Biomedical subjects
Publications and source records attributed to H Laccourreye.
Surgical treatment in three patients with benign tumors of the infrasphenotemporal fossa was through a transoral-cervical approach, a procedure possessing particular advantages when compared with the anterior an external approaches.
Results of treatment of 135 cases of squamous cell carcinoma of soft palate treated between 1962 and 1983 in the ORL department of Hôpital Laennec, Paris, showed prognosis to be related to 3 main factors. Firstly, the frequency of syndromes and metasynchronous multiple primary cancers. Secondly, the presence of local recurrences. Their frequency should be reduced by performing first intention excision of the tumoral site with wide extension to the anterior and particularly the posterior pillars, and by the routine use of induction chemotherapy. Thirdly, nodal recurrences that can be prevented by routine prophylactic treatment of bilateral cervical lymph chains.
Evolution in concepts relative to administration of cytotoxic drugs has reinforced interest in the use of continuous infusion therapy, a method providing a twofold increase in upper respiratory and digestive tract cancer response. A new method, developed by the authors since early 1985 allows the use of chemotherapy over 5 to 10 days in the patient's home. Preliminary results show an increase in efficacy of the therapy, and a marked improvement in the patient's comfort, suggesting that the indications for this new method should be enlarged.
On the basis of 642 patients treated and followed up since 1961 at Laennec Hospital, the authors compare the results of radiotherapy, of surgery and of surgery with subsequent radiotherapy. Surgery followed by radiotherapy gives the best 3 and 5 year survival rates and the lowest local and lymph node recurrence rates. The introduction since 1970 of induction chemotherapy shows an improvement in local prognosis and 5 year survival. There has been a more marked improvement since the introduction of cisplatinum and the use of continuous infusions of cisplatinum and of fluoro-5-uracil with or without bleomycin.
Laryngeal lesions produced during prolonged intubation were studied in 11 larynxes from consecutive patients dying during intensive care. A constant finding was ulceration of the vocal process, combined in 7 cases with inter- or pre-arytenoidal subglottic ulcerations. Histology failed to reveal signs of lesions of the cricoarytenoid joint or chondritis of the posterior arch of the cricoid cartilage.
Post-operative infections are studied about 150 patients distributed in five groups according to type of surgery (total pharyngolaryngectomy, hemilaryngectomy, bucco-pharyngectomy, cordectomy, cervicotomy). An antibiotic prophylaxis by penicillin G and metronidazole was prescribed for all groups excepted the last. Only sixteen patients (seven of whom in bucco-pharyngectomy group) developed a local infection, therefore these antibiotics are indicated until mucosa cicatrisation. Systematic bacteriologic study of cervical drains is useless because they are frequently positive with non-pathogenic germs and in case of local infection the responsible germ is different of the germ obtained by culture of drain.
Tumoral responses to 3 courses of induction chemotherapy were investigated in 176 patients with squamous cell carcinomas of the head and neck previously untreated. The number of responses increased with the number of courses. Thus, out of 79 patients with a more than 50% response after the 3 courses, almost one third had no response after the first course, and 98.8% had a less than 50% response after the second course. In consequence, it may be stated that a 3rd and perhaps a 4th course is justified in patients who responded after 2 courses. There seems to be a poor correlation in responders between clinical and histological results: 68.5% of patients with complete response still had a tumour on the excised tissue. No correlation was found between the influence of T in the TNM clinical classification and that of squamous cell differentiation on the one hand and the macroscopic character of the tumour during response on the other hand.
Prognosis in cancer of the upper respiratory-digestive tract (URDT) is dominated by the importance of local and regional spread, of second localizations or metastases and of any underlying clinical condition. Stable results are obtained using local and regional treatment (surgery and/or chemotherapy) alone, and the use of chemotherapy has been evaluated since 1965, neo-adjuvant cancer chemotherapy being adapted in 1970 for cancer of URDT. From november 1982 to december 1983, 184 patients with epidermoid cancer of URDT were treated by combined therapy with Cisplatin, 5 Fluoro-uracil, Bleomycin as a continuous infusion. Results are presented of the different tumoral responses as a function of localization and stage, excluding any glandular responses.
