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Biomedical subjects

J Trotoux

Publications and source records attributed to J Trotoux.

At least 91 records · Page 5Linked to original sources
PubMed1986

[Conservative surgery of cancer of the larynx. Cordectomy, hemilaryngectomy, supraglottic laryngectomy].

Of a total of 219 partial laryngectomies performed, 119 were cordectomies, 30 hemilaryngectomies and 70 supraglottic laryngectomies. Results of each type of operation are presented with emphasis on problems of local recurrences, evidence of validity of procedure selected and of its indications. Analysis of results, with the reservation that indications were sometimes wide but always reasonable, showed an extremely low incidence of recurrences, the quality of the resection (limited or insufficient) having finally little incidence on the latter, except perhaps in the supraglottic laryngectomies. It is suggested, therefore, that no attempt should be made to "recover" a histologically detected insufficient excision by complementary radiotherapy not required in principle. This assists follow up review and allows secondary therapy if an unfavorable course is noted.

Adult↗
PubMed1986

[Tympanic reconstruction by molded grafts. Value and results. Apropos of experience in 158 cases].

Use of a moulded aponeurotic graft, shapened and then made rigid by heat and formalin, is a seductive method of tympanic reconstruction because of its simplicity and availability. Indications for and results of the application of this method are analyzed based on experience of 158 cases, with sufficient follow up in 90. The principal indication for use is large perforations, when it is possible to exteriorize the whole canal and almost all the tympanic remains, while doubt exists as to its advantages for treatment of small perforations. Its essential advantage is in fact the ease with which the graft can be positioned on external surface of malleus and inside the remains of tympanic membrane. Overall anatomical results were very satisfactory (83.5%) if one includes in failures of treatment the apparent lateralizations of graft. Functional results were poorer, with rarely complete recovery of hearing and a certain number of labyrinthizations possibly due to injury to handle of malleus or even perforation of canal. Secondary degradation of favorable results may develop because of some degree of lateralization of the newly formed tympanic membrane. These could perhaps be avoided by the technical artifices proposed by other authors.

Adolescent↗
PubMed1986

[Functional surgery of cancer of the hypopharynx. Hemilaryngopharyngectomy, posterior pharyngectomy by bilateral cervical approach].

The authors report on 48 patients operated by hemi-laryngo-pharyngectomy for spinous carcinoma of the piriform sinus. They try to precise the indications by analysing the factors influencing survival and relapses. They compare surgery to the other methods. In a second part, they report 3 cases of posterior pharyngectomy by bilateral cervical incision.

Adult↗
PubMed1986

[Choice of the 3d portion of the jejunum for reconstruction of the pharynx in circular pharyngolaryngectomies. Indications and advantages].

Many procedures are used for reconstruction of a pharyngeal gutter after circular pharyngolaryngectomy, interrupter of digestive continuity. The operation chosen was used of third part of jejunum for reconstruction, and its indications and limitations are described. The choice was based on anatomic data from dissection of 100 cadavers and values for different measurements performed (length of transplant, height of mesentery, caliber and length of vessels), and more particularly on constancy and reliability of vascularization of this digestive segment. To these advantages are added bacteriologic, technical, histologic and physiologic reasons. Results are analyzed of 11 operations carried out in the same department, from among a larger group comprising now 45 cases. Postoperative course was usually uncomplicated with rapid restoration of deglutition (a mean of 11.77 days in 9 of the 11 cases). Preoperative radiotherapy is not a contraindication and postoperative radiotherapy should be given routinely as a complement to surgery. It is usually well tolerated and transplant necrosis is not provoked. Nevertheless, the seriousness of this type of lesion is underlined by the high incidence of carcinologic failures, with an elevated risk of local and regional recurrence and of distant metastases.

Aged↗
PubMed1986

[Functional radical neck excision. Evaluation of 10 years' experience. Apropos of 434 cases].

