[Atypical laryngo-tracheal post-intubation complications: three case reports]. / Complications laryngo-trachéales post-intubation atypiques: à propos de 3 cas.

Endotracheal intubation can induce iatrogenic laryngeal and tracheal complications, particularly when the intubation lasts for a long time. The ENT pratician's job is not only to cure the laryngeal sequelaes but also to prevent and diagnose them. Authors report three atypical cases of laryngeal and tracheal post-intubation complications (laryngeal bilateral immobility, interarythenoidal synechia, oesotracheal fistulae) and discuss them regarding medical literature data.

[Long-term results of facial palsy's rehabilitation by end-to-end hypoglossal-facial anastomosis]. / Résultats à long terme de la réhabilitation des paralysies faciales périphériques par anastomose hypoglosso-faciale termino-terminale.

OBJECTIVE OF THE STUDY: To evaluate the long term functional and esthetical results of the patients who underwent a facial palsy rehabilitation surgery by a hypoglossal-facial anastomosis. PATIENTS AND METHODS: In this retrospective study, 11 patients (8 males and 3 females) with a complete facial palsy (grade VI House-Brackmann) due to an otoneurosurgery performed between 1985 and 2006 (6 vestibular schwannomas, 1 facial schwannoma of the geniculate ganglion and 4 meningiomas) were evaluated (with the help of an auto-questionnary, a physical exam and electromyography) between July and september in 2008. RESULTS: The voluntary palpebral closure was obtained in 8 cases out 11 (grade III of House-Brackmann). The lingual hemiatrophy was constant. It was major for the patients who didn't take part in a specific re-education. In these cases patients had troubles during feeding and elocution. CONCLUSION: The hypoglossal-facial is a dynamic surgical rehabilitation of choice for the facial palsy. It nearly achived 80% of good palpebral results. The end-to-end anastomosis gives a lingual hemiatrophy which is not the case with a side to end anastomosis. This atrophy can be reduced with an intensive and specific reeducation. Moreover this re-education improves the functionnal and the esthetical results for the patients who underwent an hypoglossal-facial anastomosis. This lingual hemiatrophy was then responsible for troubles for feeding and elocution.

[Cat scratch disease: a diagnosis to be aware of!]. / Maladie des griffes du chat: un diagnostic a ne pas méconnaître!

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.

[Positron emission tomography in head and neck squamous cell carcinomas]. / La tomographie par émission de positons dans les carcinomes épidermoïdes de la tête et du cou.

18F-Fluorodeoxyglucose positron emission tomography (PET) is an imaging modality which is becoming increasingly esential in oncology, especially in the management of head and neck squamous cell carcinomas (SCC). The most common uses of the PET are listed in this thematic study: initial staging, cervical lymph node metastases from an unknown primary tumor and post-therapeutic follow-up. The advantages and drawbacks of this imaging tool are exposed here according to both our experience and data from the literature. Decision schemes are suggested for each use so as to optimize the use of this imaging modality in the management of these SCC. Other fields of application for the PET are mentioned, such as the in-progress evaluation of response to chemotherapy, the interest of this imaging tool in radiotherapy as well as current biochemical developments concerning new tracers.

The dolastatins, a family of promising antineoplastic agents.

The dolastatins and some related compounds are antineoplastic pseudopeptides isolated from the sea hare Dolabella auricularia by the groups of G. R. Pettit and K. Yamada. Several groups including ours have contributed to the development of synthetic routes to most of these compounds. We recently described the synthesis of dolatrienoic acid, the lipidic component of dolastatin 14. Among all these metabolites, dolastatin 10 and dolastatin 15 exhibit the most promising antiproliferative properties and are currently under evaluation in clinical trials. These antimitotic agents seem to exert their activity by interacting with tubulin and inducing apoptosis. Research in this domain could greatly benefit from the recent elucidation of the atomic structure of tubulin. However, other targets cannot be excluded. Elucidation of the structure-activity relationships is an important step in the development of therapeutic agents. Parallel to the studies developed by other groups, our approach to exploring structural requirements for the antineoplastic activity of these compounds involved the determination of their preferred conformations in solution. Our study showed that dolastatin 10 exists in two different conformations corresponding to a cis-trans isomerization of a central amide bond. Such a situation was not demonstrated in the case of dolastatin 15. In view of elucidating the biological relevance of these findings, we elaborated hybrid molecules constituted of parts of both compounds. We also synthesized a cyclic analogue of dolastatin 10 which locked this compound in its cis conformation. Our results as well as those of others could be interpreted in terms of an existing structural model.

Opiate receptors in brain labelled in vivo with [3H]lofentanil.

