[Papillary transitional cell carcinoma of the frontal sinus]. / Carcinoma papilar de células transicionales del seno frontal.

INTRODUCTION: A case is reported of primary transitional-cell carcinoma in the frontal sinus of a 54-year-old woman, which was interesting because of the histological type, evolution, and difficulty of follow-up. CLINICAL CASE: A 54-year-old woman with no history of exposure to risk factors presented swelling of the frontal area of 3 months duration. Fine needle aspiration biopsy revealed an adenoma but TAC showed an intrasinusal tumor with destruction of the inner and outer walls. Surgical exeresis revealed the correct histological diagnosis. Local recurrence at 12 months, without cervical lymph nodes or distant metastases, was treated surgically and the patient remained asymptomatic and disease-free 24 months later. DISCUSSION: Malignant tumors of the frontal sinus are rare in the literature. We describe the histological features of transitional-cell tumor and emphasize its similarity with papilloma, benign behavior and management options, in which surgery is of choice. Prognostic and survival factors in the literature are reviewed.

[Validity of the protocol for evaluating the inappropriate use of hospitalization]. / Validez del protocolo de evaluación del uso inapropiado de la hospitalización.

BACKGROUND: The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. MATERIAL AND METHOD: In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. RESULTS: The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. CONCLUSIONS: The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services nor judgements regarding individual cases.

[Influence of secretory otitis media on mastoid pneumatization. Multiple regression analysis]. / Influencia de la otitis media secretoria en la neumatización mastoidea. Análisis mediante regresión múltiple.

The influence of secretory otitis media (SOM) on mastoid pneumatization was studied in 122 ears of 61 children under 15 who were seen at our clinic two times. Age, tympanometry, mastoid size, and time between visits were analyzed. Multiple regression analysis yielded and equation relating age and SOM with mastoid size at first examination. Another regression equation explained the contribution of SOM resolution or persistence and age on mastoid size at the time of the second examination. This equation explained 76.14% of the variability in mastoid size and showed that normal ears had better mastoid growth than children with SOM. Even thought inflammation resolved with medical or surgical treatment, mastoid pneumatization was more developed in normal subjects.

[Retropharyngeal lipoma]. / Lipoma del espacio retrofaríngeo.

Although ordinary lipoma is the most common neoplasm of mesenchymal origin, retropharyngeal lipoma is a very rare tumour and only about 20 cases have been reported. We present a further case of this kind and discuss its most important clinical features, diagnosis and treatment. Updated theories on the lipoma's etiology and their evolutive course are reviewed.

[Giant dermoid cyst of the floor of the mouth]. / Quiste dermoide gigante de suelo de boca.

Report the case of a young feminine patient, 17, presenting since the first year of her life, a swelling of few milimeters diameter, close to the frenulum of the tongue, with progressive enlargement. At examination is verified a swelling about 10 cms. diameter filling the whole ground of the mouth and pulling backwards the tongue and producing a clear protrusion in the suprahyoid region. After lateral X-ray of the neck, echography and cervical TAC, surgery is advised with the suspicion of ranula sublingualis. Removal of the tumor through medial cervictomy, finding, besides the main mass, a second one about 3 cms. diameter. The histopathological diagnosis of a cyst of the thyroglossal duct, its sitting place and the clinical course, compelled the AA. to review the slides and being obvious the presence of sebaceus glands, they change the prior diagnosis for that of dermoid cyst.

[Solitary nasal plasmocytoma]. / Plasmocitoma solitario nasal.

Report of the case of one patient diagnosed of a nasal extramedullary solitary plasmacytoma, starting as an suppurated panophtalmia. Biopsy of the mass inside the nose led to diagnosis. Comments about the difficulties of histopathological differential diagnosis, underlying the need to rule out any other systemic process (multiple myeloma). The subject was treated with inductive chemotherapy and radiotherapy, being free of the illness after 4 years follow up.

[The demand for specialized care in otorhinolaryngology]. / Estudio de la demanda asistencial especializada en otorrinolaringologiá.

BACKGROUND: The specialized medical assistance knowledge improved in hospitals since the introduction of Clinical Documentation Services, but hardly anything is known about outpatient assistance, specially in otolaryngology. METHODS: In order to find out this information, during 1992 last quarter, we sampled 20 days of outpatient consult, studying the following variables in patients visited: age, sex, diagnosis, diagnostic-therapeutic procedures and motives for hospital attention. RESULTS: In the sample first visits are 63% and second visits 37%. Only 7.5% of patients were sent to hospital and we refer the diagnosis cause. In 5.6% of cases we couldn't establish any diagnosis, the 47% of cases presented otologic pathology and the rest 47% belonged to rhinologic pathology, pharyngeal and laryngeal troubles. The frequency of diagnosis were different in age groups. In 25% of patients diagnostic-therapeutic procedures were done. CONCLUSIONS: This study supplies us interesting information about the features of ENT outpatient assistance respect sex and age, more frequent diagnostics, procedures and causes for hospital attention.

[Presentation and variants of heterotopic salivary tissue in the neck]. / Presentación y variantes del tejido salivar heterotópico en el cuello.

Dealing with a case of salivary tissue in the lower neck in a 5 year-old boy. The AA. consider the anatomoclinical and embryologic features which should be emphasized on this type of heterotopia, as well when malignancy supervenes.