Interventional sialendoscopy.
Explore the source record for details and available documents.
Endoscopy↗
Biomedical subjects
F Marchal
Publications and source records attributed to F Marchal.
Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence.
PURPOSE: To evaluate the accuracy of magnetic resonance (MR) sialography in detecting salivary glandular calculi and ductal stenoses. MATERIALS AND METHODS: In a prospective study, 64 salivary glands in 61 consecutive patients with acute or recurrent parotid or submandibular glandular swelling were examined by using three-dimensional (3D) extended-phase conjugate-symmetry rapid spin-echo (EXPRESS) MR imaging. Transverse and sagittal-oblique source images and maximum intensity projection images were obtained. All MR images were analyzed independently by two radiologists, without knowledge of the final diagnosis. The reference standard was conventional sialography, ultrasonography (US), and sialendoscopy with or without surgery in 31 glands and was conventional sialography and US in 33 glands. RESULTS: Final diagnoses included sialolithiasis (n = 23), sialolithiasis and stenosis (n = 9), stenosis without lithiasis (n = 11), early Sjögren syndrome without ductal stenosis (n = 2), ductal displacement (n = 3), and normal salivary glands (n = 16). The sensitivity, specificity, and positive and negative predictive values of MR sialography to detect calculi were 91%, 94%-97%, 93%-97%, and 91%, respectively. False-negative readings occurred due to calculi with a diameter of 2-3 mm in nondilated salivary ducts. Ductal stenosis was assessed, with a sensitivity of 100%, specificity of 93%-98%, positive predictive value of 87%-95%, and negative predictive value of 100%. Interobserver agreement was very good (kappa = 0.85-0.97). CONCLUSION: MR sialography with 3D EXPRESS imaging enables reliable prediction of salivary gland calculi and stenoses.
Adolescent↗
Cholinergic dopamine release from the in vitro rabbit carotid body.
The aim of this study was to test whether cholinergic mechanisms regulate dopamine (DA) release from the carotid body (CB) and interact with DA D(2) autoreceptors. One hundred forty-two CBs from adult rabbits were infused in vitro in a surviving medium bubbled with O(2) (Bairam A, Marchal F, Cottet-Emard JM, Basson H, Pequignot JM, Hascoet JM, and Lahiri S. J Appl Physiol 80: 20-24, 1996). CB DA content and release were measured after 1 h of exposure to various treatments: control, cholinergic agonist (0.1-50 microM carbachol), full muscarinic antagonist (1 and 10 microM atropine), antagonists of M(1) and M(2) muscarinic receptors (1 and 10 microM pirenzepine and 10 microM AFDX-116, respectively), and the DA D(2) receptor antagonist domperidone (1 microM), alone and with carbachol (1 microM). Compared with control, the release of DA was significantly increased by carbachol (1-50 microM), AFDX-116, and domperidone and decreased by atropine (10 microM) and pirenzepine (10 microM). The effects of domperidone and carbachol were not significantly different but were clearly additive. It is concluded that, in the rabbit CB, M(1) and M(2) muscarinic receptor subtypes may be involved in the control of DA release, in addition to the DA D(2) autoreceptors.
Animals↗
[Several aspects of respiratory function testing in children].
Some practical aspects of respiratory function testing (RFT) are reviewed with special interest on applications in preschool children. RFT may be used for diagnostic, management and follow up purposes. Children may benefit from RFT in a variety of pathological situations. Asthma and other obstructive airways diseases certainly represent the most frequent conditions. Vital Capacity and Forced Expiratory Volume in one second (FEV1) may usually be obtained from age 7 on. In smaller children, the forced expiratory manoeuvre is much less successful. Non invasive measurements such as respiratory resistance (Rrs) or specific airway resistance (sRaw) may be used. Rrs is usually measured by the interrupter technique or the forced oscillation technique and sRaw by body plethysmography, not requiring the estimation of thoracic gas volume. Because much variability is introduced by the upper airways, these parameters are less suited than FEV1 to establish the degree of baseline airway obstruction. On the other hand, Rrs and sRaw may quantify reversibility of airway obstruction and/or bronchial hyperresponsiveness. Lung hyperinflation may be identified by the assessment of Functional Residual Capacity (FRC) with a dilution method. More generally lung growth may be followed up in longitudinal studies of FRC even in small children. More work is needed to standardize RFT techniques and indications in the preschool child.
