Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer.

BACKGROUND: Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT-PCR) has produced encouraging results, the more discriminating markers remain to be identified. METHODS: Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT-PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC. RESULTS: SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases. CONCLUSION: PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT-PCR.

Drying of a solution in a meniscus: a model coupling the liquid and the gas phases.

A model simulating the drying of a solution in a meniscus in contact with a moving substrate is developed. It takes into account the hydrodynamics in the solution in the framework of the lubrication approximation, the vapor diffusion in the gas phase, and the variation of physical properties during drying. The free surface profile and spatial evaporation flux are not imposed a priori but result from the simulation of the mass transfer in the liquid/gas system (1.5-sided model). Several regimes are observed depending on the substrate velocity. For a large substrate velocity, the classical Landau-Levich regime is obtained. For smaller velocities, a drying front appears that is characterized by a strong concentration gradient and a peak in the evaporation flux. The coupling between the evaporation flux and the meniscus shape in this regime is analyzed. Another regime appears at a very low substrate velocity and seems to be driven by a competition between advection and diffusion. This macroscopic model simulates recent experimental results, namely, the dependence of the deposit thickness on the substrate velocity, which scales as 1/V in the regime dominated by evaporation.

Drying of colloidal suspensions and polymer solutions near the contact line: deposit thickness at low capillary number.

Drying experiments with a receding contact line have been performed with silica colloidal suspensions and polyacrylamide (PAAm) polymer solutions. The experimental setup allows to control the receding movement of the contact line and the evaporation flux separately. Deposit thickness as a function of these two control parameters has been investigated. The different systems exhibit a similar behavior: in the regime of very low capillary numbers the deposit thickness scaled by the solute volume concentration and the evaporation rate is proportional to the inverse of the contact line velocity. Both the scaling exponent and the constant (which has the dimension of a length) do not depend on the system under study. The observation of this evaporative regime confirms some recent results obtained by Le Berre et al. on a very different system (phospholipidic molecules) and fully supports their interpretation. Following their approach, a simple model based on mass balance accounts for these results. This implies that this regime is dominated by the evaporation and that the deformation of the meniscus induced by viscous forces does not play any significant role. When increasing the velocity, another regime is observed where the thickness does not depend significantly on the velocity.

[Sinonasal adenocarcinomas reviewed. Prognostic value of WHO 2005 histological classification]. / Les adénocarcinomes nasosinusiens revisités. Intérêt pronostique de la classification histologique OMS 2005.

OBJECTIVES: The WHO 2005 histological classification separates sinonasal adenocarcinoma (ADC) into three classes: intestinal-type adenocarcinoma (ITAC), low-grade sinonasal ADC and high-grade sinonasal ADC. The goal of this study was to check the relevance of this classification on the prognosis of patients treated for ADC. PATIENTS AND METHODS: All the files of patients treated consecutively in the ENT department of the Montpellier University Hospital for ADC between 1980 and 2003 were retrospectively re-examined. Each case was reviewed for anatomical and pathological data based on the immunohistochemistry results according to the WHO 2005 classification, with a study of a panel of markers: cytokeratin 7 (CK7), cytokeratin 20 (CK20), Villin, CDX2 and EGFR. The epidemiologic data, the methods of treatment and the follow-up were studied. The survival probabilities were calculated using the Kaplan-Meier method and the survival graphs were compared using a log-rank test. RESULTS: Sixty-two files were reviewed. Twelve patients were reclassified into the adenoid cystic carcinoma category and excluded from the study. In the 50 remaining cases, there were 36 ITAC cases, four low-grade ADC cases and 10 high-grade dedifferentiated carcinomas. For all of the ADC cases, the total survival at 5 years and without recurrence was 64 and 52%, respectively. The analysis of the three subgroups showed a total survival of 72.2% for ITAC, 100% for low-grade and 20% for high-grade ADC with a significant difference (p=0.044). This immunohistochemical distinction was mainly based on the expression of CK20 found in 98% of the ITAC cases and absent in low- and high-grade ADC patients. CONCLUSION: The WHO 2005 classification for sinonasal ADC provides a valuable prognosis by showing a difference in the progression profile between ITAC, low-grade ADC and high-grade ADC. Moreover, broader studies should be conducted to investigate the different subtypes of ITAC.

[Study of the platysma coli muscle vascularisation by the facial artery. Implication during the elevation of the musculo-cutaneous platysma coli muscle flap]. / Etude de la vascularisation du muscle platysma coli par les branches de l'artère faciale. Implications lors du prélèvement du lambeau musculo-cutané de platysma coli.

AIM OF THE STUDY: The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. PATIENTS AND METHODS: Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. RESULTS: The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. CONCLUSION: The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.

