Subcutaneous immunotherapy suppresses Th2 inflammation and induces neutralizing antibodies, but sublingual immunotherapy suppresses airway hyperresponsiveness in grass pollen mouse models for allergic asthma.

BACKGROUND: Both subcutaneous and sublingual allergen immunotherapy (SCIT and SLIT) have been shown to effectively suppress allergic manifestations upon allergen exposure, providing long-term relief from symptoms in allergic disorders including allergic asthma. Clinical studies directly comparing SCIT and SLIT report a different kinetics and magnitude of immunological changes induced during treatment. Comparative studies into the mechanisms underlying immune suppression in SCIT and SLIT are lacking. OBJECTIVE: We aimed to establish an experimental model for grass pollen (GP) SCIT and SLIT that would allow a head-to-head comparison of the two treatments. METHODS: BALB/c mice were sensitized with GP extract, followed by SCIT and SLIT treatments with various GP dosages. Subsequently, we challenged mice with GP and measured airway responsiveness (AHR), GP-specific immunoglobulins, ear swelling tests (EST), eosinophilic inflammation in bronchoalveolar lavage fluid (BALF), and T cell cytokine release after restimulation of lung cells (IL-5, IL-10, and IL-13). RESULTS: We find that SLIT treatment was able to suppress allergen-induced AHR, while allergic inflammation was not effectively suppressed even at the highest GP dose in this model. In contrast, SCIT treatment induced higher levels of GP-specific IgG1, while SLIT was superior in inducing a GP-specific IgG2a response, which was associated with increased Th1 activity in lung tissue after SLIT, but not SCIT treatment. Interestingly, SCIT was able to suppress Th2-type cytokine production in lung cell suspensions, while SLIT failed to do so. CONCLUSIONS AND CLINICAL RELEVANCE: In conclusion, GP-SCIT suppresses Th2 inflammation and induced neutralizing antibodies, while GP-SLIT suppresses the clinically relevant lung function parameters in an asthma mouse model, indicating that the two application routes depend on partially divergent mechanisms of tolerance induction. Interestingly, these data mirror observations in clinical studies, underscoring the translational value of these mouse models.

[Cutaneous foreign body granulomas following cervico-facial arterial embolization: Three cases]. / Granulomes cutanés à corps étrangers après embolisation artérielle de la sphère cervico-faciale : trois cas.

BACKGROUND: Foreign body granuloma is an inflammatory tissue reaction to exogenous material. Classically it appears on the face after aesthetic procedures. Herein we report for the first time three cases of facial granulomatous reactions to microbeads after arterial cervico-facial embolization. PATIENTS AND METHODS: Three patients underwent embolization of the facial arteries using Embogold® microbeads in a setting of epistaxis or tumoral hemostasis. Within 10 to 45 days painful, inflammatory, subcutaneous nodules appeared on the homolateral side of the face. Histological samples showed an inflammatory response with giant cells as well as the presence of microbeads in the skin. A favorable outcome was achieved with colchicine in one patient and with surgery in another; the third patient was lost to follow-up. DISCUSSION: The embolizing microspheres produced a local inflammatory reaction, with destruction of the vascular wall and bead migration to facial tissue leading to a granulomatous reaction. The occurrence of three cases within a period of few weeks, with several different operators and batches of products, is surprising considering the long-standing use of the product. There was no common comorbidity in the patients and no suggestion of trauma. Retrospective analysis of the product batches was normal. Gold staining could play a role in severe inflammatory response to Embogold® particles. CONCLUSION: These three cases illustrate the value of discussing potential foreign body granulomatous reaction in cases of facial nodules following cervico-facial embolization. Colchicine may offer a valuable therapeutic alternative.

Pim1 kinase protects airway epithelial cells from cigarette smoke-induced damage and airway inflammation.

