Search PubMed⌕ Search

Biomedical subjects

P Beutter

Publications and source records attributed to P Beutter.

At least 19 recordsLinked to original sources
PubMed2006

[Differenciated thyroid carcinomas with laryngo-tracheal invasion].

OBJECTIVES: Analyze the diagnosis and treatment of differentiated thyroid carcinomas with laryngo-tracheal invasion. MATERIALS AND METHODS: Among the 117 patients operated for a differentiated thyroid carcinoma in the ENT department of Tours Hospital (France) between January 1990 and December 2003, seven presented laryngo-tracheal invasion and were included in this retrospective study. RESULTS: Laryngo-tracheal resection resulted in a thyroid cartilage-shaving in two patients. We performed a resection of one side of the thyroid cartilage in one patient, a thyro-tracheal resection-anastomosis with a partial cricoidectomy in one patient, a partial vertical laryngectomy extended to the first tracheal ring in one patient and a total laryngectomy in one patient. No laryngo-tracheal resection was done in one patient. Early complications were swallowing disorders (n = 2), transitory hypoparathyroidism (n = 1), definitive recurrent nerve paralysis (n = 2), subcutaneous emphysema and hematoma (n = 1) and Claude Bernard-Horner's syndrome (n = 1). Locoregional recurrences (n = 2) and distant metastasis (n = 2) were discovered six months to four years after the laryngo-tracheal resection. With a mean follow-up of 40 month, four patients were alive (two disease free) two patients had died and one was lost of follow-up at three months. CONCLUSION: The frequency of locoregional recurrences and distant metastasis is higher for the differentiated thyroid carcinomas with laryngo-tracheal invasion than the others. In these cases, we performed macroscopic carcinological surgery preserving laryngeal functions as much as possible.

Adult↗
PubMed2005

[Chondrosarcoma of the cricoid].

OBJECTIVE: Chondrosarcoma of the larynx is a rare neoplasm generally observed on the cricoid. The purpose of this study was to define the most appropriate surgical management depending on tumor extension and histological grade. PATIENTS AND METHODS: Three males and one female were treated for chondrosarcoma of the cricoid between 1990 and 2003 in the Ear, Nose and Throat department in Tours, France. There were three grade I tumors and one grade II tumor. Tumor resection by thyrotomy was performed in two patients, total laryngectomy in one and laser desobstruction in one. RESULTS: The patient who underwent total laryngectomy remained in complete remission at five years. Among the two patients who had thyrotomy, one remained in remission at three years and the other experienced recurrence at four years and underwent a second operation. He died five years later due to another disease. Total follow-up was nine years. The patient treated by laser therapy achieved stabilization at twelve months. CONCLUSION: Computed tomography and histological grading enable choosing the best surgical procedure. Partial laryngeal surgery is indicated for small or low-grade chondrosarcomas. For large or high-grade tumors, total laryngectomy must be performed. In the event of patient refusal, laser desobstruction can provide clinical stabilization.

Aged↗
PubMed2004

[Metachronous sinonasal squamous-cell carcinoma after pharyngolaryngectomy].

OBJECTIVE: Three laryngectomized patients developed metachronous sinonasal squamous-cell carcinoma. We reviewed their files to search for clinical features useful for early diagnosis of this localization. CASE REPORTS: Two of the patients, a textile worker and a food processing worker, had occupation exposure risk factors for sinonasal squamous-cell carcinoma. The anatomic modifications created by laryngectomy contributed to late diagnosis of the metachronous tumor at an advanced stage. Surgery was performed in all three patients. Local recurrence was observed at one year in two patients. DISCUSSION: Sinonasal fibroscopy should be part of the surveillance scheme in laryngectomized patients to enable early diagnosis and treatment of metachronous tumors.

Aged↗
PubMed2004

[Extracranial internal carotid artery aneurysm].

INTRODUCTION: Extracranial aneurysm of the internal carotid artery is an exceptional finding. CASE REPORT: An 89-year-old woman consulted for a peritonsillar mass. Physical examination revealed a parapharyngeal pulsatile mass in the oropharynx. Computed tomography (CT) provided the diagnosis of extracranial internal carotid artery aneurysm. Endovascular or surgical treatment were declined. Anticoagulation medication was given. DISCUSSION: We reviewed the CT and magnetic resonance imaging findings and the clinical manifestations of extracranial internal artery aneurysm. Endovascular treatment is an alternative to open surgery.

