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R Gras

Publications and source records attributed to R Gras.

At least 19 recordsLinked to original sources
PubMed2003

[Concomitant radiotherapy-chemotherapy for unresectable cancers of the head and neck: a retrospective analysis of 130 patients].

OBJECTIVES: We analyzed retrospectively the files of 130 patients with unresectable cancer of the head and neck who were given concomitant radiotherapy-chemotherapy between January 1993 and February 2000. PATIENTS AND METHODS: The series included 41 patients with grade III cancer, 64 grade IVA, and 25 grade IVB. Treatment combined radiotherapy (70.2 Gy centered on the tumor with 50.4 Gy on the lymph nodes) and chemotherapy using three cycles of cisplatinium combined with 5-fluorouracil in continuous infusion for 120 hr. RESULTS: Local control was achieved in 51% of the patients at two years and 48% at five years. Overall survival was 45% at two years and 33% at five years, all grades included. CONCLUSION: Univariate analysis of prognostic factors points out the importance of the nutritional status before and during treatment.

Adult↗
PubMed2003

[Preliminary analysis of sentinel node detection during surgical treatment of head and neck melanoma].

OBJECTIVE: The aim of this study was to define reliability of the sentinel lymph node technique in head and neck N0 melanoma. Identification of the sentinel node, which is the first evidence of melanoma metastasis, enables selective node dissection. MATERIALS AND METHODS: Twelve patients with untreated localized cutaneous or mucous N0 melanoma of the head and neck were included in this study. After resection of the sentinel lymph node, type III neck dissection was performed during the same operative time in all twelve patients. RESULTS: The sentinel node was successfully located by preoperative lymphoscintigraphy and confirmed at surgery in eleven patients. Five of these patients had evidence of metastatic node disease, always in the sentinel node. No other metastatic node were found in the neck dissection specimens. For the six other patients with a negative sentinel node, no other metastatic node was found in the neck dissection specimens. CONCLUSION: These preliminary results are promising. The sentinel node can be mapped and identified in most patients. No metastatic node was noted in patients with a negative sentinel node. If these results are confirmed, complete node dissection should only be performed in patients with a positive sentinel node in order to achieve more conservative surgical cure of head and neck melanoma.

Adult↗
PubMed2002

[15 years experience with microvascular free tissue transfert for repair of head and neck cancer defects].

We present the modalities and results obtained with free flap reconstruction of head and neck cancers defects. This retrospective review of 165 free transfers performed between 1984 and 1999 included 89 radial forearm flaps (54%), 38 latissimus dorsi flaps (23%), 28 osteomyocutaneous flaps (17%), 6 omentum flaps (4%), 2 jejunum flaps, and 2 cutaneous scapular flaps. Indications were orobuccopharynx (34%), hypopharynx (24%), mandible (17%), craniofacial (15%) and skin (10%) defects. Flap failure rate was 9%. Reconstruction of a radiated site was a statistically significant indicator of flap failure. Four types of free flaps were preferred for reconstruction of head and neck cancer defects. The radial forearm flap was used as a lap flap for the orobuccopharynx, the tubuled radial forearm flap for reconstruction of the digestive tract after total pharyngolaryngectomy, the osteomyocutaneous free fibular flap for pelvimandibulectomy, especially for the anterior arch, the latissimus dorsi flap to fill craniofacial defects, and the free omentum flap for craniofacial complications after radiotherapy.

Adenocarcinoma↗
PubMed2001

[Psychoactive drug use in nursing homes].