Exposure to cigarette smoke (CS) is the main risk factor for developing chronic obstructive pulmonary disease and can induce airway epithelial cell damage, innate immune responses, and airway inflammation. We hypothesized that cell survival factors might decrease the sensitivity of airway epithelial cells to CS-induced damage, thereby protecting the airways against inflammation upon CS exposure. Here, we tested whether Pim survival kinases could protect from CS-induced inflammation. We determined expression of Pim kinases in lung tissue, airway inflammation, and levels of keratinocyte-derived cytokine (KC) and several damage-associated molecular patterns in bronchoalveolar lavage in mice exposed to CS or air. Human bronchial epithelial BEAS-2B cells were treated with CS extract (CSE) in the presence or absence of Pim1 inhibitor and assessed for loss of mitochondrial membrane potential, induction of cell death, and release of heat shock protein 70 (HSP70). We observed increased expression of Pim1, but not of Pim2 and Pim3, in lung tissue after exposure to CS. Pim1-deficient mice displayed a strongly enhanced neutrophilic airway inflammation upon CS exposure compared with wild-type controls. Inhibition of Pim1 activity in BEAS-2B cells increased the loss of mitochondrial membrane potential and reduced cell viability upon CSE treatment, whereas release of HSP70 was enhanced. Interestingly, we observed release of S100A8 but not of double-strand DNA or HSP70 in Pim1-deficient mice compared with wild-type controls upon CS exposure. In conclusion, we show that expression of Pim1 protects against CS-induced cell death in vitro and neutrophilic airway inflammation in vivo. Our data suggest that the underlying mechanism involves CS-induced release of S100A8 and KC.

Characterization of phenol and alkyl phenols in organic matrixes with monoethylene glycol extraction and multidimensional gas chromatography/mass spectrometry.

The use of monoethylene glycol as an extraction medium for removing phenol and alkyl phenols in organic matrixes such as hydrocarbons is introduced and combined with a practical analytical multidimensional gas chromatography approach. The analytical approach has been successfully developed for the characterization of phenol, cresols, xylenols, and alkyl phenols like 4-ethylphenol and 2,3,5-trimethylphenol. The technique employs a single-step extraction of the analytes with monoethylene glycol and sonication, followed by multidimensional gas chromatography with mass spectrometry in selected ion monitoring mode for the detection and quantitation. Extraction efficiency of phenol approached 100% while cresols, xylenols, and 4-ethylphenol were 97% or higher and 2,3,5-trimethylphenol was better than 91% under the analytical conditions used. With the technique described, a complete analysis can be conducted in less than 16 min. Reproducibility of area counts at two levels, namely, 5 ppm(w) and 50 ppm(w) over a period of 2 days were found to be less than 4% (n = 20). The analytes of interest was found to be linear over a range from 100 ppb(w) to 250 ppm(w) with correlation coefficient of at least 0.999 and detection limit of 50 ppb(w) . Spike recoveries from 500 ppb(w) to 250 ppm(w) for all analytes range from 96 to 102%.

Temperature-programmable resistively heated micromachined gas chromatography and differential mobility spectrometry detection for the determination of non-sulfur odorants in natural gas.

A portable, fast gas chromatographic method for the direct measurement of the parts per billion level of sulfur-free odorants in commercially available natural gas is introduced. The approach incorporates a resistively heated, temperature-programmable silicon micromachined gas chromatograph that employs a standard capillary column for the fast separation of methyl and ethyl acrylate from the natural gas matrix. The separation approach is coupled to a micromachined differential mobility detector to enhance analyte detectability, and the overall selectivity obtained against the matrix is described. A complete analysis can be conducted in less than 70 s. Furthermore, these two compounds can be measured accurately in the presence of other common volatile sulfur-based odorants such as alkyl mercaptans and alkyl sulfides. Repeatability of less than 3% RSD (n = 20) over a range from 0.5 to 5 ppm was obtained with a limit of detection for the target compounds at 50 ppb (v/v) and a linear range from 0.5 to 50 ppm with a correlation coefficient of at least 0.997.

The composition of house dust mite is critical for mucosal barrier dysfunction and allergic sensitisation.

BACKGROUND: House dust mite (HDM) allergens have been reported to increase airway epithelial permeability, thereby facilitating access of allergens and allergic sensitisation. OBJECTIVES: The authors aimed to understand which biochemical properties of HDM are critical for epithelial immune and barrier responses as well as T helper 2-driven experimental asthma in vivo. METHODS: Three commercially available HDM extracts were analysed for endotoxin levels, protease and chitinase activities and effects on transepithelial resistance, junctional proteins and pro-inflammatory cytokine release in the bronchial epithelial cell line 16HBE and normal human bronchial cells. Furthermore, the effects on epithelial remodelling and airway inflammation were investigated in a mouse model. RESULTS: The different HDM extracts varied extensively in their biochemical properties and induced divergent responses in vitro and in vivo. Importantly, the Greer extract, with the lowest serine protease activity, induced the most pronounced effects on epithelial barrier function and CCL20 release in vitro. In vivo, this extract induced the most profound epithelial E-cadherin delocalisation and increase in CCL20, CCL17 and interleukin 5 levels, accompanied by the most pronounced induction of HDM-specific IgE, goblet cell hyperplasia, eosinophilic inflammation and airway hyper-reactivity. CONCLUSIONS: This study shows the ability of HDM extracts to alter epithelial immune and barrier responses is related to allergic sensitisation but independent of serine/cysteine protease activity.

