Biomedical subjects

H Laccourreye

Publications and source records attributed to H Laccourreye.

At least 73 records · Page 4Linked to original sources

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↗

PubMed1989

[The versatile midface degloving approach. Re-updating the method, apropos of a case].

A recurrent adenoid cystic carcinoma of the hard palate extending to the maxillary sinus was resected through the versatile midface degloving approach. The surgical technique is discussed, and advantages and limits of the procedure are analyzed. The authors recommend this approach for midface tumors which avoids a facial scar and which sounds oncological.

Carcinoma, Adenoid Cystic↗

PubMed1989

[Primary carcinoma of the external auditory canal and the middle ear. Apropos of 14 cases].

Fourteen carcinomas of the external auditory canal and middle ear are presented regrouping eleven squamous cell carcinomas, two adenocarcinomas and one adenoid cystic carcinoma. Results are analyzed according to the treatment employed: surgery and/or radiotherapy. Four local recurrences occurred, two after radiation as initial treatment and two after surgery completed by radiation. Tumors strictly limited to the skin of the auditory canal and treated surgically are free of disease. A new classification is proposed in order to simplify and clarify the therapeutic indications and prognosis.

Actuarial Analysis↗

PubMed1989

[The thyroid nodule. A retrospective study of 200 cases].

We analysed 200 cases of thyroid nodules collected in 2 units of the Laennec Hospital. The results of clinical examination, complementary investigations per and post-operative histology and medical follow up were analysed and compared with those in the literature. The malignancy rate was 18%. With the exception of 5 cases, a rigorous medical examination revealed at least one suspicious clinical sign in these patients. Thyroid isotope scan, which was cold in 82% of cases was of no value in distinguishing between benign and malignant nodules. The authors were not in agreement on the policy to be followed when faced with an isolated cold nodule. Fine needle aspiration is the only method which allows diagnosis but it is of low reliability. Ultrasound may be reassuring when it demonstrates fine walled, small diameter cysts only, but this situation is rare. We analysed the limits and pitfalls of these various methods. It is difficult to submit a patient to regular follow up for several years with antagonist treatment, where appropriate, and in addition malignant transformation may not be recognized. With knowledge of the good prognosis of cancers operated on at the microscopic intracapsular stage and the significant number of microscopic carcinomas discovered fortuitously in the course of surgery, it would appear reasonable to at least perform a cervicotomy with extemporaneous histological examination of any cold or isofixing nodule. Lobo-isthmectomy is in practice the solution adopted and its complications are rare and minimal.

Adult↗

PubMed1989

[Local extension of epithelioma of the glottic floor; anatomo-clinical correlations and study of local failure. Apropos of 432 patients treated by partial laryngeal surgery].

The authors have studied real tumoral extension in 432 cases with N0 M0 epidermoid carcinoma of the glottic floor treated by partial laryngeal surgery over the period extending from 1972 to 1984. This retrospective study defines the limits and the errors of preoperative assessment of local extension. Clinical examination and direct suspension laryngoscopy are needed. T classification cannot be used as a sole reference in the selection of the surgical technique. The difficulties encountered in the evaluation of real tumor extension in this type of neoplasia calls for great caution on the part of the surgeon in selecting the procedure for partial laryngeal surgery. The study of the incidence of local failures in cases of real tumor extension emphasizes the need for an appropriate surgical technique for the local management of tumoral extension. The authors identify the respective place held by such techniques as thyrotomy associated with internal subperichondrial degloving and partial vertical laryngectomy with cartilage resection, and its many variants, and partial horizontal subcricoid laryngectomy (of the cricohyoepiglottopexy-type).

Adult↗

PubMed1989

[Percutaneous endoscopic gastrostomy. Indications and results in 31 patients].

