[Deafness and tinnitus in flare-ups in 10 cases of multiple sclerosis]. / Surdité et acouphènes lors de poussées dans 10 cas de sclérose en plaques.

Deafness in multiple sclerosis is rare, being reported in less than 1 p. 100 of the cases. Ten cases of deafness associated with tinnitus during acute episodes of multiple sclerosis are presented, the diagnosis being definite in 9 patients and probable, according to McAlpine's criteria, in the tenth case. These were not cases where routine examinations demonstrated a latent hearing defect, but were all patients with sudden, often unilateral, incapacitating deafness during an acute episode of the disease, with regression usually after less than 3 months. Deafness recurred in 3 patients and was the initial symptom in 5 cases. Serial audiometric examinations were performed in most cases together with recordings of various evoked potentials, including early auditory evoked potentials during or after the onset of deafness in all 10 patients. BAEPs abnormalities were noted in 8 and appeared to be correlated more with brain stem demyelinization, as it has been established for a few years, than with the deafness itself. Severe anomalies of auditory evoked potentials regressed after the acute episode in only 1 patient. Lesions of the auditory pathways within the brain stem appear to be the cause of the deafness, as shown by results of auditory tests, which pointed to a central origin. The onset of deafness did not indicate a particular progression of multiple sclerosis.

[Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double-blind drug vs. placebo study]. / Traitement des troubles de l'équilibre par l'extrait de Ginkgo biloba. Etude multicentrique à double insu face au placebo.

This study, conducted in 3 centres, included 70 patients with vertiginous syndrome of recent onset and undetermined origin. In a double-blind trial extending over a 3-month period they were given either Ginkgo biloba extract or a placebo. The effectiveness of Ginkgo biloba extract on the intensity, frequency and duration of the disorder was statistically significant. At the end of the trial, 47% of the patients treated were rid of their symptoms as against 18% of those who received the placebo.

[Surgical treatment of pituitary adenomas. An analysis of 188 cases (author's transl)]. / La chirurgie des tumeurs hypophysaires, Analyse de 188 observations.

The authors report on a series of 188 patients operated upon for pituitary tumour. Since 12 operations were performed because of local recurrence, the total number of operations was 200 : 27 by the intracranial route and 173 by the naso-sphenoidal route. Four deaths (17%) followed surgery by the former route and three (1.8%) by the latter route. During the decade under review surgical indications have decreased for large tumours belatedly diagnosed and increased for micro-adenomas giving rise to endocrine symptoms only, notably prolactin-secreting adenomas. Improved knowledge of histopathology has resulted in the classification being altered : the conventional division into eosinophilic and chromophobe adenomas has been abandoned to be replaced by cellular types corresponding to the various hormone-producing and functional adenomas. Also a new type has appeared : oncocytoma. Secreting adenomas generally have a better prognosis than non-secreting adenomas, would it be only because they are smaller. Technical advances in operations almost exclusively performed nowadays by the naso-sphenoidal route have improved the results with regard to sight. Sight is now improved in 70.5% of the cases and completely restored in 32.4%.

[The problem of malignant branchioma. A description of three cases of degeneration or epitheliomatous metastasis within amygdaloid cervical cysts (author's transl)]. / Le problème du branchiome malin. A propos de 3 observations de dégénérescence ou de métastase épithéliomateuse à l'intérieur de kystes amygdaloïdes cervicaux.

The authors describe three cases of malignant degeneration observed within amygdaloid cysts in two male and one female patient aged sixty. In one of the cases in which the cyst had been present for more than two years, there was apparently some primary degeneration, the theory favoured was that of Veau's malignant branchioma; two other cases showed metastasis of a homolateral tonsillar epithelioma within an hitherto sub-clinical amygdaloid cyst.

[Malignant change affecting stenotic scarring (caustic) of the oesophagus (author's transl)]. / La dégénérescence cancéreuse des sténoses cicatricielles (par caustique) de l'oesophage.

The authors report four cases of carcinoma of the oesophagus developing at the site of old burns. They review the classical features of this type of lesion, found in their own cases: the role of trauma from dilatations and the very long time elapsing before malignant change occurs (29 to 57 years, according to the individual cases). They discuss the prophylactic value of oesophagectomy with oesophagoplasty following severe burns with stenotic scarring. Finally, they note that whilst the treatment of these forms of carcinoma of the oesophagus is in general palliative, curative surgery may nevertheless be envisaged.

[Extensive fibromatosis of the neck muscles]. / Fibromatose extensive des muscles de la nuque.

Extensive fibromatosis, also called desmoid tumor, is a histologically benign tumor, which is nonetheless serious due to its recurrent character and to its potential for infiltration of neighboring tissues. Extensive surgery is the only effective means of treatment, radiation therapy being used only as a complement. The authors describe an elective location of the lesion in the sheaths of the scalenus muscles. This development is usually observed in young women, as is the case in the observation reported here.