Age Factors↗
[Place of the Ross procedure (pulmonary autograft) in aortic valve surgery].
The pulmonary autograft operation consists of an aortic replacement using the autologous pulmonary valve. The pulmonary valve is substituted by a cryopreserved pulmonary homograft. This operation is in fact a delicate double valve replacement whose benefits are linked to the viability of the new aortic substitute. The pulmonary autograft has superb hemodynamic features and very low thrombogenicity. The report of a selected observation offers the occasion of defining the current indications of this operation in aortic valve surgery.
Aortic Valve↗
[Advantage of lifting in parotidectomy].
INTRODUCTION: A retrospective study is presented of surgical patients undergoing simultaneous SMAS lifting technique and parotidectomy, with evaluation of the incidence of clinical Frey's syndrome. METHODS: 40 patients were operated on between 1978 and 1999. The surgical technique is described and the incidence of clinical Frey's syndrome as evaluated by questionnaire is presented. RESULTS: The 36 patients who answered the questionnaire were satisfied with the aesthetic result in terms of hidden scar and defect filling. 2 patients complained of warm cheek sensation during meals, without associated sweating. One patient who had had superficial parotidectomy in 1978 and total parotidectomy for recurrent pleomorphic adenoma in 1997 complained of Frey's syndrome. CONCLUSION: Combination of the two techniques provides excellent aesthetic results. In this study the incidence of clinical Frey's syndrome was 2%, with an incidence of incomplete Frey's syndrome in 5.5% of cases due to SMAS interposition.
Adenoma↗
[The mesorectum: improvement and anatomy of a semantic error].
AIMS: The cancer of the rectum touches 10,000 patients per year in France. Its treatment is mainly surgical. 50% of the treated patients will die of their cancer, either by loco-regional recurrence, or by metastatic disease. The rates of local recurrence vary from 10 to 40%. Heald is first who brought back recurrence rates lower than 4%, results obtained by the only surgical treatment. This treatment included the total exeresis of cellulo-fatty tissue surrounding the rectum, tissue which was baptized mesorectum. The aims of this work is to define and describe this space, and to discuss its Christian name. MATERIAL AND METHODS: The anatomical study carries on the dissection of 2 frozen pelvis of fresh man, one cut transversely on the level of L4, the other half-compartment sagittaly, then defrosted for the dissection. RESULTS: The mesorectum is defined and its various structures, fascia, vessels and nerves, are detailed. CONCLUSION: The mesorectum is an anatomical and surgical structure individualisable. Its recognition and its importance were born from the understanding of the fascia and the rectal anatomy. Its exeresis decreases the rate of the local recurrence (18). The technique of exeresis of the mesorectum must be validated, standardized, in order to be reproducible in the treatment of the cancer of the rectum.
Female↗
Interventional sialendoscopy.
Explore the source record for details and available documents.
Endoscopes↗
Prevention of Frey syndrome during parotidectomy.
