Pasteurella multocida acute epiglottitis.

INTRODUCTION: Apart from cases related to direct inoculation, pasteurellosis is a rare opportunistic infection occurring in predisposed subjects. Close contact with domestic animals, usually cats, is generally reported. Localized ENT forms are possible and are due to oropharyngeal carriage. CASE REPORT: We present the case of a patient with no notable history, who presented with laryngeal dyspnea and hyperthermia leading to a diagnosis of acute epiglottitis. Bacteremia was detected and blood cultures were positive for Pasteurella multocida. Treatment consisted of the standard treatment for acute epiglottitis with hospitalisation and intravenous antibiotics. DISCUSSION: This patient presented a history of animal exposure, but no other known risk factors. The activity spectrum of antibiotic therapy for epiglottitis should include H. influenzae and this case illustrates the diversity of the micro-organisms potentially involved. Immunosuppression or another chronic disease does not appear to be a prerequisite for ENT infection.

Epidemiology, prognosis and treatment of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx.

OBJECTIVE: The study was designed to assess the prevalence, management and survival of patients with simultaneous squamous cell carcinomas of the oral cavity and hypopharynx (OC/HP). MATERIAL AND METHODS: A multicenter, retrospective study (2 university hospitals) was conducted between 2003 and 2007 on a series of 96 patients with simultaneous squamous cell cancers of the OC/HP. RESULTS: A total of 88 men and 8 women were included in the study: 81 patients presented double sites, 14 presented triple sites and one presented quadruple sites. The tumour sites most frequently observed were: hypopharynx in 61% of cases (involving the pyriform sinus in 42% of cases) and the oropharynx in 59% of cases (involving the palatine tonsil in 30% of cases). Upper aerodigestive tract endoscopy under general anaesthesia revealed a simultaneous lesion not suspected on clinical examination in 45% of patients: the site discovered on endoscopy was hypopharyngeal in 2 out of 3 cases; the tumour was classified T1 or T2 in 95.5% of cases. Patients treated simultaneously for all sites had a better prognosis than patients in whom each tumour was treated separately. The 5-year specific survival was 34% and the 5-year overall survival was 28%. CONCLUSION: The prevalence of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx ranges between 1 to 7.4% in the literature and was 4.6% in the present series. A common treatment strategy for each of the patient's tumours appears to be superior to the current theoretical approach that consists of considering each tumour separately.

Morbidity of central compartment dissection for differentiated thyroid carcinoma of the follicular epithelium.

OBJECTIVES: To study the morbidity of central compartment dissection in differentiated thyroid carcinoma of the follicular epithelium. MATERIAL AND METHOD: A retrospective study of 83 patients (61 patients operated by total thyroidectomy and 22 patients operated by total thyroidectomy and central dissection) was performed. Postoperative serum calcium and laryngeal mobility were studied and statistically compared (Chi(2) test, Fisher's exact test). RESULTS: No significant difference was observed between the two groups in terms of the incidence of recurrent laryngeal nerve paralysis or permanent hypoparathyroidism. In contrast, transient hypoparathyroidism was more frequent among patients undergoing thyroidectomy associated with central dissection (P=0.02). CONCLUSION: Central compartment dissection associated with total thyroidectomy does not increase the risk of recurrent laryngeal nerve paralysis or permanent hypoparathyroidism, but is responsible for an increased rate of transient hypoparathyroidism.

Dorsally displaced extra-articular distal radius fractures fixation: Dorsal IM nailing versus volar plating. A randomized controlled trial.

