111 results on '"N. Saroul"'
Search Results
2. Neuropatie uditive
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T. Mom, M. Puechmaille, O. Plainfossé, N. Saroul, L. Gilain, and P. Avan
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General Medicine - Published
- 2022
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3. Neuropatías auditivas
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T. Mom, M. Puechmaille, O. Plainfossé, N. Saroul, L. Gilain, and P. Avan
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General Medicine - Published
- 2022
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4. Rinosinusite acuta
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N. Saroul, F. Casanova, L. Montrieul, C. Daveau, J. Becaud, T. Mom, L. Gilain, and M. Fieux
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General Medicine - Published
- 2021
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5. Meatoplastias
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M. Puechmaille, N. Saroul, A. Dissard, A. Houette, L. Gilain, and T. Mom
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General Medicine - Published
- 2021
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6. Meatoplastiche
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M. Puechmaille, N. Saroul, A. Dissard, A. Houette, L. Gilain, and T. Mom
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- 2020
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7. Évaluation de la déglutition des patients opérés d’une pharyngolaryngectomie totale circulaire. Étude multicentrique du GETTEC
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D. Blanchard, S. Albert, N. Saroul, P. Gorphe, Sylvain Morinière, C.-A. Bach, Nicolas Fakhry, C. Fuchsmann, Sébastien Vergez, Florent Espitalier, and Xavier Dufour
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03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Surgery ,030223 otorhinolaryngology - Abstract
Resume But Les pharyngolaryngectomies totale circulaires sont realisees pour des tumeurs evoluees du pharynx ou dans un contexte de recidive post-radique. Plusieurs procedes de reconstruction du pharynx par lambeau libres ou pedicules sont utilises et sont choisis selon l’operateur. Cette etude a pour but d’evaluer les resultats fonctionnels sur la deglutition a long terme de ces patients en fonction du type de lambeau utilise pour la reconstruction. Materiel et methode Une etude retrospective multicentrique a ete menee de janvier a septembre 2016 dans le groupe Gettec. Tous les patients operes d’une pharyngolaryngectomie totale circulaire et en remission etaient inclus et devaient remplir le questionnaire du deglutition handicap index (DHI) et avoir une fibroscopie de deglutition. 46 patients (39 hommes 7 femmes) ont ete inclus pendant cette periode. Le lambeau ante-brachial tubulise (groupe LABT) etait utilise dans 19 cas, le grand pectoral en fer a cheval (groupe LGP) dans 15 cas et le jejunum libre (groupe LJL) dans 12 cas. Resultats Le DHI moyen etait de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans difference significative ; 27 patients avaient une deglutition normale, 9 mixee, 8 liquide, 3 etaient alimentes par gastrostomie. La nasofibroscopie de la deglutition obtenait un pourcentage de patient avec une deglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04). Conclusion Cette etude a montre que le type de lambeau de reconstruction d’une pharyngolaryngectomie totale circulaire n’a pas d’impact sur la qualite de la deglutition postoperatoire evaluee par le patient par autoquestionnaire du DHI.
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- 2019
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8. 694P Prognostic impact of facial nerve resection in patients treated for a primary parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric study of the REFCOR group with propensity score matching analysis
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F. Chatelet, N. Fakhry, R. Garrel, E. de Monès, N. Saroul, F. Mouawad, J. Thariat, C. Even, V. Costes Martineau, P. Herman, S. Chevret, and B. Verillaud
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Oncology ,Hematology - Published
- 2022
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9. Ethmoïdite aiguë compliquée d’un abcès rétro-oculaire chez un enfant de 13 ans
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L Montrieul, N Saroul, O Bons, and L Gilain
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Ophthalmology ,Retrobulbar abscess ,Ethmoid Sinusitis ,medicine.medical_specialty ,business.industry ,Medicine ,business ,Surgery - Published
- 2019
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10. Melanomi mucosi cervicofacciali
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N Saroul, Odile Casiraghi, et les membres du Refcor, Antoine Moya-Plana, François Janot, L de Gabory, Sébastien Vergez, and Juliette Thariat
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Medicine ,030223 otorhinolaryngology ,business ,Humanities - Abstract
I melanomi maligni cervicofacciali devono essere divisi in due gruppi distinti: i melanomi di origine cutanea e i melanomi mucosi. In effetti, queste due entita presentano importanti differenze in termini di storia naturale, epidemiologia, gestione terapeutica e prognosi. Il melanoma cutaneo e la forma predominante. La sua incidenza e in costante aumento da diversi decenni, con dieci nuovi casi in Francia per 100 000 abitanti e per anno (all’origine di 1 600 decessi). Il principale fattore di rischio e l’esposizione al sole, mentre le forme familiari rappresentano solo il 10% dei pazienti. Nel 30% dei casi, la localizzazione e cervicofacciale. Le particolarita anatomiche di questa regione influenzano significativamente le modalita terapeutiche e la prognosi di questi pazienti, che e piu riservata. Benche il trattamento resti prima di tutto chirurgico, sono stati compiuti recentemente progressi importanti nel trattamento degli stadi avanzati con lo sviluppo delle terapie mirate (in particolare, anti-BRAF) e dell’immunoterapia (anti-PD1). Un posto importante deve essere attribuito alla prevenzione primaria e all’educazione dei pazienti, soprattutto in termini di protezione solare. Il melanoma mucoso, dal canto suo, e un tumore raro che rappresenta meno del 5% di tutti i melanomi. La sua localizzazione preferenziale e cervicofacciale, in particolare a livello nasosinusale. La prognosi del melanoma mucoso e riservata. In effetti, questa patologia e difficile da controllare localmente a causa del suo carattere spesso multifocale e dei vincoli anatomici della regione cervicofacciale, che rendono difficile la realizzazione di un’exeresi oncologica soddisfacente. Inoltre, c’e un significativo rischio metastatico all’origine di una significativa mortalita precoce. Il trattamento di riferimento e la chirurgia tipicamente seguita da una radioterapia adiuvante. Nuove tecniche di irradiazione (adroterapia, ecc.) e terapie innovative (terapie mirate, ecc.) sono in corso di valutazione.
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- 2017
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11. Melanomas mucosos cervicofaciales
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Odile Casiraghi, François Janot, L de Gabory, Sébastien Vergez, Antoine Moya-Plana, N Saroul, Juliette Thariat, and et les membres du Refcor
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030223 otorhinolaryngology - Abstract
Los melanomas malignos cervicofaciales deben dividirse en dos grupos distintos: los melanomas de origen cutaneo y los melanomas mucosos. Estas dos entidades presentan diferencias importantes en terminos de historia natural, de epidemiologia, de tratamiento y de pronostico. El melanoma cutaneo es la forma predominante. Su incidencia esta en constante aumento desde hace varias decadas, con 10 nuevos casos anuales en Francia por cada 100.000 habitantes (responsables de 1.600 fallecimientos). El factor de riesgo principal es la exposicion solar. Las formas familiares solo representan el 10% de los pacientes. En el 30% de los casos, su localizacion es cervicofacial. Las particularidades anatomicas de esta region influyen sobre todo en las modalidades terapeuticas y en el pronostico de estos pacientes, que es mas reservado. Aunque el tratamiento es sobre todo quirurgico, se han realizado recientemente progresos importantes en el tratamiento de los estadios avanzados con el desarrollo de las terapias dirigidas (anti-BRAF en particular) y de la inmunoterapia (anti-PD1). Se debe conceder un lugar importante a la prevencion primaria y a la educacion de los pacientes, sobre todo en terminos de proteccion solar. En cuanto al melanoma mucoso, es un tumor raro, pues representa menos del 5% de todos los melanomas. Su localizacion preferente es cervicofacial, en particular a nivel nasosinusal. El pronostico del melanoma mucoso es reservado. Esta patologia es dificil de controlar localmente debido a que suele ser multifocal y a las exigencias anatomicas de la region cervicofacial, que dificultan realizar una reseccion oncologica satisfactoria. Ademas, existe un riesgo metastasico importante responsable de una mortalidad significativa precoz. El tratamiento de referencia es la cirugia, seguida clasicamente de una radioterapia adyuvante. Se estan evaluando nuevas tecnicas de irradiacion (hadronterapia, etc.), asi como tratamientos innovadores (terapias dirigidas, etc.).
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- 2017
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12. Schwannome du sinus frontal
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L. Gilain, A. Coutu, N. Saroul, and J. Petersen
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03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Surgery ,030223 otorhinolaryngology - Abstract
Resume Introduction Les schwannomes nasosinusiens sont rares, et particulierement au niveau du sinus frontal. Cas clinique Nous rapportons le cas d’une patiente atteinte d’un schwannome du sinus frontal gauche decouvert lors d’une complication a type de sinusite frontale avec complications orbitaire et oculaire. Le geste a consiste en une exerese tumorale par voie endonasale et un drainage par voie externe. Discussion L’origine des schwannomes du sinus frontal sont multiples avec des expressions clinico-radiologiques variees, rendant leur diagnostic difficile leur exerese etant par ailleurs complexe.
