[How to perform laryngeal nasofibroscopy in adults].
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Administration, Oral↗
Biomedical subjects
S Hans
Publications and source records attributed to S Hans.
[Pain when removing a silicon Blake drain].
OBJECTIVES: A prospective analysis of pain intensity and related factors observed when removing a Blake suction drain after head and neck surgery. MATERIALS AND METHODS: An inception cohort of 100 patients managed at a single institution (university teaching and tertiary referral center), by 10 surgeons, during the months of March-July 2004. Two different scales were used to evaluate pain (see and ). The variables under analysis were: age, gender, comorbidity, overall pain and psychological status, anti-pain treatment, type of disease (benign vs malignant), type of surgery performed, location of the drain, number of drains removed and delay from surgery. RESULTS: No complications were noted at the time of drain removal. The volume drained varied from 10 to 450 cc (mean value 90 cc). At the time of drain removal no pain was noted in 50% to 60% of patients according to the scale used. Minimal pain and strong pain were noted in 45% - 36% and 5% - 4% of patients, respectively. Among the variables under analysis, the age of the patient was the only variable significantly related to the intensity of pain noted at the time of removal of the drain whatewer scale was used for analysis. Pain was statistically more pronounced as age declined (p=0.011 and p=0.04 according to the scales used). CONCLUSION: At our department, due to its very good drainage ability, its facility of use and the very low intensity of pain noted at the time of removal, the Blake drain has replaced the time honoured Redon-Jost drain conventionally used after head and neck surgery.
Adolescent↗
[How to perform and analyze a stroboscopic examination?].
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Diagnosis, Differential↗
Evaluation of frozen section diagnosis in 721 parotid gland lesions.
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Diagnostic Errors↗
[Octylcyanoacrylate (Dermabond) for skin closure at the time of head and neck surgery: a longitudinal prospective study].
OBJECTIVES: A prospective non-randomised evaluation of the octyl-2-cyanoacrylate (Dermabond) for skin closure in head and neck surgery. MATERIALS AND METHODS: An inception cohort of 52 patients managed by six otorhinolaryngologists head and neck surgeons at a single institution (university teaching and tertiary referral center) during the months of May-July 2004. The length of the skin incision varied from 3 to 30 cm (mean: 7 cm). Morbidity evaluation, longitudinal analysis of the evolution of the scar, and analysis of the degree of satisfaction. RESULTS: Postoperative death was not encountered. The overall morbidity rate was 3.8% (2/52). There was no instances of wound dehiscence's. A subcutaneous abscess was noted in one patient. From an aesthetic point of view, the scar appearance was considered to be slightly retracted during the first postoperative month and to be very good 2 to 4 months from initial surgery. Only one patient developed a minimal cheloid scar. Among the 47 patients who expressed an opinion postoperatively regarding the use of the octyl-2-cyanoacrylate (Dermabond) for skin closure, the degree of satisfaction was very high due to the ability to take an early shower (40 patients) followed by the lack of skin sutures (5 patients) and the lack of any allergic skin reaction (2 patients). CONCLUSION: At our department, the octyl-2-cyanoacrylate (Dermabond) for skin closure at the time of head and neck surgery is becoming more and more utilized due to the completion of a solid and aesthetic suture, the ability to take an early shower and the high degree of satisfaction expressed by the patients.
Adult↗
[Dysphonia: current methods of evaluation].
OBJECTIVES: The aim of this review article was to provide an update on current techniques for evaluation of dysphonia in routine clinical practice. MATERIALS AND METHODS: Recent medical and other scientific literature was reviewed and pertinent current theories concerning the physiology of laryngeal function described. RESULTS: Perceptual voice quality evaluation by a professional jury of listeners is still considered to be the most reliable and complete means of evaluating pathologic voice, even though it is difficult to perform in routine and the results lack reproducibility. The objective evaluation of the vocal fundamental frequency and its variations and the spectral characteristics of voice has the advantage of being simple to perform, reproducible and quantifiable. However, automatic measurements need to be analyzed with precaution for severe dysphonia, the computer algorithms being designed for voices retaining a certain periodicity. Aerodynamic measurements are quantifiable and reproducible and provide information as to the quality of laryngeal function as a transducer of aerodynamic energy into acoustic energy. Videostroboscopy and electroglottography provide information as to the quality of the laryngeal vibrations, the source of sound production. CONCLUSIONS: All of these types of analysis are complementary, informing as to different aspects of vocal quality and laryngeal function. No one measurement alone can diagnose or characterize dysphonia.
