Globo faríngeo y reflujo faringo-laríngeo

The globus sensation is one of the most frequent complaints in a basic ENT clinic. The etiology is still unknown, although some hypotheses have been suggested such as: psychological abnormalities, esophageal and cricopharyngeal muscle disfunction and the laryngopharyngeal reflux. Laryngopharyngeal reflux is the most frequent pathology related to the globus feeling. We've tried in this study to determine the incidence of laryngopharyngeal reflux in a group of 30 patients with globus feeling. We found 26.7% of these patients with an abnormal pH monitoring test.

Effects of several flavonoids on the growth of B16F10 and SK-MEL-1 melanoma cell lines: relationship between structure and activity

Although flavonoids seem to be capable of acting at all stages of the carcinogenic process, little information is available on their action in melanoma cell lines. The aim of this study was to assess the response of B16F10 and SK-MEL-1 melanoma cell lines to treatment with six different flavonoids after 24 and 72 h of exposure and to relate the response to their structure. We then compared the findings with those for melphalan treatment. When cultures were treated for 24 h, only slight inhibition at the highest concentrations (25 and 50 microM) of tangeretin and luteolin were observed, whereas melphalan caused a dose-related inhibition of growth at all concentrations. Quercetin, hesperetin, 7,3'-dimethylhesperetin and eriodictyol did not produce any effect at 24 h on B16F10 or SK-MEL-1 cells, results which point to the low toxicity of flavonoids. After 72 h of exposure culture growth was inhibited by 7,3'-dimethylhesperetin at 50 microM, but lower concentrations had no effect. Tangeretin was the most effective of the flavonoids in inhibiting B16F10 and SK-MEL-1 cell growth, showing a clear dose-response curve after 72 h. These results suggest that the absence of the C2-C3 double bond on hydroxylated flavonoids results in a loss of effect on both the cell lines, while the higher activity of tangeretin compared with 7,3'-dimethylhesperetin suggests that the presence of at least three adjacent methoxyl groups confers a more potent antiproliferative effect.

[Usefulness of 201T1 gammagraphy in the diagnosis of carcinoma of the larynx]

For the evaluation of a patient with a laryngeal tumor we need the clinical exam and other exams as the CT scan or MRI. Those studies have a sensitivity of less than 80%. For that reason in the last years there has been a development of new techniques trying to increase the accuracy. The 201Tl SPECT is one of them although it was developed for cardiological purposes. We present our experience in 46 patients with laryngeal tumor in whom we did a 201Tl SPECT as part of the extension study. The sensitivity of the study was 81.6% in the diagnosis of the primary tumor and 46.1% for the neck adenopathies. The 201Tl SPECT can be a good method for the evaluation and detection of recurrences in patients with pharyngo-laryngeal tumor.

Partial epiglottectomy as a possible treatment for globus pharyngeus?

Globus pharyngeus is a relatively common complaint in an ear, nose, and throat consulting room and may account for 3-4% of outpatient referrals. The cause is still unknown, although a number of hypotheses have been suggested. Between 40% and 75% of the patients remain symptomatic despite any treatment regimen. Thirteen patients from a group of 124 with the diagnosis of globus pharyngeus and no response to medical treatment were treated with partial epiglottectomies. One year after the surgery all but one patient were free of symptoms. Our experience indicates that partial epiglottectomy can be a good treatment for those patients with globus pharyngeus in whom no cause is found after all studies are performed or when medical treatment fails.

[Antibiotic prophylaxis in oncologic pharyngolaryngeal surgery: ceftriaxone versus clindamycin and gentamycin]

There are many papers comparing two antibiotic protocols for the profilaxis of head and neck infections after laryngeal surgery. We present one prospective and randomised study in 60 patients comparing the efficacy of two protocols. The comparison was between ceftriaxone versus the association of clindamicyn and gentamicyn. In our database we included the risk factors for infection, the surgical approach, the duration of surgery and the patient characteristics. We observed an incidence of 28% of infection, with a 23.3% in the clindamicyn + gentamicyn group and a 33.3% in the ceftriaxone group. The differences between the two groups were not statistically significant. In this study we observed a small difference between the amount of alcohol comsuption, the effectiveness of the surgical drainage, the surgical approach and the presence of wound infection. The difference was not statistical significant due to the small group of patients. The profilaxis was adequate for the total laryngectomy and cordectomy group, with a higher incidence of wound infection in patients treated with a supraglottic laryngectomy.

