Paragangliomas carotídeos: hacia un tratamiento personalizado que reduzca la morbilidad / Carotid body tumours: Towards a personalised treatment that reduces morbidity

Los paragangliomas carotídeos (PGC) son tumores infrecuentes que muy raramente son causa de muerte. El conocimiento de las bases genéticas de los tumores de origen hereditario, más de un tercio del total, ha permitido identificar a la población en riesgo y establecer en ella medidas para un diagnóstico precoz de los tumores. El tratamiento más habitual ha sido el quirúrgico que, en no pocos casos, origina una importante morbilidad. Un amplio contingente de los PGC no experimenta crecimiento alguno, lo que justifica una conducta expectante. Aquellos tumores con crecimiento significativo deben ser tratados. La radioterapia ofrece unas cifras similares de control a las de la cirugía y no presenta secuelas neurológicas ni vasculares. No obstante, la cirugía está indicada en PGC Shamblin I/II de pacientes jóvenes, en los raros tumores malignos o hiperfuncionantes y en el fracaso de la radioterapia. Los tumores múltiples familiares deben tratarse conservadoramente (AU)

Carotid body paragangliomas (CBP) are uncommon tumours that very rarely cause death. The genetic basis of tumours of hereditary origin (more than a third of the total) has been determined in the last few years, which has helped to identify the population at risk and to implement screening methods for an early diagnosis of tumours. The most common treatment of CBP has been surgery, which frequently causes significant morbidity. A significant number of paragangliomas do not experience any growth, which justifies a wait-and-see approach using annual image studies. Those tumours with significant growth must be treated. Radiotherapy has similar outcomes to surgery and has no neurological or vascular sequelae. However, surgery is indicated in Shamblin I/II carotid body tumours in young patients, in the rare malignant or hyper-functioning tumours, and in the failure of radiotherapy. Multiple tumours of familial origin should be treated conservatively (AU)

Giant neck liposarcoma with pathological clavicular fracture.

Liposarcomas generally originate in the extremities or retroperitoneum, they are very unusual in the head and neck region, and extremely rare in the thorax. The mainstay of treatment for liposarcomas is surgical excision. We report a very unusual case, not reported before to our knowledge, of a well-differentiated liposarcoma arising from the supraclavicular fossa that produces a pathological clavicular fracture. The patient underwent complete resection of the lesion, without damage of the cervical nerves. Eight months after the surgery the patient is free of recurrence. We demonstrate that giant liposarcomas can be resected completely without morbidity.

Segundos tumores primarios en el cáncer escamoso de cabeza y cuello / Second primary tumors in head and neck cancer

Introducción: El desarrollo de un segundo tumor primario (STP) en el cáncer escamoso de cabeza y cuello (CECC) presenta elevada mortalidad y condiciona la decisión terapéutica. Objetivo: Describir las características clínicas de los STP y determinar su implicación en la supervivencia. Material y método: Revisión de 633 pacientes con CECC entre 1984-2004 describiendo las principales características de los STP. Resultados: Se observan en el 11% de los CECC. Los tumores índice que se asocian más a un STP son los de laringe supraglótica (21%) y cavidad oral (16%). Los STP ocurren sobre todo en el área de cabeza y cuello (47%), pulmón (32%) y esófago (11%). Tienen gran impacto en la supervivencia de los pacientes con CECC, reduciéndola en un 30% (23% versus 53% en el grupo control). Conclusiones: Debido a la alta incidencia de STP es necesario profundizar en su estudio para realizar una prevención adecuada y un tratamiento eficaz

Introduction: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. Purpose: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. Material and method: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. Results: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). Conclusion: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated

[Distant metastases in head and neck cancer]. / Metástasis a distancia en el cáncer de cabeza y cuello.

INTRODUCTION: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. PURPOSE: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. METHODS AND MATERIALS: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. RESULTS: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). CONCLUSIONS: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated.

Metástasis a distancia en el cáncer de cabeza y cuello / Distant metastases in head and neck cancer

Introducción: La presencia de metástasis a distancia (MD) no es un evento muy frecuente en los carcinomas de cabeza y cuello (CECC) y se asocia con muy mal pronóstico. Objetivo: Investigar la las principales características clínicas y factores de riesgo asociados con el diagnóstico de MD en CECC. Material y método: Estudio retrospectivo de 633 pacientes con CECC para describir las características clínicas de las MD. Resultados: Se observan en el 6,2% de los CECC. Las localizaciones que más las originan son la hipofaringe (14,4%), los primarios de origen desconocido (11,8%) y la orofaringe (8,5%), apareciendo con mayor frecuencia en pulmón (58%) y hueso (22%). Determinan un gran impacto en la supervivencia, reduciéndola al 2,5% a los 3 años (49,5% en el grupo control a los 5 años). Conclusiones: Es preciso realizar un seguimiento adecuado para su detección precoz y tratamiento eficaz, investigando nuevos protocolos terapéuticos que incluyan la quimioterapia

Introduction: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. Purpose: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. Methods and Materials: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. Results: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). Conclusions: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated

[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.

