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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 199 records · Page 11Linked to original sources
PubMed1988

[Vocal rehabilitation after total laryngectomy by musculomucous tracheo-esophageal fistula. Results apropos of 27 cases].

Twenty seven cases of Myomucosal Tracheoesophageal shunt following total laryngectomy performed at Laennec Hospital are presented. The surgical technique which was initially reported by M. Strome is summarized. The advantages of this procedure as compared to other tracheoesophageal fistulas are discussed. The first sixteen cases of this series failed: 12 stenoses occurred and 4 flaps necrosed. The eleven last Myomucosal shunts of this series are functioning. Aspiration was only problematic in one case. Six of the eleven functioning shunts have excellent voicing; three other patients are able to voice before completion of speech therapy and one patient has a too short follow-up for voice evaluation. The authors emphasize the contra-indications for the procedure. Medical conditions that can potentially lead to flap necrosis include: arteritis, diabetes mellitus, and gastrointestinal reflux.

Female↗
PubMed1988

[Partial surgery of epithelioma of the glottic area].

Technical aspects are described for partial vertical surgery used in 286 patients with epithelioma of vocal cords. Results and limitations are discussed and the place of partial vertical or partial supracricoid horizontal surgery with cricohyoidoepiglottopexy defined. Progress in therapeutic strategy is outlined and the value of induction chemotherapy emphasized.

Carcinoma↗
PubMed1988

[Esophagectomy and pharyngectomy in cancers of the upper respiratory and digestive tracts and the esophagus. Results apropos of 16 cases].

A series of 16 squamous cell carcinomas of the pharynx with an extension to the cervical esophagus, or multiple primaries of the pharynx and esophagus is presented. The surgical procedure consisted of an oesophagectomy associated with either total pharyngolaryngectomy, or partial pharyngectomy, or transmandibular resection. 13 patients received neo-adjuvant chemotherapy: CDDP-5-FU. Postoperative complications occurred in less than 20% without any postoperative death. One-year and five-year actuarial survival rates were respectively 20% and 13.3%. The mean survival was 9.5 +/- 3.7 months. 75% of the deaths were due to local or cervical lymph node recurrences. Neo-adjuvant chemotherapy could improve the prognosis of these pharyngo-oesophageal carcinomas.

Adult↗
PubMed1988

[Percutaneous and implantable catheters in cancers of the upper respiratory and digestive tracts. Apropos of 600 cases].

For two years, 600 catheters (234 silicone catheters, 153 tunnelisation cuffed catheters and 188 total implantable systems) were place for chemotherapy in patients with head and neck cancer. Percutaneous catheters remain for 152 days and total implantable systems for 188 days. Total complications decrease with greater experience of physicians and using improved catheters.

Aged↗
PubMed1988

[Olfactory meningioma with ethmoido-orbital extension. Diagnostic and therapeutic problems. Apropos of a case].

Our purpose is to present a case of olfactory meningioma with extensive invasion of the orbit and the ethmoid sinuses revealed by an exophthalmia. Diagnosis discussions with others tumors of the ethmoid sinuses are presented. Meningioma resection was realized simultaneously by ENT surgeons and neurosurgeons through a bifrontal coronal skin flap and orbital roof remaining. Anterior skull base reconstruction was performed with a madreporic coral graft, which is a simple, fast and reliable technique, permitting a complete skull base closure.

Ethmoid Sinus↗
PubMed1988

[Partial supracricoid laryngectomies: techniques, indications and results].

The authors present results of a retrospective study on 99 patients who underwent a partial supracricoid laryngectomy. Indications included carcinomas developed on the laryngeal vestibule, in the ventricle or at the glottic level. This represents an alternative to total laryngectomy. Surgical techniques and functional results are discussed. Ninety-eight percent of patients could be decanulated and a regular diet was possible in 94%. The survival rates are 76% after three years and 68% after five years. Local recurrences occurred in 3% of cases and cervical metastases were not controlled in 13%. The authors comment on indications for surgery according to the site of involvement. Contra-indications are massive invasion of the pre-epiglottic space, extension away from the superior aspect of the cricoid and arytenoid fixation.

Cricoid Cartilage↗
PubMed1988

[Reconstruction of the anterior face of the base of the skull using coral grafts].

