Papillary neoplasm of the endolymphatic sac in a patient with von Hippel-Lindau disease.

Glandular tumours involving the middle ear and the mastoid are rare, and distinguishing between adenoma and adenocarcinoma is difficult. Two distinct histopathological patterns are accepted. While their clinical presentation differs, both require primary surgical treatment and both have a high rate of local recurrence. The papillary form takes a more aggressive course and wider regional spread. This pattern occurs predominantly in women. Its microscopic appearance and clinical course have been extensively described by Heffner who considered it as "low-grade adenocarcinoma of probable endolymphatic sac origin". A few cases have been associated with von Hippel-Lindau disease. The case of a 32 year old black woman is described. It is suggested that papillary adenocarcinoma of the endolymphatic sac should be considered in the spectrum of neoplasms seen in von Hippel-Lindau disease.

Radiotherapy with concomitant continuous cisplatin infusion for unresectable tumors of the upper aerodigestive tract: results of a phase I study.

A phase I-II study was initiated in February 1991 of concomitant radiation and cisplatin (CDDP) in the treatment of unresectable head and neck squamous cell carcinomas (n = 12). The first patient was treated palliatively for a cervical recurrence of laryngeal cancer. The 11 other patients had locally advanced (stage IV) previously untreated carcinomas of the oropharynx (n = 9), hypopharynx (n = 1), or cervical node with unknown primary site (n = 1). Standard external radiation was carried out up to a total dose of 60 Gy/6 weeks (7 MeV electron beam) for the first patient and 72 Gy/8 weeks (Co60 beam) for the other 11 patients. CDDP was infused continuously during the entire radiation treatment, 5 days/week. The starting dose was 4 mg/m2/day and was escalated by increments of 1 mg/m2/day; dose-limiting toxicity was observed at 7 mg/m2/day. Neutropenia (grade 4, one patient; grade 3, three patients) and thrombocytopenia (grade 3, one patient; grade 2, one patient) were the limiting factors. Therefore, the recommended dose of CDDP is 6 mg/m2/day. All patients but one completed the scheduled radiation. For the entire group, mucositis was not more severe than that observed with radiotherapy alone. There was no nephro-, oto-, or neurotoxicity. A complete response was obtained in eight (66%) patients. Of these, four were free of disease 12-34 months after completion of treatment and one had a total glossectomy for a tongue necrosis. For the whole series, the mean overall survival was 16 months posttreatment. Pharmacokinetic analysis indicated the total cisplatin accumulation at the end of treatment to be 743-1551 ng/ml. Accumulation of ultrafilterable platin was noted in only one patient (137 ng/ml at the end of treatment).

The holmium:YAG laser for treatment of inferior turbinate hypertrophy.

Chronic hypertrophic rhinitis is sometimes refractory to local, as well as general, medical treatment. Before undertaking surgical reduction of the inferior turbinates, there is indisputably a place for cauterization or laser vaporization of the inferior turbinate mucosa. The authors present a study of 46 patients treated by the holmium:YAG laser for chronic hypertrophic rhinitis. The results after only one laser session are satisfactory in 89.1% at 6 months' follow-up and in 52.2% with mean follow-up of 16.2 months. No major secondary effects were observed.

Nasopharyngeal tuberculosis.

Rhinopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated finding. The authors report a recent case of an isolated rhinopharyngeal tuberculosis in a 64-year-old female. A review of the literature is presented. They emphasize the clinical presentation, that, in all aspects, may resemble a malignant tumour of the nasopharynx, as well as the difficulty of obtaining a pathological and bacteriological diagnosis.

Value of investigation in the diagnosis of allergic fungal rhinosinusitis: results of a prospective study.

The authors report a prospective study in which the aim was to analyse the usefulness of different criteria in optimizing the diagnosis of allergic fungal rhinosinusitis. From 1995 to 1998, 165 patients were operated on for chronic rhinosinusitis. Investigations used in this study for the diagnosis of allergic Aspergillus rhinosinusitis consisted of an analysis of clinical, radiological, immuno-allergic criteria. Fourteen patients presented with allergic Aspergillus rhinosinusitis. One hundred and fifty-one patients did not present any of the necessary criteria for the diagnosis of allergic Aspergillus rhinosinusitis. The results show that the characteristic macroscopic appearance, the maxillary sinus localization, and the presence of positive specific IgE to Aspergillus fumigatus are arguments that reinforce the diagnostic certitude of allergic fungal sinusitis. No specific clinical or radiological criteria orients a diagnosis of chronic rhinosinusitis toward that of allergic fungal rhinosinusitis. The other immuno-allergic tests do not contribute to the diagnosis of allergic fungal rhinosinusitis. pathological, mycological, and

Mucoceles of the paranasal sinuses: uncommon location.

