Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study.

BACKGROUND: Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days. METHODS: Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization. RESULTS: Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®. CONCLUSIONS: This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions. TRIAL REGISTRATION: The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered.

[Rhinoplasty and reconstruction of the nasal dorsum: role of an autologous graft of the concha media]. / Rhinoplastie et chirurgie d'harmonisation du dorsum nasal: apport de la greffe autologue de cornet moyen.

BACKGROUND: Aesthetic and functional rhinoplasty can improve facial beauty. Surgical procedure may require autogenous grafts. These bone or cartilage grafts are harvested from different parts of the body. The objective of our study is to evaluate the use of nasal concha media as a new type of graft in rhinoplasty. MATERIALS AND METHODS: Patients consulted for aesthetic as well as for functional problems. They had dorsum deformities. The inclusion criteria had been the achievement of a harmonization surgery of the nasal dorsum, associated or not with another aesthetic or functional rhinoplastic intervention. The grafts are quickly and easily removed by endoscopic endonasal approach under optical control. The removed graft is then shaped and inserted by hidden approach during a rhinoplastic operation. Complications have been noticed for harvesting site and recipient site. RESULTS: Ten patients have benefited from this new technique from 2002 to 2007. They consulted for aesthetic as well as for functional problems in 9 cases. One person consulted for aesthetic matters only. The removal of these grafts has led to no complication. One case of infection has been noticed, and one dorsum irregularitie has been noticed. Aesthetic and functional results have been analysed over an average step back of two years and show at least comparable results to techniques already published. CONCLUSION: The concha media seems to serve well as graft material in some indications of rhinoplasty. The primary indication of this type of graft is in the harmonization surgery of the nasal dorsum. These grafts do not replace the other existent autologous grafts, but advantageously complete the technical arsenal of the rhinoplastician. A study involving a wider population should be done to validate the interest of this new type of filling graft in rhinoplasty.

[Comparison between external radiotherapy and laser microsurgery for the treatment of TisT1N0 glottic carcinoma: Clinical modelling and cost-minimization study from the French national health insurance payer's point of view]. / Place de l'analyse médico-économique dans la décision thérapeutique en cancérologie ORL. L'exemple du cancer limité de la corde vocale (Tis, Tla). Comparaison entre la radiothérapie externe et l'exérèse laryngoscopique laser CO2. Création d'un modèle clinique et étude de minimisation de coûts suivant la perspective de l'Assurance Maladie.

OBJECTIVES: The excellent effectiveness of both treatment modalities (radiotherapy, endoscopic laser surgery) for early glottic carcinoma (Tis, TlaN0) is similar (carcinologic, functional and QoL results). This is part of an evidence-based medicine policy, which is to choose the cheapest of various treatment modalities known as equally effective and equally morbid. Is analytical economic approach useful and efficient to guide decision making? The aim of this study is to perform a costminimization analysis using an objective clinical modeling. MATERIAL AND METHODS: For each modality, probabilities of various events were recorded from review of literature. Only local recurrences which constitute the major end-point affecting survival were considered. French national Health insurance's point of view (as the payer's point of view), with a 100% case-mix based payment system was used. Results of cost-minimization between laser endoscopic surgery and external radiation therapy are: Global Cost of laser endoscopic surgery is about 2613.01 euro. Without (90% of cases) and with recurrence it is about 1700.36 euro and 10826.87 euro respectively. Global Cost of external radiation therapy is about 4490.88 euro. Without (90% of cases) and with recurrence it is about 3578.23 euro and 12704.74 euro respectively. CONCLUSION: Cordectomy by CO2 laser seems to be an efficient cost-effective alternative to radiotherapy for early glottic carcinoma management from the French national Health insurance perspective.

[Inflammatory pseudotumor of the larynx in children]. / Tumeur pseudo-inflammatoire du larynx chez l'enfant.