Aged↗
PubMed2003

[Infectious complications after surgery for hypopharyngeal and laryngeal carcinomas].

OBJECTIVE: The objective of this study was to analyze the infectious complications of procedures for carcinoma of the hypopharynx and the larynx to optimize the prevention of septic risks. MATERIAL AND METHODS: This retrospective study included 608 patients who underwent total (n=270) or partial (n=338) laryngectomy between 1984 and 1999. The procedures were performed under rigorous conditions of surgical asepsis and with prolonged antibiotic chemotherapy depending on the type of laryngectomy and past history of external radiotherapy. Twenty factors were studied. Univariate analysis, including 9 factors, and multivariate analysis were performed. RESULTS: The global rate of infectious complications was 11.1%. The percentages of salivary leaks, other wound infections and non-wound infections were respectively 11.9%; 1.5%; 1.5% for total laryngectomy and 1.8%; 2.4%; 3.8% for partial laryngectomy. Statistically significant factors were tumor stage, postoperative hematoma, postoperative lymphorrhea and, to a lesser degree, pharyngeal localization. CONCLUSION: Our rate of infectious complications in oncologic pharyngeal and laryngeal surgery, which is low compared with data in the literature, emphasizes the importance of strict measures of surgical asepsis and prolonged antibiotic chemotherapy as is recommended for so-called contaminated surgery.

Anti-Bacterial Agents↗
PubMed2002

[Cervical osteophytes and ENT disease: three surgery cases].

Vertebral cervical hyperostosis is frequent in the general population but is rarely symptomatic. Dysphagia is the most frequently encountered symptom. We report three cases of cervical hyperostosis leading to ENT symptoms. Two patients had bilateral laryngeal paralysis, rarely described in the literature. These three cases were treated surgically.

Aged↗
PubMed2002

[Hemangiopericytoma of the infratemporalis fossa: a multi-operated patient].

Hemangiopericytoma (HPC) was diagnosed in a 65-year-old man in 1991. Initially the tumor was located in the maxillary sinus. Resection was followed by multiple recurrences involving the infratemporalis fossa (ITF), the nasopharyngeal region, and the right tonsillar region. Over a 10-year-old period, the histology pattern remained unchanged. Multiple approaches, as described in the literature, were used for resection depending on the site of the recurrence. To data, no malignant structure has been identified. Pain and cranial nerve deficits (V2, V3) have been the main squeleae. This case points out the limitations of radical resection because of the difficulty of the approach to this anatomic region. CT scan must be performed to choose the best access route depending on the primary site of the tumor and its extension.

Aged↗
PubMed2002

[Tracheocele: a rare cause of pharyngeal disorders].

A 40-year-old woman with an uneventful history consulted for an episode of cervical swelling and pharyngeal disorders with sensation of a foreign body. Cervical and ENT examination was normal. The barium swallow showed a normal esophagus and the CT scan showed an air image in the right side of the trachea. The diagnosis of tracheocele was made at surgery and was confirmed by histology. Clinical, endoscopic, and radiologic outcome was favorable three months after surgical resection of the diverticulum. Tracheocele is rarely reported in the literature. It results from a congenital or acquired weakness of the tracheal wall. The right side is involved more frequently. No specific signs or symptoms have been identified. Diagnosis is often based on CT findings. Surgery confirms the diagnosis and allows resection.

Adult↗
PubMed2001

[Teratoma of the rhinopharynx and the infratemporal fossa in neonates: report of 3 cases].

Teratomas are tumors which develop in childhood or early adulthood, generally in the gonads. More rarely these tumors may be found in an axial localization, notably in cervicofacial forms. We report three cases of teratomas observed in rhinopharynx of three neonates operated at the Clocheville General Hospital. We present the main anatomoclinical features of these tumors, focusing on the cervicofacial forms in neonates. All three cases occurred in female neonates presenting acute dyspnea within the first hours of life, requiring intubation in two cases. The first two tumors invaded the infratemoral region and the third was a pediculated tumor of the velum exteriorized via the mouth. In one case antenatal ultrasound had suggested the diagnosis of a right temporomaxillary tumor. Rapid excision of the rhinopharngyeal component allow extubation for the two intubated infants and pathology diagnosis. In the first infant operated at 2 months, the lateral route was adapted to age, with mandibulotomy with section of the coronoid process but preserving the mandibular condyle. The second infant was operated at the age of 3 weeks using a wide frontotemporoperitonial approach then at the age of 3.5 months for recurrence extending to the floor of the temporal fossa and the middle ear. A type C infratemporal approach was used with lost-bone temporal craniectomy. Per-buccal excision was possible in the third infant with resection at the base of implantation. No recurrence has been observed in the first two cases at 3.5 and 2.5 months follow-up in the first two cases. The third infant was lost to follow-up.

