Biomedical subjects

A Chays

Publications and source records attributed to A Chays.

At least 19 recordsLinked to original sources

PubMed2005

[Postoperative radiotherapy in N0 laryngeal cancer].

PURPOSE: A retrospective study to re-assess the indications for postoperative radiation therapy in squamous cell carcinoma of the larynx staged N0 after gross resection. PATIENTS AND METHODS: Between January 1975 and December 2000, 166 patients with squamous cell carcinoma of the larynx were treated by total laryngectomy with or without neck dissection. Surgery was completed by external radiotherapy delivering 45 to 65 Gy to the tumour bed and 45 to 50 Gy to cervical lymphatic chains. Minimal follow-up was 36 months and median follow-up was 98 months. RESULTS: The rate of nodal recurrence was 6% (median time for relapse was 9 months). The survival rates at 1, 2, 3 and 5 years were 93.5, 84, 80 and 69% respectively, with a 8 year 3 month median survival. The univariate analysis showed 4 parameters, which significantly increased the risk of local recurrence: the medical necessity for immediate tracheotomy, the subglottic involvement, the involvement of the whole larynx and the presence of lymphatic embols in the neck dissection. There was no statistically significant difference between the patients with or without a neck dissection. Fifty-nine secondary cancers were observed, 15 of them occurring in the head and neck area. The late complications consisted of cervical subcutaneous fibrosis (7%), oesophageal stricture (4%), oeso-tracheal fistula (l%), hypothyroidism (3%), bone necrosis (1%). CONCLUSION: Prophylactic cervical radiotherapy in laryngeal cancers resulted in 6% cervical node recurrence rate. This value may represent the maximal rate to accept if one would favour new therapeutic strategies based on restricted indications for radiotherapy.

Adult↗

PubMed2005

An anatomical study of the vestibulocochlear anastomosis (anastomosis of Oort) in humans: preliminary results.

Von Oort first described the vestibulocochlear anastomosis in 1918, and there have been very few anatomical studies of it. It is located at the bottom of the internal auditory meatus and links the saccular nerve to the cochlear nerve. The aim of this study was to investigate the micro-anatomical characteristics of this anastomosis. We dissected 10 human temporal bones from five heads. We found the vestibulocochlear anastomosis in seven of the specimens, of which six were clearly visible. We were unable to uncover it in three specimens due to dissection problems. Its length was evaluated to be between 0.5 and 1 mm, with a diameter of 0.5 mm. The vestibulocochlear anastomosis could be the pathway for the nerve fibers of the cochlear efferent system, whose description remains incomplete. However, no anatomist, histologist or physiologist has demonstrated this function. From the results of this study, it seems likely that the vestibulocochlear anastomosis exists. Other studies are necessary to link it to the efferent system.

Aged↗

PubMed2005

[Curthoys and Halmagyi Head Impulse test: an analytical device].

UNLABELLED: Described in 1988 by Curthoys and Halmagyi, the Head Impulse test enables checking the individual response of each of the six semicircular canals to fast head movements within less than one minute. Interpretation of test results requires careful clinical observation of the eye/head synchronism. But, due to the very short duration of the phenomenon, such synchronism is often difficult to confirm. This is so difficult that, sixteen years after its first description, the test is still rarely performed in daily practice. OBJECTIVES: We describe hereafter a device which allows confirmation of the positive or negative test results for each of the six canals without increasing test duration. METHOD: A high resolution and high light sensitivity video camera located in front of the patient's face at a distance of 80 cm is connected to a computer for automatic image analysis. RESULTS: With this device, the practitioner can confirm a positive test by simple observation on the videooculocephaloscope (HIT scope) and record an image for later reference. With videooculocephalography (HIT graph), movements can be recorded for analysis to quantify the deficit of each semicircular canal.

Diagnostic Techniques, Neurological↗

PubMed2005

[Treatment of voice prosthesis leakage. Preliminary results].

UNLABELLED: Numerous voice prostheses have been developed since the early eighties. The device, located in the tracheo-esophageal wall, can generate local complications. The most frequent and the hardest to treat is peri-prosthetic salivary leakage. OBJECTIVE: To present a new management scheme for peri-prosthetic salivary leakage by BIOPLASTIQUE injection. PATIENTS AND METHOD: Five patients, with residual peri-prosthetic salivary leakage after different treatments were managed by peri-prosthetic injection of BIOPLASTIQUE, a medical silicone elastomere. The injection was performed under general anesthesia in four points around the prosthesis: above, below, left and right. RESULTS: Leakage disappeared after one or two injections in all patients. No technical problem was encountered. CONCLUSION: Although this method still has to pass the test of time, our preliminary results are encouraging. Such a procedure could be performed under local anesthesia in order to minimize its cost.

