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D Chevalier

Publications and source records attributed to D Chevalier.

At least 19 recordsLinked to original sources
PubMed2006

Respiratory epithelial adenomatoid hamartomas of the sinonasal tract.

We report the clinicopathologic features of two cases of respiratory epithelial adenomatoid harmartoma (REAH) of the sinonasal tract. Hamartomas are rare in the nasal cavity. Histologically, these lesions were characterized by a glandular proliferation lined by ciliated respiratory epithelium originated from the surface epithelium. The two patients were evaluated by a gastroenterologist to assess intestine colocalization. The treatment was a complete surgical resection through limited approach. We should be aware of this entity as a differential diagnosis for inverted papilloma and well-differenciated adenocarcinoma. Fine histopathological analysis is necessary to avoid aggressive surgery for this benign lesion.

Adenomatoid Tumor↗
PubMed2006

Ethnic differences in the distribution of CYP3A5 gene polymorphisms.

The genetic polymorphism affecting the CYP3A5 enzyme is responsible for interindividual and interethnic variability in the metabolism of CYP3A5 substrates. The full extent of the CYP3A5 genetic polymorphism was analysed in French Caucasian, Gabonese and Tunisian populations using a polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) strategy. In the three populations, eight, 17 and ten single nucleotide polymorphisms (SNPs), respectively, were identified, among which nine correspond to rare new mutations. Also identified were 16 alleles including eight new allelic variants. Significant differences were observed in the distribution of these alleles. Particularly, the frequency of the CYP3A5*3C null allele in French Caucasians (81.3%) and in Tunisians (80.0%) is higher than in the Gabonese population (12.5%) (p < 0.001). Considering the CYP3A5 genotypes of the tested individuals, only 10.4% of French Caucasians and 30.0% of Tunisians were identified as CYP3A5 expressors. In contrast, 90.0% of Gabonese subjects appear to express the CYP3A5 protein.

Alleles↗
PubMed2006

Local recurrence after CO2 laser cordectomy for early glottic carcinoma.

OBJECTIVES: To point out prognosis factors of local recurrence after endoscopic cordectomies for Tis, T1a, T1b, and T2 glottic squamous cell carcinomas. STUDY DESIGN: A cohort of 110 patients treated from January 1990 to December 2000 at a single institution was retrospectively analyzed: 21 had Tis, 76 T1a, 7 T1b, and 6 T2 (mean follow-up 42 mo; range 1-160 mo). METHODS: The depth and extension of the excision were graded according to the European Laryngological Society Classification. Univariate analysis was used to review the impact on disease-free survival of factors related to the host, the tumor, and the treatment. RESULTS: According to the Kaplan-Meier method, the 5 year overall survival and the disease-free survival were 87% and 75%, respectively. The rates of cause-specific survival, ultimate local control with laser alone, and laryngeal preservation were 97%, 84%, and 90%, respectively. Univariate analysis by the log rank test revealed that vocal muscle infiltration (P = .001) and subglottic involvement (P = .02) have a significant impact on disease-free survival. Of the 22 patients with local recurrence (17 T1a, 1 T1b, and 4 T2), 9 were managed with total laryngectomy, 5 with partial laryngectomy, 4 with further laser cordectomy, 2 with radiotherapy, and 2 had no curative treatment. CONCLUSION: Transoral laser surgery for early glottic carcinoma is a valid alternative to radiotherapy and partial laryngectomy in terms of oncologic results. It offers low morbidity and excellent retreatment options in case of local failure. Careful patient selection for laser surgery is essential to secure good results.

Adult↗
PubMed2005

Clinical outcome in patients with high-grade internal carotid artery stenosis after irradiation.

The authors followed up 41 consecutive patients (21 symptomatic) with internal carotid artery stenosis > or =70% and previous neck irradiation. After 28 months, 15 patients (36.6%) had died, five (12.2%) had had an ischemic stroke, and 15 (36.6%) had a new malignancy. Having a new malignancy was the only independent predictor of death. The major risk for patients with ICA stenosis > or =70% and previous neck irradiation is malignancy, not stroke.

Adult↗
PubMed2005

[Perioperative evolution of the nutritional status in head and neck surgical patients. Prospective and descriptive case series].

