Biomedical subjects

R Peynègre

Publications and source records attributed to R Peynègre.

At least 19 recordsLinked to original sources

PubMed1996

Epithelial cell proliferation in nasal polyps could be up-regulated by platelet-derived growth factor.

The modifications of epithelial differentiation and proliferation observed in nasal polyps (NP) could be related to local secretion of growth factors, among which platelet-derived growth factor (PDGF) could play a key role. We therefore prospectively studied, by immunohistochemistry, proliferating cell nuclear antigen (PCNA, an S-phase cell marker), PDGF, and CD-68 (activated macrophages marker) expression in NP and inferior turbinate mucosa (NM) in 11 patients. Our data show that PCNA and PDGF expression are increased in NP epithelium, while CD-68 expression is increased in NP epithelium and lamina propria when compared to NM. Increased local PDGF secretion by numerous activated macrophages could therefore be involved in epithelial cell proliferation up-regulation in NP. PDGF could also be involved in the pathogenesis of NP via its connective tissue remodeling actions.

Antigens, CD↗

PubMed1996

Nasal polyposis pathogenesis: a flow cytometric and immunohistochemical study of epithelial cell proliferation.

In nasal polyps, constantly associated with chronic inflammation, frequent epithelial morphological changes (squamous metaplasia, secretory hyperplasia) suggest a dysregulation of epithelial cell proliferation. Cell proliferation in nasal respiratory epithelium was therefore evaluated in nasal polyposis. In 20 patients, we compared cell proliferation in mucosa from the inferior turbinate to these in nasal polyps using two methods: Flow cytometry analyzing first the ploidy and the percentage of S-phase cells (propidium iodide DNA labeling), secondly the percentage of Ki-67-labeled cells and the green fluorescent index (fluorescein-conjugated anti-human Ki-67 antigen labeling, and thirdly the percentage of Ki-67-labeled cells being in S-phase. Immunohistochemistry, quantifying the expression of Ki-67 antigen in the epithelium permitting to calculate a Ki-67 index. All cell-populations studied were diploid. Percentages of S-phase cells, Ki-67-labeled cells, Ki-67 labeled cells being in the S-phase and green fluorescence index was significantly higher in nasal polyps than in mucosa Ki-67 index were significantly higher in nasal polyps than in mucosa in the epithelium. Epithelial cell proliferation which is therefore increased in nasal polyp could play an important role in nasal polyposis pathogenesis and its relationships with inflammation can be suggested.

Cell Division↗

PubMed1996

[Place of iridium 192 implantation in irradiation of T1-T2 squamous cell carcinoma of the velopharyngeal arch].

We have reviewed the results of 165 T1 and T2 squamous cell carcinomas of the faucial arch treated by definitive irradiation including or not iridium 192 brachytherapy to ascertain whether a significant relationship exists between iridium implantation, local control, complications and survival. From March 1971 to November 1990, 58 T1 and 107 T2 (NO: 107/165; N1: 30/165; N2: 9/165; N3: 19/165) biopsy proven squamous cell carcinomas of the tonsillar region (104/165) and the soft palate and uvula (61/165) were treated in the Henri Mondor Hospital by definitive irradiation with curative intent. From 1971 to 1981 (period 1), only guide gutter technique was available, so that implants were reserved for small tumors: patients were either managed by definitive telecobaltherapy to tumor site and neck node areas (group I; n = 48; mean dose: 70 Gy; confidence interval: +/- 5.5, 5 fractions of 1.8 Gy per week) or by exclusive iridium implant (group 2; n = 11; all T1NO; 64 Gy +/- 4.8) or by a combination of external beam radiation therapy to tumor site and neck nodes areas and iridium implant (group 3; n = 40). In 1981 (period 2), a new plastic tube technique, which enables implantation of larger areas, was introduced and all patients (group 4; n = 66) were then managed by external radiation therapy (group 3 + 4: 47 Gy +/- 4.3) followed by an iridium implant (31 Gy +/- 10.5). Clinically positive neck nodes either received additional external dose with electrons or were excised. Overall 5-year survival (Kaplan Meier) was 23%, 50.5%, and 60% in groups 1, 2 and 3 + 4, respectively (p < 0.001, log rank). Five-year local control was 58%, 100%, and 91%, respectively (p < 0.001). Five-year necrosis rate was 10%, 25% and 30%, respectively (NS). Comparison of results between the two periods of the study (group 1 + 2 + 3 vs group 4) shows that these two groups are statistically comparable according to site and size of tumor and N status and that both local control (77% vs 94% at 5 years; p < 0.01) and disease free survival (56% vs 71%; p = 0.03) were improved after 1980, while there was a trend to an increase in overall survival (42% vs 53% at 5 years; p = 0.08); nodal control (86% vs 95% at 5 years) and necrosis rate (11% vs 20% at 5 years) were not modified. Multivariate analysis showed that both local control (p < 0.0001) and overall survival (p < 0.0001) were improved when tumor was implanted. We recommend then to treat T1 and T2 squamous cell carcinomas of the faucial arch by external radiation therapy to tumor site and neck areas (45 Gy/25 fractions/5 weeks) followed by a 30 Gy iridium implant and, for patients with clinically positive nodes, either a further 25-30 Gy electron beam irradiation to the nodes or neck node dissection.

