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Points essentiels Devant un tableau d’otite externe trainante malgre un traitement bien conduit, en particulier sur un terrain immunodeprime, il faut toujours rechercher une osteomyelite de la base du crâne qui necessite un traitement antibiotique parenteral urgent de plusieurs semaines. L’otite moyenne aigue (OMA) est la plus frequente des infections bacteriennes de l’enfant. Chez l’enfant de moins de 2 ans presentant une OMA purulente, l’antibiotherapie par amoxicilline est systematique pour une duree de 8–10 jours. Apres 2 ans d’âge et si les symptomes d’OMA sont peu bruyants, un traitement symptomatique peut se justifier en premiere intention. L’otite seromuqueuse (OSM) est frequente apres un episode d’OMA et ne devient chronique qu’apres 3 mois d’evolution. La pose d’aerateurs trans-tympaniques reduit la frequence des episodes d’OMA. Toute OMA compliquee d’une meningite impose une surveillance par audiogramme et IRM de l’oreille.

Mixed nanocrystalline Ce-Zr-O oxides (Ce/Zr = 1 or 7/3) were prepared by modified Pechini route using ethylene glycol solutions of metal salts. Detailed characterization of their real structure and surface properties by X-ray diffraction on synchrotron radiation with the full-profile Rietveld analysis, high resolution electron microscopy with elemental analysis, Raman spectroscopy, UV-Vis and X-ray photoelectron spectroscopy revealed a high homogeneity of cations distribution in nanodomains resulting in stabilization of disordered cubic phase. This provides a high dispersion of NiO loaded on these mixed oxides by wet impregnation, a high reactivity and mobility of oxygen in these catalysts and strong interaction of Ni with support in the reduced state. This helps to achieve a high activity and coking stability of developed catalysts in CH4 dry reforming in feeds with CH4 concentration up to 15% and CH4/CO2 ratio =1.

Hartmut P.H. Neumann is supported by grants from the Deutsche Krebshilfe (Grant 107995 to H.P.H.N.). Stephane Richard is supported by grants from the Direction Generale de l’Organisation des Soins (French Department of Health), the Institut National du Cancer (INCa; French NCI), and the Ligue Nationale contre le Cancer (Comites du Cher et de l’Indre; French League against Cancer).

Successful treatment of acromegaly improves disease-related cardiovascular mortality and morbidity, but its effects on autonomic modulation of the heart rate are unknown.We documented treatment-induced changes in time-domain heart rate variability, taking into account the confounding effects of obstructive sleep apnea.Sixteen consecutive patients (12 males, aged 43 ± 12 y) with newly diagnosed acromegaly underwent overnight (12:00-7:00 am) cardiac Holter recordings coupled with polysomnography. Data were obtained before and 10 ± 6 months after successful treatment of acromegaly.IGF-1 levels fell from 807 ± 333 to 207 ± 69 μg/L and normalized in all patients. Seven patients (44%) had obstructive sleep apnea (apnea-hypopnea index 33 ± 21/h) at baseline. Treatment had no significant effect on polysomnographic indices. After treatment, increases were noted in the normal-to-normal heart period (NN), SD-NN, the percentage of NN differing from the previous NN by greater than 50 msec, and the root mean square of successive differences in NN (each P.05). These heart rate variability results were not influenced by the type of treatment, and there was no relationship between changes in NN and changes in the apnea-hypopnea index (P = .58).Early after successful treatment of acromegaly, we observed increased parasympathetic modulation/decreased sympathetic modulation of the nighttime heart rate, an effect that seems unrelated to changes in sleep apnea status. Treatments aimed at normalizing IGF-1 may improve cardiovascular homeostasis through improved cardiac autonomic nervous system modulation.

A unique combination of methods (TPD of O2, thermogravimetry, isotopic heteroexchange of oxygen in different modes) was used to carry out detailed studies of oxygen mobility and reactivity in mixed praseodymium nickelates-cobaltites (PrNi1 − x Co x O3 + δ) and their composites with doped cerium dioxide (Ce0.9Y0.1O2 − δ) as promising cathodic materials stable towards the effect of CO2 in the intermediate-temperature region. It is shown that in the case of composites of PrNi1 − x Co x O3+δ-Ce0.9Y0.1O2 − δ synthesized using the Pechini method and ultrasonic treatment, stabilization of the disordered cubic perovskite phase due to redistribution of cations between the phases provides high oxygen mobility. Preliminary results on tests of cathodic materials of this type supported on planar NiO/YSZ anodes (H.C. Starck) with a thin layer of YSZ electrolyte and a buffer Ce0.9Y0.1O2 − δ layer showed that power density of up to 0.4 W/cm2 was reached in the region of medium (600–700°C) temperatures, which was close to typical values for fuel cells of this type with cathodes based on strontium-doped perovskites and their composites with electrolytes.

