Publications by authors named "François Gorostidi"

15 Publications

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[Laryngeal reinnervation].

Rev Med Suisse 2020 Oct;16(709):1845-1848

Service d'ORL et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.

The surgical management of unilateral and bilateral vocal cord paralysis depends on the severity of the condition, the potential for spontaneous recovery, the patient's age and vocal expectations. Standardized re-innervation surgeries, unilateral non-selective and bilateral selective, are viable alternatives to static procedures currently under evaluation in prospective studies. Neurorraphy of the ansa cervicalis loop to the recurrent laryngeal nerve allows lasting vocal recovery and potentially superior results to medialization and thyroplasty, by maintaining the visco-elastic properties of the vocal cord and preventing its atrophy. Selective bilateral reinnervation shows potential for recovery of inspiratory abduction with improved respiratory function without vocal deterioration.
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October 2020

Head and neck tumors angiogenesis imaging with Ga-NODAGA-RGD in comparison to F-FDG PET/CT: a pilot study.

EJNMMI Res 2020 May 7;10(1):47. Epub 2020 May 7.

Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Background: Angiogenesis plays an important role in head and neck squamous cell carcinoma (HNSCC) progression. This pilot study was designed to compare the distribution of Ga-NODAGA-RGD PET/CT for imaging αβ integrins involved in tumor angiogenesis to F-FDG PET/CT in patients with HNSCC.

Material And Methods: Ten patients (aged 58.4 ± 8.3 years [range, 44-73 years], 6 males, 4 females) with a total of 11 HNSCC were prospectively enrolled. Activity mapping and standard uptake values (SUV) from both Ga-NODAGA-RGD and F-FDG PET/CT scans were recorded for primary tumor and compared with the Wilcoxon signed-rank test. The relation between the SUV of both tracers was assessed using the Spearman correlation.

Results: All HNSCC tumors were visible with both tracers. Quantitative analysis showed higher F-FDG SUV in comparison to Ga-NODAGA-RGD (14.0 ± 6.1 versus 3.9 ± 1.1 g/mL, p = 0.0017) and SUV (8.2 ± 3.1 versus 2.0 ± 0.8 g/mL, p = 0.0017). Both F-FDG and Ga-NODAGA-RGD uptakes were neither correlated with grade, HPV status nor p16 protein expression (p ≥ 0.17).

Conclusion: All HNSCC tumors were detected with both tracers with higher uptake with F-FDG, however. Ga-NODAGA-RGD has a different spatial distribution than F-FDG bringing different tumor information.

Trial Registration: NCT, NCT02666547. Registered 12.8.2012.
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http://dx.doi.org/10.1186/s13550-020-00638-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205972PMC
May 2020

[Anosmia and COVID-19].

Rev Med Suisse 2020 Apr;16(N° 691-2):849-851

Service d'ORL et chirurgie cervico-faciale, CHUV, 1011 Lausanne.

Anosmia associated or not with dysgeusia seems to be a frequent symptom in cases of infection with SARS-CoV-2 responsible for COVID-19. It can be the initial symptom of the disease or remain isolated in pauci-symptomatic patients. Waiting for scientific confirmation and in the context of the current pandemic, it seems essential to consider any patient with a new anosmia as being infected with SARS-CoV-2 until proven otherwise. These patients should therefore isolate themselves and remain alert to the occurrence of other symptoms suggestive of the infection and/or be tested. Topical and systemic corticosteroids and nose washes are contraindicated. The natural course of anosmia seems to be favorable in most cases.
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April 2020

[Thyroid nodules and thyroid differentiated cancers: an update on diagnosis and surgical management.]

Rev Med Suisse 2019 Oct;15(665):1752-1759

Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, CHUV et Université de Lausanne, 1011 Lausanne.

The incidence of differentiated thyroid cancers has increased in the past 30 years, mainly due to overdiagnosis. It is therefore crucial to adapt diagnostic and therapeutic approaches to avoid overtreatment that exposes patients to unnecessary risks. Accordingly, international guidelines on the subject are regularly updated. Ultrasound and cytology guide the management for thyroid nodules. Some microcarcinomas can now be actively followed without immediate surgery, and some low-risk cancers can be adequately treated with lobo-isthmectomy. The indications for central neck dissection remain controversial. Technological advances allow minimizing specific complications of thyroid surgery and facilitate scarless surgery.
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October 2019

Graves Disease Causing Pancytopenia: Case Report and Literature Review.

