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Biomedical subjects

P Romanet

Publications and source records attributed to P Romanet.

At least 19 recordsLinked to original sources
PubMed2001

[Labyrinthine fistulae and cholesteatoma].

Labyrinthine fistula is a potentially serious complication of cholesteatoma. During or after surgery, cholesteatoma can induce partial or total destruction of cochleovestibular functions. We operated 38 patients from 1983 to 1996. The site of the fistula was the external semi-circular canal in 90% of the cases. The facial nerve canal was eroded in 66% of the cases. We performed 11 CT scans; only 7 evidenced the fistula. We removed the matrix of the cholesteatoma during the initial surgery in 35 cases and in 3 left the fistula in situ for subsequent excision at a second operation. Postoperative hearing loss compared with the preoperative situation was observed in 66% of the patients. Deafness was observed in 4 ears (11%). Hearing improved after surgery in 23% of the patients. We consider that a closed technique with immediate removal of the cholesteatoma matrix is indicated for most fistulae but that second-intention resection (combined approach tympanoplasty) is the better choice when the fistula is wide and the ear is infected. In some cases (old patient, one functional ear, better ear) an open technique may be preferred without risk for the cochleovestibular functions.

Adolescent↗
PubMed2001

[MRI screening of vestibular schwannomas without gadolinium: usefulness of the turbo gradient spin echo T2-weighted pulse sequence].

The purpose of this retrospective MRI work was to evaluate the use of turbo gradient spin echo (TGSE) high resolution imaging for the detection of eighth nerve schwannomas, without injection of gadolinium. The TGSE sequence (slice thickness: 3 mm with 1.5 mm interleaving; matrix: 512) was compared with a reference sequence: T1-weighted spin echo (SE) after gadolinium injection (slice thickness: 3 mm, matrix: 256). Among 380 internal auditory meatus (IAM) explored, 34 abnormalities were detected on T2-weighted TGSE images compared with 19 on contrast-enhanced T1-weighted SE images. This new sequence has a 100% sensitivity, a 96% specificity and a 100% negative predictive value. Using a rigorous protocol for IAM analysis with the TGSE sequence, gadolinium injection may no longer be needed systematically for vestibular schwannoma screening, but might only be necessary when an abnormality or a doubt persists after TGSE. This approach allows about 20% cost reduction for each patient, a savings of 11,433 euros considering only the true negatives observed in this study.

Adolescent↗
PubMed2000

[Mastoid cortical bone grafts in ossiculoplasty].

Ossicular homografts have been left for safety reasons with regard to viral transmission diseases. Several means are usable to reconstruct ossicular chain: synthetic prosthesis and autologous bone. On grounds of disponibility, biocompatibility, cost and use easiness we have been using mastoid cortical bone since 1995. We have studied hearing results and tolerance of 45 ossiculoplasties performed with cortical bone. Two years after, we have been obtaining as good or even better functional results with cortical bone graft than with auto or homologous ossicular bones (air bone gap inferior or equal to 20 DB in 89 % of the cases) and no extrusion. Thus, cortical bone seems to be, the better material when autologous ossicular bones are not available.

Adolescent↗
PubMed1999

[General physicians' viewpoint on the evaluation of health care quality in the hospital].

The principal objective of this work was to determine whether the evaluation of general practitioners' satisfaction vis-à-vis a health care establishment impacted that establishment to improve the quality of the services it provides. Ten doctors were randomly selected and 100% agreed to respond to a semi-directive interview. Two independent doctors analysed each corpus and identified 15 themes, of which 5 systematically came up: the organisation of the care of patients, the availability of hospital doctors, the transmission of information, the speed of emergency admissions, and the patient-hospital doctor relationship. The opinion of private practice doctors usefully complements the evaluation of patient satisfaction used to identify the weaknesses of an establishment. It is proposed to include this evaluation in the procedure of continued improvement of the quality of care within establishments.

Academic Medical Centers↗
PubMed1991

[Emergencies in ORL: management by the anesthesiologist].