Female↗
PubMed1999

[Otosclerosis surgery: a series of 227 cases. Introduction of CO2 laser].

OBJECTIVES: To evaluate the effects of the size of the footplate opening on the hearing results in surgical treatment of otosclerosis and the use of CO2 laser in this indication. PATIENTS AND METHODS: 190 patients with otosclerosis underwent 227 procedures between 1986 and 1995. Hearing results and symptoms were analyzed to compare the different procedures: 140 stapedectomies, 87 Fisch's stapedotomies, 35 of them with manual perforator, 52 of them with CO2 laser. RESULTS: Air/bone gap closure within 10 dB was obtained in 87, 92 and 97 percent of stapedectomies and in 80, 84 et 90 percent of stapedotomies after 3 months, 1 and 3 years (NS). Bone conduction was improved in 81, 80 et 63 percent of stapedectomies and 87, 97, 60 percent of stapedotomies after the same time (NS). Air/bone gap closure within 10 dB was obtained in 75 and 80 percent of manual perforator stapedotomies and in 84 and 88 percent of CO2 laser stapedotomies after 3 months, and 1 year (NS). Bone conduction was improved in 78 and 96 percent of manual perforator stapedotomies and 95 and 100 percent of CO2 laser stapedotomies after the same time (NS). No facial palsy or prolonged vertigo occurred. There was one case of anucusis following a stapedectomy. CONCLUSION: Although both stapedectomy and stapedotomy produced equivalent air/bone gap closure, reduction of inner ear trauma was noted with Fisch's stapedotomy. CO2 laser technique is a safe procedure, which optimizes the Fisch's stapedotomy.

Adolescent↗
PubMed1998

Bacteriology of chronic purulent secretions in chronic rhinosinusitis.

The aim of this work was to study the bacterial flora of purulent secretions during chronic rhinosinusitis. We studied a total of 533 patients divided into two groups. The control population consisted of 139 adults (> 16 years) of both sexes seen in the community or hospitalized for less than 72 hours for non-rhinological conditions. The rhinosinusitis group consisted of 394 patients referred to the ENT clinic with chronic rhinosinusitis. All the patients with rhinosinusitis had had a post-nasal discharge for at least three months, associated with purulent or mucopurulent secretions originating from the involved sinus cavity. All samples were obtained endonasally under endoscopic guidance from the sinus ostium or from the sinus cavity during surgery. Cultures were positive in 81.3 per cent of the control subjects and 83.1 per cent of the patients with rhinosinusitis. Corynebacteria, coagulase-negative staphylococci, propionibacteria and peptostreptococci were the main commensal organisms, while Haemophilus influenzae, streptococci, Streptococcus pneumoniae, Prevotella spp and Fusobacterium spp were probable causative pathogens. Anaerobes were isolated from approximately 25 per cent of the patients in the rhinosinusitis group. Betalactamase producers represented 27.5 per cent of H. influenzae and 28 per cent of Prevotella spp isolates. Diminished susceptibility to penicillin was found in 13 per cent of S. pneumoniae isolates. The amoxycillin-clavulanate combination was the most active oral antibiotic tested against the pathogenic species in vitro.

Adult↗
PubMed1998

Solitary fibrous tumour of the larynx: report of a case.

Solitary fibrous tumour is a particular kind of mesenchymal tumour, classically arising in the pleura. We report the first case arising in the larynx, associated with a metastasizing adenocarcinoma. The diagnosis is mainly histopathological, especially when strong immunoreactivity for the CD34 antibody is present.

Adenocarcinoma↗
PubMed1998

[Esophageal morphology with ultrasound imaging after laryngectomy: effect on quality of esophageal speech].

