PubMed Health⌕ Search

Biomedical subjects

D Ayache

Publications and source records attributed to D Ayache.

At least 19 recordsLinked to original sources
PubMed2000

Microangiopathy of the inner ear, retina, and brain (Susac syndrome): report of a case.

Microangiopathy of the inner ear, retina, and brain was first described in 1979 by John O. Susac. Since then, approximately 60 cases have been reported. Otolaryngologists must be aware of this syndrome, in which cochleovestibular symptoms are an important part of the diagnosis. In this article, we report a new case of Susac syndrome and discuss the diagnosis, physiopathologic characteristics, and treatment of this disease.

Adult↗
PubMed2000

Use of the carbon dioxide laser for tracheobronchial pathology in children.

The carbon dioxide (CO2) laser has been used to treat tracheobronchial pathology for more than 20 years. It was initially employed in adults and now has been found to be useful in the treatment of certain lesions in children. We present our experience with this technique in 30 patients treated with a CO2 bronchoscopic laser from 1987 to 1995 in the Ear, Nose, and Throat Department of Armand Trousseau Hospital. Four different types of pathologies have been successfully treated with the laser: selective cases of tracheobronchial stenosis following trauma and/or secondary to neonatal ventilation, posttraumatic tracheobronchial granuloma (due to foreign bodies or tracheotomies), tracheobronchial granulomas of infectious origin (tuberculosis), and selective cases of tracheobronchial tumor.

Adolescent↗
PubMed2000

[Assessment of perilymphatic pressure using the MMS-10 tympanic membrane displacement analyzer (Marchbanks' test) in patients with Meniere's disease: preliminary report].

OBJECTIVES: The aim of this study was to investigate non-invasive measurement of perilymphatic pressure using the MMS-10 tympanic displacement analyzer (Marchbanks' test) in patients with Meniere's disease. METHODS: We performed measurements in 20 patients with Meniere's disease and in 9 normal subjects with normal hearing. Data were collected in three groups: healthy ears of normal-hearing patients, healthy and affected ears in patients with Meniere's disease. RESULTS: We found no significant differences between the 3 groups for the types of the graph. Measurements of the tympanic membrane displacement test variables (Vi and Vm) showed large inter-subject variations. No significant difference was found between the 3 groups for cochlear aqueduct patency. CONCLUSION: Preliminary results of this short series show that assessment of perilymphatic pressure using the MMS-10 procedure does not seem to be useful in Meniere's disease.

Adolescent↗
PubMed2000

[Susac's syndrome: improvement with combined cyclophosphamide and intravenous immunoglobulin therapy].

We report a case of Susac's syndrome characterized by subacute encephalopathy, bilateral hearing loss and multiple bilateral branch retinal artery occlusions in a forty-year-old-white-woman. Brain Magnetic Resonance Imaging showed on T2-weighted images multiple, punctate areas of increased signal intensity in periventricular white matter, gray matter and brainstem most of them being enhanced by gadolinium. Cerebrospinal fluid was acellular but with an increased protein level (1.66 g/l). Treatment with cyclophosphamid and intravenous immmunoglobulin resulted in dramatic improvement of the clinical status over the following months and CSF normalization.

Adult↗
PubMed2000

[Revision surgery of otosclerosis: a review of 26 cases].

OBJECTIVES: The aim of this study was to identify causes of primary stapedectomy failures and to evaluate hearing results in revision stapes surgery. MATERIAL AND METHODS: We retrospectively reviewed a series of 26 revision stapedectomies. Patient characteristics, preoperative findings, causes of failure and complication of primary stapedectomy and postoperative hearing results were noted. RESULTS: Conductive hearing loss was the most common reason for revision surgery (77 %). Leading causes of stapedectomy failure included prosthesis malfunction (42 %), fibrous adhesions (37,5 %), incus erosion (12,5 %) and otosclerotic regrowth (12,5 %). When revision was indicated because of cochleo-vestibular complication, middle ear exploration revealed 3 problems: oval window granuloma or excessively long prosthesis or perilymphatic fistula. In this series, postoperative air-bone gap was closed to less than 10 dB in 57 % of cases, to less than 20 dB in 71 % of cases and we did not observed any sensorineural hearing loss. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but the risk of sensorineural hearing loss does not appear to be higher than in primary surgery. Revision surgery is a challenging problem that must be performed by an experienced surgeon.

Adult↗
PubMed1999

Head and neck infantile myofibromatosis--a report of three cases.

Infantile myofibromatosis (IM) is a proliferative disorder characterized by the development of single or multiple nodular lesions arising from cutaneous, subcutaneous, muscular, bone or visceral structures. This proliferation may occur at any anatomical site, but in 30% of the cases it involves the head and neck. We report here three cases of head and neck IM occurring in young children and presenting as solitary lesions. The clinical heterogeneity and the misleading histopathological appearances can make the diagnosis difficult. The treatment is surgical but the low rate of recurrence and the possibility of spontaneous tumoral regression may lead to conservative surgery or therapeutic abstention.

