Neoplasia papilar de polaridad inversa: un nuevo subtipo de tumor renal de buen pronóstico / Papillary renal cell neoplasm with reverse polarity: A new subtype of renal tumour with favorable prognosis

Introducción: La neoplasia papilar renal de polaridad inversa (NPRPI) ha sido recientemente reconocida como una entidad separada de la clasificación tradicional de los carcinomas papilares de células renales por sus peculiares características histopatológicas, inmunofenotípicas y moleculares, y un comportamiento indolente. Material y métodos: En este trabajo aportamos 6 nuevos casos y realizamos una revisión de la literatura publicada al respecto hasta el momento actual, recopilándose un total de 104 casos. Resultados: Nuestros casos de NPRPI corresponden a 5 hombres y una mujer, con edades comprendidas entre los 47 y los 91 años. En 5 casos la NPRPI resultó un hallazgo incidental en piezas de nefrectomía indicada por la presencia de otro tumor renal y en uno la NPRPI fue el motivo de la intervención quirúrgica. Nuestros casos presentan tamaños entre los 2 y los 13mm, y una histología papilar con revestimiento en monocapa de células eosinófilas con núcleos de bajo grado en localización apical. Inmunohistoquímicamente muestran una constante positividad para GATA3 y negatividad para vimentina. Se identificaron mutaciones en KRAS en el 50% de ellos. Tras un seguimiento comprendido entre uno y 60 meses, 5 de los pacientes seguían vivos sin recurrencia o metástasis y uno falleció a causa de un carcinoma urotelial. Conclusiones: Nuestros casos concuerdan con las características clínicas y patológicas descritas en los publicados hasta el momento. Aportamos la primera serie nacional y corroboramos la existencia de unos criterios diagnósticos definidos y constantes que permiten considerar la NPRPI como una entidad propia distintiva. (AU)

Introduction: Papillary renal cell neoplasm with reverse polarity (PRNRP) has recently been recognized as an entity separate from the traditional classification of papillary renal cell carcinomas, due to its specific histopathological, immunophenotypic and molecular characteristics, as well as its indolent behavior . Material and methods: We provide 6 new cases and a review of the literature published until the present time, which comprises a total number of 104 cases. Results: Our PRNRP cases correspond to 5 men and one woman aged between 47 and 91 years. In 5 of the 6 cases, the PRNRP was an incidental finding in nephrectomy specimens. Nephrectomy had been indicated due to the presence of another renal tumor, except for one case, in which surgical intervention was indicated due to PRNRP. Our cases present mass sizes between 2 and 13mm, as well as papillary histology with a monolayered lining of eosinophilic cells with low-grade nuclei in apical location. Immunohistochemically, they show a constant positivity for GATA3 and negativity for vimentin. KRAS mutations were identified in 50% of our cases. After a follow-up ranging between one and 60 months, 5 of the cases were still alive without recurrences or metastases, and one died from urothelial carcinoma. Conclusions: Our cases agree with the clinical and pathological characteristics described in the PRNRP cases published to date. With the present study, we provide the first series of national cases corroborating the existence of well-defined and constant diagnostic criteria that allow PRNRP to be considered as a distinctive entity. (AU)

Papillary renal cell neoplasm with reverse polarity: A new subtype of renal tumour with favorable prognosis.

INTRODUCTION: Papillary renal cell neoplasm with reverse polarity (PRNRP) has recently been recognized as an entity separate from the traditional classification of papillary renal cell carcinomas, due to its specific histopathological, immunophenotypic and molecular characteristics, as well as its indolent behavior. MATERIAL AND METHODS: We provide 6 new cases and a review of the literature published until the present time, which comprises a total number of 104 cases. RESULTS: Our PRNRP cases correspond to 5 men and one woman aged between 47 and 91 years. In 5 of the 6 cases, the PRNRP was an incidental finding in nephrectomy specimens. Nephrectomy had been indicated due to the presence of another renal tumor, except for one case, in which surgical intervention was indicated due to PRNRP. Our cases present mass sizes between 2 and 13 mm, as well as papillary histology with a monolayered lining of eosinophilic cells with low-grade nuclei in apical location. Immunohistochemically, they show a constant positivity for GATA3 and negativity for vimentin. KRAS mutations were identified in 50% of our cases. After a follow-up ranging between one and 60 months, 5 of the cases were still alive without recurrences or metastases, and one died from urothelial carcinoma. CONCLUSIONS: Our cases agree with the clinical and pathological characteristics described in the PRNRP cases published to date. With the present study, we provide the first series of national cases corroborating the existence of well-defined and constant diagnostic criteria that allow PRNRP to be considered as a distinctive entity.

