Biomedical subjects
Publications and source records attributed to L Castillo.
This is the first published French case of a rhinosinusitis caused by Bipolaris sp. in an immunocompetent patient and suggests that this organism must be considered as an opportunistic human pathogen in warm and damp climate like the south-east of France. Bipolaris sp. is the most isolated fungi in allergic fungal sinusitis.
UNLABELLED: Recurrent laryngeal nerve paralysis is a much-dreaded complication of thyroid surgery. OBJECTIVE: To study the feasibility and the reliability of a recurrent laryngeal nerve monitoring technique. MATERIALS AND METHODS: This was a prospective study including 36 patients proposed for thyroid surgery with recurrent laryngeal nerve monitoring. They underwent post-operative fibre-optic laryngeal examination and speech therapist consultation. RESULTS: Our technique of nerve monitoring showed a 98 per cent sensitivity and 86 per cent specificity. CONCLUSIONS: Recurrent laryngeal nerve monitoring is a feasible and reliable technique. It can be used to avoid bilateral nerve injury and to increase the surgeon's confidence but not to replace a systematic nerve identification and a careful dissection.
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OBJECTIVES: Hypocalcemia is the most common complication of total thyroidectomy. During surgery the blood supply to preserved parathyroid glands may be compromised, monitoring for post operative hypocalcemia is often the primary reason patients remain in hospital. The aim of this prospective study was to evaluate the role of early parathyroid hormone (PTH) assay for predicting thyroidectomy-related hypocalcemia. MATERIAL AND METHODS: 62 patients underwent total thyroidectomy between November 2004 and April 2005 in our institution. Quick PTH assay was performed 1 hour post thyroidectomy. Based on the result (PTH > or <16 pg/mL) the patients were separated into two groups. Serum calcium levels and ionised fractions were determined 24, 48 and 72 hours after surgery. Post operative hypocalcemia was defined as calcium levels <2.00 mmol/L and/or ionised calcium levels <1.00 mmol/L. RESULTS: In 16 cases hypocalcemia occurred in the first 72 hours (25.8 %). In all of these cases, PTH measured 1 hour after thyroidectomy was < or = 16 pg/mL. All patients with PTH >16 pg/mL one hour after the operation remained normocalcemic. Of the 29 patients with a PTH < or =16 pg/mL at one hour post surgery, 13 remained normocalcemic. Quick PTH measurements which were < or =16 pg/mL post thyroidectomy were an excellent predictive factor of hypocalcemia with a sensibility of 100%, a specificity of 71.7%, a positive predictive value of 55.2% and a negative predictive value of 100%. CONCLUSION: PTH measurement 1 hour post thyroidectomy can potentially highlight those patients at risk of hypocalcemia. This would allow more efficient replacement therapy with calcium and vitamin D thus avoiding complications and reducing total hospital stay.
CandidaDB is a database dedicated to the genome of the most prevalent systemic fungal pathogen of humans, Candida albicans. CandidaDB is based on an annotation of the Stanford Genome Technology Center C.albicans genome sequence data by the European Galar Fungail Consortium. CandidaDB Release 2.0 (June 2004) contains information pertaining to Assembly 19 of the genome of C.albicans strain SC5314. The current release contains 6244 annotated entries corresponding to 130 tRNA genes and 5917 protein-coding genes. For these, it provides tentative functional assignments along with numerous pre-run analyses that can assist the researcher in the evaluation of gene function for the purpose of specific or large-scale analysis. CandidaDB is based on GenoList, a generic relational data schema and a World Wide Web interface that has been adapted to the handling of eukaryotic genomes. The interface allows users to browse easily through genome data and retrieve information. CandidaDB also provides more elaborate tools, such as pattern searching, that are tightly connected to the overall browsing system. As the C.albicans genome is diploid and still incompletely assembled, CandidaDB provides tools to browse the genome by individual supercontigs and to examine information about allelic sequences obtained from complementary contigs. CandidaDB is accessible at http://genolist.pasteur.fr/CandidaDB.
OBJECTIVES: To study the contribution of computed tomography (CT) to evaluate the intensity of the sinus mucosa's response to an inflammatory stimulus. MATERIAL AND METHODS: Eight New-Zealand white rabbits where used. Rabbit n degrees 1 was the control. CT, macroscopic examination with analysis of secretion volumes, and histological examination were used to study the response of the sinuses to inflammation. RESULTS: There was perfect match between the CT scan aspect and the quantity of secretions (kappa and Cohen's coefficient=1). The CT scan aspect well correlated with inflammatory cell infiltration (kappa and Cohen's coefficients=0.8). CONCLUSION: The CT scan contributes usefully to the analysis of sinus contents and can be used to assess the intensity of the sinus mucosal inflammatory reaction. Consequently, the CT scan can be used not only to validate an animal model of acute or chronic sinusitis, but can also be used to evaluate medical or surgical treatments in such an animal model.
