Validity of a rapid diagnostic programme for head and neck cancer.

INTRODUCTION AND OBJECTIVES: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck (SCHN), the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours. METHODS: A prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A "suspicion algorithm" was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the four years prior to the start of the study. RESULTS: 199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP. Of the patients, 27% were diagnosed in stages I and II, and 73% in stages II and IV, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. CONCLUSIONS: The implementation of a rapid diagnosis pathway for patients who, according to the algorithm created, had a suspected head and neck cancer, has not led to an increase in the diagnosis of these tumours in early stages or a decrease in diagnoses in advanced stages.

Validez de un programa de diagnóstico rápido del cáncer de cabeza y cuello / Validity of a rapid diagnostic programme for head and neck cancer

Introducción y objetivos: Dado el conocimiento epidemiológico del carcinoma escamoso de cabeza y cuello, pronóstico y supervivencia según el estadio al diagnóstico, y ante la ausencia de programas de cribado que hayan demostrado ser coste-efectivos, nos propusimos evaluar un programa de diagnóstico rápido. El objetivo del presente estudio fue analizar si la existencia de un circuito de diagnóstico rápido desde Atención Primaria, con base en una ponderación de síntomas y signos, supondría un cambio en la proporción de diagnósticos en estadios iniciales versus tardíos en estos tumores.MétodosSe ha realizado un estudio observacional prospectivo de pacientes remitidos con la sospecha de un tumor en el área ORL en nuestro centro durante 24 meses consecutivos. Se creó un algoritmo con síntomas y signos de sospecha para utilización por el médico de familia y un circuito de remisión rápida de los pacientes candidatos. Se registraron también los pacientes con sospecha de tumor provenientes de fuentes distintas de este circuito. Los datos obtenidos (edad, sexo, consumo de tóxicos, tiempo y clínica de presentación, localización del tumor y extensión), se han comparado con los de los pacientes recogidos en la base de datos de tumores del Servicio de ORL diagnosticados durante los 4años previos al inicio del estudio.ResultadosSe incluyó en el estudio a 199 pacientes y se diagnosticaron 82 tumores del área ORL. Los médicos de familia remitieron por el circuito de diagnóstico rápido creado un total de 136 pacientes y 35 (26,1%) presentaban una tumoración. Sin embargo, la mayoría de los tumores diagnosticados durante este periodo en el Servicio de ORL (47 pacientes, 57,3% de todos los tumores diagnosticados) no fueron sospechados por su médico de familia y no fueron remitidos al hospital utilizando el circuito de diagnóstico rápido. (AU)

Introduction and objectives: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck, the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours.MethodsA prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A “suspicion algorithm” was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the 4years prior to the start of the study.Results199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP.Of the patients, 27% were diagnosed in stages i and ii, and 73% in stages iii and iv, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. (AU)

Abordaje endoscópico transpterigoideo y reparación de base de cráneo tras resección de meningoencefalocele esfenoidal. Nuestra experiencia / Endoscopic transpterygoid approach and skull base repair after sphenoid meningoencephalocele resection. Our experience

Introducción y objetivos: Las fístulas de líquido cefalorraquídeo asociadas a meningoencefaloceles del receso lateral de esfenoides son entidades muy infrecuentes. Un defecto óseo congénito a este nivel da lugar a la persistencia del canal de Sternberg o canal craneofaríngeo lateral, supuesto origen de estas lesiones. Nuestro objetivo es exponer que la cirugía endoscópica nasosinusal con abordaje transpterigoideo es una técnica efectiva para su tratamiento. Métodos: Presentamos cinco casos de meningoencefaloceles de receso lateral de esfenoides tratados con cirugía endoscópica (4 mujeres y un hombre, edad media=59, rango 37-72 años). Todos presentaban rinolicuorrea y en todos se realizó un abordaje transpterigoideo con reconstrucción de la base de cráneo. Realizamos una descripción de la técnica quirúrgica y una revisión de la literatura. Resultados: Ninguno tuvo complicaciones intra o postoperatorias y solo se registró una recidiva, con una media de seguimiento de 81 meses. Conclusiones: El abordaje transpterigoideo es efectivo para el tratamiento de meningoencefaloceles de receso lateral de esfenoides. Realizar un amplio acceso para identificar el defecto, seguido de la ablación del meningoencefalocele es la clave para una cirugía exitosa (AU)

