Current therapeutic indications in laryngeal stenoses in children]

Among pediatric patients with laryngeal stenosis, acquired forms are now more common than congenital forms. External surgery is not always warranted except in complete or tight obstructions. After establishing the diagnosis by endoscopy, consequences on respiration and phonation should be assessed before deciding on the most appropriate treatment: abstention, medical therapy, endoscopic treatment, or surgical treatment by the cervical route. Surgical laryngoplasty techniques have changed radically over the last twenty years. The Cotton procedure is the most widely used. Another available method is the cricoid-split technique. These laryngoplasty procedures can be performed from birth and tracheostomy is now warranted only after failure of initial surgery.     

Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital. Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation. The operative and anesthetic technique is described in detail, together with any possible adverse events. The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.     

Posterior Laryngeal Clefts: Preliminary Report of a New Surgical Procedure Using Tibial Periosteum As an Interposition Graft

Objective: To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair. Design: Retrospective study in an academic tertiary care center. Method: The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheaI intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery. Main Outcome Measure: Clinical and endoscopic follow-up was used for evaluation of results. Results: The three patients had successful laryngeal repair at a mean follow-up of 6 months (range, 4-14 mo). Conclusion: The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow-up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.     

原发性十二指肠恶性肿瘤的X 线诊断

目的　探讨X线诊断原发性十二指肠恶性肿瘤的价值。方法　回顾性分析 2 1例原发性十二指肠恶性肿瘤的X线所见并与手术病理对照。结果　X线表现包括充盈缺损、黏膜改变、肠腔狭窄和龛影。结论　根据临床及X线表现 ,术前可以正确诊断原发性十二指肠恶性肿瘤。     

内毒素耐受THP-1细胞中糖皮质激素受体-α在炎症反应中的作用

目的:应用脂多糖(Lipopolysaccharide,LPS)刺激人单核细胞白血病细胞系THP-1细胞,模拟体外脓毒症模型,了解单核细胞系统在产生内毒素耐受时,糖皮质激素受体-α(Glucocorticoid receptor-α,GR-α)在转录水平上的表达。方法:用无血清培养基培养人THP-1细胞,将细胞随机分为4组(A、B、C、D),分别用不同浓度LPS刺激THP-1细胞24 h后,再改变LPS浓度刺激上述各组细胞24 h,分别提取RNA和蛋白质,以逆转录聚合酶链反应(RT-PCR)检测GR-α的mRNA表达,用西部印迹法(Western Blotting)检测NF-κB蛋白质表达,以酶联免疫吸附试验(ELISA)检测培养液中肿瘤坏死因子-α(TNF-α),白细胞介素1β(IL-1β),白细胞介素10(IL-10)水平。结果:A、B、C、D组GR-αmRNA与-βactin比值,NF-κB蛋白与GAPDH比值差异有统计学意义(P<0.01),在受到LPS刺激时,GR-αmRNA与NF-κB蛋白的表达负相关(r=0.816,P<0.01)。结论:内毒素耐受的THP-1细胞GR-α表达上调,这可能在THP-1细胞的内毒素耐受时炎症反应的发生起到重要作用。     

Medical information prior to invasive medical procedures in otorhinolaryngology-head and neck surgery in France

Based on a review of the medical literature (PubMed database, keywords: medical information, informed consent), the authors analyse the main medicolegal aspects concerning the patient information that must be provided in France prior to any invasive diagnostic or therapeutic medical procedures in otorhinolaryngology head and neck surgery, as well as the patient's perception and recall of the information provided, the quality of the information provided and problems encountered in providing this information. In the light of this review, several solutions are recommended to improve this essential phase prior to obtaining the patient's informed consent.     

Comparaison de l’hospitalisation à domicile et de l’hospitalisation conventionnelle dans la prise en charge des ruptures prématurées des membranes

Objective

Premature prelabour rupture of membrane (PPROM) is associated with an increased risk for both mother and fetus. Expectant management is usually advised under hospital supervision. Home care is associated with reduced cost. However, its safety in PPROM management has not been well established. Our objective was to assess neonatal and maternal outcome in pregnancies complicated by PPROM comparing home care to in-hospital management.

Study design

Retrospective study in two tertiary centers over a two-year period between January 2009 and December 2010. We included all singleton pregnancies with a history of PPROM which occured between 24 and 35 weeks of gestation. We compared women with PPROM and in-hospital management in Center 1 (Group 1; N = 42) to women with PPROM and a home care after a short period of observation in Center 2 (Group 2; N = 32), and. We studied gestational age at delivery, pregnancy complications, mode of delivery and neonatal outcome.

Results

Demographic characteristics were similar at onset of PPROM between the two groups.Women in group 2 delivered later than in group 1 (234.8 ± 19.54 days vs 224.6 ± 22.02 days; P = 0.04). There was no difference between the groups in pregnancy complications including chorioamnionitis, delivery issue and neonatal outcome. The length of stay in neonatal intensive care unit was higher in group 1 compared to group 2 (N = 43.51 ± 2.67 days for group 1 vs. N = 24.21 ± 2.72 days for group 2; P = 0.0003).

Conclusion

Home care appears to be a safe option for women with PPROM between 24 and 35 weeks with stable condition. These preliminary findings suggest performing a randomized control trial with a higher number of women, including further data such as assessment of maternal satisfaction and cost analysis.     

Fetal heart rate variability analysis for neonatal acidosis prediction

Journal of Clinical Monitoring and Computing - Fetal well-being during labor is usually assessed by visual analysis of a fetal heart rate (FHR) tracing. Our primary objective was to evaluate the...