The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital.

Primary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay.

[Childhood septic temporomandibular arthritis]. / Arthrite septique temporomandibulaire de l'enfant.

OBJECTIVE: To report a clinical case of acute otitis media in a child, complicated by septic temporomandibular arthritis and to present a review of the literature. PATIENT AND METHODS: We report a case of a 7-year-old boy who presented an altered general condition, major hyperthermia, associated with a left temporozygomatic mass in a context of recurrent bilateral acute otitis media lasting for 2 months. Emergency computed tomodensitometry (CT scan) showed left temporomandibular joint arthritis. Treatment consisted of a parenteral double antibiotic therapy and prevention of temporomandibula (TM) ankylosis. RESULTS: After 20 months of follow-up, the child showed a normal ORL examination with no maxillofacial sequelae. CONCLUSION: All temporozygomatic masses presenting in a septic context should suggest the diagnosis of TM arthritis; computed tomodensitometry should be done immediately.

[Otosclerosis surgery: a series of 227 cases. Introduction of CO2 laser]. / Chirurgie de l'otospongiose. A propos de 227 cas introduction de la platinotomie laser CO2.

OBJECTIVES: To evaluate the effects of the size of the footplate opening on the hearing results in surgical treatment of otosclerosis and the use of CO2 laser in this indication. PATIENTS AND METHODS: 190 patients with otosclerosis underwent 227 procedures between 1986 and 1995. Hearing results and symptoms were analyzed to compare the different procedures: 140 stapedectomies, 87 Fisch's stapedotomies, 35 of them with manual perforator, 52 of them with CO2 laser. RESULTS: Air/bone gap closure within 10 dB was obtained in 87, 92 and 97 percent of stapedectomies and in 80, 84 et 90 percent of stapedotomies after 3 months, 1 and 3 years (NS). Bone conduction was improved in 81, 80 et 63 percent of stapedectomies and 87, 97, 60 percent of stapedotomies after the same time (NS). Air/bone gap closure within 10 dB was obtained in 75 and 80 percent of manual perforator stapedotomies and in 84 and 88 percent of CO2 laser stapedotomies after 3 months, and 1 year (NS). Bone conduction was improved in 78 and 96 percent of manual perforator stapedotomies and 95 and 100 percent of CO2 laser stapedotomies after the same time (NS). No facial palsy or prolonged vertigo occurred. There was one case of anucusis following a stapedectomy. CONCLUSION: Although both stapedectomy and stapedotomy produced equivalent air/bone gap closure, reduction of inner ear trauma was noted with Fisch's stapedotomy. CO2 laser technique is a safe procedure, which optimizes the Fisch's stapedotomy.

[Necessity of auditory and academic supervision in patients with unilateral hearing disorder. Retrospective study of 175 children]. / Nécessité d'un suivi audiologique et scolaire de l'enfant sourd unilatéral. Etude rétrospective de 175 enfants.

This report reviews a consecutive series of 175 children suffering from unilateral hearing loss of 20 dB or more evaluated at the Clocheville Hospital between 1980-1991. We found no numerical preponderance of gender nor of side impairment. The mean age of diagnosis was 6.9 years. Based on speech frequency threshold averages, the loss was profound in 49.7%. 32.8% of the children experienced a deterioration of hearing of 10 dB or more. 40.4% of the children had repeated a grade during primary school (versus 16.3% in normal hearing population, p < 0.001). Monaural deafness especially when more than 40 dB, or delayed identification is significantly associated with a grade failure. A concerted effort aimed at early identification and management strategies in cases of unilateral hearing loss in children is warranted.

[Epidemiology of otitis media with effusion]. / Epidémiologie des otites avec épanchement.

Acute otitis media (AOM) and otitis media with effusion (OME) are very common in the young children. The relation ship between these two pathologies has not been completely established. The AOM incidence ranges between 22 to 74%. The OME which persists after onset of AOM is more frequent (20% at 2 months) than the chronic OME which concern 4.4 to 10% of the child population before the age of five. The highest age specific incidence for all episodes of AOM is one year of age. AOM and OME are most likely to occur in the winter. The OME risk factors are: the first episode of OMA before 6 month of age, the males sex, no breastfeeding, day-care centers, low socio-economic conditions and familial genetic predisposition. Passive-smoke exposure and allergy are discussed. The epidemiology assesses the actual state of these pathologies to settle, with the family, the optimum choices for the prevention.

[Primary cutaneous neuroendocrine carcinoma (Merkel tumor). Clinical and therapeutic update apropos of 4 cases]. / Carcinome neuroendocrine cutané primitif (tumeur de Merkel). Actualités cliniques et thérapeutiques à propos de quatre cas.

The clinical and pathological features of 4 cases of cutaneous neuroendocrine carcinoma are reported. There are unusual malignancies mostly observed in elderly, the prognosis is poor by loco-regional aggressivity and disseminated metastases. They are diagnosed by a pathologist: ultrastructural studies and immunohistochemistry support the diagnosis. A combination of a wild local excision, node dissection and post-operative radiation is recommended.