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Biomedical subjects

A Giovanni

Publications and source records attributed to A Giovanni.

At least 19 recordsLinked to original sources
PubMed2006

[Contribution of 18-F-FDG PET for detection of head and neck carcinomas with an unknown primary tumor].

OBJECTIVES: To evaluate the usefulness of fusioning positron emission tomography with computed tomography (PET/CT) for the detection of head and neck carcinomas of unknown primary. METHODS: This prospective study included 20 patients with cervical lymph node of squamous cell carcinoma of unknown primary after standard initial workup (nasofibroscopy and CT scan of the chest and head and neck). Patients underwent PET/CT and panendoscopy of the upper airways and upper digestive tract with PET/CT directed biopsies. The follow-up was 6 months minimum in all patients. RESULTS: A potential primary tumor was found in 10 of the 20 cases and confirmed by histology in 7 cases (3 bases of tongue, 1 tonsillar pillar, 1 vallecula, 1 tonsillar fossa, 1 piriform sinus). Four of these seven patients presented a normal endoscopy (diagnosis was made with submucosal PET/CT directed biopsies). PET/CT was normal in 10 of 20 cases with 3 false negatives. The sensitivity of PET/CT was 70%, the specificity was 70% and the accuracy was 70%. CONCLUSION: PET/CT seems to be of interest in the detection of head and neck carcinoma of unknown primary. PET/CT detected 15% of unknown primary tumors with treatment-related implications.

Adult↗
PubMed2006

[Remodeling of the nasal lobule using cartilaginous grafts on tip projection].

OBJECTIVES: Nasal tip projetion and definition are essential parameters which should be considered in the preoperative rhinoplasty plan. Jonhson and Toriumi have defined a technique of rhinoplasty to restructure the lobule using columellar strut and tip grafts. The aim of this study was to define the influence of this procedure on nasal tip projection, using the Goode method (objective measurement of the tip projection). METHODS: Forty patients underwent primary rhinoplasty, by open approach, with remodeling of the lobule using cartilagenous grafts, according to Jonhson and Torium technique. Goode ratio was calculated to assess tip projection preoperatively and postoperatively, based on photographic analysis. Moreover, postoperatively, all patients were clinically evaluated at 2, 4 and 6 months, and based on photographs of face at 2 and 6 months. RESULTS: Five hypoprojected preoperative nasal tips (Goode ratio (GR): 0,45 to 0,51) had a normal nasal tip projection postoperatively (GR: 0,55 to 0,59). Among the eight normal projected preoperative nasal tips (GR: 0,56 to 0,60), six had a normal postoperative nasal tip projection while two showed a hyperprojection (GR: 0,62 and 0,63). Among the 27 hyperprojected preoperative nasal tips (GR: 0,62 to 0,75), 17 showed a normal projection of the nasal tip postoperatively while 10 remained hyperprojected despite a decreased Goode ratio. CONCLUSION: Restructuration of the lobule, using cartilagenous grafts, is a reliable and reproducible technique allowing satisfying aesthetic results and objective measurements of the changes in nasal tip projection using the Goode method.

Adult↗
PubMed2006

[Contribution of 18FDG PET/CT post treatment surveillance of head and neck squamous cell carcinoma].

OBJECTIVE: To evaluate the contribution of 18FDG positron emission tomography for the post treatment surveillance of head and neck carcinomas. METHODS: : This prospective study included 61 patients with advanced squamous cell carcinoma of the upper airways and/or digestive tract and who underwent curative treatment. Patients underwent a standard workup (physical examination, CT scan and panendoscopy) and a PET/CT image fusion 3 months after the end of treatment. The follow-up was 6 months minimum in all patients after this workup. PET/CT was evaluated in terms of: primary tumor, cervical lymph nodes, metastases and overall patient assessment. RESULTS: : For diagnosis of the primary tumor, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT were respectively 86.7%, 82.6%, 62%, 95% and 83.6%. Values for cervical lymph nodes were: 100%, 98.2%, 80%, 100% and 98.3%. Values for metastases were: 100%, 92.2%, 66.7%, 100% and 93.2%. Values for overall patient assessment were: 88.8%, 78.1%, 64%, 94.1% and 81.4%. Performances of PET/CT were better than standard workup in 22% of patients. CONCLUSION: PET/CT contributes useful information in this indication, particularly an excellent negative predictive value.

