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Biomedical subjects

E Truy

Publications and source records attributed to E Truy.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Research of Lyme's disease in facial paralysis. A French multicenter study].

OBJECTIVES: Apparent a frigore facial palsy could possibly mask manifestations of unrecognized Lyme's disease. Since commonly used corticosteroid treatment could be deleterious if Borrelia burgdorferi infection was indeed the cause, we conducted a prospective study to search for possible infections in cases of recently diagnosed a frigore facial palsy. METHODS: For 3 years, 1990-1992, 49 French centres diagnosed a facial palsy in 346 patients (310 adults, 36 children under 15 years of age; mean age 38; range 16 months to 83 years). The patients were divided into three groups: a) facial palsy alone, b) zoster origin recognized due to outer ear eruption and c) cases with meningoradiculitis or joint signs or cases with facial diplegia. A questionnaire was used to evaluate exposure to risk of tick bits. A control group was established with 246 serum samples from subjects matched with the patients for age, geographical origin and exposure to risk of tick bits. Laboratory tests (indirect immunofluorescence and Western blot) were performed to search for anti-Borrelia burgdorferi antibodies in serum samples, and cerebral spinal fluid when possible, collected at presentation, on day 30 and on day 90. RESULTS: Sixty percent of the patients were urban dwellers, 15% lived in rural and 25% in semi-rural areas. There were 294 patients with facial palsy alone and their serum results were compared with those of the matched controls. There was no significant difference in the positivity for Borrelia burgdorferi antibodies between these two groups. CONCLUSION: These findings indicate that, unless there are clinical signs suggestive of borreliosis, it would not be necessary to test for Lyme's disease in patients with apparent a frigore facial palsy.

Adolescent↗
PubMed1994

A clinical study of human type IV collagen as tympanic membrane grafting material. Preliminary noncomparative study.

OBJECTIVE: To evaluate tolerance for this middle-ear implant and its effectiveness in eardrum healing under various pathologic conditions. SETTING: A 12- to 18-month follow-up case series at an institutional referral center offering hospitalized care. PATIENTS: Twenty-six eligible volunteers suffering from tympanic perforation or tympanic pocket retraction class II and III in Tos' classification. INTERVENTION: Patients underwent implantation with the type IV collagen film (film called "MTY" from the French membrane tympanique). The surgical procedure was similar to those using the temporal aponeurosis or the tragal perichondrium. OUTCOME MEASURE: Anatomic criteria was determined by otoscopy, and functional audiometric criteria was determined by air-borne gap measurements and by effects on cochlear function. RESULTS: Twenty-two of 26 patients were completely healed after 6 months, with no subsequent evolution. Nineteen of 26 subjects underwent a 1-year postoperative audiometric follow-up examination: 13 (68%) had an air-borne gap less than 10 dB, four (21%) had between 11 and 20 dB, and two (11%) had between 21 and 30 dB. Adverse effects included one patient whose MTY fell into the middle ear, three patients with transient myringitis, and one patient with otitis media with effusion. CONCLUSIONS: A human type IV collagen film may be a possible alternative to autologous tissue in tympanic membrane reconstruction. This new biomaterial was tested on patients with various diseases common in clinical otology, and demonstrated a good biocompatibility of MTY in the different pathologic conditions of chronic otitis media. A future randomized, controlled trial will randomly allocate patients to receive either MTY collagen film or tissue from the temporal aponeurosis.

Adolescent↗
PubMed1994

Failures in outpatient tonsillectomy policy in children: a retrospective study in 311 children.

The literature suggests that outpatient tonsillectomy in children is a safe and cost-effective procedure. These conclusions have been based on the low rate of post-operative complications. Recent papers suggest contra-indications for ambulatory surgery in some patients. A retrospective study involving 311 children was performed in our Department. We defined two groups in which the out-patient policy had failed. The first group (43 children) comprised inpatient children scheduled because of an unhealthy preoperative state (12 patients), a sleep-apnea syndrome (5 children), a major associated procedure (3 patients), a social or family environment not reliable enough for postoperative supervision (19 patients) or because of parental refusal (4 patients). The second group (268 patients) was constituted of scheduled outpatients. In this group, the outpatient policy failed in 31 and children had to be kept overnight, because complications occurred. The main short-term complication was bleeding (13 patients). In 8, delayed complications were observed. Thus, according to the literature, children with concomitant heavy medical problems or with a poor social environment have to be managed as inpatients. For the others outpatient procedures were possible but parents should previously be informed of the possible overnight hospital supervision which is needed in 11.6% of cases. When comparing the youngest patients under 4 years of age with the others, although the preexisting medical and social conditions are important factors that may contraindicate ambulatory surgery, once the latter has been decided on, there is no significant difference between the two age groups regarding the number of children requiring overnight hospital supervision.

