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PURPOSE: We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. METHODS: Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student's T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant. RESULTS: The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876-0.918), MGAP 0.860 (95 % CI 0.835-0.886), GAP 0.849 (95 % CI 0.823-0.876) and T-RTS 0.796 (95 % CI 0.762-0.830). CONCLUSIONS: Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.

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OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.

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BACKGROUND: Immunotherapy appears to be a potent treatment against Alzheimer's disease (AD), but the mechanisms underlying neural-immune interaction are still not known. METHODS: Here, we determined cell death and distribution of lymphocyte subsets of peripheral blood mononuclear cells (PBMC) in AD and aging, e.g. T (CD4+ CD3+, CD8+ CD3+), B (CD19+) and NK (CD16++CD56+) cells. RESULTS: Increased apoptosis was found in CD4+ T and NK cells in AD, while in aging all subsets were affected. The expression of anti-apoptotic Bcl2 correlated with observed cell death in T-helper and B cells irrespective of dementia. The levels of Bcl2 in T-cells were significantly increased in mild AD. Apoptosis and Bcl2 levels were also elevated in the APP (751SL)xPS1 (M146L) transgenic mouse model. CONCLUSION: The mechanisms triggering apoptosis and activation of lymphocytes in AD appear therefore to be different than those in immunosenescence and possibly bear an important biomarker to monitor immunotherapy in AD.

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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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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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El objetivo del trabajo fue evaluar qué sucede con las personas que han sufrido una pérdida y su duelo ha sido tan intenso que les ha llevado a consultar en el CSMA. Utilizando los criterios diagnósticos del DSM IV se recogieron durante el período comprendido entre 1990 y 1999, un total de 37 historias con el diagnóstico en el Eje 1 de Duelo V62.82. Se analizaron las siguientes variables: edad, tipo de pérdida, familiar perdido y evolución, dentro de esta última se observó que habían abandonado el CSMA por lo que se contactó con ellos telefónicamente a fin de evaluar las causas que motivaron el abandono. Resultados: La edad media fue de 44 años con un intervalo entre 19 y 67 años. El tipo de pérdida fue: enfermedad (n = 17); accidente (n = 11 ); suicidio (n = 9). El familiar perdido fue: hijo (n = 14); esposo (n = 12); padres (n = = 4); novio (n = 4); hermano (n = 2); amigo (n = l). Respecto a la evolución por orden de frecuencia las causas fueron: abandono (n = 18); continúan (n = = 11); alta (n = 8). En cuanto al abandono se consiguió localizar a 13 pacientes (72 por ciento) quienes alegaron distintos motivos para el mismo (encontrarse mejor, no verse aliviado, angustiarse más...).Conclusiones: 1. El duelo no es exclusivo de un género pero en nuestra muestra es mayor la consulta femenina (34 mujeres frente a 3 hombres). 2. No hay duelos de esposas, los 12 duelos de cónyuge son de maridos. 3. La evolución del duelo no tiene que ver con edad ni tipo de pérdida (50 por ciento abandono y 50 por ciento altas y seguimiento). 4. La frustración de no encontrar lo que se busca suele ser la causa más frecuente de abandono junto a la sustitución de la pérdida por otras actividades (AU)

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DNA ploidy and cell-cycle distribution were determined by flow cytometry in fresh tumor tissue of 27 epithelial head and neck carcinomas. Epithelial cells were labeled with a fluorescein-isothiocyanate-conjugated cytokeratin antibody to study the possible influence of contaminating stromal and inflammatory cells on the results of cell-cycle analysis of tumor cells. The patient sample included 26 men and 1 women with a mean age of 60 years. Without cytokeratin gating, 11/27 tumors (40.74%) were aneuploid. After selecting the cytokeratin population, 10 more aneuploid tumors were found that had not been detected when considering the total population. Therefore, aneuploid tumors increased from 40.74% to 77.74%. The remaining 6/27 (22.26%) tumors were diploid. In the tumors that were either aneuploid without cytokeratin gating or diploid, the S-phase and G2M phase were significantly higher after cytokeratin staining, specially in diploid tumors (24.2% versus 10% and 6.8% versus 3.2%, respectively, p < 0.01). Therefore, in head and neck tumors cytokeratin staining optimizes both the determination of DNA ploidy and cell-cycle analysis, which is advantageous for tumor staging and prognosis assessment in these patients.

