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Biomedical subjects

P Géhanno

Publications and source records attributed to P Géhanno.

14 recordsLinked to original sources
PubMed2002

[Aspergillosis of the paranasal sinus and environmental factors].

UNLABELLED: Paranasal sinus aspergilloma is a non-invasive form of Aspergillus infection being encountered more often during the last decade. METHODS: A survey of specialists in France was carried out in 1998 to investigate the role of environment in the pathogenesis of the disease. RESULTS: A total of 402 patients' reports were reviewed, most of which involved unilaterally the maxillary sinus. We observed a predominance of women (sex ratio 1.9) and dental care in the past of 338/402 patients (84.1%). Environmental exposure that could interfere with aspergilloma were found in only 136 patients (33.8%) and in 21/48 (43.8%) patients who had had no dental care. CONCLUSION: Aspergilloma of the paranasal sinus has probably a multifactorial etiology, we could not point out environmental factors in this survey.

Aspergillosis↗
PubMed2001

[Treatment of acute group A beta-hemolytic streptococcal tonsillitis in children with a 5-day course of josamycin].

MATERIAL AND METHODS: In this randomized open study, 325 children aged two to 15 years with acute tonsillitis and a positive test of GA beta H streptococcal antigen were treated with josamycin 50 mg.kg-1.day-1 b.i.d for 5 days, or penicillin 50,000 to 100,000 IU/day t.i.d for 10 days. Clinical assessments and throat cultures for GA beta HS isolation were performed at the inclusion visit (V1), at the end of treatment visit (V2: day 12 for all patients) and at the follow-up visit (V3: day 30). In case of positive GA beta HS culture, the bacterial DNA by RFLP was performed to differentiate between the persistence (presence of original strain at V2), relapse (eradication at V2 and acquisition of same strain at V3) and reinfection (eradication at V2 and acquisition of different strain at V3). RESULTS: Two hundred and twenty-three patients were included in the bacteriological and clinical criteria per protocol analysis. At V2, eradication rates were comparable: 82% in josamycin and 80% in penicillin patients; clinical cure rates were 90% and 89%. At V3, relapse of GAS assessed only on clinically and bacteriologically cured patients at V2 occurred in 12% of josamycin patients and 12.8% of penicillin patients. Tolerance was good; 14% and 10% of josamycin and penicillin patients respectively experienced an adverse event. CONCLUSION: In this non-inferiority study, the efficacy of a 5-day course of josamycin is comparable to reference treatment in GA beta HS tonsillitis in children.

Acute Disease↗
PubMed2001

Current approaches to otitis media.

Acute otitis media is the most commonly diagnosed illness in children, and is one of the most common reasons for antibiotic prescription. In many countries, antibiotic resistance is increasing among the bacteria that are implicated in acute otitis media, particularly Streptococcus pneumoniae. This evolution should stimulate changes in the management of acute otitis media, particularly the following: improvement in diagnostic accuracy; reduction in antibiotic use; selection of the most appropriate drugs at the appropriate dosage; reduction in duration of treatment, when possible; and implementation of new vaccines.

Acute Disease↗
PubMed2001

[Supraglottic laryngectomy with arytenoidectomy].

Relearning to swallow is frequently difficult after supraglottic laryngectomy requiring arytenoid cartilage resection. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect without approximating the laryngeal remnants and the base of tongue. The procedure opens the median raphe and cuts the hyoid bone along the midline. The strap muscles, the perichondrium from the thyroid cartilage and thyroid lobe on the ispilateral side to the tumor are retracted laterally to be used to close the mucosal defect. Sixty-eight patients with T1-T3 carcinomas of the laryngeal margin with extension to an arytenoid in all cases and limited extension to the medial wall and/or anterior angle pyriform fossa in 33 underwent this surgical procedure. Only 5 patients had local recurrence and 8 a lymph node recurrence. Visceral metastases occurred in 21 patients (33%) and second primary tumors were diagnosed at the time of surgery or during follow-up in 19 patients (28%). Three and 5-year actuarial survival rates were 57 and 51%, respectively. Despite post operative radiotherapy, functional success was obtained in 50 patients (75%). This technique provided good tumor control and a high rate of satisfactory functional results in patients with tumors of lateral margin extended to one arytenoid.

Aged↗
PubMed2000

[Acute rhinosinusitis and sinusitis].

