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Biomedical subjects

M Hamoir

Publications and source records attributed to M Hamoir.

At least 19 recordsLinked to original sources
PubMed2005

Carotid stenting for impending carotid blowout: suitable supportive care for head and neck cancer patients?

BACKGROUND: Carotid blowout (CB) represents a dramatic end-of-life situation for palliative head and neck cancer patients, their relatives and caregivers. Recently, endovascular therapy has been proposed for head and neck surgical patients. Preliminary reports showed a better outcome with less morbidity compared to the previous treatment modalities. However, the specific use of such techniques for palliative head and neck cancer patients has not been previously described. METHOD: Retrospective review of two cases of head and neck cancer patients receiving palliative care, presenting with a CB, managed with endovascular stent placement. RESULTS: Bleeding was effectively stopped by the procedure in both cases. Both patients developed a post-procedure thromboembolism, which was immediately treated by appropriate anticoagulation therapy. Neurological symptoms resolved within 24 hours allowing rapid hospital discharge. One patient died at home seven months later. The second patient is alive five months after the procedure. No recurrence of CB occurred in either patient. CONCLUSIONS: Endovascular stent placement for CB allows a rapid arrest of bleeding and permits the use of anticoagulation therapy in order to avoid long-term neurological injury. In our view, carotid stenting should be considered as valid supportive care for palliative head and neck patients presenting with a CB.

Carcinoma, Squamous Cell↗
PubMed2005

Post-transplant lymphoproliferative disorder with supraglottic involvement.

OBJECTIVE: Transplant patients with primary Epstein-Barr virus (EBV) infection may develop post-transplant lymphoproliferative disorder (PTLD). Since many infants are seronegative at the time of transplantation, PTLD is a major concern for paediatric transplant centres. First manifestations of PTLD are frequently observed in the ENT area with adenoidal and/or tonsillar involvement. DESIGN: Retrospective study of two cases of PTLD with confirmed supraglottic involvement, their management and outcome. Only patients with pathologically and immunologically demonstrated B-cell proliferation were diagnosed as PTLD. RESULT: Two infants developed an acute stridor during PTLD respectively 8 and 10 months after orthotopic liver transplantation (OLT). These infants were seronegative for EBV at the time of transplantation. IgM anti-EBV and/or detection of EBV genome by polymerase chain reaction were positive. Laryngeal examination revealed hypopharyngeal and/or supraglottic mucosal hyperplasia. Immunostaining of laryngeal biopsy was positive for latent membrane protein-1 (LMP1). Patients were treated by a reduction in immunosuppression as far as tolerated with the intent to recover natural immune response by the patient over the proliferation of EBV-infected cells. Complete remission of PTLD was observed in these two cases. CONCLUSION: Tonsillar hypertrophy and adenoid enlargement are the most encountered features of PTLD in OLT occurring in the ENT area. Acute stridor with supraglottic involvement may also be observed in PTLD and must be promptly diagnosed as the prognosis of this disorder is related to rapid reduction in immunosuppression and consequently to the recovering of a natural immune response against the EBV infection.

Female↗
PubMed2005

The role of nasal cavity disinfection in the bacteriology of chronic sinusitis.

OBJECTIVES: Several factors may influence the results of bacteriological studies in chronic rhinosinusitis. We investigated the potential role of nasal cavity disinfection in the bacteriology of the bulla ethmoidalis in patients suffering from chronic sinusitis. MATERIAL AND METHODS: Bacteriology of the bulla ethmoidalis was studied in 176 consecutive adult patients presenting a chronic sinusitis refractory to standard medical treatment who underwent functional endoscopic sinus surgery. Two different techniques were used: (A) a technique with nasal vestibule and facial disinfection with chlorhexedin (N = 89 patients and 165 samples) vs. (B) a technique with facial, nasal vestibule and nasal cavity disinfection with a povidone-iodine solution followed by a cleansing of the nasal cavity (N = 87 patients and 166 samples). RESULTS: Culture rate was 89.6% (183 bacterial isolates) for technique (A) vs 76.5% (164 bacterial isolates) for technique (B) (p < 0.001). Major bacteria encountered in the (A) group and in the (B) group were respectively: Coagulase Negative Staphylococcus: 77 vs 40 isolates (p < 0.001); Coagulase positive Staphylococcus: 44 vs 30 isolates (p = 0.061); Streptococcus pneumoniae: 4 vs 5 isolates; Others: Streptococcus sp.: 12 vs 16 isolates; Haemophilus influenzae: 8 vs 6 isolates; Enterobacteriacea: 33 vs 53 isolates (p = 0.013) and others Gram Negative Bacilli: 3 vs 7 isolates. CONCLUSIONS: The standard (A) technique to study the bacteriology of the bulla ethmoidalis in patients with chronic sinusitis yielded a higher percentage of positive culture and of bacterial isolates than a more advanced (B) technique. This is mainly due to the higher percentage of contaminant bacteria such as Coagulase Negative Staphylococcus recovered with the standard technique. Enterobacteriacea and others Gram Negative Bacilli were more often encountered into the bulla ethmoidalis with the technique where disinfection of the nasal cavity was performed.

