Cirugía mayor ambulatoria. Estudio de 1.028 operaciones de otorrinolaringología / No disponible

Introducción: Los servicios de otorrinolaringología (ORL) se han implicado desde el inicio de la cirugía mayor ambulatoria(CMA) en esta modalidad asistencial que permite una mejor utilización de los recursos disponibles con total satisfacción de los pacientes. Material y método: Se revisa un total de 1.028 pacientes programados por patología otorrinolaringológica en la unidad de CMA de nuestro hospital. El 30,6% correspondieron a patología laríngea; el 30,1% a patología otológica, y 39,2% a patología nasal y de tejidos blandos. Se trata de un estudio observacional obtenido de las bases de datos clínicas de la unidad, manejadas mediante el programa informático Stat View 5.1.0.Resultados: De las 1.028 intervenciones previstas, 20 fueron suspendidas (1,9%). El 74,5% de los pacientes fueron intervenidos bajo anestesia general; un 1,39% sufrieron complicaciones (..) (AU)

Background: Otolaryngology or ENT departments become involved since the beginning of day surgery in this health care modality that allows a better use of available resources with overall patient satisfaction. Materials and method: A total of 1028 patients, registered for ENT pathology in the day surgery unit of our hospital, have been studied. A 30.6% corresponded to laryngeal pathology,30.1% to ear pathology, and 39.2% to nasal pathology and soft tissues. It is an observational study obtained from the databases clinical unit, managed by the programme Stat View 5.1.0.Results: From 1,028 planned interventions, 20 were cancelled,1.9%. A 74,5% patients were operated on under general anaesthesia. A 1.39% suffered intraoperative complications, a 3.9% postoperative complications and a 1.78% needed unexpected hospitalisation. There was no mortality. Conclusions: Day surgery in ENT pathology confirms the success of day surgery, because with this modality of surgery is possible to obtain a correct treatment of patients with maximum safety and good acceptance both of patients and professionals (AU)

[Selective therapeutic embolization in intractable epistaxis]. / Embolización selectiva terapéutica en epistaxis incoercibles.

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed.

Embolización selectiva terapéutica en epistaxis incoercibles / Therapeutic selective embolization in intractable epistaxis

La epistaxis es una patología frecuente dentro de la urgencia otorrinolaringológica y en muchos casos aparece como un problema menor que se solventa con tratamiento conservador. En los casos recurrentes o severos puede ocasionar importantes complicaciones sistémicas, que nos hacen evaluar terapéuticas más agresivas buscando una resolución más efectiva. La embolización selectiva en el territorio de la arteria carótida externa es un método terapéutico aceptado en las epistaxis posteriores incoercibles y refractarias a los habituales tratamientos conservadores. Exponemos tres casos de epistaxis controladas mediante esta técnica, así como una completa revisión de la bibliografía actual sobre el tema (AU)

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed (AU)

[Immunohistochemical markers of cell proliferation in laryngeal carcinoma]. / Marcadores inmunohistoquímicos de proliferación celular en el carcinoma de laringe.

Although several clinicopathological factors may contribute to the prognosis of laryngeal carcinoma, these factors are still uncertain because the carcinogenesis process and malignant behavior are not well known. Immunohistochemical methods using two important markers, PCNA and Ki67 antigen, were used to assess proliferative activity in malignant laryngeal lesions. We studied the correlation between expression of these markers and clinical factors in 72 patients with carcinoma of the larynx: age, sex, occupation, smoking, alcohol consumption, marital status, etc. We also analyzed other known biological and histopathological prognostic factors (tumor stage, histological grade, lymph node metastases, and local invasion). PCNA and Ki-67 expression differed significantly in relation to histological grade and lymph node involvement. No associations were seen between the expression of PCNA and Ki-67 antigens and other study parameters.

[Pharyngoesophageal foreign bodies]. / Cuerpos extraños faringoesofágicos.

A review was made of 77 rigid esophagoscopies to remove a foreign body from the upper digestive tract. Mean age of patients was 59 years. Meat bones were the most frequent impacted foreign body and the cervical esophagus was the most frequent site of impactation. No foreign body was found in 22% of esophagoscopies, a high rate that could have been due to our lack of confidence in radiographic studies, which yield false positive and false negative information. Esophagoscopy is performed whenever patient-referred symptoms are clear. The only complications were three cases of major esophageal erosions without perforation and one pneumothorax. A case of intramural esophageal pseudodiverticulosis was found.

[Study of bcl-2 oncogene in squamous-cell carcinoma of the larynx]. / Estudio del oncogén Bcl-2 en el carcinoma escamoso de laringe.

Apoptosis is a special type of programmed cell death that occurs in the embryonic period, in normal adult tissues, and in several pathological situations. The Bcl-2 gene (B-cell leukemia/lymphoma) is the first member of an oncogene family whose main function is to increase cell survival and inhibit apoptosis, thus participating in the carcinogenic process. This relationship motivated our study of antiapoptosis through the immunohistochemical expression of Bcl-2 oncogene in 72 patients with cancer of the larynx who underwent surgery in our department. The correlation between immunohistochemical expression and clinical factors was analyzed: age, sex, work, smoking and drinking history, marital status, etc., as well as other known biological and histopathological prognostic factors (tumoral stage, histological grade, neck metastases, and local invasion). Bcl-2 expression showed a statistically significant correlation with histological grade and regional lymph node involvement, but no correlation with the other parameters studied.

[Immunohistochemical expression of P53 suppressor genes and retinoblastoma in laryngeal carcinoma]. / Expresión inmunohistoquímica de genes supresores p53 y retinoblastoma en el carcinoma de laringe.

Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population.

