Biomedical subjects
Publications and source records attributed to J C Chobaut.
We report a case of isolated unilateral pulsatile tinnitus. Cerebral angiography showed a right intra-cranial internal carotid artery stenosis. Treatment by dilatation and stenting resulted in symptom resolution.
A pharmacokinetic study was carried out to determine moxifloxacin concentrations in sinus tissue, after oral moxifloxacin 400 mg once daily for 5 days to patients with chronic sinusitis, undergoing elective sinus surgery. Patients were randomly allocated to one of seven treatment groups, in which tissues were sampled 2, 3, 4, 6, 12, 24 or 36 h post-dose. A control group with non-infected nasal polyps was also included. Forty-eight patients (13 female, 35 male, mean age 47.1 years) were allocated to one of each active treatment group (n = 42) or to the control group (n = 6). Tissue and plasma samples were taken simultaneously and stored frozen until assayed by HPLC. Thirty-nine patients were fully valid for pharmacokinetic analysis. The geometric mean moxifloxacin plasma concentration increased from 2.32 mg/L at 2 h to a maximum of 3.37 mg/L at 4 h post-dose, decreasing to 0.37 mg/L at 36 h post-dose. The moxifloxacin concentration in sinus mucosa was consistently greater than that in plasma being 4.56-5.73 mg/kg from 2 to 6 h and 2.81-1.25 mg/kg from 12 to 36 h post-dose. The elimination rates in plasma and sinus tissues were similar. The tissue/plasma ratio was c. 200% between 2 and 6 h, and up to 328.9% at 36 h. Results were similar whatever the site of tissue sampling (maxillary sinus, anterior ethmoid sinus or nasal polyps). Tissue levels exceeded the MIC(90) of all pathogens commonly causing acute sinusitis (e.g. 5-30 x MIC for Streptococcus pneumoniae: 0.25 mg/L). These results sup-port the use of moxifloxacin 400 mg once daily as a regimen for the treatment of sinus infections.
Evolution of bacterial resistance shortens antibiotic treatment in ENT infections. The efficacy and tolerance of amoxicillin-clavulanate (ACA), with and without associated short steroid therapy, was evaluated in acute sinusitis of adults at a dosage of 1.5 g/d for 5 d vs. 10 d. This multicentre, randomized, double-blind, placebo-controlled study included 433 patients, 417 of whom were suitable for intent-to-treat (ITT) analysis. The therapeutic success rate in the ITT population, assessed according to strict clinical and radiological criteria, was respectively, 80% and 85% in the 5-d and 10-d treatment groups. Due to the statistical risks that were evidenced, the 2 durations of treatment could not be considered equivalent. The analysis of medical history shows that some risk factors (recurrence of sinusitis, previous surgical sinus drainage) seem to promote therapeutic failure and that 5-d treatment is inappropriate in these patients. The persistence of therapeutic success on day 30 was not influenced by the initial duration of treatment. The efficacy and good tolerance of ACA in acute sinusitis in adults were confirmed. Further studies will be needed to define the indications of short treatments better, which seem to be indicated in the absence of specific risk factors.
Use aluminium-containing biomaterials in otoneurosurgery for reconstitution of bone in contact with cerebrospinal fluid (CSF) also led to cases of encephalopathy and death. We report aluminium (Al) concentrations in the biological fluids of six French patients following use of Al-containing bone cement in otoneurosurgery. In five patients, the mean plasma Al levels (microgram/L) were: 1.20 +/- 0.05 (case 2), 9.20 +/- 0.10 (case 3), 1.00 +/- 0.05 (case 4), 2.80 +/- 0.05 (case 5) and 2.00 +/- 0.05 (case 6). In case 1, Al concentrations were 176 micrograms/L in the postauricular CSF accumulation, 34 micrograms/L in the pontocerebellar angle and 4 and 6 micrograms/L in the lumbar shunt. As a precautionary measure, in the first three cases the biomaterial was removed soon after the intervention, and no increase in plasma or CSF Al was observed. In the other cases, absence of neurobiological symptoms and normal concentrations of Al in plasma led neurosurgeons not to extract this biomaterial. Al assay thus may be considered to be a complementary and at times a decision-generating factor. Care is needed at all stages from sampling through analysis because Al is ubiquitous and factually high results may be clinically misleading. Herein, such considerations are discussed in conjunction with the neurotoxicity of this metal in man. In addition, the authors call for in-depth preliminary trials of these biomaterials in animals prior to introduction on the market.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery. Treatment by penicillin and surgical excision gave a good result. Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity. A trauma is often found in the previous history. Diagnosis with tumors and abscess may be difficult. The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain. Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time. The literature is reviewed without finding such a case.
The authors report about one case of giant-cell tumor of the cricoid bone (osteoclastoma, myeloplaxic tumor). The diagnosis is difficult as the clinical and radiological symptoms are not specific. A detailed iconography sums up the clinicopathological characteristics of this tumor. The authors emphasize the necessity to perform wide exeresis surgery through total laryngectomy.
Analysis of prognosis factors was performed on a surgical series of 34 of piriform sinus cancer, based on the use of a multivariate study according to the Cox model. The presentation is essentially didactic emphasizing the main points: how to collect data, what data to collect, and what judgment criterion to use. The authors detail the interpretation to be drawn from the analysis results using Cox model.
Lipoid proteinosis is a rare autosomal recessive condition affecting the majority of organ systems, but predominantly involving skin and mucous membranes. The mucocutaneous infiltration due to accumulation of a hyaline material is positive for both sudanophil and periodic acid-Schiff reagents. This was illustrated in a 14-year-old girl with parental consanguinity, who had classic manifestations.
The hearing of 23 children with cleft palates was studied at an early age (before 12 months) and before pharyngoplasty using the electrophysiologic method of auditory brain-stem response. Nineteen children showed important degrees of conduction deafness of 50 or 60 dB. Results were compared with those obtained for a group of normal children tested under the same method before age 6 months. No hearing loss was observed in this group. It is concluded that hearing defects appear at an early age in children with cleft palates and are in direct relationship to the malformation. Hypotheses concerning the etiopathogeny of these hearing losses are proposed.
Functional results of tympanoplasty are partly dependent on the ossiculoplasty phase. Based on results of 331 operations using the closed technique, statistical differences were evaluated between several classical ossicular buildings carried out essentially with homograft ossicles. The study involved assessment of postoperative audiograms practised under identical conditions, patients with anatomical failure being excluded. In type II cases, the different drum to stapes mountings tried gave better results than "malleus to stapes" mountings. In type III cases the difference was not significant. In all cases, results were significantly better when ossiculoplasty was performed during the second look.
Explore the source record for details and available documents.
Actual symptomatology of petrositis is often poor; Gradenigo's syndromes are rare. Petrositis can occur as large cystic cholesterol granuloma of the petrous apex. Their C.T. scan, surgical and pathological aspects are different from cholesteatoma of the apex.
A case of laryngeal leishmaniasis in a patient living in eastern France is reported. Mucosal leishmaniasis appears to be frequent in the New World but rare in the Old World, where only 9 cases have been published, including 3 from France. In this particular patient, there probably was some relationship between the laryngeal lesion and an unexplained malaria-like fever contracted in Algeria 19 years before. This case provides evidence that leishmaniasis is one single nosological entity throughout the world, its different clinical forms (cutaneous, mucosal, visceral) merely reflecting the adaptation of the parasite to its environment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.