Adult↗
PubMed2005

Cancer of the nasal vestibule, nasal cavity and paranasal sinuses.

The usual clinical presentation of sinonasal tumours includes symptoms that are indistinguishable from inflammatory sinus disease, namely nasal airway obstruction, pain, and epistaxis. Abnormal V1 and/or V2 sensations are a strong indication of the possibility of tumour. Computed tomography is the most reliable and informative imaging tool for evaluating the cancers of the paranasal sinuses. Magnetic resonance imaging is essential for tumour mapping because of the excellent tissue characterisation and the possibility of differentiating between neoplasms and retained secretions. A wide variety of histologies may be encountered, although squamous cell carcinoma (SCCA) is the most common. Radiation is a common adjuvant to surgery. The response of sinonasal tract tumours to radiation therapy varies with the stage and histology of the tumour. Rehabilitation after surgical resection may be accomplished with prosthodontics or reconstructive flaps. Bony erosion of the orbital walls does not constitute an indication for orbital exenteration. Patients with tumour involvement of the skull base, either in the infratemporal fossa or at the fovea ethmoidalis and cribriform plate, should be considered for craniofacial resection. Management of these tumours requires a multimodal approach, involving surgery, radiation therapy and, increasingly in recent years, chemotherapy. Management should therefore be entrusted to multidisciplinary teams only.

Chemotherapy, Adjuvant↗
PubMed2005

Initial assessment of a neck mass in children.

OBJECTIVE: To propose national recommendations for the initial assessment of a mass in the neck in children. METHODS: Comprehensive review of the available literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work up of children presenting with a mass in the neck.

Adolescent↗
PubMed2005

Initial work-up in head and neck squamous cell carcinoma.

OBJECTIVE: To propose national guidelines for the initial assessment of head and neck squamous cell carcinoma. METHODS: Comprehensive review of the literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work-up of patients with a presumed diagnosis of a squamous cell carcinoma of the upper aero-digestive tract.

Biopsy, Fine-Needle↗
PubMed2005

Management of neck masses in adults.

Initial management of a neck mass in adults is a frequently encountered problem in ENT practice. The differential diagnosis with regards to clinical presentation, localization, imaging studies and cytology and/or histology is reviewed. An algorithm is provided to help the practioner.

Adult↗
PubMed2005

Nasal obstruction and its impact on sleep-related breathing disorders.

Upper airway patency is essential during sleep in order to avoid sleep-related breathing disorders (SRBD). Nasal obstruction may have a negative impact on sleep quality and must be considered to be a co-factor in the pathophysiology of SRBD. In this paper we will discuss the relation between nasal physiology at night and sleep quality and the possible mechanisms between nasal obstruction and obstructive sleep apnea-hypopnea syndrome (OSAS). We will review the effect of the relief of nasal obstruction (with nasal dilators, medication and/or surgery) on SRBD. Also an algorithm on the management of OSAS patients when nasal surgery is indicated will be proposed.

Continuous Positive Airway Pressure↗
PubMed2004

Parapharyngeal metastases from thyroid cancer.

AIM: To emphasise the pattern of lymphatic dissemination in the parapharyngeal space from thyroid cancer. PATIENTS AND METHOD: Among 696 patients treated for thyroid cancer between 1986 and 2001, parapharyngeal metastasis was diagnosed in three patients, previously treated for papillary thyroid carcinoma. RESULTS: All three patients have been treated by surgical resection through lateral cervical approach. Two of them were controlled regionally whereas the remaining one had a submucosal pharyngeal metastasis locally resected 27 months after parapharyngeal resection. CONCLUSIONS: Parapharyngeal metastasis is rare, but should be a recognized pattern of lymphatic dissemination from thyroid carcinoma to avoid unnecessary radioiodine and because surgical resection is efficacious with acceptable morbidity.

