No convincing evidence for a causal relationship between childhood nasopharyngeal radium irradiation and head-neck tumors or hormone-related disorders later in life; a retrospective cohort study

OBJECTIVE: To study the risk of malignant and benign tumours and hormone-related disorders among patients treated with nasopharyngeal radium irradiation for hypertrophic adenoid or hearing loss caused by otitis media serosa. DESIGN: Retrospective cohort study. METHOD: The medical record registries of 9 hospitals were used to identify a radium-exposed group (n = 5358) and a control group of unexposed patients (n = 5265), who were treated by an otolaryngologist in the period 1945-1981. The vital status of the subjects was determined using municipal resident registries, and the cause of death of decedents was retrieved from Statistics Netherlands (1950-1997). The data was also coupled with the Netherlands Cancer Registry (1989-1996). For the subjects still alive in 1997, the prevalence of relevant disorders was determined using a self-administered questionnaire and disorders reported by the participants were medically verified. The risk of disease in the radium group was then compared with that of the control group. RESULTS: The average radiation doses were 2.75, 0.109 and 0.015 Gy for nasopharynx, pituitary, and thyroid, respectively. There was no statistically significantly elevated risk for malignancies of the head and neck area (radium-exposed group; n = 14; control group: n = 11 (relative risk (RR): 1.2; 95% CI: 0.6-2.8)). Four of the five thyroid carcinomas were found in the radium-exposed group (RR: 3.8; 0.5-76). Elevated risks were observed for breast cancer (RR: 1.6; 0.9-2.7) and non-Hodgkin's lymphoma (RR: 2.7; 1.0-8.7). There was an increased risk for skin basal cell carcinoma (BCC) of the head and neck (odds ratio (OR): 2.6; 1.0-6.7), but the risk of BCC of other body parts was lower (OR: 0.3; 0.1-1.3). There were no major differences between radium and control subjects with respect to benign head and neck tumours (OR: 1.0; 0.5-1.7) or hormonal disorders. Exposed men reported slightly more fertility disorders than men in the control group (OR: 1.4; 1.0-2.1), but there was no clear dose-response relationship. CONCLUSION: After a mean follow-up of 31 years, there was no strong evidence for an elevated risk of head and neck tumours or hormone-related disorders in adulthood among subjects who had been treated with nasopharyngeal radium irradiation during childhood.     

医源性子宫动、静脉瘘的彩色多普勒超声诊断及疗效监测研究

目的 探讨彩色多普勒超声对医源性子宫动、静脉瘘（AVMs）的诊断及子宫动脉灌注栓塞术（UAE）对其治疗价值的评估、监测研究.方法 选择自2007年1月至2012年12月在深圳市妇幼保健院就诊的8例医源性子宫AVMs患者为研究对象.记录其子宫形态及病灶区二维声像图、彩色多普勒血流（CDFI）显像和频谱特点,测定收缩期峰值速率（PSV）和阻力指数（RI）,分析其经血管造影确诊的医源性子宫AVMs的临床、彩色多普勒超声声像特征及UAE治疗的近、远期疗效,并对结果进行分析（本研究遵循的程序符合深圳市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书）.结果 本组8例患者在血管造影及UAE治疗前,均经彩色多普勒超声提示为子宫AVMs,其主要声像特征为宫壁均见单发类圆形无回声区,彩色多普勒显示无回声区内有丰富混叠血流信号充填;CDFI频谱显示,低阻高速血流,静脉血流动脉化频谱.所有患者在UAE治疗后2 d内出血停止.对其随访7～42个月（平均为27个月）的结果显示,均未复发出血,复查彩色多普勒超声无异常声像.本组2 例患者治疗后正常受孕.结论 彩色多普勒超声对医源性子宫AVMs的诊断及UAE对其治疗价值的评估监测有重要价值.UAE治疗医源性子宫AVMs的近、中期效果好,治疗后仍可能生育,其远期效果尚需进一步观察.     

