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Biomedical subjects

Jean-Yves Sichel

Publications and source records attributed to Jean-Yves Sichel.

At least 19 recordsLinked to original sources
PubMed2006

Packing in endoscopic sinus surgery: is it really required?

OBJECTIVE: The aim of this study was to evaluate the routine use of packing or local hemostatic agents in endoscopic sinus surgery (ESS). METHODS: Packing and/or hemostatic agents were used only when necessary in 100 consecutive adult ESS patients in a tertiary academic hospital. Necessity for packing the nose after excessive bleeding was analyzed in relation to demographic characteristics, medical history, previous surgeries, current surgical procedure, type of anesthesia, and amount of intraoperative bleeding. RESULTS: Three patients who required packing because of other reasons (such as bolstering of mucosa) were excluded from the study. The remaining 97 patients included 61 males and 36 females between the ages of 16 to 86 (mean 44). Forty-nine patients underwent only ESS, 40 ESSs associated with nasal polypectomy, and 8 underwent other endoscopic procedures. Fifty-four underwent the operation under general anesthesia and 43 under local anesthesia. Intraoperative blood loss was less than 30 mL in 82 patients (85%), 30 to 50 mL in 11 (11%), and more than 50 mL in 4 (4%). In 89 patients (92%), packing or a hemostatic agent was not used. No patient had bleeding complications postoperatively. A comparison between patients who required packing to those who did not showed that the only statistically significant associations related to general anesthesia (P = 0.0082) and to the amount of intraoperative bleeding (P < 0.001). CONCLUSIONS: Most ESS procedures can be managed without packing or any other hemostatic measures. Local anesthesia, use of local vasoconstrictors, and careful operative technique minimize the need for nose packing, thus reducing patient's discomfort, postoperative complications, and cost of surgery.

Adolescent↗
PubMed2006

Redefining parapharyngeal space infections.

OBJECTIVES: Our intent was to review the clinical signs, computed tomography (CT) scans, treatment, and outcome of parapharyngeal space infections (PPIs), and to define 2 types of infections of the parapharyngeal space (PPS) according to the location of the infectious process. METHODS: We performed a retrospective analysis of patients hospitalized in a tertiary university hospital with a diagnosis of PPI, abscess, or deep neck abscess between 1988 and 2004. Files and CT scans were reviewed after classification into 2 groups: 1) infection located in the posterior part of the PPS (PostPPI); and 2) infection located in the anterior part of the PPS (AntPPI). RESULTS: Twenty-two patients had a PostPPI; their ages ranged from 10 months to 24 years. Five patients underwent surgical drainage, and 17 others were treated solely with intravenous antibiotic therapy. No pus was found during surgery in 2 patients. The average time of hospitalization was 10 days. Only 1 complication (aspiration pneumonia) was observed. Seven patients had an AntPPI; their ages ranged from 1.5 years to 65 years. All patients underwent surgical drainage, and pus was detected in all cases. The average time of hospitalization was 35 days. Complications (septic shock, respiratory arrest, mediastinitis, pleural empyema, pericarditis) were observed in 4 patients. CONCLUSIONS: The term "parapharyngeal abscess" was assigned long before the CT scan era, and was based on physical examination and plain film radiology. In essence, the entity PPS "abscess" or "infection" is composed of 2 different disorders. Infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and with no extension into other cervical spaces except the adjacent retropharyngeal space may be termed posterior parapharyngeal infection or parapharyngeal lymphadenitis. This is a relatively benign condition, and nonsurgical treatment should be considered. Infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. Urgent surgical drainage is therefore mandatory.

Abscess↗
PubMed2006

Halofuginone prevents subglottic stenosis in a canine model.

