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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 127 records · Page 7Linked to original sources
PubMed1994

Ethmoid sinus carcinomas: results and prognosis after neoadjuvant chemotherapy and combined surgery--a 10-year experience.

From June 1982 to June 1992, 144 ethmoido-sphenoido-orbital tumors have been referred to the neurosurgical department of Ste Anne Hospital. One hundred five of them were malignant lesions, among which 83 were included into our therapeutic protocol (1) neo-adjuvant chemotherapy (CDDP + 5-FU), (2) combined surgical procedure (subfrontal and transfacial), (3) postoperative radiotherapy. Fifty nine percent of the patients had no response to chemotherapy; 19% had a partial response (reduction of the tumoral volume > 50% and < 100%), 22% had a complete response. One patient had an immediate and transient postoperative rhinorrhea responsible for meningitis (acinetobacter) that was cured after a 3-day treatment. Four patients had postoperative meningitis without any cerebrospinal fluid leakage; they were also cured. Five patients had a local suppuration that was treated by subcutaneous drainage (n = 1) or the removal of the cranial basis graft (n = 4). Oncologic results are presented for only adenocarcinomas (n = 63) because they represent the only population of this series large enough to assure significant statistical figures. The global actuarial survival rate was 53% at 3 years and 42.5% at 5 years. The 5-year actuarial survival rate was 80% for T1 tumors, 60% for T2, 40% for T3, and 25% for T4. Patients with an intracranial extension had a 3-year survival rate of 19%; none survived after 4-year follow-up. Neo-adjuvant chemotherapy seemed to influence the survival: 100% survival rate at 5 and 10 years for the complete responders. We discuss the opportunity of intraorbital exenteration, the indications, and the limits of combined surgery. We emphasize the importance of neo-adjuvant chemotherapy and of combined surgical procedures, even when the patients are complete responders to chemotherapy: complete responders who had only a transfacial approach have a 5-year actuarial survival rate of 80% (instead of 100% when a combined procedure was performed). Those who were not operated primarily recurred within 3 years and then had to be operated. We propose to follow such a combined surgery for all large ethmoidal cancers (T3 and T4) and for small tumors (T1 and T2) developed superiorly and posteriorly. Anterior T1 and T2 tumors should be operated through a single transfacial route.

Actuarial Analysis↗
PubMed1994

Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients.

A 25-year experience with total conservative parotidectomy for primary benign pleomorphic adenoma (PBPA) of the parotid gland in a consecutive series of 229 patients has been reviewed. This study focuses on survival, morbidity, PBPA recurrence, postoperative facial nerve dysfunction, and Frey's syndrome. Surgical death was never encountered in this study. The overall incidence for postoperative hemorrhage, hematoma, seroma, skin necrosis, great auricular nerve schwannoma, and keloid scar was 1.7%, 6.1%, 4.8%, 0.9%, 15.7%, and 8.3%, respectively. Five-, 10-, 15-, and 20-year PBPA control actuarial rate was 99.6%. The overall incidence for temporary facial paresis and paralysis was 64.6% and 5.6%, respectively. Kaplan-Meier actuarial analysis demonstrated that paresis recovery was noted until the eighteenth postoperative month. The overall incidence for permanent facial paresis and paralysis was 3.9% and 0%, respectively. None of the following variables--sex, age, PBPA size, PBPA location, PBPA contact with the facial nerve, inadvertent PBPA spillage, or surgeon's experience--was statistically related to PBPA recurrence and facial nerve dysfunction. The overall incidence for Frey's syndrome was 65.9%. Kaplan-Meier actuarial analysis demonstrated the need for a minimal 5-year follow-up to assess Frey's syndrome incidence. The mean age was statistically lower in patients presenting with Frey's syndrome.

Adenoma, Pleomorphic↗
PubMed1994

Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy.

Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) was studied as an alternative to total laryngectomy in 16 patients with glottic carcinoma presenting a 10-15 mm of anterior subglottic extent. The technique of the procedure is described. Results were analyzed for tumor free margins, tracheostomy decannulation, oral alimentation, phonation and disease free interval. The 3-year survival and local control rate were 68% and 86.7%, respectively. Our preliminary data suggest that the TCHEP procedure is a viable alternative to total laryngectomy for patients presenting with varying degrees of carcinoma extension below the free edge of the true vocal cords.