Following experimental investigations on animals, small coral grafts have been utilized on patients since 1985 to fill in burr holes (42 patients). This first clinical experimental step has been satisfactory. Therefore, blocks of corals have since then been used as bone graft substitutes for anterior skull basis reconstruction (12 patients). Cheap and easily sterilized, coral implants have the advantage of being inert (99% of calcium carbonate), biodegradable and well reossified. They shorten surgical procedures by avoiding the use of iliac and/or costal grafts. No infectious complications have been noted.

Biocompatible Materials↗
PubMed1987

[Values and limitations of embolization in cervical paragangliomas. Definition of a new diagnostic strategy. Apropos of 20 cases].

From 1966 to 1986, twenty cervical paragangliomas are treated by the authors: seven vagals and thirteen carotid one's. Seven patients out of these twenty underwent an embolisation during the pre-op arteriography. Studying the results, the authors show how much this embolisation increases the risk of a per-op carotid resection with by-pass, especially for the carotid localization. Dropping the embolisation, gives a chance for a new and, more acute diagnostic strategy, based on computerized tomography and digitalized arteriography. These exams should avoid the per-op discovery of these tumors in more than one half of the cases during an exploratory initial cervicotomy.

Adolescent↗
PubMed1987

[Ethmoidal adenocarcinoma surgically treated in one stage by transfacial and subfrontal approach after inductive chemotherapy. Preliminary results of a new therapeutic approach].

The authors present a new therapeutic protocol for ethmo++idal adenocarcinomas. It includes a pre-operative chemotherapy based on a four days continued infusion of cis-platinum and 5 F.U. (three cures with 3 weeks-intervals); it is followed by a carcinologic removal realized through a combined transfacial and intra-cranial approach. They discuss the interest of combined surgery which should allow a limitation of intra-cranial recurrencies. The intra-cranial extension must not be a limit to the removal even in case of dural, or even sub-dural extension. The reconstruction of the anterior basis of the skull has been simplified as much as possible: it has been performed either with a bone graft removed from the frontal flap inner table, or with a precut madreporic coral graft. In all cases, the dura has been doubled with a large shred of galea. They emphasize the efficiency of pre-operative chemotherapy. Eleven patients underwent such a protocol; two were operated in a recurrence, 9 in first hand. The preliminary results seem to be promising: the one year and two years actuarial survival rates are 84%.

Adenocarcinoma↗
PubMed1987

[Partial supracricoid laryngectomy. Technics, indications and results].

A series of one hundred and thirteen cases of supracricoid partial laryngectomy (SPCL) is presented with the description of the surgical technic. All the patients, previously untreated, were decanulated. The deglutition was eventually normal in 97.2% of those treated by SCPL with circo-hyoido-epiglottopexy (CHEP) and in 95.5% after SCPL with crico-hyoido-pexy (CHP). The carcinologic results are presented. The actuarial survival rate at 3 years was 86.5%, after SPCL with CHEP and 71.4% after SCPL with CHP. At 5 years the actuarial survival was 66.3% after SCPL with CHP. The surgical indications are discussed according to the tumor site: vestibular carcinomas should be treated by SCPL with CHP and glottic carcinomas by SCPL with CHEP. A tumor extension beyond the superior border of the cricoid cartilage precludes these surgical procedures.

Adult↗
PubMed1987

[Combined ORL and neurosurgical approach in adenocarcinoma of the ethmoid. Preliminary results apropos of 15 cases].

Fifteen cases of adenocarcinoma of the ethmoid sinus treated by a combined subfrontal and transfacial approach after induction chemotherapy are reported. The surgical technique is described precisely including a paralateronasal approach combined with a bifrontocoronal incision, a bilateral ethmoidectomy and reconstruction of the anterior base of the skull by one sheets taken-out from the inner surface of the frontal flap or more recently madreporic coralline grafts; the dura is hermetically sealed and it is lined with a large galea flap. Results were as following: one post-operative death, no clinical rhinorrhea, no recurrence from the anterior cerebral fossa, one orbital and one sphenoidal recurrences. Surgical indications are discussed according to the different extensions of the tumor and a frontal lobe extension is not a contraindication. This surgical procedure should be employed for the adenocarcinomas of the ethmoid invading the superior cells even in the absence of lysis of the cribriform plate in order to avoid the endocranial recurrences.

