The aim of this study was to reveal the relationships between the features of the primary tumour, the degree of tumour stage, the presence of human papillomaviruses (HPV) in blood and the severity of Th1/Th2 serum cytokine imbalance in patients with laryngo-pharyngeal cancer. The study was performed on 50 patients (47 men and 3 women), with age ranging from 40 to 83 years (the mean of the patients' ages was 58.4 ± 9.43 years, with a median of 60 years). A control group was represented by age-matched healthy patients (with no clinical diseases). The viral DNA was detected by PCR; the cytokine levels were determined by ELISA. A clear switch from cytokine Th1 to cytokine Th2 in cancer patients, low levels of IL-2 and IFNγ in advanced stages, as well as a positive correlation of increased levels of both IL-2 and IL-12 with the early stages of laryngo-pharyngeal cancer was observed. Loco-regional metastases were correlated with increased levels of IL-8 and IL-10 and drastic decrease of IFNγ. In advanced cancer stages, we found that the most affected were IL-2 and IFNγ correlated with increased levels of Th2 cytokines. Patients with HPV present in both primary tumours and blood showed increased values of IL-4:IL-2 ratio as compared with patients with HPV-positive primary tumours only, demonstrating the aggravation of the immunosuppressive state. The most important finding of our study is that for a correct evaluation of the Th1 to Th2 switch in cancer patients, it is necessary to establish not only the negative/positive correlations between different Th1 and Th2 type cytokines, but also the ratio between them. These parameters allowed us to state that the presence of HPV DNA in blood was associated with the most severe immunological imbalance that could potentially lead to a poor prognosis of these patients. Our findings encourage us to consider that the ratio between different Th1 and Th2 cytokines could represent a useful marker for clinical and pathological evaluation of cancer patients.

In cases of locally advanced cancers involving the junction between the hypopharynx and cervical oesophagus, the curative surgical treatment is total circular laryngo-pharyngectomy with resection of the upper cervical oesophagus, coupled with modified radical neck dissection. Techniques used to re-establish the continuity of the digestive tract have been pectoral transposition flap, gastric pull-up, jejunum or colon transposition and free pedicled fascialcutaneous flap reconstruction. Prosthetic reconstruction was thought of and used only as a temporary solution. In our clinic, we adapted the Montgomery oesophageal prosthesis as more than just a temporary solution and used it in 63 patients operated from 2004 to 2014 with advanced (stages III and IV) cancer involving most of the hypopharynx or extending towards the upper cervical oesophagus. Following total circular laryngo-pharyngectomy with bilateral modified radical neck dissection, prosthetic reconstruction was performed using the Montgomery oesophageal tube. Patients were followed up on, and their status was monitored. Favourable results encouraged the authors to further develop a new active prosthesis, with advanced design and materials that better mimic the anatomy and physiology of the replaced segment. Prosthetic reconstruction of the upper digestive tract following radical oncologic surgery is a viable option, with advantages compared to other laborious plastic techniques. The new active model is under development, hopefully offering soon a safe and more cost-effective alternative to the other techniques.

Infections profondes de l'espace cervical-défis diagnostiques et thérapeutiques Introduction. Les infections des espaces plus profonds du cou sont souvent un défi clinique, en tant qu'urgences médico-chirurgicales à un mauvais pronostic et un potentiel mortel dans l'absence d'un diagnostic précoce et bien appliqué. Rapport du cas 1. Le premier cas présenté est celui d'une femme de 72 ans atteinte d'anémie due au syndrome myélodysplasique, admise au service d'hématologie. Les symptômes étaient une dysphagie avec odynophagie et une tuméfaction sous-maxillaire droite, sur un fond apyrétique. Dans ce cas, l'infection a commencé par un abcès péri-amygdalien qui s'est ensuite développé en un abcès para-pharyngé. Les principales difficultés médicales sont apparues après la chirurgie, l'état général du patient s'aggravant malgré l'évolution favorable de la plaie chirurgicale. Une récupération totale, y compris la déglutition, était possible deux mois après avoir quitte l'hôpital. Rapport du cas 2. La deuxième patiente est une jeune femme de 26 ans avec un bon statut social et matériel, sans comorbidités associées.

Vancomycin Resistant Enterococci (VRE) are a major cause of nosocomial infections. The purpose of this study was the investigation of the genetic background of vancomycin resistance in VRE strains isolated from various clinical sources in a major hospital in Bucharest. Identification of Enterococcus faecium and E. faecalis at the species level was performed using multiplex PCR for species specific ddl (D-alanine-D-alanine ligase) genes, as for 64% of the strains the VITEK system revealed only the genus of the strains. We used a multiplex PCR approach, using primers targeting the vanA, vanB, vanC, vanD, vanE, vanG genes, revealing the presence of vanA and vanB genes, To the best of our knowledge, this is the first description of vanA and vanB genes in Romania. This specific and sensitive technique allows detection of glycopeptide-resistant strains, that may escape phenotypebased automated rapid methods.

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Diagnostic clinique et traitement de l'inflammation des glandes salivaires

This study aims to establish whether the use of biomaterials, particularly polydimethylsiloxane (PDMS), for surgical reconstruction of the esophagus with templates, Montgomery salivary tube, after radical oncology surgery for malignant neoplasia is an optimal choice for patients’ safety and for optimal function preservation and organ rehabilitation. Methods: Structural analysis by Raman spectrometry and biomechanical properties with dynamic mechanical analysis are performed for fatigue strength and toughness, essential factors in durability of a prosthesis in the reconstruction practice of the esophagus. Nanocomposites with silicone elastomers and nanoparticles used in implantable devices and in the reconstruction surgery are facing risks of infection and fatigue strength when required to perform a mechanical effort for long periods of time. Results: This report takes into account the effect of silver (Ag) nanoparticles on the fatigue strength using polydimethylsiloxane (PDMS) matrix, representative for silicon elastomers used in implantable devices. PDMS with 5% (wt) Ag nanoparticles of 100-150 nm during mechanical fatigue testing at shear strength loses elasticity properties after 400 loading-unloading cycles and up to 15% shear strain. The fatigue strength, toughness, maximum shear strength are the key issues in designing Montgomery salivary tube with appropriate biomechanical behavior for each patient. Conclusions: Prosthesis design needs to indulge both clinical outcome as well as design methods and research in the field of biomaterials.