Improved water solubility of neohesperidin dihydrochalcone in sweetener blends

Significant technological advantages in terms of sweetness synergy and hence cost-saving can be obtained if neohesperidin dihydrochalcone (NHDC) is used in sweetener blends with other intense or bulk sweeteners. The combination of NHDC with sodium saccharin or sodium cyclamate is an excellent method to improve the water solubility at room temperature of NHDC. In the case of NHDC-sodium saccharin, two different methods for blend preparation, a simple mixture and a cosolubilized mixture, can be used, with similar results obtained for solubility and solution stability properties. To improve temporally the water solubility of NHDC in combination with sodium cyclamate, it is absolutely necessary to prepare cosolubilized blends.

Antioxidant activity and radioprotective effects against chromosomal damage induced in vivo by X-rays of flavan-3-ols (Procyanidins) from grape seeds (Vitis vinifera): comparative study versus other phenolic and organic compounds

The quantitative distribution of several flavan-3-ols was determined using HPLC in a grape (Vitis vinifera) seed extract (GSE) of four cultivars grown in the region of Murcia. Polymer >/= C(4) units made up the largest group of procyanidins in the GSE (90.92%, expressed as HPLC % area). The antioxidant activity of GSE and other reference compounds was investigated by measuring their ability to scavenge the ABTS(*)(+) radical cation (TEAC). The most effective compounds were, in order: GSE > rutin > (+)-catechin > diosmin >/= ascorbic acid. The radioprotective effects of GSE and other reference compounds were determined by using the micronucleus test for anticlastogenic activity, any reduction of the frequency of micronucleated polychromatic erythrocytes (MnPCEs) being evaluated in the bone marrow of mouse exposed to X-rays. The most effective compounds were, in order: GSE > rutin > dimethyl sulfoxide (DMSO) > ascorbic acid > 6-n-propyl-2-thiouracil-6c (PTU) > diosmin. The higher ABTS(*)(+) scavenging capacity and anticlastogenic activity of GSE can be explained, structurally, by the high number of conjugated structures between the catechol groups in the B-rings and the 3-OH free groups of the polymeric polyphenolic skeleton and, in addition, by the stability of the aroxyl flavonoid radical generated in the above processes.

Constitutive nuclear factor-kappaB activity in human upper airway tissues and nasal epithelial cells

Respiratory epithelial cells are actively involved in the host defence and inflammatory reactions of the airways. Nuclear factor-kappaB (NF-kappaB) is a transcription factor that plays a pivotal role in many cellular responses to environmental changes. The inducible nitric oxide synthase (iNOS) isoform has been implicated in airway inflammation as well as in normal airway function. In this study, the hypothesis that NF-kappaB may be associated with iNOS expression in airway epithelium, not only in inflammatory processes but also under physiological conditions was examined. NF-kappaB deoxyribonucleic acid-binding activity was assayed by means of electrophoretic mobility shift assay (EMSA) and iNOS expression examined using immunohistochemical techniques in healthy nasal mucosa and chronically inflamed nasal polyps. Further NF-kappaB activity was assayed; by means of EMSA, in nasal epithelial cells isolated from both tissues. NF-kappaB was activated in nasal polyps, but also to the same extent in healthy nasal mucosa. Uniform iNOS expression was localized within the airway epithelium in both inflamed and noninflamed tissues. Along with iNOS expression, concomitant NF-kappaB activation was found in nasal epithelial cells obtained from both tissues and no differences were observed when nasal mucosa and nasal polyp were compared. These results suggest that constitutive nuclear factor-kappaB and concurrent inducible nitric oxide synthase expression in epithelial cells may play a physiological role in airway function.

