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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

252 records · Page 14Linked to original sources
PubMedDate not supplied

Analysis of survival after induction chemotherapy in pyriform sinus carcinoma.

Three hundred seventy-one primary squamous cell carcinomas of the pyriform sinus were treated at Hôpital Laennec from 1970 through 1984 and retrospectively analyzed. The local and regional treatment consisted of initial surgical resection followed by postoperative radiotherapy. Forty-three patients were not treated by induction chemotherapy; 95 patients received preoperative chemotherapy with bleomycin as a single agent; 98 patients received three preoperative courses of vincristine, methotrexate, bleomycin, or endoxan, and 46 patients were treated by three courses of induction chemotherapy consisting of cisplatin, bleomycin, methotrexate, or 5-fluorouracil. Seventy-two patients received less than 150 mg of bleomycin and 17 patients received only one or two cycles of multiple-agent chemotherapy. Survivals were higher when multiple-agent chemotherapy was employed as compared with single-agent induction chemotherapy. Further prospective investigations are necessary to confirm that induction chemotherapy enhances survival in pyriformk sinus cancers.

Aged↗
PubMedDate not supplied

Voice evaluation of myomucosal shunt after total laryngectomy: comparison with esophageal speech.

The vocal quality attained with a tracheoesophageal myomucosal shunt (MMS) as described by Strome was evaluated in four patients and compared with three esophageal speakers and two normal subjects. The patients with MMSs acquired speech sooner. Fundamental frequency, pitch, timbre, and melody were analyzed with computerized electroglottography and sonography. Intelligibility was deemed better after the MMS primarily because phonation time approximated that of normal speech, and this study suggests that, following total laryngectomy, the vocal quality achieved using the MMS is preferrable to that of esophageal speech.

Aged↗
PubMedDate not supplied

CO2 laser posterior transverse cordotomy for isolated type IV posterior glottic stenosis.

One case of isolated type IV posterior glottic stenosis successfully treated with CO2 laser posterior transverse cordotomy is presented. This report emphasized the value of the CO2 laser posterior transverse cordotomy in this situation. A review of the various therapeutic options advocated in the medical literature to treat isolated posterior glottic stenosis is also presented.

Aged↗
PubMedDate not supplied

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for "early" glottic carcinoma classified as T1-T2N0 invading the anterior commissure.

PURPOSE: "Early" glottic squamous cell carcinoma classified as T1-T2N0 with anterior commissure invasion is conventionnaly managed with vertical partial laryngectomy (VPL) or radiation therapy (RT). At our insitution, in the early 1980s, vertical partial laryngectomy was progressively replaced by supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). The medical files and operative charts of 62 patients with "early" glottic carcinoma classified as T1-T2N0 invading the anterior commissure, consecutively managed with cricohyoidoepiglottopexy, were retrospectively reviewed to ascertain whether any conclusions could be drawn regarding this treatment modality. MATERIALS AND METHODS: Survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate was analyzed using the Kaplan-Meier life table method. RESULTS: The 3- and 5-year actuarial survival estimate was 93.3% and 86.5%, respectively. The 3- and 5-year actuarial local control estimate was 98.2%. The only patient with local recurrence was successfully salvaged with RT resulting in an overall 100% local control rate and laryngeal preservation rate. The 3- and 5-year actuarial nodal recurrence estimate was 1.8%. The 3- and 5-year actuarial distant metastasis estimate was 0% and 2%, respectively. Aspiration related completion total laryngectomy and permanent tracheostomy never occurred. CONCLUSION: The present retrospective study suggests that cricohyoidoepiglottopexy for glottic carcinoma classified as T1-T2 invading the anterior commissure resulted in higher local control rates and overall laryngeal preservation rate when compared with historical series using either VPL or RT. Further series are warranted to confirm our results.

Adult↗
PubMedDate not supplied

Aspiration in unilateral recurrent laryngeal nerve paralysis after surgery.

PURPOSE: Dysphonia with hoarseness and breathiness are the key symptoms of unilateral recurrent laryngeal nerve (RLN) paralysis, whereas aspiration is not usually described. The aim of this prospective study was to assess the incidence of aspiration in patients with unilateral recurrent laryngeal nerve paralysis after head and neck or thoracic surgery. PATIENTS AND METHODS: Five patients were included and evaluated within the first week and again 2 months postoperatively. Position, tone, and tension of the true vocal cord as well as assessment of the glottic axis, arytenoid position, laryngeal sensation, status of the pyriform sinus, and salivary stasis were studied. Swallowing evaluation was performed using flexible fiberoptic laryngoscopy during dry swallowing, thick cream, methylene blue liquid as well as with swallowing videofluoroscopy. RESULTS: Three patients had no aspiration, one patient had silent aspiration, and one had symptomatic aspiration. CONCLUSION: We conclude that aspiration may occur in unilateral recurrent laryngeal nerve paralysis and have to be systematically evaluated after pneumonectomy.

Adult↗
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Supracricoid hemilaryngopharyngectomy. Analysis of 240 cases.

The supracricoid hemilaryngopharyngectomy consists of resection of the supracricoid hemilarynx and ipsilateral pyriform sinus. Two hundred forty patients underwent this procedure from 1964 through 1983. Two hundred twenty-two patients had no airway impairment, and 204 recovered normal deglutition. The local recurrence rate was 5.2%. Indications for the procedure are carcinoma of the supracricoid upper part of the pyriform sinus and carcinoma of the lateral laryngeal margin with normal vocal cord mobility.

Adult↗
PubMedDate not supplied

Normal laryngeal CT findings after supracricoid partial laryngectomy.