Carcinoma, Papillary↗
PubMed2004

Conservation laryngeal surgery for selected pyriform sinus cancer.

AIMS: This study reports the treatment of a cohort of patients with pyriform sinus squamous cell carcinoma, using conservative surgery and radiotherapy. METHODS: Thirty-four patients with pyriform sinus SCC were treated between 1986 and 2001, using partial laryngopharyngectomy with or without complementary radiotherapy. Seventy-six percent had stage III-IV lesions. Quality of life questionnaire and clinical examination were used for evaluation of laryngeal function. RESULTS: Conservation surgery was undertaken. All patients underwent neck dissection. Two thirds of the patients received post-operative radiotherapy. Reconstruction was achieved by local muscular flap in 13 cases, radial forearm free flap in 18 and pectoralis major flap in three. Five-year overall and disease-specific survival rates were 50 and 65%, respectively. Successful laryngeal function preservation with local control was achieved in 80% of the patients. CONCLUSION: Partial laryngopharyngectomy is a suitable treatment for early and selected advanced stage pyriform sinus carcinoma with a good functional and oncologic outcome.

Adult↗
PubMed2004

Extracranial sinonasal tract meningioma: a case report.

Extracranial meningioma is an unusual tumor, mainly found in the head and neck area. Before surgical removal and histopathological examination, this diagnosis is rarely considered. We report a case of an extracranial meningioma located in the frontal sinuses of a 65-year-old-woman. Symptomatology included trouble of vision due to bilateral exophtalmos and mild headaches. Bilateral exophtalmos was secondary to the development of huge frontal mucoceles. These mucoceles grew slowly due to the frontal recesses blockage by the extracranial meningioma. External approach was performed with removal of the mucocele walls and of the extracranial meningioma itself. The frontal recesses were blocked with synthetic cement, and orbital roofs were reconstructed with a polydioxanon-sheet (PDS). Frontal sinuses were excluded and filled with bone bank grafts. A review of the literature on extracranial meningioma and a discussion about the surgical management of this case are proposed in this paper.

Aged↗
PubMed2004

[Primary surgery for base of tongue and tonsillar regions carcinoma: indications, surgical approaches and resections].

The oropharynx is a complex anatomical area gathering different subsites. Optimal treatment of oropharyngeal carcinoma remains still controversial. In early stages, surgery and radiation therapy are known to provide comparable oncologic results. Till recently, advanced tumors were best treated using primary radical surgery followed by postoperative radiotherapy, but new "organ sparing" approaches like concurent chemoradiotherapy seem now able to challenge primary surgery with a better functional outcome. This paper is focused on the role of primary surgery for cancer of the base of tongue and the lateral wall of the oropharynx. The surgical indications and the various surgical approaches are debated including advantages, disadvantages and tumor resections allowed by each of them respectively. Before to be considered, suitable oncologic surgery for oropharyngeal cancer should tackle 5 issues: complete resection of the tumor, adequate exposure, function preservation, minimal morbidity and simplicity of technique. During the past decade, significant advances have been observed in reconstructive surgical procedures through the use of microvascular free flaps routinely, which allows a more functional restoration of surgical defect. Current therapeutic strategy for oropharyngeal carcinoma should be settled not only following disease-free survival results but also the functional outcome of each treatment modality respectively.

Combined Modality Therapy↗
PubMed2003

Gastric choristoma of the midline neck in a newborn: a case report and review of the literature.

The current report describes a 3-week-old boy presenting with a gastric choristoma of the anterior compartment of the neck. Initial examination at birth found 3 masses in the anterior region of the neck. The only remarkable symptom consisted of episodes of cyanosis induced by neck flexion. The neck mass was removed after computed tomography scan assessment. Pathology finding showed the diagnosis of gastric choristoma. Cervical location of a gastric choristoma in children is rare. Its presentation as a clinically palpable anterior compartment cervical mass at birth even more rare.

Choristoma↗
PubMed2003

Transnasal repair of unilateral choanal atresia.

