The clinical interest of the ary-thyro-cricoid fascicle.

The aim of this work was to study the prevalence and form of the ary-thyro-cricoid (ATC) muscular fascicle, a variable muscular slip connecting the oblique and/or transverse arytenoid muscles with the thyroarytenoid (TA) and/or lateral cricoarytenoid (LCA) muscles resembling a sphincter encircling the glottis. Thirty larynges obtained from necropsies of individuals with no known laryngeal pathology were dissected. The ATC fascicle was observed in 96.7% of the larynges. It appeared bilaterally in 60% of subjects and unilaterally in 36.7%. The posterior attachment of the muscular slip was observed to be in common with either the transverse arytenoid (34%), or the oblique arytenoid (28%) or both muscles (38%). Its fibers terminated by intermingling with either those of the LCA muscle (10.6%), or the TA muscle (38.3%) or both (51.1%). These variable attachments mean that there are nine possible variants of this muscular fascicle. The ATC fascicle was supplied by branches originating bilaterally from the recurrent laryngeal (RLN) and internal laryngeal nerves. The existence of this ATC fascicle could explain the variable position (intermediate, paramedian or lateral) adopted by the vocal folds after lesion of the RLN. The bilateral disposition and innervation of the fascicle could also complicate the interpretation of electromyographic techniques used for testing laryngeal nerve function.

Prevalence of prostate cancer and prostatic intraepithelial neoplasia in Caucasian Mediterranean males: an autopsy study.

BACKGROUND: The prevalence of carcinoma of the prostate gland (CaP) and high-grade prostatic intraepithelial neoplasia (HGPIN) was assessed in a Spanish population, representative of the Caucasian Mediterranean (CM) ethnic group. Data were compared with those described in populations from other geographical regions and in other ethnic groups. METHODS: CaP and HGPIN were evaluated in a consecutive series of prostatic glands collected at the post-mortem examination of 162 male patients born and living in Spain, aged 20-80 years, and dying from trauma. The glands were sliced every 2-3 mm. All slices were paraffin embedded and sectioned to obtain 5 microm whole-mount sections. To compare the prevalence rate in our series and in other Caucasian populations with that from other geographical areas and other ethnic groups, we used data from the autopsy study performed at the Wayne State University. RESULTS: Prevalence of CaP is 3.58, 8.82, 14.28, 23.80, 31.7, and 33.33% in the 3rd, 4th, 5th, 6th, 7th, and 8th decades, respectively. The rates of HGPIN were 7.14, 11.75, 35.71, 38.06, 45.40, and 48.15% at the 3rd, 4th, 5th, and 8th decades of life. Both CaP and HGPIN are located preferentially at the peripheral zone of the gland and in 21/27 cases (77.7%), an association between CaP and HGPIN was found. The prevalence of both lesions in CM males is significantly lower than in Caucasian American (CA) and Afro-American (AA) males in all the age groups evaluated. CONCLUSIONS: Microscopic foci of CaP and HGPIN can be documented in CM males from the 3rd decade of life onwards. The lesions become more frequent and extensive as age increases. The prevalence of both lesions seems to be significantly lower in the CM population than in CA and AA males in all the age groups evaluated.

Prevalencia de la neoplasia intraepitelial prostática en España / Prevalence of prostatic intraepithelial neoplasia in Spain

