D Brasnu

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Lutetia Parisorum, Île-de-France, France

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Publications (263)168.42 Total impact


  • No preview · Conference Paper · Sep 2014
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    ABSTRACT: Introduction La plasmocytose laryngée (PL), est une lésion bénigne rare à plasmocytes matures et polyclonaux, qu’il faut savoir distinguer du plasmocytome extramédullaire. Présentation du cas Nous rapportons l’observation d’une patiente âgée de 59 ans, ayant une dysphonie chronique comme unique symptôme, chez qui une PL isolée à localisation laryngée a été découverte. Discussion Nous discutons la présentation histopathologique, les modalités thérapeutiques, et le pronostic de cette entité. Conclusion La PL est une lésion bénigne et rare, dont le diagnostic est à évoquer devant une infiltration plasmocytaire polyclonale de la sous-muqueuse.
    No preview · Article · Nov 2013 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
  • S. Hans · C. Hoffman · A. De corgnol · M. Ménard · D. Brasnu

    No preview · Article · Oct 2013 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
  • C. Badoual · E. Tartour · S. Hans · D. Brasnu · P. Bruneval · P. Ravel

    No preview · Article · Oct 2013 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale

  • No preview · Article · Oct 2013 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
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    ABSTRACT: Malignant tumours of the salivary glands (MSGT) are rare and pleomorphic entities. Patients with advanced disease may benefit from targeted therapy; however, specific targets for optimising and personalising treatments are yet to be identified. Immunohistochemistry for C-KIT, EGFR, HER2, MUC1, phospho-mTOR, androgen/estrogens/progesterone receptors and Ki67 was carried out and evaluated in terms of progression-free and overall survival. High throughput molecular screening of key oncogenes was done in 107 patients using routine diagnostic methods and Sequenom technology. Several therapy leads were identified, including high levels of HER2 and androgen receptors in salivary duct carcinomas, C-KIT in myoepithelial carcinomas and EGFR in mucoepidermoid carcinomas. Recurrent mutations involving downstream elements of the EGFR pathway were found in HRAS, notably in tumours with a myoepithelial component, and in other key oncogenes (KRAS/NRAS/PI3KCA/BRAF/MAP2K). On the other hand, <1% of samples had EGFR or HER2 mutations. Several tumour subtypes overexpressed targets of directed therapies suggesting potential therapy leads. Genotyping results suggest activation downstream of EGFR in 18 of the 107 samples that could be associated with low efficacy of EGFR inhibitors. Other molecules, such as PI3K/MEK or mTOR inhibitors, may have anti-tumour activity in this subgroup. The high mutation rate in HRAS highlights a novel key oncogenic event in MSGT.
    No preview · Article · Aug 2013 · Annals of Oncology
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    ABSTRACT: Introduction: Laryngeal plasmacytosis (LP) is a rare benign lesion of mature polyclonal plasma cells, which should be differentiated from extramedullary plasmacytoma. Case report: Isolated laryngeal plasmacytosis was discovered in a 59-year-old woman, free of symptoms other than chronic hoarseness. Discussion: Histological presentation, treatment modalities and prognosis are discussed. Conclusion: Laryngeal plasmacytosis is a rare benign lesion that must be considered in case of submucosal polyclonal plasma cell infiltrate.
    Preview · Article · Jul 2013 · European Annals of Otorhinolaryngology, Head and Neck Diseases
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    ABSTRACT: To present the preliminary results of the qualiit of life and quality of swallowing in a series of 15 patien! treated with oropharyngectomy by transoral robotic-assisted (CTAR) (robot da Vinci, Intuitive Surgical ). A prospective monocentric non-randomized study of 15 patients with cancer of the oropharynx. Were analyzed: demographics, quality of life questionnaires (QLQ-C30 and H&N 35 EORTC) and quality of swallowing questionnairex (MDADI, DHI and EAT 10) with an average of 1 year after the end of the treatment. Fifteen patients (10 males and 5 females), mean age of 65 years (47-73 years) were included. The tumours were classified as: cT1: 4; cT2: 10 cT3: 1. Five of the 15 patients received postoperative chemoradiotherapy as histo-pathological studies showed multiple metastatic cervical lymph nodes +/- capsular rupture. For the analysis of the quality of life and quality of swallowing, the patients were divided into two groups. Group A included patients who underwent CTARs and group B, patients operated by CTAR with adjuvant chemoradiotherapy. At 12 months of the procedure, all patients had a deglutition considered as normal without feeding tube nor tracheostomy. With the three scales used, the quality of swallowing was satisfactory for all patients. It was better for patients in group A than for patients in group B. In terms of quality of life, the EORTC QLQ-C30 scale showed our patients had a high rate of satisfaction scale in "health and overall quality of life". For the EORTC H&N35 questionnaire, mean scores for "specific symptoms" were also low except for the following three items "dry mouths", "sticky saliva" and "sexuality problem". The first two items were statistically more frequent (p = 0.02 and p = 0.001) in group B patients. After transoral robotic-assisted oropharyngectomy, patients have a good quality of life and swallowing. Postoperative chemoradio-therapy compromises the quality of swallowing. Multicentric studies are required to confirm these preliminary results.
    No preview · Article · Jan 2013 · Revue de laryngologie - otologie - rhinologie

