Biomedical subjects
Publications and source records attributed to J Santini.
The case report of familial Von Recklinghausen disease, allows to remind the frequency, and the polymorphism of this affection, which is provoked by the neuro-ectodermal layer dysplasia. This case, moreover, poses a difficult problem, about the appearance of asymptomatic large optic nerves in two patients.
The technical difficulties and complications related to arterial catheterisation have inhibited the development of regional chemotherapy in ENT oncology despite the numerous theoretical advantages associated with this method. We report our recent experience with a completely implantable infusion system; 12 systems were inserted, 11 unilateral and 1 bilateral. Treatment was carried out in 8 patients and the perfect biocompatibility of the material was confirmed. Good distribution of the infusion to the tumor zone and lack of cerebral diffusion were confirmed before treatment using an infusion of free Technetium.
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Hitherto, there have been few means to assess the immediate and secondary sequellae following the anatomic upheaval of buccopharyngeal carcinological exeresis. The functional recovery test, the various criteria of which are analyzed, to which 420 patients were subjected, makes it possible to record, for the 123 complete files, the regular evolution of the progress of each patient over a period of 12 months and beyond, which is stimulating and leads us to propose a more systematic handling of such operated patients by the team of phoniatricians and speech therapists.
The authors report a case of mycotic osteitis of the upper maxillary bone due to Candida Albicans occurring in a 56 year old female patient under treatment for chronic myeloid leukemia. The etiologically difficult diagnosis could only be confirmed after deep surgical biopsy with mycological study of a fragment. A review of the literature confirmed the rarity of upper maxillary involvement by Candida Albicans. Particularly when there is isolated involvement and no evidence of a distant primary focus. The differential diagnosis essentially includes centro-facial malignant granuloma.
The clinical, epidemiological and genetic aspects of familial paragangliomas of the head and neck are discussed in relation to 6 recent cases from two families which accounted for 2 and 4 patients respectively. Tumors of the carotid body are the most frequent. Bilaterality and association with other paragangliomas are suggestive of a hereditary disorder and should lead to investigation of the family. The establishment of a family tree will define those subjects at risk in whom systemic screening should be performed. The recent advances obtained using new imaging techniques in the diagnosis, evaluation of extension and treatment should enable treatment to be instituted at an earlier stage and thus reduce functional sequelae.
Malignant non Hodgkin lymphomas (NHL) are fairly frequent, but involvement of the bony cavities of the face is less common than invasion of the cervical lymph nodes and the lymphoid components of Waldeyer's ring. In connection with a series of 17 personal observations, the authors discuss the main features of NHL and review the diagnostic problems and therapeutic alternatives. Two histologic-clinical entities can be defined: orbital NHL: generally stage I, with a low or intermediate histoprognostic grade and a good prognosis; naso-sinusal NHL: often locally advanced, these lesions are often associated with other visceral disease sites; the prognosis for these intermediate or high histo-prognostic grade lesions is much more somber.
Sixty one aged patients with advanced squamous cell carcinoma of the upper aerodigestive tract were given a chemotherapy Cis DDP-5 FU before any local treatment. The objective response rate was 77% which included 46% of complete response. Toxic manifestations were more severe than those observed in the general population with the same protocol (nine deaths during the course of the treatment). A few appropriate measures may contribute for the improvement of the therapeutic index: consideration of nutritional and cardiac status, reduction of doses according to age, pharmacokinetic monitoring of 5 FU. An acceptable level of toxicity will be necessary in the design of future, intensive induction trials. The possibility of conservative treatment with a high level of reliability would justify the use of induction chemotherapy in the aged subjects.
