ABSTRACT
Despite the common sense that we learn from our mistakes, an error is an unwelcome event when we deal with patients. Diagnostic error is common, costly, and the leading cause of malpractice litigation. Yet, errors occur occasionally in a lifetime of practice, and the consequences of these faults are significant for patients and physicians. If someone would have told me that I would miss a brain tumor in my first years of practice, in a patient presenting to my care with several cranial nerve signs, I would not have believed it. Here is how it happened.
Subject(s)
Diagnostic Errors/psychology , Medical Errors/psychology , Physicians/psychology , Emergency Service, Hospital , Humans , Malpractice , Neuroma, Acoustic/diagnosis , Physical ExaminationABSTRACT
BACKGROUND: The use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort. PATIENTS AND METHODS: This study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first. RESULTS: The median patient age was 53 (37-78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684-13.316) and PFS of 8 months (CI 95%, 6.051-9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%). CONCLUSIONS: The results of this study suggest that cetuximab plus platinum-fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Head and Neck Neoplasms/drug therapy , Platinum/therapeutic use , Adult , Aged , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/pharmacology , Antineoplastic Agents/adverse effects , Antineoplastic Agents/pharmacology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Carcinoma, Squamous Cell/pathology , Cetuximab , Disease-Free Survival , Europe , Female , Fluorouracil/pharmacology , Fluorouracil/therapeutic use , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Neoplasm Grading , Platinum/adverse effects , Platinum/pharmacology , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck , Treatment OutcomeABSTRACT
Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block.
