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Biomedical subjects

P Contencin

Publications and source records attributed to P Contencin.

At least 19 recordsLinked to original sources
PubMed2003

Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children.

OBJECTIVE: To assess the functional and anatomic results of cartilage grafting in children with a severe retraction pocket of the posterosuperior part of the pars tensa and operated on by pocket excision and cartilage grafting. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fifty six children (60 ears) with severe posterosuperior retraction pockets. INTERVENTION: Excision of the pocket and tympanic reinforcement with a tragal or conchal cartilaginous graft. MAIN OUTCOME MEASURES: Postoperative anatomic (otoscopy, computed tomography) and functional (pure tone audiometry thresholds) outcome. The follow-up time was 27 +/- 18 months (mean +/- SD). RESULTS: Retraction recurrences requiring additional surgery occurred in 5 cases (8%). The risk of recurrence was lower in children older than 10 years and when the whole surface of the pars tensa was reinforced (chi(2) test, p< 0.05 for both factors). Functionally, hearing was improved even when the ossicular chain was intact. In case of disrupted ossicular chain, direct contact between the graft and eroded incudostapedial joint gave good hearing results. CONCLUSIONS: Cartilage reinforcement of the whole surface of the pars tensa is probably the best treatment of a severe posterosuperior retraction pocket. The flexibility and thinness of cartilage from the cymba conchae makes it particularly suitable in this indication.

Cartilage↗
PubMed2000

Iatrogenic pharyngoesophageal perforation in premature infants.

BACKGROUND: Premature infants are particularly at risk of iatrogenic pharyngoesophageal perforation. It is a rare occurrence but when it does occur it often mimics esophageal atresia. In the light of 10 patients treated in our service and those reported in the literature we have highlighted the diagnostic difficulties and discussed the appropriate management. PATIENTS: Between 1980 and 1995, we treated 10 premature neonates for pharyngoesophageal perforation. Six of these neonates weighed less than 1500 g. Esophageal atresia was the primary diagnosis in 4 cases. The pharyngoesophageal perforation was caused by repeated airway intubation in 3 cases and by overenthusiastic routine postpartum suctioning or nasogastric tube (NGT) insertion in 7 others. Severe respiratory distress occurred in 7 neonates. A plain chest x-ray revealed a large right pneumothorax in 3 cases and an aberrant NGT in 3 other cases. Four neonates had a contrast esophagography and 4 neonates underwent endoscopy. Five cases were treated surgically. In 3 of these, esophageal atresia was the presumptive diagnosis and the perforation was only diagnosed intraoperatively via a right thoracotomy. One neonate required suturing of the perforation and another had a gastrostomy. In all 5 cases a mediastinal drain was left in situ. The 5 remaining neonates were treated conservatively with broad spectrum antibiotics, total parenteral nutrition, a silastic NGT and pharyngeal aspiration. One of these neonates had previously had a laparotomy for a colonic perforation. There was a good outcome in 4 neonates, one of whom required instrumental dilatation for an esophageal stricture. Bronchopulmonary dysplasia developed in 3 cases and necrotizing enterocolitis in 1 other case. Two neonates died. CONCLUSION: An iatrogenic perforation is often difficult to diagnose and can easily be confused with esophageal atresia. Clinical findings, a plain chest x-ray, an esophagography and endoscopy are helpful. Surgery can be avoided in most instances. The outcome is not always favorable especially as premature neonates are at risk of severe concomitant pathology.

Esophageal Perforation↗
PubMed1999

Nasal fossae dimensions in the neonate and young infant: a computed tomographic scan study.