[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.

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)

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

[Factors predicting Voice Handicap Index]. / Indice de Incapacidad Vocal: factores predictivos.

OBJECTIVE: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. MATERIAL AND METHODS: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. RESULTS: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. CONCLUSIONS: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia.

Índice de Incapacidad Vocal: factores predictivos / Factors predicting óbice handicap index

Objetivo: Evaluar los factores que pueden influir en la percepción de la disfonía por parte del paciente, cuantificada mediante el Índice de Incapacidad Vocal (VHI). Material y método: Se realiza un estudio prospectivo de 81 registros vocales de pacientes diagnosticados de una patología benigna de las cuerdas vocales. Las variables analizadas para calcular la predicción sobre el VHI son: tiempo máximo de fonación, análisis del espectrograma, jitter, shimmer, HNR, NNE, Fo y el análisis perceptual de la disfonía (GRABS). Resultados: Los parámetros predictivos de la puntuación total del VHI fueron la relación armónico ruido (HNR), la frecuencia fundamental (F0) y los parámetros B y S del sistema GRABS. Conclusiones: La puntuación del VHI se correlaciona con la percepción de la voz aérea y sus atributos acústicos, como la relación señal-ruido. En otros estudios, la percepción de la disfonía por parte del paciente es independiente de muchos factores que se valoran de forma rutinaria en la evaluación de los trastornos de la voz. Parece razonable asumir que el grado de insuficiencia glótica causada por lesiones vocales benignas se relacione con una baja relación señal-ruido y con la voz aérea como su característica perceptual. La subescala física parece ser un elemento independiente

Objective: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. Material and methods: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. Results: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. Conclusions: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia

[Second primary tumors in head and neck cancer]. / Segundos tumores primarios en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. PURPOSE: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. MATERIAL AND METHOD: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. RESULTS: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). CONCLUSION: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.

[The relationship between human papillomavirus and cyclin D1 gene amplification in squamous cell carcinomas of the head and neck]. / Relación entre el virus del papiloma humano y la amplificación del gen de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello.

INTRODUCTION: infection by oncogenic subtypes of human papillomavirus (HPV) and cyclin D1 gene (CCND1) amplification are frequent events in head and neck squamous cell carcinomas. The objective of this paper is to establish the relationship between the presence of human papillomavirus (HPV) gene sequences and the development of CCND1 gene amplification in these tumours. MATERIALS AND METHODS: 59 squamous cell carcinomas of the head and neck were studied for HPV types 6b and 16 and CCND1 gene amplification by polymerase chain reaction. RESULTS: HPV DNA was detected in 14 tumors (24%). Ten of them were positive for the HPV type 6b and 4 for the HPV type 16. CCND1 gene amplification was found in 15 cases (25%). Although we have found a higher frequency of CCND1 amplification in the HPV-positive cases (36%, versus 22% in the HPV-negative cases), these differences were not statistically significant (P= 0,32). CONCLUSIONS: The presence of HPV gene sequences does not seem to be related to a significative higher incidence of CCND1 gene amplification in the squamous cell carcinomas of the head and neck.

La investigación en el ejercicio profesional de la medicina especializada / Research in the professional practice of the medical speciality

La investigación tiene un papel crucial en el desarrollo económico sostenido de los países, contribuyendo de forma muy importante a aumentar nuestra calidad de vida en todos los ámbitos, a la vez que posibilita hacer frente al desafío de lo inesperado. En España la ciencia ha sido tradicionalmente relegada a un plano secundario, siendo fundamental para nuestro progreso dentro del concierto de naciones revertir este proceso. Dentro de los distintos tipos de investigación (básica, clínica y translacional) son los dos últimos los que concitan mayor interés para los médicos clínicos, existiendo una amplia variedad de enfoques dentro de las posibles investigaciones a desarrollar. La formación del médico en investigación clínica repercute en mejor asistencia, posibilitando la comprensión de los avances científicos y su aplicación a la práctica médica. Existe una tendencia a la disminución del peso de los médicos clínicos en llevar a cabo labores de investigación, lo que debe corregirse si se quieren aplicar los avances de las ciencias básicas a la práctica médica. El contacto con la investigación debe comenzar en la Facultad de Medicina y tener un peso significativo durante la residencia. Finalizada ésta, aquellos de los nuevos especialistas con mayor interés y capacidad investigadora deben realizar durante 3-4 años un entrenamiento en investigación clínica, al final del cual estarán capacitados para asumir funciones clínicas e investigadoras de forma simultánea. Finalmente, nuestra especialidad en España necesita dar un salto cualitativo con la creación de laboratorios dentro de los servicios de Otorrinolaringología en los hospitales que cuenten con infraestructuras adecuadas para el desarrollo de la investigación

