["Usual" morbidity of pediatric tonsillectomy: a study of 126 cases]. / Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos.

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems.

[Hypopharynx and larynx basaloid squamous carcinoma: our experience with 6 cases]. / Carcinoma basaloide escamoso de laringe e hipofaringe: presentación de una serie de 6 casos.

INTRODUCTION: Basaloid squamous carcinoma (BSC) of the head and neck is an uncommon, recently described variant of epidermoid carcinoma. BSC appears biologically with a greater propensity to local aggressiveness and metastatic potential than the conventional type. OBJECTIVES: To determine the incidence of BSC of the larynx and hypopharynx in our area, and to evaluate its behavior and prognosis. PATIENTS & METHODS: 272 cases of squamous carcinoma of the larynx and hypopharynx were reviewed and 6 diagnosis of BSC were made, corresponding to 6 tumors in 5 patients. Their clinical records were analyzed. An immunohistochemical study was performed, including antibodies against cytokeratins (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), epithelial markers (EMA, CEA, Ber-EP4), vimentin and three neuroendocrine markers: neuron-specific enolase, chromogranin and synaptophisin. Bcl-2 expression was also investigated. RESULTS: Most tumors were supraglottic. 5 out of 6 tumors were clinically benign, without any metastases or recurrence after exclusive surgical resection and a follow-up ranging 42 to 142 months. We detected a trend toward a primitive pattern of keratin expression. All tumors were stained with EMA and CEA MoAbs, but we could not find Ber-EP4 nor endocrine markers staining in any of them. However, BCL-2 expression was widely found in 4 out of 5 tumors immunostained. CONCLUSION: It seems to be a progressive dedifferentiation of the basaloid cell component, probably a subpopulation with more primitive features responsible of the aggressiveness reported in the literature. However, the surprising good prognosis in most of our cases makes necessary more studies and wider series to confirm our data.

Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos / "Usual" morbidity of paediatric tonsillectomy: a study of 126 cases

La amigdalectomía pediátrica todavía sigue siendo un procedimiento muy común en la práctica otorrinolaringológica, realizándose generalmente dentro de un programa de cirugía mayor ambulatoria. El objetivo de este trabajo es la investigación de la morbilidad habitual de dicha intervención, con la finalidad de optimizar el tratamiento y la calidad de la asistencia. Se han encuestado 126 pacientes pediátricos intervenidos en nuestra Unidad de Cirugía de Día, contemplándose aspectos como la duración de las molestias a la deglución, la otalgia refleja o la halitosis, así como la existencia de hemorragias u otros motivos de consulta. Se registra un dolor faríngeo significativo que dura hasta el 3º ó 4º día en aproximadamente la mitad de los casos. A la semana, casi el 70 por ciento de los operados ya está bien, coincidiendo con el día en que un 55 por ciento comienza a comer con normalidad. Un tercio de los pacientes sufren vómitos, que suelen ser el día de la intervención. En nuestro medio, la amigdalectomía ambulatoria es un procedimiento muy seguro, con escasas complicaciones y de poca gravedad. Sin embargo, la demora en el retorno a la alimentación habitual y la relativa frecuencia de vómitos postoperatorios cuestionan en cierta forma la inclusión de la amigdalectomía dentro de los programas de Cirugía Mayor Ambulatoria, haciendo al menos necesaria la instauración de protocolos de tratamiento que minimicen dichos problemas (AU)

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems (AU)

Carcinoma basaloide escamoso de laringe e hipofaringe: presentación de una serie de 6 casos / Hypopharynx and larynx basaloid squamous carcinoma: our experience with 6 cases

