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Biomedical subjects

A Gentine

Publications and source records attributed to A Gentine.

At least 19 recordsLinked to original sources
PubMed2005

[Surgical treatment of malignant sinonasal tumors with orbital extension: 20 patients].

OBJECTIVE: The purpose of this work was to assess changes in surgical treatment of malignant sinonasal tumors with orbital extension, with or without orbital exenteration, on the basis of clinical, radiological and preoperative data. MATERIAL AND METHODS: We conducted a retrospective analysis of twenty patients with malignant sinonasal tumors with orbital extension operated on from 1995 to 2002 in the ENT and head and neck department of the Strasbourg University Hospital. CT-scan and MRI were performed before surgery. When periorbital invasion was observed without orbital extension and confirmed by histological examination in the operative theatre, the orbit was preserved during the surgical procedure. Orbital exenteration was necessary for the other patients. Adjunct postoperative radiotherapy was performed in all patients (n=20). Clinical, radiological and surgical data were compared with patient follow-up to search for correlations between radiological signs and the difficult surgical decision for orbital exenteration. RESULTS: For orbital extension, the histological examination performed in the operative theatre did not confirm the results of the preoperative CT-scan in 15% of patients and the preoperative MRI in 11%. In a first group of nine patients with bony wall extension (78%, 7/9) or periorbital extension (22%, 2/9), there were no cases of recurrence at six years follow-up. In a second group of eleven patients with intraorbital extension, orbital exenteration was not performed in two (18%) because of surgically unresectable massive extension. Four of the nine other patients who underwent orbital exenteration were free of local recurrence at ten months follow-up and five were considered to have achieved oncological cure at four years follow-up. CONCLUSION: Preoperative CT and MRI are essential but the decision for orbital exenteration must be made on the basis of the histological examination performed during the operative procedure because imaging often underestimates tumor extension.

Aged↗
PubMed2005

[Primary ciliary dyskinesia. Clinical presentation and diagnosis].

UNLABELLED: Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary structure/function. OBJECTIVE: We analyzed the main clinical features and test results of PCD in order to evaluate their usefulness for diagnosis. PATIENTS AND METHODS: Retrospective study of 35 cases of PCD evaluated by the same team, with nasal brushings in all cases (special light microscopy) and electron microscopy and/or by isotopic mucociliary clearance study in some. RESULTS: In a cohort of 145 patients with suspected PCD, the diagnosis of PCD was established in 35 cases using a combination of compatible clinical features coupled with the study of nasal brushings: 13 females and 22 males, average age at time of diagnosis 25 years, situs inversus in 12 patients (34%). CONCLUSION: In the absence of consensus in the literature for diagnosis of PCD, we propose the association of the following diagnostic criteria: upper airway and bronchopulmonary infections beginning often early in the life, more inconstantly situs inversus, familial cases of PCD, consanguinity, infertility and permanent and ubiquitous abnormalities of ciliary structure/function. Nasal brushing with ciliary study (special light microscopy) seems to be an easy and reliable diagnostic criterion. Electron microscopy is necessary for proving ultrastructural abnormalities.

Adult↗
PubMed2005

[The respiratory mucociliary system and its exploration in primary ciliary dyskinesia].

BACKGROUND: We analyzed the main characteristic features of the respiratory epithelium mucociliary system and the different tests of ciliary beat and mucociliary transport (mucociliary clearance). This knowledge is necessary for an often interdisciplinary diagnosis and treatment of primary ciliary dyskinesia. METHODS: Review of the literature and personal experience of the different tests of ciliary structure and function. RESULTS: This disease is characterized by abnormalities in ciliary structure/function. The genetic mechanisms and the ultrastructural abnormalities that are involved are heterogenous compared to the relative homogeneity of the clinical presentation. CONCLUSION: The diagnostic criteria are compatible clinical features (chronic upper airway and bronchopulmonary infections, situs inversus...) coupled with tests of ciliary structure and function.

Humans↗
PubMed2005

[Recovery of saccular function after vestibular rehabilitation].

