[Pharyngitis. Etiology, diagnosis, course, treatment].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to J Dubin.
Explore the source record for details and available documents.
Within 20 cases of cervical acute necrotizing fasciitis treated in the intensive care unit and hyperbaric oxygen therapy department between 1986 and 1995, the authors report five cases of pharyngeal origin. 4 have been initially treated with anti-inflammatory drugs: non steroidal (1 case), steroidal (2 cases), non steroidal and steroidal (1 case). The five patients have been operated. They needed at least 30 days of endotracheal intubation and hyperbaric oxygen therapy. No death outcome but a important morbidity is reported. The immunosuppressive features of the two type of anti inflammatory drugs are exposed. Different publications suggesting the possible association between non steroidal anti inflammatory drugs and non cervical necrotizing fasciitis are reported. It is not possible to prove a direct link because of the number of our cases, because of the wide number of pharyngitis treated in the area, and because the absence of precise data about the use of anti inflammatory drugs in the initial treatment of this pharyngitis. Existence of other type of antalgic and non immunosuppressive drugs make the use of anti inflammatory drugs not justify.
Explore the source record for details and available documents.
Pseudorabies virus glycoproteins gE and gI are required to infect some, but not all, regions of the rodent central nervous system after peripheral injection. After infection of the retina, pseudorabies virus mutants lacking either gE or gI can subsequently infect neural centers involved in the control of circadian function but cannot infect visual circuits mediating visual perception or the reflex movement of the eyes. In this study, we used genetic complementation to test the hypothesis that gE and gI are required for entry into the specific retinal ganglion cells that project to visual centers. These data strongly suggest that gE and gI must function after the viruses enter primary neurons in the retina.
Explore the source record for details and available documents.
High-dose 5-fluorouracil (5-FU) continuous infusion over a 4-day period seems to dramatically increase the frequency of cardiac complications, which were however extremely rare in the past when it was injected in bolus form (1.6%). In order to evaluate their real incidence we looked for a relation between cardiac toxicity and clinical or 5 FU pharmacokinetic parameters. One hundred and thirty-three patients were followed up from January 1989 to March 1990, treated for head and neck, breast and colorectal cancers by high-dose 5-FU infusion (1,000 mg/sqm/d x 4 d) and cis-platinum (20 mg/sqm/d x 4 d). During each treatment course, daily electrocardiogram and 5 FU plasma assays were performed by high performance liquid chromatography, at 8 am and 8 pm. Twenty-eight patients presented 36 ischemic cardiac manifestations which were sometimes severe. Of these, 29 were asymptomatic. Cardiac toxicity frequency was not increased in the group treated for head and neck cancers. Pharmacokinetic analysis showed wide variations in 5-FU plasma levels in the 133 patients under study (from 20 to 1,200 ng/ml). Cardiac manifestations always appeared during the hours following very high 5-FU plasma levels (greater than 450 ng/ml). Cardiotoxicity seems to be linked to 5-FU plasma levels. Cis-platinum probably increases toxicity in this regimen. These findings indicate the advisability of a close follow-up by daily ECG when 5-FU is administered at high doses in continuous infusion and associated with cis-platinum. We are continuing to study 5 FU cardiac toxicity, especially in other regimens containing 5 FU and aim to evaluate the contribution of cardiac isotopic exams.
Numerous Doppler echocardiographic methods to measure stroke volume have been proposed in experimental or clinical studies, but their relative accuracy in patients compared with an invasive reference standard remains uncertain. Accordingly, we compared Doppler with thermodilution stroke volume measurement in 18 hospitalized patients, 16 with an acute manifestation of coronary artery disease and two with chronic cardiomyopathies. Doppler time-velocity integrals were measured by darkest line (modal velocity) and the leading edge (maximal velocity) techniques at the aortic annular plane, the mitral orifice, and the mitral annular plane. Two-dimensional echocardiography was used to measure cross-sectional areas (M-mode-corrected at the mitral orifice). The combination of aortic annular cross-sectional area and the leading edge technique of measuring the time-velocity integral of blood flow at this site provided the most accurate measure of stroke volume (r = 0.87, p less than 0.0001, standard error of estimate = 11 cm3; mean difference from thermodilution = 2.8 ml +/- 8.9 ml, p = NS). It also resulted in the most accurate measurement of cardiac output (r = 0.88, p less than 0.0003; mean difference from thermodilution = 0.11 L/min +/- 0.69 L/min, p = NS). Other methods yielded values that correlated less closely and deviated systematically from thermodilution measurements. We therefore conclude that of the six common methods evaluated, the aortic annular leading edge method measures stroke volume with the best accuracy and is most suitable for clinical application.
Intracranial complications following swimming or diving accidents are exceptional. A recent observation of a cerebral empyema in a 15-year old boy, with neurological sequellae was an opportunity the clarify the issue. Apart from the rapidity of the neurological signs, two points drew our attention: bacteriology, with a predominance of anaerobic germs; and the problem of therapy, both for the timing of neurosurgery and for the role of anticoagulants in venous thrombosis.
The authors recall their experience about 42 cases of island flaps for surgical defects after dermatologic epithelioma of the face. Surgical technic is described, the design, implementation and anatomy of subcutaneous flap are discussed and illustrated.
Sinusitis is mentioned as one complication of nasotracheal intubation. 30 patients admitted to the I.C.U. and prolonged intubated (+5 days) underwent clinical examination and C.T. scan: 23 C.T. scan revealed anomalies and 5 sinusitis. One patient had blood cultures positive for the organism present on nasal cultures. Patients nasally intubated are at risk for sinusitis which can have adverse effects.
Dubreuilh's melanosis or circumscribed melanosis is a current disease of the old patient's face. The therapeutical attitude should be surgical and as earlier as possible. A 5 millimeter cutaneous margin must be resected around this lesion. A review of 30 cases is made.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Five further cases of subglottic stenosis after intubation are reported. Lesions were due to chondrolysis of the cricoid cartilage: associating an Evans type anterior laryngotracheoplasty (the principle of which is recalled) with the posterior cricoid incision of the Rethi-Aboulker type produced a marked improvement in the results of posterior laryngoplasty performed alone.
Laryngeal diastema or laryngeal or posterior laryngotracheal cleft is a rare congenital malformation producing an aerodigestive communication of abnormal location which leads to severe or even fatal respiratory and infective complications. Findings in 16 cases are presented and the characteristics and particular problems of treatment of this malformation discussed. Diagnosis is presently based on results of microlaryngoscopic examination. Details are given of therapy of the commonest forms of the affection (cricoidal and upper cricotracheal), operations being performed in 9 such cases, and the place and course of forms limited to the interarytenoidal space discussed. Frequency and effect on prognosis of associated malformation are outlined. Considerable improvement has been obtained in the postoperative prognosis of cricoidal (I) and upper cricotracheal (II) forms during the last few years, and these forms must now be considered as curable.