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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 163 records · Page 9Linked to original sources
PubMed1991

Vertical partial laryngectomy: a critical analysis of local recurrence.

The purpose of this study was to evaluate local recurrence following vertical partial laryngectomies in 416 patients with either T1N0M0 or T2N0M0 glottic carcinoma. Local failure was reported according to the T stage, the precise tumor location within each stage, the true vocal cord mobility, and the surgical procedure performed. No local recurrences were observed among 42 patients who underwent thyrotomy and cordectomy when the tumor was confined to the middle third of the mobile true vocal cord. Local failure occurred in 8 of 111 (7.2%) patients in whom hemilaryngectomy was performed for tumors confined to one mobile true vocal cord. There was a diverse group of lesions within each T stage that responded differently to the surgical approaches. The differences in the initial recurrence rates are discussed in terms of careful preoperative assessment and choice of surgical technique for early glottic carcinoma.

Adult↗
PubMed1991

[Comparative study of temporal parameters of alaryngeal voices. Esophageal and tracheo-esophageal voices].

Recent studies have established significant acoustic and phonetic differences between tracheo-oesophageal (TE) and conventional esophageal voices (EV). 12 alaryngeal voices (2 esophageal, 6 myomucosal shunts, 4 tracheoesophageal phonatory protheses), and 7 normal laryngeal voices were recorded and analyzed. Speech timing including voicing and pauses distribution was evaluated and compared to laryngeal voices. Speakers with TE voices using pulmonary air were able to preserve the rythm and the syntactico-semantic structure of their speeches, as opposed to speakers with EV who often had to insufflate air into the esophagus and therefore had a staccato-like speech. The phonation time was quite similar in both situations, but the length and the number of pauses made the difference.

Aged↗
PubMed1991

[Combined approach to malignant tumors of the ethmoid and other paranasal sinuses. Principles and results].

The authors present their experience concerning combined transfacial and neurosurgical procedures in the treatment of carcinomas of the ethmoid sinuses. 109 ethmoid-spheno-orbital tumors were treated at our department from 1982 to 1990: 85 were located into the ethmoidal and/or sphenoidal sinuses; 78 of these were malignant. Among the 65 ethmoidal carcinomas which were operated through a combined route, 48 underwent an induction chemotherapy and 19 a post-operative radiotherapy. The surgical technique is detailed, mostly the intra-cranial approach and the reconstruction of the cranial basis. Clinical results, and particularly the actuarial survival rates are discussed. The 5-year actuarial survival rate is 40% for all first hand ethmoidal adenocarcinomas. The figure reaches 52% for the patients without intra-cranial extension. At last, the 5-year actuarial survival rate is 100% for patients having a complete clinical response to induction chemotherapy.

Actuarial Analysis↗
PubMed1991

[Adenoid cystic carcinoma of the parotid gland].

The authors report 7 cases of adenoid cystic carcinoma arising in the parotid gland between 1969 and 1990. All patients underwent surgery. Radiotherapy was performed twice following surgery. Local failure, nodal failure and distant metastasis are analyzed. Death appears to be related mainly to local failure. Radiotherapy does not seem to improve the local control obtained by surgery alone. Surgery must then be total and if necessary mutilating. Radiotherapy associated to surgery might be useful in case of extensive tumors for which complete eradication is not possible. A review of the world literature is performed.

Adult↗
PubMed1991

[Esthesioneuroblastomas. Could a preoperative chemotherapy improve their prognosis?].

The prognosis of malignant tumours of the olfactory epithelium of the nasal vault stays very poor. In the literature, the 5-year actuarial survival rate ranges between 50% and 65%; the 5-year recovery rate is 15% due to the high frequency of locoregional reoccurrences (60%) and metastasis (35-40%). Up to now chemotherapy was suggested as palliative treatment; but as Esthesioneuroblastomas (ETNB) appear to be sensitive to several chemotherapeutic agents (such as CDDP and 5-FU), we have decided to administer, from now on, to all patients harbouring an ETNB, an inductive chemotherapy whatever the staging and eventual diffusion of the tumour. The present paper presents our recent experience, dealing with such lesions: since 1984, 60 tumours of the ethmoid were treated in our department among which 7 ETNB (11.5%). We discuss our results concerning ETNB.

Adult↗
PubMed1991

[Extension to the infratemporal fossa of malignant tumors of the face].

The authors report about the experience of the N&T department of Laënnec Hospital with tumors of the upper facial structures invading the infratemporal fossa. This invasion is currently diagnosed preoperatively owing to the progress made in imaging. The involvement of the posterior wall of the sinus is the first CT sign. 45 tumors extended into the ITF, including 35 maxillary tumors. For the latter, the frequency of invasion of the ITF was of 38% for all histological types, and of 26% for epidermoid carcinomas. Trismus, the most characteristic sign, was present in 45% only of the tumors studied. Facial pain also was frequent. The prognosis of these tumors is extremely poor, as the survival rate was of 17% at 3 years, with a mean survival of 10 months. The failures of treatment were essentially local. The surgical treatment proposed associates scooping out the ITF to maxillary resection.

