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Biomedical subjects

P Gehanno

Publications and source records attributed to P Gehanno.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of ebastine to cetirizine in seasonal allergic rhinitis in adults.

BACKGROUND: Second-generation histamine H1-receptor antagonists are accepted first-line systemic therapy for seasonal allergic rhinitis. Ebastine is a new histamine H1-receptor blocker that may differ in efficacy from currently used second-generation agents. OBJECTIVE: To compare the efficacy of daily treatment with ebastine, 10 mg, ebastine, 20 mg, or cetirizine, 10 mg, for relieving symptoms of seasonal allergic rhinitis in adults. METHODS: In this multicenter, double-blind study, outpatients were randomized to one of three parallel treatment groups: ebastine, 10 mg, ebastine, 20 mg, or cetirizine, 10 mg once daily in the morning for a 2-week period. Patients were evaluated clinically according to symptoms, discomfort, and a global assessment at baseline and on days 8 and 15 of treatment. The total symptom score, defined as the sum of the total morning score on the day of evaluation and the total evening score on the preceding day, was the primary efficacy parameter. RESULTS: Ebastine, 20 mg (n = 111), ebastine, 10 mg (116), and cetirizine, 10 mg (116), were all effective for improving nasal and ocular symptoms. There was, however, a general trend towards more rapid relief of symptoms with ebastine, 20 mg, and this reached statistical significance in some efficacy parameters after the first week of treatment. In a subpopulation of 158 patients who presented with more severe symptoms, statistically significantly greater improvement was seen with ebastine, 20 mg, compared with ebastine, 10 mg, as indicated by the mean change from baseline in the total symptom score averaged over the treatment period (-13.7 +/- 4.7 vs -11.8 +/- 3.8; P =.027) and in the morning symptom score (-6.7 +/- 2.7 vs -5.7 +/- 2.2; P = .042). All three treatments were well tolerated. Dry mouth, headache, and somnolence were the most common adverse events. CONCLUSION: Ebastine (10 mg), cetirizine (10 mg), and ebastine (20 mg) administered orally once daily for 2 weeks all appear to be effective for relieving the symptoms of seasonal allergic rhinitis. Ebastine, 20 mg, may have advantages over ebastine, 10 mg, and cetirizine, 10 mg, in terms of a reduced time to achieve maximal efficacy and a superior level of efficacy in patients with more severe symptoms.

Adult↗
PubMed1996

Sparfloxacin versus cefuroxime axetil in the treatment of acute purulent sinusitis. Sinusitis Study Group.

In a double-blind, multicentre trial, 382 patients with a diagnosis of acute purulent sinusitis were randomised to receive sparfloxacin 200 mg once daily for 5 days following a loading dose of 400 mg on day 1 (n = 193) or cefuroxime axetil 250 mg twice daily for 8 days (n = 189). Patients were classified as success or failure according to clinical symptoms plus bacteriological and radiological data at the end of treatment and at a follow-up visit. In analyses of the intent-to-treat (n = 374) and evaluable populations (n = 304), the 5 day course of sparfloxacin was at least as effective and well tolerated as the 8 day course of cefuroxime axetil. The success rates at the end of treatment in the evaluable population were 82.6% and 83.2% in the sparfloxacin and cefuroxime axetil groups, respectively. The pathogens isolated most frequently were Haemophilus influenzae (33%) and Streptococcus pneumoniae (28%). Response rates according to the bacterial aetiology of the acute sinusitis were similar in the two treatment groups. Both drugs were well tolerated. The commonest adverse events were gastrointestinal and were reported in 2.6% and 3.8% of sparfloxacin- and cefuroxime axetil-treated patients, respectively.

Acute Disease↗
PubMed1996

Evaluation of nasopharyngeal cultures for bacteriologic assessment of acute otitis media in children.

