[Salvage surgery for upper aerodigestive tract tumours]. / Chirurgie de rattrapage dans les tumeurs des VADS.

Salvage surgeries of head and neck tumors are considered as poor satisfactory either for disease control results or for aesthetic and functional outcomes. Several improvements have been made possible since few years in all fields of oncologic treatments. A new approach must be initiated in that context, moreover since take in charge for head and neck region (exclusive initial medical treatment) let us consider an increasement of clinical situations for which a salvage therapy could be performed. The new surgery techniques have to be considered, reconstructive and guided by systems, which can improve surgical skills (navigation, robotic, sentinel node procedure, nervous detection and so on), the help of reirradiation techniques, the use of medical therapy during surgical procedure, the photodynamic therapy and all the help provided by new medical imaging and modern biology, which can determine more precisely the status of the cancer when it is taken in charge. The mastery of those techniques improvements must follow on an evolution of the concepts in the field of combined salvage treatments performed by multidisciplinary teams. Those treatments have to be realized in structures, which have the techniques and the multiple skills for allowing increasement of outcomes of those severe diseases.

Head and neck cancer in young people: a series of 52 SCCs of the oral tongue in patients aged 35 years or less.

CONCLUSION: Prognosis was very poor as soon as a local failure developed. Up-front treatment should be optimized to control this rare disease. We propose producing and reporting recommendations via a concerted oncologic physician referral network. OBJECTIVES: Squamous cell carcinoma (SCC) in young people is rare and the literature is confusing. This study was carried out to assess the demographics, clinical features, and treatment outcome in a cohort of patients aged 35 years or less with SCC of the oral tongue (SCCOT). PATIENTS AND METHODS: This was a multicenter retrospective study. Fifty-two patients treated between 1990 and 2000 were identified. Descriptive statistics were analyzed to assess demographic and tumor variables. RESULTS: The WHO performance status was excellent for all patients. Thirty-seven were classified as T1-T2 and 38 were N0. All of them except one were treated with curative intent. Treatment failures were observed in 25 patients (48%). Four patients could be successfully salvaged after SCCOT recurrence or progression. The disease-free survival (DFS) was 52% at 5 years. The 5-year overall survival (OS) rate was 64%. Factors that affected the OS were invasion of the floor (p=0.009), cross over of the midline (p=0.02), positive lymph nodes (p=0.02), and the lack of disease control (p=0.0001).

Rehabilitation of irradiated head and neck tissues by autologous fat transplantation.

BACKGROUND: Treatment of head and neck cancers allows good carcinologic results but induces aesthetic and functional sequelae. Autologous fat transplants have been used to correct aesthetic defects since the past century and exhibit many of the qualities of the ideal filler. Results reported here stem from experiences from 2000, with abdominal fat grafting in 11 patients who were referred to the authors' center for aesthetic subcutaneous or submucous head and neck reconstruction after radiotherapy. METHODS: Abdominal fat tissues were harvested, and injection into host sites was performed in a manner similar to that of the lipostructure technique described by Coleman. The postoperative follow-up periods ranged from 2 to 88 months (mean, 39.9 months). Clinical monitoring of the patients was carried out. Additional pathologic study was performed on irradiated tissues surrounding the scar and on abdominal fat and treated tissues. RESULTS: No surgical procedure complications occurred. For all cases, except for one patient, the rehabilitation was aesthetic and functional. The quality of life of the patients was improved. The pathologic data highlighted a decrease in irradiated morphologic patterns characterized by an absence of necrotic areas and a high vascular network density associated with a normal histologic structure. CONCLUSIONS: Fat tissues can be successfully transplanted into irradiated areas, inducing both aesthetic and functional improvement. The cellular and/or tissular mechanisms underlying these changes need further investigation.

Influence of regular proprioceptive and bioenergetic physical activities on balance control in elderly women.

