Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 181 records · Page 10Linked to original sources

PubMed1989

[Early death after chemotherapy via central venous catheterization in tumors of the upper respiratory and digestive tracts].

Between 1987 and 1988, 1 100 patients were treated by continuous, ambulatory chemotherapy. 35 of these patients died within 90 days of the insertion of the catheter. One death would appear to be related to the catheter, 5 deaths (0.5%) were related to the chemotherapy and 29 deaths were related to progression of the malignant disease. The mortality rate associated with ambulatory chemotherapy via a central catheter would appear to be negligible when compared to deaths related to the progression of the malignant disease.

Aged↗

PubMed1989

[The versatile midface degloving approach. Re-updating the method, apropos of a case].

A recurrent adenoid cystic carcinoma of the hard palate extending to the maxillary sinus was resected through the versatile midface degloving approach. The surgical technique is discussed, and advantages and limits of the procedure are analyzed. The authors recommend this approach for midface tumors which avoids a facial scar and which sounds oncological.

Carcinoma, Adenoid Cystic↗

PubMed1989

[Primary carcinoma of the external auditory canal and the middle ear. Apropos of 14 cases].

Fourteen carcinomas of the external auditory canal and middle ear are presented regrouping eleven squamous cell carcinomas, two adenocarcinomas and one adenoid cystic carcinoma. Results are analyzed according to the treatment employed: surgery and/or radiotherapy. Four local recurrences occurred, two after radiation as initial treatment and two after surgery completed by radiation. Tumors strictly limited to the skin of the auditory canal and treated surgically are free of disease. A new classification is proposed in order to simplify and clarify the therapeutic indications and prognosis.

Actuarial Analysis↗

PubMed1989

[Local extension of epithelioma of the glottic floor; anatomo-clinical correlations and study of local failure. Apropos of 432 patients treated by partial laryngeal surgery].

The authors have studied real tumoral extension in 432 cases with N0 M0 epidermoid carcinoma of the glottic floor treated by partial laryngeal surgery over the period extending from 1972 to 1984. This retrospective study defines the limits and the errors of preoperative assessment of local extension. Clinical examination and direct suspension laryngoscopy are needed. T classification cannot be used as a sole reference in the selection of the surgical technique. The difficulties encountered in the evaluation of real tumor extension in this type of neoplasia calls for great caution on the part of the surgeon in selecting the procedure for partial laryngeal surgery. The study of the incidence of local failures in cases of real tumor extension emphasizes the need for an appropriate surgical technique for the local management of tumoral extension. The authors identify the respective place held by such techniques as thyrotomy associated with internal subperichondrial degloving and partial vertical laryngectomy with cartilage resection, and its many variants, and partial horizontal subcricoid laryngectomy (of the cricohyoepiglottopexy-type).

Adult↗

PubMed1989

[Carcinoid of the larynx. Well-differentiated neuroendocrine carcinoma. Apropos of 4 cases].

Four new cases of carcinoid (or well differentiated neuroendocrine carcinoma) of the larynx are reported. This tumor has been recognized since 1969 and may be misdiagnosed as a poorly differentiated carcinoma or adenocarcinoma if the Grimelius stain is not done. Chromogranin A, detected by immunocytochemical methods, is also a good marker of these tumors. The analysis of 41 previously published cases allows a better knowledge of this clinico-pathological entity. The main locations are supraglottic and the prognosis is poor which is very different from the bronchial carcinoid.

Female↗

PubMed1989

[Percutaneous endoscopic gastrostomy. Indications and results in 31 patients].

Nutritional assistance was indicated in 31 patients with an ENT tumour at different stages of treatment and different stages of the disease. These patients presented with disorders of deglutition with false passages (68%), aspiration pneumonia (10%), dysphagia (35%) or denutrition (17%). We used an endoscopic percutaneous gastrotomy kit produced by the Bioser company (pull technique). In 29 patients, the tube was inserted under general anaesthesia in the operating theatre to prevent dyspnoea during introduction of the tube in these patients with alteration of the airway-gastrointestinal tract junction or because the tube was inserted at the beginning of anaesthesia for ENT surgery. The tube was able to be inserted in every case, with cardiac arrest in one patient who was effectively resuscitated without sequelae, two obstructions of the cuff requiring advancement of the tube with a bougie, 2 ruptures of the thread and one case of dyspnoea. Two patients subsequently developed a wound abscess which was drained and one patient required removal of the tube. Follow-up of the patients demonstrated the good tolerance of this tube which was maintained for an average of 2.9 +/- 0.5 months (0.1 to 9 months) without any major complications. 3 benign wound infections, 4 inflammatory reactions, 4 minimal leaks, 1 case of hyperthermia, 12 cases of abdominal distension and 2 cases of displacement of the tube were observed. The weight gain was equal to 4%. The authors believe that this technique of endoscopic gastrostomy should be preferred to surgical gastrostomy.

