[Show abstract][Hide abstract] ABSTRACT: Preoperative ultrasonography and scintigraphy using (99m)Tc-sestamibi are commonly used to localise abnormal parathyroid glands. In cases of discrepant results between scintigraphy and ultrasonography, it is important to rely on another diagnostic imaging modality. (18)F-fluorodeoxyglucose (FDG) and (11)C-methionine positron emission tomography (PET) have been studied but are imperfect to detect abnormal parathyroid glands. Recently, first cases of abnormal parathyroid glands taking-up radiolabelled choline were discovered incidentally in men referred to (11)C-choline or (18)F-fluorocholine (FCH)-PET/CT for prostate cancer. We checked whether or not FCH uptake was a general feature of adenomatous or hyperplastic parathyroid glands. Methods: FCH-PET/CT was performed in 12 patients with primary (n=8) or secondary hyperparathyroidism (1 dialysed, 3 grafted) and with discordant or equivocal results on preoperative ultrasonography (US) and/or (123)I/(99m)Tc-sestamibi dual-phase scintigraphy. Results of FCH-PET/CT were evaluated, with surgical exploration and histopathologic examination as the standard of truth. Results: On a per-patient level, the detection rate of FCH-PET/CT (at least one FCH focus corresponding to an abnormal parathyroid gland in a given patient) was 11/12=92%. FCH(-)PET/CT detected 18 foci interpreted as parathyroid glands and correctly localised 17 abnormal parathyroid glands (7 adenomas and 10 hyperplasias). On a per-lesion level, FCH-PET/CT results were 17 TP, 2 FN i.e. a lesion-based sensitivity of 89%, and 1 FP. Conclusion: As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localised by FCH-PET/CT with a good accuracy. Furthermore FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.
The Journal of clinical endocrinology and metabolism. 09/2014;
[Show abstract][Hide abstract] ABSTRACT: Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum peak inspiratory flow (PIF) as a standardized simple tool for successful decannulation after surgery.
[Show abstract][Hide abstract] ABSTRACT: Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence is around 60. Tobacco is the main risk factor, especially when associated with alcohol. They occur de novo or by evolution of a precancerous lesion. Diagnosis is late in 70% of cases. They must be treated in specialized centers. Pretreatment check-up has to be done according to national guidelines. Treatment often implies primary surgery. Reconstructive surgery progresses allow for wide excisions and still acceptable quality of life. Radiotherapy, eventually potentialized, is usually performed post-operatively. Induction chemotherapy still needs to be evaluated in oral cancers, especially in an organ preservation purpose.
[Show abstract][Hide abstract] ABSTRACT: Oral cavity and pharyngeal cancers account for 75% of head and neck cancers and are the fourth most spread cancer in men. Their incidence has decreased since 1980 in men (incidence from 2011 gives 13,930 for lip, oral cavity, pharyngeal and laryngeal carcinomas) but has increased in women, linked to the more recent smoking or alcohol intoxication in women. In addition to the smoking or alcohol consumption risk factors, the EBV role in nasopharyngeal carcinomas, HPV in the oropharyngeal carcinomas and professional exposures in paranasal sinuses cancers are recognized. Head and neck cancers are the fifth most common cancer in men mortality in France. Extended anatomical sites reflect the diagnostic's complexity specific to some locations (sinuses, nasopharynx), possible therapies and prognosis depending on the affected site.
[Show abstract][Hide abstract] ABSTRACT: We undertook a study on a series of laryngeal sarcoidosis (LS), a very rare and often threatening localization to better specify laryngeal manifestations, sarcoidosis clinical expression and long-term follow-up.
[Show abstract][Hide abstract] ABSTRACT: Objectif
Évaluer le rôle d’un signe observé en nasofibroscopie, le signe de la marée (SLM), dans le diagnostic et le suivi post-chirurgical dans les diverticules de Zenker.
Patients et méthode
Cent quarante-huit patients porteurs de diverticules de Zenker ont été opérés dans notre service. Une étude vidéo-endoscopique de la déglutition était effectuée dans notre service en pré- et en postopératoire et les deux examens étaient comparés en ce qui concerne la présence du SLM. Dans un sous-groupe de 38 patients, la taille du diverticule sur le transit baryté et le délai de survenue du SLM ont été comparés.
Tous les patients présentaient un SLM à l’examen préopératoire. Aucune corrélation n’a été observée entre le délai de survenue du signe et la taille du diverticule. Des données de suivi postopératoire ont pu être obtenues chez 121 patients (suivi moyen : huit mois) : 111 patients ont été significativement améliorés pendant tout le suivi avec une disparition complète du SLM. Une récidive des symptômes a été observée durant la période de suivi chez dix patients ; sept d’entre eux avait une réapparition concomitante du SLM et eurent une chirurgie de reprise.
