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Biomedical subjects

M Remacle

Publications and source records attributed to M Remacle.

At least 55 records · Page 3Linked to original sources
PubMed1996

Use of the CO2-laser micropoint micromanipulator for the treatment of laryngomalacia.

Between September 1989 and June 1994, 21 children (17 boys, 4 girls) with moderate to severe symptoms due to laryngomalacia underwent endoscopic surgery using the CO2-laser micropoint manipulator (shot-by-shot, 0.1 s, super-pulse, 2-3 W power; 280 microns beam; 400 mm working distance). Mean age of the children was 5 months (range, 1-11 months). The procedure was performed under high-frequency jet ventilation and consisted in the resection and/or vaporization of the aryepiglottic folds. This tissue removal could be extended to the laryngeal mucosa of the arytenoids and the lateral edge of the epiglottis. Results of surgery were excellent with normalization (8 patients) or, at worst, a very definite improvement of symptoms (4 patients). Furthermore, no complications occurred due to the technique used. These results have convinced us that the CO2-laser micropoint manipulator technique, with the "super-pulse" shooting mode and high-frequency jet ventilation, is by far superior to microsurgery with cold instruments when endoscopic treatment of laryngomalacia is indicated.

Endoscopy↗
PubMed1996

Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results.

We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 +/- 2.6 s after SA and 7.8 +/- 1.6 s following PC. The phonation quotient was 288 +/- 116 ml/s after SA and 304 +/- 92 ml/s after PC. Mean vocal intensity was 62 +/- 4 dB after SA and 59 +/- 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.

Adolescent↗
PubMed1996

Endoscopic treatment of tracheal stenosis using the carbon dioxide laser and the Gianturco stent: indications and results.

The self-expandable Gianturco stent was used in 11 patients with tracheal stenosis who where treated from September 1992 through July 1994. Under optical control, the stent was placed through a bronchoscope with an outside diameter of 9 mm after cross-section and dilation of the stenosis were performed with the carbon dioxide laser according to the Shapshay technique. The follow-up period varied from 3 to 22 months, with a mean of 12 +/- 6 months. Pulmonary function tests showed a mean improvement of the peak expiratory flow (50%), from 0.95+/-0.45 L/sec before the operation to 2.13+/-0.86 L/sec after the procedure. Radiologic and fibroscopic controls showed prosthesis stability. Three patients needed a second endoscopic procedure because of malposition of the stent, the formation of granuloma at the superior end of the prosthesis, and the development of a mucous membrane webbing between the two loops of a stent. Due to the lack of long-term follow-up, this technique is reserved for the treatment of severe tracheal stenosis with cartilage impairment in patients who have contraindications for external reconstructive surgery.

Aged↗
PubMed1996

[The progression of a case in the cri-du-chat syndrome: otolaryngological, cognitive and language characteristics].

This article presents the results of the ORL, cognitive and speech examinations of a boy aged 12 years, 9 months with cat cry syndrome. The laryngeal function has normalized but a small mandibular deficiency persists. The cognitive function corresponds to a mental age of less than 3 years with a complete blockade for abstraction but a good adaptation for concrete and practical situations. The linguistic examination was performed in two complementary pragmatic contexts: standard testing and semi-induced play. The referential and expressive functions are relatively good but with a poor adaptation to the interlocutors. The cognitive-semantic function of J.M. in naming and for space relation markers corresponds to about 4 1/2 years, which is better than what could be expected based on his cognitive level on the intelligence scales. Nevertheless, the child's syntactic characteristics are those of a 3-year-old child. Therefore the disparity between the cognitive-semantic, the syntactic and the nonlinguistic cognitive functions is negligible. Only the pragmatic function of the child remains much weaker than that achieved for the other facets of his language. The linguistic results of this case of cat cry syndrome are compared with those of children of the same age and mental level with trisomy 21 or other moderate mental handicaps.

Child↗
PubMed1996

Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction.

