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Biomedical subjects

S Roman

Publications and source records attributed to S Roman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Congenital cysts and fistulas of the neck.

This retrospective study describes a series of 191 children treated for congenital cysts and fistulas of the neck between 1984 and 1999 in the pediatric ORL Department of La Timone Children's Hospital. Preauricular fistulas and cystic hygromas were not included. The anomalies in this series were classified as either malformations of the midline or malformations of laterocervical region. Malformations of the midline included the thyroglossal duct cysts (n=102) and dermoid cysts (n=21). The most common malformations of the laterocervical region were cysts and fistulas of the second cleft (n=37) followed by those of the first cleft (n=20),those of the fourth pouch (n=7), and thymic cysts (n=4). Diagnosis of malformations of the midline is usually straightforward. However, diagnosis of malformation of the laterocervical region can be problematic. Misdiagnosis often leads to inadequate treatment with recurrence and functional as well as cosmetic sequelae.

Adolescent↗
PubMed2000

Management of subglottic stenosis in infancy and childhood.

During the 12-year period between June 1987 and June 1999, 141 children underwent curative treatment for subglottic laryngeal stenosis at La Timone Children's Hospital in Marseille, France. Ninety-six children (68%) were under the age of 5 years; 106 (75%) presented with acquired stenosis and 93 had narrowing involving over 70% of the subglottic lumen. Endoscopic laser surgery was performed in 25 cases and open surgery in 116. Open surgical techniques included laryngotracheoplasty with autologous cartilage interposition in 83 cases, laryngotracheal split in 22, and cricotracheal resection in 11. After decannulation, 132 children (94%) were able to breathe normally through the upper airway. Perspectives for development of new techniques and improvement of conventional methods are discussed.

Adolescent↗
PubMed2000

[Sternocleidomastroid inflammatory pseudotumors of muscle in children].

PATIENTS AND METHODS: The files of 12 children presenting with a sternocleidomastoid tumor of infancy at the Timone Children's Hospital in Marseille between 1990 and 1999 were retrospectively studied. All of them underwent physical and ultrasonographic examination. RESULTS: The mass was firm, within the lower two-thirds of the sternocleidomastoid muscle. Ultrasonographic examination showed a soft tissue mass independent of the great vessels. Biopsy revealed a benign fibrous lesion. Eleven children were treated with stretching exercises and a surgical therapy was performed for one in whom physical therapy was unsuccessful. CONCLUSION: The sternocleidomastoid tumor of infancy is a lateral neck mass affecting children between the ages of two and four weeks. Most of the time it spontaneously resolves in four to eight months. It may be associated with congenital muscular torticollis and requires physical therapy. Surgery should be reserved for children who have failed with this treatment.

Female↗
PubMed2000

[Cricotracheal resection in children: indications, technique and results].

The most significant advance in the surgical treatment of laryngotracheal stenosis has been the changes in external procedures, notably in laryngotracheoplasty aimed at widening the regional stenosis with prosthetic material. In opposition with this therapeutic method, cricotracheal resection which removes the regional stenosis, and a large portion of the cricoid cartilage, has been proven to be a reliable technique in adults. Between June 1993 and June 1998, 10 children underwent cricotracheal resection. There were 5 boys and 5 girls with 9 acquired and 1 congenital stenosis (grade II =5, grade III =2, grade IV =3). At the time of the procedure, the patients' mean weight was 19 kg and mean age was 7.5 years. A tracheotomy present in 5 children prior to the procedure was left in situ postoperatively. In these children a rolled silastic sheet was used to maintain the caliber for 23 days and the tracheotomy canula was removed a mean 58 days later. In the 5 children operated on without tracheaotomy, the nasotracheal tube was removed a mean 2.5 days after the procedure. Mean follow-up was 43 months, with clinical and endoscopic surveillance. No growth retardation was observed among the 5 children presenting 4.5 years after the procedure. The choice between laryngotracheoplasty enlargement and cricotracheal resection is not based on documented evidence but on case-by-case decision making. We discuss here the points which appear to us to be the most relevant in terms of indication, surgical procedure, potential complications, and outcome.

