Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

No abstract

IntroductIonBy tradition, the postaural incision is closed in two or three layers. The layers consisting of periosteum, soft-tissue, and skin, each layer being closed separately. It not only consumes more of suture material, but also plenty of surgeon's time, sometimes the time for suturing equals or exceeds the time taken for mastoidectomy or tympanoplasty. The postaural incision closure can also be done in a single layer. Here, only the soft tissues and skin are sutured in a single layer. It saves both time and suture material, thereby reducing the cost of surgery as well. We did a random search on the internet to find out the efficacy of either of the procedures and to our surprise did not find any. Hence this study was undertaken to study and compare the efficacy of closing the postaural incision in a single layer versus closing in multiple layers.Data was sourced from patients who attended the outpatient department of Otorhinolaryngology, Fr. Muller Medical College Hospital, and who were diagnosed to have chronic suppurative otitis media, either tubo-tympanic or attico-antral type.Background: By tradition, the postaural incision is closed in single or multiple layers. In this study single layer closure is compared with multiple layer closure. Materials and Methods: Two hundred patients with Chronic suppurative otitis media undergoing ear surgery by post aural approach at our department were included in the study. Results: It was observed that time taken for single layer closure was far less compared with time taken for multiple layer closure, which was of statistical significance. Conclusion: single layer closure is as effective as multiple layer closure of postaural incision, with the distinct advantages of reduced closure time and lesser cost of suture material.

No abstract

No abstract