Infant and early childhood teleconsultation and training: Program description and feasibility outcomes from a statewide implementation.

To address high rates of mental health and developmental concerns facing young children ages 0-6 in the United States and internationally, providers across professional sectors need Infant and early childhood mental health (IECMH) training and support. The training and teleconsultation program (TTP) is a state-funded program developed in one Mountain West state in the United States to provide free IECMH training and teleconsultation to any provider working with young children. The TTP included access to webinars and individual or group consultation with licensed mental health providers. Webinars focused on increasing awareness and knowledge related to attachment and child development, supporting parents and caregivers, trauma-informed practice, supporting emotional health of staff and providers, and culturally responsive practices with infants, young children, and caregivers. Teleconsultation included case consultation, reflective individual and group supervision, and collaboration supports/referrals. During the 18-month evaluation period, 1568 unique providers engaged in either training or teleconsultation services, an average of 9% growth in new providers each month, with representation from all professional sectors and all state counties. This program demonstrates the feasibility and need for statewide training and teleconsultation programs to help meet the needs of providers who interact with and support young children and caregivers.

Para lidiar con las altas tasas de salud mental y preocupaciones sobre el desarrollo a las que se enfrentan los pequeños niños de edad 0-6 en los Estados Unidos e internacionalmente, quienes proveen el servicio dentro de la gama de todos los sectores profesionales necesitan entrenamiento y apoyo en el campo de la salud mental infantil y la temprana niñez (IECMH). El programa de entrenamiento y teleconsulta (TTP) es un programa con fondos estatales desarrollado en un estado del oeste montañoso en los Estados Unidos para ofrecer entrenamiento y teleconsulta gratis en IECMH a cualquier profesional que trabaja con niños pequeños. El TTP incluye acceso a seminarios web y consulta individual o en grupo con profesionales licenciados de la salud mental. Los seminarios web se enfocaron en incrementar la conciencia y el conocimiento relacionado con la afectividad y el desarrollo del niño, apoyar a progenitores y cuidadores, la práctica con atención informada sobre trauma, apoyar la salud emocional del personal y los proveedores, así como las prácticas culturalmente sensibles con los infantes, niños pequeños y quienes les cuidan. La teleconsulta incluyó consulta de casos, supervisión con reflexión tanto individual como de grupo, así como los apoyos/referencias colaborativas. Durante el período de evaluación de 18 meses, 1,568 proveedores con características particulares recibieron los servicios del entrenamiento o de la teleconsulta, un promedio de 9% de aumento de nuevos proveedores cada mes, con representación de todos los sectores profesionales y todos los condados del estado. Este programa demuestra la posibilidad y necesidad de programas de entrenamiento y teleconsulta a través de todo el estado para ayudar a satisfacer las necesidades de los proveedores que interactúan con y apoyan a los niños pequeños y quienes les cuidan.

Pour faire face aux taux élevés d'inquiétudes en matière de santé mentale et de comportement dont sont témoins les jeunes enfants âgés de 0-6 ans aux Etats-Unis et internationalement, les prestataires au travers des secteurs professionnels ont besoin de formation et de soutien en santé mentale du nourrisson et de la petite enfance (IECMH). Le programme de téléconsultation et de formation (TTP en anglais) est un programme financé au niveau de l'état développé dans un état des montagnes rocheuses aux Etats-Unis afin d'offrir une formation et une téléconsultation IECMH gratuite à tout prestataire travaillant avec de jeunes enfants. Le TTP a incorporé un accès à des webinaires et à une consultation individuelle ou de groupe avec des prestataires de santé mentale agréés. Les webinaires ont porté sur l'accroissement de la sensibilisation et des connaissances liées à l'attachement et au développement de l'enfant, au soutien des parents et des personnes prenant soin des enfants, à une pratique consciente des traumas, et au soutien de la santé émotionnelle des employés et des prestataires, et à des pratiques culturellement adaptées avec les nourrissons, les jeunes enfants et les personnes prenant soin d'eux. La téléconsultation a inclus une consultation de cas, une supervision de réflexion individuelle et de groupe, et des soutiens/références de collaboration. Durant la période d'évaluation de 18 mois, 1568 prestataires uniques se sont engagés soit dans une formation ou des services de téléconsultation, avec une moyenne de 9% de croissance chez les nouveaux prestataires chaque mois, avec une représentation de tous les secteurs professionnels et les comtés de l'état. Ce programme démontre la fiabilité et le besoin de programmes de formation et de téléconsultations au niveau de l'état afin d'aider à remplir les besoins des prestataires qui travaillent et soutiennent les jeunes enfants et les personnes prenant soin d'eux.

[Ruptured pexis after supracricoid partial laryngectomy: a series of 5 cases]. / Les lâchages de pexie dans les laryngectomies partielles supracricoidiennes: à propos de 5 cas.

OBJECTIVES: Supracricoid partial laryngectomies have a rare but a specific complication which is the rupture of the pexy. After cricohyoidoepiglottopexy or cricohyoidopexy, a separation can appear between the hyoid bone and the cricoid cartilage. Our objective was to define how to treat and to prevent this complication. METHODS: One hundred and one supracricoid partial laryngectomies were performed in our department between 1980 and 2006. A retrospective analysis of the medical charts and operative files revealed that 5 patients have had a ruptured pexy. A review of the diagnosis, management, and outcome of these five cases is presented and discussed in this paper. RESULTS: The diagnosis was done in the first post-operative month for all cases. Delay in decannulation time, swallowing disorders, local infection were associated with the rupture of the pexy. The separation between the hyoid bone and the cricoid cartilage was also suspected at neck palpation and in endoscopy. Lateral plain Xrays of the neck or CT scans were used to confirm the diagnosis. A medical treatment, a completion total laryngectomy and three revisions of the pexis were performed. CONCLUSIONS: In our series, an antecedent of radiation before surgery appears to be a risk factor for the development of this specific complication. A revision of the pexis procedure is advocated in case of a major ruptured pexis.