Child↗
PubMed2000

[Cochlear implantation in the adult and the child. Results of the Marseille experience between 1991 and 1999.

The rehabilitation of patients with profound bilateral deafness has been notable in the 1990s for the use of cochlear implantation. In 1991 a cochlear implantation programme was inaugurated by the ENT team at the Timone University Hospital, in partnership with the Public Assistance for Marseille Hospitals, allowing funding for six implants each year. This article presents the main results of this programme. Between March 1991 and November 1999, 94 patients with profound bilateral deafness were assessed. Forty patients (29 adults and 11 children) were thought to be unsuitable. To date 27 adults (4 with prelingual deafness) and 22 children have been rehabilitated using a cochlear implant. Patient selection was carried out by a multidisciplinary team. It has been possible to quantify the degree of deafness and the excitability of the auditory nerve in the adult, the cochlear permeability, and the motivation and personality of the patients. Postimplant evaluation has allowed us to study the various factors resulting from wearing an implant. In adults, testing was carried out using open lists. In children, education methods were added to perceptive, expressive and behavioural performance to arrive at a profile. The results are presented and discussed in comparison with those found in the literature.

Adult↗
PubMed1999

Evaluation of apoptosis of tumor and of apparently normal cells in human renal carcinoma.

Apoptosis of tumor cells and of apparently normal renal cells (ANRC) isolated from the same kidney in 42 untreated patients with renal carcinomas (RC) was evaluated. Thirty five of the investigated tumors were of Grawitz type in different grades of differentiation. The intensity of the apoptotic process was routinely assessed by propidium iodide staining and flow-cytometry analysis. Similar results were obtained in the same cases by using TUNEL assay, by staining with annexin V and by DNA electrophoresis. In 85% of Grawitz carcinomas the proportion of apoptotic tumor cells was quite high, with mean% +/- SD of 57.7+/-27.3, whereas in transitional cell carcinoma of the bladder (TCC), the mean percentage of cells in apoptosis was of 22.3+/-13.9. Unexpectedly, in ANRC displaying normal morphology and normal DNA content (diploidy), the mean% +/- SD of apoptotic cells were found to exceed that of apoptotic tumor cells, 79.2+/-21.6. The percentages of cells expressing Fas receptor and/or Fas ligand varied between large ranges in both tumor and ANRC, thus suggesting that other mechanisms are also involved in the activation of apoptosis. Immunohistochemical studies showed that the intensity of apoptosis correlated well with high p-53 and low bcl-2 expression. The intensity of apoptosis was generally not correlated with the cell proliferation index (S phase fraction), suggesting that in RC apoptosis can be activated in any stage of the cell cycle. Further investigations are necessary to understand the peculiar behaviour of tumor cells as well as of ANRC in renal carcinomas as compared to other types of malignancies.

Apoptosis↗
PubMed1999

Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Manitoba Chapter of CHICA-Canada.

A methicillin-resistant Staphylococcus aureus (MRSA) strain introduced into the largest tertiary-care teaching hospital in Manitoba in 1993 led to a sustained outbreak with secondary outbreaks at one community hospital, two large long-term-care facilities, and nosocomial transmission at a second teaching hospital. Control measures were consistent at each institution and were coordinated on a province-wide basis. MRSA is not currently endemic in any facility in the province.

Cross Infection↗
PubMed1999

Tartrate-resistant acid phosphatase forms complexes with alpha2-macroglobulin in serum.

