Late pneumolabyrinth after undiagnosed post-traumatic perilymphatic fistula. Case report illustrating the importance of systematic emergency management.

INTRODUCTION: Temporal bone fracture is a common complication of high-energy cranial trauma. Labyrinth involvement is rare, but there is a risk of perilymphatic rupture that is often underestimated on initial clinical examination due to the predominance of neurological and/or somatic symptoms. CASE REPORT: A patient presented with overlooked perilymphatic fistula, decompensated by hyperpressure effort due to poorly adapted management. DISCUSSION: Following a review of the literature on post-traumatic pneumolabyrinth, overall management (from diagnosis to treatment, via prevention advice) was analyzed. A constructive critique of the patient's treatment was thus made. CONCLUSION: We argue for a systematic management protocol in cranial trauma with temporal bone fracture, comprising ENT examination, millimetric-scale cross-sectional imaging of the fracture site, and standardized counseling to prevent late complications.

Transoral surgical treatment of Eagle's syndrome: case report and review of literature.

Eagle's syndrome is a symptomatic abnormal length of the styloid process and/or a calcification of the stylohyoid ligament. Diagnosis is based on common pharyngeal symptoms and is confirmed by radiologic examination, more particularly CT-scan. Medical and surgical treatments are described. Medical treatment consists in repeated local anaesthetics, steroid infiltration or analgesics administration. It is purely symptomatic and has no long-term effectiveness. Surgical treatment remains the treatment of choice and consists of removal of the abnormal process. Both transoral and external approaches have been described. The advantages of the transoral approach is a shorter operative time, the absence of aesthetic prejudice and a lesser risk of neurovascular injury. Few post operative complications have been described (surgical cervical emphysema, cervical swelling, trismus and moderate breathing difficulty) but none of the studies reported neurovascular injury, deep cervical infection nor long-term complication. We present the technique, a case report and a review of the literature of the transoral approach.

Compromised gastrointestinal integrity in pigtail macaques is associated with increased microbial translocation, immune activation, and IL-17 production in the absence of SIV infection.

Pigtail macaques (PTMs) rapidly progress to AIDS after simian immunodeficiency virus (SIV) infection. Given the strong association between human immunodeficiency virus (HIV) and SIV disease progression and microbial translocation and immune activation, we assessed whether high basal levels of immune activation and microbial translocation exist in PTMs. We found that before SIV infection, PTMs had high levels of microbial translocation that correlated with significant damage to the structural barrier of the gastrointestinal tract. Moreover, this increased microbial translocation correlated with high levels of immune activation and was associated with high frequencies of interleukin-17-producing T cells. These data highlight the relationship among mucosal damage, microbial translocation and systemic immune activation in the absence of SIV replication, and underscore the importance of microbial translocation in the rapid course of disease progression in SIV-infected PTMs. Furthermore, these data suggest that PTM may be an ideal model to study therapeutic interventions aimed at decreasing microbial translocation-induced immune activation.

[An unusual fester of the peri-auricular area: pathomimia in ENT practice]. / A propos d'une ulcération péri-auriculaire atypique: la pathomimie en pratique ORL.

We report a case of a patient who self-injured her ear and peri-auricular skin. Self-mutilation is an unusual behaviour in ENT practice. We give some elements for the diagnosis and treatment, and we emphasize the importance of the psychiatric treatment. The suicidal risk makes the vital prognosis uncertain.

[Antro-choanal polyp in children. Our experience since 1997]. / Le polype antro-choanal de l'enfant. L'expérience du service depuis 1997.

UNLABELLED: The antro-choanal polyp is a rather common pathology in children. OBJECTIVE: To discuss the diagnostic modalities, the risk factors, the differential diagnoses and treatment options. MATERIAL AND METHODS: This study was performed in an ENT department of a 3rd referal center Fifteen patients, 12 males and 3 females (8 to 16 year old), were treated for an antro-choanal polyp (Killian's polyp) between 1997 and 2007. RESULTS: All patients presented a nasal obstruction. Other signs of discovery were a rhinorrhea, a maxillary pain or a pharyngeal mass. Two patients presented a recurrence after a surgery in another center Atopy did not seem to be a risk factor. The imaging evaluation showed a tissular process developed in the maxillary sinus and extending through the maxillary ostium, or an accessory ostium, toward the nose. All patients were treated by intranasal endoscopic surgery. The middle meatal antrostomy was systematic, associated with a inferior antrostomy in 3 cases, with an anterior ethmoidectomy in one case and with a vestibular approach (Caldwell-Luc procedure) in 4 cases. Two patients presented a recurrence which necessited a new surgery. CONCLUSION: The antro-choanal polyp must be suspected in front of nasal obstruction in children. The imaging evaluation eliminates the main differential diagnoses. The endo-nasal removal seems to be the best procedure.