Adult↗
PubMed2006

[Assessment of dysarthria and dysphagia in ALS patients].

Swallowing and speech disorders are the dramatic consequences of bulbar and pseudo-bulbar syndrome in ALS. Evaluation is necessary to guide speech therapy and to measure the effects of treatment. This article revues the different examinations used to assess bulbar and pseudobulbar involvement in an ALS patient: oromotor assessment, evaluation of the functions with self assessment, perceptive and objective evaluation of speech disorders, fiberoptic endoscopic evaluation of dysphagia (FEES) and videofluoroscopy.

Amyotrophic Lateral Sclerosis↗
PubMed2006

[Papillary thyroid carcinoma metastasis to parapharyngeal lymph nodes: interest of the PET scan].

UNLABELLED: Thyroid cancer rarely metastasizes to the parapharyngeal space. A inconsistent lymphatic drainage pathway is involved, as described by Rouvière. OBJECTIVES: To demonstrate the interest of [18 F]-FDG PET in early diagnosis of metastasis and in the follow up of the patient. MATERIAL AND METHOD: 40 y.o. male with papillary carcinoma who had a secondary parapharyngeal metastasis. The diagnosis of recurrence was difficult, as the plasmatic thyglobulin was low, and the iodine scan was not informative. In this case, [18 F]-FDG PET-CT was informative (clear parapharyngeal fixation) and led to the diagnosis of recurrence. CONCLUSION: It appears that 18F FDG PET has a good diagnostic value and that its sensitivity is better than CT scan and MRI. Some authors recommend the use of [18 F]-FDG PET and scintigraphy with Iodine 131 to screen patients with thyroid cancer recurrences.

Adult↗
PubMed2005

Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction.

THE AIM OF THIS STUDY: To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure. MATERIAL AND METHODS: During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction. RESULTS: RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet. CONCLUSION: RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.

Adult↗
PubMed2005

[Determination of oesophageal speech intelligibility using an articulation assessment].

OBJECTIVE: We studied if articulation could determine esophageal speech's intelligibility. MATERIAL AND METHOD: To do so, we proposed 30 subjects distributed in three groups based on their speech proficiency level, two preliminary assessments: an articulation assessment and an intelligibility assessment. RESULTS: The study shows a significantly high correlation (86%) between the results of the articulation assessment and the intelligibility assessment in the whole of group studied. However, we noted differences in correlations according to the level of the subjects: in the novices' group, the percentage reaches 62%, in the medium group, 76%, and in the proficient one: 97%. CONCLUSION: We concluded that if the results of the articulation assessment is very high, intelligibility will be good. On the other hand, if this percentage is moderate, we can't evaluate intelligibility only with the articulation factor.

Aged↗
PubMed2005

[Increase in the abdominal respiratory movements during the sudden passage from a conversational voice to a loud voice].

UNLABELLED: The passage of the simple conversational voice to a loud voice is accompanied by an increase in the muscular tensions as well as increase in the mobilized volumes of air. OBJECTIVES: We sought to know if these additional volumes were mobilized rather by a thoracic breathing or an abdominal breathing and if this effort were accompanied by a reduction in the variability of the movements. MATERIAL AND METHOD: The study presented is a prospective experimental study undertaken on healthy subjects (10 subjects) of which we analyzed the spontaneous vocal behavior (conversation with the experimenter) in the medium of vocal spots lures (production of vowels) in a calm environment allowing a conversational voice (condition 1) and in a noisy environment obliging the subjects abruptly to use a strong voice (condition 2). Thoracic and abdominal volumes were recorded using belts provided with pressure pick-ups, while the voice was synchronized with the recordings. RESULTS: The results show a reduction in the number of rheses realized with abdominal volumes and a reduction in the abdominal volumes mobilized in condition 2, testifying to a preferential use of thoracic breathing in loud voice. They also show a reduction in the number of movements of the inspiratory type (increase in the thoracic diameter or reduction in the abdominal diameter) during the phonatory phase in condition 2, which testifies to a reduction in the variability of the strategies used by the subjects. CONCLUSION: The sudden passage to a loud voice because of the appearance of an ambient noise leads to an increase of the use of thoracic breathing, which is in agreement with the concept of voice of distress or of emergency suggested by Le Huche.

