Randomized study of 5 fluorouracil and cis platin as neoadjuvant therapy in head and neck cancer: a preliminary report.

A randomized prospective study of 5 fluorouracil (5-FU) and Cis platin preceding definitive local treatment for squamous cell carcinoma of the head and neck region was initiated in September 1986. Seventy-five patients were stratified by site (oral cavity-12, oropharynx-28, larynx-16, hypopharynx-19), and by Stage (Stage II-20, Stage III-43, Stage IV-12) and randomized to receive definitive local treatment (surgery and post-operative radiation or radiation alone) or chemotherapy followed by definitive local treatment. Chemotherapy consisted of three cycles of 120 hr 5-FU infusion 1 g/m2/day plus Cis platin 100 mg/m2 on day 1 on each cycle. Response to chemotherapy was complete in 17 patients (46%) for an overall response rate of 68%. All the patients have completed therapy with a median follow-up of more than 12 months. After local treatment, the complete response rate is 84% for the control group and 86% in the chemotherapy group. Actuarial disease-free survival at 1 year is 61% in the control group and 73% in the chemotherapy group (p = 0.25). These preliminary results show that in spite of initial tumor response, neoadjuvant chemotherapy does not improve long-term control and survival.

Effect of miglitol and acarbose on starch digestion, daily plasma glucose profiles and cataract formation.

The effect of two alpha - glucosidase inhibitors, acarbose and miglitol, on postprandial glucose levels following wheat and potato starch loading was evaluated in sand rats with resultant dramatically reduced postprandial glucose levels. The inhibitory effect on starch digestion was dose concentration-dependent. Eighty-six and 72% inhibition was reached with 1 mg of miglitol and acarbose, respectively. Daily plasma glucose profiles and cataract formation were determined following long-term feeding with a diet containing acarbose and miglitol. Both drugs led to a significant reduction in glucose levels, acarbose being more potent, possibly via inhibition and delay of carbohydrate digestion. Acarbose caused a marked decrease in cataract incidence; the mechanism for this effect requires more elucidation. Since acarbose delayed and possibly prevented cataract formation in sand rats, we support the concept of its use as an adjuvant in the treatment of diabetic patients.

[Postoperative iatrogenic lesions of the external branch of the accessory spinal nerve]. / Lésions iatroènes post-opératoires de la branche externe du spinal.

Iatrogenic lesions of the spinal nerve are rare and generally occur during cervicotomy for aetiological assessment of adenopathy. The spinal nerve is essentially damaged at two sites: the supraclavicular fossa (where the nerve is very superficial) and in the antero-lateral triangle of the neck (where the nerve approaches the sterno-cleido-mastoid muscle). The lesion of the spinal nerve essentially presents in the form of paralysis of the trapezius; which should be examined systematically postoperatively and at subsequent consultations, as the clinical signs may only develop after a certain latency period. The spinal nerve lesion requires early surgical repair (graft, suture) which gives the best results when it is associated with long-term, patient physiotherapy. Legally, the practitioner is generally condemned due to failure to obtain informed consent, which emphasises the importance of preoperative consultations during which the patients should be warned of the possibility of a lesion to this nerve.

[Drug ototoxicity. Medicolegal aspects]. / L'ototoxicité médicamenteuse. Aspects médico-légaux.

Drug ototoxicity is a preoccupying iatrogenic complication. Experimental studies over recent years, in particular a pharmacokinetic study of the elimination of aminoglycosides, have enabled the authors to define rules of prescription for parenteral aminoglycosides designed to reduce to a minimum the risk associated with their use. New aminoglycosides such as Netromycin appear to be associated with reduced toxicity. The medico-legal consequences of this complication are still rare, although more precise rules of prescription tend to make the experts more rigorous. The experimental evidence of cochleovestibular toxicity of aminoglycosides applied locally in the presence of a perforated tympanum leaves no room for doubt. The principal factor seems to be the duration of treatment. The prescription of a local aminoglycoside in the presence of a perforated tympanum would only appear to be justified from a legal point of view when absolutely indicated by antibiotic sensitivity tests.

[Iatrogenic complications of nasal sinuses surgery]. / Complications iatrogènes de la chirurgie nasosinusienne.

In order to illustrate the necessity of obtaining informed consent before any form of nasal sinus surgery, the authors present 23 cases of insurance claims filed between 1976 and 1986 in private practice. Ten serious complications (6 cases of blindness, 4 fractures of the anterior cranial (fossa) and eight cases of oculomotor nerve paralysis are reported. The legal proceedings demonstrate the real risks of radical surgery to the sinuses, as well as intranasal ethmoidectomy and rhinoplasties.

[Severe iatrogenic complications of surgery of the middle ear and their medicolegal aspects]. / Complications iatrogènes graves de la chirurgie de l'oreille moyenne et aspects médico-légaux.

