[Do analgesic sweet solutions in neonates influence glycemia? A literature review]. / Les solutions sucrées à visée antalgique chez le nouveau-né modifient-elles la glycémie ? Synthèse de la littérature.

Sweet solutions are one of the most widely used nonpharmacologic analgesics used for newborns. They alleviate mild to moderate pain induced by painful procedures. They are used daily in neonatal intensive care units before a venepuncture or a heel stick, especially for a blood-sugar measurement. It is agreed that analgesic sweet solutions do not modify glycemia results. This nevertheless remains a recurrent question that the present review attempts to answer.

[Variables determining the amount of care for very preterm neonates: the concept of medical stance]. / Diversité inter-régionale de la quantité de soins délivrés aux grands prématurés : notion de « regard médical ¼

OBJECTIVE: To compare the amount of medical interventions on very preterm neonates (24-31 weeks of gestation) in two French university tertiary care centers, one of which is involved in a Neonatal Developmental Care program. A secondary objective is to assess whether this difference in medical interventions can be linked to a difference in mortality and morbidity rates. METHODS: We prospectively included all very preterm neonates free from lethal malformation born live in these two centers between 2006 and 2010. These inclusion criteria were met by 1286 patients, for whom we compared the rate of five selected medical interventions: birth by caesarean section, chest intubation in the delivery room, surfactant therapy, pharmacological treatment of patent ductus arteriosus, and red blood cell transfusion. RESULTS: The rates of the five medical interventions were systematically lower in the center that is involved in Neonatal Developmental Care. There was no significant difference in survival at discharge with no severe cerebral ultrasound scan abnormalities between the two centers. There were, however, significantly higher rates of bronchopulmonary dysplasia and nosocomial sepsis and longer hospital stays when the patients were not involved in a Neonatal Developmental Care program. DISCUSSION: This benchmarking study shows that in France, in the first decade of the 21st century, there are as many ways to handle very preterm neonates as there are centers in which they are born. This brings to light the concept of medical stance, which is the general care approach prior to the treatment itself. This medical stance creates the overall framework for the staff's decision-making regarding neonate care. The different parameters structuring medical stance are discussed. Moreover, this study raises the problematic issue of the aftermath of benchmarking studies when the conclusion is an increase of morbidity in cases where procedure leads to more interventions.

Relative binding affinities of OmpR and OmpR-phosphate at the ompF and ompC regulatory sites.

In Escherichia coli, porin gene expression is regulated, in part, by the two-component regulatory system consisting of the two proteins EnvZ and OmpR. EnvZ is an integral inner membrane protein that is phosphorylated by cytoplasmic ATP on a histidine residue. EnvZ modulates the activity of OmpR by phosphorylation and dephosphorylation. Phospho-OmpR (OmpR-P) binds to the porin genes ompF and ompC to regulate their expression. The simple affinity model predicts that as the concentration of OmpR-P increases, initially high-affinity binding sites on ompF are filled. Then binding sites of lower affinity on ompF and ompC are occupied and this ordered binding accounts for the differential expression of the porin genes. We demonstrate that acetyl phosphate phosphorylates OmpR at aspartate 55, the same residue phosphorylated by the kinase EnvZ. Quantification of the level of OmpR-P by HPLC and direct measurement of the binding affinities enabled us to test the affinity model. Our results indicate that phosphorylation dramatically increases the affinity of OmpR for its binding sites (greater than tenfold). We also show that the affinities of OmpR-P for F1 and C1 binding sites are not sufficiently different to provide a strong basis for discrimination. The consequences of these observations for the simple affinity model are considered.

Histopathological findings after preoperative chemo-radiotherapy in oral and oropharyngeal carcinoma. A study of 28 resected specimens.

Serial sections of whole surgical specimens from 28 patients with locally advanced oral carcinoma were examined to assess the histopathological effects of a preoperative intravenous (i.v.) chemotherapy and radiotherapy protocol. In 15 cases (54%), no residual neoplastic tissue was found: in 9, the tumour area showed a dense hyalinised connective tissue, whereas in the other 6 cases foci of keratotic material were surrounded by a foreign body-type reaction. In 13 patients (46%), residual neoplastic tissue was observed: small fields of tumour were present in 6 cases, whereas tumour was widely persistent in 7. Lymph node metastases were observed in 9 cases (32%), with extracapsular spreading in 6 (21%). In 93% of cases, pathological staging on the specimen was more favourable than the clinical preoperative staging. 23 patients (82%) are alive without evidence of disease 30-55 months after surgery; 10 (43%) did not show any residual neoplastic tissue in the specimen; 10 patients (43%) showed persistence of tumour, but in 5 (21%) only small fields of tumour were observed. 4 patients (14%) died due to their tumour. The pathological data show that this protocol is successful in the treatment of advanced oral carcinoma; furthermore, they provide reliable information about the response to therapy and the subsequent course of the disease.

[The use of cisplatin as radiosensitizing agent in advanced tumors of the head and neck. Randomized study]. / Utilizzazione del cisplatino come radiosensibilizzante nei tumori avanzati della regione testa-collo. Studio randomizzato.

This study was aimed at assessing whether c-DDP administration immediately before radiotherapy could increase frequency and duration of objective responses, as well as survival, in patients affected with locally advanced stages of squamous carcinomas of the head and neck. All patients had already undergone two induction cycles according to the CABO schedule. Ninety-six of 108 treated patients could be evaluated. Treatment schedule consisted in: 1) randomized distribution of patients into two groups before induction chemotherapy; 2) two cycles of induction chemotherapy according to the CABO schedule in all patients; 3) radiation therapy: the patients in group A were given 5 mg/mq of i.v. cisplatin, 30-60 minutes before each session. The results from the two groups were compared and no significant differences were observed regarding objective response (82.5% in group A vs. 86% in group B), response duration and overall survival rates. Even though toxicity was higher in the patients in group A, therapeutic protocol never needed be modified.

