Vocal fold granulomas in six brachycephalic dogs: clinical, macroscopical and histological features.

Vocal cord granulomas are rarely observed in brachycephalic breeds but often reported in humans as contact granulomas. Six French bulldogs were included in this retrospective descriptive study. Endoscopic laryngeal examinations were performed on all dogs under general anaesthesia. Vocal cord lesions were exclusively unilateral, exophytic, approximately 3-mm wide ulcerated mucosal nodules, arising from the vocal cord. Histopathological examination mainly revealed chronic inflammatory changes on the laryngeal epithelium which were consistent with laryngeal granulomas described in humans, except for the location: vocal cord in dogs versus vocal process in humans. In humans, granulomas result from chronic physical or chemical insult to laryngeal mucosa (chronic cough or throat clearing, vocal abuse, gastro-esophageal reflux). In brachycephalic breeds, chronic inspiratory efforts and air turbulences and gastro-esophageal reflux are suspected to result in chronic laryngeal inflammation.

Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial.

Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere. TRIAL REGISTRATION: NCT02722382.

Position of maximal nasopharyngeal maximal occlusion in relation to hamuli pterygoidei: use of hamuli pterygoidei as landmarks for palatoplasty in brachycephalic airway obstruction syndrome surgical treatment.

OBJECTIVES: To assess the influence of complete nasopharyngeal occlusion on respiratory signs in brachycephalic dogs. To determine the cranio-caudal position of rostral nasopharyngeal occlusion in relation to the hamuli pterygoidei in brachycephalic dogs. To determine whether using the hamuli pterygoidei as anatomical landmarks for palatoplasty results in clinical respiratory improvement. MATERIALS AND METHODS: Prospective study of dogs diagnosed with brachycephalic obstructive airway syndrome. The dogs were scored according to the severity of their clinical respiratory signs and the nasopharynx was CT scanned. The site of most rostral nasopharyngeal occlusion was measured in relation to the hamuli pterygoidei. Measurements were compared between brachycephalic obstructive airway syndrome group, completely occluded and partially occluded groups. The hamuli pterygoidei were used as the most cranial landmarks for the palatoplasty incision, such that the incision was made at the point of maximal nasopharyngeal occlusion. Owners were interviewed through telephone for the medium-term follow-up. RESULTS: Thirty-five dogs were included. There was no significant association between the severity of respiratory clinical signs and extent of nasopharyngeal occlusion. Maximal nasopharyngeal occlusion was always located directly caudal to the hamuli pterygoidei (mean ±sd value of 9∙4 ±6∙5 mm). hamuli pterygoidei were easily palpable perioperatively in all cases. There was a significant improvement of clinical grades postoperatively. CLINICAL SIGNIFICANCE: The hamuli pterygoidei are a reliable landmark for soft palate incision for palatoplasty in these cases but the distance between them and the site of maximal nasopharyngeal occlusion varied greatly.

[Acute presentation in oral schwannoma]. / Présentation aiguë d'un schwannome intraoral.

OBSERVATION: We report an unusual presentation of an acute septic maxillary vestibular schwannoma in a 19-year-old female patient. The anatomopathological examination of the tumor showed Schwann cell proliferation and ulceration of infectious origin. DISCUSSION: Intraoral schwannomas are uncommon. They generally induce local pain on percussion and dysesthesia. Isolated intraoral schwannomas are very rarely linked with type I neurofibromatosis. They do not require any specific follow-up after exeresis.

Surgical treatment of congenital lobar emphysema in a puppy.

Congenital lobar emphysema was found in a three-month-old male springer spaniel. Clinical signs included coughing, progressive dyspnoea and abnormal lung auscultation. Radiographic examination revealed overinflation and hyperlucency of the right middle lung lobe. Following lung lobectomy, clinical signs resolved and the animal had normal exercise tolerance. Previous case reports are reviewed and discussed in relation to human congenital lobar emphysema.

Dysuria resulting from an encapsulated haematoma in a recently spayed bitch.

A 15-month-old bitch was presented for investigation of a two-month history of dysuria. Clinical signs had developed within one day of routine ovariohysterectomy. A rounded mass was palpable in the caudal abdomen which was shown radiographically to displace and compress the urinary bladder. On ultrasonography, the mass was composed primarily of pockets of hypoechoic fluid divided by hyperechoic septae; blood was obtained on fine-needle aspiration. The mass was surgically removed and the dog regained normal urinary function within a few days. Histopathological examination showed the mass to be an encapsulated haematoma, which is likely to have developed as a result of the ovariohysterectomy.

