Learning curve of medialization thyroplasty using a Montgomery™ implant.

UNLABELLED: Type I thyroplasty--also called medialization thyroplasty (MT)--is considered as an effective treatment for glottic incompetence in general and for abductor vocal fold palsy in particular. In the past there have been some concerns about the experience a laryngeal framework surgeon should have in order achieve an acceptable voice outcome. To assess the learning curve of MT performed using the Montgomery(®) hard silicone implant. A retrospective study involving 36 patients divided into three consecutive groups (1, 2, 3) of 12 MT patients or six consecutive groups (1a, 1b, 2a, 2b, 3a, 3b) of six MT patients. OUTCOME MEASURES: acoustic and aerodynamic outcome improvements (δ) compared to the duration of intervention [operative times (OT)]. Data were analysed by Anova, Kuskal Wallis and χ (2) statistical tests, according to data distributions. OT decreased significantly between groups 1, 2 and 3 with a mean OT of 90.5', 71.5' and 56' (p < 0.001), respectively. Objective δ such as maximum phonation time (MPT) (p 0.376), Estimated Sub-Glottic Pressure (ESPG) (p: 0.675) Shimmer (p: 0.543) and Jitter (p: 0.709) did not show significant improvement. Only the voice handicap index (VHI) δ of group 2 showed significant improvement (p 0.005) compared with the two other groups 1 and 3. Surgeon experience decreases the OT significantly. On the other hand, our study did not show a correlation between surgeon experience and voice outcome measures improvemnts (MPT, ESGP, Shimmer, Jitter).

Anti-Purkinje cells antibodies in two cases of paraneoplastic cerebellar degeneration.

The serum and CSF of two women with a severe subacute pancerebellar syndrome contained high titers of antibodies directed against antigens present in the perikaryon of Purkinje cells. In Western blots performed on human Purkinje cells extracts these antibodies reacted with two groups of proteins the molecular weights of which were estimated to 34-38 and 62 kilodaltons (anti-Yo antibodies). Complementary investigations revealed a tubar adenocarcinoma in the first case, an ovarian carcinoma in the second. The tubar tumoral cells also contained the protein of the highest molecular weight. Compared to the serum, the CSF contained a higher proportion of anti-Yo antibodies per mg IgG, and a fraction of the latter was likely synthesized intrathecally. These antibodies may be involved in the almost total disappearance of the Purkinje cells, as observed at autopsy of both cases.

[Sturge-Weber syndrome: apropos of an anatomo-clinical case report with prepapillary glial proliferation]. / Syndrome de Sturge-Weber: à propos d'une observation anatomo-clinique avec prolifération gliale prépapillaire.

The authors report the case of a woman with Sturge-Weber syndrome (oculotrigeminate form) presenting with neovascular glaucoma of abrupt onset during pregnancy. Since medical treatment failed, she underwent a retrobulbar alcoholisation. Three months after delivery, enucleation was performed for esthetic reasons. The enucleated eye showed diffuse choroidal angioma, total retinal detachment and a prepapillary glial proliferation. We discuss this uncommon association.

[Intracranial plasmocytoma manifesting multiple myeloma: apropos of a case]. / Plasmocytome intracrânien révélateur d'un myélome multiple: à propos d'un cas.

Neurological complications of myeloma are multiple and various. Cranial and intracranial locations have been rarely reported. They can be classified into three clinical groups: (1) cranial nerve palsies secondary to single or multiple lesions in the base of the skull, (2) intraorbital tumors, (3) intracranial tumors, either cranial myeloma extending intracranially or pure intracranial tumor (dural and/or cerebral). In our case, macroscopic and microscopic examination of the brain showed dural and cerebral involvement, confirmed by immunohistochemical studies. The radiological features are discussed (CT scan, MRI, angiography). To our knowledge, a single report of intracranial plasmacytoma documented by MRI has been reported in the literature.

Clinical and serological studies in a series of 45 patients with Guillain-Barré syndrome.

