Intensive nutritional care for patients treated with radiotherapy in head and neck cancer: a randomized study and meta-analysis.

Nutritional care improves quality of life (QOL) in head and neck cancer patients treated with radiotherapy. The aim of our study was to determine whether intensive nutritional care (INC) would further improve QOL. In addition to a control group based on European and American guidelines, patients included in the INC group received six meetings with a dietitian. QOL was measured after radiotherapy using the EORTC QLQ-C30. We performed a meta-analysis to determine the best nutritional care. In the 87 patients, the QOL scores, weight, energy, and protein intakes were similar between the INC group (n = 43) and the control group (n = 44). The meta-analysis revealed no heterogeneity and significant differences in QOL (three studies) (p = 0.46) or weight changes after radiotherapy (four studies) (p = 0.06). The nutritional care specified in the European and American guidelines is composed of well-defined recommendations, and appears sufficient to maintain QOL without further intervention.

[Personal and social identity transformations that occur over time among patients with total laryngectomy]. / La laryngectomie totale ou la métamorphose identitaire.

OBJECTIVE: To examine personal and social identity transformations that occur over time among patients treated for laryngeal carcinoma with total laryngectomy. METHOD: Patients with laryngectomy and their family underwent interviews by a sociologist and a head and neck surgeon. RESULTS: The diagnosis of cancer fills the patient's mind with images of suffering and death. Their life trajectory is more often a downward spiral. Patients are so stigmatized by the neoplasic illness that they become marginal and live in social isolation. CONCLUSION: Being laryngectomized completely transforms patients' lives because this surgery induces their topple into the world of the disabled. Total laryngectomy has a negative connotation in our society. Therapists should take this reality into account and intensify their involvement before and especially after surgery.

Early response to chemotherapy in hypopharyngeal cancer: assessment with (11)C-methionine PET, correlation with morphologic response, and clinical outcome.

UNLABELLED: Neoadjuvant chemotherapy in hypopharyngeal cancer globally improves survival, but some patients do not respond to chemotherapy and adjuvant therapy is delayed. Prediction of response to chemotherapy may allow physicians to optimize planned treatment. The aim of this study was to compare treatment response assessed early with (11)C-methionine PET and morphologic response assessed after treatment completion with MRI. METHODS: Thirteen patients with previously untreated squamous cell carcinoma of the hypopharynx, T3 or T4, were included. All patients received 3 courses of chemotherapy comprising cisplatin and 5-fluorouracil. (11)C-Methionine PET was performed before and after the first course of chemotherapy. PET estimation of response was expressed in relative variation of mean standardized uptake value (SUVmean), maximal standardized uptake value (SUVmax), volume of (11)C-methionine tumor uptake, and total tumor uptake. Posttreatment response was assessed with MRI, which was performed before the first course and after treatment completion, and expressed in relative variation of tumor volume. Patients were considered responders if their tumor volume was reduced by more than 50%. RESULTS: The relative decrease in all PET parameters correlated significantly with the relative decrease in MRI volume. The larger area under the receiver operating characteristic curve was obtained for SUVmean (0.883), but that area was close to the area of SUVmax (0.857). For methodologic considerations, SUVmax was more reproducible. The optimal threshold of response for SUVmax was -25%, leading to a mean of 83% (range, 36%-93%) sensitivity and 86% (range, 42%-100%) specificity. Using this threshold, survival at 2 y was improved for responders (83%), compared with nonresponders (57%), but the difference was not statistically significant. CONCLUSION: (11)C-Methionine PET provides early useful information about changes in tumor metabolism induced by chemotherapy in hypopharynx cancer. (11)C-Methionine PET measurements correlate with end-of-treatment response evaluated with MRI and may thus be helpful to physicians in treatment planning by avoiding unnecessary chemotherapy courses for nonresponding patients.

Failure of antibiotic therapy in acute otitis media.

The aim of this retrospective study was to determine the possible causes of failure of antibiotic therapy in children with acute otitis media (AOM). Thirty-nine samples of middle-ear fluid were obtained by myringotomy from 31 children suffering from AOM, unrelieved by antibiotic therapy administered for over 48 hours. The samples were analysed by the usual microbiological techniques, including cultures, tests for beta-lactamase producing strains and the determination of the minimal inhibitory concentration of penicillin for Streptococcus pneumoniae. In 14 samples, no bacterial strains were detected in the cultures of middle-ear fluid; and in two samples the cultures revealed two strains of bacteria. The bacteria most frequently identified were Haemophilus influenzae, found in 11 samples, and Streptococcus pneumoniae, found in seven samples, of which four produced strains with reduced susceptibility to penicillin. The failure of antibiotic therapy in AOM appears to be related to the increased resistance of Haemophilus influenzae and to the reduced susceptibility of Streptococcus pneumoniae to penicillin. Other factors contributing to the failure of antibiotic therapy in AOM may be the viruses or the bacteria that produce multiple pathogens in the middle ear.

Anatomic variations of the arteries of the nasal fossa.

OBJECTIVE: This study was performed for knowledge about the vascular supply of the nasal fossa and a description of the site of division and number of branches of the sphenopalatine artery. STUDY DESIGN: This study was performed on 10 fresh nonembalmed cadavers. Anatomic variations of nasal fossa arteries were studied. METHODS: First, 10 cephalic anatomic preparations were injected with red color latex into the right and left carotid arteries. Then, these specimens were sagittaly cut to dissect the sphenopalatine artery. Twenty vascularization cases were studied for the external branch of the sphenopalatine artery, and 10 cases were studied for the internal branch. RESULTS: The principal observations were: 1. the sphenopalatine artery division is 18 times in the infratemporal fossa and twice in the nasal fossa; 2. the nasopalatine artery supplies blood to the lower part of the septum and its anterosuperior area; and 3. the vascularization of the external wall is via the sphenopalatine artery through the arteries of the meatus and conchae. CONCLUSION: This study defines the vascular territories of the nasal fossa arteries and includes photographs of dissections.