Recurrent laryngeal nerve monitoring in children using cricothyroid membrane needle electrodes.

AIMS: Thyroid pathology is rare in children and the rate of malignancy is higher than in adults. Thyroid surgery in children is therefore particularly at risk of causing recurrent laryngeal nerve (RLN) palsies. The classical technique for monitoring the RLN is not always adapted to children due to the large size of the dedicated endotracheal tubes. MATERIAL AND METHODS: Double-needle electrodes (NIM 3.0) were placed medially or paramedially through the cricothyroid membrane and carefully kept submucosal just below the level of the vocal folds. Before identification of the RLN, the vagal nerve was dissected on the side of the concerned lobe and stimulated. The thyroid surgery was then performed with the routine identification of the RLN. The response of the RLN is periodically checked using a stimulating probe. The main outcomes were the identification and stimulation of the RLN, quality of the voice in post-operative time. OBJECTIVE: The main objective of our study is to present a simple and efficient method, available for children of all ages, in order to perform monitoring of the recurrent laryngeal nerves during thyroid surgery. RESULTS: We present the results of our retrospective series, in a tertiary-care university pediatric hospital. We included nine children, corresponding to 15 nerves. In all cases, the RLN was identified, stimulated and a positive response was obtained via monitoring. CONCLUSIONS: This technique of monitoring is safe, feasible at any age, even in neonates, and, as the electrode stays in the operation field, its position is easily controlled.

Recurrent laryngeal nerve monitoring during thyroidectomy and parathyroidectomy in children.

OBJECTIVE: Injury of the recurrent laryngeal nerve (RLN) is the most frequent complication of thyroid and parathyroid (TP) surgery. Monitoring of the RLN in children is not widely studied as this is not a common disease in the pediatric population. The aim of our study was to evaluate the reliability, feasibility and benefits of RLN monitoring during TP surgery in children. METHODS: We analyzed all children who underwent TP surgery in our department between January 2009 and March 2018. Patients were classified into three groups: without monitoring (group 1), monitoring with an endotracheal tube (group 2) and monitoring with a double-needle electrode placed through the cricothyroid ligament (group 3). RESULTS: We performed 53 surgeries (77 RLNs at risk) on 47 patients aged between 6 months and 18 years. Fourteen RLNs were in group 1, 47 in group 2 and 16 in group 3. We found one transient lesion of the RLN in group 1, three in group 2 and two in group 3. Seven patients in group 3 could not undergo monitoring with the tube because they need an orotracheal tube smaller than the smallest monitoring tube size available. The sensitivity and specificity values of the monitoring methods were 33% and 97% in group 2 and 67% and 100% in group 3, respectively. The positive and negative predictive values were 50% and 95% in group 2 and 100% and 92% in group 3, respectively. No complications arose during insertion of the electrode through the cricothyroid ligament. CONCLUSION: Monitoring of the RLN with a double-needle electrode inserted through the cricothyroid ligament is a reliable method with no associated complication, which is achievable at any age.

Otologic disorders in Turner syndrome.

INTRODUCTION: Patients with Turner syndrome (TS) have craniofacial malformations, such as Eustachian tube hypoplasia and dysfunction and velar dysfunction, which foster acute otitis media. The aim of this study was to inventory pediatric otologic disorders in patients with TS at their first ENT consultation in our center. PATIENTS AND METHODS: We reviewed the ENT consultation data of pediatric TS patients followed in our center between 2005 and 2015: otoscopy, hearing threshold, and history of acute otitis media or ENT surgery. Data were compared according to karyotype: X monosomy (45,X), mosaic (45,X/46,XX), isochromosome (46,Xi [Xq]), X ring chromosome X (XrX), with Y material, and "other". RESULTS: Ninety patients, with mean age 11.9years (±4.8years) at first ENT consultation, were included: 29% showed tympanic abnormality on otoscopy, 21% had hearing loss, 24% had history of recurrent acute otitis media; 18% had undergone adenoidectomy, 24% T-tube insertion, and 5.6% tympanoplasty. No particular karyotype was associated with higher risk of hearing loss or acute otitis media. CONCLUSION: Patients with TS showed high prevalence of pediatric otologic disorders; they therefore require close and prolonged ENT follow-up.

Criteria for admission of odontogenic infections at high risk of deep neck space infection.

OBJECTIVES: Many patients with odontogenic infections are hospitalised because of the risk of deep neck space infection. The objective of this study was to identify risk factors allowing more reliable selection of patients requiring hospitalisation for both specialists and emergency physicians. MATERIAL AND METHODS: This retrospective study was based on a cohort of 97 patients hospitalised for odontogenic infection in the Department of Otorhinolaryngology and Head and Neck Surgery of Centre hospitalier Sud Francilien, Île-de-France, from January 2008 to June 2012. RESULTS: The majority of patients presented with dental abscess (66 patients; 68%). Nineteen patients (20%) presented with deep neck space infection. The frequency of deep neck space infection was significantly higher in patients with mandibular odontogenic infection (16/55 patients (29%) than in those with maxillary odontogenic infection (3/42 (7%); P ≤ 0.009). The incidence of deep neck space infection was significantly higher in patients with dental abscess (17/66, (26%) than in those without dental abscess (2/31 (6%); P ≤ 0.03). CONCLUSION: In addition to the well-known classical criteria (fever, neck swelling, dyspnoea, dysphagia, trismus, leukocytosis, elevated C reactive protein (CRP)), the criteria for admission for odontogenic infection should include mandibular odontogenic infection and/or the presence of dental abscess.

