Biomedical subjects

D Portmann

Publications and source records attributed to D Portmann.

At least 37 records · Page 2Linked to original sources

PubMed1993

[Widened retrolabyrinthine approach: application to the surgery of acoustic neuroma].

For a long time, the role of the widened retrolabyrinthine approach (WRLA) in surgery of the posterior fossa was restricted to functional surgery of the erebellopontine angle (CPA). The widening technique described makes it possible to adapt it to surgery for the exeresis of APC tumors, irrespective of their histological nature. We have used this approach to treat 19 neurinomas of the VIII and 11 other lesions. The results obtained in the preservation of facial function and hearing match those recorded with more traditional approaches, such as the translabyrinthine and suboccipital retrosigmoid approaches. By its modularity in the access space, it is the multi-purpose approach for the CPA. In our therapeutic armamentorium, given its possibilities to preserve hearing, it has taken the place of the less flexible and more dangerous suboccipital approach.

Ear, Inner↗

PubMed1993

[Transfrontonasal approach: development of a mixed approach to ethmoid tumors. Experience of 12 cases].

Our experience in approaching ethmoid tumors through a combined pathway is currently based on 81 patients. 69 of them were malignant tumors treated by the neurosurgical subfrontal and paralateronasal transfacial rhinological approach. For the past two years, we have adopted the technical modification described in Bordeaux by Pinsolle and San-Galli enabling the approach of the ethmoid bone by means of a unique (Unterberger's scalp) incision and a unical frontonasal flap. 12 patients benefitted from this transfrontofacial access. The advantages and disadvantages of the technique are discussed.

Ethmoid Bone↗

PubMed1992

[Current data on barotraumatic ear disease with isolated vestibular expression during apnea diving].

The authors have taken an interest in isolated vertiginous symptoms observed from free diving patients. In order to achieve a current bibliographic synthesis, they resume, on basis of 6 cases, the basic principles of the physics theories and the etiopathogenic mechanisms. They try so to help in the understanding of the vestibular clinical signs observed in this successful sport.

Acoustic Impedance Tests↗

PubMed1992

[Apropos of the infratemporal pre-auricular approach (its value in the approach to the midline skull base].

The role of the infratemporal pre-auricular pathway to the median base of the skull resides in the fact that it enables very wide access to this region while sparing the facial and auditory nerves. Among the operations performed on the approaches of the base of the skull by their teams, the authors chose a particularly typical observation dealing with the indication of this pathway: a 34-year old male with a giant cholesteatoma of the tip of the petrous bone totally surrounding the internal carotid artery along its entire (intrapetrous) length, from the cervical region to the cavernous sinus, having invaded the clivus and pushed back the brainstem. This lesion is located on the side of the only healthy ear. The patient is completely deaf in the ear on the other side. The operation enabled its complete exeresis while respecting the facial, auditive and vestibular functions.

Adult↗

PubMed1992

[AIDS and lymphoma of the ear].

The authors describe the circumstances for detection of an AIDS lymphomatous complication revealed by an otological picture in one patient. The lymphomatous pathology not related to HIV is reviewed. The particularity of these lymphomas, when they are related to HIV, is their frequent initial extra-ganglionic location, their high grade histological type and their poor prognosis. The authors emphasize the need to perform a biopsy rapidly when confronted with any external otitis resistant to general and local treatments.

Adult↗

PubMed1992

[Osseointegrated implants in facial prosthesis and hearing aids].

The principles of osseointegration defined by Branemark are reviewed. The authors describe the otological applications of titanium implants: bone anchorage hearing aids (B.A.H.A.) and ear epitheses. Obtaining good results depends on the selection of the patients and the observance of a rigorous technique.

Ear, External↗

PubMed1991

[Post-traumatic facial paralysis without any fracture of the petrous bone].

