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Biomedical subjects

P Beutter

Publications and source records attributed to P Beutter.

At least 73 records · Page 4Linked to original sources
PubMed1981

[Partial vertical surgery of the larynx : results as a function of anesthesia and the employ of tracheotomy (author's transl)].

Postoperative course and complications were studied as a function of the type of anesthesia, and the employ of a tracheotomy tube and gauze drainage of the laryngeal cavity, following partial vertical surgery on the larynx of 238 patients. Findings demonstrated that a general anesthetic by intubation with total skin closure without tracheotomy and gauze drainage of the laryngeal cavity, reduced the incidence of local infections complications and the duration of hospitalization. Without insisting on the advantages of this type of anesthesia and the value of immediate suturing, the authors note that these simple techniques markedly reduce the hospitalization period at a time when emphasis is being placed on the economic impact of the duration of this period.

Anesthesia↗
PubMed1980

[Epitheliomas of the margin of the larynx. Definition, classification and extension (author's transl)].

Studying 213 cases of epithelioma of the laryngeal margin, the authors report on a 3-part study. The first part defines, classifies and specifies the extension of marginal epitheliomas, the second part studies anterior margin epitheliomas and the third, epitheliomas of the lateral margin. This first part shows that the laryngeal margin forms a precise anatomo-clinical entity which must be subdivided into anterior lateral posterior and total margins. The anterior margin consists of the free edge, the supra-hyoid laryngeal side of the epiglottis and, for the authors, the laryngeal side of the epiglottis that belongs, for the UICC, to the oropharynx. The lateral margin consists of the aryteno-epiglottic fold and, for the authors, of the intersection of the three fold that are not mentioned in the UICC or the AJC classifications. The arytenoid cartilage forms the posterior margin. Together, tumors of the anterior margin and the lateral margin make up for 94% of marginal tumors. This first part specifies the macroscopic aspects of marginal epitheliomas with their local and lymphatic extension.

Carcinoma↗
PubMed1980

[Epitheliomas of the anterior margin of the larynx. A study of 102 cases (author's transl)].

In this second part, we study 102 cases of epithelioma of the anterior margin of the larynx. The authors insist on the need for bilateral treatment of lymphatic areas on account of their frequent bilateral involvement, jumping from 9% for N0 to 80% for a fixed unilateral enlarged lymph node. Whatever the T stage, the best therapeutic results are provided by total or partial surgery of the lesion combined with surgical treatment of lymphatic areas completed by irradiation.

Carcinoma↗
PubMed1980

[Epitheliomas of the lateral margin (author's transl)].

The third part ends the study on epitheliomas of the laryngeal margin and concerns 8 cases of epithelioma of the lateral margin (aryteno-epiglottic fold and intersection of the three folds). The authors emphasize the considerable lymphatic tropism of these tumors. In 58% of these, enlarged lymph nodes were found, 65% of which showed histological involvement. Best results (survival and local sterilisation) are provided by surgery, partial or complete, depending on the T stage, the tumoral site, and combined with lymphadenectomy, completed by irradiation.

Carcinoma↗
PubMed1980

[Laryngotracheal stenosis. Indications and results on the basis of 59 cases (author's transl)].

On the basis of 59 cases of laryngotracheal stenosis, the authors summarised their experience in 3 chapters. The first section defines the etiology, therapeutic indications and results obtained according to whether the stenosis was purely laryngeal or laryngotracheal and whether the vocal cords are mobile or immobile. The second part studies the results of procedures of enlargement of the laryngeal cavity (Rethi-Aboulker type). These results are satisfactory in pure laryngeal stenosis, but are often inadequate for stenosis of the crico-tracheal junction or combined laryngeal and tracheal stenosis. The third part defines the technique and indicates the value of crico or thyrocrico-tracheal resection anastomosis procedures in laryngotracheal stenosis. Thus, there is not single form of treatment for laryngotracheal stenosis. On the basis of pre and per-operative assessment, a choice will be made between the Rethi procedure, crico-tracheal resection or combination of the two.