Introduction and objectives: Cerebrospinal fluid leaks associated to meningoencephaloceles of the sphenoid lateral recess are rare entities. A congenital bony defect at this level results in the persistence of Sternberg's canal, or a lateral craniopharyngeal canal, which is supposed to be the origin of these lesions. Our objective was to show that the endoscopic transpterygoid approach is an effective technique for their treatment. Methods: We present a series of 5 cases of meningoencephaloceles of the sphenoid lateral recess treated with endoscopic sinus surgery (4 women and one man; mean age=59, range 37-72 years). Cerebrospinal fluid rhinorrhoea was present in all of them and they all underwent a transpterygoid approach with reconstruction of the skull base. We describe the surgical technique and review the literature. Results: No complications were observed during surgery or the postoperative period. After a mean follow-up of 81 months, only one recurrence was seen. Conclusions: The transpterygoid approach has proven to be effective for the treatment of meningoencephaloceles of the sphenoid lateral recess. Providing wide access to identify the defect, followed by meningoencephalocele ablation, is the key for successful surgery (AU)

Endoscopic transpterygoid approach and skull base repair after sphenoid meningoencephalocele resection. Our experience.

INTRODUCTION AND OBJECTIVES: Cerebrospinal fluid leaks associated to meningoencephaloceles of the sphenoid lateral recess are rare entities. A congenital bony defect at this level results in the persistence of Sternberg's canal, or a lateral craniopharyngeal canal, which is supposed to be the origin of these lesions. Our objective was to show that the endoscopic transpterygoid approach is an effective technique for their treatment. METHODS: We present a series of 5 cases of meningoencephaloceles of the sphenoid lateral recess treated with endoscopic sinus surgery (4 women and one man; mean age=59, range 37-72 years). Cerebrospinal fluid rhinorrhoea was present in all of them and they all underwent a transpterygoid approach with reconstruction of the skull base. We describe the surgical technique and review the literature. RESULTS: No complications were observed during surgery or the postoperative period. After a mean follow-up of 81 months, only one recurrence was seen. CONCLUSIONS: The transpterygoid approach has proven to be effective for the treatment of meningoencephaloceles of the sphenoid lateral recess. Providing wide access to identify the defect, followed by meningoencephalocele ablation, is the key for successful surgery.

Treatment of vocal fold scar by carbon dioxide laser and collagen injection: retrospective study on 12 patients.

Vocal fold scars are the result of injury to the vocal fold lamina propria. This condition leads to an impaired vibration and usually to poor voice quality. The purpose of our study was to compare the pre- and posttreatment voice assessment scores in patients treated by CO(2) laser-assisted freeing of the scar followed by collagen injection. A group of 12 patients (10 women and 2 men) with vocal fold scars was studied retrospectively. Voice assessment was based on stroboscopy and on perceptual scores using the Grade (G) of the GRABS scale, subjective evaluation by the use of the Voice Handicap Index (VHI), aerodynamic measurements [maximum phonation time (MPT) and phonation quotient (PQ)], and acoustical measurements (frequency range and low intensity). Stroboscopy showed an improvement on the mucosal vocal fold wave and on the glottic competence. The mean VHI was improved from 63.16 to 45.5; G from 2 to 1.41; MPT from 7.05 to 8.62 s; and PQ from 463.02 to 358.54 ml/s. CO(2) laser freeing of vocal fold scars followed by collagen injection, combined with speech therapy, improved significantly the aerodynamic parameters (efficiency of voice), but not the acoustical scores.

