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Purpose: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. Methods: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. Results: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2–4) in the aspiration group versus 2.0 days (IQR 2–3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. Conclusion: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings. [ABSTRACT FROM AUTHOR]

Objective: Trimethoprim/sulfamethoxazole has been suggested as a treatment option for chronic rhinosinusitis with purulence. This study aimed to assess the functional and endoscopic outcomes after a three-month course of low-dose trimethoprim/sulfamethoxazole. Methods: A prospective study was performed, comprising patients referred to a tertiary care medical centre with a diagnosis of chronic rhinosinusitis with purulence. Trimethoprim/sulfamethoxazole was prescribed at 960 mg/day for three months. Sinonasal complaints and endoscopic findings were documented, and bacteriological data were compared. Results: Fifteen patients were included. Staphylococcus aureus was the most common bacterium cultured (86 per cent). Improvement in nasal function, as measured by the 22-item Sino-Nasal Outcome Test, was highly significant at three months (p < 0.0005). This improvement slightly decreased but remained significant at 6, 9 and 12 months. No side effects were noted. Endoscopic scores revealed similar and concordant improvements. Conclusion: Long-term low-dose trimethoprim/sulfamethoxazole therapy seems to be a safe option for selected patients. Additional randomised multicentre studies remain necessary. [ABSTRACT FROM AUTHOR]

Summary: Study Purpose: For ten years the market for resorbable fillers has seen a large increase. A CE mark is sufficient for its placing on the market, they do not require AMM because they are not considered drugs. The Macrolane® is a hyaluronic acid NASHA gel-based technology, available on the French market since 2007 as filler used in all areas of the body except face and breasts. It is highly crosslinked, which slows its resorption, leaving in place long-term waste. At end of 2008, Macrolane® received a CE mark for breast augmentation. The aim of this paper is to review current scientific knowledge on the Macrolane™ and list the many uncertainties regarding its recent breast indication. Materials and methods: We reviewed the PubMed literature and study levels of evidence on Macrolane®. All AFFSAPS communication and correspondence with the SOFCPRE on hyaluronic acids and particularly Macrolane™ were collected. Results: At the moment there is no scientific study of high level of evidence which has studied the effects of Macrolane® on breast parenchyma in terms of carcinogenesis or the disruption of radiological monitoring of the breast. The subglandular method of injection remains complex and uncertain especially about the risk of wrong passage. Conclusions: The Macrolane® is proposed as an alternative less invasive than breast implants. Nevertheless the lack of scientific data on this product led to its non approval by the Food and Drug Administration in the United States. Currently there remains too much uncertainty on this filler for reasonable use plebiscite. It would therefore be preferable to return to the manufacturer the burden of proof of Macrolane® safety and security and limit its use in clinical trials yet. [ABSTRACT FROM AUTHOR]

We welcome the opportunity to continue the discussion and to clarify issues you raised in your letter. You will find enclosed a point-by-point response to your comments. Please note that all of these points are already discussed in the "discussion" section of our article "Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess". Regarding the retrospective design of our study, we think that the length of hospital stay was the best criterion to be used as primary outcome because it is a clinical endpoint and a composite criterion, reflecting the global improvement of the patient. Our study included PTA patients aged under 15 because the management of peritonsillar abscess in children follows specific guidelines and requires specific care, and due to evident issues of understanding, compliance and pain handling, incision and drainage under local anaesthesia is not routinely used in younger children. We fully agree that this subject remains an area of debate and we are perfectly aware that due to methodological limitations and especially the retrospective design, the level of evidence of our study is not sufficient to draw firm conclusions on the superiority of one technique on the other. At this day, only low-quality evidence studies have been published on this subject and the debate remains opened to determine whether needle aspiration or incision and drainage is the most safe and effective technique in treating peritonsillar abscess. [ABSTRACT FROM AUTHOR]

Summary: Submental skin and fat excess are common with aging. Real cutaneous crop in pronounced forms, may be felt with difficulty by patients, which leads them to consult. The proposal of a conventional face-lift is not always suitable or accepted by a predominantly male population. Therefore, an anterior medial cervicoplasty with elliptical excision of excess skin and a medial platysmaplasty will be an interesting alternative. The authors offer a new description of this technique by simplifying, compared to the previously described techniques. Two clinical cases are reported, with both types of recommended incisions. This procedure is performed under local anesthesia. The results obtained by this technique were considered good to excellent by all operated patients in our unit. The final scar that may appear significant and sometimes unacceptable for some surgeons remains in fact very inconspicuous. The anterior medial cervicoplasty is an easy technique that allows responding gracefully to a frequent request, with good cosmetic results and few complications. [Copyright &y& Elsevier]

Summary: Study purpose: High-pressure injections (HPI) in the hand are rare and their prognosis is often tragic, some authors report up to 48% of amputations. Poorly standardized, their management is often too late and inadequate. The HPI of paint results in inoculation of toxic particles in depth that are particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. We wanted to simulate in rats, the physiopathology of HPI with paint. The aim of this study is to authenticate an advantage to achieve consistently a second surgical debridement at 48–72 hours in HPI with paint. Materials and methods: Six rats were injected with 200 bars of white glycerophtalic paint in the leg. At six hours and then every 24 hours for four days, we did a debridement and a surgical washing, then at the end of intervention a tissue sample was analyzed by histology. Results: Despite surgical debridement and thorough washing, at each step we found the persistence of painting in the intermuscular septa by light microscopy. From 24 hours, a necroinflammatory process is set up with an influx of neutrophils, organizing themselves into micro-abscesses. It will be very deleterious, initially by encouraging risk of sepsis, and then facilitating the formation of extensive fibrosis, which is the cause of functional impairment. Conclusion: We established the kinetics of tissue under HPI with paint using an animal model. It appears that single emergency surgery is insufficient to manage this “septic compartment syndrome”. Therefore, we recommend a systematic surgical “second look” at 48–72 hours to complete the debridement of residual inoculum and necrotic tissue without wound closure. [ABSTRACT FROM AUTHOR]

The article offers information on the effect of dupilumab on atopic manifestations in patients treated for atopic dermatitis in real-life practice. It mentions the ophthalmological examination was abnormal for 10 patients at inclusion with one case of acute allergic conjunctivitis; and also mentions treatment for conjunctivitis requires collaboration with an experienced ophthalmologist.