[The place of imaging in the investigation of the parotid and parapharyngeal space]

What strategy should be adopted and what results should be expected from imaging techniques in the various pathological process affecting the parotid and parapharyngeal space? When the pathological process is associated with morphological changes in the parotid, it is sometimes necessary to have recourse to imaging. MRI is the method of choice. Pathology in the parapharyngeal space (PPS) always requires an MRI and/or CT scan. It is necessary to have a very thorough understanding of the anatomy of the PPS and associated spaces to obtain a precise preoperative assessment and, where possible, an indication of the nature of the lesion.

Vaccination against ticks (Boophilus spp.): the experience with the Bm86-based vaccine Gavac

The control of tick infestations and the transmission of tick-borne diseases remain a challenge for the cattle industry in tropical and subtropical areas of the world. Traditional control methods have been only partially successful and the parasites continue to result in significant losses for the cattle industry. Recently, vaccines containing the recombinant B. microplus gut antigen Bm86 have been developed. Our vaccine formulation (Gavac, Heber Biotec S.A., Havana, Cuba) has been registered and is commercially available in Cuba, Colombia, Dominican Republic, Brazil and Mexico. In controlled pen trials, Gavac has been effective for the control of artificial infestations of B. annulatus, B. decoloratus and chemical-sensitive and resistant B. microplus strains from Australia, Africa, America and Iran. In controlled field trials in Cuba, Brazil, Argentina and Mexico, Gavac has shown a 55-100% efficacy in the control of B. microplus infestations in grazing cattle 12-36 weeks after the first vaccination. Field trials under production conditions have been conducted in Cuba, Colombia, Brazil and Mexico in pure and cross-bred cattle herds. The application of Gavac has increased the time between acaricide treatments by an average of 32 /-21 days (P = 0.0005) resulting in important savings for the cattle industry. In Cuba, a cost-effectiveness analysis was conducted in more than 260000 animals. The cost-effectiveness analysis showed a 60% reduction in the number of acaricide treatments, together with the control of tick infestations and transmission of babesiosis, which resulted in savings of 23.4 dollars animal(-1) year (-1). These results clearly demonstrate the advantage of vaccination and support the application of Gavac for the control of Boophilus spp. infestations.

Nasopharyngeal tuberculosis

Rhinopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated finding. The authors report a recent case of an isolated rhinopharyngeal tuberculosis in a 64-year-old female. A review of the literature is presented. They emphasize the clinical presentation, that, in all aspects, may resemble a malignant tumour of the nasopharynx, as well as the difficulty of obtaining a pathological and bacteriological diagnosis.

[Does allergic fungal sinusitis exist? Preliminary results of a prospective study]

Allergic aspergillar sinusitis is a very controversial clinical feature. We present results of a prospective study aimed at evaluating the reality of allergic aspergillar sinusitis in a nosologic and clinical point of vue. During a 5 months period, 31 patients underwent surgery: 21 sino-nasal polyposis, 5 chronic sinusitis without polyposis, 5 chronic sinusitis with radiologic images evocative of mycosis. The study was carried out using clinical criteria (per-operative discovery of glue-like, thickened and viscous aspect of the secretions), pathologic criteria (the presence of elements consitutive of allergic mucin), mycological criteria (direct examination and culture), and immunoallergic criteria (specific IgE for Aspergillus fumigatus, serology for Aspergillus fumigatus and Aspergillus flavus (IgM, IgG), skin tests for Aspergillus fumigatus). In three cases we suspect an allergic aspergillar sinusitis (one patient presenting a bilateral chronic sinusitis and two patients presenting a sinonasal polyposis). In two patients presenting a sinonasal polyposis, a allergic fungal sinusitis was suspected, fungal identification was not possible.

Nasal nitric oxide concentration in paranasal sinus inflammatory diseases

In normal upper airways, nitric oxide is generated by the paranasal sinus epithelium and then diffuses into the nasal cavities. This study examined whether or not nasal NO concentration is affected by paranasal sinus inflammatory diseases. The influence of obstruction (nasal polyposis) and/or inflammation (allergy or chronic sinusitis) of the paranasal sinuses on nasal NO concentration was evaluated in nasal allergic (n=7 patients) or nonallergic (n=20) polyposis, nonallergic chronic sinusitis (n=10) and Kartagener's syndrome (n=6) and compared with control subjects (n=42). A score of alteration of the paranasal sinus (number of altered and occluded sinuses) was determined by a computed tomography scan. The nasal NO concentration in nasal nonallergic polyposis (150+/-20 parts per billion (ppb)) was significantly decreased compared with both controls (223+/-6 ppb, p=0.01) and polyposis with allergy (272+/-28 ppb, p<0.0001). In each group, the nasal NO concentration was inversely correlated with the extent of tomodensitometric alteration of the paranasal sinuses. In Kartagener's syndrome, the nasal NO concentration (14+/-2 ppb) was drastically decreased compared with all other groups, despite the presence of open paranasal sinuses. Thus, the nasal NO concentration in patients with nasal polyposis appeared to be dependent on both the allergic status and the degree of obstruction of the paranasal sinuses.

