SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients.

OBJECTIVE: To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. METHODS: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. RESULTS: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures". CONCLUSION: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.

[VOTE versus ACLTE: comparison of two snoring noise classifications using machine learning methods]. / VOTE versus ACLTE: Vergleich zweier Schnarchgeräuschklassifikationen mit Methoden des maschinellen Lernens.

BACKGROUND: Acoustic snoring sound analysis is a noninvasive method for diagnosis of the mechanical mechanisms causing snoring that can be performed during natural sleep. The objective of this work is development and evaluation of classification schemes for snoring sounds that can provide meaningful diagnostic support. MATERIALS AND METHODS: Based on two annotated snoring noise databases with different classifications (s-VOTE with four classes versus ACLTE with five classes), identically structured machine classification systems were trained. The feature extractor openSMILE was used in combination with a linear support vector machine for classification. RESULTS: With an unweighted average recall (UAR) of 55.4% for the s­VOTE model and 49.1% for the ACLTE, the results are at a similar level. In both models, the best differentiation is achieved for epiglottic snoring, while velar and oropharyngeal snoring are more often confused. CONCLUSION: Automated acoustic methods can help diagnose sleep-disordered breathing. A reason for the restricted recognition performance is the limited size of the training datasets.

[Sentinel lymph node in tumors of the larynx: technique and results]. / El ganglio centinela en tumores de laringe: técnica y resultados obtenidos.

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.

El ganglio centinela en tumores de laringe: técnica y resultados obtenidos / Sentinel lymph node in tumors of the larynx: technique and results

Objetivos: Determinar la aplicabilidad de la técnica del ganglio centinela (GC) en tumores N0 de laringe. Material y métodos: Realizamos un estudio prospectivo en 19 pacientes con tumores N0 de laringe. Infiltramos peritumoralmente 1mCi de nanocoloides de albúmina marcados con 99mTc con endoscopio rígido bajo anestesia general. Detectamos el GC intraoperatoriamente con una sondagamma durante el vaciamiento cervical. Los resultados histológicos del GC se comparan con los del vaciamiento cervical. Resultados: Identificamos el GC en 17 pacientes (89,47%). Once pacientes presentaron GC libres de tumor, reflejando correctamente el estatus del cuello (pN0). Tres pacientes presentaron metástasis en el GC l. Encontramos 3 falsos negativos. La sensibilidad de la técnica fue 50,0% (3/6) y el VPN de un 78,6%. Conclusiones: Pensamos que para que la técnica del GC sea aplicable en tumores de laringe se precisan de un mayor número de estudios, siendo fundamental la realización de un correcta selección de los pacientes

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential

[Clinical evaluation of the patient with a chronic snoring disease]. / Evaluación clínica del paciente con roncopatía.

INTRODUCTION: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. MATERIALS AND METHODS: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. RESULTS: The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. CONCLUSIONS: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

Evaluación clínica del paciente con roncopatía / Clinical evaluation of the patient with a chronic snoring disease

Introducción: Los pacientes con trastornos respiratorios relacionados con el sueño son sometidos habitualmente a un examen otorrinolaringológico antes de tomar una decisión terapéutica. Este examen debería ser predictivo sobre la existencia de síndrome de apnea obstructiva del sueño (SAOS), reproducible y debería determinar las zonas de obstrucción de la vía aérea. Hemos evaluado el examen clínico ORL y comparado con la literatura con el ánimo de estandarizar el mismo. Material y métodos: Hemos realizado el mismo protocolo de anamnesis y exploración a 181 pacientes, de los cuales 127 tienen realizada también una polisomnografía (PSG). Resultados: La edad media de los pacientes fue de 49,6 años, con un IMC de 29,3 kg/m2. El 92,7% presentaron un paladar patológico, el 4,5% presentaron una hipertrofia amigdalar importante y el 66,5% índices de Mallampati modificados elevados. El 68,8% se estadió como Fujita IIb y un 39,2% presentó obstrucción nasal. Conclusiones: La exploración de la vía aérea superior (VAS) es muy importante para el diagnóstico de la roncopatía crónica. La mayoría de los pacientes presentan alteraciones morfológicas que se pueden representar mediante escalas visuales para hacerla más reproducible. La zona de obstrucción no predice la severidad del síndrome de apnea del sueño

Introduction: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. Materials and methods: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. Results: The patient’s mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. Conclusions: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS

[Temporalis myofascial flap: technique description and results in our patients]. / Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes.

