Value of sentinel lymph node biopsy in papillary thyroid cancer: initial results of a prospective trial.

The objectives of the study were to evaluate the performance of sentinel lymph node biopsy (SLNB) in detecting occult metastases in papillary thyroid carcinoma (PTC) and to correlate their presence to tumor and patient characteristics. Twenty-three clinically node-negative PTC patients (21 females, mean age 48.4 years) were prospectively enrolled. Patients were submitted to sentinel lymph node (SLN) lymphoscintigraphy prior to total thyroidectomy. Ultrasound-guided peritumoral injections of (99m)Tc-phytate (7.4 MBq) were performed. Cervical single-photon emission computed tomography and computed tomography (SPECT/CT) images were acquired 15 min after radiotracer injection and 2 h prior to surgery. Intra-operatively, SLNs were located with a gamma probe and removed along with non-SLNs located in the same neck compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted to histopathology analysis. Sentinel lymph nodes were located in levels: II in 34.7 % of patients; III in 26 %; IV in 30.4 %; V in 4.3 %; VI in 82.6 % and VII in 4.3 %. Metastases in the SLN were noted in seven patients (30.4 %), in non-SLN in three patients (13.1 %), and in the lateral compartments in 20 % of patients. There were significant associations between lymph node (LN) metastases and the presence of angio-lymphatic invasion (p = 0.04), extra-thyroid extension (p = 0.03) and tumor size (p = 0.003). No correlations were noted among LN metastases and patient age, gender, stimulated thyroglobulin levels, positive surgical margins, aggressive histology and multifocal lesions. Sentinel lymph node biopsy can detect occult metastases in PTC. The risk of a metastatic SLN was associated with extra-thyroid extension, larger tumors and angio-lymphatic invasion. This may help guide future neck dissection, patient surveillance and radioiodine therapy doses.

A prospective study of long-term dysphagia following total laryngectomy.

OBJECTIVE: To evaluate the degree of dysphagia in patients before and after total laryngectomy using the Performance Status Scale for Head and Neck Cancer Patients (PSS) and to determine the effects of post-operative radiation therapy, neck dissection, and pharyngoesophageal spasm on PSS scores. METHODS: We performed a controlled, prospective study at a tertiary referral university hospital. Twenty consecutive patients undergoing laryngectomy were included. Patients were followed for at least two years post-operative, without evidence of local, regional, or distant disease. Only patients with squamous cell carcinoma limited to the endolarynx requiring total laryngectomy with or without elective neck dissection for surgical management of cancer and with no pre-operative treatment were included. Dysphagia was evaluated by PSS prior to surgery and again two years postoperatively with an emphasis on eating in public and normalcy of diet domains. Video fluoroscopic evaluation of swallowing was performed one year after treatment. RESULTS: The relative number of patients with low mean scores in PSS (i.e. usually swallow paste of fluid food in presence of some selected persons or alone; < or = 50) increased after total laryngectomy (p = 0.04). Patients with lower scores reported more frequent spasm of the pharyngoesophageal segment (p = 0.005). Mean scores of both domains decreased after surgery (p < 0.05). CONCLUSION: Eating in public and normalcy of diet scores decreased in 50% of patients after total laryngectomy.

Estimation of the bronchodilatory effect of deep inhalation after a free run in children.

The bronchomotor effects of a deep inhalation (DI) may provide relevant information about the mechanisms of exercise-induced airway obstruction in children and may be assessed by respiratory conductance (Grs) measured using the forced oscillation technique. The aims of the present study were to assess the effect of DI on Grs after exercise in relationship to the lung function response to exercise. Grs at 12 Hz using a head generator and spirometric data were measured in 62 children suspected of asthma before and 5 min after a 6-min free run. After exercise, Grs was significantly increased by DI in 38 subjects, who also showed larger Grs and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) responses to exercise than the 24 nonresponders. Stepwise regression indicated significant correlation between the response of Grs to DI and both Grs and FEV1/FVC responses to exercise. The data are consistent with exercise-induced bronchoconstriction being reversed by deep inhalation.

[Treatment of exacerbations of chronic obstructive pulmonary disease with pristinamycin]. / Traitement des exacerbations de broncho-pneumopathie chronique obstructive (BPCO) par la pristinamycine.

