Reconstruction microchirurgicale et prise en charge globale des patients porteurs de cancer ORL : l’importance d’une approche qualité et d’un circuit protocolisé [Microsurgical reconstruction and full management of patients with head and neck cancer: Importance of a quality approach and a circuit protocolisation]

Main of study: Management and surgical reconstruction of head and neck cancers remain a challenge. From the first consultation to surgery and radiotherapy, it is necessary to save time to ensure optimum treatment and better survival rates. Objectif: To establish a kind of quality approach to the management of patients with head and neck cancers. 54 patients who had microsurgical reconstruction after head and neck cancer were included in this study between 1997 and 2006. Results : Multiple data were considered: body mass index (BMI), ASA stage, age, existence of a pre-or postoperative radiotherapy, the surgeon's experience and the number of veins drainage. The success rate is superior when more than one draining vein is sutured to the flap for patients with a BMI > 20. Radiotherapy does not seem to affect the survival of the flap. Conclusion: According to current literature, the survival rate of these patients is better when the overall time care is less than 100 days. That period is possible with a perfect organization of the medical and paramedical team. Therefore, we propose to include these patients in a circuit protocolisation care, which saves time, to better inform patients and improve survival rates. Buts: la prise en charge et la reconstruction chirurgicale des cancers ORL restent un challenge. De la première consultation à la chirurgie et la radiothérapie, il est nécessaire de gagner du temps afin d’assurer une traitement optimum et un meilleur taux de survie. Objectif : établir une sorte d’approche qualité de la prise en charge des patients porteurs de cancers ORL. 54 patients qui ont bénéficié d’une reconstruction microchirurgicale suite à un cancer ORL ont été inclus dans cette étude entre 1997 et 2006. Résultats : plusieurs données ont été étudiées : l’index de masse corporelle (IMC), le stade ASA, l’âge, l’existence d’une radiothérapie pré ou post opératoire, l’expérience du chirurgien ainsi que le nombre de veines de drainage. Le taux de succès se révèle supérieur lorsque plus d’une veine de drainage est suturée au lambeau, pour des patients ayant un IMC > 20. La radiothérapie ne semble pas avoir de répercussion sur la survie du lambeau. Conclusion : conformément à la littérature actuelle, le taux de survie de ces patients est meilleur lorsque le temps global de prise en charge est inférieur à 100 jours. Ce délai court n’est possible qu’avec une parfaite organisation de l’équipe médicale et paramédicale. De ce fait, nous proposons d’inclure ces patients dans un circuit de prise en charge protocolisé, ce qui permet de gagner du temps, de mieux informer le patient et d’améliorer le taux de survie

Use of the infra hyoid musculo-cutaneous flap in soft palate reconstruction.

To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients.Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2.The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis

Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors

AbstractCutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection

Fractional snow cover in the Colorado and Rio Grande basins, 1995-2002

A cloud-masked fractional snow-covered area (SCA) product gridded at 1 km was developed from the advanced very high resolution radiometer for the Colorado River and upper Rio Grande basins for 1995-2002. Cloud cover limited SCA retrievals on any given 1-km2 pixel to on average once per week. There were sufficient cloud-free scenes to map SCA over at least part of the basins up to 21 days per month, with 3 months having only two scenes sufficiently cloud free to process. In the upper Colorado and upper Grande, SCA peaked in February-March. Maxima were 1-2 months earlier in the lower Colorado. Averaged over a month, as much as 32% of the upper Colorado and 5.5% of the lower Colorado were snow covered. Snow cover persisted longest at higher elevations for both wet and dry years. Interannual variability in snow cover persistence reflected wet-dry year differences. Compared with an operational (binary) SCA product produced by the National Operational Hydrologic Remote Sensing Center, the current products classify a lower fraction of pixels as having detectable snow and being cloud covered (5.5% for SCA and 6% for cloud), with greatest differences in January and June in complex, forested terrain. This satellite-derived subpixel determination of snow cover provides the potential for enhanced hydrologic forecast abilities in areas of complex, snow-dominated terrain. As an example, we merged the SCA product with interpolated ground-based snow water equivalent (SWE) to develop a SWE time series. This interpolated, masked SWE peaked in April, after SCA peaked and after some of the lower-elevation snow cover had melted. Copyright 2008 by the American Geophysical Union

Long-Term Alterations of Cytokines and Growth Factors Expression in Irradiated Tissues and Relation with Histological Severity Scoring

PURPOSE: Beside its efficacy in cancer treatment, radiotherapy induces degeneration of healthy tissues within the irradiated area. The aim of this study was to analyze the variations of proinflammatory (IL-1α, IL-2, IL-6, TNF-α, IFN-γ), profibrotic (TGF-β1), proangiogneic (VEGF) and stem cell mobilizing (GM-CSF) cytokines and growth factors in an animal model of radiation-induced tissue degeneration. MATERIALS AND METHODS: 24 rats were irradiated unilaterally on the hindlimb at a monodose of 30 Gy. Six weeks (n=8), 6 months (n=8) and 1 year (n=8) after irradiation the mediators expression in skin and muscle were analyzed using Western blot and the Bio-Plex® protein array (BPA) technology. Additional histological severity for fibrosis, inflammation, vascularity and cellularity alterations scoring was defined from histology and immnunohistochemistry analyses. RESULTS: A significant increase of histological severity scoring was found in irradiated tissue. Skin tissues were more radio-sensitive than muscle. A high level of TGF-β1 expression was found throughout the study and a significant relation was evidenced between TGF-β1 expression and fibrosis scoring. Irradiated tissue showed a chronic inflammation (IL-2 and TNF-α significantly increased). Moreover a persistent expression of GM-CSF and VEGF was found in all irradiated tissues. The vascular score was related to TGF-β1 expression and the cellular alterations score was significantly related with the level of IL-2, VEGF and GM-CSF. CONCLUSION: The results achieved in the present study underline the complexity and multiplicity of radio-induced alterations of cytokine network. It offers many perspectives of development, for the comprehension of the mechanisms of late injuries or for the histological and molecular evaluation of the mode of action and the efficacy of rehabilitation techniques

Site testing for submillimetre astronomy at Dome C, Antarctica

Over the past few years a major effort has been put into the exploration of potential sites for the deployment of submillimetre astronomical facilities. Amongst the most important sites are Dome C and Dome A on the Antarctic Plateau, and the Chajnantor area in Chile. In this context, we report on measurements of the sky opacity at 200 um over a period of three years at the French-Italian station, Concordia, at Dome C, Antarctica. We also present some solutions to the challenges of operating in the harsh polar environ- ment. Dome C offers exceptional conditions in terms of absolute atmospheric transmission and stability for submillimetre astron- omy. Over the austral winter the PWV exhibits long periods during which it is stable and at a very low level (0.1 to 0.3 mm). Higher values (0.2 to 0.8 mm) of PWV are observed during the short summer period. Based on observations over three years, a transmission of around 50% at 350 um is achieved for 75% of the time. The 200-um window opens with a typical transmission of 10% to 15% for 25% of the time. Dome C is one of the best accessible sites on Earth for submillimetre astronomy. Observations at 350 or 450 {\mu}m are possible all year round, and the 200-um window opens long enough and with a sufficient transparency to be useful. Although the polar environment severely constrains hardware design, a permanent observatory with appropriate technical capabilities is feasible. Because of the very good astronomical conditions, high angular resolution and time series (multi-year) observations at Dome C with a medium size single dish telescope would enable unique studies to be conducted, some of which are not otherwise feasible even from space

Plasmablastic lymphoma: oral presentation in patient suffering from osteradionecrosis of the jaw

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