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Biomedical subjects

J Lacau St Guily

Publications and source records attributed to J Lacau St Guily.

At least 19 recordsLinked to original sources
PubMed2006

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT-PCR detection of cytokeratin 19 mRNA.

The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin-eosin-safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse-transcriptase polymerase chain reaction (real-time RT-PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT-PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT-PCR assay were 16.3 and 36.0%, respectively (P<0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (P<0.0001). These results indicate that real-time RT-PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC.

Adult↗
PubMed2003

[Use of botulinum toxin type A in neuro-ORL].

Dystonia is the result of abnormal contractions of muscles, which may disturb activities between agonist and antagonist muscles. Since synchronization of laryngeal and masticatory muscles is highly necessary to allow opening and closure of the larynx or the mouth, expression of dystonia is especially exhibited. Focal laryngeal dystonia may disturb phonation, but also breathing or swallowing, which may be difficult to identify. In ORL, the botulinum toxin is used to treat focal dystonias, especially laryngeal (spamodic dysphonia being predominant) and oromandibular dystonias. Beside these indications, intracutaneous injections of botulinum toxin may be helpful in Frey's syndrome in patients with gustatory sweating; injections in the upper esophageal sphincter are also performed in cricopharyngeal dysphagia although this indication is mainly controversial.

Botulinum Toxins, Type A↗
PubMed2003

[2003 update of Standards, Options and Recommandations for radiotherapy for patients with salivary gland malignant tumors (excluding lymphona, sarcoma and melanoma)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers. and specialists from French public universities,general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been defined, the document is submitted for review by independent reviewers. RESULTS: This article presents the updated clinical practice guidelines concerning irradiation of patient with salivary gland tumors. The main recommendations are: 3 dimensional conformal radiotherapy (with or without intensity modulation) or 2D irradiation can be used; for surgical complete resected patients, postoperative photon radiotherapy should not be used in case of low grade stage I and 11 tumors(standard, level of evidence B2) but should be used for high grade stage II, II and IV tumors and for low grade stage III and IV tumors(standard, level of evidence B2). Neutron therapy should not be used in all of these cases (standard, level of evidence D); for patients presenting an incomplete macroscopic or microscopic surgical residual disease, postoperative irradiation must be delivered(standard). Neutron or photon therapy can be either delivered (options); for non operable patients neutron or photon therapy can be either delivered (options, level of evidence B2); for unresectable tumors or in case of recurrent neoplasms, exclusive neutron therapy or surgical tumor reduction combined with postoperative photon beam irradiation can be proposed (options, level of evidence C).

Combined Modality Therapy↗
PubMed1998

Asymmetry of the laryngeal reflex responses to superior laryngeal nerve stimulation unrelated to the length of the recurrent nerves in the porcine model.

Electrical stimulation of the superior laryngeal nerve (SLN) can elicit reflex responses in the cricothyroid (CT) and thyroarytenoid (TA) muscles. We made bilateral recordings of the responses evoked in these muscles in piglets by the stimulation of either the right or the left superior laryngeal nerve (SLN). The stimulus intensity was gradually increased to study the "persistence" of the responses. We observed a direct, ipsilateral response in the CT muscle, and reflex, ipsilateral and crossed responses in both CT and TA muscles. The ipsilateral or contralateral responses obtained in TA muscles, following stimulation of the left SLN, were significantly delayed in comparison with those evoked by stimulation of the right SLN. This delay cannot be explained by the difference in length between the right and the left recurrent laryngeal nerves, but rather by an asymmetry in the sensory afferent pathway. The functional significance of this observation remains to be determined.

Afferent Pathways↗
PubMed1997

Dysphagia in oculopharyngeal muscular dystrophy: a series of 22 French cases.

Twenty-two patients (mean age = 67.9 years) with oculopharyngeal muscular dystrophy (OPMD) were referred for dysphagia from 1987 to January 1995. Six patients had suffered aspiration pneumonia, and three had significantly lost weight, while 19 complained of discomfort during swallowing but without weight loss. Swallowing was assessed by fiberscopy during swallowing (last eight patients), videofluoroscopy (12 cases) and manometry (19 cases). Twelve patients underwent a cricopharyngeal (CP) myotomy: 10 showed improvement, one had a partial improvement, and the procedure failed in one (mean follow-up = 29.6 months). In the other cases, CP myotomy was postponed, refused or contraindicated. Of the 22 patients, three died from OPMD consequences. Factors associated with favorable outcome were adequate residual pharyngeal propulsion and no weight loss. In a majority of cases, CP myotomy constitutes an effective treatment of dysphagia with adequate residual propulsion but does not modify the final prognosis and is contraindicated in cases with pharyngeal aperistalsis.