Adult↗

PubMed1993

[Aspergillosis of the sphenoid sinus. Apropos of 4 cases].

Aspergillosis of the sphenoid sinus is a rare entity. The authors report four cases of non invasive aspergillosis sinusitis, three isolated cases and one with nasal polyps. All cases were treated by functional endoscopic surgery. Good results were noted with a mean follow-up of 18 months. Frequency, clinical features, treatment, and etiopathogenesis of sphenoidal aspergillosis are discussed.

Aged↗

PubMed1992

[Nasal and sinusal polyposis. Semiology and values of magnetic resonance imaging].

Twelve patients with nasal polyposis were examined with magnetic resonance imaging (MRI) prior to surgical ethmoidectomies (20 ethmoidectomies). MRI signal was analyzed in correlation with surgical findings in order to define the semiology of nasal and sinuses polyps. One of the most important point of this semiology is based on the analysis of sequences after administration of gadolinium. MRI seems an interesting method for analysing the extension of nasal polyposis and could be useful for ENT surgeons before an endoscopic nasal surgery.

Adolescent↗

PubMed1992

[Brush technique in cytological analysis of the nasal mucosa. A critical and comparative analysis].

The cytological study of the nasal mucosa is one the essential steps toward a better understanding of the physicopathological mechanisms involved in chronic affections of the nose. The development of a reliable, reproducible noninvasive technique to obtain cells in the prerequisite for this analysis. The brush technique is based on the use of a small cylindric nylon brush which is rotated as it is moved back and forth across the nasal mucosa to harvest the various cell types present on the surface of the mucosa. The specimen obtained is centrifuged and examined under an optical microscope. A semi-quantitative analysis is carried out to determine the relative richness of the specimen in epithelial cells (ciliated, qoblet and basal cells) and in inflammatory cells (neutrophils, basophils, eosinophils, lymphocytes, and monocytes). A precise differential cell count is then performed. According to the results obtained, an immunologic marker study of lymphocyte subsets may also be done using the same specimen. This technique may be used in both children and adults and permits cell harvest from various sites within the nasal fossa. Already tested in the study of the activity of cilia, this method is promising for the cytological study of the nasal mucosa. The brush method and other techniques of cell harvest are described and compared.

Adolescent↗

PubMed1992

[Inverted papilloma of the nose and paranasal sinuses. Retrospective study of 18 cases].

The authors report about 18 cases of inverted papillomas treated between 1981 and 1991. The average age of the patients is 51 years, with a marked male predominance. The average follow-up is of 4 years. The most often noted revealing sign is unilateral nasal obstruction. A history of polypectomy and nasosinual surgery is found in 45% of the cases in our series. The treatment was surgical in all cases, including 4 De Lima's procedures, 11 procedures through a paralateronasal approach, 2 ethmoidectomies through an endonasal approach, and 1 degloving for a septal lesion. Endonasal surgery was performed for two limited tumors, for which the diagnosis of inverted papilloma never could be made preoperatively. The recurrence rate observed in our series is 5%. Out of 18 patients, 4 presented with a malignant change, either at once (2 cases) or some time after the primary exeresis of the inverted papilloma (2 cases). In the light of the results, and after analyzing the literature, the authors reassert the necessity of radical exeresis for inverted papilloma. Rhinosinual endoscopy must remain a diagnostic means and never is an indication of exeresis of inverted papilloma. The authors emphasize the difficulty of the histological diagnosis and set forth the various problems arising from the malignant degeneration of inverted papillomas. Recent discoveries on viral etiopathogenesis and on the oncogenic potential of the type-16 papilloma virus may allow characterizing the evolutive and prognostic features of inverted papillomas in the future.