Stereotactic body radiation therapy for head and neck tumor: disease control and morbidity outcomes

We evaluated the efficacy and safety of stereotactic body radiation therapy (SBRT) for patients with head and neck tumors. From April 2005 through April 2008, 34 patients with head and neck tumors were treated with CyberKnife SBRT. Twenty-one of them had prior radiotherapy. Treatment sites were orbit (n = 7), cervical lymph nodes (n = 6), nasopharynx (n = 5), oropharynx (n = 4) and others (n = 12). The prescribed dose ranged from 19.5 to 42 Gy (median, 30 Gy) in 3-8 fractions for consecutive days. The target volume ranged from 0.7 to 78.1 cm(3) (median, 11.6 cm(3)). The median follow-up was 16 months. Treatment was well tolerated without significant acute complications in any cases. Complete response rate and partial response rate were 32.4% and 38.6%, respectively. The overall survival rates were 70.6% and 58.3% at 12 and 24 months, respectively. The overall survival was better in patients without prior radiotherapy within the previous 24 months or in case of smaller target volume. Six patients suffered severe late complications. All these patients had prior radiotherapy, and 2 of them developed massive hemorrhage in the pharynx and both died of this complication 5 and 28 months, respectively, after SBRT. Our preliminary results suggest that SBRT is an effective treatment modality for head and neck tumors. However, re-irradiation has significant risk of severe and even fatal late complications in the form of necrosis and hemorrhage in re-irradiated areas.     

Use of nasal preparations and the incidence of sinonasal cancer.

Data from a population based case control study in western Washington were analysed to determine whether the use of nasal sprays and drops was associated with an increased risk of sinonasal cancer. Telephone interviews were conducted with incident cases (n = 53) diagnosed between 1979 and 1983 or their next-of-kin, and with controls (n = 552) regarding their past use of nasal preparations, history of rhinologic problems, smoking history, alcohol consumption, and a number of other known or suspected risk factors. Both cigarette smoking and alcohol consumption were associated with an increased risk of sinonasal cancer; the strongest associations were found with squamous cell tumours. Subjects who reported a history of nasal preparation use were 3.5 times (95% confidence interval = 1.7-7.0) more likely than non-users to develop sinonasal cancer. The risk of sinonasal cancer increased with increasing duration of use of nasal preparations. These findings suggest the need for a more detailed investigation of the possible adverse consequences of long-term use of nasal preparations.     

Percutaneous endoscopic gastrostomy: experience of three years]

Patients who are not able to eat do need tube feeding. The most preferred way of artificial enteral nutritional support is feeding via percutaneous endoscopic gastrostomy (PEG) tubes. Head and neck cancer patients do represent a special group of patients needing a PEG. On the one hand at the time of admission to the hospital they are mainly undernourished. On the other hand the failure rate of placing a PEG is the highest among them. Furthermore in the perioperative period nasogastric tubes do cause a lot of complications in these settings. 188 PEG placements were carried out from July 1995 till November 1998. Indications: head and neck cancer (n = 171), neurologic disorders (n = 17). PEG tubes were placed 76 times during intratracheal narcosis and 112 times following local anaesthesia. 39 times there was a prior abdominal surgery in our patients medical history. The pull-through, the push-wire and the introducer techniques were used. Beside the usual oro-gastric way of endoscopying (n = 163), 25 times the following alternative ways of entering the upper gastrointestinal tract were used: transnasal route (n = 4), through a Kleinsasser type direct laryngoscope (n = 7) and via the opened pharynx (n = 14). No immediate or late onset procedure related complications occurred. During a follow-up of 22,480 tubedays 26 minor (dermatitis n = 24, ulcer n = 2) and 8 major (abscess n = 4, perforation/peritonitis n = 3, stomach and bowel wall necrosis n = 1) complications occurred. The success rate of placing a PEG was 98.9%. In head and neck cancer patients placing a PEG is suggested when there is a need for at least a 7 days time tube-feeding. Using the described alternative ways, a PEG tube can be placed almost always. Because of the uncertain outcome, nutritional support via PEG tubes is suggested also in cachectic patients and in vegetative state as well.     