A total of 434 functional évidements of neck were conducted in 313 patients, taking into account all primary localizations. Details of the procedure used are described while emphasizing the need for an évidement tending towards one as complete as a radical operation. Surgery was usually elective (89% of cases) but in 11% considered as essential. A high proportion of lymph nodes classified as no were, however, found to be invaded (22.8%, including 27.5% of these with capsule rupture). Despite this, glandular recurrence on the side of functional évidement was extremely low (less than 7%) even when recurrence was epithelial or involved a second localization. These findings emphasize the validity of functional évidement and confirm published data, known to be difficult to analyze. Although the value of this operation with respect to the cancer is well established, the actual functional interest, particularly in relation, to external branch of XI th nerve is debatable.

Adult↗
PubMed1982

[Personal experience of anaesthesia in ear surgery. Two year study].

Study of 168 cases of ear surgery, from September 1979 to September 1981. Various anaesthetic protocols were compared with a view to decreasing per-operative bleeding: --in 9 cases: Fluothane --in 11 cases: Alfatesine --in 89 cases: Neuroleptanalgesia --in 39 cases: Narcozep. The various proposals for controlled hypotension are discussed and the conclusion is drawn that, regardless of the method used, the percentage of failures was essentially identical and seemed to be related more to errors in assessment of the duration of the operation than to the drug used. A corollary to this attitude was the possibility of a 25% rate in delayed post-anaesthetic recovery.

Adjuvants, Anesthesia↗
PubMed1982

[Limited resection in partial surgery for carcinoma of the larynx. Prognostic consequences and therapeutic implications].

Limited resection in partial surgery for carcinoma of the larynx leads to discussion of three surgical attitudes: total surgical resection as a matter of principle, additional treatment by radiotherapy, or waiting, with the need for strict surveillance. The present study reports the results of this latter attitude adopted in 23 cases out of 24 of limited resection in a group involving 119 partial laryngectomies (vertical or horizontal) consisting of: 57 cordectomies, 20 hemilaryngectomies, 42 supraglottal laryngectomies. Results of analysis show that there was no recurrence and patients were well with a 3 year follow-up in 19 cases of limited resection out of 24. Overall survival following limited resection was identical to that seen after satisfactory resection, but there was a marked difference with insufficient resection (X2 significant) Following partial laryngeal surgery involving a limit resection, it is felt to be legitimate to temporise as long as the patient can be seen regularly. Such an approach would not seem to modify the overall survival in these patients.

Adult↗
PubMed1982

[The influence of age on the course and prognosis of carcinomas of the larynx and hypopharynx].

On the basis of clinical impressions only, the authors had felt the carcinomas of the larynx and hypopharynx were probably graver in young subjects than in the elderly, and that age was a determinant factor in therapeutic decisions. 585 records including 216 carcinomas of the piriform fossa and 369 carcinomas of the larynx were studied over a period of 8 years. This study failed to reveal any difference related to age between populations aged less than 60 years and more than 60 years, both with regard to the prevalence of carcinomas whatever the siten the presence or absence of nodes, histological spread, loco-regional prognosis and actuarial survival. The latter parameter was studied by establishing the distribution between patients aged less than 55 and those 55 and over to obtain equivalent groups in terms of numbers. Overall, the prognosis seemed to be rather better in the younger patients, which would imply a therapeutic attitude independent of age.

Adult↗
PubMed1982

[Surgical diathermy treatment of buccopharyngeal tumors].

Surgical diathermy excision was employed to treatment 138 cases of buccopharyngeal cancer, either as initial followed by irradiation therapy, or as complementary treatment to radiotherapy in unsuccessful cases. Results were favorable in 34 patients with tonsillar carcinoma and 38 cases of soft palate cancer, but the method was only moderately effective for recurrences in these regions. In 36 cases of tongue cancer, and 30 with cancer of the floor of the mouth, this therapeutic procedure was particularly effective for treating patients not responding to radium needle implantation.

Electrocoagulation↗
PubMed1982

[Comparative study of the significance of lymphadenopathy in carcinomas of the hypopharynx, larynx and epiglottis. 574 cases].

