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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 109 records · Page 6Linked to original sources
PubMed1996

[Contribution and limits of acoustic analysis of the voice and alaryngeal speech with a computerized system].

Through a review of published acoustical analyses of alaryngeal voice and speech, our aim was to establish the interest and the limitations of a computerized acoustical system. One case of esophageal voice and one case of tracheoesophageal voice were analysed with the Kay Elemetrics Multidimensional Voice Program for voice and Computerised Speech Lab for speech. All the acoustical parameters are altered in alaryngeal voice. The automatic calculation of frequential parameters are promising but there are errors due to the importance of altered voicing. Speech analysis is an important complement to evaluate the phonatory behavior of laryngectomized patients.

Computer Systems↗
PubMed1996

[Surgery of primary malignant melanomas of the mucosa of the nasal fossa and facial sinuses].

A retrospective analysis of 22 patients with primary malignant melanoma of the nasal fossa and/or paranasal sinuses consecutively managed with surgery at our department from 1975 to 1993 was conducted. Fifteen patients had negative margins of resection. Neoadjuvant chemotherapy and post-operative radiation therapy was associated in 4 and 5 of these 15 patients, respectively. Four patients had positive margins. Adjunctive treatment was chemotherapy and postoperative radiation therapy in 2 and 3 of these 4 patients, respectively. The remaining 3 patients were managed with palliative treatment (debulking surgery and chemotherapy). No patients were lost to follow up. A 3-year follow-up was always achieved. In patients in whom surgical resection achieved negative margins, the 5-year actuarial survival, and local control estimate was 17.9%, and 26.9%, respectively. None of the variables under analysis were statistically related to local recurrence or survival. Death always occurred within 24 months from initial diagnosis in all 7 patients but one in whom surgical resection with negative margins was not achieved or debulking surgery was performed.

Aged↗
PubMed1996

[Laryngectomies and pharyngo-laryngectomies with tracheo-laryngo-pharyngeal shunt of Pearson type. Technique, indications and preliminary results].

The preliminary results achieved in a series of 10 patients consecutively managed at our department with Pearson's subtotal pharyngolaryngectomy, during the year 1995, are presented. The surgical procedure is described. Follow up varied from 6 to 13 months. None of the patients were lost to follow-up. None of the patients recurred locally or died from surgical-related complications. Nine patients achieved successful rehabilitation of speech and voice. One patient refused to use a functional shunt. Speech and voice parameters achieved by the third postoperative month are presented. Postoperative swallowing impairment was not encountered. The preliminary data achieved and the review of the medical literature suggested that Pearson's subtotal pharyngolaryngectomy should be discussed in patients conventionally managed with total laryngectomy or pharyngolaryngectomy and tracheosophageal puncture with voice prosthesis insertion.

Adult↗
PubMed1995

[Long-term results of total conservative parotidectomy for pleomorphic adenoma].

OBJECTIVES: Evaluation of the long-term results (10 and 15 years) achieved with total conservative parotidectomy for pleomorphic adenoma. METHODS: A retrospective analysis of the files of 127 patients with pleomorphic adenoma of the parotid gland consecutively treated with a total conservative parotidectomy at our department from 1970 to 1985. Actuarial analysis (Kaplan Meier method) of survival and local recurrence, as well as overall estimation of immediate and definite postoperative facial paresis and paralysis was performed. RESULTS: Ten- and fifteen-year survival and local control estimations were 90.8% and 99.1%, respectively. Immediate and permanent facial paresis and paralysis overall estimates were 64.6% and 6.3% and 2.1% and 0%, respectively. CONCLUSION: Total conservative parotidectomy for pleomorphic adenoma results in a very high long term local control associated with a very low rate of facial dysfunction.

Adenoma, Pleomorphic↗
PubMed1995

[Exclusive chemotherapy in T1-T3N0 cancers of the vocal cord with complete clinical response after neoadjuvant treatment with a cisplatin-fluorouracil combination].

OBJECTIVES: Evaluation of cisplatin-fluorouracil exclusive chemotherapy for invasive squamous cell carcinoma of the glottis staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy. METHODS: A retrospective analysis of the files of 69 patients with a well-differentiated untreated invasive squamous cell carcinoma, staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy is presented. Actuarial analysis (Kaplan Meier method) of survival and local failure is presented among the group of 25 patients treated with exclusive chemotherapy and the group of 44 patients in whom the local treatment (partial laryngeal surgery or radiation therapy) initially planned was maintained. RESULTS: Three-year survival and local control estimate was 91.8% and 69.3%, respectively after exclusive chemotherapy and 92.5% and 97.2% if the local treatment was performed as initially planned. Patients with local recurrence after exclusive chemotherapy were always salvaged with partial laryngeal surgery or radiation therapy resulting in an overall 100% local control and laryngeal preservation rate. CONCLUSION: Exclusive chemotherapy for T1-T3N0 glottic carcinomas with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy should be considered especially in patients in whom preservation of voice is of utmost importance.

Adult↗
PubMed1995

Madreporic coral for cranial base reconstruction. 8 years experience.