Percutaneous Gastrostomy Tube Placement Using a Balloon Catheter in Patients With Head and Neck Cancer

Background: Patients with head and neck cancer frequently require gastrostomy feeding. The aim of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with push‐type gastrostomy tubes using a rupture‐free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance in patients with head and neck cancer with swallowing disturbance or trismus. Methods: Percutaneous CT and fluoroscopic gastrostomy placement of push‐type gastrostomy tubes using a RFB catheter was performed in consecutive patients with head and neck cancer between April 2007 and July 2010. The technical success, procedure duration, and major or minor complications were evaluated. Results: Twenty‐one patients (14 men, 7 women; age range, 55–78 years; mean age, 69.3 years) underwent gastrostomy tube placement. The tumor location was the pharynx (n = 8), oral cavity (n = 7), and gingiva (n = 6). Gastrostomy was performed in 15 patients during treatment and 6 patients after treatment. Percutaneous radiologic gastrostomy was technically successful in all patients. The median procedure time was 35 ± 19 (interquartile range) minutes (range, 25–75). The average follow‐up time interval was 221 days (range, 10–920 days). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow‐up periods. Conclusion: Percutaneous CT and fluoroscopic‐guided gastrostomy with push‐type tubes using a RFB catheter is a relatively safe and effective means of gastric feeding, with high success and low complication rates in patients with head and neck cancer in whom endoscopy was not feasible.     

Adult renal neoplasms in the material of the Pathology Department of the Szeged University

AIMS: The authors investigated the frequencies of the various histological types of adult renal tumours. METHODS: The slides of 469 nephrectomies performed in the Department of Urology, Szeged University between 1990 and 2003 were revised according to the 1997 Heidelberg and 2004 WHO classification schemes. RESULTS: 86.7% of all the tumours (n = 407) were malignant. Among the malignant tumours, the frequency of renal cell carcinomas was 91.1% (n = 371). 88.4% of the renal cell carcinomas (n = 328) were of conventional type, 5.6% (n = 21) were papillary and 4% (n = 15) were chromophobe. The authors observed 3 Bellini duct, 1 mucinous tubular and 3 non-classifiable carcinomas, with a combined incidence of 1.8%. 84.5% of the conventional carcinomas were clear cell (n = 277), 8.8% were eosinophilic granular (n = 29), 3.9% were multilocular cystic (n = 13) and 2.7% were sarcomatoid carcinomas (n = 9). The median age of the patients with conventional carcinoma was 60 (median, range: 25-84), in the papillary group it was 62 (43-78), and in the chromophobe group was 59 (17-77).The median age of patients affected by transitional cell carcinoma was 64 (range: 45-81). As far as benign tumours are concerned (13.2%, n = 62), oncocytomas (n = 37, 7.8% of all the tumours) affected mainly females, whereas angiomyolipomas (n = 21, 4.4% of all the tumours) occurred in females only. In 13 oncocytoma cases, the tumours were initially diagnosed as malignant. CONCLUSIONS: Adult malignant renal tumours affect mainly patients around the age of 60. The commonest diagnosis was clear cell carcinoma of conventional type. The incidence of clear cell carcinoma was 5% higher than that reported in the literature (84.5% vs 70-80%) whereas that of papillary carcinoma was 5% lower (5% vs 10-15%). In comparison with the literature data, oncocytomas were relatively common (8% instead of 3%), and not rarely, it was difficult to distinguish them from renal cell carcinomas.     

体表肿块的CT诊断价值

目的:研究体袁肿块的CT表现并探索其诊断价值.方法:对48例体表肿块作CT扫描,所有病例均经临床或手术病理证实.结果:CT诊断脂肪瘤11例,结核及感染10例,神经纤维瘤2例,表皮样囊肿2例,骨瘤4例,肌肥厚2例,血肿2例,骨纤维异常增殖1例,多形性腺瘤1例,脊柱侧弯畸形1例.恶性肿瘤12例.病理诊断符合率91.6%.结论:CT能明确判断体表肿块的解剖部位及大小,并能结合影像学特点及密度值作出定性诊断,结合临床资料可作出部分病因诊断.     

