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Biomedical subjects

V Strunski

Publications and source records attributed to V Strunski.

At least 19 recordsLinked to original sources
PubMed2006

Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases.

AIMS: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery. MATERIALS AND METHODS: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination. RESULTS: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery. CONCLUSION: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.

Calcium↗
PubMed2005

[A rare case of nasal and buccal obstruction in a child: the antrochoanal polyp of Killian].

Nasal obstruction is a frequent symptom of consultation in paediatric otorhinolaryngology. Usually, adenoid hypertrophy is the cause. Sometimes the examination reveals the presence of polyps in the nose. The antrochoanal polyp of Killian is particularly frequent in childhood. The obstruction is usually unilateral, but the posterior extension of a bulky polyp to the oropharynx can cause a major discomfort, sometimes a respiratory distress. We report the observation of a 10-year-old patient presenting a bulky polyp of Killian, visible in the oropharynx and then discuss the features of this polyp in the literature.

Child↗
PubMed2005

[Intra cranial abscess and empyemas from E.N.T. origin].

OBJECTIVES: The purpose of this study was to evaluate the diagnosis criteria, the bacteriology and the evolution after adapted treatment of intracranial abscess of ENT origin. MATERIAL AND METHODS: It was a retrospective study from 1985 to 2003 concerning 22 patients who had brain abscesses secondary to an ENT infection. RESULTS: The infectious origin was sinusoid in 32% of cases, otologic in 32% of cases, pharyngeal or dental in 27% of cases and cutaneous in 9% of cases. The clinical symptoms were: fever in 55% of cases, headache in 73% of cases (Intra cranial hypertension syndrome in 23% of cases), epilepsy in 32% of cases and various other neurologic symptoms. Bacteria were identified in 82% of cases. In 50% of cases multibacterial associations were found. All the patients had bi antibiotherapy associated to surgical excision of the abscess (16 cases) or single (or more) punction (stereotaxic guided or not) of the abscess. 3 patients (14%) died and 50% are alive and well. CONCLUSION: The diagnosis of cerebral abscess is often difficult. The "classical" intracranial hypertension associated to high fever is usually incomplete and sometimes absent. There is no predominant bacteria involved and multibacterial infections are frequent. Despite abscesses are serious and potentially lethal, an early diagnosis, a medical (antibiotics) and surgical treatment (punction and/or surgical excision) may completely be cured in more than 50% of cases.

Adolescent↗
PubMed2005

[Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients].

OBJECTIVES: To study the place of the total thyroïdectomy compared to the sub-total thyroidectomy and the lobectomy in benign nodular thyroid pathology, about complications and prevention of the recurrence. PATIENTS AND METHODS: The evolution of the number and the type of thyroïdectomy among the total thyroidectomy, subtotal thyroidectomy and the lobectomy was analyzed in a retrospective study including 735 patients in the service of Head and Neck Surgery in the University Hospital in Amiens, France over a 12 years period, for a multinodular goiter, a toxic and a nontoxic solitary nodule. The post-operative transient and permanent recurrent nerve paralysis and hypocalcemia of the total thyroidectomies were studied and compared with the other surgical procedures of the study and in a review of the literature in order to study benefit and risks. RESULTS: Multinodular goiters were the most thyroid pathologies (80%). The total thyroidectomy became gradually the most frequent surgical procedure, from 17% to nearly 70% of the surgical procedures over 12 years, with depend on the currently abandoned subtotal thyroidectomy and the lobectomy. No significant difference appeared concerning the recurrent and parathyroid complications between the 3 procedures. CONCLUSION: The post-operative morbidity is not statistically different between the total thyroidectomy and the other procedures. The total thyroidectomy prevents moreover nodular recurrences whose surgical treatment is difficult without benefit of the L-thyroxine treatment prevention. It implies a substitute opotherapy that the other surgical techniques cannot nevertheless always avoid. Nowadays, the total thyroidectomy is the gold treatment for surgical treatment of multinodular benign goiters. Many factors must be considered concerning the solitary nodules: the size, the evolutivity, the fine needle aspiration the aspect of the contralateral lobe. In all the cases, the decision will have to be consensual between the patient, the endocrinologist and the surgeon.

France↗
PubMed2005

Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France.

CONCLUSIONS: The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management. OBJECTIVE: To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region. MATERIAL AND METHODS: A total of 356 patients were included in a retrospective study covering the period 1987-1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan-Meier method, the Cox model and the chi2 test. RESULTS: The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II-IV tumors owing to the small number of cases.

Adult↗
PubMed2004

[Angioedema and angiotensin converting enzyme inhibitors: a report of 19 cases].