Research has a very important role in the financial development of countries; it improves our life quality in all aspects and helps to face unexpected happenings. In Spain science has been left to a second plane and we feel necessary to reverse this situation. Amongst the different kinds of research (basic, clinical and translational) the two last ones are most interesting for clinical doctors. Training of the doctor in the research field helps to a better practice as the advances in research can be applied to clinical practice. There is a tendency for doctors to be involved less in research and it is very important to modify this situation. Research should start in Medical school and play an important role throughout the training period. Once training has concluded, those with capacity and interest in research should follow a 3-4 years training in the field and after that period they can undertake both clinical and research roles. Finally, in Spain our speciality needs to create specific research laboratories in those ENT departments in hospitals with adequate infrastructure to develop research

[Prognostic factors in adenoid cystic carcinoma of salivary glands]. / Factores pronósticos en el carcinoma adenoide quístico de glándulas salivares.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is a relatively rare tumor which is characterized by its long clinical history, with multiple recurrences and late distant metastasis. The aim of the present study is to show our experience in the management of this tumor and the relationship of different clinico-pathological parameters with its prognosis. MATERIAL AND METHODS: A retrospective study was carried out between 1984 and 2004 in 28 patients with ACC of the salivary glands, analyzing the most outstanding clinico-pathological variables in this tumor related to the prognosis of the tumor and the survival. RESULTS: The overall survival rates at 5, 10 and 15 years were 88%, 69% and 52% respectively. Ten (36%) patients presented local recurrence and 10 (36%) presented distant metastasis (four of which also have local recurrence). Although the differences were not statistically significant, the patients with solid histological subtype (p=0.17), with positive margins status (p=0.2), with perineural invasion (p=0.59), and those treated with surgery alone (p=0.19), presented a worse survival. DISCUSSION/CONCLUSION: Our study confirms that the ACC is a tumor with a high tendency to local recurrence and development of distant metastasis, even long term, which means a close follow-up for life. Nevertheless, it also demonstrates that acceptable survival rates can be obtained with aggressive treatment.

Relación entre el virus del papiloma humano y la amplificación del gen de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello / The relationship between human papillomavirus and cyclin D1 gene amplification in squamous cell carcinomas of the head and neck

Introducción: La infección por los subtipos oncogénicos del virus del papiloma humano (HPV) y la amplificación del gen de la ciclina D1 (CCND1) son dos alteraciones frecuentes en los carcinomas epidermoides de cabeza y cuello. El objetivo de este trabajo es estudiar la relación entre la presencia del HPV y el desarrollo de la amplificación delCCND1 en dichos carcinomas. Material y métodos: Se estudian 59 carcinomas epidermoides de cabeza y cuello, en los cuales se determina la presencia de los tipos 6b y 16 del HPV y la amplificación del CCND1 mediante la reacción en cadena de la polimerasa (PCR). Resultados: Se detectó el ADN del HPV en 14 tumores (24%). Diez de ellos eran positivos para el HPV 6b y 4 para el HPV 16. El gen CCND1 se hallaba amplificado en 15 casos (25%). Aunque la amplificación del CCND1 fue más frecuente en los casos con integración del HPV (36% en los casos HPV-positivos frente al 22%en los HPV-negativos), estas diferencias no fueron estadísticamente significativas (P=0,32). Conclusiones: La presencia del HPV en las células tumorales no parece relacionarse con una incidencia significativamente mayor de amplificación del gen CCND1 en los carcinomas epidermoides de cabeza y cuello (AU)

Introduction: infection by oncogenic subtypes of human papilloma virus (HPV) and cyclin D1 gene (CCND1) amplification are frequent events in head and neck squamous cell carcinomas. The objective of this paper is to establish the relationship between the presence of human papilloma virus (HPV) gene sequences and the development of CCND1 gene amplification in these tumours. Materials and methods: 59 squamous cell carcinomas of the head and neck were studied for HPV types 6b and 16 and CCND1 gene amplification by polymerase chain reaction. Results: HPVDNA was detected in 14 tumors (24%). Ten of them were positive for the HPV type 6b and 4 for the HPV type 16.CCND1 gene amplification was found in 15 cases (25%). Although we have found a higher frequency of CCND1 amplification in the HPV-positive cases (36%, versus 22% in the HPV-negative cases), these differences were not statisticallysignificant (P= 0,32). Conclusions: The presence of HPV gene sequences does not seem to be related to a significative higher incidence of CCND1 gene amplification in the squamous cell carcinomas of the head and neck (AU)

[Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation]. / Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica.

