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Ménière's disease is frequent in our area. It is a disabling pathology that affects the patient's quality of life. Its etiology and pathophysiology remain unclear and there are some therapeutic alternatives with controversial results. We present our series and treatment protocol for Ménière's disease and discuss the current evidence regarding its medical treatment. In the last 10 years, 252 patients were diagnosed with Ménière's disease based on their symptoms, and the results of tonal audiometry, videonystagmography and caloric stimulation tests. All cases received medical treatment according to our management protocol. Ménière's disease is more frequent in women (54.76%); 83.73% of cases are unilateral. Among these, vertigo was observed in 93.7%, hearing loss in 88.1%, tinnitus in 86.1% and pathologic caloric stimulation tests in 71% (88.27% with a reduced vestibular response). A 5-year follow-up was performed in 89.6% of the patients. Subjective improvement as reported by patients was achieved in 94.4% of the cases. There is great controversy about the medical treatment of Ménière's disease. We found no evidence for the most adequate medical treatment among the different alternatives described in literature. The patient's acceptance and understanding of the disease is very important.

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There is an important need to find relevant biomarkers that show high sensitivity and specificity for early diagnosis and prognosis of cancer. An immune response to cancer is elicited in humans, as demonstrated in part by the identification of autoantibodies against a number of tumor-associated antigens in sera from patients with different types of cancer. Identification of tumor-associated antigens and their cognate autoantibodies is a promising strategy for the discovery of relevant biomarkers. During the past few years, proteomic approaches, including SEREX, SERPA and, more recently, protein microarrays, have been the dominant strategies used to identify tumor-associated antigens and their cognate autoantibodies. In this review, we aim to describe advantages, drawbacks, and recent improvements of these approaches for the study of humoral responses.

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Objetivo: Mostrar la alta toxicidad crónica derivada del consumo regular de tabaco. Material y métodos: Se lleva a cabo una breve revisión de la toxicidad del consumo de tabaco. Resultados: La tasa general de mortalidad de los fumadores es el doble de la de los no fumadores. Uno de cada 2 fumadores morirá prematuramente por enfermedades derivadas del consumo de tabaco. El riesgo de enfermedad está incrementado, sobre todo en enfermedades tumorales, respiratorias y cardiovasculares. Conclusiones: Fumar cigarrillos es una conducta extremadamente tóxica (AU)

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We present a serie of 1,093 patients that underwent, along 10 years, endoscopic surgery due to paranasal sinus pathology in a third level hospital. The technique used is described, the long term results analysed, as well as the minor and major complications specially the CSF fistulas and their cause.

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Se presenta una serie de 1.093 pacientes intervenidos a lo largo de 10 años de cirugía endoscópica por patología nasosinusal en un hospital de tercer nivel. Se describe la técnica empleada y se analizan los resultados a largo plazo, así como las complicaciones menores y mayores, en especial las fístulas de L.C.R. y sus causas. (AU)

We present a serie of 1,093 patients that underwent, along 10 years, endoscopic surgery due to paranasal sinus pathology in a third level hospital. The technique used is described, the long term results analysed, as well as the minor and major complications specially the CSF fistulas and their cause (AU)

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Management of patients with carcinoma of the larynx should systematically include an appropriate treatment of lymph nodes according to the TNM stage. One of the most controversial points of the treatment in these patients is the management of the clinically negative neck (N(0)). A retrospective study of 295 patients with laryngeal carcinoma and N(0) neck undergoing treatment in our centre between 1983 and 1993 is presented. We observed a significant decrease in the survival of clinically N(0) patients with histologically affected lymph nodes. Lymphadenopathy was more frequently detected in patients with supraglottic tumours (38 per cent) when compared to glottic tumours (16 per cent). In our experience, routine bilateral and unilateral dissection of N(0) necks in all supraglottic tumours and in T3-T4 glottic tumours, respectively, is the most beneficial approach for patients in terms of survival.

