Biomedical subjects
D Seguin
Publications and source records attributed to D Seguin.
The magnitude of acute and chronic alcohol abuse in trauma patients.
OBJECTIVE: To assess the incidence of acute alcohol intoxication and the proportion of trauma patients with evidence of chronic alcohol abuse. DESIGN: Prospective cohort study. SETTING: Regional level I trauma center. PARTICIPANTS: Patients aged 18 years and older admitted with blunt or penetrating trauma. MAIN OUTCOME MEASURES: Admission blood alcohol concentrations (BACs), the Short Michigan Alcohol Screening Test (SMAST), and biochemical markers for chronic alcohol abuse. RESULTS: Of the 2657 patients enrolled, 47.0% had a positive BAC and 35.8% were intoxicated (BAC > or = 100 mg/dL) on admission to the emergency department. Intoxicated patients were more likely to be 25 to 34 years old, male, and nonwhite; the highest proportion of intoxicated patients was among victims of stab wounds. Three fourths of acutely intoxicated patients had evidence of chronic alcoholism as indicated by a positive SMAST, and 25% to 35% of acutely intoxicated patients had biochemical evidence of chronic alcohol abuse. CONCLUSIONS: The high prevalence of both acute intoxication and chronic alcoholism in trauma patients indicates the need to diagnose and appropriately treat this pervasive problem in trauma victims.
Effects of alcohol intoxication on the initial assessment of trauma patients.
STUDY OBJECTIVES: To evaluate the influence of alcohol intoxication on the initial assessment and treatment of trauma patients. DESIGN: A prospective study of 2,237 trauma patients 18 years of age or older admitted to a Level I trauma center over a 19-month period. RESULTS: The study population was primarily male (78%) and white (73%) and had sustained blunt trauma (79%). One thousand fifty-three patients (47.1%) had positive blood alcohol concentration (BAC); median BAC in patients with any detectable alcohol was 179 mg/dL. When stratified by injury severity categories and compared with nonintoxicated (BAC less than 100 mg/dL) patients, intoxicated patients with an Injury Severity Score (ISS) of 1 to 15 were more likely to undergo the following: field and/or ED intubation (relative risk [RR], 2.22; 95% confidence interval [CI], 1.7 to 2.7); diagnostic peritoneal lavage (RR, 1.83; CI, 1.43 to 2.3); head computed tomography scanning (RR, 1.18; CI, 1.0 to 1.4); and intracranial pressure monitoring (RR, 1.41; CI, 0.74 to 2.7). The effects were less pronounced for those patients with an ISS of more than 15, except for intracranial pressure monitoring where patients with an ISS of more than 15 were 47% more likely to have intracranial pressure monitoring if intoxicated (RR, 1.47; CI, 1.2 to 1.9). CONCLUSION: Acute intoxication appears to alter the initial assessment of injury severity, resulting in an increased use of invasive diagnostic and therapeutic procedures.
[Therapeutic approach in chronic maxillary sinusitis. Apropos of 469 patients and 640 sinuses].
Between 1982 and 1987 we treated 469 patients who accounted for a total of 640 involved sinuses. These patients suffered from various stages of chronic sinusitis. Endoscopy of the maxillary sinuses enabled us to collect important information regarding the state of the mucosa and secretions, to collect bacteriological samples and to inspect the ostium and take pressure measurements. There was an 80% success rate in cases of sinusitis treated by drainage. In our opinion the indication for inferior meatotomy is as an extraction procedure and is not of value for aeration drainages. Nevertheless, out of a total of 141 inferior meatotomies performed, 80% remained patent after a mean follow up period of 3 years.
[Indications, technics and results of middle meatotomy. Apropos of 94 cases].
Middle meatotomies were essentially performed during the second period of our study from 1985 to 1987. The typical indication was for closed sinusitis, in order to allow aeration and satisfactory drainage. This was performed with an optical system at 30 degrees. The technique used was an anterior approach via total unciformectomy or a posterior approach using an Ostrum forceps. Good results, i.e. meatotomies which remained patent, were obtained in 80% of cases. The mean period of follow up was 3 years (6 months to 4 years). There were few complications overall for this form of endonasal surgery, though the possibility of damage to the lacrymal duct does exist. Synechiae were the most important functional complication and need to be prevented by meticulous post-operative care.