OBJECTIVE: To determine normal values in the size of nasal fossae to better delineate the concept of nasal stenosis in young infants with nasal obstruction and without choanal atresia. DESIGN: Case series. SETTING: Referral center. PATIENTS: Consecutive sample of 62 infants (aged 0 to 6 months) with no craniofacial anomalies who underwent conventional axial computed tomography scans for a neurologic disorder. INTERVENTION: From computer-stored images, the slices taken at the level of the nasal fossae floor and those just above were examined. The length and 10 measurements of the width of the nasal fossae were used to determine normal values. RESULTS: Most measurements, even the length of the nasal fossae, were positively correlated to the age of the patient (R = .44). In the age 0 to 2 months group, the median length was 29.35 mm (range, 21.3-40.4 mm). It was 31.5 mm in the age 4 to 6 months group (range, 25.3-36.9 mm). The anterior bony aperture seems to be the most accurate distance for the assessment of neonatal nasal fossae stenosis. Its median width was 13.5 mm (range, 8.8-17.2 mm). Large variations characterized the dimensions of the middle nasal fossae and the choanae: median values were 7.6 mm (range, 4.9-13.5 mm) and 14.3 mm (range, 10.8-19.0 mm), respectively. CONCLUSIONS: This study defined the normal range of variation for the main dimensions of the nasal fossae in the horizontal plane. These can be used as a basis for determining nasal stenosis in cases of neonatal obstruction.

Cephalometry↗
PubMed1999

[Chronic laryngitis in children: the role of gastroesophageal reflux].

UNLABELLED: Gastro-oesophageal reflux (GOR) is associated with a number of inflammatory ENT disorders in the adult and is correlated with recurrent croup in the child. AIM: To estimate the frequency of GOR in a population of children consulting for chronic laryngotracheal symptoms. METHOD: The study included 17 children, aged between 2 and 14 years (mean: 7 years) all of whom suffered from dysphonia or a chronic cough. After a clinical ENT examination, each child had a fibreoptic laryngoscopy and a long duration pH-study lasting between 18 and 24 hours. RESULTS: Pathological GOR was discovered in 10 children, i.e. 59%. Overall the number of refluxes per study varied from 6 to 816 (mean 156). The vast majority of these refluxes occurred when the child was awake. CONCLUSION: In our series of children with chronic laryngotracheal disorders, at least 59% were shown to suffer from pathological GOR.

Adolescent↗
PubMed1998

Squamous cell carcinoma of the trachea in an infant: a case report.

Primary malignant tumours of the trachea are extremely rare in infants. This report describes an 11-month-old boy suffering from severe dyspnea with a 5-month history of stridor and 'bronchitis'. A hard mass could be palpated below the right lobe of the thyroid gland. Roentgenograms and endoscopy showed an exophytic tumour filling more than 80% of the tracheal lumen. A tracheal resection and a subtotal thyroidectomy with primary anastomosis was performed. An invasive squamous cell carcinoma of the trachea was diagnosed. This is the first reported case in an infant in the English literature. A local recurrence was found on MRI 19 weeks later. The infant died at 16 months of age.

Carcinoma, Squamous Cell↗
PubMed1998

Hoarseness and gastroesophageal reflux in children.

The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.

Child↗
PubMed1997

Non-endoscopic techniques for the evaluation of the pediatric airway.

In children with stridor, a detailed evaluation of the airway is often required to assess precisely its anatomical and functional status. Various methods of assessment have been developed and airway management may include, as well as rigid and flexible endoscopy, the use of imaging techniques such as plain X-rays, a barium oesophagogram, ultrasound, a CT scan, a magnetic resonance image (MRI) and an angiogram, as well as respiratory function tests including acoustic rhinometry and flow volume loops or even pH monitoring. This article aims to highlight the valuable information these alternative techniques can provide.

Airway Obstruction↗
PubMed1997

[Recurrent thyroid abscess in children and malformations of the pyriform sinus].

