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[Use of the PVC, a laryngoscope for difficult intubation].

The PCV (Piquet-Crinquette-Vilette) laryngoscope has been designed for use in difficult endotracheal intubation in the adult. Its blade, 170 mm long, is curved, narrow (12 mm internal diameter) and semicircular in cross-section, like a closed C. An 8 mm endotracheal tube can be pushed through this blade. There is a cold light source. The use of this blade requires a teeth protector. The epiglottis will be lifted directly, and the blade will be moved into the vestibule, stopping short of the vocal cords. The endotracheal tube will then be introduced into the laryngoscope blade which guides it in between the cords. Once the tube has been checked to be within the trachea, the laryngoscope is removed by sliding the blade backwards over the tube. The PCV may be introduced into the mouth either on the right, or on the left, or behind the molar teeth, or between two teeth. It can held with the handle horizontal in case of a prominent sternum. The limits of this tool are a mouth opening of less then 20 mm, and some rare predictable difficulties which require an X-ray assessment to determine the best intubation technique to be used. Of 115 patients with a predicted difficult endotracheal intubation, fifty were intubated with the PCV without any failures. Also, twenty-five patients, out of thirty, were successfully intubated with the PCV after an attempt with a MacIntosh blade had failed. Of these five failures, one was never intubated by any technique whatsoever, two were intubated by fibroscopy and two by the ENT surgeon.

Anesthesiology↗

Salivary scintigraphy for assessing the protective effect of pilocarpine in head and neck irradiated tumours.

Patients with head and neck cancers can develop salivary hypofunction after radiotherapy. The use of pilocarpine during radiotherapy treatment has been shown to be an effective treatment, although its usefulness is being discussed. The aim of this study was: (1) to determine the value of a semiquantitative scintigraphy method for measuring the uptake and excretory salivary function of patients with head and neck irradiated tumours; and (2) to study the usefulness of pilocarpine as a salivary gland protector during radiotherapy. We prospectively studied 49 patients (mean age 61 years, range 29-87 years) with head and neck cancer in need of radiotherapy. Patients were divided into two groups consecutively: group P (26 patients) received 5 mg of pilocarpine three times per day starting the day before radiation therapy, and group NP (23 patients) received radiotherapy without pilocarpine and were used as the control group. Salivary gland scintigraphy and a visual analogue scale (VAS) of mouth dryness were obtained from each patient before radiotherapy and during the first year after treatment. The most frequent finding after radiotherapy was a quick impairment in parotid and submaxillary excretion (P < 0.001). There were no statistical differences comparing the pilocarpine group against the non-pilocarpine group. Parotid and submaxillary uptake significantly decreased after radiotherapy in both groups (P < 0.001). However, a tendency to recover within the pilocarpine group was observed in both the parotids and the submaxillary glands at 12 months. No differences were found comparing the VAS results in both groups. Strikingly, VAS data did not correlate with salivary gland dysfunction observed by means of scintigraphy. In conclusion, salivary scintigraphy is a useful technique to evaluate objectively the salivary gland function of patients with head and neck irradiated tumours as well as to test the response to pilocarpine. However, despite better results on the salivary uptake at 12 months, pilocarpine did not significantly improve salivary gland function.

Adult↗

[How I treat...oropharyngeal mucositis associated with radiotherapy for head and neck cancer].

Oral mucositis the major acute effect of head and neck radiotherapy. According to the degree, irradiation may be compromised in dose and overall time with consequences on outcome. Up to now there is no standard accepted protocol. A strict program of local and general hygiene is mandatory. Analgesics are often required. Amifostine acts as a protector of salivary glands GM-CSF and G-CSF stimulate proliferation of mucosal basal cells. Sucralfate plays a barrier role. Camomile plant extract is anti-inflammatory, well tolerated and cheap. Povidone-iodine is better than chlorhexidine as an antiseptic agent. PTA lozenges with polymixin E, tobramycin and amphotericin B showed a marked power of selective microbial decontamination.

Head and Neck Neoplasms↗

[Z-100 as radiation mucositis protector in head and neck tumor management].

To study the radioprotective effect of Z-100 against mucositis, twenty-five patients with head and neck malignancies were received external irradiation of 30-61.2 Gy (mean 44.4 Gy) concurrent with Z-100 injection twice a week. Of these cases, an incidence of dysphagia was less than 20% and white coating mucositis below 50%. Frequency of radiation mucositis in these regions was reduced compared to our previous experiences; efficacy of 88%. This combined therapy seems to be a promising method.

Adult↗

[Epidermal growth factor: a probable oral and digestive health protector].

The integrity of oral and digestive mucosa depend on many salivary components like the Epidermal Growth Factor (EGF). Sometimes indicative, sometimes stimulated or modulated factor of oral and digestive health, EGF appears as a clinical marker in neoplastic and inflammatory diseases. As cellular growth factor, it protects the digestive mucosa with stimulation of mucus production and with inhibition of gastric secretion. Equally implicated in healing process, it enhances this one, and determines, in patients, more or less sensibility to inflammatory damages. Its strategic place in various pathologies, as stomach ulcer and tumoral process, open research prospects with a real potential of repair and pronostic.

Biomarkers↗

[Evaluation for the training and behavior of dental treatment in our special patients center].

With a view to modifying the respective behaviors of patient, protector and operator so that a relationship of reliability can be established among them, we have adopted the training for dental treatment in the medical care system for handicapped children. We took this opportunity to classify the present handling methods at the practice of medical care into 4 groups (A, B-1, B-2, C) and to examine the training effect in each group and its features. [Method] On 145 patients having received treatment in the Dental Center for the Handicapped Children in our Hospital, number of patients by group, average age at the first examination, average training frequencies before and after treatment, average treating frequency, behavior in the training and relationship between each group and the disorder were examined for the card. [Results] 1) About 40% of the subjects for examination became capable of receiving treatment without any controlling appliance before the final treatment. 2) Average training frequency and average treating frequency had higher values of B-1 group than for other groups. 3) Behavioral estimation during the training revealed that A and B-1 groups showed better performance in mouth washing, brushing and cleaning by brushing than B-2 group, but the case was the contrary with oral use of three-way syringe and the vacuum. [Conclusion] Application of various behavior-modifying techniques to the training for dental treatment in children with psychosomatic disorder made its effect and features.

Behavior Therapy↗