OBJECTIVES: Halofuginone is a low-molecular weight quinazolinone alkaloid coccidiostat that inhibits collagen type I synthesis, extracellular matrix deposition, and angiogenesis. This study was conducted to assess its potential in preventing subglottic stenosis (SGS). METHODS: We induced SGS in 10 dogs randomly divided into 2 groups. Each group received treatment between 3 days before and 21 days after the induction of SGS. One group received oral halofuginone 40 microg/kg, and the other was given placebo. The area of the subglottic lumen was measured at baseline and 3 months later. In addition, human tracheal fibroblasts were cultured. The inhibitory effect of halofuginone was compared to the effect of mitomycin. RESULTS: All dogs survived throughout the study with no side effects. Three months after the operation, no halofuginone-treated dog had SGS, in contrast to a 66% to 80% stenosis rate (mean, 72%) in controls (p < .008). Thick fibrotic tissue was found in the placebo-treated larynges, whereas an almost normal architecture was observed in halofuginone-treated larynges. Halofuginone inhibited the growth of human tracheal fibroblasts by 75%, in comparison with 60% inhibition by mitomycin (no statistically significant difference). CONCLUSIONS: This preliminary study shows that halofuginone is effective in preventing SGS caused by an acute injury. Halofuginone has a potential therapeutic role in preventing SGS in humans.

Animals↗
PubMed2005

A new surgical technique for primary closure of long-term tracheostomy.

OBJECTIVES: To delineate a technique that avoids the complications associated with surgical closure of long-term or permanent tracheostomy (LTT). Study design A case series that describes the technique and clinical outcomes. METHODS: Thirty-seven of 300 patients with a previously established LTT underwent primary surgical closure of their stoma after their underlying disease had been resolved. The surgical technique combined a turnover flap with medialization of fibroadipose tissue, followed by additional closure with an advancement skin flap. RESULTS: After a mean follow-up of 3.2 years, no patient developed major complications. Four patients developed minor complications, which responded to conservative treatment. In all patients, the functional results were satisfactory, as were the cosmetic results, with the exception of 1 case. None required re-tracheostomy. CONCLUSION AND SIGNIFICANCE: This simple and reliable new surgical technique for closing LTT avoids the potential failures and complications encountered in previously published procedures.

Follow-Up Studies↗
PubMed2005

Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip).

OBJECTIVE: The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls. STUDY DESIGN: The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS). RESULTS: The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics. CONCLUSION: Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.

Adolescent↗
PubMed2005

Purulent chondritis of the laryngeal framework cartilages.

This manuscript reports on our experience with purulent chondritis of the laryngeal cartilages (PCLC), an entity that has not yet been described. Three patients had a diagnosis of PCLC. The probable causes were relapsing polychondritis, a previous prolonged intubation, and an idiopathic cause. The patients suffered from hoarseness and inspiratory stridor for 1 to 3 months before diagnosis. None complained of pain in the neck. Laryngoscopy showed supraglottic edema. A computed tomography scan revealed abscess formation between the intact inner and outer perichondria of the thyroid cartilage. The treatment included rigid endoscopy, external incision and drainage, and prolonged medical therapy. The culture results were Staphylococcus aureus in the first 2 cases and Aspergillus fumigatus in the third. The second patient (in whom the cricoid cartilage was also affected) required emergency tracheotomy. The other 2 patients did not require airway intervention. The rarity of PCLC and the relatively mild symptoms require a high index of suspicion for its diagnosis.

Abscess↗
PubMed2005

Mechanism of cochlear excitation at low intensities.

In order to assess the mechanisms of cochlear activation, the cochlear fluids of one cochlea of a guinea-pig (I) were coupled to those of a cochlea of a second guinea-pig (II) by means of a saline-filled narrow bore tube, the ends of which were placed in the fluids around the opened round windows of both cochleae, thus joining the two cochleae from two different animals into a single, larger, unsealed fluid system. In response to air-conducted sound stimulation of cochlea I, auditory nerve-brainstem evoked responses could be recorded in animal II, not only when the coupling tube was filled with saline, but also when it was filled with ultrasound gel (viscosity 100,000 greater than that of water), when there was a very large hole encompassing a relatively large expanse of the cochlear shell of animal I, and even when animal I was no longer alive. The necessary control experiments were performed. Therefore, it is suggested that at low stimulus intensities, the passive, incoming basilar membrane traveling wave may not activate the cochlea. Instead the fluid pressures (condensation/rarefactions) induced in the cochlear fluids by vibrations of the stapes footplate may be adequate to directly activate the outer hair cells, which then generate an active component of basilar membrane displacement.

