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Biomedical subjects

Jean-Pierre Lavieille

Publications and source records attributed to Jean-Pierre Lavieille.

13 recordsLinked to original sources
PubMed2007

Surgical management of lesions of the internal carotid artery using a modified Fisch type A infratemporal approach.

OBJECTIVE: To report seven cases of vascular repair of the internal carotid artery (ICA) using a modified Fisch type A infratemporal approach and a venous grafting. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care center. PATIENTS: We have analyzed the clinical presentation, paraclinical assessment, and postoperative results regarding the vascular repair and the facial and auditory function from seven consecutive patients. All patients have been operated on by a multidisciplinary team of ENT and vascular surgeons. RESULTS: The study includes four men and three women, aged from 21 to 62 years old. Six patients suffered from vascular traumatic injury after motor vehicle accident (n = 5) or cervical manipulation (n = 1) and one patient presented an atheromatous stenosis. All benefited from a vascular repair with a venous grafting through a modified Fisch Type A infratemporal approach. No death and no new stroke were noted (mean follow-up, 34 mo). The postoperative angiographies showed six functional grafts and one asymptomatic thrombosis. Six immediate postoperative facial palsy occurred but recovered to Grade I or II within 6 months. There was one traumatic injury of the facial nerve and one postoperative anacusis. For the six other patients, the reconstitution of the external auditory canal and ossicular chain allowed to limit the hearing loss to a mean air-bone gap of 22.5 dB (range, 15-35 dB). CONCLUSION: The lesions of the intrapetrous aspects of the ICA remain the subject of debates regarding the indication for a vascular repair. For young or in good health patients, the infratemporal approach provides a safe and reliable access to the horizontal segment of the ICA, offering to the vascular surgeons optimal conditions for the vascular repair.

Adult↗
PubMed2006

Age-related hearing loss in CD/1 mice is associated to ROS formation and HIF target proteins up-regulation in the cochlea.

Pathologies of senescence, in particular those of neurosensory organs represent an important health problem. The improvement of the life expectation entails the fast increase of the frequency of the age-related hearing loss (ARHL) in the population. There are numerous factors that contribute to this process, which include altered vascular characteristics, hypoxia/ischemia, genetic mutations and production of reactive oxygen species. We were interested in understanding the mechanisms involved in the cochlear degeneration in a mouse model of ARHL, the cd/1 mice. Since in human, hypoxia/ischemia is an important pathogenetic factor for inner ear disease, the regulation of HIF-1 activity in the cochlea, the presence of radical oxygen species in the cochlea and its subsequent disturbances of cellular signaling cascades were investigated. In this study, we explored auditory function of cd/1 mice at the age of 4, 12 and 24 weeks and correlated it with the presence of oxidative damage in the cochlea, and cochlear HIF-1 responsive target genes regulation, involved in pathways promoting inflammation such as tumor necrosis factor (TNF-alpha), or cell death with the p53 protein, Bax protein and surviving factors with insulin-like growth factor-1 (IGF-1). After implantation of electrodes for auditory nerve acoustic thresholds measurements, we analyzed every cochlea. First, we confirmed that the cd/1 mice presented a characteristic profile of ARHL starting at 12 weeks of age. Then, according to our previous report [Riva, C., Longuet, M., Lucciano, M., Magnan, J., Lavieille, J.P., 2005. Implication of mitochondrial apoptosis in neural degeneration in a murin model for presbyacusis. Rev. Laryngol. Otol. Rhinol. 126 (2), 67-74], we noticed many alterations in the cochlea. Histologically, at 4 weeks, intensive HIF-1alpha expression was detected in the cochlea followed by ROS formation at 12 weeks, which may lead to cochlear degeneration and induction the onset of ARHL in the cd/1 mice model. In the cochlea, while the inner and the outer hair cells remained intact at 4 and 12 weeks, the spiral ganglion was more altered. Moreover, the Schwann cells of the spiral ganglion seemed to be more vulnerable to free radical damage than the neurons and degenerated more rapidly. The mechanisms of degeneration in the spiral ganglion involved a caspase-3 and Bax mediated-apoptosis via p53 protein accumulation. Since oxygen radicals are required for the post-translational stabilization of HIF-1alpha during hypoxia, the tandem " HIF-ROS " induced multiple reactions within the cochlea, like a strong inflammatory response with increased expression of TNF-alpha, and inhibition of neuronal protection mechanisms with repression of IGF-1.