Female↗

PubMed2005

[Sinuso-nasal sarcoidosis].

OBJECTIVES: Sinonasal sarcoidosis is unusual and may be misdiagnosed. We describe the characteristic clinical presentation observed in three patients treated in our institution and define the complementary explorations leading to diagnosis. Basis for treatment is also developed. PATIENTS AND METHODS: Among one hundred and one patients treated for sarcoidosis between 1983 and 2003 in three department of RD Hospital, three had histologically proved sinonasal sarcoidosis. These three cases were retrospectively analyzed and compared with the literature. RESULTS: All patients complained of chronic rhinosinusitis without improvement under usual treatment. Computed tomography showed usual aspects of chronic rhinosinusitis. The diagnosis was finally based on the biopsy of the nasal mucosa. Even if sarcoidosis had been already diagnosed, the main point was the delay between ENT symptoms and diagnosis because all clinical presentations and radiological aspects were aspecific. CONCLUSION: This case report underlines the difficulty to diagnose sinonasal sarcoidosis. When a patient is treated for sarcoidosis, sinonasal localization of the disease must be suggested in the event of chronic rhinosinusitis. On the other hand, sarcoidosis must be suggested and specific complementary examination must be performed in the event of chronic rhinosinusitis without improvement under usual treatment. ENT biopsy remains the main argument for diagnosis.

Adult↗

PubMed2005

[Benign positional vertigo, an armchair for diagnosis and for treatment: description and significance].

OBJECTIVES: The benign positional vertigo is a very frequent pathology. It requires to establish the diagnosis, to fixe the head in some positions to get various nystagmus which are observed directly or by video-nystagmoscopy or analyzed by video-nystagmography. PURPOSE: To describe the diagnostic and therapeutical interests of a special armchair, now available, whose characteristics are to be able to swivel around two axes of vertical and horizontal rotations, the patient being completely interdependent of the armchair. It thus makes it possible to place the patient's head in position wished with a high degree of accuracy and facility. METHODS: After a short description of the characteristics of armchairs classically used, the authors describe in detail this new armchair Its geometrical characteristics are reported and its capacities, like its mode of use: fixing of the patient with armchair then mobilization of the unit "armchair-patient" and setting in position of the head at the point of the space desired by the ENT. RESULTS: The authors report the main advantages of this armchair. It allows a great accuracy of movement given to the semicircular canals, a possible mobilization with an amplitude until there ever reached, a significant reduction of the proprioceptive entries of patient, a perfect safety of the examination, a possible mobilization of obese or arthritic patients and, finally, a very increased comfort for the patient himself. Finally future technological developments possible are brought back. CONCLUSION: Thanks to the use of the armchair of mechanical assistance, the diagnosis and treatment of benign positional vertigo appear more certain, more precise and more practical at the same time for the medical doctor and the patients. A multicentric study is in process to show its interest in this pathology.

Diagnostic Equipment↗

PubMed2004

[Vibration-induced nystagmus: mechanism and clinical interest].

UNLABELLED: In 1973 Lücke described nystagmus induced by application of a vibrator on the mastoid process. Since that time, several Authors have applied the vibrator test in normal subjects or patients suffering from various well-characterized conditions. OBJECTIVE: Recognizing that results obtained with the vibrator test are sometimes in contradiction with those of other vestibular tests, our aim was to formulate an assumption regarding the genesis of induced nystagmus in an attempt to explain such contradictions. MATERIAL AND METHODS: We considered seven very different clinical situations. Each patient underwent a standard protocol including pendular and caloric tests as well as the vibrator test. We sought an assumption allowing, i) an interpretation of the characteristic features of nystagmus induced by the vibrator in any situation, ii) an understanding of the reasons why some vibrator test results do not correlate with those of other vestibular tests. RESULTS AND CONCLUSION: We assume that the vibrator stimulates phasic cells of the cupula and the vestibular maculae preferentially, if not exclusively. This assumption allows us to retain a very simple protocol for the vibrator test useful for routine clinical practice.

