Biomedical subjects
Publications and source records attributed to V Strunski.
Paraganglioma are rare lesions, which come from neural cells. They arise the most frequently from carotid body. The tumor is classically located in the carotid bifurcation, between internal and external carotid arteries. We report a case of carotid body paraganglioma which is uncommonly located under the carotid bifurcation.
OBJECTIVE: To assess the efficacy and tolerability of once-daily treatment with budesonide aqueous nasal spray in patients with nasal polyps. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Sixteen hospital clinics. PATIENTS: One hundred eighty-three patients with moderate-sized nasal polyps causing clinically significant symptoms during a 1-week run-in period. INTERVENTIONS: Patients were randomized to receive 1 of the following 4 budesonide aqueous nasal spray treatments: 128 microg once daily in the morning and placebo in the evening, 128 microg twice daily, 256 microg once daily in the morning and placebo in the evening, or placebo for 8 weeks. Nasal polyp size was scored and peak nasal inspiratory flow was measured at clinic visits at the beginning and end of the run-in period and after 4 and 8 weeks' treatment. Patients recorded daily peak nasal inspiratory flow, symptom scores (ie, blocked nose, runny nose, and sneezing) and sense of smell on diary cards. MAIN OUTCOME MEASURES: Mean change in nasal polyp size at the end of treatment; mean changes in combined and individual symptom scores. RESULTS: All doses of budesonide aqueous nasal spray significantly (P<.01) reduced polyp size; no significant differences were noted between the 4 treatment groups. The mean improvement in clinic peak nasal inspiratory flow at 8 weeks was 65.9 L/min with budesonide aqueous nasal spray, 128 microg twice daily; 71.6 L/min with budesonide aqueous nasal spray, 256 microg once daily; and 54.6 L/min with budesonide aqueous nasal spray, 128 microg once daily (all P<.001 vs placebo). Combined and individual symptom scores and sense of smell improved significantly in all budesonide-treated groups; the effect on symptoms became apparent within 1 to 2 days of the first dose. Budesonide aqueous nasal spray was well tolerated. CONCLUSIONS: Doses of budesonide aqueous nasal spray, 128 microg once daily, were found to be effective in the treatment of nasal polyps, and doses of budesonide aqueous nasal spray, 256 microg once daily, did not show any significant additional efficacy.
Between January 1997 and June 1999, we screened for hearing loss using evoked otoacoustic emissions in 320 newborns in the neonate intensive care unit at the Amiens University Hospital. The purpose of this study was to search for correlations between deafness and one of the hearing loss risk factors identified by the Joint Committee on Infant Screening. Three risk factors were found to be significant: craniofacial abnormalities, low birth weight (less than 1500 g) and a familial history of hearing loss. Unfortunately a large proportion of the infants were lost to follow-up. Evoked otoacoustic emission provide an excellent screening technique for hearing loss in newborns. Such screening implies however the creation of networks to assure patient follow-up.
We report a case of Wegener's disease with an exceptional 10-year course before diagnosis subsequent to the development of severe ENT features. Mucosal ulcerations involving the mouth and the pharynx were highly extensive and resolved completely, but temporarily, with cyclophosphamide and corticosteroid therapy.
Cervical spondylodiscitis is described more often in children than in adults. Many cases occur after cervical or facial surgery, usually as a complication after difficult intubation, endoscopy or foreign body extraction. We report the first case of cervical spondylodiscitis occurring subsequent to secondary tracheoesophageal puncture for implantation of a phonatory prosthesis. Signs were not specific leading to difficult diagnosis and treatment. We discuss the impact of bacterial contamination during tracheoesophageal puncture.
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Subcutaneous emphysema and pneumomediastinum are well-known complications of barotrauma. There are no fascial barriers between the posterior mediastinum and the retropharyngeal and epidural spaces; thus, air can diffuse freely to the epidural space and produce an epidural pneumatosis. We report a case of epidural pneumatosis caused by a pneumomediastinum following nasotracheal intubation for an attempted suicide. This benign complication of air leakage was easily recognized on computed tomography (CT) scan.
We report our functional results about 81 ossiculoplastys during tympanoplasty with closed technique in chronic cholesteatomatous otitis. We discuss our functional results and the post-operative assessment of the audiometric gain. Patients presented either cholesteatomatous otitis sequelea or any preliminary status (retraction pockets) with attical impairment.
