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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 73 records · Page 4Linked to original sources
PubMed1998

Silent gastroesophageal reflux disease in patients with pharyngolaryngeal cancer: further results.

BACKGROUND: Gastroesophageal reflux disease is associated with various head and neck manifestations. The aim of this retrospective study was to determine the incidence of asymptomatic, or "silent," gastroesophageal reflux disease (GERD) in patients treated for pharyngolaryngeal squamous cell carcinoma. METHODS: Twenty-four-hour pH monitoring was performed in 72 consecutive patients without digestive manifestations (pyrosis, retrosternal heartburn) of GERD treated for pharyngolaryngeal carcinoma. Statistical analysis of the relationship between reflux scores achieved and various patient parameters (age, tobacco and alcohol consumption, gastric ulcers, medications which decrease esophageal sphincter pressure), tumor parameters (staging), and therapeutic parameters (drugs administered during neo-adjuvant chemotherapy) was performed. RESULTS: Incidence of silent GERD varied from 36% to 37% according to the reflux scores. No relationship was found between the reflux scores and the patient or tumor parameters. Among the therapeutic parameters, a statistical relation was noted between the total dose of Cisplatin and the reflux scores (p = .005). CONCLUSIONS: Silent GERD is a common finding in patients treated for squamous cell carcinoma of the pharyngolarynx. Additionally, chemotherapy including Cisplatin may aggravate GERD during the course of therapy.

Adult↗
PubMed1998

Neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy for advanced endolaryngeal carcinoma classified as T3-T4: 5-year oncologic results.

BACKGROUND: Historically, total laryngectomy with voice-prosthesis insertion and near-total laryngectomy were the surgical options advocated for advanced supraglottic and transglottic tumors classified as T3-T4. METHODS: The present retrospective study reviewed our experience with neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) in a series of 60 patients with an isolated, untreated, advanced supraglottic/transglottic invasive squamous cell carcinoma classified as T3-T4. RESULTS: The Kaplan-Meier 5-year actuarial survival, local failure, nodal failure, and distant metastasis estimates were 72.7%, 8.3%, 9.2%, and 9.8%, respectively. Survival was significantly reduced in patients with nodal failure (p = .001) and distant metastasis (p = .007). Overall, a 91.7% laryngeal preservation rate and a 98.3% local control rate were achieved. CONCLUSION: Our report was a retrospective analysis and did not present a control group exclusively managed with SCPL-CHP. Therefore, we were unable to demonstrate that the use of neo-adjuvant chemotherapy prior to SCPL-CHP allowed for an increase in local control, laryngeal preservation, and survival. However, the use of neo-adjuvant chemotherapy allowed for remobilization of a fixed arytenoid cartilage in 10 patients who thus became amenable to SCPL-CHP. The key role of neo-adjuvant chemotherapy in this series was as a prognostic indicator for suitability for SCPL-CHP in the case of supraglottic-transglottic tumor with arytenoid cartilage fixation. Our data also supported the notion that SCPL-CHP is a valid alternative to total laryngectomy with voice prosthesis insertion and near-total laryngectomy in selected patients with a previously untreated supraglottic/transglottic invasive squamous cell carcinoma classified as T3-T4. Furthermore, the successful use (in terms of surgical outcome, laryngeal preservation, and survival) of SCPL-CHP after neo-adjuvant chemotherapy suggested that laryngeal organ-preservation strategies, in advanced endolaryngeal transglottic and/or supraglottic invasive squamous cell carcinoma, should not be limited to the use of laryngeal radiotherapy after neo-adjuvant chemotherapy.

Adult↗
PubMed1998

Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Deglutition↗
PubMed1998

Computerized tomography of the glottis after intracordal autologous fat injection.

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autologous fat in one patient in whom this material was used for injection laryngoplasty.

