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Fieux M, Tournegros R, Biot T, Tringali S. Eustachian tube balloon dilation. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:103-106. [PMID: 37620173 DOI: 10.1016/j.anorl.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Eustachian tube dysfunction is a frequent pathology of middle-ear ventilation, leading to many more or less disabling otologic symptoms. Severity varies from simple otitis media with effusion to aggressive chronic otitis or cholesteatoma. First-line treatment is medical, but surgery can also be proposed. It consists in balloon dilation of the Eustachian tube, in order to increase ventilation and improve symptoms. It is performed in second-line in patients with Eustachian tube dysfunction confirmed by tubomanometry, after failure of local drug treatment. It can be performed under general or local anesthesia but it is mandatory to use a medical device with market authorization for this indication. The main aim of this surgical note is to describe the technique of balloon dilation in the treatment of Eustachian tube dysfunction and the three balloon models with CE label and market authorization currently available in France and in Europe. Balloon dilation of the Eustachian tube appears to be a promising option to restore natural middle-ear ventilation in patients with chronic obstructive Eustachian tube dysfunction.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Université Paris-Est-Creteil, Inserm, IMRB, 94010 Créteil, France; CNRS EMR 7000, 94010 Créteil, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - T Biot
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon-Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Institut de biologie et chimie des protéines, laboratoire de biologie tissulaire et d'ingénierie thérapeutique, UMR 5305, CNRS/université Claude-Bernard Lyon 1, 7, passage du Vercors, 69367, cedex 07 Lyon, France
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Fieux M, Brudasca I, Tringali S, Trung Nguyen D. Systematic MRI in post-COVID-19 anosmia might not be necessary. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00022-X. [PMID: 38395663 DOI: 10.1016/j.anorl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France.
| | - I Brudasca
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, hôpital Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - D Trung Nguyen
- Service d'ORL et chirurgie cervico-faciale, hôpitaux de Brabois, CHRU de Nancy, 54500 Vandoeuvre-lès-Nancy, France
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Patel J, Bains K, Kalra S, Singh I, Kohli I, Dukovic D, Chaudhry H, Sohal A, Yang J, Tringali S. The Effects of Malnutrition on Inpatient Outcomes in Patients With Gastroparesis: A Nationwide Analysis. Cureus 2023; 15:e47082. [PMID: 38022097 PMCID: PMC10645593 DOI: 10.7759/cureus.47082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Gastroparesis (GP) is a chronic debilitating gastric motility disorder defined as delayed emptying of the stomach content without mechanical obstruction. It can result in nutritional deficiencies, leading to poor overall outcomes. We assessed the impact of malnutrition on in-hospital outcomes in patients with gastroparesis. Methods Patients with a primary discharge diagnosis of GP between January 2016 and December 2019 were included in the National Inpatient Sample (NIS) database. Data on patient demographics, hospital characteristics, the Charlson Comorbidity Index (CCI), and the etiology of gastroparesis were collected. The association between malnutrition and outcomes, including mortality, deep vein thrombosis (DVT), pulmonary embolism (PE), sepsis, acute kidney injury (AKI), length of stay (LOS), and total hospitalization charges (THC), were analyzed using the multivariate regression model. Results A total of 182,580 patients with gastroparesis were included in the analysis. Patients with gastroparesis and malnutrition had a higher risk of mortality (adjusted odds ratio {aOR}, 3.29; p<0.001), sepsis (aOR, 0.43; p<0.001), DVT (aOR, 2.34; p<0.001), and PE (aOR, 2.68; p<0.001) compared to patients with gastroparesis without malnutrition. No significant difference was noted in the rates of AKI. Patients with malnutrition also had a prolonged LOS (2.96 days; p<0.001) and higher THC ($22,890; p<0.001) compared to patients without malnutrition. Conclusion Gastroparesis patients with malnutrition are at a greater risk of worse outcomes than those without malnutrition. The early identification of malnutrition in gastroparesis patients can predict morbidity and mortality and assist in risk stratification to enhance outcomes. Further studies are encouraged to identify factors associated with malnutrition in gastroparesis and the impact of interventions to prevent and treat malnutrition.
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Affiliation(s)
- Jay Patel
- Internal Medicine, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, USA
| | - Kanwal Bains
- Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Isha Kohli
- Public Health Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dino Dukovic
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Hunza Chaudhry
- Internal Medicine, University of California, Fresno, USA
| | - Aalam Sohal
- Hepatology, Liver Institute Northwest, Seattle, USA
| | - Juliana Yang
- Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, USA
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Tournegros R, Tringali S, Fieux M. Persistent retro-orbital pain after acute otitis media. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:247-249. [PMID: 37024398 DOI: 10.1016/j.anorl.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; UMR 5305, laboratoire de biologie tissulaire et d'ingénierie thérapeutique, institut de biologie et chimie des protéines, CNRS/université Claude-Bernard-Lyon 1, 7, passage du Vercors, 69367 Lyon cedex 07, France
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Inserm, IMRB, université Paris Est-Créteil, 94010 Créteil, France; CNRS EMR 7000, 94010 Créteil, France.
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Biot T, Benzerdjeb N, Tringali S, Fieux M. Nasal fossa tumor. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:141-142. [PMID: 36805191 DOI: 10.1016/j.anorl.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- T Biot
- Service d'ORL, d'Otoneurochirurgie et de Chirurgie Cervico-Faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - N Benzerdjeb
- Service d'Anatomopathologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Institut de Pathologie Multisite, 69310 Pierre Bénite cedex, France; Université de Lyon, Université Lyon 1, 69003 Lyon, France
| | - S Tringali
- Service d'ORL, d'Otoneurochirurgie et de Chirurgie Cervico-Faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, 69003 Lyon, France
| | - M Fieux
- Service d'ORL, d'Otoneurochirurgie et de Chirurgie Cervico-Faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, 69003 Lyon, France.