Subtotal carbon dioxide (CO2) laser arytenoidectomy for endoscopic treatment of bilateral immobility of the vocal folds in adduction is a variant of total arytenoidectomy. The principal modification involves preservation of a thin posterior shell providing good postoperative fixation of the arytenoid region. The risk of aspiration is thus averted and collapse of arytenoid mucosa into the larynx during inspiration is prevented. The risk of synechia with the posterior commissure is avoided. The CO2 laser is operated at a working distance of 400 mm with a continuous 7-W beam in superpulse mode. Operation time is thus reduced to approximately half an hour and the risk of postoperative edema is reduced. Tracheotomy is not necessary. Forty-one patients, including 16 men and 25 women, were treated by this technique between 1985 and 1994. Their mean age was 55 +/- 17 years, ranging from 11 to 83 years. Follow-up ranged from 1 month to 111 months (9 years 3 months), with a mean of 56 +/- 29 months (4 years 8 months). The mean peak forced expiratory flow-peak inspiratory flow ratio (normal = 1), which permits a measurement of respiratory quality, is improved from 3.7 +/- 1.4 preoperatively to 1.6 +/- 0.5 postoperatively (p<.001). Postoperative voice measurements show a mean vocal intensity of 61 +/- 3 dB hearing level, a mean maximum phonation time of 8 +/- 4 seconds, and a mean phonation quotient of 397 +/- 150 mL/s. As for vocal quality, 38% of the patients now have a near-normal voice according to our high-resolution frequency analysis, and all of the patients retained satisfactory voice quality.

Adult↗
PubMed1996

Exudative lesions of Reinke's space. An anatomopathological correlation.

Few anatomopathological criteria for distinguishing vocal nodules, polyps or REINKE's edema have been established in previously published studies. In order to study this issue, 163 samples (from 119 patients) were examined by an experienced anatomopathologist, without her prior knowledge of the macroscopic or microscopic diagnosis. In all the cases, the presence of exudative phenomena in REINKE's space proved to be the determining factors, with four outstanding stages of evolution: edema, fibrosis, deposits of fibrin and development of vascular ectasia. Although each of the three entities were seen to have their specific characteristics, a large number of lesions showed histological features which were not very specific, and were dominated by edema. Furthermore, the coexistence of different anatomopathological features makes each group heterogeneous. We propose a model which groups all the exudative lesions of REINKE's space by insisting, on the one hand, on the evolution of the anomalies and, on the other hand, the etiological factors (vocal misuse, tobacco, alcohol acute, vocal trauma ...) which determine the onset of either one or other lesion.

Exudates and Transudates↗
PubMed1996

The contribution of videostroboscopy in daily ENT practice.

Videostroboscopy has now left specialized voice laboratories and must be made available to general ENT practice. It is based on an optical illusion giving the impression of slow motion from a series of successive vocal cycles but it is the least awkward system to examine the movement of vocal folds while waiting for the development of very high speed video recordings which would enable to visualize a real single cycle. The equipment comprises a stroboscope, a CCD type of camera, a video recorder, a microphone, a monitor or television screen and rigid optics and/or a fiberscope. An examination lasts about 1/2 an hour and must follow a protocol for which we have developed a simplified index card based on the one proposed by HIRANO and B less. This simplified version has the advantage of being easily integrated into daily ENT practice. A visual examination of the larynx was carried out on 732 patients. Videostroboscopy was undertaken in 69.2% of cases and was found to be useful or essential in 68% of the cases where it was carried out. Furthermore, it enabled to correct a diagnosis in 13% of these cases. It was especially performed in the assessment of benign organic pathologies where associated pathologies have to be looked for (nodules--87.7%; REINKE's edema--72.2%; mucosal cysts--92.6%; sulcus and scars--83.3%), as well as for tumors (73.7%). Among the dysfunctional pathologies, it was principally carried in cases of hypokinetic dysphonia (87.7%). Videostroboscopy is a pertinent examination because, when it was used, it enabled to modify the initial diagnosis in 17% of dysfunctional dysphonias, 20% of nodules, 23% of REINKE's edemas and 17% of granulomas.

Fiber Optic Technology↗
PubMed1996

Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements.

The perceptual GRBAS scale for deviant voice quality (completed with a "I" parameter: Instability = fluctuation of voice quality over time) was tested in 5 different institutes on 943 voice patients. Each voice was evaluated separately by 2 professionals. The interrater correlation reaches 0.87 for G (grade), 0.70 for R (roughness), 0.69 for B (breathiness) and 0.65 for A/S (asthenicity/strain). Experience with the scale significantly improves the interrater agreement. The intrarater correlation (80 voices; time interval 2-6 months) is systematically slightly stronger than the interrater correlation. Further, GIRBAS/acoustical correlations were investigated on 80 pathological voices, by using the Multidimensional Voice Program (MDVP) of Kay. Principal component analysis allows reduction of 21 MDVP parameters to 5 clinically relevant aspects, with a typical acoustical measurement for each of them. The strongest correlations are found between G and Shimmer/Noise to harmonics ratio, R and Jitter, and B and Shimmer. As tremor and diplophonia are easily identified perceptually and acoustically, it seems useful to add this information respectively to AS and R. The GIRBAS scale seems to be a valuable instrument for clinical practice.

