Biomedical subjects

J Depondt

Publications and source records attributed to J Depondt.

33 records · Page 2Linked to original sources

PubMed1993

[Value of the characterization of cytokeratins in the oropharyngeal epithelium].

Cytokeratins are cytoskeletal components and constitute the intermediate filaments of epithelial cells. They are twenty in number and their distribution characterizes a very specific profile in each kind of epithelium. The authors characterized the cytokeratin repartition of the normal oropharyngeal epithelia in order to study their alterations in pathologic tissues, especially in neoplastic and dysplastic epithelia. The normal oropharyngeal epithelium shows cytokeratin pattern of non keratinized stratified epithelia. Three mucosa samples were studied from inflammatory, dysplastic and neoplastic epithelia. According to the alterations of cytokeratin repartition in the two last samples, cytokeratin pattern analysis could allow a characterization or the differentiation stage of neoplastic tissues before the expression of morphogenic criteria.

Antibodies, Monoclonal↗

PubMed1993

[Conservative trans-mandibular lateral pharyngectomy. Functional results in a series of 38 patients].

The authors present their experience with conservative transmandibular lateral pharyngectomy used for access to oropharyngeal tumours of the buccal cavity. This study was conducted to evaluate both early results and later aesthetic and functional sequelae after a simplified operation using mini-plaques. This surgical route was used for 38 patients since 1985, including 9 for salvage operations. Surgical indications were tumours of the posterior wall of the pharynx (28), the posterior part of the tongue (8), the retromolar tigone (1), the intramaxillary commissure (2) and the pelvi-lingual region (2). Access via the mandibulotomy was always evaluated peroperatively on the basis of the cleavability of the periosteum of the medial mandibular table. Immediate follow-up was uneventful in 74% cases. Post-operative complications included two general decompensations due to the original lesion, four minor local complications (spontaneous by regressive non-unions) and four local complications requiring a second intervention (flap necrosis, 2; orostomy, 2). Five of the complications were directly related to the mandibulotomy, giving an overall rate of 13%; the rates for first intention and salvage surgery were 9% and 18% respectively. Functional capacity was considered excellent in 75% of the cases and the aesthetic results were good in 94%. The satisfactory post-operative course, the low rate of major complications both after first intention and salvage surgery, and the excellent functional and aesthetic results suggest that transmandibular bucco-pharyngectomy should be preferred whenever the state of the cancerous lesion does not require exeresis of the ramus.

Adult↗

PubMed1992

Neoadjuvant combination of carboplatin and 5-FU in head and neck cancer: a randomized study.

A prospective, randomized, multicenter study of patients with oropharyngeal and pharyngolaryngeal tumors compared locoregional treatment alone with neoadjuvant chemotherapy with carboplatin/5-fluorouracil (5-FU) followed by locoregional treatment. The aim of the study was to evaluate the role of chemotherapy on survival and on the need for mutilating surgery. Since 1988, 219 patients (105 with oropharyngeal and 114 with pharyngolaryngeal tumors) have entered the study. All patients randomized to neoadjuvant chemotherapy received three cycles of carboplatin 400 mg/m2 day 1 and 5-FU 1 g/m2/d as a continuous infusion days 1 through 5 every 3 weeks. Neoadjuvant chemotherapy was given to 108 patients. The 268 evaluable courses induced a low rate of grade 3 or 4 toxicity. Four patients (3.6%) died of major complications. The complete response (CR) rate was 31%, which represented a decrease in mutilating surgery of 30%. (Patients with CRs had radiotherapy alone instead of radiosurgical treatment as originally planned.) The objective response rate was 61%. Survival curves for the chemotherapy and chemotherapy-naive groups were not significantly different. The rate of nodal recurrence was significantly higher in the chemotherapy group, however, and chemotherapy did not decrease the rate of second primary tumors or distant metastases. Thus, the justification for neoadjuvant chemotherapy may be a decreased rate of mutilating surgery. These preliminary results are encouraging, but follow-up is as yet too short to allow definite conclusions.

Adult↗

PubMed1992

Advanced carcinoma of the tongue: total glossectomy without total laryngectomy. Review of 80 cases.

Opinions are divided over the validity of total glossectomy without associated total laryngectomy for advanced carcinoma of the tongue. This retrospective study evaluates the oncologic and functional results obtained in 80 patients who underwent total glossectomy as a primary procedure or as salvage surgery. Satisfactory swallowing ability was obtained in 41 patients, and speech was understandable in 49 patients. The survival rate at 1 year was 65%, with early recurrence of the disease, which was especially frequent in patients with prior radiotherapy, being the major cause of death. The study confirms the poor prognosis of cases with mandibular involvement, and the fact that partial laryngectomy, when required, impairs functional results. In the light of the authors' experience, total glossectomy without total laryngectomy should only be undertaken in motivated and well-supported patients able to accomplish the difficult rehabilitation process.

Adult↗

PubMed1990

Comparison of cefpodoxime proxetil with cefaclor in the treatment of sinusitis.