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Sohal A, Bains K, Dhaliwal A, Chaudhry H, Sharma R, Singla P, Gupta G, Dukovic D, Sandhu S, Roytman M, Tringali S. Seasonal Variations of Hospital Admissions for Alcohol-Related Hepatitis in the United States. Gastroenterology Res 2022; 15:75-81. [PMID: 35572478 PMCID: PMC9076155 DOI: 10.14740/gr1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical experience suggests an increased hospitalization rate for alcohol-related hepatitis (AH) in the winter months; however, seasonal variations in the prevalence of hospitalizations for AH have not been described previously. We hypothesized that AH hospitalizations would be higher in the winter months due to the holiday season and increased alcohol sales. Methods Patients with primary or secondary discharge diagnosis of AH were included in the study (International Classification of Diseases, Clinical Modification-10th Revision codes K70.4 and K70.1) between January 2016 and December 2019. The primary outcome measure for this study was daily hospitalizations by each month of the year. Secondary outcome measures included the rate of in-hospital mortality associated with AH, for each month. Results The highest number of AH-related admissions was reported in July (n = 56,800; 9%), followed by August (n = 55,700; 8.8%) and May (n = 54,865; 8.7%). February had the lowest number of admissions (n = 46,550; 7.37%). The adjusted mortality was highest in December (overall mortality: 9.6%; adjusted odds ratio: 1.29; 95% confidence interval: 1.142 - 1.461; P < 0.0001) and lowest in May (overall mortality rate: 7.7%). No difference was noted between length of stay and total hospitalization cost between months. Conclusion Our findings demonstrate that seasonal variations in hospitalizations related to AH do exist across the United States. Regional differences also exist and follow unique patterns. The increase in admissions for AH is in line with other studies suggesting that heavy drinking happens during the warm season. Hospital administrators and other stewards of healthcare resources can use seasonal patterns to guide allocation of resources.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Kanwal Bains
- Department of Clinical Nutrition, Brigham and Women’s Hospital, Boston, MA, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus, Tucson, AZ, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, CA, USA
- Corresponding Author: Hunza Chaudhry, Department of Internal Medicine, UCSF Fresno, Fresno, CA 93722, USA.
| | | | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | - Sunny Sandhu
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, CA, USA
| | - Steven Tringali
- Department of Internal Medicine, University of California, Fresno, CA, USA
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Fieux M, Tournegros R, Zaouche S, Tringali S. Bioactive glass in canal wall reconstruction tympanoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:293-296. [PMID: 34535425 DOI: 10.1016/j.anorl.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Zaouche
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
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Voisin N, Tringali S, Fieux M. Laryngeal dyspnoea and COVID-19. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:415-416. [PMID: 33773950 PMCID: PMC7969825 DOI: 10.1016/j.anorl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- N Voisin
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69495 Pierre Bénite cedex, France
| | - S Tringali
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69495 Pierre Bénite cedex, France; Université de Lyon, Université Lyon 1, 69003, Lyon, France
| | - M Fieux
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69495 Pierre Bénite cedex, France; Université de Lyon, Université Lyon 1, 69003, Lyon, France; Université Paris Est Creteil, INSERM, IMRB, 94010 Créteil, France; CNRS ERL 7000, 94010 Créteil, France.
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Tournegros R, Tringali S, Fieux M. External auditory canal tumour. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:303-306. [PMID: 33339742 DOI: 10.1016/j.anorl.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Tournegros
- Service d'otorhinolaryngologie, d'otoneurochirurgie et de chirurgie cervico-faciale, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite, France.
| | - S Tringali
- Service d'otorhinolaryngologie, d'otoneurochirurgie et de chirurgie cervico-faciale, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite, France
| | - M Fieux
- Service d'otorhinolaryngologie, d'otoneurochirurgie et de chirurgie cervico-faciale, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite, France
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Fieux M, Zaouche S, Philouze P, Truy E, Hermann R, Tringali S. Low-fidelity otoscopy simulation and anatomy training: A randomized controlled trial. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:231-234. [PMID: 33092986 DOI: 10.1016/j.anorl.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate whether the use of low-fidelity otoscopy simulation improved medical students' theoretical knowledge of middle ear anatomy and pathologies compared to traditional teaching methods. METHODS This was a randomized controlled trial. Simulation workshops were conducted in April 2019 in the Lyon Sud University medical faculty, France. Students were randomly assigned to the simulation group (n=105) or to the control group (n=95). The students in the control group answered a questionnaire evaluating theoretical knowledge (25 true-false questions) before the simulation tutorial, while the students in the simulation group answered the same questions after the tutorial. Both groups also filled out a satisfaction questionnaire for feedback. RESULTS 196 of the 200 students who participated in the study completed the knowledge assessment questionnaire. Scores were 32.0% higher in the simulation group than in the control group (mean scores, 12.0/20 vs. 9.1/20; P<0.0001). 184 of the 191 students who completed the satisfaction questionnaire (96.3%) were satisfied or very satisfied with the workshop, and all but one (99.5%) recommended keeping it in the curriculum. In the free comments fields, students highlighted the educational value of learning without the stress of patient discomfort. CONCLUSION Otoscopy simulation is an effective training method, improving theoretical knowledge compared with conventional theoretical training.
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Affiliation(s)
- M Fieux
- Service d'otologie et otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université de Lyon, université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France.
