Virulence of clinical Mycobacterium tuberculosis strains in Lodz, Poland.

SETTING: The transmission of tuberculosis (TB) in the population and the development of disease are determined not only by the patient's immunological status, but also by the virulence of Mycobacterium tuberculosis strains. OBJECTIVE: To examine the virulence of M. tuberculosis clinical isolates with recognised transmission collected from 2006 to 2007 in a population in Lodz, Poland. METHODS: A total of 36 isolates were studied to determine their sensitivity to human neutrophil peptide 1 (HNP-1) and intracellular growth within THP-1 cells. Bacterial strains were cultured using HNP-1 at different concentrations. After incubation, the number of colony-forming units (cfu) was determined by bacteria plating. The intracellular survival was examined on days 3, 6 and 8 post-THP-1 infection by cfu enumeration. RESULTS: Overall, 69% of the isolates showed greater resistance to the highest HNP-1 concentration (15 g/ml) than the virulent H37Rv strain, and the growth of 10 strains was totally inhibited. On day 8, 56% of the strains displayed higher cfu numbers than the virulent H37Rv strain. CONCLUSION: The results suggest that isolates from our urban population represent highly virulent phenotypes. We could not find any significant difference in virulence between strains with unique genotypes and those in clusters.

[Hermann Oppenheim (1858-1919) -- an excellent neurologist without academic recognition: 150th anniversary of his birthday, January 1, 2008]. / Hermann Oppenheim (1858-1919) - ein exzellenter Neurologe ohne akademische Anerkennung : Zum 150. Geburtstag am 1. Januar 2008.

Hermann Oppenheim (1858-1919) had a financially modest upbringing and studied medicine in the German cities of Göttingen and Bonn. At the Berlin Charite Hospital, where he had become a lecturer, and as an established neurologist he eventually cofounded the Association of German Neurologists. It was his life's goal to establish neurology as a special field of medicine. At the height of his teaching career, he spent a decade (from 1891 to 1901) trying to attain full professorship. His efforts eventually fell prey to arrogant and delaying decisions at the administrative level, which he countered by resigning from the medicine faculty of Friedrich Wilhelm University in Berlin. Internal antisemitic tendencies could be seen in these difficulties. Oppenheim himself was a member of the Central Association for Citizens of the Jewish Faith, an association for strengthening Jewish identity and Jewish awareness. His possibilities were exhausted at the university level. There remains the question of how much he could have achieved, had the full range of opportunities been made available to him.

[In vitro studies of factors possibly influencing the performance of latex condoms]. / Etude en laboratoire de facteurs pouvant influencer la qualité des préservatifs masculins.

Male condoms are undoubtedly the best protection against sexually transmitted diseases. The French Military Health Service buys condoms from civilian manufacturers using a public purchasing process. This process includes strict technical analysis that allows selection of the best supplier. In addition each batch of condoms delivered to French armed forces undergoes quality testing in the laboratory of the Armed Services Central Pharmacy before being distributed to troops. Despite these strict control measures, several isss remain unclear. One issue involves the shelf life of condoms stored in warm humid tropical conditions. Another issue involves the effect of lubricants on condom quality. The purpose of this report is to describe a study designed to gain insight into these two issues. This study was conducted by the Armed Services Central Pharmacy in colaboration with the Procuremnt and Central Establishment Directorate. Findings showed that stage conditions have no negative effects on the intrinsic physico-chemial properties of condoms supplied by two different manufacturers. Conversely use of inadequate lubricants (alimentary or cosmetic compounds) appeared to have extremely deleterious effects on condom quality. Laboratory tests showed that lubricants composed mainly of fatty acids dramatically decreased the effectiveness of condoms.

[Surgical approach of the petrous vertical segment and upper cervical internal carotid]. / Approche chirurgicale du segment vertical pétreux et cervical haut de la carotide interne.

