Chemotherapy advances in locally advanced head and neck cancer

The management of locally advanced unresectable head and neck squamous cell cancer (HNSCC) continues to improve. One of the major advances in the treatment of HNSCC was the addition of chemotherapy to radiation in the treatment of non-surgical patients. The majority of the data regarding chemotherapy in HNSCC involve cisplatin chemotherapy with concurrent radiation. However, several new approaches have included targeted therapy against epidermal growth factor receptor and several recent studies have explored the role of induction chemotherapy in the treatment of HNSCC. The purpose of this article is to provide an overview of the role of chemotherapy in the treatment of locally advanced HNSCC.     

Diazepam Versus Clobazam for Intermittent Prophylaxis of Febrile Seizures

Objective  

To compare the effectiveness of intermittent clobazam versus diazepam therapy in preventing the recurrence of febrile seizures and assess adverse effects of each drug.     

Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire.

OBJECTIVES: Food frequency questionnaires (FFQ) are frequently used in epidemiologic studies of nutrition and food intake. However, the use of FFQs in patients receiving maintenance dialysis has not been extensively studied. We hypothesize that FFQ is a useful tool to assess the food intake differences between patients receiving dialysis and patients not receiving dialysis. DESIGN: Matched exposed-unexposed study with case-controlled design. SETTING: Outpatient dialysis unit affiliated with a tertiary-care community medical center. PATIENTS: From a pool of 102 maintenance hemodialysis (MHD) outpatients in a community dialysis unit, 30 adult MHD outpatients (15 men, 15 women, aged 55.8 +/- 14.6 years) were selected randomly as case subjects. They included 16 African Americans, 8 whites, 4 Hispanics, and 2 Asians. Eleven MHD patients took the multivitamin, Nephrovite (R&D Laboratories, Marina del Rey, CA), regularly. From an archive of 1,610 nondialytic individuals with known FFQ data, 30 control subjects were selected randomly to match the age, race, and sex of the case subjects. INTERVENTION: We used Block's FFQ (version 98), an 8-page self-administered questionnaire that has been widely used in epidemiologic studies. A group of trained research assistants supervised the FFQ administration and interviewed those patients who were not able to answer all of the questions without assistance. Student t test was used to compare group means in form of daily dietary intake, and conditional logistic regression was used to calculate odds ratios for predetermined dichotomizing cutoff levels. MAIN OUTCOME MEASURES: Food intake characteristics of MHD patients as compared with control patients not receiving dialysis. RESULTS: Statistically significant differences between MHD case subjects and nondialytic control subjects were observed between the amounts of daily intake for vitamin C (84 +/- 63 mg/d v 127 +/- 70 mg/d, P = .01), dietary fiber (12 +/- 6 g/d v 18 +/- 11 g/d, P = .02), potassium (2,024 +/- 1,088 mg/d v 2,701 +/- 1,429 mg/d, P = .04), cryptoxanthin (56 +/- 88 microg/d v 140 +/- 118 microg/d, P = .003), and lycopene (2,052 +/- 2,234 microg/d v 4,524 +/- 3,979 microg/d, P = .004). These data indicate that MHD patients had a significantly lower intake of vitamin C, dietary fibers, potassium, and 2 of the carotenoid compounds when compared with individuals not receiving dialysis. Moreover, the daily intake of vitamin B(6) was significantly higher in MHD patients probably because of the high pyridoxine content in Nephrovite. By using the conditional logistic regression analysis, the odds ratios for lower than predetermined cutoff levels in patients receiving dialysis were significant for vitamin C, potassium, and the 2 previously mentioned carotenoids (odds ratio between 3.50 and 7.50, P < .05). CONCLUSIONS: Patients receiving dialysis may consume significantly lower amounts of potassium, vitamin C, and dietary fibers as well as lower amounts of some carotenoids. The FFQ seems to be a useful tool to compare dietary intake of MHD patients with other groups, although it may underestimate the amount of daily protein and energy intake and, hence, may not be an accurate tool for individual assessment of food intake. More studies are required to evaluate the validity of the FFQ in dialysis patients. The lower vitamin C, fiber, and carotenoid intake of MHD patients may be atherogenic. Hence, the hypothesis is proposed that prescribed restrictions in potassium in MHD patients may lead to reduced fruit and vegetable intake, leaving meat and fats as the main source of calories. This may contribute to atherosclerosis and increased cardiovascular morbidity and mortality in these patients. This hypothesis needs to be evaluated in future studies.     

Evaluation of brainstem function in patients with spasmodic dysphonia using vestibular evoked myogenic potentials and auditory brainstem responses

CONCLUSION: The vestibular area is closer than the auditory region to nucleus ambiguus. If a 'shared' lesion involves regions of adjacent nuclei of the brainstem in patients with spasmodic dysphonia then vestibular area involvement is more possible than that of the auditory region. OBJECTIVES: The authors hypothesize that lower brainstem lesions and involvement of descending pathways of the spinal tract may be the site of lesion in patients with spasmodic dysphonia. PATIENTS AND METHODS: Ten patients with spasmodic dysphonia were tested using the auditory brainstem response (ABR) and vestibular evoked myogenic potentials (VEMPs). RESULTS: No ABR abnormalities were found in right ears. Results of ABR on the left ear showed that one patient had abnormal ABR. This patient had severe sensorineural hearing loss on the left side. VEMPs displayed normal response in two patients bilaterally. First positive (p13) and second negative (n23) waves of VEMP could not be recorded in three cases unilaterally and in five patients bilaterally.     

Outcome research, nutrition, and reverse epidemiology in maintenance dialysis patients.

High morbidity and mortality of maintenance dialysis patients have led to an increase in interest in outcome research in an attempt to identify causes for this adverse outcome. It has been proposed that a substantial amount of this risk can be explained by protein energy malnutrition, chronic inflammation, or concurrent combination of both, known as malnutrition-inflammation complex syndrome (MICS). Elements of overnutrition, such as increased weight or high serum cholesterol levels, which are deleterious in the general population, paradoxically are protective in dialysis patients. Conversely, a low body mass index and low serum levels of cholesterol, creatinine, and possibly homocysteine are risk factors for poor outcome in dialysis-dependent populations. These reverse or paradoxical relationships between nutritional markers and outcome are referred to as reverse epidemiology. The MICS appears to be a main contributor to the reverse epidemiology and poor outcome. Mortality is the most definitive and objective clinical outcome, whereas hospitalization and quality of life (QoL) are additional relevant but somewhat less objective outcome measures in dialysis populations. A systematic classification of outcome measures and their related epidemiologic and statistical assessment tools in dialysis patients are reviewed. The effect of MICS on outcome can be examined by epidemiologic studies that are based on large samples of dialysis patients, use multivariate techniques, and, as long as they follow strict methodologic requirements, provide an invaluable economical alternative to expensive clinical trials.