Recurrent and advanced cancer in the head and neck region is usually associated with limited therapeutic concepts and a dismal prognosis. Efforts mainly focus on palliative treatment in order to improve the patient's quality of life. From May 1989 to December 1994, a total of 120 intra-operative radiotherapy (IORT) procedures with high-energy electron beams (mean energy: 7 MeV: mean dose: 20 Gy) were performed in 95 patients. Therapy was usually performed under endotracheal anaesthesia (84%). There were 91 cases (75.8%) of recurrence in the lymph nodes of the neck and 14 cases (11.7%) of local recurrence. 15 patients (12.5%) received IORT as part of the initial treatment. Considering the palliative nature of IORT in these patients, only an R2 resection (gross residual tumour) was achieved in 71.7%. Local tumour control was nonetheless possible in 17% (R2 resection) to 64% (complete R0 resection), with a mean 11-month follow-up period for survivors (mean for deceased patients: 8 months). Regarding palliative criteria, IORT proved to be feasible since patients profited from short hospitalisation (median: 10 days), a low complication rate (27 instances; e.g. tracheostomy: 11; necrosis: 8, or fistula: 3) and, in part, a substantial reduction of pain (73.8%). Most of them regained physical and psychic integrity for weeks to months and were able to take part in social life during the final stage of their disease.

Adult↗

PubMedDate not supplied

[Hereditary hypogranular thrombocytopathic thrombocytopenia. Ultrastructural study of a megakaryocytopathy (author's transl)].

The ultrastructure of megakaryocytes and blood platelets has been studied in 3 members of a Swiss family, in which a haemorrhagic diathesis of varying degree occurred in at least three generations. Blood platelets show an extremely low number of dense granules, slightly increased mean diameter and irregular distribution of glycogen in unusually large clusters. The number of megakaryocytes in bone marrow is normal. Electron microscopy shows asynchronous development of their structural components: a severe defect in maturation of specific granules is followed by retardation and irregularity in the demarcation of the "platelet prospective fields", Golgi membranes have few vesicles, glycogen occurs partly in huge clusters and megakaryocytes with mature platelet fields are very rare. The ultrastructural picture of platelet formation in megakaryocytes indicates that this haemorrhagic syndrome may be understood as a megakaryocytopathy. The results of functional and biochemical analyses performed on blood platelets show a defect in both phases of aggregation and in PF 3 availability, normal survival, decreased total sialic acid content, and absence of the heaviest platelet population ("D") isolated by discontinuous sucrose gradient. The autosomal dominant transmission of this together with its concomitance with blood group O suggest its relationship with the familial thrombopathic thrombocytopenia described in 1968 by Kurstjens and al. in a Dutch family [13].

Blood Platelet Disorders↗