BACKGROUND AND PURPOSE: Supracricoid horizontal partial laryngectomy (SCPL) is increasingly used to treat endolaryngeal carcinoma. However, few radiologic reports of these procedures exist. Our purpose was to evaluate the normal CT appearance of the neolarynx after surgery. METHODS: SCPL includes cricohyoidopexy (CHP), cricohyoidoepiglottopexy (CHEP), and tracheocricohyoidoepiglottopexy (TCHEP). We examined CT scans obtained from 18 patients without local superficial recurrence who underwent SCPL: 10, CHEP; seven, CHP; and one, TCHEP. Three reference sections were used to analyze the main surgical reconstruction: an upper section through the hyoid bone, a lower section through the cricoid cartilage, and a middle section in between. The distance between the hyoid bone and cricoid cartilage was measured. RESULTS: The epiglottis and valleculae were visible in the upper section in seven of 10 patients who underwent CHEP; this finding allowed distinction between CHEP and CHP. The arytenoids were depicted in 13 of 18 cases and reflected neolaryngeal shortening. The lower section showed the empty cricoid lumen lined by a thin mucosa; the anterior arch of the cricoid was amputated at TCHEP. The middle section showed the neovestibule, the lateral boundaries of which were the hypertrophic neoaryepiglottic folds; the anterior limit was the epiglottis for CHEP or the base of the tongue for CHP. The average distance between the hyoid bone and cricoid cartilage was 11 mm. CONCLUSION: Normal CT anatomy of the larynx after SCPL is defined. Three key sections may accurately distinguish the various types of SCPL. CT is a valuable tool for depicting tumor recurrence, especially when the tumor is submucosal.

Aged↗
PubMedDate not supplied

[Exenteration: taboo of cholesteatomatous chronic otitis. Opinion based upon personal experience (author's transl)].

The authors recall that in cholesteatomatous chronic otitis exenteration should be performed only as a last resort. This accepted, to wish to present it as an opprobious operation responsible for all evils is excessive. In 288 cases of cholesteatomatous chronic otitis treated between 1971 and 1978 (out of 433 cases of progressive otitis) 241 were treated surgically by the technique involving destruction of the osseous meatus. Amongst these 241 exenterations, there were 106 (i. e. 40%) in which the indication was absolute since they involved ears which were either cophotic or had already undergone exenteration. Reviewing a recent study of the local appearance in 225 cases of exenteration including 198 for cholesteatoma, they find 84% of ears perfectly dried up and healing in the long term. With regard to the restoration of healing, this problem arose, later, in only 6% of cases.

Cholesteatoma↗
PubMedDate not supplied

[The contribution of standard views of the mastoids in the treatment of cholesteatoma (author's transl)].

The authors consider than standard films of the mastoid (bilateral Schüller, mastoid tips displaced) are essential in all cases of chronic cholesteatomous otitis since they frequently provide the surgeon with useful information concerning appropriate management. Their opinion is illustrated by very convincing cases. Furthermore, they form part of personal hypotheses concerning the course and the interpretation of certain aspects.

Cholesteatoma↗
PubMedDate not supplied

[Primary bronchogenic and pharyngo-laryngeal carcinomas (author's transl)].

The study of 112 case histories of lung cancers, both primary and secondary, has allowed the authors to determine as being of 5% the incidence of primary bronchogenic carcinoma associated with treated pharyngo-laryngeal cancer. One out of three such primaries was a solitary lung opacity. Bronchogenic primaries appeared be almost as frequent as lung, pleura and mediastine secondarie. They can be diagnosed at any moment of the treatment or follow-up of pharyngo-laryngeal cancer, and appear to occur later than pulmonary metastases. Their symptoms are more "bronchopulmonary" in nature. They are more frequently associated with endolarynx and chorda carcinomas. They are possibly more frequent in cases of smaller primaries without lymph-node involvement. Solitary lung opacities should be considered as independent primaries and constitute the best candidates for efficient pulmonary treatment. Treated pharyngo-laryngeal patients should undergo regularly spaced lung roentgenograms and frequent tracheal sputum cytology.

Bronchial Neoplasms↗
PubMedDate not supplied

[Undifferentiated cancers of the thyroid gland. Value of adriblastin].

About 21 cases, the authors recall general characteristics of undifferentiated cancers of thyroid gland. They underline the difference between undifferentiated trabecular cancers and anaplastic cancers of which evolution is highly malign and explosive. A few observations confirm interest of Adriblastin associated with a wide surgery.

Adult↗
PubMedDate not supplied

[Primary pharyngolaryngeal carcinoma, pulmonary metastases and carcinoma of the bronchus (author's transl)].

On the basis of 112 cases of pulmonary or mediastinal neoplasms observed during the treatment or follow-up of 952 carcinomas of the pharynx and larynx, the authors study in detail 45 cases of metastases. They draw the following conclusions:--metastases present clinically relatively early in the treated course of pharyngolaryngeal carcinomas: 85% before 18 months.--cannonball lesions are the commonest endo-thoracic clinical metastases: 6 out of 10.--carcinomas of the hypopharynx are at the origin of 2/3 of cannonball lesions (alpha less than or equal to 0.02) and 1/4 of mediastinal lymphadenopathies and pleural effusions.--endolaryngeal carcinomas are rarely at the origin of cannonball lesions and are associated almost exclusively with mediastinal lymphadenopathies and pleural effusions (alpha less than 0.001). The influence of the size of the primary tumour, of lymph node involvement, of capsular rupture and of failure to eliminate all malignant cells from the primary lesion are considered and discussed.

Bronchial Neoplasms↗