[Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. / Syndrome d'apnées obstructives du sommeil de l'adolescent : particularités et prise en charge.

Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.

[Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea]. / Diagnostic du syndrome d'apnée obstructive du sommeil chez l'enfant (2­18 ans) : place de la polysomnographie et de la polygraphie ventilatoire.

The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologists, ENT surgeons, pediatricians, neurophysiologists, sleep specialists) drew up a consensus document on the value of electrophysiological recordings in the diagnosis of OSAS in children. Technical considerations and recommended sensors, respiratory event definitions, and scoring criteria are presented according to the 2012 and 2014 recommendations of the American Academy of Sleep Medicine (AASM). Polysomnographic criteria for sleep-disordered breathing in children and the French National Authority for Health guidelines for indications of polysomnographic studies were reported. Relevance and limits of in-lab PSG, home PSG, and respiratory polygraphy were presented and guidelines were proposed to improve the diagnosis and follow-up of these children.

[Thyroglossal duct cysts, surgery and histology]. / Le kyste du tractus thyréoglosse, chirurgie et histologie.

70 years ago Sistrunck described a specific procedure for the management of thyroglossal duct cysts. However, this surgical procedure is not performed often. In a review on 28 cases, the authors have determined whether the Sistrunck's operation was too extensive in the treatment of thyroglossal duct cysts. 28 surgicals procedures have been performed during five years, 6 Schlange's procedure and 22 Sistrunck's procedure. We have had 17% of complications with only one recurrence, after six months, with Schlange's operation. During the interventions, we have been able to see and feel a duct in only one case. This difficulty in determining the presence of a duct intra-operatively could suggest that there was no duct. So we have undertaken a histological study of all 28 specimens obtained from surgery. Results showed the presence of one or multiple tracts in 72% of cases. Finally, this study show that Sistrunck's procedure is still the best operation for treatment of all cases of thyroglossal duct cysts. All other operations, and particularly Schlange's procedure, are inadequate because they are in contradiction with histological and embryological studies.

[Azithromycin versus josamycin: treatment of 89 cases of acute pneumonia]. / Azithromycine versus josamycine: traitement de quatre-vingt-neuf pneumopathies aiguës.

In an open, multicenter randomized clinical trial on patients with acute pneumonia, 5-day therapy using a new oral macrolide antibiotic, azithromycin (Az), was compared with standard 10-day therapy using another macrolide, josamycin (J). Eighty-nine patients were treated (46 Az, 43 J); both groups were comparable, except in terms of the sex ratios. The causative agent was determined in 31 cases; streptococcal pneumonia was the most common diagnosis (48%). Cure rates were 93% for J and 80% for Az (p greater than 0.30), as judged by a fall in body temperature and an improvement in clinical condition and in radiographic findings. Among 6 failures, there were 4 cases of empyema (1 J, 3 Az). Of 6 deaths, 2 were pneumonia-dependent (1 J and 1 Az, Haemophilus and Streptococcus pneumoniae, respectively). We conclude that 5-day Az is as effective as 10-day J and that such short-course therapy is an advantage in the treatment of pneumonia caused by macrolide susceptible pathogens.