Biomedical subjects

J Santini

Publications and source records attributed to J Santini.

At least 19 recordsLinked to original sources

PubMed2006

Thyroid surgery and recurrent laryngeal nerve monitoring.

UNLABELLED: Recurrent laryngeal nerve paralysis is a much-dreaded complication of thyroid surgery. OBJECTIVE: To study the feasibility and the reliability of a recurrent laryngeal nerve monitoring technique. MATERIALS AND METHODS: This was a prospective study including 36 patients proposed for thyroid surgery with recurrent laryngeal nerve monitoring. They underwent post-operative fibre-optic laryngeal examination and speech therapist consultation. RESULTS: Our technique of nerve monitoring showed a 98 per cent sensitivity and 86 per cent specificity. CONCLUSIONS: Recurrent laryngeal nerve monitoring is a feasible and reliable technique. It can be used to avoid bilateral nerve injury and to increase the surgeon's confidence but not to replace a systematic nerve identification and a careful dissection.

Adolescent↗

PubMed2006

[Early PTH assay after total thyroidectomy: predictive factor for post operative hypocalcemia?].

OBJECTIVES: Hypocalcemia is the most common complication of total thyroidectomy. During surgery the blood supply to preserved parathyroid glands may be compromised, monitoring for post operative hypocalcemia is often the primary reason patients remain in hospital. The aim of this prospective study was to evaluate the role of early parathyroid hormone (PTH) assay for predicting thyroidectomy-related hypocalcemia. MATERIAL AND METHODS: 62 patients underwent total thyroidectomy between November 2004 and April 2005 in our institution. Quick PTH assay was performed 1 hour post thyroidectomy. Based on the result (PTH > or <16 pg/mL) the patients were separated into two groups. Serum calcium levels and ionised fractions were determined 24, 48 and 72 hours after surgery. Post operative hypocalcemia was defined as calcium levels <2.00 mmol/L and/or ionised calcium levels <1.00 mmol/L. RESULTS: In 16 cases hypocalcemia occurred in the first 72 hours (25.8 %). In all of these cases, PTH measured 1 hour after thyroidectomy was < or = 16 pg/mL. All patients with PTH >16 pg/mL one hour after the operation remained normocalcemic. Of the 29 patients with a PTH < or =16 pg/mL at one hour post surgery, 13 remained normocalcemic. Quick PTH measurements which were < or =16 pg/mL post thyroidectomy were an excellent predictive factor of hypocalcemia with a sensibility of 100%, a specificity of 71.7%, a positive predictive value of 55.2% and a negative predictive value of 100%. CONCLUSION: PTH measurement 1 hour post thyroidectomy can potentially highlight those patients at risk of hypocalcemia. This would allow more efficient replacement therapy with calcium and vitamin D thus avoiding complications and reducing total hospital stay.

Adolescent↗

PubMed2005

Analysis of the dinucleotide repeat polymorphism in the epidermal growth factor receptor (EGFR) gene in head and neck cancer patients.

BACKGROUND: Epidermal growth factor receptor (EGFR) overexpression is associated with poor prognosis in head and neck cancer. The first intron of EGFR gene is polymorphic (9-23 CA repeats) and transcription declines when the number of repeats increases. PATIENTS AND METHODS: EGFR polymorphism (fluorescent genotyping) and expression (ligand-binding assay) were analyzed in tumors and normal tissues from 112 patients (100 men, 12 women; mean age 60 years). RESULTS: The number of CA repeats varied from 15 to 22. Allelic distribution was trimodal (predominance of 16, 20 and 18 CA repeats). EGFR concentrations were significantly higher (P=0.02) in homozygous tumors as compared with heterozygous. Considering homozygous tumors, or classifying genotypes as short/long/intermediary (two alleles <17 versus two alleles > or =17 versus others), no relationship was observed between tumoral EGFR genotype and expression. In the 76 tumors exhibiting at least one 16-CA allele, the length of the remaining allele was inversely correlated to EGFR expression (P=0.047). Tumoral EGFR expression, performance status (WHO criteria) and node involvement were independent predictors of specific survival (P <0.01). Tumoral or normal tissue EGFR genotype did not influence survival. CONCLUSIONS: Intron 1 EGFR polymorphism may be implicated in the regulation of EGFR expression in head and neck tumors.

Adult↗

PubMed2005

[Contribution of computed tomography in experimental sinus surgery].

