[How I do it: salivary duct preservation in the excision of small oral tumors]

Benign tumors, in-situ carcinomas and small carcinomas of the anterior floor mouth or of the internal surface of the cheek may require resection of salivary duct papilla i.e. papilla of submandibular duct or Stensen's duct. If a lymph node dissection is not required, excision of submandibular or parotid duct which papilla is interested in the resection can be avoided using a surgical technique not reported. The authors present two cases illustrating a simple surgical proceeding of salivary duct resection/transposition. The present method can be used to keep a functional principal salivary gland with an optimal oncologic result.

Usefulness of estimated surface area of damaged skin as a proxy of mite load in the monitoring of sarcoptic mange in free-ranging populations of Iberian wild goat, Capra pyrenaica

In this study we examined the influence of several factors, like the surface of skin with lesions attributable to Sarcoptes scabiei, the time of year and host sex and age on variations of mite load in Iberian wild goats, Capra pyrenaica, from the Sierra Nevada Natural Space, southern Spain. As well, the surface area of skin with scabietic lesions estimated during field surveys were compared with measurements taken in the laboratory and the potential for using categories based on surface areas estimated during monitoring and management programs was analyzed. The surface area of the skin lesions measured in the laboratory and the time of year were the main factors affecting mite load. Results also revealed discrepancies between the surface area of lesions estimated in the field and those measured in the laboratory. The highest error percentages were associated with lesions ranging between 25 and 75% of host skin surface area. By reducing the number of categories of mange infestation (from 5 to 3) the proportion of cases correctly classified using data from field surveys increases. Our analyses suggest that the estimated surface areas of scabietic lesions is a useful relative index of mite abundance and/or intensity of parasitation in Iberian wild goat. Therefore, we conclude that revised classifications should be used in the monitoring of sarcoptic mange in wild populations, since data can be obtained in an inexpensive, fast and non-invasive fashion.

Negative effect of the arthropod parasite, Sarcoptes scabiei, on testes mass in Iberian ibex, Capra pyrenaica

Testes mass is a key factor in male reproductive success and is potentially exposed to so-called 'parasitic castration'. This is the result of the direct destruction or alteration of reproductive cell lineages (parasitic castration sensu stricto), or the indirect detrimental effects - for example, via body condition - on the ability of progenitors to produce or rear offspring (parasitic castration sensu lato). There are enormous gaps in our knowledge on the effects of parasites on the testes of wild mammals and in an attempt to rectify this dearth of data we examined the relationship between the skin parasite Sarcoptes scabiei and testes mass in Iberian ibex Capra pyrenaica. We considered data from 222 males that were culled in the population from the Sierra Nevada in Spain. Our results provide evidence that sarcoptic mange is associated with reduced size-corrected testes mass in Iberian ibex which supports the hypothesis that parasitism is a determining factor in gonad plasticity in male mammals. We discuss several hypothetical causes of this relationship and highlight the need to deepen the sub-lethal effects of pathogens if we are to accurately understand their modulator effects on host population dynamics.

Surgical-site infections and surgery of the salivary glands

OBJECTIVES

To determine the surgical-site infection (SSI) incidence rate targeted on salivary gland surgery over a 2-year period (from January 2007 to December 2008). Then identify any risk factors associated with SSI in all the patients operated with no antibiotic prophylaxis in accordance with French Anesthesiology Society guidelines.

POPULATION AND METHODS

Ninety-three patients were operated during the standard SSI surveillance period. A case-control (one case for five controls) study was then conducted aiming to identify risk factors.

RESULTS

The SSI incidence rate was 9.7%. The case-control study failed to identify any relevant risk factor with univariate analysis.

CONCLUSION

As no risk factors could be identified, we suggest that surgical antibioprophylaxis could be relevant in salivary glands surgery and should be evaluated in this setting.