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSION: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population. / Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). MATERIAL AND METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSIONS: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

Management of cervical lymph node recurrence of melanoma of the head and neck.

OBJECTIVES: To compare the diagnostic accuracy between Positron emission tomography using 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG-PET scan) and conventional work-up such as ultrasound (US) and/or Computed tomography (CT) in the detection of cervical lymph node recurrences of melanoma of the head and neck after initial cervical lymph node surgery. METHODS: A retrospective review was performed on patients who presented with clinical and/or radiological suspicion of isolated cervical lymph node recurrence after lymph node surgery from April 2004 to January 2007. All patients underwent CT and/or US of the neck, and FDG-PET scan before salvage neck dissection. None of included patients had clinical or radiological detectable distant metastases at the time of the lymph node dissection. Performances of conventional imaging and FDG-PET scan in detection of lymph node recurrence were calculated and compared by using the histopathological results of lymphadenectomy as gold standard with Fischer's exact test. RESULTS: Of the twelve cases in included in the study (9 patients, 3 of them had 2 consecutive lymph node redissection for a second lymph node recurrence), melanoma recurrence was found in 10 cases (83%). Sensitivity, specificity, positive predictive value and negative predictive values were 78.6%, 40%, 78.6%, and 40% respectively for conventional imaging and 85.7%, 40%, 80% and 50% for FDG-PET scan. No statistically significant difference was found between the 2 methods. CONCLUSION: This is the first study that compares the diagnostic accuracy between FDG-PET scan and conventional imaging in the detection of cervical lymph node recurrence of melanoma of the head and neck. Our results showed that FDG-PET scan is actually not better than conventional imaging to detect these cervical lymphatic recurrences.

Capillary flow technology with multi-dimensional gas chromatography for trace analysis of oxygenated compounds in complex hydrocarbon matrices.

By employing multi-dimension gas chromatography with capillary flow technology in combination with highly selective capillary columns and a pressurized liquid injection system, light oxygenated compounds such as methanol, ethanol, n-propanol, 2-propanol, and n-butanol in the presence of either light hydrocarbon, heavy hydrocarbon, or aromatic matrices can be measured accurately with minimal possibility of a false positive. Using this technique, a detection limit of at least 0.20 ppm (w/w) with a linear correlation coefficient greater than 0.9993 over a range from 0.5 ppm to 600 ppm (w/w) and a relative standard deviation of greater than 2.7% are achieved for the solutes tested. The technique can also be effective for the measurement of other classes of oxygenated compounds such as ethers, aldehydes, and ketones. Another added benefit for the implementation of capillary flow technology is the capability to conduct column back-flushing, where heavier, undesired solutes in a sample can be back-flushed from the chromatographic system to improve system cleanliness and sample throughput.

Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española / Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population

Introducción: En España el ictus es la sexta causa de discapacidad. Sus secuelas producen alteraciones motoras, sensoriales y cognitivas, que pueden minimizarse con una actuación terapéutica temprana. Por ello se necesitan instrumentos de evaluación rápida que detecten déficits en estas áreas. El Oxford Cognitive Screen Test (OCS) es un test breve diseñado para la valoración de funciones cognitivas en pacientes con ictus. Nuestro objetivo fue generar una versión española (OCS-E) realizando una adaptación lingüística y cultural.Material y métodosDiseño de validación lingüística con doble traducción y 10 reuniones de consenso del equipo investigador multidisciplinar. Tres estudios piloto administrando el test respectivamente a 5 usuarios potenciales, 23 personas sanas y 23 diagnosticadas de ictus isquémico (61%) o hemorrágico, con edades entre 31-88 años.ResultadosEl OCS-E mantiene las 10 tareas originales, la codificación de respuestas y el sistema de puntuación. Se modificaron y ampliaron las instrucciones de administración, lo que asegura la fiabilidad del contenido y de su aplicación. En 5 tareas se han modificado imágenes, números y frases. La tarea praxia se amplió para evaluar ambos miembros superiores. Los estudios piloto confirmaron que las personas de la población diana comprendían de forma adecuada las tareas, con independencia de la existencia de problemas cognitivos.ConclusionesLa adaptación cultural ha generado una versión lingüística y conceptualmente equivalente, permitiendo su estudio psicométrico y posterior aplicación en población española. El OCS-E puede ser un instrumento de cribado útil para evaluación rápida de funciones cognitivas postictus. (AU)

Introduction: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S).Material and methodsThe linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years.ResultsThe OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems.ConclusionsThe OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke. (AU)

A symbolic-numeric approach to find patterns in genomes. Application to the translation initiation sites of E. coli.