BACKGROUND: The recent emergence of penicillin-resistant Streptococcus pneumoniae, particularly in acute otitis media (AOM), has increased interest in the development of noninvasive procedures that might help to predict the bacterial etiology of this condition. We conducted an open multicenter study to evaluate the predictive value of the nasopharyngeal (NP) sampling in children with AOM by comparing the bacteriologic results of NP cultures with those of pus collected by myringotomy in the same patients. METHODS: The NP secretions and the pus obtained by myringotomy were collected concomitantly in 354 children younger than 6 years of age with clinical signs of AOM. The clinical usefulness of NP culture was determined by calculating its sensitivity and specificity, and especially its positive and negative predictive values for the three main pathogens responsible for AOM, Haemophilus influenzae, S. pneumoniae and Moraxella catarrhalis. RESULTS: A positive NP culture was found to have little predictive value for H. influenzae (52%), S. pneumoniae (43%) and M. catarrhalis (19%). In contrast the negative predictive value of NP cultures was much greater and was accompanied by negative middle ear fluid cultures in more than 95% of children, especially for S. pneumoniae. Furthermore the incidence of beta-lactamase-producing strains of H. influenzae at both sampling sites was similar (30 and 35%, respectively), as was the incidence of penicillin-resistant S. pneumoniae (50 and 54%). CONCLUSION: It appears that the correlation between results of NP and middle ear fluid cultures in children with AOM is too weak to allow NP culture to be recommended for the bacteriologic documentation of this disease. However, these results should not overshadow the considerable epidemiologic value of NP cultures, particularly with reference to the monitoring of pneumonococcal susceptibility in children. The collection of NP cultures should therefore be promoted for their collective epidemiologic value.

Bacterial Infections↗
PubMed1996

Efficacy of single-dose ceftriaxone in experimental otitis media induced by penicillin- and cephalosporin-resistant Streptococcus pneumoniae.

We used a gerbil model of otitis media to assess the efficacy of single-dose ceftriaxone against three Streptococcus pneumoniae strains highly resistant to penicillin (MICs, 4 to 8 micrograms/ml) and with various susceptibilities to ceftriaxone (MICs, 0.5, 4, and 8 micrograms/ml). Middle ear infection was induced by bilateral transbullar challenge with 10(7) bacteria per ear. Antibiotic treatment was administered subcutaneously at 2 h postinfection. Infection status was checked 2 days later by counting the bacteria in middle ear and cerebrospinal fluid samples. With the cefriaxone-susceptible strain (MIC, 0.5 microgram/ml), we tested doses of 5 to 100 mg/kg of body weight. With a dose of 50 mg/kg, treatment outcome was equivalent to that with amoxicillin, which was used as a reference (25 mg/kg, two injections); no bacteria were recovered from 82% of the middle ear samples, and the rate of cerebrospinal fluid culture positivity was significantly reduced to 6%, relative to 59% for the untreated controls. Similar efficacy was obtained with a dose of 100 mg/kg against the two ceftriaxone-resistant strains. Pharmacokinetic study indicates that the values of the parameters in plasma after the administration of a dose of 100 mg/kg (peak level of total drug, 268 +/- 33 micrograms/ml; elimination half-life, 0.8 h; area under concentration-time curve, 488 micrograms.h.ml-1) were still suboptimal compared with the values of the parameters measured in pediatric patients after intravenous or intramuscular administration of a dose of 50 mg/kg. Our results indicate the efficacy of ceftriaxone against experimental cephalosporin-resistant pneumococcal otitis and provide a basis for the clinical use of single-dose ceftriaxone against pneumococcal otitis media.

Animals↗
PubMed1996

Clonal distribution of penicillin-resistant Streptococcus pneumoniae 23F in France.

We studied the clonality of clinical isolates of Streptococcus pneumoniae 23F, the serotype most often associated with penicillin resistance in France. Clinical isolates obtained between November 1992 and April 1993 from nasopharyngeal samples from children with acute otitis media from different regions of the country were analyzed. The genetic polymorphism of penicillin-susceptible and -resistant 23F isolates (MIC, 2 mg/liter) was studied by pulsed-field gel electrophoresis. The resistant isolates were closely related, whereas the susceptible isolates were genetically heterogeneous. PCR amplification and restriction of the genes encoding penicillin-binding proteins (PBPs) 1A, 2B, and 2X also showed that the 24 resistant isolates had similar patterns which were very different from those of the susceptible isolates. All resistant isolates gave the same PBP pattern, with low affinities of PBPs for penicillin. Our results indicate that, in contrast to penicillin-susceptible 23F isolates, the penicillin-resistant 23F isolates have a single clonal origin, suggesting the rapid clonal spread of a resistant epidemic strain throughout the country.