During the common cold in the adult, involvement of the sinusal mucosa, confirmed by CT scan, is virtually constant and justifies the term "rhinosinusitis" that is now applied. The presence of bacterial superinfection can only be demonstrated by positive laboratory results on a sample, which is never performed in usual practice; thus the practitioner must rely on presumptive factors. Among them, an essential element is the unilateral nature of painful symptoms and purulent rhinorrhoea. When symptoms are bilateral, antibiotics should not be prescribed except when the condition has not been resolved by symptomatic treatment during several days. In such cases, other important discriminating factors are also examination showing pus originating from below the middle meatus or sinusal X-ray showing a liquid level or a total opacity. On the other hand, clinical suspicion of localisation of infection in the frontal or sphenoid sinuses unquestionably requires rapid antibiotic treatment. Presently the choice of antibiotic tends toward products active on both Haemophilus producing beta-lactamase and on pneumococci with reduced sensitivity to penicillin having only a low level of resistance.

Acute Disease↗
PubMed2000

[Orbital complications of sinusitis in adults].

Orbital complications of sinusitis are rare in adults but delayed diagnosis is vision and life threatening. We report our experience in 6 patients to present clinical history, bacteriology and discuss the modality of treatment. There were 4 young men and 2 women, aged from 16 to 79 years old. Only one patient had an immunocompromised underlying condition (HIV infection). Four patients had preseptal abscesses and three post septal cellulitis or abscess (one patient had preseptal abscess and post septal abscess and hematoma). Two patients had a complete unilateral loss of light perception. Pathogens encountered were Streptococcus species: 4, strict anaerobes: 1, Pseudomonas aeruginosa: 1 (patient with AIDS). Patients recovered from infection with antibiotics in 6 and surgery in 5 but sequellar blindness occurred in 2 patients. Our experience emphasizes the necessity of antibiotic treatment in bacterial sinusitis and importance of early diagnosis and appropriate management of complications.

Abscess↗
PubMed2000

[Retro-pharyngeal and pharyngeal-laryngeal lipomas].

Pharyngeal and laryngeal lipoma are uncommon mesenchymal tumors. This report discusses the clinical and pathological features of five cases and a review of the literature. Symptoms included dysphagia, throat discomfort and airway obstruction in three patients. These complaints occurred over several years. One patient had a recurrent fibrolipoma and had experienced several surgical procedures. Surgery is the treatment of choice including conservative procedures but for large tumors open surgical approaches rather than endoscopic techniques should be employed. Recurrent tumor may be a sign of incomplete excision but also of a well-differentiated liposarcoma.

Adult↗
PubMed1999

Otogenic intracranial infections in adults.

OBJECTIVE: To assess the type and bacteriology of otologic diseases associated with bacterial meningitis in adults. METHOD: Retrospective review of 79 patients over an 18-year period. RESULTS: Acute otitis media was diagnosed in 32 patients, chronic otitis in 29 (16 with cholesteatoma), and cerebrospinal fluid leak in 18. Streptococcus pneumoniae was a common cause of meningitis-complicating acute otitis media (69%) or cerebrospinal fluid leak (50%), whereas other bacteria or negative cultures were found in the cerebrospinal fluid of patients with chronic otitis. Surgery was performed promptly in 26 patients; four patients died. CONCLUSIONS: Early diagnosis of otogenic bacterial meningitis is essential to allow appropriate antimicrobial treatment. Antimicrobials active on gram negative bacilli and anaerobes should be used in patients with chronic otitis. An emergency surgical procedure is required in patients whose neurologic or infectious status fails to improve under antimicrobial treatment.

Adolescent↗
PubMed1999

[Squamous cell carcinoma of the ENT organs in the course of the HIV infection].

UNLABELLED: The link between the occurrence of a SCC in the head and neck and human immunodeficiency virus infection is controversial. METHODS: A survey of specialists in France was carried out in 1995 to investigate it's incidence since the start of the epidemic. RESULTS: Twenty one patients (sex ratio 20/1) with concomitant HIV infection and SCC of the head and neck were evaluated. The age distribution ranged from 30 to 63 with a mean of 44 years-old. Twelve patients were under 45 years-old. There was no obvious relationship between any peculiar risk group for HIV infection and occurrence of a SCC. At the time of diagnosis of their carcinoma 10 patients had clinical and/or biological features for AIDS. Alcohol and tobacco consumption were present in twelve patients, moderate in four and absent in five patients. Oropharyngeal carcinoma was frequent in patients without risk factors and immunodepression. CONCLUSION: The high rate of young adults and patients with no or moderate risk factors for SCC suggests that SCC could be related to HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Endoscopic surgical treatment of Zenker hypopharyngeal diverticuli. Apropos of 59 cases].