| | - S Zaouche
- Service d'otologie et otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université de Lyon, université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
| | - P Philouze
- Service d'ORL et chirurgie cervico faciale, Hospices Civils de Lyon, hôpital de la Croix Rousse, université de Lyon, université Claude Bernard Lyon 1, 69004 Lyon, France
| | - E Truy
- Service d'ORL, de chirurgie cervico faciale et d'audiophonologie, Hospices Civils de Lyon, hôpital Edouard Herriot, université de Lyon, université Claude Bernard Lyon 1, 69003 Lyon, France
| | - R Hermann
- Service d'ORL, de chirurgie cervico faciale et d'audiophonologie, Hospices Civils de Lyon, hôpital Edouard Herriot, université de Lyon, université Claude Bernard Lyon 1, 69003 Lyon, France
| | - S Tringali
- Service d'otologie et otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université de Lyon, université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
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Fieux M, Duret S, Tringali S. Low-grade fever and stiff neck. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:215-216. [PMID: 33077408 DOI: 10.1016/j.anorl.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Fieux
- Service d'otologie et d'otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - S Duret
- Service d'otologie et d'otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Service d'ORL et chirurgie cervico-faciale, centre hospitalier Lucien-Hussel, 38200 Vienne, France
| | - S Tringali
- Service d'otologie et d'otoneurologie, Hospices Civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
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Herman P, Vincent C, Parietti Winkler C, Loundon N, Couloigner V, Tankere F, Tringali S, Gallet P, Papon JF, Montava M, Lavieille JP, Charpiot A, Schmerber S. Conseils de bonne pratique. Corticothérapie en ORL en contexte de pandémie COVID-19. Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale 2020. [PMCID: PMC7198192 DOI: 10.1016/j.aforl.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fieux M, Duret S, Bawazeer N, Denoix L, Zaouche S, Tringali S. Téléconsultation en ORL : enquête de satisfaction en période pandémique COVID-19. Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale 2020. [PMCID: PMC7298459 DOI: 10.1016/j.aforl.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
But Étudier l’intérêt de la téléconsultation en période de pandémie liée au COVID-19. Matériel et méthodes Étude prospective comportant une enquête de satisfaction réalisée au sein d’un service d’ORL d’un centre hospitalo-universitaire où la téléconsultation a été mise en place pour remplacer les consultations programmées. Les patients étaient répartis en deux groupes selon leur niveau de satisfaction pour en identifier les facteurs prédictifs. Une valeur de p < 0,005 était considérée statistiquement significative. L’objectif principal était d’évaluer le taux de satisfaction des patients à la suite d’une téléconsultation en ORL pendant le confinement mondial. L’objectif secondaire était d’identifier des facteurs prédictifs de la satisfaction globale des patients. Résultats 125 patients ont été vu en téléconsultation sur une période de 7 jours d’inclusion et 100 patients ont complété le questionnaire. Le taux de satisfaction globale était de 87 %. Aucun facteur prédictif cliniquement pertinent n’était associé de façon statistiquement significative avec la satisfaction. Respectivement 76 et 61 % des patients avaient jugé satisfaisante la qualité du son et de la vidéo sans impact significatif sur leur satisfaction globale (respectivement OR = 3,40 ; valeur de p = 0,049 et OR = 3,79 ; valeur de p = 0,049). L’absence d’examen physique n’était pas significativement corrélée à une diminution de la satisfaction globale (OR = 0,30 ; valeur de p = 0,027). Conclusion La téléconsultation ne permettait pas une prise en charge médicale complète mais en situation de pandémie, elle a été bien accueillie par les patients. Elle représentait un moyen simple de maintenir la continuité des soins médicaux tout en réduisant le risque de contamination par contact direct entre les patients et le personnel soignant.
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Fieux M, Mélan JB, Hermann R, Truy E, Tringali S. The medical uses of manosonic nebulizers (AMSA®) in 2018. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:73-76. [PMID: 32674996 DOI: 10.1016/j.anorl.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of repeated application of manosonic nebulizers (AMSA®) is to ensure active Eustachian tube rehabilitation and optimal middle-ear drug diffusion. In response to recent changes in marketing authorizations issued by the French National Drug Safety Agency (ANSM), the present study investigated how AMSA® is used in the Auvergne-Rhône-Alpes Region of France. MATERIAL AND METHODS A prospective non-interventional regional 1-year survey was conducted in 701 general practitioners and community and hospital ENT physicians in the Auvergne-Rhône-Alpes Region, using a questionnaire sent by mail with a reminder at 2 months. Percentage responses were compared on Chi2 test with alpha risk of 5%. Non-respondents were excluded. ENDPOINTS The main endpoints were rate of AMSA® prescription, and prescription modalities in a specific geographical territory (Auvergne-Rhône-Alpes Region) in 2018. RESULTS 93% of the 114 respondents prescribed AMSA®, with 4,000 prescriptions in 1 year. 66.7% prescribed this treatment to avoid recourse to myringotomy. Mean treatment duration was 2 weeks (50.9% of respondents). The most frequent nebulized substance was saline serum (68.4% of respondents), sometimes associated to corticosteroids or mucolytics. CONCLUSION The majority of physicians in the Auvergne-Rhône-Alpes Region, and notably the ENT physicians, were AMSA® prescribers for the treatment of Eustachian tube dysfunction and its consequences. However, the duration and modalities of use of AMSA® were very heterogeneous, and further studies are needed to standardize prescription.
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Affiliation(s)
- M Fieux
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
| | - J-B Mélan
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - R Hermann
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - E Truy
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - S Tringali
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
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Fieux M, Franco-Vidal V, Devic P, Bricaire F, Charpiot A, Darrouzet V, Denoix L, Gatignol P, Guevara N, Montava M, Roch JA, Tankéré F, Tronche S, Veillon F, Vergez S, Vincent C, Lamas G, Tringali S. French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:483-488. [PMID: 32636146 DOI: 10.1016/j.anorl.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.
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Affiliation(s)
- M Fieux
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - V Franco-Vidal
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - P Devic
- Service de Neurologie Clinique et Fonctionnelle, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - F Bricaire
- Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - A Charpiot
- Service ORL et Chirurgie Cervico-Faciale, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France
| | - V Darrouzet
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - L Denoix
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - P Gatignol
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - N Guevara
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier de Nice, IUFC, 31, Avenue de Valombrose, 01600 Nice, France
| | - M Montava
- Service ORL et Chirurgie Cervico-Faciale, Hôpital de la Conception, AP-HM, 147, Boulevard Baille, 13005 Marseille, France
| | - J A Roch
- Service de Radiologie, Hôpital Privé Jean Mermoz, 55, Avenue Jean Mermoz, 69008 Lyon, France
| | - F Tankéré
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Tronche
- SFORL, 26, Rue Lalo, 75016 Paris, France
| | - F Veillon
- Service de Radiologie, Hôpital de Hautepierre, 1, Avenue de Molière, 67200 Strasbourg, France
| | - S Vergez
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Larrey, 24, Chemin de Pouvourville, 31059 Toulouse, France
| | - C Vincent
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Salengro, Rue Michel Polonowski, 59037 Lille, France
| | - G Lamas
- Service ORL et Chirurgie Cervico-Faciale, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Tringali
- Service d'Otologie et d'Otoneurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
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Fieux M, Duret S, Bawazeer N, Denoix L, Zaouche S, Tringali S. Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:257-261. [PMID: 32624390 PMCID: PMC7306717 DOI: 10.1016/j.anorl.2020.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS To assess the benefit of telemedicine consultation during the Covid-19 pandemic. MATERIAL AND METHODS A prospective study of patient satisfaction with telemedicine consultation was carried out in the ENT department of a university hospital center where telemedicine consultations were set up to replace scheduled out-patient consultations. Patients were divided into two groups according to overall satisfaction, in order to identify predictive factors. The significance threshold was set at P<0.005. The main endpoint was patient satisfaction after an ENT telemedicine consultation during global lockdown. The secondary endpoint comprised predictive factors for overall satisfaction. RESULTS One hundred of the 125 patients with telemedicine consultation over a 7-day inclusion period completed the questionnaire. Overall satisfaction was 87%. There were no clinically relevant predictive factors significantly associated with satisfaction. Sound and video quality was satisfactory for 76% and 61% of patients respectively, without significant impact on overall satisfaction (respectively: OR=3.40, P-value=0.049; and OR=3.79, P-value=0.049). Lack of physical examination did not significantly correlate with reduced overall satisfaction (OR=0.30, P-value=0.027). CONCLUSION Telemedicine consultation did not allow complete medical care but, in a difficult time like the global pandemic, was well accepted by patients. It is a simple way to maintain continuity of care while reducing contamination risk by avoiding direct contact between patients and healthcare professionals.
