Search

Sudden deafness is a medical emergency, for which etiopathology is ill-known and no therapeutic consensus exists. This study is aimed at demonstrating that a greater audiometric gain can be achieved if trimetazidine, a major cellular anti-ischemia agent, is associated with hemodilution, than when the treatment is based on hemodilution only. 42 patients suffering from sudden deafness were all treated with hemodilution before their 7th day of deafness, half of them being given 3 tablets of trimetazidine daily in addition and the other half placebo, during one month. The results of this double-blind trial demonstrate an additional audiometric gain of 10% in the trimetazidine group for all frequencies, as well as a higher percentage of total recovery, ie. 63% vs. 47% in the placebo group. No particular sensitivity to treatment was noted according to the shape of the audiometric curve or in the case of initial cophosis, known to be of poor prognosis. The statistic significance was not established due to the small number of cases. The association of trimetazidine and hemodilution therefore seems to be an interesting therapeutic approach for sudden deafness, owing to the clinically appreciable audiometric improvement we have noted.

The treatment of acquired immunodeficiency syndrome (AIDS)—associated Kaposi's sarcoma (KS) is controversial. 1 Local treatments include the argon laser, 2 cryotherapy, 3 and intralesional vinblastine. 3 We report our experience with intralesional bleomycin used in the treatment of cutaneous KS. Methods. Since September 1987, two observers used intralesional bleomycin to treat 15 men with biopsyproven AIDS-associated KS. The median age was 35 years (range, 29 through 63 years). The known risk factor was homosexuality in nine cases and not known in six cases. At inclusion, the median CD4 cell count in 13 patients was 199×10 9 /L (range, 1 to 634×10 9 /L) Cutaneous lesions (not previously treated) were located on both the face and the body. The size of the lesions ranged from 2 to 15 mm. Both macular and nodular lesions were observed. The median number of lesions treated per patient was eight (range, one through 19). Two

Interstitial laser phototherapy (ILP) guided by magnetic resonance imaging (MRI) may become an attractive adjunctive modality for the treatment of deep and surgically inaccessible tumors of the head and neck when accurate methods of laser dosimetry and "real-time" monitoring techniques with the MRI are introduced. We recently demonstrated in ex vivo and in vivo models, a linear relationship between levels of laser energies, thermal profiles, MR signal intensity changes, and histopathological tissue damage. Results of treatment in a patient with an unresectable large right jugulodigastric metastatic squamous carcinoma using new approach of MRI guided ILP are now reported. The patient complained of significant right-sided neck pain and headaches secondary to a rapidly growing metastatic lymphadenopathy which recurred after previous surgery, radiation, and chemotherapy. Two treatment sessions were used at an interval of 2 weeks. Each treatment was performed in the MRI suite under heavy sedation. Using a 600-microns bare fiber of the Nd:YAG laser implanted interstitially under MR guidance, the metastatic node was treated at three sites. T1- and T2-weighted images were performed prior to, immediately after, 24 and 48 hours, and 4, 5, 7, 9, 16, and 25 days post-treatment. Successful relief of pain and growth arrest of this node was observed after the second treatment and at the 3-month follow-up. These results demonstrate that this technique of ILP guided by MRI may be feasible in humans, and will become clinically practical when appropriate methods of dosimetry and instrumentation are developed.

Thyroglossal duct cyst, a common clinical entity, may undergo malignant change. The majority of such malignancies are capillary adenocarcinomas; squamous cell carcinomas are rare. Only 7 cases have been reported since 1950. The authors present a case of a 65 years old man who died 16 months after the tumor's discovery.

Seventy two head and neck cancers have been treated with a combination of Cis-DDP (20 mg/m2/day) and bleomycin (6 mg/m2/day, 24 hours infusion) given for 5 days 3 courses every 3 weeks in preoperative cases and for 6 days (4 courses every 3 weeks) in non preoperative cases. Fifteen patients treated for local recurrence after irradiation experienced no significant response and their actual survival at 12 months is 22%. For the other patients the objective response rate was 78% with 10 complete responses and the projected survival at 12 months varies from 62% to 92% according to the subsequent treatment (irradiation or surgery followed by irradiation). These results are in agreement with a few reports using similar combinations; but it needs to answer new questions about possibility of surgical strategy variations in the cases of good or complete responses with such a chemotherapy.