OBJECTIVES: To evaluate the outcomes of the surgical correction of unilateral choanal atresia using a transnasal approach. PATIENTS AND METHOD: Over a 36-months period (from 1999 to 2001), seven children underwent endoscopic endonasal repair of an unilateral choanal atresia using the microdebrider (powered instrumentation). At the end of the procedure, topical application of Mitomycin-C was performed. No postoperative nasal stenting was inserted. Clinical characteristics of these patients, CT scan examination, complications of the procedure and outcomes were analysed and compared to historical cases treated in the same institution from 1990 to 1998. RESULTS: Seven patients (2 M/5F) (age 6 to 46 months) presented with primary unilateral choanal atresia and were operated during the period from 1999 to 2001. All the patients were symptomatic before surgical correction. No patients showed other facial anomaly. Of the 7 patients procedures, 6 (85.7%) remained patent (follow-up range 12 to 36 months). Mean surgical repair per patient before obtaining patent choana was 1.14. One patient required surgical transnasal revision nine months after the initial procedure with a patent choanal after this second procedure (follow-up 9 months). Minor turbinoseptal synechiae diagnosed 6 months after the surgical correction occurred in one patient and was the only postoperative complication. When compared to historical cases of unilateral choanal atresia (19 patients from 1990 to 1998) repaired without endoscopic control and without Mitomycin-C, it was shown that this current method provided better results; mean surgical repair per patient; 1.14 vs 1.89 and 85.7% of patent choanae at twelve months vs 47.3%. CONCLUSION: An endoscopic endonasal approach without postoperative stenting, using the microdebrider seems to us the treatment of choice for unilateral choanal atresia. The exact role of the topical application of Mitomycin-C needs to be further investigated.

Child, Preschool↗
PubMed2003

Computer assisted surgery and endoscopic endonasal approach in 32 procedures.

UNLABELLED: Computer aided surgery (CAS) is now routinely introduced in the ENT surgical field especially in endoscopic endonasal surgery. OBJECTIVE: Using a frameless computer aided surgery for endoscopic endonasal approach (SurgiGATE ORL TM), we tried to evaluate the practical use of such a system, to calculate supplementary installation time of the procedure, to determine the number of matching attempt (referencing) before starting optonavigation and to determine its clinical accuracy. PATIENTS AND METHODS: Thirty two patients underwent endoscopic endonasal surgery with the help of CAS; 13 revision cases (2 nasal polyposis, 7 paranasal sinus mucoceles, 4 frontal recess stenosis) and 19 primary cases (16 inflammatory diseases, 3 benign tumor removal). Paired points matching was used as referencing before optonavigation. Clinical accuracy of CAS was calculated at two confidence points during optonavigation and measured in multiples of the pixel size on CT Scan. RESULTS: Number of matching attempts before starting optonavigation was; mean 1.8 (1-4). Supplementary installation time of the system was; mean 15 minutes (10-40). Clinical accuracy at two confidence points was always between 0.5 mm and 2 mm. (6 < 0.5 mm, 16 < 1 mm, 10 < 2 mm). There was no major complication during surgery neither no side effect due to the use of the CAS except for one case who presented a slight tongue edema due to a wrong position of the dynamic reference base (maxillary splint) during the procedure. CONCLUSIONS: CAS and optonavigation using the surgiGATE ORL TM is safe and efficient in endoscopic endonasal surgery. The accuracy of the system is sufficient and its use appropriate for primary either revision rhinologic procedures.

Adolescent↗
PubMed2003

[Pharyngoesophagolaryngeal metastases of medullary thyroid carcinoma. A case report].

We report the case of a patient with medullary thyroid carcinoma (MTC) who presented multiple pharyngoesophagolaryngeal metastases detected by flexible laryngoscopy. Pathology confirmed the diagnosis after resection with CO2 laser under direct laryngoscopy. Because of worsening dyspnea, complete circular pharyngolaryngectomy was performed with reconstruction of the pharyngeal region with a major pectoralis musculocutaneous flap. The postoperative period was satisfactory. At 17 months, calcitonin level was elevated; subcutaneous cervical metastases of the MTC developed and were resected. At 27 months, oral nutrition and phonation remained satisfactory. We discuss the diagnostic and therapeutic strategies used for this very unusual form of locoregional spread of medullary carcinoma of the thyroid gland.

Biomarkers, Tumor↗