OBJECTIVES: To study the contribution of computed tomography (CT) to evaluate the intensity of the sinus mucosa's response to an inflammatory stimulus. MATERIAL AND METHODS: Eight New-Zealand white rabbits where used. Rabbit n degrees 1 was the control. CT, macroscopic examination with analysis of secretion volumes, and histological examination were used to study the response of the sinuses to inflammation. RESULTS: There was perfect match between the CT scan aspect and the quantity of secretions (kappa and Cohen's coefficient=1). The CT scan aspect well correlated with inflammatory cell infiltration (kappa and Cohen's coefficients=0.8). CONCLUSION: The CT scan contributes usefully to the analysis of sinus contents and can be used to assess the intensity of the sinus mucosal inflammatory reaction. Consequently, the CT scan can be used not only to validate an animal model of acute or chronic sinusitis, but can also be used to evaluate medical or surgical treatments in such an animal model.

Animals↗

PubMed2004

[Evaluation of rhinologic signs among smokers].

OBJECTIVE: As well as others usually irritative factors, cigarettes smoke has many medical consequences that aren't well known at the present time. The aim of this study is to describe the rhinologic signs caused by cigarettes consumption. MATERIAL AND METHODS: Two groups (smoker and control) of 20 patients (10 men and 10 women) were contituted. Individual patient status was evaluated by questionnaire, analogic visual scale, clinical examination and rhinomanometry. RESULTS: Nasal resistances, nasal obstruction and posterior rhinorrhea evaluated by, analogic visual scale are significantly higher in the smoker group as compared to the control group (Mann-Whitney test; total nasal resistance: p<0.00001, uninasal resistances: p<0.00001, nasal obstruction: p<0.0001, posterior rhinorrhea: p<0.01). They are significantly higher among smokers of 20 cigarettes a day than among smokers of 10 cigarettes a day. DISCUSSION: The control group was completly safe of rhinologic signs, so we used it to confirm the normal values of nasal resistances. Posterior rhinorrhea and nasal obstruction are 2 important signs which should be researched in smokers; its severity is correlates with cigarettes consumption. CONCLUSION: Tobacco is an important irritative factor for nasal mucosa.

Adult↗

PubMed2004

[Diagnosis of thyroid nodule. Application of evidence-based medicine].

OBJECTIVE: The frequency of thyroid nodules requires an appropriate and consistent undertaking of such pathology by the entire medical profession. Over the past few years, the ANAES (National Agency of Health Accreditation and Evaluation - 1995 - 1997) had formulated medical recommendations. Our work aimed at updating such recommendations considering recent literature developments and their level of evidence. MATERIAL AND METHODS: We have selected high-level of evidence's articles published since 1997 dealing with the diagnostic undertaking of thyroid nodule. Such analysis was conducted using the search engine "Medline" and the level of evidence of the selected articles was evaluated by taking into account the professional recommendations of the "literature analysis and gradation of recommendations' guide" of ANAES. RESULT: At present, two diagnostic tests are necessary in the diagnostic evaluation of a thyroid nodule (ultrasonography and fine-needle aspiration). CONCLUSION: The medical recommendation will hence result in the synthesis of these two different diagnostic tests, nevertheless fine-needle aspiration being essential and having priority in evaluating the risk of cancer.

Diagnosis, Differential↗

PubMed2004

[The supracricoid laryngectomy with cricohyoidopexy. Carcinological and functional results. 23 cases report of the Centre A. Lacassagne (Nice)].

OBJECTIVE: This study is to estimate the survival results, the morbidity and the functional consequences of the supracricoid laryngectomy with cricohyoïdopexy (SL-CHP). PATIENTS AND METHODS: Between 1990 and 2001, 23 patients had a SL-CHP in Centre Antoine Lacassagne of Nice. The average age was of 59 years. Patients were classified as follow: 1 T1, 11 T2, 10 T3 and 1 T4 (invasion of the thyroid cartilage without involving of anterior soft tissues). 17 patients were NO (73.9%). A bilateral radical neck dissection was performed in 10 cases, a radical neck dissection was associated to a functional neck dissection (1 case) and a homolateral functional neck dissection (10 cases). RESULTS: The limits were insufficient for a patient. Six patients were N+ (28.5%) of which 4 N+R+. The average delay was 21 days and 32.7 days to remove respectively the tracheotomy and the nasogastric tube. A functional total laryngectomy was done in two cases. We noted two cases of local recurrence. Survivals according to the method of Kaplan-Meier are 81% in 3 years and 75% in 5 years. CONCLUSION: The SL-CHP represents an alternative to the total laryngectomy for the supraglottic and transglottic carcinomas.