[Adenoid cystic carcinoma of the larynx. A case report and review of the literature]

Laryngeal adenoïd cystic carcinoma (ACC) is a rare disease due to the poor distribution of the accessory salivary glands in this area. The authors describe a case of ACC arising from the sus glottic area and underline the difficulty of such a diagnosis, which is in fact an histologic finding. The signs of discovery of a laryngeal ACC are not different from other tumors of the area, except pain frequently evoked in these tumors. Laryngeal ACC arises exceptionally before the age of 20 years and no risk factor is known. The most frequent localization is in the sub-glottic area, but sus glottic and glottic localizations have been reported. Evolution is marked by the onset of cervical lymph adenopathies and systemic metastasis most often located in the lung. The treatment comprises wide surgical exerisis followed by radiotherapy. Other reports seem to indicate that the pronostic of the laryngeal location of this disease is worse than in other areas of the head and neck.

Comparative study of transfer factor and acyclovir in the treatment of herpes zoster

Reactivation of varicella herpes virus (VHV), latent in individuals who have previously suffered varicella, gives rise to herpes zoster and in some cases leads to a sequela of post herpetic neuritis with severe pain which is refractory to analgesics. Many different antiviral agents have been tried without achieving satisfactory results. Of all the antiviral agents employed, acyclovir has been the most successful in reducing post herpetic pain. However acyclovir has not been as reliable as interferon alpha (IFN-alpha). We have previously looked into the use of transfer factor (TF) as a modulator of the immune system, specifically with respect to its effectiveness in the treatment of herpes zoster. In this work findings from a comparative clinical evaluation are presented. A double blind clinical trial of TF vs acyclovir was carried out in which 28 patients, presenting acute stage herpes zoster, were randomly assigned to either treatment group. Treatment was administered for seven days and the patients were subsequently submitted to daily clinical observation for an additional 14 days. An analogue visual scale was implemented in order to record pain and thereby served as the clinical parameter for scoring results. The group treated with TF was found to have a more favorable clinical course, P < or = 0.015. Laboratory tests to assess the immune profile of the patients were performed two days prior and 14 days after initial treatment. The results of these tests showed an increase in IFN-gamma levels, augmentation in the CD4+ cell population but not the percentage of T rosettes in the TF treated group. These parameters were however insignificantly modified in patients receiving acyclovir. Although TF treated patients showed an increase in CD4+ counts these cells remained below the levels for healthy individuals. The fact that IFN-gamma levels as well as the counts for CD4+ cells rose in the TF treated group and not in the acyclovir one is very significant and confirms the immunomodulating properties of TF.

Mucoceles of the paranasal sinuses: uncommon location

Mucoceles are the most common lesions causing expansion of the paranasal sinuses. The sinuses most commonly involved are, in decreasing order of frequency, frontal sinus, ethmoid sinuses, maxillary sinus and sphenoid sinus. We reviewed 46 cases of surgically proven mucoceles and the purpose of this study was to report five cases of mucoceles in an uncommon location.

[Bilateral closure of the nasal cavity. An original surgical technique of treatment of severe recurrent epistaxis in Rendu-Osler disease]

In the Rendu Osler disease, epistaxis are seen in 80 to 90% of patients, and the multiple treatments that have been proposed have each shown their failure to achieve satisfactory results. We propose, in the case of abundant epistaxis, a bilateral closure of the nasal cavity. This technique has been initially described by Young in 1967 in the treatment of chronic atrophic rhinitis. This operation was carried out in two patients who presented with serious daily epistaxis, poorly tolerated, and refractory to several treatments. Neither of these patients has presented a post-operative bleeding episode with a one year and six months follow-up respectively. Anatomically, the results are satisfactory in both patients, with total closure of the nasal cavity. Functionally, both patients are satisfied, with an appreciable improvement in the quality of life despite total nasal obstruction.

The holmium:YAG laser for treatment of inferior turbinate hypertrophy

Chronic hypertrophic rhinitis is sometimes refractory to local, as well as general, medical treatment. Before undertaking surgical reduction of the inferior turbinates, there is indisputably a place for cauterization or laser vaporization of the inferior turbinate mucosa. The authors present a study of 46 patients treated by the holmium:YAG laser for chronic hypertrophic rhinitis. The results after only one laser session are satisfactory in 89.1% at 6 months' follow-up and in 52.2% with mean follow-up of 16.2 months. No major secondary effects were observed.

