[Sinonasal mucosal melanoma]. / Melanomas mucosos nasosinusales.

Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis.

Melanomas mucosos nasosinusales / Sinonasal mucosal melanoma

Los melanomas mucosos de cavidad nasal y senos paranasales son tumores raros, agresivos y presentan un mal pronóstico. El diagnóstico de sospecha se confirma mediante el estudio inmunohistoquímico con la proteína S-, HMB, vimentina y citoqueratina. Se realiza una revisión retrospectiva de 6 pacientes entre 1991 y 2005, con el diagnóstico de melanoma nasosinusal. Con una edad media de 70 años y un rango variable entre 51 y 83 años, se registran dos varones y cuatros mujeres. Se realizó cirugía en cuatro pacientes, radioterapia después de una recidiva local reintervenidad en una paciente y quimioterapia en tres pacientes. Tres de los cuatro pacientes intervenidos (75%) tuvieron una recurrencia local. En la actualidad la supervivencia libre de esta enfermedad para esta patología es del 33% (2 de 6). Los melanomas mucosos de cabeza y cuello tienen un tratamieto difícil, alta recurrencia local y pobre pronóstico

Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis

[Cutaneous melanoma of the head and neck]. / Melanomas cutaneos de cabeza y cuello.

The clinical records of 20 patients with the diagnosis of cutaneous melanoma of the head and neck treated between 1991 and 2005 were retrospectively reviewed. Advances in diagnostic techniques and treatment have had obvious impact on outcomes in cutaneous melanoma. Cutaneous melanoma of the head of neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size and depth. Evaluation for regional and distant metastatic disease is necessary in advanced stage disease. Adjuvant therapy may be indicated in regional nodal disease.

Melanomas cutáneos de cabeza y cuello / Cutaneous melanoma of the head and neck

Se realiza una revisión retrospectiva de 20 pacientes diagnosticados de melanomas cutáneos de cabeza y cuello tratados entre 1991 y 2005. Los avances en las técnicas diagnósticas y en el tratamiento han tenido un impacto obvio en los resultados de los melanomas cutáneos. En estadios tempranos se realiza una resección quirúrgica completa. Los márgenes de resección están determinados por la extensión superficial y en profundidad. Cuando la enfermedad se diagnostica en un estadio avanzado es necesario el estudio de las metástasis regionales y a distancia. El tratamiento complementario podría estar indicado cuando existe afectación regional

The clinical records of 20 patients with the diagnosis of cutaneous melanoma of the head and neck treated between 1991 and 2005 were retrospectively reviewed. Advances in diagnostic techniques and treatment have had obvious impact on outcomes in cutaneous melanoma. Cutaneous melanoma of the head of neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size and depth. Evaluation for regional and distant metastatic disease is necessary in advanced stage disease. Adjuvant therapy may be indicated in regional nodal disease

[Predictive biochemical indicators of a postlaryngectomy pharyngocutaneous fistula: a clinical study]. / Indicadores bioquímicos predictivos de fístula faringocutánea postlaringuectomía: un estudio clínico.

UNLABELLED: The aim of this clinical study was to determinate biochemical predictor indicators of postlaryngectomy pharyngocutaneous fistula. PATIENTS AND METHODS: We have studied 100 patients with T2- 4 a laryngeal and piryform sinus carcinoma who underwent a laryngectomy. All patients were ASA 2-3. We studied serum albumin, protein serum level, cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05). RESULTS: 19% of the patients developed a postlaryngectomy pharyngocutaneous fistula, with a long-stay of 25 days vs. 10 days of stay in patients without postlaryngectomy pharyngocutaneous fistula. 7 postlaryngectomy pharyngocutaneous fistula needed surgical repair. Low serum albumin (< 3.5 g/dL) and a low level of serum proteins (< 6.5 g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous fistula (p < 0.05). CONCLUSIONS: Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of postlaryngeal pharyngocutaneous fistula.

[Postseptal orbital cellulitis and sinusitis. Descriptive study of 8 cases and literature review]. / Celulitis orbitaria retroseptal y sinusitis. Presentación de 8 casos y revisión de la literatura.

This is a retrospective study of 8 patients with postseptal orbital cellulitis (stages II-V of Chandler) caused by sinusitis during 1999-2003. The variables analyzed in this study included age, sex, delay in diagnosis, aetiology, imaging studies, microbiology specimens collected and treatment. Delays in diagnosis were frecuent. CT was the best radiologic study. Polymicrobial infections were the rule, including anaerobes. 4 patients of 8 needed surgical drainage. A general guideline for the management of periorbital and orbital cellulitis according to the clinical staging of the process is presented.

