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Biomedical subjects

O Laccourreye

Publications and source records attributed to O Laccourreye.

At least 109 records · Page 6Linked to original sources
PubMed1996

Cisplatin-fluorouracil exclusive chemotherapy for T1-T3N0 glottic squamous cell carcinoma complete clinical responders: five-year results.

PURPOSE: To evaluate cisplatin-fluorouracil exclusive chemotherapy (EC) for T1-T3N0 glottic squamous cell carcinoma complete clinical responders (CCR) after cisplatin-fluorouracil induction chemotherapy (IC). PATIENTS AND METHODS: A retrospective analysis was performed of 58 patients with T1-T3N0 glottic squamous cell carcinoma CCR after IC consecutively managed at our department between 1985 and 1992. Twenty-one CCR were managed with EC. Thirty-seven CCR were managed with IC and a conventional laryngeal-preservation modality. Analyses of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor were performed using the Kaplan-Meier actuarial life-table method. In CCR managed with EC, the independent factors of age, tumor classification, exact tumor location, true vocal cord motion, arytenoid cartilage motion, total dosage of drugs delivered, and number of courses received were tested for potential correlation with survival, local recurrence, nodal recurence, and distant metastasis. RESULTS: The 5-year survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor rates in CCR managed with EC were 95.2%, 70.7%, 0%, 0%, and 14.3%, respectively. The 5-year rates of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor in CCR managed with IC and a conventional laryngeal-preservation modality were 86.1%, 97%, 2.7%, 6%, and 14.5%, respectively. Local recurrence was statistically more likely in CCR managed with EC (P = .002). Local recurrence in CCR managed with EC was always salvaged with partial laryngectomy or radiation therapy, which resulted in an overall 100% local control and laryngeal-preservation rate within this group. In CCR managed with EC, none of the variables analyzed was statistically related to survival, local recurrence, nodal recurrence, or distant metastasis. CONCLUSION: The present retrospective studies demonstrated that within T1-T3N0 glottic squamous cell carcinoma CCR, there is clearly a significant subset of patients with chemocurable tumors who achieved both perfect preservation of structure-supporting voice and long-term survival after EC. Careful monthly follow-up evaluation allowed for timely successful salvage of local recurrence after EC without the need for total laryngectomy. Such management did not appear to increase the risk for subsequent nodal failure, subsequent distant metastasis, or reduced survival.

Adult↗
PubMed1996

The role of computed tomography and magnetic resonance imaging in planning for conservation laryngeal surgery.

Refined laryngeal conservation surgeries have been devised to maintain the voice while eradicating even extensive glottic and hypopharyngeal tumors. The role of diagnostic imaging is to adequately define the extent of disease in conjunction with endoscopy. Critical areas to be evaluated are the tongue base, vallecula, pre-epiglottic space, arytenoid cartilages, postcricoid region, hypopharynx, thyroid cartilage, and subglottis.

Humans↗
PubMed1996

[Supra-cricoid partial laryngectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results].

21 patients with glottic carcinoma presenting anterior infraglottic extent of tumor, classified T2-T4, were offered and extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) between 1979 and 1994 at our department. The technique for the procedure, the duration of tracheotomy tube, naso-gastric feeding tube, and hospital stay are presented. Postoperative complications and management were described. The 5-year actuarial survival, local control, nodal recurrence, distant metastasis, and metachroneous second primary tumor estimate was 74.7%, 88.9%, 11.1%, 22.4% and 15%, respectively. Overall a 95.2% (20/21) local control rate was achieved with a 90.5% (19/21) laryngeal preservation rate.

Actuarial Analysis↗
PubMed1996

[Development of reconstruction techniques of the anterior skull base after tumor excision].

183 benign and malignant tumors of the anterior cranial base were operated in the department of neurosurgery at Ste Anne's hospital, from June 1982 to December 1993. The bone defect was repaired first with bone sheets taken from the inner table of the cranial flap. Then allografts of irradiated bone and madreporic coral blocks were used as reconstruction material. Since January 1992, no bone reconstruction was performed; the anterior base was just covered with a sheet of Vicryl Composit Mesh (VCM) which was secured bilateraly on the pterion, the temporalis pars squamosa and around the ethmoid defect. This sheet of VCM reinforces the dural plane, which is always lined with a pediculated galea flap. These technical changes and evolution were motivated by: i/- a desire to simplify the surgical technique: ii/- the risk of transmission of viral diseases such as Creutzfeld Jacob disease by allografts, iii/- the frequency of splits and/or falls of madreporic coral grafts. Whatever the material, the infection risks were identical: 8% of subcutaneous and/or deep suppurations, 5% of post-operative meningitis. One patient presented with a transient clinical rhinorrhea.

