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2.
Respir Med Res ; 77: 11-17, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927479

RESUMO

BACKGROUND: End-of-life (EOL) communication is crucial, particularly for cancer patients. While advanced care planning is still uncommon, we sought to investigate its impact on care intensity in case of organ failure in lung cancer patients. METHODS: We prospectively included consecutive lung cancer patients hospitalised at the Grenoble University Hospital, France, between January 1, 2014 and March 31, 2016. Patients could be admitted several times and benefited from advanced care planning based on three care intensities: intensive care, maximal medical care, and exclusive palliative care. Patients' wishes were addressed. RESULTS: Data of 739 hospitalisations concerning 482 patients were studied. During the three first admissions, 173 (25%) patients developed organ failure, with intensive care proposed to 56 (32%), maximal medical care to 104 (60%), and exclusive palliative care to 13 (8%). Median time to organ failure was 9 days [IQR 25%-75%: 3-13]. All patients benefited from care intensity that was either equal to or lower than the care proposed. Specific wishes were recorded for 158 (91%) patients, with a discussion about EOL conditions held in 116 (73%). CONCLUSIONS: In case of organ failure, advanced care planning helps provide reasonable care intensity. The role of the patient's wishes as to the proposed care must be further investigated. CLINICAL TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with the identifier NCT02852629.


Assuntos
Planejamento Antecipado de Cuidados , Neoplasias Pulmonares/terapia , Planejamento Antecipado de Cuidados/organização & administração , Planejamento Antecipado de Cuidados/normas , Idoso , Atitude Frente a Morte , Comunicação , Cuidados Críticos/organização & administração , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Feminino , França/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/organização & administração , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Relações Médico-Paciente , Estudos Prospectivos , Assistência Terminal/organização & administração , Assistência Terminal/normas , Assistência Terminal/estatística & dados numéricos
3.
Rev Mal Respir ; 36(9): 1064-1068, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31611026

RESUMO

INTRODUCTION: Immune-checkpoint inhibitors have been approved for first and second line treatments of metastatic non-small cell lung cancer based on the results of several phase III trials. Patients with organ transplantation were excluded from these studies because checkpoint inhibitors could activate allo-reactive T cells leading to acute graft rejection. CASE REPORT: A 71-year-old Caucasian-male was diagnosed with stage IV pulmonary adenocarcinoma with multiple metastases, without molecular alteration and negative PD-L1 status. He had a left kidney transplant, and his immunosuppressive regimen consisted of sirolimus and mycophenolate mofetil. After failure of two therapeutic lines (carboplatin-paclitaxel and erlotinib) a multidisciplinary oncology meeting with the nephrologist started third line treatment with nivolumab 3mg/kg every 15 days, with no modification of the immunosuppressive treatment. The patient received a total of 14 injections of nivolumab with stable disease but treatment was discontinued due to acute rejection of the transplanted kidney 6 months later, without need for dialysis. The patient died of a chylothorax related to progression of the tumour 12 months after initiation of nivolumab. CONCLUSION: Immune checkpoint inhibitors are a potential treatment for solid organ transplant patients despite the risk of graft rejection.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos Imunológicos/administração & dosagem , Imunossupressores/administração & dosagem , Transplante de Rim , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Idoso , Quimioterapia Combinada , Evolução Fatal , Humanos , Masculino
4.
Rev Stomatol Chir Maxillofac ; 104(1): 10-7, 2003 Feb.
Artigo em Francês | MEDLINE | ID: mdl-12644785

