Clinical and epidemiological study of vertigo at an outpatient clinic.

OBJECTIVES: The main goal of this study was to set up a database of vertigo patients that could serve as a reference for other ENT services treating these pathologies. We present a clinical and epidemiological study of vertigo in an ENT outpatient clinic in 2001 and describe our diagnosis protocol. MATERIAL AND METHODS: This was a prospective study of 591 patients (18% of the total number of 3283 first visits) controlled and treated at the ENT service of the Hospital Clinic in Barcelona. The main variables studied were sex, age, clinical characteristics and the results of physical and basic instrumental examinations. RESULTS: After obtaining a clinical history and performing a physical examination, pure-tone audiometry, impedance audiometry and electronystagmography, 394 patients were discharged with a medical report, diagnosis and prescription for treatment. The other 197 patients whom the standard examination was unable to diagnose were referred to a multidisciplinary committee for re-evaluation. CONCLUSION: A correct diagnosis is essential to ensure adequate treatment and attain an acceptable balance between cost and effectiveness.

Leishmaniasis cutánea: a propósito de un caso / Cutaneous leishmaniasis: our experience

Presentamos un caso de leishmaniasis cutánea que debuta con adenopatía cervical sin foco evidente de su patología. Revisamos su diagnóstico y tratamiento (AU)

We present one cutaneous leishmania case that begun with cervical adenopathy without evident focus. We revise its diagnosis and treatment (AU)

[Jugular vein thrombosis: report of six cases]. / Trombosis de la vena yugular, a propósito de seis casos.

Venous thrombosis in superior extremities and neck represent less than 5% of the total of venous thrombosis. Internal jugular vein thrombosis is associated with intravenous drug abuse, long term venous catheterization, local infection or spontaneous occlusion. The clinical findings are cervical swelling, progressive inflammatory signs overlying sternomastoid muscle, and an important functional limitation. Diagnosis is confirmed by cervical ultrasounds and contrast-enhanced computer tomography. Usual treatment involves anticoagulation and antibiotics, surgery is not frequently needed. We described the management and outcome of six cases of internal jugular vein thrombosis.

Trombosis de la vena yugular: a propósito de seis casos / Jugular vein thrombosis: report of six cases

La trombosis venosa en extremidades superiores y cuello representa menos del 5 por ciento del total de las trombosis venosas. La trombosis yugular interna (TYI) es una patología asociada a drogadicción parenteral, cateterizaciones venosas prolongadas, infecciones locales o también de aparición espontánea. Se presenta en forma de tumefacción cervical y signos inflamatorios progresivos a lo largo del borde anterior del esternocleidomastoideo junto a una importante limitación funcional. El diagnóstico se realiza mediante ecografía cervical y tomografía con contraste. El tratamiento habitual es con anticoagulantes y antibióticos con pocas indicaciones quirúrgicas. Presentamos seis casos de trombosis yugular interna; revisamos diagnóstico, tratamiento y evolución (AU)

Venous thrombosis in superior extremities and neck represent less than 5% of the total of venous thrombosis. Internal jugular vein thrombosis is associated with intravenous drug abuse, long term venous catheterization, local infection or spontaneous occlusion. The clinical findings are cervical swelling, progressive inflammatory signs overlying sternomastoid muscle, and an important functional limitation. Diagnosis is confirmed by cervical ultrasounds and contrast-enhanced computer tomography. Usual treatment involves anticoagulation and antibiotics, surgery is not frequently needed. We described the management and outcome of six cases of internal jugular vein thrombosis (AU)

[Cutaneous leishmaniasis: report of a case]. / Leishmaniasis cutánea: a propósito de un caso.

We present one cutaneous leishmania case that begun with cervical adenopathy without evident focus. We revise its diagnosis and treatment.

Glutathione and glutathione S-transferases in human squamous cell carcinomas of the larynx and GSTM1 dependent risk.