Electrodiagnosis↗
[Long term results of exclusive chemotherapy for glottic squamous cell carcinoma complete clinical responders after induction chemotherapy].
OBJECTIVES: To evaluate the long-term results of exclusive chemotherapy for T1-T3N0M0 glottic squamous cell carcinoma complete clinical responders after induction chemotherapy. MATERIAL AND METHODS: Between 1985 and 2000, 69 patients with glottic squamous cell carcinoma complete clinical responders after induction chemotherapy were managed with exclusive chemotherapy at our department. Chemotherapy associated platinum and fluorouracil. This retrospective analysis evaluated actuarial survival, treatment morbidity, oncologic events and laryngeal preservation. Various independent factors were tested for potential correlation with survival and local recurrence. RESULTS: The 5-year Kaplan-Meier actuarial survival, local control, lymph node control estimate were 83,6%, 64,8%, 98,6% respectively. Chemotherapy never resulted in death. The 10-year actuarial metachronous second primary tumors estimate was 32%. The overall laryngeal preservation rate was 98,6%. CONCLUSION: Altogether our data and the review of the literature suggest that in patients achieving a complete clinical response after and induction based chemotherapy regimen, the completion of an exclusive chemotherapy regimen appears to be a valid alternative to the conventional use of radiotherapy or chemo-radiation protocols.
Adult↗
[Mitomycin C: prevention and treatment of anterior glottic synechia].
OBJECTIVES: Topical applications of mitomycin C to the anterior glottis may prevent anterior glottic synechia (prevention group) or restenosis (treatment group). METHODS: In the prevention group, six patients with glottic carcinoma involving the anterior commissure were treated by transoral laser surgery. Repeated procedures were performed in one patient. For the six patients in the treatment group, the anterior glottic synechia was secondary to frontolateral laryngectomy (three patients), transoral laser therapy for laryngeal papillomatosis (two patients) or bilateral glottic carcinoma (one patient). Mitomycin C (0.4 mg/ml) was used as a topical application on the anterior commissure for a duration of 4 minutes. Outcome was assessed clinically at three months using a visual scale: no synechia (success), micro-synechia (partial failure), and synechia (failure). RESULTS: In the prevention group, there were six successes and one partial failure. In the treatment group, there were two successes, three partial failures, and one failure. No side effects were noted. CONCLUSION: Topical application of mitomycin C was effective to prevent anterior glottic synechia after transoral laser surgery for glottic carcinoma involving the anterior commissure. It is an alternative to endolaryngeal keel in patients with sequellar synechia. These preliminary results should be further evaluated in a larger series.
Adult↗
[Quality of life before and after thyroplasty for vocal fold paralysis].
OBJECTIVES: The aim of our prospective study was to evaluate the vocal handicap in relation with the quality of life in patients with unilateral vocal fold paralysis (UVFP), before and after thyroplasty with Montgomery implant (type I). METHODS: Ten patients had to file the VHI questioner before and three months after thyroplasty. The 30 items of the Voice Handicap Index scale are sub-divided in 3 categories referring to "Functional", "Physical" and "Emotional" dimensions. RESULTS: Before thyroplasty, the global score and the 3 sub-scales rating are high reflecting severe impairment in speech communication (VHI total = 65,9/120, F = 25.7/40, E = 19.9/40, P = 20.8/40). Three months after thyroplasty, a significant improvement is found predominantly in the field of functional and emotional evaluation, corresponding to an improved quality of social life (VHI total = 20,9/120, F = 6.3/40, E = 3.6/40, P = 10.6/40). CONCLUSION: These results show the interest in using the autoevaluation VHI scale as a complementary evaluation associated to perceptual, acoustic and aerodynamic evaluation to objectify the functional improvement in voice quality after thyroplasty.
Aged↗
[Montgomery thyroplasty implant under local anesthesia for unilateral laryngeal paralysis].