  • No preview · Article · Oct 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale

  • No preview · Article · Oct 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale

  • No preview · Article · Oct 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
  • S. Hans · B. Delas · P. Gorphe · M. Ménard · D. Brasnu
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    ABSTRACT: Les robots ont envahi le monde industriel et récemment médical. En chirurgie, après la mise au point de différents prototypes, Intuitive Surgical® a développé le robot chirurgical Da Vinci. Ce robot conçu pour la chirurgie abdominale s’est imposé en urologie au cours des années 2000. Les avantages de cette chirurgie minimale invasive assistée par robot (CMIR) sont multiples et sont décrits dans l’article. Les inconvénients sont dominés par le prix et l’absence de retour de force. En cancérologie des voies aérodigestives supérieures, les premières études de faisabilité chez des animaux, des mannequins et des cadavres datent de 2005, suivies en 2006 par les premières publications chez des patients. Les premières séries comprenant plus de 20 patients traités par CMIR ont permis de souligner la faisabilité pour les localisations suivantes : oropharynx, larynx supraglottique et hypopharynx. Ces études ne permettent pas de valider la technique de CMIR en terme carcinologique. La CMIR permet de diminuer le nombre de trachéotomies nécessaires, une réhabilitation de la déglutition plus rapide et une durée d’hospitalisation plus courte. Des améliorations techniques sont attendues. Des robots de nouvelle génération de volume plus réduit, plus ergonomiques, et donc plus adaptés aux voies aérodigestives supérieures (VADS) seront probablement disponibles.
    No preview · Article · Feb 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
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    S Hans · B Delas · P Gorphe · M Ménard · D Brasnu
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    ABSTRACT: Robots have invaded industry and, more recently, the field of medicine. Following the development of various prototypes, Intuitive Surgical® has developed the Da Vinci surgical robot. This robot, designed for abdominal surgery, has been widely used in urology since 2000. The many advantages of this transoral robotic surgery (TORS) are described in this article. Its disadvantages are essentially its high cost and the absence of tactile feedback. The first feasibility studies in head and neck cancer, conducted in animals, dummies and cadavers, were performed in 2005, followed by the first publications in patients in 2006. The first series including more than 20 patients treated by TORS demonstrated the feasibility for the following sites: oropharynx, supraglottic larynx and hypopharynx. However, these studies did not validate the oncological results of the TORS technique. TORS decreases the number of tracheotomies, and allows more rapid swallowing rehabilitation and a shorter length of hospital stay. Technical improvements are expected. Smaller, more ergonomic, new generation robots, therefore more adapted to the head and neck, will probably be available in the future.
    Full-text · Article · Dec 2011 · European Annals of Otorhinolaryngology, Head and Neck Diseases

