[Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses]. / Análisis epidemiológico de 72 carcinomas de fosas y senos paranasales.

OBJECTIVE: The aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinuses. MATERIAL AND METHODS: We performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported. RESULTS: The average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity. Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-year adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p = 0.0002). CONCLUSIONS: Carcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.

Análisis epidemiológico de 72 carcinomas de fosas y senos paranasales / Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

Objetivo: Analizar las principales características epidemiológicas de los pacientes afectos de un carcinoma de fosas y senos paranasales. Material y métodos: Se realizó un estudio de forma retrospectiva a partir de 72 carcinomas localizados en las fosas y senos paranasales. Se analizaron las distintas localizaciones, distribución por edad y sexo, consumo de hábitos tóxicos, clasificación TNM y tipo de tratamiento realizado. Resultados: La edad media de los pacientes en el momento del diagnóstico fue de 63 años. El 75% de los pacientes (54/72) fueron varones y el 25% (18/72) mujeres. En el 64% de los casos (46/72) el origen fue los senos paranasales, diagnosticándose un total de 30 carcinomas de etmoides, 15 carcinomas de senos maxilares y 1 carcinoma de esfenoides. En el 36% restante (26/72) el tumor tenía su origen en la fosa nasal, localizándose la gran mayoría en el vestíbulo nasal (21/26). El carcinoma escamoso fue el tipo histológico más frecuente en ambas localizaciones. La supervivencia ajustada a los 5 años, para los 72 carcinomas estudiados, fue del 60% (IC: 54-66), del 36% para los carcinomas de senos paranasales (IC: 28-44) y del 86% (IC: 79-93) para los carcinomas de fosas nasales. Según el tamaño tumoral la supervivencia ajustada en los 46 carcinomas de senos paranasales a los 5 años fue del 80% en los T2, del 71% en los T3, del 19% en los T4a y del 6% en los T4b (p=0,0002). Conclusiones: Los carcinomas de fosas y senos paranasales representan un grupo de tumores con unas características epidemiológicas diferentes del resto de tumores de cabeza y cuello

Objective: The aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinuses. Material and methods: We performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported. Results: The average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-year adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002). Conclusions: Carcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck

[Airway management in ICU patients with mechanical ventilation]. / Mantenimiento de la vía aérea en pacientes de UCI bajo ventilación mecánica.

A prospective protocol for the management of the airway was applied to patients in the ICU. Acute complications due to intubation and tracheotomy as well as laryngo-tracheal lesions were studied in 125 consecutive patients during one year from the moment of extubation. Thirty four cases (27%) needed reintubation, and 58 tracheotomies were performed (46%). The average length of intubation was of 10 +/- 7 days. Sixty five patients (53%) had acute complications due to intubation and 30 (52%) had acute complications due to the traccotomy. The high incidence of laryngo-tracheal lesions in the 85 patients who underwent early exploration (76 cases [90%]) was reduced in those who underwent late exploration (11 cases [20%]). Analysis of possible prognostic factors in the development of late lesions allows us to affirm that a reduction in the length of intubation diminishes the presence of late lesions. We recommend the avoidance of oro-tracheal intubation prolonged for more than 10 days by the early carrying out of tracheotomy.

[Post-mortem study of laryngotracheal lesions produced by prolonged intubation and/or tracheotomy]. / Estudio necrópsico de las lesiones laringotraqueales por intubación prolongada y/o traqueotomía.

Injuries of the laryngotracheal axis caused by prolonged intubation in critically ill patients raise the issue of the timing of tracheotomy in intubated patients. In 1992 a prospective study was begun in intensive care patients with intubation lasting more than 48 hours. Eight months later, post-mortem data on the laryngotracheal axis of deceased patients was added to our prospective study protocol. The study was closed with 125 cases (52 deceased). The clinical data of 73 surviving patients was compared with that of 18 post-mortem cases. The macroscopic results of the post-mortem study are summarized by grading the lesions according to a personal modification of the Lindholm classification. All cases had laryngotracheal injuries. Only 15% of the lesions were located in the tracheal region. Five cases were classified as grade 2, with an average orotracheal intubation of 9 days, 9 cases as grade 3 with 15 days intubation, and 4 cases as grade 4 with 21 days intubation. We concluded that the severity of laryngotracheal injuries in the early post-mortem exploration was related with the duration of intubation.

[Grading system for nasosinusal polyposis treated by functional endoscopic surgery]. / Sistema de estadiaje de la poliposis nasosinusal tratada mediante cirugía endoscópica funcional.

A system for grading nasosinusal polyposis treated by functional endoscopic sinus surgery is needed. We propose our CER system, which was designed for easy use and reliable classification of polyposis involvement. Four levels, from zero to four, are added as suffixes to three letters. These levels indicate increasing intensity and are used to categorize the clinical (C), endoscopic (E) and radiological, (R) grade of polyposis. The same system was used for postoperative follow-up and criteria were established for defining the surgical result as good, average, or poor.

[Lesions of the laryngotracheal axis due to prolonged intubation and/or tracheotomy. Preliminary data of a follow-up guidelines]. / Lesiones del eje laringotraqueal por intubación prolongada y/o traqueotomía. Datos preliminares de un protocolo de seguimiento.

Lesions caused by prolonged intubation and tracheostomy when performed in critically ill patients to keep the airways opened are a permanent topic of discussion between intensive care professionals and otolaryngologists. We present a prospective study of such complications following the guidelines elaborated by the intensive care unit and the otolaryngology department of our hospital. The outcomes obtained in the first-year follow up allow us to verify a high incidence of such lesions in the initial period (87%) and a markedly decreased frequency in the following twelve months (17%). Results also show the relation between prolonged intubation and the appearance of laryngotracheal lesions. We conclude that it is very important to reduce the intubation period by performing an earlier tracheostomy.