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Affiliation(s)
- M Fieux
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
| | - S Duret
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - N Bawazeer
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Umm Al Qura University, Mecca, Saudi Arabia
| | - L Denoix
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - S Zaouche
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - S Tringali
- Service d'Otologie et d'Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
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17
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Fieux M, Daveau C, Tringali S. Barotrauma and orbital pain. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:435-436. [PMID: 32335000 DOI: 10.1016/j.anorl.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- M Fieux
- Service d'ORL, Hospices Civils de Lyon, Université Lyon 1, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France.
| | - C Daveau
- Service d'ORL, Hospices Civils de Lyon, Université Lyon 1, Centre Hospitalier Croix Rousse, Lyon, France
| | - S Tringali
- Service d'ORL, Hospices Civils de Lyon, Université Lyon 1, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
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18
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Fieux M, Darrouzet V, Tringali S. Peripheral facial nerve palsy and cholesteatoma. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:81-82. [DOI: 10.1016/j.anorl.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Pierre-Marie P, Tringali S, Beldjoudi G, Pommier P, Tanguy R. EP-1237 Vestibular schwannoma: Results of hypofractionated stereotactic radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Blanc F, Ayache D, Calmels MN, Deguine O, François M, Leboulanger N, Lescanne E, Marianowski R, Nevoux J, Nicollas R, Tringali S, Tessier N, Franco-Vidal V, Bordure P, Mondain M. Management of otitis media with effusion in children. Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 135:269-273. [PMID: 29759911 DOI: 10.1016/j.anorl.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines concern the management of otitis media with effusion (OME) in children under the age of 12 years. They are based on extensive review of MEDLINE and Cochrane Library publications in English or French from 1996 to 2016 concerning the methods of diagnosis and assessment of otitis media with effusion, as well as the efficacy of tympanostomy tubes and medical and surgical treatments of OME.
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Affiliation(s)
- F Blanc
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France.
| | - D Ayache
- Service d'ORL, fondation Rothschild, 75019 Paris, France
| | - M N Calmels
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - O Deguine
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - M François
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - N Leboulanger
- Service d'ORL, hôpital Necker, AP-HP, 75015 Paris, France
| | - E Lescanne
- Service d'ORL, CHU de Tours, 37000 Tours, France
| | | | - J Nevoux
- Service d'ORL, hôpital Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R Nicollas
- Service d'ORL pédiatrique, AP-HM La Timone, 13005 Marseille, France
| | - S Tringali
- Service d'ORL, CHU de Lyon, 69003 Lyon, France
| | - N Tessier
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | | | - P Bordure
- Service d'ORL, CHU de Nantes, 44093 Nantes, France
| | - M Mondain
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France
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21
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Schmidt K, Kelley W, Tringali S, Huang J. Achieving control of resistant hypertension: Not just the number of blood pressure medications. World J Hypertens 2019; 9:1-16. [DOI: 10.5494/wjh.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023] Open
Abstract
Resistant hypertension (RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy (BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.
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Affiliation(s)
- Kara Schmidt
- Department of Internal Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
| | - William Kelley
- Department of Internal Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
| | - Steven Tringali
- Department of Internal Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
| | - Jian Huang
- Department of Internal Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
- Medicine Service, VA Central California Health Care System, Fresno, CA 93703, United States
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Abstract
Clinical guidelines on hypertension have evolved over the past several decades. Each recommends varying blood pressure (BP) cut-offs which define hypertension, determine the thresholds to initiate pharmacotherapy, and guide treatment targets. In addition, different techniques of measuring BP in clinical trials may further contribute to the discrepancies in the achieved BP targets. Physicians find it difficult to navigate through different recommendations for hypertension management based on studies among different age groups and patients with a variety of co-morbidities and target organ involvement. In 2003, JNC 7 recommended a BP goal of < 140/90 mmHg in the general population and < 130/80 mmHg in those with diabetes mellitus or renal disease. JNC 8 re-set the BP target at < 140/90 mmHg for all adults under the age of 60 regardless of co-morbidities, and an even higher target of < 150/90 mmHg for those 60 years or older without diabetes or chronic kidney disease. The more recent results of the Systolic BP Intervention Trial (SPRINT) have a significant influence on the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline which redefines hypertension as BP ≥ 130/80 mmHg. It emphasizes individualized cardiovascular risk assessment and recommends a more aggressive BP target of < 130/80 mmHg and a treatment threshold based on the age, co-morbidities, and cardiovascular risk. The 2017 ACC/AHA guideline also advocates proper BP measurement and provides the estimates of corresponding BP values for clinic, home, and ambulatory BP monitoring measurements. A higher prevalence of hypertension is expected based on the ACC/AHA 2017 guideline. Its implementation may potentially lead to better BP control through enhanced awareness, improved adherence, and more timely initiation and intensification of pharmacologic therapy. Although there is no one-size-fits-all BP target, the ACC/AHA 2017 guideline is simple, inclusive and practical. Nonetheless, more studies are warranted to help further individualize BP goals for elderly patients and those with certain co-morbidities or multiple cardiovascular risk factors.
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Affiliation(s)
- Nitin Thinda
- Department of Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
| | - Steven Tringali
- Department of Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
| | - Jian Huang
- Department of Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
- Department of Medicine Service, VA Central California Health Care System, Fresno, CA 93703, United States
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Tringali S, Huang J. Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target? World J Hypertens 2017; 7:1-9. [DOI: 10.5494/wjh.v7.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
Reduction of diastolic blood pressure to less than 60-80 mmHg does not improve mortality and may lead to adverse cardiovascular events in high risk patient populations. Despite a growing body of evidence supporting the J-curve phenomenon, no major society guidelines on hypertension include a lower threshold target for diastolic blood pressure. Many major society guidelines for hypertension have been updated in the last 5 years. Some guidelines include goals specific to age and co-morbid conditions. The Sixth Joint Task Force of the European Society of Cardiology and the Canadian Hypertension Education Program are the only guidelines to date that have recommended a lower threshold target, with the Canadian guidelines recommending a caution against diastolic blood pressure less than or equal to 60 mmHg in patients with coronary artery disease. While systolic blood pressure has been proven to be the overriding risk factor in hypertensive patients over the age of 50 years, diastolic blood pressure is an important predictor of mortality in younger adults. Post hoc data analysis of previous clinical trials regarding safe lower diastolic blood pressure threshold remains inconsistent. Randomized clinical trials designed to determine the appropriate diastolic blood pressure targets among different age groups and populations with different comorbidities are warranted. Hypertension guideline goals should be based on an individual’s age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.