The authors suggest replacement of the term "infra-temporal fossa" (indicating in the international anatomical nomenclature the pterygo-maxillary fossa) by the term "infra-spheno-temporal fossa" which would seem anatomically more appropriat. In the context of an operation performed in this region for a recurrence of a nasopharyngeal angiofibroma, a review and anatomical study of the different approaches has been undertaken and a classification established. The antero-inferior approach via the cervico-trans-oral route would seem to be of particular interest, offering good exposure of the anatomical features of the region and avoiding the parotid bed ans dissection of the facial nerve.
A patient with cancer of both the hypopharynx and esophagus was treated by partial pharyngolaryngectomy, subtotal esophagectomy and a reconstructive one-stage coloplasty. Surgical and carcinologic problems raised by this technique are discussed.
Explore the source record for details and available documents.
A study of the effects of the CO2 laser on bone was undertaken using human mandibles obtained from cadavers. Different series of shots were used, varying the power and duration of the shots, as well as the latent period between two impacts with intermittent shooting. For a given impact duration, the depth of penetration increased in proportion to power up to 25 watts. Beyond, penetration was less deep but more extensive. For a given intensity, the duration of the shot did not result in any variation in penetration. These findings and their possible clinical implications are discussed.
Explore the source record for details and available documents.
Based on findings in 14 cases of post-intubation laryngeal immobility simulating a paralysis, it is demonstrated that a mechanical cause bringing into play the arytenoids exists in every case. The origin may be from a synechia between the vocal cords, crico-arytenoid ankylosis, inter-arytenoid and plate of the cricoid fibrosis, or a combination of these lesions. Conclusive evidence of the type of lesion involved is rarely apparent from clinical or paraclinical examinations, an exact diagnosis requiring a median thyrotomy. This emphasizes the need for pathologic investigation of the arytenoidectomy surgical specimens. These findings suggest that neurogenic theories concerning the etiopathogenicity of post-intubation laryngeal immobility be revised.
Twenty-seven patients with undifferentiated carcinoma and eleven with lymphoma of the thyroid are reviewed. Histologic sections of all tumors were re-examined critically. Most tumors were extensive forms spreading beyond the thyroid. Complete macroscopic excision was performed in 18 cases, incomplete excision in 12 patients. Surgery was not carried out in 8 patients, while radiotherapy was given to 27 cases. Local changes decide the prognosis whatever the findings on histology. Undifferentiated carcinomas have a poor local prognosis even after apparently satisfactory macroscopic excision. Effective local control was obtained in all cases of lymphoma treated by surgery and radiotherapy combined.
The authors analyse the results of treatment of 84 squamous cell carcinomas of the mobile portion of the tongue treated between 1961 and 1982. 64% of the patients treated were Stage I or II. The local recurrence rate was 13% at 5 years (6/43) for T1, T2. Recurrences were more frequent after interstitial radium therapy (17% at 5 years: 5/28) than after partial glossectomy performed at the outset (6.6% : 1.15). The treatment of stage NO remains controversial. The frequency of lymph node recurrences remains proportional to lymph node involvement by histology (NO, N-: no recurrences; NO, N+: 18.1%: 6/33) but seemed to be independent of the initial treatment of the regional nodes: no treatment, neck dissection with or without subsequent external radiotherapy. It is important to emphasize that lymph node recurrences contralateral to the tumour always occurred in the presence of initial homolateral lymphadenopathy with capsular rupture. Other oncological failures were frequent (35% : 20/56) at 5 years, grouping together visceral metastases (14.3% : 8/56) and second primary cancers in the upper respiratory/digestive tract (21.4% : 12/56).
A new classification for laryngotracheal stenoses in adults is proposed, based on 145 cases treated between 1965 and 1980. Three factors were analyzed when establishing this classification: the extent of laryngeal and tracheal cartilage involvement, laryngeal mobility, and the complexity of the lesions as a function of whether they were systematized or not. This new approach enables a more functional therapy for these stenosis to be instituted.
Laryngotracheal stenosis in 145 adults was the direct result of laryngeal lesions in 27 cases and of iatrogenic etiology in 118. External injury was at the origin of most of the direct cases, the resulting complex anatomical lesions being treated with difficulty and having a very poor prognosis. Lesions of an indirect origin were principally sequelae from intensive care, their analysis and treatment being more easily systematized.