The efficacy and tolerance of cefpodoxime proxetil were compared with those of cefaclor in a multicentre, international, prospective, double-blind, placebo-controlled study in adult outpatients suffering from acute sinusitis. At the end of treatment, cefpodoxime proxetil was more effective than cefaclor, producing complete clinical cure in 84% of cases (102/122) vs 68% of cases (77/114) in the cefaclor group (P = 0.01). The overall clinical efficacy (cure + improvement) was similar in the two groups with 95% (116/122) satisfactory responses in the cefpodoxime proxetil group and 93% (106/114) in the cefaclor group. Bacteriological response was similar with 95% eradication in the cefpodoxime proxetil group (55/58) vs 91% with cefaclor (63/69).

Acute Disease↗

PubMed1990

[Conservative transmandibular lateral pharyngectomy in cancer of the lateral oropharyngeal wall].

The authors present conservative transmandibular lateral pharyngectomy (CTLP) as a substitute for BPTM operations in cancers of the tonsillar region. The mandible is sectioned along the symphyses and the oropharynx is widely exposed through an incision of the pelvilingual sulcus. The authors propose a primary operability criterion that allows to salvage the mandibular angle, which is usually sacrificed. This can be assessed peroperatively by testing the possibility to cleave and spread inwardly the pharyngomandibular region following detachment of the pterygoid muscles. The functional and cosmetic benefits of this method are obvious and should commend its more frequent utilization.

Bone Plates↗

PubMed1990

[Mouth and pharyngeal hyperalgesic syndromes in AIDS].

In a series of 12 patients suffering from an HIV infection, including 9 with confirmed AIDS, who complained about pharyngeal pain in a fixed site, having a progressive intensity and not relieved by antalgics and the specific treatments that were prescribed empirically, and for whom etiological investigation yielded negative results, Thalidomide proved to be the only effective means of healing the exulcerated, nail-mark lesions or the ulcerated, budding, neoplastic-like lesions, and of completely suppressing pain.

Acquired Immunodeficiency Syndrome↗

PubMed1989

[Otologic manifestations presenting and predominating in necrotizing angiitis].

The authors report on 5 observations of necrotising angiitis with a specifically otological onset, namely 4 Wegener's syndromes and one periarteritis nodosa. In all 5 cases, the initial symptomatology consisted of otological signs in a feverish context, producing pictures of serous or sero-purulent otitis. Its resistance to usual forms of therapy led in 3 cases to the installation of transtympanic aerators, and in 2 cases to the performance of an antro-attico-mastoidectomy. One of the observations led to the discovery in the middle ear of a histological aspect specific to the disease, from which it can be considered that the otologic impairment could be a specific seat of the disease. The 5th observation is particular in that it was the otological signs which revealed each time a new progression of the disease, enabling the immediate implementation of an adapted treatment prior to the occurrence of the systemic signs. 3 observations proved the difficulty of diagnosis at the initial stage, when at times only the otological signs are present, together with the importance of its discovery prior to the occurrence of systemic lesions that are occasionally irreversible. Any isolated otological symptomatology in a feverish context, resisting usual therapies, should evoke the diagnosis, and lead to the performance of further duly adapted examinations (sedimentation rate, pulmonary X-ray, proteinuria, hematuria).

Adult↗

PubMed1988

[Buccopharyngeal Kaposi's sarcoma in AIDS. Apropos of 51 cases].

The authors present a series of 51 cases of buccopharyngeal Kaposi's sarcoma observed in patients with AIDS. The diagnosis of Kaposi's sarcoma is generally obvious due to its appearance, its constantly violaceous colour and its site, especially palatine and velar. When Kaposi's sarcoma is the first manifestation of the disease, it appears to be associated with a relatively favourable pejorative connotation when the nevertheless extremely modest median survival of these patients is compared with that of patients who initially presented with an opportunistic infection not associated with Kaposi's sarcoma. Buccopharyngeal Kaposi's sarcoma is usually only an epiphenomenon. It is rare that the local course requires any tumour reduction treatment. When such treatment is required, radiotherapy with 35 Gys is currently considered to be the best solution.

Acquired Immunodeficiency Syndrome↗

PubMed1987

[Plastic surgery of aplasia of the external ear. Apropos of 65 cases].

Principles underlying reconstructive surgery of external ear for major aplasia are described and results presented for 65 patients treated using a cartilaginous framework of a costal autograft as described by B. Brent. Possibilities are discussed of combining this technic with auditory function surgery and the wearing of an auditory prosthesis within the framework of general care of major aplasias.

Cartilage↗

PubMed1987

[Laryngeal dyspnea of infectious origin in the adult. Apropos of 54 cases].

Principal etiologies in 54 patients with acute laryngeal dyspnea of infectious origin were epiglottitis (35 cases), glotto-subglottal laryngitis (8 cases) and adjacent infections (9 cases). These cases are reviewed together with the relevant published literature and various conclusions drawn. The affection is serious (35 deaths out of 425 cases in the literature), and requires careful examination, immediate treatment and routine hospital care under surveillance. Apart from cases where the condition of the patient necessitates urgent intubation, those cases with rapidly evolving signs over 24 hours must be admitted to intensive care since worsening of dyspnea can lead to delayed decompensation. Wide spectrum antibiotic therapy is necessary for patients with epiglottitis and adjacent infective ulcerations since many germs may be implicated, while for the always benign glotto-subglottal laryngitis Amoxicillin + clavulinic acid is sufficient.