The main obstacle to successful management of aneurysms involving the high cervical internal carotid artery (ICA) is to obtain an adequate exposure. In this report we describe our experience in 5 patients presenting carotid aneurysms at the skull base, intermediately below the carotid foramen. Exposure is achieved in two stages. The cervical stage consists in resection of the styloid processes and muscles followed by anterior displacement of the mandibular condyle. This exposes the vertical segment of the petrous ICA. The petrous stage consists in partial petrectomy exposing the jugular bulb and the third segment of the facial nerve. Using this route, the vertical intrapetrous segment of the ICA can be drilled away without damaging the middle ear. In our series, no vascular complications occurred. Damage involving the facial glossopharyngeal and vagal nerves is discussed. This approach appears to be a suitable alternative to the conventional infratemporal approach which sacrifices the middle ear.

[Functional results of the surgery of unilateral acoustic neuroma]. / Les résultats fonctionnels de la chirurgie des neurinomes de l'acoustique unilatéraux.

The authors sent a circumstantial questionnaire to 224 surviving patients out of a 228 unilateral acoustic neurinoma operated on from June 83 to December 90 range of patients in order to assess their complaints. Seventy-two per cent of these neurinomas were Stade III or IV of Koos. Translabyrhintine approach was used for 85% and suprapetrous approach for 15%. The post-operative mortality rate is 1.75%. At the end of the procedure, the removal seemed total in 99% of cases and the anatomical facial nerve continuity was preserved in 94% of cases. Our patients kept or recovered a normal (Grade I of House--52%) or almost normal (Grade II of House--14%) facial motion in 66% of cases. A normal facial rest stretching with a complete eyelid closure but an asymmetrical facial mimic (Grade III of House) were in 20% of cases, and a more important facial palsy with incomplete eyelid closure was in 4% of cases (Grade IV of House). Patients needed an hypoglosso-facial anastomosis in 10% of cases. Always, this anastomosis restored a good facial motion near the Grade III of House. Hearing preservation was achieved for 45% of the attempts (through a suprapetrous approach) but hearing so preserved was functional (pure tone loss less than 50 db) in 37.5% of cases (5% of all the patients of this series) and only 61% of these patients kept or recovered a normal or almost normal facial motion. Varying, often regressive, complications were observed: C.S.F. leakages (7.5%) through the operative wound in two third of cases, owing to a pressure raising due to meningitis or C.S.F. circulatory constraint and usually cured by lumbar punctures and, if need be, antibiotics and, in one third of cases, through the tympanic cavity then nostril because of a hole remaining on the petrous drilled wall and usually needing a reintervention, swallowing difficulties (3%), due to a contralateral vagus nerve palsy in half of cases, postoperative hematomas (1.75%), fatal in one out of two times, brain traumatism (1.75%), meningitis (0.4%). The answers of patients were proper enough to be used for this study in 80% of cases (178). Their subjective answers about facial motion agreed with our objective assessment in 84% of cases that is emphasizing the difficulties of all attempt to this type of valuation. Our patients point out balance troubles in 67% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

[Enlarged trans-temporal crania fossa approach. Technique and indications]. / La voie sus-pétreuse élargie. Technique et indications.

The authors report their experience using an enlarged middle cranial fossa approach for the removal of 33 acoustic neurinomas and 10 cerebellopontine angle meningiomas. The Technique is defined. This approach proved suitable for stage I neurinomas, ensuring total removal in all 13 patients with stage I lesions, hearing conservation in 9 (69.2%) of these patients, grade 1 + 2 facial nerve function in 80% of patients and grade 3 function in 20% of patients. While total removal was always possible for stage II neurinomas, the functional results were poor with hearing conservation in only 3 of 15 patients (20%), grade 1 + 2 facial nerve function in 45% of patients and grade 3 function in 54% of patients. Total removal was possible in only 1 of 4 patients with stage III neurinomas. This approach proved excellent for cerebellopontine anale meningiomas, providing wide access to the tumor and protecting the acoustico-facial bundle situated behind the tumor. Among the 10 patients operated by this route, 8 had conservation of hearing and all 10 had normal facial motricity (grade I) at 3 months.

Intranasal ethmoidectomy in nasal polyposis in children. Indications and results.