Child↗
PubMed1999

Obliterative otosclerosis.

From January 1990 to December 1996, 293 primary stapedectomies for otosclerosis were performed, among which 14 had obliterative otosclerosis (4.7 per cent). Probability of bilateral obliterative disease was 50 per cent. With this particular condition, a drill-out procedure was used to perform either a stapedectomy or a stapedotomy. In two patients with bilateral 'far-advanced otosclerosis', surgery was effective in enabling the patient to benefit from hearing-aids. In patients with a measurable hearing-loss, an air-bone gap closure to within 10 dB was achieved in 62.5 per cent of the cases and to within 10-20 dB in 37.5 per cent of the cases, with no deterioration of air-conduction thresholds at 8 kHz. A mild sensorineural hearing loss at 4 kHz was observed in 25 per cent of the cases. There was no statistical difference between stapedectomy and stapedotomy. According to these results, the drill-out technique is a safe and effective procedure in cases of obliterative otosclerosis.

Adolescent↗
PubMed1999

Results of partial laryngectomy for benign neural tumors of the larynx in children.

The objective of this study was to assess the long-term results of partial laryngectomy for benign neural tumors of the larynx. We reviewed 8 patients with laryngeal involvement -- 7 with neurofibromatosis and 1 without -- treated between 1980 and 1994. The mean age was 6.5 years. A partial laryngectomy was performed in 7 cases. All the tumors were located in the aryepiglottic folds. Clinical, radiologic, and endoscopic follow-ups were used for evaluating recurrence. A good laryngeal airway, swallowing without aspiration, and voice quality were sought in assessing the functional results. Five patients had good functional results with no recurrences. One patient died of malignant transformation and metastatic dissemination of his disease. To summarize, partial laryngectomy is a relatively safe and effective procedure, even in childhood, for treating this rare localization of neurofibromatosis. A malignant transformation of the tumor is possible and carries a poor prognosis.

Adolescent↗
PubMed1999

[Variations and incidents encountered during stapes surgery for otosclerosis].

The aim of this study was to report peroperative variations and incidents encountered during stapes surgery for otosclerosis, from a retrospective series of 293 primary stapedectomies performed in the ENT department of Fondation Adolphe de Rothschild, from january 1990 to december 1996. Pitfalls related to anomalous states or pathological conditions were observed in 81 cases (27.6%) and were classified as follow: narrow oval window niche (12.3%), floating footplate (5.8%), obliterative otosclerosis (4.7%), ossicular chain problems (3.4%), loss of perilymph and/or intravestibular bleeding (2.4%), fixed malleus (1%). Hearing results following surgery are presented. Because of the relatively high incidence of these unforeseen events, the otologic surgeon must be well trained and experienced to be able to use all reasonable stapedectomy or stapedotomy techniques.

Ear↗
PubMed1997

Midline cervical cleft.

Midline cervical cleft is a rare congenital anomaly of the ventral neck and its embryological origin has not been clearly established. Less than 100 cases have been reported in the literature. We present a case of midline cervical cleft operated on at the age of 2 months in order to illustrate its clinical presentation and surgical management.

Branchial Region↗
PubMed1997

[Neuroglial heterotopia. Apropos of 8 cases with non-nasofrontal sites].

Neuroglial heterotopia, glioma, is an uncommon congenital nervous tissue tumor, usually found in a nasofrontal localization. About 60 cases with an atypical localization, usually in the pterygomaxillary fossa have been reported. We present 8 cases. Symptomatology followed CT-scan or MRI identified localization and was helpful in orienting diagnosis before biopsy. Exeresis was difficult, particularly in deep infratemporal localizations reaching the base of the skull. The main risk is recurrence. Different surgical approaches have been discussed and should be adapted to each case.

Choristoma↗
PubMed1996

[Treatment by CO2 broncho-laser for acquired tracheobronchial stenosis in children with bronchopulmonary dysplasia].