We retrospectively reviewed the clinical files of 45 Guillain-Barré syndrome (GBS) patients admitted to our Department between 1979 and 1989. The age distribution was bimodal with a first peak in young adults (20-40 years), and a second one between 60 to 70 years. Seasonal distribution showed a late fall and a hivernal predominance. Three patients experienced a second attack of GBS 2-9 years after the first one. Thirty-one (69%) presented antecedent events, most often a respiratory tract infection (n = 20) or enteritis (n = 6). Serological studies were systematically performed, including antibody titers against herpes simplex virus, Epstein-Barr virus, cytomegalovirus (CMV), respiratory syncytial virus, human immunodeficiency virus, Mycoplasma pneumoniae, Campylobacter jejuni/coli and cardiolipin. These studies showed the presence of antibodies indicative of a CMV primary infection in 22% cases and of a Campylobacter jejuni/coli infection in 13%. Co-infection was observed in 3 cases. Serology remained negative in 12 patients with a preceding respiratory infection. There was no correlation between serology and the severity of the disease. Absence of antecedent events and of positive anti-infectious serology was observed in only 10 patients.

Intrathecal synthesis of anti-mycobacterial antibodies in patients with tuberculous meningitis. An immunoblotting study.

Cerebrospinal fluid (CSF) and serum samples from eight patients with bacteriologically proven (6) or clinically suspected (2) tuberculous meningitis were tested for the presence of anti-mycobacterial IgG antibodies by an affinity-mediated immunoblot technique. This technique is based on agarose gel isoelectric focusing of paired CSF and serum samples diluted to the same IgG concentration, and transfer of the specific IgG antibodies onto mycobacterial antigen-loaded nitrocellulose sheets. An intrathecal synthesis of anti-mycobacterial oligoclonal IgG antibodies, often superimposed on diffuse polyclonal production was shown in all patients but not in patients with tension headache or other neurological disorders. Similar results were obtained when a purified mycobacterial antigen, A60, was used for coating the nitrocellulose sheets in place of a whole mycobacterial homogenate, indicating that A60 was a major immunogen. The number of anti-mycobacterial oligoclonal IgG bands increased with time, and persisted for years even in clinically cured patients. Some IgG bands had no detectable anti-mycobacterial activity, at least with the antigens preparations used in this study. The demonstration of such anti-mycobacterial IgG bands in the CSF could be a useful adjunct for the diagnosis of tuberculous meningitis, especially in the case of negative cultures.

Herpes simplex virus type 2 meningitis without genital lesions: an immunoblot study.

Two sexually active female patients presented with acute meningitis. The CSF abnormalities were severe and persistent. In spite of the absence of genital lesions, serological studies revealed a primary infection by herpes simplex virus type 2. An immunoblot study revealed intrathecal synthesis of anti-herpes antibodies early in the course of the disease.

[Posterior cortical atrophy: anatomo-clinical variant of Alzheimer's disease]. / L'atrophie corticale postérieure: variante anatomo-clinique de la maladie d'Alzheimer.

The authors report the case of a 66-year-old woman who developed progressive occipital dysfunction and lately a dementing illness. Brain CT revealed posterior cerebral atrophy. Post-mortem examination showed the characteristic features of Alzheimer's disease, mainly in the posterior areas, relatively sparing the amygdala and Ammon's horn. The occurrence of focal signs and lesions in Alzheimer's disease is emphasized.

Monoclonal IgM gammopathy with anti-myelin associated glycoprotein (MAG) activity and polyneuropathy. A study of three cases.

The authors describe three patients with a chronic sensory-motor polyneuropathy associated with a monoclonal IgM gammopathy. In each case, the M-component was shown to display an antibody activity against the Myelin-Associated Glycoprotein (MAG) in a western blot technique. Sera from the three patients stained specifically the myelin sheaths of normal human peripheral nerves after incubation with rabbit anti-IgM. Motor conduction velocities were very low in each case. Morphological studies of the sural nerve from one patient revealed a moderate loss of myelinated fibres, some onion-bulbs but also a microangiopathy and signs of axonal degeneration.

Homolateral disappearance of essential tremor after cerebellar stroke.

The case of a patient with essential tremor in whom tremor disappeared on the right side after a homolateral cerebellar infarct is reported. The pathophysiology of essential tremor remains unknown. Vascular and surgical lesions of dentorubrothalamic pathway have been reported to improve various kinds of tremor including essential tremor. In this patient, a lesion of this pathway related to the cerebellar infarct probably explains the homolateral cessation of essential tremor.