[Cataract surgery and its impact on balance and autonomy in elderly]. / Incidence d'une chirurgie de la cataracte sur l'équilibre et l'autonomie du sujet âgé.

PURPOSE: Cataract is a major cause of visual impairment among elderly. Cataract surgery improves visual afferencies and can have an impact on balance. The present study assessed the impact of cataract surgery upon balance and autonomy in elderly. We realized clinical examinations and objective tests the day before surgery and 2-months later. METHODS: The initial cohort consisted of 66 patients that had to undergo a cataract surgery. Their mean age was 79 +/- 0.5. For logistic reasons, only 33 patients have been completely evaluated before and after surgery. Each patient underwent a history and examination that have assessed autonomy, walking, visual and then cochleo-vestibular functions including bone vibratory test and dynamic computerized posturography (Equitest). RESULTS: After 2 months, cataract surgery had no incidence on balance. The fear of falling has stayed the same whereas the number of falls has been noticeably reduced by surgery. The overall score of Equitest has shown an increase in visual dependence after surgery. Although cataract surgery has no incidence on autonomy, it may improve the quality of life among older people by leisure activities recovery. CONCLUSION: An early physical rehabilitation facilitated by visual improvement after surgery can also prevent visual dependence and autonomy loss. We recommend vestibular rehabilitation in elderly with major visual dependence.

Complications of percutaneous tracheostomy.

Percutaneous tracheostomy is a technique that, reputedly, is simple to perform and causes few complications. It is routinely used in intensive care. We present two patients with tracheal stenosis. In one patient, we had to perform an anastomotic resection to cure the patient; in the other patient, we had to place an endoluminal conformer. To our knowledge, this complication has not been reported in association with the use of this technique.

[Cervical cystic lymphangioma in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they once were generally an unexpected operative findings. Now, with the progress in modern medical imaging the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of renous origin, grases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficulté in adults than in children and recurrences are rare.

[Rehabilitation of the paralyzed face by hypoglossal-facial nerve anastomosis. An analysis of 7 cases]. / Réhabilitation de la face paralysée par anastomose hypoglosso-faciale. Analyse de sept cas.

After facial nerve injury, in cerebello-pontine tumors surgery, hypoglossal-facial anastomosis is the most common procedure, to rehabilite a paralysed face, if direct facio-facial graft is not possible. This procedure must be done, in a second time, during the next year and followed with a specific reeducation. In seven patients operated between 1985 and 1996, we performed clinical evaluation and electrophysiological examination. The best evaluation is the clinical evaluation using the G. Freyss's facial testing. Best results are seen in early, specific and continued reeducation. All our patients have a good recovery of facial nerve function, but clinical examination and electrophysiological results are not correled with an objective video performance. The management of such patients needs efficient oto-neurosurgical team and specific trained physiotherapists.

[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases]. / Les cellulites cervico-médiastinales nécrosantes. A propos de 3 cas.

OBJECTIVE: To outline the most appropriate treatment of descending necrotizing mediastinitis. MATERIALS AND METHODS: Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived. DISCUSSION: Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.

[Sickle cell disease and vertigo: a possible diagnosis in metropolitan France. Review of the literature and case report]. / Drépanocytose et vertige: un diagnostic possible en France metropolitaine. Revue de la littérature àpropos d'un cas.

Sickle cell anemia is frequently associated with auditory dysfunction. However peripheral vestibulopathy is uncommon. The purpose of this report is to describe a patient who presented repeated episodes of severe vertigo attributable to sickle cell disease. Discussion of this case includes a review of the literature.

[Thyroid teratoma in adults]. / Tératomes thyroïdiens de l'adulte.

A new case of thyroid teratoma is reported in an adult and the heighten other cases of the literature are reviewed. This pathology, rather frequent and always benign in infants, is distinguished in adults by a malignant metastatic course for 14 cases of 19. The reported case, the second one in a male adult, remains a benign one after 14 years.

[Cervical cystic lymphangiomas in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they are generally unexpected operative findings. Now, with the progress in modern medical imaging, the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of venous origin. 9 cases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficult in adults than in children and recurrences are rare.

[Neurinoma of the intrapetrous facial nerve (apropos of 5 cases)]. / Les neurinomes du nerf facial intrapétreux (à propos de 5 cas).

Five patients with intra-petrous facial neuromas were treated between 1993 and 1995. The most common symptom was facial paralysis in four cases and conduction hearing loss with a mass behind the tympanic membrane in one case. For all cases a MRI led to an accurate diagnosis of the tumoral invasion. Four patients had an operation (one middle cranial fossa approach, one transmastoidal approach and two transmastoidal approach and middle cranial fossa approach associated). Results are analysed and a discussion on the clinical and para-clinical diagnosis as well as the treatment method is realized considering the literature.