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Biomedical subjects

M Remacle

Publications and source records attributed to M Remacle.

At least 91 records · Page 5Linked to original sources
PubMed1989

Initial long-term results of collagen injection for vocal and laryngeal rehabilitation.

The records of 14 patients who have benefited from intralaryngeal injections of ZCI collagen for at least 3-4 years were reviewed. All patients still living were evaluated. Qualitative phonatory measurements included laryngostroboscopy and frequency voice analysis, while quantitative studies included maximum phonation times and phonatory quotients. The absence of both local and general inflammatory reactions was observed in these patients, confirming the excellent host tolerance of ZCI collagen and the stability of the functional results achieved.

Adult↗
PubMed1989

Subglottic haemangioma in the infant: contribution by CO2 laser.

The availability of the low intensity CO2 laser beam, and the possibility of defocalization that is associated with control of subglottic high frequency jet ventilation, requires a more interventionist attitude regarding dyspnoea caused by a subglottic haemangioma in the infant. It is indeed possible reliably to reduce the size of the subglottic haemangioma, and thus to avoid a lengthy period of intensive care, as well as the problems of prolonged intubation or tracheostomy for drainage, while also avoiding long term steroid therapy. This approach in no way affects the spontaneous evolution of subglottic haemangioma in the infant; there is a tendency for the haemangioma to regress after the age of one year. The treatment does, however, permit a considerable improvement in the comfort of the infant's life during this difficult period between 3 and 12 months. We illustrate this new attitude by presenting a report on four cases.

Carbon Dioxide↗
PubMed1989

[CO2 laser treatment of the glottic sulcus and of epidermoid cyst. Technic and results].

The CO2-lasers of the new generation are equipped with milliwatts, super-pulse, small spot size (700 U or less). These technical improvements safe permit in resection of vocal fold benign lesions like polyps, nodules, or even sulcus glottidis. Our resection technique for sulcus glottidis and epidermoïd cysts is presented in 18 cases. If very strict rules of microsurgical treatment are respected, the functional results are as good as those with conventional techniques (93% of good results).

Adult↗
PubMed1989

[Abscess of the larynx resembling a tumor].

The authors report a case of laryngeal abcess due to Pseudomonas Aeruginosa, of the preepiglottic space with destruction of the epiglottis and granulomatous reaction of the epiglottic endolaryngeal side. The differential diagnosis of the endoscopic image includes neoplasm, granulomatous diseases and laryngeal abscess. Biopsies revealed the diagnosis of laryngeal abscess without habitual causing factors. The treatment consisted in CO2 laser microsurgery with debulking, as complete as possible, of the granulomatous reaction in association with adapted antibiotherapy.

Abscess↗
PubMed1988

Collagen implants in the human larynx. Pathological examinations of two cases.

We have studied two postmortem human laryngeal specimens after the injection of collagen. The first larynx was removed 14 days after injection, while the second was examined 5 months after injection. The specimens are described macroscopically and microscopically. Excellent tolerance to the collagen was noted, with virtually no inflammatory reaction seen. The collagen injected seems to have been colonized progressively by the host cells and by neovessels. These findings coincide closely with those observed in animal models. In comparison to the inflammatory granulomas found after injections with Teflon, the absence of inflammatory reactions following the use of collagen does at least contribute to justifying its continued application clinically.

Adult↗
PubMed1988

Interest in frozen section examination of margins and lymph nodes in laryngeal surgery.

One hundred and one patients presenting with a squamous cell carcinoma of the larynx underwent surgery in our department between January 1980 and May 1985. In most of these patients, nodes were removed from the main lymphatic drainage pathways and subjected to immediate frozen section examination. The results from frozen section examination of the nodes were then compared with those from the surgical specimens of cervical neck dissections performed on the patients according to the classic rules. In addition, margin resections were made and examined by frozen section after removal of the tumour. In the event of a positive finding, these resections were continued until healthy tissue was reached, the specimens being examined in addition by classic methods. Immediate frozen sections enable the margins of the resection to be verified correctly. In our series we were brought to extend the limits of resection in 10 cases out of 68 (15 per cent). It can also be seen that the accuracy of the pathologist's reading of the frozen sections is satisfactory. The overall level of error is three out of 68 (4.5 per cent). All the errors correspond to false negatives. The aim of avoiding neck dissections in the presence of N0, thanks to nodal selection with frozen section, is not attained. We find a 6/61 rate of false negatives for N0-N1 (10 per cent) when we compare the frozen sections of the selected nodes and the neck dissections. This is due to the fact that the surgeon may be led astray by a reactive hyperplastic node whilst other less inflammatory neighbouring nodes are in fact the site of metastasis.

Carcinoma, Squamous Cell↗
PubMed1987

[Vocal cord paralysis in the intermediary and paramedian position. Etiology and treatment].

The purpose of this paper is to recall the neuroanatomical bases of the motrice laryngeal innervation and the consequences of a lesion at that level. On the other hand, the type of management and effective therapy our service uses in those cases of unilateral of bilateral vocal cord paralysis. The management is principally based on the E.M.G., the objective phonatory measurements including the spectral voice analysis. The unilateral paralysis is usually treated by the speech pathologist reeducation and, if necessary, GAX collagen injection in the vocal cord. The bilateral paralysis, generally in adduction, is cured in the most cases with a CO2 laser arytenoidectomy.

Electromyography↗
PubMed1987

Recurrent nerve paralysis after thyroidectomy. Therapeutic approach.