Field studies and cost-effectiveness analysis of vaccination with Gavac against the cattle tick Boophilus microplus

The control of tick infestations and the transmission of tick-borne diseases remains a challenge for the cattle industry in tropical and subtropical areas of the world. Traditional control methods have been only partially successful and the parasites continue to result in significant losses for the cattle industry. Recently, vaccines containing the recombinant Boophilus microplus gut antigen Bm86 have been developed. These vaccines have been shown to control tick infestations in the field. However, extensive field studies investigating the efficacy and cost-effectiveness of vaccination have not been reported and are needed to appraise the effect of this new approach for tick control. Here is reported the results of the application of Gavac in a field trial including more than 260,000 animals in Cuba. In this study the correlation between the antibody response to vaccination and the effect on ticks fertility is determined. Physiological status of the animals was found to affect the primary response to vaccination but not the antibody titers after revaccination. A cost-effectiveness analysis showed a 60% reduction in the number acaricide treatments, together with the control of tick infestations and transmission of babesiosis, which resulted in savings of $23.4 animal-1 year-1. These results clearly demonstrate the advantage of vaccination and support the application of Gavac for tick control.

Effectiveness of ribosomal fractions of Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and the membrane fraction of Kp (Ribomunyl) in the prevention of clinical recurrences of infectious rhinitis. Results of a multicenter double-blind placebo-controlled study

A multicenter, double-blind, placebo-controlled study was conducted to investigate the efficacy of an immunostimulant, Ribomunyl, in the prevention of recurrences of infectious rhinitis in adults. This trial involved 327 patients (168 Ribomunyl treated and 159 placebo cases) with an average of 4.3 +/- 1.8 rhinitis episodes per patient recorded during the year preceding the study. The main criterion of efficacy was the cumulative number of recurrences of infectious rhinitis during a 6-month follow-up period, as analyzed by standard tests. An additional analysis of relative risk of recurrences used multivariate failure for time data. Ribomunyl was effective throughout the study period, starting from the first month of treatment: a mean of 1.0 +/- 1.1 recurrences was recorded in the Ribomunyl group as compared to 1.5 +/- 1.4 recurrences in the placebo group; this indicated one-third fewer infections (P = 0.001). The protective effect of Ribomunyl on the relative risk for recurrences was estimated to be 0.58 by multivariate analysis (95% CI: 0.43-0.78, P = 0.0001). Analysis of secondary criteria also favored Ribomunyl: 38.5% less antibiotic courses per patient (0.8 +/- 1.3 vs 1.3 +/- 1.6; P = 0.002) and the number of days with antibiotics (5.6 +/- 9.3 vs 9.1 +/- 12.1; P = 0.002).

Nasal nitric oxide is increased in allergic rhinitis

BACKGROUND

Nitric oxide (NO) plays a major role in the regulation of vascular tone and in non-specific host defence. The epithelium in the paranasal sinuses was recently identified as the major site of NO production in the upper airways.

OBJECTIVE

To investigate NO status in allergic rhinitis, we compared the NO concentration in the nasal cavities of control subjects (n = 19) and in patients with allergic rhinitis (n = 36) with symptoms (WS, n = 17) or without symptoms (WOS, n = 19) on the day of the test.

METHODS

NO concentration was measured using a chemiluminescent analyser aspiring from each nasal cavity at a sampling flow rate of 0.7 L/min, before and 10 min after administration of a nasal vasoconstrictor.

RESULTS

The mean NO concentration (+/- SE) in the control was 235 +/- 11 ppb and 225 +/- 9 ppb in the right and left nostrils respectively, and was decreased by 14% and 12% by the nasal vasoconstrictor (P < 0.001). The NO concentration in patients with allergic rhinitis was significantly higher in the right and left nostrils (382 +/- 20 ppb and 396 +/- 28 respectively, P < 0.0001 versus control). All WOS patients demonstrated normal or increased NO concentrations in both nostrils, whereas two WS patients showed decreased NO concentrations in the left nostril. Inhalation of a nasal vasoconstrictor increased NO concentration by 6% and 27% in the right and left nostrils respectively in WS patients.

CONCLUSION

Nasal NO concentration is increased in patients with allergic rhinitis. Interestingly, patients without symptoms on the day of the test also showed a clear-cut increase in nasal NO production, which could reflect a permanent inflammation of the sinus mucosa.