Nasal polyposis in children is a rare pathology that is difficult to treat, with results that are often disappointing. The aim of this paper is focused on the surgical possibilities of ethmoidectomy by endonasal approach. Thirty-nine ethmoidectomies were performed in 24 children with a mean age of 12 years (cystic fibrosis, n = 7; Woakes' syndrome, n = 2; isolated polyposis, n = 15). The decision for surgical treatment was based upon the severity of initial symptoms, principally nasal obstruction, lack of improvement after medical treatment, and the assurance of good surgical follow-up. Twenty-three children were followed up for a mean of 3 years. Complete recurrence was noted in 13% of the cases (n = 3). In all the other cases, including those with partial recurrence, the lives of the children were transformed. Ethmoidectomy by endonasal approach is reliable if the appropriate surgical techniques are strictly followed. It has proven its efficacy in children with nasal polyposis with results that are very encouraging compared to previously proposed therapies.

[Comparative study of cartilaginous and synthetic laryngotracheoplasty. An experimental study in rabbits]. / Etude comparative des laryngotrachéoplasties cartilagineuse et synthétique. Travail expérimental chez le lapin.

The most significant advance in the treatment of laryngotracheal stenosis in children is the augmentative laryngotracheoplasty using a graft of autologous rib cartilage (ARC). In order to reduce the potential morbidity of this technique due to the additional surgical procedure, the use of a ceramic, hydroxyapatite (HA), implant was compared to ARC in a randomized experimental study in 99 New Zealand rabbits: 32 rabbits had ARC grafts, 33 had HA implants covered with a graft of perichondrium (HAP) and 33 had naked HA implants. At 3 months, immediately before necropsy, there was no significant clinical difference between the 3 groups of animals. Histological examination was performed in 81 animals. Implants were found in 54 specimens. More implants were found in the ARC group than in the HA groups (p < 0.003). No difference was noted between the 3 groups in the epithelial covering of the implant, the amount of inflammation, the analysis of the interface between the implant and the cricoid cartilage and in the viability of the graft. No implant was found in 27 animals. However, scar bands of approximately the same width as the implant were responsible for cricoid diastasis in 23 cases. Therefore, it seems that the missing implant played the role of spacer. While this experimental study does not eliminate HA as a augmentative implant in the subglottic region of the rabbit, the evolution of the scar bans must be followed for a longer period in rabbits before considering the clinical application of this technique.

[Repair of the auricular area after petrosectomy]. / La réparation de la région auriculaire après pétrectomie.

The authors report a retrospective series of 12 patients presenting periauricular tumors having invaded the external auditory canal and concha: 5 squamous cell carcinomas, 3 basal cell carcinomas, 2 Darrier-Ferrand sarcomas, 1 parotidean adenocarcinoma, 1 radionecrosis. The operation included an extralabyrinthic petrosectomy, an amputation of the pavilion, and a ganglionic evidement following a histological analysis. The reconstruction processes used 3 pedicle grafts and 9 free grafts. The carcinological extension modalities of the cancers invading the entire external auditory canal require the sacrifice of the tympanic cavity and an external temporalectomy in a single block for carcinological and functional reasons. The massive invasion of the concha inevitably leads to the sacrifice of the auricular pavilion. The best means of reconstruction is with the free graft of the musculus latissimus dorsi. The price to be pay esthetically must be reduced by the placement of an epithesis.

[Laryngotracheal fissure in infants. Indications, technique, results]. / La laryngotrachéofissure chez le nourrisson. Indications, technique, résultats.

Since laryngotracheofissiure, or anterior cricotomy, has been introduced in 1980, the number of tracheotomies performed in infants has decreased as this procedure is an alternative to tracheotomy for difficult extubation. Since then, the indications of this procedure have become wider, but a number of preoperative criteria, such as the pulmonary capacity, must be strictly assessed. We report on our experience with 14 children who underwent laryngotracheofissiure during the past 4 years. The indications, the surgical technique and the results are evaluated.

[A multiparameter method of computer-assisted objective vocal evaluation]. / Une méthode multiparamétrique d'évaluation vocale objective assistée par ordinateur.

The aim of this study is to validate an aid for the evaluation of dysphonia with objective measurements. We recorded exhaled airflow, fundamental frequency and sound level pressure, for a sustained vowel "a", with 51 dysphonic subjects and 15 normal subjects. The following measurements are made on these three parameters: mean value, standard deviation and coefficient of variation. The exhaled airflow volume was also computed for a duration of 2 seconds. A principal components analysis of the measurements indicated that it is possible to recognise the classes of vocal evaluation and vocal pathology. These findings reinforce on objective aid for the vocal evaluation of dysphonia.