Adolescent↗
PubMed1993

Cleft larynx: management and one-stage surgical repair by anterior translaryngotracheal approach in two children.

Cleft larynx is a rare congenital anomaly which is now being reported with increasing frequency. It is characterized by a midline posterior defect. Two children underwent laryngeal cleft repair by an anterior translaryngeal approach. Tracheotomy was avoided and closure of the anterior laryngofissure was carried out over the nasotracheal tube. The patients were cared for in a pediatric intensive care unit until extubation. Extubation was performed on day 8. The older child had few functional problems and did well whereas the younger child did poorly. In this latter case, the initially successful surgical result was impaired by post-operative aspiration, due to numerous possible factors: gastroesophageal reflux secondarily controlled by Nissen fundoplication, disturbed swallowing as a result more of the cleft repair work than of the surgical approach, or else immaturity of the suction-swallowing reflex.

Child, Preschool↗
PubMed1993

Role of long-term stenting in treatment of pediatric subglottic stenosis.

Twelve cases of childhood subglottic stenosis diagnosed either acquired or congenital were treated using an endolaryngotracheal Montgomery T-tube. Stenting lasted on average 5.6 months. Tracheotomy closure was possible in 75% of cases on average 15.3 months after diagnosis. Tube-linked complications involved the child pulling out, forward migration of the tube out, lower tracheal migration of the tube, clogging and the formation of granulation tissue at its superior extremity. Comparison of outcomes with those for laryngeal surgery (cricoid split, laryngotracheal reconstruction) found in the literature, suggests that long-term T-tube stenting is the optimal treatment for subglottic stenosis where tracheomalacia precludes laryngeal surgery.

Airway Obstruction↗
PubMed1993

Characteristics of transient otoacoustic emissions in patients with sudden idiopathic hearing loss.

In a prospective study of 24 patients hospitalized with sudden idiopathic hearing loss syndrome (SIHLS), tonal audiometry was conducted first at an early stage after onset (Day O), again a second time (Day A, mean = 4.12 days), and again a third time (Day B, mean = 8.71 days). Transient evoked otoacoustic emissions (TEOAE) were recorded on Days O and A elicited by click stimulation. The question under investigation was whether TEOAE presence, TEOAE amplitude or peak amplitudes for the various 200-Hz-wide bands on Day O could be exploited to assess cochlear function, as indicated by pure-tone audiometry on Days A and B. The TEOAE amplitude on Day O was found to be correlated with improvement in tone threshold on Day B at 2 kHz. One significant correlation emerged between the band amplitude on Day O and the audiometric frequency improvement: on Day B between peak amplitude at 1.2 kHz and 1 kHz frequency improvement. From these results, TEOAE could theoretically be a means to assess cochlear functioning during SIHLS for 1 and 2 kHz frequencies. However, correlations are too weak to form the basis of any predictive test that could be clinically useful.

Acute Disease↗
PubMed1993

[Launois-Bensaude disease and sleep apnea syndromes. Apropos of a recent case].

About a recent case of Launois-Bensaude's disease (Madelung's disease) the authors discuss the possibility of complications such as bronchopathy and sleep apnoea syndrome. General anaesthetics have to be performed with care, the anaesthetic risk exists even so during the premedication. Such patients have to be explored before the general anaesthetics by sleep polysomnography.

Humans↗
PubMed1993

[Cochlear implant in children. General principles. Results of the Lyons team].