Abdominal Muscles↗
PubMed2004

[Pleomorphic adenoma of the parotid: histopathological study].

OBJECTIVES: Capsular ruptures play a major role in recurrences of parotid pleomorphic adenomas. The aim of this retrospective study was to define histomorphological characteristics of pleomorphic adenoma in order to define possible recurrence mechanisms and to set a clear surgical management. MATERIAL AND METHOD: Histological study was performed after reviewing of slides originating from 100 patients with pleomorphic adenomas of the parotid gland. These patients were treated in our institution during the period May 1992 - November 2002. RESULTS: The studied population was distributed into 3 histological subtypes for better analysis. Hypocellular (stroma rich) pleomorphic adenoma was reported in 56%, hypercellular pleomorphic adenoma was reported in 29% and "classic" in 15%. Thinness of capsule was significantly related to hypocellularity. Pseudopodias and satellite nodules were reported in 72% of this series. CONCLUSION: Due to capsular characteristics, surgical excision should avoid dissection in the vicinity of the tumor in order to avoid capsular bare area, so minimizing the risk of surgical induced recurrence. According to these findings, enucleation surgery for pleomorphic adenoma should not be performed anymore. Parotidectomy techniques (total or lateral) constitute the surgical procedures of choice.

Adenoma, Pleomorphic↗
PubMed2004

[Primary cancer of the parotid gland: an anatomoclinical approach].

BACKGROUND: Carcinoma of the parotid gland presents a wide variety of clinical presentations, behaviors and prognoses. The aim of this study was to define the characteristic clinical presentations and the prognostic factors of these tumors. MATERIAL AND METHOD: Sixty-six patients with carcinoma of the parotid gland seeing during the 1985-2003 period were included in this study. Mean patient age was 55 years; the sex-ratio was 1. RESULTS: The most common histological types of this series were mucoepidermoid carcinoma and adenoid cystic carcinoma. Stage I tumors were reported in 59% the series while only 18% the patients of this series had stage III and IV disease. Pain was reported in 45% all patients. Facial nerve clinical involvement was reported in 11% all patients. DISCUSSION: Both tumoral stage and histological grading are independent prognostic factors influencing the therapeutic strategy. Clinical course and tumor growth distinguished between malignant tumors with benign clinical behavior and malignant tumors with malignant clinical behavior. A preoperative workup with physical examination, fine needle cytology and MRI helps to define the preoperative diagnostic and to adapt the therapeutic strategy.

Adenocarcinoma↗
PubMed2004

[Diagnosis management of Warthin tumour: clinical presentation, fine needle cytology and MRI].

OBJECTIVES: Warthin tumour is the second most frequent benign tumour of the parotid gland after pleomorphic adenoma. The aim of this retrospective study was to define clinical, cytological and MRI characteristics in order to work out a therapeutic strategy. MATERIAL AND METHOD: During the period May 1991-January 2003, 53 patients with Warthin tumors were treated in our institution. Clinical data were reported from medical records reviewing. Histological diagnoses were compared with FNAB and MRI results. RESULTS: Warthin tumours represented 13% of all parotid lesions of our series. Mean age of patients was 58 year-old. Sex ratio was 3.8 men and 1 woman. Sensitivity of FNAB for Warthin tumour diagnosis was 75% while positive predictive value was 71%. Six cases of false positive patients were reported: 2 acinic cells carcinomas, 2 pleomorphic adenomas, 1 dermoid cyst, 1 branchial cyst. CONCLUSIONS: Surgical management is based on partial parotidectomy that may be adapted to the tumour location. Because of elderly patients, benign nature and low risk of malignant transformation of Warthin tumours, one might prompt to adopt a conservative strategy, avoiding surgery in some cases. Despite diagnosis of Whartin tumour on FNAB and MRI, one must be cautious in recommending conservative treatment in order to avoid ignoring a surgical tumour.