OBJECTIVE: The authors present a case of recovery of saccular function after vestibular rehabilitation. MATERIAL AND METHOD: Vestibular rehabilitation is proposed to a patient presenting a left lateral body deviation as well as postural disorders at the time of the vertical movements and in car, associated with an unilateral abolition of vestibular evoked myogenic potentials (VEMP). RESULTS: We observe a recovery of VEMP and a disappearance of symptomatology after vestibular rehabilitation. CONCLUSION: A loss of saccular function can involve a postural disorder in some circumstances. The best treatment is vestibular rehabilitation. We insist on the need for knowing otolithic semiology in order to propose suitable explorations and therapy.

Electronystagmography↗
PubMed2004

[ENT Resident Activity in the Strasbourg Hospital ENT Emergency Clinic].

OBJECTIVES: We present an original study about ENT resident activity in an emergency ENT clinic. MATERIALS AND METHODS: The emergency unit's activity was analyzed over a seven-Month period from December 1, 1999 to June 30, 2000. ENT residents reported patient age, gender, duration of consultation, symptoms, and care delivered as well as the level of emergency and referral (general practitioner, emergency unit, other clinic, direct). RESULTS: A total of 147 emergency days were analyzed. During the study period, 1237 patients were examined, representing 8.4 patients per day and 26.5% of the ENT clinic outpatient activity. Mean patient age was 31.8 Years; 58% of the patient were male. Most of the cases did not correspond to true emergencies (53%). Half of the patients were not referred by a general practitioner. Emergency care was more justified when the patients were referred by a general practitioner or another emergency unit. The predominant pathological situations managed were acute external and middle ear otitis, epistaxis, angina, vertigo, and facial injuries. CONCLUSION: Over half of the patients came to the emergency clinic spontaneously, presenting minor problems. These data can be explained by the fact that residents are permanently present at the ENT emergency clinic. It would be interesting to conduct a similar study in ENT emergency care units where the resident is not permanently present.

Adult↗
PubMed2004

[Allergic fungal sinusitis: ten cases].

OBJECTIVES: Diagnosis, nosological individualization, and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We present ten cases of allergic fungal sinusitis and review the literature to highlight the main clinical, radiological, biological, immunoallergological, mycological, and therapeutics features. MATERIAL AND METHODS: This retrospective study included ten patients (six men and four women, mean age 45 years) with allergic fungal sinusitis diagnosed on the basis of all diagnostic criteria reported in the literature. RESULTS: Six patients had isolated allergic fungal sinusitis which was associated with allergic bronchopulmonary aspergillosis in the four others. Treatment combined endoscopic sinus surgery and corticosteroids, which provided good results in six patients and average results in three. Treatment failure was observed in one patient. CONCLUSION: As in the case of allergic bronchopulmonary aspergillosis, a set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The most appropriate endoscopic sinus surgery and the best corticosteroid regimen remain to be determined.

Adult↗
PubMed2004

Bilateral latero-pontine infarction: a rare syndrome, an unusual imaging.

The authors present one case of bilateral infarction of the brain stem, in the territory of the antero-inferior cerebellar artery. Besides the fact that such bilateral ischaemic lesions are rare, the initial clinical presentation mimicking a vestibular neuronitis indicates that this latero-pontine syndrome may appear as a peripheral disorder. It also reminds clinicians that careful and repeated examinations should always be performed in all patients suffering from vertigo. An unusual iconography is also presented.

Cerebral Infarction↗
PubMed2004

Treatment of acute mastoiditis: report of 31 cases over a ten year period.

