PubMed Health⌕ Search

Biomedical subjects

G Chantrain

Publications and source records attributed to G Chantrain.

At least 19 recordsLinked to original sources
PubMed2005

Mediastinal tracheostomy: unilateral resection of the anterior chest wall.

Since the first reliable mediastinal tracheostomy described by Grillo et al. in 1966, many new techniques have been described in order to reduce the number of complications. We here report the case of a 55-year-old man who was referred for surgery with post-radiochemotherapy recurrence of a double neoplasm of the pharyngolarynx extending to the proximal trachea and the medial part of the oesophagus. Through a median sternotomy, a pharyngolaryngoesophagectomy was performed with an extended tracheal resection. The reconstruction of the upper digestive tract was performed with a gastric pull-up. The mediastinal tracheostomy was performed with a pectoralis major muscular flap through a right unilateral resection of the manubrium, the right clavicular head and the right first and second costal cartilages. Historically, the mediastinal tracheostomy was performed through a large bilateral resection of the anterior chest wall, in order to prevent the tension on the tracheocutaneous sutures. Nowadays, with the possibility of various pedicled flaps, bilateral resection no longer seems to be necessary. This unilateral resection leads to a reduction in post-operative sequelae.

Esophagus↗
PubMed2005

Initial assessment of a neck mass in children.

OBJECTIVE: To propose national recommendations for the initial assessment of a mass in the neck in children. METHODS: Comprehensive review of the available literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work up of children presenting with a mass in the neck.

Adolescent↗
PubMed2005

Initial work-up in head and neck squamous cell carcinoma.

OBJECTIVE: To propose national guidelines for the initial assessment of head and neck squamous cell carcinoma. METHODS: Comprehensive review of the literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work-up of patients with a presumed diagnosis of a squamous cell carcinoma of the upper aero-digestive tract.

Biopsy, Fine-Needle↗
PubMed2004

Physiotherapy in obstructive sleep apnea syndrome: preliminary results.

Apneic patients have hypotonia of the lingual and supra-hyoid muscles. The dysfunction of theses muscles leading to a collapse of the upper airway is responsible for the apnea. The goal of this study, designed as a before-after trial, is to determine the effect of lingual and supra-hyoid muscle strengthening on obstructive sleep apnea. Thirty-four patients with obstructive sleep apnea were included (consecutive sample). Only 16 patients completed the study. The treatment consisted of 30 sessions of transcutaneous neuromuscular stimulation administered to the submental region associated with muscular exercises. The effect on apneic events was analyzed with a polysomnography before and after the treatment. Thirteen patients could be analyzed for the statistical studies. The mean apnea-hypopnea index (AHI) decreased from 32.9 to 20.6 (Wilcoxon rank test: P = 0.017). Seven patients ended the study with an AHI of less than 10, and three more patients decreased their AHI by more than 50%. This treatment significantly decreased the AHI in most of the patients. A larger study with more patients and with a long-term follow-up is necessary to determine the place of physiotherapy in the treatment of obstructive sleep apnea.

Adult↗
PubMed2003

A comparison of survival lifetime of the Provox and the Provox2 voice prosthesis.

The Provox (Atos Medical AB, Hörby, Sweden) voice prosthesis was developed between 1988 and 1990 and has been used at our centre with regular success since 1993. Since 1996, a second generation of Provox (Provox2) has been used, which can be inserted by an anterograde technique. The aim of this study is to compare the survival lifetime of both voice prostheses. The survival time of the two voice prostheses were compared retrospectively in 152 devices placed in 38 patients. A Kaplan-Meier analysis was performed to determine the survival lifetimes and a log rank test was performed to compare the two curves. Clinical factors affecting the lifetime were also analysed with a Kaplan-Meier plot. The median survival lifetime of the Provox and Provox2 were 303 and 144 days respectively. The Kaplan-Meier estimation shows that this difference is statistically significant (p=0.02). It is considered an early failure if it occurs within the first three months. There was a larger number of early failures with the Provox2 than with the Provox (p=0.04). Neither the gender nor the age affected the lifetime of the devices. Radiotherapy seemed to lengthen the lifetime of the first valve. The survival lifetime of the second generation Provox2 valve is shorter than the lifetime of the first generation Provox. This could be due to the difference in elasticity of these valves that could lead to a different level of colonization and invasion of the valves by micro-organisms.

Age Factors↗
PubMed2003

[Diagnostic management of unilateral sensorineural hearing loss in adults].