[Nasal leishmaniasis in an HIV-positive patient]

Leishmania is currently one of the most clinically important protozoa in otorhinolaryngology. Mediterranean countries, including Spain, have endemic HIV and L. infantum. Dogs are the most important Leishmania reservoir. Leishmaniasis is transmitted basically by the bite of infected female Phlebotomus sandflies. Its clinical development depends mainly on the host's cellular immunity (TCD4+ lymphocyte count). About 400 cases of HIV-visceral leishmaniasis have been reported in Spain. However, exclusively cutaneous presentation of HIV-leishmaniasis coinfection has been observed in only 2-3% of cases. We report the case of a female HIV+ patient who developed cutaneous leishmaniasis of the nasal vestibule by L. infantum. The patient was treated satisfactorily with a combination of parenteral Pentostam (sodium stilbogluconate) and periodic intralesional injections of Pentostam. The patient was included in a secondary prophylaxis protocol for visceral leishmaniasis with a monthly dose of Glucantime (meglumine antimoniate) for life.

[Second primary tumors in patients with laryngeal neoplasms]

A cohort epidemiologic study of second primary tumours appeared in patients diagnosed of laryngeal neoplasms, between years 1988 and 1990, and a follow-up term of 5 years, is presented. An statistical analysis of several data to define a possible high risk group for developing primary tumours was performed for all patients.

[Nitric oxide synthase activity in nasal mucosa]

Nitric oxide (NO) plays an important regulatory role in airway function and seems to be implicated in the pathophysiology of several airway diseases. We studied the presence of NO synthase activity in human nasal mucosa and nasal polyp tissues obtained from patients undergoing septoplasty or polypectomy, respectively. NO synthase activity was quantified in tissue homogenates using citrulline release assay and was located in tissue sections using NADPH-diaphorase histochemistry. The results indicated that nasal polyps contain higher levels of total NO synthase activity than nasal mucosa tissue. In addition, nasal polyps contained mainly inducible NO synthase activity whereas all NO synthase activity detected in the nasal mucosa was in constitutive form. In both cases, NO synthase activity was localized in epithelial cells. In view of these results, we conclude that NO may be an important inflammatory mediator in the respiratory system and that the epithelium may be a source of NO production.

[Comparative study of 2 antibiotic prophylactic protocols in oncologic surgery of the pharynx and larynx]

The use of antibiotic prophylaxis in oncological pharyngeal and laryngeal surgery has reduced the risk of postoperative wound infection, which decreases morbidity and health-care costs. We report the results of a prospective randomized study in our hospital comparing the effectiveness of two antibiotic protocols, amoxicillin-clavulanate and clindamycin plus gentamicin, both given for 24 hours, in patients who underwent clean-contaminated oncological surgery of the pharynx or larynx.

Comparison of models used for UV index calculations

Eighteen radiative transfer models in use for calculation of UV index are compared with respect to their results for more that 100 cloud-free atmospheres, which describe present, possible future and extreme conditions. The comparison includes six multiple-scattering spectral models, eight fast spectral models and four empirical models. Averages of the results of the six participating multiple-scattering spectral models are taken as a basis for assessment. The agreement among the multiple-scattering models is within +/- 0.5 UV index values for more than 80% of chosen atmospheric parameters. The fast spectral models have very different agreement, between +/- 1 and up to 12 UV index values. The results of the empirical models agree reasonably well with the reference models but only for the atmospheres for which they have been developed. The data to describe the atmospheric conditions, which are used for the comparison, together with the individual results of all participating models and model descriptions are available on the Internet: http://www.meteo.physik.uni-muenchen.de/++ +strahlung/cost/.