To analyze the difference between the endolymphatic sac tumors (ELSTs) in sporadic cases and in von Hippel-Lindau (VHL) disease.Retrospective case review in a tertiary referral center.Fourteen cases of ELST, occurring since 1998, were reviewed. We analyzed the initial symptoms, characteristics of the tumor, treatment, sequelae, and follow-up for each group.The ELSTs were sporadic in 6 cases and associated with VHL disease in 8 cases. The mean age at the time of the first surgery was 26 years (range, 12-41). All except two of the patients presented with a unilateral tumor. The initial symptoms were hearing loss (n = 9), tinnitus (n = 7), and/or vertigo (n = 5). Hearing loss was more prevalent in the sporadic cases. Preoperative arteriography was performed for 4 patients, with embolization performed for 1 patient. The size of the tumor was significantly larger in the sporadic cases (31.7 mm) than in the cases of VHL disease (19.3 mm). The surgical approach was more extensive in the sporadic cases. The surgeons found 2 types of tumors. Cystic tumors with massive bleeding invading the surrounding structures (the dura mater or jugular bulb) were more common in the sporadic cases. Fibrous tumors that infiltrate the bone and have moderate bleeding were more common in the cases associated with VHL disease.Two patients with small lesions were not operated on but were followed for 6 years without tumor growth. They died of metastasis from gastric and kidney cancer. Four recurrences occurred during the 14 years of follow-up. Four facial palsies and 8 cases of profound deafness were encountered postoperatively.Sporadic tumors are more aggressive than those associated with VHL disease. Complete surgical resection should be the goal of treatment. Preoperative angiography with embolization is recommended. In some cases, embolization may be impossible, and preoperative or postoperative radiotherapy should be discussed.

The mechanism of oxygen transfer in layered nickelates having a Ruddlesden-Popper structure and their nanocomposites with Ce0.9Gd0.1O2 − δ (GDC) and Y2(Ti0.8Zr0.2)1.6Mn0.4O7 − δ (YTZM) solid electrolytes having fluorite and pyrochlore structures were studied by the oxygen isotope heteroexchange method in a flow and static reactor, thermoprogrammed desorption, and semiempirical interacting bonds method. The experimental heteroexchange data were adequately described by assuming that all atoms were equivalent in exchange in the bulk of layered nickelates, which was consistent with the cooperative oxygen migration model with fast exchange between the interstitial and regular positions. Strong interaction between the domains of the nickelate phases and solid electrolytes in nanocomposites, accompanied by a redistribution of cations between the phases, hindered the cooperative oxygen migration and led to a decrease in the diffusion coefficient as the exchange rate increased.

Resume Le cholesteatome de l’oreille moyenne est une otite chronique agressive, dont le traitement exclusivement chirurgical depend du siege de la lesion, de ses extensions au sein de l’oreille moyenne et de la mastoide, de l’existence de complications, de la conformation anatomique des cavites tympano-mastoidiennes, ainsi que de l’etat general du patient (et de ses souhaits de loisirs aquatiques). Depuis plusieurs annees, l’imagerie de l’oreille s’est imposee en pratique quotidienne comme faisant partie du bilan preoperatoire systematique d’un cholesteatome de l’oreille moyenne. L’item « imagerie du cholesteatome non opere » a fait l’objet d’une recommandation emise par la Sforl (representee par l’Afon) et par la SFR (representee par le Cireol), en octobre 2010, a l’occasion du congres annuel de la Societe francaise d’ORL et de chirurgie cervicofaciale. Cette recommandation est presentee dans cet article.

Resume Objectifs Rapporter l’experience de notre etablissement concernant l’activite d’amygdalectomie ambulatoire chez l’enfant sur une periode de sept ans et evaluer l’incidence des complications postoperatoires dans ce type de prise en charge par rapport aux amygdalectomies pratiquees en hospitalisation conventionnelle. Patients et methodes Etude retrospective sur dossiers. Resultats Sur la periode de mai 2002 a avril 2009, 276 amygdalectomies ont ete pratiquees en ambulatoire, soit 55,4 % des amygdalectomies chez l’enfant. L’âge moyen etait de 5,28 ans. Quatre-vingt-seize enfants (34,8 %) presentaient un syndrome d’apnees obstructives du sommeil (SAOS) clinique. Parmi ces 276 enfants operes en ambulatoire, la survenue d’une complication postoperatoire precoce (avant H8) a conduit a une transformation en hospitalisation conventionnelle a j0 dans six cas (2,1 %) : hemorragie precoce dans quatre cas (1,4 %) dont trois sur quatre ont necessite une reprise pour hemostase, refus alimentaire dans un cas (0,3 %), probleme parental dans un cas (0,3 %). La survenue d’une complication postoperatoire apres H8 a conduit a une re-hospitalisation secondaire dans six cas (2,1 %) : douleur et difficultes alimentaires dans deux cas (0,7 %) respectivement a j1 et j5, hemorragie dans quatre cas (1,4 %) avec reprise pour hemostase avant H24 pour un patient, j5 pour deux patients et j7 pour un patient. Un seul cas d’hemorragie est survenu entre H8 et H24. Aucune complication respiratoire n’a ete observee en perioperatoire chez les enfants qui presentaient un SAOS clinique. Conclusion Les resultats de ce travail montrent que, a l’instar des publications et meta-analyses internationales, les complications post-amygdalectomies survenant entre H8 et H24 postoperatoires, principalement hemorragiques, sont exceptionnelles. Quant aux complications respiratoires, elles surviennent le plus souvent sur des terrains a risque qui, en soit, ne relevent pas de l’ambulatoire. Ainsi, lorsque tous les criteres medicaux, sociaux et organisationnels sont reunis, l’amygdalectomie en ambulatoire est une procedure securitaire chez l’enfant.

