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Hemos valorado la utilidad, indicaciones e inconvenientes del bisturí armónico Ultracision®, en la implantación coclear, así como sus ventajas respecto de otros sistemas de electrocoagulación. Estos aspectos se analizaron en 50 implantes cocleares realizados a lo largo de estos últimos años. Como conclusión, hay que establecer que el bisturí armónico Ultracision ® encuentra sus indicaciones más importantes en el campo de la otología, en aquellos casos en los que el implante coclear está insertado en la cóclea y es necesario utilizar un sistema de electrocoagulación o incisión, con fines diversos. En la mencionada situación, el bisturí armónico Ultracision® se mostró rápido, eficaz y seguro y con evidentes ventajas respecto del corte frío o de la electrocoagulación bipolar

We have evaluated the utility, indications and disadvantages of the Ultracision® harmonic scalpel, in the cochlear implants, and his advantages compare to other electrocoagulation´s systems. These aspects were evaluated in 50 cases of cochlear implants, made along the last years. We concluded that the Ultracision® harmonic scalpel is indicated, mainly, in the otology field, in these situations in wich the cochlear implant is in the cochlea, and is mandatory the use of an electrocoagulation system. In this situation, the Ultracision® harmonic scalpel was quick, safe and sure, and with many advantages, over the traditional scalpel and the bipolar diathermy

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RESUMEN

We have evaluated the utility, indications and disadvantages of the Ultracision harmonic scalpel, in the cochlear implants, and his advantages compare to other electrocoagulation's systems. These aspects were evaluated in 50 cases of cochlear implants, made along the last years. We concluded that the Ultracision harmonic scalpel is indicated, mainly, in the otology field, in these situations in wich the cochlear implant is in the cochlea, and is mandatory the use of an electrocoagulation system. In this situation, the Ultracision harmonic scalpel was quick, safe and sure, and with many advantages, over the traditional scalpel and the bipolar diathermy.

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Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population.

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El carcinoma de laringe supone el 1 por ciento de los tumores del organismo, así como el 25 por ciento de la patología oncológica de cabeza y cuello. Los genes supresores tumorales controlan la proliferación celular mediante supresión de mecanismos específicos que estimulan la respuesta proliferativa, siendo el Rb y el p53, ambos nucleares, los más estudiados. Hemos valorado la inmunoexpresión individualizada de estos marcadores en 72 carcinomas de laringe, efectuando una correlación con diferentes parámetros clínicos de los pacientes, como son: edad, sexo, trabajo que desempeñan, tabaco, alcohol, estado civil, etc., así como con los parámetros pronósticos clásicos, tanto biológicos como anatomopatológicos (estadio tumoral, tipo histológico, grado de invasión local y metástasis linfáticas). Hemos advertido diferencias estadísticamente significativas en las medias de inmunotinción del gen Rb con respecto a los grupos de grado histopatológico, a la existencia de adenopatías tumorales y al tabaco. Por otra parte, no hemos observado correlación positiva del p53 con respecto a ninguno de los parámetros clínico Patológicos clásicos, si bien se perciben tendencias importantes, así como una media de inmunotinción relativamente alta (alrededor del 40 por ciento) en la población neoplásica total (AU)

Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population (AU)

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Esthesioneuroblastomas are fairly rare malignant tumors: only 20 cases have been reported in Spanish records. It is locally aggressive and produces late recurrences. There is no such thing as a universally accepted treatment model. We describe our experience with 7 cases seen in our hospital from 1980 to 1996. A or B stages can be treated with irradiation, surgery or a combination of both. C stages with the most aggressive tendencies may require the combined use of preoperative irradiation, surgery and chemotherapy. We analyzed the forms of presentation, diagnosis, differential diagnosis, treatment, prognosis, and survival. The 5-year survival rate was 75, 60 and 41% for stages A, B and C, respectively.

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The number of patients who undergo outpatient surgery is constantly growing in Spain. Outpatient surgery is interesting not only because of its economy, but also the social benefits that derive from patients returning home sooner and the rapid reduction of the waiting list. We discuss our experience in the last year with 40 patients who underwent surgery. We made a comparative study of patients with the same pathology and anesthetic risk who were treated by outpatient surgery and those treated by inpatient surgery with a traditional technique who were admitted 24 hours before surgery. Our rate of complications (19%) was close to the traditional rate. However, 3, 927, 000 pesetas were saved and the patients were very satisfied, which encouraged us to continue. Indications and complications are discussed.

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Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.

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We are putting forward a case of associated laryngeal paralysis placed among the paralyses of the lateral pharyngeal area. Due to the association of the Xth and XIIth cranial nerves we could consider it within the labelled as Tapia's syndrome. Nevertheless, the presumable viral etiology of the case makes such classification entitled to discussion, because only are accepted as etiopathogenetic noxes both the traumatisms and tumours.

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This study considers the efficacity of the ambulatory aerosol therapy in chronic cases of the ENT area. A nebulizer, air-jet type, of 4 microns MMAD, was the device employed, and an ample spectre antibiotic (cefotaxime) a mucolytic (N-acetyl-cysteine) plus a corticoid (methyl-prednisolone) the associated drugs. The antibiotic was discarded when otitis were the problem. The results have been favourable in 75 percent of the cases whilst negative in the resting 24 percent of the treated subjects.

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