Direct and indirect injuries of the pharynx and larynx.

Direct and indirect injuries of the pharynx and larynx. The neck is characterized by a relatively complex anatomy and a very compact content. It therefore forms an extremely vulnerable part of the human body. Although uncommon, aero-digestive tract injuries caused by trauma present a challenging situation for both the emergency doctor and the head and neck surgeon. Clinical presentations may vary from severe acute distress with immediate life-threatening airway obstruction to apparently more reassuring situations. However, the latter turn out to be frequently misleading, since patients may deteriorate suddenly as the result of unrecognized injuries. In such cases, delayed diagnosis is often associated with increased morbidity and mortality. Due to its role in phonation, breathing and alimentation, injuries to the aero-digestive tract also expose the patient to severe later impairment and a poorer quality of life. Comprehensive airway control remains the highest and often most challenging priority for the emergency physician. Careful clinical examination combined with endoscopy and computed tomography imaging form the key elements in diagnosis and early recognition of patients who may require surgical management.

The generalists' perception of quality of life in head and neck cancer.

OBJECTIVE: Patients with head and neck cancer are willing to undergo aggressive treatments and accept alterations in quality of life to attain recovery or to prolong their life. It is unclear how physicians perceive alterations in quality of life. This study examined whether physicians considered changes in quality of life when selecting a treatment for head and neck cancer. METHODOLOGY: A large, Belgian, general practitioner population received a questionnaire in the mail requesting their opinions on quality of life for patients with cancer. They assessed the impacts of symptoms, treatments, and side effects. RESULTS: 506 responses were received and evaluated. A majority of physicians (85.7%) thought that quality of life must be considered when selecting a treatment, even when it represented lower chance of survival. Moreover, 82.4% felt that proposing no treatment was justified when treatment caused impaired quality of life. Most physicians thought that the quality of life was worse for patients with cancer in the head and neck than for patients with cancer in any other location. Moreover, most physicians thought that the patient (98.2%) and the family doctor (89%) should participate in selecting the treatment. The symptoms that ranked highest for impacting quality of life were pain and breathing quality, followed by feeding requirements, voice quality, and physical appearance. Radiotherapy was thought to offer the best quality of life. CONCLUSION: Physicians considered quality of life a very important factor in treating patients with head and neck cancer. This medical perception strongly influences the choice of treatment.

[What is the standard treatment approach for a cervical lymph node metastasis from a squamous cell carcinoma of unknown origin?]. / Exploration et traitement d'un carcinome épidermoïde ganglionnaire cervical sans primitif décelé.

The diagnostic work-up of cervical lymph node metastases from an occult primary tumour in the head and neck region is well established. PET-scan, which was controversial, is nowadays an integral part of it. Common therapeutic strategies include neck dissection followed by extensive irradiation of pharyngeal mucosa and bilateral lymph node areas. Chemotherapy is often added to these treatment modalities, especially if negative prognostic factors are present on the pathological specimen. However, its therapeutic benefit is not yet proven. There are numerous phase II studies available in the literature, sometimes with controversial conclusions. Therefore, as long as there are no data issued from randomized controlled trials, the treatment decisions are copied from the ones which are used when the primary tumour is well identified in the head and neck area.

[Neoadjuvant chemotherapy in head and neck cancer]. / Chimiothérapie néoadjuvante dans les cancers "tête et cou".

Head and neck cancer represent 5% of all cancer and is often diagnosed at advanced stage. Treatment requires a multidisciplinary approach and relies on surgery, radiotherapy and/or chemotherapy. In locally advanced disease, chemotherapy has been shown to improve survival, particularly when delivered concomitantly with radiotherapy (6.5% absolute benefit in overall survival. Although induction or neoadjuvant chemotherapy has been much studied, no clear benefit has been identified but for larynx preservation. New chemotherapy regimens with adjonction of taxanes have drawn attention again on induction chemotherapy. Several randomised controlled trials have demonstrated improved response rate, disease free survival, or overall survival when docetaxel is added to cisplatin and 5 FU as induction chemotherapy. A definitive proof of the benefit of the induction approach is still lacking. To date, induction chemotherapy can only be recommended with the aim of preserving laryngeal function. Ongoing trials are expected to validate or rule out the induction strategy as a standard approach in locally advanced head and neck cancer.