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Based on a personal series of 160 cases of surgically treated closed orbital floor fractures, the authors discuss the various reconstruction procedures and their respective indications. Emphasis is placed on surgical access and osteoplasty techniques. In this series, both cutaneous upper eyelid (127 patients) and transconjunctival approaches (33 cases) were used. Access through the upper eyelid gave the fewest complications; transconjunctival surgery was reserved for pure "blow-out" fractures. Several materials were tested for osteoplasty: conventional techniques included Silastic sheets (112 cases), corticospongiosal bone grafts (16 cases), and lyophilized dura mater (9 cases); new techniques included use of resorbable thermoplastic sheets (23 cases). Choice of a material depends on the size of the defect to be filled. Thin Silastic sheets are the ideal solution for small defects. Bone grafts are reserved for extensive losses of substance.
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Preoperative ultrasound exploration of the cervical node regions was performed for 207 patients; US findings were compared with data obtained by physical examination and histopathologic analysis. Ultrasonography offers multiple advantages: detection of subclinical lymph nodes, accurate measurement of node volume, facilitating classification, evaluation of vascular relations, and particularly diagnosis of internal jugular vein thrombosis. Despite the limitations of ultrasonography, the rapidity and noninvasiveness of this technique make it the procedure of choice for the initial workup of patients with a cervicofacial epithelioma.
150 patients were treated at the Centre Antoine-Lacassagne by CDDP-5 FU induction chemotherapy. Amongst the 134 cases suitable for evaluation, there were 86.6% of greater than 50% responses including 45.5% complete responses (CR). These clinical findings led to changes in post-chemotherapy protocol, mutilating surgical procedures such as total laryngectomy being replaced in complete responders by radiotherapy only. These changes did not lead to any alteration in the survival of the patients. The degree of tumour control at 1 and 2 years was 91.4% and 81.4% for complete responses, 74.6% and 60.6% for partial responses (PR) with survival rates of 1 and 2 years 94% and 78.3% for CR and 77% and 55.1% for PR. The possibility of conservative treatment with a high level of reliability would alone appear to be justification for the use of induction chemotherapy in cervico-facial oncology.
A prospective study of histopathologic data from 195 cervical evidements performed in the Centre Antoine-Lacassagne between 1979 and 1983 evaluated the prognostic value of morphologic criteria reflecting the regional immunity reaction of lymph nodes. Results failed to demonstrate any statistically significant correlation between the various groups, particularly with respect to localization, tumor extension and degree of histologic differentiation. These data are in line with other immunologic criteria, particularly measurement of lymphocyte subpopulations.
Seven cases of non-Hodgkin lymphoma of the nasal cavities and paranasal sinuses are reported. All but one were primary lesions. Five of the 7 cases involved only the facial structures. Sites of involvement were the maxillary sinus (4 cases), the nasal fossae (2 cases), and one case in which lesions of both the ethmoid and sphenoid sinuses were associated with intracranial extension. CT studies showed sinus opacification and invasion of adjacent structures, but bone destruction was inconstant. Follow-up studies during treatment revealed rapid tumor regression with non specific images of mucosal hypertrophy.
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Thirty-two patients with head and neck carcinoma received a multidrug chemotherapy protocol including low dose methotrexate (LDMTX) (30 mg/m2) and cisplatin as their initial treatment. A sensitive immunoenzymatic technique was used for systematic MTX blood monitoring (0-56 hr) in all patients. The MTX-related side effects observed in 15 patients (47%) were significantly associated with an increase in systemic drug exposure occurring early during drug infusion. The average end-of-infusion concentration varied from 8 X 10(-7) M for nontoxic patients to 1.45 and 3.12 10(-6) M for moderately and severely toxic patients respectively. The area under the curve (AUC) (0-56 hr) was also directly related to the increase in side-effects. Total body clearance was reduced in an inverse manner. Volumes of distribution and terminal elimination half-lives were not related to the presence or intensity of MTX side-effects. Based on these data, the institution of folinic acid rescue adapted to the MTX blood concentration, a measure previously not suggested for LDMTX, completely prevented severe toxicity in a subsequent series of 26 patients without modification of the response rate.