Inflammatory rheumatism and nasal polyposis

We report five cases of seronegative inflammatory rheumatism associated with nasal polyposis. The patients were four women and one man, mean age 49.5 years (range 42-59 yrs.). Two patients had polyarthralgia predominating in the hands, wrists and knees and two patients had symmetrical acromelic polyarthritis. The fifth patient, a woman, had oligoarticular arthritis. In a single female patient, X-rays showed moderate erosions of both tarsometatarsal bones. The inflammatory syndrome was moderate with mean ESR 23 (12-38) and immunological investigations were negative except for the presence of pANCA (50-200 U) in three patients. HLA-A1, B8, and Bw35 antigens were found in three of the five patients. In all cases, nasal and sinus polyposis (NSP) preceded rheumatism and the joint symptoms were accompanied by worsening of the ENT symptoms. NSP was confirmed by CT scan of the nasal fossae and sinuses. Polyps were surgically removed in four patients and the histology showed neither granuloma nor vasculitis. In four patients the joint symptoms, which responded poorly to nonsteroidal anti-inflammatory drugs (NSAIDs), improved markedly after ENT treatment (surgery and topical steroids) and synthetic antimalarials. The concomitant course of the joint and ENT symptoms suggests there may be a link between inflammatory rheumatism and NSP.

Radiotherapy with concomitant continuous cisplatin infusion for unresectable tumors of the upper aerodigestive tract: results of a phase I study

A phase I-II study was initiated in February 1991 of concomitant radiation and cisplatin (CDDP) in the treatment of unresectable head and neck squamous cell carcinomas (n = 12). The first patient was treated palliatively for a cervical recurrence of laryngeal cancer. The 11 other patients had locally advanced (stage IV) previously untreated carcinomas of the oropharynx (n = 9), hypopharynx (n = 1), or cervical node with unknown primary site (n = 1). Standard external radiation was carried out up to a total dose of 60 Gy/6 weeks (7 MeV electron beam) for the first patient and 72 Gy/8 weeks (Co60 beam) for the other 11 patients. CDDP was infused continuously during the entire radiation treatment, 5 days/week. The starting dose was 4 mg/m2/day and was escalated by increments of 1 mg/m2/day; dose-limiting toxicity was observed at 7 mg/m2/day. Neutropenia (grade 4, one patient; grade 3, three patients) and thrombocytopenia (grade 3, one patient; grade 2, one patient) were the limiting factors. Therefore, the recommended dose of CDDP is 6 mg/m2/day. All patients but one completed the scheduled radiation. For the entire group, mucositis was not more severe than that observed with radiotherapy alone. There was no nephro-, oto-, or neurotoxicity. A complete response was obtained in eight (66%) patients. Of these, four were free of disease 12-34 months after completion of treatment and one had a total glossectomy for a tongue necrosis. For the whole series, the mean overall survival was 16 months posttreatment. Pharmacokinetic analysis indicated the total cisplatin accumulation at the end of treatment to be 743-1551 ng/ml. Accumulation of ultrafilterable platin was noted in only one patient (137 ng/ml at the end of treatment).

Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow-up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow-up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.

Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial

PURPOSE

To report the final results of a prospective randomized trial that aimed to evaluate efficacy and toxicity of concomitant postoperative radiotherapy and Cisplatin infusion in patients with Stage III or IV squamous cell carcinoma of the head and neck and histological evidence of extracapsular spread of tumor in lymph node metastase(s).

METHODS AND MATERIALS

Radiotherapy was delivered using a daily dose of 1.7 Gy for the first 54 Gy and 1.8 to 2 Gy until the completion of the treatment. Cisplatin 50 mg i.v. with forced hydratation was given or not every week (i.e., seven to nine cycles) concurrently with radiotherapy. A total of 44 patients were treated by irradiation only (RT group) and 39 by irradiation with chemotherapy (CM group).

RESULTS

The RT group displayed a higher rate of loco-regional failures as compared to CM group (41 vs. 23%; p = 0.08). The overall survival, the survival corrected for deaths by intercurrent disease, and the disease-free survival were better in CM group as compared to RT group with statistically significant differences. Survival without loco-regional treatment failure was better in the CM group, the difference being close to the level of significance (p = 0.05). Survival without distant metastases were comparable in the two therapeutic groups. Ten severe late complications were observed, four in the RT group (17%) and six in the CM group (22%). Cox univariate analysis confirmed the importance of the therapeutic modality in predicting the overall survival, the survival corrected for deaths by intercurrent disease, and the disease-free survival.

CONCLUSIONS

The present final report of this phase III study confirms preliminary results. The concomitant use of 50 mg weekly Cisplatin infusion and postoperative radiation improved loco-regional control and survival. No significant increase of late radiation complications was observed in the CM group.

[Metastatic cervical adenopathies of unknown primary site. Long-term course]

We conducted a retrospective study of 34 patients treated by radical neck dissection followed by radiotherapy for one or several cervical adenopathies without a primary tumor. Mean follow-up was 48 months. During follow-up, 6 patients developed a presumed primary tumor, and 11 patients presented with recurrent lymph nodes. We found no statistically significant predictive factor, as to either clinical characteristics or the histological nature of the adenopathies. On the other hand, the number of metastatic lymph nodes found on the surgical specimen was correlated with the risk of lymph node recurrence. Among the prognostic factors with an unfavorable effect on survival, the dimensions of the adenopathy, its fixed characteristic and its TNM status, were identified. In this series, the appearance of a primary tumor did not seem to worsen the prognosis. On the other hand, the appearance of lymph node recurrence predicted poorer survival rates. The results are discussed and compared with those found in the literature.