PURPOSE: In patients with aerodigestive cancer, laryngectomy places the esophagus in a superficial position, allowing easy ultrasound examination of this organ. The purpose of the present study was to assess oesophagus morphology after laryngectomy using echotomography and to compare this morphology with voice quality. MATERIAL AND METHODS: In the present study, ultrasonography was performed in 28 patients (delay from surgery: 3 +/- 3 years): 15 were operated using laryngectomy technique (LT) and 13 with pharyngolaryngectomy technique (PLT). On transversal echography, antero-posterior and latero-lateral diameters, esophagus area and dilatation during phonation were systematically measured. These data were compared to the voice quality assessed by two independent observers. RESULTS: A smaller latero-lateral diameter and area were found in the PLT group than in the LT group (p < 0.05) with a flat aspect in group LT. This was associated with faster and better voice acquisition in the PLT group. CONCLUSION: Morphologic study of the esophagus after laryngectomy using ultrasound is in favor of pharyngolaryngectomy technique which allows better conditions for acquiring esophageal voice in better conditions. This could be due to the small area, circle shape and tonicity of the esophagus after this type of surgery.

Esophagus↗
PubMed1998

[Results of vestibular neurotomy from a socio-professional point of view].

Vestibular neurotomy, in addition to the fact that it preserves the hearing, is considered to be the most effective form of treatment for incapacitating unilateral Menières disease which is resistant to medical treatment. The authors have carried out a retrospective study of 20 cases of vestibular neurotomy operated on between 1986 and 1996. They have evaluated the results of the suppression of vertigo and the improvement of quality of life. Each patient was given a questionnaire. The parameters studied were the quality of daily life, professional life and driving ability. The mean follow-up period was 3 years. This study confirms the good results obtained with vestibular neurotomy for vertigo: complete control of attacks of vertigo was obtained in 90% of cases according to the criteria laid down by the American Committee on Hearing and Balance, as modified in 1985 (AAO, 1985). This study has also confirmed that the quality of patients lives is greatly enhanced both for everyday activities, professional activities and driving.

Adult↗
PubMed1996

Bacteriology of the adult middle meatus.

The aim of this work was to assess the commensal flora in the adult middle meatus. Thus, 139 samples were taken from subjects of both sexes, over 16 years of age, seen in the community or hospitalized for less than 72 hours for non-rhinological conditions. They had had no nasal or sinus conditions in the previous three months. One hundred and thirteen samples contained at least one aerobic or anaerobic bacterium. Fifty-nine samples yielded a single organism in culture. A maximum of five organisms were isolated from a given patient. These results show that the adult middle meatus contains a mixed commensal flora and should prove useful in interpreting endonasal swab cultures during acute and chronic sinus infection.

Adolescent↗
PubMed1995

[Lateral efferent system and evoked auditory potentials. Response in tinnitus].

The effects of ipsi- or contralateral masking have been studied in 45 normal hearing subjects and in 49 tinnitus patients. With normal subjects, ipsilateral masking during auditory stimulation involves--in opposition to contralateral masking which does not alter any latencies--a significant lengthening of all the latencies in the brainstem, except that of the first wave (right and left), and a significant decreasing of the amplitudes of the waves I L and R. It was important to know whether the lengthening of the latencies in the brainstem--which we suppose to be due to the stimulation of the lateral efferent system--was not in fact due to a preferential stimulation of the auditory cells from the basis of the cochlea. Yet experiments have shown that continuous masking of 40 dB at 750 Hz or 4000 Hz added to stimulation, involved no significant modification of the latencies in normal subjects. Therefore the lengthening of the latencies obtained with white noise masking, belonged to an other sphere. The second problem concerned the responses of tinnitus patients. Ipsilateral masking in white noises does not alter any latencies in the patients' brainstem. They seem to have lost the possibility of reacting to any additional noise coming from the outside. As we have already noticed, their latencies before masking were different from those of normal subjects. With masking the patients, latencies remained unchanged whereas the latencies of normal subjects lengthened and caught up the patients. To conclude, we suppose the lateral efferent system can be explored by the adjunction of white noise masking, ipsilateral to the stimulation. The expected response is a lengthening of interpeak I-V latency, without any modification of the latency of the first wave. Tinnitus patients generally do not have that type of response to white noise masking. Their lateral efferent system may not be operating.

Adult↗
PubMed1995

[Tracheal carcinoma infiltrating the thyroid gland and mimicking subacute thyroiditis. Contribution of Doppler to differential diagnosis].

In the present case Color Coded Doppler showed a marked increase in vascularization in the right lobe of the thyroid with high systolic velocities (1 m/s). This sign was only doubtful compared with clinical, biological and isotopic data. Because of dramatic laryngeal dyspnea, surgery was conducted which allowed the final diagnosis of thyroid invasion by tracheal epidermoid carcinoma. This demonstrates the particular role of Color Coded Doppler in the management of inflammatory thyroid diseases.

Adult↗