Bone Transplantation↗
PubMed1996

[Contribution and limits of acoustic analysis of the voice and alaryngeal speech with a computerized system].

Through a review of published acoustical analyses of alaryngeal voice and speech, our aim was to establish the interest and the limitations of a computerized acoustical system. One case of esophageal voice and one case of tracheoesophageal voice were analysed with the Kay Elemetrics Multidimensional Voice Program for voice and Computerised Speech Lab for speech. All the acoustical parameters are altered in alaryngeal voice. The automatic calculation of frequential parameters are promising but there are errors due to the importance of altered voicing. Speech analysis is an important complement to evaluate the phonatory behavior of laryngectomized patients.

Computer Systems↗
PubMed1996

[Surgery of primary malignant melanomas of the mucosa of the nasal fossa and facial sinuses].

A retrospective analysis of 22 patients with primary malignant melanoma of the nasal fossa and/or paranasal sinuses consecutively managed with surgery at our department from 1975 to 1993 was conducted. Fifteen patients had negative margins of resection. Neoadjuvant chemotherapy and post-operative radiation therapy was associated in 4 and 5 of these 15 patients, respectively. Four patients had positive margins. Adjunctive treatment was chemotherapy and postoperative radiation therapy in 2 and 3 of these 4 patients, respectively. The remaining 3 patients were managed with palliative treatment (debulking surgery and chemotherapy). No patients were lost to follow up. A 3-year follow-up was always achieved. In patients in whom surgical resection achieved negative margins, the 5-year actuarial survival, and local control estimate was 17.9%, and 26.9%, respectively. None of the variables under analysis were statistically related to local recurrence or survival. Death always occurred within 24 months from initial diagnosis in all 7 patients but one in whom surgical resection with negative margins was not achieved or debulking surgery was performed.

Aged↗
PubMed1996

[Laryngectomies and pharyngo-laryngectomies with tracheo-laryngo-pharyngeal shunt of Pearson type. Technique, indications and preliminary results].

The preliminary results achieved in a series of 10 patients consecutively managed at our department with Pearson's subtotal pharyngolaryngectomy, during the year 1995, are presented. The surgical procedure is described. Follow up varied from 6 to 13 months. None of the patients were lost to follow-up. None of the patients recurred locally or died from surgical-related complications. Nine patients achieved successful rehabilitation of speech and voice. One patient refused to use a functional shunt. Speech and voice parameters achieved by the third postoperative month are presented. Postoperative swallowing impairment was not encountered. The preliminary data achieved and the review of the medical literature suggested that Pearson's subtotal pharyngolaryngectomy should be discussed in patients conventionally managed with total laryngectomy or pharyngolaryngectomy and tracheosophageal puncture with voice prosthesis insertion.

Adult↗
PubMed1995

[Long-term results of total conservative parotidectomy for pleomorphic adenoma].

OBJECTIVES: Evaluation of the long-term results (10 and 15 years) achieved with total conservative parotidectomy for pleomorphic adenoma. METHODS: A retrospective analysis of the files of 127 patients with pleomorphic adenoma of the parotid gland consecutively treated with a total conservative parotidectomy at our department from 1970 to 1985. Actuarial analysis (Kaplan Meier method) of survival and local recurrence, as well as overall estimation of immediate and definite postoperative facial paresis and paralysis was performed. RESULTS: Ten- and fifteen-year survival and local control estimations were 90.8% and 99.1%, respectively. Immediate and permanent facial paresis and paralysis overall estimates were 64.6% and 6.3% and 2.1% and 0%, respectively. CONCLUSION: Total conservative parotidectomy for pleomorphic adenoma results in a very high long term local control associated with a very low rate of facial dysfunction.

Adenoma, Pleomorphic↗
PubMed1995

[Exclusive chemotherapy in T1-T3N0 cancers of the vocal cord with complete clinical response after neoadjuvant treatment with a cisplatin-fluorouracil combination].