Caloric Tests↗

PubMed2004

[Anatomohistologic study of von Oort's vestibulocochlear anastomosis].

OBJECTIVES: The vestibulocochlear anastomosis was first described in 1918 by von Oort. It is situated deeply at the bottom of the internal acoustic meatus, and spreads from the saccular nerve before its terminal ramifications, to the cochlear nerve before its penetration into the cochlea. Nerve fibers of the cochlear efferent system are thought to pass through it. The aim of our study was to investigate the anatomy of the vestibulocochlear anastomosis and characterize its histological features. METHOD: [corrected] Ten human temporal bones were dissected. Serial sections were obtained for histological evaluation. RESULTS: The vestibulocochlear anastomosis was found in seven of the specimens, perfectly visualized in six. Average diameter was 0.5 mm with lengths varying from 0.5 to 1 mm. Serial histological sections demonstrated the nervous nature of the anastomosis and its relations with the saccular and cochlear nerves. The epinevrium of the saccular nerve was continuous with the supposed anastomosis in five of the specimens, demonstrating the distinct nature of the anastomosis from the saccular and cochlear nerves. We did not find any evidence linking these fibers to the cochlear efferent system. DISCUSSION: The vestibulocochlear anastomosis was found in seven of our ten dissections. The anastomosis is probably an anatomic reality composed of nerve fibers. The efferent function of these fibers remains to be demonstrated.

Anastomosis, Surgical↗

PubMed2003

[Are we sectioning the cochlear efferent system during vestibular neurotomy?].

INTRODUCTION: In addition to sensory neurons which transmit information from the inner ear to the brain, there is a system of efferent feedback fibers, called the olivocochlear system, carrying signals from the brain to the ear. Over the past half-century, the efferent system has been extensively studied in animals and results provided theories as to the functional significance of these efferents: to improve signal-to-noise ratio in the auditory periphery, to mediate selective attention, and to protect the inner ear from acoustic overexposure. The results of several studies conducted in man rely on the study of patients who have undergone a vestibular neurectomy. Indeed, anatomical data show that olivocochlear efferents could travel along or inside the vestibular part of the auditory nerve before reaching the organ of Corti. Therefore, these patients may be considered as an experimental model of unilaterally de-efferented subjects. However, to date, none has reported the existence of olivocohlear efferents in the vestibular section following neurectomy. MATERIALS AND RESULTS: In this study, we present the histological results from 18 vestibular sections and show the absence of olivocochlear efferents. CONCLUSION: These results provide a reason to reconsider the results of previous experiments conducted in similar patients and ask for further studies on the olivocochlear efferents pathways.

Cochlea↗

PubMed2003

[Ethmoid adenocarcinoma: a series of 17 cases].

INTRODUCTION: Ethmoid adenocarcinoma are and represent rare, 2.5 to 3% of head and neck cancers. The 5-year survival is around 50% for all stages. We present a series of 17 patients treated in our institution. OBJECTIVES: Expose the treatment of these patients and evaluate the results. METHODS: A retrospective study of 17 consecutive patients, treated between 1992 and 1999 for an ethmoid adenocarcinoma (15 T4 and 2 T2) and evaluated in 2002, with a mean follow-up of 5.8 years. RESULTS: In May 2002, 4 (23.53%) patients were alive and disease-free, 3 (17.65%) were alive with recurrence and 10 (58.82%) was died. The 5-year survival with Kaplan Meyer method is 41%. CONCLUSION: This series demonstrates the contribution of a combined approach for T3 and T4 tumors. The bifrontal approach induced an important morbidity in our series and should be replaced by the nasofrontal approach. Most teams agree that postoperative radiotherapy is necessary but the appropriateness of chemotherapy is still discussed. Some authors are of the opinion that it has no action on adenocarcinoma and others that it improves survival. It seems to have been efficient in our T4 patients.

Adenocarcinoma↗

PubMed2003

[Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular decompression].