Cuerpos extraños faringoesofágicos / Pharynogesopnageal foreign bodies

Hemos realizado una revisión de 77 esofagoscopias rígidas para extraer cuerpos extraños del tracto digestivo superior. La edad media de los pacientes fue de 59 años, el cuerpo extraño más frecuente los huesos de carne y el esófago cervical el lugar más común de impactación. Un 22 por ciento de las esofagoscopias fueron negativas, una alta tasa que nosotros atribuimos a nuestra falta de confianza en los estudios radiológicos dada la existencia de falsos positivos y negativos, lo que nos lleva a realizar la esofagoscopia siempre que la clínica del paciente es clara. Como complicaciones sólo encontramos tres casos de erosiones esofágicas importantes sin ninguna perforación y un neumotórax. También encontramos un caso de pseudodivertículo esofágico intramural (AU)

A review was made of 77 rigid esophagoscopies to remove a foreign body from the upper digestive tract. Mean age of patients was 59 years. Meat bones were the most frequent impacted foreign body and the cervical esophagus was the most frequent site of impactation. No foreign body was found in 22% of esophagoscopies, a high rate that could have been due to our lack of confidence in radiographic studies, which yield false positive and false negative information. Esophagoscopy is performed whenever patient-referred symptoms are clear. The only complications were three cases of major esophageal erosions without perforation and one pneumothorax. A case of intramural esophageal pseudodiverticulosis was found (AU)

[Malignant melanoma of the middle ear, a rare site]. / Melanoma maligno de oído medio, una rara localización.

Melanomas of upper airway tract constitute around 1% of the total melanomas of head and neck. It's for this reason we cannot forget their location in middle ear, although it is truly rare, and we have only found three cases published in literature. We report a patient of 75 years old, who went to our hospital with otorrhea of two months of evolution, with subjective sensation of deafness. In the exploration ENT a bleeding neoformation was observed by otoscopy, which occupied all external auditory canal. The biopsy of this neoformation was informed as malignant neoplasm. These cells show a little cytoplasmic melanotic pigment and were positive to the tinction with Masson Fontana, as well as to the immunohistochemical antibodies S-100 and HMB-45. These antibodies are specific of malignant melanoma. We had a low opinion of surgical treatment because the affectation of the temporal bone and the size of melanoma. Because of badly prognosis, our patient died six months after the diagnosis.

[Effectiveness of tonsillectomy, evaluated by acoustic rhinometry]. / Eficacia de la adenoidectomía evaluada mediante rinometría acústica.

Hypertrophy adenoid commonest cause of nasal obstruction in paediatrics. The morbility can be try alteration in the respiratory physiology, as well as in the face development and function of the middle ear. We used the acoustic rhinometry to evaluate the surgical results of the adenoidectomy in children with hypertrophy adenoid, compiling the data on their clinic, and correlating them as well with the rhinometric results. The acoustic rhinometry is a relatively new method of exploration of the nasal cavity. We obtain space measures that are going to allow to us to prove it. These measures are the cross-sectional areas and volumes registered in the nasal cavity when this cavity is divided longitudinally in two zones, the previous one until 32 mm measured from the narina, and the later one to 64 mm from the same point. For this study we have taken 45 patients with hypertrophied adenoids. We have made measurements pre and post surgery. Our results show a clear gain in areas as in volumes after surgery and also show the utility of the acoustic rhinometry like method of exploration at the time of quantifying the morphometric alterations of the nasal cavity.

[Olfactory esthesioneuroblastoma. Review of seven cases]. / Estesioneuroblastoma olfatorio. Revisión de siete casos.

Esthesioneuroblastomas are fairly rare malignant tumors: only 20 cases have been reported in Spanish records. It is locally aggressive and produces late recurrences. There is no such thing as a universally accepted treatment model. We describe our experience with 7 cases seen in our hospital from 1980 to 1996. A or B stages can be treated with irradiation, surgery or a combination of both. C stages with the most aggressive tendencies may require the combined use of preoperative irradiation, surgery and chemotherapy. We analyzed the forms of presentation, diagnosis, differential diagnosis, treatment, prognosis, and survival. The 5-year survival rate was 75, 60 and 41% for stages A, B and C, respectively.

[ENT outpatient surgery]. / Cirugía ambulatoria en ORL.

The number of patients who undergo outpatient surgery is constantly growing in Spain. Outpatient surgery is interesting not only because of its economy, but also the social benefits that derive from patients returning home sooner and the rapid reduction of the waiting list. We discuss our experience in the last year with 40 patients who underwent surgery. We made a comparative study of patients with the same pathology and anesthetic risk who were treated by outpatient surgery and those treated by inpatient surgery with a traditional technique who were admitted 24 hours before surgery. Our rate of complications (19%) was close to the traditional rate. However, 3, 927, 000 pesetas were saved and the patients were very satisfied, which encouraged us to continue. Indications and complications are discussed.

[Invasive giant prolactinoma]. / Prolactinoma invasivo gigante.

Large prolactin-secreting tumors are rare and their endocrinological and surgical management may be complex. We report the case of a patient with a prolonged history of unilateral tinnitus and sensation of a stopped-up ear who had a very large, invasive and aggressive tumor of the sphenoidal region with bone destruction, invasion of structures in every direction from the sellar region and extracranial extension to the ethmoid and nasopharynx. Serum prolactin level at the time of diagnosis was 16,860 ng/ml (normal: 3-17 ng/ml). Medical treatment with bromocriptine reduced the prolactin level to 31 ng/ml and reduced the size of the tumor, although less than expected. The literature is reviewed and the rarity of such large, invasive prolactinomas is highlighted, as well as the absence of symptoms and signs suggesting the presence of such a large tumor of the skull base.

[Middle ear carcinoma]. / Carcinoma de oído medio.

Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.