[Aesthetic parotidectomy: face lift incision and SMAS flap]. / Parotidectomie esthétique: incision dissimulée de lifting pré-capillaire et lambeau de SMAS.

INTRODUCTION: Traditional parotidectomy skin incision (bayonet-shaped incision) is adapted from an extirpative standpoint but not ideal cosmetically. There are three main drawbacks: Scar, retro-mandibular depression and Frey syndrome. The goal of this prospective study was to evaluate the feasibility of this facial incision for extirpative purposes and to define the clinical benefit in terms of scar and retromandibular depression. METHOD: Ten patients with parotid tumors were included during the period 2005-2006. All patients had benign tumours: 5 males and 5 females. Mean age was 49 yrs. (42-67). Investigated parameters were: "retromandibular depression", "skin scar" and "Frey syndrome". Analogic visual satisfaction scale (1-10) was used by patients to assess these data postoperatively at 15 days, 1 month and 6 months. RESULTS: This face lift approach allowed very good surgical exposure not only of the parotid area but the posterior submandibular region and over the sternocleidomastoid muscle. Postoperative lateral facial contour was symmetric and good in all cases. Six patients assessed this parameter 8/10 and 4 assessed 10/10. After removal of stitches the facial skin scar was considered good in 100% of cases. Six patients assed this parameter 9/10 and 4 assessed 10/10. No Frey syndrome was reported by any patients within 16 months postoperatively. CONCLUSION: Association of a face skin lift approach and a SMAS flap yields a very good cosmetic outcome after surgical parotidectomy. As aesthetic considerations are obvious in breast surgery, aesthetic considerations have a great place in parotid and head and neck surgery.

One-round determination of seven leukocyte subsets in rhesus macaque blood by flow cytometry.

BACKGROUND: Rhesus macaques are frequently used in biomedical research as experimental models for studying infectious diseases and for preclinical vaccination trials. The infection of these monkeys with simian immunodeficiency viruses (SIV) or simian-human immunodeficiency viruses (SHIV) reproduces the clinical and immunological characteristics of human infection by human immunodeficiency virus (HIV). Evolution of the immune response in the infected animals is generally analyzed by determining the lymphocyte subsets on blood samples using flow cytometry but requiring multiple, blood consuming, determinations. METHODS: Cell subsets present in whole-blood samples were labeled with a combination of anti-human monoclonal antibodies to CD2, CD20, CD4, CD8, and CD14 coupled to FITC or PE and analyzed by flow cytometry. RESULTS: In one round, we obtained the precise determination of macaque blood cell composition by flow cytometry. Monocytes, granulocytes, eosinophils, B lymphocytes, helper, and cytotoxic T lymphocytes were distinguished. Results obtained correlated strongly with those obtained with conventional blood cell differential systems and with separate staining of lymphocytes. The analysis of blood from healthy rhesus macaques and SHIV-infected animals demonstrated the accuracy of the determination even in very pathological situations such as macaques with simian AIDS. CONCLUSIONS: Our method allows fast determination of the blood cell composition and will be particularly useful to evaluate the cell subset evolution of macaques involved in large-scale experimental trials.

Implication of the C-terminal domain of nef protein in the reversion to pathogenicity of attenuated SIVmacBK28-41 in macaques.

We have analyzed the nef gene sequences amplified from 12 macaques presenting various patterns of infection with SIVmacBK28-41, a clone derived from attenuated SIVmacBK28. We have observed seven mutation hot spots at positions 56, 75, 432, 588, 680, 699, and 779. The major alteration was a thymidine insertion at position 699, leading to a frameshift in the SIVmacBK28-41 nef gene and changing the last 15 amino acids of Nef into a 31-amino-acid-long C-terminal domain nearly identical to that encoded by pathogenic SIVmac239 and SIVmac251. The insertion was found at early time points in proviruses obtained from rapid progressor macaques, after 2 years postinfection in progressors, and rarely or only after 4 years postinfection in nonprogressors. Fixation of the other mutations occurred only after insertion of thymidine 699. Phylogenetic analysis demonstrated that the nef genes isolated from progressors evolved from the allele present in SIVmacBK28-41 to alleles present in SIVmac239 or SIVmac251, whereas nef sequences from nonprogressors stayed clustered with that of the inoculated molecular clone. These data stress the importance of the C-terminal extremity of the Nef protein of SIVmac239 or SIVmac251 in viral pathogenesis.

A functional measles virus replication and transcription machinery encoded by the vaccinia virus genome.

Measles virus encodes three proteins required for the encapsidation, transcription and replication of viral genomes. The genes for these proteins have been inserted into the vaccinia virus genome together with the gene for the bacteriophage T7 RNA polymerase. Cells infected with this recombinant virus were able to encapsidate, transcribe and replicate a CAT gene positioned in the negative polarity behind a T7 promoter and flanked by measles virus genomic termini. Inhibition of the accumulation of the nucleocapsid proteins by actinomycin D led to an increase in CAT expression. Thus the measles virus polymerase activity, encoded by the vaccinia genome, was regulated by the level of measles proteins just as the authentic polymerase. The recombinant vaccinia described in this study could be useful for the production of measles virus-like particles encoding foreign genes and employed in vaccination or gene therapy strategies.

Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.

OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. METHODS: Review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. Arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean C-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. Synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.

Patient satisfaction in a dental school.

PURPOSE: The objective of this study was to measure patients' satisfaction with the facility, services and treatment received at a dental school clinic. METHOD: The 31-item questionnaire consisted of demographic items and items in a 5-point Likert-type format addressing issues such as security, satisfaction with the facility, helpfulness of the staff, progress of treatment, fees, universal precautions taken, quality of care and treatment with dignity and compassion. The questionnaire also asked whether the patient would recommend the school to others seeking dental care. In 1997, patients completed the survey in the clinic waiting room prior to their dental appointment for that day. The survey was conducted over 3 months until 500 patients had participated, representing about 16% of the active patient population. %s of responses were computed and cross tabulations were used to compare responses based on demographics. RESULTS: The most frequently reported reason for wanting to be a patient at the dental school was low cost (67%) followed by up-to-date care (19%). 45% of patients indicated that a friend, neighbour or relative referred them, followed by 34% indicating referral by a dentist. More than 90% responded positively to the items concerning issues related to treatment except for satisfaction with progress of treatment and comparison of care received at the school to care elsewhere. For these 2 items, at least 80% responded positively. 99% indicated they would recommend the dental school to others seeking dental care. CONCLUSION: Results indicate that the vast majority of the patients surveyed are satisfied with the facility, services and treatment received. Comments that addressed areas of concern included the length of time to get an appointment and the length of time the appointment took, and it was recommended that the process of treatment be expedited.

[Combat psychiatry or psychiatrist on the battlefield?]. / Psychiatrie de l'avant ou psychiatre à l'avant?

Military psychiatrists, close to the troops, during the external operations in which the French army is involved since some years, are reviving with an operational battlefield practice. What they owes to their predecessors is actually included in a discipline, a military institution, and a society which have evolved. Psychosocial psychiatric practicing, in such an opportunity, finds a privileged source of reflections and lessons. Some of them may be used beyond their initial specific frame.

[Microangiopathic hemolytic anemia associated with uterine sarcoma: report of a case. Review of the literature]. / Anémie hémolytique microangiopathique associée a un sarcome utérin: rapport d'un cas. Revue de la littérature.

Microangiopathic hemolytic anemia (MAHA) is a rare but severe complication of neoplastic disease. The diagnosis of thrombotic microangiopathy is based on a triad of a hemolytic anemia with schistocytes, thrombocytopenia, and renal failure. Carcinoma-associated MAHA and chemotherapeutic-induced MAHA have been described. Because of differences concerning prognosis and treatment it is important for the clinician to distinguish these two syndromes. However, to our knowledge, this is the first case of a sarcoma-associated thrombotic microangiopathy.

[Presymptomatic detection of familial colonic polyposis]. / Dépistage présymptomatique de la polypose colique familiale.

In familial adenomatous polyposis coli (APC) it is possible to detect APC carriers either by research of bilateral congenital hypertrophy of the retinal pigment epithelium (CHRPE) or by genetic diagnosis (APC gene is localized in 5q21). These detections were performed in 33 patients of four families with the same positivity for genetic typing (11 patients) or for CHRPE (11 patients) which thus avoided annual coloscopy.

[Apropos of a case of sleep hypochondriasis]. / A propos d'un cas d'hypocondrie du sommeil.

About one case of an important sleeplessness for 4 years, the authors show the characteristics of this moan, which they would want to call it "Sleeping hypochondria". This hypochondria is very "efficient" because the sleeping quality is always subjective. More, patient and therapeut especially invest it. Oftenly, hypnotics are ordained. In this case, the confusion between offered and real symptoms could be grown. In fact, the last one is the patient moan, his speech subject. The treatment of this particular case, by paradoxical injunction, allowed to create a breaking of the patient system. The paradoxical cure, by made-self prescription, allows to understand much better the "insomnia work" in the aggressive relationship with the therapeut.

[Bromazepam against anxiety in psychiatric patients (author's transl)]. / Utilisation du bromazépam dans le traitement de l'anxiété en milieu psychiatrique.

In this study involving 30 hospital patients (23 inpatients and 7 out-patients) with neurosis or depressive syndrome, bromazepam 12 mg/24 hours in 2 or 3 divided doses proved effective in controlling anxiety symptoms. The results, as measured by the Hamilton scale, were satisfactory in two-thirds of the cases, notably in neurotic anxiety. Free-floating anxiety and somatic symptoms were relieved. Undesirable reactions consisted of daytime somnolence (5 cases), feeling of dizziness (1 case) and fatigue (1 case).