[Otology manifestations of the Anderson-Fabry disease]. / Manifestaciones otológicas en la enfermedad de Fabry-Anderson.

Anderson-Fabry disease in an inherited X-linked metabolic disorder involving glycosphingolipid metabolism. Few data are available regarding cochlear involvement. Clinical manifestations of Fabry disease appeared on the first decade of life. The prognosis of males with Fabry disease is serious and life expectancy is limited; clinical evolution of heterozygous females is clearly better. We report a family with Fabry disease in several members. The mother, already dead, had two child which have been examined in our department; the male, without a risk of ototoxicity, or acoustic trauma, has progressive hearing loss, tinnitus and dizinness sometimes; the daughter, without a history of deafness, shows unilateral hearing loss on high-tone frequencies. It is important to emphasize these data to those physicians expert in children with Fabry disease because early enzyme replacement therapy intervention should offer increased possibilities of regression of the disease.

[Metastasis to the parotid gland]. / Metastasis en la glandula parótida.

INTRODUCTION: Metastatic disease in the parotid gland has been observed and reported in the literature, and its treatment is controversial. MATERIAL AND METHODS: We review 48 patients with parotid tumors that underwent surgery during 1997-2004. The clinical and histogical features are reviewed. RESULTS: Among these 48, there were 12 cases of metastatic tumors to the parotid (25%). The pathohistological analysis of these tumors revealed that 8 were epidermoid carcinoma (66%), 1 patient was a melanoma (8%), 2 lymphomas below clavicules (16%) and 1 patient with a metastasis of a primary renal cancer. All patients underwent parotidectomy and 10 also cervical neck dissection (6 cases showed cervical metastases). 8 patients received radiotherapy after surgery. CONCLUSIONS: In our study parotid metastases are relatively common in patients submitted for parotid surgery. Often the site of origin of the primary tumor is the facial skin, and the primary tumors most commonly are melanomas or squamous-cell carcinomas, but it is possible distant primary tumors below clavicules.

Celulitis orbitaria retroseptal y sinusitis. Presentación de 8 casos y revisión de la literatura / Postseptal orbital cellulitis and sinusitis. Descriptive study of 8 cases and literature review

Se realiza un estudio retrospectivo sobre 8 pacientes con diagnóstico de celulitis orbitaria retrospectal (fase II-V de Chandler), secundaria a sinusitis, diagnosticadas y tratadas en nuestro servicio entre los años 1999 y 2003. En este estudio se analizan las siguientes variables: edad, sexo, retraso en el diagnóstico, etiología, estudios de imagen realizados, estudios microbiológicos y forma de tratamiento. Se constata que los retrasos en el diagnóstico fueron frecuentes, el scanner fue el método diagnóstico de elección y las infecciones polimicrobianas fueron la regla, incluyendo anaerobios. De los 8 pacientes, 4 precisaron drenaje quirúrgico. Se presenta un protocolo para el manejo de la celulitis orbitaria severa asociada a sinusitis

This is a retrospective study of 8 patients with postsepta 1 orbital cellulitis (stages II -V of Chandler) caused by sinusitis during 1999-2003. The variables analyzed in this study included age, sex, delay in diagnosis, aetiology, irnaging studies, microbiology specimens collected and treatment. Delays in diagnosis were frecuent. CT was the best radiologic study. Polymicrobial infections were the rule, including anaerobes. 4 patients of 8 needed surgical drainage. A general guideline for the management of periorbital and orbital cellulitis according to the clinical staging of the process is presented

Manifestaciones otológicas en la enfermedad de Fabry-Anderson / Otology manifestation of the Anderson-Fabry disease

La enfermedad de Fabry-Anderson es un déficit genético ligado al cromosoma X, y se debe a un error del metabolismo de los glucoesfingolípidos. Los síntomas clínicos suelen aparecer a partir de la primera década de la vida y se han descrito pocos casos donde se identifique la afectación coclear. El pronóstico de la enfermedad en los hombres es grave y la expectativa de vida es limitada; el curso clínico de las mujeres heterocigotas es claramente mejor. Presentamos una familia de pacientes con la enfermedad de Fabry. La madre, fallecida, tuvo dos hijos que son el objeto de nuestro estudio; el varón, sin tener factores de riesgo de ototoxidad, ni trauma acústico, refiere una hipoacusia neurosensorial progresiva, acúfenos y ocasionalmente mareos; la hija, aunque no refiere hipoacusia, en la audiometría tonal se aprecia una pérdida auditiva unilateral en frecuencias agudas. Es importante llamar la atención de los especialistas implicados sobre las manifestaciones de la enfermedad de Fabry en el niño, especialmente porque el tratamiento de sustitución enzimática ha demostrado su efectividad para conseguir la regresión de la enfermedad