Recurrent "abscesses" occurring in the thyroid area in children are due to branchial anomalies. Their origin is located close to the oesophageal inlet at the apex of the lateral hypopharyngeal process: the pyriform sinus. The key for the diagnosis comes from laryngohypopharyngoscopy. The true original anomaly is a controversial topic: the persistence of a canal originating from the 3rd or 4th branchial pouch. Anyhow, these anomalies sometimes build tracts or cysts in the deeper parts of the neck, down to the supraclavicular or thoracic areas. Most often, they are limited to the soft tissues surrounding the left thyroid lobe. In these cases, no cyst wall can be found. The 3 cases reported here allow us to ascertain that a pharyngeal infection is the trigger for the neck abscess. Furthermore, a mucosal opening can be the only found anomaly. After recovery from the infectious process, these anomalies have to be treated by a mucosal suture of the pyriform sinus. The recurrent laryngeal nerve should be first discovered and the removal of a small piece of cartilage can be required. If these diagnostic and therapeutic procedures are used at the first infectious episode, they may prevent the occurrence of repeated thyroid "abscesses" in children.

Abscess↗
PubMed1997

[Gastroesophageal reflux and dysphonia in children].

UNLABELLED: With the exception of congenital anomalies, the aetiology of dysphonia in children is often unknown. Yet, in adults, GOR has been shown to play an important role. 22 children (aged between 2 and 14 years, 14 boys and 8 girls), who had been suffering from a chronic dysphonia for more than six months were seen at consultation. After a clinical ENT examination including a fibreoptic laryngoscopy, each child had a long duration pH-study that lasted approximately 24 hours. Using the classical criteria for GOR, a pathological GOR was discovered in 14 children, ie 64%. Analysis of the pH traces revealed that the vast majority of refluxes occurred when the child was awake. CONCLUSION: more than 64% of children suffering from chronic dysphonia had pathological GOR. The pH traces highlighted that the majority of these refluxes occurred when the child was awake.

Child↗
PubMed1996

Is nasal polyposis in cystic fibrosis a direct manifestation of genetic mutation or a complication of chronic infection?

Cystic fibrosis (CF) is the most common autosomal recessive disease among Caucasians. It is characterized by abnormal transepithelial sodium and chloride transport. The clinical expressions of the disorder are highly variable including nasal polyposis. Some authors have found that CF children with nasal polyposis form a distinct subgroup of patients within the clinical heterogeneity of the disease with milder gastrointestinal and pulmonary symptoms. The aim of this prospective study was to verify whether the clinical manifestations in CF children with nasal polyposis are different from control CF patients, and to identify any correlation between a phenotype of nasal polyposis and a genotype. Sixty-six CF children, aged 1-25 years, consecutively underwent ENT examination including nasal endoscopy. Twenty-one had nasal polyposis. The remainder formed the control group. There was no statistical difference in the mode and age of presentation of the disease between the two groups. The clinical manifestations (Schwachman and Kulczycki score, colonization by Staphylococcus aureus and Pseudomonas aeruginosa) were comparable between the two groups. We found no statistical difference in the repartition of genotypes between the polyposis and the control groups. Nasal polyposis does not seem to be genetically dependent, but a larger sample of patients is needed to reach an accurate conclusion.

Adolescent↗
PubMed1995

Gastroesophageal reflux and ENT disorders in childhood.

Among controversies in pediatric otorhinolaryngology, the role of gastroesophageal reflux (GER) in inflammatory disorders of the upper airway remains of major concern. A laryngeal involvement by GER was demonstrated in adults and a correlation with GER has been found in pediatric populations with recurrent croup. However, although considered statistically significant, these results concern a few patients only and are inconclusive for a causal relationship. In addition, pH monitoring, often considered as the gold standard for the diagnosis of GER disease, has failed in giving normal values in ENT disorders. Eventually, upper pharyngeal and nasal involvements by GER and GER-related otitis media or otalgia have been suggested by some authors. In the 6th International Congress on Pediatric Otolaryngology, the Symposium on GER was designed to help physicians in improving their knowledge of the data from the literature and their understanding of the involved mechanisms. Bearing in mind the potential severity of GER disease, the audience also heard and debated the most up-to-date methods of assessing GER and treating it in patients with possibly related otorhinolaryngological symptoms. Here is the summary of this symposium.

