[Hearing status of Robin sequence patients]

OBJECTIVE

To determine wether Robin sequence is a risk factor for conductive and/or sensorineural hearing loss.

PATIENTS

13 children with type III Robin sequence, admitted in our institution between 1984 and 1997 for tracheotomy were enrolled in this retrospective study.

METHODS

Each child had several audiological evaluations including subjective and objective methods adapted to their age. Subjective methods were audiometric tests, objective methods were Click Evoqued Otoacoustic Emissions and Auditory Brainstem Response.

RESULTS

3 children had normal hearing, 10 children had a conductive hearing loss caused by middle ear effusion, 4 patients had also a congenital permanent sensorineural evolutive hearing loss. Among the 4 infants with a sensorineural hearing loss, 2 had a polymalformative syndrome, and 2 had an isolated Robin sequence.

CONCLUSION

Robin sequence is a risk factor for sensorineural hearing loss and conductive hearing loss. This hearing loss should be assessed as soon as possible after birth by otoscopy, click-evoqued otoacoustic emissions, auditory brainstem response and audiometric tests.

Appearance and evolution of calcitic and aragonitic otoconia during Pleurodeles waltl development

The aim of this study is to determine the stages of appearance, morphology, crystallographic structure and chemical composition of otoconia during the inner ear development of an urodele amphibian, Pleurodeles waltl. The first otoconia are detected in the otocyst. Near hatching, calcitic otoconia are polyhedral in the saccule and cylindrical in the utricle. During the following stages, the saccular otoconia agglomerate and constitute a polyhedral calcitic otolith. At larval stage 44, aragonitic fusiform otoconia appear on the otolithic surface. At stage 52, X-ray diffraction analysis shows calcite and aragonite patterns. In adults, all the saccular otoconia are aragonitic. In contrast, the utricular otoconia do not show any modification up to adulthood. In the endolymphatic sac, otoconia appear at stage 45 and in the lagena at stage 49. They remain aragonitic up to adulthood. Energy dispersive X-ray spectroscopy (EDXS) elemental analysis of the otoconia reveals a high quantity of calcium with trace quantities of sodium, magnesium, phosphorus, sulfur, chlorine and potassium. However, magnesium and sulfur have a lower concentration in lagenar aragonitic otoconia than in utricular and saccular calcitic ones. As in adults, trace amounts of strontium are only found in aragonitic otoconia.

The influence of cylindrical geometry on X-ray stress tensor analysis. II. Applications

The usual formulation used for determining stresses by X-ray diffraction with a flat specimen is not valid when the sample has a curved surface. In the first paper of this series [Françoiset al.(1995).J. Appl. Cryst.28, 761–767], a general formulation was presented, showing that two effects arise simultaneously: a translation and a rotation effect. In the present paper, analytical formulae, derived from the general expression and valid under certain assumptions, are given. They exhibit a linear relation between the measured strain and sin2ψ and they can be used in many practical cases. Experimental and numerical examples of the use of the simplified and the general formulation on thick and thin wires, thin layers on wires, convex and concave specimens, and isotropic and textured samples are given. The range in which the classical and the present formulation are valid is also studied.

Implementation of a database on drugs into a university hospital Intranet

Several databases on drugs have been developed worldwide for drug information functions whose sources are now electronically available. Our objective was to implement one of them in our University hospitals information system. Thériaque is a database which contains information on all the drugs available in France. Before its implementation we modeled its content (chemical classes, active components, excipients, indications, contra-indications, side effects, and so on) following an object-oriented method. From this model we designed dynamic HTML pages according to the Microsoft's Internet Database Connector (IDC) technics. This allowed a fast implementation and does not imply to port a client application on the thousands of workstations over the network of the University hospitals. This interface provides end-users with an easy-to-use and natural way to access information related to drugs in an Intranet environment.

X-ray diffraction texture analysis of cylindrical samples

The effect of the curvature of the sample surface on X-ray diffraction has been studied. A theoretical model, based on a ray-tracing method, has been developed to take into account the geometric effects which modify the collected intensities. The model enables alignment corrections for the sample and the incident beam, in relation to the goniometer centre. This can be achieved by comparing experimental normalized intensities for a zero tilt angle (ψ = 0°) to the normalized intensities calculated by the model. The texture analysis of a zircaloy-4 tube (with a 9.5 mm diameter and an incident-beam spot size of 1.2 mm diameter) confirms the validity of the results.

Texture and residual-stress analysis using a kappa goniometer

A kappa goniometer allowing the analysis of large samples (thickness up to 60 mm) has been constructed. It was designed to perform the analysis of crystalline texture and residual stress by X-ray diffraction with both χ- (or Ψ-) and Ω-type assembly configurations. Tilt-angle values up to 80° and 2θ values up to 165° can be reached. Validation has been achieved by checking the setting precision and the assembly reliability for the two types of configuration for which the system has been designed.