OBJECTIVE: Describe the management of laryngeal pseudotumor in a young boy with exclusive endoscopic resection with laser CO2 resection. MATERIAL AND METHOD: Case report. RESULTS: We report a rare case of a laryngeal pseudotumor in a child that was successfully treated with endoscopic resection with laser CO2 vaporization. The last follow-up at 12 months revealed no evidence of recurrence and no voice sequelae. This is the first case reported that was successfully treated after a single procedure. It is the second one where tracheotomy was avoided. CONCLUSION: Endoscopic resection with laser CO2 vaporization is a safe and effective treatment in cases of limited laryngeal inflammatory pseudotumor in a pediatric population, but close follow-up is necessary because of the risk of local recurrence.

[Bilateral hypopharyngocele]. / Hypopharyngocèle bilatérale.

OBJECTIVE: Describe the management of bilateral hypopharyngocele in a trumpet player. MATERIAL AND METHOD: Case report of a professional trumpet player suffering from bilateral hypopharyngocele. RESULTS: A professional trumpet player was referred for an ORL consultation after he noticed that a bad sound was produced while he was playing associated with cervical pain. A CT scan demonstrated an asymmetric bilateral hypopharyngocele with no other abnormality. Because of the mild symptoms and the professional context, a successful conservative approach was used with antireflux medications. He was advised to seek professional instruction in order to improve his technique. On follow-up examination 6 months later, he had had no further problems since adopting the corrected techniques. CONCLUSION: Pharyngoceles are rare and easily misdiagnosed. Because of the mild symptoms and the professional context, a conservative medical approach should be proposed (antireflux medications) combined with specific orthophonic and physical therapy to modify breathing and trumpet playing techniques.

[Endostenting using a Y-stent for hematoma after thoracic aorta surgery]. / Endostenting par prothèse en Y sur hématome après chirurgie de l'aorte thoracique.

OBJECTIVE: To describe the diagnostic and therapeutic management of extrinsic tracheobronchial compression after thoracic aorta surgery. PATIENT AND METHODS: We report the case of a female patient with Marfan syndrome. RESULTS: A 27-year-old woman with Marfan syndrome presented respiratory distress after type III dissecting aneurysm of the descending aorta from extrinsic compression (hematoma) of the lower third of the trachea and the left bronchial stump. We placed a Y-stent (Y-Tracheobronxane, Novatech SA, France), thus restoring a satisfactory channel. A few days later, the patient developed right congestive heart failure from compression of the left pulmonary artery secondary to the progression of the hematoma. Medical treatment for this cardiological complication and the progressive resorption of the hematoma made it possible to remove the stent after 21 days with no dyspneic recurrence. CONCLUSION: Placing a Y-stent is possible and effective and has few iatrogenic consequences in cases of extrinsic tracheobronchial compression from a hematoma occurring during heavy thoracic vascular surgery. With surgical revision impossible given the risks, stent placement allows progressive resorption of the hematoma, thus ending the compression of the bronchial tree.

Grazing Incidence X-ray diffraction on Langmuir films: toward atomic resolution.

We have analyzed grazing incidence diffration (GIXD) data from condensed phases of Langmuir films of long-chain fatty acids at the air-water interface by using a new method consisting of a careful extraction of the structure factors followed by fitting of molecular parameters. We show that, contrary to the general belief, the information contained in GIXD spectra is enough to obtain near-atomic structural information. In particular, we directly determine for the first time the orientation of the chain backbone planes and of the carboxylic headgroups and we evaluate chain conformation defects. This new method allowed us to evidence a new phase of symmetry p2gm at high pressure, corresponding to a minimum in lattice energy, but never observed.

Single-center retrospective series of fourteen patients with mucosal melanoma of the nasal cavity and paranasal sinuses.

OBJECTIVES: Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare and highly aggressive tumor. We report our experience over 20 years in management of this tumor. PATIENTS AND METHODS: A retrospective study included 14 patients with primary sinonasal mucosal melanoma. RESULTS: The series comprised 8 male and 6 female patients, with a median age at diagnosis of 67 years. Staging on the American Joint Committee on Cancer classification of sinus cancer was 14% T2, 22% T3, 75% T4a and 7% T4b. All patients underwent primary surgical treatment; 71% received adjuvant external radiotherapy. Median recurrence-free interval was 28.7 months. Two- and 5-year overall survival was 43% and 32%, respectively. Median follow-up was 43 months. CONCLUSIONS: Mucosal melanomas of the nasal cavity and paranasal sinuses are very specific entities. Limited pathophysiological knowledge still precludes effective medium- and long-term management. Future treatment will probably be based on global adjuvant or neoadjuvant-targeted chemotherapy.