OBJECTIVES: Based on an inception cohort of 63 patients with unilateral vocal fold paralysis consecutively treated with thyroplasty and Montgomery's implant under local anesthesia during the years 1997-2002, we recorded i) morbidity and mortality, ii) evolution of dysphonia and swallowing impairment and iii) a prospective analysis of selected speech and voice parameters in an attempt to determine their evolution during the first 12 postoperative months and to search for potential statistical relationships with the following variables (age, gender, side of the paralysis, etiology of the paralysis, time between onset of paralysis and thyroplasty, position of the paralyzed true vocal fold, nerve involved, associated pneumonectomy, prior intracordal injection of autologous fat and surgeon). RESULTS: The overall complication rate was 8%. Minor complications occurred in 6.5% of the patients and included 4 cases of laryngeal edema successfully treated with oral steroids. Major complications occurred in 1.5% of the patients. Intralaryngeal hematoma requiring temporary tracheotomy was the major complication. Swallowing was improved in 93.5% of the patients. Immediate improvement of speech and voice was noted in all. Secondary degradation of speech and voice occurred in one patient. At revision thyroplasty lateral displacement of the implant was noted and successfully repositioned. At one month post-operatively, the values of maximum phonation time, speech rate, group phrasing standard deviation of the fundamental frequency, jitter and shimmer were statistically improved while the fundamental frequency did not vary significantly. At 12 months post-operatively the noise to harmonic ratio was improved while the other parameters remained stable. No significant statistical relationship was found between the post-operative speech and voice parameters and the variables under analysis. CONCLUSION: Based on the current series and a review of the medical literature, thyroplasty with Montgomery's implant under local anesthesia appears to be an easy, effective and safe procedure that might be used in all patients with unilateral laryngeal nerve paralysis.
Adult↗
[Carbon dioxide laser transoral microsurgery for glottic carcinoma in situ].
OBJECTIVE: To evaluate the oncologic results of glottic carcinoma in situ (CIS) treated with transoral carbon dioxide laser microsurgery. METHODS: A retrospective review of 12 patients with glottic CIS previously untreated, treated with carbon dioxide laser transoral microsurgery between January 1990 and December 1999 was conducted. RESULTS: Initial and ultimate local control rates were 75%, and 100%, respectively. Three local failures occurred: two glottic CIS were treated by carbon dioxide laser transoral microsurgery, one squamous cell glottic carcinoma was treated by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The ultimate rate of laryngeal preservation rate was 100%. CONCLUSIONS: Based on the material of this study, recommended treatment for glottic CIS should be carbon dioxide laser transoral microsurgery. Difficulties in endoscopic exposure of the larynx is a contraindication. Further studies are necessary to confirm these preliminary results.
Adult↗
Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders.
BACKGROUND: The current studies documented the results achieved with chemotherapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders after a platin-based induction chemotherapy regimen. METHODS: Group I consisted of 36 patients with tumors originating from the glottis. Group II consisted of 31 patients with tumors originating from sites within the pharyngolarynx other than the glottis. A minimum of 3 years of follow-up was achieved. Statistical analyses of survival, local control, lymph node control, distant metastasis, and second primary tumor rates were based on the Kaplan-Meier life-table method. Laryngeal preservation rates and local control rates are presented. RESULTS: The 5-year actuarial survival estimate was 85.1% in Group I patients and 54.8% in Group II patients. Survival was statistically more likely to be reduced in Group II patients compared with Group I patients (P = 0.01). The 5-year actuarial local control estimate was 65.7% in Group I patients and 37.5% in Group II patients. Local failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.02). Local control rates after salvage treatment were 100% in Group I patients and 83% in Group II patients. Laryngeal preservation rates after salvage treatment were 100% in Group I patients and 64% in Group II patients. The 5-year actuarial lymph node control estimate was 90% in Group I patients and 73.7% in Group II patients. Lymph node failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.04). The 5-year actuarial estimate for patients without distant metastasis was 100% in Group I patients and 90% in Group II patients. Distant metastasis was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.03). The 10-year actuarial estimate for patients without metachronous second primary tumors was 56.4% in Group I and 46.1% in Group II. CONCLUSIONS: The current report 1) contradicts the old dogma of nonchemocurability for invasive squamous cell carcinoma of the upper aerodigestive tract and 2) suggests that the use of a platin-based chemotherapy-alone regimen with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx who are classified as T1-T4N0M0 complete clinical responders after receiving an induction chemotherapy regimen is best indicated when the tumor originates from the glottis.