Crystallographic and chemical composition of otoconia in the salamander Pleurodeles waltl

The aim of the present study was to define the morphology and the crystallographic and chemical composition of otoconia in different regions of the inner ear in Pleurodeles waltl (urodele amphibian). The inner ear of adults was microdissected and otoconia were analyzed by scanning electron microscopy (SEM), X-ray diffraction, energy dispersive X-ray (EDX) and transmission electron microscopy. Two types of crystals were detected by SEM. Otoconia had different shapes depending on their location in the membranous labyrinth. One type had a cylindrical body with a triplanar smooth facet at each end, the other ones had either a prismatic shape with flat sides and end faces or a fusiform shape with rounded body and pointed end. The forms corresponded to those previously identified by other authors. These two types of otoconia had different X-ray diffraction patterns. The cylindrical otoconia were calcitic and located in the utricle, the other ones were aragonitic and located in the saccule, lagena and endolymphatic sac. An analysis by EDX indicated that both types of otoconia contained about 95% calcium with trace quantities of sodium, magnesium, phosphorus, sulfur, chlorine and potassium. Trace amounts of strontium was only found in the aragonitic otoconia.

[Surgical management of laryngeal stenosis in children]

Surgical management of children with laryngotracheal stenosis changed recently because of the procedure of single-stage approach. Between January 1992 and April 1997, 101 children underwent surgery for laryngotracheal stenosis in our department: 47 of them had a single stage procedure, and 54 a classic laryngotracheoplasty with stenting with an Aboulker's tube or silastic sheets. The majority of the cases were acquired stenosis (64%) and the others congenital. The degree of stenosis was graded into four categories according to Cotton's classification. Thirty six cases were grade 2, 44 cases were grade 3, 21 cases were grade 4. Subglottic localization of the stenosis was found in 64% of the cases and the mobility of the vocal folds was normal in 60% of the cases. The surgery was considered successful after one procedure when there was a permanent and permeable laryngotracheal lumen (no more than grade 1) not requiring a tracheotomy. Of the 47 single-stage procedures, 38 were successful (81%); of the 54 cases managed with classic methods, 30 were successful (55%). These results and the indications of the different surgical procedures are discussed.

[The value of orbital ultrasonography in ethmoid sinusitis in children]

PURPOSE

To assess the value of orbital sonography (US) compared to CT in the management of children with ethmoid sinusitis.

MATERIAL AND METHODS

A total of 13 consecutive patients admitted for non-complicated ethmoid sinusitis (absence of visual or neurological symptoms) were prospectively evaluated at US and CT.

RESULTS

Three patients had no evidence of postseptal involvement at US. Ten patients had variable degree of postseptal involvement at US: hypoechoic area or fluid collection in the extraconal fat along the medial orbital wall. Results were confirmed at CT in all patients.

CONCLUSION

US is useful to confirm the presence of postseptal involvement in patients with ethmoid sinusitis. Contrary to CT, findings at US remain non-specific as to the nature of involvement. Nonetheless, US is helpful for patient management.

Transnasal endoscopic repair of congenital defects of the skull base in children

OBJECTIVE

To examine imaging findings and methods of endoscopic treatment of congenital skull base defects in children.

DESIGN

Retrospective study and case series.

SETTING

Academic tertiary care center.

PATIENTS

Four patients (aged 12 and 14 months and 8 and 13 years) were included from 1995 to 1997. Three presented with a nasal glioma, which was recurrent in 1 case. The fourth patient presented with bacterial meningitis due to a spontaneous cerebrospinal fluid leak. Computed tomography and magnetic resonance imaging were used to locate the defect of the skull base.

INTERVENTION

Transnasal endoscopic resection of the glioma or the meningocele, with immediate repair of the skull base defects using free mucosal flaps and/or pediculized mucosal flaps and/or conchal cartilage together with fibrin glue and nasal packing during a 3-week period.

RESULTS

None of the 4 patients has experienced recurrent cerebrospinal fluid leaks or postoperative meningitis.

CONCLUSIONS

The transnasal endoscopic repair of congenital meningoceles is a reliable technique in select pediatric patients. Computed tomography and magnetic resonance imaging provide information that can be used to help the surgical procedure.

Facial neuromas in children: delayed or immediate surgery?

OBJECTIVE

The objective of this study was to investigate the clinical characteristics and outcome of facial nerve neuromas in children. To date, no specific study has focused on children, and the management of these tumors is not codified.

DESIGN AND SETTINGS

A review of case series treated in a tertiary care center of pediatric otolaryngology.

SUBJECTS

The treatment and outcomes for 7 children (4 infants and 3 adolescents) were analyzed.

RESULTS

Six patients underwent complete removal of tumor and immediate restoration of the nerve continuity. The grade of facial palsy improved in 4 of the 6 children, but did not get better than grade 3 (House classification). The remaining patient was managed conservatively and remained stable clinically and radiologically after 9 years follow-up.

CONCLUSIONS

These findings support the reasonable strategy of combining conservative assessment of these slow-growing tumors with regular clinical and radiologic evaluations and radical surgery using various procedures. The choice depends on the age of the child, the extent and growth rate of the tumor, the grade of facial palsy, and the hearing function.