While recurrent nerve paralysis is a less frequent complication of thyroid surgery today thanks to the surgical techniques effected with identification of the recurrent nerve, it however is not a rare one (4 to 5%). It should systematically be sought by means of laryngoscopy both before and after operation. It is worth an objective assessment, quantitatively with measurement of the phonatory quotient and maximum phonatory time as well as qualitatively with analysis of vocal frequency. The often speech pathologist treatment is completed by injection of GAX collagen into the vocal fold by endoscopic approach under microscopic control. Of 35 cases of paralysis treated during the last three years, we have had three cases after thyroid surgery, i.e. less than 10%.

Electromyography↗
PubMed1987

[Correction of a glottis gap by injection of collagen. Apropos of 25 cases].

Results of treatment of patulous glottis by injection of collagen are discussed. The technique used differs little from that in which Teflon is employed, the difference being that the collagen paste is injected into Reinke's space. The quantity deposited varies between 1 and 1.5 cm3. Twenty-five patients had been treated in this way by April 1986, the longest follow up being for 19 months (mean: 9.5 months). The compound presents remarkable tolerance and no complication has been noted up to the present. Results were at least equal to those obtained using Teflon. Vocal quality was evaluated, apart from by vocal recordings, by analysis of vocal spectrum and objective measurements such as phonatory quotient and output. Results appear to be stable and although some reduction in quantity injected was noted most of the collagen becomes living tissue by colonization with host tissue. Availability of new generations of collagen such as that crosslinked at 35 mg/ml will probably resolve definitely the problem of persistence of results.

Adult↗
PubMed1987

[Non-Hodgkin lymphomas of the larynx. Apropos of a case].

In connection with a recent observation of laryngeal lymphoma, we have looked through the literature and listed 79 cases. Preferentially, these are male subjects over fifty years of age. The symptoms are slowly progressive dyspnea and unilateral otalgia. Laryngoscopy shows a smooth-surfaced tumour, regular in shape and pinkish grey in colour, generally localized at the supra-glottic level. Therapeutic strategy is closely linked with histologic investigation and the stages of progression. Treatment is based on radiotherapy to the affected area, associated with chemotherapy in the case of extralaryngeal lymphomatous involvement. While prognosis remains good in the case of an isolated laryngeal attack, it is less so in the case of multiple localization.

Aged↗
PubMed1986

[Laryngeal manifestations of sarcoidosis].

The diagnosis, in our department, of two cases of sarcoidosis involving the larynx has brought us to carry out an exhaustive review of the literature. One hundred and four cases of sarcoidosis involvement of the larynx have been found, 3 of these causing paralysis of the vocal cords. To these we add our own cases: one with vocal cord paralysis and one with upper glottic attack. The pathogenesis is recalled. The clinical, biological and anatomo-pathological manifestations are set out in detail. The various therapeutic proposals are recalled. Basic treatment depends on systemic corticotherapy at a dosage of 30-80 mg of prednisone throughout several months. We use the CO2 laser to destroy the obstructive laryngeal lesions. We recommend endoscopic arytenoidectomy by CO2 laser in cases of paralysis of the vocal cord dilators where the quality of the voice is essential and the physical demands slight. In contrast, where respiratory ventilation must be given importance, King's arytenoidopexy is to be preferred.

Adult↗
PubMed1986

Exploration of glottic function before and after injection of collagen for rehabilitation of the vocal cord.

After more than one year's use of injectable collagen for vocal and glottic rehabilitation, the subjective and objective results have been presented for a series of 18 patients, 17 of whom had paralysis of one vocal cord, while one patient had a post-traumatic atrophy of the left cord. The assessment is based on rigid and flexible fibroscopy, stroboscopy, the objective phonatory assessment with measurement of the phonatory quotient and mean flow rate, EMG of the vocal cords and frequential analysis of the voice. Apart from the improvement in the phonatory quotients and outputs after injection, the noteworthy results have been the persistence of flexibility and undulation in the cord injected, visible by stroboscopy, and also the reappearance of the fundamental and 2 or 3 first harmonics on frequential analysis of the voice. The mean follow-up was 6.5 months, with a maximum of 14 months and minimum of 1 month. At the medium term, injectable collagen would appear to be a worthwhile alternative to Teflon because of its simplicity of use, its very great tolerance and the quality of the functional results obtained.

Adult↗
PubMed1985

[Mediastinal tracheotomy in cervicofacial oncologic surgery. Contribution of the pectoralis major myocutaneous flap].

Four cases of anterior mediastinal tracheostomy with myocutaneous Pectoralis Major flap are described. Resection of the manubrium, clavicular heads and the cartilages of the first and second ribs is necessary. The use of myocutaneous Pectoralis Major flap give good functional results. No infection or hemorrhage of mediastinal great vessels occurred. The indications of Anterior mediastinal tracheostomy are discussed. Stomal and peristomal recurrences following laryngectomy for carcinoma represents the indication of choice. Stomal recurrences are difficult to treat and the prognostic is poor. Prevention of the stomal recurrences is discussed.

Aged↗
PubMed1984

Usefulness and limitations of sinus echography in the child.

The authors report their preliminary experience in B-mode maxillary sinus echography. The experience takes into account a series of 52 sinuses of children under 10. The study revealed that maxillary sinus echography is a rapid, harmless and quite specific method (i.e. a method which reports few false positives when the existence of possible artifactual echoes is not disregarded), sensitive for secretions, less sensitive for polyps and mucosal thickenings, mainly posterior ones. The method is hampered by the presence of the anterior bone wall, which creates artifacts and thus false positives; yet, it is probably in the child where this handicap is the smallest since normally, in the child, the bone wall is the thinnest. Echography appears to be a really complementary method for radiology, but--according to this preliminary experience, at least--it cannot still pretend to act as a substitute for it. The reproducibility of the method and its reliability, among others in relation to sinusoscopy, are still to be investigated with more accuracy.

Child↗