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J P Fombeur

Publications and source records attributed to J P Fombeur.

At least 19 recordsLinked to original sources
PubMed2002

Comparison between caloric and canal impulse rotatory test.

It has been suggested that the rotatory test using videosnystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, which the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

Caloric Tests↗
PubMed1996

Relationship of antibodies to thyrotropin receptors and to thyroid ultrasonographic volume in euthyroid and hypothyroid patients with autoimmune thyroiditis.

It has been reported in hypothyroid patients with Hashimoto's thyroiditis and in patients with primary myxoedema that antibodies (Ab) to the TSH-receptor (R), which inhibit the thyroid gland, decrease both thyroid hormonogenesis and cell growth in vitro. We investigated, in 169 newly diagnosed patients with euthyroid (n = 83) or hypothyroid (n = 86) autoimmune thyroiditis, the relationship between thyroid autoimmunity expression and thyroid ultrasonographic volume or thyroid hormonal status. In patients positive for TSH-receptor (R) antibodies (Ab), negative correlations (P < 0.01) were found between TSH-R Ab levels and free T4 (FT4) values in a euthyroid (r = -0.63), as well as in a hypothyroid (r = -0.54) state, and between TSH-R Ab and total thyroid volume (TTV) values in an euthyroid (r = -0.62) as well as in a hypothyroid (r = -0.53) state. In contrast, no positive correlations were found between TSH levels and FT4 values or TTV levels in patients positive as well as negative for TSH-R Ab in an euthyroid or in a hypothyroid state. These data demonstrate in vivo, that, in contrast to TSH, TSH-R Abs are related to both thyroid hormonal production and volume in euthyroid or hypothyroid patients with autoimmune thyroiditis.

Adolescent↗
PubMed1995

Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules.

OBJECTIVE: The prevalence of sporadic forms of medullary thyroid carcinoma (MTC) has been studied in patients living in an area of moderate iodine deficiency. Such forms of MTC are usually diagnosed after surgery and have little chance of definitive cure. Using the measurement of basal serum calcitonin (CT) levels in a large series of patients with both thyroid disease and normal 24-hour urinary iodine excretion, we assessed the prevalence of MTC and, in patients affected with the disease, we also evaluated the stage of the disease according to surgical findings and post surgical plasma CT levels. PATIENTS: A prospective study of 657 patients with thyroid disease (469 with nodular and 188 with non-nodular thyroid disease). As controls, 40 normal subjects were also studied. MEASUREMENTS: In all patients: (1) measurement of basal serum CT, free T4, total T3, TSH levels and serum TSH-receptor, peroxidase and thyroglobulin (Tg) antibody concentrations, (2) thyroid ultrasonography, (3) fine needle aspiration cytology (FNAC). In patients with increased basal CT levels: (1) measurement of serum CT levels during pentagastrin test prior to surgery, (2) histological examination and immunostaining with both anti-CT and anti-Tg antibodies of all the nodular thyroid tissue surgically removed, (3) measurement of basal and pentagastrin stimulated serum CT values after surgery. RESULTS: All the patients with non-nodular thyroid disease had normal basal CT levels. Four patients (0.84%) with nodular thyroid disease (2 with uninodular and 2 with multinodular goitre) had both elevated basal and pentagastrin stimulated CT levels. In the two patients with uninodular goitre, FNAC was suggestive of MTC in 1 (nodular diameter 8.0 cm) and of follicular carcinoma in 1 (nodular diameter 2.5 cm). Histological examination of the nodules confirmed these histotypes. Immunostaining with anti-CT antibodies was positive in the former patient but also in the latter. FNAC was suggestive of benign adenomatous tissues in the two patients with multinodular goitre. Histological examination of all the thyroid nodules confirmed the cytological findings. However, serial sections through the gland in each of these two patients showed an occult follicular carcinoma which had, however, positive staining with anti-CT antibodies. Furthermore, immunostaining with anti-Tg antibodies was negative in the patient with MTC but positive in the 3 patients with follicular carcinoma. Finally, both basal and pentagastrin stimulated CT levels remained elevated after total thyroidectomy only in the patient with FNAC suggesting MTC. CONCLUSIONS: This study demonstrates a surprisingly high prevalence of sporadic forms of medullary thyroid carcinoma in patients with nodular thyroid disease. Such forms of medullary thyroid carcinoma seem to be unrelated to iodine intake and may be pure or mixed with a follicular carcinoma. In these mixed thyroid carcinomas, only the neoplastic follicular pattern was seen on both cytological and histological examination. Routine measurements of serum calcitonin levels should therefore be considered an integral part of the diagnostic evaluation of thyroid nodules. Indeed, increasing the accuracy of diagnosis of medullary thyroid carcinoma encourages the surgeon to perform more radical treatment, thus achieving more frequent normalization of post-operative serum calcitonin levels.