Acoustic Stimulation↗
PubMed2004

"Starplasty" prevents tracheotomy complications in infants.

OBJECTIVE: The average age of children undergoing tracheotomy has declined over the years and the indications for tracheotomy have changed from acute airway obstruction due to infection, to treatment of chronically ill children. Tracheotomy-related complication rates are more numerous in younger children and in certain cases have proved to be fatal. A variety of operative techniques have been advocated for reducing the rate of tracheotomy-related morbidity and mortality. This manuscript reports on our experience with a new technique--starplasty tracheotomy (SPT)--and assesses the value of this procedure in preventing tracheotomy-related complications in infants (under 6 months old), in whom complications are more frequent and more dangerous. METHODS: Children less than 6 months old who underwent tracheotomy in the Department of Otolaryngology/Head and Neck Surgery, Hadassah University Hospital, Jerusalem, between the years 1999 and 2003 were studied. They were divided into two groups according to the surgical technique preferred and performed by the senior surgeon on call. Children in group 1 underwent tracheotomy by means of a regular technique and children in group 2 underwent SPT. All events related to the tracheotomy were recorded and a comparison was made between the two groups. RESULTS: Eleven of a total of 26 pediatric tracheotomy patients were less than 6 months old. Five underwent regular tracheotomy (RT) and six underwent SPT. Three complications were encountered in the RT group and none in the SPT group. Accidental decannulation and failure to re-insert the cannula resulted in severe hypoxemic brain damage in one patient with RT. No tracheotomy-related deaths occurred. CONCLUSION: Our experience supports the existing data regarding the superiority of SPT over RT in preventing dangerous tracheotomy-related complications in infants. We, therefore, recommend performing SPT in all infants undergoing tracheotomy, even at the price of having to perform surgical closure of TCF after decannulation in some cases.

Age Factors↗
PubMed2004

Mitomycin does not prevent laryngotracheal repeat stenosis after endoscopic dilation surgery: an animal study.

OBJECTIVES/HYPOTHESIS: Conflicting data exist in the literature regarding the role of mitomycin in the prevention and treatment of laryngotracheal stenosis. The purpose of the study was to assess the value of mitomycin in preventing repeat stenosis after endoscopic dilation surgery of well-established stenoses. STUDY DESIGN: Prospective controlled animal study. METHODS: Laryngotracheal stenosis was induced in 16 dogs. After a period of 3 months the dogs underwent endoscopic dilation and were randomly divided into two groups. The control group received immediate topical application of normal saline. Dogs in the mitomycin group received immediate topical application of 0.5 mg mitomycin. The animals were then observed for 3 more months before euthanasia. The laryngeal lumens were measured endoscopically at baseline, before dilation, and before euthanasia. A comparison was made between the two study groups by means of the Wilcoxon rank-sum test for change in the percentage of stenosis attained by the endoscopic dilation. RESULTS: Nine dogs were included in the control group, and seven in the mitomycin group. Group comparison for initial occlusion before endoscopic dilation using Wilcoxon rank-sum test showed no difference between the two groups (z = 0.16 [P =.87]). Three months after endoscopic dilation, no difference was observed between the two groups regarding the change in the percentage of occlusion (z = -0.21 [P =.83]). CONCLUSION: Mitomycin exerts a benefit equal to that of normal saline when applied to a well-established laryngotracheal stenosis in dogs and does not prevent repeat stenosis after endoscopic dilation surgery.

Alkylating Agents↗
PubMed2004

OK-432 therapy for cervical lymphangioma.

