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P Gehanno

Publications and source records attributed to P Gehanno.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prognostic value of lymph node involvement in oral cancers: a study of 137 cases.

OBJECTIVE: The aim of this study was to assess the prognostic value of lymph node involvement in patients with squamous cell carcinoma of the oral cavity. STUDY DESIGN: Retrospective study of 137 patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy (84 N0, 23 N1, 16 N2,14 N3). Twenty-three patients in the N0 group had a history of surgery or radiotherapy. One hundred fourteen patients underwent limited or radical neck dissection unilaterally or bilaterally. METHODS: The histological charts were reviewed and correlated with preoperative lymph node clinical stage. The local failure rate and the overall survival curves were calculated with respect to clinical and histological stages. The causes of death were analyzed. RESULTS: No evidence of lymph node metastasis was found in 47.4% of cases (54 of 114 patients). Among the node-positive (N+) patients, 39 had rupture of the lymph node capsule (R+). In the N0 group, 27.8% of patients were N+. Regional control rates after surgery and radiotherapy were 95% at 1 year and 85.4% at 5 years. The local failure rates were 6% in N0, 8.7% in N1, 31.2% in N2, 51.7% in N3, 9% in node-negative (N-), and 29% in N+R+ patients. The overall survival rates at 3 and 5 years were, respectively, 44.7% and 34.8% in the N0 group, 37.7% and 37.7% (same rate at 3 and 5 years) in the N1 group, and 31.2% and 15.8% in the N2 group. None of the patients in the N3 group survived beyond 2 years. The overall survival rates at 5 years were 42.8% and 17.5% in the N- and N+ groups, respectively. CONCLUSIONS: In patients with locally advanced tumors (T4), clinical nodal status and histological nodal invasion were key prognostic factors. The presence of occult metastases in the N0 group justifies routine neck dissection.

Adult↗
PubMed2000

Five vs. ten days of antibiotic therapy for acute otitis media in young children.

BACKGROUND: Many publications in recent years have argued in favor of shortened therapy for acute otitis media. However, doubt persists regarding children younger than 2 years, and some authors therefore restrict short course therapy to children older than 2 years. METHODS: In a prospective, comparative, double blind, randomized, multicenter trial we compared cefpodoxime-proxetil, 8 mg/kg/day in two divided doses for 10 days, with an identical 5-day regimen followed by a 5-day placebo period. RESULTS: Between October, 1996, and April, 1997, 450 children (mean age, 14.3 months) were enrolled, 227 in the 5-day group and 223 in the 10-day group. In the per protocol analysis clinical success was obtained on Days 12 to 14 after the beginning of treatment (main analysis) in 175 (84.1%) of the 208 children receiving the 5-day regimen and 194 (92.4%) of the 210 children receiving the 10-day regimen (P = 0.009). The superiority of the standard regimen was more marked among children cared for outside their homes (92.5% vs. 81.5%). Clinical success persisted on Days 28 to 42 among 134 (85.4%) of the 157 assessable patients in the 5-day group and 144 (83.7%) of the 172 assessable patients in the 10-day group (P = 0.68). CONCLUSIONS: The 10-day regimen resulted in a higher success rate at the conclusion of therapy, but there were no differences between the two study groups 4 to 6 weeks after enrollment in the study protocol.

Acute Disease↗
PubMed2000

[Prognostic influence of cutaneous involvement in malignant tumors of the oral cavity].

The aim of this study was to assess the prognostic influence of cutaneous involvement in T4 squamous cell carcinoma of the oral cavity. The population was a homogeneous group of 137 patients. Cutaneous tumor localizations were observed in 20 of them. Surgery and radiotherapy were given in 103 cases and salvage surgery was performed in 34. Local control at 5 years was achieved in 68.5 % of the patients. Carcinologic failure rate was 55 % and 27.3 % in patients with and without cutaneous involvement respectively (p =0. 013). 5-year survivor rate was also correlated with cutaneous involvement: 10 % versus 32.2 % (p <0.0001).

Adult↗
PubMed1999

[Cancers associated with cancer of the esophagus].

Secondary neoplastic localisations observed in oesophageal epidermoid carcinoma are essentially in the upper oesophagogastric tract, in particular the hypopharynx, the oropharynx and the buccal cavity. The associated morbidity of the mucous membrane of the upper oesophagogastric tract and that of the oesophagus, with regard to the risk of developing epidermoid carcinoma, is linked to a common risk factor, simultaneous alcohol and tobacco intoxication. The high frequency of these secondary localisations, which can be synchronous or metachronous, suggests they should be routinely sought during pretreatment evaluation of oesophageal cancer as well as during mid- and long-term follow up.