Adipose Tissue↗
PubMed1998

Comparison and evolution of perceptual and acoustic characteristics of voice after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

The present prospective study, based on a series of 12 male patients managed with supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP), was designed i) to compare the perceptual and acoustic parameters before surgery and at 6 months after sugery, ii) to evaluate the evolution of the perceptual and acoustic parameters between 6 and 18 months postoperatively, and iii) to determine the correlations between the perceptual and acoustic parameters preoperatively and at 18 months postoperatively. The roughness was found to be significantly worsened after SCPL-CHEP. The jitter, shimmer, noise-to-harmonic ratio, and degree of voiceless increased significantly after SCPL-CHEP. Neither acoustic nor perceptual parameters varied significantly between 6 and 18 months postoperatively. Preoperatively, a strong statistical correlation was found between grade, roughness and strain and all acoustic parameters but F0. Breathiness was statistically correlated with all acoustic parameters but jitter. Postoperatively the only statistical correlation noted was between roughness and F0.

Carcinoma, Squamous Cell↗
PubMed1998

Supracricoid partial laryngectomies in the elderly: mortality, complications, and functional outcome.

A review of the postoperative course, complications, and functional outcome of 69 elderly patients (older than 65 years of age) consecutively managed with a supracricoid partial laryngectomy between 1977 and 1993 is presented. The tumors were glottic and supraglottic in origin in 53 and 16 patients, respectively. A cricohyoidoepiglottopexy, a tracheo-cricohyoidoepiglottopexy, and a cricohyoidopexy were performed in 48, five, and 16 patients, respectively. Immediate laryngeal, cervical, and medical complications were noted in 5.8%, 10.2%, and 10.2% of patients, respectively. Supracricoid partial laryngectomies never resulted in perioperative or postoperative death. The 5-year actuarial survival and local control estimates were 68%, and 93.9%, respectively. Late surgical complications included laryngocele, laryngeal stenosis, and pneumonia from aspiration-related death in 4.3%, 4.3%, and 1.4% of patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 1.4%, 1.4%, and 2.91% of patients, respectively. Overall a 92.8% laryngeal preservation rate was achieved. Univariate analysis of the potential correlation of different factors with the mortality incidence and causes, the incidence and type of the various complications, and the incidence for postoperative aspiration is presented.

Actuarial Analysis↗
PubMed1998

Local failure after supracricoid partial laryngectomy: symptoms, management, and outcome.

The medical files of 15 patients with local recurrence after supracricoid partial laryngectomy consecutively managed at Laënnec Hospital were reviewed. The clinical symptoms and the laryngeal computed tomography appearance of local recurrence, as well as the salvage treatment performed, are presented. The main presenting symptom was dyspnea. None of the local recurrences was considered to be unresectable. One patient refused any form of salvage treatment. Radiation therapy and salvage total laryngectomy were the options retained for local salvage. A minimum 5-year follow-up was always achieved. In patients who underwent salvage total laryngectomy, perioperative or postoperative death and postoperative pharyngocutaneous fistula were not encountered. The 5-year survival was 33.3%. The local control rate was 66.6%. The percentage of patients who experienced nodal recurrence was 26.6%, and the distant metastasis estimate was 53.3%. The cause of death was distant metastasis in eight patients, local recurrence in two, and intercurrent disease in one. Peristomal recurrence was not encountered. Overall, 80% local control and 6.6% laryngeal preservation rates were achieved.

Adult↗
PubMed1998

Botulinum toxin type A for Frey's syndrome: a preliminary prospective study.

Fourteen patients with severe Frey's syndrome (occurring after conservative parotidectomy) managed with intracutaneous injection of botulinum toxin type A were prospectively evaluated. Results were analyzed for effectiveness, complications, and adverse effects. Complications were not encountered. The only adverse effect noted was a temporary and slight partial paresis of the upper lip of 3 months' duration in 2 patients. Permanent paresis was not encountered. Frey's syndrome was always controlled within 2 days following the intracutaneous injection of botulinum toxin A. Frey's syndrome recurrence was not encountered with a follow-up duration that varied from 3 to 9 months (mean follow-up 7 months). This preliminary report confirmed that in patients who have Frey's syndrome after conservative parotidectomy, the intracutaneous injection of botulinum toxin is a valuable treatment option that should be further investigated.

