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Biomedical subjects

B Luboinski

Publications and source records attributed to B Luboinski.

At least 91 records · Page 5Linked to original sources
PubMed1991

Computed tomographic density of metastatic lymph nodes as a treatment-related prognostic factor in advanced head and neck cancer.

Pretherapeutic identification of patients likely to benefit from neoadjuvant chemotherapy for head and neck epidermoid cancer is of interest. We retrospectively analyzed the pretherapeutic computed tomographic (CT) scans of lymph nodes of 70 patients with head and neck cancer. All 70 patients were clinically classified as having stage IV disease. The purpose of our analysis was to compare the prognostic value of CT node density with that of the following factors: age, T and N categories, Eastern Cooperative Oncology Group performance status, tumor site, histopathologic type of disease [squamous cell carcinoma (SCC) or undifferentiated carcinoma of nasopharyngeal type (UNCT)], and type of local-regional treatment. A simple two-grade nodal density grading system was devised. The density of normal adjacent muscle was chosen as the density standard. A node was classified grade 1 if less than 33% of the node consisted of hypodense zones. A node was classified grade 2 if more than 33% of the node consisted of hypodense zones. Patients with grade 1 nodes had a complete response rate of 68% (21/31) compared with 8% (3/39) for those with grade 2 nodes (P less than .0001). The only other factor associated with complete node response was UCNT (P less than .03). However, node density remained the significant prognostic factor after adjustment for histopathologic type. Follow-up ranged from 16 to 44 months, with a median of 29 months. Patients with grade 1 nodes had a median survival time of 32 months versus 13 months for those with grade 2 nodes (P less than .01). A prospective study should validate the prognostic value of CT node density and its possible use in determining optimal multimodal therapy for advanced head and neck cancers.

Adolescent↗
PubMed1991

Squamous cell carcinoma of the upper aerodigestive tract associated with well-differentiated carcinoma of the thyroid gland.

The association of squamous cell carcinoma of the upper aerodigestive tract with well-differentiated thyroid carcinomas has rarely been reported in the literature. We report 10 cases illustrating this occurrence. In eight cases, the thyroid carcinoma was discovered accidentally on histological examination of a single neck node, a neck node dissection specimen, an unexpectedly found thyroid nodule, or a systematically resected thyroid lobe, all during surgical treatment of an upper aerodigestive tract carcinoma. In the other two cases, metastatic thyroid neck nodes appeared during the follow-up of a patient with an upper aerodigestive tract carcinoma. No case of upper aerodigestive tract carcinomas was found during the follow-up of thyroid cancer patients. In most cases, adequate thyroid cancer surgery was performed simultaneously or later. Prognosis was essentially determined by the upper aerodigestive tract cancer.

Carcinoma, Squamous Cell↗
PubMed1991

Rhabdomyosarcoma of the larynx in children: a series of five patients treated in the Institut Gustave Roussy (Villejuif, France).

Rhabdomyosarcoma of the larynx is a malignant disease rarely seen in children. We present five cases (3 males, 2 females) observed among 126 patients with rhabdomyosarcoma of the head and neck (excluding the orbit) treated in the Institut Gustave-Roussy between 1955 and 1981. The patients were aged between 5 1/2 years and 13 1/2 years at the time of diagnosis. The presenting symptoms were dysphonia and/or dyspnea; tracheotomy was required in two cases. All five patients received chemotherapy consisting of vincristine, cyclophosphamide, actinomycin D + procarbazine or doxorubicin. Four patients also received radiotherapy (45 Gy during 5 weeks). Laryngectomy was not performed. Treatment sequelae included regional hypoplasia, huskiness, and subclinical thyroid insufficiency; two patients developed a benign thyroid adenoma. One patient presented a bilateral carotid stenosis subsequent to radiotherapy performed on "wide fields" portal designed to provided prophylactic treatment on uninvolved lymph nodes. All the patients are alive and relapse-free with a follow-up of between 13 and 17 years. This small series of RMS of the larynx shows that patients can be cured without laryngectomy, although long-term sequelae associated with radiotherapy are observed.

Adolescent↗
PubMed1991

Anterior skull base tumour. The choice between cranial and facial approaches, single and combined procedure. From a series of 78 cases.