AIM: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD). METHODS: According to greatest linear dimension (GLD) of the entire lesion determined with fluorescein angiography (FA) patients were divided into two groups. In the first group GLD was <3000 microm and in the second one GLD was 3000-5000 microm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA). RESULTS: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recruited to participate in the study. All participants in the study completed the follow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesions (n = 32) compared with 15 patients (46.8%) in the group of larger lesions (n = 32) did not show significant leakage in FA at the end of follow up (p = 0.02). A GLD increase >1000 microm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p = 0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the group of larger lesions lost less than three lines of vision (p = 0.06). Relevant side effects related to verteporfin therapy were not recorded, except for four patients (6.2%) with infusion related back pain. CONCLUSIONS: These results suggest that lesion size at baseline may be a prognosis factor in PDT in patients with subfoveal predominantly classic CNV secondary to AMD. There are no relevant side effects or safety concerns derived from verteporfin therapy.
OBJECTIVE: As well as others usually irritative factors, cigarettes smoke has many medical consequences that aren't well known at the present time. The aim of this study is to describe the rhinologic signs caused by cigarettes consumption. MATERIAL AND METHODS: Two groups (smoker and control) of 20 patients (10 men and 10 women) were contituted. Individual patient status was evaluated by questionnaire, analogic visual scale, clinical examination and rhinomanometry. RESULTS: Nasal resistances, nasal obstruction and posterior rhinorrhea evaluated by, analogic visual scale are significantly higher in the smoker group as compared to the control group (Mann-Whitney test; total nasal resistance: p<0.00001, uninasal resistances: p<0.00001, nasal obstruction: p<0.0001, posterior rhinorrhea: p<0.01). They are significantly higher among smokers of 20 cigarettes a day than among smokers of 10 cigarettes a day. DISCUSSION: The control group was completly safe of rhinologic signs, so we used it to confirm the normal values of nasal resistances. Posterior rhinorrhea and nasal obstruction are 2 important signs which should be researched in smokers; its severity is correlates with cigarettes consumption. CONCLUSION: Tobacco is an important irritative factor for nasal mucosa.
OBJECTIVE: The frequency of thyroid nodules requires an appropriate and consistent undertaking of such pathology by the entire medical profession. Over the past few years, the ANAES (National Agency of Health Accreditation and Evaluation - 1995 - 1997) had formulated medical recommendations. Our work aimed at updating such recommendations considering recent literature developments and their level of evidence. MATERIAL AND METHODS: We have selected high-level of evidence's articles published since 1997 dealing with the diagnostic undertaking of thyroid nodule. Such analysis was conducted using the search engine "Medline" and the level of evidence of the selected articles was evaluated by taking into account the professional recommendations of the "literature analysis and gradation of recommendations' guide" of ANAES. RESULT: At present, two diagnostic tests are necessary in the diagnostic evaluation of a thyroid nodule (ultrasonography and fine-needle aspiration). CONCLUSION: The medical recommendation will hence result in the synthesis of these two different diagnostic tests, nevertheless fine-needle aspiration being essential and having priority in evaluating the risk of cancer.
Epidermal growth factor receptor (EGFR) signaling pathways play a key role in the regulation of cell proliferation, survival and differentiation. As a consequence, EGFR is one of the best studied ligand-receptor system and specific EGFR inhibition approaches are currently among the most promising and the most advanced in the clinical setting. Monoclonal antibodies (mAbs) and specific tyrosine kinase inhibitors (TKIs) have been developed, among which C225 (Cetuximab) and ZD1839 (Iressa), respectively, are the most advanced. The aim of the present review was not to cover the field of EGFR inhibitors, but to compare at experimental and clinical levels the different key points governing the actions of mAbs and TKIs. In addition, combinations of conventional chemotherapies with EGFR targeting drugs, as well as resistance mechanisms of EGFR targeting, have been reviewed.