Humans↗
PubMed1995

Treatment of vocal fold immobility by glutaraldehyde-cross-linked collagen injection: long-term results.

Fifty-three cases of unilateral vocal fold immobility treated by glutaraldehyde-cross-linked (GAX) collagen over a 6-year period with a mean follow-up of 4.5 years were reviewed for assessment of the immediate and long-term effects on phonation. The mean amount injected was 1.47 mL. No long-term local or systemic reaction to the collagen was seen. The median preoperative maximum phonation time (MPT) was 7.5 seconds, the median immediate postoperative MPT 12 seconds, and the median long-term postoperative MPT 11 seconds. The median preoperative phonatory quotient (PQ) was 564 mL/s. The median immediate postoperative PQ was 320 mL/s, whereas the median long-term postoperative PQ was 385 mL/s. The quantitative improvement in the voice as measured by the PQ was thus 67% for the short range and 49% for the long range. The decline in the results over time was 20.3%. Vocal frequency analysis showed that the fundamental frequency and harmonics returned and were maintained in the long term for more than 80% of the patients with the help of speech therapy. This relative stability is explained by the findings of previous histological work. The fact that collagen, unlike Teflon, does not cause an inflammatory reaction and the partial maintenance of the improvement achieved, which is to be compared with the instability of the effects produced by resorbable substances, make it the "least objectionable" injectable for the treatment of unilateral glottic fold immobility. One must overcompensate 20% to 30%, given the results of the long-term stability studies.

Collagen↗
PubMed1995

[Granulocytic sarcoma of the larynx. Report of a case and literature review].

Granulocytic sarcoma of the larynx. Case report and review of the literature. Granulocytic sarcoma is a rare extramedullary tumor. It occurs either as an isolated tumor or associated with acute or chronic myelogenous leukemia. It has also been reported in patients with myelodysplastic syndromes when the granulocytic sarcoma is a harbinger of imminent disease progression. Granulocytic sarcoma can occur anywhere in the body. The larynx is a rare site of this lesion. A first case of glottic localisation is presented. The treatment of granulocytic sarcoma must include surgery, radiation and chemotherapy.

Aged↗
PubMed1995

CO2 laser and Gianturco stent for endoscopic treatment of tracheal stenosis.

The self-expandable Gianturco stent was used in eleven cases of tracheal stenosis treated from September 92 to July 94. The stent is placed through a 9 mm outside diameter bronchoscope under optical control after cross-section and dilation of the stenosis with the CO2 laser according to the Shapshay technique. The follow-up varies from 3 to 22 months with a mean of 12 +/- 6 months. Pulmonary function tests (PFTs) show a mean improvement of the PEF (peak expiratory flow). Complications have been corrected in three patients with a second endoscopic procedure: the first case for malposition, the second for granuloma at the superior end of the prosthesis, and the third for the development of a mucous membrane webbing between the two loops of the stent. Owing to the lack of long-term follow-up, we reserve this technique for the treatment of severe tracheal stenosis with cartilage impairment in patients contraindicated when external reconstructive surgery is contraindicated.

Aged↗
PubMed1995

[Granular cell tumor localized in the glottis in children. Apropos of a case].

We report the first case of adult granular cell tumor form localized in the glottis in a 8 year-old girl. The first symptom was a chronic dysphonia. Examination with rigid optic demonstrated an irregular yellow hypertrophic lesion in the posterior third of the left vocal fold. The lesion was removed by CO2 laser micro-spot under general anesthesia. There has been no recurrence after 15 months of follow-up and the postoperative voice quality is satisfactory regarded both objectively as subjectively. Granular cell tumors are rare. The histogenesis is still badly known. Enzymological and electron microscopy studies seem to indicate a nervous origin (Schwann cells). Treatment is surgical. Wide local excision is the general rule for limited lesions with easy access. When bigger lesions are present in more vital structures such as trachea or oesophagus, surgery has to be more cautious.