OBJECTIVE: Evaluation of carbon dioxide (CO2) broncholaser for treating acquired proximal tracheo-bronchial stenosis in children with bronchopulmonary dysplasia. DESIGN: Retrospective study from June 1987 through August 1995, with 39 months follow-up. PATIENTS AND METHODS: During the study, 65 children were treated for bronchopulmonary dysplasia. Eight of those (average age: 42.6 months) had symptomatic tracheo-bronchial stenosis; they were treated with CO2 broncholaser and represented 23.5% of all broncholaser applications. All patients presented multiple lesions. Ten symptomatic well-organized lesions (obstructive bridles or diaphragms), all accessible to broncholaser, were treated. Broncholaser was the primary treatment used, except in one case where it was used following balloon dilatation failure. An adaptable rigid fibroscope combined with a CO2 Sharplan laser was used. All interventions were performed under general anesthesia. RESULTS: Lesions not reaching the trachea's bifurcation (eight cases) disappeared following one laser session with significant clinical improvement. Lesions extending to the trachea's bifurcation (two cases) only showed partial improvement despite three laser sessions. The results remained stable throughout the follow-up period. There were no major complications. CONCLUSIONS: Broncholaser is a safe and efficient method of treating stenoses occurring in patients with bronchopulmonary dysplasias. Obstructive lesions (such as bridles or diaphragms) and those which do not reach the trachea's bifurcation, give the best results.

Bronchi↗
PubMed1996

[Acute epiglottitis in adults. A series of 41 cases].

Acute epiglottis is not strictly a childhood disease. We report our experience with acute epiglottis in adults with a retrospective series of 41 patients seen from 1986 to 1994. The main complaint was painful dysphagia. The diagnosis was confirmed a examination of the larynx. Therapeutic management in a hospital setting is required due to the risk of ventilatory obstruction (therapy to be adapted to the patient's ventilatory status).

Acute Disease↗
PubMed1994

[Minor aplasia of the ear: anatomical findings and results of functional surgery].

We report a retrospective study of 57 cases of minor aplasia of the ear. Each case was analyzed according to the clinical presentation, audiometric results and preoperative radiography. Intra-operative classification of the malformation was obtained in 56 of the 57 cases. The post-operative anatomic and functional results were analyzed. Stapedectomy in type II malformations (stapedo-vestibular ankylosis) gave the best results but this procedure also carries the highest risk for the inner ear. Globally, functional results were good or average in 48% of the patients. These results may appear unsatisfactory but must be appreciated in light of the fact that half of the patients benefited from the operation (particularly in eliminating further use of an external hearing aid). Nevertheless, the long-term stability of these audition results is unknown.

Adolescent↗
PubMed1994

[Contribution of x-ray computed tomography in the diagnosis of cervical suppuration].

The authors report their experience with computed tomography (CT) in 27 cases of cervical suppurations. The diagnosis was confirmed surgically in 24 cases and by the improvement of clinical signs and CT after antibiotics in 3. Two types of CT features were identified: collected abscesses (n = 22) visualized as encapsulated heterogeneous hypodense formations and extensive suppurative cellulitis (n = 5) formed by large diffuse hypodense collections without a clearly visible peripheral wall. The extension of the suppurative process could be evaluated precisely with CT, especially in certain anatomic areas where physical examination is difficult including mediastinal suppurations (n = 2), extension of parapharyngeal suppurations to the retrostyleal area (n = 1), and pterygo-maxillary and epidural collections (1 each) the latter in combination with a tuberculous abscess. Computed tomography is also useful in the etiological diagnosis (search for foreign body, cystic malformations, tuberculosis) and in post-treatment follow-up to visualize the absence of collections after cure in cases of favourable outcome and to determine the extent of the suppurative process in case of complications.

Adult↗
PubMed1993

[Kikuchi's disease. Apropos of a case. Review of the literature].

Kikuchi's disease is rare necrotic histiocytosis of the lymph nodes. Since the first description in Japan in 1972 by Kikuchi, several cases have been reported. The disease occurs most frequently in young women. Manifestations include enlargement of the cervical lymph nodes, sometimes with fever, and often associated with other non-specific clinical signs. Blood chemistry, including immunologic tests, are often normal but neutropenia and raised erythrocyte sedimentation rate have been reported. Diagnosis relies on the histological examination of lymph node biopsies. Generally the clinical course is favourable in 3-4 months. Secondary systemic lupus erythomatosus may develop and require regular follow-up. The aetiology of this rare disease is still unclear although certain observations would favour an immunological process. Very rare in France, we report a case of Kikuchi's disease in a pregnant woman and present a review of the literature.

Adult↗
PubMed1992

[Upper functional dysphagia. Apropos of 33 cases].

Upper functional dysphagia, occurring in the absence of tumoral obstruction, includes swallowing disorders caused by a disturbance of the reflex, velopharyngoesophageal time of deglutition. Thirty-three patients with such disorders have been studied. Fourteen suffered from a neurologic affection (including 4 brainstem tumors and 6 cerebrovascular neurologic disease), 10 from myopathy, 9 from a localized affection of the upper sphincter of the esophagus. Diverticula were excluded from this study. The exploration resorted to fiberendoscopy of esophageal follow-through, pharyngoesophageal manometry, radiocinema, and MRI for some of the latter patients. Cricopharyngeal myotomy was carried out in 16 of these patients, with good results in 10 and failures in 6. The role of the various additional examinations and of myotomy is discussed.

Adolescent↗