Genotoxic effects of vanadium pentoxide on human peripheral lymphocytes and mucosal cells of the upper aerodigestive tract

In addition to tobacco and alcohol consumption, pollutants found in certain industries and in the environment play an important role in carcinogenesis in the upper aerodigestive tract. The aim of the present study was to investigate whether vanadium pentoxide may have a genotoxic effect on human mucosal cells and lymphocytes. The single cell microgel electrophoresis assay (Comet assay) was used to detect DNA damage induced by vanadium pentoxide in human nasal epithelia (n = 11) and in lymphocytes (n = 11). Mucosa was harvested from inferior nasal turbinates, while lymphocytes were obtained via venous puncture. Vanadium pentoxide was applied at concentrations of 0.06 mM, 0.12 mM, 0.24 mM, and 0.47 mM. Aqua bidestillata served as solvent and negative control and N-methyl-N'-nitro-N-nitrosoguanidine at 0.07 mM (MNNG) was used as positive control. The trypan blue exclusion test was applied to assess cytotoxicity. Whereas vanadium pentoxide induced dose-dependent DNA migration in lymphocytes, mucosal cells did not show comparable genotoxic effects. Cytotoxic effects allowed for viabilities exceeding 80%. The results indicate that vanadium pentoxide is capable of inducing single-strand-breaks and/or alkali-labile damage in the DNA of human lymphocytes. By contrast, mucosal cells proved not to be sensitive in this setting. Thus, a possible role of vanadium in the tumorigenesis of head and neck cancer appears unrelated to direct genotoxic effects.     

Neck lymph node dissection in squamous cell carcinoma originating in the head-and-neck area; the significance for the prognosis]

Neck dissection has a therapeutical as well as a prognostic relevance with respect to regional recurrence and distant metastases. Between January 1973 and July 1986 576 neck dissections in 511 patients (396 men, 115 women, among whom 486 with squamous cell carcinoma of the head and neck, and 14 with neck metastases of an unknown primary tumour) were performed at the department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam. Patients with tumour at the margins were excluded. Recurrence-free curves were calculated according to Kaplan-Meier and the log rank test was used to test the differences. All patients underwent a comprehensive neck dissection and were irradiated postoperatively when three or more tumour-positive nodes or extranodal spread were reported by the pathologist. Endpoint for analysis was occurrence of an ipsilateral neck recurrence or of a distant metastasis. Figures were corrected for a simultaneous recurrence at a higher level. A total of 29 neck recurrences (7.2%; n = 523) and 26 distant metastases (10.7%; n = 281) were demonstrated in the 5-year follow-up period. The number of positive nodes was of prognostic significance for both events (p = 0.039 and p = 0.0027). Extranodal spread was shown only to increase the incidence of distant metastases (p = 0.017), whereas its prognostic value with regard to recurrence in the neck was nullified by the strict institution of postoperative radiotherapy. It is recommended to give radiotherapy to patients with two positive nodes and possibly to every patient with a histopathologically positive neck.(ABSTRACT TRUNCATED AT 250 WORDS)     