Adolescent↗
PubMed1998

Speech and voice characteristics after near-total laryngectomy. A preliminary prospective study.

Selected characteristics were prospectively compared in the speech and voice of 10 patients managed with near-total laryngectomy. Tape-recorded speech samples were measured for durational features with a stopwatch. Acoustic features were analyzed with the Computerized Speech Lab and the Multidimensional Voice Program from Kay Elemetrics. Speech and voice parameters recorded preoperatively were compared with the parameters recorded postoperatively. Our data corroborate the prior reported good quality of the voice and speech after near-total laryngectomy.

Adult↗
PubMed1998

[Vertical partial laryngectomy with false vocal cord flap reconstruction: carcinologic and functional results].

Glottic reconstruction with false vocal cord flap was carried out to improve vocal function after vertical partial laryngectomy. This retrospective study reports carcinologic and functional results of 77 patients operated by vertical partial laryngectomy with or without glottic reconstruction. Five years actuarial survival rate and tumoral control rate were 79% and 90% respectively, without significant differences between patients with or without glottic reconstruction. Vocal study found that supraglottic structures were involved in neoglottic closure in 47% of the patients. Anterior commissure web was statistically reduced in patients with glottic reconstruction. The carcinologic results of this study allow for glottic reconstruction at the time of vertical partial laryngectomy. Neoglottic closure and postoperative anterior commissure web are factors which could influence final vocal results.

Aged↗
PubMed1998

[Intra-cord injection of autologous fatty tissue and recurrent unilateral paralysis].

A prospective analysis of intracordal autologous fat injection for inferior laryngeal nerve paralysis of various origins was conducted in a series of 20 patients with a minimum 6 month follow-up. Adverse side effects were a sub-cutaneous abdominal hematoma, and a pseudo intracordal cyst in 1 patient. Aspiration, noted in 11 patients, disappeared immediately after the injection of fat in 10 patients. Subjective evaluation and objective acoustic recordings documented improvement in voice quality at 6 months. Three patients had a secondary reinjection of fat resulting in an overall 100% success rate. Such preliminary data, together with the review of the literature suggests, that intracordal autologous fat injection is a highly valuable treatment option in patients with unilateral inferior nerve paralysis.

Abdomen↗
PubMed1998

[En bloc resection of the carotid axis in epidermoid carcinoma of the head and neck. Retrospective analysis of 7 cases].

En bloc resection of carotid artery involved by squamous cell carcinoma was performed in 7 patients from 1993 to 1997. Cerebral tolerance was tested with qualitative evaluation of cerebral blood flow during preoperative balloon test occlusion of the internal carotid artery. Four patients later underwent permanent carotid occlusion prior to en bloc resection, 2 patients underwent carotid ligation without reconstruction and one patient underwent carotid resection associated with carotid reconstruction. The preliminary neurovascular and carcinologic results are presented. One patient had definitive stoke postoperatively. Follow-up ranged from 3 to 34 months. Two patients died by the 6th and 26th postoperative month respectively. Among the remaining 5 patients, tumoral recurrence occurred in two. Two patients have survived more than 2 years, but one of them had local recurrence and distant metastases. Considering these data and the review of the literature, selection of patients after carcinologic and cerebral tolerance evaluation is important in order to improve survival and quality of life of these patients.

Adult↗
PubMed1997

Cricotracheal anastomosis for assisted ventilation-induced stenosis.