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- 2018
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13. Oncologic outcomes, prognostic factor analysis and therapeutic algorithm evaluation of head and neck mucosal melanomas in France
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A. Moya-Plana, A. Aupérin, R. Obongo, A. Baglin, F.R. Ferrand, B. Baujat, N. Saroul, O. Casiraghi, S. Vergez, P. Herman, F. Janot, J. Thariat, B. Vérillaud, L. de Gabory, S. Albert, G. Andry, E. Babin, C. Bach, J.-M. Badet, C. Badoual, A.C. Baglin, A. Banal, B. Barry, E. Baudin, R.J. Bensadoun, C. Bertolus, J.-P. Bessède, D. Blanchard, C. Borel, A. Bozorg-Grayeli, R. Breheret, P. Breton, L. Brugel, G. Calais, E. Cassagnau, L. Castillo, P. Ceruse, F. Chabolle, D. Chevalier, J.C. Chobaut, O. Choussy, A. Cosmidis, A. Coste, V. Costes, L. Crampette, V. Darrouzet, P. Demez, P. Dessi, B. Devauchelle, L. Digue, G. Dolivet, F. Dubrulle, S. Duflo, X. Dufour, C. Even, S. Faivre, N. Fakhry, C. Ferron, F. Floret, R. Garrel, L. Geoffrois, L. Gilain, A. Giovanni, A. Girod, B. Guerrier, S. Hans, P. Hofman, M. Housset, R. Jankowski, F. Jegoux, M. Juliéron, M.-C. Kaminsky, F. Kolb, J. Lacau St Guily, L. Laccoureye, B. Lallemant, P. Lang, E. Lartigau, J.-P. Lavieille, M. Lefevre, X. Leroy, O. Malard, F. Massip, O. Mauvais, J.-C. Merol, J. Michel, T. Mom, S. Morinière, E. de Monès, G. Moulin, G. Noel, G. Poissonnet, J.-M. Prades, D. de Raucourt, E. Reyt, C. Righini, Y. Marie Robin, F. Rolland, B. Ruhin, N. Sarroul, P. Schultz, E. Serrano, O. Sterkers, V. Strunski, A. Sudaka, M. Tassart, S. Testelin, A. Timochenko, B. Toussaint, E. Uro Coste, G. Valette, T. Van den Abbeele, A. Varoquaux, F. Veillon, M. Wassef, Institut Gustave Roussy (IGR), Service de biostatistique et d'épidémiologie (SBE), Direction de la recherche clinique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Département de cancérologie cervico-faciale [Gustave Roussy] (CCF), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Clermont-Ferrand, Laboratorium für Physikalische Chemie (ETH-LPC), Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology [Zürich] (ETH Zürich), French Rare Head and Neck Cancer Expert Network (REFCOR), Service d'Oto-Rhino-Laryngologie (O.R.L.) et de Chirurgie Cervico-Faciale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), French Rare Head and Neck Cancer Expert Network. (REFCOR), Laboratoire d'études spatiales et d'instrumentation en astrophysique (LESIA), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Service d'ORL et de Chirurgie Cervico-Faciale (PARIS - BICHAT - ORL et CCF), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Médecine nucléaire, Département d'imagerie médicale [Gustave Roussy], Service d’ORL et de chirurgie cervico-faciale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Paul Strauss de Lutte contre le Cancer (Strasbourg), Génétique, immunothérapie, chimie et cancer (GICC), UMR 6239 CNRS [2008-2011] (GICC UMR 6239 CNRS), Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Chambre Régionale d'Agriculture des Pays de la Loire, Service de chirurgie, Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Service d’Otorhinolaryngologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Service d'ORL, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Département de chirurgie maxillofaciale et stomatologie [CHU d'Amiens-Picardie], CHU Amiens-Picardie, Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Service de Radiologie (LILLE - Radio), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de médecine gériatrique, CHU de Saint-Etienne, Université Paris 13 (UP13), Hôpital Pellegrin, Service d'ORL et chirurgie cervico-faciale, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d'ORL et Chirurgie Cervico-Facial, Hôpital de la Timone [CHU - APHM] (TIMONE), Fluides, automatique, systèmes thermiques (FAST), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Géomatériaux (DGCB-LGM), École Nationale des Travaux Publics de l'État (ENTPE)-Centre National de la Recherche Scientifique (CNRS), Neurobiologie des réseaux sensorimoteurs (NRS (U7060)), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS), Centre méditérannéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), University of St Andrews [Scotland], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Centre hospitalier universitaire de Nantes (CHU Nantes), Statistique en grande dimension pour la génomique, Département PEGASE [LBBE] (PEGASE), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Reims (CHU Reims), Institut d'Electronique du Solide et des Systèmes (InESS), Centre National de la Recherche Scientifique (CNRS), Service d'ORL et de Chirurgie Cervico-Faciale (TOURS - ORL et CCF), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Rennes (UNIV-RENNES), Service de chirurgie oncologique cervico-faciale [centre Antoine Lacassagne, Nice], Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA)-UNICANCER-Université Côte d'Azur (UCA), Department of Otolaryngology and Head and Neck Surgery, University Hospital of Grenoble, BP 217, 38043, Grenoble Cedex 09, France, Université Joseph Fourier - Grenoble 1 (UJF), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), CRLCC René Gauducheau, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Réhabilitation Chirurgicale mini-Invasive et Robotisée de l'Audition, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de cristallographie et sciences des matériaux (CRISMAT), École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Institut de Chimie du CNRS (INC), Department of Head and Neck Surgery, Hôpital Larrey [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service d'oto-rhino-laryngologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Biomécanique et génie biomédical (BIM), Réseau d’Expertise Français sur les Cancers ORL Rares - French Network of Rare Head and Neck Tumors (REFCOR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours (UT), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Université Nice Sophia Antipolis (1965 - 2019) (UNS), Université de Lille-UNICANCER, Université de Rennes (UR), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), Normandie Université (NU)-Normandie Université (NU)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche sur les Matériaux Avancés (IRMA), Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Rouen Normandie (UNIROUEN), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Les Hôpitaux Universitaires de Strasbourg (HUS), Service Chirurgie maxillo-faciale et plastique de la face [CHU Toulouse], Pôle Céphalique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Tours-Centre National de la Recherche Scientifique (CNRS), and Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)
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0301 basic medicine ,Oncology ,Male ,Cancer Research ,Multivariate analysis ,medicine.medical_treatment ,0302 clinical medicine ,Paranasal Sinuses ,Medicine ,Prospective Studies ,Stage (cooking) ,Head and neck ,Lymph node ,Melanoma ,Aged, 80 and over ,Mucosal melanoma ,Middle Aged ,Prognosis ,Progression-Free Survival ,3. Good health ,Tumor Burden ,Survival Rate ,medicine.anatomical_structure ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,Mouth Neoplasms ,France ,Algorithms ,Paranasal Sinus Neoplasms ,Adult ,medicine.medical_specialty ,Nose Neoplasms ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,03 medical and health sciences ,Young Adult ,Internal medicine ,Humans ,Sinonasal ,Aged ,Neoplasm Staging ,Radiotherapy ,business.industry ,Head and neck cancer ,Mouth Mucosa ,medicine.disease ,Otorhinolaryngologic Surgical Procedures ,Oral cavity ,Radiation therapy ,Nasal Mucosa ,030104 developmental biology ,Oral Cavity Mucosal Melanoma ,Radiotherapy, Adjuvant ,business - Abstract
International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.
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- 2019
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14. [Proposal for the delineation of postoperative primary clinical target volumes in ethmoid cancers]
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F, Guillemin, J, Miroir, L, Piram, R, Bellini, N, Saroul, N, Pham Dang, P, Boisselier, J, Bourhis, V, Calugaru, A, Coutte, P, Graff, Y, Pointreau, S, Racadot, X S, Sun, J, Thariat, J, Biau, and M, Lapeyre
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Postoperative Care ,Ethmoid Bone ,Radiotherapy Planning, Computer-Assisted ,Skull Neoplasms ,Humans ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging - Abstract
It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.
- Published
- 2019
15. [Erratum to 'Delineation of the primary tumour clinical target volumes and neck node levels selection of parotid cancers' [Cancer Radiother. 23 (2019) 255-263]]
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L, Piram, T, Frédéric-Moreau, R, Bellini, F, Martin, J, Miroir, N, Saroul, N, Pham Dang, J, Biau, and M, Lapeyre
- Published
- 2019
16. [Proposal for the selection and delineation of clinical target volumes for the radiotherapy of submandibular gland tumours]
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T, Frédéric-Moreau, L, Piram, R, Bellini, F, Martin, J, Miroir, N, Saroul, N, Pham Dang, J, Biau, and M, Lapeyre
- Subjects
Risk ,Submandibular Gland Neoplasms ,Lymphatic Irradiation ,Radiotherapy Planning, Computer-Assisted ,Humans ,Neoplasm Invasiveness ,Radiotherapy Dosage ,Organ Size ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Tumor Burden - Abstract
This article provides a proposal for the selection and delineation of clinical target volumes for the treatment with radiation of submandibular glands tumours. This article does not deal with external radiotherapy indications but specifies the volumes to be treated if radiotherapy is chosen. High-risk and low-risk peritumoral clinical target volumes are described based on the probability of local tumoral spread. High-risk and low-risk clinical target volumes are illustrated on CT-scan slices. A proposal for the selection of nodal clinical target volumeis also proposed.