Adult↗
PubMed1994

[Computerized evaluation of acoustic parameters of voice and speech after partial supracricoid laryngectomy with cricohyoidoepiglottopexy].

Nineteen supracricoid porticol laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) speakers and 19 normal adult laryngeal (NAL) male speakers took part in this prospective study. Computed analysis of the voice and speech parameters was performed using the Computed Speech Lab from Kay Elemectrics. Parameters recorded for voice analysis were the average fundamental frequency, the fundamental frequency standard deviation, the jitter, the shimmer, the noise to harmonic ratio and the degree of voiceless. Parameters recorded for speech analysis were the maximum phonation time of the /a/ vowel, the phrase grouping and number of words read per minute. Speech and voice parameters statistically differed among NAL and SCPL with CHEP speakers. Among SCPL with CHEP speakers, none of the following factors (age, cricopharyngeal myotomy, piriform sinus tension, associated ipsilateral neck dissection, speech rehabilitation therapy) were statistically related to the frequential and durational variables. Jitter of SCPL with CHEP speakers was reduced as time elapsed from CHEP completion increased (p = .002). Maximum phonation time was reduced if one arytenoid cartilage was resected (p = 0.025).

Adult↗
PubMed1994

[Results of the treatment of spontaneous widening of tracheo-esophageal punctures after laryngeal implant].

Vocal rehabilitation by tracheosophageal puncture procedure and voice prosthesis was employed in a series of 68 patients (64 men and 4 women). The mean age was 68.4 years and ranged from 39 to 78 years. Enlarging tracheoesophageal fistula and leakage occurred in 31 patients. One or several conservative treatments were employed in 23 patients. Surgical closure of the tracheoesophageal fistula was performed in 5 patients (closure without muscular interposition: 3 patients, closure with sternomastoid muscle interposition: 2 patients). Leakage around the prosthesis was noted 8 days to 39 months postoperatively (mean: 11 months). Successful rates of conservative treatments were as following: prosthesis replacement with a small gauge catheter for several days followed by a prosthesis replacement: 9/17 (52.9%), replacement of prosthesis: 4/12 (33%), Gax Collagen injection: 3/9 (33%), cauterization of the tracheoesophageal tract: 0/1. Surgical closure was successful in all cases. Repuncture and prosthesis replacement was successful in one patient. Conservative treatment is initially recommended including prosthesis replacement with a small gauge catheter for several days and followed by a prosthesis replacement. Surgical treatment with muscular interposition is recommended in case of failure of conservative treatments.

Adult↗
PubMed1994

[Inverted nasosinusal papilloma and lateronasal rhinotomy].

The authors report about 18 cases of inverting papillomas treated between 1972 and 1992. (17 men and 1 woman). The minimum follow-up was of 30 months. The mean age was 55 years with ages ranging from 26 to 85 years. The most frequent symptom encountered was unilateral nasal obstruction. A synchronous carcinoma occurred in 2 patients. Treatment was always surgical: lateral rhinotomy and total ethmoidectomy. A local recurrence occurred in 1 on 16 benign inverting papillomas (6.2%). No local recurrence occurred in malignant inverting papillomas treated by surgery and followed by postoperative radiation. A metachronous malignant papilloma never occurred. Because of the high risk of recurrence and malignant transformation and after analyzing the literature, the authors recommend a lateral rhinotomy and total ethmoidectomy with as limited after effects as possible.

Adult↗
PubMed1994

[Specific reactivity to serotonin of afferent vessels in human pharyngolaryngeal carcinoma. Methodology and initial results].

This work describes an experimental protocol studying action of Serotonin (5-HT) on vessels feeding human pharyngolaryngeal carcinoma. Right and left superior laryngeal arteries were obtained during total (pharyngo)laryngectomy. As tumor growth is asymmetrical, tumor and opposite side arteries were considered as tumor (T) and control (C) vessels, respectively. (T) and (C) vessels were cut in 3 mm rings and suspended in organ chambers for pharmacological studies. Preliminary results (2 tumors, 7 tumoral rings and 5 control rings) indicate that 5-HT induces specific vasoconstriction in (T) arteries feeding human pharyngolaryngeal carcinoma.

