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Biomedical subjects

P Narcy

Publications and source records attributed to P Narcy.

At least 19 recordsLinked to original sources
PubMed1995

Screening for neonatal and infant deafness in Europe in 1992.

Many methods of screening for hearing impairment are available. The aim of our study was to determine which ones were really used in 1992. At the request of the British Audiology Society, we conducted an inquiry into the organization of screening for deafness in neonates and infants in Europe. In practice all 6-9 month-old infants are tested with behavioural tests in every country. For the neonates, generally only those at risk for hearing-impairment (about 5%) were tested. The most widely used tests were behavioural ones. Only specialized centers used transient evoked otoacoustic emissions (TEOAEs). This last test assesses the active mechanical properties of the cochlea and allows detection of even mild or unilateral sensorineural deafness.

Audiometry↗
PubMed1995

[Deafness in the neonatal period: basis for screening].

Deafness must be recognized in infancy in order to reduce auditory disability to a minimum. To achieve this, it is important to implement screening programmes as soon after birth as possible. In the United States, the Joint Committee on Infant Hearing recommended in 1982 that identification of hearing loss should be screened in the neonatal period. This early detection is now considered critical for optimal rehabilitative outcome. This paper presents the "state of art" neonatal screening principles and procedures. In France, neonatal screening programs for auditory dysfunction are not consistent with these principles. Evoked otoacoustic emissions represent an important advance in screening for hearing loss in normal neonates and babies from neonatal intensive care units. This method records very low intensity sound energy released by the cochlea in response to a brief sound stimulation. These otoacoustic emissions show promise as a rapid, cost-effective means of quickly discharging all babies with normal peripherical auditory systems.

Deafness↗
PubMed1995

[Conservative otoplastic modelling: early operative indication].

The authors presents their philosophy and their experience in the field of otoplasty in young children. The modelling and conservative characteristic of the surgical procedure, used for over 6 years, allows surgery on children as young as 3 years old. They detail the different operative steps underlining the rarity of the complications, the natural results achieved and the stability of these results with the child growth.

Ambulatory Surgical Procedures↗
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↗
PubMed1994

Ultrasonographic evaluation of the tongue and the floor of the mouth: normal and pathological findings.

An ultrasonographic study of the tongue and the floor of the mouth was performed in 30 healthy children (aged from 1 day to 15 years) in order to assess the normal US anatomy of this region. The scans were performed in sagittal and coronal planes with a 7.5-mHz transducer. Moreover, 22 children (aged from 1 day to 15 years) presenting with various clinical symptoms underwent US examination. This series included infectious and congenital diseases. The US findings were correlated with surgery and pathology in 19 cases, with the clinical follow-up in 2 cases and with the nuclear study in 1 case. In each case, US could anatomically locate the lesion with very good accuracy. We conclude that US of the tongue and the floor of the mouth in children yields overall very good accuracy in the investigation of diseases of this region. In this study, our purpose was (1) to evaluate the normal sonographic anatomy of the tongue and the floor of the mouth in children and (2) to determine whether it was possible to correctly localize various lesions and to evaluate their nature in order to guide the therapeutic approach.

Adolescent↗
PubMed1994

Role of congenital hypothyroidism in hearing loss in children.

No significant difference was found for the auditory thresholds at conversational and high frequencies between 42 children with congenital hypothyroidism treated with L-thyroxine and an age-matched control group, regardless of the cause of the thyroid failure or hormone level and the age at the start of treatment.

Adolescent↗
PubMed1994

[Orbital cellulitis in children].