BACKGROUND: Balance disorders increase considerably with age due to a decrease in posture regulation quality, and are accompanied by a higher risk of falling. Conversely, physical activities have been shown to improve the quality of postural control in elderly individuals and decrease the number of falls. The aim of this study was to evaluate the impact of two types of exercise on the visual afferent and on the different parameters of static balance regulation. METHODS: Static postural control was evaluated in 44 healthy women aged over 60 years. Among them, 15 regularly practiced proprioceptive physical activities (Group I), 12 regularly practiced bioenergetic physical activities (Group II), and 18 controls walked on a regular basis (Group III). RESULTS: Group I participants displayed lower sway path and area values, whereas Group III participants displayed the highest, both in eyes-open and eyes-closed conditions. Group II participants displayed intermediate values, close to those of Group I in the eyes-open condition and those of Group III in the eyes-closed condition. Visual afferent contribution was more pronounced for Group II and III participants than for Group I participants. CONCLUSIONS: Proprioceptive exercise appears to have the best impact on balance regulation and precision. Besides, even if bioenergetic activity improves postural control in simple postural tasks, more difficult postural tasks show that this type of activity does not develop a neurosensorial proprioceptive input threshold as well, probably on account of the higher contribution of visual afferent.

Physical activity improves gaze and posture control in the elderly.

Ageing is associated with a decrease in the quality of balance regulation, in particular through dysfunctions of gaze control and postural stabilization, which results in an increased risk of falling. Conversely, the practice of physical and sporting activities has been shown to improve every level of postural regulation. This study is to assess the effects of the practice of physical activities on vestibulospinal reflex and ocular movements of visual and vestibular origins in elderly people. Gaze control and posture stabilization were evaluated in 13 healthy aged women who regularly practised physical activities and in 13 healthy aged sedentary women of a similar age, by dynamic posturographic test with electromyography, as well as electronystagmography with caloric and rotational vestibular tests, ocular saccades, smooth pursuit and optokinetic tests. The gaze and posture control performance of the active group was better; the proprioceptive and vestibular sensitivities were higher, visual detection quality was good, and reaction time was low. Regular physical activity develops or maintains the efficiency of the reflexes involved in postural control, especially through adequate neurosensorial information, which allows the central integrative structures to generate a more appropriate motor response.

Unilateral trigeminal anaesthesia modifies postural control in human subjects.

The influence of trigeminal afferences on postural stabilization was tested. Twenty-seven subjects were recruited to evaluate the impact of trigeminal disturbance on orthostatic postural control before and after unilateral truncular anaesthesia of the mandibular nerve. Balance control quality was assessed using static posturography by means of statokinesigrams and lateral deviation. Postural control monitored by measuring the area covered by the centre of foot pressure decreases after anaesthesia in the eyes open condition. Postural deviation in the eyes closed condition was observed after anaesthesia in the controlateral side of anaesthesia. These data document the effects of trigeminal afferences on postural stabilization.

Mood states and anxiety influence abilities to maintain balance control in healthy human subjects.

Previous studies have shown that anxiety and balance disorders could be related; however, the association between psychological processes and equilibrium remains ambiguous. In this study, we have examined whether mood states and anxiety may influence the ability to use the somatosensory, visual and vestibular systems and affect balance control in healthy subjects. Seven male students were submitted to a program testing equilibrium over a 12-day period, during which moods and anxiety states were assessed using self-evaluated questionnaires. Significant negative correlations were found between moods, including anxiety, and the subject's sensory and motor systems of balance control, suggesting that low moods may alter balance performance. However, depending on the type of mood, it is likely that adverse changes in mood states may affect balance in different ways, either through the sensory organization or motor control.

Effects of exercise-induced fatigue with and without hydration on static postural control in adult human subjects.

Postural instability can be the result of various factors, including fatigue. Although it is well known that exercise-induced fatigue may be responsible for a decrease in performance, its effects on postural control, as well as those of hydration, have been relatively little explored. This study evaluated the effects of fatigue, with and without rehydration, on postural control in 10 healthy subjects who regularly practice sports activities. All subjects were submitted to three types of ergocycle exercises: maximal oxygen uptake (Vo2max) and submaximal exercises in no-hydrated and hydrated conditions at a power corresponding to approximately 60% of the Vo2max of each subject. Static posturographic tests were performed immediately before (control) and after exercises. The postural control performance decreased from the best to the worst: control, hydration, dehydration, and Vo2max. Fast Fourier transformation of the center of foot pressure showed three patterns of amplitude spectral density, with an increase of spectral amplitude for dehydration, more important for Vo2max conditions. Spectral amplitudes for control and hydration conditions were relatively similar. This hierarchy suggests that fatigue mainly alters muscular effectors and sensory inputs, such as proprioception, resulting in poor postural regulation. Moreover, fluid ingestion could be responsible for the preservation of muscular functions and of sensory afferences accurately regulating postural control.