Surgical management of maxillary sinonasal inverted papilloma

OBJECTIVE

The extent of the surgery required when sinonasal inverted papilloma (IP) originates in the maxillary sinus is still the subject of debate. The principal aim of the study was to evaluate the efficacy of exclusive endoscopic removal or when combined with a limited vestibular anterior antrostomy of the maxillary IP.

METHODS

A retrospective analysis was carried out of 64 patients with IP treated in our university tertiary referral center from 1993-2007. Endoscopic removal of the IP was done for all patients, either exclusively or combined with an open approach. All patients were followed up for more than 1 year and the local control rate has been compared between patients with maxillary IP and others, and with both approaches.

RESULTS

The overall recurrence rate was 14% (9/64), for a mean follow up of 48 months (12-120 months). Twenty-three patients (23/64) had maxillary IP. Ten of them had endoscopic resection alone, 13 had a combined approach (1 with lateral rhinotomy). There were 4 recurrences (17%) three of which had had endoscopic surgery alone. We did not perform a medial maxillectomy in the first instance. There were no cases of epiphora or atrophic rhinitis. conclusion: We showed that the combined method (endoscopic assisted by a minimal vestibular approach) was an efficient and safe method to treat maxillary sinus IP. This approach could preserve the lacrimal duct and the inferior turbinate when these structures were not involved, even when there was a large maxillary sinus extension of the disease.

Sarcoptes scabiei: Specific immune response to sarcoptic mange in the Iberian ibex Capra pyrenaica depends on previous exposure and sex

Host acquired immunity is a critical factor that conditions the survival of parasites. Nevertheless, there is a shortage of data concerning inter-individual immunological inequalities in wild mammals. Sarcoptic mange is a widespread parasitosis that severely affects mammals such as the Iberian ibex (Capra pyrenaica). Despite some work on the subject, the immune response to sarcoptic mange infestation is still a complex and poorly understood phenomenon. To improve knowledge of the host-Sarcoptes immunological interaction, 18 Iberian ibexes were experimentally infested. IgG levels were assessed using ELISA to test for potential factors determining the specific immune response to infestation. Previous exposure and sex appeared to affect the IgG response to infestation and our results suggest a sex-biased immunomodulation. We discuss the immunological pattern of host-Sarcoptes interactions and also suggest further lines of work that may improve the understanding of immunological interactions of host-Sarcoptes systems.

Bronchopulmonary nematode infection of Capra pyrenaica in the Sierra Nevada massif, Spain

The present investigation examined the prevalence and abundance of bronchopulmonary nematodes in 213 randomly hunted Iberian ibexes (Capra pyrenaica) (87 females and 126 males) in the Sierra Nevada mountain range in Spain between 2003 and 2006. Post mortem examination revealed an overall prevalence of 72% for adult nematodes (Cystocaulus ocreatus 44%, Muellerius capillaris 44%, Protostrongylus sp. 40%, and Dictyocaulus filaria 4%). The abundances were 13.45+/-3.97, 5.18+/-2.49, 6.36+/-2.16, and 2.27+/-0.46, respectively. Protostrongylid adults showed similar infection rates, which were statistically different from that of D. filaria. 20% of the examined Iberian ibexes were infected by three protostrongylid nematodes species, 24% of C. pyrenaica were affected by two protostrongylid species, while infestations with only one protostrongylid species were detected in 20% of the examined animals. The overall prevalence of larvae nematodes in the examined animals was 100%, and the overall abundance (number of the first stage larvae per gram) was 86.45+/-20.63. There was a high correlation between the two sets of data (adults and larvae). Results of the present investigation provided foundation for the effective control of bronchopulmonary nematode infection in Iberian ibex.

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

BACKGROUND

Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment.

METHODS

Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade.

RESULTS

After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events.

CONCLUSION

The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.

Endoscopic resection of sinonasal adenocarcinomas

OBJECTIVE

To evaluate the outcome and morbidity of endoscopic resection of sinonasal adenocarcinomas.

METHODS

This is a case series of 17 patients diagnosed with sinonasal adenocarcinoma that were resected endoscopically between 1999 and 2008.

