Biomedical subjects
Publications and source records attributed to D Herman.
A double blind multicentre study of seasonal rhinitis (108 patients) has compared Loratadine and Cetirizine. The results of clinical scores are significantly good for both products. Only tolerance is different and in favour of Loratadine, since sleepiness was found in 9.5% of patients treated with Cetirizine, and 3.6% with Loratadine.
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Mucoceles of the appendix and associated pseudomyxoma peritonei are a heterogeneous group comprising various histopathologic lesions with differing prognoses. Between 1983 and 1990, we treated eight patients with appendiceal mucocele, three cystadenomas and five cystadenocarcinomas, three of which had accompanying pseudomyxoma peritonei. All patients were more than 50 years of age. Women outnumbered men by seven to one. Preoperative diagnosis was acute appendicitis or appendiceal abscess in all instances of mucocele unaccompanied by pseudomyxoma peritonei. Ultrasound of the abdomen, together with paracentesis, diagnosed pseudomyxoma peritonei in two of three patients. Elevated carcinoembryonic antigen levels were found in six of the eight patients and monitoring of this parameter was useful in the early detection of the two recurrences observed. The three patients with cystadenomas remain free of disease after appendectomy. Of the five patients treated for cystadenocarcinoma by right colectomy, two underwent reoperation after recurrence of disease. One patient died 41 months later of intestinal obstruction caused by pseudomyxoma peritonei. Pseudomyxoma peritonei significantly decreases survival of patients with appendiceal mucocele. In these patients, aggressive initial surgical management, repeated if need be, is indicated.
The massive hemorrhagic accidents of multinodular goiter are very rare, implicating the vital prognosis through an airway obstruction by tracheal compression. To illustrate this situation, the authors present an original case with a large cervico-thoracic hematoma without any respiratory's difficulties. The serious evolutive potential of that situation in spite the unworrying aspect of the patient, bring them to operate in delayed emergency.
The authors present a typical case of a traumatic internal carotid aneurysm rupture appearing 40 years after a blunt head trauma and surgically treated with success. The etiopathogenic and clinical aspects are reviewed and the important place of the angiography in diagnostic and therapeutical strategy is discussed.
The compatibility of downloaded MEDLINE references with software packages designed for maintenance of personal bibliographic databases is considered. The nine packages reviewed enable one to import batches of records downloaded from one or more presentations of the MEDLINE database, online or CD-ROM; and enable the user to re-format records into the various styles required by journal editors. Some basic features of the packages are tabulated, and details of record-importing facilities are described. Details of suppliers and prices are given.
Disorders of the upper respiratory tract, particularly allergic rhinitis are commonly associated with bronchial hyperresponsiveness. The latter may be responsible for chronic cough, a common symptom in patients with allergic rhinitis, which, as previously shown, can be the sole presenting manifestation of bronchial hyperresponsiveness. Theophylline is widely used in patients with asthma for its bronchodilator effect, whereas its action on bronchial reactivity is controversial. The aim of this study was to determine the effect of theophylline administration on bronchial hyperresponsiveness in patients with allergic rhinitis complaining of chronic cough. Fourteen patients were studied. All of them were judged atopic on the basis of positive skin tests to common allergens. During control, spirometry, flow-volume curves and specific airway conductance (SGaw) were measured. Bronchial challenges were then performed with increasing concentrations of carbachol, and dose-response curves were constructed. The concentration of carbachol, which decreased SGaw by 35% from baseline (PD35) was determined by interpolating from the dose-response curve. After control measurements patients received in a randomized, double-blind crossover fashion either theophylline 10 mg/kg/day orally or placebo for 30 days. Measurements were then redone. After a washout period of 8 days the measurements were repeated, and patients received theophylline or placebo for a second period of 30 days. Measurements were again performed at the end of this last study period. During control all patients had normal baseline lung function data and showed marked bronchial hyperresponsiveness, PD35 amounting to 26 +/- 7 micrograms of carbachol (normal value greater than 160 micrograms). No significant changes in PD35 were noted after placebo and washout when compared with control values.(ABSTRACT TRUNCATED AT 250 WORDS)
Reporting 55 cases of laryngeal trauma, the authors detail the etiologies and the lesions observed and expose their trauma management. Endoscopic results are basic in the evaluation of the gravity of the trauma. Radiological investigations, especially C.T. scan, take the second place. The use of endolaryngeal stent in the surgical treatment is as limited as possible. A precise lesional staging and a great rigour in the operative management can only guarantee the recovery of normal vocal and respiratory functions.
Based on the study of 25 cases, the authors recall the frequency and pathogeny of these lesions, specifying the surgical technique and presenting their results. The risks of this surgery lie in the ever possible impairment of the facial nerve and labyrinthization on treble frequencies (2 cases). The incidents are tympanic perforation (1 case) and the opening of the temporomandibular joint. It is not always possible to preserve the skin of the external auditory canal. It can be reconstructed by a free (3 cases) or pedicle (3 cases) graft of more simply in case of small loss of substance by a temporal fascia graft.