- Published
- 2019
17. Assessment of swallowing function after circumferential pharyngolaryngectomy. A multicenter study by the GETTEC group
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Sébastien Vergez, D. Blanchard, S. Albert, Sylvain Morinière, C.-A. Bach, N. Saroul, C. Fuchsmann, Xavier Dufour, Florent Espitalier, Nicolas Fakhry, and P. Gorphe
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Context (language use) ,Laryngectomy ,Free flap ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,Swallowing ,Forearm ,Pharyngectomy ,medicine ,Humans ,030223 otorhinolaryngology ,Retrospective Studies ,Gastrostomy ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Pharyngeal Neoplasms ,Surgery ,Endoscopy ,Deglutition ,medicine.anatomical_structure ,Otorhinolaryngology ,Multicenter study ,030220 oncology & carcinogenesis ,business ,Follow-Up Studies - Abstract
Objective Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction. Material and method A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases. Results Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04). Conclusion Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire.
- Published
- 2018
18. [Delineation of the primary tumour clinical target volumes and neck node levels selection of parotid cancers]
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L, Piram, T, Frédéric-Moreau, R, Bellini, F, Martin, J, Miroir, N, Saroul, N, Pham Dang, J, Biau, and M, Lapeyre
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Radiotherapy ,Lymphatic Metastasis ,Humans ,Neck ,Parotid Neoplasms - Abstract
Salivary glands tumours are uncommon tumours showing a large diversity of histological types. This article presents a synthesis of patterns and paths of invasion of parotid glands tumours in order to propose an approach of the delineation of primary tumour clinical target volumes and of the selection of lymph nodes target volumes. This article does not discuss treatment indications but defines clinical target volumes to treat if radiotherapy is indicated. Postoperative situation being the most frequent, the delineation of primary tumour clinical target volume is based on an anatomical approach.
- Published
- 2018
19. [Toxicity of docetaxel, platine, 5-fluorouracil-based induction chemotherapy for locally advanced head and neck cancer: The importance of nutritional status]
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M, Bernadach, M, Lapeyre, A F, Dillies, J, Miroir, J, Moreau, F, Kwiatkowski, N, Pham-Dang, N, Saroul, X, Durando, and J, Biau
- Subjects
Adult ,Male ,Age Factors ,Nutritional Status ,Anemia ,Docetaxel ,Middle Aged ,Infections ,Thrombocytopenia ,Tumor Burden ,Enteral Nutrition ,Head and Neck Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,Weight Loss ,Humans ,Female ,Fluorouracil ,Cisplatin ,Aged ,Febrile Neutropenia ,Retrospective Studies - Abstract
The objective of this study was to identify predictive factors of toxicity of docetaxel, platin, 5-fluorouracil (TPF) induction chemotherapy for locally advanced head and neck cancers.From July 2009 to March 2015, 57 patients treated consecutively with TPF were included retrospectively. There were 47 males (83%), the median age was 56 years [40-71 years]. Thirty-eight patients (67%) were treated for inoperable cancer (highly symptomatic and/or high tumor burden) and 19 (33%) were treated for laryngeal preservation. There were 47% stage IVa, 32% stage III and 21% stage IVb. At diagnosis, there were 53% stable weight, 28% grade 1 weight loss, 17% grade 2 weight loss and 2% grade 3 weight loss.Forty-seven percent of patients were in partial response after TPF, 28% in complete response, 7% stable, 2% progressing and 2% discordant response. The possibility of oral feeding without a feeding tube was predictive of a better response (P=0.02). Thirty-nine percent of patients increased weight during TPF, 35% were stable, 18% in grade 1 weight loss, 6% in grade 2 and 2% in grade 3. Six of the patients (10.5%) died during chemotherapy: four from febrile neutropenia, one from pneumopathy and one of unknown cause. Age 57years and older was associated with a higher risk of grade≥3 anemia and thrombocytopenia. There was a higher risk of grade≥3 infection for weight loss at diagnosis (P=0.04) and feeding tube (P=0.05). There was a higher risk of grade≥3 neutropenia for weight loss during TPF (P=0.03).Induction chemotherapy by TPF has an strong anti-tumor efficacy (75.5% objective response) but an important morbidity with 10% toxic deaths in our very symptomatic population with a very important tumor burden. Age and nutritional status are important factors to consider.
- Published
- 2018
20. Frontal sinus schwannoma
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L. Gilain, J. Petersen, N. Saroul, and A. Coutu
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medicine.medical_specialty ,Tumor resection ,Context (language use) ,Schwannoma ,03 medical and health sciences ,0302 clinical medicine ,otorhinolaryngologic diseases ,Frontal Sinusitis ,medicine ,Humans ,Sinus (anatomy) ,External drainage ,Frontal sinus ,business.industry ,Middle Aged ,Neuroma ,medicine.disease ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Frontal Sinus ,Surgery ,Female ,Radiology ,business ,030217 neurology & neurosurgery ,Neurilemmoma ,Paranasal Sinus Neoplasms - Abstract
Introduction Nasal sinus schwannomas are rare tumors, particularly in the frontal sinus. Case report The authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage. Discussion The pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.
- Published
- 2018
21. [Description of the GORTEC 2017-03 study: Postoperative stereotactic radiotherapy for early stage oropharyngeal and oral cavity cancer with high risk margin (PHRC-K-16-164)]
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J, Biau, J, Miroir, C, Millardet, N, Saroul, N, Pham-Dang, S, Racadot, F, Huguet, F, Kwiatkowski, B, Pereira, J, Bourhis, and M, Lapeyre
- Subjects
Postoperative Care ,Oropharyngeal Neoplasms ,Research Design ,Humans ,Margins of Excision ,Mouth Neoplasms ,Radiosurgery ,Combined Modality Therapy ,Risk Assessment ,Neoplasm Staging - Abstract
The GORTEC 2017-03-Stereo-postop study is a phase 2, multicentric, nationwide study, funded by the hospital clinical research program (PHRC). The sponsor is Centre Jean-Perrin in Clermont-Ferrand, in partnership with the GORTEC. The principal investigators are Dr J Biau and Dr M Lapeyre. The main objective is to study severe late toxicity of postoperative stereotactic radiotherapy (6×6Gy) for early stage oropharyngeal and oral cavity cancer with high risk margins. The secondary objectives include acute toxicity, efficacy, nutritional impact and quality of life. The population is adult patients, with pT1 or pT2 squamous cell carcinoma of the oropharynx or oral cavity (except lips), without indication of neck irradiation or concomitant chemotherapy, with at risk margin (R1, less than 5mm or uncertain). Ninety patients will be included over a 2-year period; this was calculated to limit the rate of 2-year severe toxicity at 5 to 15%, with a 2-year local control of at least 80 to 90%. If this study is considered as positive, stereotactic radiotherapy (6×6Gy) could become the third therapeutic option, with brachytherapy and normofractionated intensity-modulated radiotherapy (IMRT), for postoperative irradiation of oropharyngeal and oral cavity cancer with high risk margins.
- Published
- 2017
22. Prévention des traumatismes sonores aigus à l’unité
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F. CASANOVA, N. SAROUL, and J.-B. NOTTET
- Abstract
L’incidence des traumatismes sonores aigus reste élevée en milieu militaire malgré des efforts de prévention. Le but de notre étude était d’évaluer l'utilisation et l’opinion des militaires sur les différents moyens de protection individuelle. Un questionnaire a été proposé aux militaires de différentes unités de l’armée de Terre et 1 315 réponses ont été analysées. Sur le plan des résultats, 99,5 % des militaires interrogés déclaraient porter des protections auditives lors des tirs en stand alors que l’absence de protection concernait 8,9 % des militaires lors des tirs en situation opérationnelle. La première cause d’absence de protection évoquée par les militaires était la difficulté à percevoir l’environnement sonore. C'est pourquoi les bouchons à atténuation non linéaire sont de plus en plus utilisés : ils permettent de garder une communication avec l'extérieur tout en étant protégé contre les bruits impulsionnels, mais pas contre les bruits continus. Un militaire sur six déclarait avoir déjà été victime d’un traumatisme sonore aigu et un sur trois avoir déjà présenté des acouphènes aigus après un tir malgré le port des protections auditives. Ces antécédents de TSA de même que les acouphènes occasionnels après tir étaient corrélés aux difficultés de mise en place des protections auditives qui étaient retrouvées chez plus de 10 % des militaires. C'est pourquoi des protections « moulées sur mesure », adaptées au conduit auditif pourraient être envisagées pour diminuer l’incidence des traumatismes sonores aigus.