Arteries↗
PubMed1994

[Cisplatin-fluorouracil chemotherapy in epidermoid cancers of glottic origin staged as T2].

A retrospective analysis of 94 patients presenting well-differentiated untreated invasive glottic squamous cell carcinomas, staged as T2 according to the 1987 Union Internationale contre le Cancer staging classification system, managed at our institution from March 1982 to April 1991 with cisplatin-fluorouracil neo-adjuvant chemotherapy, was conducted. Following neo-adjuvant chemotherapy, partial laryngeal surgery, and radiation therapy were performed in 85.1% (80/94) and 4.2% (3/94) of cases, respectively. Perioperative chemotherapy (fluorouracil) and postoperative chemotherapy (cisplatin-fluorouracil) was performed in 68.7% (55/80) and 63.7% (51/80) of patients who underwent surgery, respectively. Following neoadjuvant chemotherapy, one patient (1.1%) refused any form of treatment, and "exclusive" chemotherapy was performed in 9.6% (9/94) of cases. A 3-year follow-up was always achieved and 66 patients (70.2%) presented with a 5-year follow-up. A complete clinical response was achieved in 32.9% of cases following neo-adjuvant chemotherapy. A complete histological response was noted in 31.2% (25/80) of patients treated with partial laryngeal surgery following neo-adjuvant chemotherapy. A strong statistical relation was noted between complete clinical response and complete histological response (p < .0001). Chemotherapy related death never occurred in our series however chemotherapy related toxicity lead to reduction in the drug dosages and chemotherapy arrest in 14.3% and 3.6% of cases, respectively. The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary estimate was 84.9%, 8.4%, 1.1%, 2.2%, and 10%, respectively. The overall local recurrence rate varied from 25% following neo-adjuvant chemotherapy and radiotherapy, to 33.3% following "exclusive" chemotherapy, and 3.7% following neo-adjuvant chemotherapy and partial laryngeal surgery. Overall local control and laryngeal preservation was achieved in 98.9% and 97.8% of patients respectively. Our data suggests that the use of neo-adjuvant cisplatin-fluorouracil induction chemotherapy deserves further consideration in the management of glottic carcinomas staged as T2.

Adult↗
PubMed1994

[Malignant transformation of inverted papilloma of the nasal sinuses.. Apropos of a series of 7 cases].

Seven cases of malignant inverting papillomas are presented (6 men and 1 woman) with ages ranging from 31 to 72 years (mean age: 58 years); the minimum follow up was 37 months. The diagnosis was based on the histopathologic analysis of biopsy in five patients. In two patients the diagnosis was confirmed by the pathological analysis of the specimen. Treatment was always surgical: lateral rhinotomy and total ethmoidectomy. Neoadjuvant chemotherapy was given to four patients. Post operative radiation therapy was delivered in five patients. Five patients on seven died: local recurrence and systemic metastases: 3; systemic metastases: 1; second primary: 1. Reports from the literature are discussed. The authors emphasize the treatment modalities based on complete tumor removal through lateral rhinotomy.

Adult↗
PubMed1994

[Contribution of L lactate and amino-acid enzymatic biosensors for the analysis of Frey syndrome].

Twelve patients with Frey's syndrome after total parotidectomy for plemorphic adenoma were analysed using simultaneously 2 biosensors. Biosensors allowed for detection of L lactate and amino acid level on intact skin. The assay procedure and the results achieved with the simultaneous use of these 2 biosensors are presented. The L lactate biosensor appears to be an interesting tool for Frey's syndrome analysis. The sensibility of the amino acid biosensor is not sufficient enough to allow its use at time of Frey's syndrome analysis.

Amino Acids↗
PubMed1993

Cricohyoidopexy in selected infrahyoid epiglottic carcinomas presenting with pathological preepiglottic space invasion.

