L. Gilain

A prospective investigation of dispositional optimism as a predictor of health-related quality of life in head and neck cancer patients

The aim of this study was to investigate the role of dispositional optimism (DO) as a predictor of health-related quality of life (HRQL) in a sample of upper aerodigestive tract cancer (UADT) patients. A prospective observational study design was used with a cohort of patients from one centre. DO was evaluated using a French version of the Life Orientation Test (the FLOT) translated and validated for this study. HRQL was evaluated using the EORTC QLQ-C30 prior to and 3 months following treatment. The association between FLOT ratings and HRQL was evaluated using linear multiple regression analysis and a two-way ANOVA with repeated measures. Baseline data were gathered on 101 subjects and follow-up data on 88 of these. The sample was dichotomized around the median FLOT score creating ‘optimist’ and ‘pessimist’ groups. Before treatment, optimists reported better role, cognitive and emotional function, less pain and fatigue and a better global rating of HRQL than did pessimists. Following treatment, optimists reported better role and cognitive functioning, less pain and better global HRQL than did pessimists. Pessimists reported a greater deterioration in the role domain following treatment than did optimists. At no point did pessimists rate HRQL better than optimists. The results suggest that optimism is associated with better HRQL in French UADT cancer patients.

Dispositional Optimism Predicts Survival Status 1 Year After Diagnosis in Head and Neck Cancer Patients

PURPOSE The aim of this study was to investigate the hypothesis that, independent of other known prognostic factors, pessimistic head and neck (H&N) cancer patients have a greater risk of being dead 1 year after diagnosis than do optimistic patients. PATIENTS AND METHODS A prospective observational study design was used with a cohort of H&N cancer patients diagnosed during the period from March 1, 1997, to August 31, 1998, at the Centre Hospitalier Universitaire, Clermont-Ferrand, France. Dispositional optimism (DO) was evaluated at baseline using a French version of the Life Orientation Test translated and validated for this study. One-year survival status was collected on all subjects. The analysis of the hypothesized association between DO and 1-year survival was performed using multiple logistic regression analysis, controlling for other sociodemographic and clinical variables. RESULTS The sample size was 101 patients, representing all but one of those patients fitting the inclusion criteria who were diagnosed during the recruitment period. Of these, 51 were alive at 1 year after diagnosis, 45 were dead, and five were lost to follow-up. The multivariate analysis was performed on the data from the 96 subjects in whom 1-year survival status was known. Controlling for known predictors of H&N cancer survival, pessimistic subjects (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01 to 1.24) and those living alone (OR, 4.14; 95% CI, 1.21 to 14.17) were more likely than optimistic subjects and those living with others to be dead at 1 year. CONCLUSION The results of this study of a cohort of French H&N cancer patients indicate that dispositional optimism predicts 1-year survival independent of other sociodemographic and clinical variables.

Adénocarcinomes de l'ethmoïde : analyse rétrospective des facteurs pronostics

Objectifs Determiner les differents facteurs pronostiques de survie des adenocarcinomes (ADK) de l’ethmoide Materiel et methodes Soixante patients atteints d’un ADK de l’ethmoide. 59 hommes et une femme. Age moyen de 62,2 ans (41-82). Etude retrospective sur 20 ans. Les donnees suivantes ont ete analysees : duree d’exposition au bois, incidence de la maladie, signes d’appel de la maladie et donnees sur l’etat general du patient (score ASA). Les signes radiologiques recueillis par tomodensitometrie et imagerie par resonance magnetiquenucleaire ont ete analyses. Les caracteristiques histologiques ont ete notees. La classification TNM selon UICC 2002 et selon Roux/Brasnu a ete etablie sur la base des constatations cliniques et radiologiques. Les differents traitements utilises ont ete repertories. L’evaluation des taux de survie et l’impact des differents facteurs pronostiques ont ete realises par la methode de Kaplan-Meier et analyse multivariable. Resultats L’incidence etait de 2,86 nouveaux cas par an. La duree moyenne d’expositiona la poussiere de bois etait de 25,6 ans (2-44). Les tumeurs T3/T4 etaient predominantes (66,7 %). La survie globale brute etait de 46,5 % a 5 ans. La survie etait significativement. Conclusion Les facteurs de survie des ADK de l’ethmoide retrouves dans cette etude sont le stade tumoral et l’envahissement du sinussphenoidal. L’atteinte du sinus sphenoidal devrait, selon cette etude, venir completer les criteres de stadification de l’adenocarcinome de l’ethmoide.

Mucosal melanoma of the nasal cavity and paranasal sinuses.

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.

Ventilator-associated sinusitis: microbiological results of sinus aspirates in patients on antibiotics.