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- 2011
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23. Tuberculose épilaryngée : considérations épidémiologiques, cliniques et sanitaires
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J.-F. Vellin, Laurent Gilain, O. Baud, N. Saroul, J.-L. Kemeny, and O. Nohra
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Gynecology ,medicine.medical_specialty ,Otorhinolaryngology ,business.industry ,Medicine ,Surgery ,business - Abstract
Resume Objet Rapporter un cas de tuberculose laryngee et rappeler la prise en charge sanitaire de la pathologie tuberculeuse en pratique ORL. Materiel et methode Un patient, avec un antecedent de tabagisme, suivi pour une sarcoidose pulmonaire, a ete adresse pour dysphonie et dysphagie. L’examen ORL a revele une ulceration isolee de la face laryngee de l’epiglotte. Cette ulceration faisait evoquer une sarcoidose laryngee, un carcinome ou une tuberculose epilaryngee. Une pan-endoscopie des voies aerodigestives superieures a permis de diagnostiquer une granulomatose gigantocellulaire avec necrose caseeuse. La culture des biopsies a identifie un Mycobacterium tuberculosis. Resultats Le traitement antituberculeux institue a permis la disparition des symptomes ORL. L’ulceration epiglottique a disparu a trois mois de traitement. La regression des images pulmonaires faisait suspecter une tuberculose pulmonaire ancienne associee. La decouverte de ce cas de tuberculose laryngee a permis de mettre en place une surveillance sanitaire intra- et extrahospitaliere. Conclusion La tuberculose epilaryngee doit etre evoquee en cas de lesion atypique. La declaration obligatoire permet de mettre en place les enquetes sanitaires.
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- 2008
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24. An unusual cause of tracheal stenosis: diagnosis and management? Tracheopathia osteochondroplastica
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A, Bachy, N, Saroul, C, Darcha, R, Bellini, T, Mom, and L, Gilain
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Male ,Tracheal Diseases ,Humans ,Osteochondrodysplasias ,Tracheal Stenosis ,Aged - Published
- 2011
25. Une cause rare de céphalées et de troubles neurosensoriels : la dysplasie fibreuse osseuse cranio-faciale
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T. Mom, M. André, A. Mania, N. Saroul, A. Couturier, O. Aumaître, and A. Bardy
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Gastroenterology ,Internal Medicine - Abstract
Introduction La dysplasie fibreuse osseuse (DFO) est une maladie benigne sporadique congenitale rare (prevalence inferieure a 1/2000). L’atteinte peut etre monostotique ou polyostotique. L’anomalie moleculaire est une mutation somatique du gene GNAS codant pour la sous-unite α de la proteine G avec pour consequence un defaut de differentiation des osteoblastes, une proliferation fibreuse medullaire et une hyperactivite osteoclastique en partie liee a l’expression excessive de l’IL-6 dans les cellules mutees. Cette mutation affectant egalement d’autres types cellulaires, cette maladie peut etre associee a des manifestations cutanees (taches « cafe au lait ») et endocrines (puberte precoce, hyperthyroidie, acromegalie, syndrome de Cushing) dans le cadre du syndrome de Mac Cune-Albright, a un diabete phosphore ou encore a des myxomes dans le cas du syndrome de Mazabraud. Observations Nous rapportons les cas de quatre patients atteints de DFO crânio-faciales. 1re observation : femme de 71 ans. Antecedents : aucun. Symptomatologie : depuis 2 ans, instabilite a la marche avec, depuis 3 mois, quasi-cecite de l’œil droit. Examen ophtalmologique : AV 2e observation : femme de 24 ans. Antecedents : aucun. Symptomatologie : vertiges positionnels depuis 2 mois. Examen ophtalmologique : normal. Examen neurologique : normal. Scanner + IRM : lesion sphenoidale droite de contenu graisseux. Scintigraphie osseuse : pas d’autre lesion. Bilans phosphocalcique et endocrinien : normaux. Traitement et evolution : surveillance clinique et radiologique car lesion non responsable de la symptomatologie. 3e observation : homme de 51 ans. Antecedents : cirrhose virale et ethylique. Symptomatologie : cephalees frontales s’aggravant depuis 2 mois. Examen ophtalmologique : normal. Examen neurologique : normal. Scanner + IRM : lesion evocatrice de DFO des sinus frontal et sphenoidal gauches. Scintigraphie osseuse : pas d’autre lesion. Bilans phosphocalcique et endocrinien : normaux. Traitement et evolution : les perfusions d’AREDIA vont etre debutees prochainement. 4e observation : femme de 51 ans. Antecedents : aucun. Symptomatologie : cephalees frontales invalidantes depuis 2 ans. Examen ophtalmologique : normal. Examen neurologique : normal. Scanner + IRM : epaississement d’allure fibreuse frontal bilateral et ethmoidal. Scintigraphie osseuse : pas d’autre lesion. Bilans phosphocalcique et endocrinien : normaux. Traitement et evolution : disparition des cephalees des la 1re perfusion d’AREDIA. A un an, stabilite de la lesion au scanner. Espacement des perfusions a tous les 6 mois. Conclusion Devant des cephalees, des nevralgies, des atteintes sensorielles (vision, audition, equilibre, olfaction), des troubles fonctionnels (obstruction nasale, dilatation des voies lacrymales, trouble de l’occlusion des mâchoires), des complications infectieuses (sinusites, otites, mastoidites), il faut evoquer le diagnostic de DFO cranio-faciale et realiser un scanner du massif facial et du crâne complete d’une IRM pour le diagnostic differentiel de meningiome en plaque de la base. On observe schematiquement 3 formes : osteolytique, condensante, et moderement condensante ressemblant a l’os pagetique pour laquelle le diagnostic differentiel se fera par la constatation de la persistance de la lame corticale. La biopsie osseuse n’est pas systematique. Un traitement chirurgical est discute au cas par cas, en particulier en cas de complication nerveuse ou d’evolutivite des lesions. En cas de douleur resistante aux traitements habituels, l’utilisation de biphosphonates est recommandee. Chez les patients non repondeurs, plusieurs cas cliniques ont montre le succes d’un anticorps monoclonal dirige contre le recepteur de l’IL-6, le tocilizumab. Des etudes, comme l’etude randomisee TOCIDYS, sont necessaire pour faire la preuve de cette efficacite.
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- 2014
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26. [Epilaryngeal tuberculosis: epidemiologic, clinical and healthcare considerations]
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N, Saroul, J-F, Vellin, O, Baud, O, Nohra, J-L, Kemeny, and L, Gilain
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Adult ,Male ,Mycobacterium Infections ,Tuberculosis, Laryngeal ,Laryngoscopy ,Sarcoidosis, Pulmonary ,Antitubercular Agents ,Humans ,Mycobacterium tuberculosis ,Magnetic Resonance Imaging - Abstract
To report a case of laryngeal tuberculosis and to consider tuberculosis management in ENT practice.A 44-year-old man, a smoker with pulmonary sarcoidosis experienced dysphonia with dysphagia. Laryngeal fibroscopy revealed an ulcerated epiglottic lesion. Direct laryngoscopy was performed to detect carcinoma, laryngeal sarcoidosis or tuberculosis. The histologic study revealed granulomatosis with giant cells and caseous necrosis. Tissue culture identified Mycobacterium tuberculosis.Antituberculosis therapy decreased dysphonia and dysphagia. Isolated ulceration disappeared at three months. Pulmonary infiltration decreased in radiography. The discovery of this case of laryngeal tuberculosis instigated hospital and community tuberculosis surveillance.The ENT specialist should be aware of laryngeal tuberculosis in suspicious lesions. Mandatory declaration of such cases can motivate setting up tuberculosis surveillance.
- Published
- 2007
27. Apport de l’imagerie par résonance magnétique dans le diagnostic de cholestéatome de l’oreille moyenne : analyse d’une série de 116 cas
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M. Akkari, J. Gabrillargues, N. Saroul, T. Mom, and L. Gilain
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Otorhinolaryngology ,Surgery - Published
- 2012
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28. Comparaison de différents marqueurs de dénutrition chez le patient atteint d’un cancer des voies aéro-digestives supérieures
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R. Pastourel, E. Dumousset, N. Saroul, T. Mom, Y. Boirie, and L. Gilain
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Otorhinolaryngology ,Surgery - Abstract
But de la presentation Evaluer l’etat nutritionnel de 45 patients, atteint d’un premier cancer des voies aero-digestives superieures, lors de leur prise en charge initiale. Materiel et methodes L’evaluation nutritionnelle reposait sur l’examen clinique (Indice de Masse Corporelle, Circonference Musculaire Brachiale et Short Physical Performance Battery (SPPB), l’impedancemetrie (indice de masse maigre selon la formule de Kyle et indice de masse musculaire selon la formule de Janssen), la biologie (albumine et pre-albumine), le scanner (indice de masse musculaire en L3) et le Nutrition Risk Index (N.R.I.) (1,519 × Albumine + 0,417 × poids actuel/poids habituel × 100) utilises comme mesure de reference de l’etat nutritionnel. Resultats L’âge moyen des patients etait de 63 ans pour un sex ratio de 0, 80 (4 hommes pour une femme). Le taux de patients denutris d’apres le N.R.I. etait de 49 %. Ce taux etait fortement variable selon l’outil de mesure utilise. Il etait de 62 % d’apres l’indice de masse musculaire en L3 calcule sur le scanner abdominal, de 45 % d’apres l’indice de masse musculaire calcule selon la formule de Janssen par impedancemetrie, de 37 % d’apres l’albumine, de 26 % d’apres la circonference musculaire brachiale, de 23 % d’apres le SPPB, de 19 % d’apres l’indice de masse maigre calcule selon la formule de Kyle par impedancemetrie, et de seulement 14 % d’apres la pre-albumine. Conclusion Il existe une grande variabilite dans l’evaluation nutritionnelle initiale, selon l’outil utilise. Le N.R.I., outil de reference, donne un taux de patients denutris superposable a la litterature (environ 50 %), au contraire des criteres biologiques pris individuellement. Les mesures anthropometriques donnent aussi des valeurs bien plus faibles. Les valeurs recueillies par l’impedance varient selon la methode de calcul. La formule decrite par Janssen donne un taux de patients denutris comparable au N.R.I. L’evaluation de l’indice de masse musculaire sur coupe scannographique en L3 donne le taux le plus eleve.
