[Several cases of otogenic meningitis].
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Biomedical subjects
Publications and source records attributed to E Poncet.
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The authors studied 11 children (mean age 5 1/2 years) before and during anaesthesia, and then several times from 1 to 6 hours after the injection of althesin. The anaesthetic agent was either pure althesin or althesin combined with dextromoramide. The electroclinical correlations described for adults are also found in children: slow waves, discontinuous and then isoelectric recording during the operation stage, then rapid recovery after ending drug administration. The special interest of this study was the analysis of E.E.G. recordings during the hours following clinical recovery: only once was the recording like that of full consciousness. Repeated recordings were all of drowsiness and even sleep, despite the clinical state of the subject. A short associated study concerns the E.E.G. of neonates during their first 24 hours, born to mothers anaesthetised with alfathesin.
The atuhors analyze the case of a three-year-old child suffering from an abnormal condition of the left internal ear, revealed by copious discharge of cerebro-spinal fluid at the onset of 5 attacks of meningitis. A direct approach to the plate and the bony and aponeurotic contents of the oval fossa made it possible to seal this off and this was checked surgically eighteen months later. On this occasion a general survey was carried out into the usual circumstances in which such a discovery is made, pathological concepts and treatment for these accidents. It would appear that unusual permeability may be found either in the internal auditory meatus or in the cochlear aqueduct. Therapeutic procedure depends on circumstances. Blocking the oval fossa is not always effective and should be reserved for cases in which abnormalities impair function. Choice between blocking the internal auditory meatus and eradication of the cochlear aqueduct depends to some extent on the information supplied by tomography, but more on the pathogenetic conclusions reached.
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From 1973 to 1977, 15 patients with laryngeal stenosis were treated by a method of continuous dilatation in the ENT department of the "Enfants Malades" Hospital. The results were viewed with regard to the importance of the complications, the chance of decanulation, the carrying time of the canula, adaptation to effort, functional respiratory tests, the value of language, intellectual and psychic repercussions, and repercussions on the social life. In this series the method of dilatation seems remarkably reliable.
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13 children suffering from velo-pharyngeal insufficiency were operated. A transposition of the posterior pillar was carried out. After exposing the principle of the method, the anatomical bases of the operation and the operation technique used are described. The pharyngeal sphincter thus reconstituted has nearly always resulted in an improvement in the phonation in these subjects.
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The authors describe their therapeutic attitude over the past few years towards severe epistaxis. In an emergency, anterior and posterior tamponage using thick tents is the main treatment used. Double balloon probes have been discontinued, in spite of the fact that they were well-tolerated, on account of the disappointing results they gave. In cases of relapse, when the posterior tampon is removed after 48 hours, systematic ligature of the sphenopalatine artery is carried out on arteriosclerosis patients aged about fifty who have high blood pressure. In other cases, the authors wait to see the effect of leaving a second tampon in place for a further 48 hours. In patients suffering from renal inadequacy, reabsorbable tents are preferable, prevention being the main aim, avoiding all treatment liable to counteract haemostasis. Generally speaking, ligature of the external carotid is often ineffective. It is the sphenopalatine artery which should be tied off (100 cases in the O.-R.L. Dept. of the Hôpital Foch). Ligature of the ethmoid is rarely indicated.