[Otorhinolaryngological consultation material in PDA: SEORL-PDA]. / Material de Consulta de Otorrinolaringología en PDA: SEORL-PDA.

OBJECTIVES: Occasionally, the Otolaryngologist needs to accede quickly to medical information in order to retrieve data or to solve doubts. In this way, it seems to be of interest to design a clinical guide that could be consulted as a PDA program (Pocket PC and Palm versions), in a personal computer or Internet. MATERIAL AND METHODS: Clinical contents of protocols, guides, and articles, preferably based on the evidence and the clinical experience of 102 authors. Implementation of a program that allows the guide to be used in a PDA, to update it or to add notes using tools that could be downloaded from a web page. RESULTS: A clinical practice guide SEORL-PDA version 1.1, with thirteen ENT's topics, calculation algorithms, internal links and possibility of update the content and to add notes. DISCUSSION: SEORL-PDA is a clinical guide in PDA format, with enough information and possibilities. Its downloading and installation is easily done following the instructions of the web created with these purposes.

Material de Consulta de Otorrinolaringología en PDA: SEORL-PDA / Otorhinolaryngological consultation material in PDA: SEORL-PDA

Objetivos: En ocasiones el otorrinolaringólogo precisa consultar la información médica de forma rápida para tomar decisiones, aclarar dudas o instaurar tratamientos. Por ello, es de interés diseñar un programa basado en una guía clínica que pueda ser consultada en un ordenador personal, a través de Internet o instalable en una PDA (versiones Pocket PC y Palm). Material y métodos: Contenidos clínicos de protocolos, guías, vías y artículos, preferentemente basados en la evidencia y en la experiencia de 102 autores. Implementación informática que permita usar la guía en una PDA y actualizar o añadir notas a los contenidos a través de herramientas que se descargan desde una página web. Resultados: Guía de práctica clínica SEORL-PDA® versión 1.1 con trece temas de ORL, algoritmos de cálculo, enlaces internos y posibilidad de actualizaciones y notas. Discusión: SEORL-PDA® es una guía clínica en PDA con gran cantidad de datos y posibilidades. Su descarga e instalación se realiza fácilmente siguiendo las instrucciones de la web creada a tal efecto

Objectives: Occasionally, the Otolaryngologist needs to accede quickly to medical information in order to retrieve data or to solve doubts. In this way, it seems to be of interest to design a clinical guide that could be consulted as a PDA program (Pocket PC and Palm versions), in a personal computer or Internet. Material and methods: Clinical contents of protocols, guides, and articles, preferably based on the evidence and the clinical experience of 102 authors. Implementation of a program that allows the guide to be used in a PDA, to update it or to add notes using tools that could be downloaded from a web page. Results: A clinical practice guide SEORLPDA ® version 1.1, with thirteen ENT's topics, calculation algorithms, internal links and possibility of update the content and to add notes. Discussion: SEORL-PDA® is a clinical guide in PDA format, with enough information and possibilities. Its downloading and installation is easily done following the instructions of the web created with these purposes

[Multimedia educational material. A tool of support to the Otolaryngology training]. / Material educativo multimedia. Una herramienta de apoyo a la enseñanza de la Otorrinolaringología.

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher.

Material educativo multimedia. Una herramienta de apoyo a la enseñanza de la Otorrinolaringología / Multimedia educational material. A tool of support to the Otolaryngology training

La información médica ha tenido un empuje extraordinario por las tecnologías multimedia. Sin embargo, la formación universitaria debe ser un proceso pedagógico más complejo. Presentamos un material educativo multimedia (MEM), adaptado como "Seminarios de Otorrinolaringología", al que se accede libremente desde una plataforma en red vinculada a la universidad. En la elaboración del MEM participaron profesores ORL, pedagogos, diseñadores gráficos e informáticos. Está estructurado en módulos de contenidos que integran textos, imágenes, vídeos, audios y animaciones. Destaca la presentación esquemática con acceso progresivo a contenidos a través de enlaces y vínculos. Las imágenes reales marcadas y los vídeos completan este aspecto descriptivo. Los recursos pedagógicos: objetivos, plan trabajo, glosario, referencias, índice y buscador apoyan este material. Las actividades y simulaciones instrumentales completan la formación en el diagnóstico y tratamiento. El MEM es una herramienta útil en la enseñanza universitaria de la Otorrinolaringología, sin desplazar la figura clave del profesor

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher

[Genetic alterations in sinonasal adenocarcinoma in wood workers studies with comparative genomic hybridization]. / Alteraciones genéticas en adenocarcinomas nasosinusales de trabajadores de la madera mediante hibridación genómica comparativa.