BACKGROUND: Our purpose was to know the use of psychoactive drugs including neuroleptics (NL), benzodiazepines (BNZ) and antidepressants (AD) in nursing homes (NH) in the city of Barcelona. METHOD: Cross-sectional descriptive study of 384 clinical records of people living in 19 NH. The correct use of drugs was estimated by Garrad's and Beers et al criteria. RESULTS: Average age (SD) of residents was 83 years (2.0). The average consumption of drugs was 5 (2.7); 248 individuals (64.6%) were taking at least one psychoactive drug: 81 (21%) consumed NL, 179 (46.6%) BNZ and 73 (19%) AD. 48 (12.5%) NH residents consumed long-acting BNZ and 26 (6.7%) had surpassed the recommended time of consumption for short-acting BNZ. In 21 (26%) NH residents who consumed NL, its use would not be justified. CONCLUSIONS: It is necessary to reduce the use of long-acting BNZ, to encourage a correct use of NL and to achieve a correct identification of depressive disorders in NH.

Aged↗
PubMed2001

Partial frontolateral laryngectomy with epiglottic reconstruction for management of early-stage glottic carcinoma.

OBJECTIVES: The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma. STUDY DESIGN: Retrospective study. METHODS: Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased. RESULTS: Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five-year survival rates calculated according to the Kaplan-Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow-up of 5 years. CONCLUSION: These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.

Carcinoma, Squamous Cell↗
PubMed2001

[Reconstruction of the palate vault by free forearm cutaneous flap in oncology].

Surgical reconstruction after partial superior maxillectomy raises a major functional challenge and postoperative recovery implies difficult prosthetic rehabilitation. Between 1989 and 2000, 23 free radial forearm flap reconstruction were performed for palate defects. Twenty-two patients were treated for cancer-related defects and one patient for a non-malignant tumor. Immediate reconstruction was performed in 21 cases and delayed reconstruction in 2. Radiation therapy had been given prior to surgery in 7 patients, Flap necrosis occurred in 2 patients who had surgery alone. Deglutition and phonation outcome was satisfactory in all patients. Trismus was the most frequent complication (7 cases). The free radial forearm flap is the gold standard surgical treatment for superior maxillary defects. In these patients, and exclusive skin flap enables complete reconstruction.

Adult↗
PubMed2001

Computational aspects of protein identification by mass spectrometry.

Recent developments in proteomics and genomics provide huge quantities of data to analyze. Automatic interpretation of mass spectrometry data has become essential for high-throughput processes aiming to study complete proteomes. There exist two main sources of mass spectrometric data: peptide mass fingerprint and fragmentation spectra, both of which require specific bioinformatic algorithms. We present a survey of these algorithms and discuss the efficiency of the different approaches and the possible improvements that may lead to a complete automatic high-throughput identification process.

Computational Biology↗
PubMed2000

[The pectoralis myofascial flap in oropharyngeal and pharyngolaryngeal reconstruction in salvage surgery].

BACKGROUND: The pectoralis major myofascial (PMMF) flap is rapidly mobilized, reliable in a number of clinical situations calling for vascularized soft tissue coverage in the head and neck. Salvage surgery after radiation failures produce salivary fistula, skin flap necrosis, vascular rupture. Use of PMMF improves healing in such cases. METHODS: A retrospective review performed at the university hospital, Marseille, between August 1987 and August 1999, was undertaken in two groups of salvage surgery. Groupe 1: protection of great vessels and fistula prevention after total laryngectomy (TL) and pharyngolaryngectomy (PL). Groupe 2: intra oral and pharyngeal defects reconstruction. Outcomes were classified in three types: type 1 - no complications; type 2 - delayed healing; type 3 - complicated healing. In groupe 2, in six cases the amount of flap contraction was analysed by C.T. scan. RESULTS: 83 PMMF was performed. Groupe 1, 57 cases (TL 28 cases, PL 26 cases); groupe 2, oral cavity défect 9 cases; oropharyngeal défects; 17 cases. There was no flap necrosis or vascular rupture. The donor site complications rate was 9.2%. The overall complications follow up was; groupe 1; type 1: 66%; type 2: 32%; type 3: 2%. In the groupe 2, type 1: 81%; type 2: 19%; type 3: 0%. The flap contracture was 30%. The use of PMMF in salvage surgery must be indicated in all cases after TL or PL, and is an excellent alternative from soft tissue coverage of oropharyngeal defects.