The authors analysed 62 cases of severe iatrogenic complications occurring after middle ear surgery (death, cophosis, PFP) between 1976 and 1986. They compared their results to those of a similar study conducted between 1950 and 1975. They observed an increase in the number of legal proceedings, probably due more to the increased demand by patients than to a higher incidence of these complications. Civil proceedings are much more frequent than penal proceedings. The authors stress the importance attributed by judges to the expert report and to the obtaining of informed consent.

[Medicolegal aspects of esthetic surgery]. / Aspects médico-légaux de la chirurgie esthétique.

The particular features of the contractual agreement binding patient and plastic surgeon are recalled. The obligation of the result appears to be distorted in the course of jurisprudence. The severity of the judgements means that great care must be taken in the management before, during and after the operation (study of the patient's motivations, informed consent, iconographic survey, technical equipment, postoperative care,...). The problem of competence and the technical training of the surgeon are also discussed.

[Evaluation of cochleovestibular sequelae of craniocervical injuries]. / Evaluation des séquelles cochléo-vestibulaires des traumatismes cranio-cervicaux.

After reviewing the elements of cochleovestibular assessment designed to demonstrate objective disorders, the authors try to evaluate the principal sequelae of cranio-cervical trauma.

[Atypical involvement of undifferentiated carcinomas of the nasopharyngeal type. Apropos of 3 cases]. / Localisations atypiques des carcinomes indifférenciés de type nasopharyngé. A propos de 3 cas.

We report 3 cases of undifferentiated carcinomas of nasopharyngeal type (UCNT) found in unusual sites and compare them with histologically identical tumors found in the nasopharynx. Using viral serology and viral marquers found in the tumor cells, we looked for a link with the Epstein Barr Virus (EBV) which exists in the nasopharyngeal site. It appears that UCNT found in unusual sites have a poorer prognostic than the same nasopharyngeal tumors; no link was found with EBV. The number of published cases is too small to form a conclusion, therefore, we propose a systematic search for EBV, presenting our protocol, each time is discovered UCNT in an unusual site.

[Use of endoscopy in pituitary surgery]. / Utilisation de l'endoscopie dans la chirurgie pituitaire.

Endoscopy has changed many of surgical procedures concerning nasal and paranasal cavities. It has been proposed for transnasal removal of pituitary adenomas. The authors report their experience concerning four pituitary macroadenomas operated with the neurosurgical team of Sainte-Anne hospital. The endonasal trans-septal route seemed to be more anatomical and less traumatic than the rhinoseptal sublabial route. The 30 degrees rigid Hopkins endoscope was a good help for controlling the absence of any tumor remnant in the supra and parasellar regions after complete removal of the tumor performed through the endoscope or with the operating microscope. The authors discuss the advantages and limitations of such endoscopic procedures in the light of recent literature.

[Apropos of 2 cases of mucocele with major ophthalmologic complications treated by endoscopic endonasal surgery]. / A propos de deux cas de mucocèle avec complications ophtalmologiques majeures traitées par chirurgie endo-nasale endoscopique.

We report two cases of frontal and ethmoidal mucocele revealed by severe ophtalmologic complications and present the clinical data and computed tomography and magnetic resonance imaging results together with the treatment. The surgical approach and technique are discussed. Recovery of ophtalmologic deficiency was excellent.

[Atelectasis of the maxillary sinus. Analysis of progression stages. Apropos of 4 cases]. / Processus atélectasique du sinus maxillaire. Analyse des stades évolutifs. A propos de 4 cas.

We analyzed atelectasic processes occurring in the maxillary sinus. Several publications in the literature have tempted to analyze the pathogenesis. Clinically the processes are often silent and only revealed when the major opthalmological complication, enophthalmia, becomes patent. In other cases there is a long history of chronic sinusitis. There is a spectacular retraction of the maxillary sinus walls leading to collapse of the orbital floor and enophthalmia. We report four cases of maxillary sinusitis with atelectasia of the sinus walls at different stages of progression. These observations and data in the literature emphasize the importance, whatever the state of development, of endoscopic osteal decompression to avoid ophthalmological complications.

Dynamic changes in maternal decidual leukocyte populations from first to second trimester gestation.