Anderson-Fabry disease in an inherited X-linked metabolic disorder involving glycosphingolipid metabolism. Few data are available regarding cochlear involvement. Clinical manifestations of Fabry disease appeared on the first decade of life. The prognosis of males with Fabry disease is serious and life expectancy is limited; clinical evolution of heterozygous females is clearly better. We report a family with Fabry disease in several members. The mother, already dead, had two child which have been examined in our department; the male, without a risk of ototoxicity, or acoustic trauma, has progressive hearing loss, tinnitus and dizinness sometimes; the daughter, without a history of deafness, shows unilateral hearing loss on high-tone frequencies. It is important to emphasize these data to those physicians expert in children with Fabry disease because early enzyme replacement therapy intervention should offer increased possibilities of regression of the disease

Metástasis en la glándula parótida / Metastasis to the parotid gland

Introducción: La existencia de metástasis parotídeas ha sido reflejada en la literatura, siendo su tratamiento controvertido. Material y métodos: Se realiza un estudio retrospectivo sobre 48 pacientes sometidos a cirugía de parótida entre los años 1997 y 2004, revisándose aspectos clínicos e histológicos. Resultados: De los 48 pacientes intervenidos, en 12 casos se diagnosticó metástasis parotídea de un tumor primario (25%). El estudio histopatológico identificó: tumor primario en la piel en 9 pacientes (8 carcinomas epidermoides y 1 melanoma), 2 linfomas de localización inicial infraclavicular y un carcinoma renal de células claras. Los 12 pacientes fueron sometidos a parotidectomía, acompañada de vaciamiento ganglionar cervical en 10 pacientes (en 6 de ellos se identificaron metástasis ganglionares); 8 pacientes recibieron tratamiento radioterápico postquirúrgico. Conclusión: En nuestro estudio las metástasis parotídeas son relativamente frecuentes en el global de los pacientes intervenidos por tumores de parótida. En la mayoría de las ocasiones el tumor primario se encuentra en zonas cutáneas próximas (melanomas o carcinomas epidermoides), aunque es posible que el tumor primario se encuentre por debajo de las clavículas

Introduction: Metastatic disease in the parotid gland has been observed and reported in the literature, and its treatment is controversial. Material and methods: We review 48 patients with parotid tumors that underwent surgery during 1997-2004. The clinical and histogical features are reviewed. Results: Among these 48, there were 12 cases of metastatic tumors to the parotid (25%). The pathohistological analysis of these tumors revealed that 8 were epidermoid carcinoma (66%), 1 patient was a melanoma (8%), 2 lymphomas below clavicules (16%) and 1 patient with a metastasis of a primary renal cancer. All patients underwent parotidectomy and 10 also cervical neck dissection (6 cases showed cervical metastases). 8 patients received radiotherapy after surgery. Conclusions: In our study parotid metastases are relatively common in patients submitted for parotid surgery. Often the site of origin of the primary tumor is the facial skin, and the primary tumors most commonly are melanomas or squamous-cell carcinomas, but it is possible distant primary tumors below clavicules

[Minimally invasive surgery for treating of complicated fronto-ethmoidal sinusitis]. / Cirugía mínimamente invasiva para el tratamiento de la sinusitis fronto-etmoidal complicada.

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is nowadays the "gold standard" for frontal sinus pathologies, but management of acute situations and the aproach and/or the extent of the surgery perfomed in the frontal recess remains controversial nowadays. MATERIAL AND METHODS: We report our experience in 4 patients with orbital celulitis due to frontal sinusitis who underwent combined external surgery (mini-trephination) and endoscopic sinus surgery. RESULTS: All patients managed sinus patency without any complications. CONCLUSIONS: We found this combined sinusotomy as an easy, effective and reproductible technique in order to resolve the difficult surgical management of complicated frontal sinusitis.