AIM OF THE STUDY: To assess the perioperative evolution of the nutritional status of head and neck surgical patients. DESIGN: Prospective, descriptive case series. PATIENTS AND METHODS: Fifty-four patients candidates for total or partial laryngectomy for malignancy of the neck tract without a past of neck surgery. The nutritional status of all patients hospitalized for total pharyngolaryngectomy, total or partial laryngectomy was assessed by 1) clinical parameters including weight (W), weight variation (WV, percentage of loss), Body Mass Index (BMI), triceps skin fold measurement (T), midarm circumference (M), and 2) biological parameters such as serum albumin (SA), transthyretin (TTR), lymphocytes (Ly). These parameters were noted at the time of diagnostic laryngoscopy (T1), the day before surgery (T2), and 10 days afterward (T3) when patients were authorized to eat normally. All patients had enteral nutrition (EN) support (35 kcal/kg/day) starting at D1 and for 10 days afterward. Only complete data per patient were analyzed. RESULTS: 24 patients were excluded. During the 21 days [7-53] preoperative period (T1-T2), WV was (6.6% [-8,1-+20.0] [T2] vs. 4.7% [-12,9-+20.0] [T1], p<0.05) without difference in T and M. In the postoperative period (T2-T3), all parameters worsened, except T, with: WV (8.2% [-8,1-+20.0] [T3], p<0.05 vs T2), M (27.4 cm [20.0-37.0] [T3] vs 28.3 cm [20.5-39.0] [T2], p<0.05) et TTR (0.21 mg/l [0.09-0.36] [T3] vs. 0.27 mg/l [0.08-0.45] [T2], p<0.05). BMI was 22.9 [15.2-36.7] (T1) vs 22.9 [15.2-35.3] (T2), NS and 22.1 [15.0-34.9] (T3), p<0.05 vs (T2). CONCLUSION: The nutritional status in malignancy head and neck surgical patients seems to be best assessed by loss weight. It worsened mainly during the postoperative period even if a well-conducted EN was performed as defined by the French consensus conference.

Adult↗
PubMed2005

CYP2A13 genetic polymorphism in French Caucasian, Gabonese and Tunisian populations.

Since human CYP2A13 is expressed in the respiratory tract and is involved in the activation of tobacco-specific nitrosamines, some of the previously reported sequence variations may contribute to inter-individual and inter-ethnic differences in the susceptibility of tobacco-related tumorigenesis. The aim was to compare the frequencies of the 578C > T (Arg101Stop), 3375C > T (Arg257Cys) and 7520C > G (3'-untranslated region) mutations in several populations. The frequencies of the 578C > T polymorphism were 3.8, 0 and 1.0% in French Caucasians, Gabonese and Tunisians, respectively. In the same populations, the frequencies of the 3375C > T mutation were 0, 15.3 and 4.2%, respectively, whereas the frequencies of the 7520C > G mutation were 1.0, 20.8 and 7.3%, respectively. Marked inter-ethnic variations in CYP2A13 were identified and confirmed. These findings provide data for further studies that associate CYP2A13 haplotypes with an incidence of smoking-related tumours in respect of ethnicity.

3' Untranslated Regions↗
PubMed2004

[Severe laryngomalacia: surgical indications and results in 33 patients].

INTRODUCTION: Laryngomalacia is the most common course of stridor in children: with a 50% to 75% incidence. About 50% to 60% of congenital laryngeal anomalies that present with stridor are due to laryngomalacia. In most cases, the disease followed a benign course but the prognosis is less favorable in 10% to 15% of cases. These patients may require surgical intervention. MATERIALS AND METHODS: This prospective study included 33 patients referred to our institution from May 1998 to May 2003 for severe laryngomalacia. The diagnosis of severe laryngomalacia was based on clinical and if necessary paraclinical data. An endoscopic laser resection of arytenoid mucosal excess associated if necessary with suprahyoid epiglottectomy was performed in all patients. RESULTS: Mean age of the children was 7.5 Months (range, 2 weeks-4 Years). Ninety-six percent of the patients had complete resolution of symptoms before the fourth postoperative week. Ninety one percents of the patients had effective oral feeding within the first Month (48% immediately after surgery). The average hospital stay was 6 days (range, 3 to 14). Weight gains were found to be satisfactory in all cases since children were discharged the hospital. CONCLUSION: Endoscopic laryngeal surgery is an appropriate therapy for treatment of severe forms of laryngomalacia. It is a safe and effective surgical procedure.

Child, Preschool↗
PubMed2003

Congenital pharyngolaryngeal band: report of an unusual case of respiratory distress.

Congenital pharyngolaryngeal band (PLB) is an extremely rare congenital abnormality, characterized by a fibrous web extending from the nasopharynx to the epiglottis. We report a case of unilateral pharyngolaryngeal band in a new-born who presented severe airway obstruction and feeding difficulties. The band extended from the right postero-inferior part of the nasopharynx to the right lateral margin of the larynx. Faucial pillars and tonsil were absent on this side. Endoscopic and radiological assessments excluded associated cervicofacial abnormality. Two endoscopic laser resection procedures were necessary to liberate the larynx from PLB. Clinical and radiological assessment advocated a second pharyngeal pouch development failure as the origin to PLB.

Airway Obstruction↗
PubMed2003

Comparison of remifentanil and alfentanil during anaesthesia for patients undergoing direct laryngoscopy without intubation.

