Bilateral paranasal sinus mucopyoceles in a child with cystic fibrosis.

Mucoceles of the paranasal sinuses are well-described complication of chronic sinusitis in adults. They are extremely rare in children and the main predisposing factor is cystic fibrosis (CF). We report a case of bilateral ethmoid and maxillary sinus mucopyoceles, associated with CF occurring in a six months old boy. The main symptom was a complete nasal obstruction. The marsupialization of mucocele was performed by endoscopic surgery. One year follow-up showed no recurrence.

[Amphicrine adenoma of the middle ear: three cases reports and a review of the literature]. / Adénome amphicrine de l'oreille moyenne: à propos de 3 cas et revue de la littérature.

UNLABELLED: Amphicrine adenoma is an extremely rare tumor of the middle ear. We report three cases obtained over a twenty year period. THE AIM OF THIS STUDY: is to discuss our clinical cases and review the literature. MATERIALS AND METHODS: Three cases of middle ear amphicrine tumour were reviewed. RESULTS: During a 10 year period (1986-2006) three cases of middle ear amphicrine tumour were treated at our unit (2 male, 1 female). The presenting complaint was hearing loss in all 3 cases. Amphicrine adenoma is diagnosed by an immuno-histological examination of pathological specimens. Differential diagnosis can be difficult and one individual was initially treated as an adenocarcinoma by radiotherapy. This patient succumbed to cerebral mycosis two years post-radiotherapy. The other two patients have no evidence of recurrence eight and nine years post treatment. CONCLUSION: Historically, differential diagnosis between amphicrine adenoma and adenocarcinoma of the middle ear has been very difficult. Carcinoid tumour is considered to be a more agressive form of amphicrine adenoma. Tumour progression is through loco regional invasion. Complete excision by surgical management with long term follow up is the treatment of choice.

[Benign paroxysmal positional vertigo of the horizontal and superior semicircular canals]. / Vertiges positionnels paroxystiques bénins des canaux latéraux et antérieurs.

The incidence of benign paroxysmal positional vertigo (BPPV) of the horizontal and superior semicircular canals is much less than that of BPPV due to affection of the posterior semicircular canal. Their diagnosis is however much more difficult and still prone to controversies. The provocative manoeuvre of the BPPV of the horizontal canal (BPPV-HSC) is the manoeuvre of rotation of the head in dorsal position. A horizontal positional nystagmus is obtained. There are two forms of BPPV-HSC: the geotropic form and the ageotropic form. In the geotropic form, the liberatory manoeuvre is a "barbecue" rotation of 180 with 360 degrees towards the healthy side. In the ageotropic form, there is no universal liberatory manoeuvre. Moreover as some cases of neurological aetiology have been recognized, it is not appropriate to apply ineffective manoeuvres. The BPPV of the superior canal (BPV-SSC) is very rare. The provocative manoeuvre is the Dix and Hallpike's manoeuvre. It causes positional torsional and vertical nystagmus with an opposite direction to that obtained for a BPPV of the contra-lateral posterior canal. The liberatory manoeuvre is a Semont manoeuvre, which is identical to that we would make for a contra-lateral BPPV of the posterior canal.

Intrauterine pressure monitoring with a balloon-tipped catheter.

Clinical experience with the latex and new estane balloons and a short and flexible guide is described. The extraovular balloon as an intrauterine pressure sensor is compared to the open-ended transcervical intraamniotic catheter, and the balloon is considered superior in many respects. The transcervical extraovular water-filled 0.8-ml estane balloon is recommended for use in place of the open-ended transcervical catheter in all clinical situations in obstetrics in which there is a need for monitoring intrauterine pressure.

Abnormal fetal growth patterns. Ultrasonic diagnosis and management.