RESUMO

OBJECTIVE: The aim of the study was to assess the results of curative treatment of patients with squamous cell carcinoma of the tongue and to evaluate survival and predictive factors of recurrence. PATIENTS AND METHODS: A series of 309 patients with squamous cell carcinoma of the tongue treated with curative intent was studied from January 1988 to December 1999. The percentage of oral tongue cancer was 82.2 and the percentage of cancer of base of the tongue was 17.8. Most patients underwent surgical procedure alone or combined with radiotherapy (92%). We performed 252 neck dissections. Bilateral dissections were performed for cancer of the apex linguae, cancer of the base of the tongue, for patients with N2c neck disease and whenever the primary tumor site crossed the median line. Twenty-five patients (8%) were treated with radiation therapy alone. Mean follow-up was 55 months. The functional results were assessed within a minimum of 10 months postoperative follow-up. RESULTS: In 45.2%, there was histological evidence of node invasion with 53.5% of extracapsular node spread in the neck specimens. Extracapsular node spread did not influence survival or recurrences. Occult cervical metastasis in an elective neck dissection in clinically negative necks was found in about 20% of patients with 47% of extracapsular node spread (41% for cancer of mobile tongue and 80% for those of base of the tongue). About 23% of patients with cancer of base of the tongue staged N0 had histological node invasion in controlateral neck nodes. The postoperative mortality rate was 0.9%. The rate of complications was 17%. The cancer recurred in 41.7% of all cases. Twelve percent of all patients had second primary cancers of the upper aerodigestive tract. The overall survival and non-recurrence rates at 2 and 5 years were higher in cancer of oral tongue than in cancer of base of the tongue. Survival rates were better when neck nodes were clinically or histologically negatives and in early-stage carcinomas. Non-recurrence rates were better when nodes were clinically or histologically negatives and when margins of exeresis were not involved. The functional results were better in oral tongue cancer than in base of the tongue cancer. DISCUSSION: Prognosis (survival and non-recurrence rates and functional results) of squamous cell carcinomas of oral tongue was better than prognosis of those of base of tongue. We recommend an aggressive surgical procedure even in patients with neck classed N0 (with reservations for T1 lesions with small depth of invasion): an ipsilateral supraomohyoid neck dissection for cancer of oral tongue and a bilateral supraomohyoid neck dissection for cancer of base of the tongue, cancer of oral tongue which crosses the median line of the oral cavity and cancer of the apex linguae. Postoperative radiotherapy must be performed when margins are positives and/or when nodes are involved with or without extracapsular spread.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias da Língua/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Seguimentos , Previsões , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Prognóstico , Radioterapia Adjuvante , Taxa de Sobrevida , Neoplasias da Língua/patologia , Resultado do Tratamento
5.
Br J Oral Maxillofac Surg ; 40(4): 307-12, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12175831

RESUMO

The principle of mandibular reconstruction by dynamic bridging plates in association with a bone graft is based on the double bridge reconstruction method. However, the plate can be used alone. Our aim was to report the long-term results of this treatment for mandibular lateral defects in fragile patients. From 1993 to 1999, 38 consecutive patients had primary reconstructions with bridging plate for lateral mandibular defects. Their mean age was 58.4 years (26-86) and the mean follow-up was 50 months (6-89). Excluding removal of plates for local recurrences, the overall success rate was 78%. Plates were removed after a mean of 20.4 months (1-66). No plates fractured. Dynamic bridging plates allow an immediate and efficient reconstruction with reduced operating time and compare favourably with conventional plates. They can also be used as a stand-by for patients who are to have a delayed free flap reconstruction.


Assuntos
Placas Ósseas , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Implante de Prótese Mandibular/instrumentação , Prótese Mandibular , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/cirurgia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Sarcoma/cirurgia , Análise de Sobrevida , Resultado do Tratamento
6.
Arch Otolaryngol Head Neck Surg ; 127(7): 794-7, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11448352

RESUMO

OBJECTIVES: To present 8 new cases of primary intraosseous carcinoma of the jaws and to review the literature for an analysis of treatment modalities and patient outcomes. DATA SOURCES: A MEDLINE search from 1970 to 1999. The articles chosen and the study of the references of every one that produced additional articles provided database information for 28 patients. Eight new patients from our institutions were added. STUDY SELECTION: Our criteria of inclusion included the absence of ulceration of the oral mucosa, a negative result in the search for a distant primary tumor, and convincing histological documentation. DATA EXTRACTION: The variables of the analysis included age, sex, site of the tumor, condition of the oral mucosa, tumor size, neck status, treatment modalities, recurrences, and survival. DATA SYNTHESIS: Twenty-eight patients were identified in the literature, for a total of 36 patients. There were 28 males (78%) and 8 females (22%) ranging in age from 4 to 76 years (mean, 54 years). The tumor site was the mandible in 33 patients (92%) and the maxilla in 3 (8%). Of the 34 patients treated, 19 (56%) had recurrences. Overall 2- and 4-year survival was 60.5% and 39.9%, respectively. Patients who underwent radical surgery and postoperative radiotherapy (n = 11) had a 2- and 3-year survival probability of 61.3% and 40.9%, respectively, whereas in the remaining patients (n = 25), the rates were 59.7% and 31.3%, respectively (P =.60). CONCLUSIONS: Strict diagnostic criteria must be applied. The prognosis associated with primary intraosseous carcinoma of the jaws is poor and suggests the need for aggressive treatment.