Cirugía mínimamente invasiva para el tratamiento de la sinusitis fronto-etmoidal complicada / Minimally invasive surgery for treating of complicated fronto-ethmoidal sinusitis

Objetivo: La cirugía endoscópica nasosinusal (CENS) se considera actualmente la técnica quirúrgica de elección en la patología del seno frontal, aunque el abordaje y la extensión de la cirugía ante la sinusitis frontal complicada sigue siendo un tema en discusión en la actualidad. Material y métodos: Presentamos nuestra experiencia sobre 4 pacientes con celulitis orbitaria por sinusitis frontal aguda, tratados mediante sinusotomía frontal combinada externa (mini-trepanación) y cirugía endoscópica nasosinusal. Resultados: Tras la intervención los cuatro pacientes resolvieron la complicación orbitaria, permeabilizando el ductus nasofrontal sin morbilidad asociada ni necesidad de nuevas intervenciones. Conclusiones: La técnica de la sinusotomía combinada es una técnica eficaz y reproductible para solucionar de forma adecuada el complejo problema de las complicaciones orbitarias de la sinusitis frontal

Objectives: Functional endoscopic sinus surgery (FESS) is nowadays the "gold standard" for frontal sinus pathologies, but management of acute situations and the aproach and/or the extent of the surgery perfomed in the frontal recess remains controversial nowadays. Material and Methods: We report our experience in 4 patients with orbital celulitis due to frontal sinusitis who underwent combined external surgery (mini-trephination) and endoscopic sinus surgery. Results: All patients managed sinus patency without any complications. Conclusions: We found this combined sinusotomy as an easy, effective and reproductible technique in order to resolve the difficult surgical management of complicated frontal sinusitis

[Lipid profile and hearing-loss aged-related]. / Perfil lipídico de la sordera ligada al envejecimiento.

OBJECTIVES/HYPOTHESIS: Presbycusis is the most prevalent cause of hearing-loss in the older, but pathogenesis is not well-know. The premise of this study is that hyperlipemia increase risk of age-related hearing-loss. PATIENTS AND METHODS: 180 patient more than 65 years-old were studied. All patients had bilateral hearing-loss and no renal, neurological, thyriod or middle-ear pathology. We explored serum levels of cholesterol, HDL, LDL and triglycerides. We performed tonal audimetry in all patients. RESULTS: The 71% of patients has hypercholesteremia and the highest serum levels were detected in 65-69 years-old men (mean media 5,27). Patients with hypercholesteremia had worse hearing-loss than patients with normal lipid serum levels (p < .05). CONCLUSIONS: Our study sugest that hypercholesteremia are associated to age-related hearing-loss, possibly by an atherosclerosis mechanism.

[Prolonged hospital stay in patient with head and neck cancer: impact of nutritional status and pharyngeal problems]. / Estancia hospitalaria prolongada en pacientes con cáncer de cabeza y cuello: el impacto del estado nutricional y los problemas faríngeos.

UNLABELLED: Patients who underwent surgery for head and neck malignant neoplasms loose two important human functions: phonation and swallowing. The purpose of this study is to determine the impact of nutritional status and pharyngeal problems in hospital stay in these patients. PATIENTS AND METHODS: Fifty-four patients with oral and pharyngolaryngeal carcinomas underwent surgery were prospective studied to determinate predictors of 2 weeks or longer hospital stay. We studied the impact of malnutrition, tumour location, pharyngeal postoperative problems and infections on hospital stay. RESULTS: 53% of the patients unwent surgery had more than two weeks of hospital stay. Postoperative pharyngeal problems was the strongest correlate of prolonged hospital stay (69% of patients) while only 23% of patients had longer stay because of severe infection (sepsis, neunoniae). Malnutrition or tumor location were not risk factors of prolonged hospitalization stay in our study. CONCLUSIONS: These findings suggest that swallowing problems are the strongest predictors of long hospital stay in head and neck cancer patients.

[Heavy alcohol intake, malnutrition and head and neck cancer patients]. / Ingesta excesiva de alcohol, malnutrición y cáncer de cabeza y cuello.

UNLABELLED: Head and neck cancer patients are frecuently heavy alcohol drinkers. The aim of this study is to determine the impact of alcohol intake on nutritional status and the impact in prognoses. PATIENTS AND METHODS: Fifty patients with oral and pharyngolaryngeal carcinomas were prospective studied in a control-case study. We studied nutritional status and tumoral recurrence in alcoholic and non-alcoholic patients. We also studied alcohol intake after oncologic treatment in these patients. RESULTS: 51% of these patients had excesive alcohol intake before oncologic, treatment. The impact of malnutrition was 70% in alcoholic patients vs 30% in non-alcoholic (p < 0.01). Tumoral recurrence was 30% in alcoholic patients vs 13% in non-alcoholic patients (p < 0.05 ). Only 48% of alcoholic patient stopped alcohol intake after treatment. CONCLUSIONS: Excesive alcohol intake in head and neck cancer patients is a predictive malnutrition factor and it is related to poor prognoses. Alcoholic patients with head and neck cancer and malnutrition need an agresive nutritional, medical and psycosocial support after oncologic treatment, in order to reach a better and longer survival.

