[Efficacy and tolerability of cefixime in the treatment of otorhinolaryngeal infections in adults]. / Efficacité et tolérance du céfixime dans le traitement des infections otorhinolaryngées de l'adulte.

Cefixime was used in the treatment of 59 patients, 44 of whom had sinusitis, 9 otitis media and 6 various ENT infections. The clinical and bacteriological effectiveness of the drug could be evaluated in 44 patients and its safety in all 59 patients. The most common responsible pathogens were Haemophilus influenzae, streptococci including Streptococcus pneumoniae and various Enterobacteriaceae. In more than 50 per cent of the cases, the clinical picture was one of acute exacerbation of a chronic infection. The patients received cefixime 200 mg b.d. for a mean duration of 12 days. Clinical cure was achieved in 80 per cent. Fourteen out of 44 patients underwent surgery. Minor abdominal discomfort was reported by 15 per cent of the patients, and one discontinued therapy because of side-effects. Cefixime was effective and well tolerated. It is suitable for the treatment of ENT infections in adults, such as those treated in this study.

Activity modelling for assessing the usability of telematics applications in healthcare.

With the development of Telematics Applications in Healthcare, it becomes obvious that the success of these services is tightly linked with their usability and their acceptance by users. That is why Users Requirements Analysis appears as an essential step before implementation of new computer services. In many cases, particularly when doctors are directly involved in the management of information, there is a strong interaction between their usual activity and the new tasks implied by the computer. In those cases, Activity Modelling can be useful to describe the way people are working, the motivations that underlie this activity, the place of information management in this activity. Moreover, these models can help to forecast possible difficulties or reasons for failure of the data management when computerised. Obviously, these models are highly depending on the healthcare organisation but some basic lines can be transferable. In this paper we illustrate the Activity Modelling Methodology by examples from Telematics exchanges between GPs and Hospitals.

[The CO2 broncholaser in the treatment of subglottic and tracheal stenosis. Apropos of 14 cases]. / Le broncholaser CO2 dans le traitement des sténoses sous-glottiques et trachéales. A propos de 14 cas.

The authors report the results of CO2 broncholaser treatment in 14 cases of iatrogenic cricotracheal stenosis. A stable patency of the laryngotracheal airway was successfully obtained in 43% of stenoses treated with the broncholaser alone. In another 43% of patients improvement was obtained. Failure occurred in 14% of cases. Heat disruption of the cartilagenous support was the most frequent cause of failure and recurrence. The development of rigid bronchoscopes which can be coupled to CO2 laser would appear to us to be a real technical advance. The apparatus is easy to handle and is increasingly being used as first intention. It has several advantages compared to endoscopic materials used with the YAG laser. The effect of CO2 on the tissues would seem to be better adapted than the YAG for iatrogenic stenoses.

[Results and indications of curietherapy of the eustachian tube with iridium 192 in chronic otitis in the adult]. / Résultats et indications de la curiethérapie de la trompe d'eustache à l'iridium 192 dans l'otite chronique de l'adulte.

Between January 1985 and January 1988, 56 patients received radioactive implant therapy of the Eustachian tube with Iridium 192 in the context of tympanoplasty for chronic otitis with tubal dysfunction. After reviewing the method used, we present the results by category of chronic otitis and attempt to propose its indications. Tubal dysfunction was assessed on clinical and otoscopic data and tubal manometry in each patient. A randomised study would appear to be necessary to confirm the interesting results obtained in chronic mucous otitis, in the sequelae of chronic otitis, in evolving retraction pockets and finally for certain manifestly discharging cavities.

[Failure and complications of esthetic rhinoplasty. Apropos of 30 reoperations]. / Echecs et complications des rhinoplasties esthétiques. A propos de 30 rhinoplasties secondaires.

Out of 150 rhinoplasties carried out over 3 years in a Surgical Department. 20% of cases had previously undergone one or several surgical procedures. Based on these cases, the authors analysed the principal factors producing failure in cosmetic rhinoplasties and proposed a preventive strategy. The osteocartilaginous dorsum and point of the nose are considered separately in this paper.

[Mucocutaneous leishmaniasis. Report of 2 cases]. / La Leishmaniose cutanéo muqueuse. A propos de deux cas.

Two new cases of midfacial granuloma caused by leishmaniasis are reported. This disease is very rare in France but very frequent in South America, where it occurs in two forms called UTA and Espundia. These are described here as well as the means of diagnosis and treatment for this disease. A brief review of the cases published in France seems to indicate that the disease is underestimated in this country. The study of the cases published in other African or European countries shows that all species of Leishmania can produce a midfacial granuloma.

[Amalgamated and reinforced bone powder graft in the correction of the nasal ridge]. / Le greffon de poudre d'os amalgamé et armé dans la correction de l'arête nasale.

A number of surgical procedures have been described to correct irregularities of the consequences of excessive resection of the nasal ridge. Among these procedures the authors propose a bone powder graft mixed with tissue glue and reinforced with surgicel. The graft is in the form of a sheet of variable thickness which is malleable and can be perfectly shaped to fit the nasal ridge. It is positioned between the osteo-cartilagenous supporting structures and the skin. It smoothes out rough areas and compensates for any underlying loss of substance. It may be combined with a bone or cartilage graft which serves as a support and also acts to smoothe out the irregular form of the latter.

[Endoscopic surgery of the turbinates. Preliminary results]. / La chirurgie endoscopique des cornets. Etude préliminaire.

Turbinate surgery has become more precise thanks to miniaturisation and improvements in optical systems, therby allowing endoscopic surgery throughout the procedure including its posterior portion. Endoscopic turbinate surgery includes surgery of the hypertrophied middle turbinate "concha bullosa" which requires diagnosis for successful treatment (septoplasty, endonasal ethmoid surgery). Endoscopy has improved inferior turbinate cauterisation which has become more complete and precise especially for the posterior portion of the turbinate. It allows the use of new techniques: the YAG laser and the CO2 laser. Endoscopy allows good control during resection of the tail of the inferior turbinate and ensures hemostasis in the event of hemorrhage occurring during this procedure.

[Curietherapy of the eustachian tube with Ir-192]. / Curiethérapie de la trompe d'Eustache par Ir 192.

An essential success factor for tympanoplasties is effective aeration of middle ear, lack of tubular permeability being a factor for failure. The anti-inflammatory effect of curietherapy with Iridium 192 introduced into the tube during middle ear surgery was studied in 38 patients. Tubular dysfunction was evaluated by clinical and manometric examinations. During operation, a sealed plastic tube 1.6 mm in diameter was introduced into the Eustachian tube, an Iridium wire inserted on the following day, and a dose of 1.5 and 3 Gy applied to two groups respectively. Tubular function was assessed as normal or almost normal in 61% of cases. Results were compared with a group of 30 patients not receiving curietherapy.

How to convince your manager to invest in an HIS preimplementation methodology for appraisal of material, process and human costs and benefits.

Investing in information technology has become a crucial process in hospital management today. Medical and administrative managers are faced with difficulties in measuring medical information technology costs and benefits due to the complexity of the domain. This paper proposes a preimplementation methodology for evaluating and appraising material, process and human costs and benefits. Based on the users needs and organizational process analysis, the methodology provides an evaluative set of financial and non financial indicators which can be integrated in a decision making and investment evaluation process. We describe the first results obtained after a few months of operation for the Computer-Based Patient Record (CPR) project. Its full acceptance, in spite of some difficulties, encourages us to diffuse the method for the entire project.