Quimioterapia Neoadyuvante en Tumores Luminales Experiencia del Hospital Oncológico Marie Curie / Neoadjuvant Chemotherapy in Luminal Tumors Experience of the Marie Curie Cancer Hospital

Introducción La quimioterapia neoadyuvante (QTn) es una herramienta de uso cada vez más frecuente en el tratamiento del cáncer de mama. su repercusión es objetivada a partir de parámetros clínicos (examen físico y estudios por imagen) y parámetros anatomo-patológicos sobre la pieza quirúrgica. Existe variabilidad en el impacto de la Qt según el subtipo molecular. Este estudio evalúa el grado de respuesta (clínica y patológica) a la QTn de las pacientes con cáncer de mama subtipo luminal y la tasa de cirugías conservadoras en este subgrupo. Objetivo Describir la tasa de respuesta clínica y patológica obtenida en el subgrupo de pacientes luminales y evaluar la tasa de conversión a cirugía conservadora luego del tratamiento neoadyuvante. Material y método Se analizaron 220 historias clínicas pertenecientes a pacientes que realizaron neoadyuvancia en el periodo 2014-2017 en el Servicio de Patología Mamaria del Hospital Oncológico Marie Curie. Se incluyeron 78 pacientes con diagnóstico de carcinoma invasor subtipo luminal A y B, Her 2 negativas. Se evaluó la tasa de respuesta clínica, patológica y la tasa de cirugía conservadora. Resultados Se clasificaron como Luminal A el 26.9% (n=21) de las 78 pacientes, y Luminal B el 73.1% (n=57). La distribución por tamaño tumoral fue: T1 en el 1.25% (n= 1); T2 en 46.1% (n= 36); T3 en 37.2% (n=29) y T4 en el 15.4% (n=12) de los casos. No presentaban compromiso axilar (N0) el 24.3% de las pacientes (n=19), y se vio afectación ganglionar el 75.5 % (n= 59). El Estadio clínico más frecuente fue el III A (32% = 25 pacientes). El 60.3% (47 pacientes) de los casos tenía indicación de mastectomía de inicio y el 39.7% (41 pacientes) eran candidatas a cirugía conservadora. Posterior a la quimioterapia, se indicaron cirugías conservadoras en el 52.6 % (n=41) y mastectomía en el 47.4% (n=37), con una tasa de conversión a cirugía conservadora del 24.4%. La respuesta clínica completa fue del 28.2% (n=22) y la respuesta patológica completa del 16.6%. Conclusión Se observó una respuesta clínica y patológica acorde a la experiencia de otros centros, sobre todo en el subtipo luminal B, con una alta tasa de conversión a cirugía conservadora del 24.4%. Esto nos permite considerar la quimioterapia neoadyuvante como una opción de tratamiento válida para aquellas pacientes con cáncer de mama subtipo luminal B- Her 2 negativa.