In order to define the most adequate surgical procedure to apply on anterior skull base lesions, we reviewed 78 cases of either benign (43 cases) or malignant (35 cases) tumours; they were treated either by a single surgical approach including transfacial approach (TF) in 9 cases, transbasal approach (TB) in 15 cases and fronto-orbital ridge deposition (FORD) in 16 cases or by a combined procedure: TB + TF (28 cases), TB + FORD (10 cases). In 7 cases, a pterional approach was associated to one of these combined procedures. A classification is proposed, based on the tumour extension along the anteroposterior axis: I) anterior to the crista galli; II) anterior to the anterior clinoïd process; III) posterior to the anterior clinoïd process; and along the vertical axis A: below the bone level; B: below the dura level; C: at and above the dura level. This classification appears very useful to choose among the surgical procedures which one is the more appropriate. In type A tumour (N = 8), TF is sufficient while in type B (N = 38) and C (N = 32) a cranial route is always necessary; among the latter, a combined procedure is frequently asked for posterior tumours type II (N = 29) and III (N = 24). However, others parameters such as tumour consistency, vascularization and need for en-bloc removal are also relevant in this choice.

Adolescent↗
PubMed1991

Papillary carcinoma in thyroglossal duct remnants.

About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk's operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.

Adenocarcinoma↗
PubMed1991

Case report 670: Chondroblastoma maxillary sinus.

A benign chondroblastoma of the left maxillary sinus developed in a 14-year-old girl. Roentgenographic examination showed an expanding, well-defined, calcified tumor. Facial and skull chondroblastomas may be related to primary or secondary centers of enchondral ossification, and therefore they may derive from the cartilage of growth plates [3]. Initial biopsy was inconclusive, but after surgical removal a histological diagnosis was made.

Adolescent↗
PubMed1991

Paragangliomas of the head and neck. Immunohistochemical analysis of 16 cases in comparison with neuro-endocrine carcinomas.

Sixteen cases of paragangliomas of the head and neck including 8 of the vagal body, 3 of the carotid body, 2 jugulotympanic, 2 vagal or jugulotympanic and 1 of the larynx were analysed. Clinically, 13 tumors were benign, 2 showed local aggressivity and 1 showed metastases. All tumors were tested with antisera directed against neuron-specific enolase (NSE), chromogranin A (CGA), S-100 protein, neurofilaments (NF), glial fibrillary acid protein (GFAP) and cytokeratin (CK). Immunohistochemical results were compared with those of 5 cases of neuroendocrine carcinoma (NC) (1 of the oral vestibule, 1 of the larynx, 1 Merkel-cell tumor of the skin and 2 medullary thyroid carcinomas). Immunoreactivity for NSE and/or CGA was always positive in all paragangliomas and NC. S-100 protein was positive in sustenticular cells in all cases of paragangliomas and focally in two cases of NC. NF and GFAP were focally positive in 3 and 2 paragangliomas respectively; and in 1 NC. CK was constantly negative in all cases of paraganglioma and constantly positive in all cases of NC. Antibody anti-CK is the single most useful immunomarker for differential diagnosis between paraganglioma, frequently benign neoplasms and NC commonly aggressive in the head and neck. These findings are consistent with the current concepts of the neuroendocrine system.

Adolescent↗
PubMed1991

Airway obstruction and high-frequency jet ventilation during laryngoscopy.

High-frequency jet ventilation has been reported as an effective method of ventilation during laryngoscopy, but may expose the patient to the risks of barotrauma or alveolar hypoventilation. The aim of the study was to evaluate the determining factors of pulmonary complications under high-frequency jet ventilation in 83 patients undergoing laryngoscopy for upper airway cancer. Pulmonary distention was mainly influenced by upper airway obstruction score (p = .0001), while patients with chronic obstructive pulmonary disease (COPD) did not suffer from gas trapping. Impaired gas exchange was predicted by increased weight (p = .0001), smaller injector diameter (p = .02), and lower airway obstruction (p = .001). Hypercapnia occurred in both upper and lower airway obstruction, while hypoxemia was principally observed in COPD patients. Emphasis is placed on monitoring by pulse oximetry, end-expiratory pressure, and PCO2 measurement, especially in patients with obesity, COPD, or upper airway obstruction.