Tartrate-resistant acid phosphatase (TRAP) is a standard histochemical marker of differentiated osteoclasts and has been proposed as a serum/plasma marker for osteoclast activity. Enzyme assays have been described that show elevated TRAP enzyme activity in the serum or plasma of patient groups known to have increased bone metabolism. However, the poor stability of the enzyme and potential contribution from nonosteoclastic sources make it problematic to measure in patient samples. Immunoassays developed to measure TRAP in serum and plasma have yielded widely varying TRAP levels in both normal and disease states. It is not clear if this variability is caused by differences in assay calibration, antibody specificity, and/or TRAP instability. In this paper, we report that purified TRAP spiked into serum forms high molecular weight complexes. Complex formation results in greatly decreased TRAP enzyme activity and immunoreactivity. The complexing protein in serum has been identified as alpha2-macroglobulin (alpha2M). Similar complexes are observed in stored patient samples. In vitro studies with purified components show that TRAP binds to alpha2M primarily through noncovalent ionic interactions. Our results demonstrate that one mechanism of TRAP instability in serum is complex formation with alpha2M and suggest further that current TRAP enzyme and immunoassays may not accurately measure the circulating level of TRAP.

Acid Phosphatase↗
PubMed1998

Pilomatrixoma of the head and neck in children: a study of 38 cases and a review of the literature.

OBJECTIVES: To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. DESIGN: Retrospective study. SETTING: A tertiary care center. PATIENTS: Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n = 38) between 1989 and 1997. INTERVENTION: All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n = 11) or without (n = 23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. RESULTS: In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twenty-nine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). CONCLUSIONS: Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.

Adolescent↗
PubMed1998

Congenital and acquired perilymph fistula: review of the literature.

Perilymph fistula is caused by an abnormal communication between the perilymph space and the middle ear. The etiology is either congenital or acquired. The congenital fistula can be associated or not with clinical symptoms or radiologically detectable abnormalities of the temporal bone. In patients presenting congenital fistula without symptoms or radiologically detectable abnormalities, little malformations of the middle ear may be detected during surgery. The acquired fistula can be caused by iatrogenic trauma, physical injury or erosion. As far as therapy is concerned, surgical treatment can be performed and the perilymph fistula thus represents one of the few causes of sensorineural hearing loss that can be treated surgically. However, the main challenge is the identification of those patients that need to undergo an exploratory tympanotomy, since there are no clinical-audiologic symptoms or radiographic indicators that can be considered pathognomonic of perilymph fistula. The aim of this review of the literature is to define the guidelines for preoperative diagnosis to indicate exploratory tympanotomy both in children and in adults. On the basis of our results, exploratory tympanotomy should be performed in patients with vertigo and/or progressive, sudden or fluctuating hearing loss in association with one or more than one of the following elements: a history of cranial trauma, radiographically detectable abnormalities of the inner ear, congenital malformations of the head, recurring meningitis, positive fistula test. The surgical treatment consists in placing a graft of temporalis fascia or tragal perichondrium and it usually results in a significant improvement of vestibular symptoms and sometimes of the hearing function as well.

Cochlear Aqueduct↗
PubMed1998

[Surgery of intravitreous nuclear luxations post-phacoemulsification].

PURPOSE: To evaluate anatomical and functional results after surgery of retained nucleus or nuclear lens fragments into the vitreous cavity after phacoemulsification. METHODS: Files of 46 patients that underwent vitrectomy for posterior retained nuclear fragments between July 92 and June 96 were studied retrospectively. Minimum follow-up was 6 months. Patients having only cortical material were excluded. In 34 cases the nucleus or nuclear fragments were removed posteriorly during a pars plana vitrectomy using either fragmentation with fragmatome (13 cases) or cutting with the vitreotome tip (21 cases). Anterior removal after pars plana vitrectomy was performed in 12 cases. 20 patients were operated on the first week, 12 during the second week and 14 after the second week following phacoemulsification. RESULTS: Forty-one per cent of the patients reached 20/40 or better. 28% had less than 20/200. 8 (17%) patients presented a retinal detachment, 6 a cystoid macular edema, 6 a bullous dystrophy, and 9 an elevated intraocular pressure. At the end of follow-up 89% have been implanted (50% had been implanted at the end of the cataract surgery). We found no correlation between visual acuity and timing of surgery, anterior or posterior site removal of nuclear fragments or lens implantation during phacoemulsification. CONCLUSION: Dislocation of the nucleus into the vitreous cavity is a serious event during phacoemulsification because of its inflammatory and retinal complications. Vitreoretinal surgery allows good visual recovery in about half of the patients. Technical handling depends primarily on the nucleus density. An IOL may be placed at the end of phacoemulsification if the nucleus is not too hard and if the anterior segment has been cleaned carefully.