BACKGROUND: Because the potential for complications is great, orbital cellulitis must be recognized promptly and treated aggressively. POPULATION AND METHODS: The files of 38 children admitted from 1988 to 1993 because of orbital or periorbital cellulitis were retrospectively analyzed. Clinical findings included fever, edema, pain, rhinorrhea, conjunctivitis, limitation of eye movement, loss of vision and ophthalmoplegia. All patients had hemogram, ionogram, blood cultures, search for soluble antigens in blood and/or urine, C-reactive protein measurement; they also had roentgenographic examination of the sinuses, orbital ultrasonography and/or CT scan in patients with retroseptal cellulitis. All patients were given systemic antibiotic therapy. RESULTS: Thirty-five patients had preseptal and three retroseptal cellulitis. Preseptal cellulitis was associated to sinusitis in 17 patients, to ocular infection in 11 (seven conjunctivitis and four dacryocystitis), to an infected wound in six. Seventy-three per cent of the patients with ocular infection were less than 2 years of age with a significant preponderance of girls (64%). The three cases of retroseptal cellulitis were associated to sinusitis. Orbital echography was performed in five cases, permitting to recognize the three cases of retroseptal cellulitis that was confirmed by CT scan. Twenty-five of the 38 children were given oral antibiotics during the days preceding admission, explaining the relative rarity of positive bacteriological findings (seven cases). Thirty-five of the 38 children were given IV cefotaxime + fosfomycin, associated to netromycin in 16 cases. Mean duration of treatment was 3 days (range: 1-7). IV antibiotherapy was followed by oral amoxicillin-clavulanic acid administration in 25 patients and pristinamycin in 11. CONCLUSIONS: Orbital cellulitis in children, more frequently preseptal, have a good prognosis under adapted antibiotherapy. A retroseptal cellulitis requires multidisciplinary management because of the risk of extension of infection from the orbit to the eye and/or into the cranial cavity.

Anti-Bacterial Agents↗
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↗
PubMed1993

Audiological assessment of eleven congenital hypothyroid infants before and after treatment.

Eleven congenital hypothyroid newborns were consecutively referred for audiological evaluation before any treatment. Evoked otoacoustic emissions were present bilaterally in 9 newborns. These results suggest the normality outer hair cells and contrast with results obtained in experimental studies. The auditory brainstem responses in 6 newborns showed a prolonged wave I, as previously reported by other authors. At 9 to 12 months of age, all children treated had evoked otoacoustic emissions in at least one ear. In 9 cases, the auditory threshold was normal (equal to or below 20 dB) as determined by behavioural tests.

Auditory Threshold↗
PubMed1993

[Cysts of the lacrimal tracts in the newborn infant].

At birth, a thin membrane often remains at the distal end of the nasolacrimal duct in the inferior meatus. The rupture is spontaneous during the first month of life. Sometimes this impatency can lead to a symptomatology usually limited to an uni or bilateral dacryocystitis. Exceptionally a cyst can develop in the nasolacrimal passageways. The authors describe three cases of intranasal occurrences, two of which brought about an obstructive dyspnea. Twelve cases have been described in the literature. This affliction predominantly occurs in young girls. Whenever the nasal obstruction is isolated, it is important to eliminate any other cause of intranasal tumor, especially an encephalocele, before any surgical intervention. Computerized tomographic scan is indispensable in order to eliminate any connection with the intracranial space. Magnetic resonance imaging appears promising. For the authors, the treatment must be surgical and must be kept simple. It consists in a cyst excision.

Cysts↗
PubMed1993

[Screening of deafness in the young child. Value, techniques and initial results of products of acoustic distortion].

Distortion-product otoacoustic emissions are otoacoustic emissions evoked by two pure tones called primaries and proposed in order to provide a frequency specific investigation of the cochlea. This paper first reports complete input-output functions of distortion-product otoacoustic emissions for conventional audiometric frequencies in a population of 35 neonates without any risk for cochlear function. Distortion-product otoacoustic emissions could be useful, in association with evoked otoacoustic emissions and comportemental audiometry, to precisely evaluate the peripheral auditory system in infants and neonates.

Audiometry↗
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↗
PubMed1992

Bacteremia during tonsillectomy.

To determine the risk of bacteremia during tonsillectomy, we cultured blood specimens that were taken from 32 children during surgery and tonsillar swabs that were obtained just before excision, and compared the results with quantitative cultures of the excised tonsillar tissue. Twenty-five children had Haemophilus influenzae within the tonsillar tissue (density range, 10(3) to 10(8) colony-forming units per gram), and seven had Streptococcus pyogenes (density, 10(3) colony-forming units per gram in one case, 10(5) colony-forming units per gram in one case, and 10(6) colony-forming units per gram in five cases). Twelve perioperative blood cultures were positive; H influenzae was found nine times, and Micrococcus species was found one time, and alpha-hemolytic streptococci were found two times. Haemophilus influenzae was always present in the corresponding tonsillar specimens, although there was no apparent relationship between the density of colonization of the tonsillar tissue and a positive blood culture.

Bacteremia↗