OBJECTIVE: To review the long-term results and our experience with cricotracheal anastomosis via a cervical approach for assisted ventilation-induced stenosis. DESIGN: A case series of 41 patients consecutively treated with cricotracheal anastomosis. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Group 1 consisted of 22 patients with stenosis reaching the lower border of the cricoid cartilage that did not require resection of the cricoid cartilage. Group 2 consisted of 19 patients in whom correction of the stenosis required cricoid resection. MAIN OUTCOME MEASURES: Statistical analysis of airway patency was based on the Kaplan-Meier actuarial life table method. Incidence for the various postoperative complications was presented. Univariate analysis was performed to analyze the relationships between various factors, airway patency, and the incidence for the various complications encountered. RESULTS: The Kaplan-Meier 5-year airway patency estimate was 100% in group 1 patients and 82.5% in group 2 patients. In group 2 patients, complementary treatment with dilatations in 2 patients resulted in an overall 94.8% airway patency rate. In the last patient, the airway patency was not reestablished after cricotracheal anastomosis, and a Montgomery T tube was inserted. Postoperative complications included unilateral inferior laryngeal nerve paralysis (3 patients), cervical neck abscess (2 patients), pneumothorax (1 patient), and major subcutaneous emphysema (1 patient). None of the following variables was statistically related to the airway patency or to the various complications encountered: sex, age, cause for stenosis, delay from initial injury, prior treatment, presence of a tracheotomy, number of tracheal rings resected, type of sutures used, and type of anastomosis performed. CONCLUSIONS: The data reported reemphasized that cricotracheal anastomosis with or without cricoid resection is a safe and reliable procedure for assisted ventilation-induced upper tracheal stenosis reaching and/or involving the subglottis and/or cricoid cartilage.

Adolescent↗
PubMed1997

Supracricoid hemilaryngopharyngectomy conversion to Pearson's near-total laryngectomy: a case report.

BACKGROUND: Pearson's near-total laryngectomy was initially advocated in patients with extended glottic carcinoma and hypopharyngeal carcinoma. More recently, the utility of near-total laryngectomy for supraglottic pharyngeal, base of tongue, and other cancers such as thyroid cancer with anterior tracheal wall invasion has also been reported. METHODS: The purpose of this case report was to demonstrate the feasibility of this procedure in the setting of severe aspiration after supracricoid hemilaryngopharyngectomy. RESULTS: The first case of successful conversion from supracricoid hemilaryngopharyngectomy to Pearson's near-total laryngectomy in a patient with severe and recurrent aspiration is presented. CONCLUSIONS: This case report suggests that when partial laryngopharyngectomy results in severe and recurrent aspiration, rather than having to convert the patient to a total laryngectomy with tracheoesophageal puncture, a near-total laryngectomy is a reasonable option with acceptable functional results.

Carcinoma, Squamous Cell↗
PubMed1997

Adductor spasmodic dysphonia: case reports with acoustic analysis following botulinum toxin injection and acupuncture.

We analyzed frequency and duration parameters of voice and speech in two men with adductor spasmodic dysphonia (SD). One was treated with botulinum toxin injection; the other received acupuncture therapy. Improvement after acupuncture therapy in terms of standard deviation of fundamental frequency, acoustic perturbation measurements, durational measurements of voice and speech, and spectrographic analysis was comparable to the results achieved with botulinum toxin injection. Voice and speech parameters were stable 1 year after acupuncture therapy.

Acupuncture Therapy↗
PubMed1997

In situ lifetime, causes for replacement, and complications of the Provox voice prosthesis.

One hundred Provox voice prostheses consecutively inserted in 37 patients and replaced only when phonation was impaired or complications noted were analyzed for in situ lifetime, causes for replacement, and complications. The mean in situ lifetime was 311 days. Actuarial analysis (Kaplan-Meier method) of the in situ lifetime revealed that 65.9%, 23.7%, and 16.4% of the voice prosthesis were still in situ by the 6th, 12th, and 18th postinsertion month. Cause for replacement was salivary leakage through the prosthesis valve, salivary leakage around the prosthesis, deterioration of the prosthesis, and excessive crusting resulting in increased airflow resistance in 33%, 27%, 24%, and 16% of cases, respectively. Complications included granulation tissue formation, cervical cellulitis, necrosis of the tracheoesophageal puncture, tracheostomal stenosis, and swallowing impairment in six, two, one, three, and one patient, respectively.

Actuarial Analysis↗