Biomedical subjects

M Remacle

Publications and source records attributed to M Remacle.

At least 37 records · Page 2Linked to original sources

PubMed2000

Microsurgery of sulcus vergeture with carbon dioxide laser and injectable collagen.

Between January 1989 and June 1998, we operated on 45 patients for sulcus vergeture. The studied population encompassed 38 women (84%) and 7 men (16%). The median age was 36 (range 12 to 71 years). The surgical technique is based on a concept of Cornut and Bouchayer according to which the dissection of the epithelium adherent to the deep subepithelial plane improves the vocal fold vibration. Dissection is performed with a single-pulsed carbon dioxide laser at 2 to 3 W with a pulse duration of 0.1 second. We use the Super-pulse microwave. The Acuspot micromanipulator provides a spot size of 250 microm at 350-mm focal length. When the vocal fold is atrophic, surgery is completed with a bovine or autologous collagen injection; the median injected quantity is 0.3 mL (range 0.1 to 0.4 mL). The epithelial microflap is redraped with fibrin glue. Voice therapy is indispensable for correcting the associated hyperkinetic dysphonia. The median postoperative follow-up period is 5 months (range 1 to 18 months). In terms of median values, the maximum phonation time improved from 9 to 13 seconds, the phonation quotient improved from 296.5 to 228.5 mL/s, and the spectral analysis distribution improved by 1 class. Stroboscopic examination reveals an improvement of the vibratory symmetry, amplitude, and wave. Subjectively, the patients describe an improved ability for vocal effort and the regression or disappearance of vocal fatigue. Although the timbre is improved, the voice often remains breathy and hoarse.

Adult↗

PubMed1999

Use of injectable autologous collagen for correcting glottic gaps: initial results.

We report our results pertaining to the use of injectable autologous collagen for the correction of dysphonia resulting from a glottic gap. To date 20 cases have been treated, 13 of which were for unilateral vocal fold immobility and 7 for sulcus vergeture and/or scar. Collagen is extracted from the skin. Approximately 5 cm2 is necessary to yield 2 ml. Injection must take place in the deep layer of Reinke's space. No patient suffered from any local or general intolerance. The phonatory glottic gap was totally or partially closed. In the paralysis group, the improvements were the following: the median maximum phonation time improved from 5.8 seconds to 11 seconds, the median mean flow rate from 0.13 ml/s to 0.09 ml/s, the median glottic gap from 8.4 to 4.5 ml/dB per s, the median intensity range from 21 to 29 dB, and the median frequency range from 141 to 195 Hz. The spectral analysis layout classification improved from 2 to 3.

Adult↗

PubMed1999

A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results.

OBJECTIVE: Report a new technique of laser-assisted uvulopalatoplasty (LAUP) for snoring performed as a one-stage procedure. STUDY DESIGN: A decision-tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Muller's maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the pharyngeal lumen, pulse oximetry, and polysomnography in case of sleep apnea syndrome was suspected. METHODS: The authors performed their LAUP technique on 43 patients (48.5%) whose snoring was mainly caused by the velum. This technique consists of scarifying the velum by vaporizing the mucosa and the submucosa along a rectangle extending from the palatal dimple to the uvula and having a width of 1.5 to 2 cm. Vaporization of the palatal arches follows without exceeding the junction of the anterior and posterior pillars in height. The uvula is cut if necessary, preserving a length of at least 0.5 cm. The other patients underwent different procedures according to the cause of snoring. RESULTS: There was no significant difference between LAUP and uvulopalatoplasty (UPPP) regarding pain. No permanent phonatory disorders and no regurgitation occurred. Satisfaction evaluated on a scale ranging from 0 to 10 was equivalent for the two techniques: mean value = 7.68 (+/-2.18) for LAUP and 8.60 (+/-2.27) for UPPP. The mean follow-up was 17 months (range, 1-37 mo). Satisfaction was also identical for all techniques. CONCLUSION: Our LAUP technique combined with other procedures according to a decision-tree is efficient and safe.

