[Influence of the nasogastric tube in the pathology of the maxillary sinus]. / Influencia de la sonda nasoesofágica en la patología del seno maxilar.

INTRODUCTION: Nasoesophageal tube (NT) is very often used by the ear, nose and throat specialists in head and neck oncological surgery. It is well known the irritative effect that it has on the nasosinusal mucosa. The aim of this study is to analyze the relationship between the use of the NT and the pathology of the maxillary sinuses. MATERIAL AND METHOD: The study was carried out in 25 patients treated in our department who had been fed by NT, after surgery. A plain sinus X-ray was performed in the pre-operatory period and a control radiograph in the post-operatory period, and the results have been analyzed. RESULTS AND CONCLUSIONS: No sinusitis had been observed whatever length of time the NT remained in situ.

Primary ciliary dyskinesia: a genome-wide linkage analysis reveals extensive locus heterogeneity.

Primary ciliary dyskinesia (PCD), or immotile cilia syndrome (ICS), is an autosomal recessive disorder affecting ciliary movement with an incidence of 1 in 20000-30000. Dysmotility to complete immotility of cilia results in a multisystem disease of variable severity with recurrent respiratory tract infections leading to bronchiectasis and male subfertility. Ultrastructural defects are present in ciliated mucosa and spermatozoa. Situs inversus (SI) is found in about half of the patients (Kartagener syndrome). We have collected samples from 61 European and North American families with PCD. A genome-wide linkage search was performed in 31 multiplex families (169 individuals including 70 affecteds) using 188 evenly spaced (19cM average interval) polymorphic markers. Both parametric (recessive model) and non-parametric (identity by descent allele sharing) linkage analyses were used. No major locus for the majority of the families was identified, although the sample was powerful enough to detect linkage if 40% of the families were linked to one locus. These results strongly suggest extensive locus heterogeneity. Potential genomic regions harbouring PCD loci were localised on chromosomes 3p, 4q, 5p, 7p, 8q, 10p, 11q, 13q, 15q, 16p, 17q and 19q. Linkage analysis using PCD families with a dynein arm deficiency provided 'suggestive' evidence for linkage to chromosomal regions 8q, 16pter, while analyses using only PCD families with situs inversus resulted in 'suggestive' scores for chromosomes 8q, and 19q.

An isotopic study of nasal mucociliary transport in newborns: preliminary investigation.

The diagnosis of primary ciliary dyskinesia (PCD) depends on electron microscopic examination of cilia obtained from mucosal biopsies of the nasal turbinates or the trachea. This is an invasive, time-consuming, and expensive technique. The low incidence of this abnormality, the large number of infants and children with suggestive symptoms, and the lack of a reliable screening test make the decision to proceed with diagnostic biopsy a common problem in recurrent or chronic respiratory pediatric conditions. To improve this situation early in infancy, nasal mucociliary transport was evaluated in 10 normal newborns using the Tc-99m-labeled seroalbumin technique, and the results obtained were compared with those corresponding to a newborn with Kartagener's syndrome. Transport velocity in normal newborns was similar to that observed in older children and in adults, in contrast to the tracer immobility seen in the affected newborn. This technique is simple, safe, objective, and well tolerated in this age group and might be used as an early screening test to ruling out PCD.

Superior laryngeal nerve evoked potentials: an experimental study in the rabbit.

An experimental model is described for recording laryngeal evoked potentials at the brainstem level through electrical stimulation of the superior laryngeal nerve. Rabbits were divided into two groups according to age: Group 1 consisted of 20 adults (over 6 months old), while group 2 was comprised of 1-month-old rabbits. Under general anesthesia, the superior laryngeal nerve was electrically stimulated and the corresponding evoked potentials were recorded by needle electrodes placed close to the dorsal and ventral aspects of the brain stem. Clear age-related differences were observed for latency, amplitude, and morphology of the potentials. This fact suggests postnatal maturation of the nerve structures, both peripheral and central. Sectioning the superior laryngeal nerve abolished all responses. Adduction of both vocal cords was observed in conjunction with the use of stimulation.

Prognostic value of histopathological parameters in 51 supraglottic squamous cell carcinomas.

The prognosis for supraglottic squamous cell carcinomas is difficult to establish. A study of 19 histopathological parameters (14 from the primary tumor and 5 from the lymph node metastases) was undertaken in 51 supraglottic epidermoid carcinomas. All patients were subjected to supraglottic horizontal laryngectomy with bilateral functional neck dissection and postoperative radiotherapy. A discriminant analysis was performed to relate the different histopathological variables to 5-year survival. Capsule rupture and the number of metastatic lymph nodes were the only two parameters significantly related to survival (P < .01). Histopathology (in particular, lymph node metastases) proved more effective in predicting patient evolution than TNM staging.

Analysis of DNA content in supraglottic epidermoid carcinoma.