Adult↗
PubMed1995

[Myotomy of the upper esophageal sphincter in upper functional dysphagia. A series of 34 cases].

OBJECTIVES: Patients with disorders of the upper oesophagus often present with swallowing impairment. We evaluated our results in 34 patients treated with cricopharyngeal myotomy. METHODS: Etiologies were muscular in 11 patients, neurogenic in 10, cricopharyngeal achalasia in 7 and could not be ascertained in 6. A 4 to 6 cm myotomy of the cricopharyngeal muscle and the lower part of the oesophageal constrictor muscle was performed. Incision was made to the mucosa. Outcome was evaluated in terms of functional improvement, weight gain and post-operative mode of food intake. RESULTS: Favourable results were obtained in 19 patients. Incomplete improvement was achieved in 6 and the operation was unsuccessful in 11. CONCLUSION: The quality of residual pharyngeal propulsion appears to be the determining element in operative success and should be used in determining indications.

Adolescent↗
PubMed1995

Laryngeal tardive dyskinesia.

Neuroleptic treatment frequently induces movement disorders, the tardive dyskinesias. These are frequently seen in the orobuccolingual region. Although the beginning of neuroleptic treatment can cause acute dystonia and breathing difficulty, chronic neuroleptic treatment has only rarely been shown to affect the laryngeal musculature. Laryngeal abnormal movements were assessed in 12 patients receiving chronic neuroleptic treatment who showed orobuccolingual abnormal movements. The Abnormal Involuntary Movement Scale was systematically assessed in all patients. Clinical examination revealed that 8 had speech disorders, 8 had breathing difficulties, and 5 had swallowing disorders. Laryngeal endoscopy showed that 10 of the patients had intermittent partial obstruction of the glottis, due to repetitive abnormal adduction of the vocal cords. Percutaneous electromyography of the thyroarytenoid muscles showed spontaneous irregular and prolonged muscular contractions, while the patients were at rest and when speaking. The patients were not aware of these movements. In view of this finding, laryngeal dyskinesia should be considered and studied as a possible side-effect of chronic neuroleptic use.

Adult↗
PubMed1995

Improvement of dysphagia following cricopharyngeal myotomy in a group of elderly patients. Histochemical and biochemical assessment of the cricopharyngeal muscle.

Cricopharyngeal myotomy is not effective in all cases of dysphagia. However, it should be the specific treatment in cases of dysphagia caused by a primary cricopharyngeal muscle dysfunction. Of a group of 10 patients with swallowing disorders in the absence of any defined cause, 7 (mean age, 81.6 years) were improved by a myotomy and 3 were not. The cricopharyngeal muscle was studied histologically and biochemically and compared to muscle obtained from nondysphagic subjects. In the muscle of the 7 improved patients, homogeneous histologic abnormalities were demonstrated: connective tissue infiltration, inflammatory cell infiltration, and degenerative changes of the muscle fibers. Conversely, muscles of the nonimproved patients and of the controls did not present the same degree of histologic lesions.

Aged↗
PubMed1993

[Deglutition disorders in Lyme disease with severe neurological involvement].

A 67-year old man consulted for dysphagia to solid food and weight loss. Four years earlier he had developed Lyme disease with severe neurological involvement. Magnetic resonance imaging showed, on T2-weighted sequences, multifocal high-intensity signals located in the periventricular white matter and the brain stem. The disorders of deglutition were evaluated by cineradiography and manometry which showed deficient relaxation of the superior esophageal sphincter and delayed initiation of the pharyngeal phase; intrapharyngeal propulsion was preserved. On the basis of these findings cricopharyngeal myotomy was performed with subsequent improvement of the disorders. Treatment with doxycycline was prescribed. The significance of these deglutition disorders as regards infection and neurology is discussed and it should have therapeutic implications.

