Implementation and assessment of a fast-track programme to improve communication between primary and specialized care in patients with suspected cancer: how to shorten time between initial symptoms of cancer, diagnosis and initiation of treatment

Purpose. This study aims to asses a cancer fast-track programme (CFP) to shorten the time since a patient with suspicion of cancer is referred by the primary care (PC) physician to the specialized medical team. Methods. Guidelines for main suspected tumours were designed to help PC physicians to detect and rapidly refer cases to the CFP oncology coordinator, who sent them to the appropriate department to accelerate diagnosis, staging and therapy. All patients analysed in this report were referred from June 2009 to July 2012. Results. A total of 897 suspected cancer cases were submitted and finally 705 were studied. In 205 (29 %) a cancer diagnosis was confirmed within 23 days (median). Therapy was initiated within 46 days after referral (median). Early diagnoses with a potential curative approach were made in 166 (82 %). Conclusions. This CFP decreased the waiting time for cancer diagnosis, by improving communication between PC physician and specialized care teams. Most patients included in this program could get therapy with curative intent (AU)

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Implementation and assessment of a fast-track programme to improve communication between primary and specialized care in patients with suspected cancer: how to shorten time between initial symptoms of cancer, diagnosis and initiation of treatment.

PURPOSE: This study aims to asses a cancer fast-track programme (CFP) to shorten the time since a patient with suspicion of cancer is referred by the primary care (PC) physician to the specialized medical team. METHODS: Guidelines for main suspected tumours were designed to help PC physicians to detect and rapidly refer cases to the CFP oncology coordinator, who sent them to the appropriate department to accelerate diagnosis, staging and therapy. All patients analysed in this report were referred from June 2009 to July 2012. RESULTS: A total of 897 suspected cancer cases were submitted and finally 705 were studied. In 205 (29 %) a cancer diagnosis was confirmed within 23 days (median). Therapy was initiated within 46 days after referral (median). Early diagnoses with a potential curative approach were made in 166 (82 %). CONCLUSIONS: This CFP decreased the waiting time for cancer diagnosis, by improving communication between PC physician and specialized care teams. Most patients included in this program could get therapy with curative intent.

[Cerebro spinal fluid (CSF) leaks in ear: revision of 5 cases]. / Fístulas de líquido cefalorraquídeo en oído: a propósito de 5 casos.

CSF leaks in the ear are the result of an abnormal communication between subarachnoid and tympano mastoid areas, most of then as a result of trauma (90%). They mean a lisk of meningitis (4-50%) directly related to the etiology. Our aim is to present the CSF leak cases seen in our hospital in the last 2 years and a revision of their management. The main factor for a sucessful surgical repair is to use a multilayer tecnhique with a sucess rate close to 100%.

Fístulas de líquido cefalorraquídeo en oído: a propósito de 5 casos / Cerebro spinal fluid (CSF) leaks in ear: revision of 5 cases

Las fístulas de líquido cefalorraquídeo (LCR) en el oído derivan de una comunicación anormal entre el espacio subaracnoideo y el tímpanomastoideo, la mayoría de etiología traumática (90%). Van a tener gran interés desde el punto de vista clínico por el potencial riesgo de meningitis (4-50%), directamente relacionado con la etiología. Nuestro objetivo es realizar una presentación de los casos de fístulas de LCR en oído aparecidos en nuestro hospital en los últimos dos años, haciendo así mismo una revisión y un estudio crítico de los métodos empleados actualmente para el manejo de dicho proceso. El factor más importante para el éxito de la cirugía es el uso de una técnica multicapa con dos o más materiales de soporte, presentando un éxito cercano al 100%, cuando materiales artificiales sean usados en combinación con múltiples capas de tejido autólogo

CSF leaks in the ear are the result of an abnormal communication between subarachnoid and tympano mastoid areas, most of then as a result of trauma (90%). They mean a lisk of meningitis (4-50%) directly related to the etiology. Our aim is to present the CSF leak cases seen in our hospital in the last 2 years and a revision of their management. The main factor for a sucessful surgical repair is to use a multilayer tecnhique with a sucess rate close to 100%

[Arguments in favor of hearing loss screening programs]. / Argumentos en favor de programas de screening de hipoacusia.

In recent years criteria for the cochlear implant candidacy have been widened to childhood, therefore we are compelled to look for the earlier possible diagnosis of deafness. With this aim the AA. have reviewed the diagnostic process of hearing loss made during the last two decades and, consequently, be aware of the problems and planning solutions to avoid unnecesary delays in the treatment.

[Monitoring drug ototoxicity with distortion products]. / Monitorización de la ototoxicidad por fármacos con productos de distorsión.

Distortion products are currently considered an objective method for rapidly evaluating the functional status of the cochlea, which is interesting for the monitoring of drug ototoxicity. We studied 40 ears from patients who had received an ototoxic drug, tobramycin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. A significant reduction was observed in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous hearing loss on the DP-grams and divided the patients into two groups: normal hearing and sensorineural hearing loss. Patients were evaluated at the same time by conventional audiometry to compare the effect of tobramycin on both tests. To conclude, tobramycin had little effect on audiometric thresholds, but produced an evident change in the amplitude of the distortion products.