DNA analysis by flow cytometry is considered to be of prognostic value in epidermoid carcinoma of the head and neck. However, few and contradictory studies have been made on laryngeal carcinomas. We studied 48 epidermoid carcinomas in patients subjected to horizontal supraglottic laryngectomy with a 5-year- followup. The technique described by Hedley for fixated and paraffin-embedded tumors was used. Thirteen tumors were excluded on the grounds of presenting variation coefficients in excess of 10. Of the 35 cases analyzed, 28 (80%) were diploid and seven (20%) aneuploid. No correlation was observed between tumor ploidy and patient survival, recurrence, or any of the histopathological variables studied.

Nasal mucociliary function in the normal newborn.

Nasal mucociliary transport has been studied using the seroalbumin-Tc99m radioisotope method in 10 adults and 10 normal newborns under 28 days of age. The mean transport velocity was 8 and 6 mm/min for the normal adults and newborns, respectively, with no significant differences between the two (P = 0.07).

Clinical and ultrastructural correlations in nasal mucociliary function observed in children with recurrent airways infections.

A study was made of 106 children between 1 and 15 years of age (mean 6 years) with recurrent upper and lower airways infections since birth. Nasal mucociliary transport (NMT) velocity was determined in all subjects by the Tc99m-labeled seroalbumin technique. In 42 children, NMT was found to be altered. In this group of patients the technique was repeated in a period of between 1 and 2 years later. In 23 cases (55%) transport had normalized, while in 19 (45%) it remained altered. Recurrent pneumonia and constant rhinorrhea were more frequent in this group. Situs inversus was only detected in 2 of these patients. Pathology showed ciliary ultrastructure, the absence of dynein arms and microtubule alterations. The absence of cilia was observed in some patients. Normal cilia were also encountered in children with persistently altered nasal mucociliary transport.

Nasal mucociliary transport and ciliary ultrastructure in cystic fibrosis. A comparative study with healthy volunteers.

Cystic fibrosis (CF) is a deadly hereditary disease that produces an abnormally thick, viscous and abundant secretion in the respiratory tract. This secretion in turn leads to the development of recurrent respiratory infections and irreversible lung damage. We have studied nasal mucociliary transport by means of an isotopic technique in 12 patients with CF and in 12 healthy volunteers. Nasal mucociliary transport was repeated at 12-18 months in the patients. In five randomly selected patients ciliary ultrastructure was studied. The velocity of nasal mucociliary transport was significantly slower than in healthy persons (P < 0.001) and no significant differences were observed in both studies (P < 0.05). No significant differences were either observed in the CF group between the homo- and heterozygotes (P < 0.5), or in those six patients infected by Pseudomonas aeruginosa (P < 0.05). Ciliary ultrastructure was normal in one patient. In another patient the sample showed no cilia, while the remaining three exhibited changes similar to those observed in chronic respiratory infections: supernumerary peripheral tubules, ciliary disorientation and ciliary complexes.

Upper lateral cartilage transposition in the surgical management of nasal valve incompetence.

INTRODUCTION: The treatment of nasal valve dysfunction is very controversial and many otorhinolaryngologists do not always take surgery into consideration. The purpose of this paper is to present the author's surgical technique and the description of 13 patients on which it may work. MATERIAL AND METHOD: Thirteen cases presenting with nasal obstruction secondary to nasal valve dysfunction are reviewed. All of the patients presented with internal valvulary incompetence and in three of them an alar collapse was associated. Diagnosis was achieved by means of the clinical findings and physical examination. An open rhinoplasty approach was employed. The surgical technique consisted in a transposition of the upper lateral cartilage over the alar cartilage. In the three patients with alar collapse a fixation graft from the septal cartilage was also employed. RESULTS: Nasal obstruction and valvular incompetence seemed improved in all of the cases. CONCLUSION: Upper lateral cartilage transposition seems to be an adequate method to solve the nasal valve incompetence.

Immotile cilia syndrome: nasal mucociliary function and nasal ciliary abnormalities.

We present 17 patients with a typical symptomatology of immotile cilia syndrome, seven of them with complete situs inversus. Firstly, a study of the nasal mucociliary transport was made by means of the radioisotopic technique with serum albumin-Tc99m. In all cases there was absence of transport. Secondly, we studied the ultrastructure of the nasal cilia. Defects in the dynein arms were frequently found (65%). In two cases (11%) there were no cilia; in two other cases the cilia were normal, and in another two cases alterations of the central pair of microtubules were seen. Ciliary complexes were detected in all cases. We conclude that in patients with chronic or recurrent infections of the airways without known cause we must initiate a study of the nasal mucociliary transport. If this is absent or decreased, study of ciliary ultrastructure should be carried out. If mucociliary transport is normal, immotile cilia syndrome is ruled out and ultrastructural study of the cilia is not required.

Young's syndrome: a further cause of chronic rhinosinusitis.