[Partial lower turbinectomy in children: indications, technique, results]

Inferior turbinate surgery has been proposed as a treatment modality in severe childhood hypertrophic rhinitis refractory to medical treatment. The authors present a series of 38 children treated in the otorhinolaryngology department of the Timone University Hospital, Marseille, and the Rangueil University Hospital, Toulouse. Thirty eight children between 9 and 16 years of age (27 males and 11 females) underwent a bilateral inferior turbinectomy, and followed-up for a period of 6 months to 4 years. Allergy was fund in 19 patients, asthma in 11 patients, and an underlying sinus pathology associated in 9 patients. Turbinate surgery was isolated in 16 cases, and in 22 cases, it was associated with an adenoidectomy, a septoplasty, and/or an ethmoidectomy. The authors discuss the operative indications, and describe the turbinectomy technique in children. Post-operative complications are rare (no crusting rhinitis, one non symptomatic synechia). One case of nasal bleeding was noted after nasal packing removal. Functional obstructive symptoms were improved in near 90% of cases. Asthma was improved or disappeared in 27.3% of cases, and no cases of worsening asthma was noted. The authors conclude that this type of turbinectomy is efficient and non-iatrogenic when a precise indication and a rigorous technique are applied.

[The voice of the child, morphological evolution of the larynx and its acoustic consequences]

From a review of the literature, the authors analyze the role of laryngeal modifications in the evolution of a child's voice. The modifications found are topographic (laryngeal descent in the neck), morphologic (increase in volume modification of laryngeal shape), and histologic (lamina propria differentiation), each responsible for acoustic modifications. The chronological evolution of the voice integrates these modifications in a global context of development, where the central nervous system is of primary importance.

Deglutition after supracricoid laryngectomy: compensatory mechanisms and sequelae

This study is based on the videofluorographic exploration of deglutition in 14 patients who were treated by supracricoid laryngectomy. The choice of this population rests on two criteria: a 1-year postoperative delay, and absence of residual deglutition disorders elicited by patient history. Asymptomatic aspiration was seen in 6 cases. In the cricohyoidoepiglottopexies (CHEP), aspiration occurred uniquely in patients who did not recuperate satisfactorily from epiglottic dynamics. The deglutition sequelae are less invalidating relative to the cricohyoidopexies (CHP), with a possible recuperation of the dynamic sequence of the pharyngeal swallow. On the other hand, in the CHP, a complete reorganization of the stepwise sequence of the different neuromuscular events is necessary.

[Efficacy of partial inferior turbinectomy in the treatment of nasal obstruction. Retrospective study apropos of 71 patients]

Longtime discredited, practiced with reticence even today, the inferior turbinectomy represents the treatment of choice in patients with persistent chronic nasal obstruction despite medical treatment or cauterization. Between January 1989 and December 1995, 81 patients underwent an isolated bilateral inferior turbinectomy (without an associated septal or sinus intervention). This retrospective study analyzes the short and long-term results in 71 patients with a one year minimum follow-up. Turbinectomy was in all cases always partial and managed under endoscopic guiding. Mean follow-up was 33 months, based on a patient's questionnaire. No cases of crusting rhinitis were observed. 81,7% of patients were improved by the surgical intervention. In asthmatic patients, no worsening of the asthma was noted, whereas in 28,5% of these cases, there was an improvement or disappearance. Non serious adverse effects appear after surgery as rhinorrhea (16%) and post nasal drip (18,4%). The surgical turbinate reduction represents an option in the care of patients with chronic nasal obstruction associated with inferior turbinate hypertrophy.

Nonperturbative analytical solution for steady-state photorefractive recording

A nonperturbative analytical solution for steady-state photorefractive recording in the diffusion approximation has been obtained. It applies to any arbitrary modulation depth m and includes, as limit cases, the perturbation solutions reported by previous authors.

[Deep cystic enteritis in Peutz-Jeghers syndrome (pseudoinfiltrating lesions in a patient with enteric polyps)]

We report a case of enteritis cystica profunda observed in a patient who, owing to both his personal and familial history, had been diagnosed and suffering from Peutz-Jeghers syndrome. The patient was operated because of a clinical picture of intestinal invagination. Together with hamartomatous polyps, anatomopathological study of the segment of the small intestine removed revealed the presence of lesions typical of Enteritis cystica profunda consisting in the presence of benign encysted glands and pools of mucous in the deep layers of the intestinal wall. The main characteristics of this interesting and rare entity are briefly commented.

