Biomedical subjects
Publications and source records attributed to A Perrin.
Four cases of Rosai and Dorfman's disease are presented. This adenomegalic sinusal histiocytosis is usually a benign affection even though the appearance and degree of glandular enlargement can suggest malignant disease. A literature review showed 215 cases reported up to the present.
Results of radiologic, radiotomographic and CT scan imaging of patients with major aplasias of ear are presented. In the absence of an indication for functional surgery these explorations allow evaluation of the risk of an epithelial inclusion within an undetected anlage of external auditory canal. When functional surgery is indicated results of these investigations allow assessment of pneumatization of petrous bone, possibility of construction of a new external auditory canal, and the internal ear. Study of middle ear is still insufficient in the region of the ossicula, particularly the fenestrae and stapes.
Principles underlying reconstructive surgery of external ear for major aplasia are described and results presented for 65 patients treated using a cartilaginous framework of a costal autograft as described by B. Brent. Possibilities are discussed of combining this technic with auditory function surgery and the wearing of an auditory prosthesis within the framework of general care of major aplasias.
Based on data from 109 patients operated upon for 125 major aplasias of ear, clinical and operative aspects and results of surgery are analysed. Functional prognosis is related essentially to the nature of the stapes, normal in 66% of cases, and the quality of healing of the newly formed canal. One auditive result out of four in cases of unilateral aplasia and one out of two in bilateral cases constituted the proportion of patients obtaining socially valuable postoperative auditive gain. Functional surgery for aplasia of ear should therefore be reserved mainly for bilateral forms because of the lack of any alternative to apparatus wearing.
Principal etiologies in 54 patients with acute laryngeal dyspnea of infectious origin were epiglottitis (35 cases), glotto-subglottal laryngitis (8 cases) and adjacent infections (9 cases). These cases are reviewed together with the relevant published literature and various conclusions drawn. The affection is serious (35 deaths out of 425 cases in the literature), and requires careful examination, immediate treatment and routine hospital care under surveillance. Apart from cases where the condition of the patient necessitates urgent intubation, those cases with rapidly evolving signs over 24 hours must be admitted to intensive care since worsening of dyspnea can lead to delayed decompensation. Wide spectrum antibiotic therapy is necessary for patients with epiglottitis and adjacent infective ulcerations since many germs may be implicated, while for the always benign glotto-subglottal laryngitis Amoxicillin + clavulinic acid is sufficient.
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Results of treatment of 135 cases of squamous cell carcinoma of soft palate treated between 1962 and 1983 in the ORL department of Hôpital Laennec, Paris, showed prognosis to be related to 3 main factors. Firstly, the frequency of syndromes and metasynchronous multiple primary cancers. Secondly, the presence of local recurrences. Their frequency should be reduced by performing first intention excision of the tumoral site with wide extension to the anterior and particularly the posterior pillars, and by the routine use of induction chemotherapy. Thirdly, nodal recurrences that can be prevented by routine prophylactic treatment of bilateral cervical lymph chains.
Sufficient mouse H-2 and human HLA class I gene sequences have become available to make a statistical analysis of nucleotide variations within the multigene families possible. In the H-2 and HLA families, a group of four H-2K allelic sequences and three HLA-A sequences were compared with a group of four non-H-2 and three non-HLA-A sequences, respectively. Simple calculations show that nucleotide variations in each group do not occur in a random independent fashion. It is therefore possible that a number of mutations are "concerted" between the subgroups. Interestingly, these concerted mutations are clustered and distributed almost exclusively in the 5' end of H-2 and HLA genes, which is very rich in GC nucleotides, and where the dinucleotide CpG is particularly frequent. The general concept of unequal repair is proposed as the basis of a model which is supported by these observations.
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The authors present a cases of localised exostosis of the angle and the ascending ramus of the mandible. They stress the technical problems posed by this giant exostosis and they propose an original operative approach together with a complete review of the literature.
Data were analyzed from case-reports of 80 patients undergoing resection graft procedures for benign mandibular tumors, and operated upon and followed up in the Stomatology and maxillo-facial surgical Unit, Hospital Salpêtrière, Paris from 1970 to 1984. In 27 cases surgery was by first intention; in the others it followed one or several previous operations, their multiplicity sensibly affecting the decision to operate and the development of postoperative suppurations.