Mucoceles are the most common lesions causing expansion of the paranasal sinuses. The sinuses most commonly involved are, in decreasing order of frequency, frontal sinus, ethmoid sinuses, maxillary sinus and sphenoid sinus. We reviewed 46 cases of surgically proven mucoceles and the purpose of this study was to report five cases of mucoceles in an uncommon location.

Connectivity and control in the year 2000 and beyond.

By now, most executives are familiar with the famous Year 2000 problem--and many believe that their companies have the situation well in hand. After all, it seems to be such a trivial problem--computer software that interprets "oo" to be the year 1900 instead of the year 2000. And yet armies of computer professionals have been working on it--updating code in payroll systems, distribution systems, actuarial systems, sales-tracking systems, and the like. The problem is pervasive. Not only is it in your systems, it's in your suppliers' systems, your bankers' systems, and your customers' systems. It's embedded in chips that control elevators, automated teller machines, process-control equipment, and power grids. Already, a dried-food manufacturer destroyed millions of dollars of perfectly good product when a computer counted inventory marked with an expiration date of "oo" as nearly a hundred years old. And when managers of a sewage-control plant turned the clock to January I, 2000 on a computer system they thought had been fixed, raw sewage pumped directly into the harbor. It has become apparent that there will not be enough time to find and fix all of the problems by January I, 2000. And what good will it do if your computers work but they're connected with systems that don't? That is one of the questions Harvard Business School professor Richard Nolan asks in his introduction to HBR's Perspectives on the Year 2000 issue. How will you prepare your organization to respond when things start to go wrong? Fourteen commentators offer their ideas on how senior managers should think about connectivity and control in the year 2000 and beyond.

Intraoperative facial nerve monitoring in posterior fossa surgery: prognostic value.

A retrospective study was done of 43 patients operated on for acoustic neuroma by a translabyrinthine approach with intraoperative facial nerve monitoring. Direct stimulation of the facial nerve at the level of the cerebellopontine angle (CPA) and the internal auditory canal (IAC) permits the calculation of a R ratio that has a predictive value for postoperative facial function: R = R'/R'', where R' is the ratio of the minimal intensity (I) of stimulation capable of inducing a response after direct stimulation of the facial nerve at the level of the CPA over the electromyographic response amplitude (A): R' = I(CPA)/A(CPA), R'' being equal to the ratio of these same measurements after stimulation at the IAC: R'' = I(IAC)/A(IAC). Statistical analysis has shown that an R ratio 2 permits the supposition of an alteration of facial function. This prognostic value is more precise if the R ratio is co-related to the macroscopic aspect of the facial nerve at the end of surgery.

Deglutition after supra-glottic laryngectomy.

This study of swallowing after a horizontal supra-glottic laryngectomy proposes to analyze the frequency of long-term post-operative complications, their mechanisms of onset, as well as their compensatory mechanisms. It rests on the study of three groups of patients: a retrospective series of 74 charts, a group of 14 patients studied at a distance from the intervention, and a group of 15 patients who have been entered in a prospective study concerning the post-operative care of partial laryngectomies. For these two groups, the swallowing work-up consisted of, besides a clinical evaluation, a video-laryngoscopy and a video-radioscopy. Knowledge of the compensatory possibilities as a function of the specifics of the surgical technique, and their evaluation for each patient with video-radioscopy allows for an adapted care protocol.

Deglutition after supracricoid laryngectomy: compensatory mechanisms and sequelae.

This study is based on the videofluorographic exploration of deglutition in 14 patients who were treated by supracricoid laryngectomy. The choice of this population rests on two criteria: a 1-year postoperative delay, and absence of residual deglutition disorders elicited by patient history. Asymptomatic aspiration was seen in 6 cases. In the cricohyoidoepiglottopexies (CHEP), aspiration occurred uniquely in patients who did not recuperate satisfactorily from epiglottic dynamics. The deglutition sequelae are less invalidating relative to the cricohyoidopexies (CHP), with a possible recuperation of the dynamic sequence of the pharyngeal swallow. On the other hand, in the CHP, a complete reorganization of the stepwise sequence of the different neuromuscular events is necessary.

Evaluation of some velar functions before and after surgical treatment of snoring.

The aim of this prospective study was to evaluate velar function before and after uvulopalatopharyngoplasty for isolated snoring and for sleep apnoea. It is based on the analysis of oral and nasal airflow during phonation by an EVA workstation of 24 patients before and after the surgical intervention. The results show (1) quantitative and qualitative airflow abnormalities before the operation, (2) an increase in the percentage of nasal airflow flow after the operation, and (3) a change in the airflow sequence, which is improved after the surgical procedure. In conclusion, this work confirms a modification of velar function after uvulopalatopharyngoplasty and raises the problem of contra-indications to this intervention.