OBJECTIVE: To describe our experience with sclerosing treatment of lymphangiomas in the head and neck region by intralesional injections of OK-432. STUDY DESIGN: Case series. METHODS: Patients with the diagnosis of a macrocystic-type cervical lymphangioma were treated by one to three intralesional injections of OK-432 (0.01 mg of OK-432/1 mL of lymphangioma fluid, up to a maximum of 0.2 mg in the first injection and 0.3 mg in the second or third injections). All injections were performed under ultrasound guidance. Children were injected under sedation. RESULTS: Eleven patients were treated with injections of OK-432: 7 children and 4 adults. They were followed up for a period of 5 to 68 (mean 30) months. Eight (73%) patients had complete or subcomplete resolution of the lymphangioma after one or two injections. In three (27%) cases, no response was obtained (2 cases) or the lymphangioma recurred (1 case) after two to three injections. In two cases, surgical excision was performed. There was no evidence of fibrosis around the cysts. There were no complications to OK-432 injections. CONCLUSION: Intralesional injection of OK-432 is an effective treatment modality for macrocystic-type lymphangiomas in the head and neck region. It has no complications, and surgical excision in case of failure is not compromised by fibrosis. Sclerosing of macrocystic-type lymphangiomas with OK-432 should therefore be considered before surgical excision.

Adult↗
PubMed2004

New approach for implantable hearing aids: a feasibility study.

The objective of this study was to test the feasibility of a new kind of implantable hearing device based on a cerebrospinal fluid hydroacoustic pathway by which sound waves are conducted from the dura mater to the inner ear by cerebrospinal fluid. In this prospective animal study, a piezoelectric bimorph was implanted into 2 guinea pigs and 1 dog between the skull bone and the dura at the parietal area. The bimorph was connected transdermally by wires to a click generator. The auditory brain stem response was recorded after stimulation of the piezoelectric device by the click generator. In the 3 animals, the auditory brain stem response could be recorded in response to a stimulus intensity of 135 dB peak equivalent (pe) sound pressure level (SPL; instrument setting), corresponding to 3.8 V activating the device. The auditory brain stem response disappeared during white noise masking, proving that the origin of the response was in the inner ear. The threshold was 125 and 115 dB pe SPL in the 2 guinea pigs and 135 dB pe SPL in the dog (instrument setting). We conclude that transmission of sound waves by a cerebrospinal fluid hydroacoustic pathway to the inner ear is possible. Such a device would have advantages over more traditional implantable hearing devices: it would not be necessary to couple it to the ossicular chain, and it could be used in patients with infected middle ears.

Animals↗
PubMed2004

Cochlear activation at low sound intensities by a fluid pathway.

In order to assess the mechanisms responsible for cochlear activation at low sound intensities, a semi-circular canal was fenestrated in fat sand rats, and in other experiments a hole was made in the bone over the scala vestibuli of the first turn of the guinea-pig cochlea. Such holes, which expose the cochlear fluids to air, provide a sound pathway out of the cochlea which is of lower impedance than that through the round window. This should attenuate the pressure difference across the cochlear partition and thereby reduce the driving force for the base-to-apex traveling wave along the basilar membrane. The thresholds of the auditory nerve brainstem evoked responses (ABR) and of the cochlear microphonic potentials were not affected in the fenestration experiments. In addition, holes in the scala vestibuli of the first turn did not cause ABR threshold elevations. These results contribute further evidence that at low sound intensities the outer hair cells are probably not activated by a base-to-apex traveling wave along the basilar membrane. Instead it is possible that they are excited directly by the alternating condensation/rarefaction fluid pressures induced by the vibrations of the stapes footplate. The activated outer hair cells would then cause the localized basilar membrane movement.

Acoustic Stimulation↗
PubMed2003

Adverse reaction to surgical sutures in thyroid surgery.

BACKGROUND: A mild reaction to surgical sutures after thyroid surgery is common and is characterized by local edema and inflammation around the surgical scar. Severe reaction with microabscesses and granulomatous masses is quite rare. METHODS AND RESULTS: Two cases of severe reaction to silk sutures after thyroid surgery are presented. Meticulous surgical removal of all surgical sutures along with granulomatous masses, granulation tissue, and microabscesses cured both patients. Pathologic examination revealed giant cells and lymphocytes. Intradermal skin tests were positive to silk sutures. The etiology and the treatment options are discussed. CONCLUSIONS: In rare cases, severe reaction to silk sutures may develop after thyroid surgery. Surgical removal of the stitches is the treatment of choice. Intradermal skin test is a good predictor of allergy to sutures.

Adult↗