[Efficacy and tolerance of cefotiam hexetil in the super-infected chronic sinusitis. A randomized, double-blind study in comparison with cefixime]. / Efficacité et tolérance du céfotiam hexétil dans le traitement de surinfection de la sinusite chronique. Etude randomisée, en double aveugle, comparison au céfixime.

Efficacy and safety of a new oral third generation Cephalosporin, Cefotiam Hexetil (CTM) 200 mg bid were compared with those of Cefixime (CX) 200 mg bid over 10 day duration of treatment. One hundred and twenty two ambulatory adults suffering from chronic sinusitis were randomized by ENT specialists in this multicentre prospective double blind, doubled dummy study. Sinusitis diagnosis evocated in front of fascial pain, purulent nasal discharge and/or obstruction was confirmed with sinus X-ray. Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion. One hundred and seventy one patients were evaluated for efficacy analysis (62 and 59 respectively in CTM and CX groups). Regarding demographic data, clinical and radiological signs, the two populations were comparable at inclusion excepted for sex and weight (female: 73% in CTM group versus 47% in CX group). The overall clinical success rate at the end of treatment (cure+improvement) was not significantly different between the two groups (CTM: 82% versus CX: 80%). The incidence of adverse events was less frequent in the CTM group (14.5% versus 19%). In conclusion, CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults.

Indirect immunofluorescence in the investigation of rapidly progressive sensorineural hearing loss and Menière's disease.

Being aware of the conservation of antigenicity, we performed indirect immunofluorescence on non fixed non decalcified frozen hamster's cochlea. Once killed, the heads of the hamsters were immediately dipped into liquid nitrogen and then stored at -20 degrees C until cutting. The sections were done at the same temperature, with Tissue-Tek embedding the heads to avoid breaking, using a sharp tungsten knife. The immunofluorescence itself was performed with the sera of the patients which were revealed through donkey fluorescein-conjugated antiserum to human immunoglobulins. For counterstaining, we used Evans blue. Twenty patients with rapidly progressive sensorineural hearing loss (according to the clinical criteria of MacCabe) and 6 with Menière's disease were tested. Five had a specific fluorescence on the stria vascularis. A correlation with the lymphocyte transformation test on human inner ear antigen has been found (p = 0.055).

[Primary sclerosing cholangitis and autoimmune cochlear deafness: a new syndrome?]. / Cholangite sclérosante primitive et surdité endocochléaire auto-immune: nouveau syndrome?

Association of autoimmune cochlear hearing loss with primary sclerosing cholangitis is reported in two patients. Endocochlear sensorineural hearing loss was associated with the presence of anti-cochlear antibodies in the serum directed against the walls of vessels in the stria vascularis. The hearing loss appeared at the same time or shortly after the diagnosis of cholangitis. This association, which has never been described, may reinforce the theory of the role of immunologic factors in the pathogenesis of primary sclerosing cholangitis, possibly linked to or initiated by vasculitis.

Spontaneous retraction pockets in chronic otitis media medical and surgical therapy.

Results of a series of 228 spontaneous retraction pockets in chronic otitis media are reported and a classification is proposed. Under medical therapy, 78 retraction pockets of stage I and II (out of 95) were followed for five years. Sixteen percent deteriorated into stage III and were operated on; the others stabilized or improved towards normal tympanic membrane (23%). Different methods of surgical therapy were used in 150 retraction pockets (all the stages III and many stages II). Even with silastic sheeting and strengthening of the tympanic membrane, a recurrent retraction pocket was observed in 24 cases (16%). Functional results were obviously better when the ossicular chain was rebuilt from an intact malleus to an intact stapes and either from an intact malleus to a mobile footplate or from the tympanic membrane to an intact stapes. Surgery of retraction pockets must be used not only to prevent cholesteatoma formation but also to prevent erosion of the stapes.

New immunobiological tests in the investigation of Menière's disease and sensorineural hearing loss.

The aim of the study was to determine the usefulness of new immunobiological tests using fractioned human inner ear antigen in the investigation of 4 Menière's disease and 12 rapidly progressive sensorineural hearing loss (RPSNHL). Each patient underwent a full ENT examination and a full range of immunobiological tests comprising ESR, electrophoresis, IgG, A, M, circulating immune complexes, cryoglobulins, complement, organ and non-organ auto-antibodies. The two new tests were the lymphocyte transformation test (LTT) and the immunoperoxidase test against total or fractioned human inner ear antigens. Four main bands were found in electrophoresis with the following molecular weights: 130,000, 45,000, 22,000, and 14,000. The heaviest band corresponded to IgG contained in the inner ear extract. Three cases of bilateral RPSNHL had positive LTT against inner ear antigens. No serum of patients showed a characteristics band with the immunoperoxidase test with regard to the serum of healthy subjects. At least four abnormal inflammatory non-specific tests were shown in the cases of positive LTT. Out of 3, 2 patients received steroids and improved their hearing.

Reconstruction of radical mastoidectomy by obliteration technique.