Adult↗

PubMed1990

Randomized study of 5 fluorouracil and cis platin as neoadjuvant therapy in head and neck cancer: a preliminary report.

A randomized prospective study of 5 fluorouracil (5-FU) and Cis platin preceding definitive local treatment for squamous cell carcinoma of the head and neck region was initiated in September 1986. Seventy-five patients were stratified by site (oral cavity-12, oropharynx-28, larynx-16, hypopharynx-19), and by Stage (Stage II-20, Stage III-43, Stage IV-12) and randomized to receive definitive local treatment (surgery and post-operative radiation or radiation alone) or chemotherapy followed by definitive local treatment. Chemotherapy consisted of three cycles of 120 hr 5-FU infusion 1 g/m2/day plus Cis platin 100 mg/m2 on day 1 on each cycle. Response to chemotherapy was complete in 17 patients (46%) for an overall response rate of 68%. All the patients have completed therapy with a median follow-up of more than 12 months. After local treatment, the complete response rate is 84% for the control group and 86% in the chemotherapy group. Actuarial disease-free survival at 1 year is 61% in the control group and 73% in the chemotherapy group (p = 0.25). These preliminary results show that in spite of initial tumor response, neoadjuvant chemotherapy does not improve long-term control and survival.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

Iridium 192 implantation of T1 and T2 carcinomas of the mobile tongue.

Between 1970 and 1986, 166 patients with T1 or T2 epidermoid carcinomas of the mobile tongue were treated by iridium 192 implantation (70 T1N0, 83 T2N0, 13 T1-2 N1-3). Five-year actuarial survival was 52% for T1N0, 44% for T2aN0, and 8% for or T1-2 N1-3. Cause specific survivals were 90%, 71%, and 46%, respectively. Local control was 87% for both T1N0 and T2N0, and 69% for T1-2 N1-3. Seven of 23 failures were salvaged by surgery, increasing local control to 96% for T1 and 90% for T2. Thirty-six patients developed a minor or moderate necrosis (16% T1, 28% T2). Half of these involved bone but only five required surgical intervention. Both local control (LC) and necrosis (nec) increased with increasing dose but improvement beyond 65 Gy is minimal (less than or equal to 60 Gy: LC = 78% nec = 13%; 65 Gy: LC = 90% nec = 29%; greater than or equal to 70 Gy: LC = 94% nec = 23%). For N0 patients, neck management consisted of surveillance (n = 78), elective neck dissection followed with external irradiation for pathologically positive nodes (n = 72), or irradiation (n = 3). Clinically positive nodes (13 patients) were managed by either neck dissection followed by external irradiation if pathologically positive (n = 10) or irradiation alone (n = 3). Regional control was 79% for N0 patients, improving to 88% after surgical salvage, and was 9/13 for N1-3 patients. We recommend that T1 and T2 carcinomas of the mobile tongue be treated by iridium 192 implantation to deliver 65 Gy. Mandibular necrosis should be reduced by using an intra-oral lead-lined dental mold.

Adult↗

PubMed1990

[Mucocutaneous leishmaniasis. Report of 2 cases].

Two new cases of midfacial granuloma caused by leishmaniasis are reported. This disease is very rare in France but very frequent in South America, where it occurs in two forms called UTA and Espundia. These are described here as well as the means of diagnosis and treatment for this disease. A brief review of the cases published in France seems to indicate that the disease is underestimated in this country. The study of the cases published in other African or European countries shows that all species of Leishmania can produce a midfacial granuloma.

Aged↗

PubMed1990

[Amalgamated and reinforced bone powder graft in the correction of the nasal ridge].