We report a large two-generation pedigree with seven affected males segregating for an X-linked mixed conductive sensorineural deafness. The patients present with atypical Mondini-like dysplasia, dilated petrous facial canal, dilatation of the internal auditory meatus fully connected with enlarged cochlear canals, and, in one patient, a wide bulbous posterior labyrinth. Obligatory carrier females are mildly affected. Molecular characterization of this family revealed a deletion of locus DXS169, in Xq21.1. Loci DXS72 and DXS26, which, respectively, flank DXS169 proximally and distally, were intact. Since a gene responsible for X-linked progressive mixed deafness with perilymphatic gusher (DFN3) has previously been assigned by deletion mapping to a slightly more distal interval between DXS26 and DXS121, this study indicates either two different deafness genes or the involvement of a very large region in Xq21.
Among the hidden parts of the middle ear, the posterior part of the atrium undoubtedly raises the most interest of otologists. The attic is a frequent localization of cholesteatoma and retraction pouches. Its anatomy is not well known, especially the anterior and internal walls. This anatomic study, based on the dissection of 41 petrus bones was designed to determine the anatomic limits and describe the "noble structures" of this region in order to "guide" future surgical procedures.
Recurrent polyposis after 116 endonasal ethmoidectomies performed in 61 patients were investigated on the basis of functional, endoscopic and tomodensitometric data. The results of the endoscopic examinations revealed that the anterior ethmoid was involved most often (41%) with either a single localization or in combination with other sites in the sinuses. Functional rhinosinus symptomatology was satisfactory in most cases after a mean follow-up of 22 months, especially for nasal obstruction which was initially predominant (91%). Headaches, especially fronto-orbial localizations, clearly decreased after the operation but there was no correlation between the presence of headache after the operation and the recurrence of the polyposis. Computed tomography gave results similar to those obtained by endoscopy. However, a distinction could not be made between radio-opaque images of polyposis and certain cicatricial or inflammatory reactions. Unlike the functional outcome, ethmoidectomy had little effect on these images. Recurrent polyps appeared most often on the anterior ethmoid and the role of the initial infundibulotomy can be debated. It would appear that the prognosis of polyposis is not modified by extended anterior ethmoidectomy, suggesting that a more conservative surgical approach may be appropriate for frontal ethomoidal polyps.
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We report a new case of primary atypical carcinoid of the larynx. This rare neuro-endocrine neoplasm of the larynx was initially mis diagnosed in 50% of the cases published. Since, characteristically these are lesions of the epilarynx causing dysphonia at early stages of development, the diagnosis should be kept in mind when the work-up for dysphonia reveals a small tumor of the epiglottis or aryepiglottic folds. The histological diagnosis should be oriented by Grimelius staining and confirmed immunoperoxidase marker studies for chromogranin and cytokeratin. Although, atypical carcinoids of the larynx are aggressive malignant tumors, the prognosis for early lesions of less than 1 cm is excellent. However, unlike early squamous cell carcinomas, these tumors do not respond well to radiation therapy. Primary surgery is the treatment of choice.
Rhinopharyngeal localization of amyloidosis is particularly rare. The authors report a case of isolated amyloidosis of the cavum, and provide a brief summary of the amyloid substances and other localizations of this pathology.
The authors report a case of cervical abscess due to yersinia enterocolitica. This is a currently exceptional localization of an enteropozoonosis which is little-known, but whose incidence is increasing throughout the world.
A study of dysosmia and dysgeusia in the elderly was undertaken in 50 patients, according to a simplified protocol based on an interview, a complete ENT examination, chemical gustrometry and recognition olfactometry. As far as olfaction was concerned, 11% of the patients interviewed said they were hyposmic, whereas following the olfactometric examination, hyposmia was found in 25% of the patients. As far as gustation was concerned, 5% of the patients complained of parageusia. The chemical gustrometric examination revealed 4% of cases of hypogeusia. As a conclusion to this study, it appears that olfactory and gustatory disorders are well tolerated in the elderly, and are not a cause for referral. The recognition olfactometric examination permits the detection of hyposmia with a relatively remarkable frequency.
The free fasciocutaneous forearm flap has been described only recently. Five cases of pharyngeal or oral repair with a forearm flap (FAF) are reported and used as a basis to discuss anatomical features and the technique used for removal of the flap. The relevant literature is reviewed. The FAF appears to be the flap of choice for reparative surgery of pharynx or mouth regions in oncology, the principal advantages of this flap being: fineness, flexibility and plasticity of the skin, reliability and lack of morbidity, and function effectiveness with respect to phonation and feeding. Indications for forearm and myocutaneous flaps in oncology of upper respiratory and digestive tracts are assessed critically, other indications for the forearm flap being cutaneous repair of cervicofacial lesions due to tumor or injury. The forearm flap is of pronounced value for cervicofacial repair surgery and constitutes a new step in the plastic conception of these repair procedures.