The in vivo binding of [3H]lofentanil was studied in various regions of the brain in rat. After intravenous injection of [3H]lofentanil the disposition of the labelled drug in the brain paralleled exactly the regional distribution of opiate receptors measured in in vitro binding assays. The labelling was saturable and could be prevented by naloxone when given before [3H]lofentanil, in all the regions except in the cerebellum. The long-lasting occurrence of the specific labelling was entirely compatible with the extremely slow dissociation rate of lofentanil and its long duration of action. This explains why [3H]lofentanil is not displaceable by naloxone in vivo. Subcellular fractionation experiments revealed that all the labelling in the frontal cortex but not in the cerebellum was particulate-bound and entirely displaceable by naloxone. The advantages of [3H]lofentanil in vivo are its extremely low non-specific binding and its ability to reveal very low occupancy of opiate receptors in brain.

Antineoplastic activity of didemnin congeners: nordidemnin and modified chain analogues.

Nordidemnin (2), a natural analogue of the marine cyclodepsipeptide didemnin B (1b), showed cytotoxic activity against L1210 leukemia and antineoplastic activity against P388 leukemia as well as B16 melanoma; nordidemnin (2) was as active as didemnin B (1b). The influence of synthetic modifications in the linear peptidic chain on in vitro and in vivo activity was also studied. Replacement of the terminal lactyl residue by mandelyl and 3-(p-hydroxyphenyl)propionyl residues in compounds 3 and 4, respectively, did not affect the cytotoxic activity against L1210 leukemia (ID50 of 1.1 nM and 1.2 nM, respectively) or the in vivo activity against P388 leukemia. Unlike these aromatic substituants, the lipophilic palmityl residue induced a dramatic loss in cytotoxic activity. The inverted chirality of the MeLeu joining residue in compound 6 caused a marked reduction in the in vitro activity.

Synthesis and biological activity of chimeric structures derived from the cytotoxic natural compounds dolastatin 10 and dolastatin 15.

The natural cytotoxic compounds dolastatins 10 and 15 exhibit great similarities in structure and in their biological activity profiles. Two compounds (1 and 2) formed by interchanging the dolaisoleuine residue of dolastatin 10 and the MeVal-Pro dipeptide of dolastatin 15 were synthesized in order to evaluate the possible equivalence of these units. These compounds can be considered as chimeras of dolastatins 10 and 15 formed by the N-terminal part of the former and the C-terminal part of the latter and vice versa. Both analogues exhibited a marked decrease in their cytotoxic activity but showed similar differential cytotoxicity with regard to the cell lines assayed compared with the parent compounds. HT-29 cell line was the least sensitive one. However, this activity was in the nanomolar level and close to that of vincristine. The differences in their effect on tubulin polymerization were less pronounced. We confirmed the already known crucial role of the Dil residue in this assay. The nonequivalence of the Dil unit and the MeVal-Pro dipeptide probably reflects modification in the relative positions of the N-dimethylamino and the phenyl moieties.

Meta-analysis of normative cervical motion.

STUDY DESIGN: Meta-analysis of normative cervical range of motion literature performed by applying summary statistics to range of motion and reliability values reported among studies. OBJECTIVES: To identify reliable and valid methods for measuring active and passive cervical range of motion and to estimate normative values. SUMMARY OF BACKGROUND DATA: Range of motion studies use a variety of measuring instruments and statistical analyses, making it difficult to select the most suitable instruments, procedures, and normative values for clinical application. Reviews of the literature, being limited in scope, have not quantitatively synthesized the literature. METHODS: Range of motion and reliability data were grouped by technology and types of motion, then summarized by deriving means and variabilities. Clinical validity was assessed by examining discrepancies, variabilities, and correlations. Change in range of motion as a function of age was determined by comparing range of motion ratios (fourth:third and seventh:third decades). RESULTS: Nine technologies were identified. Overall, passive motion was greater than active motion, and range of motion decreased as age increased, with women exhibiting greater range of motion than men. Variations within each technology were as large as or larger than those between technologies, indicating that clinical procedures are as important as the accuracy and precision of the technology itself. Reliability has not been adequately tested for the majority of technologies. CONCLUSIONS: Clinical procedures appear to be as important as accuracy and precision in determining the reported range of motion values. Further research is needed to establish a gold standard for normative values and to identify an instrument that is reliable for all motions.

Acute laryngeal paralysis induced by the migration of a totally implantable venous access device's catheter tip.

The authors report a case of acute vagus nerve paralysis that appeared during a course of chemotherapy. The drugs had been administered through a totally implantable venous access device (TIVAD), whose catheter tip had migrated into the right internal jugular vein (IJV) and was surrounded by a complete venous thrombosis. The supposed aetiology of this paralysis was a leakage of the cytotoxic drug (5-fluorouracil) from the vessel wall into the surrounding carotid space, because of the stagnation of the chemotherapeutic agent above the thrombosis. Four months after cessation of chemotherapy, the laryngeal paralysis was still evident.