Eleven wood-workers with sinonasal adenocarcinoma were analyzed by comparative genomic hybridization. This technique serves as a screening test for regions of copy number changes in tumor genomes. We have applied the technique to map DNA gains and losses in 9 cases of formalin-fixed, paraffin-embedded tumors and 2 cases of frozen tumors. Gains were found most frequently than losses. Whole arm chromosomic gains were detected in high frequencies at 8q, 7q, 12q and 18p and losses at 18q, 8p, 10q, 5q, 14q and 17p. The segment most frequently amplified was 18p11.1-q11 (45%), even though others like 7q21-22 (18%) were related with lower survival rates. This analysis allows us to know for the first time the chromosomic aberrations that occur and may play an important role in sinonasal adenocarcinoma. In the future, comparative genomic hybridization could be used in the woodworkers with long exposition to wood dust to detect initial genetic aberrations and obtain an early treatment and diagnosis of the disease.

Alteraciones genéticas en adenocarcinomas nasosinusales de trabajadores de la madera mediante hibridación genómica comparativa / Genetical disorders in sinonasal adenocarcinomas in wood-workers by comparative genomic hybridization

Se estudian 11 pacientes trabajadores de la madera que desarrollaron adenocarcinomas nasosinusales. Se utilizó la hibridación genómica comparativa como método de análisis en el conjunto del contenido genómico en 9 tumores parafinados y 2 tumores congelados.Encontramos alteraciones en todos los casos predominando las ganancias cromosómicas frente a las pérdidas. Las ganancias más frecuentes de brazos cromosómicos se observan en 8q, 7q, 12q y 18p y las pérdidas o deleciones en 18q, 8p, 10q, 5q, 14q y 17p. El mayor número de amplificaciones se encontró en 18p11.1-q11 (45 por ciento), aunque otras como 7q21-22 (18 por ciento) se relacionaron con menor supervivencia. Por primera vez, este análisis permite conocer las alteraciones cromosómicas ocurridas en los adenocarcinomas nasosinusales y es un primer paso en el diseño de un modelo de progresión. En un futuro, la hibridación genómica comparativa podría ser utilizada en trabajadores expuestos al polvo de madera para detectar las alteraciones genéticas iniciales y contribuir al diagnóstico y tratamiento precoz de la enfermedad. (AU)

Eleven wood-workers with sinonasal adenocarcinoma were analyzed by comparative genomic hybridization. This technique serves as a screening test for regions of copy number changes in tumor genomes. We have applied the technique to map DNA gains and losses in 9 cases of formalin-fixed, paraffin-embedded tumors and 2 cases of frozen tumors. Gains were found most frequently than losses. Whole arm chromosomic gains were detected in high frequencies at 8q, 7q, 12q and 18p and losses at 18q, 8p, 10q, 5q, 14q and 17p. The segment most frequently amplified was 18p11.1-q11 (45%), even though others like 7q21-22 (18%) were related with lower survival rates. This analysis allows us to know for the first time the chromosomic aberrations that occur and may play an important role in sinonasal adenocarcinoma. In the future, comparative genomic hybridization could be used in the woodworkers with long exposition to wood dust to detect initial genetic aberrations and obtain an early treatment and diagnosis of the disease (AU)

[DNA ploidy and S phase in relation to metastases of pharyngolaryngeal epidermoid carcinoma]. / Ploidía de ADN y fase S en relación con las metástasis de los carcinomas epidermoides faringolaríngeos.