[Preoperative endocavitary curietherapy of stage Ib-IIa-IIb cervical carcinoma. Personal observations]. / Curieterapia endocavitaria pre-operatoria nel carcinoma della cervice uterina agli stadi Ib-IIa-IIb. Osservazioni personali.

From 1980 through 1984, 41 patients with squamous cell cervix carcinoma and 1 with adenosquamous carcinoma were treated with preoperative irradiation. Clinical stages were Ib in 6 patients, IIa in 24, and IIb in 12. At surgery, lymph node metastases were found in 5 cases, and residual tumors in 8. The latter risk patients were given further external radiotherapy after surgery. Overall three-year survival rates for FIGO stage Ib was 100%; 91.6% for stage IIa, and 83% for stage IIb (minimum follow-up: 3 years). Two patients died from locoregional recurrence of the disease 12-24 months after the treatment, and 2 from distant metastases; 5 patients have showed signs of local improvement. Our results seem to point to pelvic lymph node involvement as the major prognostic factor: in fact, 40% only of the patients with involved lymph nodes is alive. Actuarial survival rates show 90.4% of patients to be alive at 5 years. Tolerance to the combined use radiotherapy and surgery was fair: no severe side-effects were observed. Even though our results are encouraging, a randomized study is still recommended to verify the actual value of this treatment versus combined surgery and radiotherapy or radiotherapy alone.

[Quadrantectomy and adjuvant radiotherapy in carcinoma of the breast. Initial results of our cases]. / Quadrantectomia e radioterapia adiuvante nel carcinoma della mammella. Primi risultati della nostra casistica.

The conservative treatment of early breast cancer always requires irradiation of residual mammary tissue. The preliminary results obtained in 45 early breast cancer patients, who received quadrantectomy plus axillary dissection, followed by radiation of residual breast are reported. Radiation was performed by the two opposed field technique. In some cases the residual breast tissue was compressed using a special accessory provided with the Theratron 780. In addition to the tumor dose of 50 GY, 10 GY boots was added to the surgical scar using 7 MeV electrons. The 6 patients with positive axillary nodes received 6 courses of adjuvant chemotherapy (CMF) after radiotherapy. All patients are currently alive and free of disease. The 64% (29 patients) were followed up for at least 5 years, and 36% (16 patients) for at least 3 years. Only 2 cases of local recurrence were encountered (4.4%). The esthetic result was satisfactory in all cases. No side effects due to treatment were noted.

Chest irradiation as an attempt to improve the response after induction chemotherapy in small cell lung carcinoma.

Forty-six patients with small cell lung carcinoma received cyclic chemotherapy with cisplatin-VP 16 and vincristine, doxorubicin, and cyclophosphamide. The responding patients were given prophylactic cranial irradiation. Patients without metastases not achieving a complete response (CR) following induction chemotherapy were given chest irradiation. The response rate was 73.9 per cent. Response was improved by radiation therapy in only 9 per cent of the patients with limited disease. Median survival was 39 weeks, with 2 patients surviving for longer than 24 months. The duration of response and survival in complete and partial responders was similar; absence of radiation therapy in the patients with CR might explain this finding.

[Pulmonary disease after radiotherapeutic treatment of carcinoma of the breast with fast electrons from an 18 MeV betatron]. / Malattia polmonare post-radioterapica nel trattamento del carcinoma della mammella mediante l'impiego di elettroni veloci di un betatrone da 18 MeV.

Instances of lung complications observed at the radiotherapy division of the department of oncology, Greater Hospital of St. John the Baptist and the City of Turin in the treatment of 110 breast cancer patients with fast electrons produced by an 18 MeV betatron are described and compared with those noted 2 yr after TCT treatment of 192 subjects. Lung fibrosis was observed in 5.5% of cases 15 months after fast electron treatment, as opposed to 14.1% after TCT. The mean age of patients with such complications after fast-electron treatment was much higher than after TCT (70.16 yr as opposed to 55.55 yr).

[Dynamic telethermography in primary bone and soft tissue tumours (author's transl)]. / La teletermografia dinamica dei tumori primitivi delle ossa e delle parti molli.

Twelve cases of primative bone neoplasm and of soft tissues sarcomas have been thermographycally observed. All cases were positive and cutaneous hyper-thermic areas corresponding to the neoplasies under consideration were noticed. This hyper-thermic area was in all cases larger than the area of bone's disease radiographycally detectable. Five cases were controlled before during and after a conservative radio-chemotherapic treatment. Thermographic and clinic finding's variation were always according; precocious than radiography. The results are to emphasize the utility of thermography in the prognosis, in the diagnosis of neoplastic extension, in conservative treatment control and in the follow-up of treated patients.

[Epithelial neoplasms of the head and neck. Study of 72 cases treated with radiotherapy only or combined with chemotherapy]. / Neoplasie epiteliali del capo-collo. Nostre osservazioni su 72 casi trattati con radioterapia esclusiva o associata a chemioterapia.

A comparison between the effects of radiotherapy with and without supplementary chemotherapy in 72 cases of head and neck tumours treated Turin, Oncology Department is reported. The overall results were similar to those in the international literature (59.7% local remissions 2 yr after treatment). Personal experience is cited for the view that radiotherapy alone should always be employed on the satellite lymph node chains in N0 patients (clinically negative nodes), whereas chemotherapy should be added when node positivity (N1 or N2) is apparent at the outset.