Antibiotic prophylaxis in head and neck cancer surgery.

A randomized, placebo-controlled, double-blinded trial of cefamandole in the prophylaxis of infection after major head and neck surgery was performed. Patients were given the drug on call to the operating room, and again four and eight hours after the initial dose. Twenty of 25 patients were evaluable. Wound infection developed in five of nine placebo recipients (55%), and three of 11 (33%) receiving cefamandole. Mean duration of hospitalization was 91.1 days in the placebo group, 34.3 in the cefamandole group (p less than 0.05). The study was stopped because of excessive morbidity in the placebo group. Cefamandole decreases the duration of hospitalization following major head and neck cancer surgery.

Assessment of the guinea pig's middle ear cell-mediated response using the mixed lymphocyte response (MLR).

The mixed lymphocyte response (MLR) of the guinea pig was assessed using skin allografts placed in the tympanic cavity, in comparison to the MLR obtained with allografts sutured on the backs of these animals. The MLR obtained from middle ear stimulation was transient. It was not altered by previous systemic immunization, nor did it alter the subsequent MLR obtained when the allografts were implanted on the backs of the guinea pigs. Immunoperoxidase and hematoxylin/eosin stainings of the tympanic allografts were also attempted to make a pathological correlation. Our findings are compatible with other observations of mucosal immune systems.

Monoclonal antibodies (Mabs) in head and neck cancer.

The development of monoclonal antibodies (Mabs) represents a major contribution of immunology to the study of head and neck cancer. The interest of the otolaryngologist in this new field is quite recent, but our knowledge of cancer and other immunoproliferative disorders will exponentially expand with the characterization of tumor-associated antigens of squamous cell carcinomas. The author reviews briefly the technique for producing monoclonal antibodies and presents an overview of the application of Mabs to clinical medicine, oncology and, more specifically, head and neck cancer. Very few contributions have been made in head and neck cancer, but the field of Mabs will significantly alter our diagnostic and therapeutic armamentarium.

The cell-mediated response of the guinea pig's middle ear.

In this project, we studied the cell-mediated response of guinea pig's middle ear. The specific objective was to characterize rejection of skin grafts on the back (allo- and iso-grafts) after primary stimulation (iso- or allo-) in the ear or on the back. The method used was the mixed lymphocyte response with and without phytohemagglutinin (PHA). Preliminary results showed that the middle ear is able to mount a normal immune response, both locally and systemically. Such basic studies will help us to understand the otologic immune response as a whole and may shed some light on the immune phenomena observed in middle ear transplantations.

Immune defence mechanisms of the nasal mucosa.

The authors present a working knowledge of immunology as it applies to the nose. The normal immune response is elaborated upon in its different aspects (non-specific and specific types of response). A detailed description of the immune defence mechanism is given with emphasis on the clinical syndrome associated with immune disorders.

[Pharyngeal paraesthesis secondary and gastro-esophageal reflux]. / Paresthésies pharyngées et reflux gastro-oesophagien.

Globus is an ill-defined entity. Patients present with a variety of diffuse, imprecise symptoms related to the pharynx. A complete investigation with radiological and manometric studies will put in evidence, in most cases, a gastro-esophageal reflux. The anti-reflux treatment is usually successful. The authors insist here on the various pathophysiological mechanisms.

High resolution CT scan of the temporal bone.

With the new high resolution CT scanners with target reconstruction, detailed radiological anatomy can be assessed. Hence, very small structures within the petrous portion of the temporal bone are accessible owing to better density resolution. Not only bony structures but also soft tissue elements are directly visible, which represents an advantage over multidirectional conventional tomography. This technique is described and examples of the normal anatomy of the temporal bone are presented.

Radiographic evaluation of the symptom-producing adenoid.

Adenoid hypertrophy has several variable symptoms. In this study, symptoms were divided into minor and major. A lateral radiograph of the nasopharynx was performed in 114 patients to study the superior and antroadenoid diameters. With proper statistical analysis, a correlation was made between the various clinical groups (scores) and the adenoid measurements. Our results support Hibbert's findings that the antroadenoid width is a better indicator of the symptom-producing adenoid than adenoid mass measurements with their loosely defined norms. A thorough history and physical examination remain paramount in the diagnosis and management of adenoid hypertrophy.