Surgical management of carotid body tumors.

BACKGROUND: Carotid body tumors (CBT) should be considered when evaluating every lateral neck mass. METHODS: A retrospective study was conducted of 52 patients with 57 CBT. The surgical approach and complications were reviewed. All patients were operated on without preoperative embolization. RESULTS: Multifocal paraganglioma (PG) were detected in six cases. A succinate dehydrogenase subunit D (SDHD) mutation was discovered in four patients. Vascular peroperative complication occurred in one case. Vascular reconstruction was decided peroperatively in five cases (8.8%). Vascular reconstruction was 0% for Shamblin 1 or 2 tumors, but 28.5% for Shamblin 3. A postoperative nerve paresis was reported in 24 patients (42.1%) and vagal nerve paralysis persisted in four cases (7.01%). The rate of serious complications, e.g., permanent nerve palsy, preoperative and postoperative complications, was 14.03%; it was 2.3% for Shamblin 1 or 2 tumors and 35.7% for Shamblin 3. One patient had malignant PG with node metastasis and was not referred for radiotherapy. No recurrence or metastasis was reported after 6-year follow-up. CONCLUSION: Early surgical treatment is recommended in almost all patients after preoperative evaluation and detection of multifocal tumors. Surgical excision of small tumors was safe and without complication, but resection of Shamblin 3 tumors can be challenging. Routine preoperative embolization of carotid body paragangliomas is not required.

[Information security in a radiotherapy centre: Controlling risks to better cope with them]. / Sécurité de l'information en centre de radiothérapie : contrôler ses risques pour mieux y faire face.

The dematerialization of data, the multiplication of sharing and exchanges between professionals, the increase of business software offer (patient files, human resources management, financial management, document management, etc.) question us about the security of information systems. This protection contributes to the quality of the care of patients in respect of their rights, to ensure the confidentiality, traceability and sustainability of digital personal health data and to strengthen the confidence of professionals in the system and its uses. But what security procedures are currently being undertaken in the radiotherapy centres?

[From quality management to dynamic management through quality: Deployment within a radiotherapy group]. / De la démarche qualité vers la gestion dynamique par la qualité : déploiement au sein d'un groupe de radiothérapie.

In 2015, the quality group of the radiotherapy clinic Groupement de Radiothérapie et d'Oncologie des Pyrénées (GROP, Pau, France) decided to review the deployment of its quality approach in order to optimize it continuously. For this, two improvements were proposed: an involvement of process drivers and a material and financial investment in document management software. The implementation of these organizational and managerial provisions enabled us to better cover the requirements of the ISO 9001 standard, the international reference in quality management.

Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism.

INTRODUCTION: Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction. MATERIALS AND METHOD: A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C. RESULTS: Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique. CONCLUSION: With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C.

Can hydrodynamic contact line paradox be solved by evaporation-condensation?

We investigate a possibility to regularize the hydrodynamic contact line singularity in the configuration of partial wetting (liquid wedge on a solid substrate) via evaporation-condensation, when an inert gas is present in the atmosphere above the liquid. The no-slip condition is imposed at the solid-liquid interface and the system is assumed to be isothermal. The mass exchange dynamics is controlled by vapor diffusion in the inert gas and interfacial kinetic resistance. The coupling between the liquid meniscus curvature and mass exchange is provided by the Kelvin effect. The atmosphere is saturated and the substrate moves at a steady velocity with respect to the liquid wedge. A multi-scale analysis is performed. The liquid dynamics description in the phase-change-controlled microregion and visco-capillary intermediate region is based on the lubrication equations. The vapor diffusion is considered in the gas phase. It is shown that from the mathematical point of view, the phase exchange relieves the contact line singularity. The liquid mass is conserved: evaporation existing on a part of the meniscus and condensation occurring over another part compensate exactly each other. However, numerical estimations carried out for three common fluids (ethanol, water and glycerol) at the ambient conditions show that the characteristic length scales are tiny.

Surgical alternatives to uvulopalatopharyngoplasty in sleep apnea syndrome.

Uvulopalatopharyngoplasty (UPPP) is the surgery most often performed for sleep apnea syndrome (SAS). However, good results with UPPP, demonstrated by polysomnography, have been reported in only 50% of cases. Failure of UPPP may be caused by: 1) bad management of the SAS, which is better treated in some patients with nasal CPAP than with surgery; and 2) an airway obstruction located not only at the palatopharynx (PP) level. Other surgical procedures to enlarge other sites of obstruction are described. Retro-tongue-base-pharynx (RTBP) surgery is emphasized, including mandibular advancement, hyoid bone suspension, and tongue base reduction. Maxillomandibular advancement is the most efficient technique but also the most complicated.

Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years).

BACKGROUND: Between 30 and 50% of patients with sinonasal polyposis (SNP) will require surgical treatment. OBJECTIVE: To determine the medium term risks and benefits of endonasal ethmoidectomy in SNP. METHOD: 132 cases of SNP have been retrospectively studied before and after endoscopic nasal surgery with a mean follow-up of 5 years. Functional symptoms and appearances on endoscopic examination were recorded on graded scales. Non-parametric statistical analyses for matched series were used in the assessment of data. RESULTS: Post-operative normalisation of nasal function was obtained in 62% of cases. Each of the four main nasal symptoms (nasal obstruction, rhinorrhoea, facial pain and anosmia) was improved (p = 0.001). Patients with associated asthma or ASA triad had higher scores for nasal obstruction and rhinorrhoea (Fisher's exact test; p < 0.02). The pre-operative clinical stage of SNP correlated neither with recurrence nor with functional outcomes (Fisher's exact test; p > 0.05). The requirement for steroid treatment of concurrent asthma was also reduced post-operatively (p = 0.001). The association with asthma and its level of treatment was not related to the frequency of recurrence of SNP (Chi2; p > 0.6). CONCLUSIONS: Functional outcomes for patients with SNP and asthma were significantly improved by endoscopic surgical treatment, even if the appearance of the nasal mucosa did not always return to normal.

[Repeat surgery for thyroid nodules (excluding cancer and hyperthyroidism)]. / Reprises chirurgicales en pathologie nodulaire thyroïdienne (cancer et hyperthyroïdie exclus).

Second procedures for recurrent thyroid disease are known to carry a high risk of iatrogenic damage, particularly to the inferior laryngeal nerves and parathyroid glands. This risk has been clearly evaluated for the primary procedure, but is less clearly for second procedures. A series of 117 patients with solitary or multiple cold thyroid nodules were evaluated (excluding those patients re-operated for recurrent thyroid carcinoma or goitre associated with hyperthyroidism) to determine the operative risks. The level of transient and permanent recurrent laryngeal nerve palsy was 2.56% and 1.7% respectively. The level of transient and permanent hypocalcaemia was 12.9% and 4.62% respectively. The frequency of re-operation for recurrent disease involving the pyramidal lobe following total thyroidectomy (6 cases) highlights the importance of removing it during the primary procedure. The number of cases of cancer discovered at re-operation was 4.3% (5 cases out of 117).

[Substernal goiter. Report of 212 cases]. / Les goitres plongeants. A propos de 212 cas.

AIM OF THE STUDY: The aim of this retrospective study was to report the results of the surgical treatment in a series of 210 patients operated on for substernal goiters. PATIENTS AND METHOD: From 1982 to 1996, 210 patients with substernal goiters, including 80% of women, were operated on via a cervical approach in 208 cases, via a sternotomy in two cases. Two patients with operative contra-indications were not operated on. Twenty-five were operated on for a substernal recurrence of a goiter. In 160 cases, extraction of the substernal portion was easy. In 48 cases, removal of the substernal portion was facilitated by the discovery of the recurrent nerve at its entering into the larynx and a downward dissection of the tracheal attachments of the lobe. The complete dissection of the cervical portion made easier the ascension of the substernal portion even in very large substernal components. RESULTS: Three papillary carcinomas were diagnosed. A transient laryngeal nerve palsy occurred in 7.2% of the patients and a transient hypoparathyroidism in 13.4%, A definitive laryngeal nerve palsy occurred in 1.2% of the patients, and a persistent hypoparathyroidism in 2.1%. Of the 25 patients who underwent surgery for recurrence of a goiter, three (12%) developed a transient laryngeal nerve palsy, one (4%) a permanent nerve palsy, four (20%) a transient hypoparathyroidism and one (4%) a persistent hypocalcemia. CONCLUSION: CT scan and MRI are the best explorations to evaluate intrathoracic extension of substernal goiters. Thyroidectomy was performed via a cervical incision in 208 patients and via a sternotomy in two patients only. The complete dissection of the cervical portion with discovery of the recurrent nerve at its entering into the larynx, facilitates the ascension of the substernal portion even in very large substernal goiters.

[MRI/CT x-ray comparison in the pre-operative evaluation of cancer of the larynx. Apropos of 46 cases]. / Comparaison IRM/TDM dans le bilan pré-opératoire des cancers du larynx. A propos de 46 cas.