Adenocarcinoma↗
PubMed1986

[Induction chemotherapy in cancers of the respiratory and digestive tracts by continuous infusions combining cisplatinum (C), fluorouracil (F), bleomycin (B) or C and F].

A series of 344 patients with squamous cell carcinoma (oropharynx, larynx, hypopharynx, or buccal cavity) were treated between November 1982 and January 1985 by chemotherapy. This involved either cisplatinum (C) on day 1 followed by continuous infusion of 5-fluorouracil (F) and bleomycin (B) from day 1 to day 4 or C combined with F as continuous infusion from day 1 to day 4. Tumoral response was 61% and nodal response 61%. Among the 234 patients operated upon, 31 (13%) were free from tumoral cells in the specimen and 25 (48%) with residual tumor. Toxicity of cancer chemotherapy was markedly minimized with the second regimen involving continuous administration of Cisplatin over 24 hours for a period of 4 days. Tolerance was improved mainly in the digestive and renal spheres: cardiovascular complications related to essential hyperhydration during administration of single-dose Cisplatin on day 1 were non-existent with this new continuous mode of administration. This new procedure should optimize results and improve the comfort of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Survival in cancers of the piriform sinus after induction chemotherapy].

285 cases of primary squamous cell carcinoma of pyriform sinus were treated by initial surgery completed by radiation. 242 patients received neo-adjuvant chemotherapy: Bleomycin as single agent (n = 95), Vincristine-Methotrexate-Bleomycin or Endoxan: 3 courses (n = 98), CDDP-Bleomycin, 5 FU or Methotrexate: 3 courses (n = 40). Chemotherapy was not administrated to 43 patients. Actuarial survival at 3 years without chemotherapy was 30%, after Bleomycin: 31%, VMB-VME: 47%, CMB-CFB: 61%. The 5-year survival without chemotherapy was 17%, with Bleomycin: 28%, with VMB-VME: 32%. Actuarial survival at 5-year including only deaths due to cancer was 13% without chemotherapy, 29% with Bleomycin and 39% with VMB-VME. This increasing of survival was directly related to improvement of locoregional prognosis.

Adult↗
PubMed1986

Short-term results of the combination of cis-platinum, 5-fluorouracil and bleomycin in advanced upper aerodigestive tract cancers.

Randomized trials comparing radiotherapy alone with combined radio- and chemotherapy are reviewed. Some 184 patients with advanced upper aerodigestive tract cancers were treated between November 1982 and December 1983 before any loco-regional treatment by three courses of the combination of cis-platinum, 5-fluorouracil and bleomycin, given every three weeks. At the end of three courses 88% of patients (162/184) were evaluable. Among these 162 patients, 102 achieved complete macroscopic remission or over 50% regression. Oropharyngeal cancers were most responsive, whereas results were less satisfactory for oral cancers. Histological sterilization was observed in 30% of patients with complete macroscopic regression. Toxicity was moderate. It is too early to appreciate the the survival benefit.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Cancers of the soft palate. Apropos of 135 cases].

Results of treatment of 135 cases of squamous cell carcinoma of soft palate treated between 1962 and 1983 in the ORL department of Hôpital Laennec, Paris, showed prognosis to be related to 3 main factors. Firstly, the frequency of syndromes and metasynchronous multiple primary cancers. Secondly, the presence of local recurrences. Their frequency should be reduced by performing first intention excision of the tumoral site with wide extension to the anterior and particularly the posterior pillars, and by the routine use of induction chemotherapy. Thirdly, nodal recurrences that can be prevented by routine prophylactic treatment of bilateral cervical lymph chains.

Adult↗
PubMed1986

[Chemotherapy at home. A new methodology].

Evolution in concepts relative to administration of cytotoxic drugs has reinforced interest in the use of continuous infusion therapy, a method providing a twofold increase in upper respiratory and digestive tract cancer response. A new method, developed by the authors since early 1985 allows the use of chemotherapy over 5 to 10 days in the patient's home. Preliminary results show an increase in efficacy of the therapy, and a marked improvement in the patient's comfort, suggesting that the indications for this new method should be enlarged.

Antineoplastic Combined Chemotherapy Protocols↗