Le SLM observé en vidéofibroscopie de la déglutition est un outil supplémentaire pour le diagnostic de diverticule de Zenker et pour l’évaluation de l’efficacité de la chirurgie lors du suivi postopératoire.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 12/2013; 130(6):314–317.
[Show abstract][Hide abstract] ABSTRACT: Las alteraciones neurológicas de la faringe pueden ser aisladas o estar integradas en síndromes complejos, lo que convierte su tratamiento en un problema multidisciplinario. A las alteraciones de la deglución suelen asociarse con frecuencia problemas articulatorios por insuficiencia velar y alteraciones respiratorias. El examen otorrinolaringológico es indispensable para orientar el diagnóstico hacia una causa neurológica, periférica, nuclear o supranuclear, o hacia un origen neuromuscular o muscular.
[Show abstract][Hide abstract] ABSTRACT: Oculopharyngeal muscular dystrophy (OPMD) is a late onset autosomal dominant genetic disease mainly characterized by ptosis and dysphagia. We conducted a Phase I/IIa clinical study (ClinicalTrials.gov NCT00773227) using autologous myoblast transplantation following myotomy in adult OPMD patients. This study included 12 patients with clinical diagnosis of OPMD, indication for cricopharyngeal myotomy, and confirmed genetic diagnosis. The feasibility and safety end points of both autologous myoblast transplantation as well as the surgical procedure were assessed by videoendoscopy in addition to physical examinations. Potential therapeutic benefit was also assessed through videoendoscopy and videofluoroscopy of swallowing, quality of life score, dysphagia grade, and a drink test. Patients were injected with a median of 178 million myoblasts following myotomy. Short and long-term (2 years) safety and tolerability were observed in all patients, with no adverse effects. There was an improvement in the quality of life score for all 12 patients, and no functional degradation in swallowing was observed for 10 patients. A cell dose dependant improvement in swallowing was even observed in this study. This trial supports the hypothesis that a local injection of autologous myoblasts in the pharyngeal muscles is a safe and efficient procedure for OPMD patients.Molecular Therapy (2013); doi:10.1038/mt.2013.155.
[Show abstract][Hide abstract] ABSTRACT: Objectif
Le but de cette étude était d’évaluer l’intérêt du monitorage des nerfs laryngés inférieurs (NLI) dans la stratégie opératoire des thyroïdectomies et parathyroïdectomies totales. Le risque respiratoire d’une paralysie récurrentielle (PR) bilatérale peut faire discuter une chirurgie en deux temps en cas de non stimulation du premier côté.
Patients et méthodes
Cette étude prospective a été réalisée chez 100 patients successifs, de mai 2007 à mars 2011. Un monitorage était réalisé par voie translaryngée. Le NLI du premier côté disséqué était stimulé. En cas de stimulation négative, l’abord controlatéral était différé pour éviter le risque de PR bilatérale.
Les indications étaient principalement un carcinome thyroïdien (34 %), une maladie de Basedow (27 %), un goitre multinodulaire (27 %) et une hyperplasie des parathyroïdes (9 %). Il s’agissait d’une reprise chirurgicale chez sept patients. Quatre NLI identifiés du premier côté n’étaient pas stimulables, faisant différer l’abord controlatéral. Une PR unilatérale transitoire était observée chez ces quatre patients et deux PR étaient observées alors que la stimulation était positive. Du second côté, parmi les 96 NLI qui devaient être stimulés, deux n’ont pas été visualisés (une PR transitoire, une PR définitive), deux n’étaient pas stimulables (deux PR définitives) et 92 étaient stimulables (neuf PR transitoires dont deux associées au premier côté paralysé transitoirement, une PR définitive). L’incidence, à l’échelle nerf, des PR transitoires était de 9,6 % et celle des PR définitives (unilatérales) était de 2 %.
