Friedrich G.,Medical University of Graz |
Dikkers F.G.,University of Groningen |
Arens C.,Otto Von Guericke University of Magdeburg |
Remacle M.,Leuven University Hospital of Mont Godinne |
And 6 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2013
Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken. © 2013 Springer-Verlag Berlin Heidelberg.
Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): An open-label phase 3 randomised trial
Bourhis J.,Institute Gustave Roussy |
Sire C.,Center Hospitalier Of Lorient |
Graff P.,Center Alexis Vautrin |
Gregoire V.,Catholic University of Louvain |
And 24 more authors.
The Lancet Oncology | Year: 2012
Background: Concomitant chemoradiotherapy and accelerated radiotherapy independently improve outcomes for patients with locally advanced head and neck squamous-cell carcinoma (HNSCC). We aimed to assess the efficacy and safety of a combination of these approaches. Methods: In our open-label phase 3 randomised trial, we enrolled patients with locally advanced, stage III and IV (non-metastatic) HNSCC and an Eastern Cooperative Oncology Group performance status of 0-2. We randomly allocated patients centrally with a computer program (with centre, T stage, N stage, and localisation as minimisation factors) in a 1:1:1 ratio to receive conventional chemoradiotherapy (70 Gy in 7 weeks plus three cycles of 4 days' concomitant carboplatin-fluorouracil), accelerated radiotherapy-chemotherapy (70 Gy in 6 weeks plus two cycles of 5 days' concomitant carboplatin-fluorouracil), or very accelerated radiotherapy alone (64·8 Gy [1·8 Gy twice daily] in 3·5 weeks). The primary endpoint, progression-free survival (PFS), was assessed in all enrolled patients. This trial is completed. The trial is registered with ClinicalTrials.gov, number NCT00828386. Findings: Between Feb 29, 2000, and May 9, 2007, we randomly allocated 279 patients to receive conventional chemoradiotherapy, 280 to accelerated radiotherapy-chemotherapy, and 281 to very accelerated radiotherapy. Median follow-up was 5·2 years (IQR 4·9-6·2); rates of chemotherapy and radiotherapy compliance were good in all groups. Accelerated radiotherapy-chemotherapy offered no PFS benefit compared with conventional chemoradiotherapy (HR 1·02, 95% CI 0·84-1·23; p=0·88) or very accelerated radiotherapy (0·83, 0·69-1·01; p=0·060); conventional chemoradiotherapy improved PFS compared with very accelerated radiotherapy (0·82, 0·67-0·99; p=0·041). 3-year PFS was 37·6% (95% CI 32·1-43·4) after conventional chemoradiotherapy, 34·1% (28·7-39·8) after accelerated radiotherapy-chemotherapy, and 32·2% (27·0-37·9) after very accelerated radiotherapy. More patients in the very accelerated radiotherapy group had RTOG grade 3-4 acute mucosal toxicity (226 [84%] of 268 patients) compared with accelerated radiotherapy-chemotherapy (205 [76%] of 271 patients) or conventional chemoradiotherapy (180 [69%] of 262; p=0·0001). 158 (60%) of 265 patients in the conventional chemoradiotherapy group, 176 (64%) of 276 patients in the accelerated radiotherapy-chemotherapy group, and 190 (70%) of 272 patients in the very accelerated radiotherapy group were intubated with feeding tubes during treatment (p=0·045). Interpretation: Chemotherapy has a substantial treatment effect given concomitantly with radiotherapy and acceleration of radiotherapy cannot compensate for the absence of chemotherapy. We noted the most favourable outcomes for conventional chemoradiotherapy, suggesting that acceleration of radiotherapy is probably not beneficial in concomitant chemoradiotherapy schedules. Funding: French Ministry of Health. © 2012 Elsevier Ltd.
Caron P.,Center Hospitalier University Larrey |
Broussaud S.,Center Hospitalier University Larrey |
Bertherat J.,University of Paris Descartes |
Borson-Chazot F.,Federation dEndocrinologie et des Maladies de la Nutrition |
And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010
Context: Few data are available on pregnancy outcomes in women with acromegaly. Study Design: This was a retrospective multicenter study. Patients: The study included 46 women with GH-secreting pituitary microadenomas (n = 7) or macroadenomas (n = 39). Their mean age was 31.7 yr (±4.5 yr). Incomplete transsphenoidal surgical resection (n = 39) and pituitary radiation (n = 14) had been performed, respectively, 2.9 ± 2.6 and 7.3 ± 4.2 yr before pregnancy. The patients were receiving dopamine agonists (n = 25) and/or somatostatin analogs (n = 14), and GH/IGF-I hypersecretion was controlled and uncontrolled in, respectively, 23 and 34 cases. Five pregnancies followed the fertility treatment. Results: Fifty-nine pregnancies resulted in 64 healthy babies. Gestational diabetes and gravid hypertension occurred in four (6.8%) and eight (13.6%) pregnancies, respectively, and both were more frequent when GH/IGF-I hypersecretion was not controlled before pregnancy. Visual field defects were diagnosed during pregnancy in four women, three of whom were diagnosed with acromegaly during the pregnancy. Seven women had isolated headache. Magnetic resonance imaging performed 3.9 ± 0.3 months after delivery showed that the size of the adenoma had increased in three cases, decreased in two cases, and remained stable in 22 cases. Seventeen women breast-fed with no complications. Four women gave birth to a small-for-gestational-age infant; all had received somatostatin analogs, alone or in combination with dopamine agonists, during pregnancy. The mean IGF-I level fell significantly during the first trimester in 12 cases (before conception 588 ± 207 ng/ml, first trimester 319 ± 126 ng/ml, P = 0.002), whereas the GH concentration did not change significantly. Conclusion: The following conclusions were reached: 1) pregnancy in women with active or uncontrolled acromegaly may be associated with an increased risk of gestational diabetes and gravid hypertension; 2) pregnancy is occasionally associated with symptomatic enlargement of GH-secreting pituitary macroadenomas; 3) changes in serum GH and IGF-I concentrations are variable during pregnancy, indicating that routine monitoring is not mandatory if the pregnancy is uneventful; and 4) GH-suppressive treatment can be safely withdrawn after conception in most acromegalic women. Copyright © 2010 by The Endocrine Society.
