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Résumé Le nez et les fosses nasales assurent la ventilation, le conditionnement de l’air inspiré et l’olfaction. Ils peuvent être le siège de pathologies inflammatoires, infectieuses et tumorales ou d’anomalies architecturales préopératoires voire postopératoires, altérant ces fonctions, pour lesquelles l’examen clinique sera d’un rendement variable. Nous verrons tout d’abord, après un bref rappel physiologique, l’examen dit « de débrouillage » qui permettra au chirurgien non ORL de sélectionner les patients justifiant d’une exploration fonctionnelle préopératoire plus poussée. Nous présenterons ensuite les explorations complémentaires existantes : consultation ORL et endoscopie des fosses nasales, imagerie, technique de mesure du flux aérien nasal. À l’issue de ce bilan complémentaire, le praticien doit être en mesure : de savoir s’il existe ou non une obstruction nasale préopératoire et de la quantifier et de la rattacher à une cause, de dépister les contre-indications à la rhinoplastie mais aussi de connaître les structures anatomiques pouvant être à l’origine de troubles ventilatoires postopératoire, de prévoir d’emblée un geste adapté, qu’il soit esthétique pur ou esthético-fonctionnel. Au total, il existera 3 groupes de patients : ceux qui ne présentent aucune contre-indication au geste de rhinoplastie, ceux qui présentent une indication de geste esthético-fonctionnel, ceux qui présentent une contre-indication à la rhinoplastie. Summary Nose and nasal cavity provide ventilation, inspired air conditioning and olfaction. They may be the seat of inflammatory, infectious and malignant disease, or preoperative or postoperative architectural abnormalities, altering these functions, for which clinical examination will be a variable return. First of all, we’ll see, after a brief physiological reminder, descrambling examination which allows non-ENT surgeon to select patients justifying a further preoperative functional exploration. In total, there will be three groups of patients: those who have no cons-indication to rhinoplasty, those with an indication of aesthetic and functional rhinoseptoplasty, those with cons-indication for rhinoplasty. [ABSTRACT FROM AUTHOR]

Abstract: Ureteric valves are a rare cause of ureteric obstruction. Fifty cases have been described in the literature. We report two new cases. The first is of a 12-year-old child with left multiple ureteric valves associated to bilateral vesico-ureteric reflux. The patient was treated by uretero-ileoplasty with unfavourable evolution to renal failure. The second case is that of a proximal ureteric valve discovered in a 30-year-old woman who had postpartum acute pyelonephritis. Treatment consisted in ureteric resection–anastomosis with favourable outcome. Based on a review of the literature, we discuss epidemiologic, etiologic, diagnostic and therapeutic aspects of this malformation. [Copyright &y& Elsevier]

Summary: Increasing life expectancy coupled to an increasing incidence of cardiovascular disease with age is leading to an ever increasing number of elderly referred for aortic valve replacement. Patients. —: Hospital mortality has been analysed and updated according to a group of 442 patients aged ⩾80 years who underwent an aortic valve replacement between January 2000 and December 2004 either isolated (n = 344) or associated with coronary revascularisation (n = 86), mitral valvuloplasty (n = 5) or aortic surgery (n = 7). A group of 621 octogenarians operated before December 2000 was analysed in order to determine long term results. Results. —: Operative mortality is 7.5% (n = 33). Independent predictive factors of mortality were : aortic insufficiency (30%, p < 0.004), NYHA class IV (20.5%, p < 0.001), left and right heart failure (11.5 % and 19.4%, p < 0.02), chronic renal insufficiency (18.5%, p < 0.04), emergency (37.5%, p < 0.001, OR = 4.7) left ventricular ejection fraction (21.1 %, p < 0.004, OR = 0.9) and redo surgery (35.3%, p < 0.001, OR = 6). Mortality was also increased in case of coronary revascularization (11.6%), mitral or tricuspid surgery (20%) and ascending aorta procedure (25%). Conclusion. —: Functionnal improvement and increasing long term survival obtained at the cost of a rather low operative mortality, justify aortic valve replacement in octogenarians. Surgical decision should be taken on an individual basis taking into account general status and mental heath. [Copyright &y& Elsevier]