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Sillitti C, Melilli M, Padalino L, Bognanni R, Tringali S, Conte A, Raccuia S, Del Nobile M. Healthy pasta production using inulin from cardoon: first results of sensory evaluation. ACTA ACUST UNITED AC 2016. [DOI: 10.17660/actahortic.2016.1147.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Diallo A, Gratacap M, Tringali S. Sudden sensorineural hearing loss due to an osteolytic lesion. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:443-444. [PMID: 27663775 DOI: 10.1016/j.anorl.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Diallo
- Service d'otologie et d'oto-neurotologie, hospices civils de Lyon, service d'otologie et d'oto-neurotologie, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - M Gratacap
- Service d'otologie et d'oto-neurotologie, hospices civils de Lyon, service d'otologie et d'oto-neurotologie, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - S Tringali
- Service d'otologie et d'oto-neurotologie, hospices civils de Lyon, service d'otologie et d'oto-neurotologie, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France.
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Acharya T, Huang J, Tringali S, Frei CR, Mortensen EM, Mansi IA. Statin Use and the Risk of Kidney Disease With Long-Term Follow-Up (8.4-Year Study). Am J Cardiol 2016; 117:647-655. [PMID: 26742473 DOI: 10.1016/j.amjcard.2015.11.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/29/2022]
Abstract
Few studies have examined long-term effects of statin therapy on kidney diseases. The objective of this study was to determine the association of statin use with incidence of acute and chronic kidney diseases after prolonged follow-up. In this retrospective cohort study, we analyzed data from the San Antonio area military health care system from October 2003 through March 2012. Statin users were propensity score matched to nonusers using 82 baseline characteristics including demographics, co-morbidities, medications, and health care utilization. Study outcomes were acute kidney injury, chronic kidney disease (CKD), and nephritis/nephrosis/renal sclerosis. Of the 43,438 subjects included, we propensity score matched 6,342 statin users with 6,342 nonusers. Statin users had greater odds of acute kidney injury (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14 to 1.48), CKD (OR 1.36, 95% CI 1.22 to 1.52), and nephritis/nephrosis/renal sclerosis (OR 1.35, 95% CI 1.05 to 1.73). In a subset of patients without co-morbidities, the association of statin use with CKD remained significant (OR 1.53, 95% CI 1.27 to 1.85). In a secondary analysis, adjusting for diseases/conditions that developed during follow-up weakened this association. In conclusion, statin use is associated with increased incidence of acute and chronic kidney disease. These findings are cautionary and suggest that long-term effects of statins in real-life patients may differ from shorter term effects in selected clinical trial populations.
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Affiliation(s)
- Tushar Acharya
- Division of Cardiology, Department of Internal Medicine, University of California, San Francisco-Fresno Medical Education Program, Fresno, California
| | - Jian Huang
- Medicine Service, VA Central California Health Care System, Fresno, California; Department of Medicine, University of California, San Francisco-Fresno Medical Education Program, Fresno, California
| | - Steven Tringali
- Department of Medicine, University of California, San Francisco-Fresno Medical Education Program, Fresno, California
| | - Christopher R Frei
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, Texas; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Eric M Mortensen
- Department of Medicine, VA North Texas Health Care System, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ishak A Mansi
- Department of Medicine, VA North Texas Health Care System, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
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27
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Acharya T, Tringali S, Bhullar M, Nalbandyan M, Ilineni VK, Carbajal E, Deedwania P. Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation. Am J Cardiol 2015; 116:1852-7. [PMID: 26611122 DOI: 10.1016/j.amjcard.2015.09.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
Identification of precursors of atrial fibrillation (AF) may lead to early detection and prevent associated morbidity and mortality. This study aimed to examine the association between frequent atrial premature complexes (APCs) and incidence of AF. For this retrospective cohort study, we analyzed Holter recordings obtained from 2000 to 2010 of 1,357 veterans free of AF at baseline. All pertinent data in electronic medical records were reviewed to ascertain baseline characteristics. Holter groups with frequent (≥100/day) and infrequent (<100/day) APCs were compared for development of new AF over a median follow-up of 7.5 years. Multivariate Cox regression analyses were performed before and after propensity score matching. Mean age was 64 years with 93% men. Mean body mass index, hemoglobin A1C, low-density lipoprotein, left atrial size, and heart rate were 31.24 kg/m(2), 6.42%, 107.92 mg/dl, 4.26 cm, and 73 beats/min, respectively. AF was noted in 21.8% of patients with frequent APCs compared to 5.6% of those with infrequent APCs. After adjusting for demographics, medication use, co-morbidities, and laboratory and echocardiographic findings, multivariate Cox regression analyses confirmed frequent APCs to be independently associated with higher incidence of AF (hazard ratio [HR] 2.97, 95% confidence interval [CI] 1.85 to 4.80; p <0.001). In propensity-matched groups, this association remained significant (HR 2.87, 95% CI 1.65 to 4.98; p <0.001). Additionally, atrial couplets (≥50/day), atrial bigeminy (≥50/day), frequent runs of ≥3 APCs (≥20 runs/day), and longer runs (≥10 beats/run) were significantly associated with AF (HR 3.11, 3.67, 2.94, and 1.73, respectively, all p <0.05). In conclusion, frequent APCs (≥100/day) are associated with greater risk of AF.
