BackgroundThe use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort.Patients and MethodsThis study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first.ResultsThe median patient age was 53 (37–78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684–13.316) and PFS of 8 months (CI 95%, 6.051–9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%).ConclusionsThe results of this study suggest that cetuximab plus platinum–fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.

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The authors make a literature review and stress the importance of differentiating between NS and salivary gland neoplasia. Histology is essential in case of ulcerated neoformation of the oral cavity, to adapt treatment, avoiding unsuitable approaches.

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Os corpos estranhos nas fossas nasais são causas frequentes de recurso à urgência, sobretudo em idade pediátrica.Na maioria dos casos são inofensivos, podendo permanecer vários dias sem causar lesões. As pilhas sendo uma exceção,representam uma importante ameaça com necessidade de remoção urgente.Descreve-se o caso de uma criança com 4 anos de idade, observada no Serviço de Urgência com suspeita de corpoestranho na fossa nasal. Apresentava obstrução nasal e rinorreia unilateral sanguinolenta, com 5 horas de evolução.A radiografia dos ossos próprios nasais identificou um objeto redondo, radiopaco com sinal de duplo halo. Mediantea suspeita de uma pilha na fossa nasal, procedeu-se à sua imediata remoção sob anestesia geral.Pretendemos alertar para a perigosidade deste tipo de objeto, assim como para a necessidade de uma abordagemdiagnóstica e terapêutica céleres, a fim de evitar complicações graves.

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Despite the common sense that we learn from our mistakes, an error is an unwelcome event when we deal with patients. Diagnostic error is common, costly, and the leading cause of malpractice litigation. Yet, errors occur occasionally in a lifetime of practice, and the consequences of these faults are significant for patients and physicians. If someone would have told me that I would miss a brain tumor in my first years of practice, in a patient presenting to my care with several cranial nerve signs, I would not have believed it. Here is how it happened.