[Cholesteatoma of the maxillary sinus. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to A Rigaud.
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The authors report a case of chronic interstitial pneumonia with a very unusual appearance (on plain films and CT); in fact such ribbon-like linear opacities with concentric and pseudo-cavitary disposition have not been previously described. They are comparable but different from the linear opacities described by Carrington in some cases of chronic eosinophilic interstitial pneumonia, which are vertical and peripheral. They are also different from the curvilinear sub-pleural opacities reported in some cases of asbestosis. On the basis of the anatomic findings they discuss the specificity of such radiologic patterns or their sole value as an evolutive state.
Repeated epistaxis in a 12 year old child revealed an aneurysmal bone cyst of ethmoid, an exceptional localization for this lesion. Modern imaging techniques (CT scan, NMR) provided precise data on its extent, primordial for decision as to surgical approach. NMR imaging was more effective than the CT scan for diagnosis, since blood lakes were identified, and for determination of extent, since tumoral elements were distinguished from sinusal retentions.
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The surgical treatment of juvenile naso-pharyngeal angiofibroma involved a potential haemorrhagic risk: the average intra-operative blood loss was estimated at between 1,300 and 2,800 ml in many reports. Two cases are reported in which haemodilution and autologous blood transfusion were used. The method consisted in pre-operative repeated phlebotomies ("leap-frog") and normovolaemic acute haemodilution; thus, 1,700 ml of autologous blood was collected in the first case, and 2,300 ml in the second one. Autotransfusion was carried out and no homologous blood transfusion was used in the peri-operative period. The use of this method, although compelling, had many advantages (financial saving, suppression of adverse reactions with homologous transfusion, transfusion of fresh blood, reduction of postoperative oedema).
Seven cases of acute sphenoid sinusitis were reviewed. Two happened after deep sea diving. Headache of variable location and fever were the most predominant presenting symptoms (5/7). Purulent discharge in the cavum was present in three. Correct diagnosis was delayed from six to twenty-four days after beginning of symptoms, when a neurologic deficit became apparent : mainly paralysis of the sixth and third cranial nerves. Computed axial tomography was the most useful radiologic procedure for demonstrating sinus opacification in every patient. Two patients died, three had complete recovery, one had persistent epileptic focus after brain abscess. Last patient had paraparesis and incontinence of urine after study of cerebrospinal fluid (C. S. F.) flow with methylene blue. Cannulation of the sphenoid sinus was performed in two patients and surgical drainage in three. Gram negative microorganisms and Staphylococcus aureus were isolated from the sphenoid sinus of only three patients. Blood cultures were negatives in every cases and C. S. F. in six. First choice antibiotics was an association of aminoglucosides and broad-spectrum penicillin in six cases. It always had to be changed.
Ultrastructural anomalies were studied in vibratory cilia of middle ear mucosa and findings compared with those observed in pituitary and bronchial mucosae. Anomalies noted on electron microscopy are reported and commented.
Since the first descriptions by McBride and then Stewart, and later reports by wegener, numerous publications have contained data emphasizing the diagnostic and classification difficulties of these affections, 450 cases having been documented up to the present times. Findings clearly demonstrate that mediofacial necrosis differs greatly by its pathological, etiopathogenic and out come features, and particularly the localization of the lesions. Eight case were investigated, and conclusions drawn that it was important to identify the different affections grouped under the term "mediofacial necrosis", in order to isolate cases of pure malignant centrofacial granuloma, which have no detectable etiology and cannot be integrated in another nosological framework.
A brief historical survey is completed by the presentation of a technique for immediate prosthetic rehabilitation during facial hemiresections for malignant tumors. The method presents multiple advantages when compared to typical drainage procedures from the physiological, mechanical and psychological points of view. A detailed description of the introduction of this prosthesis is followed by a brief summary of postoperative sequelae and the advantages the method supplies due to its extreme simplicity in application.
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Mianserin (60 mg daily) was compared with chlorimipramine (150 mg daily) in the treatment of 145 depressed in- and outpatients in four centres. The trial was double-blind and fully randomized. Both drugs were effective antidepressants. No significant differences in efficacy could be demonstrated by means of the Hamilton rating scale for depression, the Beck self-rating scale or the clinical global impression, for both in- and outpatients. Hypotension, dry mouth and tremor increased significantly more in inpatients with chlorimipramine than with mianserin. At the end of treatment weight gain was increased significantly more in outpatients after treatment with mianserin. No differences could be demonstrated between the drugs for other side-effects.
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Among deep mycoses, sub-mocosal phycomycosis due to Entomophthora Cornata is of interest to stomatologists as it is mainly located in the middle and lower areas of the face. symptomatology is characterized in general by upper naso-labial deformation the extent of which is dependent on the stage of development reached. The only means of identifying the nature of the lesions is by biopsy which always enables diagnosis of deep mycosis to be made and sometimes, by means of a culture, identification of the agent responsible. This is a lower saprophytic fungus of decaying vegetable and telluric matter. It usually enters the body through the mucous membrane when there is a traumatic fissure. Ingress through the teeth should not be overlooked. Antifungal preparations and reconstructive surgery constitute the treatment early application of which determines prognosis.
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