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OBJECTIVE: The aim of this work is to study the chronology in the biological covering of the hydroxyapatite bioprostheses in the healthy middle ear of the rat. STUDY DESIGN AND SETTING: Dense hydroxyapatite is implanted into the middle ear of 45 Long-Evans rats, between stapes and tympanic membrane. The sample was divided into 3 groups for morphologic, functional, and chemical studies at 15 days, 3 months, and 6 months after surgery, respectively. RESULTS: The short-term studies reveal that the prostheses is surrounded by a fibrous epithelial tissue referred as the interface; it presents a marked inflammatory reaction that decreases gradually in the medium-term and long-term studies; in this way, we observe a progressive adhesion between implant and the contact tissues. CONCLUSIONS AND SIGNIFICANCE: This model has enabled us to study the cell reaction produced by the contact of the prostheses with bone and soft tissue and their impact on the functional qualities of the prostheses.

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Cervical lymph node involvement in laryngeal tumors could be a market impact on the disease prognosis. We performed a retrospective study of 430 patients who underwent surgery to treat laryngeal carcinoma in our center over a 10-year period. The objective was to correlate clinical and pathological lymph node involvement with the site of origin and size of the tumor, the treatment and its impact on patient survival. We observed a significantly greater incidence of lymph node involvement in tumors originating from supraglottis, with a rate of occult lymph node metastases of 31%. Patients with lymphadenopathy that remained undetected in the absence of surgical treatment and those with nonmetastatic lymphadenopathy presented similar 5-year survival rates, 83% y 98% respectively. However, the 5-year survival decreased to 24% in the presence of metastatic lymph node involvement. These results support the proposal that treatment of laryngeal carcinoma should include the region of the cervical nodes as well.

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La afectación ganglionar cervical en los tumores laríngeos, parece constituir uno de los factores más importantes en el pronóstico de la enfermedad. Hemos realizado un estudio retrospectivo de 430 pacientes con carcinoma de laringe intervenidos en nuestro centro durante un período de 10 años, correlacionando la afectación ganglionar clínica y patoógica con el origen y tamaño del tumor, el tratamiento realizado y su repercusión en la supervivencia de los pacientes. Observamos una mayor afectación ganglionar estadísticamente significativa en los tumores de origen supraglótico con un 31 por ciento de adenopatías (N) ocultas y una supervivencia menor a los 5 años en los pacientes con N desconocidos (No clínicos), por no actuación quirúrgica, con respecto a los pacientes con N sin afectación histológica (No patológicos), un 83 por ciento y 98 por ciento respectivamente. Sin embargo, cuando existe afectación ganglionar patológica (N positivos), la supervivencia disminuye al 24 por ciento. Estos resultados apoyan la teoría de que la terapia del carcinoma laríngeo no es exclusiva de este órgano y ante cualquier tratamiento debe contemplarse además el territorio linfático cervical (AU)

Cervical lymph node involvement in laryngeal tumors could be a market impact on the disease prognosis. We performed a retrospective study of 430 patients who underwent surgery to treat laryngeal carcinoma in our center over a 10-year period. The objective was to correlate clinical and pathological lymph node involvement with the site of origin and size of the tumor, the treatment and its impact on patient survival. We observed a significantly greater incidence of lymph node involvement in tumors originating from supraglottis, with a rate of occult lymph node metastases of 31%. Patients with lymphadenopathy that remained undetected in the absence of surgical treatment and those with nonmetastatic lymphadenopathy presented similar 5-year survival rates, 83% y 98% respectively. However, the 5-year survival decreased to 24% in the presence of metastatic lymph node involvement. These results support the proposal that treatment of laryngeal carcinoma should include the region of the cervical nodes as well (AU)

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Teratomas are germ-cell tumors that usually originate in the gonads. Extragonadal teratomas are rarely found in the neck, particularly in adults. A case of cervical teratoma that presented as a rapidly growing mass in a young man is described. The diagnostic problems are commented.

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Surgery, alone or in combination with other therapeutic measures, is one of the main approaches to curing laryngeal cancer. The risk of complications is implicit in any surgical procedure. We describe our experience with general and local complications in surgery for laryngeal cancer and examine their relation to tumor extension and surgical technique. A review was made of a series of 431 patients who underwent surgery for laryngeal cancer over a 10-year period (1982-1991). Twenty-two patients (5.1%) had systemic complications, including upper gastrointestinal hemorrhage (n = 5), massive cervical hemorrhage (n = 5), and four renal failure. Minor complications were recorded in 77 cases (17.8%), predominantly pharyngocutaneous salivary fistula, which developed in 55 patients (13.8%). The incidence of local complications was significantly greater in patients with extensive local spread (T4). There were no differences among patients with regional spread. The surgical technique and type of pharyngoesophageal reconstruction played no role in the development of complications. Preoperative radiotherapy did not influence on the development of salivary fistulas.