Diagnostic ultrasound is a useful tool in the management of high-risk pregnancies and provides valuable information about abnormal fetal growth patterns including excessive fetal size and intrauterine growth retardation. Two patterns of growth retardation can be distinguished ultrasonically. Fetuses exhibiting "reduced growth potential" type patterns have little risk of fetal distress and are readily recognized as small for gestational age at birth. Fetuses suffering from uteroplacental insufficiency frequently exhibit a pattern of biparietal growth arrest in the third trimester. These fetuses have a high risk of fetal distress and should be closely monitored with other parameters of fetal-placental function including serial estriols and oxytocin challenge tests. Utilizing conventional pediatric growth criteria, the existence of intrauterine growth retardation is often unrecognized in this latter group.

Double-blind, placebo-controlled, multi-centre trial of the efficacy and tolerance of niflumic acid ('Nifluril') capsules in the treatment of tonsillitis in adults.

A double-blind, placebo-controlled study was carried out in 231 adult patients suffering from acute diffuse pharyngitis or acute tonsillitis with fever and dysphagia to assess the effectiveness of niflumic acid combined with standard antibiotic therapy in relieving pain and inflammation. Patients were allocated at random to receive either 4 capsules of 250 mg niflumic acid or placebo daily in addition to 1.5 million units phenoxymethyl penicillin for 4 to 5 days. Clinical assessments before and after 2 and 4 days of treatment showed that there was faster resolution of fever, pain, adenopathy, pharyngeal congestion and dysphagia, and improved patient comfort in the niflumic acid group. Few side-effects were recorded and there were only 4 drop-outs due to side-effects in patients receiving niflumic acid.

Composition of diets of low-income pregnant women: comparison of analyzed with calculated values.

Nutrient composition of diets of low-income pregnant women was determined by laboratory analysis and by calculation from food tables. Twenty-two diet composites, each representing a subject's 24-hour intake, were so evaluated. Findings from use of the two methods were compared. Mean analyzed and calculated values compared favorably for food energy, protein, fat, carbohydrate, potassium, magnesium, and zinc, although large differences in values as determined by the two methods were found in some single diet composites. Analyzed values compared less favorably with calculated values for calcium, phosphorus, iron, sodium, and the six vitamins studied.

Nutrient intake of low-income pregnant women: laboratory analysis of foods consumed.

Nutrient intake of a group of 22 young, mainly black, low-income pregnant women was evaluated by use of data resulting from laboratory analysis of foods prepared and consumed in the home over a 24-hour period. Magnesium, zinc, and folacin were the nutrients least well supplied in the foods consumed. Analyzed values for daily intake of the three were below 50% of the RDAs. Mean energy intake was considerably lower than recommended allowances, even though mean gain in weight was somewhat greater than that recommended for normal pregnancy, a finding like that of other investigators. The wide range in daily intake of energy and various nutrients among subjects is comparable with that found in a number of other studies, which showed that many individuals have marked deviations in intake from day to day. Analyzed diets also were examined in terms of nutrient density. Mean nutrient density for protein, calcium, phosphorus, vitamin A, thiamin, riboflavin, niacin, and ascorbic acid compared favorably with that of the RDAs, in contrast with the poor nutrient density for zinc, magnesium, and folacin. Laboratory analysis of the diets had the advantage of providing information about nutrient content of foods as prepared and consumed in the home. The analysis had particular advantage in the evaluation of content of zinc, magnesium, and folacin, as data for the three nutrients in food composition tables are limited.

Determination of substituents distribution in carboxymethylpullulans by NMR spectroscopy.

The distribution of carboxymethyl substituents in the alpha-(1 --> 6)-linked maltotriosyl repeating units of a carboxymethylpullulan (CMP) series was investigated by high resolution NMR spectroscopy on very short oligomers (DPn = 1.2-1.5) obtained by acid hydrolysis. A series of 2D NMR experiments on parent pullulan, hydrolysed pullulan and CMP was used to assign the proton and carbon chemical shifts of CMP acid hydrolysates. The degree of substitution (DS) and the relative distribution of -CH2COONa groups at OH-2, OH-3, OH-4 and OH-6 of glucose residues (DSi) were determined from 1H NMR measurements. From a set of CMP samples, widely different in degree of substitution, it was observed that the substitution at C-2 is predominant and decreases according to the order C-2 > C-3 > C-6 > C-4. Taking into account the availability of each OH group in the parent pullulan, an order of relative reactivity of hydroxyl groups is defined according to the relation: Ri = DSi/ni, where ni is the number of free OH groups in a maltotriose unit (MTU) for a given site C-i, the reactivity order was found to be OH-2 > OH-4 > OH-6 > OH-3.