We report our experience with 59 cases of Zenker's diverticulum, all treated endoscopically from 1979 to 1998. The ages ranged from 59 to 98 years. There were contraindications for conventional surgery or deep general anesthesia for all the patients. The surgical technique of endoscopic treatment was performed under general anesthesia, using a specially designed endoscope for exposure. Scissors, and after 1990 CO2 LASER, were used to divide the posterior cricopharyngeal muscle fibers. There was no major complication. Our results are comparable with literature, 92% success, even though a small diverticulum may paradoxically remain. Besides, from our experience, it may be necessary to perform two sessions for diverticulum larger than 3 cm. This safe and efficient treatment can be recommended for patients of all ages with a contraindication for conventional surgery.

Aged↗
PubMed1997

Fluticasone propionate aqueous nasal spray compared with oral loratadine in patients with seasonal allergic rhinitis.

The effectiveness and safety of fluticasone propionate aqueous nasal spray (200 micrograms once daily for 4 weeks) were compared with those of loratadine (10 mg once daily for 4 weeks) in 114 adults and adolescents with seasonal allergic rhinitis in this multicenter, double-blind, double-dummy, randomized, parallel-group study. Patients recorded their nasal symptoms (nighttime and daytime obstruction, sneezing, itching, rhinorrhea, and overall discomfort) using a 4-point scale (0 = no symptoms, 3 = very frequent symptoms) in daily diaries. Clinicians assessed patients' nasal symptoms (nighttime and daytime obstruction, sneezing, itching, and rhinorrhea) using a 4-point scale at every scheduled visit. Clinicians and patients assessed the overall effectiveness of treatment at the end of the study. Fluticasone propionate improved clinician-rated total nasal symptom scores (defined as the sum of five nasal symptoms) more than loratadine at the 2-week and 4-week assessments (P < or = 0.008). Clinicians give fluticasone propionate better global ratings than loratadine (P = 0.04). After 4 weeks of treatment, between-group differences in clinician-rated individual nasal symptoms favored fluticasone propionate (P < 0.05), with the exception of nasal itching (P = 0.11). These findings were confirmed by between-group differences in the percentages of symptom-free days calculated from patient-recorded daily diary-card data. Both treatments were well tolerated. The incidence of adverse events between groups was similar. Fluticasone propionate aqueous nasal spray 200 micrograms administered once daily in the morning was more effective than loratadine 10 mg administered once daily for the treatment of seasonal allergic rhinitis.

Administration, Intranasal↗
PubMed1996

[Clarithromycin versus amoxicillin-clavulanic acid in the treatment of acute maxillary sinusitis in adults].

The efficacy and safety of clarithromycin and amoxicillin-clavulanate in the treatment of acute maxillary sinusitis was compared in an open multicenter outpatient study. Two hundred and eighty patients were randomly assigned to receive either clarithromycin 500 mg 12-hourly or amoxicillin-clavulanate 500 mg 8-hourly orally for 8 days. Clinical and radiologic signs and symptoms, and sinus culture were not significantly different in the two treatment groups. A clinical and radiological success or improvement was achieved after the end of treatment in 115/134 (85.8%) patients treated with clarithromycin and in 110/129 (85.3%) patients treated with amoxicillin-clavulanate. Adverse events were reported for 14.8% and 12.2% of patients for clarithromycin and amoxicillin-clavulanate, respectively. In this study clarithromycin was as effective and well tolerated as amoxicillin-clavulanate acid in the treatment of acute maxillary sinusitis.

Acute Disease↗
PubMed1995

[Lymphoepithelial hyperplasia of the parotid gland and HIV infection].

A retrospective review of 10 patients with parotid enlargement is presented. Nine patients were known to be antibody positive for the HIV and one was subsequently tested to be positive. Parotid enlargement was nodular in 9 patients, bilateral in 7, unilateral in 2. One patient had a diffuse enlargement with xerostomia and xerophtalmy. Histological results confirmed begnin lymphoepithelial lesion in all patients. Pathogenesis, diagnostic, pronostic and therapeutic problems are discussed in a literature review.

Adult↗