Adult↗
PubMed1999

A molecular scanner to automate proteomic research and to display proteome images.

Identification and characterization of all proteins expressed by a genome in biological samples represent major challenges in proteomics. Today's commonly used high-throughput approaches combine two-dimensional electrophoresis (2-DE) with peptide mass fingerprinting (PMF) analysis. Although automation is often possible, a number of limitations still adversely affect the rate of protein identification and annotation in 2-DE databases: the sequential excision process of pieces of gel containing protein; the enzymatic digestion step; the interpretation of mass spectra (reliability of identifications); and the manual updating of 2-DE databases. We present a highly automated method that generates a fully annoated 2-DE map. Using a parallel process, all proteins of a 2-DE are first simultaneously digested proteolytically and electro-transferred onto a poly(vinylidene difluoride) membrane. The membrane is then directly scanned by MALDI-TOF MS. After automated protein identification from the obtained peptide mass fingerprints using PeptIdent software (http://www.expasy.ch/tools/peptident.html + ++), a fully annotated 2-D map is created on-line. It is a multidimensional representation of a proteome that contains interpreted PMF data in addition to protein identification results. This "MS-imaging" method represents a major step toward the development of a clinical molecular scanner.

Automation↗
PubMed1999

Improving protein identification from peptide mass fingerprinting through a parameterized multi-level scoring algorithm and an optimized peak detection.

We have developed a new algorithm to identify proteins by means of peptide mass fingerprinting. Starting from the matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF) spectra and environmental data such as species, isoelectric point and molecular weight, as well as chemical modifications or number of missed cleavages of a protein, the program performs a fully automated identification of the protein. The first step is a peak detection algorithm, which allows precise and fast determination of peptide masses, even if the peaks are of low intensity or they overlap. In the second step the masses and environmental data are used by the identification algorithm to search in protein sequence databases (SWISS-PROT and/or TrEMBL) for protein entries that match the input data. Consequently, a list of candidate proteins is selected from the database, and a score calculation provides a ranking according to the quality of the match. To define the most discriminating scoring calculation we analyzed the respective role of each parameter in two directions. The first one is based on filtering and exploratory effects, while the second direction focuses on the levels where the parameters intervene in the identification process. Thus, according to our analysis, all input parameters contribute to the score, however with different weights. Since it is difficult to estimate the weights in advance, they have been computed with a generic algorithm, using a training set of 91 protein spectra with their environmental data. We tested the resulting scoring calculation on a test set of ten proteins and compared the identification results with those of other peptide mass fingerprinting programs.

Algorithms↗
PubMed1999

A symbolic-numeric approach to find patterns in genomes. Application to the translation initiation sites of E. coli.

DNA sequence data provided by genome sequencing programs open new research prospects. In this respect, computational investigations are of major importance to discover new 'functional/structural patterns' and to improve biological process knowledge. For example, even though the principal steps of translation initiation in prokaryotes are known, it is difficult to point out the exact pattern of the mRNA that is recognized by the ribosome. In this study, we have carried out a systematic context analysis of the complete genome of E. coli, around codons in competition for translation initiation. Using a combinatorial approach, we first show that it is possible to accurately define the initiation site by looking for the localization of patterns representing various combinations of trinucleotides. We have combined this approach with a statistical analysis based on the frequencies of these patterns. This leads to a decision tree, able to discriminate true and false starts with a recognition level near 90%. Our method may help to precisely localize the beginning of open reading frames, and point to likely mistakes for some genes in the database. The method may be included as a component of a gene recognition system, is not restricted to a particular genome or a two-classes discrimination, and may be applied to a broader class of biological patterns.

Base Sequence↗
PubMed1999

Clinical experience with Gore-Tex for vocal fold medialization.