Barotrauma↗
PubMed1991

[Measurement of the kinetics of cell proliferation of cancer of the oropharynx in vivo by the incorporation of bromodeoxyuridine and flow cytometry].

Forty-six tumors from patients with oropharyngeal carcinoma were analysed by flow cytometry after injection of bromodeoxyuridine (Budr) for the labelling index, the duration of S phase and the potential doubling time (Tpot). The results show large variations in Tpot (from 2.6 to 16.7 days) among these tumors from the same site and with the same histology. The variations in Tpot were not significantly related to TNM status and differentiation grade. However, aneuploid tumors had statistically significant shorter Tpot. The predictive value of Tpot regarding the response to radiotherapy is currently under investigation.

Bromodeoxyuridine↗
PubMed1991

[Electrochemotherapy, a new antitumor treatment: first clinical trial].

Electrochemotherapy (ECT) is a new antitumor treatment which consists in delivering electric pulses to the tumor some minutes after an intravenous injection of bleomycin. We report here the first clinical trial of ECT, applied to patients with permeation nodules of head and neck squamous carcinomas. ECT was well tolerated by patients, no serious incident occurred and a clear antitumor efficiency was found.

Bleomycin↗
PubMed1991

[Prefabricated free grafts and neovascularized free grafts. 150 cases in rats].

The use of vascularized, composite and prepared free transplants is a recent technique. Two types of transplants were grafted in rats (150 operated cases). For the prefabricated free transplants, each component remains vascularized by rami of the main pedicle: vessels, nerves, bone, periosteum, cartilage, muscle, skin (50 cases). The graft is transplanted immediately. Neovascularized free transplants are quite different, the various components being laid around the vascular pedicle (100 cases). Neovascularization revascularizes the components. The free graft is transplanted 5 weeks after being prepared. The period of observation ranges from 3 to 12 months. Observation includes macroscopy, arteriography, histology and intravascular dye injections. The results with prefabricated free transplants show normal vascularization of soft tissues. There is bone in all cases, it is normal in 80% of cases. In neovascularized transplants, the bone is normal in 33% of cases only, and totally resorbed in 46%. Prefabricated free transplants produce better results than neovascularized free transplants and must be preferred. The merit of these composite free transplants is that they produce free transplants selectively, using various tissues and chosen vascular pedicles. These transplants are a useful and futuristic alternative for highly sophisticated reconstructive surgery.

Animals↗
PubMed1991

[Free forearm flap used in the reconstruction of the cervico-cephalic region. 43 cases].

The free neurovascular antebrachial transplant was described by Yang-Guofan in 1978. In 1981, we brought the description of this free transplant to Europe. Forty-three antebrachial grafts were made to reconstruct the cervicocephalic extremity. We had various indications: floor of the mouth and base of the tongue: 18 cases, facial structures: 7 cases, posterior wall of the pharynx: 9 cases, rescue surgery for esophagoplasty: 6 cases, mandible: 2 cases (using a bone rod taken from the radius), internal aspect of the cheek: 1 case. All grafts were revascularized. In 41 cases, the indications were carcinological, the last 2 cases being benign lesions. The early postoperative mortality included 1 case, not related to the nature of the operation (neoplasm). There was no failure of free transplants. Surveillance was ensured every half-hour during 12 hours, then every 3 hours. Discriminating sensation was recovered in 39 of 43 cases. Mandibular bone reconstructions were knit at the 3rd month. The main disadvantage of removing this graft is esthetic, as it leaves a considerable scar on the forearm. The free antebrachial transplant provides an effective solution to the reconstructions of the cervicocephalic extremity, when a narrow, thin, supple, reinnervated, compound transplant is needed.

Adolescent↗
PubMed1991

[Mandibular reconstruction using free vascularized fibula transplant].