BACKGROUND: Pristinamycin is a bactericidal antibiotic whose spectrum covers the main respiratory pathogens including S. pneumoniae poorly sensitive to penicillin. It has not yet been evaluated in short course treatment of acute exacerbations of chronic obstructive bronchitis (AECB). METHODS: 476 patients suffering from an AECB were randomised to either a short course of pristinamycin, 3 G daily for 4 days, or conventional treatment with co-amoxiclav (AAC) 2G daily for 8 days. The duration of follow-up was 6 months. RESULTS: The clinical success rate at 21 days was the same in both groups at 87.2% and 87.9%, CI95% [-7.0%, 6.0%], in the protocol population (FEV1<80%). Among the 120 patients in whom a bacterial pathogen was isolated at the time of inclusion a satisfactory bacteriological response was obtained in 84.6% of the PRI patients against 78.2% of the AAC patients. The time to relapse was comparable with a relapse rate of 25% reached in 128 days in the PRI group and 125 days in the AAC group. Treatment related side effects occurred in 9.2% of the PRI group and in 10.6% of the AAC group. CONCLUSION: Pristinamycin 3 G daily for 4 days is as effective and well tolerated as co-amoxiclav 2G daily for 8 days in the treatment of AECB.

[Efficiency of a four-day course of pristinamycin compared to a five-day course of cefuroxime axetil for acute bacterial maxillary sinusitis in adult outpatients]. / Efficacité comparée de la pristinamycine en quatre jours et du céfuroxime axétil en cinq jours dans le traitement des sinusites maxillaires aiguës bactériennes de l'adulte.

OBJECTIVE: The aim of this multicentric, randomized, double blind study was to demonstrate that a 4-day treatment with pristinamycin 1 g bid was as efficient as a 5-day treatment with cefuroxime axetil 250 mg bid in adults presenting with an acute maxillary sinusitis. DESIGN: The clinical diagnosis was based on the association of sub-orbital pain, purulent rhinorrhea and purulent discharge on the middle nasal meatus and was confirmed radiologically. A rhinoscopic bacteriologic sampling was made on the middle nasal meatus. RESULTS: Four hundred and eighty five patients were included in the study: in France (n = 301), Tunisia (n = 48), Poland (n = 69) and Argentina (n = 67) between January 2001 and February 2002. Cultures were positive in 199/434 patients (46%), mainly S. pneumoniae (34.2%), H. influenzae (21.5%), S. aureus (15.4%), and M. catharralis (7.9%). The clinical cure rate at day 12-19 in the per protocol population, the main study criterion, was equal to 91.4% (201/220) and 91.1% (195/214) respectively in the pristinamycin and cefuroxime axetil groups; delta = 0.14%; 95%CI: [-5.1%; 5.3%]. The non-inferiority of 4-day pristinamycin versus 5-day cefuroxime axetil was demonstrated. The efficacy at follow up after treatment (day 26-31) was 88.6% and 85.8% respectively, confirming the non-inferiority. The bacteriological cure rate at day 12-19 was 87% (87/100) and 87.9% (87/99) respectively. Both treatments were well tolerated. CONCLUSION: A 4-day course with pristinamycin 1 g bid is as effective as a 5-day course of cefuroxime axetil 250 mg bid in the treatment of acute maxillary sinusitis in adults.

Neck lymph node metastases to the posterior triangle apex: evaluation of clinical and histopathological risk factors.