Cochlear implant is a transductor system used to transform acoustic vibrations into an electric current which stimulates the vestibulocochlear nerve. It may be either extracochlear, the nerve being stimulated through an electrode placed near the cochlea, or intracochlear, the electrode being inserted within the cochlea. Cochlear implantation in children is nowadays a safe and performing method to complete total deafness of sensorineural origin. However it must be only applied to total deafness which fail to show an improvement with conventional acoustic prostheses. In addition, partly for anatomical reasons, partly because of the time required to be sure of the indication, cochlear implantation can only be performed between 18 and 24 months of age.

Child↗
PubMed1993

[Malignant external otitis. Apropos of 7 recent cases].

Seven recent malignant external otitis are described. The authors report criteria of both etiology, bacteriologic, radionuclide scanning computed tomography. Now, for the positive diagnosis, the radionuclide scanning is essential. The computed tomographic scan provided the best anatomic imaging of the infection process. The treatment of choice is systemic antibiotic therapy as fluoroquinolones antibiotic. This antibiotic is active against P. Aeruginosa and has an excellent bone penetration. Only one patient died and another suffered from osteomyelitis of the base of the skull. The radionuclide scanning is very important for criteria of healing, particularly about stoppage of systemic antibiotic therapy.

Adult↗
PubMed1993

[Subglottal stenosis following intubation in children].

BACKGROUND: Subglottal stenosis following intubation of children is infrequent, but significant. It is therefore necessary to know more about predisposing factors. MATERIAL AND METHODS: The files of all the 1,006 children who were intubated from 1982 to 1989 were studied. The following data were analysed: weight, height, locality of intubation, type and diameter of tube, reason for intubation, duration of intubation, delay and type of clinical signs of subglottal stenosis, treatment of this complication. RESULTS: Twelve children (1.5%) developed subglottal stenosis; 9 were 5 months to 7 years old; the other 3 were neonates, 2 of them with a very low birth weight. The disease responsible for intubation was neurologic in origin in 6 cases, respiratory in 4 and hemodynamic in 2. The tube used for 4 children was too large, based on standards for age and weight. The mean duration of intubation was 21.1 days (1-129 days). Primary failure to extubate usually revealed subglottal stenosis, which was assessed by laryngoscopy. It was necessary to reinsert a tube for a mean duration of 20.2 days (4-41 days) in 11 of the 12 children; all patients received corticosteroids. 6 children required tracheostomy for 37 to 365 days. Dilation was necessary in 7 children. Finally, 9 children fully recovered, 1 has an asymptomatic persistent stenosis, 1 is still intubated with severe neurologic sequellae and 1 died accidentally, probably as a result of obstruction by tube dilation. CONCLUSION: Stenosis remains a severe complication of intubation. The diameter of the tube is probably the most aggressive factor. It seems preferable to use a smaller, therefore cuffed tube and to secure the airways, if necessary, by inflating the cuff.

Child↗
PubMed1992

[Tracheotomy in children. Indications, major surgical principles, importance of nursing].

Tracheotomy in children has two main fields of indication: 1) obstructions of the upper respiratory tract, the main cause being today the post-intubation stenosis; 2) long term mechanical ventilation. When performed in good conditions, with adapted care, there are few complications, among them the accidental denaculation being the most worrying. When long-term tracheotomy is needed, parent-education, together with special equipment and adapted environment may allow the return of the tracheotomised child at home in secure conditions. Special attention with preventive measures during intubation is recommended in order to reduce the number of tracheotomies for post-intubation stenosis.

Child↗
PubMed1992

[Chronic hoarseness in children. Evaluation based on personal series of 64 cases].

Chronic hoarseness is frequent among children, as shown by 64 cases observed over an 18-month period in a specialized phoniatric outpatients clinic. Age at the first consultation for these 64 patients was 3-14 year although the hoarseness was already known for more than 1 year in 40 patients (62.5%). The main findings at laryngoscopy were an edematous vocal cord (33%), a unilateral or bilateral nodular lesion (26%), and an epidermoïd cyst (17%). The larynx was normal in 2 patients only. Orthophonic re-education was prescribed for 45 patients (70%); it was followed by laryngeal microsurgery in 3 patients: 9 patients were completely cured, 26 were improved, 4 showed no improvement, 16 could not be located for follow-up. Chronic hoarseness in children has numerous etiologies which can be divided into 5 main groups. The 2 more frequent are the hyperkinetic or hypokinetic laryngeal dysfunctions and the congenital lesions. The 3 other groups are much less frequent: juvenile laryngeal papillomatosis, recurrent palsy and pithiatic aphonia. Laryngoscopy is important for the diagnosis. Orthophonic re-education represents the main treatment; it completes the surgical treatment when microsurgery of the larynx is necessary.