Acute Disease↗

PubMed1986

[Cervicofacial lymphangiomas in children].

Of 41 children, 22 girls and 19 boys, with cervicofacial lymphangioma, 31 had congenital lymphangiomas, 30 lymphangiomas with cervical expression but only 9 were restricted to the neck region. Operation in 35 children showed that in 12 cases the lymphangioma was limited in extent and failed to extend to the neck or parotidojugular region, and excision was complete and there were no recurrences. Partial excision was performed in 23 children in whom the lymphangioma extended to various degrees into the tongue, pharynx or larynx, and tracheotomy was necessary in 10 of these cases. Several operations, and particularly endoscopic resections, are often necessary in this type of dysembryoplasia in order to obtain a sufficient airway. Esthetic results are often disappointing.

Child, Preschool↗

PubMed1985

[Postoperative infection in ORL oncologic surgery. The choice of preventive antibiotherapy. Experience of the ORL Department of Hôpital Claude Bernard].

The incidence of infection after cervicofacial surgery for ENT cancer varied between 38 and 60% as a function of the type of operation, and prophylactic antibiotic therapy administered, in a series of 133 cases. Contamination was greatest after operations of longest duration and with the largest exposure of tissue. Previous cobalt therapy was an aggravating factor. The highest risk of infections complications resulted therefore from combined salvage operations and the use of a musculocutaneous flap. Among these infections, a purulent bronchorrhea was a frequent and potentially serious complication sometimes the cause of septicemia. A review of 4 different antibiotic therapy regimens showed the pre-operative administration failed to alter the outcome. Combined penicillin-5 imidazole treatment, effective in preventing local and regional anaerobic infection, resulted in secondary infection developing in about 56% of cases. It was not able, in fact, to cover under certain circumstances during prolonged surgery, the postoperative risk of inhalation of gram-negative anaerobic and aerobic bacteria form the buccal cavity. Short-term antibiotic therapy was totally ineffective. It is suggested that combined penicillin-5 imidazole be reserved for operations provoking little contamination of the tracheobronchial region, such as total laryngectomy and total pharyngo-laryngectomy, and that prophylactic therapy using an antibiotic with a wide spectrum against gram negative germs be administered prior to major buccopharyngeal operations with tracheotomy.

Anti-Bacterial Agents↗

PubMedDate not supplied

Lateral supraglottic pharyngo-laryngectomy with arytenoidectomy.

BACKGROUND: Supraglottic laryngectomy for tumors of the epilarynx requiring arytenoid cartilage resection is frequently associated with problems in relearning to swallow, and aspiration is frequent. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect. METHODS: An apron skin incision is used to expose the hyoid bone and strap muscles. The median raphe is opened, and the hyoid bone is cut along the midline and released on its posterior surface. The thyrohyoid and stemothyroid muscles ipsilateral to the tumor are separated, with the perichondrium from the thyroid cartilage. This forms a continuous flap that includes the suprahyoid muscles and hemihyoid bone, together with the strap muscles and thyroid lobe that will be used for closure. RESULTS: Thirty-three patients with T1-T3 carcinomas of the laryngeal margin, with extension to one arytenoid in all cases and to the pyriform fossa in 14, underwent this procedure. Only 5/33 (15%) patients had locoregional recurrences. Visceral metastases occurred in 11/33 (33%) patients, and second primary tumors were diagnosed at the time of surgery or during follow-up in 9/33 (27%) patients. Three-year and 5-year actuarial survival rates were 57% and 51%, respectively. Despite the need for radiotherapy in 26 patients, functional success was obtained in 26/33 cases (79%). CONCLUSION: This technique provided good tumor control and a high rate of satisfactory functional results. It can be applied to patients with tumors of the lateral margin which unilaterally extend to the aryepiglottic fold, the arytenoid, and the medial well of the pyriform fossa.

Adult↗

PubMedDate not supplied

Primary and salvage surgery for cancer of the tonsillar region: a retrospective study of 120 patients.

The present series compares results in our head and neck department from primary and salvage surgery for tumors of the tonsillar region from 1978 to 1985. Of 120 consecutively admitted patients, 70 underwent primary surgery followed by irradiation, and 50 underwent salvage surgery after the failure of primary radiotherapy. Follow-up has been continued for the past 6 years. Musculocutaneous flaps were employed in all patients requiring them after the introduction of this reconstructive technique in 1981. The actuarial survival rate after primary surgery was 58% at 3 years and 46% at 5 years. For salvage surgery the figures were 38% and 24%, respectively. This disappointing survival rate in salvage surgery resulted from a higher postoperative mortality (8% versus 1.4% in primary surgery) and from a higher local failure rate (36% versus 14%). The outcome was invariably unfavorable when tonsillar tumors extended into the base of the tongue.

Actuarial Analysis↗