Clin Med Insights Case Rep 2018 25;11:1179547618781090. Epub 2018 Jun 25.

ENT Surgery Department, University Hospital Centre (CHUV), Lausanne, Switzerland.

Background: Graves disease or other causes of thyrotoxicosis are frequently associated with cytopenia. Although anemia is the most common, other cell lineage can be affected. Pancytopenia is a rare complication of thyrotoxicosis.

Case Presentation: We report a case of a 33-year-old Chinese man who presented a nonsevere pancytopenia in the context of a newly diagnosed Graves disease. Restauration of euthyroid state led to progressive correction of pancytopenia.

Conclusions: Literature review shows other rare cases of pancytopenia. It is usually nonsevere with just extremely rare cases of transfusion reported. Evolution was always favorable after achievement of euthyroid state. Its mechanism remains poorly understood, especially because those patients have no vitamin or iron deficiency. The exact physiopathological process remains unclear but 2 causes seem to overlap: reduced production of hematopoietic cells from the bone marrow and increased destruction or sequestration of mature hematopoietic cells. Despite unclear mechanism, the presence of hematologic abnormalities including pancytopenia must not be considered as a contraindication to antithyroid drug therapy.
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http://dx.doi.org/10.1177/1179547618781090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069025PMC
June 2018

Lamb larynx model for training in endoscopic and CO laser-assisted surgeries for benign laryngotracheal obstructions.

Eur Arch Otorhinolaryngol 2018 Aug 4;275(8):2061-2069. Epub 2018 Jun 4.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Bugnon 46, 1011, Lausanne, Switzerland.

Purpose: With adequate indication and meticulous execution, endoscopic procedures can efficiently treat a subset of adult and pediatric benign laryngotracheal stenosis and obstructions, but these procedures are precise and very demanding. The difference between a successful and a failed surgery, with potentially debilitating side effects, resides in small details. The learning curve is long and very few centers worldwide have a sufficient case load making adequate training difficult. While indications and concepts of endoscopic procedures can be learned in books and by observing trained colleagues, the dexterity and the precise realization need to be practiced, ideally not initially on patients.

Methods: We describe here the lamb model system for the initial training in such procedures. We provide a step-by-step guide for endoscopic approaches intended to treat pathologies such as laryngomalacia, bilateral vocal fold paralysis, posterior glottic stenosis, and laryngotracheal clefts.

Conclusions: The lamb model system does not pose ethical issues, and it is easy to obtain and to handle. It was used during an international training course for laryngotracheal stenosis by novice and advanced airway surgeons. It was unanimously judged as relevant and useful by the participants.
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http://dx.doi.org/10.1007/s00405-018-5011-7DOI Listing
August 2018

Temporary tracheal stenting using endovascular prosthesis in the management of severe refractory stenosis following slide tracheoplasty.

Eur Arch Otorhinolaryngol 2018 Jan 26;275(1):275-280. Epub 2017 Oct 26.

Department of Otorhinolaryngology, Lausanne University Hospital, 1005, Lausanne, Switzerland.

Objectives: To evaluate the role of endovascular stents in temporary tracheal stenting and endoscopic treatment strategy for patients with severe refractory tracheal stenosis following slide tracheoplasty.

Methods: Two patients had severe tracheal stenosis after slide tracheoplasty for long segment congenital tracheal stenosis. Both these patients were managed endoscopically and an endovascular prosthesis was used to temporarily stent the trachea. Short and long term results were evaluated clinically and with repeated endoscopies.

Results: The 2 patients had an excellent recovery immediately after the stent placement and continue to have an optimal, age-appropriate stable tracheal diameter after stent removal.

Conclusion: Endovascular stents can be temporarily used to stent the trachea in the endoscopic treatment strategy to correct refractory severe tracheal stenosis following slide tracheoplasty.
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http://dx.doi.org/10.1007/s00405-017-4792-4DOI Listing
January 2018

Extraluminal biodegradable splint to treat upper airway anterior malacia: A preclinical proof of principle.

Laryngoscope 2018 02 16;128(2):E53-E58. Epub 2017 Sep 16.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objective: Upper airway malacia highly complicates the treatment of benign laryngotracheal stenosis, and no ideal option is available to date. We here explore the use of extraluminal biodegradable splints in an animal model of long-segment anterior tracheomalacia (TM). We show the efficacy, as well as the tissue tolerance, of a custom-made biodegradable extraluminal device surgically inserted around the trachea.

Study Design: Preclinical animal study.