Three males--aged 32, 35, and 27 years--presented Young's syndrome: a combination of obstructive azoospermia and chronic sinopulmonary infection. The evaluation of nasal mucociliary transport using an isotopic technique revealed mucociliary stasis in one case and decreased clearance in the others (< 2 mm/min). Ciliary ultrastructure was normal in two patients, while the other showed mucous hyperplasia and low ciliary density which made correct ciliary evaluation not possible. The clinical development of this syndrome is chronic, although less severe than in the other two syndromes that exhibit primary failure of mucociliary transport: cystic fibrosis and primary ciliary dyskinesia. Young's syndrome should be considered in the differential diagnosis of patients suffering from chronic rhinosinusitis, particularly with cystic fibrosis and primary ciliary dyskinesia syndrome.

[The primary ciliary dyskinesia syndrome. A frequent pathology]. / Síndrome de discinesia ciliar primaria. Una patología frecuente.

The prevalence of primary ciliary dyskinesia syndrome (PCDS) in Western countries is of 1/40,000 but is 13% in patients with bronchiectasis. The aim of this study was to determine the prevalence of PCDS in patients with bronchiectasis and sinusitis, including whether or not these patients present specific clinical signs. Eighteen patients with these two conditions from an area with 750,000 inhabitants in Valencia (Spain), were studied for 2 years. Radiologic and clinical information was recorded and mucociliary motility was measured with albumin marked with radioactive technetium. The structure of the nasal mucosa cilia was also studied. In 14 patients (77%) mucociliary motility was suppressed and in 13 ultrastructural changes typical of PCDS were observed. Only male infertility and situs inversus were more frequent in patients with PCDS; other clinical signs were equally severe and frequent in patients with PCDS and in those in whom no cause for bronchiectasis and sinusitis could be found. We conclude that 1) the prevalence of PCDS in patients with bronchiectasis and sinusitis is 77%; 2) in these patients a test of mucociliary motility is sufficient for diagnosis (structural study not being required); 3) the prevalence of PCDS in our population seems to be greater than that described; and 4) clinical signs are similar in patients with PCDS and in those with bronchiectasis of unknown genesis.

Pull-through oropharyngectomy in advanced stage malignant tumours.

Surgery is the first therapeutic option in extensive oropharyngeal carcinomas. An operation to treat these tumours is described, based on the hemiglossopelvectomy without mandibulectomy technique. Tumours located in the oropharynx are resected downwards by a modified pull-through approach, performing the resection of the oropharyngeal tumour in monoblock with the ipsilateral neck dissection, avoiding any action upon the mandible. The operation has been performed in 14 consecutive patients. By avoiding either mandibulotomy or mandibulectomy, morbidity and post-operative recovery are improved.

Cholesteatoma in children: results in open versus closed techniques.

Cholesteatoma in children presents characteristics that differentiate it from the adult condition. Surgery has been performed in 55 ears. The main reason for referral was otorrhoea (83 per cent), either alone (29 per cent) or with hearing loss (54 per cent). Apart from three cases with an intact eardrum, a perforation was always present mostly posterior-superior (50 per cent). Open techniques were performed in 27.3 per cent of the ears and the closed technique in 72.7 per cent. Only in 18 per cent of cases was the ossicular chain normal and mobile. The attic was occupied by cholesteatoma in 79 per cent. Recurrence took place in 37 per cent and 13 per cent of the closed and open techniques respectively. Open techniques tend to be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.

Non-Hodgkin's lymphoma of the head and neck in association with HIV infection.

People infected with HIV have a greater risk of developing malignancies. The most frequent one is the Kaposi's sarcoma (KS). The second is the Non-Hodgkin's lymphoma (NHL). We report six cases of NHL in association with HIV infection (NHL-HIV) of the head and neck. Three of them had extranodal location (2 oral lymphomas and one case affecting the maxillary sinus). The other 3 cases were located in the cervical nodes. The oral malignancies were treated with radiotherapy (RT). Chemotherapy was applied to the other 4. Only one of our patients has survived more than two years. In one case the NHL was the first manifestation of the infection with HIV. Diagnosis of extranodal NHL requires search for AIDS.

Contribution of artificial intelligence to the knowledge of prognostic factors in laryngeal carcinoma.

Many studies have investigated prognostic factors in laryngeal carcinoma, with sometimes conflicting results. Apart from the importance of environmental factors, the different statistical methods employed may have influenced such discrepancies. A program based on artificial intelligence techniques is designed to determine the prognostic factors in a series of 122 laryngeal carcinomas. The results obtained are compared with those derived from two classical statistical methods (Cox regression and mortality tables). Tumor location was found to be the most important prognostic factor by all methods. The proposed intelligent system is found to be a sound method capable of detecting exceptional cases.

Nasal mucociliary function during the menstrual cycle in healthy women.

Nasal mucociliary transport time was studied in nine healthy women over the menstrual cycle using the vegetable charcoal powder technique. Three measurements were made at different points of the cycle: during the early follicular phase, periovulatory phase and luteal phase. The mean transport times were 10.1 +/- 3.50, 5.1 +/- 2.08 and 7.5 +/- 3.28 minutes, respectively. Transit was significantly accelerated during the periovulatory phase (p less than 0.01), when the seric estrogens are at their highest level.