Adenolymphoma↗
PubMed2004

[Recurrences of pleomorphic adenomas of the parotid: development of concepts].

OBJECTIVES: The aim of this study was to examine the surgical and pathological factors that led to recurrent parotid pleomorphic adenomas. The study also tried to determine best practice for the treatment of recurrence. In addition the study looked at the correlation between fine needle cytology and definitive histology. MATERIAL AND METHOD: Histological study was undertaken on 100 pleomorphic adenomas surgically removed from patients in our institution between 1992 and 2002. Study of diagnostic value of fine needle cytology aspiration and MRI for pleomorphic adenoma diagnosis was performed in 181 patients operated on for parotid tumors. RESULTS: Hypocellular pleomorphic adenomas often have a thin capsule and constitute the most frequently encountered histological type in recurrence. Pseudopodias are considered as an additional factor in recurrence. In our series, cytological study had an excellent diagnostic value with a sensitivity of 92% and a PPV of 96%. MRI study had a sensitivity of 83% and a PPV of 89%. CONCLUSIONS: According to these findings, enucleation surgery on a pleomorphic adenoma should not be performed anymore. Parotidectomy techniques (total or lateral) constitute the surgical treatment of choice. Fine needle aspirate cystology in a useful diagnostic procedure. Management of recurrences is based on surgery with total parotidectomy and facial nerve preservation. Role of radiotherapy is still indeterminate.

Adenoma↗
PubMed2004

[Study of the supra-glottic pressure during partial constriction of the vocal tract].

OBJECTIVES: Phonation in a small plastic tube 22 cm length and 5 mms diameter (basic exercise of the method of Dr Amy de la Brèteque), is current practice in vocal rehabilitation in France. This work aims to show the effects of this method on the glottic vibration. The hypothesis was that at the time of phonation in the tube with a strong flow as recommended in the method, the vocal cords vibrate without contact. This limits the mechanical trauma at this level. MATERIAL AND METHODS: We have analyzed the sound production in a tube in 11 trained and not trained subjects. We simultaneously collected the intra-oral air pressure and the vocal signal which was subjected to a spectral analysis. RESULTS: Spectral analysis confirmed that the signal was produced correctly i.e. with a strong flow and without interruption of the sound less rich in harmonics. We interpreted these results in the light of our preceding works on the glottic vibration and we show that this vocal production was of the sinusoidal type; this implies the absence of physical contact between the vocal cords, which validates our hypothesis. CONCLUSION: Further works are necessary to better understand the physical relations between the supra-glottic aerodynamic phenomena and the vibratory functioning of the vocal cords and also to analyze the therapeutic potential ofthe method within speech therapy rehabilitation.

Adult↗
PubMed2004

[Voice handicap evaluation after supracricoid partial laryngectomy].

UNLABELLED: The importance of patient self-impressions has been emphasized in determining the success of cancer treatment. The supracricoid partial laryngectomy (SCPL) is recognized as a suitable procedure for the treatment of T1b and T2 glottic carcinoma. The aim of this surgical procedure is the preservation of a physiologic phonation with optimal oncologic control. METHOD: Measurements included Voice handicap Index (VHI), Voice Related Quality of'Life (VRQL), subjective (GRBAS) and objective analysis. OBJECTIVES: evaluate voice problems after SCPL, provide correlations between patients' daily activities, VHI, and subjective evaluation of the dysphonia. PATIENTS: 53 patients were assessed more than 1 year after SCPL. 26 patients, less than 60 years of age and professionally active were included. The mean age was 48 years (43 to 59 years). Eleven patients had professional activities in the communications industry requiring a compulsory daily use of their voices. RESULTS: 57.6% of the active patients underwent a cessation or an adaptation of their professional activities. The mean VHI was 52.22. It was respectively 36.3, 50.03 and 52.42 according to the grade 1, 2, 3 of dysphonia. Correlations between VHI and the time laps since intervention (p: 0.047). discontinuation of professional activities (p: 0.037), and grade of dysphonia (p: 0.049) were found. CONCLUSION: VHI allows an evaluation of the voice problems after SCPL. A significant impact on voice is reported after SCPL and may influence the patient's life, with potential disturbance of their professional activities. Potential post surgical voice impact must be considered when the therapeutic options are discussed.