[Rhinocerebral mucormycosis]. / Une mucormycose rhinocérébrale.

INTRODUCTION: Mucormycosis is a rare and acute fungal infection which is frequently lethal. The rhinocerebral form is usually seen in diabetics, but other localizations may occur in severely immunocompromised subjects. OBSERVATION: We report the case of a sphenoidal sinusitis associated with a probable cavernous sinus thrombosis and carotid artery thrombosis with middle cerebral artery territory infarction. Diagnosis was made on histological examination following sphenoidotomy. Early medical and surgical treatment led to a good outcome. CONCLUSION: The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome.

[Endobronchial lipomas and their treatment: one case report]. / Lipomes endobronchiques et leur traitement: a propos d'un cas.

PURPOSE: Starting from a clinical observation of an endobronchial lipoma and in the light of worldwide literature, the aim of this case report is to specify the epidemiology, the key points of the diagnosis and the advantage of endoscopy both in the diagnosis and the treatment of these rare benign bronchopulmonary tumours. CLINICAL CASE: Recent pneumopathy in the right superior lobe bronchial area in a 73 year old female, symptomatic with cought. Biopsy exeresis gave the histological diagnosis. DISCUSSION AND CONCLUSION: The clinical symptoms due to bronchial obstruction associated with the conventional radiological and computed tomography signs orientate the diagnosis definitively obtained through the anatomopathological study. This histological study is carried out from biopsies performed either during a bronchial fibroscopy or during a tracheobronchoscopy. By confronting the benign macroscopic aspect and the data from the extemporaneous anatomopathological study of the lesion, endoscopy provides an early-stage diagnosis and makes it possible to perform a concomitant and conservative treatment before the stage of irreversible broncho-pulmonary complications. It also avoids the risks and sequelae of classical surgery by thoracotomy.

[Treatments of hereditary hemorrhagic telangiectasia of the nasal mucosa]. / Indications et stratégies thérapeutiques des épistaxis dans la maladie de Rendu Osler.

UNLABELLED: Hereditary Hemorrhagic Telangiectasia is a systemic autosomal dominant disorder involving blood vessels. The most common symptom is recurrent epistaxis. The treatments of these epistaxis are numerous but such treatments are often symptomatic and their effects are often not sustained. Some of these treatments may be complicated by visceral vascular malformations. The aim of this study is to propose a treatment plan for these patients with hierarchical organisation of therapeutic options taking into account of their previous therapy. METHOD: H. Plauchu organized in Paris, december 2002 a meeting with any medical specialists of this disease. They have analysed variety of therapies that have been proposed for epistaxis control in Hereditary Haemorrhagic Télangiectasia. RESULTS: Most common use packing of nasal fossa and then hyperselective embolization of the internal maxillary and facial arteries for severe epistaxis. For chronic epistaxis, best treatment use sclerotics products (Ethibloc) and laser. After discussion, primary embolization could be useful to reduce vascularization of nasal fossa. CONCLUSION: Treatment of epistaxis in Hereditary Haemorrhagic Telangiectasia could increase in few years. Use of an index card of for epistaxis in the disease of Rendu-Osler could help to find treatment of choice.

[Tumor-bronchial actinomycosis simulating a recurrence of lung cancer 14 years after initial treatment: A case report]. / Actinomycose bronchique pseudo-tumorale simulant une ré-évolution d'un cancer bronchique 14ans après la prise en charge thérapeutique initiale : à propos d'un cas.