OBJECTIVES: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. PATIENTS AND METHODS: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. CONCLUSION: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction.

Factores pronósticos en el carcinoma adenoide quístico de glándulas salivares / Prognostic factors in adenoid cystic carcinoma of salivary glands

Objetivo: El carcinoma adenoide quístico (CAQ) es un tumor relativamente raro que se caracteriza por presentar un curso clínico prolongado, con múltiples recurrencias y metástasis a distancia tardías. El objetivo de nuestro estudio es mostrar la experiencia acumulada en nuestro hospital en el manejo de este tumor, relacionando a su vez diferentes parámetros clínico-patológicos con el pronóstico de la enfermedad. Material y método: Se realiza un estudio retrospectivo de 28 pacientes intervenidos de CAQ de glándulas salivares, analizando las variables clínico-patológicas más relevantes en este tumor en relación con el pronóstico de la enfermedad y la supervivencia. Resultados: La supervivencia global de nuestra serie fue del 88%, 69% y 52% a los 5, 10 y 15 años respectivamente. Diez (36%) pacientes presentaron recidiva local y 10 (36%) presentaron metástasis a distancia (de los cuales 4 tenían recidiva local). Aunque las diferencias no fueron estadísticamente significativas, los pacientes con subtipo histológico sólido (p=0,17), con bordes quirúrgicos afectados (p=0,2), con invasión perineural (p=0,59), y los tratados sólo con cirugía (p=0,19) presentaron peor supervivencia. Discusión/conclusiones: Nuestro estudio confirma que el CAQ es un tumor con gran tendencia a la recidiva local y al desarrollo de metástasis a distancia, incluso a largo plazo, lo que exige por nuestra parte un seguimiento estrecho y de por vida del paciente. No obstante, también demuestra que se pueden conseguir unas tasas de supervivencia aceptables con un tratamiento agresivo

Objective: Adenoid cystic carcinoma (ACC) is a relatively rare tumor which is characterized by its long clinical history, with multiple recurrences and late distant metastasis. The aim of the present study is to show our experience in the management of this tumor and the relationship of different clinico-pathological parameters with its prognosis. Material and methods: A retrospective study was carried out between 1984 and 2004 in 28 patients with ACC of the salivary glands, analyzing the most outstanding clinico- pathological variables in this tumor related to the prognosis of the tumor and the survival. Results: The overall survival rates at 5, 10 and 15 years were 88%, 69% and 52% respectively. Ten (36%) patients presented local recurrence and 10 (36%) presented distant metastasis (four of which also have local recurrence). Although the differences were not statistically significant, the patients with solid histological subtype (p=0.17), with positive margins status (p=0.2), with perineural invasion (p=0.59), and those treated with surgery alone (p=0.19), presented a worse survival. Discussion/conclusion: Our study confirms that the ACC is a tumor with a high tendency to local recurrence and development of distant metastasis, even long term, which means a close follow- up for life. Nevertheless, it also demonstrates that acceptable survival rates can be obtained with aggressive treatment

Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica / Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation

Objetivo: Determinar la sensibilidad y especificidad del nistagmo de agitación cefálica (NAC), que se provoca girando la cabeza rápidamente en el plano horizontal, en el estudio de pacientes con patología vestibular periférica unilateral. Pacientes y metodología: Realizamos un estudio retrospectivo en 83 pacientes con patología vestibular periférica unilateral correlacionando el NAC con el resto de las pruebas videonistagmográficas. Resultados: Se registraron 23 NAC positivos, 21 en pacientes con hiporreflexia en la prueba calórica y los dos restantes con dichas pruebas simétricas, pero con otras alteraciones nistagmográficas asociadas. La sensibilidad del NAC para determinar la existencia de hiporreflexia es de 48,8%, pero la especificidad es del 95%, alcanzando el 100% cuando consideramos como estándar ideal la existencia de anomalías nistagmográficas. Conclusiones: El NAC es una prueba sencilla que puede permitir con gran fiabilidad determinar que un paciente porta una asimetría en la función vestibular

Objectives: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. Patients and methods: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. Results: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. Conclusion: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction

[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.