INTRODUCTION: Vascular compression of the Vth cranial nerve is the leading cause of trigeminal neuralgia. Microvascular decompression has been promoted by Jannetta since 1970. We used the minimally invasive retrosigmoid approach, with the complementary help of endoscopic procedure. OBJECTIVES: MRI results, surgical findings and pain relief were studied after endoscopic assisted microvascular decompression. MATERIAL AND METHODS: Between 1991 and 2000, 98 surgeries were performed on 79 patients unresponsive to medical treatment, after an average of 6 years from the onset of the disorder. The mean follow-up period after operation was 28 months. RESULTS: MRI predicted neurovascular conflict with sensitivity of 93.6% and specificity of 100%. Pain relief after surgery was complete in 69% of the cases, partial in 21%. Surgery was a failure in 6% of the cases and 4% of patients were lost. Complications were limited to 10% of CSF disorders but only 1% (1 patient) needed a surgical revision. CONCLUSION: Microvascular decompression, performed through a key-hole approach, without cerebellum retraction and with endoscopic assisted surgery, yields a low risk of morbidity, even in elderly patients, and could be considered acceptable causal treatment of trigeminal neuralgia.

Decompression, Surgical↗

PubMed2003

[Lips reanimation with temporalis myoplasty technique].

PURPOSE OF THE STUDY: The authors report their experience in lips reanimation with lengthening temporalis myoplasty for treatment of facial paralysis. MATERIALS AND METHODS: We studied 8 patients with permanent facial paralysis. The surgical technique allowed to transfer temporalis tendinous of coronoid process onto lips muscular strap, without aponevrotic relay. RESULTS: Functional and aesthetic results are exposed and so complications. Specialized facial physiotherapy rehabilitation is necessary in order to improve.

Adult↗

PubMed2002

Deficits and recovery of head and trunk orientation and stabilization after unilateral vestibular loss.

The aim of the study was to analyse changes in the orientation and stabilization of the head and trunk and their recovery after complete unilateral loss of vestibular information in humans. The ability of nine Ménière's patients to orient and stabilize their heads and trunks in space was investigated during a simple dynamic task of knee-bends and compared with the performance of 10 healthy subjects. Patients' performance was recorded before unilateral vestibular neurotomy (UVN) and during the time-course of recovery (1 week, 1 month, 3 months). Experiments were performed both in eyes open (EO) and eyes closed (EC) conditions to evaluate the role of visual cues in the recovery process. Head and trunk mean angular position (orientation) and mean maximal angular rotation (stabilization) in the roll plane and the yaw plane were recorded using a video motion analysis system. The results indicate that, in the acute stage after UVN (1 week), patients exhibit marked impairments in head and trunk orientation in both visual conditions. In the EC condition, head and trunk were deviated towards the operated side in the roll plane and the yaw plane. Head and trunk stabilization in space was impaired in the roll plane and associated with increased stabilization of the head on the shoulders. Interestingly, vision caused a complete inversion of the orientation pattern, with head and trunk rotations towards the intact side in the roll plane and the yaw plane. Relative to darkness, vision also reduced head and trunk oscillations. Recovery from abnormal head orientation in the light and impaired head stability in both visual conditions was achieved within 1 month and 3 months after UVN, respectively. However, head and trunk orientation in the dark and trunk stabilization in the roll plane remained uncompensated 3 months post-lesion. These results suggest that unilateral vestibular loss leads to a postural syndrome similar to that described previously for various animal species. They confirm the necessity of vestibular inputs for properly stabilizing head and trunk during self-generated displacements in healthy subjects. They also support the notion that vestibular compensation relies on visual cues whose substitution role gradually decreases after UVN.

Adaptation, Physiological↗

PubMed2002

[Adenocarcinoma of the endolymphatic sac in children. A case report].

We report a case of an adenocarcinoma of the endolymphatic sac in a 13 years old child, which was fortuitously discovered at the time of radiological investigation of growth delay. Arising from the end of the endolymphatic sac, this rare tumour shares a similar clinic expression with other cerebellopontine angle pathologies. Radiological investigation reveals a moth eaten appearance to the posterior temporal bone and specific bony inclusions. With MRI there is an intense and/or intermediate signal on T1, a hyper signal on T2 and T1 enhancement with injection of gadolinium. Treatment is surgical and local recurrences are not uncommon. After histological confirmation, a search for Von Hippel-Lindau disease is mandatory because this tumour is not exceptional among this subset of patients. Diagnosis and therapeutic criteria will be highlighted by our case and a review of the literature.

Adenocarcinoma↗

PubMed2002

[Bilateral vestibular areflexia: quantification is required].

