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Biomedical subjects

J Trotoux

Publications and source records attributed to J Trotoux.

At least 55 records · Page 3Linked to original sources
PubMed1990

Clinical significance of otoacoustic emissions: a perspective.

The aim of this paper is to review the properties of otoacoustic emissions from a clinical point of view and to discuss the perspective interest of this test. In adults, the clinical significance of evoked otoacoustic emissions seems to be limited either in endocochlear hearing losses or for detecting retrocochlear diseases. In infants, evoked otoacoustic emissions seem to be a reliable, simple, non-invasive, and precise method for estimating auditory sensitivity for midfrequencies (1-4 kHz). Then, EOEs could be considered as an interesting way for screening auditory dysfunction in infants.

Adult↗
PubMed1990

[Surgical treatment of associated bronchial, upper respiratory and digestive tract cancers].

Between 1980 and 1987, 63 lung cancers associated with upper aero-digestive tract carcinomas were operated on 50% of the primary malignancies of the upper aero-digestive system were laryngeal. These tumors developed synchronously in 13% and metachronously in 87%. The operative mortality rate was 3%. The five years survival rate was 30%. Our results were found identical to those observed in a single lung cancer series. Coin lesion of the lung should be therefore considered as a second primary cancer. Thus, the best treatment is surgical resection. When the option exist, the lung cancer should be treated before the upper airway cancer to avoid the impact of previous irradiation and/or surgical treatment of the upper airway cancer upon the post-thoracotomy management.

Adult↗
PubMed1990

[Systematization and histomorphometry of human laryngeal nerves].

Laryngeal nerves were dissected from 100 fresh subjects in order to compare right and left superior and inferior laryngeal nerves. The origin and the distribution of the vascularization was studied. The structure of these nerves was precised through an histomorphometric approach (distribution number of myelinated fibers per mm2, diameter of myelinated fibers). A cartographic study of the laryngeal nerves confirmed the structure of this innervation. The main conclusion of this study is the importance of the plexis structure of the laryngeal innervation and the variations of the nerve fibers diameter as a function of the length of the fiber.

Computers↗
PubMed1990

[Acoustic distorsion products: technic, reproducibility and audiometric value. A new technic for the clinical evaluation of hearing].

Acoustic distorsion products are sounds emitted by the cochlea, in relation with the outer hair cell properties and the micromechanical properties of the Organ of Corti, in response to an acoustic stimulation by two primairies F1 and F2. Acoustic distorsion product 2F1-F2 have been recorded in two populations: 10 normally-hearing subjects and 10 subjects with pure sensorineural hearing losses. Three points are discussed: (i) the test-retest reliability, (ii) the clinical tolerance and (iii) the clinical applications of this test.

Adolescent↗
PubMed1990

[Pharyngoesophageal reconstruction using a vascularized free jejunal graft. Indications--technique and surveillance. Report of 90 cases].

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.

Emergencies↗
PubMed1990

[Local and lymph node recurrence of epitheliomas starting in the glottis, treated by partial laryngeal surgery: apropos of 432 patients].

Four hundred and thirty-two patients with a carcinoma of the true vocal cord, treated with a partial laryngectomy from 1972 through 1984, were retrospectively analyzed. All patients were staged as NO, MO. Survival and death rates were not presented. A three-year minimum follow-up was achieved in 97% of the cases. Local and cervical recurrences were presented and analyzed. Factors such as local tumor extent, impaired mobility of the true vocal cord, invasion of conus elasticus or thyroid cartilage, and positive margins of resection enhance the outcome of local and cervical recurrences. This present report underscores that thyrotomies, hemilaryngectomies, and cricohyoidoepiglottopexies should be adapted to the exact tumor location and the laryngeal mobilities. Cervical lymph node recurrence is less likely to happen if local control is achieved. The role and rationale for an associated elective ipsilateral cervical and paratracheal lymph chain dissection are presented and advocated.

Adult↗
PubMed1989

[ORL manifestations of gastroesophageal reflux].

In the E.N.T. area, gastro-oesophageal reflux (GOR) is manifested as atypical pharyngitis or laryngitis. E.N.T. examination is frequently negative. The diagnosis rests on demonstration of the reflux which is clinically obvious in most cases. It must be confirmed by exploratory methods, the main one being oesophageal pH measurement. Fibroscopy is useful to exclude an associated oesophagitis. GOR is very frequent in children and indeed unavoidable during the first weeks of life. It may produce inflammatory E.N.T. symptoms, but also obstructive apnoea and nocturnal cough. Management essentially consists of hygienic and dietetic measures. It is highly effective as regards both GOR and its atypical E.N.T. manifestations.

Adult↗
PubMed1989

[Cardiotoxicity of 5-fluorouracil: coronary spasm? Apropos of 2 cases with normal coronarography].