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- 2014
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29. Apport du scanner et de la ponction radioguidée dans la prise en charge des abcès retropharyngés chez l’enfant : à propos de 18 cas
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C. Martin, C. Louvrier, A. Montalban, N. Saroul, J. Gabrillargues, T. Mom, and L. Gilain
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Otorhinolaryngology ,Surgery - Published
- 2012
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30. Rhinologic symptoms in a cohort of 155 patients with ANCA-positive vasculitis.
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N., Saroul, L., Montrieul, R., Outh, T., Mom, M., Andre, O., Aumaitre, and L., Gilain
- Published
- 2021
31. Responders to biologics in severe uncontrolled chronic rhinosinusitis with nasal polyps: a multicentric observational real-life study.
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Mortuaire G, Béquignon E, Daveau C, Papon JF, Lecanu JP, Favier V, de Gabory L, Vandersteen C, Castillo L, Saroul N, Vérillaud B, Carsuzaa F, Rumeau C, Jankowski R, Michel J, de Bonnecaze G, Escabasse V, Coste A, Lefèvre G, and Malard O
- Abstract
Background: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited., Methodology: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months., Results: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months., Conclusions: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.
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- 2024
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32. Interpreting the patterns of local failure following postoperative volumetric-modulated arctherapy in oral cavity and oropharynx cancers: Impact of the different methods of analysis.
- Author
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Mione C, Saroul N, Casile M, Moreau J, Miroir J, Molnar I, Martin F, Pham-Dang N, Lapeyre M, and Biau J
- Subjects
- Humans, Female, Male, Middle Aged, Aged, Adult, Aged, 80 and over, Radiotherapy Dosage, Retrospective Studies, Treatment Failure, Radiotherapy, Intensity-Modulated methods, Neoplasm Recurrence, Local, Oropharyngeal Neoplasms radiotherapy, Oropharyngeal Neoplasms surgery, Oropharyngeal Neoplasms pathology, Mouth Neoplasms radiotherapy, Mouth Neoplasms surgery, Mouth Neoplasms pathology
- Abstract
Purpose: Intensity-modulated radiation therapy or volumetric-modulated arctherapy is nowadays the recommended radiation technique for the treatment of head and neck cancers. However, by providing a significant dose gradient between target volumes and organs at risk, there is a risk of target missing and thus recurrence in case of inadequate delineation. It is therefore necessary to determine the origin of these recurrences to improve clinical practice. Over the past years, different methods have been described for the analysis of recurrences. Using the patterns of failure of patients with oral cavity and oropharynx carcinoma, treated with postoperative volumetric-modulated arctherapy in our institution, the purpose of this work was to analyse the sites of local recurrences and to evaluate the disparity in the classification of recurrences when different methods were used., Material and Methods: Between 2011 and 2019, 167 patients who underwent postoperative volumetric-modulated arctherapy for oral cavity or oropharyngeal cancers were included (60 and 40 % respectively). Two or three dose levels were prescribed (54Gy, 59.4/60Gy±66Gy). Local recurrence occurred in 17 patients (10.2 %). We assessed the patterns of local recurrences according to four methods: 1/ volume-based method using the volume overlap between the recurrence volume and initial target volumes; 2/ volume-based method of overlap between the recurrence volume and the 95 % treatment isodose; 3/ point-based method using the position of the barycentre of the recurrence volume; 4/ combined centroid method classifying recurrences according to both the initial target volumes and dose distribution. Each case was reviewed to make a clinical judgment on these classifications and assessed them as "appropriate", "possible", or "inappropriate"., Results: For the volume-based method using overlap between the recurrence volume and the initial clinical target volume, this classification was clinically judged as inappropriate in 11 out of 17 cases (65 %). For the volume-based method using overlap between the recurrence volume and the 95 % prescribed isodose, this classification was clinically judged as appropriate in 15 out of 17 cases (88 %). For the point-based method, this classification was clinically judged as appropriate in 14 out of 17 cases (82 %). Thirteen out of 17 local recurrences had the same classification between this point-based method and the volume-based method of overlap between the recurrence volume and the 95 % prescribed isodose. For the combined centroid method, among 17 local recurrences nine were classified as type A, two as type B, two as type C, three as type D and one as type E. This classification was clinically judged as appropriate in 15 out of 17 cases (88 %). Only five out of 17 of the local recurrences were classified the same way according to the four different methods (29 %)., Conclusion: Recurrences that are "marginal" or "outfield" represent a major challenge for intensity-modulated radiation therapy/volumetric-modulated arctherapy quality assurance and improvement of delineation recommendations. To date, there are no published methods that give complete satisfaction., (Copyright © 2024. Published by Elsevier Masson SAS.)
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- 2024
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33. Expert perspectives for transoral robotic versus laser surgery for supraglottic carcinomas.
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Loubieres C, Hans S, Lechien JR, Ansarin M, Atallah S, Barbut J, Bizeau A, Burkey B, Céruse P, Choussy O, Couineau F, De Mones Del Pujol E, Dolivet G, Fakhry N, Garrel R, Giger R, Golusiński W, Gorphe P, Lorentz C, Malard O, Meccariello G, Morinière S, Pellini R, Saroul N, Tagliabue M, Vergez S, Vilaseca I, Villeneuve A, and Baudouin R
- Abstract
Objective: To assess the opinion, practices, and challenges of international key opinion leaders about two minimal invasive surgical techniques in supraglottic laryngeal tumours: transoral laser microsurgery (TLM) and the transoral robotic surgery (TORS)., Methods: Design of a questionnaire composed of seven sections and fifty questions covering descriptive data of participants, practitioners experience procedural sequences, considerations related to airways, feeding, and voice, intraoperative haemorrhage, postoperative management, and a comparative analysis of TLM and TORS in treating supraglottic laryngeal cancer., Results: A total of 27 head and neck surgeons replied to the survey. The experts had an average experience in laryngeal surgery of 20.0 ± 9.4 years, ranging from 5 to 36 years. We noted a significantly shorter installation time in TLM compared to TORS (19% of experts estimated the installation time of over 20 min with TLM vs 44% with TORS; p = 0.02). According to complications, the experts considered that bleeding was the major concern with supraglottic laryngeal surgery, especially intraoperative bleeding in TLM (52% in TLM vs 26% in TORS) (p = 0.09) and postoperative bleeding in TORS (56% in TORS vs 44% in TLM)., Conclusion: The experts did not identify a clear superiority of one technology (TLM) over the other (TORS). The two techniques seemed equivalent to the experts, except for the control of intraoperative haemostasis and visualisation of the surgical field, where TORS was perceived as superior to TLM., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Competing interest: The author Jerome R. Lechien was not involved with the peer review process of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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34. 3T-3D FLAIR MRI in Menière's disease: associated profiles with clinical symptoms and electroacoustic characteristics.
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Bachelet M, Mathilde P, Abdalah EB, Boyer L, Saroul N, Bécaud J, Pereira B, Mirafzal S, and Mom T
- Abstract
Purpose: Diagnosis of Menière's disease relies on clinical symptoms. Injected 3T MRI can show endolymphatic hydrops (EH), but correlation with the clinical status of MD, (probable -PMD or definite-DMD) remains doubtful. We revealed endolymphatic pressure disruption through functional exploration and verified if it was associated with an EH through MRI., Materials and Methods: We prospectively analyzed 3D3T FLAIR MRI of DMD and PMD patients. All of them underwent electrocochleography (EcoG), distortion-product otoacoustic emissions (DPOAEs), and videonystagmograhy (VNG). Amplitudes of summating potential (SP) and cochlear nerve action potential (AP) were measured on EcoG. DPOAE-phase was collected at 1 kHz for the 2f1-f2 DPOAE between sitting and laying position. A SP/AP ≥ 40% and a DPOAE phase-shift > 40° revealed pressure disruption., Results: 39 patients (25 women, 53 y.o. 20-78), were included, with 32 DMD ears and 11 PMD ears. MRI was performed in a median of 21 days [0; 68] from the MD incident. Audiovestibular exploration took place 41 days after the crisis [0;83]. MRI revealed an EH in 71.9% and 27.2% of DMD and PMD, respectively. When combining functional explorations and MRI, testing was positive in 97% for DMD and 82% for PMD. When abnormal (59%), VNG mainly showed hyporeflexia in the diseased ear., Conclusion: In patients suffering from DMD or PMD, with endolymphatic pressure disturbances confirmed by combined DPOAE-phase and EcoG, 3T 3D MRI reveals EH mostly in DMD but rarely in PMD. This seems to confirm that disturbance of endolymphatic pressure precedes EH., (© 2024. The Author(s).)
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- 2024
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35. Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis.