Adolescent↗
PubMed1995

[Endonasal ethmoidectomy in naso-sinusal polyposis. Results in 110 surgically treated patients].

We assessed retrospectively functional and endoscopic results obtained in 110 patients who underwent endonasal ethmoidectomy (n = 218). The patients were divided into 3 groups according to associated pathology (polyposis alone, asthma without intolerance to aspirin, Widal's disease) and outcome was evaluated after a mean 19.5 month follow-up. Function was improved in 88% of the patients. Endoscopic recurrence was seen in 40% of the patients including 10% with major polyposis. Oedema of the mucose remained in 20% of the patients and the mucosa was normal in 40%. Improvement in patients with Widal's disease was the least favourable among the three groups and was best in those with asthma and no intolerance to aspirin. Post-operative complications occurred in 12.6% of the patients and were severe in 0.9%. These satisfactory results, both in terms of function and the low rate of complications, suggest that the current medicosurgical management should be continued with particular attention to the rate of endoscopic recurrence.

Adult↗
PubMed1995

[Conditions of the remaining thyroid tissue after partial thyroidectomy].

The authors have realized a retrospective study about 246 patients who underwent partial thyroidectomy for a benign nodule or goiter between 1982 and 1991. Recurrence was analized with the method of Kaplan-Meier and concerned 11% of the patients at 3 years and 30% at 8 years. The statistical analysis showed that only patients with postoperative hormonal treatment were at risk of recurrence. This treatment was not randomized. Other studied factors (sex, age, type of surgery, pathological results, TSH level) are not correlated with recurrence. Surgical management is discussed.

Adult↗
PubMed1994

Effects of thyroid status on thyroid autoimmunity expression in euthyroid and hypothyroid patients with Hashimoto's thyroiditis.

OBJECTIVE: In patients with hypothyroid goitrous Hashimoto's thyroiditis, the recovery from hypothyroidism seems to be due to a spontaneous decrease of antibodies (Ab) to the TSH-receptor (R). In contrast, in patients with Graves' disease made euthyroid by antithyroid drug therapy, the suppression of TSH secretion by thyroid hormone during antithyroid drug treatment decreases the production of Ab to TSH-R. We investigated in patients with initially euthyroid or hypothyroid goitrous Hashimoto's thyroiditis the relationships between thyroid status and the serum TSH-R, peroxidase (TPO) and thyroglobulin (Tg) Ab concentrations in untreated or L-thyroxine (T4) treated patients. PATIENTS: A prospective study of 174 consecutive patients, referred with goitrous Hashimoto's disease in an initially euthyroid (group I, n = 78) or hypothyroid (group II, n = 96) state. The patients with positive (> or = 7%) TSH-RAb (group I, n = 18; group II, n = 22) were reinvestigated 12 months after the initiation of L-T4 therapy. After which, (1) L-T4 was continued and an evaluation performed 2 months later (i.e. 14 months after L-T4 initiation) in 9 patients of group I and in 11 patients of group II or (2) L-T4 was withdrawn and an evaluation performed 2 months later in 9 patients of group I and in 11 patients of group II. MEASUREMENTS: Measurements of basal plasma TSH, free T4 (FT4) and total T3 and serum TSH-R, TPO and TgAb. RESULTS: The prevalence of positive TSH-RAb levels did not differ between group I (23.1%) and group II (22.9%). However, the mean TSH-RAb level in group I (9.4 +/- 0.4%) was lower (P < 0.01) than in group II (11.6 +/- 0.5%). In the patients with positive TSH-R Ab, (1) the prevalences of positive TSH-RAb decreased (P < 0.001) under L-T4 therapy (group I = 22.2%, group II = 21.2%) and increased again (P < 0.01) 2 months after L-T4 cessation (group I = 77.7%, group II = 63.6%) to reach lower levels (group I, P < 0.05; group II, P < 0.01) than those obtained prior to L-T4 treatment. Statistical analysis of TSH levels through the course of the study confirmed these results. (2) In contrast to the variations of the mean TgAb values, the variations of the mean TPOAb levels in each group were in good agreement with those of TSH-RAb through the course of the study. (3) There were significant correlations between some parameters of thyroid status and both TSH-RAb (TSH, r = 0.43, P < 0.001; FT4, r = -0.35, P < 0.01) and TPOAb (TSH, r = 0.42, P < 0.001; FT4, r = -0.31; P < 0.01) levels. In contrast, no correlations were found between thyroid status and TgAb values. CONCLUSIONS: This study demonstrates that thyroid status can modulate thyroid autoimmunity expression, such as TSH-RAb and TPOAb, in patients with euthyroid or hypothyroid goitrous Hashimoto's thyroiditis. Similar results have been reported in patients with Graves' disease made euthyroid by the administration of thyroid hormone during antithyroid drug treatment.