Adaptive immunity of the tympanic membrane.

In a previous experiment an antiserum was developed in the rabbit from the lamina propria of the tympanic membrane of the guinea pig. In the present study 18 Hartley guinea pigs were used in an in vivo experiment in which the antiserum (RAGTM IgG) served passively to immunize the animals subjected to various forms of trauma to the right tympanic membrane. Two groups (18 animals) immunized with normal rabbit IgG or normal saline served as controls. The left tympanic membrane remained untouched in all groups and served as an internal control. Various forms of trauma (infection, cauterization, section), various times (one to 21 days), and diverse techniques of staining (immunofluorescence, complement, and immunoperoxidase) were studied. The results indicate that the combination of trauma and sensitization in the first group evokes a particular response in the lamina propria of the tympanic membrane in immunized animals (RAGTM IgG). The form of trauma does not influence the results, but time seems to be an important factor. This work addresses several questions concerning the possible role of the combination of trauma and sensitization in conditions that involve the tympanic membrane and middle ear clinically.

Stomal care in pharyngocutaneous fistulas.

Pharyngocutaneous fistula is a common complication in head and neck cancer surgery. Elegant technical procedures which have been designed to circumvent the problem, are often of no avail due to the poor status of the surrounding skin. In this paper, four cases are presented where major wound breakdown was treated with techniques used in the "stomal care" clinic (ileostomy, colostomy, etc.). In all cases, the wound gap closed spontaneously and no reconstructive surgery was needed even in huge fistulas. The method is encouraging and easy for the patient. It has advantages in economy of time, money, and discomfort to the patient.

Immune response of guinea pig tympanic membrane.

The authors present the results of their experiment on the immune response of the guinea pig tympanic membrane. The first step was to develop an antiserum in the rabbit from the guinea pig tympanic membrane (RAGPTM). The lamina propria was used and IgG was identified as the main constituent of this antiserum. In their initial experiment, the RAGPTM IgG seemed to be specific to the acellular connective tissues of the respiratory tract and TM. The experiment presented here is concerned with the immune response of the guinea pig tympanic membrane. The animals were sensitized by intracardiac injection with the antiserum, and within one hour the right TM was traumatized in diverse fashions (bacteriological, chemical, mechanical traumas). The left TM served as a negative control. Animals were sacrificed at 24 hours, 7 days and 21 days. Immunofluorescence staining, complement studies (C23) and immunoperoxidase techniques were used on the TM. It appears that the GPTM can be antigenic in the rabbit. The right TMs of the sensitized guinea pigs reacted differently in the sense that there seems to be homing of the RAGPTM IgG to the site of trauma and that the complement participates in the reaction at least in the first week. The lamina propria of the TM is the site of the immune response. This work will need more elaborate studies but allows us to address different questions concerning the possible role of the combination of trauma and sensitization in conditions clinically involving the TM and middle ear.

Antigenicity of the guinea pig's tympanic membrane.

The immunogenicity of the middle ear constituents is a matter of prime importance. In this work, the authors were interested in the antigenicity of the guinea pig's tymphanic membrane. They reached the conclusion, after developing an antiserum (IgG), that the tympanic membrane of the guinea pig can be antigenic in the rabbit. After purification and absorption, a cross-reactivity remains between the tympanic membrane and the mucosae of the upper respiratory system.

[Essential diet in extensive cervico-facial surgery]. / Diète essentielle dans la chirurgie cervico-faciale extensive.

A prospective nutritional study was undertaken on 26 patients submitted to pharyngo-laryngectomy with pre-operative irradiation. Three diets were compared, given through a naso-gastric Levine tube. The first diet being the hospital blenderized diet, the second one Flexical, and the third one, Flexical Control. There was no significant difference between Flexical and Flexical Control, but the biological parameters and the clinical evolution militate in favor of a widespread use of the Flexical method. The authors recommend the use of controlled defined diet as compared to the hospital blenderized diet and the more sophisticated and more expensive method as the intravenous hyperalimentation.