RESULTS

The surgery constituted the first line of treatment for all patients. Five anterior skull base reconstructions were done. Post-operative meningoencephalitis and minimal epistaxis were the complications reported. The mean follow-up was 3 years [6-107 months]. To date, there have been two local recurrences at 6 months of an insufficient resection of a tumour classified pT4 and 25 months of a pT2 resected with safe margins. Another patient presented an unique metastasis in the parietal lobe 42 months after the resection of tumour pT4 extended to the frontal lobe. Two deaths unrelated to the disease were reported while thirteen patients remained free of disease (76.5%).

CONCLUSION

The endoscopic approach is a safe and effective treatment in selected cases of sinonasal adenocarcinomas. This procedure is less invasive than conventional surgery but requires an optimal preoperative imaging protocol and an experienced surgical team. These encouraging results have to be confirmed by a larger cohort and a longer follow-up.

[Ruptured pexis after supracricoid partial laryngectomy: a series of 5 cases]

OBJECTIVES

Supracricoid partial laryngectomies have a rare but a specific complication which is the rupture of the pexy. After cricohyoidoepiglottopexy or cricohyoidopexy, a separation can appear between the hyoid bone and the cricoid cartilage. Our objective was to define how to treat and to prevent this complication.

METHODS

One hundred and one supracricoid partial laryngectomies were performed in our department between 1980 and 2006. A retrospective analysis of the medical charts and operative files revealed that 5 patients have had a ruptured pexy. A review of the diagnosis, management, and outcome of these five cases is presented and discussed in this paper.

RESULTS

The diagnosis was done in the first post-operative month for all cases. Delay in decannulation time, swallowing disorders, local infection were associated with the rupture of the pexy. The separation between the hyoid bone and the cricoid cartilage was also suspected at neck palpation and in endoscopy. Lateral plain Xrays of the neck or CT scans were used to confirm the diagnosis. A medical treatment, a completion total laryngectomy and three revisions of the pexis were performed.

CONCLUSIONS

In our series, an antecedent of radiation before surgery appears to be a risk factor for the development of this specific complication. A revision of the pexis procedure is advocated in case of a major ruptured pexis.

Density dependence of developmental instability in a dimorphic ungulate

The use of fluctuating asymmetry (FA) for biomonitoring environmental stress is limited by the lack of work on how FA in particular traits responds to specific stresses. Here, by manipulating the number of individuals in an enclosed fallow deer (Dama dama) population, we describe, for the first time, clear density dependence in the FA of juvenile jaw morphology. The impact of high population density on FA was strong for both sexes, supporting the use of FA for indexing environmental stress. In addition, there was some indication that the change in FA was greater in males (43.6%) than females (28.5%). Finally, the ability to buffer density-dependent stress was independent of body condition. We suggest that, under highly limiting conditions, whole cohorts may be unable to buffer against developmental error, irrespective of individual quality.

[Sentinel node biopsy in T2 breast cancers larger than 3 cm and clinically negative axilla compared with the T1-T2 <3 cm standard indication]

OBJECTIVE

To present our experience in the application of sentinel node (SN) biopsy in patients with breast cancer T > 3 cm without clinical evidence of axillary metastasis.

MATERIAL AND METHOD

Retrospective study of 393 cases in the period 2001--2006, divided into group (A) 47 patients with 3-5 cm T2N0 tumours and group (B) 346 patients T < 3 cm, N0. We employed the combined technique with 99mTc-colloidal rhenium sulphide and isosulfan blue dye. Preoperative lymphoscintigraphy was performed and the SN was located intraoperatively with a gamma ray detection probe and the blue dye. Axillary lymph node dissection was completed only when the SN was positive for metastasis in the histopathology analysis or not located.