[Lingual osteoma. Apropos of a case]. / Ostéome lingual. A propos d'un cas.

The authors present a case of osteoma of the tongue. This tumor was discovered without any functional symptom. Surgical resection with histological examination gives the diagnostic. This choristoma is rare, benign and clinically poor. Osteoma of the tongue is a heterotopic bone tissue and his main differential diagnosis are lingual thyroid and thyroglossal cyst. There are several opinions concerning the histogenesis of this choristoma, but an embryological anomaly is probable. Surgical removal of the tumor is curative, without any reported local recurrence.

Effects of carbon monoxide and hypoxia on cleft lip in A/J mice.

Epidemiologic evidence indicates an increase in cleft lip with or without cleft palate [CL(P)] in infants of mothers who smoke cigarettes. It appears that the principle mechanism is through carbon monoxide (CO) decreasing the oxygen (O2) available to the embryo. Previous studies have shown that maternal respiratory hypoxia can increase the incidence of CL(P) in mice. The present investigation was designed to analyze the effects of altered levels of CO and O2 in respiratory gases on the incidence of CL(P) in genetically susceptible A/J mice. Results from blood gas analysis, after a 24-hour exposure of pregnant mice during the time of primary palate development, showed that CO levels of 180 ppm in air decrease oxyhemoglobin (%O2Hb) and increased carboxyhemoglobin (%COHb) to slightly above the high end of the range found in human studies of cigarette smokers. Interestingly, the control COHb levels were higher in our CL(P) sensitive mouse strain compared with those of the range of increases found in human smokers, versus nonsmoker studies, and that the increase for treated mice (3x) was at the low end of the range for smokers. Decreasing O2 levels to 10% from 21% (normal percentage in air) more severely decreased %O2Hb and moderately decreased %COHb. At 24 hours of exposure, the incidence of CL(P) and resorption was approximately the same for both the CO and the control groups, but there were significant increases in the incidence of resorptions in the hypoxia group and of CL(P) in relation to the CO group.(ABSTRACT TRUNCATED AT 250 WORDS)

[The Bichat ball. The surgical value of oro-sinus communications]. / La boule de Bichat. Intérêt chirurgical dans les communications bucco-sinusiennes.

Bichat's ball is a mass of adipose tissue used to fill communications between the buccal cavity and the sinus. The anatomy of the structure is presented. it has a body and 6 extensions. A surgical technique is proposed in comparison with previously described methods. At 6 weeks, there has been no recurrence of buccal-sinus communication in a series of approximately 300 cases operated over a period of 15 years.

[Treatment of salivary incontinence. A proposal of a new surgical technic and the preliminary results]. / Traitement de l'incontinence salivaire. Proposition d'une nouvelle technique chirurgicale et résultats préliminaires.

Drooling is not induced by an excess of salivary but by incontinence, in case of patients with cerebral palsy and neurologically damaged. Than radical techniques of excision, duct ligations of salivary glands, the authors propose an original association of deviation of submandibular and parotid ducts behind the anterior pillar of soft palate. They discuss it with other therapeutics already proposed in the literature.

[Aggressive recurrence of a mixed tumor of the accessory salivary glands with a predominant myoepithelial composition]. / Récidive agressive d'une tumeur mixte des glandes salivaires accessoires à fort contingent myoépithélial.

A giant pleomorphic adenoma of the palate was observed. Local relapse was highly invasive. There was no cytological evidence of malignancy and the predominant myoepithelial nature of the structure suggested a possible myoepithelioma. Large exeresis of such a tumour is required.

[Mandibular metastasis of hepatocellular carcinoma. Apropos of 3 cases]. / Métastases mandibulaires des carcinomes hépato-cellulaires. A propos de 3 observations.

Three cases of mandibular metastasis of hepatocellular cancer are reported. The specific characteristics are described: rarity, discovery, localization, haemorrhagic biopsies and histological criteria. Prognosis is poor.

[Chronic and neglected luxation of the temporomandibular joint]. / Luxation chronique et négligée de l'articulation temporo-mandibulaire.