DNA sequence data provided by genome sequencing programs open new research prospects. In this respect, computational investigations are of major importance to discover new 'functional/structural patterns' and to improve biological process knowledge. For example, even though the principal steps of translation initiation in prokaryotes are known, it is difficult to point out the exact pattern of the mRNA that is recognized by the ribosome. In this study, we have carried out a systematic context analysis of the complete genome of E. coli, around codons in competition for translation initiation. Using a combinatorial approach, we first show that it is possible to accurately define the initiation site by looking for the localization of patterns representing various combinations of trinucleotides. We have combined this approach with a statistical analysis based on the frequencies of these patterns. This leads to a decision tree, able to discriminate true and false starts with a recognition level near 90%. Our method may help to precisely localize the beginning of open reading frames, and point to likely mistakes for some genes in the database. The method may be included as a component of a gene recognition system, is not restricted to a particular genome or a two-classes discrimination, and may be applied to a broader class of biological patterns.

Computational aspects of protein identification by mass spectrometry.

Recent developments in proteomics and genomics provide huge quantities of data to analyze. Automatic interpretation of mass spectrometry data has become essential for high-throughput processes aiming to study complete proteomes. There exist two main sources of mass spectrometric data: peptide mass fingerprint and fragmentation spectra, both of which require specific bioinformatic algorithms. We present a survey of these algorithms and discuss the efficiency of the different approaches and the possible improvements that may lead to a complete automatic high-throughput identification process.

Clinical experience with Gore-Tex for vocal fold medialization.

OBJECTIVES/HYPOTHESIS: Present clinical experience with vocal fold medialization under local anesthesia using a Gore-Tex implant. The procedure consists of placing the implant into a pocket formed by dissection of the inner perichondrium of the thyroid cartilage through a small window made in the thyroid ala. STUDY DESIGN: During 2 years, we used this technique preferentially in 13 of the 16 cases of vocal fold medialization (three patients underwent Teflon injection because of a contraindication to local anesthesia). Follow-up was longer than 3 months in 11 cases (mean, 13 mo). METHODS: Vocal result was analyzed by the means of perceptual analysis and by the measurement of jitter factor. Glottal leakage was evaluated perceptually using videolaryngoscopy, and oral airflow was measured during the production of a vowel. In cases with preoperative aspiration, videofluoroscopy was performed. RESULTS: Implantation was successful in all but one patient in whom extrusion of the implant material occurred. In the latter case, the implant was removed and the patient recuperated his preoperative voice without any other complication. In the 10 other cases, voice improvement assessed by perceptual and objective evaluation was satisfactory. CONCLUSIONS: Results compare favorably with those of endoscopic techniques using Teflon or collagen and laryngeal frame surgery techniques using silicone or cartilage. We conclude that Gore-Tex implantation is a simple, reproducible, and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.

Partial frontolateral laryngectomy with epiglottic reconstruction for management of early-stage glottic carcinoma.

OBJECTIVES: The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma. STUDY DESIGN: Retrospective study. METHODS: Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased. RESULTS: Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five-year survival rates calculated according to the Kaplan-Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow-up of 5 years. CONCLUSION: These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.

[Psychoactive drug use in nursing homes]. / Utilización de fármacos para el sistema nervioso central en residencias geriátricas.

BACKGROUND: Our purpose was to know the use of psychoactive drugs including neuroleptics (NL), benzodiazepines (BNZ) and antidepressants (AD) in nursing homes (NH) in the city of Barcelona. METHOD: Cross-sectional descriptive study of 384 clinical records of people living in 19 NH. The correct use of drugs was estimated by Garrad's and Beers et al criteria. RESULTS: Average age (SD) of residents was 83 years (2.0). The average consumption of drugs was 5 (2.7); 248 individuals (64.6%) were taking at least one psychoactive drug: 81 (21%) consumed NL, 179 (46.6%) BNZ and 73 (19%) AD. 48 (12.5%) NH residents consumed long-acting BNZ and 26 (6.7%) had surpassed the recommended time of consumption for short-acting BNZ. In 21 (26%) NH residents who consumed NL, its use would not be justified. CONCLUSIONS: It is necessary to reduce the use of long-acting BNZ, to encourage a correct use of NL and to achieve a correct identification of depressive disorders in NH.