OBJECTIVE: With possible extracranial and intracranial complications, acute mastoiditis is the leading complication of acute otitis media (AOM). The goal of this study is to assess the clinical features, pathogens, complications and especially management of acute mastoiditis in the ENT service, University Hospital of Strasbourg, France. METHODS: Systematic review of all medical records of patients who were admitted with acute mastoiditis from January 1993 to April 2003. RESULTS: 31 patients, 18 male (58%) and 13 female (42%) fulfilled inclusion criteria. The average age was 16, going from 6 months to 70 years, with 55% between 0 to 5 years. Most common symptom was otalgia (84%), 58% of patients had history of past AOM and 61% were under antibiotic therapy during admission. Twenty-three patients (74%) presented retroauricular swelling and erythema. 18 (58%) had a displaced pinna. Cultures taken from pus isolated Streptococcus pneumoniae in 12 cases (38.7%), Pseudomonas aeruginosa in 2 cases (6.4%), Streptococcus beta-haemolyticuis 1 case, Staphylococcus coagulase-positive 1 case and Mycobacterium tuberculosis hominis 1 case (3%). Complications of acute mastoiditis occurred in 3 cases (10%): Meningitis 2 cases and facial nerve paralysis 1 case. Surgery therapy was periformed in 84% of cases (mastoidectomy only or in combination with myringotomy with tube insertion) and medical therapy only in 16% of cases. CONCLUSION: Despite use of antibiotics, acute mastoiditis remains still a threat for patients with AOM, especially for children under 5 years of age. Great care is required from clinicians to make an early diagnosis in order to promote adequate management and prevent complications.

Acute Disease↗
PubMed2001

[Surgical treatment for squamous-cell carcinoma of the posterior pharyngeal wall: reconstruction with a free forearm flap].

Squamous-cell carcinoma of the posterior pharyngeal wall is a rare finding. Surgical treatment with preservation of laryngeal function is usually associated with relatively poor functional outcome. We report the cases of 5 patients treated by pharyngectomy with preservation of the laryngeal function. The posterior pharyngeal wall was reconstructed with a free forearm flap. This reconstruction method provided satisfactory functional results. Swallowing disorders resolved within 2 to 6 weeks following the reintroduction of oral food intake. Mean follow-up of nearly 3 years did not evidence any local tumor recurrence.

Aged↗
PubMed2001

[Nasosinusal sarcoidosis: 13 cases].

We report 13 cases of nasosinusal sarcoidosis. Sarcoidosis is a chronic, non caseating granulomatous disease. Nasosinusal involment is rare or exceptional and may be isolated (1 case in our series) or associated (12 cases in our series) with other lesions of the chest, skin, liver, spleen, bone, eyes, salivary glands, peripheral lymph nodes or with neurosarcoidosis. The clinical and CT features are various and often non specific. Nasal biopsy guided by physical examination is easy and constitute the main diagnostic criterion. The course of nasosinusal sarcoidosis is variable and no standard treatment has been established. Response to local or systemic corticosteroid therapy is also variable. The recurrence is frequent after tapering off or interrupting corticosteroids that also have important side effects.

Adrenal Cortex Hormones↗
PubMed2000

Intra-laryngeal endoprosthesis: an alternative therapeutic approach to surgical procedures of laryngeal exclusion.

The uncertain results of aryepiglottopexy in our personal experience led us to develop, for patients with aspirations associated with the risk of severe pneumonitis, three types of intralaryngeal endoprostheses (ILEP) under the systematic cover of a tracheostomy. From September 1997 to May 1999, seven protheses were implanted in six patients. It was not possible to restore the full range of laryngeal functions, i.e. deglutition, phonation and respiration. However, our results, that were obtained with an intracricoidal prothesis closed at its upper end or equipped with a phonatory valve, are quite encouraging, even more so when in association with early alimentary re-education and support continuation of our trial. These ILEPs are simple to place, well tolerated, efficacious in preventing deglutition pneumonitis and easy to remove. Furthermore, the reversibility of this bloodless procedure facilitates the monitoring of a possible recovery of the laryngeal functions.

Adult↗
PubMed1998

Pseudorandom rotational stimuli of the vestibulo-ocular reflex in humans: normal values of the transfer function.

Pseudorandom binary rotatory stimulation is used to study the vestibulo-ocular reflex (VeOR) frequency response (from 0.01 to 0.64 Hz). Fifty-two normal subjects volunteered for this test. The transfer function's gain and phase, and the corresponding coherence function between slow phase eye velocity and head velocity were computed. According to the linearity hypothesis, the results match the sinusoidal stimulation studies. In both cases, the variability of the gain was higher than that of the phase shift. Identification of some parameters of the VeOR's mathematical model were performed, using the experimental results.

Adult↗
PubMed1997

[Caseous sinusitis. Clinical, x-ray computed, surgical, histopathological, biological, biochemical and myco-bacteriological aspects. Apropos of 33 cases].