Assuntos
Neoplasias Maxilomandibulares/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Neoplasias Maxilomandibulares/mortalidade , Neoplasias Maxilomandibulares/patologia , Neoplasias Maxilomandibulares/radioterapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Taxa de Sobrevida
8.
J Craniomaxillofac Surg ; 28(6): 331-5, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11465139

RESUMO

BACKGROUND: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. PURPOSE: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. MATERIAL: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. METHODS: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. RESULTS: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. CONCLUSION: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Gengivais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Excisão de Linfonodo , Masculino , Neoplasias Mandibulares/cirurgia , Neoplasias Maxilares/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/prevenção & controle , Osteotomia/métodos , Radiografia Panorâmica , Radioterapia Adjuvante , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatística como Assunto , Retalhos Cirúrgicos , Taxa de Sobrevida , Resultado do Tratamento
9.
Am J Surg ; 178(1): 73-7, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10456709

RESUMO

BACKGROUND: In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure. METHODS: The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure. RESULTS: For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%. CONCLUSIONS: SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Esvaziamento Cervical/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/radioterapia , Pescoço/patologia , Recidiva Local de Neoplasia , Radioterapia Adjuvante , Análise de Sobrevida , Resultado do Tratamento
10.
Bull Cancer ; 86(6): 550-72, 1999 Jun.
Artigo em Francês | MEDLINE | ID: mdl-10417429

RESUMO

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the management of squamous carcinoma of the oropharynx. METHODS: Data have been identified by literature search using Medline (1991-1998) and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for squamous cell carcinoma of the oropharynx management are that: 1) diagnosis and initial assessment should be based on appropriate clinical and radiological findings; 2) the therapeutic strategy is based on surgery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, the recommended strategy involved the use of one of these modality; 4) a multimodality approach is recommended for the treatment of extended resectable tumours. Following results of recent meta-analyses, use of neo-adjuvant chemotherapy is not recommended. The same studies have shown that association of chemotherapy and radiotherapy either in sequence or in combination significantly improve survival of extended curable tumours. These associations are recommended within the framework of clinical trials; 5) follow-up of squamous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months during the first year, every six months during the second year and then every year. An annual chest x-ray is recommended. Other investigations should be performed as indicated by symptoms and clinical manifestations.


Assuntos
Carcinoma de Células Escamosas/terapia , Neoplasias Orofaríngeas/terapia , Humanos
11.
Ann Chir Plast Esthet ; 43(3): 234-9, 1998 Jun.
Artigo em Francês | MEDLINE | ID: mdl-9768065

RESUMO

Fibrous dysplasia accounts for approximately 2% of bone tumors. The ribs, proximal femurs and cranio-facial bones represent the majority of bone lesions. Surgery is the mainstay of treatment but the technique is controversial: conservative surgery or removal of dysplastic lesions followed by implantation of autogenous bone graft. The aim of this study was to assess the indications of each method. The medical records of 25 patients with fibrous dysplasia of the cranio-facial bones treated between January 1, 1980 and December 31, 1994 at the Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Bordeaux, France, were reviewed. Fourteen (56%) patients were women and 11 (44%) men. The median age at the time of diagnosis was 23 years (ranging from 8 to 56 years). The mean follow-up was 8 years. Two patients were unavailable for follow-up after treatment. The primary sites of the tumors were the mandible (n = 19 [76%]), maxilla (n = 1 [4%]) and skull (n = 5 [20%]). For mandibular lesions, the primary treatment always included a correction of deformations and asymmetry, which was the only treatment in 14 cases. Two patients required subsequent surgery to reduce further bone enlargement (1 and 2 years later in the first case and 11 years later in the second) without further problems. In 3 cases a segmental mandibulectomy followed by implantation of autogenous bone graft was required, and no further recurrence was observed. Therefore, the success rate of conservative surgery was 74% initially, and up to 86% after subsequent surgery. Skull lesions, although often very extensive, were remarkably stable and asymptomatic. They were successfully treated 4 times by conservative surgery, mainly for cosmetic reasons. One patient, with an ethmoidal tumor producing a mass effect along the course of the optic nerve, underwent a combined cranio-facial resection. As for the only maxillary tumor, three curettages were performed throughout an 11-year period and there was no evidence of further recurrence 4 years after the last intervention. In all cases, conservative surgery may be recommended as primary treatment of fibrous of the craniofacial bones, providing essential structures like the optic nerve are not at risk. Cosmetic results and local control proved excellent, and a further removal of the tumor remained feasible in the event of a recurrence. Success or failure did not correlate with tumor size, which justifies the use of this technique.


