo de 50 pacientes.

OBJECTIVE: Compare the standard transsphenoidal sublabial microscopic approach with the endoscopic transsphenoidal approach concerning the tumoral invasiveness and resection, complications of the approaches and time of post operative hospitalisation. MATERIAL AND METHODS: We realized a prospective, non randomised study with 50 patients. They were operated between 2002 and 2006. All the patients had sellar lesions with different grades of invasiveness of the cavernous sinus as classified by Knosp. The variables included in our study were tumoral invasiveness and operative resection (total, subtotal and partial), optic nerve lesion, postoperative panhypopituitarism, CSF fistula, cranial nerves deficits, epistaxis, meningitis, diabetes insipidus and carotid artery lesion. Our series included 27 males and 23 females ranging from 19 to 80 years old (48 mean). In 23 patients we used the standard sublabial microscopic approach (two patients were excluded) and for 25 patients we used the endoscopic approach. The mean follow up was of 12 months. RESULTS: In our experience the endoscopic technique presents a higher percentage of total resection comparing to the sublabial microscopic approach (60% versus 34.8%) and higher percentage of subtotal resections (32% versus 26%) with a statistical significant difference (p=0.033). The time of hospitalisation was significant shorter for the endoscopic approach group (p=0.001), diminishing by half of the time (3 days) of the microscopic approach group. Concerning the tumoral invasiveness and complications we did not appreciate any significant dissimilarity. We appreciated that a higher grade of invasiveness augments by 3.59 the risk of an unsuccessful surgery. DISCUSSION AND CONCLUSION: In our experience the endoscopic technique may favour a better tumoral resection and shorter time of hospitalisation. We did not appreciate differences concerning the complications.

Low frequency electromagnetic radiation and hearing.

OBJECTIVE: To analyse the possible impact of low and extremely low frequency electromagnetic fields on the outer hairs cells of the organ of Corti, in a guinea pig model. MATERIALS AND METHODS: Electromagnetic fields of 50, 500, 1000, 2000, 4000 and 5000 Hz frequencies and 1.5 microT intensity were generated using a transverse electromagnetic wave guide. Guinea pigs of both sexes, weighing 100-150 g, were used, with no abnormalities on general and otic examination. Total exposure times were: 360 hours for 50, 500 and 1000 Hz; 3300 hours for 2000 Hz; 4820 hours for 4000 Hz; and 6420 hours for 5000 Hz. One control animal was used in each frequency group. The parameters measured by electric response audiometer included: hearing level; waves I-IV latencies; wave I-III interpeak latency; and percentage appearance of waves I-III at 90 and 50 dB sound pressure level intensity. RESULTS: Values for the above parameters did not differ significantly, comparing the control animal and the rest of each group. In addition, no significant differences were found between our findings and those of previous studies of normal guinea pigs. CONCLUSION: Prolonged exposure to electromagnetic fields of 50 Hz to 5 KHz frequencies and 1.5 microT intensity, produced no functional or morphological alteration in the outer hair cells of the guinea pig organ of Corti.

Modificaciones aterogénicas de las partículas LDL en los pacientes con diabetes / Atherogenic modifications of LDL particles in diabetic patients

Las manifestaciones clínicas de la enfermedad arteriosclerótica constituyenla principal complicación en la población con diabetes mellitus,y son responsables del 50-70% de las muertes en estos pacientes.No se conocen con precisión los mecanismos responsables del desarrolloacelerado de arteriosclerosis en la diabetes, aunque los procesosderivados de la situación de hiperglucemia y de dislipemiadiabética desempeñan un papel importante. Ambos mecanismos estánestrechamente relacionados y pueden considerarse como doscaras de la misma moneda. Existen modifi caciones cualitativas de laslipoproteínas de baja densidad (LDL) bien conocidas, como el incrementode la proporción de partículas LDL pequeñas y densas o departículas con mayor carga electronegativa. Estas modifi caciones,que alteran las características fi sicoquímicas y biológicas de las partículasLDL, están implicadas en los mecanismos comunes mediantelos que la hiperlipemia y la hiperglucemia producen un aumento delos procesos arterioscleróticos en los pacientes con diabetes(AU)