The significance of the absence or presence of lymphadenopathy is not the same in relation to the site of the primary tumour. This study involved 574 cases, including 213 carcinomas of the piriform fossa and 361 laryngeal carcinomas, and revealed errors of omission (No - N+) in carcinomas of the piriforme fossa (50% cases) and the possibility of errors of commission (N not equal to - N - in carcinomas of the larynx. This merely confirmed the high level of lymphatic affinity of carcinomas of the piriform fossa, but at the same time emphasised the relative reliability of the clinical assessment of relevent classifications.

Carcinoma↗
PubMed1982

[Treatment of carcinomas of the vallecula and epiglottis by supraglottal surgery. Indications and therapeutic results].

A study of 87 cases of carcinoma of the vallecula and the epiglottis (margin and vestibulum) with the common feature of an essentially identical surgical technique: supraglottal horizontal laryngectomy. In the case of vallecular lesions (34 cases from T1 to T4) this operation, performed from below upwards with lymph node dissection and associated with postoperative radiotherapy, gave oncological results identical to those of total laryngectomy and better than those of other protocols based upon radiotherapy. From a functional standpoint, despite two deaths due to bronchopneumonia, with careful respect paid to local and general contraindications there were no prolonged problems, even if the postoperative course was somewhat longer in lesions of the epiglottis. Carcinomas of the epiglottis (53 cases) did not receive radiotherapy where resection was adequate and lymph node histology negative. The results, better than in those cases involving the vallecula, seemed to be identical to those published in the literature. Such partial surgery, with preservation of the voice, should thus be beneficial in patients suffering from such lesions, in particular when the larynx is unaffected.

Adult↗
PubMed1982

[Circular pharyngo-laryngectomy: reconstruction by free jejunal transplant and vascular microanastomoses in a single stage. 4 cases].

In a certain number of cases, extensive carcinomas of the hypopharynx require total pharyngeal resection, circular, and hence the restoration of continuity by a plastic procedure. Amongst the numerous procedures used (tubular flaps, substitution using a hollow organ), the authors opted for the use of free jejunal transplant with vascular microanastomoses in a single stage. Four cases very different in terms of their indications are reported. The postoperative course was in general very uncomplicated and characterised by the absence of either abdominal or pharyngeal infection. Swallowing became possible on about the 14th day. Vascular permeability was confirmed by arteriography in three cases and was felt to be satisfactory. This is, however, major surgery with a long operation (between 6 and 10 hours) and which at best requires the cooperation of two teams of surgeons. Indications should be considered with caution and in the present study involved only cases of widely extended pharyngeal carcinomas, with the exclusion of oesophageal involvement going beyond the pharyngo-oesophageal sphincter.

Aged↗
PubMed1982

[Mycotic lingual granuloma. The pseudotumoral form].

Lingual candidiasis is a condition arising from a multiple of causes, some of which are well known (thrush, etc...). Two cases of chronic lingual mycotic granuloma are presented, one of which was due to a candida, the diagnosis being confirmed by pathological examination and electrosyneresis. The course of this granuloma leads to the appearance of a true epidermoid carcinoma, as illustrated by the description of other cases that have been reported. Current therapy for the granuloma itself mainly depends on the employ of ketoconazole, but the unfavorable course of the affection raises the question of the need for associated surgery.

Candidiasis↗
PubMed1981

[Recurrent nerve paralysis following thyroid surgery (author's transl)].

Following a brief review of anatomical features, the risk of injury to the recurrent nerve is discussed as a function of the type of operation performed: subtotal thyroidectomy, ablation of a retrosternal goitre, lobectomy, and total thyroidectomy. Particular attention has to be paid to the risk of anomaly in the nerve pathway: early division or a nerve branching directly from the Xth nerve without a recurrent pathway. Paralysis may be due to simple stretching of the nerve, when regression occurs in approximately three months. Paralysis of the recurrent nerve occurred in 1.69% of cases (7 definite, including 2 of necessity), in a series of 1 184 recurrent nerve exposures.

Goiter, Substernal↗