PURPOSE: Inhibitors of angiotensin-converting enzyme are worldwide used and are a real progress for the treatment of systemic hypertension or cardiac failure and are a real progress. The most common adverse side effect is cough. Angioedema is a sudden and localized edema involving the deeper cutaneous and mucosa tissue lappers. 0.1-0.5% of patients treated by ACE inhibitors could develop angioedema. MATERIALS AND METHODS: We report a series of 19 cases, recruited in the Parmacovigilance Center of the University Hospital of Amiens from 1997 to 2003. RESULTS: All the patients had a facial swelling edema at initial presentation. Intestinal mucosa or preputial are misleading localisations. In 1/3 of cases, angioedema appeared after the first administration, in 1/3 of cases it appeared with a delay of 1-2 years. The oropharynx localisation with glottic involvement may need an airway intervention. One patient died from pulmonary distress at home. CONCLUSION: The pathophysiology is current unknown although there is increasing evidence for bradykinin accumulation involvement. The treatment by ACE inhibitors must be broken off; angiotensin II antagonists may be an alternative treatment, but has to be introduced carefully.

Adult↗
PubMed2004

[Anatomy of the external laryngeal nerve: surgical implications. Report of 30 dissections].

OBJECTIVES: This anatomic study aimed to detail the anatomy of the external laryngeal nerve and to determine the possible variations of nerves at risk. MATERIAL AND METHOD: Fifteen cadavers (30 nerves) were dissected. The peri pharyngo laryngeal route, the anatomic rapports, the branches of division and the distal penetration point of the external laryngeal nerve were noted. RESULTS: The external laryngeal nerve gave branches to the inferior pharyngeal constrictor muscle in 90% of cases and to the thyroid gland in 70% of cases. There was an adherence between the nerve and the trunk of the superior thyroid artery in 13.33% of cases. The nerve had a distal superficial route even on the cricothyroid muscle in 6.67% of cases. In one case the nerve was situated close to the medial face of the superior thyroid lobe. DISCUSSION/CONCLUSION: The external laryngeal nerve has numerous anatomic variations. The anatomic variations at risk during thyroid surgery are: an adherence between the nerve and the thyroid artery (or a course of the nerve between the branches of the superior thyroid artery); a superficial distal route; a distal situation close to the medial face of the thyroid lobe. In this study, 7 nerves were considered at risk (23.33% of cases).

Humans↗
PubMed2004

[Spontaneous otorrhea involving defects of the tegmentum tympani].

OBJECTIVE: We report two cases and a review of the literature concerning spontaneous otoliquorrhea involving congenital bone defects of the tegmen tympani. CASE REPORTS: Both patients were managed by a cooperative otological and neurosurgical team. Otological symptoms predominated. The bilateral bone defects of the tegmen tympani were highlighted by high-resolution computed tomography. Surgery was undertaken via the middle fossa approach. DISCUSSION: Spontaneous cerebrospinal fluid otorrhea related to tegmen tympani defects is rare. It occurs in adults with no previous otological history. The anomaly is congenital. Otological symptoms (differential diagnosis with serous media otitis) are usually predominant. Infectious meningitis may occur. The diagnosis is based on high resolution computed tomography and surgical treatment is required. Numerous technical approaches are possible (transmastoid and/or middle fossa approach) depending on the extent of the defect. Complete recovery is usual after adapted surgical treatment.

Aged↗
PubMed2004

[Vocal rehabilitation with tracheoesophageal prosthesis. Study of peri-prosthetic leakages].

OBJECTIVES: Peri-prosthetic leakages are a frequent complication of tracheoesophageal prosthesis used in the vocal rehabilitation of laryngectomized patients. The authors examine the effect of pre or post operative radiotherapy upon the incidence of this complication. MATERIALS AND METHOD: In a retrospective study of 67 patients rehabilited with a phonatory prosthesis between 1993 and 2002, pre or post-operative radiotherapy was carried out in 61 patients. RESULTS: A peri-prosthetic leakage occured in 38.8% of the cases. The pre or post-operative radiotherapy was not a statistically significant cause of leakage, as the age of the patient and the surgical procedure. CONCLUSION: Although not supported by the statistical study because of a lack of cases, the radiotherapy remains for the authors a factor determining in the mechanism of the peri-prosthetic leakages and bad forecast for their treatment. Realized before the surgery, it contra-indicates the phonatory prosthesis at the time of the tumor resection. In case of post-operative radiotherapy, the risks must be clearly explained to the patient.

Female↗
PubMed2004

[The verrucous laryngeal carcinoma. A rare tumor with a difficult diagnosis].

OBJECTIVES: The authors report a single case of laryngeal verrucous carcinoma and review the literature. MATERIALS AND METHOD: The delay of the diagnosis, the difficulties in its establishment and the therapeutic methods are discussed in a review of the literature. RESULTS: Histopathological diagnosis remains difficult. This may explain a great number of mistakes and the subsequent delay of in treatment. The role of radiotherapy is discussed. CONCLUSION: The diagnosis and management of the laryngeal verrucous carcinoma is difficult.

Carcinoma, Verrucous↗
PubMed2004

[Fistulisation of a tubercular adenopathy in the oesophagus. About a paucisymptomatic form].