OBJECTIVE: To evaluate the incidence of Frey syndrome (auriculotemporal nerve syndrome) after parotidectomy with and without placement of a subcutaneous implant and to examine the relationship between different implants and postoperative wound complications (hematoma, seroma, salivary fistula). DESIGN: A prospective nonrandomized controlled trial. SETTING: A primary care and referral university hospital center. PATIENTS: All patients scheduled for parotidectomy from April 1994 through August 1998 were eligible. Seventy patients were enrolled (2 refused). All 70 patients were evaluated for wound complications. Sixty patients with a follow-up of more than 1 year were evaluated for Frey syndrome. INTERVENTION: The choice of implant was left to the individual surgeon: 24 patients had no implant; 7, lyophilized dura implant; 7, polyglactin 910-polydioxanone (Ethisorb) implant; and 32, expanded polytetrafluoroethylene (e-PTFE) implant. OUTCOME MEASURES: The incidence of Frey syndrome was evaluated (1) subjectively by history (clinical Frey syndrome) and (2) objectively by using 2 newly developed tests. Both hemifaces were tested, with the normal side being used as a control. RESULTS: Clinical Frey syndrome was present in 12 patients: 11 without implants (11/24 [53%]) and 1 with an implant (1/46 [2%]) (P<.001). Objective tests were positive in 24 patients: 16 (76%) of 21 without implants and 8 (20%) of 39 with implants (P<.001). In the implanted patients, the objective tests were positive in 71% (5/7) of those with lyophilized dura, 14% (1/7) of those with Ethisorb, and 8% (2/29) of those with e-PTFE implants (P<.001). Wound complications included hematoma in 5 patients (7%), seroma in 4 patients (6%), and salivary fistula in 15 (21%). Salivary fistula occurred more frequently with Ethisorb (57%) and e-PTFE (25%) implants (P = .04). CONCLUSIONS: In patients without an implant, the incidence of Frey syndrome is 50% for subjective and 80% for objective evaluation. In patients with an implant, these incidences are 3% and 10%, respectively. Some implants are associated with a higher incidence of salivary fistula.
Adolescent↗
Assessment of bronchial reactivity by forced oscillation admittance avoids the upper airway artefact.
The forced oscillation technique (FOT) allows easy assessment of bronchial reactivity. The use of a standard FOT generator (SG) results in changes in respiratory system resistance (delta Rrs,SG) which are affected by an artefact caused by the extrathoracic upper airway (EUA). The aim was to improve the FOT assessment of bronchial reactivity with the SG by computing the change in FOT admittance (delta Ars,SG), which is theoretically unaffected by this artefact. Delta Rrs,SG and delta Ars,SG after bronchial challenge in 17 children were compared with the values measured with a head generator (HG) FOT setup (delta Rrs,HG and delta Ars,HG, respectively), which were taken as a reference, since HG provides data virtually freed from the EUA artefact. At 10 Hz, the SG significantly underestimated the resistance change: delta Rrs,SG=1.77+/-0.62 versus delta Rrs,HG=6.09+/-1.23 hPa x L(-1) x s. Delta Rrs,SG and delta Rrs,HG did not show a significant correlation. By contrast, the amplitude of the change in admittance measured by SG was close to the one obtained with the reference HG: /delta Ars,SG/=29.5+/-4.6 versus /delta Ars,HG/=32.7+/-3.9 mL x hPa(-1) x s(-1). /Delta Ars,SG/ and /delta Ars,HG/ showed a significant correlation (r=0.65, p>0.01). Similar results were found up to 20 Hz. The extrathoracic upper airway artefact was minimized when computing the change in admittance with the standard generator. This forced oscillation technique index may improve the sensitivity in assessing bronchial reactivity with the standard generator setup, which is the most common and easiest to use method for routine lung function testing.
Airway Resistance↗
Cell-associated HIV-1 RNA in blood as indicator of virus load in lymph nodes. The Swiss HIV Cohort Study.
We have developed sensitive assays for viremia and cell-associated human immunodeficiency virus type 1 (HIV-1) RNA and DNA to assess the predictive value of virological parameters determined in blood for virus load in lymph nodes (LNs). Eighteen patients were included; 13 received stavudine/didanosine/hydroxyurea and 5 stavudine/didanosine, and all had viremia <500 copies/mL for >3 months. At the time of LN biopsy (median, 10 months), the median viremia was 2.09 log copies/mL (range, <0.70-3.34). Cell-associated HIV-1 RNA and DNA were detectable in blood and LNs of all patients. The median cell-associated RNA and DNA were 2.16 log copies/106 cells and 2.60 log copies/106 cells in blood versus 4.31 log RNA copies/106 cells and 3.26 log DNA copies/106 cells in LNs. Regression analysis shows that, in treated patients with sustained low viremia, cell-associated RNA and DNA in blood are better predictors of virus load in LNs than viremia.