Summary Objectives To report our centre's experience of outpatient tonsillectomy in children over a 7-year period and to evaluate the postoperative complication rate in this type of procedure compared to tonsillectomy performed in the context of conventional hospitalisation. Material and methods Retrospective review of medical charts. Results From May 2002 to April 2009, 276 tonsillectomies were performed on an outpatient basis, i.e. 55.4% of all paediatric tonsillectomies, in children with a mean age of 5.28 years. Ninety-six children (34.8%) presented clinical OSAS. Development of an early postoperative complication (before H8) required conventional hospitalisation on D0 in six (2.1%) of these 276 children operated on an outpatient basis: early postoperative bleeding in four cases (1.4%), which required reoperation to control bleeding in three cases, refusal to feed in one case (0.3%), and a parental problem in one case (0.3%). Postoperative complications occurring after H8 required readmission in six cases (2.1%): pain and feeding difficulties in two cases (0.7%) on D1 and D5, respectively, bleeding in four cases (1.4%) with reoperation before H24 for one patient, D5 for two patients and D7 for one patient. Only one case of bleeding occurred between H8 and H24. No perioperative respiratory complications were observed in children with clinical OSAS. Conclusion The results of this study show that, in line with international publications and meta-analyses, post-tonsillectomy complications between H8 and H24 postoperatively, mainly bleeding, are exceptional. Respiratory complications usually occur in high-risk clinical settings that are not eligible for outpatient surgery. Outpatient tonsillectomy is therefore a safe procedure in children presenting all of the required medical, social and organizational conditions.

Le fratture della rocca petrosa sono frequenti, in quanto le loro cause principali sono gli incidenti stradali. La loro diagnosi e la loro gestione iniziale devono essere realizzate rapidamente in un quadro di urgenza vitale che puo farle misconoscere. La stretta collaborazione tra rianimatori, radiologi e otorinolaringoiatri (ORL) e fondamentale. Le fuoriuscite di liquor cerebrospinale e la paralisi facciale sono le due complicanze la cui gestione iniziale e fondamentale. Tuttavia, le complicanze ritardate richiedono un follow-up clinico e radiologico a lungo termine.

Las fracturas del penasco (porcion petrosa del hueso temporal) son frecuentes, porque sus causas principales son los accidentes de trafico. Su diagnostico y su tratamiento inicial deben realizarse con rapidez en un contexto de urgencia vital que puede hacer que se pasen por alto. La colaboracion estrecha entre reanimadores, radiologos y otorrinolaringologos (ORL) es fundamental. Las fugas de liquido cefalorraquideo y la paralisis facial son las dos complicaciones cuyo tratamiento inicial es fundamental. Sin embargo, las complicaciones diferidas requieren un seguimiento clinico y radiologico a largo plazo.

Partial oxidation of methane (POM) into synthesis gas over a single channel of monolithic catalyst 1.4 wt% Pt/Gd0.3Ce0.35Zr0.35Ox/α-Al2O3 was investigated. The effect of the catalyst pretreatment and of the process parameters (temperature, contact time, feed composition) on the catalytic activity and synthesis gas (syngas) selectivity was studied at conditions close to realistic ones with a minimum impact of the mass and heat transfer phenomena. Experimental data are in favor of the direct route of the syngas formation via the methane pyrolysis—selective oxidation sequence.

Partial oxidation of methane (POM) into syngas at short contact times on two catalysts containing Pt/PrCeZrO and Pt/LaCeZrO deposited on single channels of a corundum monolithic substrate was investigated. The effects of the catalyst composition, pretreatment and process parameters on activity and selectivity of the syngas formation were studied. The oxygen mobility in complex oxides was shown to determine both their stability to coking and realization of a direct selective oxidation route of the syngas generation.

Resume La duree moyenne d’un traitement orthodontique conventionnel chez l’adulte est comprise entre 18 et 24 mois. Cette duree peut etre un frein a la motivation des patients pour qui le traitement multi-attache peut etre considere comme deletere a l’insertion socioprofessionnelle. Plusieurs techniques ont ete proposees afin de tenter de diminuer la duree d’un traitement. Les techniques chirurgicales de corticotomies alveolaires ont fait l’objet de travaux cliniques et experimentaux. Cependant, elles ont toujours ete realisees de facon segmentaire, sur une dent ou un groupe de dents, mais jamais de molaire a molaire sur une meme mâchoire. Nous nous sommes interesses a cette technique, tant du point de vue de son efficacite et de sa tolerance chez l’animal que par les applications cliniques qui peuvent en decouler chez l’homme. Nous presentons 3 cas de patients adultes relevant d’un traitement orthodontique et chirugical qui ont beneficie de corticotomies vestibulaires et palatines, interdentaires et sus- apexiennes, realisees de facon concomitante a l’ensemble du maxillaire et la mandibule. La duree globale du traitement a ete divisee par deux avec une tolerance excellente. Les avantages et les inconvenients des corticotomies sont discutes a la lumiere de nos resultats cliniques.

OBJECTIVE: To compare the efficacy and safety of four radio-frequency generators (Ellman, Select Sutter, Coblator, Somnus) for the treatment of simple snoring.MATERIALS AND METHODS: Multicenter, randomized, prospective single-blind study on 120 selected patients with simple snoring (apnea/hypopnea index

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 125 - N° 1 - p. 52-57

Objective: To estimate the frequency, mechanisms and predictive factors of sleep apnoea syndrome (SAS) in a large group of children and adults with type I (CMI) and II (CMII) Chiari malformation (CM). Background: The anatomical and functional integrity of both respiratory circuits and lower cranial nerves controlling the upper airway is necessary for breathing control during sleep. These latter structures may be altered in CM, and a few investigations have reported CM related sleep disordered breathing. Methods: Forty-six consecutive unrelated patients with CM (40 CMI, six CMII), of which 20 were children (eight males) and 26 were adults (12 males), underwent physical, neurological and oto-rhino-laryngoscopic examination, MRI and polysomnography. Results: SAS was present in 31 (67.4%) of the patients with CM (70% of CMI, 50% of CMII, including mainly children). Sixty per cent of children with CM exhibited SAS, including 35% with obstructive (OSAS) and 25% with central (CSAS) sleep apnoea syndrome. SAS was observed in 73% of CM adults (57.7% OSAS, 15.4% CSAS). Severe SAS was found in 23% of CM adults. Multiple regression analysis revealed that age, type II Chiari and vocal cord paralysis predicted the central apnoea index. Conclusion: SAS is highly prevalent in all age groups of patients suffering from CM. CSAS, a rare condition in the general population, was common among the patients with CM in our study. Sleep disordered breathing associated with CM may explain the high frequency of respiratory failures observed during curative surgery of CM. Our results suggest that SAS should be systematically screened for in patients with CM, especially before surgery.