The authors, since 1985, have used 587 Madreporic Coral grafts as bone substitute in a total of 183 patients, among them in 80 cases for repair of cranial base bone defects. They report their long-term results. Partial resorption to about 40% of the initial volume occurred in almost all cases within 8 to 10 months, with complete resorption after about one year. 20% of the coral blocks moved spontaneously or split into pieces, but could easily be withdrawn rhinoscopically through the nostrils. No CSF leakage was noticed afterwards. The local infection rate was only 4%, always close to the basal coral graft. This is lower than the infection rate after using autologous bone harvested from the inner table of the bone flap (20%). Infections were cured by removal of the coral graft. Despite the mentioned draw backs, Madreporic Coral graft implants can be recommended as bone substitute in cranial base surgery: 1. The material simplifies the surgical procedure; 2. Harvesting of autologous bone is no longer necessary; 3. Transmission of infections like AIDS, Hepatitis C or Creutzfeld-Jacob-disease can be avoided with certainty.

Biocompatible Materials↗
PubMed1995

Evolution of speech and voice following supracricoid partial laryngectomy.

The evolution of voice and speech parameters following supracricoid partial laryngectomy (SCPL) has been evaluated in a prospective fashion over an 18-month period of time in three patients using the Computerized Speech Lab (from Kay Elemetrics). Preliminary results demonstrate the post-operative instability of voice parameters. Speech parameters remain stable with time. Our data stresses that voice is attained post-operatively even if one arytenoid cartilage is disarticulated at time of resection.

Aged↗
PubMed1995

Duration and frequency characteristics of speech and voice following supracricoid partial laryngectomy.

Selected characteristics were compared in the speech and voice of 28 treated with a supracricoid partial laryngectomy (SCPL) and of 14 normal adult laryngeal (NAL) speakers. Tape-recorded speech samples were measured for durational features with a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and a multidimensional voice program. The SCPL speech proved comparable to NAL speech in average fundamental frequency. The SCPL speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise to harmonics ratio, maximum phonation time, speech rate, and phrase grouping. The completion of an arytenoid cartilage resection did not statistically modify the duration and frequency features of SCPL speakers. Among SCPL speakers 1) the average fundamental frequency was statistically higher (p = .02) in patients who underwent a cricohyoidoepiglottopexy when compared to patients who underwent a cricohyoidopexy, 2) the maximum phonation time was statistically related to the patient's age (p = .002), and 3) the jitter and shimmer values were statistically related (p = .01 and p = .005) to the time elapsed since SCPL completion. Explanations and implications of these findings are discussed.

Adult↗
PubMed1995

Reconsidering a paradigm: the spread of supraglottic carcinoma to the glottis.

This study was performed to evaluate the spread of supraglottic carcinoma to the glottic level. Whole organ sections of total laryngectomy specimens from 37 patients with previously untreated supraglottic carcinomas were reviewed retrospectively. Of the 37 specimens, 20 (54%) were noted to have extension of cancer to the glottic level. A significant relationship was noted between glottic extension and abnormal cord motion (P = .0002). A statistically significant trend was noted for the relationship between inferior extension along the supraglottic mucosa and glottic level extension (P < .0001). Contrary to the prevailing model of the spread of supraglottic carcinoma, in which there is a distinct barrier to spread at the ventricle, this analysis of selected supraglottic carcinomas revealed a continuum of spread from the supraglottic to the glottis.

Chi-Square Distribution↗
PubMed1995

Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy.

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape-recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.

Adult↗
PubMed1995

[Inoperable tracheal and cricoid-tracheal stenoses. Results of laser therapy and prolonged calibration].

Palliative desobstruction was performed with laser and a Montgomery T tube in 11 patients with tracheal or cricotracheal stenosis. Surgery was theoretically indicated for these long thick stenotic areas with underlying diseased cartilage but could not be performed due to the poor clinical status of the patients or recurrence after anastomosis. Calibration with the Montgomery T tube was maintained for a mean of 5 years. The T tube was removed in 3 patients and was well tolerated in 4. Two patients died during the course of the study and two others required a definitive tracheotomy. Palliative treatment with Laser desobstruction and long-term calibration can be a useful alternative to conventional surgery.

Adult↗
PubMed1995

[Dysfunction of the facial nerve following total conservative parotidectomy for pleomorphic adenoma].

Two hundred and forty seven previously untreated pleomorphic adenoma of the parotid gland were operated with a total conservative parotidectomy between 1965 and 1992. The overall incidence for temporary facial nerve paresis and paralysis was 63.1% and 5.2%, respectively. None of the following variables sex, age, tumor size, tumor location, tumor contact with the facial nerve, degeneration of the pleomorphic adenoma, inadvertent tumor spillage, use of Surgical, and postoperative hematoma were statistically related to facial nerve dysfunction. Kaplan-Meier actuarial analysis demonstrated that facial nerve dysfunction recovery was noted until the 18th postoperative month. The use of the linear regression model with Pearson correlation underscores that the recovery time of facial nerve function significantly statistically increased with the patient's age (p = .0017). The overall incidence for permanent facial paresis and paralysis was 3.6% and 0%, respectively. Implications of these findings are discussed together with a review of the medical literature.

Adenoma, Pleomorphic↗
PubMed1995

[Subjective evaluation of voice and speech after supra-cricoid partial laryngectomy].

A prospective perceptual evaluation of the voice and speech after supra-cricoid partial laryngectomy over the first post-operative six months was performed. Ten male patients were evaluated at one, three and six months by five listeners. A voice profil was drawn from defined acoustical parameters studied, and a chronology in the voice improvement was observed. Voice therapy aims could be suggested.

Aged↗
PubMed1994

A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2.

BACKGROUND: Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented. METHODS: A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported. RESULTS: The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P < 0.0001) was noted between complete clinical response after IC and complete histologic response. CONCLUSIONS: The change from the prevailing treatment modalities of RT and VPL to a new multimodal strategy (IC+CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma.

Adult↗