Alcohol Drinking↗
PubMed1999

Down-regulation of desmosomal molecules in oral and pharyngeal squamous cell carcinomas as a marker for tumour growth and distant metastasis.

Down-regulation of adhesion molecules has been observed in a number of squamous cell carcinomas (SCC) and is considered to be associated with tumour invasiveness and lymph node metastasis. The present prospective investigation aimed at analyzing the expression patterns of desmosomal markers in oral and pharyngeal SCC and correlations that may exist between these patterns and tumour behaviour. Two constitutive desmosomal molecules, desmoplakin (Dp) and plakoglobin (Pg), were examined in 26 samples of primary carcinoma of the head and neck. The correlation between Dp and Pg expression was only moderate, reflecting functional differences between the two proteins. Whereas decreased Dp and Pg expression was closely associated with distant metastasis formation, reduced Pg expression was correlated to the development of large tumours. There were also variable relationships between the expression of these markers and lymph node invasion, histological differentiation, or survival of the patients. Biochemical analysis of cytoskeletal fractions confirmed the decrease in desmosomal proteins, particularly in tumours which later developed metastases. Down-regulation of Dp and Pg in oral and pharyngeal SCC may represent a reliable marker for extensive tumour growth and the risk of distant metastasis formation, Dp and Pg apparently having metastasis- and tumour-suppressor properties, respectively.

Adult↗
PubMed1999

Cytokeratin alterations as diagnostic and prognostic markers of oral and pharyngeal carcinomas. A prospective study.

Cytokeratin (CK) alterations have been reported in carcinomas from different anatomical sites, and these have been associated with specific aspects of tumour behaviour. In order to assess the relationships between CK modifications and future tumour behaviour, we conducted the present prospective study on 26 squamous cell carcinomas (SCC) of oral and pharyngeal mucosae and corresponding controls. Cytokeratins were investigated using two-dimensional gel electrophoresis and immunofluorescence techniques. All healthy tissues, oral lining and oropharyngeal mucosae, expressed the oesophageal type CKs, including CK 19. Other simple epithelial CKs (7, 8, 17 and 18) were not detected. In carcinomas originating from corresponding sites, expression of oesophageal CKs varied widely from one specimen to another, and simple epithelial keratins were often found. Statistical analysis indicated correlations between CK expression and the clinicopathological data of SCC patients. Small tumour size was strongly associated with the expression of CKs 10 and 19. Interestingly, an absence of lymph node involvement was significantly associated with CK 18 expression. Tumours giving rise to recurrences, metachronous tumours, and distant metastasis were significantly associated with an absence of CK 13. These results suggest that CKs 10, 19, 18 and 13 could be reliable diagnostic and prognostic markers in the assessment of oral and pharyngeal squamous carcinomas.

Adult↗
PubMed1999

Short course therapy with cefuroxime axetil for acute otitis media: results of a randomized multicenter comparison with amoxicillin/clavulanate.

BACKGROUND: Otitis media is a common infection of childhood. Increasing antibiotic resistance rates among the principal causative pathogens, Streptococcus pneumoniae and Haemophilus influenzae, are associated with failure of first line agents. OBJECTIVE: This open, randomized, multicenter study compared the clinical efficacy of a short 5-day course of cefuroxime axetil (CAE) suspension with that of amoxicillin/clavulanate (A/CA) suspension for 8 or 10 days. METHODS: Children age 6 to 36 months with acute otitis media with effusion, diagnosed by tympanocentesis and microbiologic culture, were randomized to receive CAE (30 mg/kg/day in two divided doses for 5 days) or A/CA 40 mg/kg/day in three divided doses for 10 days (A/CA-10). In French centers A/CA was given at 80 mg/kg/day in three divided doses for 8 days (A/CA-8). Patients were assessed 1 to 4 days after completing the course (posttreatment) and followed up at 21 to 28 days after completing the course. RESULTS: Of the 716 patients randomized, 252 were treated with CAE, 255 with A/CA-10 and 209 with A/CA-8. In the clinically evaluable population, the proportions of patients with clinical cure at posttreatment were 175 of 203 (86%), 181 of 205 (88%) and 145 of 164 (88%) in the CAE, A/CA-10 and A/CA-8 groups, respectively, demonstrating equivalence among the three treatments. For patients <18 months old, clinical cures were 111 of 134 (83%), 116 of 131 (89%) and 83 of 99 (84%) in the CAE, A/CA-10 and A/CA-8 groups, respectively; equivalence was also demonstrated. At follow-up, 130 of 175 (74%) CAE, 121 of 172 (70%) A/CA-10, and 112 of 142 (79%) A/CA-8 had maintained cure. A total of 837 pretreatment pathogens were isolated from middle ear fluid in 73% (522 of 716) patients, the majority of isolates were S. pneumoniae (30%) and H. influenzae (27%). The most common adverse events were gastrointestinal, the incidence of drug-related diarrhea being higher in the A/CA-10 group (18%) than in either the CAE or A/CA-8 groups (10%). CONCLUSIONS: A 5-day course of CAE, given twice daily, was shown to be equivalent to the two regimens of A/CA for treatment of acute otitis media with effusion in children.