[Surgery of functional disorders of the pharyngoesophageal sphincter. Value and contribution of cricopharyngeal myotomy]. / La chirurgie des troubles fonctionnels de la bouche oesophagienne. Valeur, apport de la myotomie du crico-pharyngien.

A series of 11 patients with severe functional disorders of superior sphincter of esophagus were treated by section of cricopharyngeal muscle. Indications for the operation are based mainly on clinical data, assisted by results of different examinations (endoscopy, manometry, radiocinema), and it could find a very wide field of application.

[Cervicofacial non-Hodgkin's malignant lymphoma. Classification, prognosis and treatment apropos of 65 cases]. / Lymphomes malins non hodgkinien cervico-faciaux. Classification, pronostic et traitement à partir de 65 cas.

The approach to non hodgkins malignant lymphomas (NHML) has changed in recent years, notably because of advances in pathological evaluation due to histo-immuno-labelling leading to a more accurate classification. Such pathology being relatively common in the cervical facial region, with a figure of 10 to 25%, this report concerns the personal experience of the authors based upon 65 cases treated in the department between 1975 and 1985.

[Intrapetrous neurinoma of the facial nerve. Removal by the oto-neurologic route]. / Neurinome intrapétreux du nerf facial exérèse par voie oto-neurologique.

A case of a 33 year-old woman presenting an intrapetrous facial nerve neurinoma is reported. The neurological finding was a quickly progressive facial nerve palsy without hearing loss which the initial diagnosis was a Bell's palsy. The radiological findings showing an petrous bone erosion located at the third portion of the facial nerve gave the diagnosis. It was confirmed by CT scan and arteriography that allows a pre-operative embolisation. A one stage operation performed by a triple retromastoid, transpetrous and retroparotid approach, allowed a complete removal. The post-operative course was uneventful and a reconstructive facial surgery was performed to restore a facial symmetry six months later. The authors review the literature about this tumor which remains rare and point out two facts: --A non regressive or recurrent or atypical facial nerve palsy had to be checked up by neuroradiology and even by surgical exploration. --The triple retromastoid, transpetrous and retroparotid approach is very interesting, allowing a one stage complete removal of the tumor and a check up of the facial nerve repair possibilities.

[Metastases to the thyroid from adenocarcinomas. Review of the world literature around five personal cases (author's transl)]. / Les métastases tkhyroïdiennes des cancers épithéliaux. Revue de la littérature mondiale a propos de 5 cas personnels.

The authors propound five personal clinical cases of intra-thyroid metastases from epithelial carcinomas. Looking through the world literature, they found 134 other such cases. Analyzing these cases, there is a marked preponderance of renal cancers. The other most frequency primary cancers are of the breast, tract, lungs and skin epitheliomas. Undeclared metastases discovered at autopsy seem to be much more frequency (approximately 7.7% of those who die of their cancer have such metastases). This discrepancy between the rarity of clinical metastases and the frequency of microscopic metastases is explained by their very great latency and their very slow progress. This justifies the attempt at a curative treatment every time this is possible: surgery plus cobalt therapy. This can produce a fairly long survival rate: one year and four months on average when the metastasis is discovered before the primary cancer; two years and then months when the metastasis is discovered after.

[The surgical treatment of scar tissue stenosis of the crico-tracheal junction (author's transl)]. / Le traitement chirurgical des sténoses cicatricielles de la joncation crico-trachéale.

On the basis of 6 personal cases, the authors report the special conditions associated with surgery for stenosis of the crico-tracheal junation : proximity of the recurrent laryngeal nerves, difficulty of accurately matching the upper and lower ends, difficulty in passage of the suture materials. They nevertheless conclude that in the treatment of stenosis at this level of the respiratory tract, resection-anastomosis would appear to give better results than those obtained by Rethi's operation. Alongside major surgery, minor therapeutic techniques and, in particular, the laser used endoscopically also have a role to play : either in the treatment of moderate stenosis, or in the prevention and treatment of recurrent stenoses after resection-anastomosis.

[Three case histories of cortical and sub-cortical auditory lesions. Audiological and tomodensimetrical confrontations (author's transl)]. / Trois observations d'atteinte cortico-sous-corticale de l'audition. Confrontations audiologiques et tomodensimétriques.

The authors describe three case histories of auditory lesions involving the cortex or subcortex of the temporal lobes. In two of the cases there are minor lesions of the hemisphere producing an amusia without verbal deafness or agnosia of non-verbal sounds. In one of the two patients, the total transitory deafness makes the use of the term cortical deafness debatable. In the third case, a bilateral vascular lesion of the temporal lobes had produced a pure verbal deafness without loss of tone discrimination or loss of the capacity to recognise changes in rhythm or sound frequency. In these three patients in whom there was no anatomical verification, the data given by the scanner and the study of evoked cortical potentials recorded over the two cerebral hemispheres allowed a fairly good study of the correlations between the topography of the lesions and their semiotic consequences.

