[Malignant mucous primary sinonasal melanoma. A clinic case]. / Melanoma mucoso maligno primario de fosa nasal. Caso clínico.

The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease.

[Tinnitus of vascular type. Diagnostic possibilities]. / Acúfeno de tipo vascular. Posibilidades diagnósticas.

It's defined tinnitus as an auditive perception of internal origin that it does not answer to vibratory external action. The rest of the sounds are considered as real biological noises and not properly as tinnitus. Tinnitus is a very common symptom in our practice. It is important to determine what causes it, since medical treatment is effective in some cases and prevents serious complications, severe bleeding and neurological consequence if any surgical treatment is carried out. We present two cases of tinnitus of vascular origen, the first caused by venous malformation and the second by an arterial one. We review the literature of this entity.

Melanoma mucoso maligno primario de la fosa nasal. Caso clínico / Malignant mucous primary sinonasal melanoma. A clinic case

Los melanomas son neoplasias poco frecuentes, con una alta tasa de mortalidad. La localización primaria en mucosas, supone menos del 1% del total de los melanomas. En el melanoma maligno nasosinusal la clínica inicialmente es poco significativa, las metástasis regionales son raras. El tratamiento más efectvo es el quirúrgico complementado con radioterapia y/o quimioterapia. Presentamos el caso de melanoma mucoso maligno primario nasosinusal, y hacemos una completa revisión bibliográfica actual sobre esta entidad

The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease

Acúfeno de tipo vascular. Posibilidades diagnósticas / Tinnitus of vascular type. Diagnostic possibilities

Se define el acúfenos como una percepción auditiva de origen interno que no responde a ninguna acción vibratoria externa. El resto de los sonidos se consideran como somatosonidos (ruidos biológicos reales) y no propiamente como acúfenos. El síntoma acúfeno es muy frecuente como motivo de consulta y tiene importancia considerar su etiología, pu es en muchas ocasiones es curativo y en otras evita complicaciones fatales por hemorragia grave y secuelas neurológicas si se realiza algún procedimiento quirúrgico. Presentamos dos casos afectos de acúfeno de origen vascular por malformación venosa y el segundo por malformación arterial. Revisamos la bibliografía referente a este tema

It's defined tinnitus as an auditive perception of internal origin that it does not answer to vibratory external action. The rest of the sounds are considered as real biological noises and not properly as tinnitus. Tinnitus is a very common symptom in our practice. It is important to determine what causes it, since medical treatment is effective in some cases and prevents serious complications, severe bleeding and neurological consequence if any surgical treatment is carried out. We present two cases of tinnitus of vascular origen, the first caused by venous malformation and the second by an arterial one. We review the literature of this entity

[Hypothyroidism in patients treated for laryngeal cancer: preliminary results]. / Hipotiroidismo en pacientes tratados de cáncer de laringe: resultados preliminares.

OBJECTIVE: The reported incidence of hypothyroidism following surgery and/or irradiation for laryngeal cancer varies widely and the condition often is misdiagnosed. This study examines the incidence of thyroid dysfunction in patients with laryngeal cancer. MATERIAL AND METHODS: Thyroid function tests were carried out in 75 patients with stage III and IV laryngeal carcinoma who were treated in our center with surgery (13 cases), radiotherapy (13 cases), or surgery and radiotherapy (49 cases) at least 18 months earlier. The clinical and histological variables recorded included T4 and TSH concentrations. Univariate and multivariate analysis was carried out with the BMDP program from UCLA (1995 version) to examine the relationship between hypothyroidism and clinical and pathological factors. RESULTS: Twenty-nine patients (38.6%) had high TSH or low T4 concentrations and were diagnosed as having hypothyroidism. Hypothyroidism was significantly related with date of surgery (before 1993) and the treatment used on the neck. Thyroid function was rarely affected in patients who underwent functional neck dissection, but radical neck dissection and irradiation of the neck always were followed by hypothyroidism. CONCLUSIONS: Thyroid testing should be performed routinely in the follow-up of laryngeal cancer. Many psychological symptoms attributed to total laryngectomy may be due to hypothyroidism, an easily treated condition.

[CO2 laser tympanostomy without ventilation tubes]. / Timpanostomía con láser CO2 sin tubos de ventilación.