Purulent meningitis developed during the immediate or late postoperative period in 10 patients undergoing minor surgical procedures for nasosinusal affections. An important point is that the meningeal infection may be a very late onset complication, the osteodural gap sometimes giving rise to several attacks of meningitis at unexpected times. Treatment should be based on the presence or absence of clinical cerebrospinal fluid rhinorrhea, of a fracture of the anterior shelf of base of cranium on tomography, and results of isotopic scanning which are valid only if positive. Surgery to close the gap is justified when rhinorrhea persists after recovery from meningitis or when recurrent bouts are reported. Even after surgery, however, there is still the risk of further attacks of meningitis. An interesting adjuvant to treatment is by antipneumococcal vaccination.
A patient with cancer of both the hypopharynx and esophagus was treated by partial pharyngolaryngectomy, subtotal esophagectomy and a reconstructive one-stage coloplasty. Surgical and carcinologic problems raised by this technique are discussed.
44 cases of tympanic involvement in the context of chronic otitis are described. 34 occurred during active chronic otitis. This is a rare possibility (approximately 4% of our own cases of chronic otitis). The following may be mentioned amongst them: 21 cases of osteitis, for which the following concepts should be borne in mind: the extreme severity of the chronic otitis responsible, in most instances, ears which had undergone multiple surgery (17/21), lesions exclusively of osteitis, but very extensive in 2/3 of cases (14/21). 7 cases of osteolytic disease, occurring severe or atypical cholesteatomatous chronic otitis and quite often involving associated osteolysis affecting the main VII, the promontory, the bulb of the internal jugular vein, or even the carotid canal. 4 cases of diffuse sub-obstructive osteomatous disease of the walls of the E.A.M., "progressive" development of which over several months was noted in 3 cases. Finally, 2 cases of mixed disease: (osteitis--osteomatoma and osteitis--osteolysis). 8 cases occurred following myringoplasty: this is a rare eventuality (approximately 1%), 1 case only of osteolysis due to iatrogenic cholesteatoma, 7 cases of osteitis, either highly localized and not preventing further myringoplasty (4 cases), or very extensive, finally resulting in a vast evacuation cavity. In 2 cases, a malformation is the origin of involvement of the tympanic at the origin of chronic otitis was felt probable, without it being possible to reach any definite conclusion concerning auriculobranchial fistula or Huschke foramen.
The authors undertook a study of changes in bone conduction (BC) during 800 operations carried out over a 5 years period (1979-1984) for chronic otitis or sequelae of chronic otitis. After elimination of ears with deafness (47) and cases unsuitable for evaluation (39), they finally included 714 records in the study. Only comparison of free and post-operative BC was made and using 4 conversational frequencies, not taking into account a deviation of 5 DB for each of these 4 frequencies. The study involved 317 myringoplasties: In 271 (i.e. 85,5%) there was no change in BC. Amongst them, 37 patients nevertheless showed a transient fall in BC. Of particular importance is the fact that almost 1/3 (11 to be exact) recovered only during the 2nd semester following surgery, a period which was even exceeded in the other 5 cases. 46 (i.e. 14.5%) were classified as "permanent" falls in BC. Amongst these in only 17 (i.e. 5%) were there "only" the three standard aggression factors for the I.O.: aspiration--scraping--manipulation of the tympano-ossicular system, without it being possible to attribute a predominant role to one more than the other. With regard to reaming of the E.A.M., those cases in which this could be considered responsible appeared to be infinitesimal. Furthermore, there was no statistically significant difference (reduced deviation test--"chi"2 test) between the number of falls in BC seen following myringoplasty with or without reaming. 83 tympanoplasties by Piston-Malleus, study of which led to the same conclusions as for myringoplasties. 118 masto-atticotomies, including 23 with posterior tympanotomy. Despite peri-labyrinthine and peri-ossicular scraping, results were essentially identical. 196 evacuation cavities (227-31 deafness) of which somewhat less than half only (46%) were ears undergoing surgery for the first time. Percentage of unchanged BC was here much more unfavourable, with 49 "permanent" falls in BC, i.e. 25%, of which, it must be said, 5 were minimal falls, and with, in 25 cases, a follow-up of less than 3 months.
The authors report six cases of rare ear diseases: fibrous dysplasia of the tympanum mimicking an partially obstructive osteoma of the external auditory canal. The authors draw a parallel between the rarity of these monostotic forms of the temporal bone which are strictly localised to a single region (tympanum-mastoid-atrium) and the diffuse forms which involve several regions at the same time; extensive papillomatosis of the external and middle ear, a rare condition with serious repercussions; two ceruminomas with very different clinical presentations and outcomes; an atrial pseudo-tumoral aspergilloma which was easily excised ans repaired with a myringoplasty with a good long term result; hypoplasia of the tympanum, which constituted a spontaneous évidement, discovered at operation for an attic cholesteatoma. This finding was sufficiently unusual to warrant reporting.
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