Guillotine and dissection tonsillectomy in children.

Tonsillectomy as an outpatient or same day-stay procedure is becoming increasingly popular. A retrospective study was performed on 1,049 children who underwent tonsillectomy and adenotonsillectomy either with guillotine or dissection with snare method. The dissection method was performed both under general anaesthesia and with local anaesthesia, but the guillotine method was performed only with local anaesthesia. Generally, bleeding control required no special intervention in the guillotine method but haemostasis was achieved by ligation and electrocauterization in one-third of the patients in the dissection group operated under general anaesthesia. The greatest percentage of haemorrhage in both methods occurred within the first four post-operative hours. There was a 1.8 per cent incidence of severe reactive haemorrhage required surgical intervention in the dissection group operated under general anaesthesia, but there was no such case in the guillotine group. The results of this study show that in carefully selected children guillotine tonsillectomy with local anaesthesia is a safe, time saving and cost-effective procedure.

Rhabdomyosarcoma of the temporal bone: clinical report.

Rhabdomyosarcoma is the most common soft tissue sarcoma of the head and neck in young children, but it is a rare entity in the temporal bone. We have detailed our experiences with two of our patients who had tumor in this site. Both were under the age of 2 years. One child had 6th and 7th nerve paralysis. The clinical features associated with these tumors and available treatment are reviewed.

[Characteristics of middle-latency auditory evoked potentials in awake and anesthetized patients]. / Caractéristiques des potentiels évoqués auditifs semi-précoces en état de veille et sous narcose.

Late auditory evoked potentials (50-500 msec latency) can be evoked by tonal stimuli but their instability prevents their use in many clinical situations. In contrast, the early responses (up to 10 msec) are stable, regardless of sleep or sedation, but they can only be evoked by transient, non-tonal stimuli. Therefore neither type may be used for an evaluation of frequency thresholds. The middle latency responses represent a compromise: first, they can be evoked by tonal stimuli of the tone-pip type and, second, they are relatively stable. For these reasons the authors have carried out a general study on the middle latency responses in subjects with normal hearing, in patients with impaired hearing and in patients under a variety of surgical anesthesia. The middle latency response evoked by clicks and tone-pips (4 sines of 500, 1000, 2000 and 4000 Hz) have a series of characteristic waves named, according to their latency, A(V), B(No), C(Po), D(Na), E(Pa). The threshold of visual detection for these potentials is situated near that of the psycho-acoustic threshold (0-20 dB). The authors point out the clinical utilization of the middle latency response especially in cases in which one desires an objective evaluation of the auditory threshold in the lower frequency range. It is important to know that the middle latency response remains present using some types of anesthesia (Ketalar, ataralgesy), disappears partially with neuroleptanesthesia and completely with inhalation anesthesia (fluothane, halothane).