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OBJECTIVES: The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. MATERIALS AND METHODS: A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. RESULTS: The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. CONCLUSION: Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.

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OBJECTIVES: Between 1st January and 31st December 2007, 331 Streptococcus pneumoniae strains were collected from 20 participating laboratories in the Pneumococcus Network Pays de la Loire county to assess their susceptibility to antibiotics and to evaluate serogroups of strains. METHOD: The coordinating centre performed MICs of penicillin G, amoxicillin and cefotaxime by the reference agar dilution method. Results were interpreted according to CA-SFM breakpoints. Sensitivity to other antibiotics were studied and serotyping of each strain performed. RESULTS: Three hundred and thirty one strains were isolated in 2007. They were collected from 30 cerebrospinal fluids, 239 blood samples, 53 middle ear fluids and nine pleural fluids. The percentage of pneumococci with decreased susceptibility to penicillin G (PDSP) was 39% and was higher in children (51%) than in adults (35%). The PDSP were often multidrug resistants especially with a high percentage of resistance to erythromycin (87.6% versus 8.4% for pneumococci sensitive to penicillin G). Finally, the most prevalent serogroup was the serogroup 19 (29.6% of isolates). CONCLUSION: A decrease of PDSP was observed since 2001 and high-level resistant strains to beta-lactams remain low. The rate of PDSP in Pays de la Loire is in the national average.

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A case is reported of a patient with cervicopharyngeal synovial sarcoma, and the clinical characteristics and therapy of these very rare tumors discussed. It appears difficult to assess prognosis because of the very few cases documented.

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Pefloxacin is a new quinolone with significant in vitro antibacterial activity and a broad spectrum. It was included in an extensive study of antibiotic diffusion into bronchial mucus. Pefloxacin was given to 35 patients divided into five groups according to the timing of sputum sampling. Plasma specimens were taken simultaneously. Pefloxacin was measured by microbiological assay. Mean pefloxacin concentrations in bronchial mucus was high, exceeding 5 mg/l. Concentrations on the first and third days were similar. The ratio of mucus concentrations to plasma concentrations was high in each case, around or often above 1. These findings show that diffusion of pefloxacin into bronchial mucus is outstanding.

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An anatomical and neuroradiologic study was conducted to define arterial irrigation of the nasal fossae, the topography of the different vascular territories, particularly that supplied by territories, particularly that supplied by the internal maxillary artery which is by far the most important, and the anastomoses of the different endo- and extra-nasal internal and external carotid systems.

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Selective embolization of the distal branches of the internal maxillary artery was performed to treat severe essential epistaxis in 11 patients. Elective indications for this technique are elderly patients with profuse epistaxis.

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Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed an elective response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitin and cefamandole.

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Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed a peculiar response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitine and cefamandole.

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The activity in vitro of the new cephamycin, cefotetan, was compared with that of cephalothin, cefoxitin, cefuroxime and cefotaxime against 226 recently isolated Gram-negative pathogens (207 Enterobacteriaceae and 19 Acinetobacter). Cefotetan was consistently more potent than cephalothin, cefoxitin and cefuroxime. Cefotaxime and cefotetan were essentially similar in activity against the Enterobacteriaceae with the singular exception of Enterobacter spp. which were markedly more susceptible to the former drug. None of the five agents was especially active against acinetobacter but cefotaxime was the best. Limited tests of bactericidal activity showed that the MBC differed from the MIC by a factor of 4 at most. Increasing the inoculum tested from 10(2) to 10(8) per ml had little adverse effect on the MIC of cefotetan. If the recommendations of the National Committee for Clinical Laboratory Standards for susceptibility to cephalosporins are applicable to cefotetan and the breakpoint criteria of less than or equal to 10 mg/l (sensitive) and greater than or equal to 32 mg/l (resistant) are acceptable, then only a few of the Enterobacteriaceae in this study were resistant. These resistant organisms were amongst Enterobacter spp. and Citrobacter spp.

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The study of the bronchial concentration of dibekacin has shown a different degree of activity than that of gentamicin. This activity resembles that of amikacin with a three hour time lag from the appearance of the bronchial peak in relationship to the serum peak. In addition there seems to be a special passage mechanism for the antibiotic from the blood into the bronchial secretions since we observed an increase in the mucus/serum ratio through time.

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In 13 cases of pneumonectomy, we have studied the concentration of TMP-SMZ in tissue and serum, after three days of treatment. Four hours after TMP-SMZ injection, the tissue's samples obtained from crushed and mixed ; the dosages were performed by a microbiological assay. As we previously described in bronchial secretions : the lung penetration of TMP is important ; the tissue concentrations were higher than in serum ; the diffusion of SMZ is low. The ratio of TMP to SMZ were diffusion of SMZ is low. The ratio of TMP to SMZ were different in serum and tissue, but the antibacterial activity is not affected in vitro by the value's modification.

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The penetration of mezlocillin into bronchial secretions collected by fiberoscopy was determined in 18 hospital patients with acute-on-chronic bronchial infection. Samples of blood and bronchial mucus were collected simultaneously 3 hours after each 12-hourly intramuscular injection of 1 g mezlocillin. Antibiotic concentrations were measured by the microbiological method. Mezlocillin concentrations in bronchial secretions averaged 50 % of concomitant serum concentrations. The rate of penetration of the drug was higher than that observed with ampicillin in similar conditions. The mean bronchial level of 3 micrograms/ml was indicative of a high therapeutic index in relation to the MICs of the pathogens isolated in these patients. It is concluded that intramuscular mezlocillin is indicated for the treatment of acute exacerbations of chronic bronchial infections due to highly sensitive organisms.

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Ten cases of vesicular eruption affecting primarily the hands (4/10) and feet (6/10) occurred in a day-nursery for infants. An enterovirus related to coxsackie A 16 virus was isolated from two vesicular fluids and nine stools. The fact that the outbreak took place in the winter, the rarity of pharyngeal lesions (2/10), the high incidence of foot lesions and the presence of listlessness as only associated symptom lead to a discussion of the relationship between this small epidemic and true hand, foot and mouth disease.

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