Adult↗

PubMed1999

Carbon dioxide laser microsurgery of benign vocal fold lesions: indications, techniques, and results in 251 patients.

Two hundred fifty-one carbon dioxide laser-assisted cases of microphonosurgery are reported. Our series includes 167 women (66.5%) and 84 men (33.5%), with a mean age of 41 (+/-11) years. Single lesions represent 67.8% (n = 170) of the cases, with 20% (n = 50) being nodules, 18% (n = 44) Reinke's edema, 9% (n = 23) polyps, 8% (n = 19) sulci and related lesions, 6% (n = 16) mucosal cysts, 4% (n = 10) scars, 2% (n = 4) granulomas, and 2% (n = 4) vascular corditis. The cases with 2 or 3 lesions represented 32% (n = 81). Carbon dioxide laser-assisted microphonosurgery is efficient, provided the working parameters are strictly adhered to: micromanipulator micropoint providing a 250-microm laser beam for a 400-mm working distance; 0.1-second single pulses; and maximum power of 3 W with the superpulse wave. Glutaraldehyde-cross-linked collagen remains our filling material of choice in cases of vocal fold atrophy. Fibrin glue is useful for covering the resection area and for setting the microflaps. Microphonosurgery cannot be dissociated from speech therapy, the planning and duration of which, in relation to the procedure, depend on the nature of the initial lesion. Twenty to 30 sessions are usually adequate, but 6 months may be necessary in the case of sulcus vergetures. Our operating technique is derived from the microphonosurgery procedures with cold instruments. In addition to the classic advantage with regard to hemostasis, the carbon dioxide laser micropoint seems to make the dissection of microflaps easier.

Adult↗

PubMed1999

Correcting vocal fold immobility by autologous collagen injection for voice rehabilitation. A short-term study.

We report on a short-term clinical study of injectable autologous collagen (Vocalogen) used to correct dysphonias arising from vocal fold immobility. The collagen is extracted from skin taken from the lower abdominal quadrant area or from just above the bikini line. About 30 cm2 of skin are required to provide 2 mL of injectable collagen. The histologic examination of the preparation before injection disclosed the presence of elastin fibers and some clusters of epithelial cells, beside the collagen fibers. The collagen is naturally reticulated, and the molecule is preserved in its entirety. The technique is exactly the same as that reported for bovine collagen: injection into Reinke's space, under general anesthesia, monitored by direct microlaryngoscopy. The amount injected is also similar: 1.5 mL for correction of glottic insufficiency in which the immobile vocal fold is in the intermediate position. Eight patients were injected, and the average follow-up was 4.5 months. Voice assessments made before and after the treatment included stroboscopy, subjective and perceptual judgments, and aerodynamic and acoustic measurements. The functional results were similar to those obtained with bovine collagen. No complications arose. The probability of any hypersensitivity reaction, always a possibility to be feared with bovine collagen, is negligible with the autologous collagen. Long-term results are as yet unknown, but from the fact that the collagen molecular structure is intact and there is little risk of foreign body response, it would be expected that autologous preparations would be more stable than bovine collagen; this appears to be the case in cosmetic applications. Autologous collagen could be employed for the same indications as bovine collagen, provided that a delay of 45 days (the time required to prepare the injectable collagen) is acceptable. The amount of collagen required is also a limiting factor, since the patient's own skin is the starting donor material.

Aged↗

PubMed1999

Palliative treatment for tracheal stenoses using carbon dioxide laser and the Gianturco stent. Long-term results.