Tuning the mechanism of DNA cleavage photosensitized by ruthenium dipyridophenazine complexes by varying the structure of the two non intercalating ligands.

The influence of the nature of ligands on the efficiency of ruthenium complexes for photosensitizing DNA cleavage was investigated. Ru(bipy)2dppz2+ and Ru(bpz)2dppz2+ were selected as DNA breakers on the basis of their high affinity for DNA due to the presence of a dppz ligand which can partially intercalate in the major groove of DNA. Their photosensitizing properties were compared to those of Ru(bipy)3(2+), a complex which binds to DNA with a far lower constant. Upon irradiation, these complexes promoted the formation of single strand breaks in supercoiled phi X 174 DNA. Unexpectedly, Ru(bipy)2dppz2+ was found to be less efficient than Ru(bipy)3(2+) whatever the dye concentration or the [base pair]/[Ru] molar ratio r. Scavenging experiments have shown that the oxidative DNA cleavage induced by Ru(bipy)2dppz2+ mainly results from a Type II mechanism. The behavior of Ru(bipy)2dppz2+ was different: this compound was clearly more efficient than Ru(bipy)3(2+) as DNA breaker and its efficiency was not modified by the presence of oxygen or by addition of scavengers of reactive oxygen species. In this case, a mechanism involving electron transfer between the excited state of the ruthenium complex and the guanine residue was proposed in agreement emission lifetime measurements. The change in mechanism observed between Ru(bipy)2dppz2+ and Ru (bipy)2dppz2+ results from an increase of the reduction potential of the ruthenium complexes in the excited state, which appears to be the main factor controlling the efficiency.

Ewing's sarcoma of the mandible: a case report.

The authors report the case of an 8-year-old boy with a Ewing's sarcoma localized to the mandible. The therapeutic modalities consisting of induction chemotherapy, surgical removal of the involved portion of the mandible with reconstruction using a parascapular osteo-cutaneous free flap, and maintenance chemotherapy are described. Emphasis is placed on the importance of performing a wide resection and the use of a multidisciplinary team approach in the treatment of these unusual tumours.

[Treatment of epistaxis of carotid origin by rhino-sinusal route]. / Le traitement des épistaxis d'origine carotidienne par voie rhino-sinusienne

Epistaxis of carotid origin usually calls for adventurous and complicated techniques such as trapping, embolization or releasable balloons. But there is an O.-R.-L. technique which is no less effective: the direct rhino-sinusal approach to the sphenoidal sinus followed by tenting or occlusion through the fascia lata. This tamponage, when applied very close to the source of the bleeding, has proved very effective and only cuts off the carotid axis progressively and is generally well-tolerated. To set against theoretically possible risks of extensive thrombosis are the indisputable practical advantages. In particular, any O.-R.-L. practitioner well versed in surgery of the sinuses can follow this procedure. Several cases are described.

[Management of severe epistaxis caused by so-called vascular or hypervascular tumors]. / Conduite à tenir au cours des épistaxis graves dues aux tumeurs dites vasculaires ou hypervascularisées

The authors begin by recalling the various tumoral conditions responsible for severe epistaxis. They differentiate between: angiomas and pseudo-tumoral angiomatous formations, vascular or so-called vascular tumours and hypervascularized tumours. In an emergency, immediate tamponage is essential. Treatment is also preventive: a gentle clinical examination and biopsies in the operating theatre. Particular stress should be laid on the contribution of super-selective arteriography which enables embolization to be carried out during the investigation. Embolization is particularly advocated, notably in cases of naso-pharyngeal fibroma, when there is a tumoral projection obstructing the pterygo-maxillary fossa or when there is considerable vascularization stemming from a branch of the external carotid other than the internal maxillary. Whatever the situation, any embolization, if it is to be permanently effective should be followed within 48 to 72 hours by surgical excision.