Adult↗
Allylated monosaccharides as precursors in triple reductive amination strategies: synthesis of castanospermine and swainsonine.
The feasibility of the triple-reductive amination reaction for the synthesis of complex indolizidine frameworks is illustrated by application to the potent glycosidase inhibitors castanospermine and swainsonine. The target compounds were obtained from known carbohydrate precursors in yields of 23 and 14%, over nine and 13 steps, respectively. The iodoetherification reaction of allylated monosaccharides was shown to be a practical reaction for the synthesis of the tricarbonyl precursors for the key triple reductive amination reactions.
Alkylation↗
[Treatment of recurrent unilateral paralysis with thyroplasty with Montgomery implant].
OBJECTIVES: An analysis of thyroplasty with Montgomery implant under local anesthesia for unilateral laryngeal nerve paralysis. PATIENTS AND METHOD: An inception cohort of 21 patients was operated on with a minimum follow-up of 9 months. All patients had severe dysphonia and breathlessness. Seven patients had aspiration with a non efficient cough. RESULTS: The only adverse side effect was a subcutaneous cervical hematoma in one patient. Aspiration disappeared immediately after completion of the thyroplasty. Immediate improvement of speech, cough, and breathlessness was achieved in all patients. Over time, speech and voice remained stable in all patients. Recurrence of aspiration was not encountered. CONCLUSION: Such data supported the notion that the thyroplasty with Montgomery implant under local anesthesia is an extremely valuable option in patients with unilateral laryngeal nerve paralysis.
Adult↗
Objective voice quality analysis before and after onset of unilateral vocal fold paralysis.
This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery). The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.
Aged↗
Objective voice analysis after autologous fat injection for unilateral vocal fold paralysis.
This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.
Acoustics↗
Phonatory mechanisms after vertical partial laryngectomy with glottic reconstruction by false vocal fold flap.
A prospective randomized study was designed to compare phonatory mechanisms in patients treated with frontolateral partial laryngectomy (FLPL) with or without glottic reconstruction with false vocal fold (FVF) mucosal flap. Objective voice assessment was based on computerized acoustic recordings and videolaryngostroboscopy performed before, 1 year after, and 2 years after surgery. Phonatory mechanisms were studied according to the surgical technique and correlated with acoustic recordings. The results showed that supraglottic structures participated in laryngeal closure and voice production in 80% of cases in which a standard FLPL was performed. The FVF mucosal flap was involved in both laryngeal closure and voice production in 54% of patients treated with glottic reconstruction. The type of laryngeal closure (glottic or supraglottic) statistically influenced the acoustic measurements. As glottic closure is more frequent in patients treated with glottic reconstruction, the authors recommend performing reconstruction of the glottis with an FVF mucosal flap when an FLPL is indicated.
Adult↗
An instructive function for Notch in promoting gliogenesis in the zebrafish retina.
The Gal4-UAS technique has been used to misexpress a constitutively active Notch receptor variant (notch1a-intra) in the developing zebrafish retina. This is the first study to use this technique to misexpress genes and assess their function in neural development of the zebrafish. Expression of activated Notch1a either ubiquitously, driven by a heat-shock70 promoter, or in a spatially regulated manner, controlled by the deltaD promoter, causes a block in neuronal differentiation that affects all cell types. Developing cells take on either a glial fate or remain undifferentiated. A large number of cells eventually undergo apoptosis. These phenotypic effects of activated Notch1a are expressed cell autonomously. Cells within central regions of the retina adopt a glial fate if they express activated Notch1a in a time window that extends from 27 to 48 hours postfertilization. This period corresponds mainly to the time of origin of ganglion cells in the normal retina. Activation of notch1a at later stages results in defects in cell type specification that remain restricted to the ciliary marginal zone, whereas neuronal types are specified normally within the central region. These observations indicate that glial differentiation is initiated by Notch1a-intra expressing cells, which become postmitotic in the same time window. Our results strongly suggest that Notch1a instructs a certain cell population to enter gliogenesis, and keeps the remaining cells in an undifferentiated state. Some or all of these cells will eventually succumb to apoptosis.
Animals↗