[Extensive pharyngeal necrosis: an unusual complication of dermatomyositis]. / Nécrose pharyngée extensive: complication exceptionnelle d'une dermatomyosite.

To our knowledge, the occurrence of extensive pharyngeal necrosis in patients with dermatomyositis has not yet been reported. We report such a case characterized by a vast ulceration of the posterior laryngeal wall, extending from the velum palati to the larynx and responsible for both dysphagia and dysphonia. Treatment with an immunosuppressant had no effect on the lesions.

[Superficial temporal fascia pedicle flap. Applications in cervicofacial surgery. Apropos of 20 cases]. / Le lambeau pédiculé de fascia temporal superficiel. Applications en chirurgie cervico-faciale. A propos de 20 cas.

The superficial temporal fascia is formed by a fine fibro-muscular layer situated between the subcutaneous plane of the temporal region and the temporal muscle aponeurosis. The superficial temporal artery and its branches run within the fascia which acts as a veritable vessel carrying sheet. The therefore useful in that in minimises esthetic and functional complications at the donor site. This reliable, polyvalent arterialised aponeurotic type flap behaves above all as a covering or interpositional flap. Our clinical experience involves 20 cases, in addition to the applications already published: covering material in cases of loss of facial substance, otopoiesis, organisation of open techniques, we propose its use during oro-bucco-pharyngoplasty and for sealing the base of the skull.

[Surgery for hyperthyroidism. Results and current trends]. / La chirurgie de l'hyperthyroïdie. Résultats et orientations actuelles.

From 1974 to 1990, the same surgeon operated 96 cases of hyperthyroidism: 72 cases of Basedow's disease, and 24 basedoid goiters. The preliminary preparation with antithyroid agents, sedation, Lugol and beta-blockers is particularly important, as is rehydration, high-dose sedation and beta-blockers, if required, during the postoperative period. There are few complications: 1 hematoma, 1 permanent unilateral laryngeal paralysis, 1 permanent hypocalcemia, 5 transient psychical and/or cardiac disorders, 1 malignant exophthalmia. There was no thyrotoxic crisis. Long-term follow-up allows nothing 4 recurrences as well as hypothyroidism in 46% of all cases. The size of the thyroid remains left in place is closely related to hypothyroidism. One case of vesiculo-papillary carcinoma is noted among the 24 cases of basedoid goiters (4.5%), which justifies total thyroidectomy in such cases. There also was one papillary carcinoma among the 72 patients with Basedow's disease (1.3%).

[The pectoralis myofascial flap in oropharyngeal and pharyngolaryngeal reconstruction in salvage surgery]. / Applications du lambeau fascio-musculaire de grand pectoral dans la chirurgie de l'oro-bucco-pharynx et pharyngo-laryngé en rattrapage.

BACKGROUND: The pectoralis major myofascial (PMMF) flap is rapidly mobilized, reliable in a number of clinical situations calling for vascularized soft tissue coverage in the head and neck. Salvage surgery after radiation failures produce salivary fistula, skin flap necrosis, vascular rupture. Use of PMMF improves healing in such cases. METHODS: A retrospective review performed at the university hospital, Marseille, between August 1987 and August 1999, was undertaken in two groups of salvage surgery. Groupe 1: protection of great vessels and fistula prevention after total laryngectomy (TL) and pharyngolaryngectomy (PL). Groupe 2: intra oral and pharyngeal defects reconstruction. Outcomes were classified in three types: type 1 - no complications; type 2 - delayed healing; type 3 - complicated healing. In groupe 2, in six cases the amount of flap contraction was analysed by C.T. scan. RESULTS: 83 PMMF was performed. Groupe 1, 57 cases (TL 28 cases, PL 26 cases); groupe 2, oral cavity défect 9 cases; oropharyngeal défects; 17 cases. There was no flap necrosis or vascular rupture. The donor site complications rate was 9.2%. The overall complications follow up was; groupe 1; type 1: 66%; type 2: 32%; type 3: 2%. In the groupe 2, type 1: 81%; type 2: 19%; type 3: 0%. The flap contracture was 30%. The use of PMMF in salvage surgery must be indicated in all cases after TL or PL, and is an excellent alternative from soft tissue coverage of oropharyngeal defects.