Biomedical subjects
Publications and source records attributed to E Marbaix.
The clinical observation of an oral pulse granuloma allows to detail the clinical and pathological characteristics of this lesion. The etiology of this particular granuloma is explained by the introduction of alimentary particles into maxillary bone. A review of the literature about this subject is also made.
Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective results were evaluated by measurement of the maximum phonation time, the phonatory quotient, vocal frequency analysis, and laryngostroboscopy. These results are as good as those with Zyderm Collagen II (ZCI). Avoidance of useless overcorrection, better resistance to collagenase, and less induced hypersensitivity differentiate GAX from ZCI.
The use of Gax collagen is proposed for correcting velopharyngeal insufficiency with posterior pharyngeal wall augmentation. The indications for this procedure are velopharyngeal insufficiency that remains after surgery and treatment by a speech pathologist. The procedure is also valuable after velum paralysis. Collagen (2.5-5cc) is injected through a device designed for vocal-fold and laryngeal rehabilitation. Several injection points are necessary to raise a good Passavant's ridge. The muscular activity of the posterior pharyngeal wall models the collagen pad for the first 3 weeks; afterwards, the collagen shape remains unchanged due to its integration in the host tissues. At this time, five patients have been injected with Gax collagen and have improved. The oldest case dates from 28 months ago; the most recent dates from 8 months ago. There were no adverse reactions, and the results remain stable at the present time.
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A new implant made of purified fibrillar collagen (P.F.C.) and hydroxylapatite particles (HA) (Maxill-HAPR) is tested in canine mandibulae and surrounding tissues so that its integration and its bone-induction capacity can be histologically studied. A clinical case is also reported. The goal of this combined implant is to improve the interface of the HA particles with the host-tissues through the P.F.C. This study shows that P.F.C. is replaced after two months by host fibro-conjunctive tissues. Between 3 and 4 months, ossification areas are observed. After 6 months, the host conjunctive tissue is replaced by bone surrounding the HA particles. P.F.C.-HA implants can be made for replacement or restoration of facial bones not submitted to important forces like the frontal or malar bones.
The records of 14 patients who have benefited from intralaryngeal injections of ZCI collagen for at least 3-4 years were reviewed. All patients still living were evaluated. Qualitative phonatory measurements included laryngostroboscopy and frequency voice analysis, while quantitative studies included maximum phonation times and phonatory quotients. The absence of both local and general inflammatory reactions was observed in these patients, confirming the excellent host tolerance of ZCI collagen and the stability of the functional results achieved.
Nonhistone nucleoproteins associated with the nucleolar organizer regions (NORs), the genes coding for the ribosomal RNA precursor, can be visualized by silver staining. The black dots (AgNORs) appearing on the nuclei are thought to reflect cell differentiation. In this study, AgNORs were counted and their area was measured and compared with the area of the nuclei in normal and carcinomatous cells of the uterine cervix. The number of AgNORs per nucleus was significantly higher in the endocervical than in the basal exocervical epithelium (p less than 0.005) and in the carcinomatous epithelium, either in situ or invasive, than in both normal epithelia (p less than 0.002). Individual AgNORs were significantly smaller in carcinoma in situ than in endocervical epithelium (p less than 0.05) or in invasive carcinoma (p less than 0.01). Significant differences were also found in the total AgNORs area per nucleus between the following groups: basal exocervical versus endocervical epithelium (p less than 0.01), basal exocervical and endocervical epithelium versus invasive carcinoma (p less than 0.001), and in-situ versus invasive carcinoma (p = 0.02). The conclusions are that the number and the total area of AgNORs per nucleus increase with the differentiation of the cell or with its carcinomatous transformation, but no prognostic significance can be drawn so far from our measurements.
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We have studied two postmortem human laryngeal specimens after the injection of collagen. The first larynx was removed 14 days after injection, while the second was examined 5 months after injection. The specimens are described macroscopically and microscopically. Excellent tolerance to the collagen was noted, with virtually no inflammatory reaction seen. The collagen injected seems to have been colonized progressively by the host cells and by neovessels. These findings coincide closely with those observed in animal models. In comparison to the inflammatory granulomas found after injections with Teflon, the absence of inflammatory reactions following the use of collagen does at least contribute to justifying its continued application clinically.