Lymph node metastases in pharyngolaryngeal squamous-cell carcinoma are the clinical finding that most precisely condition prognosis. Sometimes the presence of subclinical metastases modifies the initial therapeutic strategy because they are not detected by physical exploration or imaging techniques. We tried to establish a relationship between the tumor's intrinsic aggressiveness and the development of metastases through tumoral DNA damage. Aneuploidy and the S phase were more frequent in tumors of the larynx, particularly supraglottic tumors, that developed lymph node metastases (72%) than in diploid tumors with a normal S phase (18%). In pharyngeal tumors, no differences could be established because most were aneuploid with a high S phase and metastases. Flow cytometry is highly sensitive, but not sufficiently specific for routine clinical use. However, it is a useful point of departure for our line of research, which will continue with a search for more specific genetic or molecular markers of metastases among the general DNA abnormalities.

Ploidía de ADN y fase S en relación con las metástasis de los carcinomas epidermoides faringolaringeos / DNA ploidy and S phase in relation with metastases of pharyngolaryngeal epidermoid carcinoma

Las metástasis ganglionares en los carcinomas epidermoides faringolaríngeos son el dato clínico que condiciona el pronóstico de forma más precisa. En ocasiones la presencia de metástasis subclínicas hace que el planteamiento inicial se vea alterado al no poder ser detectadas en la exploración ni por las técnicas de imagen. Se trató de establecer una relación entre la agresividad intrínseca del tumor y el desarrollo de las metástasis teniendo en cuenta el daño del ADN tumoral. Utilizando la aneuploidía y el aumento de la fase S podemos observar cómo los tumores laringeos, sobre todo los supraglóticos, presentan esta alteración de forma más significativa, cuando desarrollan metástasis ganglionares (72 por ciento) en relación a los tumores diploides y con fase S normal (18 por ciento). En los tumores laríngeos no es posible establecer diferencias pues la mayoría son aneuploides con fase S alta y metastásicos. El procedimiento de la citometría de flujo tiene alta sensibilidad pero es poco específico para aplicar en la clínica de forma rutinaria. Aunque nos sirve de partida para abrir esta línea de investigación, debemos buscar otros marcadores genéticos o moleculares más específicos del proceso de metástasis dentro de la alteración general del ADN (AU)

Lymph node metastases in pharyngolaryngeal squamous-cell carcinoma are the clinical finding that most precisely condition prognosis. Sometimes the presence of subclinical metastases modifies the initial therapeutic strategy because they are not detected by physical exploration or imaging techniques. We tried to establish a relationship between the tumor's intrinsic aggressiveness and the development of metastases through tumoral DNA damage. Aneuploidy and the S phase were more frequent in tumors of the larynx, particularly supraglottic tumors, that developed lymph node metastases (72%) than in diploid tumors with a normal S phase (18%). In pharyngeal tumors, no differences could be established because most were aneuploid with a high S phase and metastases. Flow cytometry is highly sensitive, but not sufficiently specific for routine clinical use. However, it is a useful point of departure for our line of research, which will continue with a search for more specific genetic or molecular markers of metastases among the general DNA abnormalities (AU)

Grado nuclear en punciones de carcinoma de mama: características ópticas y análisis de imagen / Nuclear grade in breast carcinoma aspirates: optical features and image analysis

Planteamiento: Establecer la fiabilidad de unos parámetros subjetivos (tamaño y pleomorfismo nuclear, nucléolo y grado de dispersión celular) utilizados para establecer el grado nuclear de malignidad en punciones de mama, mediante su comparación con un examen morfométrico a través de un proceso digital de imagen. Material y métodos: El trabajo se realizó con 60 punciones con aguja fina (PAAF) correspondientes a carcinoma ductal infiltrante de mama. En primer lugar se estableció en cada una de las PAAF el grado nuclear mediante observación al microscopio. A continuación se realizó el estudio morfométrico, seleccionando una serie de parámetros (área, perímetro, diámetro máximo, forma circular y forma rugosa). Resultados: En el examen microscópico, 21 casos (35 por ciento) correspondieron a un grado nuclear I, 31 casos (51,7 por ciento) a un grado nuclear II y ocho casos (13,3 por ciento) a un grado nuclear III. Se estableción un estudio comparativo microscópico/morfométrico, así como una correlación entre los grados nucleares y los resultados morfométricos de los diferentes marámetros estudiados. con respecto al tamaño y el área media, existió una correlación estadísticamente significativa (P<0,05) con los grados subjetivos. En cuanto al pleomorfismo y la desviación estándar media, también la correlación fue significativa (p<0,05). Conclusiones: Los parámetros citológicos que mejor representan al grado nuclear son el tamaño de los núcleos y el pleomorfismo de los mismos, siendo además los que mejor se correlacionan con los resultados morfométricos (AU)

[DNA ploidy and cell cycle phase analysis with flow cytometry in bladder wash. Preliminary experience]. / Análisis de ploidía de ADN y fases del ciclo celular por citometría de flujo en el lavado vesical. Experiencia preliminar.

