[Synovial sarcoma with cervicopharyngeal expression]. / Sarcome synovial d'expression cervico-pharyngée.

A case is reported of a patient with cervicopharyngeal synovial sarcoma, and the clinical characteristics and therapy of these very rare tumors discussed. It appears difficult to assess prognosis because of the very few cases documented.

[Short-term complications of transtympanic aerators]. / Complications à court terme des aérateurs transtympaniques.

Three hundred and thirteen transtympanic aerators (TTA), including 309 T-tubes, were inserted between november 1985 and April 1987 at the Bretonneau hospital, Paris. Twenty-three (7%) were expelled spontaneously, 16 (5%) became obstructive and in 6 cases a change of TTA was required. The commonest complication was otorrhea. Younger children tended to develop early otorrhea. There were 7 cases (2%) of early otorrhea and 50 (16%) of secondary otorrhea. By contrast the onset of secondary otorrhea was independent of age. A relationship with penetration of water into the middle ear through the TTA could not be confirmed. At the present time the authors permit bathing without any special precautions. In parallel, between november 1985 and august 1987, 84 bacteriological samples were obtained in cases of otorrhea related with a TTA, whether or not the latter had been inserted at Bretonneau. Predominant organisms were Hemophilus influenzae (30%), Pseudomonas aeruginosa (30%) and Staphylococcus (18%). On the basis of results of antibiotic sensitivity studies using the organisms discovered in these samples, the authors suggest local therapy based upon polymyxin or rifamycin as treatment of first choice.

[Bacteriological study in acute otitis media]. / Etude bactériologique de l'otite moyenne aiguë.

A retrospective study was conducted of 587 bacteriological samples collected from 387 children with acute otitis media treated as outpatients over a period of 30 months, to determine relative frequency of the causative germs and their resistance to antibiotics. The most frequently involved bacteria were staphylococci (16 p.cent) of which 70 p.cent were Staph. Epidermidis, and Haemophilus (17 p.cent), résistance to ampicillin being present in 19 p.cent. These results, which differ from those in the published literature, suggest that paracentesis with systematic bacteriological typing is the treatment of choice in acute otitis media.

[Current bacteriologic status and therapeutic results in acute otitis media in children aged over 3 months]. / Bactériologie actuelle des otites moyennes aiguës chez l'enfant de plus de trois mois et conséquences thérapeutiques.

355 children, 3 months to 15 years old, presenting with acute otitis media, underwent a bacteriological study of otitis exsudate. From November 1985 to September 1987, 162 myringotomy and 149 acute otitis media spontaneously discharging were studied in Paris. From October 1981 to September 1987, 62 myringotomy and 46 spontaneously discharging acute otitis were studied in Valognes. There was none pathogenic bacterium in respectively 20 and 14% of the samples. Two or more pathogenic bacterium were isolated in 24 and 7% of the samples. In Paris as in Valognes, 3 pathogens were predominants: Haemophilus (17% were beta-lactamase producers), S. pneumoniae and Staphylococcus. There was only 5 and 3% Streptococcus pyogenes, 2% Branhamella catarrhalis in Paris, none in Valognes. Pseudomonas was present only in case of spontaneous otorrhea, even if recent. For the moment, the combination of amoxicillin with clavulanic acid is not our first treatment in case of acute otitis media in children. Actually we prescribe amoxicillin alone, 50 to 100 mg/kg/day. If the child is allergic to beta lactamin, we give him the combination of trimethoprime and sulfamethoxazole.

[Bacteriologic study of acute otitis media in hospitals and private practice]. / Etude bactériologique de l'otite moyenne aiguë en pratique hospitalière et en pratique libérale.

The authors report the results of the study of 435 bacteriological samples taken in children presenting with acute otitis media, in the out-patient department of ENT at the hospital Bretonneau (Paris) and in Valognes (Manche) from October 1981 to September 1987. Three bacterial organisms prevailed: Haemophilus (37 and 22% respectively), S. pneumoniae (25 and 7%) and Staphylococcus (16 and 17%). Pseudomonas was fairly frequent in cases with otorrhea, even when recent. Comparison with other studies shows the clear progression of the incidence of Haemophilus in acute otitis media. The percentage of the strains secreting a beta-lactamase was 17% whether the children live in the country or in town. The frequency of S. pneumoniae was independent of age but was clearly lower in cases with prolonged or relapsing otitis. According to these results, the authors discuss the therapeutic strategy for acute otitis media. Amoxicillin still remains the antibiotic of choice. In case of persisting or relapsing otitis, the bacteriological examination will allow choosing the best adapted antibiotic: first generation cephalosporin, clavulanic acid and amoxicillin or trimethoprime and sulfamethoxazole.