The authors present the comparative value of CT scan and MRI in the pre-operative staging of 46 laryngeal carcinomas. The "in depth" evaluation conducts the choice of conservative surgery. CT scan is the reference but MRI reveals itself as effective and even more in certain cases. The spontaneous contrast gradient for soft tissues of the MR imaging explains this effectiveness of the method. The paraglottic space and the subglottic extension are more easily studied by MRI. If the expansion of the MRI Unities allows this indication of the pre-operative staging of laryngeal carcinomas is an excellent one.

[Inflammation and laryngitis]. / Inflammation et laryngites.

1. DISTINCT ENTITIES: Unlike inflammation or the middle ear or nasal or sinus cavities, there is no direct link between acute and chronic inflammation of the larynx. Chronic laryngitis is a distinct nosological entity. Patients with recurrent allergic laryngitis do not necessarily develop chronic laryngitis as is observed in patients with nasal allergy. 2. RESEARCH: There is no research data on infections of the larynx comparable to that available for the middle ear or the nasal cavities. This is probably related to the difficulty of accessing the laryngeal mucosa and the risks related with this condition. 3. CLINICAL TRIALS: While fundamental research remains to be conducted, their is a large body of clinical trials on the topic, although one must be prudent concerning the terms used. 4. NOSOLOGOGY: In French the term "croup" designates diphtheritic croup and must be distinguished from the more general term used in English. Clinical trials must be interpreted with caution since it is often difficult to ascertain which type of laryngitis is concerned. 5. GRAVITY SCORES: Widely used in the English literature, gravity scores are not generally used in French pediatric ENT units and have no real equivalent in French. 6. DYSPHONIA AND DYSPNEA: Dysphonia is the leading sign of chronic laryngitis. Dyspnea is the leading sign of acute laryngitis. Dyspnea is more frequent in children and is related to disease severity. 7. BACTERIA AND VIRUSES: Epiglottitis (supraglottic laryngitis) is related to bacterial infections while subglottic laryngitis is related to viral infections requiring antibiotics in combination with corticosteroids. 8. H. INFLUENZAE: The most common causal agent of epiglottitis, type B Haemophilus influenzae, is not the only culprit. 9. ADULTS: Epiglottitis can also occur in adults where it is as severe as in children. 10. SYSTEMIC CORTICOSTEROIDS: Emergency administration of systemic and inhaled glucocorticoids in the hospital setting is the basic treatment for glotto-subglottic laryngitis. Dosage must be high, more than 0.3 mg/kg dexamethasone for 48 hours, followed by oral corticosteroids.

[Subtotal laryngectomy with cricohyoidopexy. Carcinologic results and early functional follow-up. Apropos of 49 cases]. / Laryngectomie sub-totale reconstructive avec cricohyoïdopexie résultats carcinologiques et suites fonctionnelles précoces. A propos de 43 cas.

Forty-three patients underwent a subtotal laryngectomy with cricohyoidopexy and neck dissection. The 5 years overall survival rate was 67%, the actuarial survival rate was 75%. The 5-year actuarial local control and nodal control rate were namely 89% and 90%. Pronostic factors for survival were tumor size (5-year actuarial survival rate for T2a, T2b and T3 were namely 89%, 72%, 48%) and node involvement (5 years actuarial survival rate was 85% if N-, and 46% if N+). The median duration was 22 days for decanulation, 30 days for removing the feeding tube. The median hospital discharge day was 38. Total laryngectomy was performed in one case (2.3%) for persistent aspiration. Post operative mortality was 0%. The most common complication was aspiration pneumoniae (11.6% of the cases).

[Cervical paraganglioma. Results apropos of a series of 33 patients]. / Paragangliomes cervicaux. Résultats à propos d'une série de 33 patients.

During the period 1971-1993, 33 patients were treated for cervical chemodectomas, 41 tumors were diagnosed. Seven patients had multicentric tumors. All patients expect one with bilateral carotid tumor were treated surgically. A carotid resection was performed in 4 patients. Six patients were given radiation therapy: five patient after surgery and one treated by irradiation alone. During the follow-up period one patient died of bone metastasis 6 years after a partial surgery and radiation therapy, and one had local recurrence treated with irradiation. The surgical management is the major treatment of these tumors, it revealed no postoperative cerebrovascular accident and limited complications secondary to unavoidable nerves sacrifice. Radiation therapy is performed only on particular cases: surgery contra-indications and nonradical resection.

[Our experience in reconstructive surgery in glottic cancers]. / Notre expérience de la chirurgie reconstructive dans les cancers glottiques.

A retrospective study was carried out in 58 patients operated between 1978 and 1983 for cancer of larynx of glottic origin and mainly T1 and T2. Functional results were always of good quality, and the recurrence rate significantly lowered by the use of the Majer-Piquet or C.H.E.P. procedure when compared with results after thyroidectomy. A simplified technique is proposed.