A pesar de la complejidad del desarrollo de la nariz y de la region mediofacial, las anomalias congenitas nasales son infrecuentes. Los quistes y fistulas del dorso nasal, los encefaloceles y las heterotopias gliales nasales son los mas frecuentes. El riesgo consiste en ignorar una posible comunicacion con el sistema nervioso central en la fosa craneal anterior. Estas malformaciones se encuentran de forma global en alrededor de 1/40.000 nacidos vivos. Pueden aparecer con o sin obstruccion ventilatoria. Si se tiene en cuenta que los neonatos son respiradores nasales obligatorios, la obstruccion nasal suele diagnosticarse en el periodo neonatal, mientras que el diagnostico de las anomalias congenitas sin obstruccion nasal suele ser mas tardio. Este articulo incluye una descripcion embriologica de la nariz y de la region mediofacial. En el se retoman y se describen las principales hipotesis embriologicas del desarrollo de la region frontonasal, en especial la teoria del espacio prenasal de Grunwald a la luz de los recientes resultados obtenidos mediante embriologia experimental. Se describen las principales malformaciones mediofaciales, asi como sus modalidades terapeuticas.

Nonostante la complessita dello sviluppo del naso e della regione mediofacciale, le anomalie congenite del naso sono rare. Le piu frequenti sono le cisti e fistole del dorso del naso, gli encefaloceli e le eterotopie gliali nasali. Il rischio e di ignorare una comunicazione potenziale con il sistema nervoso centrale a livello del piano anteriore della base del cranio. Queste malformazioni sono complessivamente riscontrate in circa il 1/40 000 nati vivi e possono manifestarsi con o senza ostruzione ventilatoria. Tenuto conto del fatto che i neonati sono respiratori nasali obbligati, l’ostruzione nasale e generalmente diagnosticata nel periodo neonatale, mentre la diagnosi di anomalie congenite senza ostruzione nasale e in genere piu tardiva. Questo articolo comprende una descrizione embriologica del naso e della regione mediofacciale e riprende e discute le grandi ipotesi embriologiche di sviluppo della regione nasofrontale, in particolare la teoria dello spazio prenasale di Grunwald, alla luce dei recenti risultati ottenuti nell’embriologia sperimentale. Saranno descritte le principali malformazioni mediofacciali e le loro modalita di gestione.

Summary Objectives The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment. Methods Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment. Results The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia. Conclusions We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.

Resume Objectifs – Nous avons voulu verifier l'adequation aux criteres requis des parametres pharmacocinetiques/pharmacodynamiques d'Augmentin®, forme pediatrique, par mesure des concentrations d'amoxicilline et d'acide clavulanique dans le sang et le liquide auriculaire d'enfants ou de nourrissons. Methodes – Une etude pharmacocinetique, multicentrique, non comparative, ouverte, randomisee en cinq groupes selon l'heure des prelevements, a ete menee chez 36 enfants traites (80 mg/10 mg kg–1 j–1 en 3 prises pendant 3 jours). Les prelevements sanguins et auriculaires ont ete effectues simultanement. Les dosages ont ete realises par HPLC. Nous avons calcule : le pourcentage de penetration des 2 composes dans l'oreille moyenne ; le quotient inhibiteur dans le liquide auriculaire ; le temps pendant lequel les concentrations seriques et auriculaires etaient superieures a la CMI ; celui pendant lequel les quotients inhibiteurs auriculaires etaient superieurs a 5 ; le rapport des aires sous courbe sur la CMI serique et auriculaire. Resultats – Pour l'amoxicilline : les CA etaient de 7,23 ; 7,40 ; 7,08 ; 6,01 et 3,31 mg/l a 1 h, 2 h, 3 h, 8 h et 12 h. Les CS s'echelonnaient de 14,5 mg/l a 0,46 mg/l. Pour une CMI de 1 mg/l, ces valeurs correspondaient a un T > CMI de 66 % dans le sang et de 100 % dans le liquide auriculaire et un quotient inhibiteur maximum de 7,5 dans ce dernier. Pour l'acide clavulanique, les CA etaient de 0,58 ; 0,94 ; 0,62 ; 0,11 et 0,11 mg/l a 1 h, 2 h, 3 h, 8 h et 12 h (valeurs superieures a celles qui inhibent in vitro les betalactamases d'H. influenzae et de M. catarrhalis. Conclusion – Le schema etudie est en adequation avec les prerequis pharmacodynamiques des betalactamines.

Wegener's granulomatosis (WG) is a severe and potentially lethal granulomatosis. Even though no specific radiological criteria exist, CT may suggest the correct diagnosis at an early stage. Recent improvement in the prognosis is related to earlier diagnosis, allowing the initiation of efficient and specific treatment before any severe complications occur. We reviewed a series of WG cases in order to establish the CT diagnostic criteria.