Assuntos
Displasia Fibrosa Óssea/cirurgia , Crânio/patologia , Crânio/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Ann Chir Plast Esthet ; 43(2): 132-40, 1998 Apr.
Artigo em Francês | MEDLINE | ID: mdl-9768079

RESUMO

Our large experience of shotgun injuries to the face emphasizes the need for a reappraisal of primary treatment for this poorly documented topic. The medical records of 165 patients, treated at our institution between january 1st, 1982 and december, 31st 1996 for such an injury, were reviewed. Almost all cases were exclusively self-inflicted lesions. The guns were mainly twelve-gauge and occasionally 16 or 20-gauge. Close range wounds in an heterogeneous area--soft-tissue, mandible, muscles of the tongue and floor of the mouth, oral and nasal cavities, maxilla and paranasal sinuses--caused massive damage. A topographic classification based on the soft-tissue and bone loss is reported. After initial management (including securing the airway and control of bleeding), conservative debridement of all devitalized tissues and stabilization of the fractures were performed. As soon as possible, bone and soft tissue reconstruction was undertaken using local or distant flaps. However, immediate definitive reconstructive procedures were scarcely [corrected] used and only in particular cases. We believe that a carefully planned reconstruction schedule is required to achieve satisfactory appearance and function.


Assuntos
Traumatismos Faciais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ferimentos por Arma de Fogo/cirurgia , Traumatismos Faciais/classificação , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos por Arma de Fogo/classificação
13.
Rev Stomatol Chir Maxillofac ; 98(6): 336-8, 1998 Feb.
Artigo em Francês | MEDLINE | ID: mdl-9533238

RESUMO

Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.


Assuntos
Adenoma Pleomorfo/cirurgia , Neoplasias Parotídeas/cirurgia , Análise Atuarial , Adenoma Pleomorfo/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Carcinoma/cirurgia , Paralisia Facial/etiologia , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Doenças Linfáticas/patologia , Doenças Linfáticas/cirurgia , Linfoma/patologia , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/cirurgia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Parotidite/patologia , Parotidite/cirurgia , Complicações Pós-Operatórias , Transtornos de Sensação/etiologia , Análise de Sobrevida , Sudorese Gustativa/etiologia
14.
Rev Stomatol Chir Maxillofac ; 98(3): 138-42, 1997 Sep.
Artigo em Francês | MEDLINE | ID: mdl-9340723

RESUMO

Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.


Assuntos
Nervo Acessório/fisiopatologia , Neoplasias de Cabeça e Pescoço/cirurgia , Excisão de Linfonodo , Esvaziamento Cervical , Nervo Acessório/anatomia & histologia , Nervo Acessório/cirurgia , Traumatismos do Nervo Acessório , Doenças dos Nervos Cranianos/etiologia , Dissecação , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/classificação , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Músculos do Pescoço/inervação , Músculos do Pescoço/cirurgia , Cervicalgia/etiologia , Dor/etiologia , Exame Físico , Escápula/inervação , Escápula/fisiopatologia , Ombro/inervação , Ombro/fisiopatologia , Inquéritos e Questionários
16.
Ann Chir Plast Esthet ; 42(3): 223-7, 1997 Jun.
Artigo em Francês | MEDLINE | ID: mdl-9768159

RESUMO

Marginal mandibulectomies are now widely performed in the anterior aspect of the mandible providing that the preoperative clinical and radiologic evaluation shows no bone invasion. These marginal resections can be extended to the posterior area. Molar, retromolar and ascending ramus resections can be performed. This removes the upper bone segment preserving the dental canal whenever possible. From 1990, 14 patients were treated with this technique for carcinoma of the retromolar triangle (9 cases) and oropharynx (5 cases). 11 different flaps were used to cover the soft tissue defect and 3 direct sutures were performed. Eleven patients underwent postoperative radiotherapy with a mean dose of 58 Gray. Median follow-up was 32 months. Functional and cosmetic results were very satisfactory due to preservation of mandibular continuity. We found no osteomyelitis, postoperative fracture or radionecrosis. This technique avoids a segmental resection in some well-defined cases and the disability produced as a result of this treatment. There is therefore, no need for complex reconstruction and the operating time is shortened in fragile patients.


