[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

[Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer]. / Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical.

OBJECTIVE: To determine the results of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy. METHODS: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. RESULTS: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of 16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary (58%). The five years survival was 31%. CONCLUSION: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure.

Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical / Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer

Objetivo: Evaluar los resultados de la reconstrucción con una interposición gástrica tras la realización de una faringolaringoesofagectomía. Material y métodos: Se revisaron las historias clínicas de 12 pacientes consecutivos que fueron tratados de una faringolaringoesofagectomía entre 1995 y2000. Todos los pacientes tenían un estadio avanzado y seles realizó una reconstrucción con una interposición gástrica.Se valoraron en el postoperatorio la capacidad de deglución,las complicaciones y la supervivencia. Resultados: Se estudiaron5 casos primarios de hipofaringe y 7 de esófago cervical.En 3 casos fue preciso asociar a la reconstrucción un colgajo locorregional. Se realizaron un total de 16 vaciamientos a 8pacientes. Sólo en 2 pacientes los ganglios linfáticos no estaban afectos. La mortalidad perioperatoria ocurrió en 4 pacientes de 12. En el momento del alta el 7 de los 8 pacientes presentaban una buena deglución. Las complicaciones más frecuentes fueron las pulmonares en un 58%. La supervivenciaa los 5 años fue del 31%. Conclusión: La reconstrucción con una plastia gástrica está indicada en aquellos casos que sea preciso reconstruir la hipofaringe y el esófago en un mismo tiempo quirúrgico. Dado su elevada morbimortalidad se recomienda una cuidadosa selección de los pacientes (AU)

Objective: To determine the results of gastric pullup reconstruction following pharyngo-laryngo-esophagectomy. Methods: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. Results: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary(58%). The five years survival was 31%. Conclusión: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure (AU)

[Laser cordectomy: oncologic outcome and functional results]. / Cordectomías láser: resultados oncológicos y funcionales.

OBJECTIVE: Early glottic carcinoma can be effectively treated with radiation or endoscopic laser surgery. We evaluated our experience treating early glottic cancer with laser CO2 surgery. MATERIAL AND METHODS: 64 patients with Tis, T1 and T2 carcinoma, who underwent endoscopic CO2 laser excision between January 1999 and July 2002, were retrospectively analyzed. We performed an objective and subjective evaluation of speech, and evaluation of physical, emotional and functional well being. The mean follow-up was thirty months. RESULTS: No patient died of this laryngeal neoplasm. Local control was achieved in 96% (62/64). Two patients with recurrence required total laryngectomy as savage treatment. Cause-specific survival was 100%, and overall survival was 98% (63/64). Voice quality was affected by laser surgery but impact on the quality of life was minor. CONCLUSIONS: Laser cordectomy for treatment of early glottic cancer is a valid alternative to radiation, with good outcome for voice and minimum impact on quality of life.

Cordectomías láser: resultados oncológicos y funcionales / Laser cordectomies: outcomes and functional results

Objetivo: El carcinoma glótico en estadios iniciales puede tratarse eficazmente con radioterapia o con cirugía endoscópica láser. Evaluamos nuestra experiencia en el tratamiento del carcinoma glótico en estadios iniciales con cirugía láser CO2. Material y método: Estudio retrospectivo de 64 pacientes con tumores Tis, T1 y T2 glóticos a quienes se les realizó una resección endoscópica láser CO2 entre enero de 1999 y julio de 2002. Se realizó una valoración objetiva y subjetiva de la voz y una valoración del bienestar físico, emocional y funcional. El seguimiento medio fue de 30 meses. Resultados: Ningún paciente murió a consecuencia de su carcinoma de laringe. El control local fue del 98 por ciento (62/64). A los dos pacientes con recidiva local se rescató con una laringectomía total. La supervivencia causa-específica fue del 100 por ciento y la supervivencia global del 98 por ciento (63/64). La calidad de la voz se afectó tras la cirugía, pero el impacto que tiene en la calidad de vida es pequeño. Conclusiones: La cordectomía láser para tratar el carcinoma glótico en estadios iniciales es una alternativa válida a la radioterapia, con buen pronóstico y un pequeño impacto en la calidad de vida (AU)