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Chatelet F, Chevret S, Fakhry N, Even C, Malard O, de Monès E, Saroul N, Mouawad F, de Boutray M, Mauvais O, Vergez S, Evrard D, Righini C, Schultz P, Baudouin R, Poissonnet G, Atallah S, Haroun F, Morinière S, Evrard C, Philouze P, Paasche A, Lesnik M, Lelonge Y, Herman P, and Verillaud B
- Abstract
Objectives: The management of the facial nerve (FN) is a major issue in parotid cancer, especially when there is no preoperative facial palsy and FN invasion is discovered intraoperatively. The aim of this study was to assess the impact of FN resection in patients with parotid cancer abutting the FN, without pretreatment facial palsy, using a propensity score matching., Materials and Methods: Data from all patients treated between 2009 and 2020 for a primary parotid cancer abutting or invading the FN but without pretreatment facial palsy were extracted from the national multicentric REFCOR database. Three different definitions of tumors abutting the FN were used for sensitivity analyses, in a retrospective setting. Propensity score matching was used to assess the impact of FN resection on disease-free survival (DFS), overall survival (OS) and locoregional recurrence-free survival (LRRFS)., Results: A total of 163 patients with parotid cancer abutting or invading the FN without pretreatment facial palsy were included. Among them, 99 patients (61 %) underwent FN resection. After overlap weighting and multiple imputation, no benefit of FN resection over preservation was found in terms of OS (HR = 1.21, p = 0.6), DFS (HR = 0.88, p = 0.5) and LRRFS (HR = 0.99, p = 1). Sensitivity analyses revealed similar results, and no significant efficacy was found in the subgroup analyses., Conclusion: In this retrospective study with propensity score analysis, FN resection did not improve survival outcomes in patients without preoperative facial palsy treated surgically for a primary parotid cancer abutting the FN. In line with recent guidelines, the results of this study suggest that FN preservation should be considered whenever possible in this specific group of patients., Competing Interests: Declaration of competing interest The authors have declared no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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36. Auditory Rehabilitation in Single-Sided-Deafened Patients after Surgery to the Cerebellopontine Angle for Vestibular Schwannoma: What Is the Patient's Choice?
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Loukine Bézé M, Puechmaille M, Trillat C, Barrat A, Bécaud J, Saroul N, Khalil T, Coll G, and Mom T
- Abstract
Background : Surgical resection of vestibular schwannomas (VS) can be responsible for single-sided deafness (SSD). Hearing restoration can be a challenge both for the otolaryngologist and the patient. Patients and Methods : In a retrospective series, we analyzed the charts of SSD patients operated on for VS from 2005-2021, checking which type of hearing rehabilitation was chosen. All patients who wanted a hearing restoration underwent a hearing in noise test (HINT) in a stereo auditorium with and without a bone-anchored hearing device (BAHD) worn with a headband on the deaf side. Then, they had a preimplantation one-month trial with the BAHD at home vs. contralateral routing of signal (CROS) or BiCROS (with contralateral signal amplification) hearing aids (HAs). Results : Among 52 charts of the included adult SSD patients, only 29 (56%) eventually chose a hearing rehabilitation device (14 BAHD). Only one BAHD patient required a device explantation for skin complications, but then asked for reimplantation. Another one swapped the BAHD for HAs 2.5 years after. Two patients only occasionally used their BAHD with a headband. Nine patients preferred HAs, mainly BiCROS. Their contralateral hearing was significantly less than BAHD patients ( p < 0.05), and only three used their HAs every day. Conclusions : Hearing rehabilitation in SSD patients after VS surgical resection is chosen in about 50% of cases. In complement of HINT, a real-life comparative hearing trial helps patients chose the best device, with good long-term results when a BAHD is chosen. HAs are preferred when contralateral hearing is altered but are not always worn.
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- 2024
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37. Cytobacteriological testing of drainage pus from peritonsillar abscess is not contributive in clinical practice: A STROBE analysis.
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Bivahagumye L, Gosselet V, Cambier S, Puechmaille M, Gibold L, and Saroul N
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- Humans, Retrospective Studies, Female, Male, Adult, Middle Aged, Aged, Suppuration microbiology, Young Adult, Peritonsillar Abscess microbiology, Peritonsillar Abscess therapy, Drainage methods, Anti-Bacterial Agents therapeutic use
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Purpose: Peritonsillar abscess (PTA) is a frequent pathology. Treatment consists in drainage of the collection, associated to probabilistic antibiotic therapy. The usefulness of cytobacteriological testing (CBT) of the drainage pus is controversial., Material and Methods: A retrospective study of patients managed for PTA between 2013 and 2020 in our university hospital was performed. The main objective was to assess the usefulness of CBT in the management of PTA. The secondary objectives were to determine the bacteriological profile involved in the onset of PTA and to assess the rate of bacterial resistance to antibiotics prescribed on a probabilistic basis., Results: The study included 207 patients: 70 outpatients (33%) and 137 inpatients (67%). Probabilistic antibiotic therapy was implemented in 100% of patients. CBT was performed systematically and was negative in 106 patients, revealing oropharyngeal flora in 40% of cases, polymicrobial flora in 50% and sterile samples in 10%. In the 101 patients with positive CBT, the bacteria isolated were penicillin-sensitive in 99%. All patients were successfully treated. In the light of the bacteriological results, no changes were made to the probabilistic antibiotic therapy introduced on admission., Conclusion: CBT on drainage pus had no impact on the management of PTA. CBT is therefore unnecessary in patients with no comorbidities and no signs of severity at admission., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)
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- 2024
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38. Preliminary trials of trackerless augmented reality in endoscopic endonasal surgery.
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Espinel Y, Lombion N, Compagnone L, Saroul N, and Bartoli A
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- Humans, Endoscopy methods, Surgery, Computer-Assisted methods, Augmented Reality, Imaging, Three-Dimensional methods, Nasal Cavity surgery, Nasal Cavity diagnostic imaging
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Purpose: We present a novel method for augmented reality in endoscopic endonasal surgery. Our method does not require the use of external tracking devices and can show hidden anatomical structures relevant to the surgical intervention., Methods: Our method registers a preoperative 3D model of the nasal cavity to an intraoperative 3D model by estimating a scaled-rigid transformation. Registration is based on a two-stage ICP approach on the reconstructed nasal cavity. The hidden structures are then transferred from the preoperative 3D model to the intraoperative one using the estimated transformation, projected and overlaid into the endoscopic images to obtain the augmented reality., Results: We performed qualitative and quantitative validation of our method on 12 clinical cases. Qualitative results were obtained from an ENT surgeon from visual inspection of the hidden structures in the augmented images. Quantitative results were obtained by measuring a target registration error using a novel transillumination-based approach. The results show that the hidden structures of interest are augmented at the expected locations in most cases., Conclusion: Our method was able to augment the endoscopic images in a sufficiently precise manner when the intraoperative nasal cavity did not deform considerably with respect to its preoperative state. This is a promising step towards trackerless augmented reality in endonasal surgery., (© 2024. CARS.)
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- 2024
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39. Study protocol: the biologics in severe chronic rhinosinusitis with nasal polyps survey.
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Favier V, Daveau C, Carsuzaa F, Fieux M, Vandersteen C, Castillo L, Papon JF, de Gabory L, Saroul N, Verillaud B, Rumeau C, Jankowski R, Michel J, de Bonnecaze G, Lecanu JB, Coste A, Béquignon E, Malard O, and Mortuaire G
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- Humans, Chronic Disease, Prospective Studies, France, Observational Studies as Topic, Omalizumab therapeutic use, Multicenter Studies as Topic, Rhinosinusitis, Nasal Polyps drug therapy, Nasal Polyps complications, Sinusitis drug therapy, Rhinitis drug therapy, Rhinitis complications, Biological Products therapeutic use
- Abstract
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent condition affecting approximately 2% of the population. Medical treatment consists long-term use of intranasal corticosteroids and short-term use of oral corticosteroids, in adjunct with saline solution rinses. Surgical management is proposed in patients who failed after medical treatment. In France, two biologics are reimbursed in case of severe uncontrolled CRSwNP despite medical treatment and endoscopic sinus surgery. Waiting for head-to-head biologics comparison, studies should report the efficacy and safety of biologics in large real-life cohorts. This study protocol describes the aims and methods of a prospective, observational, national, multicentric cohort of patients with CRSwNP treated with biologics., Methods and Analysis: The BIOlogics in severe nasal POlyposis SurvEy is a French multicentre prospective observational cohort study. The main aim is to assess the efficacy and tolerance of biologics in patients with CRSwNP, with or without association with other type 2 diseases, and to determine the strategies in case of uncontrolled disease under biologics. Patients over 18 years old requiring biologics for CRSwNP in accordance with its marketing approval in France (ie, severe nasal polyposis, with lack of control under nasal corticosteroid, systemic corticosteroids and surgery) are invited to participate. Collected data include topical history of surgical procedures and biologics, medication and use of systemic corticosteroids, visual analogical scales for specific symptoms, Sino-Nasal Outcome Test-22 questionnaire, nasal polyp score, asthma control test, Lund-Mackay score on CT scan and IgE concentration and eosinophilic count on blood sample., Trial Registration: NCT05228041/DRI_2021/0030., Competing Interests: Competing interests: All authors report personal fees as expert consultant for Sanofi and GlaxoSmithKline., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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40. Cannabidiol protects C2C12 myotubes against cisplatin-induced atrophy by regulating oxidative stress.
