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The static and dynamic aspects of nasal anatomy determine the characteristics of the air flow passing through the nose and the thermo-hygrometric and particulated conditioning of the inhaled air. Through rhinomanometry it is possible to measure nasal cavities resistance to the passage of inhaled and exhaled air. Ventilation obstacles in the nose are frequent and varied: they are examined with the consequences of nasal obstruction at local and zonal level.

Presentation of a 48-y old woman who developed a neuroendocrine tumor of the nasal cavities. This lesion progressed rapidly despite an extensive resection and repeated chemotherapy. The patient refused radiotherapy. Before her death, 28 months later, she exhibited a paraneoplastic Cushing-like syndrome. At autopsy, restricted to the brain, there was a 5 cm diameter tumor invading the frontal area without alteration of the hypothalamus or the pituitary gland. Routine histology and electron microscopy confirmed the neuroendocrine nature of the tumor. Immunohistochemistry revealed the tumor to be positive only for neurone specific enolase, negative for S-100 protein, neurofilament and ACTH. The pituitary gland was positive for most usual hormones (GH, PRL, TSH, LH, FSH) but only few cells were slightly positive for ACTH. Many Crooke cells were observed. These findings suggest that the tumor secreted an ACTH-like substance (not detected actually by immunochemistry) that stimulated the activity of the adrenal cortex but inhibited normal production of ACTH at the pituitary gland level.

The authors related a case of high osteoplasic tracheopathy in a women, 79 years old. The semiology and the different etiopathogenic theories are reviewed. The affection is characterized by the presence in the tracheal sub-mucosa or sometimes the bronchial sub-mucosa of cartilagenous and often bony spaces, which cuases the stenosis of the respiratory lumen. In this related case, the lesions are situated at the level of a tracheal segment compressed by an important goitre. It seems to be caused by a local metaplasia induced by the compression.

Studies of regional lung function were performed on two children with bronchogenic cysts before and after surgery. The first patients, aged two, presented with a severe and continuous airflow obstruction leading to significant disturbance of perfusion per unit of alveolar volume; the abnormalities of perfusion were partly reversible when the ventilation was restored after surgery. Patient no 2, aged 10 years, had a voluminous peripheral cyst, which was shown to be ventilated by pulmonary function studies and further confirmed by bronchography. After lobectomy, studies revealed a reduction in the functional pulmonary parenchyma in the right hemithorax. The abnormal distribution of perfusion was still seen two years after the operation.

The authors have measured, with the agar diffusion technique, the antibiotic concentrations in the serum as well as in the normal nasal, lachrymal and salivary secretions, after an intramuscular injection of 500 mg of ampicillin and of 200 mg of erythromycin. Bacillus subtilis is used as test germ for dosage of ampicillin and Sarcina lutea for the dosage of erythromycin. An important quantity of ampicillin (0.5 to 2.5 microgram/ml) passes into the nasal secretion. Its passage into the saliva is very irregular and is usually very slight. Bacillus subtilis is not suitable for systematically studying the ampicillin concentration in the lachrymal secretion, which displays a strong, inherent inhibitory effect on this micro-organism. Important concentrations of erythromycin are found in the three secretions: 0.5 to 3.25 microgram/ml in the nasal mucus and in the lachrymal secretion, 0.3 to 4.5 microgram/ml in saliva.

Radical neck dissection remains the keystone to lymph nodes control in modern Head and Neck Surgery. Like any major operation, it has inherent complications ranging from minor surgical complications such as wound infection to potentially life-threatening complications such as fistula or carotid rupture. We have observed two cases of surgical damage of the phrenic nerve following radical neck dissection. Transient or definitive phrenic nerve palsy after radical neck dissection has been previously reported. The physiopathology according to the age and the clinical implications of that rare complication are discussed.

Ceruminoma is a rare form of tumor in man. Most of them are found in the external ear, rarely in the middle ear. The authors review the relevant literature and report a case of ceruminal adenoma arising in the middle ear. The prognosis of these tumors is relatively bad because of their potential malignancy and the tendency for recidivation. Recommendations for treatment are deep excision, postoperative irradiation in malignant types and regular follow-up visits.

A case of chronic atrophic polychondritis in a 75 year old female patient is reported. The disease started with an asymptomatic lesion of the nasal septum. It was diagnosed after involvement of the auricular cartilages, which was followed by an ocular and then by a tracheal symptomatology. A histological study by means of optical microscopy and of electronic microscopy is presented. The general characteristics of chronic atrophic polychondritis are given. It is a systemic, inflammatory disease, and progresses by successive outbreaks. Its gravity lies in the frequency of laryngeal and tracheo-bronchial lesions. Its pathogeny is unknown. Two hypotheses are considered: the first, that it is due to a disturbance in the metabolism of mucopolysaccharides ; the second is based on an immunological mechanism.

The effects of amiodarone by injection have been studied in 100 patients. 50% of these patients were in cardiac failure. Amiodarone was given intravenously over 30 seconds in a dose of 300 mg; in 15 of the patients a further dose of 150 mg was given after ten minutes. Amiodarone was found to be particularly effective in the tachy-arrhythmias (90% successful) in which it brought about slowing (18 cases out of 30) or conversion (17 cases out of 30). Just as good results were obtained for the atrial tachycardias (90% success rate) and in the junctional tachycardias. This treatment is less effective for atrial flutter (50% successful) and for ventricular arrhyrthmia, in which the success rate was only 60%. It is possible to use the defibrillator after amiodarone has been administered. This drug is well tolerated, and no increase in cardiac failure has been noted in these patients. There does remain, however, the possibility of hypotension and perhaps of circulatory collapse, which is rapidly reversable; this is probably due to vasodilator activity. Intracavitary studies in 8 patients have shown that amiodarone causes slowing of sino-atrial and of atrio-ventricular conduction. Amiodarone may equally worsen a distal conduction defect. The uses for this anti-arrhythmic drug, which is particularly effective at the atrial level, are discussed in this paper.

In order to appreciate the permeability of the Eustachian tube the authors measure the rhino-pharyngal pressure necessary to induce the opening of the tube. This opening is obtained by Valsalva method or by a deglutition associated to an overpressure. The measures are realized on divers, the majority of them never suffered before from any barotraumatic trouble. The modifications of pressure produced in the middle ear during the tubal opening are demonstrated by recording the correspondant variations of the tympano-ossicular compliance. By performing the Valsalva, we have better results than those obtained by actively clearing of the ears associated to a rhino-pharyngal overpressure. The method is of easy and quick apply. We consider as normal the levels of the forcing pressure ranging below 90 cm H2O.

After guoting the different origins of the post-traumatic ventilatory disorder, the author describes the working of the two valves, liminal and turbinal, which adjust, among normal man, the intranasal flow of the respiratory currents. Then, he describes anterior and posterior rhinomanometry, used furniture and measured parameters. Finally, the author gives the methodology of according to the nature of the ventilatory disorder, and the normal values of rhinomanometric parameters.

Thermographic analysis of the skin of the forearm of normal men submitted to nasal instillation of 1 ml of a solution of 48/80, 1 X 10(-2), demonstrates that the skin vessels undergo local vasodilatation. Erythema and wheals sometimes appear, due to the stimulation of the dermal mast cells. Mast cells of the nasal mucosa are never stimulated by such instillation. The differences between dermal and nasal mast cell reactions are in accordance with the concept of mast cell heterogeneity.