Nutritional assistance was indicated in 31 patients with an ENT tumour at different stages of treatment and different stages of the disease. These patients presented with disorders of deglutition with false passages (68%), aspiration pneumonia (10%), dysphagia (35%) or denutrition (17%). We used an endoscopic percutaneous gastrotomy kit produced by the Bioser company (pull technique). In 29 patients, the tube was inserted under general anaesthesia in the operating theatre to prevent dyspnoea during introduction of the tube in these patients with alteration of the airway-gastrointestinal tract junction or because the tube was inserted at the beginning of anaesthesia for ENT surgery. The tube was able to be inserted in every case, with cardiac arrest in one patient who was effectively resuscitated without sequelae, two obstructions of the cuff requiring advancement of the tube with a bougie, 2 ruptures of the thread and one case of dyspnoea. Two patients subsequently developed a wound abscess which was drained and one patient required removal of the tube. Follow-up of the patients demonstrated the good tolerance of this tube which was maintained for an average of 2.9 +/- 0.5 months (0.1 to 9 months) without any major complications. 3 benign wound infections, 4 inflammatory reactions, 4 minimal leaks, 1 case of hyperthermia, 12 cases of abdominal distension and 2 cases of displacement of the tube were observed. The weight gain was equal to 4%. The authors believe that this technique of endoscopic gastrostomy should be preferred to surgical gastrostomy.

Adult↗

PubMed1989

[Bronchial cancer associated with upper respiratory and digestive tract cancers].

The authors report a series of 63 cases, all operated, of bronchial cancer associated with upper airway cancer. The laryngeal portion of the upper airways was the site of cancer in 50% of cases. The two cancers occurred synchronously in 13% and at different times in 87% of cases. Operative mortality was 3%. Post-operative complications were dominated by bronchopulmonary congestion. Long-term survival was similar to that in series of operated bronchial cancer alone and was 70% at one year and 30% at five years. These results should lead to all isolated pulmonary lesions being considered as second primary cancers with early surgical resection being proposed.

Adult↗

PubMed1989

[Tumors of the nasal fossa. Retrospective study of a series of 67 cases].

This retrospective study reviews 67 tumors of the nasal fossa treated at hospital Laënnec (Paris). The clinical significance of histology and the therapeutic results for each pathological tumor (mainly, carcinoma, melanoma, lymphosarcoma, neuroma, malignant plasmocytoma, inverted papilloma, vascular tumors) are described. Treatment and surgical procedure will be analyzed.

Adult↗

PubMed1989

[Lymph node failure in epithelioma of the glottic floor treated by partial laryngeal surgery. Apropos of 432 patients].

The authors assessed ganglionic failure in a series of 432 cases of N0 M0 epidermoid carcinomas of the glottic floor following partial laryngeal surgery. The overall of ganglionic failure was 7.8%. This rate of failure is related to 64.7% death rate, i.e. 5.1% of the 432 patients under study. This retrospective study differentiates between primary ganglionic failure and secondary ganglionic failure. Primary ganglionic failure is the first local/regional carcinologic event to develop after treatment of any glottic lesion. Secondary ganglionic failure is related to isolated local failures. The percentage of primary ganglionic failure was 5.1%. It was responsible for deaths occurring in 54.5% of cases. The percentage of secondary ganglionic failure was 2.7% and it was responsible for deaths occurring in 83.3% of cases. Factors promoting ganglionic failure (real tumor extension, tumor infiltration, altered laryngeal mobility, local control and efficacy of retakes of local failures) are discussed. The importance of prophylactic surgical procedures guarding from ganglionic failure, such as the ipsilateral jugular-carotid and recurrent nerve approaches is emphasized. Although such procedures can be of aid in cases of T2 or T3 N0 M0 epitheliomas of the glottic floor, they present no alternative in the course of retake operations of local failures.

Adult↗

PubMed1988

[Inoperable cancers of the upper respiratory and digestive tracts. Value of chemotherapy: 185 cases].

A series of 185 squamous cell carcinomas of the head and neck was retrospectively analyzed. Induction chemotherapy was systematically administered. The overall tumour response rate was 38 per cent, and 39 tumours (22.4 per cent) became resectable after chemotherapy. The survival of complete responders was statistically higher than that of non or partial responders. Complete responders treated either by radiation therapy or surgery had similar survivals. Surgery improved the prognosis and reduced the rate of local and regional failures in non responders, including poor responders (less than 50 per cent).

Carcinoma, Squamous Cell↗

PubMed1988

Further experience with the myomucosal tracheoesophageal shunt.