Otologic features and teachings of a bombing attempt.

The authors present 13 casualties observed after the bombing attempt in Djibouti (March 1987). All of them suffered blast injury to the ear. The scene and the circumstances of the explosion are described. A correlation is sought between the location and position of each casualty and the lesions he presented, with reference to animal experiment data, namely the shock waves propagation conditions. The otologic lesions are commented on with reference to acute acoustic trauma, and the need for a special study of vestibular outcome of blast injuries is emphasized.

[Controlled clinical trial and homeopathic treatment of ORL and recurrent respiratory tract infections in children: preliminary survey of homeopathic physicians]. / Essai clinique contrôlé et traitement homéopathique des infections ORL et respiratoires récidivantes de l'enfant: enquête préliminaire auprès de médecins homéopathes.

We performed a survey to assess the feasibility of a placebo-controlled clinical trial of the treatment of recurrent ENT/respiratory tract infections in children, to assess the diversity of the drugs prescribed, and the acceptability of a clinical trial to homeopathic physicians. A mailed questionnaire was sent to 237 homeopathic physicians, asking for details of prescriptions for 10 consecutive children consulting for ENT/respiratory recurrent infections, and for two simulated cases. We also asked for their opinion about homeopathic treatment evaluation. Only 48 (20 per cent) questionnaires were returned completed. These gave 309 different acute treatments and 422 different preventive treatments for the 10 consecutive patients and 87 different prescriptions for the simulated cases. A total of 467 different drugs were used. The physicians who replied were favourable to the evaluation of homeopathic drugs, reluctant for the use of a placebo; and they would like to receive training in drug evaluation. Setting up a clinical trial in this field would require specific methodological and logistical adaptations, and a detailed training programme for the homeopathic doctors beforehand.

[Imaging protocol in salivary pathology]. / Protocole d'exploration en imagerie de la pathologie salivaire.

Numerous techniques have been used for imaging salivary glands including standard radiography, scintigraphy, sialography, echography, computed tomography and finally NMI. These different techniques each have their own indications or complementary role. We therefore developed a protocol for using the different imaging techniques according to the different salivary pathologies encountered. This protocol is given as an examination flow chart to be used in light of clinical findings. A large number of images selected by P. Laudenbach illustrate the typical pathologies encountered. Special emphasis is placed on sialography, an important imaging technique, unfortunately somewhat neglected.

[Congenital neck masses. Embryonic origin and diagnosis. Report of the CIREOL]. / Pathologie cervicale congénitale. Origine embryologique et diagnostic. Rapport du CIREOL.

Various congenital cervical anomalies are found in the neck region including defects of the branchial apparatus (branchial, thymic and parathyroid anomalies) and vascular anomalies. They manifest as cystic masses, sinuses, fistulas and as ectopic glands. This multicentric retrospective imaging study done in 5 different radiological centers (4 adult radiological departments and 1 pediatric radiological department) shows the result in understanding the congenital cervical anomalies and include 63 patients. The age of the patients varied between 24 days-81 years with a mean age of 23 years. This study included 27 patients having congenital branchial pouch anomalies (4 cases of anomalies of obliteration of the 4 th arch), 14 cases of cervical cystic hygromas, 11 thyroglossal tract cyst cases, 1 congenital laryngocele case, 1 case of jugular ectasia, 3 cases of capillary haemangioma. The embryologic basis of these different malformations were reviewed. Their characteristic findings and sites were illustrated together with their typical et atypical appearances. The frequency of occurrence of each branchial anomaly were plotted, the second branchial cleft cyst being by far the most common congenital cystic neck mass (70%). The study revealed the role of different imaging modalities in the diagnosis of various congenital cervical anomalies, especially in some particular complicated cases of congenital neck masses presenting in adult. Imaging study helps the clinician to anticipate any difficulties in unforeseen circumstances that may arise including infection haemorrhage, or parapharyngeal extension. Understanding the various radiologic appearances of these anomalies is greatly aided by familiarity with their embryologic origin. Moreover, considering the anatomic location and radiologic appearance, the precise embryologic origin can be accurately predicted.

[Postoperative quality of life for patients with a vestibular schwannoma]. / Qualité de vie chez les patients opérés d'un schwannome vestibulaire.