Neuropatía auditiva en lactantes / Auditory neuropathy in infants

Neuropatía auditiva es una alteración auditiva caracterizada por la ausencia de cualquier componente neural en los potenciales evocados auditivos del tronco cerebral y evidencias fisiológicas del mantenimiento de la función mecánica de las células ciliadas externas a través del registro de otoemisiones acústicas o del potencial microfónico coclear. Se considera que en su etiopatogenia están implicados gran cantidad de procesos, siendo muy variables su repercusión sobre la función auditiva. Exponemos el proceso de diagnóstico y la actitud adoptada en dos casos de reciente diagnóstico de neuropatía auditiva. El primer caso es una niña sin ningún factor de riesgo de hipoacusia en la que se realizan las exploraciones por ausencia de respuesta a estímulos sonoros en comparación con las reacciones de su hermana gemela. En éstas se detecta la presencia de otoemisiones acústicas y unos registros desestructurados de potenciales evocados auditivos del tronco cerebral por lo que se establece el diagnóstico de hipoacusia, siendo la evolución posterior la de una hipoacusia neurosensorial profunda con ausencia de ganancia con prótesis auditivas, estando en la actualidad pendiente de recibir un implante coclear. En el segundo caso se trata de un niño con antecedentes de hiperbilirrubinemia, que pasó un cribado de hipoacusia con otoemisiones. Posteriormente, ante la sospecha de hipoacusia por parte de la madre, se repiten las exploraciones a los tres meses adoptando los tests electrofisológicos un patrón típico de neuropatía auditiva. En este caso la evolución del niño ha sido diferente, y a pesar de mantenerse un registro de potenciales evocados desestructurados, es cada vez más evidente que el niño mantiene una audición suficiente, ya que a los once meses responde a los sonidos del habla y en la audiometría condicionada los umbrales auditivos son sugerentes de hipoacusia leve o moderada (AU)

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory evoked potentials, and normal cochlear outer hair cell function. It is believed that a variety of processes are involved in its pathophysiology and their influence on hearing can differ. We describe the diagnostic sequence and management of two new cases of auditory neuropathy in infants. The first case was a girl with no risk factors for hearing loss. Her absence of response to sounds was compared with her twin's reactions. Otoacoustic emissions were present but no auditory evoked potential response was detected. Her evolution was characteristic of deep sensorineural hearing loss without a hearing aid. At present she is awaiting a cochlear implant. The second case was a boy who underwent hearing loss screening for hyperbilirubinemia. Examinations were repeated three months later because the mother suspected hearing loss. Objective tests showed a pattern of auditory neuropathy. The boy's evolution was different: in spite of the presence of destructured auditory evoked potentials; it was evident that the boy conserved some hearing and had thresholds suggestive of moderate hearing loss (AU)

Estudio clínico de la ototoxicidad del cisplatino con productos de distorsión / Clinical study of cisplatin ototoxicity with distortion products

El registro de productos de distorsión acústica es considerado en la actualidad un método audiológico objetivo para evaluar de forma rápida el estado funcional de la cóclea, teniendo interés su uso en la monitorización de la ototoxicidad medicamentosa. En este trabajo hemos estudiado una muestra de 50 oídos de pacientes que tomaron cisplatino, realizando dos controles secuenciales con productos de distorsión 2f1-f2, de forma previa y posterior a la toma del fármaco, observando disminuciones significativas en las amplitudes de los DP-Gramas en los registros obtenidos. Al mismo tiempo hemos evaluado la influencia que sobre su registro pueda tener la presencia de una hipoacusia neurosensorial previa a la toma del fármaco, al dividir a los pacientes en dos grupos: normooyentes y con hipoacusia neurosensorial. Simultáneamente hemos valorado estos pacientes con audiometría tonal, comparando los resultados de las dos técnicas empleadas. Como conclusión, observamos la escasa repercusión que el fármaco ha ejercido sobre los umbrales audiométricos, siendo patentes los cambios en el registro de los productos de distorsión (AU)

Distortion products are an objective method of hearing assessment that provides a rapid way to evaluate the functional status of the cochlea, so they are interesting for monitoring drug ototoxicity. We studied 50 ears from patients who received an ototoxic drug, cisplatin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. We observed a significant reduction in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous sensorineural hearing loss on DP-grams, dividing the patients into two groups: normal hearing and sensorineural hearing loss. All these patients were evaluated at the same time by conventional audiometry in order to compare the effect of cisplatin on both tests. We conclude that cisplatin produced little effect on audiometric thresholds and an evident effect on the amplitude of distortion products (AU)

Monitorización de la ototoxicidad por fármacos con productos de distorsión / Monitoring drug ototoxicity With distorsion products