A follow-up study to the initial work of Strome and colleagues in advancing the concept of the myomucosal flap for voicing following total laryngectomy is described. Data are evaluated from 30 patients. Seven of the eight original patients have functioning shunts with excellent voicing and six remain tumor free at more than two years. In the Laennec Hospital (Paris) series of 22 patients, seven shunts are functioning independently. Eleven of 20 inferiorly based flaps stenosed, and all stenoses occurred at the posterior tracheal wall. Technique refinements improved the patency percentage with the seven successes occurring in the last 13 procedures. Four patients in the series had flap necrosis, two of whom had diabetes mellitus and two others extensive paratracheal resections. The technique continues to merit consideration, recognizing that there is a learning curve before success can be anticipated.

Esophagus↗

PubMed1988

[Chemotherapy and partial surgery in epithelioma of the pharyngo-larynx].

On the basis of a series of 185 patients, the authors evaluate the results of the therapeutic sequence chemotherapy-partial surgery in carcinomas of the pharyngolarynx. The action of chemotherapy is confirmed (80% clinical responses greater than 50%, 55% residual tumours or in complete histological regression). The therapeutic sequence chemotherapy-surgery gave 25% local failures and 1% lymph node failures. The development of the therapeutic strategy in carcinomas of the pharyngolarynx is considered in relation to the action of current modalities of chemotherapy.

Actuarial Analysis↗

PubMed1988

[Tumor and lymph node response to chemotherapy. Prognosis in cancer of the pyriform sinus and the lateral laryngeal margin].

The prognostic value of the tumoural and lymph node response to chemotherapy was studied in cancers of the piriform sinus and the lateral laryngeal margin. 102 operable patients were selected and were operated after chemotherapy. The incidence of loco-regional failures and visceral metastases was significantly higher in the absence of any lymph node response.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

[Pharyngo-esophageal diverticula. Treatment and results].

27 patients were seen in the ENT department of Hopital Laennec for pharyngo-oesophageal diverticulum between 1970 and 1987. 25 patients were operated: diverticulectomy in 14 cases, diverticulopexy in 10 cases. Cricopharyngeal myotomy was performed in every case. In one case, myotomy was the only treatment. The postoperative course and the functional results were analysed in the 3 groups. The operative indications are discussed. The functional results were excellent regardless of the technique used (95.8% in the present series).

Aged↗

PubMed1988

[Continuous ambulatory chemotherapy in cancer of the upper respiratory and digestive tract].

Chemotherapy of the upper respiratory and gastrointestinal tracts is currently based on Cis-platinum-5 FU administered by continuous infusions which, up until 1985, were performed in hospital during a 4 days admission. These infusions can now be administered on an outpatient basis over a period of 6 days. More than 600 patients have been treated in this way. The improvement in the results observed on a population of 86 operable patients confirms the value of prolonged continuous infusions. The clinical and psychological acceptability of this method, which allows the patient to maintain his autonomy and sometimes his occupation, is an important advance which could promote extension of this approach, particularly in view of its economic advantages.

Ambulatory Care↗

PubMed1988

[Coral: a new procedure for cranio-facial reconstruction].

Twenty two cranio-facial reconstructions were performed utilizing madreporic coral graft, genera porites. Long-term tolerance was excellent. Surgical technique is described and coral properties are analyzed. Coral grafts used for anterior skull base reconstruction were partly reossified without any infectious complication.

Biocompatible Materials↗

PubMed1988

[Mobility of the vocal cord and the arytenoid in cancer of the larynx and the hypopharynx. Anatomo-clinical study].

Fourty one squamous cell carcinoma of the hypopharynx, laryngeal margin and larynx were studied in order to compare the vocal cord and arytenoid mobilities with the tumoral extension to the intrinsic laryngeal muscles. Several whole organ sections were performed on the surgical specimen for studying specifically the lateral and posterior cricoarytenoid muscles, thyroarytenoid muscles and crico-arytenoid joint. The weight of the tumor located at the top of the arytenoid cartilage without any tumoral extension of the crico-arytenoid muscles can fix the arytenoid, preserving the vocal cord mobility. On the other hand, the simultaneous immobility of vocal cord and arytenoid was associated respectively with 66% of tumoral extension to the crico-arytenoid muscles in hypopharynx and lateral margin carcinomas, and 33% in endolaryngeal tumors. The authors emphasize that a separate clinical evaluation of vocal cord and arytenoid mobilities would give more precise informations concerning surgical indications of laryngeal conservative surgery.

Arytenoid Cartilage↗