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes / Temporalis myofascial flap: technique description and results in our patients

Introducción: El tratamiento quirúrgico de los tumores de cavidad oral y seno maxilar precisa una reconstrucción del defecto. Es preferible realizarla en un solo tiempo quirúrgico para disminuir la morbilidad del paciente y el coste sanitario. El colgajo miofascial del temporal es muy versátil para la reconstrucción de defectos de cavidad oral, base de cráneo, orbitarios y maxilares. Material y métodos: Describimos la técnica quirúrgica y presentamos nuestros resultados tras la reconstrucción de defectos tras maxilectomía total o parcial con el colgajo miofascial del músculo temporal en 22 pacientes. Resultados: No se ha producido la necrosis total en ningún caso y en 4 hubo una pequeña dehiscencia de sutura. Conclusión: El colgajo miofascial es una opción excelente para la reconstrucción de cavidad oral y seno maxilar

Introduction: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. Material and methods: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. Results: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. Conclusion: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Nuestros hallazgos en la videofibrosomnoscopia / Our findings in the sleep endoscopy exams

Introducción: La videofibrosomnoscopia es una técnica que permite la visualización de la faringe de un paciente al que se le ha inducido el sueño farmacológicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibración y colapso de los pacientes con roncopatía crónica. Material y métodos: La prueba se realizó a un total de 51 pacientes. A todos se les realizó una anamnesis estándar y una exploración otorrinolaringológica como parte del diagnóstico habitual. Resultados: La zona de obstrucción más frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstrucción hallada en la consulta y la vista durante la VFS. Conclusiones: La VFS es una técnica útil en el diagnóstico del paciente con roncopatía y es aconsejable su utilización para saber con certeza el tipo de obstrucción del paciente

Introduction: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. Materials and methods: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. Results: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. Conclusions: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient´s obstruction

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía / Changes in immunoglobulin levels following adenoidectomy and tonsillectomy

Introducción: Los órganos linfoides del anillo de Waldeyer producen todos los tipos de inmunoglobulinas (principalmente la G y la A), desarrollando su actividad principal entre los 4 y los 10 años de edad, es decir, aquella en la que la patología adenoamigdalar causa el mayor número de indicaciones quirúrgicas de las mismas. Nuestro estudio pretende analizar el impacto que la exéresis adenoamigdalar causa sobre los niveles de inmunoglobulinas en el niño.Material y métodos: Presentamos un estudio prospectivo de 89 pacientes sanos entre 4 y 10 años intervenidos en nuestro servicio de adenoidectomía y adenoamigdalectomía, a los cuales se les determinaron los niveles de inmunoglobulinas G, A y M preoperatoriamente y al mes y cuatro meses. Resultados: Las cifras de IgG sérica sufrieron un descenso postoperatorio, recuperándose parcialmente a los cuatro meses. La IgA descendió en menor medida y la IgM apenas sufrió variaciones. Ninguna de las inmunoglobulinas estudiadas descendió por debajo de niveles considerados normales. Discusión/Conclusiones: La intervención amigdalar y adenoidea causan descensos postoperatorios en las cifras séricas de inmunoglobulinas G y A, con recuperación parcial a medio plazo. En ningún caso las cifras séricas descienden por debajo de los niveles considerados normales, y en ninguno de los niños estudiados la intervención causó patología postoperatoria derivada de una alteración de la inmunidad (AU)

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency (AU)

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico / Hypopharyngeal cancer: analysis of the evolution and surgical results

Objetivo: El cáncer de hipofaringe es un cáncer muy agresivo que generalmente se diagnostica en estadios muy avanzados, siendo su pronóstico desalentador y la tasa de supervivencia muy baja. El objetivo de este estudio es presentar la evolución y los resultados postoperatorios de pacientes tratados en nuestro servicio por cáncer de hipofaringe. Material y Método: Realizamos un estudio retrospectivo sobre 60 pacientes intervenidos quirúrgicamente entre los años 1980-1999. En su mayoría se trataba de estadios avanzados (III-IV) y el 75 por ciento presentaban adenopatías palpables en el momento del diagnóstico. Resultados: La supervivencia a los 5 años fue de 38,4 por ciento. Encontramos una incidencia de metástasis a distancia y segundos tumores de un 12,5 por ciento y un 10,4 por ciento respectivamente. Conclusiones: El carcinoma de hipofaringe continúa siendo el cáncer de cabeza y cuello de peor pronóstico. La tasa de supervivencia parece estar relacionada primeramente con el estadio tumoral de presentación y particularmente con el estatus de los ganglios linfáticos cervicales (AU)

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases (AU)

Tumores malignos de la glándula parótida / Malignant tumors of the parotid

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Tratamiento del cuello NO en el cáncer supraglótico / Treatment of the NO neck in supraglottic cancer