Adult unilateral hearing loss is a frequent complaint observed by the E.N.T. specialist. With a pure tone audiometry, we can recognize a conductive hearing loss from a sensorineural hearing loss. In case of a conductive hearing loss, a temporal bone computed tomography is the first choice procedure. For the sensorineural hearing loss, the standard screening test is the brainstem evoked response auditory (BERA), which can be completed by a magnetic resonance imaging (MRI). The BERA have a false negatives level of 2 to 15% according to the studies, which means that a checking must be done 6 months later. The improvement of MR examination offers a better detection of very small tumours (2-3 mm). The cost of a MRI is equivalent to the cost of 2 BERA. In conclusion, we propose MRI as the only investigation to be performed in case of an unilateral sensorineural hearing loss.

Hearing Loss, Sensorineural↗
PubMed2000

Clinical aspects of early and late hypocalcaemia afterthyroid surgery.

AIM: This study aimed to evaluate hypocalcaemia (time-course) and need for calcium administration after thyroid surgery in 135 consecutive cases (69 bilateral subtotal thyroidectomies, 50 unilateral lobectomies, 13 total thyroidectomies and three isthmectomies) for benign lesions and for differentiated carcinoma in 89% and 11% respectively. RESULTS: In unilateral lobectomy, two parathyroid glands were identified and preserved in 72%, and one gland in 28% of the patients; calcaemia decreased by 10% on average in the early post-operative period (P<0.001). Calcium treatment (average: 2.3 days) was administered to 34% of the patients, these patients had lower nadir post-operative calcaemia than those who did not receive calcium: 2.03 vs 2.14 mmol/l (P<0.001). Their calcaemias reverted to normal within 1 week after surgery and remained normal thereafter without further calcium administration. In bilateral procedures, four parathyroid glands were preserved in 40%, three in 42%, two in 16%, and only one in 2% of the cases. Calcaemia decreased by 15% on average (P<0.001), and early hypocalcaemia was common and severe in some patients: nadir post-operative calcaemia <2.0 mmol/l in 61%, and <1.75 mmol/l in 6% of the cases. Post-operative hypocalcaemia was more pronounced after total than subtotal thyroidectomy (1.86+/-0.19 vs 1.98+/-0.14 mmol/l P=0.014), and also after lymph node dissection (1.83+/-0.11 mmol/l). Serum parathormone (PTH) decreased from 36 ng/l before surgery to 17 ng/l in the week thereafter (P=0.001). There was a linear relationship between the number of preserved parathyroid glands and early hypocalcaemia. The percentage of patients requiring calcium treatment was: 24 h (15%), 2-7 days (26%), 8-180 days (33%), >1 year (9%). DISCUSSION: The number of parathyroid glands preserved in situ did not help predict the duration of post-surgical calcium treatment, nor the final outcome of hypocalcaemia. However, when total calcium levels were compared in patients having had one or two glands preserved vs three or four parathyroid glands, it was possible to show that despite prolonged calcium administration, late calcaemias remained significantly lower during the first 6 months in patients with a smaller number of parathyroid glands. Hypoparathyroidism, defined functionally on the basis of requirement of calcium supplementation 1 year after surgery, occurred in 8.6% of patients after bilateral lobectomy (despite measurable but inappropriately low-PTH concentration). This outcome could have been predicted earlier (after 3 to 6 months) and the patients perhaps given the benefit of definitive vitamin D treatment earlier, in order to avoid late and prolonged hypocalcaemia. Evaluation after 1 year showed that only one patient out of 82 bilateral lobectomies (1.2%) had permanent hypoparathyroidism and needed calcium whereas hypocalcaemia was persistent in one out of four patients who had undergone a staged procedure (i.e. heterolateral lobectomy years after a previous operation).

Adolescent↗
PubMed1999

Tonsillar lymphoma and AIDS.

A case of a patient presenting unilateral tonsillar enlargement, whereby non-Hodgkin lymphoma (NHL) and AIDS were diagnosed, is presented. The clinical and pathological aspects of this pathology, its pathogenicity and treatment are reviewed.

Adult↗
PubMed1998

Laryngeal aspergillosis in an acquired immunodeficiency syndrome patient.