BackgroundThe efficacy of systemic antibiotics on the treatment of ventilator-associated infectious maxillary sinusitis (VAIMS) is debated. The objective of this study was to determine the etiologic diagnosis of VAIMS in patients receiving antibiotics. MethodsPatients mechanically ventilated for more than or equal to 72 h, who had persistent fever while on antibiotics for more than or equal to 48 h, underwent computed tomography scan followed by transnasal puncture of involved maxillary sinuses. VAIMS was defined as follows: fever greater than or equal to 38°C, radiographic signs (air fluid level or opacification of maxillary sinuses on computed tomography scan), and a quantitative culture of sinus aspirate yielding more than or equal to 103 colony-forming units/ml. ResultsTwenty-four patients had radiographic signs of sinusitis. The mean ± SD prior durations of mechanical ventilation and antibiotic exposure were 9.5 ± 4.7 days and 6 ± 4 days, respectively. Six unilateral and nine bilateral VAIMS were diagnosed in 15 patients. The median number of etiologic organisms per patient was two (range, one to four). The bacteriologic cultures yielded gram-positive bacteria (n = 21), gram-negative bacteria (n = 22), and yeasts (n = 5). Forty percent of causative agents were susceptible to the antibiotics prescribed. Seven patients with VAIMS developed 10 concomitant infections: ventilator-associated pneumonia (n = 5), urinary tract infection (n = 3), catheter infections (n = 2). In all cases of ventilator-associated pneumonia, the implicated agents were the causative agents of VAIMS. ConclusionIn VAIMS patients on antibiotics, quantitative cultures of sinus aspirates may contribute to establish the diagnosis. The frequent recovery of microorganisms susceptible to the antimicrobial treatment administered suggests that therapy of VAIMS with systemic antibiotics may not be sufficient.

Acute abscess of the base of the tongue: a rare but important emergency.

BACKGROUND Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely. OBJECTIVE Lingual abscesses call for prompt and aggressive management because they are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated. CASE REPORT A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan. DISCUSSION Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection. CONCLUSION We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy.

Sinonasal mucosal melanomas

OBJECTIVES Sinonasal mucosal melanomas account for approximately 1% of all melanomas. These tumors are particularly aggressive, with a recurrence rate between 37 and 54% and a 5-year survival rate between 20 and 46%. Metastases are frequent. The main objective of this study was to analyze all of our cases of sinonasal mucosal melanomas and determine any prognostic factors. PATIENTS AND METHODS All our cases of sinonasal mucosal melanoma over a period of 10 years were included. Ten cases were analyzed. The mean age was 71 years (range: 61-85 years) for seven women and three men. The clinical, radiological, anatomopathological, and surgical data as well as the characteristics of disease progression were analyzed. These data were compared to those reported in the literature. RESULTS The mean follow-up was 36.3 months (range: 2-96 months). The 5-year overall survival was 40%. Seven patients developed local recurrences after a mean follow-up of 16 months (range: 2-27 months) with associated metastases in three cases. Analysis of the prognostic factors showed that tumors classified as T1 and limited to the nasal fossae had a better prognosis. CONCLUSION Sinonasal mucosal melanomas are rare tumors with a high mortality rate. Treatment of these tumors requires extensive surgical treatment associated with external radiotherapy.

Laryngeal chondrosarcoma: a report of five cases

Abstract Laryngeal chondrosarcoma is a rare tumor that is known for its indolent course and its tendency to ultimate recurrence. According to the actually adopted classification, 95% of the reported cases are of a low-grade type. A consensus recognizing conservative surgery as the most reasonable treatment for these lesions has almost been reached. However, fear of jeopardizing the patency of the laryngeal airway as a result of a wide cricoid excision and also the fear of repeated recurrences could still push some surgeons to perform a total laryngectomy in the case of laryngeal chondrosarcoma. After a brief review of the literature, we will present five cases of laryngeal chondrosarcoma that were treated and followed at the Clermont-Ferrand University Medical Center over the last two decades. These cases exhibit many of the clinico-pathologic features of the tumor and illustrate the pitfalls of diagnosis and treatment. In light of this presentation, we will discuss the widely accepted management as well as a newly suggested treatment modality for this disease.

Frequency specificity of distortion-product otoacoustic emissions produced by high-level tones despite inefficient cochlear electromechanical feedback

Distortion product otoacoustic emissions (DPOAEs) are thought to stem from the outer hair cells (OHCs) around the normally narrow place tuned to the primary tone stimuli. They are thus said to be frequency-specific: their local absence should accurately pinpoint local OHC damage. Yet the influence of impaired tuning on DPOAE frequency specificity is poorly documented. Mice with local damage to OHCs were examined. Their DPOAEs were frequency-specific in that audiometric notches were accurately tracked. The same cochleae were further impaired by ischemia or furosemide injection inducing strial dysfunction with flat loss of sensitivity and tuning, while the preexisting pattern of damaged OHCs remained unaltered. Despite the loss of cochlear activity, DPOAEs produced by high-level (> or =70 dB SPL) primaries remained large in about the same interval where they had been initially normal, i.e., that with nondamaged OHCs, albeit with a slight frequency shift, of -1.1 kHz on average. Thus, the ability of DPOAEs to map structurally intact OHCs cannot be a mere consequence of cochlear tuning as it largely persists in its absence. The key element for this correct mapping is likely part of intact OHC structures (e.g., stereocilia bundles) and must have some tuning of its own.

Cellulitis due to Streptococcus pneumoniae with Diminished Susceptibility to Penicillin in an Immunocompromised Patient

A 74-year-old man with multiple myeloma developed facial and cervical cellulitis and severe sepsis as a complication of surgery (alar region basal cell carcinoma). The etiological agent was, surprisingly, penicillin-resistant Streptococcus pneumoniae (PRSP). The patient successfully received 16 days of antibiotics. Amoxicillin was given as monotherapy during the last 14 days of treatment. PRSP can be responsible not only for otitis media, pneumonia or meningitis, but also for various other types of infection in patients with predisposing factors.