Subglottic cyst in a newborn.

Subglottic laryngeal cysts in the newborn are extremely rare. It is difficult to establish if the cyst is acquired or congenital because respiratory distress requires intubation in the I.C.U. generally without prior endoscopy. A case report is presented, followed by a discussion of possible aetiology and management protocol; the advantages of the CO2 laser make excision of the cystic sac possible without tracheotomy.

[Nasopharyngeal fibroma. Forms extended to the infratemporal fossa]. / Le fibrome naso-pharyngien. Formes extensives à la fosse infra-temporale.

There are two clinicopathologic forms of nasopharyngeal fibroma: a median, compact form for which surgical treatment is simple, and a racemose, pedicled form raising problems for exeresis due to its extensions into the infratemporal fossa and the middle cranial fossa. A 4-stage grading is essential, and it has become easier with the progress made by imaging. The clinical findings, the contribution of imaging and the surgical procedures are studied for stages III and IV. Statistics are presented for 26 nasopharyngeal fibromas, including 10 invasive forms. Two approaches of the infratemporal fossa have been used in this series; the PLN approach with a large fronto-naso-maxillary flap, and the pre-auricular infratemporal lateral approach. The exeresis of stage III lesions requires the lateral approach.

Septorhinoplasty in children: benefits of the external approach.

Following a series of septorhinoplasties performed on 28 children over a period of eight years as well as a review of the literature, the authors consider that the taboo on this sort of surgery would seem to have passed. Given that the septum plays a fundamental role in the projection of the nasomaxilliary complex, it is clear that certain surgical rules must be applied: the perichondrium must be left intact, no wide cartilaginous resections must be made, the areas of contact between the septum, the vomer, and the perpendicular lamina of the ethmoid must be reconstituted, and finally, the remodeled cartilage must be repositioned. For all of the above reasons, the external approach, performed on 20 children, is the best suited for this sort of operation. No serious long-term complications were observed.

[Trimetazidine and degenerative deafness. Effect on hearing and integration]. / Trimétazidine et surdités dégénératives. Effets sur l'audition et l'intégration.

This study was conducted in order to assess the activity of trimetazidine dosed at 60 mg/day in patients presenting degenerative loss of hearing. Ten centers participated in this multicenter double-blind placebo-controlled trial which spanned 6 months. Included were 251 patients (118 women, 133 men) presenting with pure perception bilateral symmetrical deafness concerning predominantly the acute frequency range. 228 patients terminated the study, including 115 in the trimetazidine group and 113 in the placebo group. The evolution over a 6-month treatment period was significantly better with trimetazidine as regards the following parameters: audibility as assessed by pure-tone audiometry, namely at the acute frequency range (p = 0.002), intelligibility as assessed by speech audiometry (p = 0.008), subjective evaluation of hearing loss and its impact on the patient's social life. Results confirm the value of trimetazidine hearing loss management, based on clinical, subjective criteria as well as audiometric ones. Parameters reflecting best trimetazidine's efficacy were intelligibility and the psychological/behavioral impact of the impairment, allowing for better social integration of the subject.

[A multicenter double blind versus placebos study of trimetazidine in tinnitus. A clinical approach to tinnitus]. / Etude multicentrique à double insu contre placebo de la trimétazidine dans les acouphènes. Approche clinique des acouphènes.

This multicenter controlled double-blind study versus placebo was carried out in order to determine in which types of tinnitus trimetazidine dosed at 60 mg/day was likely to be of any therapeutical benefit. This trial was conducted over a period spanning 2 months and involved 13 hospital centers. Enrolled were 315 patients presenting with subjective tinnitus. The analysis bore on 290 patients (136 receiving trimetazidine and 154 receiving placebo). Aside from the epidemiological pertinence of this study, results revealed a significantly higher rate of improvement with trimetazidine, as assessed on the basis of subjective clinical criteria, intensity (p = 0.004), periodicity (p = 0.003), and the extent of discomfort (p less than 0.001), as well as audiometric ones. The evolution of the intensity of tinnitus, as measured either by Fowler's comparative scale method or by masking the sick ear, varied significantly (p = 0.007 and p = 0.026, respectively) depending upon whether patients received trimetazidine or placebo. The type of tinnitus which responded best to trimetazidine was recent-onset tinnitus (less than or equal to 2 years) and ischemic disease related tinnitus.