The authors report the case of a 15 year old adolescent who presents a rhabdomyosarcoma of the rhinopharynx. This young patient underwent 23 months before a kidney transplantation and was since under immunosuppressing treatment including corticoids, azathioprine and cyclosporin A. The characteristics of this tumor make it probably induced by the therapeutic based on cyclosporin.
Renal cell carcinoma (Grawitz's tumor), may metastasize to the head and neck region at different stages of its evolution. The authors present four cases illustrating the difficulties of the preoperative and histopathological diagnosis. The data on otolaryngological localisations are reviewed.
Alternaria allergens, separated by SDS polyacrylamide gel electrophoresis and transferred onto a nitrocellulose membrane, were identified using sera from Alternaria-allergic patients. 30 Alternaria components of spore and mycelium, ranging in molecular weight from more than 150 to 12 kD, bound IgE antibodies. 15 were detected by more than 25% of the sera and only 4 (85, 56, 42, 31 kD) by more than 50% of the sera. Among these four major allergens, the 56-kD component was present mostly in the spore extract, the 85- and 42-kD fractions in the mycelium extract and the 31-kD in both extracts. The 31-kD component showed the highest IgE binding and the highest frequency of binding (95% with mycelium extract and 79% with spore extract). It was composed of two subunits.
19 patients presenting with saddle deformity of the nose were operated upon between 1981 and 1988. Either a bony or a cartilagenous autograft has been employed according to the nature of the deformity. The mean follow-up was two and a half year. The results confirm the high rehability of cartilagenous grafts in the treatment of partial deformities. Treatment of total saddle deformities proved to be less satisfactory with spontaneous resorption of two grafts out of six, one of which was a homologue bony graft from the bank.
The authors present a case of intracerebral expansive pneumatocele following a ethmoido-sphenoidal fracture by a bullet. The case presented is exceptional, as the bullet went through the brain case without injuring the neurological structure. The patient is operated on through the low paralateronasal approach, by filling the ethmoid and the sphenoid with autologous bone material. This surgical treatment makes closure of the fistula and disappearance of the pneumatocele possible, however, not enough time has gone by for making other judgments. This approach, which has a much lower morbidity rate than the approach of the anterior stage through craniectomy, is effective for fractures of the sphenoid and the posterior ethmoid.
Methods of surgical repair after total pharyngo-laryngectomy have considerably improved since the introduction of micro-surgical techniques. The use of free autografts for reconstruction of the pharynx is now preferred in most centers to the use of musculo-cutaneous flaps. The free forearm flaps appears to be particularly suitable for this type of repair. The authors report on their experience in performing this procedure with one of their patients. The results of this technique in major published series are then compared with those achieved with similar procedures employing free jejunal interposition grafts.
Cervico-facial actinomycosis is a chronic bacterial disease caused by actinomycetes. The diagnosis may be made on the specific anatomo-pathological appearance of the granulomas and be confirmed by anaerobic culture of the germs. The authors report two atypical cases: the first is a case of a thyroglossal pseudocyst, the second that of adenoidal vegetations in an adult. Treatment with Penicillin G or V for six weeks produced a favourable response. The various clinical forms of the condition described in the literature, should encourage the physician to include bacteriological testing for actinomycetes among his investigations.
Specific immunotherapy (ITS) can be a preventative measure for occupational allergy when allergens cannot be fully eliminated. Many allergens provoke IgE-mediated reactions, but when they are haptens and the physiopathology is complex, then the value of ITS is restricted. However, with common allergens whose density increases with occupation, such as house dust and house dust mites for domestic employees, pollens for florists and animal epithelia for breeders, then ITS is effective. On the other hand, when the allergen is specific for the job, of which there are two well documented examples in bakers asthma from wheat flour and laboratory worker's asthma to small laboratory animals there are disparate results. Overall, there is only a modest place for ITS in the treatment of professional asthma, because of the lack of purified, well-standardised extracts.
Acquired deficiency in C1 esterase inhibitor (C1 INH) was first described by Caldwell in 1972. Since that date, about 30 cases have been reported, in most cases during proliferative lymphocyte B syndromes. The acquired C1 INH deficiency can provoke episodes of angioneurotic edema as in hereditary AE. The complement profile differs, notably by the usual sudden fall in C1. Documented data suggest consumption of complement and therefore of C1 INH. The present case is the first reported of an acquired C1 INH deficiency during a cold hemagglutinin disease. The activation of complement by the classical pathway appears provoked by tumoral cells rather than a humoral factor, as suggested by the efficacy of anti-tumoral therapy in contrast to plasmapheresis in the present case. A possible mechanism for the C1 INH deficiency is discussed.