RESULTS

The SN detection rate for T2 > 3 cm was 94 % in the scintigraphy and 96 % with the probe, with no statistically significant differences between T < 3 cm (97 % and 98 %). In T2 > 3 cm, the final staging was 45 % pN0, 8 % pN1mi, 34 % pN1a, 11 % pN2a and 2 % pN3a. We found statistically significant differences (p < 0.05) when compared with palpable T < 3 cm and non-palpable cancer (62 % pN0 and 74 % pN0, respectively). In the follow-up of T2 > 3 cm (median 42.88 months) we did not find any axillary relapse which could be considered a false negative of the technique.

CONCLUSION

The detection of sentinel lymph nodes is feasible and safe in tumours larger than 3cm with clinically negative axilla. Axillary lymph node dissection can be avoided in 45 % of these patients and therefore, we consider that they should be included as a general indication in breast cancer SN detection.

[Myasthenia gravis and oropharyngeal disorders: two cases reports]

OBJECTIVE

Description of two atypical clinical cases of myasthenia gravis with pharyngeal dysphagia.

CASES REPORTS

A retrospective study from two cases report of myasthenia gravis with pharyngeal dysphagia.

CONCLUSION

The decrease of the laryngeal ascent and the desynchronization of the upper oesophageal sphincter opening appears as the main physiopathological mechanisms. The aspirations are frequent. In front of pharyngeal dysphagia, myasthenia have to be evocated. The alteration of the pharyngeal swallowing can be inaugural in this disease. The cholinesterase inhibitors can help for the diagnostic.

[Patient preference survey on the lack of taste and odor of Nasonex nasal spray. Which impact on compliance to treatment?]

In order to assess the acceptability of a new scent-free formulation of mometasone furoate (Nasonex) among allergic rhinitis patients, who already have been treated by the scented formulation of Nasonex, a phone survey was performed with a sample of 216 patients recruited by Nasonex GP's prescribers and pharmacists. The aim of this survey is to assess the diagnosis modalities, the allergic rhinitis characteristics and associated symptoms in one hand and in the other hand, the main reasons which led them to prefer a new scent-free formulation, in comparison with the only commercialized scented mometasone furoate (Nasonex) at the time when this survey was conducted. The impact of unscented Nasonex on patient's compliance to treatment was also assessed. This survey confirms that the GP is the key actor who usually establish the allergy diagnosis and the interrogatory is the principle method used. The prick test was more often and significantly used in 35% of the perennial rhinitis instead of 19% in seasonal allergic rhinitis (p < or = 0.05). When the diagnosis of allergy was established by an allergologist, 89% of them used a prick test. In this survey, asthma was associated in 24% of the patients, particularly in who suffering from perennial allergic rhinitis. 85% of patients rate their smell as globally good. 75% of the treated patients were interested by the new unscented formulation of Nasonex, regardless of the type of their rhinitis, seasonal or perennial. About 60% of patients stated that the lack of odor will led them to be more compliant to their treatment.

[Correlation between laryngoscopic examination and the gastroesophagial reflux in dysphonic patient]

OBJECTIVES

The gastro-esophageal reflux disease is responsible of oto-rhino-laryngological symptoms included dysphonia. We studied the relationship between reflux disease and dysphonia. The research for the prevalence of reflux disease, in a dysphonic population, has been performed by a clinical and laryngoscopic survey.

METHODS

175 patients were included prospectively. Each patient replies to the questionnaire and see the physician to do a laryngoscopic examination during the same time. A physician jury sees all videos to determine gastro-oesophagial reflux disease laryngoscopic signs.

RESULTS

Statistically significant correlations were found for vocal oedema and posterior hypertrophia in relation with reflux.

CONCLUSION

We have pointed out that laryngoscopy is not an adequate diagnosis tool, because it is operator dependant. Nevertheless the diagnosis of gastro-esophageal reflux disease, regarding the vocal symptoms, is proposed when associated with clinic reflux signs (pyrosis).

[Major orbital complications of acute maxillary sinusitis of dental aetiology]

OBJECTIVES

To demonstrate the importance of searching for a dental aetiology when confronted with an orbital cellulitis secondary to an acute unilateral maxillary sinusitis and to diagnose and treat as soon as possible in order to avoid visual sequelae.