Diagnosis in a suspected case of laryngeal pseudo-actinomycosis was confirmed by examinations conducted in the Pasteur Institute. This capricious and misleading affection is reviewed, its treatment requiring only simple but prolonged antibiotic therapy.

An orbital injury can be responsible for compressing the optic nerve in the optic canal. This compression leads to a syndrome of physiological division with homo-lateral blindness and absence of pupillary reaction of light during stimulation of the injured eye, whereas the light reflex is present with contralateral stimulation. Computed tomography studies show the compression site directly: optic canal fracture, or indirectly: hematoma of posterior ethmoidal cells and sphenoidal sinus, fracture of the posterior part of the orbit. This type of injury can be improved by surgical decompression of the optic nerve via a trans-ethmoid-sphenoidal approach. The surgical technique will be first described. Then, the authors will report a series of 13 cases. In 6 cases, surgical decompression allowed recovery of visual acuity. The authors emphasize the uncomplicated post-operative course. Indeed, no complication was recorded and the hospitalization time was very short.

The authors report their experience in the Treatment of essential Trigeminal Neuralgia with controlled increments of radiofrequency heating from an electrode inserted in the Gasserian ganglion or the posterior rootlets. Assuming that the less myelinated small fibers (A delta and C) are more sensitive to the heat than the heavily myelinated A beta and A alpha fibers, graduate controlled thermo coagulation could produce a differential destruction of pain fibers. 30 patients were treated with this method since 10 months. In all cases, the patients experienced immediate relief. There was no mortality and no neurological morbidity outside the trigeminal nerve. The most serious undesired result has been the production of anesthesia or marked hypesthesia in 10% of our cases.

The ambulatory intervention in ORL surgery presents a certain amount of constraint : anaesthetic, surgical, medicolegal and socio-economic. In spite of the lack of medicolegal definition for ambulatory anaesthesia, these anaesthetic intervention may take place in conditions approaching the other anaesthetic intervention provided that some rules are respected. The authors propose a practical treaty for the ambulatory intervention ORL surgery and as an illustration to this presentation propose a sample of a hundred ambulatory interventions.

A case of undifferentiated epithelioma of the left parotid gland occurred 2 years after the removal of a cystadenolymphoma in the right parotid gland. The relationship of these two tumours was supported by several statements: the immunohistochemical study demonstrated in the epithelial cells of the 2 neoplasms the existence of ACE, usually thought as characteristic of cystadenolymphoma. Besides, it showed a high number of plasma cells secreting IgA in the stroma of the 2 tumours, the ultrastructural study performed on the epithelioma also demonstrated some similarities between epitheliomatous cells and epithelial cells of cystadenolymphomas (outlined epidermoid or glandular differentiation, numerous mitochondria). A peculiar, perhaps immunological mechanism could induce the cancerization, according to the theories used to explain the histogenesis of cystadenolymphoma.

Treatment of sequelae of ophthalmopathy of Basedow's disease, essentially exophthalmos, oculomotor disorders and upper eyelid retraction, is of particular importance because of the functional and esthetic problems presented. Improvement in the different symptoms can be obtained by surgical treatment, but patients must have been perfectly stable with respect to both the thyroid and ophthalmologic plan for at least 6 months. It marked exophthalmos exists this is treated initially by orbital enlargement. Oculomotor problems are then resolved and finally treatment is terminated by surgery to eyelids. Very satisfactory functional and esthetic results are obtained.

A method for conducting "brain stem early derived potentials" using an inexpensive microcomputer is described. This type of examination is, however, difficult to perform, and is not currently employed in clinical practice. The contribution offered by this data-processing system is emphasized.

This study of the Brainstem evoked Response has been done to try to find the exact location of neurologic disorders. The authors wanted to see if there were differences between normal subjects and patients with multilocular sclerosis, when the auditory stimulus in increasing from 10 pps to 50 pps. From 15 normal subjects (30 ears) the results have been compared to those obtained from 6 patients. The findings were: -- there is no adaptation phenomenon in the Brainstem (the conduction time in the Brainstem is absolutely constant). -- there is an adaptation which occurs before the first peak, happening later at 50 pps than at 10 pps. -- in the multilocular sclerosis the findings were: augmentation of the peak to peak delay no synchronisation of the peaks so that is very difficult to recognize each peaks. And the peaks are easier to recognize at 50 pps than at 10 pps which fact unexpectable. This dyssynchronisation at the compression and rarefaction click is for the authors an important factor for the multilocular sclerosis diagnosis.