Uniparental (mtDNA, Y-chromosome) polymorphisms in French Guiana and two related populations--implications for the region's colonization.

Blood samples collected in four Amerindian French Guiana populations (Palikur, Emerillon, Wayampi and Kali'na) in the early 1980s were screened for selected mtDNA and Y-chromosome length polymorphisms, and sequenced for the mtDNA hypervariable segment I (HVS-I). In addition, two other Amerindian populations (Apalaí and Matsiguenga) were examined for the same markers to establish the genetic relationships in the area. Strong dissimilarities were observed in the distribution of the founding Amerindian haplogroups, and significant p-values were obtained from F(ST) genetic distances. Interpopulation similarities occurred mainly due to geography. The Palikur did not show obvious genetic similarity to the Matsiguenga, who speak the same language and live in a region from where they could have migrated to French Guiana. The African-origin admixture observed in the Kali'na probably derives from historical contacts they had with the Bushinengue (Noir Marron), a group of escaped slaves who now lead independent lives in a nearby region. This analysis has identified significant clues about the Amerindian peopling of the North-East Amazonian region.

Thin-film luminescence under ultraviolet irradiation.

The features of visible dielectric thin-film luminescence under UV irradiation are discussed for single layers with a particular high-index/low-index couple, HfO(2)/SiO(2). We exploit those results in an attempt to understand the proper luminescence of three different mirror stacks in terms of both luminescence efficiency and angular emission.

Human genetic diversity (immunoglobulin GM allotypes), linguistic data, and migrations of Amerindian tribes.

GM haplotype frequencies were examined in 49 Amerindian tribes (from North, Central, and South America) to investigate the congruence of genetic variation with that observed in language and geography. We used two approaches: (1) the mobile site method, which allows a two-dimensional representation of genetic variation where the distances between reference points (i.e., the locations of the populations in the geographic map after displacements) are close to the genetic distances, and (2) a multivariate analysis (factorial correspondence analysis), which permits a visual interpretation of the geographic distribution of GM haplotypes on a map, completed by a cluster analysis. The results show a strong gradient from the Bering Strait to South America. The Eskimo and Na-Dene are genetically different from all other Amerindians, reflecting their more recent migrations. The orientation of most trajectories of the tribes from Central and South America can be interpreted as earlier migrations along the Pacific and Atlantic coasts. We conclude that geographic and linguistic factors played a part in the genetic diversity of Amerindian tribes.

Gm and Km allotypes in Wayampi, Wayana and Emerillon Indians from French Guiana.

We have studied 506 Amerindians from three French Guiana groups: 194 Wayampi, living in Trois-Sauts, and 100 in the Camopi area; 47 Emerillon also living in the Camopi area and 165 Wayana on the Litani and Maroni rivers. All samples were tested for G1m(1,2,3,17), G3m(5,6,10,11,13,14,15,16,21,24,28) and Km(1) by the classical method of hemaglutination inhibition. The phenotype and haplotype distributions are presented and have been subjected to factorial correspondence analysis. Two Gm haplotypes are common: Gm1,17;21,28, and Gm1,2,17;21,28, but with an important variation in frequency. A rare haplotype, probably the result of a genetic anomaly: Gm1,17;21R,28, is frequent in the Emerillon (17%). These populations show no evidence of Black or Caucasian admixtures.

Immunoglobulin allotypes (GM and KM) in three Amerindian populations of French Guiana.

We have studied 506 Amerindians from three French Guiana groups: 194 Wayampi, living in Trois-Sauts, and 100 living in the Camopi area; 47 Emerillon also living in the Camopi area and 165 Wayana living on the Litani and Maroni rivers. All samples were tested for G1M (1,2,3,17), G3M (5,6,10,11,13,14,15,16,21,24,28) and KM(1) by the classical method of hemaglutination inhibition. The phenotype and haplotype distributions are presented and have been subjected to factorial analysis of correspondence. Two common GM haplotypes are GM1,17:21,28 and GM1,2,17;21,28 but with an important variation in frequency. A rare haplotype, GM1,17;21R,28, probably the result of a genetic anomaly, is frequent in the Emerillon (17%). These populations show no evidence of Negroid or Caucasian admixtures.

[Evidences for genetic transmission of pulse arterial pressure]. / Evidences pour une transmission génétique de la pulsatilité artérielle.