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Srikanth S, Sy F, Kotak K, Kiel RG, Bajwa M, Tandon A, Loures-Vale AA, Aftab W, Tringali S, Ambrose JA. A Single Controlled Exposure to Secondhand Smoke May Not Alter Thrombogenesis or Trigger Platelet Activation. Nicotine Tob Res 2015; 18:580-4. [PMID: 26101293 DOI: 10.1093/ntr/ntv133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/09/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Chronic secondhand smoke (SHS) exposure increases cardiovascular events, particularly acute thrombotic events. There are little human data on acute SHS exposure. The aim of this study was to determine whether a single controlled exposure of humans to SHS increased thrombogenesis. METHODS After 6-8 hours fast, subjects (n = 50) were exposed to constant dose SHS (particulate level of 500 μg/m(3)) for 120 minutes in a temperature-regulated and ventilated, simulated bar environment. Blood was drawn before and immediately after SHS exposure for thromboelastography (TEG) and flow cytometry. Maximum clot strength (MA) was measured using TEG and platelet leukocyte aggregates (LPA) were measured as an index of platelet activation. Anti-CD 14 antibodies were used as leukocyte markers and anti-CD 41 antibodies as platelet markers for cytometry. Data were analyzed using students' t test for paired samples. RESULTS There was no effect of acute exposure to SHS on platelet activation or thrombogenesis. Also, intra group (smokers [n = 19] and nonsmokers [n = 31]) comparisons of LPA and TEG parameters did not show changes with SHS exposure. CONCLUSIONS While there are abundant data showing enhanced thrombogenesis and platelet activation following repeated exposure to SHS, our study suggests that a single exposure does not appear to significantly alter thrombin kinetics nor result in platelet activation. The effects of SHS on thrombogenesis might be nonlinear.
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Affiliation(s)
- Sundararajan Srikanth
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Fridolin Sy
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Kamal Kotak
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Richard G Kiel
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Muhammad Bajwa
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Abishek Tandon
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Andreia A Loures-Vale
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Waqqas Aftab
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - Steven Tringali
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
| | - John A Ambrose
- Division of Cardiovascular Medicine, University of California San Francisco, Fresno, CA
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Acharya T, Huang J, Tringali S, Frei CR, Mortensen EM, Mansi I. STATINS FOR SECONDARY AND PRIMARY PREVENTION AND THE RISK OF KIDNEY DISEASE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Acharya T, Tringali S, Singh M, Huang J. Resistant hypertension and associated comorbidities in a veterans affairs population. J Clin Hypertens (Greenwich) 2014; 16:741-5. [PMID: 25243893 DOI: 10.1111/jch.12410] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 01/13/2023]
Abstract
Resistant hypertension (RH) is understudied and its reported prevalence varies with study populations. The authors sought to determine its prevalence and association with certain comorbid conditions in a Veterans Affairs population. This cross-sectional study utilized demographic and clinical data from 17,466 patients. Chi-square or t test was used for comparing groups with and without RH. Multivariate logistic regression analysis was used to determine independent associations. Overall, the prevalence of RH was 9%, and 13% of all hypertensive patients met criteria for RH. After adjusting for confounding variables, RH was significantly associated with older age (odds ratio [OR], 1.007), higher body mass index (OR, 1.04), Framingham score (OR, 1.14), and coexisting coronary artery disease, cerebrovascular accident/transient ischemic attack, peripheral vascular disease, congestive heart failure, chronic kidney disease, diabetes mellitus, erectile dysfunction, and metabolic syndrome (OR, 1.3, 1.32, 1.29, 2.88, 2.13, 1.2, 1.12, and 1.2, respectively; all P<.05). Our results indicate a complex interplay of certain comorbid conditions among patients with RH and suggest the need for multifaceted interventions in this high-risk population to prevent cardiovascular events.
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Affiliation(s)
- Tushar Acharya
- Primary Care Service, VA Central California Health Care System, Fresno, CA; Department of Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA
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Madero B, Avan P, Bazin A, Chays A, Mom T, Khalil T, Tringali S, Zaouche S, Dubreuil C, Hassoun T. Cochlear Microphonics: A Promising Tool for Hearing Monitoring in Cerebellopontine Angle Surgery. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moncef B, Jacquesson T, Gleizal A, Tringali S, Abouaf L, Vighetto J, Raverot G, D'hombres A, Jouanneau E. The Multidisciplinary Minimally Invasive Skull Base Surgery Unit: An Example of a Transversal Collaboration to Improve the Patient's Care Path. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vigier S, Traverse-Glehen A, Durbec M, Tringali S, Dubreuil C, Ceruse P. Deep cervical granular cell tumor: An atypic location suggestive of neurogenic origin. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:65-7. [DOI: 10.1016/j.anorl.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
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Acharya T, Acharya S, Tringali S, Huang J. Association of antidepressant and atypical antipsychotic use with cardiovascular events and mortality in a veteran population. Pharmacotherapy 2013; 33:1053-61. [PMID: 23776095 DOI: 10.1002/phar.1311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES To determine the patterns of antidepressant and atypical antipsychotic use in a veteran population with depression, and to determine if an association exists between specific antidepressant classes and atypical antipsychotics and the occurrence of cardiovascular events and all-cause mortality. DESIGN Retrospective, cross-sectional study. SETTING Primary care clinic at a Veterans Affairs hospital. PATIENTS A total of 1136 patients diagnosed with depression who were receiving antidepressant monotherapy (664 patients) or no antidepressant therapy (472 patients [controls]) between June 2009 and December 2010. MEASUREMENTS AND MAIN RESULTS Data on patient demographics, disease diagnoses, laboratory data, and drug therapy profiles were collected through medical record review. Of the 1136 patients, the mean patient age was 61 years, 90% were men, and 77% were smokers. Mean body mass index was 30.4 kg/m(2) , blood pressure 126/73 mm Hg, hemoglobin A1c 6%, low-density lipoprotein cholesterol level 106.7 mg/dl, and Framingham score 17. Patients receiving antidepressant monotherapy were grouped according to antidepressant class; selective serotonin reuptake inhibitors (SSRIs) were most common. Concomitant use of atypical antipsychotics was more common with the serotonin-norepinephrine reuptake inhibitor (venlafaxine), SSRI, and serotonin receptor antagonist (trazodone) classes (p=0.0067). After adjusting for demographics, concomitant drugs, and comorbidities, SSRI use was significantly associated with lower all-cause mortality (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.19-0.71, p=0.0028). Notably, noradrenergic and specific serotonergic antidepressant (mirtazapine) use was significantly associated with higher prevalence of heart failure (OR 3.26, 95% CI 1.029-10.38, p=0.0445). Use of atypical antipsychotics was significantly associated with a higher prevalence of cerebrovascular events (OR 2.23, 95% CI 1.29-3.83, p=0.0036) and all-cause mortality (OR 2.05, 95% CI 1.03-4.1, p=0.04). CONCLUSION Our results favor treatment of depression with SSRIs among patients at increased cardiovascular risk due to the potential mortality benefit of this class of drugs. Atypical antipsychotics should be used with caution in the elderly population. Mirtazapine use in patients with heart failure and depression deserves further investigation.