Adult↗
PubMed2003

[Concomitant radiotherapy-chemotherapy for unresectable cancers of the head and neck: a retrospective analysis of 130 patients].

OBJECTIVES: We analyzed retrospectively the files of 130 patients with unresectable cancer of the head and neck who were given concomitant radiotherapy-chemotherapy between January 1993 and February 2000. PATIENTS AND METHODS: The series included 41 patients with grade III cancer, 64 grade IVA, and 25 grade IVB. Treatment combined radiotherapy (70.2 Gy centered on the tumor with 50.4 Gy on the lymph nodes) and chemotherapy using three cycles of cisplatinium combined with 5-fluorouracil in continuous infusion for 120 hr. RESULTS: Local control was achieved in 51% of the patients at two years and 48% at five years. Overall survival was 45% at two years and 33% at five years, all grades included. CONCLUSION: Univariate analysis of prognostic factors points out the importance of the nutritional status before and during treatment.

Adult↗
PubMed2003

[Preliminary analysis of sentinel node detection during surgical treatment of head and neck melanoma].

OBJECTIVE: The aim of this study was to define reliability of the sentinel lymph node technique in head and neck N0 melanoma. Identification of the sentinel node, which is the first evidence of melanoma metastasis, enables selective node dissection. MATERIALS AND METHODS: Twelve patients with untreated localized cutaneous or mucous N0 melanoma of the head and neck were included in this study. After resection of the sentinel lymph node, type III neck dissection was performed during the same operative time in all twelve patients. RESULTS: The sentinel node was successfully located by preoperative lymphoscintigraphy and confirmed at surgery in eleven patients. Five of these patients had evidence of metastatic node disease, always in the sentinel node. No other metastatic node were found in the neck dissection specimens. For the six other patients with a negative sentinel node, no other metastatic node was found in the neck dissection specimens. CONCLUSION: These preliminary results are promising. The sentinel node can be mapped and identified in most patients. No metastatic node was noted in patients with a negative sentinel node. If these results are confirmed, complete node dissection should only be performed in patients with a positive sentinel node in order to achieve more conservative surgical cure of head and neck melanoma.

Adult↗
PubMed2003

[Recurrences of pleomorphic adenomas of the parotid: changing attitudes].

OBJECTIVE: The real issue of parotid surgery for pleomorphic adenoma is its risk of recurrence. The aim of this study was to compare the changing attitudes towards the pathology and surgical treatment in order to better define prevention and management of pleomorphic adenoma recurrences. MATERIAL AND METHOD: Histological study was performed after reviewing of slides originating from 100 patients with pleomorphic adenomas of the parotid gland, treated in our institution during the period May 1992 - November 2002. Study of the diagnostic value of fine needle cytology aspiration and MRI for pleomorphic adenoma diagnosis was performed for 181 patients operated on for parotid tumors. RESULTS: Hypocellular pleomorphic adenomas often have a thin capsule and constitute the most frequently encountered subtypes of recurrence. Pseudopodia are considered as an additional risk of recurrence. In our series, cytological study gave excellent diagnostic value with a sensitivity of 92% and a PPV of 96%. MRI study had a sensitivity of 83% and a PPV of 89%. CONCLUSIONS: According to these findings, enucleation surgery on a pleomorphic adenoma should not be performed any more. Parotidectomy techniques (total or superficial) constitute the surgical treatment of choice. The management of recurrences is based on surgery, with total parotidectomy and facial nerve preservation. The rôle of radiotherapy is still indeterminate.

Adenoma, Pleomorphic↗