Introducción: El carcinoma basaloide escamoso (CBE) de cabeza y cuello es una variante infrecuente de carcinoma epidermoide que se ha descrito muy recientemente, apuntándose que posee mayor agresividad y capacidad metastásica que el tipo convencional. Objetivos: El propósito de esteestudio ha sido establecer la incidencia del CBE de laringe e hipofaringe en nuestro medio en relación con las otras formas de carcinoma epidermoide, así como analizar su comportamiento biológico para determinar si representa una forma clínica más agresiva como se ha descrito en la literatura. Pacientes y métodos: Se revisaron 272 pacientes afectos de carcinoma epidermoide de laringe e hipofaringe, extrayéndose de la base de datos aquéllos con el diagnóstico histopatológico de variantes de carcinoma epidermoide. Se estudiaron las preparaciones en los casos sugerentes, dada la reciente descripción del CBE que impedía su diagnóstico en los casos más antiguos. Se extrajeron un total de 6 casos de carcinoma basaloide escamoso en 5 pacientes, de los que se revisó la historia clínica. Hemos realizado un estudio inmunohistoquímico de los cinco primeros casos, empleando una batería decitoqueratinas (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), marcadores epiteliales (EMA, CEA, Ber-EP4), vimentina y tres marcadores neuroendocrinos (enolasa neuronoespecífica, cromogranina y sinaptofisina). También se incluyó la expresión del gen Bcl-2. Resultados: Los tumores asentaron mayoritariamente en la región supraglótica. El comportamiento clínico en 4 de los 5 pacientes fue muy benigno, con crecimiento excrecente, poco infiltrante y sin metastatizar. Se detecta una tendencia a la expresión de un patrón de citoqueratinas más primitivo. Todos los tumores marcaron de forma variable con EMA y CEA. No se apreció expresión de Ber-EP4, ni tampoco de los marcadores neuroendocrinos. En cambio, el anticuerpo dirigido contra la proteína del bcl-2 marcó muy considerablemente cuatro de los cinco casos en que se envió. Conclusión: Pensamos que estos resultados indican una progresiva desdiferenciación del componente basaloide, el cual representaría una fracción constituida por elementos más primitivos, y conferiría posiblemente la mayor agresividad que aparece recogida en la mayor parte de las series informadas hasta el momento. Sin embargo, el sorprendente buenpronóstico de nuestros casos hace que sean necesarios ulteriores estudios con mayores series para confirmar los datos publicados (AU)

INTRODUCTION: Basaloid squamous carcinoma (BSC) of the head and neck is an uncommon, recently described variant of epidermoid carcinoma. BSC appears biologically with a greater propensity to local aggressiveness and metastatic potential than the conventional type. OBJECTIVES: To determine the incidence of BSC of the larynx and hypopharynx in our area, and to evaluate its behavior and prognosis. PATIENTS & METHODS: 272 cases of squamous carcinoma of the larynx and hypopharynx were reviewed and 6 diagnosis of BSC were made, corresponding to 6 tumors in 5 patients. Their clinical records were analyzed. An immunohistochemical study was performed, including antibodies against cytokeratins (CK 7, CK 8, CK 19, CK 20, CK 1, 10, 5, 14, y CK 10), epithelial markers (EMA, CEA, Ber-EP4), vimentin and three neuroendocrine markers: neuron-specific enolase, chromogranin and synaptophisin. Bcl-2 expression was also investigated. RESULTS: Most tumors were supraglottic. 5 out of 6 tumors were clinically benign, without any metastases or recurrence after exclusive surgical resection and a follow-up ranging 42 to 142 months. We detected a trend toward a primitive pattern of keratin expression. All tumors were stained with EMA and CEA MoAbs, but we could not find Ber-EP4 nor endocrine markers staining in any of them. However, BCL-2 expression was widely found in 4 out of 5 tumors immunostained. CONCLUSION: It seems to be a progressive dedifferentiation of the basaloid cell component, probably a subpopulation with more primitive features responsible of the aggressiveness reported in the literature. However, the surprising good prognosis in most of our cases makes necessary more studies and wider series to confirm our data (AU)

[Diagnosis of common causes of vertigo using a structured clinical history]. / Diagnóstico de causas frecuentes de vértigo mediante historia clínica estructurada.

The structured clinical history is the most sensitive test for diagnosing vertigo. Its diagnostic effectiveness on the first visit was analyzed and key signs and symptoms with high predictive value for common causes of vertigo were identified. One hundred outpatients who complained of dizziness or loss of balance were evaluated using a structured clinical interview. Each questionnaire was examined independently by three blinded investigators, who assigned a diagnosis and identified the elements of the history that figured most prominently in the diagnosis. The gold standard was defined as independent selection of the same diagnostic category by all three investigators. A first-visit diagnosis was obtained in 40% of patients (95% confidence interval 30-50%): 38% women and 42% men. Causes included benign positional paroxysmal vertigo (BPPV, 13 patients), headache-associated vertigo (9), Meniere disease (7), cervical vertigo (3), psychiatric dizziness (2), post-traumatic vertigo (2), vertebro-basilar transient ischemic attack (1), vestibular neuritis (1), convulsive seizure (1), and presyncope (1). The best predictors of BPPV were the precipitating mechanism (specificity [SP] 100%), positional nystagmus (sensitivity [SE] 90%, SP 63%), and the Dix-Hallpike test (SE 82%, SP 71%). Elements predictive of headache-associated vertigo were duration of the attack (minutes) and a personal history of headache (both, SP 100%). Other predictors were facial hypoesthesia (SE 92%, SP 47%) and associated neurological disease (SE 82%, SP 58%).