Clinical manifestations derived from atherosclerosis are the leadingcomplications in patients with diabetes mellitus, being responsible of50-70% of deaths in these individuals. The precise link between accelerateddevelopment of atherosclerosis and diabetes is not completelyunderstood, although mechanisms related with hyperglycemiaand diabetic dyslipidemia play an important role. Both mechanismsare closely related and frequently are two faces of the same coin.There are well-recognized qualitative modifications of low-densitylipoproteins, such as an increased percentage of small, dense LDLparticles with higher electronegative charge. These modifications disturbingphysicochemical and biological characteristics of LDL particlesand are involved in the common mechanisms by which dyslipidemiaand hyperglycemia promote increased atherosclerosis indiabetic patients(AU)

A prospective study of quality of life in 77 type 1 diabetic patients 12 months after a hospital therapeutic educational programme.

AIM: The aim of therapeutic education includes improvement of quality of life (QOL). However, the majority of studies are focused on biomedical or behavioural markers only. We performed a prospective study to assess QOL in adult type 1 diabetic patients for one year following a hospital educational programme. METHODS: During this prospective single-centre study, QOL was assessed by the DQOL questionnaire in 77 consecutive patients at baseline and three, six and 12 months after a three-day educational programme. RESULTS: The rate of response was 72.7% (n=55) at three months and 67.5% (n=52) at one year. The overall DQOL score improved at three months from 65.6+/-10.1 to 70.1+/-10.4 (P<0.001), and at one year from 65.1+/-10.4 to 68.5+/-11.7 (P=0.001). Patients exhibited greater satisfaction (66.3+/-15 versus 75.3+/-14.1, P<0.001), a diminished impact of diabetes (61.2+/-10 versus 63.4+/-9.6, P=0.016) as well as of anxiety related to diabetes (67.6+/-18.6 versus 73.6+/-16.2, P=0.009) at three months. This significant improvement was maintained at one year. Improvement in DQOL score at three months was positively correlated with a reduction in HbA(1c) (7.6+/-1.4% versus 7.8+/-1.4%, P=0.032), (r=-0.293, P<0.037). Patients with serious hypoglycaemia before the programme appeared to derive greater benefit from therapeutic education (OR: 9.88, 95% CI: 1.094-89.20). CONCLUSION: QOL assessed by DQOL improved after therapeutic education and during the following year. The improvement in DQOL score at three months correlated with a reduction in HbA(1c) levels and appeared to particularly benefit to those who had severe hypoglycaemia before the programme.

One-year efficacy and safety of Web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: the PumpNet study.

AIM: Conventional follow-up of type 1 diabetic patients treated with continuous subcutaneous insulin infusion (CSII) was compared with intensive coaching using the Web and the cellular phone network for retrospective data transmission and short message service (SMS). METHODS: Thirty poorly controlled patients (HbA1c 7.5-10%) were enrolled in a bicenter, open-label, randomized, 12-month, two-period, crossover study. After a 1-month run-in period, 15 patients were randomly assigned to receive weekly medical support through SMS based upon weekly review of glucose values, while 15 patients continued to download self-monitored blood glucose (SMBG) values on a weekly basis without receiving SMS. After 6 months, patients crossed over to the alternate sequence for 6 additional months. Visits at the clinic were maintained every 3 months. RESULTS: Patients with long-standing inadequately controlled diabetes (24 +/- 13 years) were included. A non-significant trend to reduction in HbA(1c) (-0.25+/-0.94%, P<0.10) and mean glucose values (-9.2+/-25 mg/dl, P=0.06) during the 6-month SMS sequence was observed as compared with the no-SMS period. No safety issue (hypoglycemia, glucose variability) was reported. Adherence to SMBG was not affected by the trial. Quality of life analysis suggests a significant improvement in DQOL global score, as well as the DQOL satisfaction with life subscale, during the SMS sequence. CONCLUSIONS: Long-term telemedical follow-up of insulin pump-treated patients using a cellular phone-, SMS- and Web-based platform is feasible, safe, does not alter quality of life and associated with a trend toward improved metabolic control.