PubMed | Center Hospitalier University La Timone, Hospital Puerta Of Hierro, University of Barcelona, Center Hospitalier University la Pitie Salpetriere and 7 more.
Type: Comparative Study | Journal: European heart journal | Year: 2016
Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator.Patients (n = 263, age = 63.4 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 39.4 mL in RVS group vs. -29.3 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of echo-responders defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401).This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study.NCT 00833352.
PubMed | Center Hospitalier University la Timone, Assistance Publique Hopitaux de Paris, University of Nantes, Center Hospitalo University Of Reims and 5 more.
Type: Journal Article | Journal: European radiology | Year: 2016
To assess the performance of a simplified MRI protocol consisting of a contrast-enhanced three-dimensional MR angiography (CE-MRA) in association with a post-contrast T1-weighted sequence (T1WIV) for the detection of HNPGLs in SDHx mutation carriers.This retrospective sub-study is based on the multicenter PGL.EVA cohort, which prospectively enrolled SDHx mutation carriers from 2005 to 2009; 157 index cases or relatives were included. CE-MRA and the T1WIV images were read solely with knowledge of the clinical data but blind to the diagnosis. Sensitivity, specificity and likelihood ratios for the simplified MRI protocol were compared to the full MRI protocol reading results and to the gold standard status obtained through the consensus of an expert committee.The sensitivity and specificity of the readings of the simplified MRI protocol were, respectively, 88.7% (95% CI=78.1-95.3) and 93.7% (95% CI=86.8-97.7) versus 80.7% (95% CI=68.6-89.6) and 94.7% (95% CI=88.1-98.3) for the readings of the full MRI protocol.The simplified post-contrast MRI with shorter duration (5 to 10minutes) showed no performance difference compared to the lengthy standard full MRI and can be proposed for the detection of head and neck paragangliomas (HNPGLs) in SDHx mutation carriers. Rapid angio-MRI protocol and the usual lengthy protocol show equal diagnostic performance. The CE-MRA is the key sequence for the detection of HNPGLs. The T1WIV sequence assists in localizing HNPGLs.
PubMed | University of Lausanne, Aix - Marseille University, Center Hospitalier University La Timone Assistance Publique Hopitaux Of Marseille and Center Hospitalier University La Timone
Type: Journal Article | Journal: Journal of neurosurgery | Year: 2016
Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up.Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed.The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months). Very bothersome facial hypesthesia was reported in only 3 patients (0.6%).Retrogasserian GKS proved to be safe and effective in the long term and in a very large number of patients. Even if the probability of long-lasting effects may be modest compared with microvascular decompression, the rarity of complications prompts discussion of using GKS as the pragmatic surgical first- or second-intention alternative for classical TN. However, a randomized trial, or at least a case-matched control study, would be required to compare with microvascular decompression.
Hascoet S.,Toulouse University Hospital Center |
Fraisse A.,Center Hospitalier University la Timone |
Elbaz M.,Toulouse University Hospital Center
Catheterization and Cardiovascular Interventions | Year: 2013
Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a deflectable catheter delivery system in a patient with a PFO, recurrent stroke, and an inferior vena cava filter. Copyright © 2013 Wiley Periodicals, Inc.
PubMed | Center Hospitalier University La Timone, Toulouse University Hospital Center and University of Monastir
Type: | Journal: Journal of forensic and legal medicine | Year: 2016
Forensic units have a central role to play in healthy public policy, by the collection and management of violence. This study aims to describe the characteristics of physical Intimate Partner Violence (IPV) against men reported over 10 years in the forensic unit of Toulouse (France) and to compare them with the characteristics of physical IPV against women over the same period. All the medico-legal reports of male victims over 18 years of age between 2005 and 2014 were analyzed. Female victims over 18 years of age in the same period were randomized by year in order to study a similar number of individuals. We analyzed 712 forensic reports of male victims and 865 forensic reports of female victims. Repeated consultation concerned 20.5% of women and 7.5% of men (p<0.001). More male victims than female victims consulted in an emergency unit (p<0.001). The most frequently alleged manner of attack was punching for male victims (34.1%) and grabbing or pushing for female victims (86.7%). There were fewer wounds and vascular or visceral injuries for female victims (p=0.001). There were more reports of no injury for female victims (p<0.001) and fewer reports with at least two injuries (p=0.002). The most common injuries were superficial skin injuries (abrasion, bruise or hematoma) for both groups. On the one hand, physical IPV against women was more frequent than against men, while physical IPV against men seemed to be more severe than against women. The distribution of alleged manners of attack and injuries were consistent with previous studies. However, the mechanisms of the origin of the process of violence are difficult to apprehend in such a dyadic context. The findings should be interpreted with caution, but they provide original and substantial material, which can be useful in recognizing victims and in developing preventive strategies. With this aim, forensic units have a central role to play in the collection of violence and in individualized management. In France, this subject has not been extensively studied and future research is needed to emphasize the characteristics of IPV in order to better understand the phenomenon and to create and assess public policies in order to prevent it.