Introduction Neoadjuvant chemotherapy (QTn) is a tool that is increasingly used in the treatment of breast cancer. its repercussion is objectified based on clinical parameters (physical examination and imaging studies) and anatomo-pathological parameters on the surgical specimen. There is variability in the impact of Qt according to the molecular subtype. This study evaluates the degree of response (clinical and pathological) to the QTn of patients with luminal subtype breast cancer and the rate of conservative surgeries in this subgroup. Objective To describe the clinical and pathological response rate in the subgroup of luminous patients and to evaluate the conversion rate in a conservative surgery after neoadjuvant treatment. Material and method We will analyze 220 clinical records belonging to patients that developed during the 2014-2017 period in the Breast Pathology Service of the Marie Curie Oncology Hospital. We included 78 patients with a diagnosis of invasive carcinoma luminal subtype A and B, their 2 negative. The clinical and pathological response rate and the rate of conservative surgery in each group were evaluated. Results Luminal A was classified as 26.9% (n = 21) of the 78 patients, and Luminal B was 73.1% (n = 57). The distribution by tumor size was: T1 at 1.25% (n = 1); T2 at 46.1% (n = 36); T3 in 37.2% (n = 29) and T4 in 15.4% (n = 12) of the cases. There is no axillary involvement (N0) in 24.3% of the patients (n = 19), and the ganglion was affected 75.5% (n = 59). The most frequent clinical stage was III A (32% = 25 patients). Sixty-three percent (47 patients) of the cases had an initial mastectomy indication and 39.7% (41 patients) were candidates for conservative surgery. After chemotherapy, conservative surgeries were indicated in 52.6% (n = 41) and mastectomy in 47.4% (n = 37), with a conversion rate to conservative surgery of 24.4%. The complete clinical response was 28.2% (n = 22) and the complete pathological response was 16.6%. Conclusion A clinical and pathological response was observed according to the experience of other centers, especially in luminal subtype B, with a high conversion rate to conservative surgery of 24.4%. This allows us to consider neoadjuvant chemotherapy as a valid treatment option for those patients with luminal B-Her 2 negative breast cancer.

Rapid-behaviour responses as a reliable indicator of estrogenic chemical toxicity in zebrafish juveniles.

Whereas biochemical and molecular parameters have been well recognised as important "signposts" of individual disturbance to endocrine disrupting chemical's (EDCs) exposure, behavioural endpoints are yet greatly overlooked as a routine tool in environmental risk assessment of EDCs. However, life histories are intimately associated with numerous inter- and intra-specific interactions, which invariably depend on the performance of effective behaviours. Within fish species, one of the most important factors influencing energy turnover earlier in the development is locomotor activity. This essential trait reflects the organism's ability to generate and coordinate the metabolic energy required for both reproductive and non-reproductive behaviours. Inappropriate movement responses due to toxic effects of contaminants may ultimately impact important ecological variables. Therefore, in the present study, the swimming bursts of zebrafish juveniles exposed for 40 d to the synthetic estrogen ethinylestradiol (EE(2)), tested at environmentally relevant concentrations (nominal concentrations of 0.5, 1 and 2 ng L(-1)), were investigated in order to address the potential of rapid-behaviour patterns as an effective response indicator of estrogenic endocrine disrupting chemical's exposure. This synthetic estrogen was selected due to its high prevalence in aquatic ecosystems, ability to mimic natural estrogens and proven record of causing negative effects in fish reproduction. The behavioural responses were compared with established endpoints used in the screening of EE(2) effects at adulthood. Results indicate that zebrafish juveniles' swimming activity was significantly decreased upon EE(2) exposure. Since reduced locomotion of zebrafish may impact foraging, predator avoidance, drift and transport, and even interfere with social and reproductive behaviours, a fitness decline of wild fish populations can ultimately be hypothesized. Furthermore, behavioural endpoints were found to display higher sensitivity to EE(2) than either vitellogenin gene induction or reproductive parameters determined at adulthood. Overall, the findings of this work not only demonstrate the power of high-throughput behavioural responses, able to act as sensitive early warning signals of EDC exposure, but also highlight the potential of behavioural endpoints in providing a more comprehensive and non-invasive measure of EDC's exposure.

Drifting towards the surface: a shift in newborn pipefish's vertical distribution when exposed to the synthetic steroid ethinylestradiol.