A patient with a history of squamous cell carcinoma of the right upper lung lobe treated 14 years before by concomitant chemo-radiotherapy was referred on account of dyspnea. Bronchial endoscopy revealed complete obstruction of the right main bronchus highly suggestive of a tumor recurrence. However, biopsy samples only showed inflammatory and necrotic tissue with no evidence of malignancy. Despite complete tissue resection by rigid bronchoscopy, a rapid and complete recurrence occurred requiring the placement of a Y-shaped bronchial prosthesis. Repeat histological, bacteriological and mycological analyses were negative. The patient was soon readmitted to hospital for a lung infection due to recurrence of obstruction inside and around the prosthesis. Bacterial examination of biopsy samples identified Actinomyces meyeri. Appropriate antibiotic therapy led to a complete regression of the bronchial obstruction. Unfortunately, the patient died a few months later due to massive hemoptysis after the removal of the prosthesis. Autopsy examination showed a fistula between the right main bronchus and pulmonary artery, with no evidence of neoplastic recurrence nor the persistence of lesions associated with actinomycosis.

Salvage brachytherapy of posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area.

PURPOSE: Brachytherapy performed in patients with posterior pharyngeal wall carcinoma in a previously irradiated area is evaluated in terms of local control, survival, and complications. METHODS AND MATERIALS: Between January 1982 and July 1993, 14 patients were treated with interstitial low dose rate brachytherapy alone for posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area (local recurrences in five cases and second tumors in nine cases). Tumor size ranged from 1 to 4 cm. No patient had a macroscopic nodal involvement or metastase at the time of diagnosis. Median dose delivered was 55 Gy (39 to 60 Gy). RESULTS: Thirteen patients were assessed for local control. Twelve of them achieved complete macroscopic response within 2 months after brachytherapy. Local relapse occurred in five patients, from 5 to 29 months after brachytherapy. One patient developed distant metastatis without loco-regional relapse. Disease free survival was 69, 59, and 37% at 1, 2, and 5 years, respectively; overall survival was 78, 50, and 21% at 1, 2, and 5 years, respectively. Three patients were still alive without recurrence (8, 8, and 10 years after treatment). We did not observe any severe acute or delayed toxicity. CONCLUSION: Based on these results, interstitial brachytherapy should be considered as a potentially curative treatment for selected patients with posterior pharyngeal wall squamous cell carcinoma in a previously irradiated area. There are no reports in the literature on this subject.

Occurrence of monosialosyl pentahexaosylceramide GalNAc-GM1 as specific tumor-associated ganglioside of human head and neck squamous cell carcinomas.

In a recent study of the ganglioside profiles of human head and neck squamous cell carcinomas versus normal tissue, one unidentified GX ganglioside was found exclusively in tumor extracts, migrating between GM1 and GD3 by thin-layer chromatography. To determine the chemical structure of this ganglioside which accounted for 3-8% of the total gangliosides, the lipid samples were pooled and separated by high-pressure liquid chromatography to obtain individual ganglioside species purified to homogeneity. The tumor-associated GX ganglioside was analyzed by gas-liquid chromatography, mass spectrometry and immunostaining on thin-layer plates with mouse monoclonal antibodies after enzymatic cleavage. The data allowed the identification of GX ganglioside as GalNAc-GM1 that has been reported as a very minor brain ganglioside in humans. Thus, GalNAc-GM1 is a specific tumor-associated ganglioside in human head and neck squamous cell carcinomas that could be potentially valuable for clinicians.

Self-expanding metal stents for the management of bronchial stenosis and bronchomalacia after lung transplantation.

BACKGROUND: Airway stenosis or malacia after lung transplantation, usually as a result of anastomotic ischemia, remains a major problem. METHODS: The authors report their experience with the Gianturco expandable stent for the management of 23 bronchial stenoses in 18 patients following lung transplantation. Stent placement occurred an average of 5.6 months after transplantation. RESULTS: Stents were well tolerated and produced immediate symptomatic and functional improvement. The mean follow-up after implantation was 21 months (range, 4 to 48 mo). The authors removed five stents by endoscopy and replaced them, and removed one stent entirely. Laser resection was used to control granulomas or partial fibrosis stenosis that occurred in four stents (14.3%) after an average of 4 months. One stent broke but was still in place and effective 32 months later. One patient died of hemorrhage 4 months after stenting. CONCLUSION: Although it can still be improved, this expandable metal stent is suitable for the treatment of posttransplantation proximal bronchial stenosis.