Adult↗
PubMed1994

Study of the efficacy and safety of ciprofloxacin in the treatment of chronic sinusitis.

Over a 12-month period, 56 patients with acute exacerbations of chronic sinusitis were included in this study. The mean age of the patients was 48.6 +/- 10.1 years. The period between the onset of sinus symptoms and inclusion in the study was 10.1 +/- 12.1 years and the exacerbation had lasted 2.4 +/- 4.4 months. Patients were given 500 mg ciprofloxacin twice daily for 9 days. Bacteriological specimens taken at inclusion were positive in 53.6% of cases, 25 Gram-positive and 16 Gram-negative pathogens being isolated. At the end of the treatment, rhinorrhoea, which was the main criterion for evaluation of the efficacy of treatment, had disappeared in 46/54 (85%) patients who were examined. Of the 30 patients whose sinusitis was confirmed by bacteriological test, the bacteria were eradicated in 90% of cases. At the end of a 4-week follow-up period after the end of treatment, the clinical success rate was 74.5%, the partial success rate 21.2% and the failure rate 4.3%. There were no bacteriological recurrences. Ten adverse events were observed in seven patients and in four (7%) of these treatment had to be withdrawn. This study showed ciprofloxacin to be an effective and well tolerated treatment for exacerbations of chronic sinusitis treated in non-hospital practice.

Adult↗
PubMed1994

Study of the efficacy and safety of ciprofloxacin in the treatment of chronic otitis.

Over a period of 18 months 76 patients presenting with acute exacerbations of chronic otitis were enrolled in this study. The mean age of the patients was 46.4 +/- 16.8 years, the interval between the onset of symptoms of otitis and enrollment in the study was 22.1 +/- 19.4 years and the infective episode had been developing for 36.4 +/- 72.4 days. The patients received either 500 or 750 mg ciprofloxacin twice daily for a period of 9 days with no topical antibiotic treatment. The bacteriological specimen taken at enrollment was positive in 93% of the patients and led to the isolation of 85 microorganisms, 65% of which were Pseudomonas aeruginosa, Staphylococcus aureus or Proteus mirabilis. At the end of the treatment period, discharge from the ears (the primary clinical evaluation criterion) had ceased in 44/69 (64%) patients examined. The clinical cure rate was 23/39 (59%) for patients treated with 500 mg ciprofloxacin twice daily and 21/30 (70%) for those treated with 750 mg twice daily (difference was not statistically significant). At the end of a 4-week post-treatment follow-up, the clinical relapse rate was 7%. There was no relapse in the patients with chronic otitis which had been bacteriologically documented. Eight adverse effects were observed in five patients and treatment had to be discontinued in one case. This study shows ciprofloxacin to be an effective and safe agent for use in the treatment of acute exacerbations of chronic otitis treated in general practice. In certain cases, however, additional treatment with a topical antibiotic may be desirable.