HHHFNC治疗新生儿Ⅰ型呼吸衰竭疗效观察

目的 观察加温湿化经鼻导管高流量通气(HHHFNC)治疗新生儿Ⅰ型呼吸衰竭的疗效.方法 将2014年10月至2016年5月中国人民解放军海军总医院收治的82例Ⅰ型呼吸衰竭新生儿按随机排列表法分成HHHFNC组40例和经鼻持续气道正压通气(nCPAP)组42例.比较两组通气后1h和24h血气分析指标、变更有创通气率、并发症发生率.结果 HHHFNC组1h、24hPaCO2较nCPAP组低,差异均有统计学意义(t值分别为2.656、3.141,均P<0.05).HHHFNC组患儿喂养不耐受(χ2=4.518,P=0.033)、鼻部压疮发生率明显低于nCPAP组(Fisher精确P=0.009),差异均有统计学意义(均P<0.05).HHHFNC组患儿无气漏症病例,而nCPAP组气胸发生率为9.5%,均为足月儿,在足月儿中发生率达33.3%.结论 与nCPAP相比较时,HHHFNC在治疗Ⅰ型新生儿呼吸衰竭时虽然氧合及远期并发症无统计学差异,但可减少二氧化碳潴留,对于早产儿可减少鼻部压疮及喂养不耐受的发生,可能减少足月儿气漏伤的发生.故在各类疾病导致的Ⅰ型呼吸衰竭中,HHHFNC可能成为替代nCPAP的有效无创通气方法之一.     

Trends in emergency department reported head and neck injuries among skiers and snowboarders

BACKGROUND: Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada. METHODS: Skiers and snowboarders (< 18 years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e., controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study. RESULTS: Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR) = 0.16; 95% Confidence Interval (CI) = 0.09-0.30) and from 1995-97 (AOR = 0.71; 95% CI = 0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR = 0.69; 95% CI = 0.44-1.07) and from 1995-97 (AOR = 0.56; 95% CI: 0.35-0.91). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR = 0.19; 95% CI = 0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99. CONCLUSIONS: The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents.     

Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial

BACKGROUND AND AIMS: This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery. METHODS: 49 Malnourished (weight loss >10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and postoperative tube-feeding (group II) or arginine-supplemented preoperative and postoperative tube-feeding (group III). Of these patients, 31 completed a full QOL assessment on the first day of preoperative nutritional support, one day before surgery, and 6 months after surgery. Both a disease-specific (EORTC QLQ-C30) and a generic questionnaire (COOP-WONCA) were used. One way analysis of variance (ANOVA) and the Kruskal-Wallis test were applied for testing differences in scores between groups. RESULTS: Between baseline and the day before surgery, both preoperatively fed groups revealed a positive change for the dimensions physical and emotional functioning and dyspnea (with significance in group II, P=0.050,0.031,0.045 respectively). Group III showed a negative change in appetite (P=0.049). Between baseline and 6 months after surgery, there were no differences between group I and both pre-fed groups. There were no differences in favour of group III compared to group II. CONCLUSION: Enteral nutrition improves QOL of severely malnourished head and neck cancer patients in the period preceding surgery. No benefit of preoperative enteral feeding on QOL could be demonstrated 6 months after surgery.     

头颈恶性肿瘤放射性口腔黏膜炎危险因素meta分析

目的 系统评价头颈恶性肿瘤放疗后放射性口腔黏膜炎的危险因素,为在临床工作中预防头颈恶性肿瘤患者放射性口腔黏膜炎的发生提供循证证据。 方法 通过计算机检索数据库PubMed、Embase、MEDLINE、Ovid、Web of Science、Cochrane Library、中国知网、维普、万方中公开发表的与头颈恶性肿瘤患者放疗过程中引起放射性口腔黏膜炎的危险因素有关的文献,检索各数据库从建库起至2020年6月的相关文献,由两位研究人员独立完成文献筛选、资料提取、质量评价,运用Rev Man 5.3软件和Stata 12.0软件进行分析。 结果 共计纳入14篇文献(英文5篇,中文9篇),结果显示,联合化疗(OR=2.24,95％CI:1.66～3.02)、吸烟(OR=2.12,95％CI:1.45～3.10)、饮酒(OR=1.58,95％CI:1.09～2.29)、糖尿病(OR=1.99,95％CI:1.46～2.70)、口腔pH≤7(OR=3.11,95％CI:2.13～4.55)、口腔卫生差(OR=4.38,95％CI:2.19～8.73)、未使用抗生素(OR=5.92,95％CI:2.91～12.04)、未使用黏膜保护剂(OR=5.39,95％CI:2.89～10.04)是头颈恶性肿瘤放射性口腔黏膜炎的危险因素,差异均有统计学意义(P＜0.05)。 结论 联合化疗、吸烟、饮酒、糖尿病、口腔pH≤7、口腔卫生差、未使用抗生素、未使用黏膜保护剂是头颈恶性肿瘤放射性口腔黏膜炎的危险因素,医务人员在临床工作中可采取相应预防措施降低放射性口腔黏膜炎的发生率及严重程度。     