Endocrine disrupting chemical (EDC) effects during early life have the potential to modulate population structure, either directly through increased mortality or by causing inappropriate aggregation events, thus affecting the number of young that will reach adulthood. An alteration in the dispersal and recruitment patterns can also impair the connectivity among geographically distant populations. However, the detection of EDC-induced effects occurring after egg hatch, when newborns increase their chances of contacting with environmentally dispersed contaminants, is not a simple process as effects might be masked by the large natural mortality rates that usually occur during fish early life. Since there is a lack of information regarding the impact of EDCs on fish early life dispersal patterns, particularly on vertical migrations patterns, the effects of environmentally relevant concentrations of EE(2) on the vertical distribution of newborn fish was assessed through an ex situ exposure experiment. Syngnathus abaster newborns were exposed to EE(2) (nominal concentrations of 8, 12 and 36 ng L(-1)) and the dynamics of their vertical distribution was monitored for up to 40 d. No significant differences in overall mortality were observed between treatments or in the dynamics of the registered death curves. Nevertheless, an alteration in the distribution patterns was observed. The commonly benthic newborn tended to shift their vertical distribution towards the surface, in a dose-dependent manner. Curiously, a follow up of the exposed pipefish confirmed that EE(2) effects were also noticeable upon sexual maturity, namely by the alteration of several primary and secondary sexual characters. The observation that vertical distributional patterns, at least in pipefish, are clearly altered at environmentally relevant EE(2) concentrations indicates that EDC's impact in fish larvae behaviour should be considered when addressing the effects of contaminants, given the obvious implications on population connectivity, stability and persistence.

The unpredictable effects of mixtures of androgenic and estrogenic chemicals on fish early life.

Estuarine shallow areas and coastal lagoons are known to receive and concentrate multiple inputs, either from land, rivers or coastal areas, being intensively impacted by chemical contamination, namely endocrine disrupting chemicals (EDCs). Despite the ubiquitous coexistence of several classes of EDCs in most of these aquatic ecosystems, there is still limited information regarding their combined effects. Furthermore, given the immediate implications for population dynamics, the available laboratory studies almost invariably focus on very specific life history stages, such as embryonic development or reproduction, thus creating a gap on our knowledge of what happens in between. During this 'intermediate phase', the newborn larvae and juveniles face numerous challenges whose outcome may impair reproduction or even survival. The black-striped pipefish, Syngnathus abaster, member of the Syngnathidae family (comprising pipefish, seahorses and seadragons), usually breeds in coastal areas such as estuaries, where its newborns are immediately exposed to EDCs. Given the ongoing decline of pipefish populations, together with the observed shrinkage and fragmentation of seagrass meadows, known to be impacted by EDCs, a first reasonable question to address is if pipefish newborns respond to environmentally relevant concentrations of ubiquitous EDCs, either single or in combination. Hence, a seven days exposure experiment to the estrogenic chemical ethinylestradiol (EE(2)) and the androgenic chemical tributyltin (TBT), single and in binary mixtures, was conducted. Selected behavioural (e.g. predator avoidance) and developmental variables (e.g. growth) were monitored in pipefish juveniles after EDCs insult. The obtained results indicate that EE(2), TBT, or their combined exposure, do impact pipefish early life. However, the pattern of results emerging from the measured variables clearly indicates that mixtures significantly modulate newborn responses in distinct ways when compared to individual chemical's exposure. These findings further demonstrate the importance of addressing the issue of chemical mixtures of pollutants acting through dissimilar mode of action. Independently of all the observed response variations, an ultimate conclusion seems certain: EE(2) and TBT, single or in combination, induce disruption patterns able to imbalance pipefish survival. Since these (as well as other) contaminants are present in estuarine areas, profound implications in population structure could be expected, ranging from a decrease in recruitment to a disruption of sexual selection. Inexorably, these stressors simultaneously operate in already declining populations.

Interprofessional education for students of the health professions: the "Seamless Care" model.