Adolescent student's compliance with testicular self examination

To determine what adolescents students know or feel about testicular cancer, (TC) and the testicular self examination, (TSE), technique, 127 males students (mean age 16.14 years) were given a 21 item questionnaire. The role of the primary physician and the role of written and visual educational material were assessed for effectiveness in increasing the regular performance of monthly testicular self examination by male students at a Health Education Course at Cervantes Public School at Bayamón, P.R. Out of 127 male student, only 2.4%, (n = 3), initially knew about the symptoms of TC. Analysis of the attitude and knowledge questions revealed that respondents were not sure about general concepts in TC and, were not sure that this cancer could be self diagnosed. This study pretends to assess the effects of modeling and guiding practice as components within a comprehensive testicular self examination education program for adolescents male students. Three groups were studied from 10th, 11th, and 12th, grade. The variables investigated were knowledge of testicular cancer, attitudes toward testicular cancer, and frequency of self reported testicular self examination. The participants then received written material plus a physician's lecture on TC and TSE. Upon follow up, 87.5%, (n = 113) of the students reported performing monthly TSE, (P < 0.001), a statistically significant increase in performance. Although 20.3% (n = 26) reported having a physical examination by a physician within the previous 3 months, less than 4.7%, (n = 6) reported being taught TSE by a physician. Physicians need to educate males about testicular cancer and its early detection.

[Facial motor lesion after surgery of the parotid gland]

The authors report a retrospective study of 351 parotidectomies observed during a 28 years period. The average follow-up is 28 months. Preoperative and post-operative facial nerve function, type of parotidectomy, surgical management of facial nerve and histologic diagnosis according to the revised WHO classification (1990) are presented. Type of parotidectomy and degree of tumor malignancy are statistically analyzed. It seems that occurrence of post-operative facial nerve dysfunction depends on radical parotidectomy, whereas long term dysfunction is determined by tumor malignancy. Malignant epithelial tumors of the major salivary glands proved to be radiosensitive. Apart from preoperative dysfunction, clinical involvement and impossible facial nerve dissection, the authors insist upon sparing the facial nerve, event in the case of microscopic residual tumors, and prefer postoperative radiotherapy.

Radiotherapy of stage I and II carcinomas of the mobile tongue and/or floor of the mouth

From 1977 to 1990, 94 evaluable patients were treated with iridium-192 implantation in the Centre Claudius Regaud for a Stage I (52 patients) or a Stage II (42 patients) squamous cell carcinoma of the mobile tongue and/or the floor of the mouth. Interstitial brachytherapy was associated with external irradiation in 68 patients (group 1; mean dose, 48 Gy for external irradiation, 26 Gy for brachytherapy) or was exclusive in 26 patients (group 2; mean dose, 66 Gy). The mean follow-up was 44 months. Eleven acute complications were noted during or immediately after the implant (1 lethal myocardial infarction, 6 hematomas of the tongue which spontaneously resolved, 3 local sepsis). The mean duration of the mucositis was 9 weeks (from 4 to 20 weeks). Ten patients (17%) experienced a late complication (8 in group 1, 2 in group 2): 3 bone necroses requiring hemimandibulectomy (1 post-operative death), 1 tongue necrosis treated by a transoral mucosal excision, 6 bone expositions which recovered after medical treatment. Local control rates for T1 and T2 tumors were 75% (39/52) and 51% (21/41), respectively. Sixteen patients (17%) presented a nodal relapse which was associated in 6 cases with a concomitant local relapse. The local control rate of T1 tumors was 64% (23/36) in group 1 versus 100% (16/16) in group 2 (p < 0.01). For T2 tumors, these figures were 45% (14/31) and 70% (7/10), respectively (p > 0.3). The influence of 13 parameters on the local control was studied in analysis. In the one model analysis, a cox regression tumor size was significantly predictive of actuarial local recurrence (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Polychlorinated biphenyl residues in various fatty foods consumed in Guipúzcoa, the Basque Country (Spain)

Three congeners of polychlorinated biphenyls (PCBs)--the 2, 2', 3, 4, 4', 5'-, 2, 2', 4, 4', 5, 5'-hexachloro, and 2, 2', 3, 4, 4', 5, 5'-heptachlorobiphenyls--were determined in 18 samples of butter, 44 of fish (hake and anchovy) and 24 of egg, all of which came from markets in Guipúzcoa. The total content as Araclor 1260 was also determined. Quantitation was carried out by gas chromatography in a capillary column and electron capture detector. The total content in butter ranged from 20 to 60 ng/g (fat basis), in fish from 10 to 250 ng/g (edible part), and in eggs from 1 to 10 ng/g (edible part). None of these exceeded the tolerance limits established by the Canadian Government Guideline and USFDA.