数字减影血管造影辅助鼻内镜治疗鼻咽纤维血管瘤的护理

目的:探讨数字减影血管造影辅助鼻内镜治疗鼻咽纤维血管瘤的护理.方法:对采用Seldinger技术动脉插管造影栓塞配合手术治疗鼻咽纤维血管瘤的护理进行回顾性总结.结果:5例均一次造影栓塞成功,4例痊愈,1例好转出院.结论:数字减影血管造影治疗鼻咽纤维血管瘤可大大降低手术危险性及术后复发率,减轻病人的痛苦,护理人员应具备相关新业务、新技术的护理知识.     

Pilomatrixoma often not identified as such

OBJECTIVE: To inventory incidence, diagnosis and treatment of pilomatrixoma. DESIGN: Retrospective. METHOD: Patients treated in the period 1984-1996 in the department of Surgery of the Medical Spectrum Twente, Enschede for a pilomatrixoma were traced via the Dutch Automatic Morbid-Anatomical Records Office (PALGA). Data were collected by status study. Also, the patients or their parents were interviewed by telephone about recurrences. RESULTS: Forty-eight patients with 54 pilomatrixomas had been treated. The ages varied from 2 to 77 years, 14 patients were younger than 14 years. The correct diagnosis had been made preoperatively in 11 patients (20%) in four of whom (7%) the manifestation was not the first one. In many cases (69%), the condition was mistaken for an atheromatous cyst, in children as well (in 47% of the cases). The pilomatrixoma was localized in the head and neck area 25 times, in eight of these in the parotid region. Owing to incorrect interpretation of the abnormality, three children with a pilomatrixoma in the head and neck area underwent a more radical operation than necessary. CONCLUSION: The clinical diagnosis was frequently missed. In cutaneous tumours occurring in children or localized in the head and neck area the diagnosis of pilomatrixoma should be considered.     

Beneficial effects of cryosurgical treatment in benign and low-grade-malignant bone tumors in 120 patients

BACKGROUND: Benign and low-grade malignant bone tumours are generally treated with intralesional curettage. At microscopic level tumour cells are left behind and may be responsible for a recurrence. Therefore adjuvant local treatment is necessary. METHOD: By spraying liquid nitrogen into the remaining cavity, tumour cells are frozen very rapidly. Ice crystals formed in the (tumour) cell will mechanically damage the cell resulting in cell necrosis. This combined treatment of surgery and freezing is called cryosurgery. RESULTS: In 120 patients with a follow-up of at least 1 year the treatment results were good. The tumours were: aneurysmatic bone cyst (n = 32), simple bone cyst (n = 13), chondroid tumour (n = 43), giant-cell tumour (n = 13), eosinophilic granuloma (n = 7) and monostotic fibrous dysplasia (n = 12). There were 10 recurring tumours, some of them very small; 6 recurrences were treated successfully by cryosurgery again; in 2 recurrences marginal resection was carried out; 2 recurrences remained (as yet) untreated. CONCLUSION: Cryosurgery as a therapy of benign and low-grade malignant bone tumours yields results nearly as good as marginal resection, and has the advantage that segmental bone resections, which need extensive reconstructions are avoided.     