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.

Insulin-like growth factor-I (IGF -I) is likely to be an indicator of somatotropin (ST) administration in the horse. To investigate the different ways ST administration may be detected, the following aspects of IGF -I concentrations in plasma were studied: (i) the daily variation; (ii) variation following a treadmill test; (iii) concentrations at rest and after exercise; and (iv) concentrations in plasma from two young horses and two adults treated with methionyl equine somatotropin (e ST). In the population of horses at rest, IGF -I mean concentration (SEM) was 261 (104) ng ml(-1). In post race samples, IGF -I mean concentration was 187 (100) ng ml(-1). All of these data indicate that exercise does not modify IGF -I concentration in plasma. The magnitude of the increase in IGF -I following administration of e ST differed according to the age of the horses. The critical value of 700 ng ml(-1)was exceeded for 1 day in adult horses and for at least 11 days in young horses. These results show that IGF -I has potential as an indirect marker of ST administration in horses.

Insulin-like Growth Factor I is a marker of Somatotropin administration. In order to quantify this peptide in horse plasma samples, a high performance liquid chromatography/electrospray mass spectrometry method using R3 Insulin-like Growth Factor I as internal standard was developed. The extraction procedure involves an acid ethanol extraction and an immunoaffinity purification. Quantification is made possible by using deconvolution software and by measuring the insulin like growth factor-I/internal standard ratio. Comparison between high performance liquid chromatography/electrospray mass spectrometry and two immunological methods indicated agreement between methods even though more samples are needed to confirm this finding.

The insulin-like-growth-factor-I (IGF-I) peptide is known to be a marker for growth hormone administration. The development of a quantification method by electrospray ionization mass spectrometry (ESI-MS) coupled with high-performance liquid chromatography (HPLC) is required. This paper describes a method to quantify IGF-I using the internal standard R3 IGF-I in its oxidized forms. A deconvolution software was used to quantify the set of multi-charged molecules recorded on an ESI ion trap mass spectrometer. The results (i.e., linearity, reproducibility and concentration range) were obtained on standard samples and the described LC-ESI-MS method should be applicable to biological samples.

The mdx mouse is a widely used animal model of human muscular dystrophy. Although diaphragm muscle exhibits severe muscle weakness throughout the life of the animal, the limb muscle function of mdx mice spontaneously recovers by 6 mo of age. Pharyngeal dilator muscles such as sternohyoid (SH) contribute to upper airway patency during breathing. We hypothesized that SH muscle function was impaired in 6-mo-old mdx mice. Mechanical properties and myosin heavy chain (MHC) composition were investigated in isolated SH from 6-mo-old control (C, n = 10) and mdx (n = 10) mice. As compared with C, peak tetanic tension (Pmax) and maximum shortening velocity were 50% and 16% lower in mdx mice (p0.001 and p0.05, respectively). Peak mechanical power was lower in mdx than in C (19.0 +/- 3.2 versus 57.4 +/- 5.1 mW g(-)(1), p0.001). Both C and mdx SH were composed exclusively of fast myosin isoforms. As compared with C, mdx SH presented a higher proportion of IIX-MHC and a reduction in IIB-MHC (each p0.001). In conclusion, our results demonstrated severe SH muscle dysfunction in 6-mo-old mdx mice, that is, at a time when limb muscle function has recovered. Thus, SH muscle of the mdx mouse may be an excellent muscle for studying Duchenne muscular dystrophy.

The authors report a series of eight cases of isolated tracheoesophageal fistula without esophageal atresia (or an H type fistula), treated in three pediatric ENT departments. This is a rare malformation whose diagnosis requires investigation for associated anomalies. The clinical signs are mainly respiratory but also digestive and the symptomatology can be severe. The diagnosis can be made with a barium swallow combined with cineradiography, but a tracheoesophageal endoscopy remains the investigation of choice. The treatment is surgical. In most cases, the fistula is accessible by a right or left cervicotomy, depending on the surgeon's practice, with a much lower postoperative morbidity as compared to a thoracotomy. The postoperative management was straightforward in most of our cases. We discuss the role of gastro-esophageal reflux with respect to postoperative morbidity as well as systematic treatment for reflux peri-operatively. The pros and cons of the various surgical approaches are also discussed.

Le reflux gastro-œsophagien est habituellement une pathologie benigne, spontanement resolutive, se manifestant principalement par des signes digestifs. Plus recemment, des manifestations laryngotracheales a type de laryngospasme, laryngomalacie, laryngites recidivantes, etc., ont ete imputees au reflux gastro-œsophagien. Toutefois, les mecanismes liant ces deux pathologies ne sont pas univoques et restent controverses. Le diagnostic de reflux gastro-œsophagien repose principalement sur la pHmetrie prolongee dont la negativite ne permet malheureusement pas d'eliminer la responsabilite du reflux. C'est donc en definitive en presence d'un faisceau d'arguments suffisant, l'efficacite du traitement anti-reflux qui va permettre de rattacher a celui-ci les manifestations laryngotracheales observees.

