Induction chemotherapy in primary resectable head and neck tumors - a prospective randomized trial

Although induction chemotherapy prior to local therapy produces encouraging initial response rates in head and neck cancer, randomized studies have failed to demonstrate an advantage in survival. All randomized studies included only patients with far advanced stage III and IV disease which appears to be the main reason for the low rate of complete responses (max. 18%) in these trials. According to statistical considerations nearly 50% complete responders are necessary before improved survival benefit can be expected. Until now, such complete response rates are only achieved with induction chemotherapy in resectable T2-T3, N0-N2 disease. Therefore, we started a prospective randomized trial including only patients with these stages of disease. Patients were stratified by primary tumor site and neck node status and were randomized to receive either induction chemotherapy with three cycles of carboplatin/5-FU prior to surgery and radiotherapy (arm A, 49 patients) or standard treatment with surgery and radiotherapy (arm B, 47 patients). Patients were stratified by primary tumor site and neck disease. After a follow-up of 12-48 months overall survival was 72% in arm A and 53% in arm B (n.s.). Considering only the patients with cancer of the oral cavity and the tonsil overall survival was 88% in arm A and 44% in arm B (p<0.05). As of today, the number of patients with carcinomas of the hypopharynx and base of tongue is too small for a statistically significant statement, but preliminary data indicate a better overall and disease-free survival without chemotherapy in these patients. Therefore, we recommend controlled trials with induction chemotherapy in patients with primary resectable carcinomas of the oral cavity and the tonsil, stages T2-T3 and N0-N2, prior to surgery but not in patients with cancer of the hypopharynx and base of the tongue.

Two outbreaks of botulism associated with consumption of green olive paste, France, September 2011

Two family outbreaks of botulism (a total of nine cases) were identified in south-east and northern France in early September 2011. The source of infection was considered to be a ground green olive paste. Botulinum type A toxin was identified in seven cases and in the incriminated olive paste. Incorrect sterilisation techniques were observed at the artisanal producer’s workshop. These episodes highlight the potential public health threat of Clostridium botulinum linked to inadequate sterilisation of food products.

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases.

Validity of intradermal tuberculin testing for the screening of bovine tuberculosis in Madagascar

A sample survey with the objective of determining the prevalence of bovine tuberculosis by means of an intradermal tuberculin test was conducted in Madagascar and it was found that the prevalence rate varied from 0-30% by veterinary district. In order to estimate the true prevalence, the validity of the test was investigated by assessing its sensitivity and specificity in two groups of animals from two different regions, which were destined for slaughter. In the first group where the probability of non-infected animals should have been the highest, sensitivity was estimated at 0.52 (n = 21) and specificity at 0.99 (n = 79). In the second group selected on the basis of apparent ill health of the animals in a high-prevalence bovine tuberculosis area, sensitivity was estimated at 0.8 (n = 10) and specificity at 1 (n = 12). The results obtained from both groups of cattle were not combined for statistical purposes because the sensitivity of the skin test seemed to fluctuate in relation to the chronicity of the disease. These fluctuations are discussed. However, since the first group of zebu cattle was more representative of the cattle population across the country as a whole, its results were retained as operational parameters for further screening.