The otorhinolaryngologic (O.R.L.) diseases seen in the emergency room are frequent and diverse. Most of them need the otorhinolaryngologist and anaesthetist to be present in order to realise fast, adequate and, above all, well coordinated gestures. The foreign bodies, the hemorrhagies, the traumas, the infectious diseases and finally the respiratory distress can be classified by frequency order. The laryngo tracheal dyspneas (DL) are first considered because they are the most dramatic emergencies: infectious DL in children, DL secondary to tracheal intubation or tracheotomy, DL caused by a tumor, traumatic DL secondary to a knock, a blast, a burn or a thyroidectomy, edematous DL and "DL after tracheotomy". The infectious O.R.L. emergencies are observed in the serious pharyngeal diseases, in the cervical cellulitis and during the complications of sinusitis or mastoiditis. The foreign bodies (CE) are the most frequent cause of O.R.L emergencies. The complications depends of the location of the foreign: almost nonexistent if the CE is located in the nasal fossa or in the meatus acusticus externus, inconstant if CE is oropharyngeal or oesophageal. The complications may be fatal if CE is pharyngotracheal and are relevant to the exact location of CE which result in emergency behavior. The considered oesophageous lesions not due to CE are chemical burns and perforations; in emergency, hemorrhagic O.R.L. lesions only epistaxias are concerned; O.R.L. hemorrhage need to be studied with their specific causes.

Adolescent↗
PubMed1990

[Juvenile otospongiosis, reflections apropos of a personal statistics].

The authors report 8 cases of youthful otosclerosis over 512 surgical otosclerosis cases. This study is compared for literature's datas: frequency comparable (1 to 1.6%), start age sometimes early, before 4 years for one case. The family's antecedents are quickly, but not always present. The clinical and audiometric study are detailed. In all cases one inner ear malformation (communication with cerebrospinal fluid) has been eliminated by one computer tomography. The treatment is often a long follow up, to operate in adolescent age, or adult. The surgery is earlier, when the hearing loss is fast. This surgery is classic and one hypertrophic stapedius platine is often found. The results are not as good as those in adults, but are correct.

Adolescent↗
PubMed1990

[Trimetazidine and degenerative deafness. Effect on hearing and integration].

This study was conducted in order to assess the activity of trimetazidine dosed at 60 mg/day in patients presenting degenerative loss of hearing. Ten centers participated in this multicenter double-blind placebo-controlled trial which spanned 6 months. Included were 251 patients (118 women, 133 men) presenting with pure perception bilateral symmetrical deafness concerning predominantly the acute frequency range. 228 patients terminated the study, including 115 in the trimetazidine group and 113 in the placebo group. The evolution over a 6-month treatment period was significantly better with trimetazidine as regards the following parameters: audibility as assessed by pure-tone audiometry, namely at the acute frequency range (p = 0.002), intelligibility as assessed by speech audiometry (p = 0.008), subjective evaluation of hearing loss and its impact on the patient's social life. Results confirm the value of trimetazidine hearing loss management, based on clinical, subjective criteria as well as audiometric ones. Parameters reflecting best trimetazidine's efficacy were intelligibility and the psychological/behavioral impact of the impairment, allowing for better social integration of the subject.

Aged↗
PubMed1989

[Nephronophthisis, tapeto-retinal degeneration, encephalopathy and vermian agenesis: a new association. Apropos of 3 familial cases].

We observed a combination of nephronophthisis, tapetoretinal degeneration, vermian agenesis and encephalopathy in three first cousins. Juvenile nephronophthisis, the main inherited renal disease of childhood, is occasionally associated with a genetically linked disease involving the eyes and/or bone and/or liver and/or nervous system. We have assembled approximately one hundred cases of complex nephronophthisis. We discuss the various associations, among which the Senior syndrome (nephronophthisis + tapetoretinal degeneration) is the most frequent. The familial combination seen in our patients has apparently not been previously reported and seems to represent a new expression of the disease.

Brain Diseases↗
PubMed1986

[Non-traumatic rhinorrhea from a latero-sellar fistula of the temporal fossa adjacent to an empty sella turcica. Computed tomography aspects; surgical treatment].

The authors report a case of non traumatic rhinorrhea due to an osteo-dural fistula communicating between the latero-sellar part of the left middle cranial fossa and the sphenoidal sinus. This fistula, probably congenital, was adjacent to an intrasellar arachnoidocele ("empty" sella turcica), but was not responsible for it. This lesion was demonstrated by CT scan associated with the injection of Metrizamide. The surgical treatment (trans-sphenoidal approach) allowed complete cure of the fistula and its associated symptoms.

Cerebrospinal Fluid Rhinorrhea↗