[Tracheal infection following oncological surgery in larynx and pharynx]. / Colonización traqueal en cirugía oncológica de laringe y faringe.

Surgical wound infection is one of the most frequent complications in pharyngo-laryngeal external surgery. They are usually polimicro with gram-positive, negative both aerobial and anaerobial microrganisms. The trachea is usually sterile and contamination is due to the intoduction during intubation of germs from the oropharyngeal area. A retrospective study was performed including 40 patients with pharyngo-laryngeal carcinoma. When the tracheostomy was done a culture from the internal trachea wall was obtained for micro study. Only one patient had an sterile culture from the trachea. There were 3 patients with just one microorganism and all the rest had at least two, being mixed aerobial and anaerobial flora the most frequent.

The inflammatory properties of electronegative low-density lipoprotein from type 1 diabetic patients are related to increased platelet-activating factor acetylhydrolase activity.

AIMS/HYPOTHESIS: Chemical and biological characteristics of LDL(-) from type 1 diabetic subjects were analysed. The diabetic patients were studied during poor and optimised glycaemic control. MATERIALS AND METHODS: Total LDL was subfractionated into electropositive LDL(+) and electronegative LDL(-) by anion exchange chromatography and the lipid and protein composition of the two determined. RESULTS: LDL(-) differed from LDL(+) in that it had higher triglyceride, non-esterified fatty acids, apoE, apoC-III and platelet-activating factor acetylhydrolase (PAF-AH), as well as lower apoB relative content. No evidence of increased oxidation was observed in LDL(-). LDL(-) increased two-fold the release of interleukin 8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) in endothelial cells, suggesting an inflammatory role. Optimisation of glycaemic control after insulin therapy decreased the proportion of LDL(-), but did not modify the composition of LDL subfractions, except for a decrease in PAF-AH activity in LDL(-). The possibility that LDL(-) could be generated by non-enzymatic glycosylation was studied. Fructosamine and glycated LDL content in LDL subfractions from type 1 diabetic patients was greater than in LDL subfractions isolated from normoglycaemic subjects, and decreased after glycaemic optimisation in both subfractions. However, no difference was observed between LDL(+) and LDL(-) before and after insulin therapy. CONCLUSIONS/INTERPRETATION: These results provide evidence that LDL(-) is not produced by glycosylation. Nevertheless, LDL(-) from diabetic patients displays inflammatory potential reflected by the induction of chemokine release in endothelial cells. This proatherogenic effect could be related to the high PAF-AH activity in LDL(-).

[Hodgkin and Non-Hodgkin lymphomas in otorhinolaryngology]. / Linfomas Hodgkin y No-Hodgkin en otorrinolaringología.

Lymphomas of the head and neck arise in lymph nodes and extranodal areas as Waldeyer ring, nasal cavity, thyroid gland and salivary glands. Though anatomically in close proximity, lymphomas presenting at the ENT area have different clinical characteristics if they are Hodgkin or Non-Hodgkin. We included 31 patients with the diagnosis of lymphoma and diagnosed in our Department between 1999 and 2002. We studied all the different variables that differentiate Hodgkin and Non-Hodgkin's lymphoma. Both types of lymphoma usually present as a cervical mass. Non-Hodgkin lymphoma have extranodal involvement more frequently and also a more advance disease at diagnosis. It is important to include the lymphoma in the differential diagnosis of any cervical mass or ENT lesion.

[Pharyngeal globe and pharyngo-laryngeal reflux]. / Globo faríngeo y reflujo faringo-laríngeo.

The globus sensation is one of the most frequent complaints in a basic ENT clinic. The etiology is still unknown, although some hypotheses have been suggested such as: psychological abnormalities, esophageal and cricopharyngeal muscle disfunction and the laryngopharyngeal reflux. Laryngopharyngeal reflux is the most frequent pathology related to the globus feeling. We've tried in this study to determine the incidence of laryngopharyngeal reflux in a group of 30 patients with globus feeling. We found 26.7% of these patients with an abnormal pH monitoring test.