A number of surgical procedures have been described to correct irregularities of the consequences of excessive resection of the nasal ridge. Among these procedures the authors propose a bone powder graft mixed with tissue glue and reinforced with surgicel. The graft is in the form of a sheet of variable thickness which is malleable and can be perfectly shaped to fit the nasal ridge. It is positioned between the osteo-cartilagenous supporting structures and the skin. It smoothes out rough areas and compensates for any underlying loss of substance. It may be combined with a bone or cartilage graft which serves as a support and also acts to smoothe out the irregular form of the latter.

Bone Transplantation↗

PubMed1990

[Curietherapy of the Eustachian tube using Ir-192 in chronic otitis of tubal origin].

Failure of chronic otitis surgery, especially tympanoplasty, are mainly related to Eustachian tube dysfunction. A new technique of anti-inflammatory irradiation of the Eustachian tube was designed in 1985 in Créteil to improve the Eustachian tube function. The Eustachian tube is catheterized during the tympanoplasty using a plastic tube, 1.6 mm in diameter; this tube is closed at the external end. The other end of the tube is open and goes through the opposite nasal cavity. The plastic tube is loaded 24 h later with a 4.5 cm long irridium 192 wire to deliver a dose of 3 Gy on the reference isodose, 4 mm in diameter, in approximately 3 h. The tube is then gently withdrawn through the nasal cavity. Seventy-four patients, 16 years old or more, took part in the study. The method was performed successfully in 62 patients. Fifty-six patients were followed up; mean follow-up was more than 20 months. The follow-up assessment included otoscopy, audiometry, impedancemetry and residual Rinne measurement. Otoscopy results were adequate in 86% of patients. Hearing was improved in 44% of patients. Impedancemetry was adequate in 70% of patients and residual Rinne lower than 20 dB in 56%. These results are better if compared with those of a series of 30 tympanoplasties performed without intracavitary irradiation in 1984: the tympanoplasty failure rate then was 73%. In conclusion, this new procedure proved to be safe and simple and led to an improvement of the functional results of complex tympanoplasty.

Adolescent↗

PubMed1989

[Efficacy and tolerability of cefixime in the treatment of otorhinolaryngeal infections in adults].

Cefixime was used in the treatment of 59 patients, 44 of whom had sinusitis, 9 otitis media and 6 various ENT infections. The clinical and bacteriological effectiveness of the drug could be evaluated in 44 patients and its safety in all 59 patients. The most common responsible pathogens were Haemophilus influenzae, streptococci including Streptococcus pneumoniae and various Enterobacteriaceae. In more than 50 per cent of the cases, the clinical picture was one of acute exacerbation of a chronic infection. The patients received cefixime 200 mg b.d. for a mean duration of 12 days. Clinical cure was achieved in 80 per cent. Fourteen out of 44 patients underwent surgery. Minor abdominal discomfort was reported by 15 per cent of the patients, and one discontinued therapy because of side-effects. Cefixime was effective and well tolerated. It is suitable for the treatment of ENT infections in adults, such as those treated in this study.

Adolescent↗

PubMed1989

[Are ciliary abnormalities always present in Kartagener's syndrome? A study of 16 patients].

Kartagener's syndrome is defined as the combination of bronchiectasis, sinusitis and situs inversus. Assessment of characteristic ultrastructural changes and of their clinical expression was possible by examining the ciliated cells in the airways of 16 patients (12 children). Respiratory cilia of 11/13 patients were found to have abnormal motility. Quantitative ultrastructural data were obtained for 15 patients. Findings were absolutely normal in 2 cases. In 13 cases, ciliary abnormalities affected all the cilia, the majority of them (70-90%) or some of them (20-40%) (n = 7, n = 4, n = 2, respectively). The most frequently encountered aberration was a lacking external dynein arm. Summing it up: 1) ultrastructural ciliary abnormalities do not appear consistently in Kartagener's syndrome; 2) the lack of external dynein arms of cilia is the most frequent anomalous finding: 3) the clinical expression of ciliary dysfunction varies and the exact correlation between ultrastructural data and the intensity of the clinical manifestations remains to be established.