[Pretreatment dysphagia in patients with advanced head and neck cancer]. / Disfagia pretratamiento en pacientes con cáncer avanzado de cabeza y cuello.

OBJECTIVE: To define swallowing dysfunctions in head and neck cancer patients with respect to tumor site. PATIENTS AND METHODS: A consecutive cohort of 52 patients with stage III-IV head and neck cancer without prior tracheotomy or treatment were studied according to tumor site: oral cavity (n = 8), oropharynx (n = 8), hypopharynx (n = 13) and larynx (23). All patients underwent nasoendoscopy prior to treatment. Swallowing function (dysphagia, aspiration and Swallowing Performance Status Seale score) was analyzed with reference to tumor localization using chi 2 and Fisher exact tests. RESULTS: Laryngeal and hypopharyngeal neoplasms neoplasms showed the most severe pre-treatment swallowing dysfunction (27% pre-treatment vs. 11% post-treatment), and oral and oropharyngeal neoplasms showed the most severe post-treatment swallowing dysfunction (6% pretreatment vs. 68% post-treatment). Aspiration and tumor localization revealed not statistically significant differences between groups. Pre-treatment dysphagia did not correlate with post-treatment dysphagia. CONCLUSIONS: Laryngeal and hypopharyngeal neoplasms showed severe pre-treatment swallowing dysfunctional and oral and oropharyngeal neoplasms showed severe post-treatment swallowing dysfunction.

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

UNLABELLED: Patients who underwent surgery for head and neck malignant neoplasms are problematic because dysphagia, pain and postoperative secuelaes. Nutritional support is necessary in more than 90% of all patients with head and neck cancer. The purpose of this study is to determine nutritional support in these patients and problems related to nutrition. METHODS: Fifty-four patients with oral and pharyngolaryngeal carcinomas underwent surgery were studied prospectively. We studied nutritional support (oral nutrition, enteral nutrition or parenteral nutrition) and problems related to nutrition: aspiration neumoniae and pharyngostoma. RESULTS: The 7% of the patients underwent oral feeding after surgery, 87% enteral nutrition with nasogastric tube and 6% parenteral nutrition. We identified neumoniae in 6% of patients and faringocutaneous fistula in 19%. When patients leaved the hospital, 98% of the patients underwent oral feeding and one patient had nasopharyngeal tube for enteral nutrition. CONCLUSIONS: 1. Artificial nutrition was necessary in 93% patients with oropharyngolaryngealcancer; 2. Enteral nutrition was the most useful modality of alimentation (87%); 3.25% of patients had postoperative complications: (18% pharyngostoma, 6% neumoniae); 4. Oral feeding was possible in 98% of patients out of hospital.

[Nutritional status in head and neck cancer patients: the impact on the prognoses]. / El estado nutricional en pacientes con cáncer de cabeza y cuello: implicaciones pronósticas.

UNLABELLED: Malnutrition is reported to affect 30-50% of all patients with head and neck cancer. The impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study is to determine if nutritional status is related to postoperative complications (pharyngostoma) or tumor recurrence. METHODS: Fifty patients with T2-4 head and neck carcinomas underwent surgery were studied prospectively. Nutritional status was related to postoperative complications and 2-year survival. RESULTS: Twenty-seven patients present malnutrition (54%). We had 15 patients with pharyngostoma and 11 tumor recurrences. We did not find any correlation between the pharyngostoma and malnutrition, but we we found correlation between malnutrition and tumor recurrence (p < .05). CONCLUSION: Malnutrition has negative impact on outcome of patients with head and neck carcinomas.

[Nasal endoscopic surgery in complicated ethmoiditis]. / Cirugía endoscópica nasal en etmoiditis complicadas.

Spread of infection from paranasal sinuses is uncommon but, when it occurs may lead to serious ocular or intracranial complications. In this article we present four patients, three of them with orbital complications and one with an intracranial abscess, who were successfully treated with endoscopic surgery of the sinuses and antibiotic therapy. We describe some potential advantages of this approach.