El registro de Productos de Distorsión Acústica es considerado en la actualidad un método audiológico objetivo para evaluar de forma rápida el estado funcional de la cóclea, teniendo interés su uso en la monitorización de la otoxicidad medicamentosa. En este trabajo hemos estudiado una muestra de 40 oídos de pacientes que tomaron un antibiótico aminoglucósido, la tobramicina, realizando dos controles secuenciales con Productos de Distorsión 2fl-f2, deforma previa y posterior a la toma del fármaco, observando disminuciones significativas en las amplitudes de los DP-Gramas en los registros obtenidos. Al mismo tiempo hemos evaluado la influencia que sobre su registro pueda tener la presencia de una hipoacusia neurosensorial previa a la toma de fármaco al dividir a los pacientes en dos grupos: normooyentes y con hipoacusia neurosensorial. Simultáneamente hemos valorado estos pacientes con audiometría tonal, comparando los resultados de las dos técnicas empleadas. Como conclusión, hemos observado la escasa repercusión que el fármaco ha ejercido sobre los umbrales audiométricos, siendo patentes los cambios en el registro de los Productos de Distorsión (AU)

Distortion products are currently considered an objective method for rapidly evaluating the functional status of the cochlea, which is interesting for the monitoring of drug ototoxicity. We studied 40 ears from patients who had received an ototoxic drug, tobramycin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. A significant reduction was observed in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous hearing loss on the DP-grams and divided the patients into two groups: normal hearing and sensorineural hearing loss. Patients were evaluated at the same time by conventional audiometry to compare the effect of tobramycin on both tests. To conclude, tobramycin had little effect on audiometric thresholds, but produced an evident change in the amplitude of the distortion products (AU)

[Clinical study on the ototoxicity of cisplatin with distortion products]. / Estudio clínico de la ototoxicidad del cisplatino con productos de distorsión.

Distortion products are an objective method of hearing assessment that provides a rapid way to evaluate the functional status of the cochlea, so they are interesting for monitoring drug ototoxicity. We studied 50 ears from patients who received an ototoxic drug, cisplatin. Two consecutive measurements were made using distortion products 2f1-f2, before and after taking the ototoxic agent. We observed a significant reduction in the amplitudes of the DP-grams. At the same time, we evaluated the influence of previous sensorineural hearing loss on DP-grams, dividing the patients into two groups: normal hearing and sensorineural hearing loss. All these patients were evaluated at the same time by conventional audiometry in order to compare the effect of cisplatin on both tests. We conclude that cisplatin produced little effect on audiometric thresholds and an evident effect on the amplitude of distortion products.

[Auditory neuropathies in infants]. / Neuropatía auditiva en lactantes.

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory evoked potentials, and normal cochlear outer hair cell function. It is believed that a variety of processes are involved in its pathophysiology and their influence on hearing can differ. We describe the diagnostic sequence and management of two new cases of auditory neuropathy in infants. The first case was a girl with no risk factors for hearing loss. Her absence of response to sounds was compared with her twin's reactions. Otoacoustic emissions were present but no auditory evoked potential response was detected. Her evolution was characteristic of deep sensorineural hearing loss without a hearing aid. At present she is awaiting a cochlear implant. The second case was a boy who underwent hearing loss screening for hyperbilirubinemia. Examinations were repeated three months later because the mother suspected hearing loss. Objective tests showed a pattern of auditory neuropathy. The boy's evolution was different: in spite of the presence of destructured auditory evoked potentials; it was evident that the boy conserved some hearing and had thresholds suggestive of moderate hearing loss.

[The study of otoacoustic emissions in diabetes mellitus]. / Estudio con otoemisiones acústicas en la diabetes mellitus.

Cochlear activity was evaluated by means of otoacoustic emission in patients with normal hearing and insulin-dependent diabetes mellitus. Twenty diabetic subjects were studied by recording click evoked otoacoustic emissions (TEOAE) and distortion products otoacoustic emissions (DPOAE) 2fl-f2 and comparing the results with those obtained in a control group of non-diabetic with normal hearing. The results obtained in the diabetic group showed a statistically significant decrease in mean amplitude, in the amplitude of every click evoked otoacoustic emissions and in the mean amplitudes of various distortion products compared with the control group. These findings suggest the presence of cochlear disorders in diabetic patients, probably produced by impaired functional properties of the outer hair cells.

[Value of auditory evoked potentials of the cerebral brainstem in the diagnosis of retrocochlear tumors]. / Valor de los potenciales evocados auditivos del tronco cerebral en el diagnóstico de patología tumoral retrococlear.

The use of auditory brainstem response (ABR) in the diagnosis of retrocochlear tumoral pathology has been established for years, but the development of magnetic resonance imaging for the same purpose calls for a review of the value of this method. We studied 200 ABR records made to exclude pathology. The results indicate that ABR is useful as a screening method in this type of pathology when carried out in a population with any auditory symptom, although it was not very suggestive. In most positive tests, the presence of pathology is not confirmed.