OBJECTIVE: Early glottic carcinoma can be effectively treated with radiation or endoscopic laser surgery. We evaluated our experience treating early glottic cancer with laser CO2 surgery. MATERIAL AND METHODS: 64 patients with Tis, T1 and T2 carcinoma, who underwent endoscopic CO2 laser excision between January 1999 and July 2002, were retrospectively analyzed. We performed an objective and subjective evaluation of speech, and evaluation of physical, emotional and functional well being. The mean follow-up was thirty months. RESULTS: No patient died of this laryngeal neoplasm. Local control was achieved in 96% (62/64). Two patients with recurrence required total laryngectomy as savage treatment. Cause-specific survival was 100%, and overall survival was 98% (63/64). Voice quality was affected by laser surgery but impact on the quality of life was minor. CONCLUSIONS: Laser cordectomy for treatment of early glottic cancer is a valid alternative to radiation, with good outcome for voice and minimum impact on quality of life (AU)

[Detection of herpes simplex virus and Epstein-Barr virus in squamous cell carcinoma of the upper airways and digestive system]. / Detección del virus herpes simplex y del virus de Epstein-Barr en los carcinomas de células escamosas de vías aerodigestivas superiores.

OBJECTIVE: Previous studies have investigated the role of viruses in tumor origin of head and neck cancer. Despite this, mechanis of viral carcinogenesis remain unclear. The aim of this study is to determine the prevalence of herpes simplex virus (HSV) and Epstein-Barr virus (EBV) in malignant laryngeal and oropharyngeal lesions. MATERIAL AND METHODS: Fresh frozen specimens of 28 laryngeal and oropharyngeal squamous cell carcinomas were studied. The presence or absence of HSV and EBV was determined with polymerase chain reaction (PCR) assays. RESULTS: None of the samples showed evidence for EBV DNA. One tonsilar carcinoma case (3.5%) was positive for HSV DNA detection. CONCLUSIONS: These results do not support HSV and EBV as etiological factors in head and neck cancer.

[Osteoplastic flap: our experience]. / Osteoplastia frontal: nuestra experiencia.

OBJECTIVE: Despite the advances of endoscopic surgical techniques, the frontal sinus obliteration via the osteoplastic flap (OPF) remains the treatment option for frontal sinus pathologies. The aim of this study is to evaluate indications, procedures and results of this technique. MATERIAL AND METHODS: Retrospective study of thirty one patients that underwent OPF procedure between 1986 and 1999. RESULTS: The average patient's age was 42 years. The treated pathologies were: 12 mucoceles, 8 fractures, 4 osteomas, 4 sinutisis, 1 frontal abscess, 1 frontal osteomielitis and 1 orbital celullitis. The main clinical symptoms were headache (32%) and nasal obstruction (29%). The surgical approaches es used were: brow incision in 24 patients (78%), bicoronal in 5 (16%) and through the frontal wound in 2 traumatic cases (6%). Endonasal surgical procedures were associated in 8 patients (25%). Frontal sinus obliteration was performed in 23 patients (74%). Surgical revision was necessary in two cases. The were no serious complications. The overall esthetic and functional outcome was good. CONCLUSIONS: OPF with fat obliteration is an useful technique in patients who had frontal sinus disease refractary to other methods.

Sinusitis complicadas y cirugía endoscópica nasal / Complicated sinusitis and endoscopic sinus surgery

Introducción: Las sinusitis complicadas pueden tener consecuencias graves si no se tratan adecuadamente. Tradicionalmente, los casos quirúrgicos se han tratado mediante abordajes externos. Actualmente, se puede realizar esta cirugía vía endoscópica. Objetivo: Este estudio ha sido diseñado para evaluar nuestros resultados en las sinusitis complicadas tratadas con cirugía endoscópica nasal. Métodos: El estudio revisó 18 pacientes con sinusitis complicadas tratadas por cirugía endoscópica nasal entre 1993 y marzo 2000.Había 12 complicaciones orbitarias y 6 intracraneales. Seis pacientes necesitaron un abordaje quirúrgico adicional. Resultados: Diecisiete pacientes (94 por ciento) curaron de sus procesos. Un paciente con un síndrome de fisura orbitaria superior murió al mes debido a complicaciones vasculares y respiratorias. Otro paciente con una sinusitis frontal lateral requirió una osteoplastia frontal por enfermedad persistente. Dos pacientes tenían como secuela convulsiones leves. Ninguno de los pacientes tenía secuelas oculares. No hubo complicaciones quirúrgicas. Conclusión: La cirugía endoscópica nasal es un procedimiento seguro y eficaz en el tratamiento de las sinusitis complicadas. Actualmente, un abordaje sinusal abierto raras veces está indicado (AU)