Five fluoro-uracil (5-FU) is a cytotoxic drug which has been extensively used for chemotherapy since 1957. Ischaemic heart disease resulting from its administration is rare. Spontaneous angina during infusions of 5-FU was observed in two patients with electrocardiographic changes suggesting coronary spasm. After treatment, clinical examination, electrocardiogram, echocardiogram, stress test, coronary angiography with left ventriculography were all normal. An Ergonovine test was performed in one patient but failed to elicit coronary spasm. In the other patient, intravenous trinitrin and diltiazem were ineffective in preventing the ischaemic changes. A review of the literature is presented (51 cases). The pathophysiology of 5-FU-induced ischaemic heart disease is not fully understood. In 9 cases, coronary angiography was normal and coronary spasm was suggested as a possible cause. However, antispastic drugs are usually ineffective. It has been shown experimentally that 5-FU has a direct toxic effect on the myocardium.

Adult↗
PubMed1989

[Submucosal resection of the inferior nasal turbinates].

Nasal obstruction is frequently related to hypertrophy of the bony inferior nasal conchae. Medical management and/or isolated correction of deviation of the nasal septum are often inadequate. Surgical management, although it has raised controversy, becomes the only therapeutical course. Submucosal resection of the conchae was performed in 104 patients between 1986 and 1988. Subjective analysis of postoperative data shows 82% of successful surgery cases yielding good nasal repermeabilization with some minor unpleasant effects, such as nasal crusts or discharge in 46% of cases. The authors describe the surgical technique as well as its indications, and its advantages as compared to medical treatment, cauterization or subtotal resection of the conchae in incapacitating nasal obstruction cases.

Adult↗
PubMed1989

[Parotid tumors of intermediate malignancy. Prognostic assessment. Review of the literature].

In 264 patients operated at Hôpital Boucicault for neoplasma of the parotid gland, 9 presented mucoepidermoid carcinoma and 4 had acinic cell adenocarcinoma. These latter 13 cases of intermediate malignancy tumors were assessed, although the retrospective follow-up period was insufficient to formulate an estimate on the survival rate of these patients. The authors further review the bibliographical data useful in evaluating the prognosis for such neoplasia. They stress the controversy existing around opinions concerning histology-based prognosis and recent advance on nuclear DNA. Indications for postoperative radiotherapy is discussed.

Carcinoma↗
PubMed1989

[Echography in studying the hyothyroepiglottic space. Normal image. Pathologic aspects. Histologic correlations].

Invasion of the hyothyroepiglottic (HTE) space, or pre-epiglottic space, constitutes an important element in selecting the type of therapy in cancer of the larynx (functional surgery, radiotherapy), the oropharynx and the hypopharynx. Clinical examination and standard X-ray films provide insufficient information. High frequency real time ultrasonography offers a reliable means for exploring the pre-epiglottic space, as evidenced by this study carried on 34 histologically-confirmed cases taken among 77 cases of carcinoma of the upper digestive and respiratory tracts. Advantages presented by this method over CT-scanning and MR imaging in this particular pathological are simplicity, rapidity and low cost, combined with good performance.

Humans↗
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

[Complete tumor remission after chemotherapy. What should be done?].

When confronted with complete chemotherapy-induced histological/clinical regression of a tumor, should the initial therapeutical strategy be modified? Such situations occur more and more frequently. Additional treatment must be carried out in all instances. Indeed, a correlation between complete clinical and histological regression was demonstrated in 66% of cases by histological examination of surgical specimens. It is doubtless recommended to avoid mutilating surgery and to continue chemotherapy for another year. However, whenever partial surgery had been programmed initially, the same indications and excision limits should be maintained. Combination chemical and surgical treatments yield better local results. Nonetheless, this is not always the case and the patient's tolerance to chemotherapy and background should influence the final decision. Radiotherapy then constitutes a choice alternative.

Adult↗
PubMed1989

[Midazolam in ORL endoscopy in adults].

A prospective study was carried out in 20 selected subjects undergoing ENT endoscopy, with spontaneous ventilation of room air after premedication with midazolam IM 1.5 kg-10 [corrected] and then sedation with 0.07 mg.kg-1 IV and dextromoramide 0.03 mg.kg-1 IV and local anesthesia. The procedure was satisfactorily completed in the 20 cases; alertness was preserved in the 20 cases; total amnesia for the procedure was obtained in 19 cases. There were significant alterations in systolic blood pressure, heart rate and respiratory rate but these remained within strictly physiological limits. Blood gas results were similarly affected but at the limit of normal in 6 cases after 30 minutes of the procedure. Cardiovascular tolerance was excellent but close surveillance of the sedative effects on ventilation was required. Provided these conditions are respected, midazolam would appear to be of particular interest in ENT endoscopy.

Adult↗
PubMed1989

[Malignant midline granuloma, diagnostic and therapeutic problems].

This is an analysis of 4 patients with suspicion of centro-facial granulomatosis. Diagnosis is difficult, mainly based upon clinical data, without precise histopathological presentation. The main differential diagnosis is Wegener's granulomatosis. The etiology of centrofacial granulomatosis is still unknown but multiple theories have been proposed: systemic disease, lymphoma. In one case, the initial histopathological diagnosis was undifferentiated carcinoma and the patient received chemotherapy (i.e., Adriamycin, Vincristine, Bleomycin and Steroids). A complete response was achieved. The interest of chemotherapy in the treatment of centro-facial granulomatosis is discussed.

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↗