Carcinoma, Squamous Cell↗
PubMed1991

[Muco-epidermoid tumors of the parotid gland. Diagnostic and therapeutic attitudes].

On the basis of a retrospective series of thirteen cases treated between 1969 and 1989, the authors have studied the diagnostic and therapeutic issues connected with mucoepidermoid parotid tumors. The diagnosis is histopathological, but it is sometimes difficult to establish because of the histological polymorphism of these tumors. The degree of malignancy is variable and generally low. It is determined according to clinical and histopathological criteria, although there is not always a correlation between these criteria and the malignancy of evolution. Surgical exeresis is sufficient to cure most of these tumors. However, postoperative radiation therapy is indicated in case of tumoral invasion. Out of the ten cases of mucoepidermoid parotid tumor, nine were treated in first intention with exclusive surgery, and one case underwent postoperative radiation therapy. No local recurrence was noted. Out of the three patients who had a second-intention surgical exeresis, one died after repeated recurrence in spite of the complementary radiation therapy.

Adolescent↗
PubMed1990

Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma.

The partial horizontal supracricoid laryngectomy with cricohyoidoepiglottopexy consists of resection of the whole thyroid cartilage and paraglottic space. The cricoid cartilage, the hyoid bone, most of the epiglottis, and at least one arytenoid cartilage are conserved. Thirty-six patients with squamous cell carcinoma of the glottis who underwent this procedure from 1974 through 1986 are presented. All 36 recovered physiologic deglutition and phonation. None required a permanent tracheotomy. The 3-year actuarial survival rate was 86.5%. The local recurrence rate was 5.5%. The indications for the procedure are carcinomas of the glottis that 1) spread beyond the confines of the membranous portion of the true vocal cord or 2) present with limitation of true vocal cord mobility. The procedure is presented as a useful alternative to radiotherapy, partial vertical laryngectomy, and total laryngectomy in select cases of glottic carcinoma.

Adult↗
PubMed1990

Treatment of Frey's syndrome with topical 2% diphemanil methylsulfate (Prantal): a double-blind evaluation of 15 patients.

Fifteen patients with severe gustatory sweating after total parotidectomy and facial nerve preservation were asked to take part in a double-blind study. All patients were alternatively treated with topically applied placebo and topically applied 2% diphemanil methylsulfate (an anticholinergic agent). A 10-day period was allowed between applications for return of symptoms. Two-percent diphemanil methylsulfate provided partial relief in 33.3% of patients and total relief in 40% of patients. Involvement of the hairy temporal line region with gustatory sweating was the main reason for failure. Duration of relief varied from 2 to 4 days. The only side effect was dryness of the mouth noted in two patients.

Administration, Topical↗
PubMed1990

Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas.

The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty-eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tracheostomy. The 3-year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.

Adult↗
PubMed1990

[Local and lymph node recurrence of epitheliomas starting in the glottis, treated by partial laryngeal surgery: apropos of 432 patients].

Four hundred and thirty-two patients with a carcinoma of the true vocal cord, treated with a partial laryngectomy from 1972 through 1984, were retrospectively analyzed. All patients were staged as NO, MO. Survival and death rates were not presented. A three-year minimum follow-up was achieved in 97% of the cases. Local and cervical recurrences were presented and analyzed. Factors such as local tumor extent, impaired mobility of the true vocal cord, invasion of conus elasticus or thyroid cartilage, and positive margins of resection enhance the outcome of local and cervical recurrences. This present report underscores that thyrotomies, hemilaryngectomies, and cricohyoidoepiglottopexies should be adapted to the exact tumor location and the laryngeal mobilities. Cervical lymph node recurrence is less likely to happen if local control is achieved. The role and rationale for an associated elective ipsilateral cervical and paratracheal lymph chain dissection are presented and advocated.

Adult↗
PubMed1989

Myomucosal shunt following total laryngectomy: a report of 31 cases.

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.

Adult↗
PubMed1989

Adenocarcinoma of the ethmoid sinuses. Results of a new protocol based on inductive chemotherapy combined with surgery. Four years experience.

New therapeutic modalities for Ethmoidal Adenocarcinomas are presented. Thirty three patients harbouring such a tumour have been treated during the last four years. Twenty three were included in the following protocol:--the first step consisted in inductive chemotherapy based on a four-day course of continuous cisplatine (CDDP) and 5-fluoro-uracyl (5-FU infusion)--the second step was the tumour removal, which was performed through a combined transfacial and subfrontal approach. A contralateral ethmoidectomy was always performed. The integrity of the sphenoidal sinus was systematically checked. The cranial base was reconstructed with madreporic coral grafts; then a large extra-dural pediculated galea flap was placed onto the anterior base to line the sub-frontal dura. The authors discuss the results of this series of rare tumours.

Adenocarcinoma↗