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Le Bacquer O, Sanchez P, Patrac V, Rivoirard C, Saroul N, Giraudet C, Kocer A, and Walrand S
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- Humans, Cisplatin toxicity, Cachexia metabolism, Catalase metabolism, Quality of Life, Thiobarbituric Acid Reactive Substances metabolism, Thiobarbituric Acid Reactive Substances pharmacology, Muscle Fibers, Skeletal metabolism, Muscular Atrophy chemically induced, Muscular Atrophy prevention & control, Muscular Atrophy drug therapy, Oxidative Stress, RNA, Messenger metabolism, Cannabidiol pharmacology, Cannabidiol metabolism, Cannabidiol therapeutic use, Neoplasms metabolism
- Abstract
Cancer and chemotherapy induce a severe loss of muscle mass (known as cachexia), which negatively impact cancer treatment and patient survival. The aim of the present study was to investigate whether cannabidiol (CBD) administration may potentially antagonize the effects of cisplatin in inducing muscle atrophy, using a model of myotubes in culture. Cisplatin treatment resulted in a reduction of myotube diameter (15.7 ± 0.3 vs. 22.2 ± 0.5 µm, P < 0.01) that was restored to control level with 5 µM CBD (20.1 ± 0.4 µM, P < 0.01). Protein homeostasis was severely altered with a ≈70% reduction in protein synthesis ( P < 0.01) and a twofold increase in proteolysis ( P < 0.05) in response to cisplatin. Both parameters were dose dependently restored by CBD cotreatment. Cisplatin treatment was associated with increased thiobarbituric acid reactive substances (TBARS) content (0.21 ± 0.03 to 0.48 ± 0.03 nmol/mg prot, P < 0.05), catalase activity (0.24 ± 0.01 vs. 0.13 ± 0.02 nmol/min/µg prot, P < 0.01), whereas CBD cotreatment normalized TBARS content to control values (0.22 ± 0.01 nmol/mg prot, P < 0.01) and reduced catalase activity (0.17 ± 0.01 nmol/min/µg prot, P < 0.05). These changes were associated with increased mRNA expression of GPX1 , SOD1 , SOD2 , and CAT mRNA expression in response to cisplatin ( P < 0.01), which was corrected by CBD cotreatment ( P < 0.05). Finally, cisplatin treatment increased the mitochondrial protein content of NDUFB8, UQCRC2, COX4, and VDAC1 (involved in mitochondrial respiration and apoptosis), and CBD cotreatment restored their expression to control values. Altogether, our results demonstrated that CBD antagonize the cisplatin-induced C2C12 myotube atrophy and could be used as an adjuvant in the treatment of cancer cachexia to help maintain muscle mass and improve patient quality of life. NEW & NOTEWORTHY In an in vitro model, cisplatin treatment led to myotube atrophy associated with dysregulation of protein homeostasis and increased oxidative stress, resulting in increased apoptosis. Cotreatment with cannabidiol was able to prevent this phenotype by promoting protein homeostasis and reducing oxidative stress.
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- 2024
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41. Carcinomas of the external auditory canal: Management and results: A multicenter REFCOR propensity score matching study.
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Brenet E, Atallah S, Guerlain J, Moya-Plana A, Verillaud B, Kania R, Bakhos D, Philouze P, Righini CA, Bozorg A, Mérol JC, Labrousse M, Vergez S, Fakhry N, Gallet P, Cullié D, Malard O, Mauvais O, Fath L, Schultz P, Dufour X, Saroul N, Evrard D, Lesnik M, Even C, Costes V, Thariat J, Taillandier de Gabory LL, Makeieff M, Dubernard X, and Baujat B
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- Humans, Retrospective Studies, Propensity Score, Radiotherapy, Adjuvant, Prognosis, Ear Canal pathology, Carcinoma, Squamous Cell pathology
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Objectives: To analyse prognostic factors and survival outcomes of malignant tumors of the external auditory canal, to investigate the role of regional surgery, and adjuvant radiotherapy in early stages and to investigate the role of surgery in operable T4 stage., Setting: A retrospective analysis was conducted on all patients prospectively included in the national database of the French Expertize Network for Rare ENT Cancers (REFCOR) from January 2000 to December 2016., Participants: 103 patients from 19 reference centers were included. A propensity score matching analysis was applied to enable comparisons between treatments., Main Outcomes and Measures: Event-free survival, overall survival and factors of poor prognosis of the cohort were described. The interest of local and regional surgery and postoperative radiotherapy were evaluated., Results: The factors of poor prognosis on event-free survival were immunosuppression (p = 0.002), Karnofsky status less than 90% (p = 0.02), body mass index less than 19 Kg / m2 (p = 0.0009), peripheric facial palsy (p = 0.0016), and positive margin (p = 0.0006). In early stages, locoregional surgery was associated with an increase in event-free survival (p = 0.003, HR = 0.21) versus local surgery alone, while postoperative radiotherapy was not associated with an increase in event-free survival (p = 0.86, HR = 0.91) or overall (p = 0.86, HR = 0.91). In locally advanced stages, locoregional surgery followed by radiotherapy was associated with an increase in event-free survival (p = 0.03, HR = 0.39) and overall (p = 0.02, HR = 0.34) versus chemoradiotherapy alone., Conclusion and Relevance: Regional surgery is recommended for early stages of cancers of the external auditory canal. In operable cases, locoregional surgery followed by radiotherapy is recommended., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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42. [Proposal for the delineation of postoperative primary clinical target volumes in maxillary sinus and nasal cavity cancers].
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Guillemin F, Blanchard P, Boisselier P, Brahimi Y, Calugaru V, Coutte A, Gillon P, Graff P, Liem X, Modesto A, Pointreau Y, Racadot S, Sun XS, Bellini R, Pham Dang N, Saroul N, Bourhis J, Thariat J, Biau J, and Lapeyre M
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- Humans, Maxillary Sinus diagnostic imaging, Maxillary Sinus surgery, Maxillary Sinus pathology, Nasal Cavity diagnostic imaging, Radiotherapy Planning, Computer-Assisted methods, Mouth Neoplasms pathology, Paranasal Sinus Neoplasms
- Abstract
In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy., (Copyright © 2024. Published by Elsevier Masson SAS.)
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- 2024
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43. Pathophysiology of Postoperative Hearing Disorders after Vestibular Schwannoma Resection: Insights from Auditory Brainstem Response and Otoacoustic Emissions.
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Djennaoui I, Puechmaille M, Trillat C, Bécaud J, Saroul N, Khalil T, Avan P, and Mom T
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Background : In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods : Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists-MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results : In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion : a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery.
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- 2024
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44. Comparison of the microvascular anastomotic Coupler™ system with hand-sewn suture for end to end veno-venous anastomosis for head and neck reconstruction with free flap transfer: Medico-economic retrospective case-control study.
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Mourgues C, Balayssac D, Mulliez A, Planeix CM, Feydel G, Biard A, Alaux-Boïko V, Irthum C, Saroul N, and Dang NP
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- Humans, Retrospective Studies, Case-Control Studies, Postoperative Complications, Anastomosis, Surgical methods, Microsurgery methods, Sutures, Free Tissue Flaps surgery, Free Tissue Flaps blood supply
- Abstract
The aim of this study was to assess the medico-economic impact of the MACD Coupler™ system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective case-control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer. 43 patients per group were analyzed. Rates of initial success, re-intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively K€ 0.7 [0.5; 0.8] and K€ 0.1 [0.5; 0.8] (p = 0.001) and decreased the cost for operating staff with respectively K€ 4.0 [3.4; 5.2] and K€ 5.1 [3.8; 5.4] (p = 0.03). The total management costs were not different between groups with respectively a total median cost of K€ 18.4 [14.3; 27.2] and K€ 17.3 [14.1; 23.7] (p = 0.03). In conclusion, the cost of the Coupler™ is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon., Competing Interests: Declaration of competing interest None., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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45. The Prognostic Value of Olfactory Dysfunction in Patients with COVID-19: The COVIDORA Study.
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Hamel AL, Delbos L, Natella PA, Radulesco T, Alexandru M, Bartaire E, Bartier S, Benoite G, Bequignon E, Castillo L, Canouï-Poitrine F, Carsuzaa F, Corré A, Coste A, Couloigner V, Daveau C, De Boissieu P, De Bonnecaze G, De Gabory L, Debry C, Deraedt S, Dufour X, El Bakkouri W, Gilain L, Hans S, Hautefort C, Hermann R, Jankowski R, La Croix C, Lecanu JB, Malard O, Michel J, Nguyen Y, Nevoux J, Papon JF, Patron V, Prigent M, Pruliere-Escabasse V, Renaud M, Rumeau C, Salmon D, Saroul N, Serrano E, Nhung Tran Khai C, Tringali S, Truy E, Vandersteen C, Verillaud B, Veil R, and Fieux M
- Abstract
Background: Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient's medical management (outpa-tient care, standard hospital admission, and ICU admission)., Methods: A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease., Results: Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.
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- 2024
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46. Early detection of pharyngocutaneous fistulae after total laryngectomy by cytokine in drainage: A pilot study (DEFILAC).