Reconstruction of radical mastoidectomy was performed by obliteration tympanoplasty using Palva flap in 199 ears either in one stage (normal mucosa, normal stapes, no risk of residual cholesteatoma behind the flap) or in two stages. At the 2nd stage, middle ear was reopened and the posterior cavity was checked in 34 cases. Bony pâté or ceramic granules may be added behind the flap, especially at this second stage. The closure of the tympanic membrane was achieved in 97% of cases. Residual cholesteatoma was removed in the middle ear at the 2nd stage in 17% of the ears. Late residual cholesteatoma behind the flap appeared in 5 cases where the posterior cavity had not been checked. Three early retraction pockets were due to technical failures which were more recently corrected by the use of fibromuscular graft placed between the fascia graft an the Palva flap. Three late retraction pockets progressed under the tympanic membrane from above to below. Hearing results were better in the 1st stage procedures, obviously selected: ABG within 20 dB in 83% of the ears with a normal stapes. On the contrary, in 2 stage procedures, ABG within 20 dB was achieved only in 50% of cases with a normal stapes and 29% of the ears where the crura were missing.

[Value of immunobiological tests in Menière's disease and in rapidly progressive sensorineural deafness]. / Intérêt des examens immuno-biologiques dans les maladies de Ménière et les surdités neuro-sensorielles rapidement progressives.

We have looked for abnormal immunobiologic test in 12 cases of Meniere's disease and 11 cases of rapidly progressive sensorineural hearing loss. After ruling out known etiologies, they were screened with non specific tests (sedimentation rate, electrophoresis, immunoglobulins, circulating immune complexes, cryoglobulins, complement system, auto antibodies) and inner ear specific tests (antibodies against human cochlea by indirect immunofluorescent test and lymphocyte transformation test against a pool of human inner ear. A non specific inflammatory syndrome was found in more than 50% of cases, specific tests of the inner ear were positive in 30% of cases. Corticosteroid therapy achieved a significant improvement of the hearing in 100% of the patients with a positive specific test, versus 50% of those with a negative result. A therapeutic protocol is suggested taking into account the results of the immunobiologic tests.

[Comparison between closed and open technique with muscular filling up in surgery of cholesteatoma of the middle ear. Long-term results]. / Comparaison entre la technique fermée et la technique ouverte avec comblement musculaire dans la chirurgie du cholestéatome de l'oreille moyenne. Résultats à long terme.

Advantages and disadvantages of closed versus obliteration technique are studied in a serie of 348 ears all operated on by the senior surgeon, from January 1970 to January 1980. Closed techniques were performed in 67% of cases in children and 50% of cases in adults. A follow-up at one year was achieved in 98% of the cases, at 5 years in 50% and at 10 years in 25% of the cases. This study consists of long term results after all the scheduled surgery has been performed. Residual cholesteatomas occurred in 5% of closed techniques in 1 stage and 1% of closed techniques in 2 stages at one year, in 1.2% of closed techniques in 2 stages and 5% of obliteration techniques in 1 stage at 5 years. No other residual cholesteatomas were observed. Retraction pockets on the contrary were very frequent in closed techniques in 1 stage: 15% at 1 year, 11% at 5 years and 22% at 10 years. They were less frequent for closed techniques in 2 stages: 0.9% at 1 year, 6.3% at 5 years and 2.8% at 10 years. The same figure was observed for obliteration techniques in 1 or 2 stages: 1% at 1 year, 5 and 8.9% at 5 years and 5.8 and 5.2% at 10 years. The air-bone gaps were the same for closed techniques and obliteration techniques.

Estimate of the light chain repertoire size of fetal and adult BALB/cJ and CBA/J mice.

The potential light chain repertoires expressed by IgM antibodies of fetal liver and adult spleen cells were compared. B cells from these sources were stimulated by the polyclonal mitogen bacterial lipopolysaccharide and after 3 days were fused to construct hybridomas. The light chains synthesized by these hybridomas were isolated by electrophoresis and their heterogeneity was examined by isoelectric focusing. A total of 109 BALB/c and 77 CBA/J hybridoma-derived light chains obtained from fetal liver and adult spleen cells were analyzed in this way. Fifty-three and 45 unique light chains were obtained from BALB/c and C57BL/6 hybridomas, respectively. Some of these were repeated more frequently than others, but no significant differences were seen in the heterogeneity of the light chain spectrotypes of fetal and adult CBA/J and BALB/cJ mice. Furthermore, the kappa:lambda ratio of light chains were the same in fetal liver as adult-derived hybridomas. These results show that the heterogeneity of light chains as determined by IEF and the kappa:lambda ratio of IgM immunoglobulins is established very early in ontogeny.

Microimmunodiffusion test for detection of antibodies to infectious bovine rhinotracheitis virus in bovine serum.

A microimmunodiffusion test (MIDT) specific for detection of antibodies to infectious bovine rhinotracheitis (IBR) in bovine serum has been developed. The antigen used in the MIDT was prepared from IBR virus-infected Madin-Darby bovine kidney cells grown in tissue culture. The antigen was stable, and relatively high yields were obtained readily. Results of the MIDT were obtained within 48 hours and agreed with those of the serum-neutralization test.