BACKGROUND: The aim of the present study was to establish the risk of squamous cell carcinoma (SCC) of the larynx associated with the congenital absence of glutathione S-transferase M1 (GSTM1), and to describe the expression of the isoenzymes GSTA1/2, GSTP1-1, and GSTM1 and glutathione (GSH) content in healthy and tumoral larynx tissue. MATERIAL AND METHODS: Blood samples from 160 SCC male patients and 158 controls were phenotyped for GSTM1 by ELISA. Using 37 paired samples (normal and tumour specimens) from cancer patients we carried out a descriptive study of enzyme activity by ELISA (GSTs) and Ellman's as say (GSH) RESULTS: GSTM1 null phenotype was more common in the SCC group than in controls (OR 1.9, CIs 1.18-3.05, p = 0.004). Total GST activity was higher in tumour samples than in matched healthy tissue (2.2-fold, p-0.00001), being largely determined by GSTP1-1 (1.9-fold increased in malignant tissue; p = 0.0003). The GSH content was also significantly higher in SCC than in normal mucosa (1.9-fold, p = 0.0007). CONCLUSIONS: We confirmed the GSTM1-dependent risk for larynx cancer among smokers. The overexpression of the GST/GSH system in tumours reported here indicates their possible role in chemoresistance to pharmacological therapy.

Follow-up study in head and neck cancer: cure rate according to tumor location and stage.

The purpose of this clinical study was to analyze a long-term follow-up of all the patients with head and neck cancer in our institution. Between 1973 and 1993, 1,355 consecutive cases of head and neck cancerwere diagnosed, treated and followed up regularly. All were subjected to a multidisciplinary approach, and followed up until death or for 10 years with no event of disease. The local relapse rate was 20% and the node-regional relapse rate 15%. Distant metastases were observed in 6% of the patients mainly arising from the nasopharynx (23%) followed by the hypopharynx (11%). The main organ involved was the lung (50%). Median follow-up of the group was 10 years (range 4 months to 15 years). Cancer cure was observed after 5 years in glottic and supraglottic laryngeal carcinoma, oral and nasopharyngeal cancer and after 2.5 years in patients with cancer of the oropharynx and hypopharynx. The highest cure rate was 80% in the glottis, followed by 70% in the supraglottic area, 45% in the mouth, 30% in the nasopharynx, 25% in the oropharynx, and 20% in the hypopharynx. A second primary tumor was observed in 7% of the patients and a third primary in 0.6% of the patients. Only in 7 patients, the second or third primary was seen after 5 years of follow-up. Curability should be observed after 5 years from definitive therapy of glottic, supraglottic, oral and nasopharyngeal and earlier in oropharyngeal and hypopharyngeal cancer. Further follow-up should be discontinued. Second and third neoplasias are the main problems after 5 years of follow-up but their incidence is low.

Survival after chemotherapy with cisplatin and infusion of bleomycin prior to local-regional treatment in pyriform sinus cancer.

AIMS AND BACKGROUND: The purpose of this study was to retrospectively compare different approaches including neoadjuvant chemotherapy. METHODS: Ninety-six consecutive patients with pyriform sinus squamous cell carcinoma with no distant metastases were entered. The first 48 patients were treated with surgery plus postoperative radiation therapy (50-60 Gy) over cervical lymphatics. The next 48 patients were treated by induction chemotherapy with two courses of cisplatin, 120 mg/m2 i.v. day one, plus bleomycin, 20 mg/m2/day for 5 consecutive days in 24-hr i.v. perfusion followed by definitive surgery and postoperative radiation therapy as in the first therapeutic group. RESULTS: Definitive surgery was performed in 38 control vs 39 neoadjuvant patients. Complete response was observed in 9 (18.7%) and partial response in 32 (66.7%) of 48 chemotherapy-treated patients. Partial plus complete response was seen in 41 (85.4%) of the 48 patients. Comparison between controls versus chemotherapy-treated groups showed persistence of the disease in 10 vs 9 patients; local-regional relapses in 21 versus 14 patients; and distant metastases in 4 vs 2 patients. Median survival was 12 vs 40 months. Survival curves were statistically better in neoadjuvants than in controls (P < 0.025). CONCLUSIONS: Multidisciplinary therapy slightly decreases the rate of local-regional relapses and distant metastases and should improve survival in this set of pyriform sinus cancer patients.

Myoepithelial tumors of salivary glands: a clinicopathologic, immunohistochemical, ultrastructural, and flow-cytometric study.