  • No preview · Article · Nov 2011 · Annales de Pathologie
  • M. Ménard · D. Brasnu
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    ABSTRACT: I traumi esterni della laringe sono rari. Essi pongono, a volte, temibili problemi in urgenza a causa dell’alta varietà dei quadri clinici prodotti: acuti, con una dispnea maggiore, o falsamente rassicuranti, ma che si possono scompensare secondariamente. La complessità dei quadri clinici potenziali è ampiamente spiegata dalla molteplicità degli elementi anatomici che attraversano la regione cervicale e che sono all’origine di lesioni associate. Una perfetta conoscenza degli elementi anatomici cervicali, dei meccanismi lesionali e dei segni di richiamo è indispensabile per non misconoscere la diagnosi. La gestione dei traumi esterni della laringe si basa sull’esame clinico con la rinofibroscopia, la TC cervicale e laringea e l’endoscopia, che permettono di stabilire una diagnosi di gravità e di orientare il trattamento. La presenza di una dispnea condiziona il comportamento da tenere in urgenza. Assicurare la pervietà delle vie respiratorie è sempre la priorità. Persistono, tuttavia, alcune controversie riguardo al metodo da preferire. La tracheotomia rimane la tecnica più affidabile in questo contesto, e l’intubazione, quali che siano la tecnica e l’esperienza dell’operatore, deve essere riservata a casi molto selezionati. In effetti, la conservazione della funzione futura della laringe deve essere presa in considerazione fin dallo stadio iniziale nella strategia terapeutica. I traumi minori sono sottoposti a un monitoraggio in ambito ospedaliero, mentre i traumi maggiori necessitano di un trattamento chirurgico, spesso a laringe aperta, talvolta con il posizionamento di una sonda di calibrazione. Lo scopo è quello di ristabilire una struttura laringea di sostegno stabile, più vicina possibile al normale, e di assicurare una buona copertura mucosa. Il trattamento chirurgico deve essere realizzato di preferenza nelle prime 24 h. Solamente un trattamento precoce, completo e adeguato può permettere di migliorare la prognosi funzionale laringea di questi pazienti e di limitare il rischio di postumi, tanto respiratori quanto vocali.
    No preview · Article · Dec 2010
  • M. Ménard · D. Brasnu
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    ABSTRACT: Los traumatismos laríngeos externos son infrecuentes. En ocasiones, plantean problemas urgentes muy graves debido a la gran diversidad de cuadros clínicos posibles, que pueden ser agudos con una disnea intensa o falsamente tranquilizadores pero que pueden descompensarse de forma secundaria. La complejidad de los posibles cuadros clínicos se explica en gran parte por el gran número de elementos anatómicos que atraviesan la región cervical y que son el origen de lesiones asociadas. Es indispensable contar con un conocimiento perfecto de los elementos anatómicos cervicales, de los mecanismos lesionales y de los signos de alerta para no pasar por alto el diagnóstico. El tratamiento de los traumatismos laríngeos externos se basa en la exploración física con la nasofibroendoscopia, la tomografía computarizada (TC) cervical y laríngea, así como la endoscopia, que permiten establecer un diagnóstico de gravedad y orientar el tratamiento. La existencia de disnea condiciona la conducta práctica de urgencia. La prioridad consiste siempre en asegurar la permeabilidad de las vías respiratorias, aunque existen controversias sobre el método de elección. La traqueotomía sigue siendo la técnica más fiable en este contexto; la intubación, con independencia de la técnica y la experiencia del médico, debe reservarse a casos muy seleccionados. La conservación funcional de la laringe debe tenerse en cuenta desde el estadio inicial en la estrategia terapéutica. Los traumatismos leves requieren una vigilancia en un medio hospitalario, mientras que los traumatismos graves necesitan un tratamiento quirúrgico, a menudo con abertura de la laringe y a veces con colocación de una endoprótesis. El objetivo consiste en restablecer un esqueleto laríngeo estable y lo más parecido a lo normal, así como asegurar una buena cobertura mucosa. El tratamiento quirúrgico debe realizarse preferentemente en un medio hospitalario en las primeras 24 horas. Sólo un tratamiento precoz, completo y adecuado permite mejorar el pronóstico funcional laríngeo de estos pacientes y limitar el riesgo de secuelas, tanto respiratorias como vocales.
    No preview · Article · Dec 2010
  • S. Hans · D. Brasnu

    No preview · Article · Jan 2010
  • M. Ménard · D. Brasnu

    No preview · Article · Jan 2010
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    ABSTRACT: Objective To assess the incidence of permanent recurrent laryngeal nerve paralysis and permanent hypoparathyroidism after central neck lymph node compartment (level VI) reoperation.
    No preview · Article · Apr 2009 · Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
  • H Mirghani · A Francois · G Landry · S Hans · M Menard · D Brasnu
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    ABSTRACT: To assess the incidence of permanent recurrent laryngeal nerve paralysis and permanent hypoparathyroidism after central neck lymph node compartment (level VI) reoperation. Retrospective study including 18 patients who had undergone reoperative central compartment dissection between 1999 and 2008 for recurrent thyroid carcinoma or lymph node metastasis. All patients had been previously treated by total thyroidectomy for a thyroid cancer in another institution. Twenty-two central neck compartment reoperations were performed. Four patients needed a second reoperation for carcinoma recurrence. All patients had histologic evidence of metastatic lymph nodes or recurrent thyroid carcinoma. Two patients developed permanent hypoparathyroidism and four patients had postoperative permanent recurrent laryngeal nerve paralysis. All of them had normal preoperative parathyroid and laryngeal function. In three cases, the recurrent laryngeal nerve disorder was intentionally resected for oncologic reasons. The fourth case occurred in a patient who needed a second reoperation with a sternotomy and mediastinal dissection. A central lymph node compartment reoperation can be performed with minimal morbidity when the recurrent laryngeal nerve is not invaded: 5.2% resulted in permanent recurrent laryngeal nerve paralysis and 9% in permanent hypoparathyroidism. Careful identification and exposure of the inferior laryngeal nerve in a previously non dissected area is recommended.
    No preview · Article · Apr 2009 · Annales d Otolaryngologie et de Chirurgie Cervico-Faciale

Publication Stats

2k Citations
168.42 Total Impact Points

Institutions

  • 2001-2013
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • • Service d’Anatomie-Pathologie
      • • Service d’ORL et Chirurgie Cervico-Faciale
      Lutetia Parisorum, Île-de-France, France
  • 1988-2013
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2005
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 1987-2002
    • Centre Hospitalier Sainte Anne
      Lutetia Parisorum, Île-de-France, France
  • 1996-1999
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Greenwich Hospital, Connecticut
      Гринвич, Connecticut, United States
  • 1998
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 1995
    • Centre hospitalier Laennec de Creil
      Creil, Picardie, France
  • 1989-1995
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 1994
    • Institut de Cancérologie Gustave Roussy
      Villejuif, Île-de-France, France