OBJETIVOS: Estudiar en una población española la prevalencia de la neoplasia intraepitelial prostática de alto grado (PINAG) y compararla con la prevalencia en caucasianos de otras latitudes y en afroamericanos. MÉTODO: Se extraen 162 próstatas al realizar autopsia a varones españoles de 20-80 años de edad. Fijadas en formol 10 por ciento son talladas con cortes perperdiculares al borde posterior cada 3-4 mm, en toda su longitud. Todos los bloques fueron incluidos en parafina y valorados microscopicamente. Los resultados se mapean en diagrama individual valorando focalidad y ubicación zonal del PINAG. Para comparar la prevalencia en otras latitudes y razas se usa el estudio autópsico de la Universidad de Wayne. RESULTADOS: Se considera material válido para valoración histológica a 146 próstatas correspondientes a varones con edad media de 48.5 años. Se diagnostican 42 PINAG, 20 focales y 22 multifocales. La prevalencia de PINAG por tramos de edad fue de 7,1, 14,7, 28,5, 33,3, 45,4 y 51,8 por ciento en la 3ª, 4ª, 5ª, 6ª, 7ª y 8ª décadas. CONCLUSIÓN: El PINAG comienza a expresarse en la población española a partir de la 3ª década, preferentemente focal y periférico, aumentado significativamente su prevalencia con la edad haciéndose multifocal. Valoración comparada con la prevalencia en caucasianos de otras latitudes y afroamericanos, la prevalencia en la población española es moderadamente inferior a la caucasiana americana y significativamente inferior a los afroamericanos (AU)

Valoración del consentimiento informado por médicos y pacientes / No disponible

Objetivo: El Consentimiento Informado (C.I.) cada vez está más implantado por lo que decidimos estudiar la opinión de los médicos y pacientes sobre él y su proceso de realización. Material y métodos: Estudio observacional, descriptivo y transversal mediante dos encuestas diferentes, de forma personal y telefónica, a 89 profesionales de un Hospital Universitario y a 210 pacientes sometidos a algún procedimiento diagnóstico y/o terapéutico en noviembre de 1998. Se realizó un muestreo aleatorio simple. Los datos fueron analizados mediante la χ2. Resultados: El 25,8% de los profesionales consideran que la utilización de formularios es imprescindible. Aunque el 36% (IC 95%: 26,1-45,9) de los médicos consideran que los pacientes comprenden la información recibida, el 93,4% (IC 95%: 90-96,8) refirieron haberla entendido adecuadamente. El 79,8% (IC 95%: 71,5-88,1) de los médicos refieren ofrecer explicaciones, pero sólo el 44,3% (IC 95%: 37,6-51) de los pacientes confirmaron esta oferta. El 63,3% de los pacientes se quedaron indiferentes tras recibir la información. Según el 61,8% de los profesionales y el 68% de los pacientes, el proceso del C.I. se realiza mediante la lectura del documento por el paciente. Para el 66,7% (IC 95%: 73,1-60,3) de los pacientes el objetivo de los formularios es proteger al médico. Conclusiones: Se encuentran deficiencias en aspectos como la necesidad de los documentos y su utilización, comprensión de los documentos, falta de entrega de los mismos, oferta de explicaciones, persona que lo entrega, proceso de realización, tiempo del que dispone el paciente y objetivo del documento. La información transmitida, en la mayoría de las ocasiones, no causó más ansiedad en los pacientes (AU)

Background: The Informed Consent (I.C.) every time is more implanted so that we decide to study the opinion of the doctors and patient on him and its realization process. Method: The study is observational, descriptive and traverse by means of two surveys (personal and phone) to 89 professionals of a University Hospital and 210 subjected patients to some procedure diagnostic and/or therapeutic in November 1998. It was carried out a simple aleatory sampling. The data were analyzed by means of the χ2. Results: The 25,8% of the professionals considers that the use of formularies is indispensable. Although 36% (CI 95%: 26,1-45,9) of the doctors they consider that the patients understand the received information, 93,4% (CI 95%: 90-96,8) they referred to have her appropriately expert. 79,8% (CI 95%: 71,5-88,1) of the doctors they refer to offer explanations, but only 44,3% (CI 95%: 37,6-51) of the patients they confirmed this offer. 63,3% of the patients was indifferent after receiving the information. According to 61,8% of the professionals and 68% of the patients, the process of the I.C. It is carried out by means of the reading of the document for the patient. For 66,7% (CI 95%: 73,1-60,3) of the patients the objective of the formularies is to protect the doctor. Conclusions: There are some deficiencies in aspects like the necessity of the documents and their use, understanding of the documents, lacks of delivery of them, offer of explanations, person that gives it, realization process, time of which prepares the patient and objective of the document. The transmitted information, in most of the occasions, it didn’t cause more anxiety in the patients (AU)