Action Potentials↗
PubMed2006

Serous otitis media revealing temporal en plaque meningioma.

OBJECTIVES: To present a series of temporal en plaque meningiomas involving the middle ear or mastoid, whose main symptoms suggested a serous otitis media. STUDY DESIGN AND SETTINGS: Multicentric retrospective study reviewing clinical records originating from eight tertiary referral centers. MATERIALS AND METHODS: The clinical records of 10 patients presenting with signs and symptoms suggesting serous otitis media and whose neuroimaging studies revealed a temporal en plaque meningioma involving the middle ear or mastoid are reported. RESULTS: All the patients were women, ranging from 49 to 71 years old. The delay between the onset of symptoms and the diagnosis of meningioma varied from 1 to 10 years. All the patients underwent various procedures usually applied for the treatment of serous otitis media, which failed in all the cases, particularly ventilating tube placement, which was followed by severe episodes of discharge. In all cases, the computed tomographic scans showed three imaging signs: soft tissue mass filling the middle ear or mastoid, hyperostosis of the petrous bone, and hairy aspect of the intracranial margins of the affected bone. This imaging triad must alert the otologist of the possibility of intracranial meningioma. Magnetic resonance imaging was the method of choice to assess the diagnosis of intracranial meningioma involving the middle ear or mastoid. When analyzing management options, it appeared that conventional middle ear procedures were inefficient. CONCLUSION: Temporal en plaque meningioma involving the middle ear or mastoid can mimic a serous otitis media. A computed tomographic scan is recommended for cases of atypical or prolonged unilateral serous otitis media to investigate indirect signs of a meningioma, which has to be confirmed with magnetic resonance imaging.

Aged↗
PubMed2006

Vibrant soundbridge surgery: evaluation of transcanal surgical approaches.

UNLABELLED: Since its introduction, surgery for the placement of the Vibrant Soundbridge (VSB) device has been performed using a facial recess approach. Because of the size of the VSB device, this approach requires a large facial recess that can lead to complications, i.e., facial palsy and/or taste disturbance. The purpose of this study is to develop and compare transcanal surgical approaches for leading the VSB into the middle ear. SETTING: Cadaver temporal bones in a university temporal bone laboratory. MATERIALS AND METHODS: First, two experienced senior surgeons validated the three possible approaches in human temporal bone: 1) the classical facial recess approach; 2) a small mastoidectomy, elevation of a tympanomeatal flap, small atticotomy, 0.5-mm cutting of the bony external auditory canal (EAC) from the cortical plane on its approximately two-thirds to three-fourths and then a trough to pass the electrode array into the middle ear; and 3) similar to the second approach but with replacing the cutting of the bony EAC with a tunnel from the mastoid cavity to the EAC. Both the second and third approaches were transcanal. Next, five residents and six attending surgeons performed the three operations and evaluate these different approaches by using analog visual scales (VAS) for each procedure. They assess the following: 1) the ease of passing the electrode array and the Floating Mass Transducer (FMT) into the middle ear, 2) the ease for FMT clipping, and 3) their self-confidence using each approach. Time required for the three operations was measured. Measurements of landmarks were obtained on all temporal bones. Two patient cases illustrate the clinical application of this new surgical approach. RESULTS: The two transcanal approaches were assessed to be easier, faster, and safer methods for VSB surgery than the classic facial recess approach. CONCLUSION: VSB surgery has been performed using a facial recess approach with risk for facial nerve and taste disturbance. Transcanal approaches are good alternative for this surgery. Three major limitations are to be assessed in future patient studies: the pathologic findings of the EAC, the design of the FMT regarding the axis of the ossicular chain, the long-term evaluation of the skin of the external ear canal.

Aged↗
PubMed2005

Hearing results with the titanium ossicular replacement prostheses.