INTRODUCTION: Fractures of the distal radius are very common and mainly occur in the elderly. There has been an increasing use of locked volar plate fixations which report satisfactory results. However, some authors advocate the use of nail fixation. HYPOTHESIS: The aim of this study is to compare dorsal nail plate versus locked volar plate fixation in the treatment of distal radius fractures with dorsal tilt. MATERIALS AND METHODS: The mean age of the patients was over 50 years. The study included extra-articular distal radius fractures with posterior tilt. We conducted a prospective randomized study between December 2007 and February 2009 including a group of 16 patients treated with a dorsal nail fixation (group 1) and a group of 15 patients managed with a locked volar plate fixation (group II). We analyzed both the clinical results (complications, Range of motion [ROM], tightening strength, Disabilities of the Arm, Shoulder and Hand [DASH] and Mayo Clinic scores) and the radiographic results from A/P and lateral radiographs in the early postoperative period and at 6-month follow-up. RESULTS: ROM toward extension was better in the volar plating subgroup (group I, 42.5°, group II, 57.5°; P<0.05). Pronation mobility was better in the dorsal nail subgroup (group I, 85°; group II, 80°; P<0.05). The locked volar plate fixation subgroup demonstrated a better recovery of the tightening strength as compared with the uninjured side (group I, 78%, group II, 90%, P=0.03). The DASH score was similar in both groups (group I, 22.09±22.9; group II, 20.62±20.3, P>0.05). The Mayo Clinic score was better in the locked volar plate fixation subgroup (group I, 65±13.4; group II, 85.6±19.2; P=0.002). Radiographic results were good in both groups, however anatomical reduction of the volar tilt was significantly better in group II (plate) when compared with the uninjured side. Moreover, we report on two cases of tendinous damages to the long extensor muscle of the thumb in the dorsal nail fixation subgroup despite the use of a minimally invasive implant. CONCLUSION: The management of distal radius fractures with locked volar plate fixation in active elderly patients has proved successful and leads to better results than nail fixation regarding both reduction quality and objective functional scores. LEVEL OF EVIDENCE: Level II, prospective, randomized of low-level.

[The reverse shoulder arthroplasty]. / La prothèse totale d'épaule inversèe.

The reverse shoulder arthroplasty indications are cuff tears arthropaty, revision of anatomic prosthesis and traumatology. The reverse shoulder arthroplasty doesn't need a rotator cuff integrity to be functional. However, complications are not rare (dislocation, descellement, infection...). The patient selection has to be rigorous. In any case, patient must be older than seventy years.

Immediate tonsillectomy: indications for use as first-line surgical management of peritonsillar abscess (quinsy) and parapharyngeal abscess.

OBJECTIVES: This study was designed to evaluate the efficacy and morbidity of immediate tonsillectomy used to treat peritonsillar abscess (quinsy) and parapharyngeal abscess. SUBJECTS AND METHOD: This four-year, retrospective study was based on 31 patients hospitalised in a university hospital ENT and head and neck surgery department for peritonsillar and/or parapharyngeal abscess. All patients underwent immediate, bilateral tonsillectomy. The length of hospital stay, duration of antibiotic therapy, microbiological findings, complications, and the time to complete recovery and oropharyngeal healing were recorded. RESULTS: The patients' mean post-tonsillectomy hospital stay was 2.84 days (median: 3 days). No post-operative haemorrhage was observed. All patients were considered to be cured at the day 10 follow-up visit, and complete oropharyngeal healing was observed at the day 21 visit. The duration of antibiotic therapy ranged from 10 to 15 days (mean: 11.5 days; median: 10 days). DISCUSSION AND CONCLUSION: Immediate tonsillectomy appears to be a safe and effective surgical technique for the management of peritonsillar and parapharyngeal abscess; in particular, it markedly reduces patients' hospital stay (when performed early in the course of the disease) and duration of antibiotic therapy. Immediate tonsillectomy has become the first-line treatment for parapharyngeal abscess and several types of peritonsillar abscess in our department.

Thyroid tubercle of Zuckerkandl: anatomical and surgical experience from 79 thyroidectomies.

OBJECTIVE: To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery. MATERIALS AND METHODS: We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands. RESULTS: A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side). CONCLUSION: The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the 'processus posterior glandulae thyroideae' described by Zuckerkandl.

[Wrist perilunate dislocation]. / Les luxations périlunaires du carpe.

Carpal perilunate dislocations are rare and underdiagnosed because of an ignorance of the pathology and an inappropriate incidence of radiography. The carpus is composed of two rows of bones and 33 ligaments. These ligaments are fundamental for wrist stability. Typically, the injury occurs in young male adults exposed to high-energy trauma with a wrist in hyperextension. The diagnosis is easy with a physical examen and standard postero-anterior and lateral radiographs. The Witvoët and Allieu classification of the perilunate dislocations is the most used. This classification is composed of three grades. The treatment is usually surgical and has to be realised in a short delay to minimize the important complications.

[The shoulder cuff tears]. / Les lesions de la coiffe des rotateurs de l'épaule.

