[Management of patients with bradykinin-mediated angioedema in oral and maxillofacial surgery]. / Prise en charge des patients atteints d'angiœdèmes bradykiniques en chirurgie orale et maxillo-faciale.

Bradykinin-mediated angioedema (AE) is a rare disease characterized by recurrent cutaneous or mucosal angioedema. This hereditary or acquired disease is of rapid installation, non-pruritic, usually painless and can affect the face, lips, larynx, gastrointestinal tract or extremities. When the affected area involves the upper respiratory tract, laryngeal angioedema can lead to imminent death by asphyxia. This is the reason for the high mortality rate (30 %) in undiagnosed or improperly managed patients. High-risk situations in oral and maxillofacial surgery procedures should be identified preoperatively. Short-term prophylaxis must be carried-out prior to any procedure that may trigger an attack. A multi-site reference center (CREAK) has been created to help clinicians to manage this disease. This article reviews the pathophysiologic mechanisms, the clinical presentations, the possible treatments, the acute strategies for attacks and different prophylactic possibilities in oral and maxillofacial surgery.

[Labial recurrent swelling revealing median congenital upper-lip fistula]. / Tuméfaction labiale récidivante révélatrice d'une fistule congénitale médiane de la lèvre supérieure.

Midline upper-lip fistulas are an extremely rare variant of congenital facial malformations. Less than 30 cases have been reported in the literature since 1970. We report the case of a 2 and a half-year-old girl presenting with a median congenital blind fistula of the upper lip, without any relation with the oral cavity. A recurrent swelling of the upper lip was the main symptom. Complete surgical excision of the cyst or of the fistulous tract must be obtained to avoid recurrence.

[Neoadjuvant chemotherapy of stage IIb or III cancers of the uterine cervix. Long-term results of a multicenter randomized trial of 151 patients]. / Chimiothérapie néoadjuvante des cancers du col utérin aux stades IIb et III. Résultats éloignés d'un essai randomisé pluricentrique portant sur 151 patients. Groupe coopérateur de gynécologie de la Fédération nationale des centres de lutte contre le cancer (FNCLCC).

Present chemotherapy, with cisplatin combinations, currently offers the possibility of seeking adjuvant therapy in locally advanced and bulky carcinomas of the cervix, which have an unfavorable prognosis (nodal involvement). This initial adjuvant chemotherapy may improve the results of classical pelvic irradiation. From 1982 to 1987, a randomized phase III trial was performed in order to determine the long term effect of induction chemotherapy before irradiation in stage IIb-N1, III, M0 squamous cell carcinomas of the cervix. Radiotherapy (R) for all patients consisted in 50 Gy in the pelvis with a boost by external irradiation of the brachytherapy (cumulative dose of 68 Gy). The chemotherapy regimen (C + R group) was an association of methotrexate, chlorambucil, vincristine and cisplatin, given every 3 weeks, at least two courses were to be given before assessing efficacy and two more courses were given to patients who responded. After a follow up of 5-10 years, 76 patients were fully evaluable in the R arm and 75 in the C + R arm. The response rate (> 50%) to chemotherapy was 42.5% and after completion of treatment, remission rate was 93% in the R arm and 96% in the C + R arm. The disease-free survival was 40% in the C + R group and 35% in the R group, and the median survival was 42 and 45 months respectively (NS). The survival of patients with a complete response at the end of radiotherapy was significantly better in the C + R group when they are responding to chemotherapy, than in R group (P < 0.05). Radiotherapy was not modified whether patients had an initial chemotherapy or not; tolerance was not significantly different between the two groups. Efficacy of induction chemotherapy is an available test for long term results. This approach has the potential for improving the outlook in patients with high-risk primary cancer: earlier use and higher dose intensity of chemotherapy may be associated with a better cytoreduction, and probably a better survival. Further controlled investigations are warranted to confirm the value of adjuvant chemotherapy in cervical cancer.

915 MHz microwave interstitial hyperthermia. Part I: Theoretical and experimental aspects with temperature control by multifrequency radiometry.

Microwave interstitial hyperthermia now plays an increasing part in the various hyperthermia techniques used in cancer treatment. This paper will present the design, construction and theoretical as well as experimental study of miniature coaxial antennas designed to heat tumours of various volumes and sizes. Monitoring temperature using multifrequency radiometry during hyperthermia stems naturally from the very design of these antennas. Experiments on phantoms, animals and patients in phase I clinical assessment have demonstrated that microwave interstitial hyperthermia can be achieved with temperature control and monitoring by microwave radiometry.

[Randomized trial of initial chemotherapy in 151 locally advanced carcinoma of the cervix (T2b-N1, T3b, MO)]. / Essai randomisé de chimiothérapie initiale dans 151 carcinomes du col utérin localement étendus (T2b-N1, T3b, M0).

