Ectopic pyriform sinus parathyroid adenoma.

OBJECTIVE: To describe the diagnosis and treatment of ectopic pyriform sinus parathyroid adenoma. MATERIAL AND METHODS: A 44-year-old woman presented with persistent primary hyperparathyroidism after previous failed cervical exploratory surgery. RESULTS: Diagnosis of ectopic pyriform sinus parathyroid adenoma was suggested by computed tomography and technetium-99m sestamibi scintigraphy (99mTc-MIBI SPECT/CT). A submucosal tumor was identified under laryngoscopy and resected by endoscopic CO2 laser. Histopathology confirmed the diagnosis of parathyroid adenoma. CONCLUSIONS: Ectopic pyriform sinus locations are rare in parathyroid adenoma. 99mTc-MIBI SPECT/CT facilitates diagnosis, especially in case of previous failed neck exploration. Endoscopic CO2 laser resection is the treatment of choice.

Laryngeal chondrosarcoma: report of two cases.

OBJECTIVE: The present study describes the clinical, radiological and histological features of laryngeal chondrosarcoma, on the basis of two clinical cases, and discusses management. CASE STUDIES: Two male patients, aged 63 and 51 years, presented with low-grade chondrosarcoma revealed respectively by a mass in the lateral neck and by laryngeal dyspnea. CT showed a tumoral process with calcification, developed from the thyroid and cricoid cartilage, respectively. The first patient underwent partial and the second total laryngectomy. DISCUSSION: Chondrosarcoma is diagnosed on the basis of combined clinical, radiological and histological signs. Differential diagnosis with chondroma may be difficult, especially in grade-1 chondrosarcoma. CONCLUSION: Laryngeal chondrosarcoma is a rare tumor. Management is basically surgical. Prognosis is generally good, depending essentially on histologic grade.

Head and neck free-flap reconstruction in the elderly.

OBJECTIVE: To evaluate the reliability of free-flap head and neck reconstruction in the elderly. MATERIAL AND METHODS: All patients who underwent free-flap head and neck reconstruction in our institution between 2000 and 2010 were included in this retrospective study. In all, 418 patients (301 men and 117 women) were enrolled, including 95 patients aged 70 years or older (mean age=60.2±11.6 years). The impact of age on free-flap failure and local and general complication rates was assessed on univariate and multivariate analysis. RESULTS: Advanced age had no impact on free-flap failure and local complications rate but was correlated with a higher risk of general complications (multivariate analysis: P=0.007). A high level of comorbidity also had a significant impact on the general complications rate (multivariate analysis: P=0.001). Patients who underwent circular total pharyngolaryngectomy showed elevated risk of free-flap failure (P=0.005) and local complications (P=0.001) on multivariate analysis. CONCLUSION: Free-flap reconstruction of the head and neck is safe and reliable in the elderly. Nevertheless, meticulous patient selection, mainly based on the level of comorbidity, is necessary.

[Total pharyngolaryngectomy in the 21st century: indications, oncologic and functional outcomes]. / Les pharyngo-laryngectomies totales au 21ème siècle : indications, résultats carcinologiques et fonctionnels.

INTRODUCTION: The development of laryngeal preservation protocols has considerably modified the indications for total (pharyngo-)laryngectomy (TPL). The objectives of our study are to analyze the current indications for TPL and to evaluate the oncologic and functional outcomes after TPL and their predictive factors. METHODS: All patients who underwent TPL for squamous cell carcinoma of the larynx or hypopharynx, at our institution, between 2000 and 2009, were included in this retrospective study. Predictive factors of oncologic and functional outcomes were assessed in univariate and multivariate analyzes. RESULTS: A total of 130 patients were enrolled in our study including 119 men and 11 women, with a mean age of 65.9 years. TPL was realized for salvage in 65 patients. Extra-laryngeal tumor extension (n = 42) was the main indication for TPL in the 65 remaining patients. Overall survival was 49 and 41% at 3 and 5 years respectively. In multivariate analysis, primary tumor site (hypopharynx in comparison to larynx; p = 0.04) has a significant pejorative impact on overall survival. Oral alimentation (no enteral nutrition) was recovered successfully by 94% of the patients. In multivariate analysis, primary tumor site (hypopharynx) has a significant pejorative impact on functional results (deglutition: p < 0.0001; phonation: p = 0.03). CONCLUSION: Primary tumor site is one of the main predictive factor of oncologic and functional outcomes after TPL.

[Immune competence before and after curative radiotherapy in breast cancer (author's transl)]. / Bilan immunitaire avant et après radiothérapie curative de malades porteuses de cancer du sein.

The level of non-specific immune response was evaluated in 409 operable breast cancer patients by a battery of classical tests performed at least before and after treatment. We propose a synthetic classification of the various tests into 5 categories (from I 1 to I 5) of growing pejorative weight for a rapid and better understanding between the laboratory and the clinicians and also for overall comparison in time. With this type of evaluation the percentage of patients exhibiting depressed immune response was 14 per cent initially and rose to 39 per cent at the end of irradiation. Six months later, however, only 3 per cent of the patients had an immune assessment lower than the initial level. The pronounced immune depression observed by other authors concerned mainly patients having undergone post-operative irradiation after removal of the breast. The curative treatments used here in the hope of avoiding radical breast surgery was performed under much different ballistic, biological and psychological conditions which should be taken into account before condemning the dangers of this method.

[Cardiovascular effect of various morphine-line analgesics in rabbits anesthetized with thiopental or alphadione (Alfatesine)]. / Effets cardiovasculaires de divers analgésiques morphinomimétiques chez le lapin anesthésié à l'aide de thiopental ou d'alphadione (Alfatésine)

Alphadione (Alfatésine, Althesin, CT 1341), a steroid anaesthetic with a quick and short action, has but a very moderate analgesic activity, so it is necessary in human anaesthesian, to associate with it a morphinic analgesis systematically. Therefore it was interesting to study the response of cardiovascular system when using this type of association. Our results show that the cardiovascular depressive effects of morphinic analgesics, when they exist, are not increased by the presence of alphadione.

[Variations in the activity of various curarizing substances as a function of the time of administration]. / Variations de l'activité de diverses substances curarisantes en fonction de l'heure d'administration

This experiment was carried out upon the male-adulte-AF SPF-Wister Rat, anesthetized by the use of pentobarbital-Na at the only dosage of 40 mg/kg/IP and put under artificial ventilation. The animals were divided into two groups: Group I, "diurnal animals" curarized between 10 a.m and 4 p.m; Group 2, "nocturnal animals" curarized between 9 and 12 p.m. Four drugs of the curarimimetic (pachycurare, non-depolarizing) type: gallamine, D-tubocurarine, pancuronium and AH-8165 were studied at doses presenting the same activity. The total curarizing effect measured by the surface defined by the curve of curarization within ten mns was constantly and significantly lowered in "nocturnal animals": a 25 p. 100 diminution with gallamine, 20 p. 100 diminution with D-tubocurarine, 27 p. 100 diminution with pancuronium, 19 p. 100 diminution with AH-8165. The hypothesis is that this diminution in the action of curarizing substances may be, to a great extent, in keeping with the rise of their metabolism -- the hepatic enzymatic activity being, in the rat, a nocturnal animal, definitely increased during the night.