We analyse the most important clinical, CT, surgical, histopathological, biological, biochemical, mycological and bacteriological features of caseous sinusitis, i.e. chronic, poorly symptomatic sinusitis which are resistant to usual treatment. CT shows an opacity of the maxillary sinus with often a hyperdense foreign body (dental overfilling) but no valid predictive criteria for fungal etiology. The endoscopic or surgical procedures point out a caseous mass often called fungal mass or aspergilloma. The biochemical composition of this mass (water, proteins, lipids) is similar to that of tissues surrounding the sinus. The calcium value is variable and shows no correlation with CT imaging. The qualitative and quantitative analysis of the metals (zinc, lead, silver, copper, iron) is of relevance for exogenic origin (dental overfilling). The fungal etiology is inconstant (20 cases) after the mycological investigations. We discuss the nosologic and diagnostic features of caseous sinusitis, fungal or not, and which are often or too often called aspergillosis sinusitis.

Adult↗
PubMed1997

[Rotatory impulse test does not replace caloric tests].

We sought to determine whether the rotatory impulsional test was capable of exploring the canalar function with sufficient precision to replace the caloric test, as it has been recently affirmed. We first compared the observed preponderance from this test with that measured during a sinusoidal (20 and 4 s) test. We observed that, in the case of a significant preponderance for a given test, there was complete redondance with the preponderance observed with any other test. The rotatory impulsional test does not present any specific advantage compared to other kinetic test as far as the observation of the preponderance phenomenon. We then compared the preponderance with the results of the caloric tests and came to the following conclusions i) the absence of preponderance does not allow us to predict the absence of vestibular deficit, due to the fact that 37% of the deficits were compensated for including acoustic neuroma; ii) the presence of a preponderance does not allow a priori to say whether it is of vestibular, cervical, or central origin and systematic caloric tests shows that almost one fourth of preponderance observed is not associated with unilateral weakness iii) supposing that a clinical argument allow us to conclude as to the probable vestibular origin of a vestibular preponderance, the direction of this preponderance does not allow us to determine which side is involved. In fact, if the undercompensated deficits are 3 times more frequent than overcompensated deficits, the proportion of preponderance not linked to a significant deficit indicates that the probability of encountering a preponderance related to a specific undercompensated deficit is approximately 50%. We thus did not find in the rotatory impulsional test any specific advantage allowing us to predict the laterality of a vestibular lesion.

Caloric Tests↗
PubMed1996

Intracanalicular and intratemporal facial nerve schwannomas.

Facial nerve schwannomas can mimic acoustic neuromas. We report herein two cases: a purely intracanalicular and an intratemporal facial nerve tumor extending into the internal auditory canal and the cerebellopontine angle. These tumors have to be suspected in patient with small-size tumors presenting with facial paralysis. We advocate translabyrinthine or middle fossa approach to facilitate nerve anastomosis. The establishment of the correct properative diagnosis is difficult, but the patient must be warned about the impossibility of preserving the facial nerve in these tumors.

Case Reports↗
PubMed1996

Siblings with congenital renal tubular acidosis and nerve deafness.

Two siblings (a boy and a girl) had congenital renal tubular acidosis (RTA) with nephrocalcinosis. Hearing loss due to nerve deafness was diagnosed at 13 1/2 and 9 years of age, respectively. The parents, who are second cousins, are healthy. They have another boy who is unaffected. This is in accordance with an autosomal recessive gene. The association of RTA and deafness was first noted by Royer in 1967, and so far some 50 cases have been described. The literature is reviewed.

Acidosis, Renal Tubular↗
PubMed1996

[Hypothyroidism following radiosurgical treatment of cancers of the hypopharynx].

In a series of 224 patients treated between 1980 and 1992 for hypopharyngeal carcinoma by surgery and post postoperative radiotherapy we found an overall 54% incidence of elevated TSH levels. Decreased FT4 levels were associated in about one-third of the patients. When thyroidectomy was performed, 71% of the patients developed thyroid dysfunction. Most TSH abnormalities (45%) occurred within two years of treatment. Nevertheless, long-term followup is indicated since those complications may be delayed. Hormonal replacement therapy is recommended for patients with elevated TSH.

Adult↗