Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis.

BACKGROUND: Cervical necrotizing fasciitis (CNF) associated with descending necrotizing mediastinitis (DNM) is a rapidly evolving and life-threatening condition. The aim of this retrospective study was to describe a treatment strategy for CNF with DNM and present a management algorithm for mediastinal extensions of CNF. METHODS: Patients diagnosed and treated for CNF with DNM over 14 years in a tertiary referral centre were included. RESULTS: Seventeen adult patients were included. The origin of infection was mainly oropharyngeal. The diagnosis of CNF/DNM was based on clinical and computed tomography findings. All patients underwent cervicotomy for CNF. In ten patients, DNM was located above the carina and could be accessed by a cervical approach. In seven patients, DNM was below the carina, and necessitated sternotomy for anteroinferior mediastinal involvement and posterolateral thoracotomy for posteroinferior mediastinal involvement. All patients received broad-spectrum antibiotics. One patient died 3 days after surgery. The median hospital stay was 30 days. There was no recurrence during long-term follow-up. CONCLUSION: Prompt diagnosis and early surgical treatment are essential for reducing mortality in CNF/DNM. All patients should undergo extensive cervicotomy. The surgical approach to the mediastinum depends on the supracarinal or infracarinal location of the disease.

[Treatment of a voluminous rhinophyma]. / Traitement d'un volumineux rhinophyma.

OBJECTIVE: The purpose of this study was to present an advanced case of rhinophyma and to discuss the pathophysiology, clinical presentation and treatment of this pathology. CASE REPORT: A 75-year-old patient presented to the ENT out-patient department with a large rhinophyma causing nasal obstruction and eating problems in addition to its aesthetic social burden. RESULTS: The patient was operated under antibiotic coverage. The operated site was left to heal and later covered with a full-thickness skin graft. During the 5-year postoperative follow-up period, there were no complications, no recurrence of the rhinophyma, and the patient retained a good aesthetic result. CONCLUSION: Rhinophyma is the highest of the four grades of rosacea progression. The diagnosis is usually clinical. Surgical treatment is reserved for the advanced nodular forms and is performed under antibiotic coverage in order to prevent the risk of chondrolysis of the nasal cartilages.

[Therapeutic management of glottic tumours: about a series of 41 cases of subtotal laryngectomy with cricohyoidoepiglottopexy (CHEP)]. / Stratégie de prise en charge des tumeurs du plan glottique a partir de l'etude d'une série de 41 laryngectomies subtotales avec CHEP.

OBJECTIVES: 1) To analyse the oncological and early functional results of partial supra-cricoid laryngectomy with crico-hyoido-pexy performed as a primary treatment modality on patients diagnosed with glottic squamous cell carcinoma involving the anterior commissure; 2) To propose a therapeutic management. PATIENTS AND METHODS: This is a retrospective study conducted over a period of 10 years (1995-2005). Inclusion criteria included: 1) Squamous cell carcinoma of the vocal cords reaching the anterior commissure; 2) Absence of previous treatment for the glottic lesion; 3) Minimum follow-up period of 24 months. The functional results were evaluated according to duration of hospitalization, and the time elapsed before decanulation and realimentation. Statistical analysis was performed using the stat-view software. RESULTS: Forty-one patients underwent partial supra-cricoid laryngectomy. All patients had a tumour stage I or II. Mean follow-up was of 88 months. Tumour resection was complete in 95% of cases. The rate of lymph node involvement was 7.3%. Four patients (9.8%) developed local recurrence 13 months, on average, postoperatively. Three patients (7.3%) developed a metachronous lesion 14 months, on average, postoperatively. Three patients (7.3%) died during the follow-up period (2 cases related to the cancer). The specific survival and recurrence-free survival rates were 95% and 84.7% respectively. There was no statistically significant difference in survival rates between patients with stage I and stage II tumours. The mean duration of hospitalization was 24 days. The mean time intervals to decanulation and realimentation were 21 and 15 days respectively. CONCLUSION: Partial supra-cricoid laryngectomy with crico-hyoido-pexy is one surgical option in laryngeal conservative surgery. This surgical procedure allows for adequate oncological control and good functional results as long as the indications are well respected and the surgical techniques are well mastered.

The importance of "legalese" in biotechnology patents.

If your patent claims do not use established patent terminology, their scope may turn out to be narrower than you think.

Electrical activity suppresses nicotinic acetylcholine receptor gamma subunit promoter activity.

Nicotinic acetylcholine receptors are pentameric, transmembrane, ligand-gated ion channels critical for neuromuscular signal transmission. Prior to innervation, the genes encoding these receptors are expressed in nuclei throughout the muscle fiber. Muscle innervation leads to a dramatic decrease in expression of these genes in extrasynaptic nuclei. This reduction in gene expression can be reversed by muscle denervation. The effects of denervation on receptor gene expression can be blocked by electrical stimulation of muscle using extracellular electrodes. The molecular mechanisms by which muscle electrical activity leads to altered patterns of nicotinic acetylcholine receptor gene expression are not well understood. Using an in vitro electrical stimulation paradigm to induce muscle activity, we have been able to mimic the effect of innervation on extrasynaptic acetylcholine receptor gene expression. We have found that a 93-bp region of 5'-flanking DNA, spanning nucleotides -150 to -57 relative to the transcription start site of the gamma subunit gene, is required for the suppression of gene expression in response to muscle activity. Sequences downstream of this region are transcriptionally active but are not responsive to muscle activity. However, these downstream sequences become responsive to muscle activity when placed under the control of the gamma subunit muscle-specific enhancer.