Final results of a randomized trial comparing chemotherapy plus radiotherapy with chemotherapy plus surgery plus radiotherapy in locally advanced resectable hypopharyngeal carcinomas.

After neoadjuvant chemotherapy, a routine conservative approach followed by salvage surgery was evaluated in terms of local control and survival in cases of advanced potentially resectable hypopharyngeal carcinoma. Between 1985 and 1989, 92 patients with T3 or T4-NO,N3 operable squamous cell hypopharyngeal carcinomas received three courses of neoadjuvant chemotherapy every 2 weeks involving a combination of cisplatin, 100 mg/m2, on day 1 and fluorouracil, 1 g/m2, on days 2 to 5, followed by total laryngopharyngectomy plus postoperative radiotherapy in 47 patients (arm A) or radiotherapy alone in 45 patients (arm B). Randomization was always performed prior to chemotherapy. The response rates of tumor and node to chemotherapy were, respectively, 67% in arm A versus 79% in arm B (P > 0.05) and 54% in arm A versus 73% in arm B (P > 0.05). Grade III or IV toxicity was similar, affecting 15% of patients and 7% of cycles in arm A versus 16% of patients and 6% of cycles in arm B. After a mean follow-up of 92 months, survival was statistically better (P = 0.04) in arm A (5-year overall survival, 37%; median survival, 40 months) than in arm B (19% and 20 months) because of a better local control rate (63% versus 39%; P < 0.01). Better results were obtained for mutilant surgery in terms of local control and overall survival, regardless of response to neoadjuvant chemotherapy.

[Laryngeal paralysis after tracheal intubation for anesthesia]. / Paralysie laryngée après intubation trachéale en anesthésie.

A 17 year old man was anaesthetized for osteosynthesis of a fractured left femoral diaphysis. Endotracheal intubation was easy, anaesthesia and surgery were both uneventful. On recovery, some hoarseness was noticed. Two months later, an ENT examination showed signs of laryngeal paralysis. The presumed explanation was compression of the recurrent nerve by the high-positioned balloon of the tracheal tube. Recovery was complete four months later.

[Pneumomediastinum and subcutaneous emphysema after translaryngeal jet ventilation]. / Pneumomédiastin et emphysème sous-cutané au décours d'une ventilation translaryngée par oxygène pulsé.

The use of emergency transtracheal jet ventilation in a 62 year-old female with laryngeal papillomatosis and respiratory distress is reported. Adequate ventilation of the lungs with an intermittent jet of oxygen under high pressure (5 bar) allowed anaesthesia and surgery to be carried out. Pathogenesis of the mediastinal and subcutaneous emphysema discovered at the end of the procedure is discussed.

[Facial nerve anatomy in neonates. Second and third parts : Surgical applications]. / Contribution à l'étude de l'anatomie du nerf facial du nouveau-né. 2e et 3e portions : application chirurgicale.

Anatomy of the second and third parts of the facial nerve in the neonatal period was studied by dissection of 15 cadavers. A particular feature was the shortness of the 3rd portion, due to the absence of development of the mastoid. The facial nerve lies an average of 2.4 mm below the antral floor, close to the vertical portion of its posterior border. The stylomastoid foramen is situated on the external surface of the mastoid rudiment, masked by the anterior border of the digastric muscle. Though surgery is rarely indicated, the characteristic features of facial nerve anatomy in neonates should be known.

[Relations between sinus aspergillosis, primary rhinoliths and dental pathology]. / Rapports entre l'aspergillose sinusienne, les rhinolithes primitifs et la pathologie dentaire.

Sinus aspergilloses, which can be classified as aspergillar sinusitis and pseudo-tumoral forms, are probably much more prevalent than would appear form the published literature. Many cases of caseous sinusitus reported since the end of the last century were probably unrecognized aspergillosis infections. In the same way, primary rhinoliths can probably be related to aspergillosis. Many cases of sinus aspergillosis appear to be of dental origin, particularly when radiography detects the presence of dental obturation paste in the sinus opacity: this appearance in the sinus opacity: this appearance is almost pathognomic of the affection. Sinus aspergillosis should be recognized as recovery can be obtained in the majority of cases by simple sinus washouts, without the need for chemotherapy.

[Tracheal agenesis]. / Agénésie trachéale.

A case of tracheal agenesis is reported. At present, this lethal and rare malformation cannot be recognized before birth. Circumstances of the pregnancy and the stages leading to the diagnosis at birth are reported. Autopsy allows to classify the type of malformation and to search for others malformations, as seen in the VATER syndrome. A tracheo-oesophageal fistula is always present. The mechanism is unknown and there is no chromosomal anomaly. Fifty cases have been published in literature.