INTRODUCTION: Decidual leukocytes are critical to the development of the fetomaternal interface, regulating tolerance to the semi-allogeneic fetus and vascular transformation of the uterine spiral arteries. Despite the continuation of these processes beyond the first trimester of pregnancy, the second trimester has largely been unstudied, with investigation focusing on early gestation and term tissues. We sought to characterize changes in decidual leukocyte populations from first to second trimester. METHODS: Multicolor flow cytometry was performed on isolated decidual leukocytes from elective terminations of pregnancy between 6 and 20 weeks of gestation for study of first (6-12 weeks) and second trimesters (13-20 weeks). Specific subpopulations were identified by comparison to isotype and fluorescent-minus-one (FMO) controls. RESULTS: Decidual natural killer cells (CD56(+)CD16(-)CD3(-)) did not change in number, although a population of dNK with decreased CD56 brightness was observed in second trimester decidua. CD14(+)HLA-DR(+) macrophage numbers declined from first to second trimester (p = 0.031), yet a CD163(+)CD206(+) subset designating alternatively activated M2-like macrophages increased during the same period (p = 0.015). Intermediate CD205(+) dendritic cells demonstrated significant decline (p = 0.022), but immature CD209(+) and mature CD83(+) dendritic cells did not differ between trimesters. Total CD3(+) and CD3(+)CD4(+) T lymphocytes increased (p = 0.0079, p = 0.0028); CD3(+)CD8(+) T cells trended towards increase but did not differ significantly. CONCLUSION: Several changes in leukocyte subsets are observed in the second trimester that promote a tolerogenic and angiogenic decidual microenvironment through mid-gestation.

Supracricoid partial laryngectomy: an alternative to total laryngectomy for locally advanced laryngeal cancers.

OBJECTIVES: The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges. STUDY DESIGN: We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004. RESULTS: Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival. CONCLUSION: Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

Preparation of a dietary fiber mixture derived from different sources and its metabolic effects in rats.

In this study we analyzed a commercial dietary fiber blend known as Fiber-Plus and a dietary fiber mixture (DFM) prepared in our lab (10% apple pectin, 10% orange pectin, 36% locust bean gum and 44% corncob composed of 56% fiber). DFM provided greater inhibition of starch digestion and glucose absorption (p < 0.05) than did Fiber-Plus. DFM was also found to be significantly more efficient (p < 0.05) than Fiber-Plus at reducing the glycemic response following starch loading. Rats fed DFM or corncob demonstrated a much lower glycemic response following a test meal as compared to those fed a fiber-free diet. Both fiber sources decreased fasting cholesterol and triglyceride concentrations; transit time was shortened and fecal values were higher than those of controls. beta-glucuronidase activity in intestinal segment contents and feces was lower in rats fed fiber. We conclude that DFM is effective in controlling plasma glucose and lipid levels. Corncob, a novel fiber source, could be beneficial in the treatment of gastrointestinal tract disorders and in the elimination of carcinogenic elements.

Beneficial effects of acarbose on daily plasma glucose profile and cataract development in sand rats.

Sand rats were used as a model for nutritionally induced type II (non-insulin-dependent) diabetes in an effort to evaluate the effect of acarbose on carbohydrate digestion. Daily plasma glucose profiles, insulin levels and weekly cararact development were determined following long-term feeding with a diet containing acarbose (20 or 40 mg/100 g diet). Acarbose not only dramatically decreased daily plasma glucose and insulin levels (p < 0.05) but also delayed, and possibly prevented, cataract formation in sand rats. The effect of acarbose persisted for 150 days. The control of daily plasma glucose levels and reduction of insulin levels obtained with acarbose may lead to the delay of cataract formation in sand rats. These results could have potential applications to diabetic patients as an adjunct treatment.

Tobacco industry smokers' rights publications: a content analysis.

OBJECTIVES: This study was undertaken to identify the content of tobacco industry smokers' rights publications and to analyze their major themes. METHODS: Fifty-eight issues of smokers' rights publications from 1987 to 1992 were selected at random and analyzed. The number of publications per year, number of mentions (sentences) in different thematic categories per year, and number of mentions per category per publication were examined. RESULTS: The number of smokers' rights publications increased rapidly from 1987 to 1992. The number of mentions across all thematic categories increased over time, with the largest numbers appearing in 1990, 1991, and 1992. The category of Political and Social Action comprised the highest average number of mentions across years. CONCLUSIONS: These publications appear to be consistent with past and present tobacco industry strategies to counter tobacco control efforts and negative public perceptions by attempting to refute scientific evidence about the health impact of environmental tobacco smoke. Additionally, they serve the industry goals of encouraging smokers to take action to protect their rights, mobilizing public opinion, and delaying societal rejection of smoking and secondhand smoke and acceptance of smoking restrictions.

Characteristics of sheltered care facility operators in California in 1973 and 1985.

During the past 20 years, sheltered care homes have become the primary supervised community residence for mentally ill patients outside of licensed hospitals. To determine factors associated with sheltered care operators' remaining in business, follow-up interviews were conducted in 1985 with operators of 151 sheltered care facilities in California whose operators had been surveyed in 1973. Fifty-five of the original operators continued to operate the facility at 12-year follow-up, and 96 were new to the facilities since 1973. Compared with the original operators, the new operators were younger and better educated, were more likely to be men, and were more likely to be totally dependent on the business for their income. Operators who were members of local associations for sheltered care operators were more likely to have remained in business over the 12-year period, as were those who owned facilities with more than six beds.