The overall and renal toxicity of racemic gossypol acetic acid was assessed in 6 mongrel dogs. Oral racemic gossypol acetic acid was given orally at doses increasing from 10 to 40 mg/d for a total of 6 weeks in 3 female dogs and from 40 to 80 mg/d for a total of 4 weeks in 3 male dogs. The animals were then sacrificed. Drug tolerance was excellent. Pathological examination of the liver and heart was normal. Renal function remained normal. The renal excretion of K, Mg, phosphate and acid remained normal. Serum K remained within the range appropriate for animals on a K-free diet. Pathological examination of the kidney disclosed mild proximal tubule vacuolization similar to that observed in animals on a K-free diet and small brownish pigment deposits in a few tubular cells. Spermatogenesis was arrested in the testes of one of the 3 male dogs. We conclude that short exposure to 10 to 80 mg/day of gossypol does not result in detectable toxic effect. Neither significant hypokalemia nor a tubular K leak were observed.
One hundred and one patients presenting with a squamous cell carcinoma of the larynx underwent surgery in our department between January 1980 and May 1985. In most of these patients, nodes were removed from the main lymphatic drainage pathways and subjected to immediate frozen section examination. The results from frozen section examination of the nodes were then compared with those from the surgical specimens of cervical neck dissections performed on the patients according to the classic rules. In addition, margin resections were made and examined by frozen section after removal of the tumour. In the event of a positive finding, these resections were continued until healthy tissue was reached, the specimens being examined in addition by classic methods. Immediate frozen sections enable the margins of the resection to be verified correctly. In our series we were brought to extend the limits of resection in 10 cases out of 68 (15 per cent). It can also be seen that the accuracy of the pathologist's reading of the frozen sections is satisfactory. The overall level of error is three out of 68 (4.5 per cent). All the errors correspond to false negatives. The aim of avoiding neck dissections in the presence of N0, thanks to nodal selection with frozen section, is not attained. We find a 6/61 rate of false negatives for N0-N1 (10 per cent) when we compare the frozen sections of the selected nodes and the neck dissections. This is due to the fact that the surgeon may be led astray by a reactive hyperplastic node whilst other less inflammatory neighbouring nodes are in fact the site of metastasis.
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Results of treatment of patulous glottis by injection of collagen are discussed. The technique used differs little from that in which Teflon is employed, the difference being that the collagen paste is injected into Reinke's space. The quantity deposited varies between 1 and 1.5 cm3. Twenty-five patients had been treated in this way by April 1986, the longest follow up being for 19 months (mean: 9.5 months). The compound presents remarkable tolerance and no complication has been noted up to the present. Results were at least equal to those obtained using Teflon. Vocal quality was evaluated, apart from by vocal recordings, by analysis of vocal spectrum and objective measurements such as phonatory quotient and output. Results appear to be stable and although some reduction in quantity injected was noted most of the collagen becomes living tissue by colonization with host tissue. Availability of new generations of collagen such as that crosslinked at 35 mg/ml will probably resolve definitely the problem of persistence of results.
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In 1962, Arnold used injectable Teflon to reintroduce Brünings' technique for rehabilitating the paralysed vocal cord. Although Teflon would not appear to be carcinogenic, the technique is not entirely trouble-free. Injectable collagen as a biological implant seems to be an attractive alternative since it is a component part of the extracellular protein matrix. In actual clinical use, the collagen is easily injectable, is well-tolerated by patients, and is only subject to limited resorption. It also undergoes some transformation into living connective tissue with neovascularization. Our study was carried out on 14 patients: 13 had vocal cord paralyses from various causes and 1 had vocal cord atrophy as a sequel to traumatic injury. The therapeutic indication for correction in all of these patients was dysphonia for which speech therapy had failed to produce an adequate result. One patient was found to suffer from symptomatic aspiration as well. The actual technique of surgery involved the injection of a mean quantity of 1.5 cc collagen into the submucosal tissue of the affected cord during direct laryngoscopy. Postoperatively, all of our patients showed improved dysphonia without secondary effects occurring from the collagen. We also found lessened aspiration in our patient so affected. Our period of follow-up to date ranges from 3-12 months.
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The authors present their experience of tomodensitometry in cervico-facial pathology. Their work approaches the subject successively from three angles, first comparing 51 cases of tomodensitometric exploration to the classic techniques used in cervico-facial pathology. Next, a correlation is established between the tomodensitometric images and surgical biopsies from 28 pharyngolaryngeal cancers. From the third angle, some selected cases are used to illustrate the contribution by tomodensitometry to the radiology of cervico-facial pathology. From this study, tomodensitometry would appear to be a radiological investigation of choice in cervico-facial oncology for estimating the extent and depth of the tumour, while equalling if not being superior to the traditional radiological techniques for assessing the lesions in this region, whether they be benign or malignant.