Bilateral vestibular loss, that should be more precisely qualified as "horizontal semicircular canal bilateral loss", is a concept usually defined by the following characteristics: - no response to caloric tests, - no response to pendular test with a 20-second period, - increasing gain of the cervico-ocular reflex. We present five cases. We increased the stimulation frequency to a level higher than usually, employed and observed that: - at a given frequency threshold a certain amount of reactivity may be observed, - above that threshold the reactivity increases in proportion with stimulation frequency. The apparent vestibular loss is actually related to stimulation frequency. This phenomenon could be explained by considering the physiology of phasic and tonic cells.

Aged↗

PubMed2001

Cochlear schwannomas.

In a series of 179 cerebellopontine angle (CPA) tumors, the authors present nine cases (5%) that were cochlear nerve neuromas. There were six men and three women (mean age, 51 years). Preoperative magnetic resonance imaging confirmed the diagnosis in one case with a labyrinthine extension and raised suspicions in the other four cases, which were confirmed during surgery. The remaining neuromas were discovered intraoperatively. The mean time between first observation and surgery was 9 months. Preoperatively, all patients underwent a complete otoneurological assessment. The middle fossa approach was used for the patient with the labyrinthine extension, and the retrosigmoid approach was used for the other eight cases. In all patients facial nerve function was preserved. Sudden or major hearing loss without associated vestibular symptoms or preoperative facial paralysis may be predictive of a cochlear component of a CPA tumor. The near-field relationships of cochlear neuromas located at the level of the acoustic and facial nerves can be appreciated because of their small size and strong contrast enhancement.

Journal Article↗

PubMed2001

Onset overmasking of a brief amplitude increment in a pure tone and sensorineural hearing impairment.

HYPOTHESIS: The goal of this investigation was to determine, in patients with sensorineural hearing loss who may show an audiologic alteration in onset overmasking, whether different pathologic conditions differ in this respect, and whether patients with a vestibular neurotomy damaging the cochlear efferents will be affected. BACKGROUND: Auditory detection of brief signals, when presented at the beginning of a simultaneous long masking sound, may require a higher acoustic level than when presented after several hundred milliseconds. The proposed explanation, in terms of auditory nerve fibers adaptation has been based on the observation of a proportionally smaller increase of firing in response to an amplitude increment at the onset of a stimulus. However, this may not explain all the data, and other underlying processes are certainly involved. The degree or type of sensorineural pathologic condition may be a contributing factor. In addition, the cochlear efferent system, which exhibits a time course and a high-frequency predominance compatible with that of onset overmasking, could be involved. METHODS: Onset overmasking of a brief amplitude increment in one pure tone was examined in 6 normal subjects, 12 patients who had undergone vestibular neurotomy, 8 subjects with Meniere's-like symptoms, 5 subjects with presbyacusis, and 3 patients with a small neuroma. Both ears of all subjects were tested. Detection thresholds, amount of onset overmasking, and differences between the two ears were examined. RESULTS: All results from subjects with presbyacusis and neuroma were within the range observed in the group of normal subjects. In the group of eight Ménière's syndrome patients, four had results outside the normal range, three had deteriorated detection, and one had better detection. Among the 12 subjects who had undergone neurotomy, 2 had better detection in the unoperated ear. CONCLUSIONS: The results from Ménière's patients indicate that, in addition to the previously reported improved detection threshold for short onset delay, a deterioration of detection thresholds may occur in some subjects. Overall, the results from neurotomized ears do not provide evidence for an involvement of cochlear efferents in this tested psychoacoustic task.

Adaptation, Physiological↗

PubMed2000

[Our current results with acoustic neurinoma surgery].

Out of 130 CPA tumors operated on between 1993 and 1997, 91 were vestibular schwannomas less than 25 mm with preoperative hearing and normal facial function. The pre and postoperative facial and hearing functions were analyzed prospectively. The surgical technique applied was the complete tumor removal via retrosigmoid approach under facial nerve monitoring and CPA endoscopy. Clinical features were analyzed to determine postoperative facial grading (House-Brackmannn) and tonal and vocal audiometrical datas (PTA-SDS) at 8 days, 90 days and 1 year. We achieved 96 % of good facial results (Grade I and II/HB) and 46,5 % of postoperative conserved hearing. For tumors less than 25 mm in the CPA, good preoperative hearing level, preoperative AOE and BER seem to be predictive factors for hearing preservation. Early diagnosis associated with the advances in minimal invasive otoneurological techniques leads to perform complete removal of this type of tumors with respect of facial and hearing functions.

Adult↗