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Affiliation(s)
- Tushar Acharya
- Primary Care Service, Veterans Administration Central California Health Care System, Fresno, California; Department of Medicine, University of California, San Francisco, Fresno Medical Education Program, Fresno, California
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Tringali S, Perrot X, Collet L, Moulin A. Exposition sonore et répercussions auditives au cours de la stimulation magnétique transcrânienne répétitive : données récentes et revue de la littérature. Neurophysiol Clin 2013; 43:19-33. [DOI: 10.1016/j.neucli.2012.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 04/16/2012] [Accepted: 07/07/2012] [Indexed: 12/12/2022] Open
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Durbec M, Vigier S, Brosset R, Mottier C, Dubreuil C, Tringali S. Post-traumatic total deafness with normal CT scan. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:281-3. [DOI: 10.1016/j.anorl.2011.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 11/08/2011] [Accepted: 12/12/2011] [Indexed: 11/24/2022]
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Reagle Z, Tringali S, Gill N, Peterson MW. Diagnostic yield and renal complications after computed tomography pulmonary angiograms performed in a community-based academic hospital. J Community Hosp Intern Med Perspect 2012; 2:17722. [PMID: 23882362 PMCID: PMC3714054 DOI: 10.3402/jchimp.v2i2.17722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/24/2012] [Accepted: 05/02/2012] [Indexed: 11/26/2022] Open
Abstract
Background Venous thromboembolism and pulmonary embolism (VTE/PE) remain a diagnostic challenge. The computed tomography pulmonary angiogram (CTPA) has emerged as a popular diagnostic test for PE. However, there is limited data on diagnostic yield and complications in actual clinical settings. Our goal was to determine the diagnostic yield for PE and rate of renal complications following CTPA in a large community hospital setting. Methods A retrospective chart review of 1,514 patients who underwent CTPA in the emergency department or during the initial 24 hours of admission to a community-based academic hospital. Results Of 1,514 CTPAs, 125 were positive for VTE/PE yielding a positive diagnosis in 8.2%. Dyspnea was the most common symptom in patients and a normal physical exam was the most common finding. Among the 925 patients with adequate data to calculate the rate of contrast-induced nephropathy (CIN), 25.8% had an increase of at least 25% in serum creatinine following the CTPA. Pre-existing diabetes and age were the most important predictors of CIN. Conclusions CTPA has a low diagnostic yield for PE in a community setting, and in some patient populations, the rate of contrast-induced nephropathy may be higher than previously reported in the literature. Due to the retrospective nature of this study we were limited in using pre-test scoring systems and in measuring the impact of alternative CT diagnoses on patient management.
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Fleury A, Ambrun A, Ferber-Viart C, Zaouche S, Dubreuil C, Tringali S. One radiologic image may hide behind another. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:259-61. [PMID: 21798841 DOI: 10.1016/j.anorl.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 02/20/2011] [Accepted: 05/10/2011] [Indexed: 10/17/2022]
Affiliation(s)
- A Fleury
- Service d'otologie et d'otoneurotologie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France
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Durbec M, Bienvenu AL, Picot S, Dubreuil C, Cosmidis A, Tringali S. Maxillary sinus fungal infection by Acremonium. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:41-3. [PMID: 21233038 DOI: 10.1016/j.anorl.2010.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/15/2010] [Accepted: 10/22/2010] [Indexed: 11/16/2022]
Affiliation(s)
- M Durbec
- Service d'Oto-Rhino-Laryngologie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France
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Navarro R, Fleury A, Ambrun A, Dubreuil C, Tringali S. Dilatation of the vestibular aqueduct and lipiodol. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:120-3. [PMID: 20826124 DOI: 10.1016/j.anorl.2010.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 05/28/2010] [Accepted: 05/29/2010] [Indexed: 11/16/2022]
Affiliation(s)
- R Navarro
- Département d'Otologie et d'Otoneurotologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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Fuchsmann C, Traverse-Glehen A, Durbec M, Dubreuil C, Tringali S. Glioblastoma multiforme mimicking a frontal abscess after surgery for a large vestibular schwannoma. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:46-8. [PMID: 20822757 DOI: 10.1016/j.anorl.2010.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Routine vestibular schwannoma surgery can result in serious and potentially lethal infectious complications. A high degree of vigilance is necessary to diagnose these uncommon infections and in case of postoperative neurological symptoms, brain magnetic resonance imaging should be performed to eliminate a brain abscess. In some cases, the final diagnosis is not the expected one. CLINICAL PRESENTATION A 39-year-old man presented three months postoperatively after a vestibular schwannoma removal by translabyrinthin approach with a rapid and progressive history of headaches, confusion, and left hemi paresis with fever. The brain CT and MRI were in favour of a delayed postoperative frontal abscess. TECHNIQUE A biopsy under stereotactic guidance was performed. Histopathologic examination revealed WHO grade 4 glioblastoma multiforme. CONCLUSION Symptoms and signs of glioblastoma multiforme are congruent with brain abscess. Its rapid evolution, the normality of the first magnetic resonance imaging, and its radiological aspect made it a differential diagnosis of a postoperative brain abscess and should be systematically researched.
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Affiliation(s)
- C Fuchsmann
- Département d'otoneurochirurgie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Charpiot A, Tringali S, Ionescu E, Vital-Durand F, Ferber-Viart C. Vestibulo-Ocular Reflex and Balance Maturation in Healthy Children Aged from Six to Twelve Years. ACTA ACUST UNITED AC 2010; 15:203-10. [DOI: 10.1159/000255338] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 08/14/2009] [Indexed: 11/19/2022]
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Gardes S, Hellot M, Tringali S, Larbre JP, Biron F, Llorca G, Girard R. [Monoarthritis caused by Streptococcus pyogenes after nasal septoplasty: interest of the nasal decontamination in preoperative care]. Med Mal Infect 2009; 40:548-51. [PMID: 20018472 DOI: 10.1016/j.medmal.2009.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 03/30/2009] [Accepted: 11/13/2009] [Indexed: 11/19/2022]
Abstract
The nasal septoplasty is a very current intervention in otorhinolaryngology surgery. The infectious complications of this intervention are rare and mostly mild. We report here the case of a patient hospitalized in ambulatory surgery within a fracture of the nose with luxation of the septum in the nasal fossa. This patient was operated for a reduction of this fracture with septoplasty. Twelve hours after the intervention the patient presented septic arthritis due to Streptococcus pyogenes. The tracks of prevention are presented.
