Randomized study of 5 fluorouracil and cis platin as neoadjuvant therapy in head and neck cancer: a preliminary report.

A randomized prospective study of 5 fluorouracil (5-FU) and Cis platin preceding definitive local treatment for squamous cell carcinoma of the head and neck region was initiated in September 1986. Seventy-five patients were stratified by site (oral cavity-12, oropharynx-28, larynx-16, hypopharynx-19), and by Stage (Stage II-20, Stage III-43, Stage IV-12) and randomized to receive definitive local treatment (surgery and post-operative radiation or radiation alone) or chemotherapy followed by definitive local treatment. Chemotherapy consisted of three cycles of 120 hr 5-FU infusion 1 g/m2/day plus Cis platin 100 mg/m2 on day 1 on each cycle.

[Medicolegal aspects of esthetic surgery].

The particular features of the contractual agreement binding patient and plastic surgeon are recalled. The obligation of the result appears to be distorted in the course of jurisprudence. The severity of the judgements means that great care must be taken in the management before, during and after the operation (study of the patient's motivations, informed consent, iconographic survey, technical equipment, postoperative care,.

[Severe complications of tonsillectomy].

The authors report 15 fatal complications after tonsillectomy based on the claims made between 1976 and 1986 to three insurance companies specialised in medical defence. The advantages and disadvantages of tonsillectomy with intubation and with the Sluder apparatus are recalled. Analysis of the legal proceedings of these cases reveals the principal points of jurisprudence: the importance of the preoperative assessment, pre-anaesthetic examination and informed consent.

[Severe iatrogenic complications of surgery of the middle ear and their medicolegal aspects].

The authors analysed 62 cases of severe iatrogenic complications occurring after middle ear surgery (death, cophosis, PFP) between 1976 and 1986. They compared their results to those of a similar study conducted between 1950 and 1975. They observed an increase in the number of legal proceedings, probably due more to the increased demand by patients than to a higher incidence of these complications.

[Iatrogenic complications of nasal sinuses surgery].

In order to illustrate the necessity of obtaining informed consent before any form of nasal sinus surgery, the authors present 23 cases of insurance claims filed between 1976 and 1986 in private practice. Ten serious complications (6 cases of blindness, 4 fractures of the anterior cranial (fossa) and eight cases of oculomotor nerve paralysis are reported. The legal proceedings demonstrate the real risks of radical surgery to the sinuses, as well as intranasal ethmoidectomy and rhinoplasties.

[Drug ototoxicity. Medicolegal aspects].

Drug ototoxicity is a preoccupying iatrogenic complication. Experimental studies over recent years, in particular a pharmacokinetic study of the elimination of aminoglycosides, have enabled the authors to define rules of prescription for parenteral aminoglycosides designed to reduce to a minimum the risk associated with their use. New aminoglycosides such as Netromycin appear to be associated with reduced toxicity.

[Postoperative iatrogenic lesions of the external branch of the accessory spinal nerve].

Iatrogenic lesions of the spinal nerve are rare and generally occur during cervicotomy for aetiological assessment of adenopathy. The spinal nerve is essentially damaged at two sites: the supraclavicular fossa (where the nerve is very superficial) and in the antero-lateral triangle of the neck (where the nerve approaches the sterno-cleido-mastoid muscle). The lesion of the spinal nerve essentially presents in the form of paralysis of the trapezius; which should be examined systematically postoperatively and at subsequent consultations, as the clinical signs may only develop after a certain latency period.