Introducción: Las metástasis regionales ocultas en el cáncer supraglótico N0 son motivo de clásicas controversias. El objeto de nuestro estudio es aportar nuestra experiencia para determinar en qué medida influye el tratamiento cervical en la recidiva regional de los cánceres supraglóticos N0. Material y métodos: Presentamos un estudio retrospectivo de 246 pacientes con cáncer supraglótico y cuello clínicamente negativo, tratados en nuestro servicio entre los años 1977 y 1999. Resultados: El 11,4 por ciento del los pacientes no fue tratado a nivel cervical, presentando un 23 por ciento de metástasis o recidivas cervicales en la evolución. El 66,7 por ciento de los pacientes fueron tratados con cirugía ganglionar (vaciamiento cervical funcional), apareciendo metástasis ocultas en el 24 por ciento de los casos. La recidiva regional global fue de 2,9 por ciento en estadios iniciales (T1/T2) y 13,1 por ciento en estadios avanzados (T3/T4). En los pacientes pN+ se realizó tratamiento con radioterapia postoperatoria en el 85 por ciento de los casos, con un índice de recidiva del 8,8 por ciento. La observación en los pN0 arrojó un índice de recidiva regional del 6,1 por ciento. En los cuellos contralaterales, en aquellos casos en que la cirugía fue unilateral (tumor claramente lateralizado), el seguimiento clínico presentó un índice de recidivas del 5,5 por ciento. Los pacientes tratados con radioterapia aislada presentaron un índice de recidiva del 5,5 por ciento. Discusión/Conclusiones: El tratamiento cervical de los cánceres supraglóticos N0 está indicado. Realizamos el mismo tratamiento cervical (cirugía o radioterapia) que al tumor primario, obteniendo buenas tasas de control de recidivas, inferiores al 10 por ciento. En caso de vaciamiento patológicamente negativo realizamos seguimiento clínico. Si la anatomía patológica es positiva (pN+) realizamos radioterapia postoperatoria cuando hay más de dos ganglios afectos o rotura capsular en alguna de ellos (AU)

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them (AU)

[Benign surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology]. / Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica.

In our milieu, Dr. Peset Hospital, Valencia, we have collected between 1979 and 1998, a total amount of 683 thyroidectomies. Between them 101 carcinomata and 582 bening thyroid pathology. In this work are studied the bening pathology treated surgically. 86.4 percent were women and 13.6% men. Middle age 45 years. By complementary explorations, echography the solid single node by 41.9 percent of cases and solid numerous nodes by 34.7% were the more important findings found. By gammagraphy with greater frequency discovered a cold single node by 44.2% of cases. Anatomopathological types more frequently found were single hyperplastic node (13.3%), multiple hyperplastic nodes (27.6%), spreading hyperplasy (9.1%) and follicular adenoma (37.4%). The aim of this work is the comparative study of findings of complementary explorations with the anatomopathological results gained through the surgical pieces.

Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica / Benin surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology

En nuestro medio del Hospital Dr. PEset de Valencia hemos recogido, en el período comprendido entre 1979-1998 un total de 683 tiroidectomías. En ellas se detectaron 101 carcinomas y 582 patologías benignas de tiroides. En el presente trabajo vamos a estudiar la patología benigna tratada quirurgicamente en nuestro Servicio. De los pacientes con patología benigna el 86,4 por ciento fueron mujeres y el 13,6 por ciento varones, con una edad media de 45 años. En las exploraciones complementarias en la ecografía los principales hallazgos encontrados fue el nódulo sólido único en el 41,9 por ciento y nódulos sólidos múltiples en el 31,7 por ciento. En la gammagrafía el hallazgo observado con mayor frecuencia fue el nódulo frío único en el 44,2 por ciento de los casos. Los tipos anatomopatológicos hallados con mayor frecuencia fueron los siguientes: hiperplasia nodular única (13,3 por ciento), hiperplasia nodular múltiple (27,6 por ciento), hiperplasia difusa (9,1 por ciento) y adenoma folicular (37,4 por ciento). El objetivo del presente trabajo es realizar un estudio estadístico comparando los hallazgos de las exploraciones complementarias (ecografía y gammagrafía) con los resultados anatomopatológicos definitivos de las piezas quirúrgicas (AU)

[Malignant tumors of the parotid gland]. / Tumores malignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We sheltered an amount of 147 cases. The pathologic distribution between benign and malign tumors was as following: 121 benign tumors (83%) and 26 malign tumors (17%). Here we study malign parotid tumors, which represent 17% of total parotid tumors. Sensibility and specificity of FNA was 54% and 96.5% respectively. We performed almost with similar frequencies total and suprafacial parotidectomies in 46% and 42% of cases respectively. Total parotidectomy with facial resection is indicated in cases with tumor nerve infiltration and has been done in 8% of cases. The main complications of surgery were facial nerve dysfunction and Frey syndrome. Permanent facial nerve dysfunction and and transitory facial nerve disfunction occurred in 3.8% and 30.8% of patients respectively. Frey syndrome appeared in 10% of patients operated of parotidectomy. Recurrences occurred in 15.4% of patients.

[Treatment of the NO neck in supraglottic cancer]. / Tratamiento del cuello NO en el cáncer supraglótico.

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.