Child↗
PubMed1995

[Tonsillectomy in a day care hospital. A socioeconomic study at the Robert Debré Hospital in Paris].

Tonsillectomy as an outpatient procedure in children is a common practice in the United States and many other countries. In French public hospitals, it remains quite rare. A 6-month prospective study was conducted in order to check the procedure's feasibility in a large Paris university children's hospital, to describe the involved population and to search for the possible benefits which could be made by a public hospital from an increase in day surgery practice for tonsillectomy. In terms of quality of postoperative outcome, this study confirms the absence of major complications related to this procedure if the proper criteria are met for day surgery. In fact, medical and social findings from the involved patients tend to limit here a large extension of this procedure. For example, in the inpatients group, more than 43% of children had a tonsillar hypertrophy with significant airway obstruction and 47% did not have lodging conditions which would allow day surgery with the required safety. Only 20% of patients could be transferred to ambulatory surgery which leads to 2-3 additional cases each week here. Finally, the cost analysis shows no benefit in human resources at this hospital because the requested differential activity threshold would not be reached.

Ambulatory Surgical Procedures↗
PubMed1993

Size of endotracheal tube and neonatal acquired subglottic stenosis. Study Group for Neonatology and Pediatric Emergencies in the Parisian Area.

OBJECTIVE: Risk factors for acquired laryngotracheal stenosis in newborn infants are poorly known. The extreme scarcity of acquired laryngotracheal stenosis in young infants in France, compared with the published rate in the English literature, suggested that these patients may be treated in a different way in France. A prospective study was performed to analyze local features. DESIGN: Six-month multicenter inception cohort study. SETTING: Seven neonatal intensive care units of referral centers in the area of Paris, France. PATIENTS: A total of 247 intubated surviving neonates in a consecutive sample during 6 months. INTERVENTION: A file was completed with sex, birth weight, gestational age, underlying disease, and every feature concerning the intubation period and the outcome. MAIN OUTCOME MEASURES: All the collected data were compared with those available from previous studies in the English literature. RESULTS: After extubation, respiratory outcome was uncomplicated in 242 cases. The five patients with dyspnea were treated medically and recovered. A much higher rate of extubation difficulties was reported in the English literature. The rate of stenosis in this series was significantly lower than in previously reported studies. The differences between this and other series seem to be higher birth weights, shorter duration of intubation, and, most important, a smaller tube size (2.5 mm in neonates weighing less than 2500 g and 3.0 mm in those weighing 2500 g or more). CONCLUSIONS: Although this is a limited series and many unknown variables can differ from those in previous studies, the size of the endotracheal tube appears to be a major risk factor for acquired laryngotracheal stenosis in the neonate. Further studies seem necessary to point out additional factors.

Birth Weight↗
PubMed1992

Gastropharyngeal reflux in infants and children. A pharyngeal pH monitoring study.

Gastroesophageal reflux has been shown to play an important role in chronic and acute inflammatory disorders of the airway. In particular, gastroesophageal reflux has been suggested to be the cause of pharyngolaryngeal problems, according to the literature, at any age. However, to our knowledge, the presence of acid in the pharynx in pathological cases has not yet been proved. A series of eight patients (aged 2 months to 7.5 years) with recurrent acute laryngotracheitis underwent a two-channel pH monitoring for 23 to 24 hours. One pH probe was placed in the lower esophagus, the other in the pharynx, at the level of the epiglottis. Acid gastroesophagopharyngeal reflux was demonstrated in every patient. A significant difference with a series of six control subjects was noted in terms of esophageal and pharyngeal pH monitoring. The most significant item is the total time the pH in the pharynx was below 6. Despite the limited number of patients, this study suggests the role of gastroesophageal reflux in recurrent laryngotracheitis in infants and children.

Acute Disease↗