Bacterial Proteins↗
PubMed1996

Cost saving of 5-day therapy with cefpodoxime proxetil versus standard 10-day beta-lactam therapy for recurrent pharyngotonsillitis in adults. A prospective general practice study.

A prospective economic evaluation was undertaken as part of a randomised clinical trial conducted in French general practice. Its aim was to compare the costs and therapeutic outcomes of a 5-day course of cefpodoxime proxetil 100 mg twice daily with 10-day courses of phenoxymethylpenicillin (penicillin V) 1 MIU 3 times daily and amoxicillin-clavulanic acid 500/125 mg 3 times daily for the treatment of recurrent pharyngotonsillitis in 575 adults. Over the 6-month study period, the total cost to society per patient treated with cefpodoxime proxetil was 123 French francs (FF; 1993 values) lower than that for patients treated with phenoxymethylpenicillin and FF227 lower than that for patients treated with amoxicillin-clavulanic acid. This cost saving was primarily attributable to a lower initial drug acquisition cost, and a reduction in the cost associated with lost productivity and general practitioner consultations. Furthermore, as a consequence of a lower relapse rate, the cost-saving ratio for cefpodoxime proxetil, expressed as FF per month free of recurrence, was FF50 less than for phenoxymethylpenicillin and FF60 less than for amoxicillin-clavulanic acid. Thus, a 5-day course of cefpodoxime proxetil is likely to be less costly for treatment of pharyngotonsillitis in the general practice setting than standard 10-day courses of phenoxymethylpenicillin and amoxicillin-clavulanic acid.

Adult↗
PubMed1996

[Total glossectomy with laryngectomy].

Because local control of locally advanced cancer of base of tongue and larynx managed with combined chemotherapy and radiotherapy is poor, we proposed total glossectomy with total laryngectomy. Twenty-one patients underwent this operation over a period of 8 years. It was a salvage surgery for 15 patients, and an up-front surgery for the 6 others. Postoperative complications occurred in ten patients, and three patients died in the postoperative period. Mean total duration of hospitalisation was 40 days. Oral feeding could be achieved in 14 patients (mean delay: 46 days), but satisfactory oesophageal voice has never been obtained. We can conclude from the analysis of this series that total glossectomy with total laryngectomy is a heavy surgery, which leads to frequent complications, severe functional sequellae, and poor survival. However, control of pain can be obtained, that justifying this heavy procedure. We recommend that patients and relatives should be fully informed about the consequences of surgery before final decision.

Actuarial Analysis↗
PubMed1995

[Outcome of the surgery of cancers of upper respiratory and digestive tracts].

The best treatment for cancer of the head and neck remains surgery followed by radiotherapy. The surgical resection became progressively more conservative for tumor of the hypopharynx and larynx whereas resection of buccal and oropharyngeal tumors became more aggressive without adding extra mutilation. New reconstructive techniques have allowed both extended resection and reconstruction with a major concern for function and cosmesis. First to be used, myocutaneous flaps have remained the workhorse of reconstructive surgery for the head and neck, mainly because they are quick to harvest and less demanding than free flaps. Nevertheless microvascular skin, bone and digestive flaps, are becoming more and more widely used even though time consuming. This drawback is balanced by the high standard of reconstruction achieved by these flaps, allowing a shorter hospital stay and a quicker rehabilitation.

Humans↗
PubMed1995

Laryngectomized patients' education and follow-up.

Functional and aesthetic problems due to mutilating surgical excisions and adjuvant radiotherapy prolonging the therapeutic period and increasing consequences, are common to all cervicofacial tumors. Laryngectomy is the most representative example, because it affects the aero-digestive tract, the site of major functions; breathing, phonation and swallowing. It necessitates excellent information to the patient post-operatively, and then adapted rehabilitation requiring the learning of oesophageal speech. A close follow-up is required to track loco-regional relapses, secondary neoplastic sites and metastases, cessation of alcohol and tobacco use, and to provide family, social and professional rehabilitation. There are often problems to manage with socio-culturally disadvantaged classes, and physically and psychologically fragile patients, whose hope of surviving is, in general, mediocre.