Adult↗

PubMed1989

[Taste disorders and associated factors in type 1 diabetes].

In order to study taste in type 1 diabetes (insulin-dependent), 57 consecutive diabetic patients (mean duration of diabetes +/- SEM = 11.4 +/- 0.4 years) and 38 control subjects underwent electrogustometry and chemical gustometry. The diabetic and control group were comparable with the exception of the ponderal index which was significantly higher in diabetics (p less than 0.05). A deterioration in taste appreciation was confirmed in the diabetic group compared to the control group on electrogustometry (mean threshold: 184.3 +/- 15.8 vs 58.7 +/- 9.2 mu A; p less than 0.001) and chemical gustometry (mean score: 13.2 +/- 0.7 vs 17.1 +/- 0.8; p less than 0.001). Electrical hypogueusia was found in 73% of the diabetics compared to 16% of controls (p less than 0.001). The 4 primary tastes were involved in the deterioration. Multivariate analysis associated the taste disorder with the diabetic status of the subjects, their alcohol and tobacco consumption. In the diabetic group the deterioration in taste was associated with the complications and duration of diabetes. On multivariate analysis peripheral neuropathy had the strongest association with taste disorders. These results suggest that deterioration in taste occurs during the progression of type 1 diabetes and that the taste disorder could be a degenerative complication of the disease. A neuropathic type mechanism could be involved.

Adult↗

PubMed1989

[The CO2 broncholaser in the treatment of subglottic and tracheal stenosis. Apropos of 14 cases].

The authors report the results of CO2 broncholaser treatment in 14 cases of iatrogenic cricotracheal stenosis. A stable patency of the laryngotracheal airway was successfully obtained in 43% of stenoses treated with the broncholaser alone. In another 43% of patients improvement was obtained. Failure occurred in 14% of cases. Heat disruption of the cartilagenous support was the most frequent cause of failure and recurrence. The development of rigid bronchoscopes which can be coupled to CO2 laser would appear to us to be a real technical advance. The apparatus is easy to handle and is increasingly being used as first intention. It has several advantages compared to endoscopic materials used with the YAG laser. The effect of CO2 on the tissues would seem to be better adapted than the YAG for iatrogenic stenoses.

Adult↗

PubMed1989

[Endoscopic surgery of the turbinates. Preliminary results].

Turbinate surgery has become more precise thanks to miniaturisation and improvements in optical systems, therby allowing endoscopic surgery throughout the procedure including its posterior portion. Endoscopic turbinate surgery includes surgery of the hypertrophied middle turbinate "concha bullosa" which requires diagnosis for successful treatment (septoplasty, endonasal ethmoid surgery). Endoscopy has improved inferior turbinate cauterisation which has become more complete and precise especially for the posterior portion of the turbinate. It allows the use of new techniques: the YAG laser and the CO2 laser. Endoscopy allows good control during resection of the tail of the inferior turbinate and ensures hemostasis in the event of hemorrhage occurring during this procedure.

Endoscopy↗

PubMed1989

[Taste in healthy subjects. Influence of alcohol and tobacco consumption].

To define the factors which may affect gustatory function, 42 healthy subjects, without any apparent taste disorder were randomly selected and investigated by electro-gustometry and chemical gustometry. A deterioration in taste discrimination was noted in drinkers in comparison with non-drinkers, both on electro-gustometry, mean threshold (SEM: 88.0 +/- 26.5 versus 47.4 +/- 7.3 microA; p less than 0.05), and also on chemical gustometry (15.1 +/- 2.1 versus 17.4 +/- 0.7; p = 0.05) and also in smokers compared with non smokers (mean of electrical thresholds SEM 104.2 +/- 22.8 versus 38.3 +/- 5.2 microA; p less than 0.01, mean of chemical scores SEM 14.3 +/- 1.1 versus 17.9 +/- 0.9; p less than 0.05). Multivariate analysis demonstrated the influence of the two factors alcohol and tobacco on taste, evaluated by electrogustometry (R2 = 0.36) or chemical gustometry (R2 = 0.28). These results suggest that alcohol and tobacco are liable to influence gustatory function in healthy subjects thereby suggesting that this influence should be taken into account using a corrective factor.

Adult↗