Respiratory complications after supracricoid partial laryngectomy.

The objective of the study was to analyze the incidence, treatment, and prevention of early and late respiratory complications in a series of patients who had supracricoid partial laryngectomies with either cricohyoidoepiglottopexy or cricohyoidopexy. From medical charts, we retrospectively reviewed 101 patients who underwent supracricoid partial laryngectomies, from 1980 to 2006, for laryngeal squamous cell carcinoma, and recorded the various postoperative complications and the time of decannulation. The mortality rate was 3.96%. Early complications included broncho-pulmonary infections and laryngeal stenoses which occurred in 9.9%. Univariate analysis showed a statistically significant relationship between the pulmonary complications and neck dissections (p < 0.04). Later, they were due to laryngeal obstruction (neolaryngeal mucosal flap, residual false vocal cord fold or arytenoid edema). The median decannulation time was 8 days, and there was a significant relationship between the decannulation delay and the pulmonary complications. Only two patients had a later definitive tracheotomy. Respiratory complications after supracricoid partial laryngectomy are frequent, but can be easily managed in most cases. A preoperative pulmonary assessment is necessary to select patients. During surgery, a precise impaction of the hyoid bone with the cricoid cartilage and a repositioning of an arytenoid can avoid some postoperative stenoses.

Yearly incidence of rhinitis, nasal bleeding, and other nasal symptoms in mature women.

OBJECTIVES/HYPOTHESIS: To evaluate, by a prospective questionnaire study, the incidence of spontaneous nasal pathology in mature women over a 12-month period, in particular nasal bleeding and the relationships of these symptoms with various factors. METHODS: Participants were drawn from a sample of 12,735 adult French volunteers participating in a study of antioxidant nutrients ("SU.VI.MAX"); 3500 women aged 50-64 years were randomly selected from good responders in the SU.Vl.MAX population. The responses of 2197 women were analysed. RESULTS: Nearly 70% of subjects reported at least one episode of rhinitis, with a mean (SD) of 1.88 (2.17) episodes per subject. Rhinitis was related to passive exposure to tobacco smoke (adjusted odds ratio [OR] 1.31, 95% CI 1.05-1.63), menopause (OR 1.47, 95% CI 1.16-1.88), and occupational exposure to vapours or dusts (OR 1.55, 95% CI 1.01-2.37). Nasal bleeding was reported as traces of blood by 16.5% of subjects, and as epistaxis (significant nasal bleeding) by 7.6%. Both symptoms were related to passive exposure to tobacco smoke (OR 1.63, 95% CI 1.22-2.19; OR 1.56, 95% CI 1.05-2.32, respectively) but not to use of systemic or topical medication. CONCLUSION: A substantial number of mature women experience nasal symptoms during the course of a year. Rhinitis and nasal bleeding were correlated with passive exposure to tobacco smoke.

Prevention of recurrent rhinopharyngitis in at-risk children in France: a cost-effectiveness model for a nonspecific immunostimulating bacterial extract (OM-85 BV).

OBJECTIVE: To estimate the pharmacoeconomic impact for the French Social Security System of preventing recurrent acute rhinopharyngitis (RARP) in at-risk children with OM-85 BV, an immunostimulating agent indicated for the prevention of recurrences. DESIGN: A decision-analysis model. The probability of progression of the infection and of its associated care, the principal direct costs linked to them, and the effectiveness of OM-85 BV were established or calculated by reviewing the available literature (published between 1984 and 2000). Four experts validated the parameters and the model. RESULTS: For the French Social Security System, the mean direct cost for an acute rhinopharyngitis (ARP) infection was 49.39 Euro(2000 values). By using OM-85 BV prevention, 1.52 infections were prevented in 6 months saving 67.83 Euro on the costs of care for the recurrently infected child. Sensitivity analyses confirmed the robustness of the model and indicated a saving of between 6.28 Euro and 303.64 Euro in direct costs for each individual treated preventively. Threshold analyses showed that OM-85 BV prophylaxis is economically profitable if more than 0.15 infections are prevented and if direct costs of care of an ARP are greater than 4.78 Euro. CONCLUSION: Non-specific immunotherapy should be considered for the child at risk of RARP and administered in addition to other recommended measures. The economic savings for the community of using a medication for which the clinical effectiveness has been demonstrated should also be taken into account in assessing its usefulness.

[Update on levofloxacin in the management of acute sinusitis with risk of complications]. / Actualités et place de la lévofloxacine dans la prise en charge des sinusites aiguës à risque de complications.

THE DIAGNOSIS OF ACUTE BACTERIAL MAXILLARY SINUSITIS: Is based on at least two of three major criteria: sinus pain, unilateral signs, increasingly voluminous and purulent rhinorrhea. Minor criteria can also be retained for diagnosis if they persist for three days. THE NEED FOR ANTIBIOTIC THERAPY: In this diagnostic context is undeniable, similar to the situation after failure of symptomatic treatment or complication. Likewise for unilateral maxillary sinusitis due to homolateral infection of the superior dental archade or for frontal, ethmoidal, or sphemoïdal sinusities. THE MOST FREQUENTLY CAUSAL BACTERIA: Are Streptococcus pneumoniae and Haemophilus influenzae. For first intention treatment generally relies on beta-lactams (amoxicilin/clavulanic acid, second or third generation cephalosporins); pristinamycin may also be useful. Fluoroquinolones active against pneumococci, e.g. levofloxacin, are reserved for cases of sinusitis with risk of complications and for second line treatment after failure in patients with acute maxillary sinusitis. COMPLICATIONS OF SINUSITIS: Can result from anatomic anomalies or from infectious mechanisms such as metastasis of a locoregional infection: peri-orbital cellulitis, orbital cellulitis, thrombophlebitis of the cavernous sinus, extradural, subdural or intracerebral abscess. Three clinical trials are under way to assess efficacy in the treatment of complicated or high risk sinusitis.