Adult↗
PubMed1993

Prevalence of subclinical hyperthyroidism and relationship between thyroid hormonal status and thyroid ultrasonographic parameters in patients with non-toxic nodular goitre.

OBJECTIVE: Basal plasma T4, T3 and TSH concentrations are usually normal in patients presenting with non-toxic nodular goitre. Using the evaluation of TSH response to TRH in a large series of such patients living in an area with normal iodine intake, we evaluated the prevalence of subclinical hyperthyroidism and the relationship between thyroid hormonal status and ultrasonographic parameters. PATIENTS: A prospective study of 242 consecutive patients (group I), referred with non-autoimmune nodular goitre, normal plasma free T4, total T3 and TSH levels, without (subgroup IA, 222 patients) or with (subgroup IB, 20 patients) clear-cut autonomous area(s) on scintigraphy. These patients were compared to 135 controls (group II). MEASUREMENTS: Plasma free T4 (FT4), total T3 (T3T) and TSH measurements. Evaluation of TSH response to TRH (delta level of increased TSH = peak TSH level during TRH test-basal TSH level), thyroid scintigraphy and morphological characteristics (number and total volume of nodule(s) and volume of extranodular tissue) determined by ultrasonography. RESULTS: In subgroup IA, (1) the mean (+/- SEM) basal TSH level (0.94 +/- 0.04 mU/I) and the mean value of increased TSH after TRH (4.92 +/- 0.34 mU/I) were lower (P < 0.001) than in group II (1.28 +/- 0.05 mU/I and 7.24 +/- 0.25 mU/I, respectively). The prevalence of SH (delta level of increased TSH below the mean -3 SD in controls) was 17.2%; (2) the mean FT4 level and the mean T3T value were not different (P > 0.05) from those of group II. In subgroup IB, (1) the mean basal TSH level (0.57 +/- 0.11 mU/I) and the mean increment of TSH after TRH (2.81 +/- 0.62 mU/I) were lower (P < 0.001) than in subgroup IA. The prevalence of subclinical hyperthyroidism was 75.0%; (2) the mean FT4 level (17.2 +/- 0.9 pmol/I) was not different from that in group II. However, the mean T3T value (1.99 +/- 0.01 nmol/I) was higher (P < 0.001) than in group II (1.65 +/- 0.05). In group I, subgroup IA and IB, there were significant (P < 0.05, at least) correlations between the numbers of nodules and both basal TSH levels and delta values of increased TSH or FT4 levels or T3T values. No correlations were found between other ultrasonographic data and plasma thyroid parameters. CONCLUSIONS: This study demonstrates a high prevalence of subclinical hyperthyroidism in patients presenting with non-toxic nodular goitres and suggests that the number of nodules, but not their total volume, is an important factor in the development of this condition.

Adolescent↗
PubMed1993

[Mycoses of the maxillary sinus. Apropos of 40 cases].

Between 1985 and 1992, 40 patients with mycosis of the maxillary sinus were treated in the department at Hôpital Saint Michel and of otolaryngology, head-neck surgery at Hôpital Saint Michel and their charts retrospectively analysed. The clinical signs, radiological findings and etiopathological hypothesis are described. The authors report their experience of functional endoscopic sinus surgery for treatment of mycosis of maxillary sinus. A high rate of postoperative successes, a low rate of complications, the recovery of a normal intrasinusal aerial flow and the easy endoscopic follow-up lead them to adverate the use FESS in primary treatment for mycosis of the maxillary sinus.

Adult↗
PubMed1993

[Initial results of 132 ethmoidectomies by endonasal approach].

47 cases of nasal polyposis and 19 cases of suppurated ethmoiditis were treated by intranasal ethmoidectomy. Results were evaluated by functional signs and nasosinusal endoscopy. 15 patients, among nasal polyposis, suffered from corticodependent asthma and 5 from Widal's disease. 64 patients were regularly followed-up for 1 to 4 years. Results in polyposis, after two years, in 47% of cases no recurrence was noted, a minor recurrence in 40% of cases, and 13% of failures with predominant Widal's disease. These results with low percentage of complications have lead us to choose intranasal ethmoidectomy. In suppurated ethmoiditis, results are good in 90% of cases if follow up is regular.