Free revascularized fibular transplants have been used in surgery for the reconstruction of long bones since 1973. The reconstruction of the mandible using a free fibular transplant has been published in 1989 only by Hidalgo. The mandible and the fibula have little in common, except for their length and a similar structure in section. The anatomical study of the free osteofasciocutaneous fibular graft included 20 fresh subjects. The vascularization of the fasciocutaneous plate is either grouped or, more frequently, tiered (2/3 of cases). The technique to remove this graft is specified. Four clinical cases are reported, including three cases of neoplasm of the floor of the mouth invading the mandible, and one case of traumatic amputation of the lower part of the face. A free composed transplant taken from the fibula has been used in all four cases. The postoperative period was normal, and the grafts were completely successful. The main indications of free transplants made of fibular bone are: extensive (more than 8 cm) or compound losses of bony substance from the mandible. The richly vascularized transplant take from the fibula is very sophisticated and performant. The length of bone that can be removed is 25 cm; the bone may be osteotomized in 2 to 4 fragments retaining their vitality. Other tissular structures such as the skin, fascia, muscle, are removed with the bone. The independence in space is threefold and regards the bone, the teguments and the vascular pedicle. The microsurgical qualities of the vascular pedicle are considerable. These free transplants improve the quality of survival (endosseous implants in one case). The morphological, functional and esthetic result is good as a rule.

Adult↗
PubMed1991

[Synchronous cancers of the esophagus and of the ORL area: results of combined treatments with esophagectomy (28 cases)].

Twenty-eight patients with synchronous esophageal and head and neck epidermoid cancers have been treated by a combined protocol including esophagectomy. Seventy-nine percent received pre-operative chemotherapy, 50% had resection of the head and neck lesion at the same time as the esophagectomy and 79% received post-operative irradiation. Two patients died during the post-operative period (7%), and 1, 2 and 3-yr survival rate (Kaplan-Meier) was respectively 64, 32 and 27%. Contrary to our initial assumption, there was no significant decrease in survival compared to patients operated on for an isolated esophageal cancer. The patients were divided into 4 very simple prognostic groups based on the T and N stages of the clinical pre-therapeutic TNM classification: T1 or T2 for esophageal lesions and different T or N stages according to the prognosis for head and neck lesions. A study of each group tended to show that esophagectomy was beneficial except in cases of synchronous T2 esophageal cancer and locally advanced head and neck cancer (there was 2-yr survival in this group). The 28 patients studied represent a particular population which presented 91 cancerous localisations during the duration of the study (mean: 3.25 localisations per patient).

Carcinoma, Squamous Cell↗
PubMed1990

So-called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary.

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis. This study reports on an additional 21 patients with this entity. Treatment of these patients included removal of the cystic metastasis with or without radical neck dissection and irradiation of Waldeyer's ring. Two patients have died of unrelated disease and two were lost to follow-up, but the remainder are alive without disease 2 months to 12 years following initial diagnosis. We believe that cystic metastases from tonsillar squamous cell carcinomas have often been mistaken for either primary squamous cell carcinomas of branchiogenic origin or with branchial cleft cysts. The distinctive histological features of cystic metastases reviewed after its correct identification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options.

Adult↗
PubMed1990

[Choice of methods for reconstruction of the cheek after carcinologic excision based on a retrospective study of 32 cases in 8 years from 1980 to 1987 at the Gustave Roussy Institute].

In this article, after reviewing the different possibilities for cheek reconstruction consecutive to carcinologic excision, we specify the choice method for closure, according to the anatomical type of substance loss incurred. In all cases, endobuccal skin covering is needed. --As regards small lesions, there is no such thing as "the" ideal flap. --As far as tegumental cheeks are concerned, the deltopectoral flap is the choice one. --In case of mucous reconstruction, submental flaps afford elegant solutions. --With large lesions, musculocutaneous flaps are best used. Lastly, it seems that the first surgical treatment (excision, curage and plasty) followed or not by radiotherapy, depending on anatomopathological findings, brings acceptable and prompt restoration of function and morphology.

Adult↗
PubMed1989

Radiation therapy in the treatment of early glottic carcinoma: the experience of Villejuif.

A retrospective analysis of 197 early glottic carcinoma treated with small field irradiation to a dose of 65 Gy is presented. The 5-year survival rate was 77.3%. Thirty-eight local failures have been observed, and the 5-year local control rate was 85.7%. Suspicion of extra glottic extension was the main prognostic factor. Final local control rate, taking into account the salvage treatment, was 90% at 5 years. Excellent functional results were observed.

Carcinoma, Squamous Cell↗