[Omeprazole: a new treatment for paranasal sinus polyps in Widal syndrome. Preliminary study]

A preliminary report is made of the potential therapeutic effect of omeprazol in reducing nasosinusal polyps. This study is based on the empirical observation of nasal airflow improvement in patients suffering from nasosinusal polyposis after administering omeprazol. Different phases of the study suggested that patients with Widal's syndrome benefited the most. Based on the results of this study, we have undertaken a randomized, parallel, double-blind, placebo-controlled clinical trial.

[Mucoceles. Review of reported cases in the last 15 years]

The AA. present a retrospective study of all instances diagnosed as mucoceles in the last 15 years (1978-1993) at General University Hospital, Valle de Hebrón. Age of occurrence and sex, foregoing pathologic history, clinical picture, diagnostic tests, treatment and subsequent course of the condition are duly considered and appraised. Our attempt has been to stablish a diagnostic clinical pattern of these conditions, which generally are uncovered through its complications.

[Pulmonary and laryngeal tuberculosis. Study of 26 patients]

A description is reported of tuberculosis cases (TBC) with symptomatic laryngeal involvement diagnosed and treated from 1982 to 1994. Twenty-six out of 2,800 (0.9%) patients diagnosed with TBC had laryngeal symptoms. Twelve patients underwent laryngeal biopsy and the disease was diagnosed in 11; the remaining 15 patients were diagnosed on the basis of the typical lesions at laryngoscopy and resolution with specific therapy; in all of them there was a pulmonary TBC associated. The mean time of clinical laryngeal symptoms was five months and the most common symptom was dysphonia. There were factors which increased the risk for TBC in 16 patients (61.5%), alcoholism being the most common symptom in 10 (38%) patients. X-Ray examination revealed bilateral infiltrates or cavitation in 81% of patients. Sputum examination for acid-fast bacilli was positive in 15 (58%) and culture for Mycobacterium tuberculosis was positive in all of them. All patients adhered correctly to the therapeutic regimen and the clinical course was towards healing: no patient had laryngeal carcinoma after one year of follow-up. The incidence of symptomatic laryngeal TBC in our environment is low and usually presents in patients with risk factors, particularly alcoholism, with a long evolution of the disease and associated with extensive pulmonary TBC. The coexistence with laryngeal carcinoma is exceptional; therefore, when the association of laryngeal symptoms and active pulmonary TBC is present it is reasonable to reserve the laryngeal biopsy for those patients with lymph node enlargement, risk factors, or when symptoms persist after a correct therapeutic regime has been instituted.

Differential activity of nitric oxide synthase in human nasal mucosa and polyps

Nitric oxide (NO) plays an important regulatory role in airway function and seems to be implicated in the pathophysiology of several airway diseases. To better understand the involvement of NO in the upper airways, we examined the presence of nitric oxide synthase (NOS) activity in human nasal mucosa and nasal polyp tissues. Nasal mucosa was obtained from seven patients undergoing septoplasty, and nasal polyps came from nine patients following polypectomy. NOS activity was quantified in tissue homogenates using the citrulline release assay and localized in tissue sections using reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase histochemistry. The results showed that nasal polyps (n = 9) contained higher levels of total NOS activity (mean +/- SD 5.94 +/- 5.71, range 1.29-18.0 pmol.min-1.mg protein) than nasal mucosa tissues (n = 7) (0.28 +/- 0.22, range 0.01-0.57 pmol.min-1.mg protein). In addition, nasal polyps mainly contained inducible NOS activity (4.67 +/- 4.57, range 1.23-15.5 pmol.min-1.mg protein) whereas in nasal mucosa all NOS activity detected was in constitutive form. In both cases, NOS activity was localized in the epithelial cells. Since NO synthase is induced in inflamed upper airways, we conclude that NO may be an important inflammatory mediator in the respiratory system and that the epithelium may be a source of NO production in the human upper airways.