Methods: Anterior TM was induced in rabbits through an anterior neck approach by removing eight consecutive anterior tracheal rings without damaging the underlying mucosa. Malacia was corrected during the same surgery by pexy sutures, suspending the tracheal mucosa to an experimental biodegradable device. Symptoms, survival, and tissue reaction were compared to healthy and sham surgery controls.

Results: The model induced death by respiratory failure within minutes. Ten animals received the experimental treatment, and those who survived the perioperative period remained asymptomatic with a maximum follow-up of 221 days. Histological studies at programmed euthanasia showed complete degradation of the prosthesis, with significant remnant fibrosis around the trachea. However, the tracheal stiffness of test segments was comparatively less than that of control segments.

Conclusion: Extraluminal biodegradable splints rescued animals with a condition otherwise incompatible with life. It was well tolerated, leaving peritracheal fibrosis that was not as stiff as normal trachea. The external tracheal stiffening was sufficient for the test animals to live through the phase of severe acute hypercollapsibility. This represents a valid option to help pediatric patients with laryngotracheal stenosis and associated cartilaginous airway malacia.

Level Of Evidence: NA. Laryngoscope, 128:E53-E58, 2018.
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http://dx.doi.org/10.1002/lary.26857DOI Listing
February 2018

L-Shaped Septal Extension Spreader Graft for Improvement of Tip Symmetry in Unilateral Cleft Lip Nose Deformities.

Ann Plast Surg 2017 Dec;79(6):571-576

From the *Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital CHUV, Lausanne, Switzerland; †Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany; and ‡Department of Paediatric Surgery, University Hospital CHUV, Lausanne, Switzerland.

Introduction: The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities.

Patients And Methods: We present a retrospective case study of 21 patients with moderate unilateral cleft lip nose deformities who underwent secondary septorhinoplasty with an L-shaped septal extension spreader graft combined with alar rim, alar batten graft, and soft tissue repositioning. Exclusion criteria were severe or complex septal deviation avoiding a stable fixation of the graft. Mean follow-up time was 28 months. Surgical outcomes were analyzed by anthropometric measurements of standardized preoperative and postoperative photographs.

Results: All parameters improved except for the nostril height. The height between the alar base and the dome defining dome symmetry, as well as the angles between the lower lateral cartilage and the alar base (α) defining the orientation of the alar rim, improved significantly. The mean ratios of cleft/noncleft side of the height between the alar base and the dome and α showed statistically significant improvements from 0.833 (preoperative) to 0.994 (postoperative) (P < 0.0001) and from 0.883 to 1.02 (P = 0.0038), respectively.

Conclusions: The L-shaped septal extension spreader graft combined with alar batten graft and soft tissue repositioning is an option for secondary rhinoplasties in unilateral cleft lip nose deformities minimizing tip rigidity with significant improvement of the dome's height and its symmetry, as well as the alar side angle.
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http://dx.doi.org/10.1097/SAP.0000000000001171DOI Listing
December 2017

External bioresorbable airway rigidification to treat refractory localized tracheomalacia.

Laryngoscope 2016 11 12;126(11):2605-2610. Epub 2016 Mar 12.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objectives/hypothesis: Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis.

Study Design: Retrospective case series.

Methods: Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult).

Results: External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway.

Conclusion: Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance.

Level Of Evidence: 4. Laryngoscope, 126:2605-2610, 2016.
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http://dx.doi.org/10.1002/lary.25918DOI Listing
November 2016

Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center.

Eur Arch Otorhinolaryngol 2017 Jan 13;274(1):367-374. Epub 2016 Aug 13.

Department of Otorhinolaryngology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7 months. 55.7 % of the cases had comorbidities, 22.8 % of the patients were premature and synchronous airway lesions were present in 32.9 % of the cases. The different morphological types of laryngomalacia (I-III) were seen in 26.6, 62 and 11.4 % of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1 %. Failures in 11 (13.9 %) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7 %, respectively. Patients with type III laryngomalacia had a limited success rate (66.7 %) as compared to patients with morphological types I and II (90.5 and 87.8 %, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.
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http://dx.doi.org/10.1007/s00405-016-4252-6DOI Listing
January 2017

Congenital lobar emphysema presenting as an airway foreign body.

Int J Pediatr Otorhinolaryngol 2015 Dec 13;79(12):2450-2. Epub 2015 Oct 13.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of the Canton of Vaud (CHUV), Lausanne, Switzerland.