Aged↗
PubMed1997

[Astigmatism caused by superior and temporal corneal incisions in cataract surgery].

PURPOSE: To compare induced astigmatism and postoperative astigmatism of a 4 mm corneal superior incision to a 4 mm temporal incision for cataract phacoemulsification surgery. METHODS: Sixty eyes underwent cataract surgery for this prospective study. Thirty had a superior corneal incision (group 1) and 30 had a temporal incision (group 2). The incision was placed according to the pre operative astigmatism:temporal approach in case of against the rule astigmatism and superior location in case of with the rule astigmatism. The incision was enlarged to 4 mm just before implantation of a foldable lens. The patients had a pre operative and a post operative (day 1, 8, 30, 180) keratometry. Some had a corneal topography too. The surgically induced astigmatism was calculated using Naeser method. RESULTS: The incision having a relaxing effect on the meridian where it is placed, the surgically induced astigmatism is against the rule for a superior location and with the rule for a temporal location. At day 30 the mean surgically induced astigmatism was 0.98 diopter in group 1 and 0.58 in group 2. At ay 30 the postoperative astigmatism was 0.51 diopter against the rule in the first group and 0.13 diopter with the rule in the second group. CONCLUSION: The superior corneal incision rarely allows to reach a minimum postoperative astigmatism as with a temporal location.

Aged↗
PubMed1997

[Choice of the site of incision for cataract surgery without suture according to preoperative astigmatism].

PURPOSE: To compare surgically induced astigmatism, postoperative astigmatism and uncorrected visual acuity after cataract surgery depending on the site of a 4 mm sutureless incision (superior scleral or corneal temporal) and on the preoperative astigmatism. METHODS: According to preoperative astigmatism and to the site of incision 4 groups have been distinguished. Group I: with-the-rule preoperative astigmatism and superior scleral incision, group II: with-the-rule preoperative astigmatism and corneal temporal incision, group III: against-the-rule preoperative astigmatism and superior scleral incision, group IV: against-the-rule preoperative astigmatism and temporal incision. The patients had a preoperative and postoperative (Day 1, 8, 30, 180, 360) keratometry. Surgically induced astigmatism, preoperative and postoperative astigmatism have been expressed according to Naeser method. The uncorrected visual acuity at Day 30 has been compared in each group. RESULTS: Preoperative astigmatism was similar in the four groups. Surgically induced astigmatism was -0.18 diopter (D) at day 30 and -0.41 D at day 360 for the scleral incisions and +0.60 D at day 30 and +0.33 D at day 360 for the temporal incisions. The postoperative astigmatism was +0.5 D at day 30 and +0.27 at day 360 for the group I and +1.22 D at day 30 and +0.95 D at day 360 for group II. There was no statistical difference in the uncorrected visual acuity. Postoperative astigmatism was -0.8 D at day 30 and -1.03 D at day 360 in group III and -0.04 D at day 30 and -0.31 D at day 360 in group IV. The visual acuity was significantly better in group IV than in group III. CONCLUSION: In cases of preoperative with-the-rule astigmatism < or = 0.75 D the two sites of incisions are possible. In cases of WTR astigmatism over 0.75 D we perform a superior scleral approach. In cases of against-the-rule astigmatism the temporal incision is the only one to consider.

Aged↗
PubMed1997

[Naso-sinusal polyposis in children. Mid-term results of sinusal surgery].