[Foreign bodies in the ear; report of 40 cases]

BACKGROUND

Foreign bodies in the external ear canal present a frequent situation in pediatric practice. It is generally benign, but infectious complications may occur.

POPULATION

Between January 1996 and March 1997, 35 children with a foreign body in the ear canal were treated in the ENT department of Robert-Debré hospital.

RESULTS

Age ranged from 15 months to 14 years, with a mean of 6.5 years. The sex ratio was 1.2 (19 boys/16 girls). Five children had bilateral foreign bodies. The most frequent foreign bodies were pearls (8/40) and cockroaches (7/40). Eleven children had complications: ear canal laceration in five cases, otitis externa in five cases, cervical adenitis in three cases, general septic syndrome with fever in one case, and drum perforation in one case.

CONCLUSION

The methods of extraction and the management of the complications are discussed.

Modeling and implementing a database on drugs into a hospital intranet

Our objective was to develop a drug information service, implementing a database on drugs in our university hospitals information system. Thériaque is a database, maintained by a group of pharmacists and physicians, on all the drugs available in France. Before its implementation we modeled its content (chemical classes, active components, excipients, indications, contra-indications, side effects, and so on) according to an object-oriented method. Then we designed HTML pages whose appearance translates the structure of classes of objects of the model. Fields in pages are dynamically fulfilled by the results of queries to a relational database in which information on drugs is stored. This allowed a fast implementation and did not imply to port a client application on the thousands of workstations over the network. The interface provides end-users with an easy-to-use and natural way to access information related to drugs in an internet environment.

Nasal foreign bodies in children

Between 1994 and 1997, a total of 72 nasal foreign bodies were removed from 68 children (28 girls and 40 boys, including 2 repeats) in the ENT Department at Robert Debré Hospital, Paris. Ages ranged from 1 to 12.5 years (median, 3 years). Two children had bilateral foreign bodies. The unilateral foreign bodies were on the right side in 67.6% of cases. The most frequent objects were plastic objects, beads, paper, cotton and foam. Insertion was witnessed by an adult or reported by the child himself in the majority of cases. The other cases were diagnosed when complications occurred (as seen by persistent rhinorrhea and a foul body odor). All foreign bodies were removed in the consultation room using a hook or nasal forceps.

[Treatment of acute otitis media in children]

Acute otitis media in children have to be treated by analgesics, antipyretics and antibiotics. The choice of the antibiotic depends on the child's age, associated clinical symptoms such as conjonctivitis, and any recent history of antibiotic treatment. Children over 2 are treated by amoxicillin or CG1, children with conjunctivitis are treated by amoxicillin + clavulanate acid, infants attending day care centers and with recent history of antibiotic treatment have to be treated by cefuroxim-axetil, cefpodoximproxetil or high dosages of amoxicillin. In case of unsatisfactory course of the disease, the infecting organism has to be identified by tympanocentesis.

Several cytogenetic subclones may be identified within plasma cells from patients with monoclonal gammopathy of undetermined significance, both at diagnosis and during the indolent course of this condition

Monoclonal gammopathy of undetermined significance (MGUS) is a frequent condition in patients over 50 years old, that ultimately leads to multiple myeloma (MM) in 20% of patients after 20 to 35 years of follow-up. Little is known about cytogenetic changes associated with this condition. We studied 19 MGUS patients both at diagnosis and after 12 to 35 months of follow-up (mean = 26), using DNA content measurement of bone marrow plasma cells (BMPC), and a new interphase fluorescence in situ hybridization technique (FISH) allowing the simultaneous identification of monotypic BMPC (fluorescent anti light-chain antibodies) and the determination of the number of copies for two different chromosomes within the same PC nucleus (one biotin-labeled probe coupled next to texas red avidin and one FITC-labeled probe). At diagnosis of the MGUS, single interphase FISH showed at least one numeric chromosome change in 13 of 19 patients, after the use of centromeric probes directed against chromosomes no. 3, no. 7, no. 9, and no. 11. At follow-up, abnormalities found at diagnosis in 13 patients were still shown. Moreover, abnormalities occurred in three of the last six patients (trisomy for one to three different chromosomes), although no patient evolved into MM. Dual interphase FISH showed that some BMPC bore numeric changes with both probes tested whereas other BMPC bore abnormality with only one of the probes tested. In patients who showed trisomy for at least three different chromosomes, distribution of numeric changes within BMPC defined significant numbers of up to seven different BMPC clones. All these various clones were shown both at diagnosis and at follow-up. In every patient, these various clones differed only for the number of abnormalities they exhibited, and could be related to each other in a model of gradual acquisition of chromosome changes. Eventually, data reported here show that MGUS patients acquire slowly, gradually, but ineluctably chromosome changes, distributed within several related subclones. However, these changes are not related to transformation into MM: among the various clones coexisting within the same patient, a peculiar change, still to demonstrate, might develop and lead to overt MM.