Adult↗
PubMed1979

[Lymphadenopathies associated with carcinoma of the larynx (author's transl)].

On the basis of 287 cases of carcinoma of laryngeal origin, treated by total or horizontal sub-glottal laryngectomy, the authors study the prognosis in lymphadenopathies. This prognosis is envisaged in the light of the international nomenclature NO, N1, N2, N3, in relation to the size of the nodes and, finally, in relation to the surgical or radiotherapeutic treatment given to the node areas. The authors emphasise the need for bilateral surgery to the node areas, this procedure being all the more extensive when the lymphadenopathy is larger. On the basis of this size, a choice must be made between radical dissection, extended cellulo-adenectomy (or functional excision).

Humans↗
PubMed1978

[Partial surgery of carcinomas of the glottis. Results and prognosis (author's transl)].

The authors present a computerized study of the prognosis of 132 cases of carcinoma of the glottis treated by vertical, partial surgery and seen over a period of 1 to 15 years at the Laennec Hospital. After defining the percentage survival at 3.5 in 10 years, the authors studied the causes of death and showed that, after 5 years, it is still deaths due to malignant recurrence which influenced the vital prognosis. These local, lymphnode and metastatic oncological failures are subsequently analyzed on the basis of clinical, surgical and histological parameters as well as in terms of the course of the disease. Such analysis makes it possible to draw the distinction between local recurrence and a second local tumor localization, and pulmonary metastases from a second pulmonary localization. Finally, the prevention of rare lymphnode recurrences is considered in terms of specific surgery for this purpose.

Chronic Disease↗
PubMed1976

[Our experience with pulsed oxygen and general anesthesia in direct suspension laryngoscopy].

The authors describe a group of 77 direct suspension laryngoscopies in which general anaesthesia and oxygen therapy were used. The technique is described in considerable detail. The catheter used is independent of the laryngoscope and is passed into the nasal cavity. Analysis of the gases in the blood of 15 patients showed that after three minutes of apnea, ventilation was still satsifactory. No pneumothorax occured during this type of anaesthesia. For the O.-R.-L. practitioner using the method, the advantages are as follows: induction anaesthesia is quicker than after neuroleptanalgesia, exposure of the larynx is excellent due to curarization and three endoscopies can be carried out in the same operation: laryngoscopy, oesophagoscopy and bronchoscopy. The disadvantage of general anaesthesia is that it makes it impossible to judge the mobility of the larynx. In 7,8 p. 100 of the cases, direct suspension laryngoscopy proved difficult or impossible to carry out fir anatomical reasons.

Alfaxalone Alfadolone Mixture↗
PubMed1976

[An unusual and dangerous clinical form: chronic osteomatous otitis].

Some chronic otites result in local or diffuse attico-antral osseous outgrowths. These may complicate all sorts of chronic otites: cholesteatomatous or otherwise, suppurative or merely inflammatory, with the tympanum open or closed. They should be distinguisged from tympanosclerosis and condensation or osseous eburnation lesions. They seem to result from post-inflammatory irritation causing metaplastic bone growth or from an exostosis. The key to their diagnosis lies in radio-tomography. From the surgical point of view, diffuse attico-antral forms are particularly dangerous and deadly. It is essential that the kopho-surgeon should be aware of their existence which, as far as we know, does not seem to have been noted so far.

Adult↗
PubMedDate not supplied

Carcinoma of the laryngeal margin.

The laryngeal margin constitutes an anatomic and clinical entity that differs from what is commonly referred to as supraglottic. The present retrospective study reviews 189 cases of carcinomas occurring in this specifically defined region. Local, nodal, and distant metastatic spread of these tumors varied depending on whether the initial tumor site was located in the anterior or lateral margin. Treatment regimens were planned according to the tumor's origin. Primary tumor site surgery associated with a modified or radical neck dissection according to N staging, followed by postoperative radiation is advocated for treatment of these tumors. Cervical nodal metastases are frequent and often bilateral (36%) in cases of anterior margin carcinoma suggesting that bilateral neck dissection sparing two jugular veins for N0 staged carcinoma and one jugular vein when there is evidence of a palpable node, be routinely used. Nodal involvement in cases of lateral margin carcinoma is also frequent but is almost exclusively confined to the ipsilateral nodes. It is suggested that homolateral neck dissection therefore be systematically associated with primary tumor site surgery for these tumors. The various anatomical aspects and pathways of extension of laryngeal margin carcinoma are discussed and a modified TNM classification is proposed.