[Epidemiological study of emergency services at a tertiary care center]. / Estudio epidemiológico de las urgencias en un hospital de tercer nivel.

INTRODUCTION AND OBJECTIVE: The number of patients attended in emergency rooms has gone up considerably in recent years. Immigration and an increase in life-expectancy have probably influenced this increase. A lot of patients come looking for immediate attention in order to avoid long waiting lists for specialist care at primary health-care facilities. The main objective is to know what pathologies in ear, nose and throat require urgent medical assistance. MATERIAL AND METHODS: This is a retrospective descriptive study of 8,872 patients seen in a year. The variables analyzed were age, gender, day of the week, time of arrival, final result). In addition, a category distribution was made, depending on the pathology suffered: otological, rhinological, pharyngeal, laryngeal, cervical and others. RESULTS: The daily mean was about 25 patients per day. There were no differences in distribution by gender. Monday was the day of the week when more patients were seen. Otological pathologies represented the most frequent reason for attending (32 %), followed by pharyngeal emergencies. However, epistaxis (9.2 %) was the most common entity. The final outcome for about 85 % of the patients was discharge to home on the same day. CONCLUSIONS: The rising demand for emergency attention in hospitals must be meticulously analyzed because it might become even worse, taking epidemiological trends into account. Different foci and new policies regarding emergency centres should be proposed.

Estudio epidemiológico de las urgencias en un hospital / de tercer nivel / Epidemiological study of emergency services at a tertiary care center

Introducción y objetivo. La actividad asistencial en urgencias ha crecido de forma considerable en los últimos años. Probablemente, la inmigración y un incremento de la esperanza de vida han influido en este crecimiento. Muchos pacientes acuden buscando atención inmediata con tal de evitar listas de espera de especialidad en los centros de salud básicos. El principal objetivo es saber qué enfermedades en otorrinolaringología requieren asistencia médica urgente. Material y métodos. Es un estudio retrospectivo y descriptivo de 8.872 pacientes visitados en un año. Se analizaron algunas variables: edad, sexo, día de la semana, hora de llegada, destino final. Además, se hizo una distribución por categorías, dependiendo de la enfermedad presentada: otológica, rinológica, de faringe, laringe, cervical y otros. Resultados. La media diaria fue de alrededor de 25 pacientes por día. No hubo diferencias en cuanto al sexo. El lunes fue el día de la semana en el que se visitó a más pacientes. La enfermedad de oído fue la más atendida (32 %), seguida por la de faringe. De todas formas, la epistaxis (9,2 %) fue la entidad más común. El destino final en alrededor del 85 % fue el alta domiciliaria el mismo día. Conclusiones. El aumento de demanda de la atención urgente en los hospitales debe analizarse de forma concienzuda porque puede ser aún peor, teniendo en cuenta las tendencias epidemiológicas. Deben proponerse diferentes focos y nuevas políticas en cuanto a las urgencias

Introduction and objective. The number of patients attended in emergency rooms has gone up considerably in recent years. Immigration and an increase in life-expectancy have probably influenced this increase. A lot of patients come looking for immediate attention in order to avoid long waiting lists for specialist care at primary health-care facilities. The main objective is to know what pathologies in ear, nose and throat require urgent medical assistance. Material and methods. This is a retrospective descriptive study of 8,872 patients seen in a year. The variables analyzed were age, gender, day of the week, time of arrival, final result). In addition, a category distribution was made, depending on the pathology suffered: otological, rhinological, pharyngeal, laryngeal, cervical and others. Results. The daily mean was about 25 patients per day. There were no differences in distribution by gender. Monday was the day of the week when more patients were seen. Otological pathologies represented the most frequent reason for attending (32 %), followed by pharyngeal emergencies. However, epistaxis (9.2 %) was the most common entity. The final outcome for about 85 % of the patients was discharge to home on the same day. Conclusions. The rising demand for emergency attention in hospitals must be meticulously analyzed because it might become even worse, taking epidemiological trends into account. Different foci and new policies regarding emergency centres should be proposed