Acquired Immunodeficiency Syndrome↗
Postparotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring.
OBJECTIVE: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. STUDY DESIGN: A prospective, nonrandomized study. METHODS: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph-based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House-Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. RESULTS: The overall incidence of facial paralysis (HB>1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. CONCLUSIONS: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph-based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.
Adolescent↗
Frey syndrome before Frey: the correct history.
OBJECTIVE: To review the chronology of publications on gustatory sweating before Frey's landmark publication. METHODS: Reports on Frey syndrome were reviewed, and all references given to publications before 1950 were obtained and examined. References to prior publications in the obtained articles were similarly reviewed. The cases described in these publications were analyzed for their compatibility with the accepted clinical symptoms of Frey syndrome. RESULTS: Despite numerous references, the case described by Duphenix in 1757 is most probably a traumatic parotid fistula. The first reported case of Frey syndrome should be attributed to Baillarger in 1853.
Eponyms↗
Methacholine-induced volume dependence of respiratory resistance in preschool children.
Enhanced negative volume dependence of airway resistance is associated with bronchoconstriction in tracheostomized paralysed open-chest animals. Significant upper airways responses may be associated with bronchoconstriction and could thereby alter the pattern of volume dependence in spontaneously breathing subjects. The aim of the study was to test whether volume dependence of respiratory resistance (Rrs) could be demonstrated in preschool children undergoing routine methacholine challenge. The volume dependence of respiratory oscillation resistance at 12 and 20 Hz (Rrs,12 and Rrs,20) was examined in eight 4-5.5-yr-old children showing a positive response to methacholine. Multiple linear regression analysis was also used to account for flow dependence during tidal breathing (Rrs,12 or Rrs,20=K1+K2¿V'¿+K3V). Rrs,12 and Rrs,20 yielded similar results. Negative volume dependence was present at baseline and significantly enhanced by methacholine (p<0.01). For instance, the mean+/-SD inspiratory K3 at 20 Hz was 4.1+/-1.3 hPa x s x L(-2) at baseline and -15.0+/-4.3 hPa x s x L(-2) after methacholine, in which case it was also larger on expiration than on inspiration (p<0.05), possibly as a result of upper airway responses. A significant increase in the negative volume dependence of respiratory resistance may thus be shown in preschool children in response to methacholine. The volume dependence (K3) during inspiration may be particularly useful in detecting bronchoconstriction, because it is less likely to be affected by upper airway mechanisms than during expiration.
Aerosols↗
Lung function testing in preschool children.
Explore the source record for details and available documents.
Child, Preschool↗
Review of objective topographic facial nerve evaluation methods.
OBJECTIVE: This study is a critical review of the described methods for objective topographic evaluation of facial nerve function to identify areas of consensus and point to future research topics. SOURCES AND STUDY SELECTION: Original research articles on the subject were identified through the Medline database and reference cross-checking. DATA EXTRACTION AND SYNTHESIS: The articles were grouped according to the methodology used for topographic facial nerve evaluation. The advantages and shortcomings of each method are evaluated. The results obtained in each publication are presented in light of the method used. CONCLUSION: Measurements localized around the facial area under investigation show maximal displacement, whereas other sites exhibit much smaller displacements. Large displacements in these locations can be used to assess synkinesis and contractures. Large intersubject variability of the same measure is found. Both linear measurement and image-subtracting techniques hold promise. but until comparative studies are performed, the best method will remain controversial. Simple systems, accurately evaluating facial motor function, are yet to be developed.
Anthropometry↗
Respiratory oscillation mechanics in infants with bronchiolitis during mechanical ventilation.