OBJECTIVE: The aim of this retrospective study was to analyse the data of patients with rhino-orbital-cerebral mucormycosis for predisposing factors, diagnosis, treatment and survival rate. The role of frozen section in early diagnosis and use of nasal endoscopy in diagnosis, treatment and follow-up of patients has also been examined. DESIGN: Retrospective case series. SETTING: University Teaching Hospital. METHODS: The case notes of 9 patients with diagnosis of mucormycosis who presented from 1973 to 2001 were examined. The data for predisposing factors, signs/symptoms, histological diagnosis, radiological intervention, medical and surgical treatment and final outcome was analysed. RESULTS: There were 9 patients with mucormycoses. Early diagnosis was made by endoscopic examination and frozen section in 5 patients, which was later confirmed by histology. Treatment included parental and/or local amphotericin, hyperbaric oxygen and debridement either by endoscopic or external approach, with or without orbital exenteration. This resulted in an overall survival of 5 patients. CONCLUSION: Frozen section diagnosis allows for early therapy since successful treatment depends on systemic amphotericin, surgical debridement and treatment of underlying predisposing factors. Nasal endoscopy is useful in diagnosis, endoscopic debridement and follow up of patients.
OBJECTIVE: As well as other usually irritative factors, the acidity of gastro-oesophageal reflux (GOR) has many medical consequences that are not well known at the present time. The aim of this study is to describe the rhinologic signs caused by this common disease. MATERIALS AND METHODS: Prospective study; two groups (GOR proved by pH-metry and control) of 20 patients (10 men and 10 women) were formed. Individual patient status was evaluated by questionnaire, visual analogue scale (AVS), clinical examination and rhinomanometry. RESULTS: Nasal resistance, nasal obstruction and posterior rhinorrhea evaluated by AVS are significantly higher in the GOR group as compared to the control group (Mann-Whitney test; total nasal resistance: p < 0.01, uninasal resistances: p < 0.001, nasal obstruction: p < 0.00001, posterior rhinorrhea: p < 0.00001). DISCUSSION: The control group was completely free from rhinologic signs, so we used it to confirm the normal values of nasal resistance. Nasal obstruction and posterior rhinorrhea are two new signs which should be researched in patients affected by GOR. CONCLUSION: GOR is an important irritative factor for nasal mucosa responsible for nasal obstruction and posterior rhinorrhea. (full article translated in english available on www.ent-review.com).
OBJECTIVE: The purpose of this study is to show the place of MIBI scintigraphy in the preoperative investigation of primary hyperthyroidism, and then to demonstrate the extent to which this test allows us to formulate new surgical strategies, thus reducing the need for neck exploration in favour of minimally invasive techniques. MATERIALS AND METHODS: We have carried out a retrospective study related to 118 cases of primary hyperthyroidism. A MIBI scintigraphy has been applied on all the patients, so that we have been able to compare its results with the surgical and histological findings. RESULTS: Our study shows a great accuracy of MIBI scintigraphy, with respect to the localization of parathyroid adenoma, which represents the major cause of primary hyperparathyroidism. Furthermore, these results prove the reliability of the new surgical strategies: unilateral neck exploration and minimally invasive surgery, when facing a single scintigraphic site. CONCLUSION: As of now, MIBI scintigraphy must be part of preoperative investigation in cases of primary hyperparathyroidism, so that by limitating the surgical neck exploration, it allows us to decrease operative time and the risks, length and cost of the hospital stay.