Nasosinusal polyposis in the pediatric population is uncommon and its etiology is unclear. In this eleven-year retrospective study, we describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 49 children. Patients were divided into three groups according to whether nasosinusal polyposis was either isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 30). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 19% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, specially chronic nasal obstruction, rhinorrhea and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e. a few micropolyp localized on the roof of the ethmoid cavity) was observed in 22.7% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 13.6%. However, recurrences were higher in patients with cystic fibrosis, since minor recurrence with no clinical manifestation was observed in 28.6% of cases and major recurrence in 17.8%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow-up of 4 years, results in this series are encouraging.

Adolescent↗
PubMed1996

Topical versus peribulbar anesthesia in cataract surgery.

PURPOSE: To compare the use of topical anesthesia with that of peribulbar anesthesia in cataract surgery. SETTING: Quinze-Vingts Hospital, Paris, France. METHODS: This prospective study comprised 45 patients who had phacoemulsification and intraocular lens implantation in both eyes with 1 to 9 months between surgeries. Each patient had peribulbar anesthesia for one surgery and topical anesthesia for the other. The anesthesia method for the first eye was randomly selected. After surgery, patients were asked to rate their pain and whether they preferred one anesthesia technique over the other. RESULTS: When topical anesthesia was given, 82.2% of patients required no intravenous medications. Overall, 62.2% preferred topical over peribulbar anesthesia, with most patients citing the lack of periocular injection as the reason. CONCLUSION: Despite the increased technical difficulty, topical anesthesia proved an effective alternative to peribulbar anesthesia for cataract surgery that avoids the risks of periocular injection and reduces the need for intravenous medications.

Administration, Topical↗
PubMed1996

The epidemiology of Chlamydia trachomatis within a sexually transmitted diseases core group.

Female sex workers in Nairobi were prospectively evaluated for risk factors of incident Chlamydia trachomatis infection. Independent risk factors included cervical ectopy (P=.007), gonococcal infection (P=.002), human immunodeficiency virus (HIV) seropositivity (P=.003), HIV seroconversion (P=.001), and duration of prostitution (P=.002). Eighteen different C. trachomatis outer membrane protein (omp1) genotypes were identified, with the allelic composition of the C. trachomatis population changing significantly over time (P=.005). Seventeen of 19 reinfections > or = 6 months apart were with different C. trachomatis omp1 genotypes. Women with HIV infection had an increased proportion of visits with C. trachomatis infection (P=.001) and an increased risk of reinfection (P=.008). Overall, the data demonstrate significant fluctuations in the genotype composition of the C. trachomatis population and a reduced rate of same-genotype reinfection consistent with the occurrence of strain-specific immunity.

Amino Acid Sequence↗
PubMed1996

Pneumococcal bacteremia in two tertiary care hospitals in Winnipeg, Canada. Pneumococcal Bacteremia Study Group.

STUDY OBJECTIVE: To review experience with pneumococcal bacteremia at two Canadian tertiary care centers. DESIGN: Retrospective record review. SETTING: Two tertiary acute care teaching hospitals in Winnipeg, Manitoba. PATIENTS: Patients identified with pneumococcal bacteremia during an 8-year period. RESULTS: Hospital records were reviewed for 534 of 617 patients with pneumococcal bacteremia. The overall case fatality ratio was 70 (13%), varying from 3.2% in children to 43% in those older than 80 years. Twenty-seven (18%) hospitalized children and 68 (23%) adults required ICU admission. Duration of hospitalization was 14.9 +/- 24.9 and 11.0 +/- 19.1 days for children at the two institutions and 22.5 +/- 37.6 days and 38 +/- 93 days for adults. For the 217 viable pneumococcal strains studied, 89% were serotypes included in the present 23-valent vaccine. Documentation of prior vaccination was present for only 9 (1.7%) patients, although 281 (89%) adults and 99 (45%) children met criteria for vaccination. CONCLUSIONS: Mortality in our population is similar to previous reports. More widespread pneumococcal vaccination in eligible populations may not only decrease mortality, but may also provide savings through decreased hospital admission and need for intensive care.

Adolescent↗