Hearing and diabetes

The results of the audiological evaluation of 47 diabetics are presented. The patients were divided into two groups: A (17/47), type I early diabetics, and B (30/47), type I chronic diabetics. The evaluation included puretone audiometry, high-frequency audiometry and auditory brainstem response. There was a control group consisting of 30 healthy subjects. In group 1 the audiological assessment was normal in all cases. In group 2 hearing loss was found in 30% of cases (9/30). Hearing loss was significantly correlated with age (p = 0.0019) and duration of diabetes (p = 0.0143), but not with diabetic microangiopathy (p = 0.1506). The authors conclude that hearing loss is not a usual feature in diabetic patients. When present, hearing loss should be attributed to the effect of diabetes on the age-related physiological impairment of the inner ear. The pathogenic mechanisms remain obscure.

Acute epiglottitis in the adult

Acute epiglottitis in the adult is a rare disease, which has shown an appreciable increase since the sixties and in our locality since 1984. We present a review of the cases registered in our hospital, analyzing their aetiology, evolution and treatment. The disease is most likely to be suspected in the presence of any patient having a sudden dysphagia, especially if he shows symptoms of an acute infection and a lack of oropharyngeal pathology.

DNA investigations on fetal material from paternity cases

Three paternity cases have been investigated where DNA was extracted from fetuses (age: 8-10 weeks old) after interruption of pregnancy. In each case it was possible to clearly identify the putative father using 5 or 6 single locus probes (SLP's). Fetal bands (SLP) could be clearly identified from mixtures of placental and fetal DNA by comparison with the maternal and paternal bands. However, it was very difficult to resolve the fragment patterns of tissue mixtures with one multi locus probe (MLP), because of band overlap. Another advantage of using SLP's was that biostatistical calculations could be carried out and very informative Essen-Möller values for the probability of paternity were obtained.

Auditory function in young patients with type 1 diabetes mellitus

Comprehension of the effect of diabetes mellitus on auditory function has been hindered by the fact that previous studies have evaluated hearing function in heterogeneous groups of patients with diabetes mellitus, thus giving conflicting results. We have performed audiometric studies in 46 consecutive patients. 13 with newly diagnosed type 1 diabetes mellitus (group 1) and 33 with type 1 diabetes mellitus of more than 3 years of duration (group 2), of 14 to 40 years of age. The results were compared to an age-matched control group. Pure-tone auditory thresholds were significantly higher in all frequencies 250-8,000 Hz in both groups when compared to the control subjects. Ten patients, all of which belonged to group 2, had auditory thresholds above 30 dB in at least one frequency, showing a conversational hearing loss that ranged between 11 and 44%. However, none of them referred subjective hypoacusia. Univariate analysis revealed significant associations between auditory thresholds and age, duration of disease as well as retinopathy, but not with neuropathy, HbA1c or hypoglycaemic episodes. Only age and duration of disease independently correlated with an auditory threshold using multiple regression. We conclude that type 1 diabetes mellitus can cause mild sensorineural hearing impairment which correlates with age and duration of disease.

Asymptomatic electronystagmographic abnormalities in patients with type I diabetes mellitus

Only a few studies have investigated vestibular function in diabetes mellitus (DM), showing contradictory results. We have performed an electronystagmographic (ENG) evaluation of 46 individuals with type I DM and 37 healthy controls. No patient reported subjective vestibular symptoms. Duration of caloric-induced nystagmus (DN) was significantly lower (2.1 +/- 0.7 vs. 2.6 +/- 0.4 min, p less than 0.01), and central nystagmus frequency of caloric response also nonsignificantly tended to be decreased (37.4 +/- 16.5 vs. 41.7 +/- 12.7 beats/30s, p = 0.21) in DM patients, as compared to controls. The latter comparison achieved significance after exclusion of newly diagnosed diabetic patients (33.4 +/- 16.1 vs. 41.6 +/- 12.7 beats/s, p less than 0.05). Depressed caloric reactions were seen in 21.8% of patients. DN was lower in patients with microalbuminuria and retinopathy, but this was not observed after exclusion of newly diagnosed diabetic patients, all of whom had normal ENG responses and no chronic diabetic complications. The existence of a lower DN and central nystagmus frequency should be borne in mind when interpreting ENG tracings in patients with long duration type I diabetes mellitus.