Lorsqu’un abord bilatéral des loges récurrentielles est prévu, le monitorage des NLI présente un intérêt majeur dans le but de limiter le risque de PR bilatérale. Une thyroïdectomie en deux temps, dans l’attente de la récupération fonctionnelle du NLI traumatisé peut ainsi être décidée. Le risque d’une PR bilatérale a été évité chez quatre patients, alors que chez deux patients, une PR bilatérale transitoire a été observée malgré une stimulation positive.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 06/2013; 130(3):134–139.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate the role of the videoendoscopic "rising tide sign" (RTS) in the diagnosis and assessment of surgical repair of Zenker's diverticulum. Study design: Retrospective. SUBJECTS AND METHODS: A total of 148 patients with Zenker's diverticulum underwent surgery in our department. A videoendoscopic swallowing study (VESS) was performed pre- and postoperatively, and the two examinations compared for the presence of the RTS. VESS characteristics based on the time to RTS onset and the size of diverticulum, as seen on a barium swallow, were also compared in a subset of 38 patients. RESULTS: All patients presented with the RTS on preoperative VESS. No correlation was observed between the time to onset of the sign and size of the diverticulum. Follow-up data were available for 121 patients (mean follow-up: 8months): 111 patients were significantly improved during follow-up, with complete disappearance of the RTS. Recurrence of symptoms was observed at this time in 10 patients. Seven of these 10 patients had concomitant recurrence of the RTS and required repeat surgery after a mean follow-up of 37months. CONCLUSION: The RTS observed by videoendoscopy is a supplementary tool for the diagnosis of Zenker's diverticulum and for evaluation of the efficacy of surgery during the postoperative follow-up.
European Annals of Otorhinolaryngology, Head and Neck Diseases 05/2013;
[Show abstract][Hide abstract] ABSTRACT: Oculopharyngeal muscular dystrophy (OPMD) is a late-onset autosomal dominant inherited dystrophy caused by an abnormal trinucleotide repeat expansion in the poly(A)-binding-protein-nuclear 1 (PABPN1) gene. Primary muscular targets of OPMD are the eyelid elevator and pharyngeal muscles, including the cricopharyngeal muscle (CPM), the progressive involution of which leads to ptosis and dysphagia, respectively. To understand the consequences of PABPN1 polyalanine expansion in OPMD, we studied muscle biopsies from 14 OPMD patients, 3 inclusion body myositis patients, and 9 healthy controls. In OPMD patient CPM (n = 6), there were typical dystrophic features with extensive endomysial fibrosis and marked atrophy of myosin heavy-chain IIa fibers. There were more PAX7-positive cells in all CPM versus other muscles (n = 5, control; n = 3, inclusion body myositis), and they were more numerous in OPMD CPM versus control normal CPM without any sign of muscle regeneration. Intranuclear inclusions were present in all OPMD muscles but unaffected OPMD patient muscles (i.e. sternocleidomastoid, quadriceps, or deltoid; n = 14) did not show evidence of fibrosis, atrophy, or increased PAX7-positive cell numbers. These results suggest that the specific involvement of CPM in OPMD might be caused by failure of the regenerative response with dysfunction of PAX7-positive cells and exacerbated fibrosis that does not correlate with the presence of PABPN1 inclusions.
Journal of neuropathology and experimental neurology. 03/2013; 72(3):234-243.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The purpose of this study was to assess the role of recurrent laryngeal nerve (RLN) monitoring in the operative strategy during total thyroidectomy and parathyroidectomy. Due to the risk of serious respiratory complications of bilateral recurrent nerve paralysis, two-stage surgery may be considered in the case on negative stimulation of the first side. PATIENTS AND METHODS: This prospective study was conducted in 100 consecutive patients between May 2007 and March 2011. Translaryngeal monitoring was performed. When stimulation of the RLN on the first side dissected was negative, dissection of the other side was deferred to avoid the risk of bilateral RLN paralysis. RESULTS: The main surgical indications were thyroid carcinoma (34%), Graves' disease (27%), multinodular goitre (27%) and parathyroid hyperplasia (9%) with seven cases of redo surgery. Four RLN identified on the first side gave a negative response to stimulation and surgery to the other side was therefore deferred. Transient unilateral RLN paralysis was observed in these four patients and two cases of RLN paralysis were observed among patients with positive RLN stimulation. Among the 96 contralateral RLNs tested, two were not visualized (one case of transient RLN paralysis, one case of permanent RLN paralysis), two gave a negative response to stimulation (two cases of permanent RLN paralysis) and 92 gave a positive response to stimulation (nine cases of transient RLN paralysis, including two cases associated with transient paralysis of the first side, and one case of permanent RLN paralysis). The incidence of RLN paralysis by nerve was 9.6% for transient RLN paralysis and 2% for permanent (unilateral) RLN paralysis. CONCLUSION: When bilateral RLN dissection is planned, RLN monitoring is particularly useful to limit the risk of bilateral RLN paralysis. Two-stage thyroidectomy, following functional recovery of the damaged RLN, can therefore be proposed. The risk of bilateral RLN paralysis was avoided in four patients, while transient bilateral RLN paralysis was observed in two patients despite positive stimulation.