From 1982 to 1987, a randomized phase III trial was performed in order to determine the long-term effect of induction chemotherapy before standard pelvic irradiation in stage IIb-N1, III squamous cell carcinomas of the cervix. Patients were randomized to either chemotherapy and radiotherapy (C + R group) vs radiotherapy alone (R group). Radiotherapy for all patients consisted of 50 Gy in the pelvis with a boost by external irradiation or by brachytherapy (cumulative dose of 68 Gy). The chemotherapy regimen was an association of methotrexate (10 mg/m2, D2-4), chlorambucil (4 mg/m2, D1-5), vincristine (0,7 mg/m2, D1), cisplatin (80 mg/m2, D5), given every 3 wks; at least 2 courses were to be given before assessing efficacy and 2 more courses were given to patients who responded. One hundred and fifty-one patients were fully evaluable, after a mean follow-up of 38 mths (range 2-7 years), 76 in the R arm and 75 in the C + R arm. The response rate (greater than 50%) to chemotherapy was 42.5%. After completion of treatment, the complete response rate was 86.8% in the R arm and 86.3% in the C + R arm. The 3 year disease-free survival was 58.7% in the C + R group and 54.5% in the R group, and the median survival was 39.5% and 47 months respectively (NS). The survival of patients with a complete response at the end of radiotherapy was significantly better in the C + R group (when chemotherapy had been active) than in the R group (p = 0.04). Although radiotherapy was not modified whether patients had initial chemotherapy or not, tolerance was not significantly different between the 2 groups. The data collected in this study indicate that: 1) efficacy of induction chemotherapy is the only available predictive test for long-term results, 2) tolerance to treatment is crucial for optimal chemotherapy delivery, 3) higher dose intensity of chemotherapy in cervical carcinoma is associated with a better tumor reduction, and probably a better survival.

[Prognostic value of estrogen and progesterone receptors in epidermoid carcinoma of the cervix uteri]. / Valeur pronostique des récepteurs d'estrogène et de progestérone dans les cancers épidermoïdes du col utérin.

The authors have studied, on 100 cases, the prognostic value of ER and PgR receptor levels in cancers of the cervix. An elevated level of ER and PgR seems to favorably influence the immediate response to the treatment. On the contrary, it does not seem that this should be a factor in the long-term evolutive prognosis.

[Effects of irradiation on vascular microsurgical sutures. Experimental study on 125 rats]. / Effets des irradiations sur les sutures microchirurgicales vasculaires. Etude expérimentale sur 125 rats.

The effects of irradiation on microsurgical sutures following vascular surgical procedures were studied in 125 rats divided into 7 groups, animals in 5 groups being irradiated at different doses. Follow-up examinations were conducted a minimum of 6 months after suturing and 2 months after irradiation. Evaluations included precise histological study of each vascular specimen removed, arteriography, and scanning electron microscopy. Findings demonstrated that it is possible to obtain satisfactory early functional results after irradiation of microsurgical anastomoses, and that the relation in time between trauma produced by radiotherapy and surgery plays an important role.

[Surgical treatment of intestinal radio-lesions. 53 patients operated, out of 171 radio-lesions among 7301 irradiated (author's transl)]. / Traitement chirurgical des radio-lésions intestinales. 53 opérés sur 171 radio-lésions parmi 7301 irradiés.

Results of a complete and homogenous series by the Medical Team of the Centre Anti-Cancéreux.--2,45% of abdomino-pelvic irradiations among 6516 cases,--but only 0.78 are serious and need surgery (i.e. 1/3 of the radio-lesions). The study concerned 65 cases;--during the same period, medical treatment alone controlled 51 cases of rectitis and 51 stenoses. The interval after irradiation is variable: 33 times, it was shorter than 1 year, in 32 cases, it was longer, up to 13 years. The plan for therapy is to continue the medical treatment as well as possible and to operate only in case of absolute need, but before obstruction;--to prefer immediate resection to internal derivation. The 27 resections resulted in 18 recoveries and 9 cases of peritonitis. In spite of the serious nature of the initial irradiated lesion, followed by this complicated radio-lesion, we observed: 28% of 5-year survivals, and over 10 years in 9 cases.

[Invasive carcinoma of the uterine cervix associated with pregnancy (author's transl)]. / Le cancer invasif du col utérin associé à la grossesse.

In 4,396 invasive cervix carcinomas treated between 1934 and 1973, 52 occurred during pregnancy or within 3 months post partum. Stages I were more frequent among pregnant women (24%) than without pregnancy (8%) and stages II were as frequent (50%). Stages I and II were more frequent among pregnant women treated during 1963-1973 than 1934-1962. The 3 years' survival rate, all stages combined, for pregnant women (42%) was lower than for matched control non-pregnant women (62%). This difference was significant at P = 0.05, but at 5 and 10 years, the difference was not significant for patients treated between 1963-1973. At an equal stage, survival rate seemed lower for stages IIb and III (P = 0.02 for these two stages combined.) The lymph node involvement was not more frequent; the decrease of global survival rate could be associated to some factors and especially incomplete therapy and an under-estimation of the tumor extension because of the pregnancy. Our results are compared to the data literature and therapeutic schedules are discussed.

[Primary cancer of the vagina and indications for therapy: on the basis of 52 cases]. / Le cancer primitif du vagin et ses indications thérapeutiques. A propos de 52 observations.

The authors studied 52 cases of primary cancer of the vagina, 7 stage I, 23 stage II, 7 stage III, and 15 stage IV. For every one primary cancer of the vagina they found 58 cancers of the cervix, 6 cancers of the endometrium, 5 cancers of the ovary, and 4 cancers of the vulva. The extent of these cancers at the time of the first examination is explained by their clinical latency. Treatment was by radiotherapy (radium therapy and telecobaltotherapy) with or without surgery. At present the 5-year survival rate is 23.8 percent. The use of high-energy therapy should lead to a distinct improvement in the results.