Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial

Mucositis is an acute inflammation of the oral mucosa because of radiotherapy and/or chemotherapy. All patients receiving radiotherapy in the head and neck region develop oral mucositis. The aim of this study was to analyse the effects of selective oral flora elimination on radiotherapy-induced oral mucositis, in a double-blind, randomised, placebo-controlled trial. Sixty-five patients with a malignant tumour in the head and neck regions to be treated with primary curative or postoperative radiotherapy participated in this study. The patients received either the active lozenges of 1 g containing polymyxin E 2 mg, tobramycin 1.8 mg and amphotericin B 10 mg (PTA) (33 patients) or the placebo lozenges (32 patients), four times daily during the full course of radiotherapy. Mucositis, changes in the oral flora, quality of feeding and changes of total body weight were assessed. Mucositis score did not differ between the groups during the first 5 weeks of radiotherapy. Nasogastric tube feeding was needed in six patients (19%) of the placebo group and two patients (6%) of the PTA group (P=0.08). Mean weight loss after 5 weeks of radiation was less in the PTA group (1.3 kg) (s.d.: 3.0) than in the placebo group (2.8 kg) (s.d.: 2.9) (P=0.05). Colonisation index of Candida species and Gram-negative bacilli was reduced in the PTA group and not in the placebo group (P<0.05). No effect on other microorganisms was detected. In conclusion, selective oral flora elimination in head and neck irradiation patients does not prevent the development of severe mucositis. Record 8 of 10 - SilverPlatter MEDLINE(R)

Most ICU infections are not nosocomial. A prospective observational study.

This work deals with classical and mixed variational statements for the analysis of layered structures under the effect of four different fields: mechanical, thermal, electrical and magnetic. Constitutive equations, in terms of coupled mechanical-thermalelectrical-magnetic filed variables, are obtained on the basis of a thermodynamics approach. The Principle of Virtual Displacements (PVD) and the Reissner&#039;s Mixed Variational Theorem (RMVT) are employed. The latter permits interlaminar variables, such as transverse stresses, transverse electrical displacements, etc. to be assumed &quot;a priori.&quot; A number of particular cases of the considered variational statements are proposed. A new condensed notation is introduced into the Unified Formulation (UF) framework, which leads to governing equations and finite element matrices in terms of a few fundamental nuclei. The Finite Element (FE) case for multilayerd plates has been addressed. Variable kinematics, as well as layer-wise and equivalent single layer descriptions have been implemented for the considered FEs according to UF. A few results show the effectiveness of the proposed approach