European Annals of Otorhinolaryngology, Head and Neck Diseases 02/2013;
[Show abstract][Hide abstract] ABSTRACT: Several studies have reported abnormalities in muscle histology of cricopharyngeal muscle (CPM) from healthy donors. However, very little is known concerning the morphological structure of this muscle that, together with the elevator eyelid muscle, represents the main muscular targets of oculopharyngeal muscular dystrophy (OPMD). OPMD is a late onset autosomal dominant inherited dystrophy due to an expansion of GCG repeats in the coding region of the ubiquitously expressed PABPN1 gene. In OPMD patients, progressive involvement of these muscles leads to dysphagia and ptosis. In this study, CPM biopsies from seven OPMD patients and five healthy individuals were investigated by histological and histochemical approaches as well as by quantitative RT-PCR analysis. Surprisingly, histological features were similar between OPMD patients and control subjects without any correlation with age: in addition to the extensive fibro-connective substitution (30–40%), all CPM showed a high variability in muscle fibre size, rimmed vacuoles, internalized nuclei, ’ragged red’ fibres and split fibres. In CPM, a higher number of satellite cells were observed as compared to other muscle, with a significant difference between control and OPMD (7% versus 12% respectively), further confirmed by increased Pax7 mRNA levels. To further evaluate the regenerative capacity of these satellite cells, OPMD and control cells were transplanted into cryodamaged tibialis anterior muscle of immunodeficient mice. This study will help us to understand the defects in muscle fibres regeneration in OPMD. Analyses on CPM are now being extended to a less affected muscle, the sternocleidomastoideus muscle (SCM) from OPMD and healthy individuals to improve our understanding of the pathophysiology of OPMD.
[Show abstract][Hide abstract] ABSTRACT: Hibernoma is a rare benign tumour of soft tissue, generally asymptomatic, usually discovered in young adults. It is a form of lipoma that originates from brown adipose tissue. Its diagnosis is based on histology, the main differential diagnoses being lipoma and liposarcoma. Its appearance on FDG PET/CT has being described only in few case reports. We report here the case of a 68-year-old patient with ENT cancer in whom an adipose tumour in the left axilla has been discovered on CT performed for staging. The diagnosis of hibernoma was suggested in the report of FDG PET/CT examination and was consistent with results of other imaging modalities. On MRI, contrast enhancement was observed after gadolinium contrast injection, which was not typical for a lipoma. On PET/CT, the FDG uptake by the adipose tumour was very intense (SUVmax = 16), which is characteristic for hibernoma that derives from brown adipose tissue. Imaging was unable to distinguish between hibernoma and liposarcoma. The diagnosis of benign mixed hibernoma-lipoma was ascertained on histopathology after complete resection of the tumour. Elements favouring hibernoma over liposarcoma are present in this observation: high avidity for FDG (SUVmax > 10) and a fluctuating intensity of uptake, SUVmax of the tumour increasing from 16 to 48 within 16 months in the presented case. A high SUVmax on FDG PET in an adipose tumour on CT seems to be more suggestive of a benign tumour, hibernoma, than of its malignant counterpart, liposarcoma.
[Show abstract][Hide abstract] ABSTRACT: Oropharyngeal squamous cell carcinomas (OSCCs) are associated with high-grade human papillomavirus (HPV) infection in 20% to 30% of cases. HPV-16 DNA has been detected in cervical lymph node metastases of HPV-16(+) OSCC. However, the meaning of HPV-16 DNA detection in lymph nodes remains controversial. Does the presence of HPV-16 DNA in lymph nodes correlate with their metastatic involvement, or is it just a consequence of the filter function of lymph nodes?
Viral load quantification using reverse transcriptase-polymerase chain reaction was retrospectively performed in primary tumors and in cervical lymph nodes, originating from levels IIa, IIb, and III, in 11 patients with HPV-16(+) OSCC and in 3 control patients with HPV-16(-) OSCC.
A total of 45 lymph node levels were analyzed. HPV-16 DNA was not detected in HPV-16(-) OSCC lymph nodes. No statistically significant difference was found between primary tumors and metastatic lymph nodes viral load (P > .01). The viral load value was significantly higher in metastatic lymph nodes than in tumor-free lymph nodes (P < .01). Among 27 tumor-free lymph node levels, the viral load value was undetectable in 16, low or medium (<10(5) copies per million cells) in 8, and high (>10(5) copies per million cells) in 3.
HPV-16 DNA detection in lymph nodes of patients affected with HPV-16(+) oropharyngeal cancer is indicative of metastatic involvement. Tumor-free lymph nodes with a high viral load value would suggest the presence of occult lymph nodes metastasis and the opportunity to use HPV-16 DNA as a metastatic marker. Further investigations are needed.
Archives of otolaryngology--head & neck surgery 09/2011; 137(9):910-4. · 1.92 Impact Factor