[Diagnosis and therapeutic pathways in head and neck cancers]. / Parcours de soins du patient présentant un carcinome epidermoïdes des voies aéro-digestives supérieures.

BACKGROUND: Cancers of uppers aero-digestives tracts represent, infrequency, the 5th cancer in the French population. Most of them (about 70%) are diagnosed at an advanced stage (stage III or IV) while they are associated with a poor prognosis (only 40% five year survival). The objective of our study was to analyze the care pathway of patients with cancers of uppers aero-digestives tracts in order to target efforts to improve the survival of these patients. METHODS: It was a descriptive and retrospective study, on medical files, on the health care pathway of patients with cancers of uppers aero-digestives tracts cared in the Head and Neck surgery department of Val de Grâce in Paris and Percy in Clamart between January 2004 and December 2006. The patients were adults with squamous cell carcinoma of uppers aero-digestives tracts. RESULTS: One hundred thirty-eight files of patients were analyzed. Fifty-five percent of patients were diagnosed at an advanced stage. On average patients have waited two months and twenty-one days before consulting a doctor for the first time. The time interval between the specialist consultation and the start of treatment was on average 7 weeks. The overall 5-year survival rate was 61%. CONCLUSION: Squamous cell carcinoma of uppers aero-digestives tracts remains serious and has a poor diagnosis, even in a population with a high social-cultural level. The long time interval before the first consultation may be reduced by improving health education among the general practitioner (primary and secondary prevention), and by establishing health care public campaigns. This would allow earlier diagnosis, more conservative therapeutic opportunities and therefore a better prognosis.

[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases]. / Les cellulites cervico-médiastinales nécrosantes. A propos de 3 cas.

OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. MATERIALS AND METHODS: Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived. DISCUSSION: Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.

Identification and characterization of the mRNA for major storage proteins from radish.

Precursors for radish storage proteins were identified by immunoprecipitation of cell-free protein-synthesis products. The 12S globulin polypeptides (21,000-33,000 Mr) are made from four larger precursors (47,500-60,000 Mr) and the 1.7 S albumin polypeptides (7,000-12,000 Mr) are synthesized as eight products of Mr about 20,000. From a cDNA library, several clones have been identified, using heterologous cDNA probes for rapeseed cruciferin and napin, and two of them (pAE10 and pBA3) used to hybrid-select the corresponding mRNA. The napin cDNA clone selects all translation products immunoprecipitated by anti-napin antibodies whereas the cruciferin clone selects only one polypeptide among the four recognized by 12S antibodies. The 12S globulin and the 1.7S albumin message sizes were estimated to be 1950 and 800 nucleotides respectively. Experiments carried out with mRNA populations from different maturation stages suggest a sequential gene expression for the two major storage protein families. In addition two napin subfamilies can be distinguished by their expression pattern. In dry seed, napin mRNA is not detectable and the amount of cruciferin mRNA decreased considerably so that it no longer represents a major fraction of dry seed mRNA.