The authors propose their experience about 6 cases of chronic dislocation of the temporo-mandibular joint. They underline the part of edentulous status as a predisposing factor also that of the anatomopathological injuries of the dislocated joint. According to the literature, they insist about the importance of surgery to set the dislocation, that in association with a temporal aponevrosis flap and occlusal adjustment, accompanied by immediate postoperative rehabilitation.

[Biopsy of the salivary glands. The importance and technic of biopsy of the sublingual gland on its anterio-lateral side]. / Biopsie des glandes salivaires. Intérêt et technique de la biopsie de la glande sublinguale sur son versant antérolatéral.

A new method of taking a sublingual gland sample is suggested by the authors in the fore pole. They emphasize on this straightforward operating act and on the amount of tissue removed. The aim of the removal could be etiologic within the framework of the Gougerot-Sjögren's syndrome, diagnostic in the sarcoidosis and rheumatoid arthritis, prognostic in the graft versus host disease.

[Prognostic and therapeutic aspects of lympho-epithelial lesions of the parotid. Apropos of 8 cases]. / Aspects pronostiques et thérapeutiques des lésions lympho-épithéliales de la parotide. A propos de 8 observations.

The so-called benign lympho-epithelial lesion (BLEL) of the parotid is a rare condition. Its diagnosis is based on histology. For a long time there have been problems with its classification and prognosis: classification since certain cases may be classified as Sjögren's syndrome or as a precursor of the latter, prognosis there may be recurrence, contralateral involvement or progression to non-hodgkin's lymphoma. The authors discuss these factors in 8 cases and propose total parotidectomy with facial nerve preservation as the treatment of choice.

The effect of testosterone replacement on plasma lipids and apolipoproteins.

Ten men with Klinefelter's syndrome were studied to assess the effect of testosterone replacement on plasma lipids and apolipoproteins. Measurements taken before the insertion of a testosterone ester implant were compared with those obtained 1 week and 4 weeks later. Mean plasma testosterone, androstenedione, total cholesterol and calculated LDL-cholesterol increased significantly after 1 and 4 weeks. No significant changes were seen in total plasma concentrations of HDL-cholesterol, HDL-cholesterol subfractions 2 and 3 or in apoplipoproteins A-I, A-II or B. A significant correlation was seen between total cholesterol and plasma oestradiol concentrations (Rs = 0.61; P less than 0.001). A significant negative correlation was seen between the concentrations of total testosterone and total triglyceride (Rs = -0.56; P less than 0.005) but not with the other lipid parameters. Testosterone replacement is associated with slight but potentially adverse changes in plasma cholesterol levels.

The role of dental canal fillings in the development of Aspergillus sinusitis. A report of 85 cases.

Radiopaque concretions in the maxillary sinus in cases of sinusitis are often observed in infections with aspergillosis. For several authors, such features are considered to be typical of these infections. For us this foreign body in most cases is believed to be related to overfilling of the teeth. We have previously drawn attention to this fact. We report 85 cases of aspergillosis of the maxillary sinus. Cases involving immunosuppressed patients were excluded because of very different clinical conditions. A radiopaque foreign body was seen in 94% of the cases. Of this group, 85% were believed to be related to overfilling of maxillary teeth with dental paste, particularly since evidence for endodontic treatment was found in the premolar/molar region. An image of intrasinus dental paste was demonstrated in 12% of the cases as a direct extension of filling paste from affected teeth. The nature of the dental paste is important because the zinc contained can stimulate the growth of Aspergillus fumigatus. In vitro studies in our laboratory also showed that the growth of A. fumigatus was stimulated with a low concentration of zinc.

[Use of very high doses of haloperidol in the treatment of acute psychotic episodes. Clinical and pharmacokinetic analysis apropos of 15 cases]. / Utilisation de très fortes posologies d'halopéridol dans le traitement des épisodes psychotiques aigus. Analyse clinique et pharmacocinétique à propos de quinze cas.

High-dosage haloperidol treatment was administered during three weeks in a rapid neuroleptization technique to fifteen patients suffering from acute psychotic episodes. Haloperidol plasma levels were determined by radioimmunoassay. The efficacy of such a therapeutic design seemed fairly good, particularly the rapid improvement during the first week. Yet, tolerance appeared to be low, with a high incidence of adverse effects, some of them unexpected. A very good correlation was observed between haloperidol plasma levels and haloperidol oral doses. By contrast, there was no correlation between plasma levels and clinical improvement. In the same way, the occurrence of adverse effects did not seem to be related to haloperidol plasma levels.