Acute Disease↗
PubMed1999

Eradication by ceftriaxone of Streptococcus pneumoniae isolates with increased resistance to penicillin in cases of acute otitis media.

This multicenter, noncomparative, nonrandomized study evaluated the clinical efficacy and safety of ceftriaxone for treating acute otitis media in children following clinical failure of oral antibiotic therapy. Middle-ear fluid samples were collected on day 0 and on day 3, 4, or 5 (day 3 to 5) and were used to test whether ceftriaxone therapy can eradicate Streptococcus pneumoniae isolates with increased resistance to penicillin (MIC >/= 1 mg/liter). At the first visit, on day 0, middle-ear fluid was sampled for bacteriological testing by tympanocentesis or otorrhea pus suction. Patients were administered 50 mg of ceftriaxone/kg of body weight/day, injected intramuscularly once daily, for 3 days. A second sample was collected by tympanocentesis if a pneumococcus isolate for which the MIC of penicillin was >/=1 mg/liter was detected in the day-0 sample and if the middle-ear effusion persisted on day 3 to 5. This second sample was tested for bacterial eradication. One hundred eighty-six children aged 5 months to 5 years, 10 months, with acute otitis media clinical failure were enrolled and treated in this trial. On day 10 to 12, 145 (83.8%) of the 173 patients evaluable for clinical efficacy were clinically cured. Of the 59 patients infected by pneumococci, 36 had isolates for which the MICs of penicillin were >/=1 mg/liter. Of those patients, on day 10 to 12, 32 (88.9%) were clinically cured. Middle-ear fluid samples collected by day 3 to 5 following the onset of treatment with ceftriaxone were sterile for 24 of the 27 (88.9%) patients who were infected as of day 0 by pneumococci for which the MICs of penicillin were >/=1 mg/liter and who were evaluable for bacteriological eradication. On day 10 to 12, 81.4% of S. pneumoniae-infected children and 87.5% of Haemophilus influenzae-infected children were clinically cured. No discontinuation of treatment due to adverse events, particularly due to local reactions at the injection site, were reported. Only 11 adverse events which had doubtful, probable, or possible links with the study treatment were recorded. Both the bacteriologically assessed eradication of pneumococci for which the MICs of penicillin were >/=1 mg/liter and the clinical cure rates demonstrate that ceftriaxone is of value in the management of acute otitis media unresponsive to previous oral antibiotic therapy.

Ceftriaxone↗
PubMed1999

[Invasive aspergillosis sinusitis in patients infected by the human immunodeficiency virus].

Invasive aspergillus sinusitis invasive is a rare, life threatening infection observed in immunocompromised patients. We report three cases of patients with AIDS. Diagnosis was based on surgical biopsy specimen performed on patients with unilateral sinusitis with facial pain and osteolysis on CT scanning, associated in one patient with neurological disorders. One patient with frontal sinusitis and meningeal involvement died despite therapy. One patient with limited maxillary sinusitis who underwent surgical satisfactory resection and antifungal therapy was successfully treated without relapse 12 months later. One patient with orbital and cavernous sinus extension of ethmoiditis was successfully cured with antifungal therapy by itraconazole. Our results confirm the necessity of early diagnosis when clinical and CTscanning are suggestive and the curability of aspergillus sinusitis.

AIDS-Related Opportunistic Infections↗
PubMed1999

[Value of MRI and computerized tomography scanner in oro-buccopharyngeal cancers with bone invasion].