CASE REPORT

Two cases are presented. The first case of a 35 year-old man who was diagnosed and treated late, for an orbital abscess secondary to a sinusitis of dental origin. The patient presented with visual signs such as diplopia and impaired occulomotoricity. The clinical diagnosis was concluded by an emergency sinus CT scan. Treatment consisted of an urgent surgical drainage associated to broad spectrum antibiotics with a high spectrum against Gram +cocci and anaerobes. Dispite this treatment regimen and two subsequent surgeries, the evolution was pejorative ending in a unilateral blindness. The second case is of a 45 year-old immunodeficient woman, presenting with the same pathology but without visual signs and whose evolution was satisfactory after adapted surgical and medical treatments. DISSCUSSION: The presence of visual and ocular signs warn on the gravity of the infection and indicate the need for urgent surgery. Sinus CT scan is essential to highlight the association between the orbit and the causal dental infection. For that, it must include the alveolar processes of the maxilla to show the dental lesion which is usually missed clinically. Functional endoscopic sinus surgery achieves two goals here; one diagnostic by the direct exploration of the nasal sinus cavities and the other therapeutic by the possible drainage all the paranasal sinuses.

[Endonasal endoscopic approach in the treatment of sino-nasal inverted papillomas]

INTRODUCTION

Sino-nasal inverted papilloma is a rare benign tumor of the nasal fossa and the paranasal sinuses for which the successful surgical treatment by an endonasal approach has been corroborated in the literature. Nevertheless, the authors aim in this study to evaluate the advantages and the limits of this approach, to analyse its failures and its recurrences, and to define the indications for using it with the external or dissimulated approach.

MATERIAL AND METHODS

42 patients presenting with a sino-nasal inverted papilloma and treated surgically over a ten year period were included in this retrospective study. The operative technique was chosen as a function of the endonasal and radiological examination results (CT scan and MRI). Follow-up was over one year for all patients.

RESULTS

Twenty eight patients were operated exclusively through an endoscopic endonasal approach. Fourteen patients were operated using a combined approach, associating either a vestibular (9 cases), a paralateral nasal (3 cases) or a fronto-orbital (2 cases) approach with endonsal endoscopy. In two cases, an associated squamous cell carcinoma was found. We observed a recurrence in 9.5% of the all cases and in 14.2% of the patients treated using a combined approach.

CONCLUSIONS

Endoscopic endonasal surgery is a validated surgical approach for the treatment of sino-nasal inverted papilloma in that total tumor removal is possible. This approach is particularly indicated in medially-situated papillomas without frontal or maxillary extension. In all other cases, associating an external or dissimulated approach is usually necessary.

Information and topology in attractor neural networks

A wide range of networks, including those with small-world topology, can be modeled by the connectivity ratio and randomness of the links. Both learning and attractor abilities of a neural network can be measured by the mutual information (MI) as a function of the load and the overlap between patterns and retrieval states. In this letter, we use MI to search for the optimal topology with regard to the storage and attractor properties of the network in an Amari-Hopfield model. We find that while an optimal storage implies an extremely diluted topology, a large basin of attraction leads to moderate levels of connectivity. This optimal topology is related to the clustering and path length of the network. We also build a diagram for the dynamical phases with random or local initial overlap and show that very diluted networks lose their attractor ability.

Sarcoptic mange and metapodial development in growing male Iberian ibex (Capra pyrenaica)

The effect of mange (Sarcoptes scabiei) on metapodial growth was studied in 24 uninfested and 16 infested male Iberian ibex from Sierra Nevada National Park (southern Spain). Our results show that infested ibex had smaller metatarsal bones, lower body weight, and a delayed rhythm of ossification, by about 1 year. We conclude that skeletal development and body weight in the Iberian ibex are sensitive to sarcoptic mange.