Aftercare↗
PubMed1995

In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media.

Eighty-four children suffering from acute otitis media caused by Streptococcus pneumoniae were treated prospectively with cefuroxime axetil suspension (30 mg/kg of body weight twice daily for 8 days). The high incidence of isolates with decreased susceptibilities to penicillin (42 of 84 isolates) allowed us to establish a relationship between clinical success and the penicillin MICs for pneumococcal isolates. It was found that cefuroxime axetil is clinically effective in the treatment of acute otitis media caused by penicillin-susceptible and penicillin-intermediate strains of S. pneumoniae. The results indicate that the risk of treatment failure with cefuroxime axetil was increased in children with otitis media caused by S. pneumoniae when the penicillin MIC were greater than or equal to 2 mg/liter.

Acute Disease↗
PubMed1995

[Use of azithromycin in ORL].

If the demonstration of the interest to treat beta-haemolytic streptococcal pharyngitis is not to be done, the recommended antibiotics, most of the time, display the drawback of a treatment with one to three intakes daily for 10 days. The azithromycin, with its numerous properties, allows for the required treatment duration, to decrease the intakes number, thus facilitating the compliance. Its in vitro activity is very good on streptococci with a MIC90 of 0.06 mg/l. Its in vivo activity in animal, with experimental Streptococcus pyogenes infection models is identical to the amoxicillin activity, and better than those of other tested macrolides. One of the major characteristics of azithromycin in man is its most peculiar pharmacokinetic with an extended half life and very high tonsillar concentrations, for at least 10 days after the administration of the product at the 1.5 g dose regimen over 3 days. In streptococcal acute tonsillitis clinical studies, with a 1.5 g dose regimen over 5 days, clinical results and bacterial eradication are identical to those obtained in the Penicillin V groups. This administration facility should greatly improve the treatment compliance and lower the risks of a prematurely discontinued treatment.

Animals↗
PubMed1995

[Malignant tumors of the petrous bone. Apropos of 25 cases].

Twenty five cases of malignant tumors of the petrous bone are presented. Prognosis depends on the histology and on the local invasion which dictate the possibility of curative surgery. Squamous cell carcinoma of the middle ear and other invasive tumors have a bad prognosis, and in spite of the progress of modern image technology, the peripetrous extension of the tumors are often underestimated. Actuarial two years survival for squamous cell carcinoma was 38%. Total excision needs at least a subtotal petrous resection with, in some cases meningal and internal carotid resection. In all cases, surgery was followed by radiation. Low grade malignant tumors had a better prognosis and required a more limited resection. In these cases, when necessary, facial nerve can be repaired by a cable graft at the time of initial surgery.

Adolescent↗
PubMed1994

Otogenic meningoencephalitis induced by Streptococcus pneumoniae in gerbils.

OBJECTIVE: Study and development of a gerbil model of pneumococcal meningoencephalitis secondary to acute middle ear (ME) otitis. Preliminary data raised the hypothesis of a direct bacterial dissemination from the ME focus to the central nervous system. This infection pattern was examined. DESIGN: Animals were inoculated bilaterally by transbulla challenge with a serotype 3 strain of Streptococcus pneumoniae at various inoculum sizes. The incidence and course of meningeal complications were studied in relation to the course of ME otitis. RESULTS: After inoculation of 40 bacteria per ear, lethal meningeal complications occurred in 14 (29%) of 48 cases. A 76% rate (25 of 33 animals) of early meningeal involvement was observed after inoculation of 10(4) bacteria per ear. Actual involvement of brain was confirmed histologically for both infection schemes. Bacterial counts 20 to 22 hours after infection with the higher inoculum showed various phases of the extension of the ME infection to brain tissue, cerebrospinal fluid, and bloodstream. Bacterial counts in ME and brain tissue were strongly correlated (P < .001). Nine of the 25 animals with infection of the central nervous system had positive brain tissue cultures without bacteremia. CONCLUSION: Gradations in inflammatory aspects of the meninges and cerebral parenchyma, together with bacteriologic findings, indicate a primary invasion of meningeal spaces that can result in lethal encephalitis and septicemia. This model might be useful for preclinical therapeutic assays on pneumococcal meningeal complications, including infections due to strains with abnormal susceptibility to antibiotics.