Further improvement of quality of life by cetirizine in perennial allergic rhinitis as a function of treatment duration.

The SF-36 Health Status Questionnaire is a generic quality of life questionnaire based on 36 questions selected to represent nine health concepts. Perennial allergic rhinitis is a disease which causes variable restrictions on the physical, psychological and social aspects of patients' lives. According to the SF-36 questionnaire assessment, quality of life is impaired in these patients. Cetirizine, a potent, reliable histamine H1-receptor antagonist, has already been found to induce significant improvement in the quality of life of patients with chronic rhinitis, as assessed by the same SF-36 questionnaire after 1 and 6 weeks of treatment. This paper further investigates the extent to which cetirizine continues to improve quality of life after a long-term treatment (6 weeks) compared to a shorter treatment (1 week). The analyses show that, despite the significant improvement found after 1 week of treatment with cetirizine compared to placebo, a further 5-week course of therapy not only maintains this improvement but continues to enhance quality of life significantly above and beyond this.

Observation of a two-step mechanism in the formation of a superstructure of cadmium-behenic acid Langmuir monolayer: evidence of an intermediate structure.

By means of grazing incidence x-ray diffraction, the structure of a behenic acid monolayer spread over chloride salt solutions of cadmium is observed to evolve from the tilted L2 phase to the superstructure (corresponding to an organized monolayer of ions in addition to the ordered organic film), through an intermediate phase. The studied salt concentrations are below the so-called "threshold" needed for the formation of this superstructure. This kinetic process involving two first-order phase transitions is confirmed by Brewster angle microscopy experiments and surface pressure-area isotherms measured at different times after monolayer deposition.

[Contribution of chemotherapy in the treatment of cancer of the cavum (UCNT): apropos of 47 cases]. / Apport de la chimiothérapie dans le traitement du cancer du cavum (UCNT): à propos de 47 patients.

The authors present, from a 47 patients retrospective study, the place of BAC chemotherapy in the treatment of undifferenciated nasopharyngeal carcinoma. Twenty three patients treated with exclusive radiation therapy are compared with 24 patients treated with three courses of BAC chemotherapy prior to and after radiation therapy. The procedure using associated chemotherapy permits to increase the 5 years survival rate up to 20% more and to obtain a 100% primary response of the tumor. This encouraging results should be confirmed by a prospective randomized study about a great number of patients.

[Interest of thyroïdectomy in the management of thyroglossal duct cysts]. / Intérêt de la thyroïdectomie dans la prise en charge des kystes du tractus thyréoglosse dégénérés.

PURPOSE OF STUDY: To discuss the authors' experience with thyroglossal duct (TD) carcinoma and expose the interest of the thyroidectomy in the management of this entity. PATIENTS AND METHODS: A retrospective review of all patients with the diagnosis of TD operated on from 1985 to 2002 was performed. RESULTS: Four cases of papillary TD carcinoma were identified. Two patients were treated by a Sistrunk procedure associated with total thyroidectomy. One patient needed a thyroidectomy fifteen years after the initial management of the papillary thyroglossal duct carcinoma. The last patient had a medical treatment, with no evidence of complication after eleven years of follow up. CONCLUSION: A microscopic focus of papillary carcinoma, without cyst wall invasion, can be managed by a Sistrunk procedure, with the need for long-term follow up. Treatment of all other thyroglossal duct papillary carcinomas should include thyroidectomy followed by radioactive iodine treatment.

[Mediastinitis caused by anaerobic bacteria. 4 cases]. / Médiastinites à germes anaérobies. Quatre observations.

In 4 cases of mediastinitis caused by anaerobes and consecutive to dental abscess (2 cases), perforation of the oesophagus and tonsillar abscess, the diagnosis was based on widening of the mediastinum associated, in 2 cases, with pneumomediastinum. II all 4 cases, Bacteroides fragilis was present among other germs. Treatment consisted of surgical drainage by thoracotomy (2 cases), or cervicotomy and antibiotic therapy. Two of the patients, who were old and had underlying diseases, died.