BACKGROUND: Complicated sinusitis can result in a significant morbidity if not appropriately managed. Traditionally, surgical cases were treated by external approaches. Now a days, the introduction of endoscopic sinus surgery allows such complications to be endoscopically approached. AIM: This study was designed to evaluate our results in complicated sinusitis treated by endoscopic sinus surgery. METHODS: The study reviewed 18 patients with evidence of sinusitis complications treated with endoscopic sinus surgery between 1993 and March 2000. There were 12 orbital and 6 intracraneal complications. Six patients did need an additional surgical approach. RESULTS: Seventeen patients (94%) had a relief of their symptoms. One patient with a superior orbital fisura syndrome died a month later due to vascular and respiratory complications. Another patient with fronto-lateral sinusitis required frontal osteoplasty for persistent disease. Two patients had long-term neurological sequelae (seizure). None had ocular sequelae. There were no complications due to the surgery. CONCLUSION: The endoscopic sinus surgery is a safe procedure with a high success rate in the treatment of complicated sinusitis. At present, open approaches to the sinuses are rarely indicated (AU)

Detección del virus herpes simplex y del virus de Epstein-Barr en los carcinomas de células escamosas de vías aerodigestivas superiores / Detection of herpes simplex virus and Epstein-Barr virus in head and neck squamous cell carcinoma

Objetivo: Diversos estudios han investigado el papel de los virus en la carcinogénesis de los tumores de cabeza y cuello. A pesar de esto, el mecanismo de la carcinogénesis viral permanece poco claro. El objetivo de este estudio es determinar la prevalencia del virus herpes simplex (VHS) y del virus de Epstein-Barr (VE-B) en tumores malignos de laringe y orofaringe. Material y método: Se estudian muestras frescas congeladas de 28 pacientes con tumores de laringe y orofaringe. La presencia o ausencia del VHS y VE-B se determinó mediante la reacción en cadena de la polimerasa (PCR). Resultados: En ninguna de las muestras detectamos el ADN del VE-B. En una muestra de carcinoma de amígdala (3,5 por ciento) detectamos el ADN del VHS. Conclusiones: Nuestros resultados no sugieren que el VHS y el VE-B tengan un papel en la etiología de los tumores de cabeza y cuello (AU)

OBJECTIVE: Previous studies have investigated the role of viruses in tumor origin of head and neck cancer. Despite this, mechanis of viral carcinogenesis remain unclear. The aim of this study is to determine the prevalence of herpes simplex virus (HSV) and Epstein-Barr virus (EBV) in malignant laryngeal and oropharyngeal lesions. MATERIAL AND METHODS: Fresh frozen specimens of 28 laryngeal and oropharyngeal squamous cell carcinomas were studied. The presence or absence of HSV and EBV was determined with polymerase chain reaction (PCR) assays. RESULTS: None of the samples showed evidence for EBV DNA. One tonsilar carcinoma case (3.5%) was positive for HSV DNA detection. CONCLUSIONS: These results do not support HSV and EBV as etiological factors in head and neck cancer (AU)

Osteoplastia frontal: nuestra experiencia / Osteoplastic flap: our experience

Objetivo: A pesar de los avances en las técnicas endoscópicas, la osteoplastia frontal (OPF) con obliteración grasa continúa siendo una opción de tratamiento para patologías que afectan al seno frontal. El objetivo de este estudio es evaluar las indicaciones, procedimiento y resultados de esta técnica. Material y método: Estudio retrospectivo de 31 pacientes que fueron intervenidos de osteoplastia frontal entre los años 1986 y 1999. Resultados: La edad media del estudio fue de 42 años. Las patologías tratadas, por orden de frecuencia, fueron: 12 mucoceles, 8 fracturas, 4 osteomas, 4 sinusitis, 1 absceso frontal, 1 osteomielitis y 1 celulitis orbitaria. La sintomatología más frecuente fue la cefalea (32 por ciento), seguida de la obstrucción nasal (29 por ciento). La vía de abordaje empleada fue superciliar en 24 casos (78 por ciento), coronal en 5 (16 por ciento) y a través de la herida frontal en 2 casos traumáticos (6 por ciento). Asociamos cirugía endoscópica nasal a 8 pacientes (25 por ciento). La obliteración del seno se llevó a cabo en 23 pacientes (74 por ciento). Fue preciso reintervenir a 2 pacientes (6 por ciento). No hubo ninguna complicación quirúrgica mayor. El resultado estético y funcional fue aceptable en todos los casos. Conclusiones: La osteoplastia frontal es una técnica quirúrgica de utilidad en gran parte de la patología del seno frontal, con buenos resultados y escasa morbilidad. Es muy útil cuando han fracasado otras técnicas o cuando la cirugía endoscópica está contraindicada. (AU)