Animals↗
PubMed1994

Use of gastro-omental free flaps in major neck defects.

BACKGROUND: The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2. PATIENTS AND METHODS: Harvesting of the flap included elevation of a segment of the greater curvature of the stomach together with the omentum pediculated on the right gastroepiploic vessels. In 8 patients with a circumferential pharyngeal defect, the graft was used in the form of a tube; in the other 10, the graft was converted into a patch to reconstruct the missing anterior pharyngeal wall. In all cases, the omentum was used to fill in the defect. In 5 patients, neck vessels were chosen as recipient vessels, and axillary vessel systems were selected in 13 because the surgical approach to neck vessels was contraindicated. RESULTS: There was no instance of total flap necrosis. Fifteen patients had an uneventful postoperative course, and oral food intake was begun on the 15th day. The remaining 3 patients developed fistulas, which healed spontaneously. The omentum was left to granulate in all patients, and skin grafts were required in 5 patients only. No abdominal complications occurred in any patients. CONCLUSIONS: These results suggest that gastro-omental free flaps are a method of choice that should be seriously considered for the reconstruction of full-thickness defects of the neck.

Adult↗
PubMed1994

Comparative efficacy and safety of cefprozil and amoxycillin/clavulanate in the treatment of acute otitis media in children.

Cefprozil is a new oral cephalosporin with activity against the most common pathogens isolated in acute otitis media. This randomized study enrolled 361 patients (mean age 29 months). Physical examination and culture via tympanocentesis were required less than 48 h before therapy. One hundred and ninety-one patients were evaluable for clinical efficacy; 99 received cefprozil (20 mg/kg/day bd) and 92 received amoxycillin/clavulanate (13.3 mg/kg/day tid). Duration of treatment was 7-9 days for 81 patients, 10 days for 105 patients and 11-16 days for five patients. The treatment groups were comparable with respect to demographics, severity of infection and number of previous episodes. Clinical evaluations of efficacy were based on physical examination including otoscopy within a 14 day period after therapy. Satisfactory clinical responses were achieved in 84% of cefprozil-treated patients and 87% of amoxycillin/clavulanate-treated patients. Pathogens most commonly isolated included Haemophilus influenzae (33%) and Streptococcus pneumoniae (22%). All 361 patients were evaluable for safety. Adverse clinical events were reported in 13% (24) of cefprozil-treated patients and 20% (36) of amoxycillin/clavulanate-treated patients. Cefprozil, administered twice a day, is comparable to a regimen of amoxycillin/clavulanate three times a day in the treatment of acute otitis media in children.

Acute Disease↗
PubMed1994

Study of the distribution of oral ciprofloxacin into the mucosa of the middle ear and the cortical bone of the mastoid process.

This multicentre study evaluates the distribution of ciprofloxacin into the tissue structures of the middle ear following multiple dosing of one 500 mg tablet every 12 h. The samples were taken perioperatively from adult patients due to undergo surgery for chronic otitis. Administration of ciprofloxacin was instigated 9 days prior to the operation. The samples were taken at different intervals after the last dose in order to evaluate variations in concentration with time. The average peak concentrations recorded and the time taken to reach these concentrations were as follows: middle ear mucosa (n = 16): 5.54 +/- 3.46 micrograms/g (3-4 h): cortical bone of the mastoid process (n = 21): 1.07 +/- 1.29 micrograms/g (4 h). The measurements carried out 12 h after the last dose show that concentrations of ciprofloxacin in the middle ear mucosa were still at least as high as the minimum inhibitory concentration for this antibiotic for most of the pathogens implicated in acute exacerbations of chronic otitis. These results suggest that, administered as an oral dose of 500 mg every 12 h, ciprofloxacin may be an effective agent for the treatment of chronic suppurative otitis. These results now need to be backed up by clinical trials.

Administration, Oral↗