BACKGROUND: Dissection of posterior triangle apex (APEX) is a surgical step in supraomohyoid and lateral neck dissections. The prevalence of lymphatic metastases at this site and the clinicohistopathologic conditions that influence their occurrence have not been established. We have evaluated the prevalence and the risk factors for cervical metastases in lymph nodes of the APEX. METHODS: Sixty-two neck dissections were performed in 51 patients with squamous cell carcinoma of the oropharynx, hypopharynx, oral cavity, glottic larynx, and supraglottic larynx or with primary occult tumor. We correlated the presence of positive metastases in the APEX with the neck level involved either clinically (CLIN) or histopathologically (H/P) and with the number of CLIN- or H/P-positive neck levels with metastases. The prevalence of metastases in the APEX in elective (N0) and therapeutic (N+) neck dissections was also compared. This prevalence was also compared with that for each neck level. The histopathologic comparisons between the APEX and the neck levels were calculated for N0, N+, and all neck dissections. The primary site of tumor was correlated with the presence of H/P-positive nodes in the APEX. RESULTS: The overall prevalence of lymphatic metastases in the APEX was 6.5%. The prevalence in N0 neck dissections was 2.3% and in N+ neck dissections it was 16.7%. The prevalence of lymphatic metastases in the APEX for primary tumors of pharynx was 23.1%, for the oral cavity it was 3.6%, and it was 0% for other sites. Metastases in the APEX were not influenced by the neck level with CLIN or H/P metastases in N+ necks. The number of CLIN- or H/P-positive neck levels had no influence on histopathologic metastases in the APEX. Factors that influenced metastases in the APEX were positive histopathologic metastases at level II for N0 neck dissections and positive histopathologic metastases at level II or III for all neck dissections. All the comparisons were analyzed using Fisher's or Poisson's test. CONCLUSIONS: The prevalence of histopathologic metastases in the APEX in N+ necks is 7.3 times greater than that of N0 necks and for primary tumors of pharynx it was 6.4 times greater than for the oral cavity and significantly greater than for the larynx. Histopathologic metastases at level II for clinically N0 necks and histopathologic metastases to level II or III for all neck dissections are risk factors for metastases in the APEX. The number of positive levels did not influence the prevalence of metastases in the APEX. There are no isolated metastases in the APEX of the posterior triangle.

Histopathological concept of chronic tonsillitis in children.

The purpose of this study was to ascertain to what degree the clinical entity recurrent tonsillitis (RT) is associated with a histopathological pattern of chronic tonsillitis. Cases of idiopathic tonsillar hypertrophy (ITH) not associated with recurrent infections were used for comparison. We performed a histopathological study of 126 palatine tonsils of children (57 cases due to RT and 69 due to ITH). The following features were evaluated: cryptal reticulation, the relative amount of diffuse and follicular lymphoid tissues, the intensity of parenchymal fibrosis, the papillary arrangements of the epithelium, the amount of debris in the lumen of the crypts, and the presence of keratin cysts. There was no significant quantitative difference between the two groups (RT and ITH) and we did not find a histological distinctive pattern of RT or ITH. Recurrent infection in the tonsils in children is not associated with a histopathological pattern which could be termed chronic non-specific tonsillitis and is clearly distinguishable from idiopathic tonsillar hypertrophy.

Histopathological comparison between tonsil and adenoid responses to allergy.

In a previous study of adenoid tissue from allergic and non-allergic patients, we concluded that in allergic children edema of the "chorium" was present in 80.4% and that treatment with antihistamine drugs may reduce this edema. The purpose of the present study was to compare the histopathology of the palatine tonsil and adenoid from allergic patients. Tissue samples were obtained from 153 patients (56 tonsils and 97 adenoids from allergic children). We analysed the intensity of the edema and its cellular components in the chorium of palatine tonsils and adenoids. The frequently seen edema in the adenoids was significantly different from that in the tonsils. The squamous epithelium of the tonsils was thicker and bad stronger intercellular junctions than the columnar epithelium of the adenoids. This fact probably makes difficult the contact of the antigen with the chorium.

Abscesso retrofaríngeo: dificuldades no diagnóstico / Retropharyngeal abscess: difficults in diagnosis

Os autores apresentam dois casos de abcesso retrofaringeo em criança, apontando suas dificuldades para o diagnóstico e alertando para importância de se ter em mente esta patologia, principalmente nos casos de toxemia com rigidez cervical e torcicolo, evitando-se, assim, com um tratamento adequadoas complicaçöes graves que podem ocorrer

Effect of dopamine on carotid chemoreceptor activity in newborn kittens.