The authors present the case of a cervico-mediastinal mass which disappeared spontaneously. The clinical presentation and the image of a fistula during the oesophagoscopy are in favour of the fistulisation of a tubercular adenopathy in the oesophagus. This pathology is rare. This observation is original by the delay of diagnosis due to a dysphagie summarizing the clinical signs and the spontaneously favorable evolution of the fistula.

Esophageal Fistula↗
PubMed2004

[The lymphoepithelial carcinoma of the parotid gland: a rare tumor for an European patient].

Lymphoepithelial carcinoma of the parotid is a rare and little known tumour The ethnic origin of the patients and the association with the Epstein-Barr virus are recognized but not invariable. The mechanism of the carcinogenesis thus remains an enigma. The authors report the observation of a patient which is remarkable because of his European origin and the positivity of serologies to the Epstein-Barr virus, and discuss the features of the lesion through the literature.

Carcinoma↗
PubMed2003

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies.

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.

Adult↗
PubMed2003

The inferior laryngeal nerve: surgical and anatomic considerations. Report of 251 thyroidectomies.

This surgical anatomic study aimed to determine (1) the anatomic relation of the laryngeal inferior nerve with the inferior thyroid artery, (2) the existence of extralaryngeal branches of division of the nerve and (3) the size of the nerve seen macroscopically. Two hundred and fifty-one patients underwent thyroid surgery during a period of 30 months. There were 50 males and 201 females. The male population underwent 28 total thyroidectomies, 13 left lobectomies and 9 right lobectomies. The female population underwent 124 total thyroidectomies, 33 left lobectomies and 44 right lobectomies. On the right side: the nerve was found superficial to the artery in 70.24% of females and 51.35% of males, the nerve was divided in 23.81% of females and 21.62% of males and seemed unusually thin in 14.29% of females and 5.41% of males. On the left side: the nerve was found superficial to the artery in 87.26% of females and 95.12% of males, the nerve was divided in 15.29% of females and 14.63% of males and seemed unusually thin in 10.83% of females and 2.44% of males. In conclusion, the inferior laryngeal nerve is characterized by its important anatomic variations, especially on the right side. These variations might be different even between males and females. Knowledge of these variations is very important in order to best identify and preserve the inferior laryngeal nerve during thyroid surgery.

Arteries↗
PubMed2003

[Combined transfacial and neurosurgical approach for the treatment of ethmoid cancers].

OBJECTIVES: The purpose of this work was to examine the indications for the combined transfacial and neurosurgical approach to ethmoid cancers. PATIENTS AND METHODS: Fifteen patients with ethmoid cancers underwent surgery via the combined approach between 1990 and 2000 at the Amiens University Hospital. The transfacial approach alone was reserved for elderly patients. RESULTS: The histological diagnosis was adenocarcinoma in 10 patients. There was one postoperative death. Mean follow-up was 45 months (range 3 - 129). Six patients died from local or metastatic recurrence. At last follow-up eight patients were disease free, two had local or metastatic recurrence. CONCLUSION: We compared systematic use of the combined approach for curative surgery with surgical strategies adopted by other teams. The combined approach is indicated for T3 or T4 tumors and for all other tumors with a posterior or superior extension. Anterior and unilateral tumors may be treated with the transfacial access alone. Limited tumors without extension to the orbit or cribiform plate may be managed endoscopically. The role of histological diagnosis and the choice of the surgical approach remain to be evaluated.

Adenocarcinoma↗
PubMed2003

[Intraorbital infected cyst in the adult].

Orbital dermoïd cyst is a rare tumour, whose pathogenesis remains unclear. This is a childhood pathology. It is usually located in the lateral orbit. This tumour is rarely observed during adulthood, and complications are often responsible for the symptomatology. We present a new case with late presentation and because of its variety, a review of the literature.

Dermoid Cyst↗
PubMed2003

[Comparison of laryngoscopy and CT-scan results before partial laryngectomy].

OBJECTIVES: Careful assessment of tumor extension is required before partial laryngectomy in order to ensure optimal carcinological safety. Laryngoscopy and CT-scan constitute the explorations of reference. We investigated the value of these two examinations and their association for the evaluation of glottic and supraglottic tumors. METHOD: We compared laryngoscopy and CT findings with those of the pathologic examination of the surgical specimen in a retrospective study of 57 patients. RESULTS: The results were presented by T-staging, then as a function of the laryngeal floor of the tumor and the anatomic localization. The laryngoscopy findings were most contributive for small tumors. Large spaces are better examined with the scanner. CONCLUSION: This study showed that the performance of laryngoscopy and CT-scan for the assessment of glottic and supraglottic tumors can be improved by a better knowledge of the limitations of each type of explorations for this type of assessment. CT-scan currently provides a better topographic assessment of the tumor than endoscopy; even higher performance can be expected with the advent of technological advances.

Adult↗