The purpose of this prospective study was to assess the impact of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in the surgical management of carcinomas with mandibular bone invasion. Thirty-five patients with squamous cell carcinoma of oral cavity or oropharynx, with mandibular spread, were studied with both imaging methods before surgical treatment. We compared the radiographic findings with histologic examination. Sensitivity of CTScan and MRI was respectively 25% and 80% to identify bone invasion. CTScan was found less effective in the assessment of bone invasion before mandibular resection and was considered more radiologist dependent. MRI is becoming the imaging method of choice for these cancers, despite inherent disadvantages including limited availability and increased cost over CTScan. MRI is accurate in large oropharyngeal tumors with extension of base of tongue and pterygoid muscle, and to study bone invasion before surgery in oral cavity tumors.

Adult↗
PubMed1999

Risk factors for surgical wound infections in patients undergoing head and neck oncologic surgery.

Risk factors for surgical wound infection are difficult to establish in head and neck surgery. Flap reconstruction, which correlates with tumour size and surgical procedure, appears to be the main risk factor. Attempts should be made by the surgical staff to improve surgical procedures in terms of duration of surgery and choice of the procedure. The intraoperative choice between primary closure and flap reconstruction should be studied further. More subtle risk factors may appear in studies of large groups of patients and/or if a distinction is drawn between early and late SWI.

Antibiotic Prophylaxis↗
PubMed1998

[Forum on bacterial resistance].

Recently, in daily newspapers and on television, attention of the audience has been focused on the overuse of antibiotics and on the role it plays in the emergence and dissemination of resistance mechanisms in the human environment. The role of food from animal origin in relation to the use of antibiotic resistance, infectious diseases, medical practice and ENT infections have accepted to answer a series of questions concerning risks versus usefulness of antibiotic usage. From the answers, we may note convergent views and discrepancies: (i) there was agreement concerning the unnecessary prescription of antibiotics in rhinopharyngitis and few other common viral infections; (ii) the risk of misuse of antibiotics in patients with poor compliance and further risk of erroneous self prescription of the remaining tablets has been cited; (iii) in the problem of resistance resulting from growth promoting antibiotics in animals, it has been experimentally shown that from 2 bacteria of the same species introduced in the animal gut, one susceptible, the other resistant, the latter will be eliminated by means of the "barrier effect"; similarly in case of transfer of resistance from an exogenous bacteria to a "resident" organism of the gut, the latter will be eliminated by the homologous susceptible ones; only an antibiotic therapy may confer importance to the resistant bacteria. In this respect, care should be taken for resistance spread such as that concerning penicillin-resistant pneumococci and surveillance and control of resistance mechanisms has become necessary. However we should look with reluctance at the diffusion of inevitably simplified and truncated information from Media, showing the negative aspects of antibiotics only. Moreover, as underlined by the expert from the Institut Pasteur, there are new perspectives in the development of effective new agents based on the modern "genomic" research.

Animals↗
PubMed1998

Pathogens isolated during treatment failures in otitis.

OBJECTIVES: A prospective study in the Paris region to evaluate the clinical and bacteriologic epidemiology of acute otitis media in infants in whom oral antibiotic therapy resulted in clinical failure. METHODS: The study included 186 children with a mean age of 17.5 +/- 13.1 months. Two-thirds of them attended a day-care center and 40.8% had a history of recurrent otitis media. The most frequently prescribed prior antibiotics were amoxicillin-clavulanic acid (43% of cases), an oral third generation cephalosporin (22.6%), erythromycin-sulfisoxazole (11.8%) and a first generation cephalosporin (10.2%). The average duration of antibiotic therapy was 6.9 +/- 2.65 days. Specimens for bacterial cultures included 188 samples of middle ear fluid obtained by tympanocentesis and 37 collected from otorrhea fluid. RESULTS: One hundred forty-one samples (62.7%) from 126 children yielded 170 bacterial isolates. In 60 children (32.3%) the culture of the ear pus was sterile. Among the 170 bacterial isolates: 67 (39.4%) were Streptococcus pneumoniae (59 patients), of which 77.6% had reduced susceptibility to penicillin (PRSP with penicillin MIC > or = 0.125 mg/l); 61 (35.9%) were Haemophilus influenzae (56 patients) of which 49.2% were beta-lactamase producers; and 8 were Moraxella catarrhalis (8 patients), of which 87.5% were beta-lactamase producers. Thirty-six patients were infected by S. pneumoniae with penicillin MIC > or =1 mg/l. In our study attending day-care center (P = 0.04), temperature >38 degrees C with signs of otalgia (P = 0.02), age <2 years (P = 0.048) and prior antibiotic treatment with erythromycin-sulfisoxazole (P = 0.006) were independently predictive risk factors for patients infected with penicillin-resistant S. pneumoniae. Pneumococcal serogroups 23, 14 and 19 were predominant (25.4, 25.4 and 23.8%, respectively). Penicillin resistance was mainly associated with serogroups 23 and 14. CONCLUSIONS: Penicillin-resistant S. pneumoniae isolates are frequently responsible for therapeutic failure in cases of acute otitis media in the Paris region.