Nasal septum lesions caused by chromium exposure among chromium electroplating workers

A chromium electroplating worker, suffering from epistaxis during work, was found to have nasal septum perforation. To determine the etiology and prevalence of nasal septum lesions, we conducted a survey of seven chromium electroplating factories and examined 79 workers. Forty workers from three aluminum electroplating factories were also enrolled as the reference group. Subjects were thoroughly examined by an otolaryngologist and each of them provided a blood and urine sample. A questionnaire interview regarding symptoms of the upper respiratory tract, past medical history, life style, and work history was also conducted. Air chromium concentrations were measured by taking area samples for 4–6 hours. Based on field observation and chromium measurements, we divided chromium electroplating into three different exposure zones: workers directly dealing with electroplating tanks (n = 31), other process workers (n = 29), and office workers and drivers (n = 19). Among the 79 chromium electroplating workers, there were 16 cases of nasal septum perforation, and 42 with either scar formation or ulceration; 10 chromium electroplating workers developed skin ulcers after performing chrome plating. No workers from aluminum electroplating factories had any nasal septum or skin abnormalities. There was a consistent trend between the degree of chromium exposure and the signs and symptoms related to the nose, throat, and skin. Immediate improvement of occupational hygiene is warranted.     

Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

OBJECTIVE: It is known that the immune system is frequently affected in patients with head and neck cancer. Although immune dysfunction could be multifactorial, this immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine on c-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor (TNFalpha) in surgical head and neck cancer patients. DESIGN: Randomized trial. SETTING: Tertiary care. SUBJECTS: A population of 36 patients with oral and laryngeal cancer were enrolled. INTERVENTIONS: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine and dietary fibre (group I, n=18); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n=18). Perioperatively and on postoperative day 5 the following parameters were evaluated: serum values of prealbumin, transferrin, albumin, total number of lymphocytes, interleukin 6, tumour necrosis factor alpha and c-reactive protein. RESULTS: The mean age was 59.6+/-10.9 y (two females/34 males). No significant intergroup differences in the trend of the three plasma proteins and weight were detected. CRP decreased in both groups (group I: 152.9+/-76.9 vs 68.9+/-82.5 mg/dl; P<0.05; and group II: 105.9+/-92 vs 43.6+/-59.1 mg/dl; P<0.05). Interleukin 6 did not change (group I: 16.3+/-12.3 vs 35.6+/-83.4 pg/ml; NS; and group II: 22.8+/-40 vs 9.9+/-17.7 pg/ml; NS). TNFalpha did not show any differences (group I: 4.6+/-1.6 vs 5.1+/-1.5 pg/ml; NS; and group II: 8.8+/-6.1 vs 5.8+/-1.7 pg/ml; NS). Lymphocytes increased in both groups (group I: 1405.6+/-517 vs 1634+/-529 x 10(6)/ml; P<0.05; and group II: 1355+/-696 vs 1561+/-541 x 10(6)/ml; P<0.05). CONCLUSIONS: Enhanced formula did not change IL6 and TNFalpha levels. Further studies are needed to determine whether route of nutrition or type of formula is the key in these patients.     

Postsurgery enteral nutrition in head and neck cancer patients

OBJECTIVE: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an arginine-enriched diet, could improve nutritional variables as well as clinical outcomes. DESIGN: Randomized clinical trial. SETTING: Tertiary care. SUBJECTS: A population of 47 patients with oral and laryngeal cancer were enrolled. INTERVENTIONS: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplemented with arginine and fiber (group I); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II). RESULTS: No significant intergroup differences in the trend of the three plasma proteins and lymphocytes were detected. Gastrointestinal tolerance (diarrhea) of both formulas was good (17.4% group I and 8.3% group II; NS). During the 3 months after hospital discharge five patients died; no differences were detected between groups (13% group I and 8.3% group II; NS). The incidences postoperative infection complications were similar (nine patients) in both groups (21.7% group I and 16.7% group II; NS). Fistula were less frequent in enriched nutrition group (0% group I and 20.8% group II; P<0.05); wound infection was more frequent in group II, but without statistical difference (4.3% group I and 12.5% group II; NS). The length of postoperative stay was 22.8+/-11.8 days in the enriched group and 31.2+/-19.1 days in the control group (P=0.07). CONCLUSIONS: In conclusion, enriched formula improves local wound complications in postoperative head and neck cancer patients. Our results suggest that these patients could benefit from an immunonutrient-enhanced enteral formula.