[Rendu-Osler disease: apropos of 50 cases followed at the Gustave-Roussy Institute]. / La maladie de Rendu-Osler: à propos de 50 cas suivis à l'Institut Gustave-Roussy

Rendu-Osler disease is an hereditary disease due to a predominantly antosomic heredity. The statistics given for 50 cases include 27 males 7 p. 100 of which had no familial antecedents. Clinically, Rendu-Osler disease begins in adulthood (44 p. 100) and often in late adulthood. In fact, it does not become really severe until about the age of 50 or 60. Epistaxis is the most frequent accident and proves fatal in more than 10 p. 100 of cases. Treatment of the nasal symptoms, whether this involves surgical excision followed by grafting or plesiocurietherapy using irridium wires, is very disappointing. The future alone will prove whether embolization gives more permanent results.

[Stenoses caused by Murphy's button in the treatment of esophageal varices]. / Les sténoses après bouton de Murphy dans le traitement des varices oesophagiennes

Treatment of oesophageal varices by insertion of Murphy's button arrests haemorrhage but in 2/3 of the cases of secondary stenosis occurs between the 4th and 8th week. The use of Blakemore's probe contributes to this. It is a very severe stenosis in 15 p. 100 of the cases and may require insertion of a wire loop. Dilatation should be started as soon as the first symptoms appear.

[Voluminous neurinoma of 2d and 3d portion of the intrapetrosal facial nerve with subtympanal extension]. / Un volumineux neurinome des deuxième et troisième portions du nerf facial intra-pétreux avec extension sous-tympanale

A patient presented with a facial nerve neurinoma of unusual size and which gave particularly clear radiological images. The curious feature of this observation is that there was no pre-operative facial paralysis as happens in about 15 p. 100 of cases.

[Current treatment of Rendu-Osler disease, excluding radiation]. / Thérapeutiques actuelles de la maladie de Rendu-Osler, à l'exception des radiations

All the methods available to O.-R.-L. practitioners for the treatment of epistaxis in Rendu-Osler disease are reviewed. In an emergency, gentleness is essential. Over the long term, procrastination for as long as possible is advisable. Super-selective arteriography and embolization are of great value in an emergency and can give some good long-term results. In fact, there is not one exclusive curative therapy. Estrogenotherapy has its advocates. Saunder's dermoplasty gives variable results, but these can be improved upon if a broad access route is used and dermoplasty extended to above and behind the nasal fossae. Because of its aggressive nature, irradiation must be kept as a last resort.

[Rendu-Osler disease treated by endonasal radiotherapy (evaluation of 62 cases)]. / Maladie de Rendu-Osler traitée par plésiocuriethérapie endo-nasale. (Bilan de 62 cas)

Two groups of patients were treated by plesiocurietherapy. The first group of 17 patients received only one exposure to radium (between 1949 and 1960). The second group received one or more doses of irridium 192 (between 1960 and 1973). The average period for stabilization of the disease was 13,2 months with radium and 20,4 months with irridium. Unfortunately, this does not give a permanent cure and, for irridium 192, the percentage of successes is only 30 p. 100 after 5 years. Logically, radiotherapy with irridium 192 should only be used when other methods have failed. The progressive accumulation of radio-lesions may, in fact, make the use of other techniques impossible.

[Sarcoidosis of the ethmoid sinus. Apropos of a case]. / Ethmoïdite sarcoïdosique. A propos d'un cas.

We report the case of a 78 year old man with unilateral persistent headache and associated bilateral kerato-conjunctivitis and minor skin lesions. Chronic ethmoiditis was diagnosed on a CT scan, and endoscopically controlled endonasal ethmoidal biopsy gave the diagnosis of sarcoid and hence the treatment. A nodular type isolated pulmonary lesion, atypical for sarcoidosis, also disappeared on steroid therapy. A review of the literature showed this to be an exceptionally rare form of the disease.