Adult↗

PubMed2004

Mucormycosis--early diagnosis and treatment.

OBJECTIVE: The aim of this retrospective study was to analyse the data of patients with rhino-orbital-cerebral mucormycosis for predisposing factors, diagnosis, treatment and survival rate. The role of frozen section in early diagnosis and use of nasal endoscopy in diagnosis, treatment and follow-up of patients has also been examined. DESIGN: Retrospective case series. SETTING: University Teaching Hospital. METHODS: The case notes of 9 patients with diagnosis of mucormycosis who presented from 1973 to 2001 were examined. The data for predisposing factors, signs/symptoms, histological diagnosis, radiological intervention, medical and surgical treatment and final outcome was analysed. RESULTS: There were 9 patients with mucormycoses. Early diagnosis was made by endoscopic examination and frozen section in 5 patients, which was later confirmed by histology. Treatment included parental and/or local amphotericin, hyperbaric oxygen and debridement either by endoscopic or external approach, with or without orbital exenteration. This resulted in an overall survival of 5 patients. CONCLUSION: Frozen section diagnosis allows for early therapy since successful treatment depends on systemic amphotericin, surgical debridement and treatment of underlying predisposing factors. Nasal endoscopy is useful in diagnosis, endoscopic debridement and follow up of patients.

Adult↗

PubMed2004

[Evaluation of rhinologic manifestations of gastro-oesophageal reflux].

OBJECTIVE: As well as other usually irritative factors, the acidity of gastro-oesophageal reflux (GOR) has many medical consequences that are not well known at the present time. The aim of this study is to describe the rhinologic signs caused by this common disease. MATERIALS AND METHODS: Prospective study; two groups (GOR proved by pH-metry and control) of 20 patients (10 men and 10 women) were formed. Individual patient status was evaluated by questionnaire, visual analogue scale (AVS), clinical examination and rhinomanometry. RESULTS: Nasal resistance, nasal obstruction and posterior rhinorrhea evaluated by AVS are significantly higher in the GOR group as compared to the control group (Mann-Whitney test; total nasal resistance: p < 0.01, uninasal resistances: p < 0.001, nasal obstruction: p < 0.00001, posterior rhinorrhea: p < 0.00001). DISCUSSION: The control group was completely free from rhinologic signs, so we used it to confirm the normal values of nasal resistance. Nasal obstruction and posterior rhinorrhea are two new signs which should be researched in patients affected by GOR. CONCLUSION: GOR is an important irritative factor for nasal mucosa responsible for nasal obstruction and posterior rhinorrhea. (full article translated in english available on www.ent-review.com).

Adult↗

PubMed2003

[Genic alterations in oral and head and neck squamous cell carcinomas: analysis of international literature].

The development of oral and head and neck squamous cell carcinomas occurs in relation with multiple events including mainly: loss of cycle cell control, evasion from apoptosis, telomerase reactivation. Complex interactions between a set of molecules, cell cycle proteins, tumour suppressor genes, oncogenes and the telomerase, occur in the multiple step process of carcinogenesis. The 2 main ways of control of the cell cycle rely on 2 tumour suppressor genes: the P53 gene and the retinoblastoma gene or RB gene. One of the regulation pathways or the 2 regulation pathways are disabled during the development of oral and head and neck squamous cell carcinomas. Most of the time, the inactivation of the P53 pathway results from a loss of function of the p53 protein, secondary to mutation and/or deletion of the P53 gene; It may also result of the amplification of the MDM2 gene and of the inactivation of the arf protein. The RB pathway leads to cell proliferation by loss of the p16 protein, by amplification of the cyclin D1 gene and less frequently by mutation of the RB gene or loss of the retinoblastoma protein. In India and South-East Asia, the activation of RAS and MYC oncogenes appears to be related with the presence of specific carcinogens in snuff and tobacco. By blocking apoptosis, the Bcl2 protein seems to increase the resistance of tumours to radiotherapy and chemotherapy.

Carcinoma, Squamous Cell↗

PubMed2003

[Interest of MIBI scintigraphy in the preoperative investigation of primary hyperthyroidism].