[Current management of acute pediatric rhinosinusitis in France]

Un groupe de médecins généralistes et multidisciplinaire de spécialistes contribue à définir les différentes formes de sinusites ou rhinosinusites aiguës de l'enfant à partir des principaux symptômes et signes cliniques. Le rôle des pathologies associées telles que l'allergie, les troubles immunitaires est envisagé. L'incidence, la présentation clinique et la prise en charge des complications sont présentées. Les indications des examens radiologiques et biologiques sont analysées. La prise en charge médicale en particulier, la place et le type des antibiotiques sont discutés. Des propositions de prise en charge selon des situations cliniques rencontrées en pratique sont présentées.

[Prospective evaluation of the method of measurement of the peak nasal inspiratory flow (PNIF) in allergic rhinitis. Observational study "Pratic in ORL"]

OBJECTIVES

To establish the ENT specialists's interest for the nasal obstruction measurement by the Peak Nasal Inspiratory Flow (PNIF) for the primary care medical management of patients with allergic rhinitis.

MATERIAL AND METHODS

A nation wide mail survey was conducted on the whole set of 2,800 French ENT specialists. Physicians had to use the PNIF in 4-consecutive patients with allergic rhinitis and assess through a questionnaire their interest for this tool.

RESULTS

About 8% of all ENTs (n = 228) responded. 65.3% of them had used the PNIF with their 4 patients, 29.7% used it in only 1 to 3 of their patients, and 5% did not use it at all. The PNIF was mainly used in moderate to severe rhinitis (94%) in contrast with mild rhinitis (32%) and in persistent rhinitis (94.2%) compared to intermittent rhinitis (54.8%). The primary motivation to use the PNIF on a systematic basis was to quantitatively assess nasal obstruction and to obtain an objective measurement of nasal obstruction. Conversely, the reasons for not using the PNIF were the needless of an objective measurement of nasal obstruction, the drawback of the PNIF in the patient physician relationship and lack of patient's acceptance of the device. Most physicians considered training for a correct usage of the PNIF was easy. Finally, about 2 thirds of the sample gave a positive rating on the usefulness of the PNIF for their patients.

CONCLUSION

This study demonstrates the interest of the practitioners to dispose of a simple and reliable tool for the follow up of nasal obstruction in allergic rhinitis.

Site fidelity, migratory behaviour, and spatial organization of female isards (Rupicapra pyrenaica) in the Pyrenees National Park, France

We studied from 1993 to 2002 the spatial organization of visually marked females in an isard ( Rupicapra pyrenaica Bonaparte, 1845) population in the Pyrenees National Park. In winter, all individuals were concentrated within the same 3.7 km2 refuge area. In summer, two patterns of space use were recorded: sedentary females (n = 33; 52.2%) remained within the refuge area, whereas migrating females (n = 29; 46.8%) summered outside the refuge area, at a horizontal distance of 1.4–9.2 km and 300–800 m higher in elevation than their winter ranges. Females were faithful to their seasonal ranges. The population was organized in well-defined spatial units in summer. This organization was roughly preserved in winter, despite the spatial concentration of the individuals by this season. The resulting spatial clustering might reduce spatial competition and pathogenic contamination between groups, allowing the maintenance of high population density. The appearance of a migratory pattern occurred probably as a result of the protected status of the species, which allowed the population to increase. Some individuals dispersed as a result of the population density increase. The two recorded patterns of space use likely arose from spatial attachment and social affinity that developed in the first years of a female’s life, and could explain the coexistence of the two spatial patterns.

In vitrorearingOestrus caucasicusthird-instar larvae and pupae (Diptera: Oestridae) from naturally-infested Iberian ibex,Capra pyrenaica(Artiodactyla: Bovidae)

Third-instar Oestrus caucasicus larvae (n = 236) obtained from Iberian ibex, Copra pyrenaica, were reared in a laboratory to obtain adult flies. They were maintained at a temperature of 21.9 +/- 2.7 degrees C and a relative humidity of 38.9 +/- 8.0 %. In all, 78 imagos emerged (33.1 %), with a sex-ratio at emergence not differing significantly from 1:1; 25 larvae did not complete pupariation. A total of 14 adult flies (17.9 % of the adults obtained) showed malformations, mainly in their wings. The pupariation period lasted around 30 hours and the pupal stage lasted on average 29.8 +/- 6.8 days. The success of pupation in both sexes was mainly determined by the weight of the larvae. Sexual dimorphism, with higher weights in females, was evident in third-instar arvae, pupae and adults. The mean longevity of adult flies was 224.8 +/- 91.4 hours and males generally survived for onger than the females.