[Results of surgery of acoustic neuroma via translabyrinth and suprapetrous approaches. Development of a classification by House and Brackmann based on facial function]. / Résultats de la chirurgie du neurinome de l'acoustique voies trans-labyrinthique et sus-pétreuse. Aménagement de la classification de J.W. House et D.E. Brackmann sur la fonction faciale.

Two studies were conducted consecutively on two series of post-operative acoustic neurinoma patients. The first one included 104 patients over a period spanning from January 1982 through April 1986; the second one bore on 75 cases enrolled between October 1985 and April 1988. Post-operative complications, sequelae, and findings were analyzed. As far as facial function was concerned, this was assessed on the basis of a classification worked out by J.W. House and D.E. Brackmann. For the first series (93 patients tested, 86 followed up and 7 who completed and returned a form arranged from Brackmann's questionnaire), the following results were obtained: 94% with anatomically intact nerves, including 50.0% grade I; 8.6% grade II; 10.7% grade III; 12.8% grade IV; 4.3% grade V, and 2.2% grade VI cases. 10 nerve sections pertaining to grade III and grade IV surgical repair cases including 10 hypoglossofacial anatomoses were reported. In the second series, 75 patients were followed up for at least 2 years. The facial nerve condition was recorded at the end of the operation, corresponding to the beginning of the nerve recuperation period. A very tight relationship was noted between the nerve condition and the end result as reflected by facial function; such correlation was also found to exist between facial function and tumor size. Likewise, end-point facial function was strictly dependent upon the incipient recuperation phase, whenever palsy had been complete or partial post-operatively. That is to say, if recovery started out after the third month following surgery, the affected hemiface would never retrieve its normal or subnormal function (grade I and II as per J.W. House and D.E. Brackmann). In this series, facial function was restored in 45%, 15%, 21%, 11%, 1%, and 0 cases corresponding to grade I, II, III, IV, V and VI, respectively. Five grade III and IV nerve sections were repaired via five hypoglossofacial anastomosis operations. We propose a slight modification be brought to the House-Brackmann classification. The aim of this study was to accurately assess the complications and sequelae secondary to surgical ablation of unilateral acoustic neurinoma by an otoneurosurgical team utilizing almost exclusively the broadened translabyrinthic (B.TL) and medial cerebral fossa or supra-petrous (SP) approaches Despite achievements realized since W.F. House [23] described those, the main problem encountered has been-excluding major complications which are fortunately rare, remains the preservation of normal or subnormal facial function.

[A free ante-brachial flap in the rehabilitation of the mucosal oropharynx]. / Le lambeau anté-brachial libre dans la réhabilitation de l'oro-pharynx buccal.

The authors report a series of 31 ante-brachial flaps used in the reconstruction of 22 circular pharyngo-laryngectomies, the most classical indication, and in 4 hemi-pelvi-glossectomies and 2 maxillectomies. The latter conditions would also appear to benefit from this technique.

[Excision-reconstruction of voluminous facial angioma under extracorporeal circulation and deep hypothermia]. / Exérèse-reconstruction d'un volumineux angiome de la face sous circulation extra-corporelle et hypothermie profonde.

The authors report a case of voluminous cervicofacial angioma with pelvi-lingual extension which had undergone multiple operations and had embolized. The exeresis consisted of cutaneous sacrifice of 10 x 10 cm combined with a longitudinal hemi-pelvi-glossectomy. Two pediculated musculocutaneous strips of greater pectoris and greater dorsal muscle were associated for reconstruction. The operation took place under extracorporeal circulation by femoral cannulation and deep hypothermia. Post-operative recovery was simple, with resumption of normal phonation and eating. No recurrence was observed upon arteriographic control at six months. The use of extracorporeal circulation is exceptional outside cardiac problems (low tracheal stenosis, intracranial aneurysm). The authors suggest the value of this technique for the treatment of angiomas purportedly inoperable because of the risk of major blood loss.