Biomedical subjects
Publications and source records attributed to J L Llorente.
Leiomyomas of the nasal cavity are very rare. A case of leiomyoma arising in the nasal septum is presented. The tumour was removed by endoscopic sinus surgery. The literature on the topic is reviewed.
A retrospective review of 193 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. All the patients received a supraglottic laryngectomy, and patients received a total of 284 elective or therapeutic neck dissections. Ninety-four (48.7%) of the patients received postoperative radiotherapy. The incidence of local recurrence was 8.2% but the recurrence rate was unrelated to the use of postoperative radiotherapy. Neck recurrence was observed in 12.9% of patients, with no influence of postoperative radiotherapy in the dissected neck. The incidence of locoregional recurrences by stage in irradiated and nonirradiated patients did not reach significant difference. The 3-year survival was 74.3%. The overall survival of the whole series and by stage was not statistically altered in combined therapy compared to surgery.
Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.
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Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.
BACKGROUND: The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission. METHODS: A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case. RESULTS: The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%). CONCLUSIONS: According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.
BACKGROUND: The identification of etiologic agents of pneumonias acquired in the community (PAC) with risk factors is difficult. The classical diagnostic methods are not profitable and thus invasive techniques are used. In this study the diagnostic use of an invasive technique such as aspirative transthoracic puncture (ATP) was evaluated in this type of pneumonias. METHODS: In 94 patients of high risk suspect of PAC the ATP was carried out. This was performed with an ultrafine needle (25G) without radioscopic control. In all cases blood cultures, serology (Legionella, Mycoplasma pneumoniae, Coxiella burnetti, Chlamydia psittaci) were performed when atypical clinical manifestations were presented and sputum examination (Gram, Ziehl, culture) was undertaken when possible. RESULTS: The sensitivity of ATP was 36% and increased to 54.6% in cases previously untreated with antibiotics. Specificity was 96.4%. The sensitivity of blood culture was 8% and sputum 13.6%. ATP was well tolerated in 97.9% with complication in only 4 (4.3%). The results of ATP led to changes in treatment in 23.1% of the cases with definitive diagnosis of pneumonia. CONCLUSIONS: Aspirative transthoracic puncture with ultrafine needle without fluoroscopic control was a very well tolerated technique with a minimum number of complications, easy to perform at the patients bedside and was used to modify treatment in 23.1% of the cases.
A retrospective review of 302 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. The 302 patients underwent a total of 383 functional neck dissections and 45 classic radical neck dissections. Pathological examination revealed nodal involvement in 117 patients (39%). In the histologically N0 group, the incidence of contralateral neck recurrence when a unilateral neck dissection and postoperative radiotherapy were carried out was 8%, rising 21% when no postoperative radiation was given. There was no difference in the ipsilateral recurrence rate in the N0 group, radiated patients (3%) and nonradiated patients (2%). Similar figures were found in the N1 group. Bilateral functional neck dissection in histologically N0, N1, and N2 necks had similar recurrence rates with or without radiotherapy. Distant metastasis appeared in 10% of N0 patients and in 35% of N3 patients. Patients who received postoperative radiotherapy showed a significantly higher rate of distant metastasis (21%) than patients who did not (8%). The number of involved lymph nodes had no relevance both in neck recurrence and distant metastasis.
The characteristics of the four major vestibular nuclei and accessory cell groups in the rat have been studied in serially cut horizontal sections. Camera lucida drawings of the vestibular nuclei and their neurons were made in these sections and subjected to a computerized image analysis. The dimensions (volume and length) and the number of cells of each vestibular nucleus were obtained, as well as morphometric parameters of their neurons (cross-sectional area, maximum and minimum diameter, and shape). These parameters were statistically analyzed by comparing the cell population from different nuclei and different parts of each nucleus. Of the major nuclei, the medial, which is the largest, has the greatest number of cells, its neurons being the smallest of all the nuclei, with the size of cells decreasing in a rostrocaudal direction. In contrast, the lateral nucleus contains the fewest cells but also the largest ones. Neurons of the superior and descending nuclei are of an intermediate size and number, with a rostrocaudal decrease in the size of the descending nucleus cells. In addition, minor nuclei are identified and described in their relationship to the other structures in the brain stem. The relevant aspects of the anatomical information in regard to functional roles are reviewed.
A case of exclusive association of pleural effusions and primary lymphedema, without ungual dystrophy is described. This isolated combination is an uncommon clinical condition with only 11 cases reported in the literature. The pathogenesis is characterized by aplasia-hypoplasia of the lymphatic vessels with consequent defective lymphatic drainage. We present a pleural effusion associated with a left lower extremity cellulitis, we argue about the differential diagnosis and treat the patient with thoracocentesis and aspiration with a favourable evolution without recidive.
Malignant fibrous histiocytomas are uncommon in the head and neck, the sinonasal tract being the most common location. This report describes 5 cases in this area: two in the nasal cavity, two in the maxillary sinus, and one in the frontal sinus. Four were primary cases and one was secondary to previous irradiation. All patients received surgical treatment, one of them with postoperative irradiation. All five patients experienced local recurrences and three also experienced distant metastases. Only one of these recurrences was successfully salvaged and the patient is alive and free of disease 3 years after resection. A summary of knowledge about the entity is reviewed.
OBJECTIVE: To study the presence of respiratory syncytial virus (RSV) and adenovirus in the effusions of the middle ear and adenoid tissue from patients with chronic otitis media with effusion by use of the polymerase chain reaction. METHOD: The effusions and adenoid samples were collected from 32 children undergoing myringotomy and ventilation tube placement for chronic otitis media with effusion. The samples were separated for viral culture, immunofluorescence and PCR analysis. RESULTS: One (3%) effusion sample was positive for adenovirus by the PCR. None of samples (effusion and adenoid) were positives for RSV. The results of viral culture and immunofluorescence were all negative. CONCLUSIONS: Our results can not support that respiratory viruses play a role in the pathogenesis of chronic otitis media with effusion.
Herpes simplex type 1 (HSV-1) has been implicated as a cause of facial paralysis. We developed an experimental model in rabbits in which we injected HSV-1 into the tongue. The animals were killed after one and three weeks. The geniculate and trigeminal ganglia and medulla were extracted and the samples were processed. The polymerase chain reaction (PCR), nested-PCR and cultures were carried out in order to detect the viral genome in the samples. The viral genome was found in all but two rabbits. None of the animals developed clinical facial palsy. We conclude that nested PCR is more sensitive for the identification of HSV-1 in samples.