[A new marker in oncology. Assay of gangliosides bound to sialic acid]. / Un nouveau marqueur en cancérologie. Le dosage des gangliosides liés à l'acide sialique.

Gangliosides are released from cells proliferating in serum and can be assayed by a LASA method. The authors report the assay method for sialic acid bound exclusively to glycosphingolipids (GASA method). They study the reliability and discuss the preliminary factors concerning this upper respiratory tract squamous cell marker.

[Extensive papilloma durum of the larynx and its malignant transformation. Apropos of 15 personal cases in 15 years]. / La papillomatose cornée extensive du larynx et sa transformation maligne. A propos de 13 observations personnelles en 15 ans.

Based on a review of 13 personal cases an attempt is made to isolate a specific laryngeal lesion: extensive papilloma durum of larynx of almost ineluctable malignant transformation. Clinical, histopathologic and therapeutic aspects of the affection are reviewed.

[Montgomery's tube in laryngotracheal stenoses in children (11 cases)]. / Le tube de Montgomery dans les sténoses laryngo-trachéales de l'enfant (11 observations).

Because of the fragility of the laryngotracheal tree in children, and the serious consequences on function of any chondritic lesion or even mucosal edema, overall endoscopic treatments combined with prosthesis insertion are preferred to any surgical procedure. Eleven cases of laryngotracheal stenosis are reported where treatment involved use of Montgomery's calibrated tube.

[Nosologic criteria for the classification of midfacial granulomatosis]. / Critères nosologiques de classification des granulomatoses médio-faciales.

The authors report three cases of Stewart's disease and five cases of Wegener's disease seen over a period of 10 years, during which time they saw no cases of non-Hodgkins malignant lymphoma presenting as a mid-facial malignant granuloma. On the basis of these cases together with a review of the literature, they argue in favour of the dissociation of Stewart and Wegener as well as that of Stewart and monomorphous NHML, raising the problem of the existence of the latter as an entity.

[Trimetazidine and degenerative deafness. Effect on hearing and integration]. / Trimétazidine et surdités dégénératives. Effets sur l'audition et l'intégration.

This study was conducted in order to assess the activity of trimetazidine dosed at 60 mg/day in patients presenting degenerative loss of hearing. Ten centers participated in this multicenter double-blind placebo-controlled trial which spanned 6 months. Included were 251 patients (118 women, 133 men) presenting with pure perception bilateral symmetrical deafness concerning predominantly the acute frequency range. 228 patients terminated the study, including 115 in the trimetazidine group and 113 in the placebo group. The evolution over a 6-month treatment period was significantly better with trimetazidine as regards the following parameters: audibility as assessed by pure-tone audiometry, namely at the acute frequency range (p = 0.002), intelligibility as assessed by speech audiometry (p = 0.008), subjective evaluation of hearing loss and its impact on the patient's social life. Results confirm the value of trimetazidine hearing loss management, based on clinical, subjective criteria as well as audiometric ones. Parameters reflecting best trimetazidine's efficacy were intelligibility and the psychological/behavioral impact of the impairment, allowing for better social integration of the subject.

[Diffuse spontaneous cervical cellulitis caused by anaerobic bacteria]. / Les cellulites cervicales diffuses, spontanées à anaérobies.

Nine cases of diffusal cervical cellulitis due to anaerobes were analysed. Some of them had right away extensions (to the inferior mediastinum or to the face). From these cases, the authors argue their treatment protocol. Surgery was performed immediately after diagnosis, and associated with intensive management. The excision of the necrotic tissue and the aperture of all cervical spaces (particularly the floor to the buccal cavity and the prevertebral space) were made. The source of infection was looked for (most often this being the teeth) and treated at the same time. Bacteriologic aero and anaerobic prelevements were done. A thoracic or facial surgery, being necessary because of persistency or appearance of extension, was performed secondary, after the patient was better prepared with a hyperoxygenation and a triple antibiotic therapy. Life prognosis improved with this treatment protocol. The gravity of the conditions presented by our patients depended more on the presence of an underlying disease (diabetes, immunosuppression, age...) or the delay of the diagnosis than on the cellulitis extension.

[Use of the YAG laser in tracheobronchial pathology. Apropos of 154 cases]. / Utilisation du laser YAG en pathologie trachéo-bronchique. A propos de 154 cas.

The laser has been used for several years in a number of medical disciplines and more recently in pneumology. The authors report their personal experience and define two principal types of indication for this technique: iatrogenic tracheal stenoses, in which the laser is able to effectively treat granulomas and to a lesser extent stenoses, and malignant tracheo-bronchial tumours, in which the laser is usually only a palliative form of treatment which improves the quality of the patient's survival. The other indications and their results are also briefly reviewed.