Proposal for relative units of value (RUV) for use in allergy examinations

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand.

Neuregulin (NRG) expression modulates clinical response to trastuzumab in patients with metastatic breast cancer (MBC)

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Background: ErbB2 overexpression is the major determinant of response to trastuzumab (Herceptin, H). Recently, some authors have reported the potential role of the expression of NRG on ErbB2 activation in breast cancer cells, and its consequences in response to treatment with H. In the present study we analyze the relationship between response to H and expression of ErbB2 and NRG in patients (pt) with MBC. Methods: Data and frozen tissue samples from 30 consecutive pt with MBC and positive ErbB2 at diagnosis [Immunohistochemistry (IHC)] were collected. All pt were treated with an Herceptin-based regimen. Central Pathologic review of ErbB2 expression was performed in all samples (Herceptest and FISH). NRG expression was studied by IHC on paraffin embedded material and by Western blotting on frozen tissue using an antibody raised against the intracellular domain of NRG. NRG expression by IHC was evaluated using a semiquantitative scoring system that assesses both extension and intensity of cytoplasmic staining. Correlation between ErbB2 and NRG expression and its influence in response to H was analyzed. Characteristics of pt: Median Age: 54; Median mts sites: 2; Treatment: H alone:1 pt; H+Taxol:15 pt; H+Taxol+Carbo: 4 pt; H+Taxol+Lip.Doxorub:2 pt, H+Vinorelbine:7 pt; H+CDDP:1 pt. Results: ORR: 76% (CR:23%, PR:53%). Median TTP: 7.8 m. After central Pathologic review, a total of 20 tumors showed ErbB2 amplification by FISH and 19 of them were Herceptest 3+. A positive correlation was observed between ErbB2 amplification and NRG expression. All complete responses (n=7) were seen in pt with ErbB2 amplification. Interestingly, in the group of tumors without ErbB2 amplification (n=10), 7 had high NRG expression levels, as assessed by IHC. Six out of these 7 tumors having high levels of NRG expression, exhibited partial responses. NRG expression, in turn, did not have impact on response among ErbB2 amplified tumors. Conclusions: These preliminary results suggest that responses to H regimens in pt with MBC can be seen in pt lacking ErbB2 amplification in presence of high levels of expression of transmembrane ligand NRG. This suggests that the group of pt that may benefit from treatment with H could be broader than currently established. A confirmatory study is ongoing in a larger series.

No significant financial relationships to disclose.

Comparison of two quantitative GC-MS methods for analysis of tomato aroma based on purge-and-trap and on solid-phase microextraction

Two analytical procedures, one based on purge-and-trap and the other on solid phase microextraction, both followed by GC-MS measurement using an ion-trap mass spectrometer in the electron impact mode, have been developed for determination and quantitation of up to 39 aroma compounds in fresh tomatoes. The method based on purge-and-trap for isolation of the volatile compounds uses Tenax as adsorbent and a hexane-diethyl ether mixture as solvent for elution. The method was validated for linearity, precision (better than 20% for most compounds), and limit of detection, which was approximately 1 ng g(-1). This method enabled identification of up to 30 compounds in real samples. Use of SPME was considered as an alternative, to simplify sample treatment while maintaining the information level for the samples (e.g. the number of compounds detected) and quality of quantitation. A procedure based on SPME using a Carboxen/polydimethylsiloxane fibre was developed and validated for determination of 29 aroma compounds; precision was better than 20% and limits of detection ranged from 4 to 30 ng g(-1).