J. Lacau St Guily

HPV and head and neck cancer

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer.

Estenosis laríngea en el adulto

Resumen Las estenosis laringeas se refieren al estrechamiento de la via aerea a este nivel y suelen ser cuadros adquiridos en el adulto. Representan un problema grave y de actualidad. A pesar de los progresos tecnicos y de los materiales utilizados en reanimacion, las intubaciones prolongadas continuan produciendo secuelas laringeas de dificil tratamiento en las formas mas graves. La cantidad de trabajos que siguen publicandose sobre el tema confirma la vigencia del problema y la necesidad de continuar buscando soluciones terapeuticas racionales y eficaces. El objetivo es restablecer una luz suficiente para la respiracion por via natural, pero con frecuencia esto se consigue a expensas de la funcion vocal. La utilizacion de soluciones terapeuticas menos invasivas, sobre todo si se reduce la necesidad o la duracion de la traqueotomia, es otro objetivo importante en el adulto, aunque no siempre resulta posible. En el nino, los problemas que surgen y los tratamientos disponibles son diferentes y no se tratan en este articulo. Sin embargo, la aproximacion de las experiencias clinicas en el campo de la estenosis del adulto y del nino pueden contribuir a aumentar el numero de tecnicas quirurgicas disponibles.

Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism

OBJECTIVE There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment. STUDY DESIGN Prospective observational study in a university teaching hospital between 2010 and 2014. METHODS The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups. RESULTS Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24pg/mL, respectively; P<0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P=0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P=0.04). CONCLUSIONS In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay. LEVEL OF EVIDENCE 3b, individual case-control study.

Upper airway obstruction assessment: Peak inspiratory flow and clinical COPD Questionnaire.

Spirometric evaluation of upper airway obstruction (UAO) is not commonly performed by Otolaryngologists. In addition, functional evaluation of UAO by flow‐volume loops (FVL) is not available in all clinical settings. More recently, peak inspiratory flow (PIF) has proven to be a useful tool to monitor UAO at the patients bedside. The aim of this work is to assess the role of PIF measured with a simple flow metre (In‐Check method) as a standardised, simple, non‐invasive tool in quantifying chronic and subacute UAO in a routine clinical practice. In addition, a Clinical COPD Questionnaire (CCQ), previously validated to assess the psychophysical status in patients with laryngotracheal stenosis, was utilised to evaluate respiratory function in UAO.

Carcinoma of the salivary glands: guidelines and case report of sustained remission with docetaxel

Salivary glands tumours are rare neoplasms for which there are few clinical trials. The most common malignant parotid tumour is the mucoepidermoid carcinoma. High‐grade mucoepidermoid carcinomas are highly aggressive tumours. The initial therapy of localized disease is known, but when there is a recurrence, several options are possible and chemotherapy is generally reserved for palliative treatment. We comment on published guidelines and report a case of sustained remission with docetaxel.

Tumori benigni della laringe

I tumori benigni della laringe costituiscono un gruppo eterogeneo di tumori, rari nella maggior parte dei casi, in grado di provocare una sintomatologia di disfonia, dispnea e disfagia. Essi pongono prima di tutto un problema di diagnosi, che deve essere istologica, e un problema di trattamento, in cui la chirurgia conservatrice, in particolare endoscopica, ha un ruolo di primo piano.

Tumores benignos de la laringe

Los tumores benignos de la laringe constituyen un grupo heterogeneo, son infrecuentes en su mayor parte y susceptibles de provocar sintomas como disfonia, disnea y disfagia. De entrada, plantean un problema de diagnostico, que debe ser anatomopatologico, y otro terapeutico, para el que la cirugia conservadora, sobre todo endoscopica, tiene un papel principal.

Trastornos de la deglución del adulto. Diagnóstico y tratamiento

Los trastornos de la deglucion comprenden todas aquellas alteraciones del proceso fisiologico encargado de llevar el contenido bucal al esofago y despues al estomago, asegurando siempre la proteccion de las vias respiratorias. Las alteraciones de la etapa inicial que afectan al paso de la laringofaringe y del esfinter esofagico superior constituyen las denominadas disfagias altas. Las principales causas de estos trastornos son los tumores del eje faringoesofagico y las afecciones neurologicas, que se observan con frecuencia. Ante un trastorno sintomatico de la deglucion, las dos exploraciones etiologicas que permiten la deteccion tumoral son la exploracion otorrinolaringologica y la fibroendoscopia esofagica. Por su parte, la exploracion neurologica permitira confirmar la existencia de enfermedad neurologica. La exploracion funcional se basa ante todo en la observacion de la deglucion, la nasofibroendoscopia durante la deglucion y la radiocinematografia cuando es necesario observar el esfinter esofagico superior. La manometria es una exploracion de gran valor para el estudio de los trastornos motores del cuerpo del esofago, pero explora mal la etapa faringea y el esfinter superior. Los tratamientos disponibles en la actualidad son los dieteticos para adaptar la textura de los alimentos, la rehabilitacion, las tecnicas de alimentacion no oral y la cirugia funcional (miotomia del cricofaringeo) o paliativa.

Patología de origen neurológico de la faringe

Resumen Las alteraciones neurologicas de la faringe pueden ser aisladas o estar integradas en sindromes complejos, lo que convierte su tratamiento en un problema multidisciplinario. A las alteraciones de la deglucion suelen asociarse con frecuencia problemas articulatorios por insuficiencia velar y alteraciones respiratorias. El examen otorrinolaringologico es indispensable para orientar el diagnostico hacia una causa neurologica, periferica, nuclear o supranuclear, o hacia un origen neuromuscular o muscular.