Carcinoma↗
PubMedDate not supplied

[Prognostic value of the number of involved nodes after neck dissection in oropharyngeal and oral cavity carcinoma].

PURPOSE: To evaluate the relationship between the number of positive nodes and probabilities of locoregional control and survival in patients with invasive squamous cell carcinomas of the oral cavity and oropharynx. MATERIAL AND METHODS: Between 1976 and 1993, we treated with curative intent 183 patients (median age: 56 years; standard deviation: 10 years). Seventy-nine patients (43%) had oropharyngeal primary invasive carcinoma and 104 (57%) had oral cavity (excluding the lip) primary invasive carcinoma. Patients with simultaneous primary lesion or visceral metastases were excluded from the analysis. All the patients had neck dissection with at least six nodes to analyse. One-hundred fifty-nine patients (87%) underwent resection of the primary lesion and 158 (86%) were treated postoperatively with external beam irradiation alone or combined with interstitial implant (median dose: 60 Gy; standard deviation: 10 Gy). Average follow-up was 52 months. RESULTS: The overall 5-year survival rate using the Kaplan-Meier method was 42.6%. The 5-year survival rates were 60.0% when lymph nodes were histologically negative, 39.5% when one lymph node was positive, 28.0% when two lymph nodes were positive and 24.4% when three or more lymph nodes were positive (P = 0.0004). The number of positive nodes did not significantly influence the specific disease-free survival and locoregional control rates. CONCLUSION: Patients with one or more positive neck nodes must have postoperative treatment.

Adult↗
PubMedDate not supplied

Brainstem auditory evoked responses in patients with tinnitus.

Brainstem auditory evoked responses of 355 patients with uni- or bilateral tinnitus were recorded in order to evaluate the effect of tinnitus on the central auditory system. The amplitudes of waves I, III and V and the latencies of each wave and interpeak latencies were compared to those of a group of 129 controls with normal hearing. The study of the control group initially identified a certain number of concurrent parameters. The brainstem evoked responses of men and women evolved differently from the age of 30 years, latencies of I-III and I-V in men lengthening with age and those of women tending to shorten. The patient groups were therefore compared to a control group of the same sex ratio or of the same sex, half being between 30 and 56 years of age. The tinnitus patients were divided into three groups according to the side affected by tinnitus. Latencies and amplitudes in these groups differed significantly from those of the control group. In order to eliminate hearing loss, the most difficult concurrent factor and almost always associated with tinnitus, the results of individuals with symmetrical hearing loss were compared to those of the control group. Tinnitus was always associated with significant lengthening of 0-I and I-V latencies on the tinnitus-affected side, with a significant reduction in amplitudes of waves I and III, and sometimes of wave V, particularly in the group with left-sided tinnitus. Comparison of tinnitus patients with symmetrical and asymmetrical hearing by sex showed that tinnitus patients of all groups had lengthening of right and left 0-I latencies, apart from the women in the group with right-sided tinnitus, and significant reduction in amplitudes of waves I and III in women and of left III only in men. When hearing loss was asymmetrical and on the tinnitus-affected side, there was also lengthening of 0-I latencies on the tinnitus-affected side in both sexes and of ipsi- and contralateral I-V latencies in women. Right- and left-sided tinnitus was associated with additional differences between the three groups. Correlation coefficient study confirmed that 0-I, I- III and I-V latencies were independent of the mean degree of deafness, deafness at high frequencies and at frequencies around the tinnitus, up to a threshold of hearing loss of 40 dB, above which 0-I and 0-V lengthened in addition to tinnitus. On the other hand, whatever the frequency, tinnitus involved significant lengthening of wave I latencies and modification of the previously recorded amplitudes. Two groups of tinnitus patients could be distinguished: the first, with symmetrical hearing loss, with symmetrical normal latencies, apart from 0-I latencies and the amplitude of the wave on the tinnitus side, and the second with hearing loss predominant on the tinnitus-affected side, with different latencies on each side, 0-I being shorter on the unaffected side, I-III and I-V being lengthened on the unaffected side and 0-I being lengthened on the tinnitus-affected side. Moreover, as disturbances of brainstem evoked responses caused by tinnitus particularly affected waves I and III, the hypothesis of possible involvement of the efferent systems could be proposed.