Between September 1992 and March 1998, the self-expandable Gianturco prosthesis was inserted in 23 patients suffering from tracheal stenosis. After radial incision and dilation of the stenosis as described by Shapshay, the positioning of the stent was performed during an endoscopic procedure under optical control. The prosthesis used was a double-ring stent 50 mm long and 20 mm in diameter. The follow-up period ranged between 0.5 and 67 months with an average of 31 +/- 18 months. Pulmonary function tests showed an average improvement of the peak expiratory flow (50%) from preoperative results of 1.06 +/- 0.60 L/s to short-term postoperative results of 2.08 +/- 0.78 L/s and long-term postoperative results of 2.11 +/- 0.78 L/s. The mean peak inspiratory flow (50%) improved from 1.43 +/- 0.85 L/s to 2.40 +/- 1.29 L/s at short term and to 2.56 +/- 1.20 L/s at long term. Eight patients out of the 23 had to undergo a second endoscopic procedure: 3 patients for granuloma vaporization; 1 patient to change a malpositioned stent; 2 patients to add a second stent because of insufficient tracheal enlargement; and 2 patients to resect mucosal membranes between the 2 stent rings and to place a second stent. Optical control of the accurate positioning and use of this model of Gianturco prosthesis helped to avoid the severe complications described in the literature (migration, extrusion, fracture, wall erosion. and hemorrhage). The follow-up must particularly target the prevention of granulomas. The self-expandable Gianturco prosthesis can be advocated for long-term palliative treatment of tracheal stenoses that are inoperable by an external surgical approach.

Aged↗

PubMed1999

Laser-assisted myringotomy combined with adenoidectomy in children: preliminary results.

Adenoidectomy and CO2 laser-assisted myringotomy were performed on 26 children (52 ears) diagnosed with adenoid hypertrophy and chronic otitis media with effusion. The age ranged between 2-15. The CO2 laser and a micromanipulator were adapted on the operating microscope. Repeated pulses of focused laser beam were fired in a roselike fashion in order to create a 2-mm round perforation in the antero-inferior quadrant of the eardrum. Three months after surgery, the tympanic membrane was perfectly healed. There were two cases of recurrence of middle ear fluid. There was no adverse effect and hearing results were good. We discuss the significance of these preliminary results and emphasize the need for further research.

Adenoidectomy↗

PubMed1999

Transoral laser microsurgery is the recommended treatment for early glottic cancers.

Medical terminology frequently mistakes the instrument for the surgical procedure: endoscopic excision of laryngeal cancers existed long before laser came into use. Lasing obeys the same rules as those of suspension laryngoscopy: if adequate laryngeal exposure is not attained, then the procedure is at risk of being incomplete and of providing few satisfactory results. Because a certain degree of literary anarchy exists in terms of definitions for the different cordectomy types, the Nomenclature Committee of the European Laryngological Society has proposed a classification. This categorization is a synthesis and a compromise between members of the Society who had developed and used, for several years, a personal classification. The proposed classification has two aims: to better understand each surgeon's technique in function of the tumoral extent; and to compare more rigorously the postoperative results. This classification includes the following procedures: Subepithelial cordectomy or decortication (Type I); Subligamentous cordectomy (Type II); Transmuscular cordectomy (Type III); Total or complete cordectomy (Type IV); Extended cordectomy encompassing the contralateral vocal fold (Type Va); encompassing the arytenoid (Type Vb); encompassing the ventricular fold (Type Vc); encompassing the subglottis (1 cm) (Type Vd).

Endoscopy↗

PubMed1999

A study of vibrato: assessment by panel of judges compared to spectral voice analysis.

Experts in voice singing and voice training were asked to judge the vibrato of 30 singers (4 samples per singer: a sung [a] held without vibrato; a sung a[ held with vibrato; a self-selected passage and an imposed passage. In the first part, they ticked the type of oscillations (vibrato, straight tone, tremolo, quivering...). In the second part, they appraised various criteria. Intra-judge and inter-judge consistencies were determined. The subjective parameters were thereafter correlated with the measurements of six parameters of the MDVP (MultiDimentional Voice Program). The measurements were carried out on each task. Intra-judge consistency was good for only one judge (67-87% consistency). Since judge 2 and 3 were hardly reproducible (45-73%; 28-57%) measurement of the inter-judge consistency was pointless. The results of judge 1 were correlated with the Fundamental Tremor Frequency Index, the jitter and the shimmer.