OBJECTIVE: The purpose of this study is to show the place of MIBI scintigraphy in the preoperative investigation of primary hyperthyroidism, and then to demonstrate the extent to which this test allows us to formulate new surgical strategies, thus reducing the need for neck exploration in favour of minimally invasive techniques. MATERIALS AND METHODS: We have carried out a retrospective study related to 118 cases of primary hyperthyroidism. A MIBI scintigraphy has been applied on all the patients, so that we have been able to compare its results with the surgical and histological findings. RESULTS: Our study shows a great accuracy of MIBI scintigraphy, with respect to the localization of parathyroid adenoma, which represents the major cause of primary hyperparathyroidism. Furthermore, these results prove the reliability of the new surgical strategies: unilateral neck exploration and minimally invasive surgery, when facing a single scintigraphic site. CONCLUSION: As of now, MIBI scintigraphy must be part of preoperative investigation in cases of primary hyperparathyroidism, so that by limitating the surgical neck exploration, it allows us to decrease operative time and the risks, length and cost of the hospital stay.

Adenoma↗

PubMed2002

Endoscopic marsupialization of congenital nasolacrimal duct cyst with dacryocoele.

A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.

Cysts↗

PubMed2002

[Primary signet ring cell carcinoma of the eccrine sweat gland in the eyelid. Immunohistochemical and ultrastructural study of a case].

We report a case of a 45-year-old woman who exhibited a primitive eccrine sweat gland carcinoma of the eyelid. Histological study showed cellular proliferation with an Indian file pattern and some signet ring cells with sialomucin secretion. Immunohistochemical study demonstrated these cells to be positive with the anticytokeratin, anti-EMA, anti-HMFG, antiestrogen receptor and antiprogesterone receptor antibodies. Ultrastructural study showed intracytoplasmic vacuoles with numerous microvilli at the apical side. Differential diagnosis with a metastasis from a mammary adenocarcinoma is difficult and a complete staging is necessary to confirm the primitive origin of the tumor. The behavior of this tumor is marked by locoregional recurrence.

Carcinoma, Signet Ring Cell↗

PubMed2001

[Concomitant bifractionated radiotherapy and chemotherapy with cisplatin and 5-fluorouracil in locally progressive, non-resectable epidermoid carcinomas of the pharynx: ten years experience at the Antoine Lacassagne center].

PURPOSE: Patients suffering from locally advanced unresectable squamous cell carcinoma of the oropharynx and hypopharynx treated with radiotherapy alone have a poor prognosis. More than 70% of patients die within 5 years mainly due to local recurrences. The aim of this study was to evaluate retrospectively the Antoine Lacassagne Cancer Center's experience in a treatment by concomitant bid radiotherapy and chemotherapy. Evaluation was based on analysis of the toxicity, the response rates, the survival, and the clinical prognostic factors. PATIENTS AND METHODS: From 1992 to 2000, 92 consecutive patients were treated in our single institution. All of them had stage IV, unresectable squamous cell carcinoma of the pharynx and they received continuous bid radiotherapy (two daily fractions of 1.2 Gy, 5 days a week, with a 6-h minimal interval between fractions). Total radiotherapy dose was 80.4 Gy on the oropharynx and 75.6 Gy on the hypopharynx. Two or three chemotherapy courses of cisplatin (CP)-5-fluorouracil (5FU) were given during radiotherapy at 21-day intervals (third not delivered after the end of the radiotherapy). CP dose was 100 mg/m2 (day 1) and 5-FU was given as 5-day continuous infusion (750 mg/m2/day at 1st course; 430 mg/m2/day at 2nd and 3rd courses). Special attention was paid to supportive care, particularly in terms of enteral nutrition and mucositis prevention by low-level laser energy. RESULTS: Acute toxicity was marked and included WHO grade III/IV mucositis (89%, 16% of them being grade IV), WHO grade III dermatitis (72%) and grade III/IV neutropenia (61%). This toxicity was significant but manageable with optimised supportive care, and never led to interruption of treatment for more than 1 week, although there were two toxic deaths. Complete global response rate at 6 months was 74%. Overall global survival at 1 and 2 years was 72% and 50% respectively, with a median follow-up of 17 months. Prognostic factors for overall survival were the Karnofsky index (71% survival at 3 years for patients with a Karnofsky index of 90-100% versus 30% for patients with a Karnofsky index of 80% versus 0% for patients with a Karnofsky index of 60-70%, p = 0.0001) and tumor location (55% at 3 years for oropharynx versus 37% for panpharynx versus 28% for hypopharynx, p = 0.009). CONCLUSION: These results confirm the efficacy of concomitant bid radiotherapy and chemotherapy in advanced unresectable tumor of the pharynx. The improvement in results will essentially depend on our capacity to restore in a good nutritional status the patients before beginning this heavy treatment.

Adult↗

PubMed2001

Longterm survival in acute rhinocerebral mucormycosis with giant cell arteritis and foreign body granulomas.