Aspergillosis is a rare infection. It varies considerably in its virulence depending on whether or not the patient affected is immunodepressed. The serious form is characterized by vascular invasion with haematogenic dissemination, tissue infarction and necrosis. The most often affected site is the lung. A laryngeal localization is exceptional and usually results from dissemination from a lower airways portal of entry. Diagnosis is difficult: cultures are only positive in 50 per cent of cases, while in 60 per cent of cases the characteristic histological features reminiscent of sprigs of mistletoe are only found on postmortem examination. In view of the high morbidity and mortality in acquired immunodeficiency syndrome (AIDS) sufferers, this condition must be treated early and aggressively. Treatment is based essentially on amphotericin B and itraconazole.

AIDS-Related Opportunistic Infections↗
PubMed1998

An unusual localisation of Kaposi's sarcoma: the external auditory canal.

The epidemic form of Kaposi's sarcoma is associated with human immunodeficiency virus infection. Cutaneous and mucosal manifestations are frequently reported in the ENT sphere, mostly involving the oral cavity. The external and middle ear are only rarely concerned with only one case of a mastoid lesion without extension to the external auditory canal (EAC) being reported to this day. The present article describes the first case of involvement of the EAC with extension to adjacent structures. This patient presented other Kaposi lesions and had been treated by systemic hormonal therapy. Thereafter local injection of a cytotoxic agent was given without effect. Finally, radiotherapy resulted in a 50% regression of the tumour mass. The epidemiologic factors and therapeutic modalities with their results are described.

Adult↗
PubMed1993

Elevated CEA in breast cancer patients with overlooked medullary thyroid carcinoma.

After mastectomy and radiation for breast cancer, two patients were found to have persistent elevated CEA in their serum. This finding was erroneously attributed to occult metastases for the first patient and to local recurrence for the second. Overlooked medullary thyroid carcinoma (MTC) was the causal disease in both patients. A review of the literature stresses the frequency of CEA elevation in serum of MTC patients. A thorough search for any possible cause of elevated levels of CEA is advocated, particularly by thyroid sonogram with a needle aspiration biopsy when a nodule is discovered and by calcitonin assay in the serum.

Adenocarcinoma, Mucinous↗
PubMed1993

Wound dressing in major head and neck cancer surgery: a prospective randomized study of gauze dressing vs sterile vaseline ointment.

A total of 207 patients were randomized in a prospective comparative study of standard gauze dressing vs sterile vaseline ointment. 179 patients were evaluable. All patients received antimicrobial prophylaxis. The two groups (86 standard and 93 vaseline) were comparable as far as age (mean, 57 yr; range, 21-84), genders (155 males/24 females), weight (mean, 66 kg; range, 40-69), type of surgery, previous or concomitant anticancer treatment. Severity of surgery was identical, as was the severity of cancer, in the two groups. Wound infection within 20 days of surgery occurred in 31.2% (29/93) of the vaseline group and 24.4% (21/86) in the standard group (NSS). Bacteremia occurred in three patients from the vaseline group and in four patients from the standard group. Bronchopneumonia occurred in 10 patients from the vaseline group and 14 patients in the standard group. The spectrum of microorganisms recovered was similar in the two groups. The need for antimicrobial treatment (empiric or for documented infections) within 20 days after surgery was 34.4% (32/93) in the vaseline group and 36.0% (31/86) in the standard group. The median delay to infection (range in days) in the vaseline group was 9 (5-15) for wound and 6 (1-12) for bronchopneumonia. For the standard group the corresponding delays were 8 (4-15) and 7 (2-19). Vaseline dressing was not associated with an increased risk of infection as compared to the standard gauze dressing.

Adult↗
PubMed1992

Antimicrobial prophylaxis for major head and neck surgery in cancer patients: sulbactam-ampicillin versus clindamycin-amikacin.