Adult↗

PubMed1998

Idiopathic subglottic stenosis in a nine-year-old boy: diagnosis and management.

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Child↗

PubMed1998

A new epiglottoplasty procedure for the treatment of intractable aspiration.

Intractable aspiration may require diversion of the airway from the pharynx. The epiglottoplasty procedure involves suturing the epiglottis onto the perimeter of the larynx without creating resistance to the natural lines of force of the epiglottic cartilage. The procedure starts by an anterior subhyoid pharyngotomy. The epiglottis is released from the pre-epiglottic space and the thyroepiglottic ligament is sectioned. The disinsertion is completed in the laryngeal lumen by sectioning the epiglottis on each side by following its edges. The pharyngoepiglottic folds are preserved so as to serve as the rotational axis for the freed epiglottis. The petiole of the epiglottis is anchored to the posterior commissure and the free edge of the epiglottis above the ala and the angle of the thyroid cartilage, while the lateral sides of the suprahyoid epiglottis are sutured to the superior part of the arytenoids. This procedure was performed successfully in three patients with intractable aspiration.

Aged↗

PubMed1998

An early MR observation of carotid involvement by retropharyngeal abscess.

We report early carotid involvement by retropharyngeal abscess in a 4-year-old boy. MR imaging showed enhancement of the wall and narrowing of the lumen of the internal carotid artery, which were thought to reflect spasm and/or arteritis. Prompt treatment may have prevented hemorrhagic and neurologic complications.

Carotid Arteries↗

PubMed1998

Reliability and clinical relevance of perceptual evaluation of pathological voices.

The perceptual GIRBAS scale for deviant voice quality was tested in 5 different institutes on 943 voice patients. Each voice was evaluated separately by 2 professionals. The interrater and intrarater correlation is satisfactory for G, R and B. Experience with the scale significantly improves the interrater agreement. Further, GIRBAS/acoustical correlations were investigated by using the multidimensional voice program (MDVP) of Kay. Principal component analysis allows reduction of 21 MDVP parameters to 5 clinically relevant clusters, with a typical acoustical measurement for each of them. The GIRBAS scale seems to be a valuable instrument for clinical practice.

Adult↗

PubMed1998

Quantitative rating of video-laryngostroboscopy: a reliability study.

The purpose of this study is to examine the most reliable and valid way for rating and comparing videolaryngostroboscopic recordings with a differentiated protocol. 30 high quality videostroboscopic recordings (2-5 minutes) of all kinds of vocal fold pathology were rated independently by 7 experienced laryngologists/phoniatricians, using a standardized and exhaustive protocol form. Interobserver agreement is high for amplitude, mucosal wave, and type of closure/symmetry, is satisfactory for regularity, consistency and vibration of the lesion (if any), and is rather moderate to low for grade of glottic closure and symmetry. As a general rule, raters trained with the protocol form show higher agreement than raters without such experience. Intraobserver consistency is good for all parameters.

Humans↗

PubMed1997

CO2 laser in the diagnosis and treatment of early cancer of the vocal fold.

