Detection of the sentinal node in squamous-cell carcinoma of the oral cavity and oropharynx. Preliminary study

INTRODUCTION: The sentinel lymph node is defined as the first relay of the lymphatic drainage of the tumor. Isotopic detection of the sentinel lymph node and absence of its metastatic invasion should theoretically be predictive of total drainage of the tumor. The goal of this study was to evaluate sentinel lymph node detectability by lymphoscintigraphy in N0 and/or N1 squamous-cell carcinoma of oral cavity and oropharynx and to determine its negative predictive value. MATERIAL AND METHOD: Lymphoscintigraphy was used for sentinel lymph node detection. The procedure required peritumoral injection of technicium-labeled colloids to enable anatomical and cutaneous location of the sentinel lymph node. A one-way Tyco-Mallinckrodt probe was used for intraoperative detection of the sentinel lymph node. This prospective study included 21 patients with N0 or N1 squamous-cell carcinoma of the oral cavity and the oropharynx. The surgical attitude based on T and N was not modified in this prospective study without direct individual benefit for the patient. Neck dissection was achieved without difficulty. RESULTS: The sentinel lymph node was identified in 20 out of 21 subjects. The sentinel lymph node was not identified in one patient with recurrence T2N0M0 squamous-cell carcinoma of the oropharynx radiated 3 years earlier. The percentage of false-negatives was 12.5% (1 false-negative out of 8 positive patients), giving a sensibility of the detection method of 87.5% (IC (95%)=[47.35-99.68]). This false-negative patient had a T3N0M0 squamous-cell carcinoma of the oropharynx with a sentinel lymph node removed in territory III. Neck dissection revealed 1 N + R- in the sub-mandibular territory associated with 27 N-R-. The probability of not finding a metastatic node at neck dissection when the sentinel lymph node is not metastatic (negative predictive value) was 92.3% (12/13) (IC (95)=[63.97-99.81]). The specificity of the method was 100%, as was the positive predictive value, because no sentinel node was diagnosed positive wrongly on frozen sections among patients without true histological node metastasis. DISCUSSION: For routine care of patients with squamous-cell carcinoma of the oral cavity and the oropharynx detection of the sentinel lymph node is proposed primarily for patients with T1T2N0 staging. Larger tumors can modify the architecture and flow within the lymphatic ducts, and consequently even the concept of a sentinel lymph node. Systematic neck dissection is required or T3T4, even when N0. Our series of T1T2N0 tumors is too small to enable statistically significant conclusions. A low level of false-negative in a larger series would be necessary to propose this technique instead of convention neck dissection for T1T2 tumors of the oral cavity and oropharynx.     

Clinical aspects of dysosmia and presentation of European Olfactory Test of "sniffin sticks": a review

The medical community has neglected olfactory dysfunction for a long time. However, over the last two decades, remarkable progress has been made in terms of understanding the sense of smell and both the assessment and diagnosis of olfactory dysfunction. Currently, there are only a few validated olfactory tests. The most commonly used one is the University of Pennsylvania Smell Identification Test. Owing to its cultural biases, this test is mostly used in the United States. "Sniffin' Sticks" are one of the first European tests to be widely used. Since their development in 1996, they have been applied in numerous studies and have found increasing use in otolaryngology clinics. The goal of this article is to present Sniffin' Sticks and to provide a review of clinical olfactory research during recent years.     

Otoacoustic emissions and extended high-frequency hearing sensitivity in young adults

The relationship between hearing sensitivity in the extended high-frequency region (8-16 kHz) and (1) the presence of synchronized spontaneous otoacoustic emissions (SSOAEs) and (2) the strength of click-evoked and distortion product otoacoustic emissions (CEOAEs and DPOAEs) was investigated in 104 ears of 57 young adults. The age range was confined to 16 to 19 years. All subjects had normal hearing in the conventional audiometric frequency range (0.5-8 kHz). Ears with detected SSOAEs had better hearing sensitivity in the extended high-frequency region and also higher levels of CEOAEs and DPOAEs than ears with undetected SSOAEs. The results support the hypothesis that the presence of SSOAEs is indicative of an ear with highly normal cochlear function over a broad frequency range.     

Guidelines and evaluation: improving the quality of consultation-liaison psychiatry

Previous research has shown that residents in the consultation-liaison unit of Geneva University Hospital did not meet proposed guidelines on three counts: quickness of response to emergency situations, reporting cases to supervisors, and consulting with supervisors on major issues. The introduction of daily meetings between residents and supervisors improved the level of compliance with guidelines, from 69.2% to 82.6% for quickness of response, from 57.6% to 97.3% for reporting cases to supervisors, and from 25.0% to 98.0% for consulting with supervisors on major issues. Periodical evaluation would thus appear to enhance performance.     