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BACKGROUND: For laryngeal carcinoma, the present TNM clinical staging system does not seem completely satisfactory as a guide for providing a prognosis for survival. We believe that natural killer cell activity would probably have a role in a more reliable system. Therefore, we analyzed the disease outcome with previously untreated epidermoid carcinoma of the larynx, evaluating classic clinical and pathologic factors, as well as natural killer cell activity in peripheral blood samples of the patients. OBJECTIVES: To determine the level of natural killer cell activity in patients with laryngeal carcinoma and to analyze the prognostic value of this finding when associated with other clinical and pathologic variables. DESIGN: Prospective cohort study of surveillance of laryngeal cancer. Mean follow-up of 42.8 months. SETTINGS: Tertiary care referral center and ambulatory and hospitalized care. PARTICIPANTS: We compared 81 men (mean age, 62.4 years; range, 35-89 years) with laryngeal carcinoma with 44 healthy men serving as control subjects (mean age, 57.6 years; range, 37-82 years). RESULTS: Natural killer cell activity was significantly reduced in patients who had died of cancer-related causes in comparison with tumor-free survivors. Overall actuarial survival differed significantly in histologically assessed nodal involvement and low natural killer cell activity. Use of the Cox proportional hazards regression model showed that the factors that seem to have a prognostic effect on survival are histologically determined nodal involvement and low natural killer cell activity. CONCLUSIONS: These results support the prognostic significance of the determination of pretreatment natural killer cell activity in peripheral blood samples from patients with laryngeal carcinoma and suggest that assessment of adding such a determination to the current tumor staging system is advisable.

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The Internet is considered by some as one of the most important advances of the late 20th century. The Internet is the functional linking of personal computers via telephone lines to a worldwide network of millions of other computers, which enables them to exchange information freely. Although the Internet crops up in daily conversation, many persons are not aware of its usefulness and relevance for ear, nose and throat specialists. The Internet is accessed by special software that maximizes the potential of this vast computer network. The most important tools are e-mail and the World Wide Web. These tools make it possible to consult multimedia medical publications, access Medline, and carry out information searches, etc. The Internet and its most important uses in otolaryngology are summarized and a list of useful addresses is given. Although its advantages still are not widely appreciated, widespread Internet use is imminent and we think that it is a useful technology to know and use. Moreover, access is becoming easier and cheaper.

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A preliminary analysis was published in 1993 of 100 cases of endoscopic sinus surgery (ESS) carried out in our service following a protocol that included sinusitis, nasal polyps, and other endoscopic nasal procedures. Another 100 cases of ESS were analyzed for the present study and compared with the 1993 group. Comparative analysis showed improved results in the second series, with fewer minor complications and no major complications. These findings confirm the general opinion that endoscopic sinus surgery requires an adequate training period before optimal results are obtained.

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Cellular and/or humoral immune reactions may be involved in the development of some cochleovestibular dysfunctions long considered idiopathic. In a clinical study of 98 patients, 82 of them with cochleovestibular disorder, a battery of immunologic studies was used. Thirty-one patients received steroid treatment, of which 19 obtained good results; 5 of these patients had positive serum antibodies.

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Since 1989 we have been using on a regular basis in our department endoscopic technics applied to fosas and paranasal sinuses. A methodological study of the first 100 cases of this type of surgery is presented. The indications, results, and complications of the surgical technique are analyzed. The cases included: sinusitis, nasosinusal polyposis, endoscopy of malignant tumors, epistaxis, various inflammatory processes, and plastic endonasal reparations. It is concluded that nasosinusal endoscopic surgery is an advantageous technique in the treatment of general nasosinusal conditions.

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Fibrous dysplasia is a rare disease which occasionally affects the temporal bone. In its monostotic form, only 27 cases have been reported until today. We present a case of monostotic fibrous dysplasia of the temporal bone coincident with a cholesteatoma of the EAC, operated on by mean of a modified radical mastoidectomy, with good results.

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Closure of nasal septal perforations represents a difficulty for the rhinologist. Several surgical techniques have been reported in this end. In the present paper we describe a chondro-perichondral-mucosal rotation flap, which has completely resolved 70% of our perforations and partially in the remainder 30%.

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