A total of 99 patients with head and neck cancer who were to undergo surgery were randomized in a prospective comparative study of sulbactam-ampicillin (1:2 ratio; four doses of 3 g of ampicillin and 1.5 g of sulbactam intravenously [i.v.] every 6 h) versus clindamycin (four doses of 600 mg i.v. every 6 h)-amikacin (two doses of 500 mg i.v. every 12 h) as prophylaxis starting at the induction of anesthesia. The two groups of evaluable patients (43 in the clindamycin-amikacin treatment group and 42 in the sulbactam-ampicillin treatment group) were comparable as far as age (mean, 57 years; range, 21 to 84 years), sex ratio (71 males, 28 females), weight (mean, 66 kg; range, 40 to 69 kg), indication for surgery (first surgery, 48 patients; recurrence, 37 patients), previous anticancer treatment (surgery, radiation therapy, chemotherapy), type of surgery, and stage of cancer. The overall infection rate (wound, bacteremia, and bronchopneumonia) within 20 days after surgery was 20 patients in each group. Wound infections occurred in 14 (33%) sulbactam-ampicillin-treated patients and 9 (21%) clindamycin-amikacin-treated patients (P = 0.19; not significant). The rates of bacteremia were 2 and 4%, respectively. The rates of bronchopneumonia were 14.3 and 23.2%, respectively (P was not significant). Most infections were polymicrobial, but strict anaerobes were recovered only from patients who received sulbactam-ampicillin. Antimicrobial treatment was required within 20 days after surgery for 42% of the sulbactam-ampicillin-treated patients and 44% of the clindamycin-amikacin-treated patients. By comparison with previous studies, we observed a decreased efficacy of antimicrobial prophylaxis in patients with head and neck cancer undergoing surgery because of the increased proportion of patients who were at very high risk for infection (extensive excision and plastic reconstruction in patients with recurrent stage III and IV cancers) and because of the longer duration of surgery.

Adult↗
PubMed1991

Wide vertical hemipharyngolaryngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap: preliminary results.

We propose a new technique of wide vertical hemipharyngolaryngectomy which combines resection of laterally localized extended pharyngolaryngeal tumors with immediate microsurgical reconstruction using a radial forearm free flap, including the tendon of the palmaris longus. It eliminates the limitations of resections, which are usually performed to avoid closure difficulties of the resulting defect. In addition, the new technique avoids the use of tumor-neighboring structures for closure, fulfilling the oncological principles of surgery performed in this region. Our preliminary results show good restored deglutition and phonation. Postoperative irradiation does not seem to affect these results.

Forearm↗
PubMed1989

Neoadjuvant chemotherapy with cisplatin, methotrexate, bleomycin and vincristine (CABO) in patients with stage III and IV squamous cell carcinoma of the head and neck.

Forty-six patients with Stage III-IV previously untreated squamous cell carcinoma of the head and neck were treated with neoadjuvant chemotherapy with cisplatin, methotrexate, bleomycin and vincristine. The overall response rate was 70%, with a 9% complete response rate. The most frequent side effects were myelosuppression, nausea and vomiting, alopecia, neurotoxicity and stomatitis. Definitive local therapy consisted of surgery alone in 13 cases, surgery plus radiation in another 13, and radiotherapy alone in 14. Six patients, four of whom died, received no definitive local therapy and two were lost to follow-up. The median disease-free survival time was 10.5 months, and the most frequent cause of failure was local regional relapse (85%). Median survival time was 13 months and there were eight long-term survivals (median 48 months). Response to chemotherapy was independent of all analysed prognostic factors. Disease-free survival and survival were significantly influenced by the presence or absence of lymph nodes. Our results do not support the routine use of neoadjuvant chemotherapy with cisplatin, methotrexate, bleomycin, and vincristine in patients with advanced cell carcinoma of the head and neck.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Vertical hemipharyngolaryngectomy: reconstruction with the radial forearm free flap.

A considerable body of literature defines techniques to restore glottic function after partial laryngectomy. The authors of this paper describe a new original technique for glottic and hypopharyngeal reconstruction after vertical hemipharyngolaryngectomy. Using a radial forearm free flap including the tendon of the palmaris longus and a sensitive branch of the radial nerve, they were able to reconstruct the missing vocal cord and a pyriform fossa. This procedure permits an extended resection without the usual phonatory or swallowing inconveniences. There is no contraindication for postoperative radiotherapy. The technique and preliminary functional results are reported.

Forearm↗
PubMed1989

Free and pedicled flaps for head and neck reconstruction in radically irradiated fields: 6 years' experience at the Jules Bordet Institute.

From 1982 to 1988, 127 flaps were performed after ablative surgery for head and neck squamous cell carcinoma: 86 pedicled pectoralis major island and 41 free flaps of different types. One hundred and four were evaluable for this retrospective study: 66 after definitive radiotherapy (6000-8000 cGy) and surgery for recurrent or persistent disease and 38 after elective surgery for Stage III and IV tumors without previous irradiation. Wound healing, hospital stay, survival rate and complications are compared between irradiated and nonirradiated areas. The indications, advantages and disadvantages of each type of flap are reviewed according to the main goals of our treatment: i.e. local disease control, restoration of function, cosmetic appearance and short hospital stay.

Adult↗