We report here the case of a 15 months old girl presenting with clinical signs and radiological exams highly suggestive of a foreign body (FB) aspiration. Diagnostic endoscopy revealed an overlooked bronchial malformation responsible for a congenital lobar emphysema (CLE). CLE presenting after one year of age is rare and can easily be misdiagnosed. Therefore, the possibility of an overlooked CLE needs to be known and evoked as an alternative diagnosis when dealing with children presenting with suspected FB aspirations. We report on this unexpected, yet misleading presentation of CLE and review the available literature on the subject.
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http://dx.doi.org/10.1016/j.ijporl.2015.09.042DOI Listing
December 2015

Endoscopic epiglottopexy using Lichtenberger's needle carrier to avoid breakdown of repair.

Eur Arch Otorhinolaryngol 2015 Nov 11;272(11):3385-90. Epub 2015 Jul 11.

Department of Otolaryngology, University Hospital, Lausanne, Switzerland.

Severe type III laryngomalacia LM is represented by a retroflexed epiglottis that touches the posterior pharyngeal wall and obstructs the laryngeal inlet. Endoscopic epiglottopexy is advised in such cases wherein pexy sutures are passed between the epiglottis and base of tongue. Using conventional needle carriers, it is difficult to pass such sutures that go deep enough into the tongue base. Such a pexy is prone to a break down. We describe a novel technique of placing these glossoepiglottic sutures using the Lichtenberger's needle carrier. We used this technique in three patients with excellent results and report no complications. We propose to use this technique in cases of epiglottic prolapse seen in severe LM and certain hypotonic conditions.
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http://dx.doi.org/10.1007/s00405-015-3707-5DOI Listing
November 2015

Clonal, self-renewing and differentiating human and porcine urothelial cells, a novel stem cell population.

PLoS One 2014 26;9(2):e90006. Epub 2014 Feb 26.

Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland ; Laboratory of Experimental Pediatric Urology, Department of Pediatric Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Although urothelial progenitor-like cells have been described in the human urinary tract, the existence of stem cells remains to be proven. Using a culture system that favors clonogenic epithelial cell growth, we evaluated and characterized clonal human urothelial cells. We isolated human urothelial cells that were clonogenic, capable of self-renewal and could develop into fully differentiated urothelium once re-implanted into the subcapsular space of nude mice. In addition to final urothelial cell differentiation, spontaneous formation of bladder-like microstructures was observed. By examining an epithelial stem cell signature marker, we found p63 to correlate with the self-renewal capacity of the isolated human urothelial clonal populations. Since a clinically relevant, long-term model for functional reconstitution of human cells does not exist, we sought to establish a culture method for porcine urothelial cells in a clinically relevant porcine model. We isolated cells from porcine ureter, urethra and bladder that were clonogenic and capable of self-renewal and differentiation into fully mature urothelium. In conclusion, we could isolate human and porcine cell populations, behaving as urothelial stem cells and showing clonogenicity, self-renewal and, once re-implanted, morphological differentiation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090006PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935977PMC
October 2014

Capturing epidermal stemness for regenerative medicine.

Semin Cell Dev Biol 2012 Oct 2;23(8):937-44. Epub 2012 Oct 2.

Department of Experimental Surgery, Lausanne University Hospital, Switzerland.

The skin is privileged because several skin-derived stem cells (epithelial stem cells from epidermis and its appendages, mesenchymal stem cells from dermis and subcutis, melanocyte stem cells) can be efficiently captured for therapeutic use. Main indications remain the permanent coverage of extensive third degree burns and healing of chronic cutaneous wounds, but recent advances in gene therapy technology open the door to the treatment of disabling inherited skin diseases with genetically corrected keratinocyte stem cells. Therapeutic skin stem cells that were initially cultured in research or hospital laboratories must be produced according strict regulatory guidelines, which ensure patients and medical teams that the medicinal cell products are safe, of constant quality and manufactured according to state-of-the art technology. Nonetheless, it does not warrant clinical efficacy and permanent engraftment of autologous stem cells remains variable. There are many challenges ahead to improve efficacy among which to keep telomere-dependent senescence and telomere-independent senescence (clonal conversion) to a minimum in cell culture and to understand the cellular and molecular mechanisms implicated in engraftment. Finally, medicinal stem cells are expansive to produce and reimbursement of costs by health insurances is a major concern in many countries.
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http://dx.doi.org/10.1016/j.semcdb.2012.09.011DOI Listing
October 2012