OBJECTIVE: To analyze the prognostic significance in bladder carcinoma of DNA ploidy and cell phase fractions measured by bladder wash flow cytometry. METHODS: Samples were obtained from 25 patients by bladder irrigation; 16 before surgery and 9 during follow-up cystoscopic examination. Cells were stained with propidium iodide and analyzed with the FacScan flow cytometer and Cellfit 2.01 (Becton-Dickinson). RESULTS: The number of cells obtained was sufficient for flow cytometric analysis in all cases. In 13 tumor samples (8 superficial and 5 invasive tumors), aneuploidy cells were detected in 3 cases that had a worse outcome; the only superficial tumor in which aneuploidy was detected presented a recurrent bladder carcinoma 15 months later. Of the 5 patients with invasive tumors, two patients with aneuploidy died within 6 months from tumor metastases. Of the patients without macroscopic tumor, only one showed an increase in the percentage of the S phase fraction (19.5% of cells in S phase). A recurrent bladder carcinoma was detected in this patient 6 months after the analysis. In patients with macroscopic tumor, analysis of the S phase fraction was not relevant for prognosis. CONCLUSIONS: Analysis of DNA ploidy and cell phase fractions by flow cytometry of bladder washings can increase the prognostic information in bladder carcinoma. Aneuploidy was associated with a worse prognosis and an increase in the S phase fraction predicted a recurrent bladder carcinoma months before it manifested clinically.

[Use of elements from the ISO 90000 system in Spanish hemotherapy]. / Uso de los elementos del sistema ISO 9000 en la hemoterapia española.

PURPOSE: To evaluate the prevalence of all twenty elements of ISO 9000 in the practice of the Blood Banks of Spain independently of being certified or not to ISO system. MATERIALS AND METHODS: By a survey sent in november 1996 to the Hospital-Based Blood Bank and Transfusional Services of 225 hospitals with more than 100 beds, and to 25 Community Blood Centers. The survey had 38 questions on the all elements of the ISO system and on other aspects of quality no directly related with it, as to be accredited by transfusional accreditation Committee, to have an hospital transfusion committee, informed consent of the transfusion and guidelines for using hemoderivatives. RESULTS: The survey was answered by 53 (21%) of hospitals and Community Blood Centers. None of the participant were certified to ISO system. The elements more used were the documentation of adverse reactions, procedures manual, validation of blood components, control of nonconforming products, and product identification and traceability, all of them used for more than 80% of participants. On the contrary, the elements less used were to have a quality unit, equipment manual, to validate the computer system, internal quality audits, criteria on purchasing, training and quality manual, all of them used by less than 30% of the participants. CONCLUSIONS: Generally speaking the elements of the ISO system more commonly used are those related to the basic ones of daily work and the least used are those related to the organisation aspects of quality. The Community Blood Centers score higher than hospital blood banks and among these, the best results are in the blood banks of hospitals more than 500 beds and the hospital accredited for teaching.

[The relation between human papilloma virus and cellular DNA content in epidermoid carcinoma of the head and neck]. / Relación entre el virus del papiloma humano y el contenido celular de ADN en los carcinomas epidermoides de cabeza y cuello.

The relation between the presence of gene sequences of human papilloma virus (HPV) and the development of abnormalities in cellular DNA content was analyzed in 31 squamous-cell carcinomas of the head and neck. The integration of HPV types 16 and 6b by PCR and DNA content was studied by flow cytometry in 31 specimens from patients with squamous-cell carcinoma of the head and neck. Eighteen (58%) cases were aneuploid. HPV DNA was present in seven tumors (22.5%), five of then HPV-6b and two of them HPV-16. Aneuploidy correlated with poorly differentiated tumors. No correlation was found between HPV integration and either cellular DNA content or the degree of histological tumor differentiation. Therefore, the presence of HPV gene sequences did not seem to be associated with a higher incidence of aneuploidy in squamous-cell carcinoma of the head and neck.