Post-traumatic facial palsies are generally observed after a transverse, longitudinal or comminuted fracture of the pars petrosa. Occasionally, the fracture does not involve the Fallopian aqueduct and another mechanism must be sought. The authors present a case of facial palsy that occurred after a Le Fort's fracture of the base of the skull, not involving the Fallopian aqueduct on the CT scan. This was confirmed by surgical exploration. The authors recall the possibility of a facial palsy through the stretching of the nerve by the petrosal nerve.

Adult↗

PubMed1991

[Autoimmune Menière's disease: current concept].

The participation of an immunological mediation is unmistakable in certain cases of Ménière's disease. After exposition of the different experimental and clinical research, it is nevertheless still not possible to precisely determine the role of these immunological occurrences in the genesis of this disease. Clinical criteria should evoke this participation and lead to the detection of certain biological anomalies most frequently found by the different teams.

Animals↗

PubMed1991

[Cochleovestibular syndrome disclosing dolicho-ectasis of the basilar trunk and vertebral artery].

The authors present a case of a cochleovestibular syndrome with a scanner showing a calcified dolico-ektasis of the basilar truncus and the left vertebral artery. The patient had typical Ménière's disease symptomatology. A retrolabyrinthic diagnosis with substantial recruitment was indicated by the results of the audio-vestibular explorations (stapedius reflex, electroculography, early brainstem evoked response, electrocochleography). The electrocochleography with glycerol test indicated labyrinthic hydrops. Finally, some reflections on the role of neurovascular problems in the pathogeny of some cochleovestibular syndromes are put forward.

Aged↗

PubMed1991

[Exostosis of the external auditory canal: clinical and therapeutic aspects].

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.

Adolescent↗

PubMed1990

A technique for reembedding celloidin sections for electron microscopy.

A new technique for reembedding celloidin sections of human temporal bones for transmission electron microscopy is described. It consists of four steps: 1. loosening of celloidin sections from glass slides with use of xylene and dissection of the area of interest, 2. removal of celloidin with use of clove oil, 3. staining with 1% osmium tetroxide and 1% tannic acid, and 4. embedding in epoxy resin. Autolytic changes were seen due to poor fixation. TEM of reembedded celloidin sections of optimally fixed tissue revealed that the celloidin-embedding procedure affected ultrastructural preservation to some degree. This included less well-preserved cell membranes and some increased electron density of the cytosol decreasing the EM resolution of intracytoplasmic organelles. The technique allows TEM analysis of the intact labyrinth at all regions in the same specimen without dissection of the fragile tissue components of the membranous labyrinth. This might make the technique useful for processing freshly fixed human inner ear tissue and temporal bones for ultrastructural histopathological analysis.

Animals↗

PubMed1990

Transmission electron microscopy of previously embedded celloidin sections.

A technique to re-embed celloidin sections of human temporal bones for transmission electron microscopy (TEM) is presented. The procedure consists of basically four different steps, starting with loosening of the celloidin sections from the glass slides, removing the celloidin using clove oil, to staining and embedding in epoxy resin. The technique allows TEM analysis of the intact labyrinth in various regions in the same specimen, as well as on the same section. This may prove useful, as prior dissection of the fragile tissue components of the membranous labyrinth is not longer necessary. The technique makes possible the retrospective study of temporal bone collections. It may also be of value for the study of the ultrastructural histopathology of the human inner ear in optimally preserved tissue.

Animals↗

PubMed1990

[Efficacy and tolerability of morniflumate in acute otitis in infants: results of a randomized study versus placebos].

In a randomized double-blind placebo-controlled, parallel group study, 79 infants with acute otitis media received treatment with suppositories containing either Nifluril (400 mg daily, morniflumate) or placebo for five days. Both groups of patients also received amoxicilline (50 mg/kg daily) for eight days. The combination of Nifluril with antibiotic therapy gave significantly greater relief from abnormalities of the tympanic membrane (after two days treatment), inflammation of the throat and nasal congestion than did antibiotic therapy alone. Overall clinical assessment confirmed a significantly greater recover rate in the Nifluril group compared with the placebo group. Very few side effects were recorded, limited to diarrhoea, without any drug interruption. Nifluril may be recommended as an effective safe adjuvant to the antibiotic treatment of acute otitis media in infants.