INTRODUCTION: In order to meet the evolution of pneumococcus resistance to beta-lactam antibiotics, a new formulation of amoxicillin (AMX) and clavulanic acid (CA), with twice as much AMX (1 g/125 mg vs. 500 mg/125 mg) was developed for the treatment of acute pneumonia in patients at risk. This formulation can also be used in the treatment of acute maxillary sinusitis using a 1 g/125 mg regimen twice-daily. OBJECTIVES: Compare the sinusal penetration of AMX and CA (1 g/125 mg twice-daily vs. 500 mg/125 mg three times a day) when administered at both regimens to demonstrate equivalent pharmacokinetic and pharmacodynamic behaviour of the former when compared to the latter. METHODS: Concentrations of AMX and CA were measured in the anterior ethmoid, maxillary, posterior ethmoid sinus and in the middle nasa concha in 62 patients undergoing surgery for nasosinusal polyps. Patients randomised in two groups corresponding to 2 oral regimens, received either 1 g/125 mg twice a day or 500 mg/125 mg three times a day for 4 days. The last dose in both groups was administered 1 h 30, 3, 5 or 8 hrs prior to surgery. Serum samples were taken simultaneously to tissue samples. AMX and CA were measured by high performance liquid chromatography. Exogenous and above all endogenous blood contamination were taken into account with the hematocrit as well as blood and tissue haemoglobin concentrations. Comparisons of tissue concentrations were made for each sampling time, according to values obtained for a specific tissue with both doses on one hand, and on the other to values obtained with a specific dose in different tissues. The calculated pharmacodynamic parameters, which are considered to be predictive for bacteriological and clinical efficacy, result directly from tissue concentrations of AMX. tissue inhibitory quotients (IQtissue = Tissue concentration/MIC). time above MICs for serum and tissue concentrations (T > MIC). RESULTS: As regards AMX, whatever the dose, at 1 h 30 and at 3 hrs, tissue concentrations did not differ significantly whatever the tissue studied (from 1.1 to 2.5 micrograms/g). Conversely, at 5 and 8 hrs, they were greater than after the 1 g/125 mg regimen given twice-daily (0.06-0.7 vs. 0.7-1.8 micrograms/g). If we consider a given dose, the comparison between the various tissues showed identical concentrations in the four tissues studied at each sampling time, except in two cases with the dose of 500 mg/125 mg 3 times a day. T > MIC for serum and tissue showed higher values than those required for AMX/pneumococcus association (40-50%) with, nevertheless, greater tissue values for the 1 g/125 mg dose given twice-daily when MIC was of 1 microgram/ml (40-52% vs. 50-66%). The maximum tissue inhibitory quotients were also greater with the twice-daily 1 g/125 mg dose, when calculated with MIC 50 or 90 of S. Pneumoniae, H. influenzae, M. catarrhalis or S. pyogenes. As for CA, concentrations were equivalent for both doses at each sampling time and greater than those required in vitro during respectively 4 and 5 hours for beta-lactamases H. influenzae and M. catarrhalis. DISCUSSION-CONCLUSION: A least an equivalence between both dose regimens was observed, with occasionally a superiority of the twice-daily 1 g/125 mg dose, in terms of pharmacokinetics, tissue penetration and pharmacodynamics for both AMX and CA. This new regimen therefore appears more appropriate for the treatment of acute maxillary sinusitis in adults.
A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.
Delirium (confusion) is an acute, reversible and fluctuating compromise of awareness and cognitive function, a state that can increase morbidity and mortality. We describe four patients with delirium associated with agitation and hyperadrenergic states refractory to haloperidol but responsive to dexmedetomidine.
BACKGROUND: Results from a 1990-1992 longitudinal study of several reinforced plastics plants showed that for those workers whose styrene exposure had decreased, color vision (CV) improved; while near visual contrast sensitivity (CS) was poorer. METHODS: In 1999, we retested these visual functions in 18 workers with good visual acuity. A cumulative exposure index (CEI), corrected for respirator use, was calculated for each worker. RESULTS: Intra-individual comparison of mandelic acid (MA) showed a significant decrease over time (Friedman; P = 0.015), but current values were not related to CEI. For CV, no significant difference was observed between 1992 and 1999; present results were not related to MA or CEI. The CS profile decreased over time, with significant differences at 3 cpd (Friedman; P < 0.05). CS did not vary with MA levels, but was significantly depressed at the intermediate frequencies among those in the upper CEIH category (Kruskal-Wallis; P < 0.05). CONCLUSIONS: These findings suggest that CS loss increases with long-term cumulative exposure, reflecting chronic damage to the neuro-optic pathways.
BACKGROUND: The referral of all children with cancer in Uruguay to a single center affords the opportunity to generate population-based incidence and mortality rates in this developing country in Latin America. PROCEDURE: All incident cases of cancer in children, 0-14 years of age, were ascertained from a combination of three sources for the period January 1992-December 1994. Diagnoses were grouped according to the International Classification of Childhood Cancer. Information on the size and age distribution of the total population was obtained from national census records. Follow-up was undertaken until December 1999 to afford a minimum interval of 5 years and the determination of mortality rates. RESULTS: The average annual incidence was 133.6 cases of cancer per million children per year and the disease distribution was similar to that in industrialized countries, with the exception of a higher rate and younger age distribution for the Hodgkin disease. The overall age-standardized mortality rate from cancer in childhood, at 6.5 per 100,000, was approximately twice that in the United States and Canada. CONCLUSIONS: Basic indicators of development suggest that Uruguay is more akin to the countries of North America and Western Europe than to those in the developing world. An opportunity has been identified to improve the outcome for children with cancer in this country.