[Amplification of oncogene c-erb-B1 and cellular DNA content in squamous cell carcinoma of the head and neck]. / Amplificación del oncogén c-erbB1 y contenido celular de ADN en los carcinomas epidermoides de cabeza y cuello.

Tumoral DNA content was studied by flow cytometry and PCR amplification of c-erbB1 in tissue samples from 31 patients with squamous cell carcinoma of the head and neck. Eighteen cases (58%) were aneuploid and 13 (42%) were diploid. Aneuploidy correlated with pharyngeal site and poorly differentiated tumors, but not with clinical stage or metastases. Six (19.3%) cases had c-erbB1 amplification, which correlated with tumor size, nodal metastasis, poor differentiation, and hypopharyngeal site. Only 20% of patients with amplification survived 30 months, compared with 64% of patients without amplification. None of the patients with aneuploidy and c-erbB1 amplification survived more than 15 months. To conclude, the measurement of cellular DNA content and c-erbB1 amplification seem to have prognostic value in squamous cell carcinoma of the head and neck.

[Clinico-histological scale for identifying preinvasive lesions of the larynx]. / Escala clínico-histológica en el pronóstico de las lesiones preinvasivas de laringe.

Preinvasive laryngeal lesions progress to infiltrating carcinoma in 7-15% of cases. Clinical manifestations and histological findings are not reliably predictive of progression. Quantitative cytometry improves predictive effectiveness, but is not a routine procedure. A clinico-histological scale consisting of 13 variables which were combined and used prospectively had a predictive value of 0.8 sensitivity and 0.9 specificity for progression of preinvasive laryngeal lesions.

[Metastasizing pleomorphic adenomas. Clinical and cytometric analysis]. / Adénomes pléomorphes métastasants. Analyses cliniques et cytométriques.

Metastasizing pleomorphic adenoma is a rare lesion, histologically benign but with a malignant clinical behaviour. Two cases are reported with a flow cytometric study. Recurrent adenoma and its metastasis were aneuploid in one case.

[Well-differentiated liposarcoma of the spermatic cord with dedifferentiation]. / Liposarcoma bien diferenciado de cordón espermático con desdiferenciación.

We report a case of well-differentiated liposarcoma with dedifferentiation of spermatic cord in a 73-year-old-man. Treatment was by orchiectomy without retroperitoneal lymph node dissection or adjuvant therapy. The patient has survived 10 months with no evidence of recurrence. Liposarcoma localized to the spermatic cord is rare; less than 70 cases have been previously reported. The literature is reviewed with special emphasis on the clinical significance of the dedifferentiation phenomenon.

[Granulomatous peritonitis due to starch. Apropos of a case]. / Peritonitis granulomatosa por almidón. A propósito de un caso.

The authors present a case of granulomatous peritonitis due to starch in a 47-year-old female. This is an infrequent, but clinically important, process. Contamination occurs mainly through rubber gloves. The symptomatology is varied and simulates a picture of acute abdomen. The diagnosis rests on examination of the liquid obtained by peritoneocentesis or peritoneal biopsy. The histopathologic picture is that of a granulomatous reaction to foreign matter, with giant cells that exhibit birefringent granules in the form of the Maltese cross. Medical management is based on the use of steroids and anti-inflammatory agents.

[Gingival hyperplasia in renal transplants treated with cyclosporin]. / Agrandamiento gingival en trasplantados renales tratados con ciclosporinas.

Cyclosporine is a Metabolita produced by the Topocladium inflamatum fungus. This substance produces an immunosuppression of the selective type, which has been responsible for the increased use of this drug for immunological caused pathologies, especially in organ transplants to inhibit body rejection. One of its secondary characteristics or effects is gingival hyperplasia (in 30 por 100 of the cases noted) an effect which generally occurs on the level or in the area of the dental papilla. An anatomopathological study of these tissues shows an increase in collagens along with a large infiltration of plasmatic cells in different states of maturity. In this article, two cases of renal transplants using cyclosporine were monitored to evaluate its effect in any on the gingival tissues.