OBJECTIVES: Evaluation of cisplatin-fluorouracil exclusive chemotherapy for invasive squamous cell carcinoma of the glottis staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy. METHODS: A retrospective analysis of the files of 69 patients with a well-differentiated untreated invasive squamous cell carcinoma, staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy is presented. Actuarial analysis (Kaplan Meier method) of survival and local failure is presented among the group of 25 patients treated with exclusive chemotherapy and the group of 44 patients in whom the local treatment (partial laryngeal surgery or radiation therapy) initially planned was maintained. RESULTS: Three-year survival and local control estimate was 91.8% and 69.3%, respectively after exclusive chemotherapy and 92.5% and 97.2% if the local treatment was performed as initially planned. Patients with local recurrence after exclusive chemotherapy were always salvaged with partial laryngeal surgery or radiation therapy resulting in an overall 100% local control and laryngeal preservation rate. CONCLUSION: Exclusive chemotherapy for T1-T3N0 glottic carcinomas with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy should be considered especially in patients in whom preservation of voice is of utmost importance.

Adult↗
PubMed1995

Evolution of speech and voice following supracricoid partial laryngectomy.

The evolution of voice and speech parameters following supracricoid partial laryngectomy (SCPL) has been evaluated in a prospective fashion over an 18-month period of time in three patients using the Computerized Speech Lab (from Kay Elemetrics). Preliminary results demonstrate the post-operative instability of voice parameters. Speech parameters remain stable with time. Our data stresses that voice is attained post-operatively even if one arytenoid cartilage is disarticulated at time of resection.

Aged↗
PubMed1995

Duration and frequency characteristics of speech and voice following supracricoid partial laryngectomy.

Selected characteristics were compared in the speech and voice of 28 treated with a supracricoid partial laryngectomy (SCPL) and of 14 normal adult laryngeal (NAL) speakers. Tape-recorded speech samples were measured for durational features with a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and a multidimensional voice program. The SCPL speech proved comparable to NAL speech in average fundamental frequency. The SCPL speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise to harmonics ratio, maximum phonation time, speech rate, and phrase grouping. The completion of an arytenoid cartilage resection did not statistically modify the duration and frequency features of SCPL speakers. Among SCPL speakers 1) the average fundamental frequency was statistically higher (p = .02) in patients who underwent a cricohyoidoepiglottopexy when compared to patients who underwent a cricohyoidopexy, 2) the maximum phonation time was statistically related to the patient's age (p = .002), and 3) the jitter and shimmer values were statistically related (p = .01 and p = .005) to the time elapsed since SCPL completion. Explanations and implications of these findings are discussed.

Adult↗
PubMed1995

Reconsidering a paradigm: the spread of supraglottic carcinoma to the glottis.

This study was performed to evaluate the spread of supraglottic carcinoma to the glottic level. Whole organ sections of total laryngectomy specimens from 37 patients with previously untreated supraglottic carcinomas were reviewed retrospectively. Of the 37 specimens, 20 (54%) were noted to have extension of cancer to the glottic level. A significant relationship was noted between glottic extension and abnormal cord motion (P = .0002). A statistically significant trend was noted for the relationship between inferior extension along the supraglottic mucosa and glottic level extension (P < .0001). Contrary to the prevailing model of the spread of supraglottic carcinoma, in which there is a distinct barrier to spread at the ventricle, this analysis of selected supraglottic carcinomas revealed a continuum of spread from the supraglottic to the glottis.

Chi-Square Distribution↗
PubMed1995

Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy.

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape-recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.

Adult↗
PubMed1995

[Inoperable tracheal and cricoid-tracheal stenoses. Results of laser therapy and prolonged calibration].

Palliative desobstruction was performed with laser and a Montgomery T tube in 11 patients with tracheal or cricotracheal stenosis. Surgery was theoretically indicated for these long thick stenotic areas with underlying diseased cartilage but could not be performed due to the poor clinical status of the patients or recurrence after anastomosis. Calibration with the Montgomery T tube was maintained for a mean of 5 years. The T tube was removed in 3 patients and was well tolerated in 4. Two patients died during the course of the study and two others required a definitive tracheotomy. Palliative treatment with Laser desobstruction and long-term calibration can be a useful alternative to conventional surgery.

Adult↗