OBJECTIVE: Despite the advances of endoscopic surgical techniques, the frontal sinus obliteration via the osteoplastic flap (OPF) remains the treatment option for frontal sinus pathologies. The aim of this study is to evaluate indications, procedures and results of this technique. MATERIAL AND METHODS: Retrospective study of thirty one patients that underwent OPF procedure between 1986 and 1999. RESULTS: The average patient's age was 42 years. The treated pathologies were: 12 mucoceles, 8 fractures, 4 osteomas, 4 sinutisis, 1 frontal abscess, 1 frontal osteomielitis and 1 orbital celullitis. The main clinical symptoms were headache (32%) and nasal obstruction (29%). The surgical approaches es used were: brow incision in 24 patients (78%), bicoronal in 5 (16%) and through the frontal wound in 2 traumatic cases (6%). Endonasal surgical procedures were associated in 8 patients (25%). Frontal sinus obliteration was performed in 23 patients (74%). Surgical revision was necessary in two cases. The were no serious complications. The overall esthetic and functional outcome was good. CONCLUSIONS: OPF with fat obliteration is an useful technique in patients who had frontal sinus disease refractary to other methods (AU)

[Complicated sinusitis and nasal endoscopic surgery]. / Sinusitis complicadas y cirugía endoscópica nasal.

BACKGROUND: Complicated sinusitis can result in a significant morbidity if not appropriately managed. Traditionally, surgical cases were treated by external approaches. Now a days, the introduction of endoscopic sinus surgery allows such complications to be endoscopically approached. AIM: This study was designed to evaluate our results in complicated sinusitis treated by endoscopic sinus surgery. METHODS: The study reviewed 18 patients with evidence of sinusitis complications treated with endoscopic sinus surgery between 1993 and March 2000. There were 12 orbital and 6 intracraneal complications. Six patients did need an additional surgical approach. RESULTS: Seventeen patients (94%) had a relief of their symptoms. One patient with a superior orbital fisura syndrome died a month later due to vascular and respiratory complications. Another patient with fronto-lateral sinusitis required frontal osteoplasty for persistent disease. Two patients had long-term neurological sequelae (seizure). None had ocular sequelae. There were no complications due to the surgery. CONCLUSION: The endoscopic sinus surgery is a safe procedure with a high success rate in the treatment of complicated sinusitis. At present, open approaches to the sinuses are rarely indicated.

[Preoperative evaluation in thyroplasty: the laryngeal lateral compression]. / Valoración preoperatoria de la tiroplastia: el test de compresión lateral de la laringe.

Thyroplasty type I has provided significant improvement to the treatment of patients with glottal incompetence. It is essential that patients be preoperatively evaluated using objective criteria. Laryngeal manual compression test are manipulations of the thyroid and cricoid cartilages that result in modifications of the position of the vocal folds. The most valuable laryngeal manual compression test for patients with glottal insufficiency is the lateral compression test. When this test results in a preoperative improvement in voice suggest that surgery will be successful. In this paper we present the objective evaluation of the effects of lateral compression test upon glottic incompetence by means of narrow band power spectrum analysis.

Valoración preoperatoria de la tiroplastia: el test de compresión lateral de la laringe / Preoperative assessment of tryroplasty: the lateral compression test of the larinx

La tiroplastia tipo I ha supuesto una importante mejora en el tratamiento de los pacientes con una incompetencia glótica. La valoración preoperatoria de estos pacientes mediante criterios objetivos es primordial. Los test de compresión manual de la laringe consisten en la manipulación de los cartílagos tiroides y cricoides, produciendo cambios en la posición de las cuerdas vocales. El test más valorado en la incompetencia laríngea es el test de compresión alar. Si se percibe una mejoría de la voz en el preoperatorio al realizar este test sugiere que la cirugía tendrá éxito. En este trabajo se presenta la evaluación objetiva del test de compresión alar sobre la glotis incompetente usando la espectrografía de banda estrecha (AU)

Thyroplasty type I has provided significant improvement to the treatment of patients with glottal incompetence. It is essential that patients be preoperatively evaluated using objective criteria. Laryngeal manual compression test are manipulations of the thyroid and cricoid cartilages that result in modifications of the position of the vocal folds. The most valuable laryngeal manual compression test for patients with glottal insufficiency is the lateral compression test. When this test results in a preoperative improvement in voice suggest that surgery will be successful. In this paper we present the objective evaluation of the effects of lateral compression test upon glottic incompetence by means of narrow band power spectrum analysis (AU)