OBJECTIVES: To determine the prognoses criteria of quality of life's impairment after vestibular schwannoma surgery. STUDY DESIGN: Our study includes retrospectively 104 consecutive patients operated between 1991 & 2000 of a vestibular schwannoma. Patients with bilateral tumors were not included, neither patients lost of follow-up. The french version of the Short Form-36 self assessment questionnaire was sent to all patients. RESULTS: The response rate was 68% (71 patients). The patients' postoperative quality of life was lower of the norm, especially for psychical dimensions. This impairing of health whatever age, tumor size, operative approach or follow-up time. Sex and 2nd surgery were the only factors associated with a lower score. Women had worse rating of physical functioning. CONCLUSION: To operate small tumors should not assume that the impact on patients'life would be necessary less than following the removal of larger tumors. Women should have particularly clear explications before surgery and while follow-up.

[Preservation of auditory function in the excision of acoustic neuroma]. / Conservation de l'audition dans l'exérèse des neurinomes de l'acoustique.

Selection criteria for the preservation of auditory function during excision of acoustic neurinoma have been defined for a long time, and the means for a successful achievement of such a goal are widely known. Recruitment of special patients, for whom maintenance of an even deeply altered hearing capacity constitutes a requisite for continuation of professional work has lead us to extend indications for the pre- and retrosigmoid approaches recommended by J.M. Sterkers. The authors present a series of 16 patients, in which a single case of cophosis was deplored.

[Tympanoplasty in the treatment of sequelae of blast injuries of the ear]. / Les tympanoplasties dans le traitement des séquelles des blasts auriculaires.

This study deals with 40 clinical files relating to auricular blast injury patients with ensuing eardrum perforation, managed either by tympanoplasty or by placement of a healing support. An analysis of the functional symptoms, the size and localization of the perforation; determination of the presence or lack of immediate post-injury infection, and of the degree and type of hearing loss suffered, permits to define the characteristics of postoperative ear status. A comparison of the study results with published data provides for specifying surgical indications and sheds light on the long-term evolution pattern in such patients.

[Effects of loud music on the Garde Républicaine musicians]. / Effets de la musique de forte intensité chez les musiciens de la Garde Républicaine.

The authors report their observations on the auditory status of 76 musicians belonging to a Republican Guard brass band, and give their interpretation of abnormal findings, as they compare percussion with wind instruments and make reference to literature data. Accompanying signs, such as ear fatigue, noise intolerance, tinnitus, ear-aches, disturbance of sleep, psychic disorders, and disturbances of equilibrium are also taken into account as predisposing factors. Lastly, an attempt is made to bring out some of the characteristics that are specific to each instrument.

[Positron emission tomography in head and neck oncology]. / Tomographie par émission de positons en oncologie de la tête et du cou.

Defining a therapeutic strategy in oncology requires a substantial amount of imaging data provided by modern techniques. While the description of the lesions and their environment has become very precise, there remains a certain degree of uncertainty concerning tissue typing. Positron emission tomography is a scintigraphy technique which can produce quantitative images of metabolic characteristics. 18F-fluorodeoxyglucose is a tracer allowing an analysis of glucose metabolism known to be highly increased in malignant tissues. Increased uptake is an indication of malignancy with an established correlation with proliferative capacity. The only limitation of the method is the generally weak uptake observed in benign hypermetabolic inflammatory or infectious areas. All stages of the disease are concerned for head and neck cancer patients. Clinical experience to date indicates that PET can be applied most usefully to search or residual disease with a possible differentiation between post-therapeutic fibrosis and viable tumor tissue as well as the identification of early relapse. Study of early response to chemotherapy is also an interesting application. Search for extension can also be improved with this technique allowing both regional and whole body explorations. Positron emission tomography is not widely available in France at the present time so all patients cannot be examined with this technique. Positron emission tomography is an evolving technique with improvements being proposed both in the technique and in tracer elements. Further information will be available with new developments in this non-invasive exploration tool.

[Current aspects of laryngeal tuberculosis: a report of four cases]. / Aspects actuels de la tuberculose laryngée. A propos de 4 cas.

OBJECTIVE: Laryngeal tuberculosis is a rare condition. This new clinical pattern of tuberculosis should be recognized by clinicians. METHODS: We report our experience with four cases of laryngeal tuberculosis. RESULTS: The principal differences in the disease pattern are an increase in the number of cases of primary laryngeal tuberculosis without any evident pulmonary involvement and the declining number of pseudotumor forms with an larger number of nonspecific laryngeal localizations. CONCLUSION: Tuberculosis should be entertained as a possible diagnosis in patients with nonspecific laryngeal disease. The diagnosis is confirmed by identification of granulomatous inflammation and acid-fast bacilli. New culture techniques and molecular biology methods such as polymerase chain reaction allow early identification of Mycobacterium tuberculosis.