The cuff tears are frequent. The cuff has a fundamental role for the shoulder stabilisation. Shoulder impingement causes pathologies from simple tendinosis to rupture with excentric arthritis. Classicaly, we describe three stades. It is fundamental to have a good knowledge of the stades and to evaluate them with clinical examination and provocating tests. The radiologic examen is very important to confirm the pathology and to evaluate the lesions. Each stade has a surgical treatment if the conservative treatment gives bad results. Choice of the surgical procedure depends of the patient age and lesion types. Most of surgical procedures are arthroscopics techniques. Open surgery is reserved to massive or arthritis lesions.

[Contribution of comparative x-rays for infantile traumatology]. / Intérêt des radiographies ostéo-articulaires comparatives en traumatologie de l'enfant.

PURPOSE OF THE STUDY: There is a controversy over whether or not routine comparative x-rays should be prescribed for young children with bone and joint trauma. We conducted a retrospective analysis to assess the contribution of such x-rays. MATERIAL AND METHODS: The series included 203 children aged less than fifteen years who had experienced bone and joint trauma. Two junior orthopedic surgeons, two senior orthopedic surgeons and two pediatric radiologists reread the x-rays to establish the diagnosis, using comparative x-rays to make any necessary correction of the diagnosis. The surgeons were asked to propose a therapeutic strategy for each diagnosis and the radiologists were asked to judge the value of the comparative x-rays. RESULTS: The comparative x-rays were found to be reliable in only 87.5% of the cases, and were useful for diagnosis in only 8.8%. There were statistically significant differences depending on the localization, the patient's age, and the physician's experience. DISCUSSION: Systematic use of comparative x-rays should be discouraged. Only trauma affecting the elbow in older children can, in particular cases, warrant prescription of comparative x-rays.

[Compound fracture of the ankle treated by locked retrograde transplantar nailing: a case report]. / Fracture complexe de la cheville traitée par clou transplantaire rétrograde verrouillé: un cas clinique.

The authors describe the use of a locked retrograde plantar nailing as primary treatment for a severe trauma of the ankle (trimalleolar fracture associated with posterior dislocation and a compound talus fracture).

Quantitative determination of immunological components of salivary gland secretion in transplant recipients.

Cancer therapies often induce oral complications. We studied longitudinally the major salivary immunoglobulin content in 42 transplant recipients using an enzyme-linked immunosorbent assay. A dramatic decrease in both sIgA and IgG is noticed post-transplant compared to pretransplant values. Only a small recovery of these immunoglobulin concentrations is seen after approximately 4 months. The reduction of sIgA and IgG in saliva could contribute to the frequent oral complications seen in these patients after transplantation and increase the risk of developing dental caries.

Caries-related salivary microorganisms and salivary flow rate in bone marrow recipients.

Cancer treatments often induce oral complications. In this study we investigate longitudinally the salivary gland function, the salivary caries-related microorganisms, and buffer capacity in bone marrow recipients. Stimulated saliva samples were taken midmorning. The salivary factors were studied in 42 patients from before transplant until 4 months after transplant. A dramatic reduction (66%) of salivary flow rate is noticed in all patients at 1 month after transplant, and only a partial recovery (42% reduction) is seen after 4 months. A clear shift toward a lower buffer capacity and a higher amount of cariogenic microorganisms is seen posttransplant. This shift is more pronounced when total body irradiation was included in the pretransplant conditioning therapy. These findings indicate that the studied parameters in transplant recipients can contribute to a higher caries risk and oral complications during the early posttransplant period.

Salivary caries risk factors in long-term event-free survivors of pediatric malignant diseases.

In this study we demonstrated that caries prevalence and Plaque Index in long-term event-free pediatric oncology patients are related to Streptococcus mutans, Lactobacillus counts and buffer capacity obtained by chairside saliva tests. The scores showed a significant correlation between the microbiological findings and caries experience in both groups. The results were compared with a control group. A similarity in the results was found between the study and control groups. In a subgroup consisting of children who were diagnosed with cancer maximum two years before oral examinations, no significant differences with a control group was noticed. In this study we did not find any evidence of long-term effects on the studied salivary caries risk factors in children who are long-term event-free after cytotoxic treatment. Chairside tests seem to be useful in this patient group: they provide us information which can contribute to the determination of the individual caries risk, and help to motivate the patient and health care workers to maintain optimal oral hygiene.