The purpose was to study the hearing results in patients receiving a Kurz titanium Bell partial ossicular replacement prosthesis (PORP) or an Aerial total ossicular replacement prosthesis (TORP). The study was a retrospective chart review in a tertiary otologic referral center. A computerized otologic database was used to identify 111 patients implanted with either a PORP or TORP prosthesis. Audiograms were reviewed and air-bone gaps were calculated for each patient. The improvement of the average air-bone gap (ABG) was 10.2 and 12.7 dB at 3 and 20 months after ossiculoplasty, respectively. Sixty-six percent of patients (73/111) had a postoperative air-bone gap of 20 dB or less. The ABG for the titanium PORP prosthesis was 14.3+/-9.7 dB, compared with 25.2+/-13.7 dB for the TORP prosthesis (P <0.05). The ABG to within 20 dB or less was obtained in the PORP group in 77% of the cases, versus 52% of the cases in the TORP group (P <0.05). Two extrusions of the prostheses were observed at 17 and 20 months after surgery (1.8%). Revision procedures for functional failure were carried out in 20 patients (18%). The rate of sensorineural hearing loss was 3.6%. The major factors influencing good audiometric results were the surgical procedure preserving the external auditory canal and the presence of the stapes. The best hearing results were achieved when a PORP was used in an intact canal wall (ICW) procedure, and the worst hearing results were achieved when a TORP was used in a canal wall down (CWD) procedure. The titanium Kurz prosthesis has been an effective implant at our institution for ossicular reconstruction.

Adolescent↗
PubMed2004

Intraoperative auditory monitoring in vestibular schwannoma surgery: new trends.

OBJECTIVE: To investigate the efficiency of a new method of brainstem auditory-evoked potential (BAEP) monitoring during complete vestibular schwannoma (VS) resection with attempted hearing preservation. MATERIAL AND METHODS: Dedicated software providing near real-time recording was developed using a rejection strategy of artifacts based on spectral analysis. A small sample number (maximum 200) is required and results are obtained within 10 s. Fourteen consecutive patients with hearing class A operated on for VS, in an attempt to preserve hearing, participated in the investigation. Postoperatively, 7 patients (50%) had useful hearing (hearing class A, 4/14; hearing class B, 3/14) on the operated side. Seven patients (50%) were reduced to hearing class D. RESULTS: Drilling of the internal auditory canal (IAC) and tumor removal at the lateral end of the IAC were identified as the two most critical steps for achieving hearing preservation. Intraoperative BAEP monitoring was sensitive in detecting auditory damage with useful feedback but its effectiveness in preventing irreversible hearing impairment was not demonstrated in this study. CONCLUSION: Combined BAEP and direct auditory nerve monitoring using the same equipment will be performed in the future in an attempt to enhance the chances of preventing irreversible hearing damage, and possibly to improve the hearing outcome significantly.

Adolescent↗
PubMed2004

Vein versus tragal perichondrium in stapedotomy.

OBJECTIVE: To assess, in otosclerosis surgery, whether the vein or the tragal perichondrium in stapedotomy with interposition yields the better long-term hearing outcome. STUDY DESIGN: A retrospective chart review of prospectively collected audiometric data of 452 ears. SETTING: Academic tertiary otology-neurotology referral center. PATIENTS: Four hundred fifty-two stapedotomies with interposition were performed in 412 patients (bilateral in 40 patients) by the senior author (R.C.) between 1987 and 1998. A tragal perichondrium graft was used in 314 cases and a vein graft was used in 138 cases as sealing material of the oval window. MAIN OUTCOME MEASURES: Audiometric data were recorded at 4 months, at 1 year, and at 3 years after surgery after American Academy of Otolaryngology-Head and Neck Surgery guidelines, except for thresholds at 3 kHz, which were not available and which were replaced with those at 4 kHz. RESULTS: There were no significant intergroup differences in initial or late postoperative hearing outcome with regard to change in the pure-tone average bone conduction and air-bone gaps, or sensorineural hearing loss. Ears treated with a vein graft showed statistically better postoperative 2-kHz air-bone gap closure (p =0.0157), but the pure-tone average air-bone gap difference was not significant. Postoperative air-bone gap closure to within 10 dB was achieved in 91% of cases in the vein group and in 76% of cases in the perichondrium group. Specific study of the bone conduction level at 4 kHz showed a sensorineural hearing loss greater than 10 dB in 8% of cases in the vein group and in 11% of cases in the perichondrium group. One case of complete sensorineural hearing loss was observed with a tragal perichondrium graft (0.22%). CONCLUSION: These results suggest that the vein should be preferred to the tragal perichondrium in stapedotomy with interposition.

Audiometry, Pure-Tone↗
PubMed2003

Facial nerve schwannoma in revision stapedotomy surgery.