[Monoclonal antibodies for the treatment of head and neck cancer]. / Place des anticorps monoclonaux dans le traitement des tumeurs de la tête et du cou.

Monoclonal antibodies are now part of the armamentarium available for the treatment of head and neck cancer. Cétuximab, a monoclonal antibody targeting EGFR, improves overall survival as compared with radiotherapy alone as radical treatment of locally advanced head and neck cancer. It is now reimbursed in Belgium after multidisciplinary discussion if cisplatin is contra-indicated. In the metastatic setting adding cétuximab to platinum based chemotherapy improves overall survival as compared with chemotherapy alone, a first-time event over a 30-year period, unfortunately not yet accessible to the Belgian patients. Other monoclonal antibodies targeting EGFR or VEGF are also currently under investigation while cétuximab is being explored in the induction, the maintenance or the post-operative radiotherapy settings.

[Head and neck tumors: standards of care and new approaches]. / Les tumeurs de la sphère ORL: standards de traitement et nouvelles approches en radiothérapie.

We intend to review the general value of radiotherapy in the management of head and neck cancer. Our aim is to define a treatment protocol which is evidence-based and therefore of use in daily clinical practice. There is general agreement on the efficacy of the concomitant schedules combining radiotherapy and chemotherapy, both in the adjuvant setting as well as in the exclusive non-surgical approach. This however does not preclude further research aiming at optimizing the therapeutic index. As far as neoadjuvant chemotherapy is concerned, applied prior to radical local treatment, there are no conclusive data available which allows us to implement this treatment option in routine clinical practice. This approach deserves further investigations and patients should be entered in well designed prospective randomized trials.

Facial pain from visceral origin.

INTRODUCTION: Unilateral facial pain in the trigeminal area is known to be caused by a cancer in the superior lobe of the lung. CASE REPORT: A 65 year old male, heavy smoker, presented a permanent otalgia and a mandibular pain on the left side. These symptoms could not be relieved by common analgesics. All explorations for common etiologies were negative. After an episode of dyspnea, a left lung cancer was discovered. Thanks to radiotherapy and chemotherapy, the patient's pain was improved. CONCLUSION: Referred facial pain is rare and can be explained by the invasion of the tenth nerve by an upper lobe lung tumor. In most cases, the patient presents a right otalgia and pain in the area of V3. The diagnosis can be delayed from 1 month to 4 years after the onset of the pain. Referred facial pain is improved by the treatment of the causal lung cancer.

Light and electron microscopic immunolocalization of bovine pregnancy-associated glycoprotein in the bovine placentome.

A bovine pregnancy-associated glycoprotein (bPAG) of 67 kDa has previously been isolated from bovine fetal cotyledons. The objective of this study was to determine the cytological localization of that protein in the placentomes and possibly the cells responsible for its production. Highly specific antisera raised against pure bPAG were used to demonstrate the cellular localization of the protein in bovine placentomes by light and electron microscopic techniques. Strong immunostaining was observed exclusively in the cytoplasm of large binucleate cells present predominantly in fetal cotyledonary tissue (villi). Some smaller weakly immunostained cells were also present in caruncular epithelium. By ultrastructural immunogold procedures, the protein was detected only within amorphous cytoplasmic granules. Granules of identical size, but weakly labeled, were found on the maternal side. All cells containing labeled granules were binucleate. These results suggest that bPAG is probably synthesized by trophoblast binucleate cells and stored in granules prior to delivery into the maternal circulation after cell migration.