Quantitative determination of immunologic components of salivary gland secretion in long-term, event-free pediatric oncology patients.

OBJECTIVES: Chemotherapy influences the human immune system. Salivary alterations occur during cancer treatment. In this article we examine the salivary immunoglobulin content in pediatric patients who were long-term event-free and correlate these findings with different oral factors. STUDY DESIGN: Fifty-two children of a study group and 63 children of a control group were examined at our University Hospital. Caries prevalence and plaque index were scored. Whole saliva samples were taken for determination of slgA and IgG concentrations and Streptococcus mutans and Lactobacillus counts. For statistical analysis the Dental Survey Plus (Providence Software Services, Bristol, England) software package was used. RESULTS: Concentrations of slgA and IgG were within normal limits in both groups; slgA level increased with age. A negative correlation between slgA concentration and caries experience was not found in all age groups. No correlation with other salivary parameters was found. CONCLUSION: Salivary content of slgA and IgG can return to normal after cytotoxic therapy in these children. Salivary IgA seem to play a role in the development of dental caries in this population.

Dental caries, gingival health, and oral hygiene of long term survivors of paediatric malignant diseases.

Fifty two children who had had cancer and been treated with chemotherapy, and who were long term event free, were examined for caries prevalence, gingival health, and oral hygiene and compared with a control group. A higher dental caries prevalence for the 14-17 year age group was noted. The restorative index was significantly lower in the age group 10-13. There were no significant differences in gingival index, plaque index, or toothbrushing frequency. It is concluded that these patients should be considered as at high risk for caries after cancer treatment. Professional dental follow up should be integrated in the medical follow up.

[Preparation of bonded porcelain inlays and onlays using a milling-coping system]. / Réalisation d'inlays et onlays de porcelaine collés à l'aide d'une fraiseuse-copieuse.

The Celay-system offers an interesting alternative to existing systems for esthetic posterior restorations with ceramics. The basic idea of the concept is to prepare, either directly on the patient or indirectly on a plaster model, a pro-inlay using a light-curable precision material. The modelling also covers the occlusal surface. This pro-inlay is then used with the help of a milling center to machine a precise replica out of a ceramic block. The copying process is carried out via three-dimensional mechanical scanning and milling using eight axes of freedom. In this way additional corrections on the ceramic within the mouth can almost completely be avoided. The system is designed to be used as a direct chairside method by the dentist or as an indirect method by the dental technician. It is a promising but unproved restoration, more research and long-term clinical evaluation is recommended.

Rheological properties of topical fluoride gels.

The rheological properties of several commercial topical fluoride gels were studied. For that purpose, we investigated hysteresis loops under standard conditions, equilibrium values, apparent viscosities as a function of shear rate, rate of thixotropic recovery, and the influence of temperature. The rheological equilibrium values, treated by the Power Law and the Cross Equation, show very important differences. Five gels show pseudoplastic behavior; seven have thixotropic properties. For the risks of fluoride gel toxicity to be lowered, high pseudoplasticity seems most desirable for the first group; for the thixotropic gels, a combination of yield value (very high viscosity at rest), the presence of a static yield value (very fast decrease in viscosity at very low shear rates), and both fast and high thixotropic recovery after destruction seems ideal. Positive and negative, as well as practically no, influence on rheological properties can be noted when the temperature changes.

[The dilemma of the 2d primary molar]. / Le dilemme de la deuxième molaire de lait.

Extensive carious lesions in primary molars often confront the dentist with a dilemma: extraction or restoration. The primary molar constitutes an important element in the development of the dentition. If extraction is considered, the dentist should be aware of the possible risks towards malocclusion or malposition. In order to understand these consequences a brief summary of normal dentition development is given, followed by a description of factors influencing development of dentition after premature extraction of a second primary molar. Premature extraction causes a disturbance in the eruption of the successor and migration of the neighbouring teeth. The eruption of the bicuspid can be delayed or accelerated according to the stage of root formation. The rate, amount and direction of migration depends on the extracted element, time of loss, spacing or crowding, eruption sequence, dental relationship, intercuspation, interaction of soft tissues and dental arch, supra-occlusion and the leeway space. To conclude the treatment modalities of pulp pathologies in primary molars are outlined. In children with deep carious lesions a treatment plan involves the child's medical history and social development as well as orthodontic, preventive and restorative aspects.