Resume Au sein des otites moyennes definies comme l'atteinte inflammatoire de la caisse du tympan, des cavites annexes et de la trompe d'Eustache, il est interessant chez l'enfant d'individualiser les otites moyennes avec epanchement. Celles-ci comportent cinq entites toutes identifiables cliniquement grâce aux donnees de l'otoscopie, grâce a l'allure evolutive et au contexte. Il s'agit de l'otite moyenne aigue, de l'otite moyenne aigue prolongee, de l'otite moyenne avec epanchement residuel, de l'otite moyenne avec epanchement persistant et de l'otite moyenne aigue recidivante. L'otite moyenne aigue associe des signes generaux et des signes locaux. D'origine infectieuse, elle guerit parfois au prix d'un epanchement residuel qui va durer plusieurs semaines definissant l'otite moyenne avec epanchement residuel. La persistance de cet epanchement au dela de trois mois, et en l'absence de signe patent d'infection, definit l'otite moyenne avec epanchement persistant (ou otite sero-muqueuse). Parfois, l'otite moyenne aigue se prolonge au-dela de trois semaines en raison de la persistance du phenomene infectieux. Favorisee par un epanchement pre-existant, elle correspond a l'otite moyenne aigue prolongee. L'otite moyenne aigue recidivante correspond a la survenue de trois episodes d'otite moyenne aigue en moins de six mois. Cette notion d'otite moyenne avec epanchement est importante car elle attire l'attention sur le continuum existant entre les differentes formes d'otite moyenne, continuum qui peut aboutir a des formes d'otite chronique graves. Elle peut egalement constituer un diagnostic d'attente lorsque les donnees cliniques, en particulier, evolutives et les antecedents font defaut.

INTRODUCTION Osteoma is a benign slow growing bone tumor with a prevalence of 3% of all benign paranasal sinuses tumors, with a peak incidence between the fourth and sixth decades, mostly involving frontal sinuses.1 PRESENTATION OF CASE We present a case of a large right ethmoidal sinus osteoma in a 12-year-old boy, complaining of frontal headaches and excessive lacrimation of the right eye. CT scan showed a very large tumor in the right anterior ethmoidal sinus (30 mm × 25 mm × 15 mm). DISCUSSION Large osteomas of the paranasal sinuses are usually resected by external approaches. However, the minimally invasive endonasal approach, which minimizes external facial scarring, is challenging for such large lesions in pediatrics. In the presented case, the osteoma was successfully resected exclusively by endoscopy-guided endonasal approach assisted by neuronavigation, with no peri or postoperative complications. CONCLUSION An endoscopic approach assisted with neuronavigation may be a minimally invasive and safe procedure for managing large osteoma of the ethmoidal sinus in pediatrics patients.

To study the predictive value of pretreatment potential doubling time and labeling index, as measured by flow cytometry in patients with head and neck squamous cell carcinoma treated with conventional radiotherapy.70 patients with a squamous cell carcinoma of the oropharynx and 4 patients with another involved head and neck site were entered in this prospective study. The duration of the S phase (TS), the labeling index (LI), and the potential doubling time (Tpot) were obtained by flow cytometry measurements of a tumor biopsy obtained after i.v. injection of 200 mg bromodeoxyuridine to the patient. The treatment consisted of 70 Gy in 7 weeks, 2 Gy per fraction and five fractions per week.The mean and median LI were 7.7% (standard deviation, SD: 5.0) and 6.3%, respectively. The mean and median TS were 9.3 h (SD: 3.6) and 8.3 h, respectively. The mean and median Tpot were 5.6 days (SD: 5.4) and 4.6 days, respectively. No significant relationship was found between the Tpot or LI and the tumor stage (T), nodal status (N), histological grade, and the site of the primary within the oropharynx. The only parameter significantly associated with an increased risk of local relapse was the tumor stage (p0.001). The mean Tpot for the group of tumors that relapsed locally was 5.3 days (SD: 3.3), compared to 6.1 days (SD: 4.08) for those who did not relapse locally (NS). Two parameters were significantly associated with a decrease in disease-free (DFS) and overall survival, namely the tumor stage (p0.005, and p0.001, respectively, for DFS and overall survival) and nodal involvement (p = 0.02 and (p0.005, respectively, for DFS and overall survival). The TS, LI, DNA index, and Tpot were not significantly associated with local relapse, DFS, and survival, either in the univariate or in the multivariate analysis.The method used to evaluate tumor cell kinetics did not provide clinically relevant kinetic parameters for this type of cancer. The classic prognostic factors (tumor stage and nodal status) were strongly associated with clinical outcome.

Objectif Les auteurs presentent un cas de carcinome epidermoide developpe sur un kyste du tractus thyreoglosse chez une adulte. Les modalites de prise en charge et la necessite d’une prevention sont discutees. Patient et methode Patiente de cinquante-cinq ans suivie pour un kyste du tractus thyreoglosse en raison d’un refus parental d’une chirurgie au cours de l’enfance. Resultats Le diagnostic a ete evoque sur une augmentation de volume et des douleurs cervicales. En raison d’un envahissement carotidien et de l’axe larynge, le traitement radiochirurgical n’a pas permis de guerison bien que l’evolution locale soit controlee par une chimiotherapie palliative avec deux ans de recul. Discussion L’exerese dans l’enfance des kystes du tractus thyreoglosse (KTT) est davantage pratiquee afin de prevenir des poussees infectieuses qu’une transformation maligne. Bien que faible, le risque de developpement d’un carcinome sur kyste du tractus thyreoglosse est certainement sous-evalue en raison d’une chirurgie d’exerese preventive tres souvent realisee dans l’enfance. Conclusion L’evolution dramatique du cas presente nous amene a recommander encore une fois une chirurgie d’exerese preventive de ce type de malformation, et a discuter les modalites de prise en charge de ce type d’evolution.