A total of 74 patients underwent cordectomy using CO2 laser for either diagnosis or treatment of an early cancer of the vocal fold. Type I cordectomy consisted in the resection of the entire epithelium, while leaving the vocal ligament intact. Type II cordectomy involved removal of the vocal fold from the vocal process to the anterior commissure and passing through the inferior thyroarytenoid muscle. Type IIIA required vocal fold resection along the internal side of the thyroid ala, while type IIIB included removal of the anterior commissure. Type I cordectomies were carried out with an Acuspot micromanipulator, which provided a 250-micron-diameter beam for a working distance of 400 mm, and in the shot-by-shot cutting mode with 3 W power superpulse. This cordectomy was carried out in 39 patients and a dysplasia or an early carcinoma were detected in 45.9% of cases. Type II and type III procedures were performed with the Microslad micromanipulator having a 700-micron-diameter beam in the continuous cutting mode, 7 W power superpulse. Fifteen cases were treated by type II cordectomy, of which 3 T1aN0M0 cases underwent postoperative radiotherapy due to insufficient resections and 2 cases with T1bN0M0 tumors later underwent reconstructive laryngectomy. A type III cordectomy was used for 14 cases of T1aN0M0 carcinomas and 3 cases of severe dysplasia. The margins of resection were found to be positive histologically in 23.5% of these cases, making frozen section examinations mandatory at time of surgery. Results of all procedures showed that voice was best after a type I cordectomy where only the epithelium was resected. In the type II and type III cordectomies, the quality of voice depended on the development of a fibrous fold and the absence of anterior synechia in the healed larynx.

Adult↗

PubMed1997

Expression of E-cadherin adhesion molecule in vocal cord carcinomas.

E-cadherin is a 120 kDa transmembrane protein that plays a major role in the maintenance of cell-cell adhesion in epithelial tissues. In the present study its expression was examined immunohistochemically for the first time using paraffin-embedded archival tissues of 38 vocal cord carcinomas. Ten cases of vocal cord polyps were used as positive controls. According to our criteria, results showed that all but one of the polyps, in which staining was lost, had strong or moderate E-cadherin expression, whereas 32% of the cases with tumors showed preserved staining, and 68% of cases showed a reduced staining. E-cadherin expression was significantly correlated with histological stages, with a greater expression in carcinoma in situ and microinvasive carcinoma than in invasive carcinoma (P = 0.010). A significant correlation was also found between E-cadherin expression and the degree of tumor differentiation (P = 0.018). Some of these findings were consistent with previously published data using fresh tissues. Our study provides evidence that E-cadherin may be linked to progression and differentiation of laryngeal cancer and could play a role as a tumor-suppressor gene in this cancer.

Cadherins↗

PubMed1997

Unifocal cervical Castleman disease in two children.

UNLABELLED: Castleman disease (CD) is a benign lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Most observations focus on adult patients. In children the disease is rare, usually localized and may be symptomatic or asymptomatic. We reported two children, 7 and 14 years old respectively, affected by unifocal cervical CD of the hyaline vascular type. CONCLUSION: Two cases illustrate that CD may mimic a neoplasm and should be considered in presence of a solitary neck mass with specific features on CT and MRI.

Adolescent↗

PubMed1997

Evaluation of proliferating cell nuclear antigen (PCNA) in supraglottic carcinoma.

It is widely accepted that tumor invasion and metastasis are the primary causes for the lethal clinical outcome of cancers. In recent years, attention has been drawn to PCNA (Proliferating Cell Nuclear Antigen) to predict the prognosis of some cancers. In the present paper, we have studied anti-PCNA antibody PC10 in supraglottic cancer by means of immunohistochemistry using paraffin-embedded sections, to demonstrate its clinical significance in this type of malignancy. Twenty-two patients with supraglottic cancer, including T1 (5 cases), T2 (13 cases) and T4 (4 cases) with N- (14 cases) and N+ (8 cases), were investigated for the PCNA expression. The percentages of PCNA positive cells were divided into three groups: < 25%, 25-75%, > 75%, with the range from 10.6 to 95.2%. Results showed that PCNA was well correlated with lymph node metastasis, and appeared to have an inverse correlation with histopathological grades. In this small group, we did not find that PCNA was correlated with T stages and tumor size. However, compared with other T-stages and tumor sizes, the correlation between lymph node metastasis and PCNA seemed to have more clinical significance in T2-stage and in tumors larger than 2 cm. PCNA could be used as a marker in predicting the clinical outcome in supraglottic cancers. An analysis on a large scale is anticipated.

Adult↗