Acute Disease↗

PubMed1990

[Management of open and closed cavities in otology].

Surgery of chronic otitis follows a few basic principles, some of which are long-standing but still topical. In the majority of cases, opening of the cavities of the middle ear uses one of the following two techniques: the open technique (radical mastoidectomy), or the closed technique (transmastoid approach or canal up technique). Whatever the technique used, a readjustment of the cavity is often indispensable to avoid any recurrence of the pathology (cholesteatoma) or the appearance of a new pathology (chronic otorrhea) and facilitates a functional step if required. Open techniques must therefore always follow the rule of the ratio V/S (where V = the volume of circulating air coming from outside, and S = the surface area of the skin of the cavity). This ratio is specific to each individual. The readjustment must enable either an increase of V (meatoconchaplasty) or a decrease of S (reconstruction of the posterior auditory canal, obliteration of the cavity), or a combination of the two. Closed techniques must also be adjusted to avoid any retraction towards the posterior or upper cavities. Depending on the clinical background and on the aggressivity of the pathology, the posterior tympanotomy can be closed, and the attic and aditus cavities of the middle ear separated by a bony fragment leaving the protympanum open upwards to enable normal ventilation towards the attic, the aditus and the antrum, or much more rarely, these cavities can be completely closed.

Chronic Disease↗

PubMed1990

[Pneumatocele caused by ballistic injury of the anterior stage of the skull base, a case report].

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.

Adult↗

PubMed1989

Modern diagnostic strategy for acoustic neuromas.

We have reviewed the most recent 120 cases of acoustic neuromas operated upon in Bordeaux, France. In so doing, we have defined the strategy required to reach an accurate diagnosis as essentially comprising three stages. The first of these is to understand that the presenting symptom complex may be typical with progressive unilateral hearing loss, tinnitus, etc., or atypical with sudden hearing loss (10%), recovering facial paralysis (3.3%) or a Menière's syndrome (3.3%). Included in the first stage of diagnosis are audiovestibular investigations. An absent stapedial reflex was noted in 41% of our cases and an abnormality in vestibular testing in 95% of cases tested. These findings would be clear indicators to proceed to the second stage of the diagnostic strategy. This second stage comprises electric response audiometry consisting of auditory brainstem response (ABR) testing and electrocochleography (ECochG) employed as a filter for determining which patients should proceed to the third stage of testing. A combination of ABR and ECochG provides the clinician with results of high sensitivity and specificity. The false-negative rate for combined results in our experience has been less than 1%. The final diagnostic stage is radiological imaging, in particular using magnetic resonance imaging (MRI) with gadolinium contrast as the modality of choice. MRI is superior to CAT scanning, especially in the diagnosis of stage I intracanalicular tumors.

Audiometry, Evoked Response↗

PubMed1989

[Mérocel's method in otorhinolaryngology].

Merocel intra-nasal pack are very effective in controlling epistaxis. Different forms of Merocel are very usefull in external otitis and after endonasal and middle ear surgery. They can protect some particular structures during oto-neuro and head and neck surgery.

Bandages↗

PubMed1989

[Labyrinthine fistulae].

The study is based on 44 cases of labyrinthic fistulas which were almost always discovered per-operatively. The authors describe the different stages of evolution, grouped under the term of "fistula". Having summed up the main therapeutic guidelines published since 1950 and following the study of the different cases presented, a therapeutic approach is proposed which takes into account the condition of the opposite ear and the open or closed technique selected. As far as audiometry is concerned, the cochlear reserve must be safeguarded. Technically speaking, the best attitude is to carry out the ablation of the matrix in one or two phases depending on the size, to prefer a closed technique and to drain the fistula at the end of the operation.

Audiometry↗