Adolescent↗
PubMedDate not supplied

[Vascular sarcomas of the ethmoid sinus (hemangioendothelioma)].

Vascular sarcomas (haemangio-endotheliomas) are tumours which are very rarely encountered in the facial mass. Only 10 cases have been found in the literature. Two cases are described: the first patient was operated on in 1968 for a localization in the left side of the ethmoid and presented 9 year later with a recurrence on the right side symmetrical with the first which remained apparently cured; a year later, there was a recurrence on the right then diffuse pulmonary metastases. The second case was that of a patient with an ethmoid localization cured by radiotherapy and surgery 20 years before, but presenting with a recurrence in the ganglia 10 years later and a parapharyngeal recurrence developing over the past 6 years. In connection with these two cases, the diagnostic difficulties involved in distinguishing these tumours from epitheliomas and sarcomas of the facial mass, which sometimes show considerable vascularization, from other vascular tumours, benign haemangioendotheliomas, glomus tumours and, in particular, haemangio-pericytomas, are described. The possibility of a long survival should be noted for some rare facial localizations: this is in contrast with the usually very rapid development of vascular sarcomas in other localizations.

Adult↗
PubMedDate not supplied

[Severe epistaxis caused by carotid artery rupture].

Epistaxis due to rupture of the carotid, usually occurs as a result of cranial or closed cranio-facial traumatism. Heamorrhage is secondary to the formation of post-traumatic arterial aneurysms or arterio-venous fistulas. Frequently, the lesion is along the intra-cavernous pathway of the internal carotid. Rupture of a spontaneous arterial aneurysm in the sphenoidal sinus is, however, extremely rare. Carotid arteriography is the main method of investigation, and this method alone is capable of detecting the carotid lesion. In addition to obvious cases, it should be requested in cases of severe, copious and recurrent epistaxis when interrogation of the patient reveals the merest hint of trauma, often a long time previously. Immediate treatment consists of anterior bilateral and naso-pharyngeal tampnage. This allows enough time for arteriography to be carried out under the most favourable conditions and also testing for carotid substitution. In order to ensure permanent thrombosis of the aneurysmal pocket or the arteriovenous fistula, most methods resolve themselves into occlusion of the carotid axis. Cervical ligature of the carotid on its own, and isolated trapping have given way to techniques employing either a combination of trapping and embolization, or the placing of a balloon probe without trapping. At present, Serbinenko is advocating using balloons released when arteriography is carried out, obliterating the fistula and left in position permanently. Finally, there is the method by which the sphenoidal sinus is approached para-lateronasally after ethmoidectomy: this is an effective method which is much less incursive than the endo-cranial approach.

Aneurysm↗
PubMedDate not supplied

[Current treatment of Rendu-Osler disease, excluding radiation].

All the methods available to O.-R.-L. practitioners for the treatment of epistaxis in Rendu-Osler disease are reviewed. In an emergency, gentleness is essential. Over the long term, procrastination for as long as possible is advisable. Super-selective arteriography and embolization are of great value in an emergency and can give some good long-term results. In fact, there is not one exclusive curative therapy. Estrogenotherapy has its advocates. Saunder's dermoplasty gives variable results, but these can be improved upon if a broad access route is used and dermoplasty extended to above and behind the nasal fossae. Because of its aggressive nature, irradiation must be kept as a last resort.

Blood Transfusion↗