"Seamless Care" was one of 21 grants awarded by Health Canada to inform policymakers of the effectiveness of interprofessional education in promoting collaborative patient-centred practice among health professionals. The "Seamless Care" model of interprofessional education was designed with input from three Faculties at Dalhousie University (Medicine, Dentistry and Health Professions). The design was grounded in relevant learning theories--Social Cognitive Theory, Self-efficacy, Situated Learning theory and Constructivism. The intervention was informed by principles of active learning, problem-based learning, reflection and role modeling. The primary goal of Seamless Care was to develop students' interprofessional patient-centred collaborative skills through experiential learning. Fourteen student teams, each including one student from medicine, nursing, pharmacy, dentistry and dental hygiene, learned with, from and about each other while they were mentored in the collaborative care of patients transitioning from acute care to the community. Student teams providing collaborative care assisted patients experiencing a chronic illness to become more active in managing their health through development of self-management and decision-making skills. This paper describes the Seamless Care model of interprofessional education and discusses the theoretical underpinnings of this experiential model of interprofessional education designed to extend classroom-based interprofessional education to the clinical setting.

[Musical perception and enjoyment in post-lingual patients with cochlear implants]. / Percepción y disfrute de la música en pacientes poslocutivos con implante coclear.

OBJECTIVES: To evaluate music perception and enjoyment following cochlear implantation and its impact on quality of life (QOL). MATERIAL AND METHOD: Eighty-eight adult post-lingually deaf cochlear implant users entered the study. The music questionnaire analyzed musical background, listening habits, and quality of musical sound through the cochlear implant. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The Glasgow Benefit Inventory evaluated the quality of life (QOL). The music questionnaires, the PMMA and the GBI were completed by 84 %, 74 %, and 82 % of patients, respectively. RESULTS: Subjective enjoyment of music and listening habits decreased post-implantation when compared with prior to deafness. Mean scores for music perception were: tone 71 %, rhythm 78 %, timbre 61 %, songs 59 %, and melodies 23 %. The quality of music sound through the cochlear implant was associated with music enjoyment and with QOL. CONCLUSIONS: Music enjoyment and perception are possible with a cochlear implant. The quality of music sound through the cochlear implant influences post-operative QOL.

Percepción y disfrute de la música en pacientes poslocutivos con implante coclear / Musical perception and enjoyment in post-lingual patients with cochlear implants

Objetivos: Evaluar la percepción y el disfrute de la música tras la implantación coclear y su impacto en la calidad de vida. Material y método: Participaron en el estudio 88 adultos con sordera poslocutiva y portadores de un implante coclear. El cuestionario de la música analizó la experiencia musical, los hábitos musicales y la calidad del sonido musical a través del implante coclear. Para estudiar la percepción de la música se empleó el PMMA (Primary Measures of Music Audiation). La calidad de vida fue evaluada mediante el GBI (Glasgow Benefit Inventory). El cuestionario de la música, el PMMA y el GBI fueron contestados por el 84, el 74, y el 82 % de los pacientes, respectivamente. Resultados: El disfrute de la música y los hábitos musicales disminuyeron tras el implante coclear cuando se compararon con la situación previa a la sordera. Los valores medios de percepción de la música fueron: tono, el 71 %; ritmo, el 78 %; timbre, el 61 %; canciones, el 59 %, y melodías, el 23 %. La calidad del sonido de la música a través del implante coclear se relacionó con el disfrute de la música y con la calidad de vida. Conclusiones: Es posible disfrutar y percibir la música con un implante coclear. La calidad del sonido de la música a través del implante influye en la calidad de vida

Objectives: To evaluate music perception and enjoyment following cochlear implantation and its impact on quality of life (QOL). Material and method: Eighty-eight adult post-lingually deaf cochlear implant users entered the study. The music questionnaire analyzed musical background, listening habits, and quality of musical sound through the cochlear implant. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The Glasgow Benefit Inventory evaluated the quality of life (QOL). The music questionnaires, the PMMA and the GBI were completed by 84 %, 74 %, and 82 % of patients, respectively. Results: Subjective enjoyment of music and listening habits decreased post-implantation when compared with prior to deafness. Mean scores for music perception were: tone 71 %, rhythm 78 %, timbre 61 %, songs 59 %, and melodies 23 %. The quality of music sound through the cochlear implant was associated with music enjoyment and with QOL. Conclusions: Music enjoyment and perception are possible with a cochlear implant. The quality of music sound through the cochlear implant influences post-operative QOL

Changes in listening habits and quality of musical sound after cochlear implantation.