Adult↗

PubMed1989

[Tumors of the nasal fossa. Retrospective study of a series of 67 cases].

This retrospective study reviews 67 tumors of the nasal fossa treated at hospital Laënnec (Paris). The clinical significance of histology and the therapeutic results for each pathological tumor (mainly, carcinoma, melanoma, lymphosarcoma, neuroma, malignant plasmocytoma, inverted papilloma, vascular tumors) are described. Treatment and surgical procedure will be analyzed.

Adult↗

PubMed1989

[Lymph node failure in epithelioma of the glottic floor treated by partial laryngeal surgery. Apropos of 432 patients].

The authors assessed ganglionic failure in a series of 432 cases of N0 M0 epidermoid carcinomas of the glottic floor following partial laryngeal surgery. The overall of ganglionic failure was 7.8%. This rate of failure is related to 64.7% death rate, i.e. 5.1% of the 432 patients under study. This retrospective study differentiates between primary ganglionic failure and secondary ganglionic failure. Primary ganglionic failure is the first local/regional carcinologic event to develop after treatment of any glottic lesion. Secondary ganglionic failure is related to isolated local failures. The percentage of primary ganglionic failure was 5.1%. It was responsible for deaths occurring in 54.5% of cases. The percentage of secondary ganglionic failure was 2.7% and it was responsible for deaths occurring in 83.3% of cases. Factors promoting ganglionic failure (real tumor extension, tumor infiltration, altered laryngeal mobility, local control and efficacy of retakes of local failures) are discussed. The importance of prophylactic surgical procedures guarding from ganglionic failure, such as the ipsilateral jugular-carotid and recurrent nerve approaches is emphasized. Although such procedures can be of aid in cases of T2 or T3 N0 M0 epitheliomas of the glottic floor, they present no alternative in the course of retake operations of local failures.

Adult↗

PubMed1988

[Inoperable cancers of the upper respiratory and digestive tracts. Value of chemotherapy: 185 cases].

A series of 185 squamous cell carcinomas of the head and neck was retrospectively analyzed. Induction chemotherapy was systematically administered. The overall tumour response rate was 38 per cent, and 39 tumours (22.4 per cent) became resectable after chemotherapy. The survival of complete responders was statistically higher than that of non or partial responders. Complete responders treated either by radiation therapy or surgery had similar survivals. Surgery improved the prognosis and reduced the rate of local and regional failures in non responders, including poor responders (less than 50 per cent).

Carcinoma, Squamous Cell↗

PubMed1988

Further experience with the myomucosal tracheoesophageal shunt.

A follow-up study to the initial work of Strome and colleagues in advancing the concept of the myomucosal flap for voicing following total laryngectomy is described. Data are evaluated from 30 patients. Seven of the eight original patients have functioning shunts with excellent voicing and six remain tumor free at more than two years. In the Laennec Hospital (Paris) series of 22 patients, seven shunts are functioning independently. Eleven of 20 inferiorly based flaps stenosed, and all stenoses occurred at the posterior tracheal wall. Technique refinements improved the patency percentage with the seven successes occurring in the last 13 procedures. Four patients in the series had flap necrosis, two of whom had diabetes mellitus and two others extensive paratracheal resections. The technique continues to merit consideration, recognizing that there is a learning curve before success can be anticipated.

Esophagus↗

PubMed1988

Madreporic coral: a new bone graft substitute for cranial surgery.

Since 1985, the authors have been using madreporic coral fragments (genera Porites) as a bone graft substitute. Of the 167 coral grafts implanted, 150 were coral "corks" used to obliterate burr holes (diameter 10 mm), five were large implants (length 20 to 40 mm) to repair skull defects, and 12 were coral blocks to reconstruct the floor of the anterior cranial fossa. Previous experimental studies suggested that coral grafts would be well tolerated and become partially reossified as the calcific skeleton was resorbed. The authors describe their experience and detail the main biological properties of these materials, which appear to be very promising for use in cranial reconstructive surgery.