Thirty three patients have been operated with total laryngectomy (LT) or pharyngolaryngectomy (PLT) with or without Zadical neck dissection, without nasogastric feeding to be and in five cases without tracheal cannula (but connection of a large tracheostomy). The authors demonstrated that there is no increasement of pharyngeal fistua. The beginning of oral alimentation has been made between the 4th and the 6th postoperative day. Such a procedure is more comfortable for the patients and decrease the hospitalisation duration.

Often difficult surgical problems are encountered during treatment of acquired stenosis of external auditory canal. Theses stenoses can be of tumoral, inflammatory or traumatic origin and are the cause of infectious complications related to epidermal retention. Even with the assistance of modern imaging procedures, preoperative investigation is not simple, precise details of lesions being obtained in greater detail during surgical exploration. Four stages are involved in surgical treatment: excision of lesion, reaming of bony canal and enlargement of auditory meatus, providing cover and maintaining graft in place. The CO2 laser can be useful for excision of lesion or possible postoperative recurrence, and adjacent pedicle flaps are best for covering site. Postoperative inflammatory episodes can be treated by infiltration of local corticoids. Whatever the result of these different techniques, long-term surveillance of these patients is essential.

The Brain stem evoked response audiometry have been studied in 34 cases of multiple sclerosis. The Brainstem in 8 cases were normal and abnormal on one or both sides in the remaining 26 cases (73.5 p. 100). A Brainstem is considered suspicious of multiple sclerosis when the first wave (N1) is normal as far as the time period is concerned, although there is a loss of synchronisation of the recording particularly as far as the higher part of the brain stem (N4 and N5). In 24 cases of multiple sclerosis of definite diagnosis (according to Mac Alpine criteria) 19 cases had abnormal recordings (79.2 p. 100). In 31 cases that had a neurological test showing a lesion of the brain stem, 23 cases of evoked potentials were abnormal (74.2 p. 100). In 3 cases that clinicaly had no lesion of the brain stem, the evoked potentials were abnormal in 2 of them, suggesting the eventuality of a lesion clinicaly non-reactive which can then be of help to confirm the diagnosis.

Confronted with nose malformations in children, surgeons experience at the same time a legitimate desire to rapidly attend to the altered anatomical structures, and a fear to aggravate the lesions existing initially by operating during a period of growth. Numerous animal experiments have not been conclusive as far as these two contradictory theses are concerned. In all cases, prudence remains mandatory, that is prudence towards the operational indications (important functional impairment), the date of the intervention (risk minimization with age), assessment of expected results (secondary malformations occurring even very late postoperatively).

The treatment of the chronic diseases of the temporomandibular joint is always difficult. At one moment or another, surgical treatment is discussed, proposed and performed. Many operations have been described to make the temporo-mandibular joint recovering its normal movements. Both joints are involved in those movements, because the joint is symmetrical. Myrhaug's technique, described in 1951, consists in the resection of all the temporal condyle. This technique which respects the meniscus and all the chondro-fibrous system of the joint creates a permanent and reducible chronic dislocation of the joint. This paper is made to show that under an experience of more than 60 operations the authors can give all the details they use, with some modifications of the original Myrhaug's technique. The authors give their own results over 60 operations: there are more than 70% of good or excellent results, without any complication. For all the cases they have operated and they present, the follow-up is more than one year and some times more than ten years. They have not seen any late complication and the results have not been modified after all that time. The main indication of this technique is the temporomandibular joint dysfunction syndrome which affects more the female population. This syndrome is made of an association of pain, cracking, abnormal movements and subdislocations, but pain is only one of the symptoms. The same operation is very efficient to treat chronic subdislocations affecting one or both joints. This Myrhaug's technique operation is very simple without any complication in the post-operative days and give very good results.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of central point myelinolysis is described in a heavy beer drinker who was found to have severe water and electrolyte disturbances on admission. The patient subsequently developed quadriparesis with pseudobulbar symptoms. The authors stress the diagnostic value of brain stem auditory-evoked responses and of blink-reflex, which were restored to normal as the patient recovered.