Adult↗
PubMed1991

[Treatment of recurrence of pleomorphic adenomas of the parotid gland].

This is a retrospective study of 10 patients who underwent surgery for a first or multiple recurrence of pleomorphic adenoma (P.A.). Recurrence may come more than 10 years after an initial episode. During initial surgery, the risk of recurrence is related to pre-operative dissemination and to failure to identify tumoral prolongations in the parotid gland. Recurrence is generally multifocal. In 2 cases, carcinoma developed in association with P.A. Treatment of benign recurrence is surgical: it consists of totalizing the previous parotidectomy. If the previous parotidectomy has been total, tumorectomy is carried out. In all cases, surgery preserves the facial nerve trunk.

Adult↗
PubMed1990

[Adult type rhabdomyoma of the soft palate: pathology of 2 cases with review of the medical literature].

In this paper, the authors report two cases of adult type rhabdomyomas of the soft palate. This tumor is composed of striated muscle cells containing striations and intracytoplasmic rod-shaped inclusions. In specimens already fixed in aqueous fixators (formalin...), some tumor cells presented a fixation artefact and displayed the morphology of so-called "spiderweb cells". Adult type rhabdomyoma is a real tumor. Total surgical removal is sufficient to cure the patient of this tumor in most cases.

Adult↗
PubMed1989

[Therapeutic approach in chronic maxillary sinusitis. Apropos of 469 patients and 640 sinuses].

Between 1982 and 1987 we treated 469 patients who accounted for a total of 640 involved sinuses. These patients suffered from various stages of chronic sinusitis. Endoscopy of the maxillary sinuses enabled us to collect important information regarding the state of the mucosa and secretions, to collect bacteriological samples and to inspect the ostium and take pressure measurements. There was an 80% success rate in cases of sinusitis treated by drainage. In our opinion the indication for inferior meatotomy is as an extraction procedure and is not of value for aeration drainages. Nevertheless, out of a total of 141 inferior meatotomies performed, 80% remained patent after a mean follow up period of 3 years.

Chronic Disease↗
PubMed1989

[Indications, technics and results of middle meatotomy. Apropos of 94 cases].

Middle meatotomies were essentially performed during the second period of our study from 1985 to 1987. The typical indication was for closed sinusitis, in order to allow aeration and satisfactory drainage. This was performed with an optical system at 30 degrees. The technique used was an anterior approach via total unciformectomy or a posterior approach using an Ostrum forceps. Good results, i.e. meatotomies which remained patent, were obtained in 80% of cases. The mean period of follow up was 3 years (6 months to 4 years). There were few complications overall for this form of endonasal surgery, though the possibility of damage to the lacrymal duct does exist. Synechiae were the most important functional complication and need to be prevented by meticulous post-operative care.

Drainage↗
PubMed1988

[On the contribution of magnets in sequelae of facial paralysis. Preliminary clinical study].

This trial was designed to evaluate the efficacy of EPOREC 1 500 magnets as an adjuvant to rehabilitation following peripheral facial paralysis. Magnetotherapy is used in many other specialties, and in particular in rheumatology. The properties of repulsion between identical poles were used to decrease the effect of sequelae in the form of contractures on the facial muscles. There were two groups of 20 patients: one group with physiotherapy only and the other with standard rehabilitation together with the use of magnets. These 40 patients had facial paralysis of various origins (trauma, excision of acoustic neuroma, Bell's palsy etc). Obviously all patients had an intact nerve. It was at the time of the development of contractures that magnets could be used in terms of evaluation of their efficacy of action on syncinesiae, contractures and spasticity. Magnets were worn at night for a mean period of six months and results were assessed in terms of disappearance of eye-mouth syncinesiae, and in terms of normality of facial tone. Improvement and total recovery without sequelae were obtained far more frequently in the group which wore magnets, encouraging us to continue along these lines.

Facial Paralysis↗