A role for nitric oxide in sensory-induced neurogenesis in an adult insect brain

In the adult cricket, neurogenesis occurs in the mushroom bodies, the main integrative structures of the insect brain. Mushroom body neuroblast proliferation is modulated in response to environmental stimuli. However, the mechanisms underlying these effects remain unspecified. In the present study, we demonstrate that electrical stimulation of the antennal nerve mimics the effects of olfactory activation and increases mushroom body neurogenesis. The putative role of nitric oxide (NO) in this activity-regulated neurogenesis was then explored. In vivo and in vitro experiments demonstrate that NO synthase inhibition decreases, and NO donor application stimulates neuroblast proliferation. NADPH-d activity, anti-L-citrulline immunoreactivity, as well as in situ hybridization with a probe specific for Acheta NO synthase were used to localize NO-producing cells. Combining these three approaches we clearly establish that mushroom body interneurons synthesize NO. Furthermore, we demonstrate that experimental interventions known to upregulate neuroblast proliferation modulate NO production: rearing crickets in an enriched sensory environment induces an upregulation of Acheta NO synthase mRNA, and unilateral electrical stimulation of the antennal nerve results in increased L-citrulline immunoreactivity in the corresponding mushroom body. The present study demonstrates that neural activity modulates progenitor cell proliferation and regulates NO production in brain structures where neurogenesis occurs in the adult insect. Our results also demonstrate the stimulatory effect of NO on mushroom body neuroblast proliferation. Altogether, these data strongly suggest a key role for NO in environmentally induced neurogenesis.     

Social context modulates behavioural and brain immediate early gene responses to sound in male songbird

Although it is well known that brain sensory information processing is a highly modulated phenomenon, how this brain function is shaped by experience and social context remains a question to explore. In this paper, we present the first attempt to investigate this problem using a songbird acoustic communication paradigm. Social context is well known to influence acoustic communicating behaviours in birds. The present paper investigates whether brain processing of auditory inputs can be modulated by this 'audience effect'. Given that call-based communication is known to be highly context-dependent, we focused on the response of male zebra finches (Taeniopygia guttata) to female calls. We tested to see if the current social context surrounding the hearing bird can modify a sound-induced immediate early gene (IEG) activation in the specific region of the caudomedial nidopallium (NCM), a songbird brain analogous to the superficial layers of the mammalian primary auditory cortex. Our results show that the expression of the sound-induced immediate early gene ZENK in the NCM is considerably enhanced when the hearing bird is in the presence of conspecifics, compared to when he is alone. This context-dependent increase of a sound-induced immediate early gene expression can be correlated with the differential behavioural response of males to the playback of the same acoustic stimulus as a function of social context.     

Oxygen and glucose deprivation induces major dysfunction in the somatosensory cortex of the newborn rat

The mechanisms and functional consequences of ischemia-induced injury during perinatal development are poorly understood. Subplate neurons (SPn) play a central role in early cortical development and a pathophysiological impairment of these neurons may have long-term detrimental effects on cortical function. The acute and long-term consequences of combined oxygen and glucose deprivation (OGD) were investigated in SPn and compared with OGD-induced dysfunction of immature layer V pyramidal cortical neurons (PCn) in somatosensory cortical slices from postnatal day (P)0-4 rats. OGD for 50 min followed by a 10-24-h period of normal oxygenation and glucose supply in vitro or in culture led to pronounced caspase-3-dependent apoptotic cell death in all cortical layers. Whole-cell patch-clamp recordings revealed that the majority of SPn and PCn responded to OGD with an initial long-lasting ischemic hyperpolarization accompanied by a decrease in input resistance (R(in)), followed by an ischemic depolarization (ID). Upon reoxygenation and glucose supply, the recovery of the membrane potential and R(in) was followed by a Na+/K+-ATPase-dependent postischemic hyperpolarization, and in almost half of the investigated SPn and PCn by a postischemic depolarization. Whereas neither a moderate (2.5 mm) nor a high (4.8 mm) increase in extracellular magnesium concentration protected the SPn from OGD-induced dysfunction, blockade of NMDA receptors with MK-801 led to a significant delay and decrease of the ID. Our data demonstrate that OGD induces apoptosis and a profound dysfunction in SPn and PCn, and underline the critical role of NMDA receptors in early ischemia-induced neuronal damage.     

Hemispheric activation and interaction: past activity affects future performance

Previous studies have shown that when hemispheric activation is modulated by a lateralised task performed concurrently with a second task, performance in the second task is affected by the side of the more active hemisphere. This effect is thought to be produced by competition for limited resources required to complete the two tasks and/or by a greater allocation of attention to the hemifield contralateral to the more active hemisphere. Little is known on how task performance is affected by the pattern of activation in the two cerebral hemispheres before a target task is conducted. The present study investigated how manipulation of hemispheric activity influenced performance of a non-lateralised task (letter matching). Greater left hemisphere activity interfered most with performance of the letter- matching task and was more pronounced in the early learning stage. Male participants were most affected by this effect. The results are discussed in relation to hemispheric interaction, functional lateralisation, and allocation of attention.     

Evidence-based management of peripheral vascular disease

Peripheral vascular disease (PVD) is very prevalent in the United States and is part of a global vascular problem. PVD patients have a heightened inflammatory state and are at high risk of death from acute cardiovascular problems rather than from progression of PVD. Modifiable risk factors for PVD include smoking, hypertension, diabetes, hyperlipidemia, elevated high sensitivity C-reactive protein, obesity, and the metabolic syndrome. Symptomatic treatment of claudication includes smoking cessation, exercise, cilostazol, statins, and revascularization with percutaneous or surgical therapy. Antithrombotic therapy with aspirin or clopidogrel is important to reduce cardiovascular events but does not affect symptoms of claudication. Patients with rest limb ischemia or ulceration should be revascularized to minimize the chance of limb loss. Percutaneous revascularization is not without significant complications, however, and future research needs to focus on inflammation, thrombosis, and restenosis in the PVD patient. Finally, new devices that tackle difficult lesions, drug-eluting stents, and pharmacologic agents that reduce global atherosclerosis are on the horizon and are likely to become critical components in the management of the PVD patient.