[Concomitant association of radiotherapy and chemotherapy (CDDP 4-6 mg/m2/daily in continuous i.v. administration) in locally advanced ORL tumors]

In order to enhance radiation effects in the treatment of unresectable Head and Neck squamous cell carcinoma, we initiated a phase I-II study in February 1991 with concomitant radiation and cisplatin in the treatment of resectable Head and Neck squamous cell carcinoma. The first patient was treated in a palliative intend for a cervical recurrence (cutaneous metastatic lymphangitis) of laryngeal cancer. The seven other patients had a Stage IV M0, previously untreated, oropharyngeal carcinoma. Standard external radiation was carried out up to a total dose of 60 Gy/6 weeks (7 MeV electron beam) for the 1st patient and 72 Gy/8 weeks (Co60 beam) for the 7 other patients. Cisplatin was given during the entire radiation treatment, by continuous infusion, 5 days a week, at doses of 4 mg/m2/d for the 1st patient, 5 mg/m2/d for the two following patients and 6 mg/m2/d for the last five patients. One patient with a poor initial performance status (three in the WHO scale) stopped his treatment on the 6th week due to a grade 3 mucositis with deglutition pneumonia. He died 2 months later with progressive carcinoma. For one other patient, treatment was discontinued for 1 week after 48 Gy, due to a grade 3 mucositis. The other patients completed the planned protocol without any interruption. Mucositis (grade 3 in two cases, grade 2 in four cases), dermitis (grade 3 in two cases, grade 2 in four cases) and neutropenia (grade 2 in two cases) were the most frequent acute toxicity. Of the seven patients treated with a curative intend, six are free of disease at 6 to 28 months after completion of treatment. A pharmacokinetic study showed a total platinum accumulation. The mean value at the end of treatment reached 1157 ng/ml. Only one patient experienced an accumulation of the ultrafilterable platinum (137 ng/ml at the end of treatment).

Predictive factors of a complete response to and adverse effects of a CDDP-5FU combination as primary therapy for head and neck squamous carcinomas

Retrospective analysis of detailed patient and tumour factors associated with a complete response to combination inductive chemotherapy with CDDP-5FU (96 or 120 hour continuous infusion) was performed using data from 147 patients with a previously untreated squamous cell carcinoma of the oral cavity, oropharynx or pharyngo-larynx following completion of two (29 patients) or three (118 patients) cycles. Adverse reactions to chemotherapy were documented for all 164 patients included in the study. Eight drug-related deaths occurred due to: acute myocardial infarction (five patients), peptic ulcer disease (two patients) and severe neutropenia with sepsis (one patient). Severe non-lethal complications included marrow depletion (14 patients), peptic ulcer (two patients), thrombophlebitis (seven patients), angina pectoris (two patients), stroke (one patient), pulmonary oedema (one patient) and convulsions (one patient). Six patients refused further treatment because of untoward side effects and tumoral progression was observed in three cases. Separate response rates for the primary site and nodes were determined and analysis of respective predictive factors of response was performed. Complete response was obtained in 31 per cent at the primary site versus 18 per cent for the nodes (p < 0.05). The combined (primary site + nodes) overall complete response rate was 22 per cent. Among 11 factors studied (age, sex, performance status, primary site, tumour differentiation, initial resectability, 5FU dosage per cycle, number of cycles, T, N and TN stages), only performance status, N stage, resectability and number of cycles were associated with a combined complete response. Multivariate analysis showed performance status, N stage, TN stage and resectability to be significant predictive factors of a combined complete response.(ABSTRACT TRUNCATED AT 250 WORDS)

Deglutition after supra-glottic laryngectomy

This study of swallowing after a horizontal supra-glottic laryngectomy proposes to analyze the frequency of long-term post-operative complications, their mechanisms of onset, as well as their compensatory mechanisms. It rests on the study of three groups of patients: a retrospective series of 74 charts, a group of 14 patients studied at a distance from the intervention, and a group of 15 patients who have been entered in a prospective study concerning the post-operative care of partial laryngectomies. For these two groups, the swallowing work-up consisted of, besides a clinical evaluation, a video-laryngoscopy and a video-radioscopy. Knowledge of the compensatory possibilities as a function of the specifics of the surgical technique, and their evaluation for each patient with video-radioscopy allows for an adapted care protocol.

Use of an enzyme-linked immunosorbent assay for serodiagnosis of clinical paratuberculosis in goats. Study by western blotting of false-positive reactions

An enzyme-linked immunosorbent assay (ELISA) was performed for diagnosis of paratuberculosis in goats, using as antigen a protoplasmic extract (PPA-3). The test was developed on the basis of the results obtained with two serum reference pools, positive and negative respectively. To avoid day-to-day variations, dilutions of the positive serum pool were included in each plate to obtain an arbitrary system, transforming absorbance into immunoglobulin (Ig) G anti-Mycobacterium paratuberculosis units. The ELISA was used on sera of two reference groups of animals. One group consisted of 35 goats suspected of being infected with paratuberculosis, which was confirmed by histological findings and isolation of M. paratuberculosis. The negative group consisted of 61 healthy goats from a farm free of paratuberculosis. The test showed a sensitivity of 100% and a specificity of 91.8%. Absorption of sera with a Mycobacterium phlei suspension did not modify either the sensitivity or the specificity of the test. Sera from the negative group were analysed by Western blotting, and four of them recognized two fractions with a molecular weight of 17.3 and 28.1 kDa.