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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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Study investigates the role of endothelin (ET) receptors in mediating early changes in cerebral blood flow--as measured by laser Doppler flowmetry (CBFLDF)--during experimental pneumococcal meningitis. Meningitis was induced with heat-killed pneumococci and confirmed by a significant increase in CBFLDF (baseline 100%; 225.3 +/- 21.8% after 6 hours; mean +/- SD), intracranial pressure (ICP), brain water content, and white blood cell count in the CSF. Intravenous administration of the selective endothelin B (ETB) receptor antagonist BQ-788 immediately before pneumococcal challenge (but not 4 hours afterward) significantly attenuated these pathophysiologic alterations (e.g., CBFLDF 6 hours after pneumococcal challenge: 116.7 +/- 17.4%). Pretreatment with BQ-123, a selective endothelin A receptor antagonist, had no significant effect on ICP and brain water content, but augmented the increase in CBFLDF and CSF white blood cell count. Since ET is known to trigger the release of nitric oxide (NO) by ETB receptor activation, we examined specific ET-NO interactions in primary rat cerebromicrovascular endothelial cells after stimulation with heat-killed pneumococci. Pneumococci induced a significant increase in both ET and NO concentrations in endothelial cell culture medium. Treatment with phosphoramidon, an inhibitor of the endothelin-converting enzyme, prevented the production of endothelin and markedly reduced NO generation. Our data provide evidence that ET is involved as a mediator in early pneumococcal meningitis in the rat and contributes to the increase in CBFLDF, ICP, brain water content, and CSF pleocytosis, presumably through ETB receptor-mediated NO production.

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The treatment of early-stage laryngeal cancer using either partial surgical techniques or irradiation still is controversial. The performance of rescue surgical procedures after irradiation is related to increased postsurgical complications and lower survival rates. We made a retrospective study of 73 patients who underwent rescue surgery after failure of radiotherapy in our department in the last 10 years. A statistical analysis was made of the complications and survival rate of these patients in accordance with tumor location and clinicopathological stage compared with patients who underwent surgery alone (n = 435). More rescue surgery was performed for glottic carcinomas (52/73) than for supraglottic carcinomas (21/73). No significant differences were found in the complication rate (23.6%) compared with the control group (19.6%). There was a significant reduction in survival in patients who underwent previous irradiation of supraglottic tumors compared with glottic tumors and the control group. In view of these results, we conclude that irradiation is not a good option as an initial treatment for supraglottic tumors and that the procedure of choice should be surgical.

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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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There are two types of rapidly progressive sensorineural hearing loss: sudden hearing loss, which is generally unilateral and develops in less than 72 hours, and rapidly progressive sensorineural hearing loss, which develops over days or months. The origin of sudden deafness is difficult to establish. Several etiopathogenic factors have been postulated, such as viral infection, autoimmune origin, vascular and metabolic disease, rupture of the labyrinthine membrane, and, recently, immune-mediated inner ear disease. We made a retrospective study of 40 patients seen in our department. Patients were given a combined treatment with steroids, nimodipine, heparin, and oxygen. Patients were divided into two groups by intravenous or oral treatment.

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We studied the functional response and phenotypic characterization of peripheral blood T cells and their correlation with the clinical stage of disease in 29 males with previously untreated carcinoma of the larynx and 24 healthy male controls. Peripheral blood T cells, phenotypically CD2+ CD3+, were significantly decreased in the patients relative to the controls. Patients with advanced locoregional extension (T4 and N1, 2, 3) also showed a diminution of the CD4+ subpopulation of T cells. DNA synthesis by purified T cells showed similar blastogenic responses in patients and controls; the interleukin-2 production of phytohemagglutinin stimulated lymphocytes was also normal. We conclude that in patients with laryngeal carcinoma there is a phenotypic alteration of the T cells that is variable according to tumor stage, without functional alterations in blastogenic capacity or IL-2 production.

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