Parotidectomy leaves a retromandibular hollow area in proportion with the amount of gland resected. Many surgeons perform primary reconstruction after superficial or subtotal parotidectomy in patients with exo-facial pleiomorphic focal adenoma. Many techniques have been proposed. We present a new technique of filling of the parotidectomy chamber by a second generation leucocyte and platelet concentrate, Platelet-Rich Fibrin (PRF, Choukroun's method).10 patients were included in this preliminary study. Subtotal parotidectomy was performed through classic procedure or lifting procedure. The macroscopic security margin of resection usually allowed performance of a SMAS flap. PRF was prepared following the original Choukroun's method.PRF slow resorption after filling of the exeresis cavity, offers a key aesthetic interest. The fibrin matrix of this biomaterial has many angiogenic and healing properties. Synergetic action of the fibrin and the platelets cytokines within PRF may improve revascularization and postoperative resumption of facial nerve function. The membrane formed by the fibrin dense fibrillary network, as well as the SMAS flap, may help to prevent the Frey's syndrome.We propose the use of PRF as a filling, healing and interposition material after parotidectomy for benign parotid tumors. Preliminary results are very encouraging. Longer prospective evaluation of this technique is necessary.

Gastroesophageal reflux is generally a benign condition, which resolves spontaneously, and which is usually manifested by digestive signs. More recently, laryngotracheal conditions such as laryngospasm, laryngomalacia and recurrent laryngitis, have been ascribed to gastroesophageal reflux. However, there is not a single common mechanism linking these two pathologies and different theories are postulated. Diagnosis of gastroesophageal reflux is based essentially on prolonged pH monitoring, where a negative result unfortunately cannot rule out reflux responsibility. Thus, in the end, in the face of a sufficient body of evidence, it is the effectiveness of the anti-reflux treatment which will make it possible to establish a link between gastroesophageal reflux and the laryngotracheal manifestations observed.

Emdoscopy forms part of the everyday diagnostic arsenal in every sector of otorhinolaryngology The investigation of the cavities of the nasal sinuses, the middle ear and, more recently, the cerebellopontine angle have greatly benefited from progress in this internal visualization [1]. The threshold between diagnostic and therapeutic endoscopy was soon crossed and the operating channel which served for palpation was rapidly occuped by laser fibers or instruments appropriate for therapeutic procedures. Easy visual acess to the deep cavities was followed by surgical therapeutic procedures with better monitoring of the operative procedure and its final outcome.

Hemangiomas are tumors. Hemangiomas near the geniculate ganglion or in the internal acoustic meatus are well known but rare. We present two cases of hemangiomas located at the porus acusticus, an even more rare site. MRI showed a millimeter-sized tumor, located in the porus acusticus, developing perpendicular to the axis of the acoustico-facial nerves, surrounding them. They were hyperintense on T1-weighted images, strongly hyperintense on T2-weighted images with a characteristic progressive and marked enhancement after injection of gadolinium DTPA. Similar signal abnormalities were present in the adjacent temporal bone, and CT scan demonstrated a honeycomb appearance with intratumoral bony spicules. These imaging criteria allows differentiation between hemangioma and neurinoma. We hypothesize that this location is related to the presence of a rich vascular plexus of the dura mater in this area.

But de la presentation Presenter les particularites des cholesteatomes extensifs du rocher. Materiel et methodes Il s’agit d’une serie retrospective de 13 patients operes d’un cholesteatome extensif du rocher entre novembre 2007 et mars 2014. Les donnees cliniques, audiometriques, radiologiques pre- et postoperatoires, l’aspect peroperatoire, et le suivi operatoire ont ete analyses. Resultats La serie comprend 5 femmes et 8 hommes avec un âge moyen de 52 ans. Il s’agissait de 10 cholesteatomes acquis et 3 congenitaux. Onze patients presentaient des antecedents otologiques ipsilateraux dont 7 tympanoplasties pour cholesteatome, 2 en technique fermee et 5 en technique ouverte. Le cholesteatome etait etendu dans la region supralabyrinthique (1 cas), infralabyrinthique (5 cas), supra- et retrolabyrinthique (4 cas), supra-, retro- et infralabyrinthique (2 cas), retro- et infralabyrinthique (1 cas). Cinq patients avaient une atteinte du labyrinthe posterieur et un des labyrinthes anterieur et posterieur. Les signes revelateurs etaient l’hypoacousie, l’otorrhee et la paralysie faciale. Deux patients ont ete operes en technique fermes et 11 en technique ouverte, il y a 6 abords labyrinthiques et 11 exclusions d’oreille moyenne. La matrice du cholesteatome etait difficile a decoller sur le sinus sigmoide, le golfe de la jugulaire, la meninge cerebelleuse et la portion labyrinthique du nerf facial. Le suivi moyen est de 27,5 mois. Deux patients ont ete perdus de vue, 2 patients ont un suivi actuel inferieur a 6 mois. En postoperatoire, 3 patients avaient des vertiges, 8 une cophose. Une seule paralysie faciale a completement recupere au bout de 2 ans, 3 patients conservant la leur. La surveillance etait clinique et une IRM etait demandee a 1 an puis a 3 ans. Il y a eu 7 cholesteatomes residuels. Conclusion Le cholesteatome extensif du rocher necessite une prise en charge techniquement difficile. L’exerese est souvent difficile en raison d’une adherence importante de la matrice du cholesteatome a la meninge de fosse posterieure, au golfe de la jugulaire et a la gaine de la premiere portion du nerf facial. Les complications sont frequentes. Le suivi est important en raison du risque de residuel eleve. Il faut aussi savoir preserver la qualite de vie des patients et en particulier, leur fonction faciale, c’est pourquoi on peut discuter de surveiller certains residuels.