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Saroul N, Loukine M, Durand M, Pereira B, Rozand I, Becaud J, Martinez Q, Mom T, Gilain L, Evrard B, Puechmaille M, and Bonnet B
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- Humans, Laryngectomy adverse effects, Interleukin-10, Pilot Projects, Cytokines, Prospective Studies, Retrospective Studies, Postoperative Complications epidemiology, Laryngeal Neoplasms surgery, Cutaneous Fistula diagnosis, Cutaneous Fistula etiology, Cutaneous Fistula epidemiology, Pharyngeal Diseases diagnosis, Pharyngeal Diseases etiology, Pharyngeal Diseases epidemiology
- Abstract
Background: The determination of cytokines in the postoperative drainage (POD) fluid could be a method for early detection of the development of a pharyngocutaneous fistula (PCF)., Materials and Methods: We conducted a prospective two-center study involving 28 patients. PODs were collected on Day 1 (D1) and Day 2 (D2) postoperatively for determination of a cytokine panel and cytobacteriological examination., Results: Eleven (39%) patients presented with PCF on average 13 ± 5.5 days after surgery. Patients with PCF had higher IL-10 (121 vs. 40.3, p = 0.04, effect size (ES) = 0.98 [0.16, 1.79]) and TNFα level (21.2 vs. 2.2, p = 0.02, ES = 0.83 [0.03, 1.63]) on D2. An IL-10 threshold of 72 pg/mL on D2 was diagnostic of the occurrence of PCF with a sensibility of 70%, specificity of 88%., Conclusion: The determination of cytokines in POD fluid on D2 is a reliable tool for predicting the development of a PCF after total laryngectomy., (© 2023 Wiley Periodicals LLC.)
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- 2023
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47. Management of 80 sinonasal undifferentiated carcinomas. Retrospective multicentre study of the French Network of Rare Head and Neck Cancers (REFCOR).
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Pouvreau P, Coelho J, Rumeau C, Malard O, Garrel R, Michel J, Righini C, Vergez S, Baudouin R, Bastit V, Marie JP, Villepelet A, Moya-Plana A, Philouze P, Saroul N, Digue L, Daste A, Renard S, Moriniere S, Carsuzaa F, Verillaud B, Poissonnet G, Schultz P, Brenet E, Mouawad F, Thariat J, Vulquin N, Castain C, de Gabory L, and Dupin C
- Subjects
- Humans, Neoplasm Recurrence, Local therapy, Combined Modality Therapy, Retrospective Studies, Maxillary Sinus Neoplasms therapy, Head and Neck Neoplasms
- Abstract
Objectives: Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive disease requiring multimodal treatment, and multiple new entities once included in the spectrum of SNUC, such as SWI/SNF-deficient carcinomas, are emerging. We aimed to provide new data regarding the role of chemotherapy and surgery and the prognostic factors of disease-free survival., Methods: This study was based on data from the REFCOR database and included patients with SNUC treated with curative intent from 2007 to 2021 across 22 centres in France., Results: A total of 80 patients were included in the analysis. Among the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) rates were 58% and 63%, respectively. Of 100% of the patients treated with irradiation, 29% underwent surgery, 56% neoadjuvant chemotherapy (82% had either a partial or a complete response) and 76% chemoradiotherapy. No treatment modality was associated with a better OS or DFS, including surgery (p = 0.34). There was a trend for a better DFS for the patients treated with chemotherapy (neoadjuvant or concomitant, p = 0.062). Overall survival at 3 years was 58% for SWI/SNF deficient group and 86% for non deficient group (p = 0.14). The locoregional relapse rate without distant metastases was 21% in the exclusive radiotherapy group and 26% in the surgery group. Grade 3 or higher toxicities concerned 9%, 32% and 29% of patients for surgery, radiotherapy and chemotherapy respectively., Conclusion: In the management of localised SNUC among all patients treated with irradiation, surgery yielded no benefit, whereas the addition of chemotherapy tended to improve disease-free survival., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Amaury Daste: Consulting or Advisory Role: Merck, MSD, BMS; Travel, Accommodations, Expenses: BMS, Merck., (© 2023 Published by Elsevier Ltd.)
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- 2023
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48. Efficacy and safety of intravenous bevacizumab on severe bleeding associated with hemorrhagic hereditary telangiectasia: A national, randomized multicenter trial.
- Author
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Dupuis-Girod S, Rivière S, Lavigne C, Fargeton AE, Gilbert-Dussardier B, Grobost V, Leguy-Seguin V, Maillard H, Mohamed S, Decullier E, Roux A, Bernard L, Saurin JC, Saroul N, Faure F, Cartier C, Altwegg R, Laccourreye L, Oberti F, Beaudoin M, Dhelens C, Desvignes C, Azzopardi N, Paintaud G, Hermann R, and Chinet T
- Subjects
- Adult, Humans, Middle Aged, Antibodies, Monoclonal, Humanized adverse effects, Bevacizumab adverse effects, Treatment Outcome, Double-Blind Method, Hemorrhage drug therapy, Telangiectasia, Hereditary Hemorrhagic complications, Telangiectasia, Hereditary Hemorrhagic drug therapy
- Abstract
Background: Bevacizumab-a humanized monoclonal antibody-has been widely used to treat patients with hereditary hemorrhagic telangiectasia (HHT), but no randomized trial has yet been conducted., Methods: This study is a double-blind multicenter randomized phase 2 trial with a 1:1 active-treatment-to-placebo ratio. We included patients over the age of 18 with a confirmed diagnosis and the need for at least four red blood cell (RBC) units transfused in the 3 months before study enrollment. Bevacizumab was administered at a dose of 5 mg/kg every 14 days with a total of six injections. The primary efficacy criterion was a decrease of at least 50% in the cumulative number of RBC units transfused in a 3-month period before and after treatment., Results: A total of 24 patients (12 in each group) were included and randomized at 4 different centers. In intention-to-treat analysis, 63.6% of patients (7/11) in the bevacizumab group versus 33.3% of patients (4/12) in the placebo group decreased the number of blood transfusions by at least 50% (p = 0.22). Hemoglobin levels significantly improved at 6 months in the bevacizumab versus placebo group (p = 0.02). The pharmacokinetics study revealed that patients with high exposure to bevacizumab had a significant decrease in RBC transfusions (p = 0.03). Fifty-nine adverse events were observed, 34 in the placebo arm versus 25 in the bevacizumab arm., Conclusion: Though the present trial was underpowered, patients with HHT receiving bevacizumab required numerically fewer red blood cell transfusions than those receiving placebo, particularly those with high exposure., (© 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
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- 2023
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49. Chronic nasal dysfunction: A clinical case illustrating the concept in practice.
- Author
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Jankowski R, Mathis-Marçon C, Fieux M, Barron M, Legré M, Favier V, Tiotiu A, and Saroul N
- Subjects
- Humans, Nasal Decongestants therapeutic use, Endoscopy, Adrenal Cortex Hormones therapeutic use, Inflammation complications, Chronic Disease, Rhinitis diagnosis, Rhinitis etiology, Rhinitis therapy, Sinusitis complications, Nasal Polyps complications, Nasal Polyps diagnosis, Nasal Polyps therapy
- Abstract
Introduction: We illustrate the diagnostic method for chronic nasal dysfunction by an observation in which the clinical history was compared to preoperative responses on the DyNaChron self-administered questionnaire, with ENT interpretation of the sinonasal CT scan preceding and guiding nasal endoscopy., Case Report: The initial suspicion of rhinitis medicamentosa was transformed by the radiological and endoscopic findings of chronic respiratory rhinitis signs. Prick tests showing sensitivity to dust mites then suggested an allergic origin of the mucosal inflammation, which affected neither the olfactory nose nor the paranasal sinuses. A septal deviation hampering visualization of the right ethmoidal reliefs completed the clinical picture. Inferior turbinate hypertrophy secondary to allergic inflammation could have been aggravated by prolonged daily use of nasal vasoconstrictors. Failure of medical treatment combining nasal lavage, topical corticosteroids and an attempt at weaning led to effective medical and surgical management combining septoplasty, bilateral inferior turbinoplasty, continuation of topical corticosteroids and initiation of allergen immunotherapy. In addition to complete relief of nasal obstruction and abandonment of nasal vasoconstrictors, improved sense of smell completed the restoration of nasal comfort., Discussion: It is helpful to conceive the nose as being anatomically and pathophysiologically a triple organ and to evaluate therapy in terms of improvement in each symptom., (Copyright © 2023. Published by Elsevier Masson SAS.)
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- 2023
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50. Critical review of diagnosis in rhinology and its therapeutical implications.
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Jankowski R, Favier V, Saroul N, Lecanu JB, Nguyen DT, de Gabory L, Verillaud B, Rumeau C, Gallet P, Béquignon E, Vandersteen C, and Patron V
- Subjects
- Humans, Inflammation, Nose, Chronic Disease, Rhinitis diagnosis, Rhinitis therapy, Nasal Polyps diagnosis, Sinusitis diagnosis, Sinusitis therapy
- Abstract
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients., (Copyright © 2023. Published by Elsevier Masson SAS.)
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- 2023
- Full Text
- View/download PDF
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