Systolic (PS), diastolic (PD), and pulse (PULS) arterial blood pressure were examined in 151 French-West-Indies families. After adjustment for sex, age, Na/K urinary ratio, alcohol consumption, use of anti-hypertensive drug, the distributions of PS and PD were correctly fitted by two commingled normal distributions, one of them including 5% of the highest values of blood pressure which have to be compared to the high prevalence of hypertension in this population (10 to 20%). By performing segregation analyses under Lalouel et al.'s unified model we do not support any genetic transmission for PS and PD. On the contrary, large evidence for genetic transmission of PULS was found, involving one locus, two equally frequent alleles. However dominance cannot be correctly inferred. Accordingly, PULS appears to be of larger interest than PS and PD to study the genetic regulation of the arterial blood pressure.

Cystic fibrosis in the population of Reunion Island.

The frequencies of the delta F 508 mutation and haplotypes linked to the cystic fibrosis (CF) gene and detected with DNA probes XV-2C and KM-19 have been studied in the population of Reunion Island, a French province located in the Indian Ocean. The deletion was present in 41.3% of CF chromosomes, whereas this proportion is about 70% in the French population. The delta F 508 mutation was associated with the haplotype B defined by the DNA markers XV-2C (allele 1) and KM-19 (allele 2) in 76.4% of CF chromosomes, while this proportion is over 90% in the French population. Founder effect, genetic drift and admixture can explain these differences.

A gene for limb-girdle muscular dystrophy maps to chromosome 15 by linkage.

Limb-girdle muscular dystrophy (LGMD) is inherited as a monogenic, autosomal recessive trait. A genetically homogeneous group of families from the Isle of La Réunion, comprising individuals at high risk for this disorder, was systematically analysed using a panel of 85 polymorphic markers spanning approximately 30% of the human genome. Linkage was detected between the LGMD gene and the marker D15S25, uncovered with the probe pTHH114 and restriction enzyme RsaI (lod score = 5.52 at a 0 = 0.0), localising this gene onto chromosome 15. Such a lod score corresponds to odds of 3.3 x 105 in favor of linkage versus absence of linkage. Additional families from other populations will need to be examined before the role of this newly identified locus can be understood.

Subtyping familial schizophrenia: reliability, concordance, and stability.

This report examines the reliability, concordance, and long-term stability of the subtypes of schizophrenia defined by four major diagnostic systems (DSM-III, DSM-III-R, ICD-10, and Tsuang-Winokur criteria) and rated both for the first hospitalization and for a best estimate diagnosis reflecting lifetime evolution of symptomatology. Schizophrenics studied belonged to two samples of multiply affected families, namely a sample selected in France and a sample of non-metropolitan French identified in the island of La Réunion. ICD-10 and DSM-III-R show opposite stringency regarding subtyping of schizophrenia, with DSM-III-R having a narrow and ICD-10 a broader definition of specific subtypes. Long-term stability of each subtype was fairly good, stability being the highest for hebephrenics and only intermediate for paranoid and undifferentiated subtypes. Comparison of two different cultural and geographical regions reveals an overall similarity of subtype frequencies in familial schizophrenia. The implications of the results for the choice of diagnostic procedures in family studies of schizophrenia are discussed.

Genealogical and genetical African admixture estimations, blood pressure and hypertension in a Caribbean community.

This study examines the relationships between blood pressure, prevalence of hypertension, and the degree of black African admixture in the population of the Caribbean Island of La Désirade which is homogeneous with respect to the environmental factors and for which the socioeconomical stratification does not match racial origin. The degree of admixture was estimated by using both genealogical information and genetic markers. Blood pressure was repeatedly measured using an automatic sphygmomanometer. After adjustment for age, sex, ponderal index, Na/K urinary ratio, and clinical alcoholism, blood pressure and prevalence of hypertension were found to be significantly higher for the individuals having the largest proportion of genes of black origin. Identical results were obtained when either genetic markers or genealogical information were used as an individual--estimator of admixture.

Genetic susceptibility to leprosy on a Caribbean Island: linkage analysis with five markers.

Our recent segregation analysis, carried out on 27 large pedigrees from a Caribbean island (Desirade), has shown the presence of recessive major gene(s) controlling susceptibility to leprosy per se and nonlepromatous leprosy, respectively. Linkage analysis was performed between each of these two detected genes and each of five markers typed in the Desirade population: HLA, ABO, Rhesus, Gm and Km. No positive significant lod score was observed. However, for leprosy per se close linkage was excluded with Rhesus and Gm (and also with ABO and HLA, considering a lower value for the frequency of the gene controlling susceptibility to leprosy per se). The highest lod score, although not significant, was obtained between the gene for nonlepromatous leprosy and ABO. Our overall results, joined with previous studies and experimental data, suggest that the gene controlling susceptibility to leprosy per se and that controlling susceptibility to nonlepromatous leprosy might be different, acting at successive stages of the immune response to infection with Mycobacterium leprae.

Studies on an isolated West Indies population. VII. Genetic linkage studies of hearing loss.

Linkage analysis was performed between the locus of sensorineural hearing loss and 14 polymorphic genetic markers on 108 informative families with a total of 721 individuals in the island of Saint-Barthélémy. No significant linkage was found, and only for Gm could tight linkage be excluded.