But de la presentation Decrire une tumeur rare de l’oreille moyenne, l’adenome. Bien que consideree comme une tumeur benigne, elle presente un risque de recidive non negligeable voire un comportement local agressif avec quelques cas de transformation maligne. Materiel et methodes Il s’agit d’une etude retrospective portant sur 6 cas d’adenomes de l’oreille moyenne, pris en charge et operes dans 2 centres entre 2000 et 2013. Les donnees cliniques, audiometriques, radiologiques pre- et postoperatoires, l’aspect peroperatoire et les caracteres histologiques et immuno-histochimiques des tumeurs ont ete etudies. Resultats Six hommes, âges de 22 a 52 ans, ont beneficie d’une exploration chirurgicale de l’oreille. Les signes fonctionnels de decouverte etaient une hypoacousie unilaterale dans 5 cas, des acouphenes, une paresie faciale ou des vertiges dans 1 cas. L’otoscopie a retrouve dans deux cas un polype charnu du conduit auditif externe, et dans les quatre autres cas une masse retro-tympanique. L’audiogramme confirmait la transmission. Dans tous les cas, le scanner retrouvait un comblement atrio attico antral, une chaine ossiculaire continue parfois demineralisee. L’IRM a montre une prise de contraste du facial chez un patient et une masse tissulaire avec retention mastoidienne chez deux autres. En peroperatoire, on visualisait une tumeur charnue polylobee, parfois friable blanche a brune. L’analyse histologique et immuno-histochimique confirmait le diagnostic d’adenome de l’oreille moyenne, avec un double contingent cellulaire, neuro-endocrine et glandulaire. Six tympanoplasties en technique fermee ont ete realisees avec sacrifice ossiculaire dans 4 cas. Un patient a ete opere pour une recidive locale a 3 puis a 6 ans. Un autre a presente 5 recidives loco-regionales, avec une extension a la base du crâne, puis a la glande parotide. Dix ans apres le diagnostic initial, sa tumeur s’est transformee en adenocarcinome avec metastases osseuses. Conclusion Consideree comme benigne, l’adenome de l’oreille moyenne n’en reste pas moins une tumeur au risque de recidive, avec des cas rares de transformation maligne. Son diagnostic est a evoquer devant toute tumeur de l’oreille moyenne. Le diagnostic definitif reste histologique. Le traitement de reference est l’exerese chirurgicale radicale. Un suivi a long terme est recommande, afin d’eliminer une recidive locale ou regionale.

But de la presentation Etudier les resultats anatomiques et fonctionnels et definir des facteurs predictifs d’echec des ossiculoplasties par prothese en titane Kurz. Materiel et methodes Etude retrospective de 130 ossiculoplasties (87 TORP et 43 PORP) sur 7 ans dans une population adulte. Les donnees anatomiques et audiometriques ont ete analysees en pre-operatoire, a court (55 jours) et moyen terme (30 mois). Des facteurs predictifs d’echec ont ete analyses par test de Chi2 et regression logistique. Resultats Pour l’ensemble de la serie : a 55 jours le Rinne residuel est de 19,0 dB, le taux d’echec de 19,2 %, a 30 mois le Rinne residuel est de 22,2 dB, le taux d’echec de 30,6 %. Les resultats fonctionnels sont meilleurs pour les PORP que pour les TORP (taux d’echec de 9 % contre 24,1 % a court terme, de 27,2 % contre 32 % a moyen terme). Pour les 72 patients suivis a moyen terme, les resultats sont stables. Le taux d’extrusion est de 0,8 %. Les facteurs de risque d’echec significatifs en analyse multivariee sont : l’absence de manche du marteau, la reprise d’otospongiose, le temps operatoire egal ou superieur a 4, le manque d’experience du chirurgien et le type de prothese TORP. Conclusion Le retablissement de l’effet columellaire par prothese en titane Kurz donne des resultats anatomiques et fonctionnels satisfaisants. Ils sont cependant moins bons principalement en cas de prothese TORP plutot que PORP, d’absence de manche du marteau et de temps operatoire egal ou superieur a 4.

Objectives To determine the incidence of Staphylococcus aureus isolates with reduced susceptibility to glycopeptides among all clinical isolates collected consecutively in two French hospitals between November 1998 and April 1999. Methods Methicillin-resistant and -susceptible S. aureus isolates were screened on vancomycin- or teicoplanin-supplemented agar plates. Glycopeptide MICs were determined by the E test procedure with a high inoculum and by an agar dilution technique. Glycopeptide-intermediate S. aureus isolates were identified as homogeneously or heterogeneously resistant to vancomycin by performing population analysis. Results Of the 640 isolates recovered from 518 patients, three from the same patient and two from two different patients showed homogeneous or heterogeneous intermediate resistance to vancomycin. Conclusion The incidence of glycopeptide-intermediate S. aureus (homogeneously or heterogeneously resistant) in a non-selected patient population, i.e. regardless of predisposing factors and glycopeptide therapeutics, remains low in the two French hospitals involved in the study, representing 0.6% of isolates.

Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 50-year-old patient presented with chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses. This is the fourth case reported to date in the literature. The clinical manifestations of the tumor were very limited, and the appearance at rhinoscopy was misleading. Radiologic imaging showed a soft tissue lesion invading the adjacent bony structures and the dura mater. Surgery was performed by a combined team of otorhinolaryngologists and neurosurgeons, and total excision of the tumor was achieved. The histologic diagnosis of this tumor is difficult because of its similarities to chondrosarcoma. [Editorial comment: The authors concisely review management of this rare tumor, emphasizing that complete surgical excision, rather than curettage, is required for long term control.]