Post-hematopoietic stem cell transplant squamous cell carcinoma in patients with Fanconi anemia: a dreadful enemy

IntroductionHematopoietic stem cell transplantation (HSCT) is a curative option for patients with Fanconi anemia (FA) and hematological manifestations but it does not prevent solid tumors, especially squamous cell carcinomas (SCC).MethodsRetrospective study in 22 FA patients who had received HSCT and had been followed up beyond 2 years after HSCT.ResultsThe median follow-up was 15 years. Six patients developed head-and-neck SCC after transplantation. The cumulative incidence of SCC at 15 and 30 years from the HSCT was 14.2% and 71.2%, respectively. One patient was diagnosed in stage IV and the rest, who were being followed up in cancer screening programs, in stage I. Treatment of SCC consisted of surgery in all patients; radiotherapy and chemotherapy were used in two patients and were poorly tolerated.ConclusionFA patients have high risk of head-and-neck SCC. Multi-disciplinary programs for early cancer detection are of special relevance in these patients.

Post-hematopoietic stem cell transplant squamous cell carcinoma in patients with Fanconi anemia: a dreadful enemy.

INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) is a curative option for patients with Fanconi anemia (FA) and hematological manifestations but it does not prevent solid tumors, especially squamous cell carcinomas (SCC). METHODS: Retrospective study in 22 FA patients who had received HSCT and had been followed up beyond 2 years after HSCT. RESULTS: The median follow-up was 15 years. Six patients developed head-and-neck SCC after transplantation. The cumulative incidence of SCC at 15 and 30 years from the HSCT was 14.2% and 71.2%, respectively. One patient was diagnosed in stage IV and the rest, who were being followed up in cancer screening programs, in stage I. Treatment of SCC consisted of surgery in all patients; radiotherapy and chemotherapy were used in two patients and were poorly tolerated. CONCLUSION: FA patients have high risk of head-and-neck SCC. Multi-disciplinary programs for early cancer detection are of special relevance in these patients.

El SPECT con 201Talio en la detección de recidiva del carcinoma de laringe / 201Thalium SPECT in the detection of recurrent laryngeal carcinoma

Objetivo. Evaluar el rendimiento del SPECT con 201Talio en la detección de la recidiva local y/o diseminación ganglionar regional del carcinoma faringolaríngeo. Material y métodos. Se estudiaron 29 pacientes con el diagnóstico de carcinoma faringolaríngeo (media: 60,9 años), tratados con cirugía, quimioterapia y radioterapia. Entre 3 a 6 meses después de finalizar el tratamiento, a todos se les practicó un estudio planar y SPECT una hora después de la administración de 148 MBq de 201Talio. La captación se valoró en 4 grados (0 no captante-3 muy intenso) y se constató la presencia o no de ganglios captantes. El resultado gammagráfico se correlacionó con el seguimiento clínico y radiológico a largo plazo (media: 2,50 años). Se valoraron como positivos de recurrencia, los estudios con captación centrocervical focal de grado 2-3 o la presencia de adenopatías captantes. Resultados. Se obtuvieron 9 verdaderos positivos, 14 verdaderos negativos, tres falsos positivos y tres falsos negativos. La sensibilidad fue del 75%, la especificidad del 82,4%, el valor predictivo positivo del 75% y el valor predictivo negativo del 82,4%. De los tres falsos positivos, dos correspondieron a captaciones en el lecho quirúrgico y uno a captación atribuida a ganglios laterocervicales. Los tres falsos negativos presentaron captaciones de grado 1, correspondiendo dos de ellos a metástasis pulmonares sin evidencia de recidiva local. Conclusión. El uso del SPECT con 201Talio en la evaluación pronóstica del paciente con carcinoma de laringe tratado muestra unos resultados muy aceptables para la detección de recidiva local y/o diseminación ganglionar regional(AU)

Objective. To evaluate the diagnostic yield of 201Thallium SPECT in the detection of local and/or regional lymph node dissemination of pharyngolaryngeal carcinoma. Material and methods. 29 patients who had been diagnosed with pharyngolaryngeal carcinoma were studied (mean age: 60.9 years). These patients had been treated by surgery, chemotherapy and radiotherapy. At between 3 to 6 month after finishing the treatment, all of them underwent a planar and SPECT study at one hour after the administration of 148 MBq of 201Thallium. Uptake was scored on four grades: from 0 (no uptake) to 3 (very intense uptake). The presence or non-presence of lymph nodes with uptake was also evaluated. All the results on the scintigraphy were correlated with long term clinical and radiological follow-up (mean: 2.5 years). The studies were classified as positive for recurrence when the uptake was 2-3 and/or with presence of lymph nodes with uptake. Results. We obtained 9 true positive, 14 true negative, 3 false positive and 3 false negative results. Sensitivity was 75%, specificity was 82.4%, positive predictive value was 75% and negative predictive value was 82.4%. Two out of three false positives corresponded to the surgical bed uptake and one was attributed to the laterocervical lymph nodes. The three false negatives had grade 1 uptakes, two of them corresponding to pulmonary metastasis without evidence of local recurrence. Conclusions. The use of 201Thallium SPECT in the prognostic evaluation in patients with a treated laryngeal carcinoma shows very acceptable results in the detection of local recurrence and/or regional lymph node dissemination(AU)