Adolescent↗
PubMed1992

[Acquired peripheral facial palsy in children. Current data illustrated by 66 recent personal cases].

The authors observed 66 cases of peripheral facial palsy (PFP) in children during a 5-year period (1986-1990). Bell's palsy (idiopathic facial paralysis) occurred in 26 children (39.3%), 1 month to 14.5 years old, with a complete recovery in 95% of the cases; a surgical decompression was carried out in 2 cases. The PFP was related to otitis in 16 cases (24.2%): acute otitis media (6), mastitis (4), serous otitis (5), cholesteatoma (1); the treatment was medical and surgical in all cases with complete recovery in 15 cases. In 15 cases the PFP was secondary to trauma (13) or surgery (2); complete spontaneous recovery occurred in 11 cases, and partial recovery following surgical treatment in 2 cases. A viral origin was retained in 6 cases: herpes zoster (3), mumps (1), echovirus (1), herpes (1); the recovery was complete in 4 cases, partial in 2 cases. In 3 cases the PFP was related to a rare cause: lymphoma, metabolic acidosis, Melkerson-Rosenthal syndrome. Bell's palsy remains the main cause of PFP in childhood; other etiologies can be ruled out by the case history, a careful physical examination, and a limited number of laboratory and/or X-ray studies; medical treatment, in particular prednisone, does not seem to have an effect upon the rate of recovery which is spontaneously high; similarly there is no evidence that surgical decompression really modifies the rate of recovery so that the authors suggest that it should be reserved to the complete forms with no clinical and electrical evidence of recovery after 3 weeks.

Adolescent↗
PubMed1992

[Congenital cysts and fistulae of the face and the neck].

The authors review the embryological, clinical and therapeutic aspects of congenital facial and cervical cysts (C) and fistulae (F), based on a personal series of 85 cases (facial: 18, latero-cervical: 29, mediocervical: 38) observed during a 5-year period. The facial forms are the result of an incomplete coalescence of the facial buds and most often present as helical F (17/18). Laterocervical C and F are due to abnormal evolution of branchial clefts; the main clinical forms are related to anomalies of the 2nd branchial cleft (24/29), usually presenting as sinus localized at the anterior border of the lower third of the sternocleidomastoid muscle (8) and amygdaloid cysts. Thyroglossal duct cysts are the most frequent of the medio-cervical C and F (35/38); they usually present as a mediocervical cyst in the thyro-hyoid space which may be revealed by an infection or a fistulization. The only appropriate treatment of congenital facial and cervical C and F is surgery providing that the resection is meticulous with complete resection of the fistula in order to avoid relapse. Complete resection also suppresses the risk of secondary malignant degeneration of amygdaloid and thyroglossal duct cysts.

Adolescent↗
PubMed1992

[Reduction laryngoplasty by external approach for glottic incompetence. Current role, demonstration of its efficacy by objective analysis of parameters of vocal quality].

Authors talk about the place of surgical treatments with cervicotomy in abducted vocal cord, about the statistics of the department of Phoniatrics of the Hospital Edouard Herriot in Lyon. These techniques have actually a marginal place. But the analysis of a recent case shows us that endoscopic treatment for vocal fold augmentation with biomaterials such as collagen or teflon can fail. So ENT surgeons have to absolutely know the Guerrier's technique to improve the quality of the voice when injectable biomaterials fail. With the description of this case, we will describe the objective analysis methods of the voice parameters that we use in the department.

Adult↗
PubMed1991

[Dural fistula of the lateral sinus. Apropos of 2 recent cases].

On the basis of two recent cases of dural fistula of the lateral sinus, the authors review the literature relating to this type of arteriovenous fistulae. The development of selective arteriographic techniques has allowed better knowing them, ensurgin the diagnosis and also treating them with embolization techniques. The role of the ENT specialist is no less important: during the clinical stage, it for him to recognize the pulsatile character of a tinnitus and to demonstrate it in order to establish the diagnosis.

Aged↗