[Comparative contribution of endoscopy, x-ray computed tomography and MRI in the preoperative evaluation of cancers of the endolarynx: apropos of 18 surgically-treated patients]

The authors carried out a prospective and comparative study of 18 patients with endolaryngeal carcinoma, with preoperative imaging of the extent of the disease by computed tomography (CT) and magnetic resonance imaging (MRI). The correlations between CT, MRI, endoscopy and postoperative histology are reported. It appears to the authors that the contribution of imaging is evident and that at present the reliability of CT is comparable to that of MRI, taking account of the current technical problems of MRI.

[Spontaneous hematoma of the thyroid gland: apropos of 2 cases]

Authors report two cases of spontaneous hematoma of the thyroid gland. Emergency surgery was performed on note of them. After reminding the role of different investigations, they discuss the interest of computed tomography to exclude extracranial carotid artery aneurysm. They explain a therapeutic approach according to the repercussions of hematoma: a compressive syndrome requires a difficult emergency surgery.

[Vertigo and diving]

The appearance of a vertigo during scuba-diving result from different pathophysiological mechanism at which oppose specific therapeutic. Whether it's during barotrauma or decompression accident, the vestibular reach can cause drowning. It is possible to make the difference between barotrauma and decompression accident, with the good study of the scuba-diving and the time when the vertigo has came. So, the therapeutic will use recompression in a multiplace hyperbaric chamber or only hyperbaric oxygen.

[Olfactory esthesioneuroma. Apropos of 12 cases]

The authors report a 12-case series of olfactory esthesioneuromas, in which they review the main characteristics of this rare tumor. The olfactory esthesioneuroma diagnosis should be evoked for all nasal tumors, especially for tumors originating in a high position. This diagnosis is confirmed by the difficult pathological examination, which currently benefits widely from immunohistochimy. Prognosis is poor and surgery is the main treatment, associated with varying degrees of radiotherapy. As far as chemotherapy is concerned, its role must be clarified.

Heart-lung transplantation for cystic fibrosis. 1: Assessment

Forty five patients with cystic fibrosis (age 5-15 years) were assessed for heart-lung transplantation between September 1987 and March 1990. The two main conditions for acceptance were (i) life expectancy less than 2 years and (ii) a severely impaired quality of life. Patients were accepted onto an active waiting list (n = 26), a provisional waiting list (n = 15), or not accepted (n = 4). Selection was made on clinical grounds with objective measurements used as an aid in assessment. As expected, the mean values for objective measures were significantly different between patients on the active waiting list compared with the provisional waiting list/not accepted group for resting heart rate (118/minute v 101/minute), percentage of ideal weight (83.2% v 93.1%), forced expiratory volume at one second as percent of predicted normal (27.3% v 47.6%), Shwachman-Kulczycki score (33.6 v 52.5), Chrispin-Norman x ray score (25.8 v 22.1), 12 minute walk (540 m v 854 m), and minimal oxygen saturation (81.5% v 92%). Psychological evaluation demonstrated a 55% incidence of individual and a 50% incidence of family morbidity. Of the 26 patients accepted onto the active waiting list, 11 have been transplanted (mean waiting time 3.3 months), 10 have died within a mean of 3.7 months of acceptance, and five remain on the active list (mean 5.6 months).

Experimental study of the effect of 6-methyl-prednisolone on ingestion-microbicidal function activity in dog neutrophils

The effect of increasing doses of 6-methyl-prednisolone on the ingestion-microbicidal function activity of dog neutrophils was studied. Histochemical and spectrophotometrical NAT reduction techniques, together with a direct overall method using C. albicans as a test micro-organism were carried out. Samples were analysed 2 and 48 h after inoculation of different doses. The histochemical NAT technique was not very precise, but quantification of responses using the spectrophotometric method revealed that at 48 h.p.i. neutrophil reducing activity declines continuously. At 2 h.p.i. in the first few days of the experiment (i.e. at lower doses), NAT reduction increased, but subsequently fell back to O.D. levels below those recorded at 48 h.p.i. Ingestion and destruction of C. albicans followed the same pattern as that recorded for NAT activity. Simple and differential leukocyte counts performed in all samples revealed leukocytosis (with neutrophilia and lymphopaenia) at 2 h.p.i. This returned to normal levels in the intervals between inoculations.