Myoepitheliomas of the salivary glands remain a controversial entity. To contribute to the knowledge of this entity, 16 myoepithelial tumors of the salivary glands were studied: 12 benign myoepitheliomas (BME) and 4 malignant myoepitheliomas (MME). The clinical and the histologic findings of each case were studied Immunohistochemistry and flow-cytometry analysis were performed from the paraffin-embedded material in 15 cases. An electron-microscopy study was performed in 8 cases. The myoepithelial tumors affected patients of both sexes equally. The mean age of the patients with BME was 54 years, and the mean age of patients with MME was 62 years. Eight cases of BME originated in the parotid gland and 4 cases originated in the minor salivary glands. All the MME developed from a benign preexistent tumor: two developed from a pleomorphic adenoma in the parotid gland, and the other two MME developed in the minor salivary gland from a BME. The myoepithelial tumors were composed of epithelioid, plasmacytoid, spindle, or clear cell types, and they showed a solid or a myxoid pattern of growth. Immunohistochemical studies revealed marked and diffuse positivity to cytokeratins, vimentin, and S-100 protein in all cases. Glial fibrillary acidic protein was positive in 8 cases (53%), and muscle-specific actin and smooth-muscle actin were positive in only 3 cases (20%); they were all cases of BME. Desmin was negative in all tumors. Ultrastructural studies showed the presence of basal membrane, tight junctions, intermediate filaments, and microvilli as well as actin-like filaments lacking focal densities in all cases. But actin-like filaments with focal densities were not identified. Flow cytometry determined that all BME were diploid with a mean proliferative index of 7.73%. Two of the MME were diploid and the other two MME were aneuploid. The mean proliferative index of MME was 11.93%. In conclusion, BME and MME originated in major and minor salivary glands can display different histologic patterns and cellular features. Some immunohistochemical and ultrastructural characteristics have been found in all these neoplasms, which supports the idea that myoepitheliomas are composed by neoplastic modified myoepithelial cells, not fully differentiated. These techniques can be useful for the diagnosis of these tumors.

Myoepithelial carcinoma arising in a benign myoepithelioma: immunohistochemical, ultrastructural, and flow-cytometrical study.

A case of myoepithelial carcinoma arising in a benign myoepithelioma of the minor salivary gland in a 71-year-old patient is reported. The tumor presented initially on the palate and had been diagnosed as "benign lesion" 40 years before. It recurred 22, 36, and 40 years after initial presentation, and a similar histopathological diagnosis was rendered. One year after the last recurrence, the tumor recurred showing typical changes of malignant transformation, and the diagnosis was malignant myoepithelioma. The light microscopy and ultrastructural features of the initial tumor were typical of plasmocytoid myoepithelioma. There were abundant round cells and rare spindle cells with uniform dispersed filaments, sometimes arranged in parallel streams without evidence of dense bodies. These cells showed micropinocytotic vesicles along the cell membrane with poorly developed intercellular junctions and were surrounded by a basal membrane. The malignant counterpart showed fewer plasmocytoid cells and a rather epithelial pattern with marked nuclear pleomorphism and formation of small, or rarely large, glandular lumina. The immunohistochemical features were similar for the benign and malignant tumors, with positivity for S-100 protein, vimentin, cytokeratins, and CAM 5.2, and were negative for GFAP, muscle-specific actin, CEA, and desmin. Flow cytometry showed a change in the DNA content profile. The benign myoepithelioma had a diploid DNA content with a low S-phase fraction of 3.9% and proliferative index of 9.1%, while the myoepithelial carcinoma had an evident aneuploid DNA stem line and an increased S-phase fraction of 8.3% with a proliferative index of 18.1%.

Precancerous lesions of the larynx: clinical and pathologic correlations and prognostic aspects.

BACKGROUND: Medical literature on the development of malignancy shows wide-ranging limitations depending on the criteria considered, but all authors agree that the presence of dysplasia in the sample is an important prognostic sign. METHOD: This is a retrospective study of 248 patients controlled and treated at the ENT and Pathology Departments of the Hospital Clinic in Barcelona between 1981 and 1991 for larynx lesions. Biopsy studies of the following pathologic entities were carried out: keratosis, chronic inflammation, and papilloma of the adult. The degree of dysplasia present in each sample was assessed. RESULTS: The overall percentage of malignancy was 15.6% in this series. Malignancy developed in 8.7% of the cases without dysplasia and in 31% (p < 0.0001) with dysplasia. The groups were correlated with gender, age, and smoking habit. The presence of epithelial dysplasia is an important prognostic factor. The risk of malignant transformation increases if the dysplasia occurs in smokers.