Aged↗
PubMed1993

[Abnormal movements of the larynx. Diagnostic approach and therapeutic perspectives].

Laryngeal movement disorders of neurological cause are actually misunderstood. In the course of chorea, or tardive post neuroleptic dyskinesia, vocal, swallowing for threatening breathing troubles could occur. Ten patients with generalized dyskinesias were studied by endoscopy with flexible laryngoscope and laryngeal electromyogram. Four of them were choreic and six had tardive dyskinesia (one had a severe breathing disorder). Nine patients had abnormal movement disorders (MD) involving intrinsic laryngeal musculature. MD were spontaneous or were triggered by vocalization. These facts suggest that dyskinesia as they involved the upper airway tract could be life threatening. Laryngeal electromyography is a useful method for diagnosis and treatment of these dyskinesia. As in spasmodic dysphonia, botulinum toxin could be helpful in this local treatment.

Adult↗
PubMed1993

[Mega-dolicho carotid arteries. Role of non-invasive imaging. Apropos of 3 clinical cases].

Three cases of aberrant (elongated and tortuous) carotid arteries of the neck are reported. In 2 patients the carotid artery abnormalities were discovered at diagnostic work-up for: 1) sudden deafness, 2) persistent pharyngeal discomfort. Both patients presented a pulsating bulge in a pharyngeal wall with no lesion of the mucosa. In the third patient, the arterial abnormality was a peroperative discovery. All patients presented factors of risk for vascular disease. In the 2 symptomatic patients, Doppler U.S. and magnetic resonance imaging made it possible to confirm the diagnosis and to eliminate other vascular or tumoral disorders. The indications and limitations of the various available diagnosis imaging procedures are assessed.

Aged↗
PubMed1992

[Upper functional dysphagia. Apropos of 33 cases].

Upper functional dysphagia, occurring in the absence of tumoral obstruction, includes swallowing disorders caused by a disturbance of the reflex, velopharyngoesophageal time of deglutition. Thirty-three patients with such disorders have been studied. Fourteen suffered from a neurologic affection (including 4 brainstem tumors and 6 cerebrovascular neurologic disease), 10 from myopathy, 9 from a localized affection of the upper sphincter of the esophagus. Diverticula were excluded from this study. The exploration resorted to fiberendoscopy of esophageal follow-through, pharyngoesophageal manometry, radiocinema, and MRI for some of the latter patients. Cricopharyngeal myotomy was carried out in 16 of these patients, with good results in 10 and failures in 6. The role of the various additional examinations and of myotomy is discussed.

Adolescent↗
PubMed1991

[Difficult intubations. A prospective study].

A prospective tubing of tracheal tubing in view of general anesthia was performed in 441 adults undergoing scheduled surgery. Before surgery, the anesthesists and ENT specialists tried to independently predict the cases of difficult tubing, according to different criteria. Tubing actually was difficult in 38 patients (8.6ù) instead of the 21 (55.2%) expected by the ENT specialists and/or the anesthesists. These difficulties were solved by bronchoscopy, which allowed tubing to be performed with a guide-probe (3 cas), by scheduled fiberendoscopy (6), tracheotomy (1), nasotracheal tubing (1), spontaneous ventilation (2), and orotracheal tubing in 25 cases. Current knowledge of the predictive criteria is incomplete: anesthesists must be aware of the assistance techniques required in case of difficult tubing in a non-ENT context.

Adult↗
PubMed1991

[Vocal restoration by tracheo-esophageal fistula. Evaluation of a 5 years' experience].

Between december 1985 and august 1990, 70 patients with total laryngectomy had their voice restaured by creation of tracheo-esophageal fistula. The tracheo-esophageal fistula was created during laryngectomy in 33 cases (20 punctures with Blom Singer prostheses, 13 surgical shunts), a few weeks later after surgery of radiotherapy in 17 cases or when production of esophageal voice feld in 20 cases. No major complication was observed. Results following voice recovery were satisfactory in 78.5% of cases (normal voice), one month after the procedure. Results are better when tracheo-oesophageal fistula was used initially (88%), than performed secondary (55%). After one year, results were satisfactory in 75.5% of cases.

Esophagus↗