Nineteen patients who presented with infrahyoid epiglottic squamous cell carcinoma with gross pathological preepiglottic space invasion, not amenable to a partial horizontal supraglottic laryngectomy, were offered a supracricoid partial laryngectomy with a cricohyoidopexy technique; this was an attempt to preserve physiological phonation, respiration, and deglutition while achieving the same local control rate as with a total laryngectomy. Preoperative chemotherapy and bilateral jugulocarotid lymph node dissection were performed in all cases. Patients were monitored for at least 5 years or until death. No patients were unavailable for follow-up. The 5-year actuarial survival (Kaplan-Meier method) was 84.2%. Local recurrence, nodal recurrence, and distant metastasis occurred once in our series, while six patients presented with a second primary tumor. We present, analyze, and compare functional results with those of the previously reported series. Our experience with the supracricoid partial laryngectomy with a cricohyoidopexy, in the face of selected infrahyoid epiglottic squamous cell carcinoma invading the preepiglottic space, not amenable to a partial horizontal supraglottic laryngectomy, suggested that a total laryngectomy might be avoided without decreasing the cure rate.

Adult↗
PubMed1993

Frey's syndrome analysis with biosensor. A preliminary study.

OBJECTIVE: Objective quantification of Frey's syndrome (gustatory sweating), following total parotidectomy. A biosensoring method of enzymatic electrodes enabling the detection of L-lactate on intact skin with the use of a skin extraction device and enzymatic electrodes is presented and analyzed. DESIGN: A criterion standard study. SETTING: This prospective trial was undertaken at our research laboratory (University of Paris [France]). Parotidectomy was performed in our department, which is a tertiary care center for parotid gland pathology. PATIENTS: Twenty-eight patients with gustatory sweating following total parotidectomy and nine control patients not operated on were asked to take part in this prospective study. MAIN OUTCOME AND MEASURES: Gustatory sweating was assessed in all patients using a clinical scale, the Minor starch iodine test, and the L-lactate biosensoring method. RESULTS: Instrumentation and assay procedure for the L-lactate biosensoring method are detailed. Statistical analysis of data was performed using the Kruskal-Wallis H Test and the Mann-Whitney U Test. Results demonstrate that this method enables objective measurement of the L-lactate on skin without the need for chemical reagents, continuous nondestructive analysis in real time, and physiological dynamic monitoring of the L-lactate rate of production after stimulus. Data achieved strongly suggested that the aberrant regeneration theory is the main clue to Frey's syndrome pathogenesis. CONCLUSION: This safe, reliable, noninvasive, objective, and highly sensitive method provides an investigative tool for clinicians as well as physiologists involved with patients presenting gustatory sweating following parotid gland surgery.

Adenoma, Pleomorphic↗
PubMed1993

New surgical obturator prosthesis for hemimaxillectomy patients.

Many materials have been used to make immediate and intermediate obturator prostheses for the hemimaxillectomy patient. The weight of the obturator prosthesis is a major hindrance. A new thermoplastic material, Polysar, is described to create a hollow obturator extension for immediate and intermediate lightweight obturator prostheses.

Elastomers↗
PubMed1993

Implantation metastasis following percutaneous endoscopic gastrostomy.

Since it was first described, the original percutaneous endoscopic gastrostomy (PEG) technique has proved to be a valuable adjunct in patients with head and neck tumours. This procedure is being increasingly utilized in the face of swallowing impairment related to head and neck carcinoma. Although generally well tolerated, it may be associated with complications. In this report, we document tumour implantation at the percutaneous endoscopic gastric site and review the report cases. It appears that implantation metastasis does alter prognosis.

Aged↗
PubMed1993

Biodegradable starch microspheres for cerebral arterial embolization.

RATIONALE AND OBJECTIVES: Various materials have been used to perform intracerebral and cervical arterial embolization for head and neck tumors and vascular malformations. This preliminary prospective study was designed to analyze the clinical and histopathologic consequences of arterial embolization into the brain using biodegradable starch microspheres. METHODS: A new arterial embolization procedure which ensured the integrity of the common and internal carotid arteries, without modifying the arterial flow, was designed. The procedure allowed for cerebral arterial microembolization in 20 Sprague-Dawley rats. Various amounts of biodegradable starch microspheres (Spherex) were introduced into the brain via the left external carotid artery. RESULTS AND CONCLUSIONS: Clinical and histopathologic results suggested that: 1) consequences of cerebral embolization using biodegradable starch microspheres are related to the amount of material embolized; and 2) Spherex microspheres behave differently from degradable microspheres in the brain. Despite the rapid biodegradability of the material, permanent damage from ischemia to the brain was noted.

Animals↗