In newborn kittens, intravenous bolus injections of dopamine may be inhibitory or excitatory to the carotid chemosensory activity. In order to further identify the role of dopaminergic mechanisms on the chemosensory activity in the kitten, 10 anesthetized, paralyzed and artificially ventilated kittens aged from 1 to 21 days were studied. The activity of a few chemoafferent fibers from one carotid sinus nerve was recorded at three levels of FiO2 in N2, 21, 8 and 100%, before and during a continuous dopamine infusion at a dose of 10 micrograms/kg/min. The immediate effect of dopamine usually was a transient inhibition of carotid chemosensory discharge. After 2 min of infusion, the activity had consistently increased from 4.5 +/- 0.8 to 8.8 +/- 1.4 impulses/s (mean +/- SEM, p < 0.05) in normoxia. Dopamine also significantly increased the steady state chemosensory response to hypoxia from 24.6 +/- 3.7 to 33.4 +/- 5.3 impulses/s. Hence, continuous infusion of dopamine has a dual effect on carotid chemoreceptor activity: early inhibition followed by excitation. The excitatory effect enhances the response to hypoxia. These data suggest that the dual effect of dopamine on carotid chemosensory discharge may be related to dopamine concentration in the carotid body.

Effects of dopamine on the carotid chemosensory response to hypoxia in newborn kittens.

In a previous study, it has been shown that bolus injections of dopamine could either stimulate or inhibit the carotid chemosensory discharge in the kitten (Marchal et al., 1992a). To further characterize dopaminergic mechanisms in the carotid body during development, the effects of a continuous infusion of dopamine on carotid chemosensory activity in air, hypoxia (8% O2 in N2) and hyperoxia (100% O2) were studied in ten anesthetized, paralyzed and artificially ventilated kittens, aged 1 to 21 days and in three adult cats. One carotid sinus nerve was prepared for recording the activity of a single or a few chemosensory afferents. In the kittens, the immediate effect of dopamine at the onset of infusion (10 micrograms/kg/min) was an inhibition of the discharge in five kittens, a progressive excitation in four and no change in one. Four minutes after the onset of dopamine infusion, there was a significant increase in chemosensory activity both in room air (from 4.5 +/- 0.8 impulse/sec to 8.8 +/- 1.4 impulse/sec, mean +/- SEM, P < 0.05) and in hypoxia (from 24.6 +/- 3.7 impulse/sec to 33.4 +/- 5.3 impulse/sec, P < 0.05) but not in hyperoxia (0.5 +/- 0.2 impulse/sec vs 0.7 +/- 0.3 impulse/sec). The adult cats received four successive dopamine infusions at the rate of 2.5, 5, 7.5 and 10 micrograms/kg/min, in an attempt to establish a dose-response relationship. The effects of dopamine infusions were consistent within, but variable between, cats. The onset of dopamine infusion was associated with an inhibition of the discharge in two cats, at all infusion rates. In one of them, chemosensory activity returned quickly to control and the response to hypoxia was enhanced. In the other cat, the inhibition of the discharge persisted for the duration of the infusion, and the response to hypoxia was inhibited. In the third cat, dopamine had no effect on the chemosensory discharge. The patterns of chemosensory responses evoked by dopamine are qualitatively similar in kittens and cats, but the excitatory type of response appear to be more readily elicited in the kitten.

Viscoelastic properties of rabbit lung during growth.

Viscoelasticity of air-filled isolated lungs of 1-120 day old rabbits was studied at a mean transpulmonary pressure (P1) of 0.65 kPa by measuring: (1) their stress relaxation (SR) following step volume changes (delta V) corresponding to 5% of the vital capacity; (2) their resistance (R1) and elastance (E1) during sinusoidal cycling at 11 frequencies (f) ranging from 0.01 to 0.65 Hz. SR data were analyzed by least-square regression using Hildebrandt's logarithmic model (Hildebrandt, J. (1970) J. Appl. Physiol. 28: 365-372): delta P1/delta V = A - B.log(t) where A is an index of elastance, and B/A is a measure of viscoelasticity. Coefficients A and B were also obtained from R1 and E1 according to: R1 = B/9.2 f and E1 = A + 0.25 B + B.log(2 pi f). Elastance corrected for lung weight increased by 40% between day 1 and days 3-7, and decreased thereafter to reach 30% of its initial value in 120 day old rabbits. B/A ratios also demonstrated an initial rise, followed by a progressive decrease. Values of B/A computed from R1 and E1 were similar to those derived from SR data in 1 day old rabbits, but were 20-30% larger in older animals, which indicates the presence of an additional rate-independent dissipation during flow. Total internal dissipation during cycling varied little with frequency; it was largest in 3-7 day old animals where it represented 20% of the stored elastic energy.