Animals↗

PubMed1988

[Chemotherapy and partial surgery in epithelioma of the pharyngo-larynx].

On the basis of a series of 185 patients, the authors evaluate the results of the therapeutic sequence chemotherapy-partial surgery in carcinomas of the pharyngolarynx. The action of chemotherapy is confirmed (80% clinical responses greater than 50%, 55% residual tumours or in complete histological regression). The therapeutic sequence chemotherapy-surgery gave 25% local failures and 1% lymph node failures. The development of the therapeutic strategy in carcinomas of the pharyngolarynx is considered in relation to the action of current modalities of chemotherapy.

Actuarial Analysis↗

PubMed1988

[Tumor and lymph node response to chemotherapy. Prognosis in cancer of the pyriform sinus and the lateral laryngeal margin].

The prognostic value of the tumoural and lymph node response to chemotherapy was studied in cancers of the piriform sinus and the lateral laryngeal margin. 102 operable patients were selected and were operated after chemotherapy. The incidence of loco-regional failures and visceral metastases was significantly higher in the absence of any lymph node response.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

[Pharyngo-esophageal diverticula. Treatment and results].

27 patients were seen in the ENT department of Hopital Laennec for pharyngo-oesophageal diverticulum between 1970 and 1987. 25 patients were operated: diverticulectomy in 14 cases, diverticulopexy in 10 cases. Cricopharyngeal myotomy was performed in every case. In one case, myotomy was the only treatment. The postoperative course and the functional results were analysed in the 3 groups. The operative indications are discussed. The functional results were excellent regardless of the technique used (95.8% in the present series).

Aged↗

PubMed1988

[Continuous ambulatory chemotherapy in cancer of the upper respiratory and digestive tract].

Chemotherapy of the upper respiratory and gastrointestinal tracts is currently based on Cis-platinum-5 FU administered by continuous infusions which, up until 1985, were performed in hospital during a 4 days admission. These infusions can now be administered on an outpatient basis over a period of 6 days. More than 600 patients have been treated in this way. The improvement in the results observed on a population of 86 operable patients confirms the value of prolonged continuous infusions. The clinical and psychological acceptability of this method, which allows the patient to maintain his autonomy and sometimes his occupation, is an important advance which could promote extension of this approach, particularly in view of its economic advantages.

Ambulatory Care↗

PubMed1988

[Coral: a new procedure for cranio-facial reconstruction].

Twenty two cranio-facial reconstructions were performed utilizing madreporic coral graft, genera porites. Long-term tolerance was excellent. Surgical technique is described and coral properties are analyzed. Coral grafts used for anterior skull base reconstruction were partly reossified without any infectious complication.

Biocompatible Materials↗

PubMed1988

[Mobility of the vocal cord and the arytenoid in cancer of the larynx and the hypopharynx. Anatomo-clinical study].

Fourty one squamous cell carcinoma of the hypopharynx, laryngeal margin and larynx were studied in order to compare the vocal cord and arytenoid mobilities with the tumoral extension to the intrinsic laryngeal muscles. Several whole organ sections were performed on the surgical specimen for studying specifically the lateral and posterior cricoarytenoid muscles, thyroarytenoid muscles and crico-arytenoid joint. The weight of the tumor located at the top of the arytenoid cartilage without any tumoral extension of the crico-arytenoid muscles can fix the arytenoid, preserving the vocal cord mobility. On the other hand, the simultaneous immobility of vocal cord and arytenoid was associated respectively with 66% of tumoral extension to the crico-arytenoid muscles in hypopharynx and lateral margin carcinomas, and 33% in endolaryngeal tumors. The authors emphasize that a separate clinical evaluation of vocal cord and arytenoid mobilities would give more precise informations concerning surgical indications of laryngeal conservative surgery.

Arytenoid Cartilage↗

PubMed1988

[Hemipharyngolaryngectomies. Functional and carcinologic results].

A retrospective study of 260 hemilaryngopharyngectomies performed between 1964 and 1986 defines the functional and oncological results of these operations and the improvement in the oncological results and survival when neoadjuvant chemotherapy is used.

Actuarial Analysis↗