BACKGROUND: Remifentanil and alfentanil are opioids often used during direct laryngoscopy (DL). This prospective, randomized study compared these agents with respect to haemodynamic and Bispectral Index (BIS) responses, glottic visualization, and rapidity of recovery (spontaneous ventilation, eye opening) in DL without intubation. METHODS: A total of 60 patients undergoing DL were randomized into two groups: remifentanil (R) and alfentanil (A). Anaesthesia was induced with propofol 2.5 mg kg(-1) and the opioid was administered 1 min later (R=2 microg kg(-1) or A=30 microg kg(-1) over 30 s). DL was commenced 1 min after (corresponding to 3 min after the beginning of induction). Glottic visualization, opioid and/or propofol re-injection, spontaneous ventilation recovery, and eye opening were recorded. RESULTS: During DL, mean arterial pressure (MAP) increased by 6% in the R group vs 20% in the A group (P<0.05) when compared with post-induction values without affecting heart rate or BIS. No significant difference was observed between groups with respect to glottic exposure, opioid and/or propofol re-injection, and spontaneous ventilation recovery (mean (SEM) 3.8 (0.6) min, R group vs 3.2 (0.7) min, A group, NS) or eye opening (7.1 (1.1) min, R group vs 7.4 (0.9) min, A group, NS). Thirty minutes after postanaesthesia care unit (PACU) admission, MAP returned to its pre-induction value in the R group (104 (3) vs 109 (3) at baseline, NS), whereas in the A group MAP remained significantly lower at this time point (96 (4) vs 106 (3) at baseline, P<0.05). CONCLUSION: This study showed that only remifentanil prevented MAP increase without adverse effects such as bradycardia during DL, and prevented MAP decrease 30 min after PACU admission.

Adult↗
PubMed2003

[Zenker's diverticulum in the elderly patient: evolution of endoscopic treatment using a CO2 laser].

OBJECTIVES: The authors report their experience in a retrospective study of 28 patients with symptomatic hypopharyngeal diverticulum. MATERIAL AND METHOD: The mean age was 70 years. Eight patients presented with severe dysphagia and nine with weight's loss. The delay before diagnosis was 17 months. All patients included were studied by an oesophageal barium swallow prior to any treatment. According to Van Overbeeck's classification, diverticula were medium sized in 11 patients, small in 8 and large in 7. All patients had endoscopic assessment of the diverticular pouch; 26 patients were treated by microendoscopic laser myotomy and 2 by resection. RESULTS: The average time for oral feeding was 4 days. None of the 28 cases had a postoperative complication. 25 patients had partial or complete relief of symptoms after their initial treatment. In 3 cases recurrence of symptoms occurred, of whom 2 underwent endoscopic revision and 1 underwent an open procedure. CONCLUSION: Endoscopic laser surgery for Zenker's diverticulum can be recommended as the treatment of choice for elderly patients. It is a useful procedure because it is swift, effective with a low rate of morbidity, even in cases with impaired of health or associated diseases.

Age Factors↗
PubMed2002

[Reconstruction after total circular pharyngolaryngectomy: comparison between gastric interposition and free jejunal flap].

AIM OF THE STUDY: To elucidate hospital mortality, morbidity and actuarial survival rates of patients with carcinoma of the hypopharynx and cervical oesophagus and to identify the technique of choice for reconstruction after pharyngolaryngectomy. PATIENTS AND METHODS: We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and January 2000. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical oesophageal in 78 cases. Follow-up was complete for all patients. Chi 2 and log rank tests were used, with a limit of significance of 5%. RESULTS: The postoperative mortality and morbidity rates were 4.8% and 38.3%, respectively. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group with regard to the respiratory complications (33% vs 47.0%, p < 0.05), local recurrences (15.8% vs 33.8%, p = 0.004) and survival without dysphagia (76% vs 89%, p < 10(-5)). CONCLUSION: Surgical ablation is a viable option for advanced hypopharyngeal and cervical oesophageal neoplasms, and stomach interposition is the preferred method of reconstruction.

Actuarial Analysis↗
PubMed2002

[Oesophageal cancer in patients with head and neck cancers: therapeutic implications].