OBJECTIVE: To evaluate listening habits and quality of musical sound after cochlear implantation. STUDY DESIGN: A total of 89 consecutive, adult, postlingually deafened, cochlear implant recipients entered the study. Music questionnaire included questions about musical background, listening habits, and quality of musical sound through cochlear implants. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The questionnaire and the PMMA were administered to 67 and 65 patients, respectively. RESULTS: Listening habits significantly decreased postimplantation. The mean score (0-100) for the adjective pairs "like-dislike," "sounds like music-doesn't sound like music," "natural-mechanical," and "easy to follow-difficult to follow" was 60, 59, 50, and 40, respectively. The adjective pairs were associated with music enjoyment. Mean PMMA scores were 71 and 78 percent for tone and rhythm, respectively, with no association with music enjoyment. CONCLUSION: Music perception through a cochlear implant is a complex phenomenon that depends on audiological and non-audiological factors.

[Clinical tumoral size dissociation in acoustic neuroma: reality or measure distortion?]. / Disociación clínica-tamaño tumoral en el neurinoma del acúistico: realidad o problema de medida?

INTRODUCTION: In this study we have analyzed (i) the audiometric frequencies more often affected in acoustic neuroma (AN), (ii) the percentage of patients presenting normal hearing and those with sudden hearing loss, (iii) if there is a correlation between tumor size and hearing loss, and (iv) the relationship between clinical and radiological parameters and audiological data. METHODS AND MATERIAL: Retrospective study of 81 patients undergoing surgical removal of a sporadic AN. RESULTS: The highest threshold in the tumor's ear was found at 8000 Hz, and the highest interaural difference at 4000 Hz. The percentage of patients presenting normal hearing and sudden hearing loss was 2.5% and 9%, respectively. No significant association was found between tumor size and hearing loss, preoperative facial palsy or Vth cranial nerve deficit. There was a significant association between the degree of hearing loss and Vth cranial nerve deficit, and between hearing loss and preoperative facial palsy. CONCLUSIONS: The association between hearing loss and Vth cranial nerve deficit, and between hearing loss and preoperative facial palsy is independent the size of the tumour.

Disociación clínica-tamaño tumoral en el neurinoma del acústico: ¿realidad o problema de medida? / Clinical tumoral size dissociation in acoustic neuroma: reality o measure distortion?

Introducción: Hemos analizado: 1) las frecuencias audiométricas más afectadas en el neurinoma del acústico (NA), 2) el porcentaje de pacientes con audición normal y con sordera súbita; 3) si hay correlación entre el tamaño tumoral y la hipoacusia; y 4) la relación entre hallazgos clínicos, radiológicos y audiométricos. Material y métodos: Estudio retrospectivo de 81 pacientes intervenidos por NA. Resultados: El mayor umbral en el oído del tumor se encontró a 8000 Hz, y la mayor diferencia interaural a 4000 Hz. El porcentaje de pacientes con audición normal y con sordera súbita fue 2,5% y 9%, respectivamente. No encontramos asociación entre tamaño tumoral e hipoacusia, parálisis facial o alteración del V par. Hallamos asociación entre hipoacusia y alteración del V par, y entre hipoacusia y parálisis facial. Conclusiones: La relación entre hipoacusia y alteración del V par, y entre hipoacusia y parálisis facial es independiente del volumen tumoral

Introduction: In this study we have analyzed (i) the audiometric frequencies more often affected in acoustic neuroma (AN), (ii) the percentage of patients presenting normal hearing and those with sudden hearing loss, (iii) if there is a correlation between tumor size and hearing loss, and (iv) the relationship between clinical and radiological parameters and audiological data. Methods and Material: Retrospective study of 81 patients undergoing surgical removal of a sporadic AN. Results: The highest threshold in the tumor´s ear was found at 8000 Hz, and the highest interaural difference at 4000 Hz. The percentage of patients presenting normal hearing and sudden hearing loss was 2.5% and 9%, respectively. No significant association was found between tumor size and hearing loss, preoperative facial palsy or Vth cranial nerve deficit. There was a significant association between the degree of hearing loss and Vth cranial nerve deficit, and between hearing loss and preoperative facial palsy. Conclusions: The association between hearing loss and Vth cranial nerve deficit, and between hearing loss and preoperative facial palsy is independent the size of the tumour

Comparison of different mobile telephones in Combi40+ users.