Child↗
PubMed1994

Treatment of lingual tonsillitis by transoral CO2 laser endoscopy.

The authors report on their clinical experiences concerning 100 cases of chronic lingual tonsillitis. The surgical treatment employed was endoscopic vaporization of affected tissues with the CO2 laser. Prior to surgical intervention, predisposing conditions such as allergy, rhinosinusitis, and gastroesophageal reflux were identified and treated. The surgical technique consisted of progressive vaporization of the lymphoid tissue at the base of the tongue until the lingual fascia was reached. A slightly defocused (700 mm) continuous 10-15 W laser beam was used at a working distance of 400 mm. Following surgery, no dyspnea was observed secondary to epiglottic edema and only one patient required postoperative hemostasis. Symptoms related to tonsil or tongue inflammation were eliminated or alleviated in 87 patients, remained unchanged in 12 patients and were worse in 1 patient.

Chronic Disease↗
PubMed1994

[Small-cell carcinoma of the parotid gland. Apropos of a case].

One case of primary small cell carcinoma of the left parotid gland is reported. A total parotidectomy with facial nerve preservation and left functional neck dissection was performed, with postoperative radiotherapy to the surgical area. A lymph node metastases appears 4 months later, and it needs radical neck dissection followed by chemotherapy. 18 months following initial surgery, our patient is free of disease. The ultrastructural and immunohistochemical studies does not suggest an origin neuroendocrine of the carcinoma. This tumor appears to have a better prognosis than small cell carcinoma of the lung, which it resembles histologically.

Carcinoma, Small Cell↗
PubMed1994

Dyskinesia of the superior oesophageal sphincter: assessment and treatment.

Pharyngo-oesophageal dyskinesias present a common symptomatology associated with those difficulties in swallowing for which the radio-manometric assessment is well known. Radiology, nevertheless, with an overall analysis of deglutition and its iatrogenic complications, as well as manometry of the superior oesophageal sphincter (OSS) with its diversity of results, according to the material, techniques, age, sex and stress involved, has convinced us of the necessity for a supplementary dynamic examination. Electromyography (EMG), simultaneously by the inferior constrictor (IC) and cricopharyngeal (CP) muscles, analyses with precision the electric activity of these two muscles, as well as the pharyngosphincteral synchronism. It is an easy examination, reproducible and without complications. In less than one year, nineteen patients suffering exclusively from a pharyngo-oesophageal dyskinesia benefited by this complete assessment. The secondary aetiologies are clearly predominant. Gastro-oesophageal reflux represents a quarter of those detected by an anamnesis alone. EMG detects 68% of functional anomaly of the OSS; manometry finds 47% and radiology 32%. Extramucosal myotomy of the OSS concerns incomplete or uncoordinated relaxation, preferentially by left cervical approach. The preliminary results, both clinical and manometric, are very satisfactory.

Aged↗
PubMed1993

High-resolution frequency analysis as applied to the singing voice.

We have applied high-resolution vocal frequent analysis to a population of singing voices. Two important elements have become apparent: (1) Confirmation that the singing formant originates in the resonators. This is observed especially on a low fundamental, and it is acquired through technical skill and experience. (2) Observation of the vibrato, which, isolated from the clinical study, regarding only its graphic presentation, could have been interpreted as 'abnormal'.

Adult↗
PubMed1993

[Recurrent respiratory distress and idiopathic subglottic stenosis: what treatment?].

BACKGROUND: Idiopathic subglottic stenosis is a rare cause of acute respiratory distress, that is difficult to treat (corticosteroids, tracheotomy). CASE REPORT: A nine-year-old boy presented with acute respiratory distress due to tracheal stenosis. The symptoms recurred after the endotracheal inflammatory membranes had been removed with forceps, despite 6-months of degressive corticotherapy. Absence of other causes of tracheal stenosis and biopsies led to diagnosis of idiopathic subglottic stenosis. The patient was treated by CO2 laser followed by degressive corticotherapy. The respiratory distress recurred within 3 months of discontinuing corticosteroids, requiring two further CO2 laser treatments. The patient became corticodependent. CONCLUSIONS: CO2 laser is an effective, wise alternative treatment of acute respiratory distress due to idiopathic subglottic stenosis that can be repeated if necessary.

Acute Disease↗