Human glutathione S-transferase mu (GST mu) deficiency as a marker for the susceptibility to bladder and larynx cancer among smokers.

The isoenzyme mu of glutathione S-transferase (GST mu) is dominantly inherited and the prevalence of this isoenzyme in the population is about 60%. An increased risk of lung cancer has been previously shown among smokers lacking GST mu in (Seidegard J., Pero R.W., Miller D.G., Beattie E.J. (1986) Carcinogenesis, 7, 751-753). The frequency of the phenotypes of this isoenzyme in bladder cancer patients (n = 75), in larynx cancer patients (n = 78) and healthy controls matched for age and smoking history is reported here. A significantly higher proportion of smokers in the control group had measurable GST mu compared with bladder cancer patients (54.6% vs. 33.3%, P < 0.01) and also compared to larynx cancer patients (55.1% vs. 33.3%, P < 0.01). Odds ratio analysis indicates that smokers with this polymorphic variant have an approximately 2-fold greater risk of developing these cancers.

An analysis of the factors affecting the average length of stay in the otolaryngology unit.

Specific factors which have an influence on the average length of stay in the otolaryngology unit of a University Hospital are studied; the patients are covered by some type of insurance and have no out-of-pocket expenses. The effect of the following variables on the average length of stay is evaluated: age, sex and type of pathology. The periods of hospitalisation are significantly longer (Mann-Whitney test) in males (p < 0.0001), in older patients (p < 0.008) and in the case of tumours, which prolong the period of stay especially of males (p < 0.0001). It is suggested that the shorter stay in the case of females may be conditioned by social and family factors.

[Cervical seminoma. Presentation of a case]. / Seminoma cervical. Presentación de un caso.

A germinal cells tumor in a male manifested as left supraclavicular mass, without other localisation, is presented. The pathologic anatomy corroborate the diagnosis of seminoma. Very few cases of a germinal cell tumor in the supraclavicular fossa, with a normal testicular exploration, have been reported.

Metastatic involvement of the cavernous sinus from primary pharyngolaryngeal tumors.

The cavernous sinus is an unusual site for metastases from tumors of the larynx and pharynx. In postmortem studies of patients with cancers of the larynx, hypopharynx, and other sites, cavernous sinus metastases have been detected in very few cases. We present 3 cases of metastatic cavernous sinus disease. Despite the lack of pathologic diagnosis by biopsy, we feel that the clinical presentation combined with computed tomography provides an accurate diagnosis.

[Serous otitis: long-term efficacy of transtympanic drainage]. / Otitis serosas: eficacia a largo plazo de los drenajes transtimpánicos.

The A. has followed for a whole year (1982), 50 patients chosen at random who underwent transtympanic ventilation, with the goal of assessing the long-term results (both audiometric and tympanometric) linked with the previous pathology.

[Characteristics of the course of glottic cancer]. / Caractéristiques évolutives du cancer glottique.

We present a retrospective study of the course of glottic cancer in a series of 302 cases. We studied the precise tumour localisation, the treatment carried out, the anatomico-pathological characteristics of the resected tissue and the results obtained as a function of the therapy used. It would seem important to stress the necessity of homogenizing the results of various authors by: presenting a series large enough for the results to be significant; there should be detailed total and prolonged follow up of patients, with use of similar evaluation parameters.

[Distant metastases originating from tumors of the larynx and hypopharynx]. / Métastases à distance provenant de tumeurs du larynx et de l'hypopharynx.

Following a review of the world literature dealing with the incidence of remote metastases in tumours in the ENT field in general, and of the larynx and hypopharynx in particular, we present a study covering 927 patients suffering from cancer of the larynx and hypopharynx. The purpose of the research was to determine the incidence and position of metastases in this type of patient, and to determine their evolution. A total of 786 patients were followed over a minimum of 4 years, and 52 cases (6.7%) of metastases were recorded. They occur all the more frequently when the primary tumour is hypopharyngeal, of the low differentiated carcinoma type, or when there is a cervical ganglionic extension.