Acute Disease↗
PubMed1997

[Endoscopic treatment of a Zenker diverticulum. 50 cases].

OBJECTIVES: Endoscopy has been used for many years as an alternative to surgery for the treatment of Zenker's diverticulum. We report our experience in 50 cases. METHODS: From 1979 to 1995, we treated 50 cases of Zenker's diverticulum endoscopically. Patients' age ranged from 59 to 98 years. All patients had contraindications for conventional surgery or deep anesthesia. The surgical technique of endoscopic treatment is performed under general anesthesia using a specially designed endoscope for exposure. Scissors, then after 1990, CO2 LASER, was used to divide the posterior crico-pharyngeal muscle fibers. RESULTS: There were no major complications. Our results, 95% success, were comparable with those reported in the literature even though, paradoxically, a small diverticulum may remain. Our experience also showed that it may be necessary to perform two sessions for diverticula larger than 3 cm. CONCLUSION: This safe and efficient treatment can be recommended for patients of all ages with a contraindication for conventional surgery.

Aged↗
PubMed1997

Multicenter study of the efficacy and safety of oral ciprofloxacin in the treatment of chronic suppurative otitis media in adults. The French Study Group.

Chronic suppurative otitis media is a common and potentially dangerous clinical condition that is difficult to treat because the most common infecting organisms are often resistant to many antibiotics. Recently, fluoroquinolones such as ciprofloxacin have provided a new therapeutic possibility, offering a wide range of antibacterial activity and proven concentration in the middle ear. Therefore in the current study, we assessed the efficacy and safety of oral ciprofloxacin (500 mg twice daily for 10 days) in the treatment of suppurative chronic otitis media in adults. One hundred sixty-four patients were enrolled during a 3-month period by 49 ear, nose, and throat physicians in general practice. The mean duration of symptoms was 158 months, with the acute exacerbation lasting 72.5 days. Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis were most commonly isolated. At the end of treatment, the otorrhea had disappeared in 104 of the 155 (67.1%) evaluated patients. The bacteriologic eradication rate was 64.5%. After 4 weeks of follow-up care, 93.2% of patients had no recurrence of infection. In 4 patients, treatment was discontinued prematurely after an adverse event. We conclude that ciprofloxacin is an effective and well-tolerated general practice treatment for suppurative chronic otitis media in adults.

Administration, Oral↗
PubMed1997

Molecular epidemiology of Streptococcus pyogenes in an area where acute pharyngotonsillitis is endemic.

During an open clinical trial in an area where streptococcal infections are hyperendemic, we studied the genetic polymorphism of Streptococcus pyogenes isolates collected from patients and from healthy carriers living in close contact with them. The clonal diversity of isolates was analyzed by pulsed-field gel electrophoresis with three restriction enzymes (SmaI, ApaI, and SacII). The pharynx of each patient and healthy carrier was colonized by a single clone, suggesting the clonal nature of streptococcal colonization in individuals. Among 52 isolates obtained from patients with acute pharyngotonsillitis, we found 14 genetically unrelated clones, showing the genetic diversity of S. pyogenes. However, two clones belonging to the M1 and M12 serotypes represented about 70% of isolates in carriers and patients. Pharyngeal colonization in cured patients was monitored for 3 to 4 months. After the initial elimination of S. pyogenes following antibiotic therapy, the rate of recolonization was high by day 30 (about 20%) and was also at that level between days 90 and 120; this was similar to the carriage rate in family contacts. Thus, cured patients can be recontaminated by unrelated clones, suggesting that colonization of healthy carriers might be a potential source of spread and redistribution of S. pyogenes isolates.

Acute Disease↗