Assuntos
Neoplasias Mandibulares/cirurgia , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Retalhos Cirúrgicos
17.
Arch Otolaryngol Head Neck Surg ; 123(2): 145-8, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9046280

RESUMO

BACKGROUND: Cervical node involvement is the most significant prognostic factor in head and neck squamous cell carcinoma. When histologic findings show node invasion, the number of positive nodes and the presence of extracapsular spread are commonly accepted as prognostic factors. OBJECTIVE: To confirm the findings of recent reports that there is no significant difference in outcome associated with extracapsular spread. SETTING: Referral center. DESIGN: Retrospective study. PATIENTS: Three hundred thirty-seven patients under-going 487 neck dissections for carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx from January 1, 1985, to December 31, 1992. For N3 node involvement, a radical neck dissection was performed; other patients underwent supraomohyoid or functional neck dissection. Two hundred forty-two patients underwent postoperative radiotherapy (mean dose, 59 Gy). OUTCOME MEASURES: Survival capabilities calculated by the Kaplan-Meier method and significance calculated by the log rank test. RESULTS: Overall 5-year survival was 50.8%. The study of prognostic factors showed no significance for extracapsular spread (P = 45). Conversely, the number of positive nodes had a significant value (P < .001). CONCLUSIONS: Extracapsular node spread per se might be considered as no longer having a definitive prognostic value. These results, consistent with those of previous reports, may be due to wider use of combined treatment modalities.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Esvaziamento Cervical , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida
18.
Rev Stomatol Chir Maxillofac ; 97(4): 225-8, 1996.
Artigo em Francês | MEDLINE | ID: mdl-8927929

RESUMO

Carcinoma of the oral cavity in patients less than thirty years of age is quite uncommon. Moreover, the usual tobacco and alcohol exposure is not found in these patients. We reviewed retrospectively the medical files of 7 patients with squamous cell carcinoma of the oral cavity treated between 1980 and 1993. Six patients were male. Mean age was 26 years. The primary site was staged T1 in 2 patients, T2 in 3 patients, T3 in 1 patient and T4 in 1 patient. The results of treatment suggest that there is no difference in control rate between this group and older patients. It is difficult to draw conclusions from most of published reports because studies often include patients up to fourty years of age and tumors of various anatomic sites. Young age and alcohol and tobacco exposure do not appear significant factors of prognosis.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Bucais/patologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Neoplasias Bucais/radioterapia , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Fumar , Taxa de Sobrevida , Neoplasias da Língua/patologia , Neoplasias da Língua/radioterapia , Neoplasias da Língua/cirurgia , Resultado do Tratamento
19.
Arch Otolaryngol Head Neck Surg ; 121(9): 994-6, 1995 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7646869

RESUMO

OBJECTIVE: To evaluate treatment of ameloblastoma of the jaws and suggest a more aggressive approach for well-defined cases. SETTING: Referral center. PATIENTS: Forty-one patients were treated for ameloblastoma of the jaws. RESULTS: Seventeen patients had a local recurrence; 14 had initial curettage and three had initial resection. Seven patients had two or more recurrences. Eight patients underwent radiotherapy; two died of progressive disease. CONCLUSIONS: Ameloblastoma had a high rate of local recurrence if not adequately removed. Segmental resection for the mandible and partial maxillectomy for the maxilla should be the primary treatment; marginal resection is appropriate only for small primary tumors. For multiple recurrences, radiotherapy is effective, and surgery and radiotherapy (50 Gy postoperatively) should be used in selected cases.


Assuntos
Ameloblastoma/terapia , Neoplasias Maxilomandibulares/terapia , Adolescente , Adulto , Idoso , Ameloblastoma/radioterapia , Ameloblastoma/cirurgia , Quimioterapia Adjuvante , Criança , Feminino , Humanos , Neoplasias Maxilomandibulares/radioterapia , Neoplasias Maxilomandibulares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do Tratamento
20.
Ann Chir Plast Esthet ; 40(4): 358-62, 1995 Aug.
Artigo em Francês | MEDLINE | ID: mdl-8561448

RESUMO

The aim of the study was to assess the results of segmental mandibular resections and the validity of mandibular reconstructions. The medical records of 95 patients treated between January 1, 1987 and December 31, 1992 were reviewed. There were 82 (86%) carcinomas, 9 ameloblastomas and 4 sarcomas. Among the 82 patients treated for carcinoma, the overall 2- and 5-year survival rates were 70% and 33% respectively. The functional results evaluated one year after surgery showed no significant difference according to the reconstruction procedure: myocutaneous flap, osteomyocutaneous flap, titanium mandibular reconstruction plate or microsurgical transfer. The most important factor in functional rehabilitation is the amount of soft tissue resected. In head and neck oncology, aggressive surgical reconstruction of the mandible must only be used in patients with good general status and fair survival probability.


Assuntos
Neoplasias Mandibulares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ameloblastoma/cirurgia , Placas Ósseas , Transplante Ósseo/métodos , Carcinoma/cirurgia , Estética , Feminino , Humanos , Masculino , Neoplasias Mandibulares/patologia , Pessoa de Meia-Idade , Sarcoma/cirurgia , Retalhos Cirúrgicos , Taxa de Sobrevida
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