AIM OF THE STUDY: To determine therapeutic and prognostic implications of an associated head and neck primary cancer in patients undergoing oesophagectomy for squamous cell carcinoma of the oesophagus. PATIENTS AND METHODS: Between 1982 and 2000, 868 patients with oesophageal cancer were operated in our institution, including 78 (9%) who underwent oesophagectomy for associated oesophageal and head and neck cancers; the latter was synchronous (n = 52) or anterior metachronous (n = 26). Influence of head and neck cancer on the treatment of oesophageal carcinoma was analysed retrospectively in terms of surgical therapeutic strategy and survival. RESULTS: Oesophageal resection consisted of oeso-pharyngolaryngectomy (n = 14, 17.9%), subtotal oesophagectomy (n = 62, 79.5%) and cervical oesophagectomy (n = 2, 2.6%). Radical resection (R0) was obtained in 85% of cases. Postoperative mortality rate was 5 % (4/78). Main complications were pulmonary (18% = 14/78) and anastomotic leaks (14% = 11/78), all of them cervical. Follow-up (mean = 25 +/- 27 months) was complete for all 78 patients. Five-year survival after R0 resection was 25%. Survival pronostic factors were denutrition, complete resection, and pT status of oesophageal tumor. CONCLUSION: In patients with associated carcinomas of oesophagus and head and neck, agressive treatment -including an oesophagectomy- allowed a 5-year survival rate more than 25% without increased mortality or morbidity rates, compared with patients operated on for isolated oesophageal carcinoma.

Carcinoma, Squamous Cell↗
PubMed2002

[Cricoid chondronecrosis after prolonged endotracheal intubation].

Subglottic area injuries after prolonged endotracheal intubation are relatively frequent but cricoid cartilage necrosis is rare, with uncertain prognosis. Endoscopic findings are evocative even when clinical signs are not. When suspected, CT scan is required. The CT appearance is not specific, but the diagnosis can be strongly suggested in cases of fragmentation and collapse of the cricoid cartilage. We report two cases of cricoid chondronecrosis.

Adult↗
PubMed2002

[Endonasal plasmocytoma: diagnosis and management].

UNLABELLED: Plasmocytomas are either medullary (disseminated form) or extramedullary with or without bone infiltration (located form). Plasmocytoma is not a common tumor but extramedullary forms mostly occur in the upper respiratory tract without specific manifestations. OBJECTIVE: The aim of this study is to discuss the management (diagnostic and therapeutic) and the follow-up of extramedullary nasal plasmocytoma. MATERIAL AND METHODS: We report a case of a 71-year-old patient with unilateral nasal obstruction manifestation. RESULTS: Endonasal biopsy concluded plasma cell tumor without extension on CT scan. Treatment consisted of external nasal surgery and radiotherapy. CONCLUSION: Diagnosis of solitary extramedullary plasmocytoma can only be confirmed when the presence of systemic disease is excluded by performing clinical, biological (marrow bone biopsy) and radiological investigations. The treatment should be based on surgery with complementary radiotherapy if there is a skull base erosion. Long term follow-up is necessary because of the high risk of diffuse marrow involvement (multiple myeloma) which may occur after a long delay.

Aged↗
PubMed2001

Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR) -- results of a phase-III multicenter clinical trial.

The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis was > or = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (> or = 88%) and specificity (> or = 77%). For lymph node groups, the sensitivity was > or = 59% and specificity > or = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV) > or = 90% and a positive predictive value (PPV) > or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.

Adult↗
PubMed2001

Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases.

BACKGROUND: Free jejunal transfer has become the standard technique for reconstruction of the pharynx and hypopharynx, especially with proximal neoplastic lesions, whereas gastric tube interposition is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when resection extends below the thoracic inlet. HYPOTHESIS: Surgical ablation is a viable option for advanced hypopharyngeal and cervical esophageal neoplasms, with stomach interposition a safe and preferred method of reconstruction. DESIGN: Retrospective analysis. SETTING: University hospital that is a regional referral institution for esophageal cancer treatment and complex digestive reconstructions after esophagectomy. PATIENTS: We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and July 1999. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical esophageal in 78 cases. INTERVENTIONS: Pharyngolaryngectomy and total esophagectomy with pharyngogastric anastomoses (n = 127); pharyngolaryngectomy, cervical esophagectomy, and reconstruction with free jejunal transplant (n = 77); and pharyngolaryngectomy and total esophagectomy with pharyngocolic anastomoses (n = 5). MAIN OUTCOME MEASURES: Postoperative mortality and morbidity, long-term survival, and prognostic factors influencing survival. RESULTS: The postoperative in-hospital mortality rate was 4.8% (10 patients), with a postoperative morbidity rate of 38.3%. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group (33% vs 47%, P<.05). The significant adverse factors affecting survival were tumor cervical localization, postoperative complications, disease stages pT3 and pT4 for the cervical esophageal tumors, microscopic pharyngeal penetration, or incomplete resection. The significant beneficial factors were tumor hypopharyngeal localization and postoperative radiotherapy. CONCLUSIONS: Surgical ablation is a viable option for advanced hypopharyngeal and cervical esophageal neoplasms, with stomach interposition the preferred method of reconstruction. Although the prognosis is poor, satisfactory short-term palliation can be achieved. The significant adverse factors affecting survival should be taken into account to select the candidates for surgery.

Adult↗