[Major orbital complications of acute maxillary sinusitis of dental aetiology]. / Complications orbitaires majeures des sinusites maxillaires aiguës d'origine dentaire.

OBJECTIVES: To demonstrate the importance of searching for a dental aetiology when confronted with an orbital cellulitis secondary to an acute unilateral maxillary sinusitis and to diagnose and treat as soon as possible in order to avoid visual sequelae. CASE REPORT: Two cases are presented. The first case of a 35 year-old man who was diagnosed and treated late, for an orbital abscess secondary to a sinusitis of dental origin. The patient presented with visual signs such as diplopia and impaired occulomotoricity. The clinical diagnosis was concluded by an emergency sinus CT scan. Treatment consisted of an urgent surgical drainage associated to broad spectrum antibiotics with a high spectrum against Gram +cocci and anaerobes. Dispite this treatment regimen and two subsequent surgeries, the evolution was pejorative ending in a unilateral blindness. The second case is of a 45 year-old immunodeficient woman, presenting with the same pathology but without visual signs and whose evolution was satisfactory after adapted surgical and medical treatments. DISSCUSSION: The presence of visual and ocular signs warn on the gravity of the infection and indicate the need for urgent surgery. Sinus CT scan is essential to highlight the association between the orbit and the causal dental infection. For that, it must include the alveolar processes of the maxilla to show the dental lesion which is usually missed clinically. Functional endoscopic sinus surgery achieves two goals here; one diagnostic by the direct exploration of the nasal sinus cavities and the other therapeutic by the possible drainage all the paranasal sinuses.

[Endonasal endoscopic approach in the treatment of sino-nasal inverted papillomas]. / Voie endonasale endoscopique dans le traitement des papillomes inversés naso-sinusiens.

INTRODUCTION: Sino-nasal inverted papilloma is a rare benign tumor of the nasal fossa and the paranasal sinuses for which the successful surgical treatment by an endonasal approach has been corroborated in the literature. Nevertheless, the authors aim in this study to evaluate the advantages and the limits of this approach, to analyse its failures and its recurrences, and to define the indications for using it with the external or dissimulated approach. MATERIAL AND METHODS: 42 patients presenting with a sino-nasal inverted papilloma and treated surgically over a ten year period were included in this retrospective study. The operative technique was chosen as a function of the endonasal and radiological examination results (CT scan and MRI). Follow-up was over one year for all patients. RESULTS: Twenty eight patients were operated exclusively through an endoscopic endonasal approach. Fourteen patients were operated using a combined approach, associating either a vestibular (9 cases), a paralateral nasal (3 cases) or a fronto-orbital (2 cases) approach with endonsal endoscopy. In two cases, an associated squamous cell carcinoma was found. We observed a recurrence in 9.5% of the all cases and in 14.2% of the patients treated using a combined approach. CONCLUSIONS: Endoscopic endonasal surgery is a validated surgical approach for the treatment of sino-nasal inverted papilloma in that total tumor removal is possible. This approach is particularly indicated in medially-situated papillomas without frontal or maxillary extension. In all other cases, associating an external or dissimulated approach is usually necessary.

[Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases]. / Pseudo-anévrysmes de l'artère carotide interne révélés par une epistaxis. A propos de deux cas.

OBJECTIVES: Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed. METHODS: The authors present two cases and effect a review of the literature. RESULTS: The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt. CONCLUSION: Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.

[Treatment of simple snoring by radiofrequency velar coblation]. / Traitement du ronflement simple par coblation vélaire.

OBJECTIVES: Short- and long-term evaluation of the efficacy and safety of radiofrequency velar coblation for simple snoring. MATERIAL AND METHODS: From February 2000 to May 2004, 175 patients underwent a single radiofrequency session for velar coblation. All patients suffered from snoring without sleep apnea. They presented modifications of the velo-pharyngeal region but did not have tonsillar or basilingual hypertrophy. Outcome was assessed in terms of pain, changes in snoring, secondary effects and complications at three months and one, two, and three years. Secondary uvulectomy was performed in 28 patients. RESULTS: At three months, snoring had decreased in 82% of patients with complete resolution in 12%. Outcome remained unchanged in 70% of patients at one, two, and three years. After uvulectomy, snoring declined in 96% of patients with complete resolution in 48%. Post-treatment pain lasted less than five days in 68% of patients. Mean duration was three days. Fifteen patients developed pharyngeal paresthesia which regressed at one year. Two patients had a nasal voice and three developed necrosis of the uvula. CONCLUSION: Velar coblation is a simple treatment for snoring which can be performed in a single session. The best results are achieved in patients whose body mass index is below 25 and after secondary uvulectomy.

[Ambulatory surgery of otosclerosis: retrospective study of 102 cases]. / Chirurgie de l'otospongiose en ambulatoire: étude rétrospective à partir de 102 cas.

A retrospective study of 102 selected patients operated for otosclerosis (34 outpatient surgery, 68 hospitalised), having all of them the inclusion criteria of the ambulatory surgery, treated as outpatient in a traditional health sector or hospitalised, depending on their own choice, has been lead. We analysed the results of the pure tone audiometric tests two to six months after surgery. No significative difference was found between the two groups on audiometric results as for the postoperative complications. On the other side, it seems that young patients are more interested by the one-day surgery. The failure of the ambulatory surgery could be explained by the vertigo or dizziness per- or postoperatively. Finally, the evaluation of the cost-benefit shows that the ambulatory surgery in a traditional health sector could lead a budgetary saving policy. A saving way that will grow in a specialized sector devoted to the ambulatory practice.