Treatment results for ethmoid sinus carcinoma.

OBJECTIVE: The aim of this study was to describe the results of treatment in patients with ethmoid sinus carcinoma. MATERIALS AND METHOD: We performed a retrospective study of 34 patients with carcinoma of the ethmoid sinus, and collected the following data: age, sex, employment, tobacco and alcohol consumption, tumour-node-metastasis stage, treatment, and survival. RESULTS: The mean patient age was 64 years. Seventy-six per cent of patients were men and 24 per cent women. Squamous cell carcinoma was the most frequent histological tumour type (44 per cent). Eleven patients were classified as T(2), six as T(3), six as T(4a) and 11 as T(4b). Two patients (6 per cent) had nodal metastasis at the time of diagnosis. The anterior skull base was involved in 17 patients (50 per cent) and the anterior orbital contents were affected in seven patients (21 per cent). The five-year actuarial observed survival rate for all patients was 44 per cent. CONCLUSIONS: Combined treatment with surgery and post-operative radiotherapy permitted good local control in patients with ethmoid sinus carcinoma. We do not recommend prophylactic neck treatment for ethmoid sinus carcinoma.

Plasma redox status relates to severity in critically ill patients.

OBJECTIVE: To determine the relation between plasma redox status and severity of illness for patients admitted to an intensive care unit (ICU). DESIGN: A prospective cohort study. SETTING: A mixed medical and surgical adult ICU with 12 beds. PATIENTS: A total of 73 consecutive patients admitted to the ICU. INTERVENTIONS: Venous blood samples were routinely obtained within 24 hrs of admission. MEASUREMENTS AND MAIN RESULTS: Plasma total antioxidant capacity and lipoperoxides were measured by spectrophotometric technique at admission to the ICU. The plasma ratio total antioxidant capacity (mM)/lipoperoxides (microM) was used as an index of plasma redox status. Plasma concentration of the markers of leukocyte activation myeloperoxidase (enzyme-linked immunosorbent assay) and polymorphonuclear-elastase (immunoactivation assay) were also measured at admission to the ICU. Analysis of correlation between plasma ratio total antioxidant capacity/lipoperoxides and APACHE III score showed a negative association (p < .001, Spearman correlation test). Myeloperoxidase and polymorphonuclear-elastase correlated positively with Acute Physiology and Chronic Health Evaluation III scores (r2 = 0.58; p < .001; and r2 = 0.05; p = .035; respectively). CONCLUSIONS: Plasma redox status relates to severity in critically ill patients. We propose that it would be reasonable to provide antioxidant therapy as part of routine management of patients admitted to a mixed ICU, regardless of the specific reason for ICU admission. Plasma redox status might become useful to evaluate the risk in critically ill patients.

Lymphocyte populations in tuberculous pleural effusions.

Different systemic and local responses to mycobacterial antigens suggest an active compartmentalization of responsive lymphocytes to tubercular antigens. This fact, observed in pleuritic processes, raises doubts about the accuracy of information obtained in the study of cells taken solely from peripheral blood. For this reason we decided to study the concept of compartmentalization in 140 patients suffering from pleural effusions. Patients were classified into six groups according to the aetiology of the effusion: group I, tuberculous, n = 23; group II, paraneoplastic, n = 41; group III, metapneumonic empyematous, n = 5; group IV, transudate, n = 38; group V, miscellaneous exudate, n = 19; group VI, unknown aetiology, n = 14. In each group we studied the lymphocyte population by using flow cytometry with doubly fluorescent monoclonal antibodies: B [expressing human lymphocyte antigen (HLA)-DR on the surface], T (CD3+), CD4+ and CD8+, and the subpopulation of activated T lymphocytes (together expressing CD3 and HLA-DR on the surface) (CD3+DR+). The study of these subpopulations in peripheral blood did not yield valuable results, but the CD3+DR+ population in pleural fluid demonstrated a diagnostic efficiency of 84% [positive predictive value (PPV) 51%, negative predictive value (NPV) 96%] at a cut-off value of 80.4 cells/mm3. The CD3+DR+ pleural fluid/peripheral blood ratio demonstrated an efficiency of 83% (PPV 50%, NPV 96%), and showed a statistically significant difference (P < 0.02) with regard to all the diagnostic groups, with the exception of the paraneoplastic effusions. The lymphocytic subpopulations study confirms the concept of compartmentalization in tuberculous pleuritis, as shown by the greater number of activated T lymphocytes present in pleural fluid in comparison with peripheral blood in tuberculous pleuritis, a 98% efficiency of adenosine deaminase (ADA) determination in pleural fluid versus a 50% value in peripheral blood, predominance of helper cells (CD4+) in pleural fluid and suppressor cells (CD8+) in peripheral blood, a greater CD4+/CD8+ ratio in pleural fluid than in peripheral blood, and a significant correlation of ADA-CD3+DR+ in pleural fluid, which does not occur in peripheral blood.

[Utility of bronchoalveolar lavage in the diagnosis of respiratory infection in HIV patients]. / Utilidad del lavado broncoalveolar en el diagnóstico de la infección respiratoria en pacientes HIV.

From January 1, 1992, to December 31, 1995, we studied 52 bronchoalveolar lavages in 45 HIV-infected patients. All patients with pulmonary symptoms and/or new pulmonary infiltrates underwent bronchoalveolar lavage (BAL) when the results of blood cultures and mycobacterial smears of sputum and urine were negative. Lavage fluid was investigated for the presence of P. carinii, bacteria, mycobacteria, fungi and virus. BAL was diagnostic in 39 (75%) cases. The organisms more frequently isolated were P. carinii and M. tuberculosis. Only one pathogen was identified in 28 cases (54%); two in ten (19%); and three in one patient (2%). BAL was, generally, well tolerated by the patient and had a high diagnostic yield in the evaluation of patients with HIV infection and respiratory symptoms.

[Results of a smoking cessation program among Spanish pulmonologists and thoracic surgeons]. / Resultado de un programa de cesación de tabaquismo en neumólogos y cirujanos torácicos españoles.

We evaluated the efficacy of a smoking cessation program using 16-hours nicotine patches offered by mail to physicians belonging to the Spanish Pneumological and Thoracic Surgery Society. Fifty-five subjects (21 women) with a mean age of 40 underwent treatment with 16-hours nicotine patches with different dose-time applications dependent on Fagerstrom test scores. Abstinence, which was verified by measuring carbon monoxide in expired air, was 23.6% after 6 months of follow-up. We observed a low rate of mild side effects.

[The use of Wagner's external fixator in the treatment of septic fractures of the femoral shaft (author's transl)]. / Le fixateur de Wagner dans le traitement des fractures septiques du fémur.

The authors have treated 10 cases of septic fracture of the femoral shaft by the following technique. In the first stage, necrotic and infected tissues were excised at the fracture site including soft tissue and bone. The importance of a large excision is emphasised. The fracture was then immobilised by an external fixator. In the second stage, the shaft was reconstructed by grafting using bone chips and sometimes massive cancellous bone autografts. The fixators were left until solid bone union had been achieved. 9 excellent results were observed. In one case, the bone refractured with recurrence of sepsis.