A case of rhinocerebral mucormycosis occurring in a 41-year-old man with insulin-treated diabetes mellitus is reported. Microscopically, biopsy samples obtained from the left ethmoid and middle turbinate sinuses contained fungi that formed mycotic granulomas associated with multinucleate giant cell arteritis. The multinucleate giant cells contained broad, infrequently septate hyphase consistent with mucormycosis. The patient received surgical debridement with extenteration of the left orbit, and intravenous liposome-encapsulated amphotericin B. After 12 months, examination of the patient revealed complete healing. Multinucleate giant cell granulomas and arteritis are only exceptionally associated with rhinocerebral mucormycosis, but these histologic findings may be correlated with a progressive disease with better prognosis.

Acute Disease↗

PubMed2001

[Use of neck platysma myocutaneous flap for reconstruction substance defects after surgical resection of oropharyngeal tumors. Report of 70 cases].

PURPOSE OF THE STUDY: We analyzed our experience with the cervical platysma myocutaneous flap and reviewed the pertinent literature. We evaluated the harvesting technique, surgical indications, reliability of the flap, its advantages and drawbacks compared with other reconstruction techniques and assessed survival and local control. MATERIALS AND METHODS: This retrospective series included 70 patients with a mean 83-month follow-up. All patients had an oral cavity or oropharyngeal carcioma ranging from T1 to T4, N0 to N2b according to the TNM classification. All underwent one-step surgery with unilateral or bilateral type III elective neck dissection, followed by tumor resection, and reconstruction with a cervical platysma myocutaneous flap. RESULTS: Complications related to flap reliability were observed in 17 cases (24.3%): 1 total necrosis (1.4%), 6 partial necrosis (8.6%), and 10 paddle epidermolysis (14.3%). Median survival and local control were 35 and 59 months respectively. Eight out of 55 preoperative N0 patients were histologically N+ (14.5%). No significant difference in risk of metastasis recurrence was evidenced between N0 and N+ patients (p > 0.05). DISCUSSION: Reconstruction after ablation of oral or oropharyngeal cancer using a cervical platysma myocutaneous flap can be easily combined with an elective neck dissection without increasing the risk of recurrence. The flap must preserve the facial artery and its submental branch and the external jugular vein to ensure reliability. When indications are strictiy applied, the properties of the platysma plasty and the anterolateral cervical situation provide very satisfactory functional and esthetic results.

Adult↗

PubMed2001

[Endovascular embolization of ophthalmic artery branches for control of refractory epistaxis: report of one case].

Embolization of the internal maxillary artery is an accepted method for control of severe or recurrent posterior epistaxis. Such endovascular treatment may fail if the vascular supply to the bleeding vessels originates in branches of the ophthalmic artery. We report one case in which embolization of the ophthalmic artery was performed to control epistaxis. Distal catheterisation at least beyond the second portion enables safe embolization.

Aged↗

PubMed2001

[Value of endonasal endoscopic surgery in the treatment of sphenoid cerebrospinal rhinorrheas. 15 cases].

UNLABELLED: Surgical management of cerebrospinal fluid leaks (CSFL) has improved these few past years with the development of paranasal sinus surgery under optical guidance. CSFL localized in the sphenoid sinus represent only 5 to 15% of all CSFL. The authors have analyzed a serie of 15 patients having undergone surgery from 1992 to 1999 for CSFL: 10 cases followed pituitary gland surgery realized through sublabial-transsphenoidal approach, 2 cases followed head trauma, 1 case followed a secondary neurosurgical procedure following recurrence of a rathke's cleft cyst, 1 case followed medical treatment of a bulky pituitary gland adenoma and 1 case was associated to an empty sella syndrome. The surgical procedure has relied on sphenoid sinus approach through the sphenoethmoidal recess (SER) (n = 8), transethmoidal approach (TE) (n = 2) or transseptal approach (TS) (n = 7) followed by a filling of the defect by a graft of fat with biological glue (n = 17). Sometimes it was associated to a cartilagenous graft (n = 7) when there was a bone defect. The average period of hospitalisation was 5.2 days (4-21), mean follow-up was 2.9 years (6 months-7 years). RESULTS: The success rate was 80% (3 failures were observed), 2 patients underwent secondary procedures by TS approach with success. Our results combined with the literature data led us to propose an alternative surgical strategy adapted to each case. Endonasal surgery under optic guidance compared to the transrhinoseptal approach represents an attractive alternative with less undesirable iatrogenic consequences.

Adipose Tissue↗