The aim of the study was to describe the pattern of respiratory oscillation mechanics and responses to positive end-expiratory pressure (PEEP) in bronchiolitis. Six infants were studied during the course of mechanical ventilation. A 20 Hz sinusoidal pressure variation was applied at the endotracheal tube where flow was measured with a pneumotachograph. Resistance and reactance obtained from the complex pressure-flow ratio were separated during inspiration (R(rs,i); X(rs,i)) and expiration (R(rs,e); X(rs,e)), and the differences between R(rs,i) and R(rs,e) (deltaR(rs)) and X(rs,i) and X(rs,e) (deltaX(rs)) were calculated. The data were corrected for the mechanical characteristics of the endotracheal tube. The measurements were repeated while PEEP was varied between 0 and 8 hPa. Two infants were found to have normal R(rs) and near-zero X(rs) and both parameters exhibited little change within the respiratory cycle or with varying PEEP. Four infants had high R(rs) at zero PEEP. In two, R(rs,i) was markedly elevated (108.5 and 85.2 hPa.s/L, respectively), and X(rs,i) was markedly negative (-25.0 and -22.5 hPa.s/L, respectively) at zero PEEP, while deltaR(rs) and deltaX(rs) were small. R(rs,i) and the absolute value of X(rs,i) decreased with increasing PEEP. This pattern of oscillation mechanics was consistent with low lung volumes and atelectasis, being reversed by increasing PEEP. In the remaining two subjects, R(rs,i) was moderately elevated (57.8 and 53.6 hPa.s/L, respectively) and X(rs,i) moderately negative (-12.5 and -7.7 hPa.s/L, respectively) at zero PEEP. DeltaR(rs) (-59.8 and -56.5 hPa.s/L, respectively) and delta(rs) (28.1 and 48.7 hPa.s/L, respectively) were large, but were dramatically reduced by increasing PEEP. These patterns were consistent with expiratory airflow limitation. Measurements of respiratory impedance are, therefore, informative in regard to the pathophysiological mechanisms occurring in bronchiolitis during mechanical ventilation, and they may be helpful in setting the level and assessing the effect of PEEP.
Airway Resistance↗
Atypical squamous cell carcinoma of the larynx and hypopharynx: radiologic features and pathologic correlation.
The objective of this study was to analyze the radiologic features of atypical forms of squamous cell cancer and correlate them with clinical, endoscopic, and histopathologic findings. The CT and MRI images of 31 patients with atypical forms of squamous cell carcinoma were reviewed retrospectively and the radiologic findings were correlated with clinical, endoscopic, and histopathologic findings. Histopathologic diagnoses included undifferentiated carcinoma of nasopharyngeal type (n = 8), verrucous carcinoma (n = 18), spindle cell carcinoma (n = 3), and basaloid cell carcinoma (n = 2). Undifferentiated carcinoma of nasopharyngeal type was located in the supraglottis or piriform sinus beneath an intact mucosa and initial endoscopic biopsy was most often negative. The discrepancy between an intact mucosa at endoscopy and a solid mass with homogenous enhancement at CT or MRI was characteristic for these tumors and warranted further investigations to obtain the definitive histologic diagnosis. Verrucous carcinoma displayed characteristic clinical, radiologic, and pathologic features, namely, an exophytic tumor arising from the glottic level displaying a rugged surface with finger-like projections but with only minor submucosal infiltration. Spindle cell carcinoma appeared as a polypoid mass with a thin stalk arising from the supraglottis. Basaloid cell carcinoma displayed a distinct lobulated enhancement pattern which was observed on contrast-enhanced T1-weighted SE images. Although the MR and CT features of atypical forms of squamous cell carcinoma cannot be considered pathognomonic they should raise the differential diagnosis even if endoscopic biopsy has been negative. The radiologist's awareness of the appearance of these unusual tumors on CT and MR images may greatly facilitate the diagnostic work-up and helps to guide the endoscopist to the adequate biopsy site in order to establish the correct diagnosis.
Aged↗