[201Thalium SPECT in the detection of recurrent laryngeal carcinoma]. / El SPECT con (201)Talio en la detección de recidiva del carcinoma de laringe.

OBJECTIVE: To evaluate the diagnostic yield of (201)Thallium SPECT in the detection of local and/or regional lymph node dissemination of pharyngolaryngeal carcinoma. MATERIAL AND METHODS: 29 patients who had been diagnosed with pharyngolaryngeal carcinoma were studied (mean age: 60.9 years). These patients had been treated by surgery, chemotherapy and radiotherapy. At between 3 to 6 month after finishing the treatment, all of them underwent a planar and SPECT study at one hour after the administration of 148 MBq of (201)Thallium. Uptake was scored on four grades: from 0 (no uptake) to 3 (very intense uptake). The presence or non-presence of lymph nodes with uptake was also evaluated. All the results on the scintigraphy were correlated with long term clinical and radiological follow-up (mean: 2.5 years). The studies were classified as positive for recurrence when the uptake was 2-3 and/or with presence of lymph nodes with uptake. RESULTS: We obtained 9 true positive, 14 true negative, 3 false positive and 3 false negative results. Sensitivity was 75%, specificity was 82.4%, positive predictive value was 75% and negative predictive value was 82.4%. Two out of three false positives corresponded to the surgical bed uptake and one was attributed to the laterocervical lymph nodes. The three false negatives had grade 1 uptakes, two of them corresponding to pulmonary metastasis without evidence of local recurrence. CONCLUSIONS: The use of (201)Thallium SPECT in the prognostic evaluation in patients with a treated laryngeal carcinoma shows very acceptable results in the detection of local recurrence and/or regional lymph node dissemination.

Diagnóstico y tratamiento antimicrobiano de las sinusitis / Diagnosis and antimicrobial treatment for sinusitis

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[Orbital cellulitis: review and presentation of 20 cases]. / Celulitis orbitaria. Revisión y presentación de una serie de 20 casos.

The orbital cellulitis is an infection of the soft tissues located behind of the orbital setum. It is presented as a complication of an acute sinusitis although it can appear as consequence of other infectious processes. We present a series of 20 cases diagnosed and treated in our center of orbital cellulitis. We expose the diagnostic criteria that we have followed, as well as the complementary tests used and the different treatments both medical and surgical.

[Lemiere's syndrome. Thrombophlebitis of the internal jugular vein induced by oropharyngeal lesion. A case report]. / Síndrome de Lemierre. Tromblofebitis de la vena yugular interna de causa orofaríngea. Revisión a propósito de un caso.

Nowadays due to the use of antibiotics the occurrence of a general complication of tonsillitis is extremely rare. Lemierre in 1936 throroughly described one of these events. We introduce a case of postanginal septicaemia detected in a previous healthy young woman. We also undertake a review of Lemierre's syndrome cases published within the last seven years in the English and Spanish literature, giving special attention to diagnostical methods and therapeutical strategies.

[Malignant otitis externa and diabetes: report of 4 cases]. / Otitis externa maligna y diabetes: descripción de cuatro casos.

Malignant otitis externa (MOE) is an uncommon infective but potentially fatal entity caused by Pseudomonas aeruginosa. It involves almost exclusively advanced aged diabetic patients. We report here four cases diagnosed at our hospital during the last 7 years. Clinical manifestations included otalgia, purulent otorrhoea, involvement of different cranial nerves and bony destruction; one patient died because of bronchoaspiration and two are alive but with sequelae. MOE should be suspected in every diabetic patient with otitis which goes unresolved with the usual antibiotic therapy. On the other hand, facial palsy should not always be attributed to a diabetic mononeuropathy and the presence of MOE should be ruled out when otitis coexists or precedes it.

[Lemierre's syndrome. Case report]. / Síndrome de Lemierre. A propósito de un caso.

The paper deals with a thrombophlebitis of the internal jugular vein, coming after a Plaut-Vincent's angina, associated to septic embolism of the lung. The syndrome was first described by Lemierre, in 1936. Together with a survey of the cases reported in the last ten years is made.