CONCLUSION: Telephone usage is a difficult challenge for cochlear implanted patients. A significant number of cochlear implanted patients are able to carry on a land-line or mobile telephone conversation. The telephone model may be a critical factor for telephone performance. OBJECTIVES: The goals of this study were to evaluate speech discrimination through land-line and mobile telephones in Combi40+ users, and to compare different mobile telephone models to find out which could be more advisable for them. PATIENTS AND METHODS: Eighteen Combi40+ implantees were tested with CID sentences and bisyllabic words presented through land-line and mobile telephones, in both quiet and noisy environments. RESULTS: Mean scores for telephonic speech discrimination were over 85% for CID sentences and 28-59% for bisyllabic words. The Siemens M55 was superior to the other mobile telephones tested.

[Speech discrimination through telephone in patients implanted with a Combi 40+]. / Discriminación verbal a través del teléfono en pacientes implantados con un Combi 40+.

OBJECTIVE: To assess speech discrimination through line and mobile telephone in cochlear implanted patients. MATERIAL AND METHODS: Eighteen patients implanted with a Combi 40+ went through different speech discrimination tests with a line telephone and three mobile telephones, in quiet and noisy environment. RESULTS: Mean scores for telephonic speech discrimination were 84-92% using CID sentences, 27-58% using bisyllabic words in quiet environment and 15-41% using bisyllabic words in noisy environment. Among the mobile telephones tested, the Siemens M55 reached the best scores. CONCLUSIONS: Telephonic speech discrimination is achieved by a significant number of cochlear implanted patients. Certain mobile telephone models appear to be more advisable for these patients.

[Quality of life in cochlear implanted patients]. / Calidad de vida en pacientes con implante coclear.

Several articles show the audiologic benefits of cochlear implants, although it is still necessary to prove their impact on quality of life. In this study, 36 Med-El processor users were included. The Glasgow Benefit Inventory (GBI) was used to measure changes in quality of life, and another questionnaire was used to evaluate the communication abilities. Eighty-six percent of the patients answered our questionnaire. The quality of life improved significantly according to the specific questionnaire. The average total benefit obtained with the GBI was +41, and the average scores related to general, social and physics benefits were +57, +16, and +3, respectively. No significant difference was found between quality of life and other parameters like insertion depth of the array, etiology or duration of the deafness.

[Diagnosis of intracranial facial schwannoma: clinical, and radiological factors, and the value of immunohistochemistry]. / Diagnóstico del schwannoma intracraneal del nervio facial. Factores clínicos, radiológicos y valor de la inmunohistoquímica.

OBJECTIVE: To analyze the clinical, radiological, and pathological features which may be useful to differentiate intracranial schwannomas of the facial nerve from vestibular schwannomas. MATERIAL AND METHODS: A retrospective study of 91 patients undergoing surgery with a clinical suspicion of vestibular schwannoma is presented. Clinical and radiological features are analyzed. Immunohistochemistry for neurofilaments was performed in selected cases of unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. RESULTS: Facial function was normal in 83% of patients with vestibular schwannoma. Both patients with facial schwannomas had preoperative House-Brackmann grade II facial function. MRI showed no main differences between facial and vestibular schwannomas. A positive immunostaining was found in unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. CONCLUSION: There are no specific clinical, radiological, or pathological factors to accurately differentiate schwannomas of the facial nerve from vestibular schwannomas.

[Is hearing preservation feasible with the retrosigmoid approach?]. / Es factible la preservación de la audición empleando la vía retrosigmoidea?