[Usefulness of the laser in post-radiotherapy arytenoid edema].
Laser treatment of post-radiotherapy arytenoid edema was applied to two groups of patients with either laryngeal mobility or immobility. When mobility was normal the technic was simple, since only resection of the arytenoid edema was necessary and results were always excellent. In the second group, resection of arytenoid edema must be combined with partial or total resection of arytenoid, but in this case there is a risk of chondritis. Results in this series were excellent and only one case of post-laser radionecrosis was noted.
[Ewing's inverted nasosinal papilloma. Critical study of therapeutic indications. Apropos of 14 cases].
Fourteen cases of Ewing's inversed papilloma of the nose and sinuses were treated as primary lesions or after recurrence. Clinical and paraclinical, mainly radiologic, endoscopic, and biologic investigations are of fundamental importance and should be as extensive for primary as for recurrent lesions. Treatment is largely dependent on the results of these examinations, is essentially surgical, and should respond to two imperatives. First, it should lead to total excision under the best possible conditions, and second, it should involve a minimum of sequelae, particular esthetic complications. Techniques for excision through the natural pathways are described, followed by those using an external approach (canine fossa or para-lateronasal approaches), as well as their advantages and inconveniences. The preferred procedure is through an open, wide, para-lateronasal approach, enabling the most effective excision to be performed, this technique appearing to be essential for recurrent lesions.
[Sinus endoscopy in the diagnosis of rhinosinal pathology].
Findings in 86 endoscopic examinations of the nose and paranasal sinuses were compared with clinical and radiographic signs. Precise evaluations of endomaxillary lesions, including analysis of secretions, and histologic examinations were conducted. Clinical and endoscopic findings failed to concord in 28 p. cent of cases, and radiological and endoscopic images in 26 p. cent of cases, the majority of these errors arising because of homogeneous total filling of the sinuses. In spite of these divergences, endoscopy is relatively non-invasive and simple to perform, and occupies a place of choice in the diagnosis of disorders of the nose and sinuses. Sinus endoscopy can also be of therapeutic value, particularly for aeration of the sinuses and during minor surgical procedures.
[Comparison of a series of tympanic homografts alone and moulded autografts].
Anatomical and functional results were compared in a series of 60 tympanic homografts alone with those obtained after 80 moulded autografts. Anatomically, the moulded autografts were definitely superior complications of microperforations in approximately one-third of cases. However, from the functional point of veiw, homografts appear to provide better results, particular when the ossicles are intact.
[Bilateral parotid gland tumors. Report on 3 cases (author's transl)].
Three cases of rarely observed bilateral parotid gland tumors are reported. In two cases the tumors were of different histological types (mixed tumor on one side and an adenocarcinoma on the other side) while in the third case they were both of the mixed variety. No clear explanation for the possible bilateral nature of these tumors was found, diagnosis being made either during the initial examination or after an interval of several years.
[2 cases of mucocele of the maxillary sinus].
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[Cricoid chondroma in a 78 year old woman].
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[Hearing disorders in children operated on for cleft palate].
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[New data on Dicrocoelium hospes Looss, 1907: anatomy of the adult and life cycle. Preliminary paper (author's transl)].
The morphological and anatomical studies of Dicrocoelium hospes Looss, 1907, from Togo set off several differences with Dicrocoelium lanceolatum Rudolphi, 1819: shape and dimensions of the body, shape and disposition of the testes, shape, dimensions and location of the vitellaria, structure of the uterus coils. The first intermediate host is found, they are three species of Limicolaria, one of them being L. aurora. The cercaria is described, its chaetotaxy confirms the validity of species D. hospes. Two species of ants: Dorylus sp. and Crematogaster sp. may be the second intermediate host.