OBJECTIVES/HYPOTHESIS: Present clinical experience with vocal fold medialization under local anesthesia using a Gore-Tex implant. The procedure consists of placing the implant into a pocket formed by dissection of the inner perichondrium of the thyroid cartilage through a small window made in the thyroid ala. STUDY DESIGN: During 2 years, we used this technique preferentially in 13 of the 16 cases of vocal fold medialization (three patients underwent Teflon injection because of a contraindication to local anesthesia). Follow-up was longer than 3 months in 11 cases (mean, 13 mo). METHODS: Vocal result was analyzed by the means of perceptual analysis and by the measurement of jitter factor. Glottal leakage was evaluated perceptually using videolaryngoscopy, and oral airflow was measured during the production of a vowel. In cases with preoperative aspiration, videofluoroscopy was performed. RESULTS: Implantation was successful in all but one patient in whom extrusion of the implant material occurred. In the latter case, the implant was removed and the patient recuperated his preoperative voice without any other complication. In the 10 other cases, voice improvement assessed by perceptual and objective evaluation was satisfactory. CONCLUSIONS: Results compare favorably with those of endoscopic techniques using Teflon or collagen and laryngeal frame surgery techniques using silicone or cartilage. We conclude that Gore-Tex implantation is a simple, reproducible, and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.

Adult↗
PubMed1999

[Intralesional injection of vinblastine in treatment of laryngeal Kaposi sarcoma associated with AIDS].

Kaposi's sarcoma (KS), is the most frequent malignant neoplasm associated with acquired immunodeficiency syndrome (AIDS). Classically arising in the skin, mucosal lesions are seen in 50 percent in oral cavity. KS rarely involves the larynx (37 cases have been reported in the world literature), when KS occurs in the larynx airway compromise can be a serious threat and immediate treatment is necessary. We report one case of KS of the supraglottic larynx, and intralesional injections were performed. A complete response was noted eleven months later. Although several modes of treatment are available (radiation therapy, systemic chemotherapy) to manage KS, intralesional injections with vinblastine sulfate may after an effective therapeutic alternative.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Medialization of paralysed vocal cord by expansive polytetrafluoroethylene implant (Gore-Tex)].

We report a technique for medialization of a paralyzed vocal cord using a Gore-Tex (expanded polytetrafluoroethylene) implant inserted under local anesthesia via a cervical incision. Gore-Tex is an expanded form of Teflon. It is used in vascular surgery (vessel repair) and esthetic surgery (particularly to increase lip volume). In esthetic surgery, the development of inflammatory processes difficult to control have been observed with teflon and appear to be less frequent with Gore-Tex due to the absence of free particles in the expanded form. The minimally invasive technique is simple and reproducible and can be performed under local anesthesia. We report a series of 9 cases operated from October 1995 to October 1997. During this period, this technique predominated (two other patients had Teflon injections). Excepting one case of extrusion of the implant material, vocal results were very satisfactory, based on both subjective and objective analysis of vocal parameters. The contribution of this technique in comparison with the reference endoscopic techniques (Teflon, collagen) and surgical techniques (silicone, cartilage) is discussed. Early results would suggest that Gore-Tex implantation can be used in the more severe forms due to vocal cord paralysis in the lateral position.

Adult↗
PubMed1995

[Reconstructive anterior frontal laryngectomy. Long-term results in T2 glottic cancers].

Between 1982 and 1992, we performed near total laryngectomy with epiglottic reconstruction in 142 patients with state T1 and T2 according to the 1987 Union Internationale contre le Cancer. In this paper, we report our experience with 61 T2 patient who were followed-up 5 years or until death. Actuarial survival was 83%. Actuarial tumor control was obtained in 91%. There were no post-operative mortalities and follow-up was usually simple. All patients underwent decanulation and were able to eat by normal track. The main drawback of this technique is speech disability. We use near total laryngectomy with epiglottic reconstruction in certain T2 patients selected according to local extension. This choice is justified by good functional results and an excellent local control. The contraindications are age over 75 years, poor patient cooperation, cardiac or pulmonary disease, fixation of the arytenoids, subglottic extension of more than 1 cm in front and 0.5 cm laterally, and extensive involvement of the ventricular folds or anterior commissure.

Adult↗