The main advantages of the retrosigmoid approach are fast and good visualization of the brainstem structures and the possibility to remove tumors of all sizes. Hearing preservation, although possible, is not always achieved. The aim of this study is to present our experience with the retrosigmoid approach for acoustic neuroma resection, emphasizing our hearing results. The notes of 56 cases of acoustic neuroma removed through a the retrosigmoid approach were reviewed. Tumor size ranged from 8 to 50 mm (mean 24 mm). Considering patients with preoperative serviceable hearing, postoperative serviceable and measurable hearing was achieved in 13.3% and 26.7% of cases respectively. No tumor recurrence occurred in our series. The retrosigmoid approach is a reliable surgical procedure for most vestibular schwannoma. However, hearing preservation results may be unsatisfactory and show wide differences depending on selection criteria and the hearing terminology used. Concerns about hearing preservation should not be the deciding factor for using this approach.

[Electro-oculographic features of persons with vitamin E deficiency]. / Manifestaciones electrooculográficas en sujetos con déficit de vitamina E.

INTRODUCTION: Vitamin E (VE) deficiency is a very rare condition which may be due to an isolated deficit or be in the context of a malabsorption disorder. OBJECTIVE: To evaluate the findings from an electrooculographic (EOG) point of view of patients with VE deficiency. PATIENTS AND METHODS: We made a retrospective evaluation of all persons with a neurological diagnosis of VE seen in the otoneurological department of our hospital. In all patients an EOG recording was made of the saccadic jerks, and the spontaneous, provoked, positional and opticokinetic (NOC) mystagmus, visual suppression of the vestibulo ocular reflex (VOR) and follow up. RESULTS: We found four cases, with an average age of 9.2 years (range 6 14 years). All the patients but one were male (75%). The EOG findings were related to cerebellar dysfunction (saccadic following) and central nervous system alterations of no value for localization (ataxic following and visual suppression of the VOR). In two patients no anomalies were seen on the EOG recording. CONCLUSIONS: In persons with VE deficiency EOG alterations are not often seen. However, it may be useful to make the recording when it is thought necessary to detect subclinical cerebellar disorders.

[Percentage of tumor in prostatic biopsy cylinders as prognosis factor of organ-limited disease in candidates for radical prostatectomy]. / El porcentaje de tumor en cilindros de biopsia prostática como factor pronóstico de enfermedad órganoconfinada en pacientes candidatos a prostatectomía radical.

UNLABELLED: The present study analyzes the prognostic influence of tumor percentage in cylinders of prostatic biopsy in this patient group. MATERIAL AND METHODS: Retrospective study of 68 patients with a diagnosis of adenocarcinoma, clinical stage T1-T2 who had undergone a radical prostatectomy from May 1997 to october 2000. Following preoperative parameters were analyzed: age, PSA, clinical staging, Gleason and six cylinders of ultrasonography-leaded transrectal prostatic biopsy, studying the amount of positive biopsies, the tumor percentage of the total amount of biopsies and the maximum percentage of tumor in one cylinder. Univariate (square-Chi, Student t) and multivariate (multiple logistic regression) analysis are performed in order to study the relationship of these parameters with the presence or not of an organ-located disease. RESULTS: An organ-located disease was shown at 44 patients through the piece of radical prostatectomy. The univariate analysis gave all studied parameters, except age, a prognostic value of the existence or not of an organ-located disease. In the multivariate analysis only the total percentage of biopsy tumors (p = 0.0002) and PSA (p = 0.005) behaved as independent prognostic factors. CONCLUSION: Tumor percentage in prostatic biopsy seems to be a factor with a high predictive value of an organ-located disease, possibly because it is an index of tumoral volume.

[Result of middle fossa vestibular neurectomy in Meniere's disease]. / Resultados de la neurotomía por fosa media en la enfermedad de Ménière.

The results and complications of 224 middle fossa vestibular neurectomies (MFVN) performed between 1968 and 1994 are reported. Relief of vertigo, hearing and tinnitus (both pre- and postoperative), facial paralysis, wound infection, suture dehiscence, cerebrospinal fluid (CSF) leak, meningitis, subdural hematoma, average hospitalization time, and death were evaluated. The procedure was effective against vertigo in Ménière's disease in 100% of the cases with unilateral involvement. The excellent results with regard to relief of vertigo and the acceptable incidence of complications make MFVN one of the most adequate surgical treatments for Ménière's disease.