A new tympanostomy procedure, by CO2 laser and without ventilation tubes, which is known as tympanolaserostomy or laser-assisted tympanostomy (LAT), was compared with traditional tympanostomy with tubes. Since 1990, we have operated on 168 ears using a CO2 laser fitted with an adapter to an operative microscope. Multiple low-power impacts (0.8-1.0 W in 0.1 s) focused on a minimal spot (0. 18 mm) were preferred. This intervention did not require anesthesia and produced circular orifices 2.0 to 2.5 mm in diameter that closed in 30-40 days. Compared with 168 ears operated by tympanostomy with tubes, laser tympanostomy produced similar rates of auditive recovery by one month and only 15% of recurrence by 6 months. Recurrences were treated with laser or with tubes if prolonged ventilation was planned. After 1 to 4 years, does not require anesthesia, tubes, or hospitalization, it reduces risk and complications, and consequently decreases costs.

[Massive hyperplasia of the arytenoid mucosa with sleep apnea and stridor. Endoscopic resection by CO2 laser]. / Hiperplasia gigante de la mucosa aritenoidea con apnea del sueño y estridor. Resección endoscópicacon láser CO2*

A case is presented of a 48 year-old woman with symptoms of severe rhoncopathy and obstructive sleep apnea, followed by middle inspiratory stridor and dyspnea to any phisial effort. Redundant hyperplasia of the arytenoid mucosa was discovered during exploration, with vibration during inspiration and closure of the lumen as it goes closer to the epiglottis. Also, severe septal deviation, hypertrophy of the pharyngeal tonsil, soft palate and uvula, and macroglossia, were diagnosed. Neither CPAP/BIAP or triple anti-reflux therapy were effective, and laser endoscopic excision resolved the laryngeal obstruction. Currently the stridor has disappeared, whereas rhoncopathy is improved with low pressure CPAP. Pathogenesis of the giant hyperplasia of the arytenoid mucosa of unknown origin is discussed, as literature search revealed only three cases reported worldwide.

[Simplified videonystagmoscopy]. / Videonistagmoscopia simplificada.

Videonystagmoscopy visualizes nystagmus on a television monitor and records it on video tape for later study, records, and reproduction. Early attempts date from long ago, but the technique only recently has spread, since the development of complex computerized equipment which, however, confines it to certain vestibular exploration laboratories. In order for this technique to become more widely used, simple equipment is needed, such as that described in this article. Our system consists of a single infrared light minivideo camera that is attached to the left eye using an eyeglass-mounting system that also occludes the right eye. The examination method is routine. Our results show the following advantages over electronystagmography: visualization of the rotary component, non-interference of visual stimuli, mechanical and electronic stability, speed, and low cost. If necessary, it can be complemented by electronystagmography and computer analysis.

[Calearo horizontal glottectomy in bilateral glottic cancer]. / La glotectomía horizontal de Calearo en el cáncer glótico bilateral.

Bilateral glottic carcinoma is an unusual tumor that presented a surgical problem that was not resolved satisfactorily until Calearo and Teatini published their horizontal glottectomy technique in 1978, which consists of block excision of both vocal cords with part of the thyroid cartilage, and conservation of the arytenoids. This laryngeal horizontal glottic technique is analogous to supraglottic horizontal laryngectomy. We report our experience with 12 cases, indicating the technical details of the procedure, the satisfactory oncological and functional results, and current indications.

[Occupational hearing loss and study of the recruitment by the brain stem auditory potentials]. / Estudio de recruitment en las hipoacusias profesionales con los potenciales auditivos del tronco cerebral.

We have studied 60 ears initial stage professional acoustic trauma and a hearing loss in the 2,000 and 4,000 frequencies at 30-40 db. We also included in the study 60 normal ears as the control group. In the first group we investigated the recruitment by the SISI test. Watson and Tolan's test, vocal audiometry and Metz's test. Recruitment was considered positive when indicated so by two of four tests. In waves I and V of BERA we have obtained the following results compared to those of the normal ears: Amplitude is similar in both waves, whatever the intensity of the click. Latencies increase with weak clicks, more in wave V, while the become equal with stronger clicks, what means the existence of recruitment. While other tests are not useful or doubtful, BERA are of interest for the study on recruitment in deep hearing loss.