Diagnóstico de causas frecuentes de vértigo mediante historia clínica estructurada / Diagnosis of common causes of vertigo using a structured clinical history

La historia clínica estructurada es el test de mayor sensibilidad para el diagnóstico de vértigo. Se analiza su eficacia diagnóstico en la primera visita, identificándose los signos y síntomas clave que presentan un elevado valor predictivo para las causas comunes de vértigo. Cien pacientes ambulatorios cuyo síntoma principal era desequilibrio o mareo fueron evaluados mediante entrevista clínica estructurada. Cada cuestionario fue evaluado de forma ciega por 3 investigadores que asignaron un diagnóstico y los elementos de la historia que más contribuyeron a seleccionar ese diagnóstico. El estándar ideal se definió como la selección independiente de la misma categoría diagnóstica por los 3 investigadores. En la primera visita, se obtuvo un diagnóstico en el 40 por ciento (intervalo de confianza al 95 por ciento, 30-50 por ciento): 38 por ciento de mujeres y 42 por ciento de hombres. Las causas fueron vértigo posicional paroxístico benigno (VPPB, 13 pacientes), vértigo asociado a cefalea (9 pacientes), Enfermedad de Méniére (7), vértigo cervical (3), trastorno del equilibrio de origen psíquico (2), vértigo post-traumático (2), accidente isquémico transitorio vértebro-basilar (1), neuritis vestibular (1), crisis convulsiva (1) y presíncope (1). Los factores predictivos para VPPB fueron el mecanismo desencadenante (especificidad [El 100 por ciento), el nistagmo posicional (sensibilidad [S] 90 por ciento, E 63 por ciento) y el test de Dix- Halipike (S 82 por ciento, E 71 por ciento). Los factores predictivos para el vértigo asociado a cefalea fueron la duración de la crisis de minutos y el antecedente de cefalea (E 100 por ciento). Otros factores predictivos fueron la hipoestesia facial (S 92 por ciento, E 47 por ciento) y la presencia de enfermedad neurológica asociada (S 82 por ciento, E 58 por ciento) (AU)

The structured clinical history is the most sensitive test for diagnosing vertigo. Its diagnostic effectiveness on the first visit was analyzed and key signs and symptoms with high predictive value for common causes of vertigo were identified. One hundred outpatients who complained of dizziness or loss of balance were evaluated using a structured clinical interview. Each questionnaire was examined independently by three blinded investigators, who assigned a diagnosis and identified the elements of the history that figured most prominently in the diagnosis. The gold standard was defined as independent selection of the same diagnostic category by all three investigators. A first-visit diagnosis was obtained in 40% of patients (95% confidence interval 30-50%): 38% women and 42% men. Causes included benign positional paroxysmal vertigo (BPPV, 13 patients), headache-associated vertigo (9), Meniere disease (7), cervical vertigo (3), psychiatric dizziness (2), post-traumatic vertigo (2), vertebro-basilar transient ischemic attack (1), vestibular neuritis (1), convulsive seizure (1), and presyncope (1). The best predictors of BPPV were the precipitating mechanism (specificity [SP] 100%), positional nystagmus (sensitivity [SE] 90%, SP 63%), and the Dix-Hallpike test (SE 82%, SP 71%). Elements predictive of headache-associated vertigo were duration of the attack (minutes) and a personal history of headache (both, SP 100%). Other predictors were facial hypoesthesia (SE 92%, SP 47%) and associated neurological disease (SE 82%, SP 58%) (AU)

Reproductive behaviour of couples at risk for sickle cell disease in Cuba: a follow-up study.

Three hundred and forty-three Cuban women at risk of having children with sickle cell anaemia or sickle cell-haemoglobin C disease were interviewed 2-8 years after the index pregnancy (that in which their risk was detected). The aim was to collect information on their attitude towards prenatal diagnosis in subsequent pregnancies. Twenty-two per cent (75/343) had dissolved their marriage and 9 per cent of these (7/75) considered that their at-risk status had influenced the separation. Sixty-three per cent of stable couples at risk (168/268) had decided to have no further children; 27 per cent of these (45/168) were afraid of having an affected child and 4 per cent (7/168) were afraid of the obstetric procedure. Nineteen per cent of the stable couples at risk (52/268) had had at least one further child or pregnancy. Of these, 44 per cent (23/52) requested prenatal diagnosis early and spontaneously, and a further 44 per cent (23/52) requested prenatal diagnosis but after re-identification by screening and recounselling. Only 12 per cent (6/52) did not request prenatal diagnosis. Attitude towards prenatal diagnosis was most positive among more educated women. The general perception of the prevention programme was good.