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Affiliation(s)
- S Gardes
- Unité d'Hygiène et d'Epidémiologie, Groupement Hospitalier Sud, Centre Hospitalier Lyon-Sud, Chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Lefebvre P, Martin C, Dubreuil C, Decat M, Yazbeck A, Kasic J, Tringali S. A Pilot Study of the Safety and Performance of the Otologics Fully Implantable Hearing Device: Transducing Sounds via the Round Window Membrane to the Inner Ear. Audiol Neurootol 2008; 14:172-80. [DOI: 10.1159/000171479] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 07/09/2008] [Indexed: 11/19/2022] Open
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Benchemam Y, Nicolas J, Alix T, Soubeyrand E, Tringali S, Labbé D, Traoré H, Compère JF, Seguin P, Bénateau H. [The Antia-Buch flap technique in reconstruction of marginal ear defects]. Rev Stomatol Chir Maxillofac 2008; 109:307-311. [PMID: 18692210 DOI: 10.1016/j.stomax.2007.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 10/30/2007] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the results of ear defect reconstruction using the Antia-Buch flap technique and to compare it to other techniques described in international literature. MATERIALS AND METHODS We performed 19 Antia-Buch flaps between November 1998 and November 2002: 15 cases after neoplastic treatment and four post-traumatic cases. Defect ranged between 15 and 40 mm. Between 30 and 40 mm, we used Fata's modification. The final assessment took into account patient satisfaction, cosmetic aspect of reconstruction assessed by the medical team, the presence of a notch at the helical rim and the degree of microtia. RESULTS All ear reconstructions were successful. No complications were reported. Fata's modification was used for eight patients. All the patients were satisfied with the result in spite of a systematic microtia. The cosmetic aspect was considered as good for 16 patients, average for three. Nine patients presented with a notch at the helical rim. DISCUSSION Reconstruction using the Antia-Buch flap is a simple and fast operative technique performed in a single operation under local anesthesia. It allows for a harmonious reconstruction of the helix and auricle with a tissue of same nature, and only a tiny cicatricial ransom, systematic microtia and frequent notch on the helical rim.
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Affiliation(s)
- Y Benchemam
- Service de stomatologie, chirurgie maxillofaciale et chirurgie plastique et esthétique, hôpital Bellevue, 42055 Saint-Etienne cedex 02, France
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Tringali S, Dubreuil C, Bordure P. [Tympanic membrane perforation and tympanoplasty]. ACTA ACUST UNITED AC 2008; 125:261-72. [PMID: 18778811 DOI: 10.1016/j.aorl.2008.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/18/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report anatomic and physiologic characteristics of the tympanic membrane, to discuss the etiology and pathogenesis of tympanic perforation, and to discuss its management. MATERIAL AND METHODS After a review of the literature, different surgical techniques and the postoperative results were evaluated. RESULTS The rate of tympanic membrane closure is greater than 90% for the majority of authors. Age, mucosa inflammation, pathological contralateral ear (perforation, otitis media, cholesteatoma), and surgical experience influence this result. DISCUSSION Even if surgical results are good, abstention must always be proposed and all complications must be explained. CONCLUSION Palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closures.
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Affiliation(s)
- S Tringali
- Service d'oto-neurochirurgie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France.
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Tringali S, Perrillas P, Pouget JF, Martin C, Dubreuil C. [How to interpret CT-scan in presence of conductive hearing loss or mixed hearing loss with normal tympanic membrane?]. Ann Otolaryngol Chir Cervicofac 2008; 125:234-240. [PMID: 18817905 DOI: 10.1016/j.aorl.2008.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 06/10/2008] [Indexed: 05/26/2023]
Affiliation(s)
- S Tringali
- Service d'oto-neurochirurgie, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
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Tringali S, Pierrillas P, Céruse P, Dubreuil C. [Endoscopic staple diverticulostomy for Zenker's diverticulum]. ACTA ACUST UNITED AC 2008; 125:128-33. [PMID: 18486099 DOI: 10.1016/j.aorl.2008.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Retrospective study to evaluate the efficacy and safety of endoscopic stapled diverticulotomy of patients with Zenker's diverticulum. METHODS Twenty-two patients with Zenker's diverticulum were evaluated. All patients had a preoperative barium swallow, which confirmed the Zenker diverticulum. SURGICAL PROCEDURE Patients underwent an attempted endoscopic resection of the Zenker diverticulum using the endoscopic stapling technique. If unsuccessful, an open approach was then taken. All patients were seen in follow-up within one and then at six months after surgery and had a barium swallow during the first month. RESULTS The patient's mean age was 74 years. The operation lasted a mean of 20minutes. Conversion to open surgery was required in five patients, which lasted a mean 20minutes. No postoperative morbidity or mortality was recorded. In two patients with a small diverticulum (2cm), persistent discomfort with no dysphagia or regurgitation was noted. The barium swallow demonstrated a persistent diverticulum without a neck. CONCLUSION Endoscopic staple diverticulotomy is an excellent first-intention method to surgically correct Zenker's diverticulum in many patients. It is a technique with a significantly shorter operative time, hospital stay, time to resumption of oral feeding and lower mortality and fewer morbidity complications.
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Affiliation(s)
- S Tringali
- Hospices civils de Lyon, service d'otoneurochirurgie, bâtiment 3, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
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Abstract
OBJECTIVES To describe the value of high resolution computed tomography scan (HRCT scan) in post traumatic hearing loss. METHOD HRCT scan of the temporal bone in millimetric cut with axial and coronal views was performed. RESULTS CT scan confirmed pneumolabyrinth with intact stapes depressed deeply into the vestibule. Surgical exploration was performed and the stapes was gently removed from the vestibule. CONCLUSION CT scan confirmed the diagnosis and studied the stapes integrity. Hearing deteriorated postoperatively is increased in case of stapes fracture. When a luxation of the stapes into the vestibule is suspected, it is important to determine how deeply and whether it is fractured. When such a case is encountered, high resolution CT scan of the temporal bone must be performed to confirm the diagnosis and to confirm integrity of the stapes.
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Affiliation(s)
- S Tringali
- Service d'Oto-neurochirurgie, bâtiment 3A, Centre hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France
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Dubreuil C, Tringali S. [How to harvest and prepare cartilage for tympanoplasty]. Ann Otolaryngol Chir Cervicofac 2006; 123:107-10. [PMID: 16733474 DOI: 10.1016/s0003-438x(06)76650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- C Dubreuil
- Service d'Oto-Neurochirurgie, Bat 3A, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex.
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