We describe a male patient who presented a progressive conductive unilateral hearing loss 20 years after otosclerosis surgery. Computed tomography (CT) scan and magnetic resonance imaging (MRI) findings suggested a facial schwannoma in its tympanic segment. At the time of revision surgery, a facial schwannoma was found to originate at the tympanic segment, pushing the prosthesis out of the oval window fenestration. The Teflon-piston was repositioned with difficulties in the central platinotomy, and the facial schwannoma was left intact.

Biopsy, Needle↗
PubMed2003

Malakoplakia of the neck.

Malakoplakia that presents in the head and neck is very rare. We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia. To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck. Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host. The symptoms are nonspecific and the diagnosis is based on the histologic findings. In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia. Bacteriologic analysis identified Escherichia coli. The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.

Aged↗
PubMed2003

A middle ear implant, the Symphonix Vibrant Soundbridge: retrospective study of the first 125 patients implanted in France.

OBJECTIVE: The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation of patients with a sensorineural hearing loss who are not able to derive adequate benefit from conventional hearing aids. A retrospective study was performed to assess the overall level of satisfaction of implanted patients and to investigate the potential determinants of postoperative success. STUDY DESIGN: A retrospective survey of audiological data from repeated measures and subjective data from self-assessment scales administered postoperatively was conducted to determine the degree of benefit and satisfaction for Vibrant Soundbridge implantees. SETTING: Twenty-one tertiary referral and teaching hospitals. SUBJECTS: The first 125 VSB implantees implanted in France between August 1997 and May 2001 were included in the study. RESULTS: No clinically significant change was observed for residual hearing postoperatively. Most patients (83%) reported they were either satisfied or very satisfied with the Vibrant Soundbridge. Analysis of correlation revealed a moderate correlation (Pearson coefficient r = 0.59) between the degree of benefit reported via the patient survey and the degree of benefit reported via the Glasgow Benefit Inventory. A moderate correlation (Pearson coefficient r = 0.66) was observed between speech comprehension scores in quiet for the preoperative unaided condition and the postoperative aided Vibrant Soundbridge condition. No correlation was observed between subjective reports of satisfaction postoperatively and performance on preoperative objective tests or patient characteristics. CONCLUSION: The results indicate a high level of satisfaction with the VSB as a treatment of sensorineural hearing impairment in patients with a wide range of characteristics. Preoperative scores for unaided speech comprehension tests in quiet may be a potential indicator of success on aided Vibrant Soundbridge speech comprehension tests postoperatively but do not reflect patient satisfaction with the device reported on self-assessment scales.

Adult↗
PubMed2003

Chronic hypoxia protects against gamma-irradiation-induced apoptosis by inducing bcl-2 up-regulation and inhibiting mitochondrial translocation and conformational change of bax protein.

Malignant tumours contain zones of chronic or acute hypoxia, which influence their prognosis and progression. The goal of our study was to understand the role of hypoxia in radio-resistance in a squamous cell carcinoma cell line of the head and neck (KB-3-1 cells). Cell growth was evaluated by Trypan blue exclusion under chronic hypoxia (3-5% O2) for 4 weeks or under normal conditions (21% O2). Cells were then gamma-irradiated either by X-ray (2-6 Gy) or UV-C radiation (0.001-10 J/cm(2)). Apoptosis was estimated by double staining with orange acridine and ethydium bromide and fluorescence microscopy. DNA content was estimated by FACS analysis. Expression of Bax, Bcl-2 and P53 was assessed by immunofluorescence and Western blotting. ROS production was measured by dichlorofluorescein fluorescence. Cell growth depends on oxygen tension. It decreased by 42 and 70% at 5 and 3% O2 compared to control with a significant cell cycle arrest rather than increased mortality. Hypoxic cells are more radio-resistant (x2.5) than normoxic cells. Under chronic hypoxia, Bcl-2 increased considerably in cells compared to control, while Bax and P53 did not change. After irradiation, in hypoxic cells very weak expression of the pro-apoptotic Bax protein and no translocation of Bax to the mitochondria were observed. In addition, irradiation of control KB-3-1 cells demonstrated a large increase in ROS production (x2) compared to cells irradiated identically under hypoxia. In conclusion, chronic hypoxia: i) seems to slow-down cell growth of KB-3-1 cells without inducing apoptosis, ii) induces Bcl-2 overexpression and prevents radiation-induced apoptosis by inhibiting ROS production and altering Bax subcellular redistribution and conformational changes.

Apoptosis↗